Photo courtesy of Mühlenchemie.
WG: What is the present position concerning the fortification of wheat flour?
Montgomery: Fortification of wheat flour with micronutrients is mandatory in 86 countries. Very good progress has been made in the African continent, especially, where 27 countries have now issued statutory regulations on fortification. And in the three Indian states of Haryana, Maharashtra, Tamil Nadu, and many others, there are important projects in place to combat the widespread folic acid and iron deficiency. About 60% of all women and children in India are anaemic, so we are very glad that we have the full support of the central government for our commitment. India is a real milestone in our work.
WG: What do these projects consist of in concrete terms?
Montgomery: We start with atta flour, which is generally used in India for the popular flat bread chapatti. Many consumers traditionally have their grain ground in small, unorganized stone mills. But we are making progress in many states in getting the government to support the option of supplying the beneficiaries of the public distribution system (PDS) with ready-ground, wholemeal atta flour fortified with sodium iron EDTA, folic acid and vitamin B12 instead of with grain. It is estimated that the PDS can reach greater than 50% of the Indian population, including the most vulnerable.
WG: If the wheat in these regions is high extraction, is fortification still necessary?
Montgomery: Unfortunately, it’s a common fallacy that wholemeal flour contains enough micronutrients to prevent deficiency symptoms. For instance, its natural folic acid content is far too low to prevent spina bifida, an opening in the vertebral column, in babies. To make matters worse, the wholemeal flour contains phytate, which reduces the bioavailability of the natural iron in wheat. That means it’s important to fortify wholemeal flour, too.
WG: That sounds like a plea for the fortification of all flours – wholemeal flour as well as top flour?
Montgomery: That would be preferable, but in practice it’s scarcely done at present. According to U.S. regulations, for example, it would not even be permitted to extend supplementation to wholemeal flour. But the market share of wholemeal flour there is currently only approximately 7%. If the percentage were to increase we would have to try and persuade the government to change the regulations.
WG: Are you making progress in Europe?
Montgomery: The industrialized states of Western Europe are a really big challenge to us. They reject fortification of any kind, without taking the fundamental removal of nutrients during milling into account. The fact is that if we grind wheat into top flour, we remove most of the vitamins and minerals naturally present in the grain. This loss could be made up for simply and effectively by fortification.
WG: Speaking of effectiveness, the fortification of flour with vitamins seems to work well and bring quick success. But progress in preventing iron deficiency is still very slow. Why is that?
Montgomery: With the trace element iron it is especially important to choose the right compound in the right amount. South Africa is a typical example. Electrolytic iron was used there for over 10 years, without bringing any improvement in the health of the population. The quantity added, 30 ppm, was simply too little, and its bioavailability was too low. But in the last legislative period it was decided to use sodium iron EDTA instead; that is by far the most effective iron formulation. Things will change now.
WG: Is it possible to prove the efficacy of flour fortification beyond doubt?
Montgomery: It certainly is if there are enough data — on the Fiji Islands, for example. Six years after the start of flour fortification, the incidence of anaemia in women of child-bearing age had fallen from 40% to 28%. Zinc deficiency is no problem at all now. And the incidence of folic acid deficiency is only 1%.
WG: Those are impressive figures. But the question then is why flour fortification isn’t practiced far more widely, at least in the developing and emerging countries. After all, the health of the population is directly related to a nation’s economic performance.
Montgomery: That really is frustrating, sometimes. China, the country with the world’s biggest population, is very much of a mystery to us in that respect. On the one hand, most of the scientific research studies on the consequences of malnutrition come from China, so a knowledge of the benefits of supplementation certainly exists. Nevertheless, nothing is happening at all. Does it have something to do with the food scandals of recent years? Perhaps. However, we are still persevering and trying to get in touch with the relevant government authorities.
WG: Even if there are no statutory regulations, the Chinese mills could still fortify their flour with micronutrients on a voluntary basis. Is that option used?
Montgomery: The Chinese milling industry is expanding enormously — but only 1% of the mills fortify their flour voluntarily. These flours are bought by consumers who are aware of the nutritional benefit and willing to pay more for it. But it is the very poor and needy who are unable to do so. Therefore, fortification must be mandatory. That is the only way to reach the masses.
WG: Doesn’t the FFI sometimes cause displeasure among the millers by calling for mandatory flour fortification? After all, they are the ones who ultimately have to bear the cost and the extra work.
Montgomery: Wheat flour is a universal staple food that is excellently suited for fortification with micronutrients. Implementation presents no problems and is very cheap; it has no negative effects at all on the quality of the products. So the milling industry is a key ally in the battle against malnutrition. But what we must emphasize even more in the future is the importance mills have for society. Millers who fortify make a significant contribution to preserving the health of a country. We must do much more to acknowledge this commitment.