If iron loss in our food is the problem, can’t we just add it back?

In the first installment of this series, I covered how iron used to be effortless, woven into everyday diets without a second thought.

Our ancestors didn’t track milligrams, stress over absorption, or pop supplements. They got enough iron just by eating because the way food was grown, prepared, and eaten naturally supported iron intake.

Today? Not so much.

By the early 1900s, industrialization was stripping iron (and other nutrients) from food. And we knew it.

We tried to fix it.

By the 1940s, governments were adding iron to food, fortifying flour, cereals, and rice, to replace what was lost.

So if fortification was supposed to be the solution, why are so many of us still iron-deficient?

Why is getting enough still an uphill battle, something we have to think about, plan around, and supplement?

What’s not working?

That’s exactly what I’m looking at in this issue: How food fortification was meant to solve the iron lost in industrialization, but hasn’t worked as well as we thought.

The Rise of Food Fortification

Iron fortification began in the 1940s in the US and UK, inspired by the success of iodine fortification in salt. Governments began adding iron to white flour and bread to combat widespread iron-deficiency anemia.

By the 1980s, iron fortification expanded beyond flour to include cereals, pasta, rice, and infant formulas.

It helped—and it’s cost-effective. But didn’t eliminate iron deficiency altogether.

Why?

How Iron Gets Added to Your Food—And Why It’s Not That Simple

Iron fortification isn’t as simple as just adding iron to our food. It’s a delicate balance of bioavailability, stability, and food compatibility.

Not all forms of iron behave the same way in food. Some dissolve easily, while others change taste, color, or texture, making fortification a tradeoff between absorption and consumer acceptability.

Which Iron Forms Are Used?

Different foods require different iron compounds based on cost, stability, and bioavailability:

• Ferrous Sulfate & Ferrous Fumarate → Highly absorbable, but can cause taste and color issues in some foods. Used in cereals, flours, and infant formulas.

• Ferric Orthophosphate → Less reactive, but also less bioavailable. Used in rice and some powdered products.

• Reduced Iron Powder → Cheap, stable, and widely used in wheat flour and grain products, but poorly absorbed.

• Encapsulated Iron → Coated to reduce reactivity, used in milk products and beverages to avoid altering taste.

Why Fortified Foods Haven’t Solved Iron Deficiency

We’ve made significant advancements in fortifying staple foods. Many would argue that fortification is, in the grand scheme of things, efficient and effective.

But many women are still iron deficient.

So what’s going wrong?

Bioavailability: Added Iron ≠ Naturally Occurring Iron

Despite our best attempts, not all iron is created equal.

Due to cost, availability, dietary restrictions, and stability, fortified foods mostly contain non-heme iron, which is harder to absorb than the heme iron found in animal sources.

Ferrous sulfate is among the most absorbable forms but is rarely used in large-scale fortification because it alters food’s taste and color.

Ferric orthophosphate and reduced iron powders are more stable and widely used, but poorly absorbed.

Fortified foods may contain iron, but that doesn’t mean your body absorbs it efficiently.

Iron-Fortified Foods Can Contain Potent Absorption Inhibitors

Iron doesn’t work in isolation. It competes with other nutrients and is blocked by certain foods:

🚫 Calcium (from dairy or fortified plant-based milks) directly competes with iron for absorption.

🚫 Phytates (found in whole grains, legumes, and nuts) bind to iron, preventing its uptake.

🚫 Polyphenols & Tannins (found in coffee, tea, and wine) reduce iron absorption when consumed with meals.

Even when foods are fortified, your diet can still limit iron absorption.

Fortified Foods Are Iron-Rich—But Nutrient-Poor

Iron fortification efforts focus heavily on processed foods (like white bread, cereals, pasta, and rice) because these are widely consumed and easy to regulate.

But many people at higher risk for iron deficiency (e.g., athletes, pregnant women, and those with gut issues) aren’t necessarily eating these foods.

Many health-conscious consumers avoid processed, fortified foods in favor of whole, unprocessed options (which, to be clear, is a good thing!).

The bigger issue? Fortified foods aren’t always nutrient-dense in ways that support iron absorption.

They contain iron, but they often lack the nutrients that support iron absorption, like vitamin C. Many whole foods naturally provide iron alongside co-factors that help the body use it effectively.

