Milk without addition of any ingredients or additives is already rich in important nutrients, especially calcium. Milk in its pure form was the norm when our ancestors began consuming milk from animals. Fast forward to modern food industry, processes such as drying, pasteurization, homogenization, or fortification create products with different texture, taste, nutritive value, and shelf life. Pasteurization is a breakthrough in the milk industry as it makes milk safer to consume. Fortification is another important process in milk. Along with pasteurization, fortification became widespread in the early 20th century. It began in the 1920s when iodine was added to table salt to prevent goiter among children in the United States.

Fortification is the addition of micronutrients that were not originally there in the food. This helps reduce health risks while increasing the nutritional value of the food supply and promoting public health. Some products of food fortification include fortified milk, cereal, fruit juices, salt, and bread. Milk is commonly fortified with fat-soluble vitamins A and D. To put it simply, fortified milk is milk with added micronutrients (vitamins A and D) not commonly found in significant amounts.

Milk is naturally low in these vitamins, especially if milk contains no fat. Whole milk naturally contains vitamin A in its fat, and more vitamin A may be added before it is sold. For the milk to be nutritionally equivalent to whole milk even if it is reduced fat, low fat, or even skim milk, vitamin A fortification is required.

Since vitamin D is found in small amounts in whole milk naturally, it is often fortified. However, due to the cow’s ability to synthesize vitamin D when exposed to sunlight and the possibility that vitamin D may be present in animal feed, vitamin D to some extent is present in milk.

VITAMIN A & D IN FORTIFIED MILK

Micronutrients are so-called because our body needs them in small amounts. However, they are equally as important as macronutrients. Micronutrient deficiency may lead to serious health problems such as goiter. Micronutrient deficiency is a global health problem. For this reason, governments require certain foods to be fortified. Fortification of whole milk with vitamin A and D is optional. But low-fat milk, nonfat milk, and low-fat chocolate should be fortified with vitamin A.

Vitamin A

According to the World Health Organization (WHO), vitamin A deficiency is one of the most common globally. This is especially true in developing countries. Vitamin A-deficient individuals may experience health problems such as night blindness, skin diseases, and certain infections.

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Since the human body cannot produce this vitamin, it must be obtained from food sources. Unfortified milk already contains significant amounts (37.7 IU per gram of fat) of vitamin A since the vitamin is associated with milk fat. However, low-fat and skim milks have less vitamin A due to the elimination of milk fat. There was a nutritional concern about the loss of vitamin A present in these products as the demand for low-fat and skim milk products surged in the United States. To address this issue, low-fat and skim milks are required to be fortified with vitamin A to the nutritional equivalent of the general milk standard.

Low or non-fat milk and chocolate milk must be fortified with 2,000 international units (IU) or 140 retinol equivalents (RE) of vitamin A per quart (often before pasteurization). For milk involved in interstate commerce, it is necessary.

Vitamin D

Fortification of milk with vitamin A was initiated in the 1940s. This was the result of the positive acceptance by the public when fortification of milk with vitamin D was started to be practiced in 1933.

Vitamin D is available in two forms: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). A plant-based source of vitamin D is vitamin D2. When exposed to ultraviolet radiation, skin spontaneously produces vitamin D3. Vitamin D3 is what commonly added in food.

Our body needs vitamin D to maintain and regulate healthy levels of minerals, including calcium, phosphate, and others in the blood. The minerals, in turn, are used for a number of processes, such as bone mineralization, muscular contraction, nerve conduction, skin, and overall healthy cellular functioning. But rickets prevention was the main reason why vitamin-D fortified milk was introduced. Since then, the disease is now rare, especially among children. Rickets is a skeletal disease in which the bones become soft and deformed. This develops from lack of vitamin D intake and exposure to sunlight.

Although it is not required, adding vitamin D to attain levels of 400 IU per quart is practiced. However, evaporated milk is required to be fortified with vitamin D.

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Aside from fortified milk, other common sources of vitamin D include oily fish, oysters, cheese, eggs, butter, and cream.

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The terms “fortified” and enriched” are very common labeling terms when talking about nutrients. They are usually read on labels of food products such as breakfast cereals, fruit juices, baked goods, and dairy products. Some people believe they are the same thing. Well, kind of— they both mean the addition of nutrients in food. But there is a difference.

Here it is.

FORTIFIED REFERS TO THE ADDED NUTRIENTS NOT ORIGINALLY IN THE FOOD

Fortification means the practice of deliberately adding an essential micronutrient, which was not originally there. Generally, fortification is done to increase the intake of a micronutrient deficient in the diet of a certain population. Currently, fortification has more applications in developing countries, where micronutrient deficiency is more widespread.

Fortification started in the early 1920s when iodine was first added to salt to treat goiter, a prevalent health problem back then in the United States. Today, iodized salt is a common product of fortification to fight iodine deficiency. Although Americans are now iodine-sufficient, iodine deficiency is still global concern. In fact, an approximate 2 billion people are iodine-deficient.

Low vitamin D intake is also common not only in developing countries, but in developed ones as well. In the U.S., 42% of the population is vitamin D-deficient. Although most vitamin D that we get is from exposure to sunlight, it is oftentimes not enough. In fact, today, Americans get most of this micronutrient in fortified foods, particularly milk, which is naturally low vitamin D.

