A Flawed Recipe

Context: Diversification of diet, not rice fortification, is key to addressing the problem of anaemia.

Critical analysis of the rice fortification programme: The programme is not required for the following reasons – 

• Overestimation of anaemic burden: 
  • The extraordinarily high anaemia figure might, firstly, be inflated because WHO haemoglobin cut-offs are used to diagnose anaemia in India.
  • Secondly, haemoglobin level can be falsely low when a capillary blood sample (taken by finger-prick) is used for measurement instead of the more reliable venous blood sample (taken with a syringe from an arm vein).
• Controversial role of iron deficiency: Iron deficiency is thought to be the primary cause of anaemia in India. But recently, a MoHFW national survey (Comprehensive National Nutrition Survey) of Indian children showed that iron deficiency was related to less than half the anaemia cases.
• The daily iron requirement is also fulfilled: Iron requirements (as per the National Institute of Nutrition [NIN] 2010) were much too high. The latest corrected iron requirements (NIN 2020) are 30-40 per cent lower, with the so-called iron “gap” also being much lower.
• Risks of overdose: Ingesting fortified salt (two teaspoons, ten g/day) or rice (quarter kilo/day) will deliver an additional 10 mg iron/day each to the diet.
  • One could exceed this requirement by a lot, without even counting the supplemental iron tablet (60 or 100 mg/week for women). When the iron intake exceeds 40 mg/day, the risk of toxicity goes up.
  • Iron causes oxidative stress and is implicated in diabetes and cancer risk. Men will also be more at risk.
• Huge costs to the exchequer: Mandatory fortification will cost the public exchequer Rs 2,600 crore annually (not insignificant in relation to the budget and worth nearly 4 crore Covid vaccine doses).
• Rice fortification is complex: The problem lies in making “matching” kernels for each rice cultivar that is distributed in the food safety-net programmes from year to year and state to state.
  • A fortified rice “kernel” or grain that is composed of rice flour paste, with the required concentration of micronutrients, is extruded into a grain that exactly matches the shape of the rice it is intended to fortify.
• Reduces the demand for naturally occurring varieties: For the sake of expediency, it might even reduce the demand for the naturally occurring diverse varieties in India.

Way Forward

• Focussing on diet diversification: There is a need to absorb the existing dietary iron better and complement this with all the other nutrients that are required by eating a diverse diet (with fruits and vegetables, for example) and improving our environment.
• It is well-known that the benefits derived from the nutrients in whole foods are greater than the sum of their parts.
• Rethinking food reductionist strategies: In 2010, Time ranked “meals in pill form” as third in the top 10 failed futuristic predictions, in a list that included time travel, jetpacks, flying cars and cyborgs. We need to rethink our reductionist strategies if we are to deliver food and nutrition security to our people.