WASHINGTON — Foods based on enriched and fortified refined grains remain a linchpin of US diet quality and have more than proved their value historically as core contributors to Americans’ nutrition, according to a new white paper from the Grain Foods Research Institute (GFRI).

Titled “History and Public Health Benefits of Enrichment and Fortification of Refined Grains,” the paper spotlights the pivotal role that enrichment and fortification of refined grains has played in addressing public health concerns and shortfalls in vital nutrients — particularly in lowering the incidence of micronutrient deficiency diseases and related health risks. The report noted that enriched and fortified grain products have provided an affordable, effective way to raise the intake of underconsumed nutrients and improve diet.

Against the backdrop of new leadership in Washington and rising government and intensifying public scrutiny of processed foods, the paper emphasized that reduced US consumption of enriched and fortified refined grains would negatively impact micronutrient intake and public health outcomes. That observation is key as the nation awaits the release of the final 2025-2030 Dietary Guidelines for Americans (DGA) later this year, said Erin Ball, executive director of the Grain Foods Foundation (GFF), GFRI’s sister organization.

“I want to educate public health folks, and I want to educate experts who are making nutrition policy or making recommendations about nutrition policy in the US,” Ball said in an interview on the white paper and why it was published. “This paper will serve to remind all of us, why do we enrich the products that our investors make, and what has that meant for public health in America. So it was two reasons: one related to policymakers and those who were advising policymakers, and one related to the fact that many of us — myself included — couldn’t recite to you the history of how we got here with refined enriched grains. We need to be able to tell that story.”

Enriched/fortified grains: Lost in the crowd?

Enrichment involves replenishing nutrients naturally found in a food that were lost or reduced during processing, often in greater amounts than originally found, GFRI explained in the report, released in late March. Fortification, on the other hand, entails the addition of nutrients not naturally found in a food to meet a specific health need.

In the US diet, enriched and fortified grain products are a significant source of micronutrients such as folic acid, B vitamins and iron, along with fiber, the paper said. The refined grains category covers a broad range of products, from “staple” grain foods that are enriched and fortified — with limited to no saturated fat or added sugar (such as bread, cereal and pasta) — to “indulgent” grain foods with higher fat and sugar content (including cakes and other bakery items).

Observational studies and the DGA, however, typically haven’t made a distinction between these types of grain-based foods, even though most refined grains consumed by Americans are staple grain foods, the report noted. Less than a quarter are indulgent grain foods, such as flour-based desserts (9.6% of that subgroup), stuffing/breading (5%), quick bread (3.9%), biscuits (2%), pie and pastry crusts (1.9%) and croissants (0.6%).

“This has been the end of a five-year Dietary Guidelines for Americans cycle, which means the advisory committee has been working together for two years, and a lot of the dialogue is very negative about refined grains,” Ball said. “There’s never a definition of refined grains discussed. It’s always just ‘refined’; they often don’t use the term ‘refined enriched.’ At the end of this cycle, and even mentioned in their scientific report, which was published in December, the (DGA) committee recommended enrichment of whole grains because enrichment is so essential, but they have a very negative view of refined grains.”

Meanwhile, critics of ultra processed foods have become vocal critics of processes like enrichment and view the addition of vitamins to food as “part of the ultra-processed foods problem,” Ball added.

While the GFF has responded to criticisms within the DGAC and from bashers of ultra-processed foods, Ball concluded more efforts were needed.

“I said, ‘OK, what’s next?’ It’s a white paper,” she explained.

History of success stories

GFRI’s paper highlighted flour enrichment and folic acid fortification as historical examples of where enriched and dietary changes that paid big dividends for US nutrition and health.

Refined grain enrichment with B vitamins and iron was proposed in the early 1900s amid elevated rates of B vitamin deficiency diseases such as pellagra (niacin deficiency), beriberi (thiamin deficiency) and riboflavin deficiency disease. Bakers began voluntarily adding high-vitamin yeasts or synthetic vitamins to their bread in the late 1930s. The term “enriched” was officially adopted by the Food and Drug Administration by the end of 1940, and the Food and Nutrition Board officially began urging the enrichment of flour and bread the following year.

In 1943, the War Foods Administration started requiring the enrichment of all bread and flour, essentially making enrichment mandatory nationwide. After World War II, the FDA created two standards of identity: “flour” and “enriched flour.”

