Food fortification, the new panacea for nutritional deficiency

There are no miracle solutions for nutrition security. Fortification is projected as one miracle to address anaemia and nutritional issues experienced by people. This is a clinical approach and cannot, and should not be, applied at large.

Usha Soolapani
| Updated: September 13th, 2021

Food is the fundamental right of every citizen. Photo: Unicef India

In a recent webinar on mandatory food fortification, experts spoke on various aspects of fortification of food, especially rice, that is being tried out in few districts in India. The webinar was organised by Alliance for Sustainable and Holistic Agriculture (ASHA), a collective working towards sustainable agriculture, farmers welfare and food safety.

Last month on Independence Day, our Prime Minister Narendra Modi also spoke about how the government is planning to overcome anaemia in the country through food fortification .  

The first time we heard the word fortification was way back in the early eighties when the government decided to make it mandatory to fortify salt with iodine. This was to address the iodine deficiency disorders which was supposed to be a big problem faced by a large number of  people, especially in the Himalayan region.

Also Read: Is mandatory food fortification a boon or bane?

Iodised salt in India

Iodised salt was introduced to India in the 1950s, but in 1983 at the Annual Meeting of the Central Council of Health, it was decided that all the edible salt in India would be iodised by 1992. I remember heated discussions about iodification amongst public health experts, when it was decided to make it mandatory. 

Experts from coastal regions asked why iodisation should be made mandatory since anyway the coastal population was consuming a lot of sea fish, a good source of iodine. Even dairy products, eggs, whole grains, green beans, strawberries, potatoes with skin, etc. were good sources of iodine.

Experts suggest promoting nutrient-dense animal-based foods like eggs, meat, dairy, fish and even insects which are eaten in several parts of India. Photo: By arrangement

Nevertheless, the project was introduced in phases from 1986 and ever since, for the last three decades we have been consuming iodised salt. 

Women started to like this form of salt as it looked clean and white, and was free flowing. There were also media reports saying that health problems faced due to iodine deficiency were now a thing of the past.  

Also Read: Stop compulsory food fortification: Health activists write to FSSAI

Few years later when my mother developed health problems, related to coordination and muscle weakness, the doctor asked me to give her normal salt which is not iodised. He said that normal salt has many micronutrients which are absent in iodised salt. 

I obtained some normal salt after considerable effort as it was just not easily available. Happily, we started using that and my mother recovered too, though I had no idea then about how it worked. But, now, many years later, I still wonder why the government of India decided to make iodisation mandatory and not a choice.

The poor households in India lack food diversity. Photo: Unicef India

Mandatory fortification of rice

Once again now, the government proposes to tackle anaemia and other issues related to nutritional deficiency through fortification. While we already have fortified milk, oil, rice and wheat, the Food Safety and Standards Authority of India (FSSAI) is working to make rice fortification  mandatory by the year 2024. Mandatory fortification of oil and milk is imminent and mandatory fortification drafts have been issued earlier this year.  

Also Read: ‘Compulsory food fortification is wasteful, ineffective and potentially harmful to human health’

On August 2, even before the prime minister declared his intent about fortification, 170 people including medical experts, nutrition experts and organisations working on food and farming wrote to FSSAI to scrap its decision to mandate synthetic fortification of foods such as rice with iron. 

The experts wrote: “Fortification with one or two chemicals to address one nutrient deficiency will be limited by another nutrient deficiency. For example, haemoglobin synthesis requires not just iron but good quality proteins and many other micronutrients as well… this proposal for mandatory fortification citing RDA [Recommended Dietary Allowances] for micronutrients while not taking into account the shortfall in macro nutrients of the population, is specious.”  

In the webinar, Veena Shatrugna, former deputy director of the National Institute of Nutrition, spoke about her concern on corporate takeover of our nutritional system. “Iron is not the only cause of anaemia. Haemoglobin is a complex molecule that requires protein and copper, magnesium and Vitamin C. What we are made to believe is that iron is going to do the magic,” Shatrugna said.  

