In 1941, the Doughnut Corporation of America marketed “Vitamin Donuts” made with newly developed vitamin-enriched flour. Their ads implied that the doughnuts’ 25 units of vitamin B1 would supply “pep and vigor.” Finally, doughnuts as health food. Alas, they did not earn the desired seal of approval from the U. S. War Food Administration and mention of vitamins was dropped from their advertising. Since then, vitamins and minerals have been added to everything from candy, soda, and beer to energy bars and plain old water, for similar marketing purposes.

Vitamin-fortified flour was one of America’s early efforts to prevent health problems by restoring nutrients lost during food processing or by adding a new nutrient. Some fortification programs succeeded in reducing or eliminating diseases caused by nutritional deficiencies.

Iodized Salt for a Healthy Thyroid
Iodized salt – table salt treated with iodine in the form of potassium iodide – was introduced in 1924 to help prevent goiter, an enlarged thyroid gland caused by iodine deficiency and characterized by a bulge in the neck. The thyroid converts iodine into hormones that enable metabolism regulation, bone development, and proper organ function.

Iodine must be taken through dietary sources such as seaweed, seafood, produce grown in the soil near sea coasts, eggs, and some dairy products. But iodine is scarce inland, and prior to the 1920s an area stretching from the upper Midwest down to the Appalachians was dubbed the “goiter belt” because iodine deficiency caused more than half the population to develop goiter. Use of iodized table salt helped eliminate goiter and other iodine deficiency problems in the United States, according to the Centers for Disease Control, although the World Health Organization reports that iodine deficiency is still a significant health concern elsewhere in the world.

Vitamin D Milk For Preventing Rickets
While Americans sprinkled iodized salt on their dinners, efforts were under- way to fortify the national diet with vitamin D, which helps bones and teeth absorb calcium for proper development. Vitamin D deficiency among mostly poor children in the northern U.S. was causing rickets – a disease marked by delayed tooth formation, softened bones and severely bowed legs.

Early 20th-century research found that rickets could be prevented with cod liver oil, which was earnestly promoted as a children’s health tonic (“bottled sunshine!” gushed one ad). The oil’s rich store of vitamin D was identified as the key to rickets prevention, and for a time a yeast called ergosterol was added to milk, which was then irradiated (briefly exposed to gamma rays, X-rays or electron beams) to convert the yeast into vitamin D. By 1932, vitamin D was isolated and purified so it could be added to milk without irradiation, and rickets all but disappeared in the U.S.

Restoring Vitamin A to Lowfat Milk
Vitamin A was added to reduced fat and skim milks starting in the 1940s. Removing fat also removes vitamin A, which must be added back in order to make lower fat milks nutritionally equivalent to whole milk. Vitamin A contributes to healthy immune system, vision, reproductive and organ function.

Vitamin-Fortified Flour and Bread
Enriching flour with nutrients was prompted by a 1936 American Medical Association report explaining that B vitamins such as thiamin, niacin and riboflavin were missing from milled white flour.

Of concern was the disease called pellagra, a deficiency of niacin (vitamin B3) and tryptophan (an amino acid that the body converts into niacin) that can lead to skin lesions, dementia and death. Pellagra was widespread across the South after the Civil War, according to FDA historian Susan White Junod, PhD, especially among the poor, whose diet relied heavily on niacin-poor corn and cured meats and lacked fresh fruits, vegetables and milk. Between 1906 and 1940 more than 100,000 Americans died from pellagra.

Adding tryptophan and B vitamins to widely-consumed products like bread and flour would help Americans get these vital nutrients, and in the 1940s the War Food Administration made flour enrichment mandatory during wartime. The increased niacin intake eradicated pellagra in the United States.

With the exception of the wartime mandate, food fortification is voluntary unless an FDA “standard of identity” must be met. For example, any product called “enriched flour” must contain specific levels of thiamin, riboflavin, niacin, folic acid and iron, and must be labeled accordingly.

Better Breakfast Cereals
Around the same time, cereal manu-facturers started fortifying their ready-to-eat breakfast cereals with vitamins and minerals, which were either mixed in with ingredients prior to cooking or sprayed on after cooking. Cereals are typically fortified with vitamins A, C and D, the B vitamins, folic acid (also a B vitamin), iron and calcium.

Folic Acid for Healthy Babies
The FDA required that folic acid (vitamin B9) be added to enriched bread, cereal, flour, cornmeal, pasta, rice and other grain products in 1998. Folic acid helps prevent spine and brain problems called neural tube defects in developing fetuses, and may help slow cognitive decline and the development of dementia and Alzheimer’s disease.

A Nutritional Success Story
Because of some food fortification programs, doctors rarely see diseases such as goiter, scurvy (vitamin C deficiency), rickets, beri-beri (B1 deficiency) or pellagra, says the FDA’s Dr. Junod, and folic acid enrichment has drastically reduced the rate of babies born with neural tube defects. Fortification continues to find target populations, with folic acid being recently approved for addition to enriched corn masa – flour made from lime-soaked corn that is used to make tortillas, tortilla chips and tamales. This new addition could, according to the FDA, “increase folic acid consumption in those who regularly consume products made from corn masa flour, including many Latina women.”