with vitamin C: the severity of the adverse effects and a complete exposure analysis. Many potential risks of excess vitamin C have been identified. In the DRI report (IOM, 2000b) the relatively mild adverse effect, osmotic diarrhea, was chosen as the endpoint for the UL for vitamin C. The DRI report explained “[the] effects are generally not serious and are self-limiting.” However the ULs for children for vitamin C were extrapolated based on body weight differences and therefore the risk of harm for children may warrant additional consideration.
The other important factor is that an exposure analysis would be needed that estimated vitamin C inclusion in food under all circumstances. For example, attention should be paid to the potential for vitamin C to increase iron absorption in instances where this effect is not desired, that is, when iron intakes are not inadequate or limited. While healthy people do not increase iron absorption in response to high doses of vitamin C, it is not known whether individuals with hereditary hemochromatosis could be adversely affected by the long-term ingestion of vitamin C (IOM, 2000b). Therefore, depending on the most current information regarding risk to specific populations, it might be decided that the scientific justification for discretionary fortification necessitated a more in-depth scientific review process or was more congruent with a trial period of fortification while more data were collected.
GUIDING PRINCIPLE 13. Currently there is limited research on the impact of discretionary fortification on the distribution of usual intakes in the population. Consideration should be given to fortification with nutrients up to the amount for products to meet the criteria as “good” or “excellent” sources of the nutrients,4 consistent with the modeling approach described in Guiding Principle 12.