Even if you eat fortified foods, you may not be absorbing as much iron as you think.

And for those avoiding them entirely, an alternative iron strategy is essential.

The Rise of Gut Inflammation & Malabsorption Issues

Increasing rates of gut inflammation and malabsorption disorders³ mean that fortification alone isn’t enough for many women.

Gut inflammation hinders iron absorption. Conditions like IBD and celiac disease trigger the production of hepcidin, a hormone that blocks iron uptake.

Even low-grade inflammation (not full-blown IBD) can disrupt iron absorption, which may explain why so many women struggle with low iron levels despite a "healthy" diet.

Iron fortification doesn’t just impact iron levels. It also affects the gut microbiome.

🔬 Studies show that iron fortification can:

• Increase the risk of intestinal inflammation 

• Reduce beneficial gut bacteria

• Promote the growth of potentially harmful bacteria

Researchers theorize that different iron formulations and doses impact gut bacteria differently, meaning some fortification strategies may do more harm than good, and better approaches are needed.

If your gut isn’t absorbing iron properly, no amount of fortified foods will fix the problem. And for some, iron fortification could even worsen gut issues.

Fortification Levels Are Designed for Deficiency Prevention—Not Optimization

Fortification levels are set to prevent widespread severe deficiency, not to help you reach optimal iron levels.

Most iron-fortified foods provide only 15-30% of the Recommended Daily Allowance (RDA), just enough to fill the gap for at-risk populations.

Iron needs vary dramatically. Some people require much more than others due to:

🩸 Heavy menstrual cycles
🤰 Pregnancy
🏃‍♀️ Endurance training
🩸 Frequent blood donation
🦠 Gut absorption issues (IBD, celiac, low stomach acid)

Fortified foods help prevent extreme deficiency—a safety net—but they aren’t designed to optimize iron stores for those with higher needs. And depending on where you live, you may be consuming more or less fortified foods than you realize.

If fortification isn’t the answer, what is?

The goal of iron fortification was to replace what was lost, but added iron isn’t the same as natural iron, and many factors still block absorption.

The good news? Small, intentional shifts can help maximize iron absorption and support your body’s needs.

Here are some simple ways to make iron work for you:

1. Prioritize natural iron sources over fortified foods. Choose heme iron sources like grass-fed meats, shellfish, and poultry. If you follow a plant-based diet, opt for sprouted, fermented, or vitamin C-rich plant sources.

2. Add vitamin C to improve absorption. Add a squeeze of lemon to lentils, beans, or spinach. Top grain bowls or salads with bell peppers or tomatoes. Eat oranges, strawberries, or kiwi with breakfast if you're having fortified cereal or whole grains.

3. Soak or sprout grains and legumes before preparing them to reduce phytates that block iron.

4. Eat fermented foods daily. If you struggle with low iron despite eating well, gut health could be the missing link. Supporting gut bacteria by eating foods like kimchi, sauerkraut, and yogurt can aid digestion.

5. Consider getting regular blood tests (e.g., hemoglobin and ferritin levels) every 6-12 months if you have heavy periods, are pregnant, train intensely, or donate blood. Tracking your iron levels will allow you to adjust accordingly.

Fortified foods have played an important role in reducing severe iron deficiency, but they weren’t designed to meet individual needs, especially for women with higher iron requirements.

The best way to maintain healthy iron levels is to focus on whole food sources, optimize absorption, and support gut health.

Iron was never meant to be something we have to track, plan, and stress over, but modern food systems have made it that way.

Fortification helped prevent the worst cases of iron deficiency, but it hasn’t been the silver bullet we hoped for.

So instead of relying on fortification alone, we can take a smarter, more intentional approach—one that works with our bodies instead of against them.

🌾 Fortified foods help prevent severe deficiency, but prioritizing whole, iron-rich foods and smart absorption strategies is key to optimizing your levels.

💬 What surprised you most about iron fortification? Reply and let me know what was most interesting to you!

1  In addition to iron, the UK Bread and Flour Regulations require that calcium carbonate, thiamin (vitamin B1), and folic acid (as of November 2024) must be added to all wheat flour sold and consumed in the UK, with some specific exceptions.

2  e.g., Kosovo and Moldova

3  The impressive rise in inflammatory bowel disease among children is particularly alarming.