Also Read: Vit C fortified rice for PDS beneficiaries in Malkangiri, Odisha; activists and nutritionists raise concerns

The government is now planning for double fortification of salt with iron. Shatrugna said that iron absorption in the diet is a huge issue. Without sufficient protein intake, the body can not absorb iron. For vegetarians this is an issue. Unless they take enough protein in the form of pulses, oils and dairy products, even if they eat huge volumes of vegetables and grains, they can still have iron deficiency.

Need for food diversity

According to public health and nutrition experts, the actual solution is to improve diets and food diversity with inclusion of millets, animal protein, dairy products and vegetables as much as possible.

“The poor households in India lack food diversity. Rice rice rice. This is what people eat every day three times. Even seventy five years after Independence, people are not getting decent food. Now the government is stressing on providing fortified rice. Is this the way to build haemoglobin,” Vandana Prasad, an expert on public health asked during the webinar. 

Tribal family in a village in Malkangiri, Odisha eating rice. Photo: By arrangement

Also Read: Agtech is our best bet for a sustainable and inclusive agrarian economy

People working on food sovereignty are more clear about achieving nutritional security. They are working on developing local food systems where local communities decide the cropping systems based on their need, which is taking care of food and nutritional security.

Kitchen gardens to eradicate anaemia

Another project on anaemia eradication is taking root in the villages of Maharashtra since 2010, started by the Mumbai Rotary Club and Sahayak Trust. The project was to introduce kitchen gardens at homes and schools in selected villages. They started in five villages and expanded to 25. 

The project initially created an education module for people to understand the importance of vegetables for keeping anaemia away. Every kitchen garden had 15 varieties of vegetables and it was meant only for home consumption. 

When a survey was carried out before this scheme began, it was found that the people in these villages had very low haemoglobin levels like 4-5 grams per decilitre. When the first phase of the project was completed in 2013, the haemoglobin level had gone up to 10-12 grams per decilitre, just because the people had included diverse vegetables into their regular diet. 

Also Read: ‘Nearly 3 million women farmers set up agri-nutrition gardens in their backyards in two years’

The project stopped for a while, but when Sahayak Trust decided to expand the project to more villages, to its surprise it found that almost 90 per cent households had continued the kitchen gardens and they were consuming vegetables in their daily diet.

Now the project is targeting more districts and villages with the support of several non-profits, and it has also included backyard poultry and mushroom cultivation. This was a scheme where the communities were not mere beneficiaries, but partners in development. Also, projects such as these do not need much resources unlike fortification which is controlled by the corporates.

Why don’t the government, FSSAI or the NITI Aayog look to replicate such models? Kitchen garden movement is also developing in other states like Kerala and many urban gardeners are developing kitchen gardens in big cities as well as in the peri urban areas.

Green Revolution and its aftermath

Since Independence, India has been trying to improve food security and address hunger in many ways. When the Green Revolution began and the government established the Food Corporation of India and a Public Distribution System, the entire focus of food security shifted to rice and wheat which were given to people at a subsidised rate. These were grown mostly in the newly developed irrigated fields of Punjab, Haryana and western Uttar Pradesh and later other state governments also started adopting the same strategy. 

Also Read: What is the cost of childhood wasting and severe acute malnutrition in India?

Farmers were provided with a high yielding variety of seeds, chemical fertilisers and pesticides and this led to the erosion of agro biodiversity, not just of rice and wheat but many other crops.

Talking about just rice. India had around 100,000 accessions of rice in the 1960s. Now the rice production in the country majorly depends on just 20-30 varieties. Debal Deb, a scientist who has systematically conserved 1,400 varieties of rice, has done nutritional analysis of many varieties. He found out that 86 varieties of rice have very high levels of iron and zinc, both very important for human health. But all these nutrients are in the rice bran. 

The mass produced rice using high yielding varieties has less nutritional quality and also it is processed in a way that leaves polished rice without bran. Naturally, people who are dependent on this rice will have nutritional deficiency. Many tribal communities are victims of this approach to food security. They are now demanding to revive their traditional food culture which is largely based on millets and uncultivated foods from the wild.

