Unlocking the hidden hunger
crisis with effective nutrition
Hidden Hunger affects more than two billion people. Even when a person
consumes adequate calories and protein, if they lack one single micronutrient, or
a combination of vitamins and minerals, their immune system is compromised
and infections take hold.
World Food Program
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The Problem
The Crisis
•
The human body requires daily
•
Malnutrition is rampant throughout
amounts of nutrients, including
the world, with devastating impact
vitamins and minerals, from the
on the global economy.
food we eat. Obtaining these
•
The terms Nutrition and A Balanced nutrients, in the right form, is
Diet are bandied about with little beyond the capability of most
understanding, while many people.
communities are experiencing •
People have moved away from their
health problems not seen by their
traditional foods, while modern
grandparents who, in many cases,
agricultural practices and food
lived in greater poverty.
processing remove essential
•
Science has done little to provide nutrients from the food chain.
solutions to this problem. The •
In consequence, we can no longer
malnourished are being fed highly
rely on a balanced diet to deliver
refined foods with added highly
the nutrients our bodies require.
refined vitamins and minerals.
•
The continued fortification of
Highly refined means that most of
depleted food with a mixture of
the goodness has been removed.
chemical isolates cannot address
These foods are not the natural
the issue of Hidden Hunger. Filling
foods our bodies are designed to
bellies and improving the Body
use, and they don’t work.
Mass Index of children has nothing
to do with nutrient repleteness.
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Current Solutions are not Working
Products containing micronutrients in
A Balanced Diet
an inorganic form cannot address daily
This is the traditional medical approach, but it nutritional needs
ignores the reality that:
•
Isolates and food nutrients have different
•
Most underdeveloped communities do not structures, use different metabolic
have access to a balanced diet. pathways and function differently in the
•
Where they do, they often cannot afford it. body.
•
When they can afford it, due to ignorance, •
The body needs these micronutrients as
they usually do not choose it. food or in a food form.
•
When they can afford and choose it, the •
Isolating nutrients and trying to get
food is often depleted, so malnutrition benefits equal to those of whole foods
persists. reveals an ignorance of how nutrition works
in the body.
Food Security
Body Mass Index (BMI)
This is the approach of the World Food
It is not sensible to use BMI to assess
Program.
nutritional status.
•
Grain is grown on depleted soils and
• Improvement in BMI can be achieved by
harvests are deficient in vital trace
merely feeding high levels of carbohydrate
minerals.
and fat.
•
The milling process results in the loss of
• Success does not even require the addition
fibre, vitamins, minerals and omega fats,
of cheap micronutrients that lack bio-
due to the removal of the husk, membrane
efficacy.
and germ. This removed goodness is
• We see confirmation of this, not only in
usually sold as animal feed.
Africa, but in the USA and the UK, where
•
Such food intervention is limited in its there is a high prevalence of obesity in
ability to strengthen the immune system. people eating refined, sterile food.
3

Nutrient Depleted Soil
Nutrient Rich Soil
Soils farmed responsibly are rich in Modern farming practices leave the soil
bio-available nutrients. These are depleted of nutrients. The resulting
incorporated and make their way into crops enter the food chain with
the food chain. insufficient vitamins & minerals
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The Refining Process Further Reduces the
Nutrient Content
Vital parts of the whole grain that contain fibre,
vitamins, minerals & omega fats are discarded.
Refinery
Nutrients
5

Food Fortification
• Where there is awareness of
•
A repeat survey in 2005
nutrient depletion, it is usually
showed no improvement,
corrected by the addition of
despite widespread use of these
isolated chemical nutrients.
fortified foods. Why is this?
•
In South Africa, the five most
•
The electrolytic iron has a
eaten foods are refined white
bioavailability of less than 2%.
maize and sugar, tea, milk and
brown bread. •
Phytates in maize further
•
Many children are seriously reduce this.
deficient in iron, zinc and
•
Inorganic iron and inorganic
Vitamin A.
zinc compete for absorption.
•
In response to these findings of
•
Electrolytic iron oxidises the
the National Food Consumption
vitamin A.
Survey (2000), the Department
of Health introduced mandatory •
Vitamins are denatured and
food fortification of all maize destroyed by cooking.
and wheat flour from 2003.
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The Standard Approach The Best Approach
Bio-available
Chemical
Nutrients
Micronutrients
Refined Grain Whole Grain
Good
Little absorption
absorption of
of Vitamins &
Vitamins &
Minerals
Minerals
Gut Gut
Gut Gut
Blood Blood
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The Solution
We need whole foods with bio-available vitamins and minerals.
Where access to fruit and vegetables is limited, whole grain cereals need to be fortified
This is achievable, affordable, and it works!
It costs less than £2 per month to provide a vulnerable child or a TB patient
with a daily nutritious meal.
supports
In Africa, we support e’Pap, a pre-cooked, whole grain food, based on
maize and fortified with soya and a cocktail of 28 nutrients. e’Pap is
produced in Africa where it’s composition and brand name are suited to
Africa's taste and tradition. The formulation is based on a local
understanding of nutritional need, and uses state of the art, first world
fortification chemistry to ensure bio-availability and bio-efficacy.
