February 18, 2025 from Medscape
Nutrition has never been a black-and-white subject. As more patients embrace whole-food diets and avoid anything processed, they may unknowingly eliminate key sources of vital nutrients. While ultraprocessed foods like sugary drinks and deli meats are linked to poor health outcomes, there’s a middle ground where many healthy, minimally processed foods exist — and they play an essential role in preventing micronutrient deficiencies.
In the U.S., the practice of fortifying staple foods began nearly a century ago to combat widespread deficiencies. Iodine was added to salt in 1924 to prevent goiter. Vitamin D was added to milk in 1933. And enriched flour became the norm after World War II, delivering thiamin, riboflavin, niacin, and iron to millions. These small interventions had a big impact: conditions like rickets, goiter, and certain types of anemia declined dramatically.
But today, as patients seek to “clean up” their diets, many are cutting out enriched breads, iodized salt, and fortified grains—mistakenly lumping them in with ultraprocessed foods. This growing trend could undo decades of public health success.
A New Risk: Micronutrient Deficiencies on the Rise
Recent research points to a concerning shift. A study found that 23% of pregnant women had inadequate iodine intake—a micronutrient essential for thyroid development. Prior to folic acid fortification in 1998, around 12% of women of childbearing age were deficient, putting them at greater risk for neural tube defects and anemia. While those rates improved for years, avoidance of fortified foods could reverse this progress.
Without iodized salt, enriched bread, or fortified milk, patients may be unknowingly setting the stage for nutritional gaps—especially when feeding children during critical growth periods.
Balancing Whole Foods and Practical Nutrition
Whole-food diets are still valuable. But it’s not practical—or always healthy—to eliminate all processed foods, especially for busy families. Minimally processed items like whole-grain bread, canned fish, unsweetened applesauce, and iodized salt offer both convenience and essential nutrients.
Rather than seeing foods as “good” or “bad,” providers can help patients adopt a more nuanced view. A tuna sandwich made with whole-grain bread? Nutritious. Unsweetened applesauce as a quick carb? Smart choice. Iodized salt over sea salt? A small but meaningful upgrade.
In reality, nutrient-fortified, minimally processed foods are often more accessible and more effective at preventing deficiencies than fully “clean” diets.
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