The Indian government has decided to provide rice fortified with iron under its PDS and mid-day meal schemes from 2024. Photo: Unicef India

Rice fortification

Broken rice grains are ground into rice flour, then mixed with water and the required nutrients to produce a dough. The fortified dough is then passed through an extruder to produce the fortified kernels, which are then blended with regular rice typically at 0.5-2 per cent ratio.

Also Read: Fighting tuberculosis with nutri-gardens

All white rice starts out as brown rice. A milling process removes the rice’s husk, bran, and germ. This process increases white rice’s shelf life but removes much of its nutrition, including fiber, vitamins, and minerals. To counteract this, white rice is artificially fortified with nutrients.

Save Our Rice campaign, a movement started in 2004 by Thanal, tried to address this issue by working on the full chain from seed to food in south India. Thanal, a non profit environmental organisation based in Thiruvananthapuram, Kerala, worked with partners such as Consumer Research Education, Action, Training and Empowerment (CREATE), based in Paramakudi, Ramanathapuram district, Tamil Nadu, and the Bengaluru-based Sahaja Samrudha. 

Consumer awareness created through this campaign helped farmers and small entrepreneurs develop markets for traditional rice which is growing now. Even some state governments and NABARD are supporting such initiatives. Studies done as part of this movement shows the nutritional richness of many varieties grown in Kerala, Tamil Nadu and Karnataka. 

Also Read: Nel Thiruvizha, Tamil Nadu’s seed festival that has revived over 150 heritage, organic paddy varieties

What will happen to this movement once rice fortification becomes mandatory? Even the medium level rice mill owners in Punjab and other states are worried because only big mills can invest in the machineries for fortification . In the letter to FSSAI experts also have raised this concern about small businesses getting affected due to mandatory fortification. It is not in the case of rice alone, but in the case of oils as well. 

Whole grains are also linked to a reduced risk of heart disease, obesity, and certain cancers. Therefore, choosing whole-grain brown, red, black, or wild rice is an excellent choice for health. Plus, these varieties are richer in disease-fighting antioxidants.

The rice provided to the children in the mid-day meal will be fortified by 2024. Photo: Nidhi Jamwal

Food fortification is no magic bullet

There are no miracle solutions for nutrition security. Fortification is projected as one miracle to address anaemia and nutritional issues experienced by people. This is a clinical approach and cannot and should not be applied at large. 

During this pandemic one has heard more about holistic food systems which can help people build immunity. This is possible in a country like India which is rich in biodiversity and our farmers are competent to manage and produce diverse seasonal foods in small land holdings.                

This needs decentralised planning for building the local food chain which will also build the local economy. While fortification helps big corporations, decentralised diverse food chains will help the local communities. 

Also Read: Ajgar lauki, tanpura lauki and sui-dhaaga: How a 64-year-old farmer is preserving desi seeds for posterity

Many also fear that the clinical fortification approach can lead to wrong understanding about food and nutrition in the long term and people will end up consuming over-processed foodstuff leading to more health issues. Already a large chunk of the population is suffering from diabetes, obesity, hypertension, cancer, etc. Many of these are triggered due to environmental factors and unhealthy diets unleashed by the food industry .

In the last few decades, cleanliness and beauty has come to be associated with the colour white. So we have white rice, white sugar, white salt… besides refined oils.  This ‘refining’ is achieved by stripping all nutrient rich parts of the food and polishing it using chemicals. This will increase the shelf-life of food products and thus help the food industry. 

However, those working in the health sector are urging people to eat fresh and seasonal food. The government should consider all these factors before jumping into mandatory fortification.

Food is the fundamental right of every citizen. Food habits in our country are so diverse and it is important to keep our health and the health of the agro ecosystem intact and also to build the local economy.

Usha Soolapani is a Thiruvananthapuram-based rice activist, and the co-founder of Thanal, an environmental organisation. Views are personal.