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The 3 Month e’Pap Effect
Before After
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HETN has Concerns about Plumpy’nut for
Long Term Use
•
Plumpy’nut is promoted and marketed
across Africa as a major breakthrough in •
Plumpy’nut uses a micronutrient cocktail
the fight against malnutrition. of chemical isolates. These are not
o It was designed to be used for a effectively absorbed into the body and
maximum of 2 to 3 weeks in cases of have little impact in addressing the
severe acute malnutrition. nutritional needs of the malnourished.
For example:
o This is appropriate, but is not the
o The recommended daily intake of
reality on the ground, and therein lies
the problem. Plumpy’nut contains 13mg of inorganic
iron with a bio-availability of about
•
For ongoing supplementary feeding, it is
0.26mg (2%).
HETN’s contention that:
o Where inorganic iron is combined with
o The high level of protein in Plumpy’nut
inorganic zinc, some 60% of the iron is
is not appropriate.
blocked. This further reduces the
o The milk powder base can cause
absorbed iron to about 0.1mg.
diarrhoea in the many who have lactase
o A healthy child requires 1mg per day of
deficiency.
absorbed iron and, if malnourished or
o The high level of oil and refined sugar
sick, could need 2mg.
(30%) would make such a product
o So, how can Plumpy’nut ever address
unacceptable in the UK.
iron deficiency when it delivers less
o The high cost of the components makes
than 10% of a child's daily needs?
it unaffordable, and therefore
unsustainable in the African context,
without donor funding.
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Health Empowerment Through Nutrition (HETN)
•
HETN is a Charitable Foundation,
o South African National Tuberculosis
registered in the UK.
Association (SANTA) - Community
•
Our goal is to address nutrient Based TB Support
depletion, believing this to be crucial in o World Vision South Africa (WVSA) -
health, education and social upliftment Orphans & Vulnerable Children
programmes. •
By providing wholegrain food, with all
•
HETN’s approach is based on numerous the cereal fats, fibres, vitamins and
scientific trials that demonstrate the minerals intact, and with the addition
importance of micronutrients in the of all the required micronutrients in a
prevention and management of chronic form that is bio-available (chelates or
disease. food form).
•
Our projects have a single aim - to o By comparing different formulations
ensure that the recipients of feeding and measuring outcomes, with the
aim of increasing the evidence base
programmes receive a daily food
that supports nutritional interventions
portion that includes all the required
in the management of chronic
micronutrients in a bio-available form.
disease.
•
Our projects are already benefiting
How We Succeed
several thousand people in South
•
By partnering with NGOs in the field, to Africa.
ensure that their nutritional •
Excellent nutrition overcomes Hidden
interventions are appropriate and cost
Hunger and improves immune function,
effective.
reducing the impact of infectious
o Society of St Vincent de Paul (SSVP) - diseases, such as TB, Malaria and HIV.
Crèche Feeding
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e’Pap Changes Lives
World Leader in Luxury Adventure Travel and Safaris
Care of the land. Care of the wildlife. Care of the people.
Our most valuable asset is our staff. With this in mind, in 2003 we initiated Positive Health
across the group. This programme is built around natural vitamins and minerals, affordable
foodstuffs and the power of positive thinking. It is geared at preventive health care and
improving the health of people living with chronic disease.
e’Pap is an important part of this initiative.
Not just another cereal, e'Pap is a nutritious and affordable meal-in-one, enjoyed by our staff
at more than 45 safari camps and lodges. Positive Health champions from each lodge educate
the local communities on the many benefits of this remarkable product.
South Africa's Largest Saw-milling Group
The e'Pap intervention with 70 of our employees cost the company R3 500 (£250) per
month. By the third month, the cost saving to the company in reduced absenteeism and
improved productivity was R34 000 (£2 430).
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South African National Tuberculosis Association (SANTA)
Feedback from Care Workers
•
At Etwatwa, some patients live in squatter
•
When e'Pap was introduced, no one believed camps, where their health is at risk. Now, most
that it would save lives. But we have seen families are getting their daily nutrition from
miracles. e'Pap. It gives them strength, children are
concentrating in class, there is a better
•
Lenasia is surrounded by poverty-stricken
response to treatment and their skin has
places. When everyone was losing hope, this
improved. We have seen e'Pap changing lives.
miracle pap came to save lives. We have 160
beneficiaries. 12 were bed-ridden, but today •
Atteridgeville is surrounded by squatter camps.
they have the power to cook and tell stories to On my first day, with 3 students, we just walked
their children. I used to cry and wonder why by silently and powerlessly, our eyes filled with
people should be so sick. Today, I walk with a tears. Bread winners had taken to their beds.
smile and a song in my heart, because I have When the miracle e'Pap was introduced, most
witnessed the dead brought back to life. families were back on their feet. They gained
weight, and grew from strength to strength.
