Breakfast cereal (or simply cereal) is a traditional breakfast made from processed cereal grains. It is traditionally eaten as breakfast primarily in Western societies. Warm cereals like porridge and grits have the longest history. Ready-to-eat cold cereals, appearing around the late 19th century, are most often mixed with milk (traditionally cow's milk), but can also be paired with yogurt instead or eaten plain. Fruit or nuts are sometimes added. Many breakfast cereals are produced via extrusion. Some companies promote their products for the health benefits that come from eating oat-based and high-fiber cereals. In South Africa, cereals are often fortified with vitamins but can still lack many of the vitamins needed for a healthy breakfast. A significant proportion of cereals are made with high sugar content.