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Hidden Hunger - Dr Douglas

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  • 1. Hidden Hunger affects more than two billion people. Even when a person consumes adequate calories and protein, if they lack one single micronutrient - or aHidden Hunger combination of vitamins and minerals -A Physician’s Perspective their immune system is compromised, and infections take hold. World Hunger Series 2007 - Hunger and Health Health Empowerment Through Nutrition World Food Program South Africa - August 2011 NutrientsThere is a global nutrition crisis, witha dual problem of hunger and obesity  The human body needs sufficient nutrients for optimum health Myth #1 - The escalation of food  On a daily basis, we require insecurity makes it imperative to maximise agricultural yields  17 minerals Myth #2 - The escalation of obesity  14 vitamins makes it imperative to promote a  9 amino acids balanced diet  2 fatty acidsOver tens of thousands of years,human beings developed sustainableways to feed themselves: Preservation of topsoil Crop rotation Natural fertilisers Locally grown, seasonal fruit and vegetables Fresh, free range meat, eggs and milk Freshly cooked, nutritious meals 1889 1
  • 2. 1919 California 1950It was no different in Southern Africa,where people had less money thanthey have today: Millet, sorghum and – more recently - maize, grown and milled at home Ground nuts, sweet potato, pumpkin, cabbage Gathering herbs, roots, shoots, fruits and wild spinach Moderate intake of fresh, free range meat, eggs and milkKalahari Bushmen Hidden Hunger  In contrast, the science of nutrition is less than 150 years old, and the ‘best evidence’ keeps shifting.  In the early 1960s, the medical advice was  Myth #4 - High protein (animal best)  Low carbohydrate (unspecified)  Low fat (Myth #5 - Traditional margarine healthier than butter)  No supplements (expensive urine) 2
  • 3. Hidden Hunger Hidden Hunger After Burkitt’s work in Uganda, the  Today, the medical advice is medical advice (late 1960s) was  Myth #6 - 5 fruit and veg  High unrefined carbohydrate (fibre)  Moderate protein (pulses good)  Moderate unrefined carbohydrate  Low fat (traditional margarine still healthier  Moderate protein than butter)  Low fat (but omegas essential)  No supplements It is interesting that Ugandans were healthier (no  Modern margarine healthier than butter appendicitis, diverticulitis, diabetes, gallstones,  Traditional margarine (trans fats) extremely ischaemic heart disease, hypertension and bad certain cancers)  No supplements Antioxidant Comparison of Plant and Animal foods Modern farming methods haveNutrient: 500 Cal Plant Based Animal Based conspired to maximise yields at theCholesterol mgFat mg 0 4000 137 36000 expense of nutrient content:Protein mg 33000 34000  Deep ploughingBeta Carotene mg 29.9 0.017Dietary Fibre mg 31000 0  NPK fertilisersVitamin C mg 293 4  Pesticides & FungicidesFolate mg 1.17 0.004Vitamin E mg 11 0.5  MonocultureIron mg 20 2  GM cropsMagnesium mg 548 51Calcium mg 545 252  Hydroponics  Early harvesting & Artificial ripeningThese nutrients are universally acknowledged as vital to protect against cancers of all kinds  Factory farmingPlant Based Foods = Equal parts of tomatoes, spinach, lima beans, potatoes and peas  Storage & TransportAnimal Based Foods = Equal parts of beef, pork, chicken and whole milk Influence of Milling on Vitamin & Today, our food contains a fraction of Mineral Content of Maize the essential micronutrients it contained 100 years ago Wholegrain Milled % Loss The Food Industry has compounded (μg/g) (μg/g) this problem by: Vitamin Vitamin A B1 - Thiamine 0 4.7 0 1.3 0 72.3 Vitamin B2 - Riboflavine 0.9 0.4 55.6  Refining Vitamin B3 - Niacin 16.2 9.8 39.5 Vitamin B6 - Pyridoxine 5.4 1.9 64.8  Milling Vitamin E 0 0 0  Processing Folate Biotin 0.3 0.073 0.1 0.014 66.7 80.8  Additives Calcium 30.8 14.5 52.9  Extensive use of sugar, corn syrup and Phosphorus 3100 800 74.2 Zinc 21 4.4 79.0 hydrogenated oils (trans fats) Iron 23.3 10.8 53.6 3