•
Today, the volunteers at Odi walk, smiling and
Children now participate fully at school. Now we
singing, because each day another patient
cry tears of joy.
wakes up from their death bed. We have 250
benefiting from e'Pap. 19 patients got up from •
e`Pap changes lives. Hamanskraal is a rural
their beds and walked again. When they see me area, where you see malnourished people
bringing e'Pap, they cry and call their children, everyday. Their lives have now changed.
and then I know that nutrition is the most Patients are back on their feet. There are
powerful medication on earth. uncontrollable smiles on the faces of the
volunteers, who have witnessed the power
•
People who live in poor circumstances at the
within the sachet. They sing and praise e`Pap
Johannesburg branch get their daily nutrition
as it works its miracles in their villages, proud
through e'Pap. It has saved lives. Most can now
that bedridden patients have got up from their
feed their families by working. Their immunity
death beds and returned to life. The patients
is boosted and they respond positively to
g a i n w e i g h t a n d r e s p o n d p o s i t i ve l y t o
medication. Most are up and about, and their
medication. The children can concentrate at
lives are now back to normal.
school. They now call the SANTA provincial
coordinator wa e`Pap (e`Pap man).
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10 March 2009
!
Health Empowerment Through Nutrition
Graham House, Chequers Close
Malvern WR14 1GP
Dear Geoff
On behalf of the South African National Tuberculosis Association, I would like to
express our appreciation of the partnership enjoyed with HETN in the distribution of
e’Pap to tuberculosis patients and related health care workers.
The pilot project of 2 tons of e’Pap per month that we are distributing in various
districts of Gauteng and North West Province is proving highly successful, as
evidenced by the progress reports from these areas. Of significance, and probably
understandably, the greatest impact is being seen on very ill / bedridden patients.
In these cases the improved nutrition is having a rapid and significant impact. I
suspect this is because their natural resilience is rising from virtually nothing to a
level that enables the TB drugs to function effectively.
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Obviously personal feelings of wellbeing will also rise with food able to make them feel
more replete. Similar reports of recipients growing stronger and more energized relate
to those who are not quite as ill. Starting from a higher ‘base’, these results can take
longer to become apparent and might even be ascribed to the TB disease becoming
less virulent.
Other reports from recipients have indicated that the e’Pap being provided is far more
beneficial than supposed enriched foods received before. This is a credit to the
methodology and formulation of the product, which is certainly starting to achieve a
major footprint in Africa.
Whatever the reasons, these e’Pap projects have proved most valuable and are well
received. Their continuation and expansion is seen as one of the three major objectives
of SANTA in the continuing fight against TB and HIV/AIDS, namely Nutrition, Awareness
and Directly Observed Therapy (DOTS). We hope and believe that by actively
extending these three activities SANTA can and will make a significant impact on the TB
pandemic in South Africa.
We look forward to the possibility of extending our partnership and close relationship
with HETN.
Yours sincerely
John Heinrich
CEO - SANTA
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P O Box 51432
Raedene
2124
Gauteng
23 March 2009
Health Empowerment Through Nutrition
Graham House, Chequers Close
Malvern WR14 1GP
Dear Geoff
On behalf of the Society of Saint Vincent De Paul Maryvale Conference we would like to offer our
sincere thanks for the donations of e’Pap we have received from you and, more particularly, our
appreciation for the partnership we have with HETN to distribute food to the crèches and the
terminally ill whom we help from our Kholofelo Ya Josefa Centre in the township.
The current project of 2 tons of e’Pap per month that we are distributing is feeding twenty crèches
with a total of 1800 children. The success of the feeding scheme is self evident - children who
were lethargic and constantly tired are now full of energy, highly active and much more receptive
to their teachers. The overall improvement in their early childhood development is astonishing as
daily intake is only one 50 gram portion of nutritionally enhanced e’Pap.
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We have seen a significant improvement in general health and in concentration. The children
previously had a bland diet - mainly mealie meal - with little or no nutritional value.
The success of the project is obvious from the requests we are getting from other crèches currently
not receiving e’Pap who all want to become a part of it and get the obvious benefits for the children in
their care. The benefits to the township as a whole from the creation of a healthy generation cannot
be overemphasized.
Of equal benefit is the tremendous improvement in the health and quality of life of the terminally ill
and bedridden patients whom we assist with our home based care service in the township. Our clients
who were previously without hope and suffering from AIDS, cancer or TB now have much improved
resistance and are able to function within their family groups.
There is growing evidence that the e’Pap being provided is a lot better than other food supplements
that have been tried and by word of mouth the benefits of ‘ePap in the diet is getting around
Alexandra.
We are grateful and proud to be able to assist HETN in this highly successful project and look forward
to continuing our work with you and hopefully extending our partnership even further.
Yours sincerely
Patrick Lorentz - President SSVP Maryvale
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A UK Charitable Foundation (1116097)
Health Empowerment Through Nutrition
Graham House
Chequers Close
Malvern
WR14 1GP
United Kingdom
Phone: (+44) 1684 580 893
email: info@hetn.org
www.hetn.org
It is not HETN’s task to feed the hungry. That is the responsibility of
Governments and International Agencies.
It is HETN’s role to establish a credible evidence base for appropriate
intervention.
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