Food fortification involves adding vitamins and minerals to foods during processing in order to boost their nutritional profile. This practice has been deemed ‘one of the most scalable, sustainable and cost-effective interventions to combat micronutrient malnutrition’. Currently, 142 countries have fortification mandates of at least one food — such as rice, wheat flour, or salt — and many more fortify various foods voluntarily. 

These fortification initiatives have tackled widespread deficiencies, fending off conditions like goiter, anaemia, and neural tube defects. For example, in the United States, the mandatory addition of folic acid (the manmade form of folate) to cereal grains since 1998 has prevented around 1,300 cases of neural tube defects in newborns each year. Salt iodisation, practiced in over 100 countries, has averted 750 million cases of goiter over the past 25 years. In Costa Rica, iron fortification has dramatically lowered anaemia rates in children from 19% to 4% and in women from 18% to 10%. And Guatemala experienced a sharp decline in vitamin A deficiency, from 22% down to 5%, within a year of introducing sugar fortification. 

The UK is no stranger to food fortification. A number of staple foods are already fortified in the UK, either by mandate or voluntarily. For example, the UK requires non-wholemeal wheat flour to be fortified with calcium, niacin, thiamine and iron — and soon folic acid as well. Many breakfast cereals are voluntarily fortified with iron, folic acid, and vitamin D. And margarine is often fortified with vitamins A and D².

² Vitamin D and vitamin A fortification was previously mandatory in the UK, but this mandate was removed in 2013. Many margarine and other fat spreads are still voluntarily fortified.

Animal products are often fortified in the UK as well. Or rather, the animals themselves are fortified. For example, dairy, a rich source of iodine, does not achieve its iodine content through entirely natural means. In addition to the iodine that they absorb through their feed, dairy cows are routinely fed iodine supplements, and their bodies absorb additional iodine via the iodine-based disinfectants used on their teats. 

Vitamin B12 does not appear in animal products altogether naturally either. For example, animals who do not naturally produce their own B12, such as chickens and pigs, are routinely fed B12 in a premix containing a range of trace minerals and vitamins. Ruminant animals like cattle and sheep, who do produce vitamin B12 naturally, are also supplemented. However, rather than directly receiving B12, they are routinely supplied with cobalt, which aids them in synthesising B12 within their digestive tract.

While animals are supplemented with vitamins and minerals that make their way into the animal products people consume, plant-based analogues like soy milk and meat-free sausages are not always fortified to match their animal-based counterparts. For example, just over a quarter of plant-based products are fortified with B12 in the UK. Zooming in on plant-based dairy, only 28% of plant-based milks, a mere 6% of plant-based yoghurts, and no plant-based cheeses at all are currently fortified with iodine. Similarly, homemade plant-based milks do not contain micronutrients like iodine either. 

This means that vegetarians and vegans — and anyone else who consumes plant-based alternatives — may not benefit from the same fortification that omnivores do.

Plant-based analogues already offer better nutrition than their animal-based equivalents across various factors, such as higher fibre and lower saturated fat. The vast majority of Britons — as many as 94% — fail to eat enough fibre (30 grams recommended per day). Meat contains no fibre at all, but plant-based analogues can help close this gap. Plant-based alternatives’ achilles heal has often been their higher salt content, but a recent study of nearly 20,000 products even points to plant-based equivalents as having lower sodium than the cold cuts, roasted/cooked red meats, and sausage products they emulate. Plant-based alternatives are thus a healthier choice across key metrics. 

However, plant-based products still underperform across micronutrients such as B12 and iodine. Given their increased average risk for some micronutrient deficiencies, vegetarians and vegans would benefit greatly from fortified plant-based alternatives, as would everyone else who even occasionally eats these products. This type of fortification is especially relevant today, as scientists are urging the public, and especially Western countries, to reduce their meat consumption for the sake of public and planetary health. 

There is a revolution in the healthiness of plant-based foods waiting to happen. Plant-based animal product alternatives are already healthier than animal products on many important macronutrients. While plant-based products have been unfairly vilified for their high degree of processing, it is further processing to improve plant-based foods’ micronutrient profiles which could unlock their next level of healthiness, elevating their nutritional profile further beyond that of animal products. 

Taste

One possible barrier to fortifying plant-based foods is taste. For example, the calcium salts used to increase the calcium content of a product may have an unpleasant flavour. One of the most commonly used calcium fortificants, calcium carbonate, may have a chalky, soapy, or lemony taste, which may not meld with a product like plant-based meat. This flavour issue is especially relevant, as large amounts of calcium salts must be added to produce a meaningful nutritional impact, given their relatively low bioavailability (20-40%).

Additionally, both iron and potassium fortification may produce an undesirable metallic taste. Thus, fortifying foods requires careful calibration, balancing sensory appeal and nutrition. In a recent focus group study in the UK, participants perceived some unpleasant or off-tastes and textures of various fortified foods. Though participants ranged according to their priorities (e.g. healthiness versus taste), taste and texture remained a guiding force in their purchasing decisions, reflecting broader evidence on consumer preferences, and highlighting the importance of getting taste just right.

This highlights an opportunity for plant-based ingredients or processing providers to develop fortification methods which do not have a negative impact on product taste. If a plant-based product can improve their micronutritional profile without compromising on taste, this will provide them a further advantage over animal products. 

Consumer perception

Another barrier to fortification is consumer appeal. In some cases, making foods more nutritious may actually make them less appealing. Unhealthy foods are perceived to be tastier, and healthy foods are perceived to be less tasty — a phenomenon known as the unhealthy = tasty intuition (or, inverted, the healthy = tasteless intuition). 

In fact, research has demonstrated that participants quite literally enjoy foods less when they have health-focused messaging on the label. In the specific context of fortification, UK focus group participants considered taste and health to be mutually exclusive. That is, they either had to choose a less tasty but healthier product or a less healthy but tastier product. This perceived tradeoff may turn consumers off. 

That said, improving the nutritional profile of plant-based products could have advantages, even if producers make the decision not to highlight the improvements in their marketing. Firstly, because products have to disclose some amount of nutritional information regardless of whether it is a prominent feature of their packaging. Secondly, simply being healthier (even without saying it) could put these products in more favourable categories or rates with respect to government health frameworks (for example, not being subject to the UK’s National Food Strategy’s proposed salt tax).

Micronutrient deficiencies are not an ailment of the past. They continue to be a real health concern in the UK today. Food fortification has a long history of successfully combatting micronutrient deficiencies, and plant-based producers ought to consider voluntarily fortifying their products with essential vitamins and minerals where possible. 

Ironically, though plant-based alternatives have been maligned as ultra-processed foods, it is this additional processing (fortification) that could boost their health profiles and help address sweeping micronutrient (e.g. selenium) and macronutrient (e.g. fibre) deficiencies in the UK.