Inescapable risks of mandatory iron fortification

Fortification will increase serum ferritin without changing haemoglobin level

Many things have been said about the necessity for mandatory iron fortification of foods in India. That it is a ‘necessity’, ‘complementary strategy’ to dietary diversity, ‘effective’ and more loudly now, that it is ‘safe’. Given what we now know, and are uncovering, about the risks associated with too much iron, particularly in children, the proclamation of safety must be made carefully.

The simple fact is that iron is not safe in excess; it is an oxidant with a variety of ill-effects. Just because a ‘tolerable upper limit was proposed for its intake, any intake less than this was thought to be safe. But no longer. We must think of the long-term risk for other diseases, not the toxicological approach of looking at acute clinical symptoms, like stomach pain. This is because we now know that iron increases the risk for many non-communicable diseases like diabetes, hypertension and even high blood cholesterol.

What is the evidence? Take diabetes: what happens when body iron stores, measured by serum ferritin concentration, increase? In the National Health and Nutrition Examination Survey of a healthy U.S. population, those with high ferritin level had a four-fold higher risk of having diabetes. In India, our team recently analysed a national, quality-controlled survey (Comprehensive National Nutrition Survey) of Indian adolescents, to evaluate the risk of high blood sugar, high blood lipids and high blood pressure as their serum ferritin increased.