Fortified foods are gaining space on supermarket and drug store shelves. Sometimes called "superfoods," fortified foods can range from pasta enriched with whole grains to orange juice with added calcium to peanut butter infused with omega-3 fatty acids. Articles about the fortified food trend have quoted experts who advise using fortified foods as one part of a balanced diet.1
What Do Dietitians Say?
I recently polled members of the American Dietetic Association (ADA) Weight Management Dietetics Practice Group about fortified foods. I received a response from Marcia Crawford, a registered dietitian who writes the blog "Nutrition Minute" (http://nutritionminute.blogspot.com/), and it contains astute observation and advice:
"I remember reading [an article about fortified foods] and thinking the first thing that was wrong was the description 'foods enhanced to have health benefits.' These foods have been enhanced for marketing purposes. So when we select our donuts, chips and enhanced water we can be (falsely) reassured that we're getting at least something good out of these nutrient-weak foods. We continue to look for a short cut to eating well, wondering why our weight is creeping up steadily and our health is declining. We still have no magic substitute for eating well and being more active. When we throw bits of information at the public and then modify our foods to match those bits of information, it's quite understandable that the public grabs at the next nutrition fad ... [And] when the next fad is floated, the public criticizes us for changing our minds on what's healthy. The headline writers, food package designers and marketers are running the world of nutrition."
How to Advise Patients
The ADA has published several resources that are useful when advising patients about fortified foods. The ADA points out that foods touted to have superior nutritional properties may also be high in ingredients such as sugar, saturated fat and sodium.2 To make fortified foods sell, companies sometimes add ingredients for palatability that could negate the supposed health benefits of consumption.
Several practice papers are referenced in ADA's "Hot Topics" entry about so-called superfoods (http://www.eatright.org/About/Content.aspx?id=5180). One of these papers describes nutrient-dense foods as those that provide substantial amounts of vitamins and minerals (micronutrients) and relatively few calories.3
Advise patients to choose nutrient-dense foods, not fortified or super foods. Lists of nutrient-dense foods can be found in the appendices of the Dietary Guidelines for Americans: http://www.cnpp.usda.gov/DGAs2010-PolicyDocument.htm.
Rather than focusing on a single disease or food component, the guidelines provide science-based advice to promote health and reduce overall risk for major chronic disease through diet and physical activity.2 By following recommendations from the new 2010 Dietary Guidelines and advising patients to always read food labels, you will provide scientifically sound advice. Today's patients are more savvy than ever. We must educate them about what is a fad vs. what is long lasting.
That said, patients may argue with you or provide illuminating information. You may learn something new! For now, recommend that patients eat naturally nutritious foods with known health benefits and myriad phytonutrients: fruits, vegetables, whole grains and nuts such as pistachios. These are all "super" foods without additives or food chemical changes. Leave the pasta to the grains group and the meats and chicken to the protein group. Calcium-enriched orange juice is one food that remains in my book of recommendations, but it's been around long enough that we know its benefits.
Down the road we'll inevitably tackle the next big food fad, whatever it is!
1. Fortified foods. How healthy are they? Wall Street Journal. June 15, 2009. http://online.wsj.com/article/SB124267976477131801.html. Accessed March 15, 2011.
2. Hot Topics: Superfoods. American Dietetic Association. November 2007. http://www.eatright.org/About/Content.aspx?id=5180. Accessed March 15, 2011.
3. Pennington J, et al. Practice paper of the American Dietetic Association. Nutrient density: Meeting nutrient goals within calorie needs: J Am Diet Assoc. 2007;107(5):860-869.
Additional reading: Nitzke S, Freeland-Graves J. Position of the American Dietetic Association. Total diet approach to communicating food and nutrition information. J Am Diet Assoc. 2007;107(7):1224-1232.
Robyn Kievit is a family nurse practitioner, a registered dietitian and a certified specialist in sports dietetics. She operates a private nutrition practice in Boston and is on staff at Emerson College. E-mail your nutrition and weight loss questions to firstname.lastname@example.org or visit her website at www.robynkievit.com. On Facebook and Twitter, search for nutritionmentor.