“From a public health perspective, the enrichment of refined grains with B vitamins served to effectively eliminate pellagra, beriberi and riboflavin deficiency disease among the general US population,” the paper said. “Pellagra-attributed mortality declined significantly in the 1940s and 1950s compared to peak levels in the late 1920s, with it being virtually eradicated in the US by 1960. Analyses of pellagra-attributed morbidity and mortality trends have concluded that cereal grain enrichment played a significant role in its eradication.”

Likewise, both beriberi and riboflavin deficiency disease are now extremely rare in the United States, with GFRI noting that clinically diagnosed vitamin deficiencies and disorders overall “are now rare in representative samples of the US population.”

“Even for folks in the industry, very few remember the story, the history, of why enrichment (of refined grains) came to be,” Ball said.

The fortification of refined grains with folic acid has seen similar success. According to the paper, that effort emerged in the 1980s and 1990s in response to a rising understanding of the etiology and prevalence of neural tube defects (NTDs), severe and debilitating birth defects of the brain and spine, including spina bifida and anencephaly.

In 1992, the US Public Health Service recommended the intake of folic acid for all women of child-bearing age via fortification, supplementation and diet to prevent NTDs. The Institute of Medicine issued a similar recommendation in 1998. But GFRI’s paper said raising folate intake through folic acid supplements proved challenging. That led to the identification of enriched grain products — a widely consumed food — as a vehicle to boost folic acid intake. In 1996, the FDA amended the standard of identity for enriched grain products to include folic acid, and folic acid fortification of enriched cereal grain products was mandated for 1998.

“The introduction of mandatory folic acid fortification of refined grain products produced a clear public health benefit with a reduction in the incidence of NTDs in the general population,” the white paper said.

Dietary debate

A key point in GFRI’s paper is that refined grains are “often misclassified and/or grouped with” red and processed meat, sugar-sweetened foods and beverages, fried foods and high-fat dairy products identified as part of an “unhealthy” or “Western” dietary pattern, flagged in epidemiological studies as having a higher risk for adverse health outcomes. But when analyzed individually, refined grain intake wasn’t linked to an increased risk of all-cause mortality, type 2 diabetes, cardiovascular disease, coronary heart disease, stroke, hypertension or cancer, the report noted.

“The Grain Foods Foundation was formed in response to the Atkins diet craze in the late ’90s and early 2000s,” Ball said. “And I think, in general, the way carbohydrates very broadly have been maligned has fed into this issue with refined grains.

“Also, public health and nutrition folks have really moved away from talking about individual foods and sometimes even individual nutrients. They talk about dietary patterns. In some ways, it’s helpful. It’s a way to describe a whole diet without focusing so much on one ‘miracle’ food or one ‘villain’ food. However, when you talk about dietary patterns, refined grains are always included in what’s called the unhealthy Western dietary pattern. And that pattern includes refined grains, red and processed meat, fried foods, full-fat dairy and sugar-sweetened beverages.”

Citing National Health and Nutrition Examination Survey (NHANES) analyses, the paper said enriched and fortified grain-based foods supply a “substantial amount” of the daily intake for micronutrients like thiamin (45%), riboflavin (25%), niacin (28%), iron (38%) and folate (50%) and have demonstrated their “essential role” in helping Americans meet recommendations for those micronutrients.

Enriched and fortified refined grains, too, remain a core source of fiber — described in the GFRI paper as an “underconsumed nutrient of public health concern” — and are one of the most affordable, widely consumed food groups, including staples like bread, rolls, tortillas, pasta, rice and ready-to-eat cereals.

“A reduction in refined grain consumption,” the paper concluded, “could potentially pose greater harm by reducing the intake of folate, thiamin, niacin, riboflavin and iron below the EAR (estimated average requirement) for large percentages of the US population — in addition to exacerbating already low intakes of dietary fiber, worsening diet quality and reversing public health successes, such as increasing the rate of NTDs and associated medical costs.”

The 2025 DGA committee’s report suggests encouraging “mostly whole grains and lower refined grains” versus the current guideline to consume “at least half” of total grain servings as whole grains and, implicitly, the other half as refined (enriched) grain foods.  

“We hope that the actual 2025-2030 guidelines, once released, will do more to meet people where they are, rather than recommending a decrease in foods that Americans love that also promote nutrient adequacy,” Ball said. “While Americans are certainly not reaching targets for whole grain consumption, working on that challenge is a project that has taken decades and is ongoing. Let’s support US consumers’ health with messages promoting ‘both halves’ of current grain foods recommendations.”

Consumption data show that people are mostly eating staple grain foods — bread, pasta, cereal, etc. — yet eating treats in moderation, she added.