  • 4. Feeding People what Rodents Thiamine – Vitamin B1 Reject  1884 – Takaki rejects the germ theory for beriberi and attributes the disease to insufficient diet  1897 – Eijkman discovers that fowl fed on polished rice develop paralysis, which can be reversed by discontinuing rice polishing  1901 – Grijns correctly interprets the connection between consumption ofSammy eats the maize germ, where the cereal fat polished rice and beriberiand micronutrients are found.Human beings refine out the nutrient rich maizegerm and eat the sterile remains. Sugar – A Natural Food – Myth #7 Positive energy balance  Every human cell can use glucose, but only the liver can metabolise fructose  It turns it into fat. Fructose increases:  Blood lipid levels – triglyceride, total and LDL cholesterol  The prevalence of type 2 diabetes, hypertension, abnormal blood clotting and heart disease  Teenage males in the US consume 34 teaspoons per day - 25% of total calorie intake Chromium? 1940 50 60 70 80  DoH ’98, USDA ’02, NIH ’03, NCHS ‘04 This is manifest in an explosion in the prevalence of chronic degenerative disease: The result is a global pandemic of  Obesity & Diabetes Hidden Hunger (Type B  Hypertension & Heart disease Malnutrition)  Mental Illness & Dementia which afflicts  Impaired immunity  Cancer the hungry and the obese  TB  Asthma  Arthritis Myth #8 - We are living longer. Few of us are living healthier. 4
  • 5. Sheffield 1887 Hardee’s ‘Monster Thickburger’ 1420 calories, 107g fat: $5.49 5
  • 6. 2001Sheffield 2007Body Mass Index (BMI)  We are bombarded with nutrition guidelines that promote a balanced diet: BMI is not a sensible measure of nutritional  MyPlate status:  5-a-Day (fruit & veg) An improvement in BMI can be achieved by eating   Traffic light labelling (fat, sugar & salt) just carbohydrate and fat – which does not equate to good nutrition  Some believe that Organic and Free  Having a BMI within the normal range does not Range are best mean you are healthy or nutrient replete  All these guidelines assume that our food  We see confirmation of this, not only in Africa, but also in the USA and UK, where there is a high contains the nutrients we need for health prevalence of obesity in people eating refined,  But 5-a-Day won’t cut it. Nor will 10! nutritionally sterile foodHidden Hunger In SA, today, the staples are  Refined maize meal (empty calories)  Bread (mostly refined)  White sugar (empty calories)  Soft drinks  Sweets  Most processed foods  Traditional margarine (trans fats)  Cooking oil 6
  • 7. Hidden Hunger Hidden Hunger Iron Deficiency - Children < 5 years:  Mozambique - 95%  The National Food Consumption  Tanzania - 65% Survey (1999) showed that South  South Africa - 37% Africans were deficient in iron, zinc,  Worldwide - 1.2 billion (1988) vitamin A and most of the B vitamins - 3.5 billion (2000) Zinc Deficiency  Is it any wonder that immunity is  Worldwide - 2 Billion (2001) impaired?In the Third World, fortification of Why it has Faileddepleted staple foods has become The electrolytic iron used has a bioavailability ofcommonplace:  less than 2% Myth #9 - We can get essential  Phytates in maize block the absorption of iron, micronutrients from chemicals added to our zinc, calcium and magnesium food  Electrolytic iron oxidizes the vitamin A  They are often toxic  The vitamins are denatured and destroyed by  They are poorly absorbed cooking  They rarely act in the body in the way intended  The RDAs are based on adult, not child food portions – which reduces the intake of the most With the exceptions of iodine and folic acid, vulnerable this has not been achieved In 1999, Nobel Prize winner, Günter Blobel, demonstrated that for vitamins and minerals to be effectively absorbed into cells, they needed to be associated with their plant carrier proteins. 7
