Snapshot of Food Fortification History in the United States

Sharman Apt Russell turns the spotlight here on the history of food fortification in the United States, including that of iodine whose deficiency is known to cause goiter. 

Salt companies were pressured into putting iodine into salt. Now hardly anyone knows what iodine deficiency looks like -- same with scurvy and other diseases

By Sharman Apt Russell


Sharman Apt Russell has published some dozen books translated into nine languages. Her Diary of a Citizen Scientist won the 2016 John Burroughs Medal for Distinguished Natural History Writing and her Hunger: An Unnatural History (Basic Books, 2005) was written with the help of a Rockefeller Fellowship. Her Within Our Grasp: Childhood Malnutrition Worldwide and the Revolution Taking Place to End It (Pantheon Books, 2021) highlights the alignment of environmental and humanitarian goals.  Sharman lives in the magical realism of the American Southwest. She teaches in the MFA program of Antioch University in Los Angeles and is a professor emeritus at Western New Mexico University in Silver City. For more information, go to

Snapshot of Food Fortification History in the United States


As a way to prevent and treat malnutrition, fortifying food with vitamins and minerals is fast, sustainable, cost-effective, and scalable. Like a lot of jargon, scalable is a term you first dislike and then find yourself using all the time. Scaling up iodine, scaling up iron, scaling up zinc. In a world of billions of people, we want good things to be scalable.

The United States is a compelling example of how food fortification can work.

Iodine is an element naturally low in some soils, leached out of flooded or glaciated areas. Our thyroid needs iodine to produce hormones, and a lack of iodine commonly causes a swelling of the neck’s thyroid gland, known as a goiter. You are tired. You feel cold. You gain weight. Tragically, you are pregnant, and your child suffers from a serious form of iodine deficiency called cretinism.

In 1820, a French chemist traveling through the “goiter belt” of America’s Great Lakes, Appalachian, and Northwestern regions suggested that table salt should be fortified with iodine, something the medical world discussed for the next hundred years. Finally, studies done on Ohio school girls from 1907-1919 proved that iodized salt could eliminate goiters. Some American salt companies embraced the idea as a public service. Others were moved by the threat of legislation mandating the addition of iodine. Large-scale iodization was in effect by 1924, accompanied by an educational campaign in schools and communities. Since then, goiters caused by iodine deficiency are rare in the United States (although mild iodine deficiency has returned partially due to less consumption of fortified salt).

By 1935, Vitamin D enriched milk also appeared on the American market. Rickets, a deformity and dysfunction of the bones, was a common problem among young children, especially poor children living in the industrialized northern cities who lacked enough sunlight and calcium in their diet. The medical community strongly supported the new product. The government played little role except to allow dairies to fortify milk since federal regulations permitted enrichment only to foods that had lost vitamins during processing.

Bread was one of those processed foods, with most cereal flours now milled in ways that required less labor and resulted in a flour that went rancid less quickly. The nutritional cost was a loss of B vitamins, important in the function of nerve cells. A diet low in B vitamins already plagued poor people in rural America, who often depended on low nutrient corn. The symptoms of beriberi, caused by a lack of Vitamin B1, range from swollen legs and a rapid heart rate to paralysis and heart failure. Eventually, a B1 deficiency can result in permanent brain damage, including memory loss and hallucinations. Similarly, pellagra is caused by too little Vitamin B3 and was diagnosed in the American South based on the “4Ds”—diarrhea, dermatitis, dementia, and death. People with severe cases of pellagra often died in mental hospitals.

As with iodization, an appeal to public service and the threat of legislation convinced the baking industry to fortify their bread with high-vitamin yeast or synthetic vitamins. There was also the pressure of national security. A shocking number of young Americans drafted for World War II were so malnourished as to be unfit for duty. In 1942, the U.S. Army began to purchase only enriched flour for its servicemen. An advertisement in one medical journal asked a handsome, puzzled soldier, “What has toast got to do with winning the war?” The answer was that the extra vitamins and minerals in enriched white bread “give you the added punch you need to tackle your war job.”

Most of the fortification in the United States was led by educational programs, consumer demand, and market competition. Eventually, a higher standard of living and a diet that included more animal products meant that diseases like rickets, beriberi, scurvy, and pellagra are now relatively unknown, even as they remain common in other parts of the world. Fortifying staples like salt, milk, and flour was a first step—a leap forward.

Globally, fortification has moved in fits and starts. In 1986, the United Nations created the Coordinating Committee on Iodine Deficiency Disorders. In 1993, a group that included the Canadian government, UNICEF, and USAID formed the nonprofit international Micronutrient Initiative. In 2002, the UN started the Global Alliance for Improved Nutrition. Since then, GAIN has reached an estimated billion people in forty countries, adding iodine to salt in Ethiopia, iron to soy sauce in China, and Vitamin A to vegetable oils in Afghanistan. In Morocco, they fortify wheat with a mix of vitamins and minerals. In Brazil, they fortify rice. Private enterprise, as well as government support, is part of this imminently scalable effort.



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