Vitamin-D fortified milk was first produced in 1933. This was when the working children lacked a healthy diet and exposure to sunlight. A lifestyle like this would lead to Rickets, a skeletal disease in which the bones soften and deform as a result of lack of vitamin D intake.

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At acidic pH levels, whey is soluble. Because of this, whey protein is ideal in boosting the level of proteins of acidic beverages that fall as sport drinks. And since it is hydrophilic and capable of binding a lot of water, it does not precipitate at its iso-electric point, unlike most proteins. Bakeries also use whey protein in their baked products.

ENRICHED REFERS TO THE ADDED NUTRIENTS THAT WERE LOST DURING PROCESSING

While fortification talks about the mere addition of micronutrients, enrichment, on the other hand, refers to the addition and replacement of nutrients lost during processing. Nearly all processing methods decrease the amount of nutrients in food. The actual level of reduction varies, depending on several factors. Processes that involve exposure of food to elevated temperature, oxygen, and light result in more losses. Because of this, processed foods such as bread, milk, and pasta are common subjects for enrichment.

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In flour milling, micronutrients suffer heavy losses. This is because milling is one stressful process, particularly during refining, in which removing the bran and germ, while leaving only the white endosperm, results in a significant decline in nutrients, particularly in B-vitamins and minerals.

To label as enriched flour, respective levels of micronutrients must be attained back.

According to the U.S. Food and Drug Administration (FDA) a pound of enriched flour should contain at least 2.9 mg of thiamin (B1), 1.8 mg of riboflavin (B2), 24 mg of niacin (B3), 0.7 mg of folic acid (B9), and 20 mg of iron. Some manufacturers also add other vitamins, zinc, and calcium at levels beyond or not present originally in the grain.

The U.S. first fortified flour and bread with iron and vitamins at the start of the Second World War to build strong, and healthy armies.

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Nowadays, fortification of white rice with vitamins and minerals is more common. One way to do this is by coating the grains with thiamin and niacin in powder form. After this, waterproofing and drying follow. Then the grains are coated again with iron and then dried once more.

FORTIFICATION AND ENRICHMENT PRACTICES AROUND THE WORLD

Australia and New Zealand

In Australia, the addition of folic acid in bread is mandatory. Leafy greens, asparagus, citrus fruits, and broccoli are rich in this micronutrient. It aids in healthy growth and development, particularly in babies during pregnancy. While most types of bread covers this fortification rule, organic bread and breads based on rice, corn or rye are an exception. Another country in Oceania, New Zealand, has chosen for a voluntary fortification standard for folic acid in baked products.

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The Philippines

In the Philippines, the government has set the mandatory fortification of food products that are consumed on a daily basis. Currently, the available products of fortification include iron-fortified rice, vitamin A and iron-fortified wheat flour (pandesal), iron-fortified refined sugar, and vitamin A-fortified cooking oil. Depending on future nutrition-based national surveys, more staple foods will be set as a subject for fortification.

Using the Sangkap Pinoy Seal Program (SPSP), the government also encourages manufacturers to fortify their products with essential nutrients. Although SPSP is voluntary, manufacturers must follow the standard set by the Department of Health (DOH).

African nations

Africa, specifically the sub-Saharan Africa, accounts for over half of malnutrition globally. Studies have shown that food fortification is an effective way of mitigation.

Since Africa has more native grains (wheat flour, maize flour, and rice) than any other continent, they are the main focus of the food fortification programs in the region.

27 African countries have set the mandatory fortification of wheat flour. And mandatory fortification of maize flour is also in effect in 10 of these countries.

The countries of the Democratic Republic of Congo, The Gambia, Lesotho, Namibia, Sierra Leone, and Swaziland voluntarily fortify the majority of their industrially milled wheat flour. In Lesotho and Namibia, more than half of their production of maize flour is fortified, although it is not mandatory.

Vietnam

In Vietnam, the staple foods, including salt, wheat flour, and vegetable oil are a part of the national mandatory food fortification program. The minerals iodine, iron, zinc, and vitamin A are essentials that the WHO figured to be of concern. Iodine deficiency is particularly high in the given population. The Multiple Indicator Cluster Survey of 2011 revealed that only 45% of the households consume iodized salt, far below the global recommendation of 90% based on the universal salt iodisation. Zinc deficiency is also very high among children (69%) and pregnant women (80%). Individuals with low zinc in their diet have increased risk of growth retardation and weak immune system.

United Kingdom

In the United Kingdom, the mandatory fortification of white flour with micronutrients, including calcium, iron, vitamins B (thiamine and niacin) has been in effect since the 1940s, in the beginning of WWII, to address the common micronutrient deficiencies in the region back then. Margarine is also fortified with vitamin A and D.

Are you a part of a manufacturing industry? For more on food fortification, refer to this WHO guidelines.

Other references:

V. Vaclavik, E. Christian. (2013). Essentials of Food Science (4th Edition). Springer, New York

Mayo Clinic, University of California, and Dole Food Company. (2002). Encyclopedia of Foods. Elvisier

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