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

That was the thinking behind food fortification. And it has helped.

Since the 1940s, iron has been added to staple foods like flour, cereal, and rice in an effort to fight widespread iron deficiency. It’s reached millions of people, lowered rates of severe anemia, and likely prevented countless cases of deficiency from ever developing. For many, it may be enough.

But it hasn’t solved the problem entirely.

Many women are still low in iron, despite decades of fortification. Despite eating fortified cereals. Despite doing “everything right.”

So what’s missing?

In this issue, I’m digging into what food fortification does well and what it doesn’t. Because when it comes to women’s iron needs, the fix hasn’t been as complete as we are perhaps led to believe.

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. Severe iron-deficiency anemia became less common in the general population.

💰 And it’s cost-effective. Fortifying staple foods reached large populations quickly and cheaply.

⛔ But didn’t eliminate iron deficiency altogether.

Why?

There are several potential reasons:

• Poor absorption: Most iron used in fortification is non-heme, which is harder for the body to absorb, especially when paired with calcium or coffee.

• Diet diversity: Many people (especially women) no longer eat large quantities of white flour or cereal, particularly those trying to eat "healthier" these days.

• Biological needs: Women’s iron demands are considerably higher due to menstruation, pregnancy, and postpartum loss. Fortified foods rarely meet those needs.

• Food context: Fortified foods aren’t consumed in isolation. Timing, meal composition, and nutrient competition affect absorption.

Fortification helped reduce severe cases, but it was never enough to fully meet women’s needs, especially today, when lifestyles, diets, and stressors have changed.

💬 What’s the most confusing part of figuring out your iron needs in today’s food landscape? Reply and let me know!