Reader Ben (also my wonderful brother-in-law) posted several comments this month on my nutrition series inquiring about how to evaluate the health benefits of foods that are fortified with various vitamins and minerals compared to natural, whole foods.

“I have been wondering if these ‘fortified foods’ are better for us, or if they have been overprocessed to the point of not being healthy. Some advocate ‘raw foods,’ or foods that have not been processed at all, are healthier and easier to digest.”

For example, the Bisquick pancakes made with white flour compared to the homemade whole wheat flour pancakes. It is a good question and one I needed to research myself.

Why do we fortify foods in the first place?

Fortifying foods began as a way to reduce public health problems. For example, iodine, a mineral naturally present in seafood, good soils and the meat of animals who consume plants grown in iodine-rich soils, was added to salt in 1924 to prevent goiters.

We now know that iodine may be vital particularly for pregnant women as it has been shown to impact fetal brain development. Although we hardly hear about goiters in the United States any more, it appears that iodine consumption is still a problem we need to monitor especially among poor populations. Some countries now mandate that iodine be added to all salt sold.

In 1943, many flours were fortified with niacin, thiamin, riboflavin and iron to prevent pellagra, a brain and skin-degenerating condition.

Since 1998, folic acid has been added to enriched grains to prevent neural tube defects in children.

Most of these enriched products appear aimed at the very poor who most likely do not take vitamin supplements or eat a healthy diet.

But what about the rest of us?

The debate about processed foods is confusing on many levels. Most of us have heard the message from various sources that we shouldn’t eat any processed foods and that we are better off eating “whole foods.” But what seems to get lost in translation is what a “processed” food is.

In today’s technology-rich world, I think it appeals to a lot of people to have one area of their life devoted to simplicity and relatively free of technology. For many people this area is food. It is easy to understand that a homegrown vegetable is better for you than a box of Mac ‘N Cheese. (and it most certainly is!) However, I think some people start to take this too far.

The case of flour is one example. You could grow your own wheat and grind your own flour (a processed food), for example. Your flour might be organic and pure and natural and all the other wonderful adjectives we can think of. But would your flour be better than an enriched flour that has been enhanced with various vitamins, such as folic acid and niacin mentioned above? Even though the enriched flour is produced by a large factory and probably grown in less desirable conditions, the answer might be that this “processed” flour is technically better for you. Similarly a yogurt with added fish oil might be healthier than one without.

*Note, I say might be, because there are factors like pesticide use and processing methods that could affect the final outcome.

What does “processed” really mean?

I also don’t think people appreciate that “processed” could also mean “cooking.” In my pancakes example, a whole foods purist would probably say that the healthiest pancake choice is neither pancake—that it would be better to just eat the eggs and milk (i.e. whole foods) in the pancakes alone and forget about making a cake out of them. We tend to deceive ourselves that just because there is whole wheat in a pancake it is less cake-like. There are some situations where cooking enhances the nutrient absorption of foods (like cooking tomatoes in oil) but most of the cooking we do probably “processes” our foods into less healthy versions of what we started with.

Recent nutritional trends also emphasize foods processed to remove “bad” ingredients, like high fructose corn syrup, gluten, and sugar. But what is amazing is the number of people who honestly believe that you can still eat the same products without those ingredients and it is somehow “healthier” for you. For example, you might buy “sugar-free” pudding at the store for your kids but when you look at the label, it generally has artificial sweeteners in it which could be just as bad for you. Perhaps you are buying gluten-free bread but bread itself is not that healthy for us and unless you have celiac disease or gluten allergy, the absence of gluten is probably of no consequence to you. Swapping rice milk for cow’s milk is not that great of a choice either as rice milk is converted to sugars in the body and has a relatively high glycemic index. Lately, a lot of “healthy recipes” I have noticed use rice milk in place of sugar as a sweetener. (For the record, I think rice milk is delicious but I don’t think of it as a health food.)

The Bottom Line

A whole foods purist would likely subsist on a diet that was almost exclusively vegetables, lean proteins and eggs with a splash of beans, nuts, whole grains and fruit. 99% of people don’t eat this way. But if you want a clear, simple, easy-to-understand guideline about what is healthy to eat, this is it.

We like our sugar, our carbs, our milk and cheese. In our family, we have come to accept that these foods may not be as healthy as we would like and should be eaten in whatever moderation we can summon. If we are going to eat these foods, we need to come up with our own hierarchy of evaluating bad versus less-bad food choices. I tend to go in this order:

1. “Banned” substances (There are certain things I won’t buy 99% of the time. Products with artificial sweeteners or trans fats are high on my list. The medical evidence may or may not support these choices but I think all of us have some things we just don’t perceive as healthy.)
2. Calorie count (At the end of the day, the calories have to stay low to maintain weight no matter what else is in the food. A low calorie count will generally only be overcome if the nutritional factors of the other food are extremely superior.)
3. Cost (Does it pay off enough nutritionally to justify the extra cost of healthier ingredients?)
4. Fat content (If it has trans fats, I will rule it out in favor of something that doesn’t. I will also go for lower saturated fat content.)
5. Dietary Fiber count (Higher dietary fiber is better.)
6. General vitamin and nutrient content (The more nutrients the better.)

Each person will have their own nutrition checklist based on nutritional needs and lifestyle choices. It is fascinating to learn what different people choose to eat and not eat. In some ways, we are all part of a grand experiment to find out what works.

How do you feel about the processed versus whole food debate? What is on your nutrition checklist? Please share in the comments.