  • 8. Abundant Scientific Evidence Wartime Rationing The Lancet (2008)  One third of child deaths are due to under nutrition  The international nutrition system is fragmented, dysfunctional and in desperate need of reform The China study (2005)  Isolating nutrients and trying to get benefits equal to those of whole foods reveals an ignorance of how nutrition works in the bodyWartime Rationing 1940-1954 Nutrient Form Very little meat, fat, eggs or sugar  Myth #10 - Many health professionals believe  2 ounces (50g) of butter per week that different forms of vitamins and minerals are  One egg per fortnight the same, but isolates and food nutrients The ‘National Loaf’ – wholegrain  have different structures Home-grown vegetables - Dig For Victory  use different metabolic pathways An apple a day keeps the doctor away  function differently in the body  Children were allocated milk, cod-liver oil and orange juice  With supplements or fortification, the crucial  Schoolchildren had a weekly dose of malt extract consideration is bio-availability and bio-efficacy Most people were better fed during wartime food rationing  Selenium, for example, is an important than before the war years antioxidant. Where there is deficiency, it has  Infant mortality rates declined become commonplace to fortify bread or salt with  Average age at which people died from natural causes sodium selenate or selenite increasedForms of Selenium Vitamin C  In the 1930s, Szent-Györgyi was awarded the Form IC50 Nobel Prize for the discovery of Vitamin C Selenium Yeast 3.0 μM  He demonstrated that the active material in paprika was ascorbic acid Selenomethionine 52.8 μM  When, with repeated distillation, he extracted Blank Yeast > 100 μM (Not an Antioxidant) crystalline ascorbic acid, he expected a strong reaction Sodium Selenite > 1000 μM (Not an Antioxidant)  But it did nothing - the concentrated whole foods he had used in his research were far Inhibition Of LDL+VLDL Oxidation more effective By Different Forms of Selenium 8
  • 9. Calcium Tuberculosis Elephants - their skeletons are maintained with the Calcium they get each day from  Tuberculosis is caused by a leaves and grass mycobacterium Pettifor showed that 30mg of Calcium in Ca-  One third of the world’s population is rich yeast is better absorbed that 300mg of infected Calcium Carbonate  Infected people dont usually get sick The former went to bone; the latter to  It is only sick people who can infect others kidney Apparently, we are not designed to eat chalk!TB – The Global Situation An Impending SA Crisis Of all infectious diseases, TB is the leading killer of adults - c.2 million people per year  It is generally accepted that over 60% of the Someone in the world is newly infected with TB South African population has TB infection in its every second latent state Between 2002 and 2020 over 150 million people  As HIV infection weakens immunity, the latent TB will become ill and 36 million will die if there is is likely to become active over the next few not better control years, giving a potential TB prevalence of 12 The evolution of drug resistant strains of TB have million had an even greater impact on morbidity and  The potential impact on society and the economy mortality in the face of the global HIV pandemic do not bear consideration Tuberculosis - History  Throughout the nineteenth and early twentieth centuries, TB was common in the cities of Europe and North America  London was one of the worst affected areas  TB once caused one in eight of all deaths in the UK  The decline was achieved through a combination of  Better housing and nutrition  Isolation of infectious patients  Pasteurisation of milk 9
  • 10. Methods of Control Deaths from Tuberculosis – New York 1854 - Sanatorium treatment began  3 months resting Year Deaths per 100,000  Initial confinement to bed  Periods of increased activity slowly introduced 1910 10029 382  Fresh air at all times and in all weathers 1920 7084 244  Enormous amounts of food 1935 – Pasteurisation of milk introduced in UK 1930 5043 178 1944 – First use of Streptomycin 1940 3569 119 1952 – First use of Isoniazid 1950 2287 57 1953 – BCG vaccination introduced in UKA Lesson from History TB & Nutrition  The association between TB and malnutrition has This dramatic shift in TB mortality was not long been known achieved with:  Malnutrition weakens immunity, increasing the  Antibiotics chance that latent TB will develop into active disease  Early detection through mass chest x-ray programmes  Malnutrition increases drug side effects, making treatment interruption more likely  Or BCG immunisation  Treatment interruption results in relapse and All of which came into widespread general drug resistance use after 1950  Good nutrition enhances the efficacy of TB drugsHIV/AIDS & Nutrition Selenium HETN does not support single issue More than 50 peer reviewed journal articles show environmentalism, nor single fixes, but by way of that: illustration:  Micro-nutrients, including the vitamins A, B6, B12 and E, and the minerals selenium and zinc, play a critical role in  In Kupka’s study of 949 HIV+ pregnant the maintenance of immune function and overall Tanzanian women, low plasma selenium was metabolism. significantly associated with increased mortality.  The HIV virus encodes the seleno-enzyme glutathione peroxidase, thereby robbing the host of selenium and the  Each 0.1µmol/l increase in plasma selenium was amino acids, cysteine, glutamine, and tryptophan. related to a 5% decreased mortality over 5.7  Persons living with AIDS suffer from extreme deficiencies of years of follow up. all of these nutrients, which are responsible for depressed  In PLWHA, the plasma selenium levels is a better CD4 counts, vulnerability to infections and cancers, dementia, depression, diarrhoea, muscle wasting, indicator of morbidity and longevity than the CD4 neuropathy and skin diseases. counts. 10
  • 11.  Odunukwe studied the impact of selenium  Hurwitz followed 174 HIV+ patients over 9 yeast in Nigerians with advanced disease months. 91 of them received 200µg/day (CD4 cell counts < 50) who were on ART.  170 participants received 200µg of Se daily of selenium yeast and 170 received ARV therapy alone. Patients  Serum Se increased significantly in the Se- were followed for 72 weeks. treated group but not in the placebo-treated  The rate of CD4 cell recovery was significantly group (+32.2μg/l v. +0.5μg/l) (P<0.001) higher and the median CD4 count increment  Greater levels of Se (in the ‘responders’) were was over twofold higher in patients on Se significantly associated with decreased HIV supplementation (+120 cells/mm3 v. +50 viral load (P<0.02) compared with controls cells/mm3).  The incidence of opportunistic infections was  This correlated with a significantly increased lower resulting in fewer hospital visits. CD4 count (P<0.04)  Weight gain was significantly higher (p =  Selenium ‘non-responders’ did not differ from 0.004). the placebo group in HIV levels and CD4  Haemoglobin increment from baseline to 64 counts weeks was 3-fold higher (+30 g/l v. +10g/l).Parallel Evidence  Finland has shown that selenium supplementation can have a major beneficial impact on the incidence of HIV/AIDS. The HIV/AIDS pandemic is only one of several,  Despite widespread, unprotected, promiscuous involving viruses that encode the seleno-enzyme sexual activity in Senegal, where soil selenium glutathione peroxidase. levels are naturally high, HIV is diffusing very Hepatitis B and C viruses, the Coxsackie B virus slowly, if at all, amongst the population. and HIV do likewise.  In the UK there is an epidemic of TB among The Chinese are winning a battle against the badgers, which is infecting cattle. It has been Coxsackie B virus which causes Keshan disease, a shown that organic herds fed on clover, which is fatal cardiomyopathy that has been common for rich in selenium, are not susceptible. When many years in inhabitants of the great selenium- badgers and traditional herds are given maize deficiency belt that crosses China. supplemented with selenium, they are no longer susceptible.The Scientific Position Academy of Science of SA Systematic reviews conclude that there is no evidence that micronutrient supplementation  The pre-antibiotic phase of dealing with TB was reduces morbidity and mortality in people living characterised by strengthening the immune with HIV/TB. But: defences with diet, improved environmental  Trials concentrate on single supplement conditions and every other conceivably helpful intervention, or supplementation with a small measure group of micronutrients  After the discovery of effective drugs, this aspect of  Neither can be expected to correct the type of nutrient deficiency seen in HIV/TB TB therapy quickly became secondary  The dose of supplement is often not  The Panel is appalled by the dearth of reliable and physiological informative studies of the nutritional influences /  The form of supplement is often not interventions on the course and outcomes of the considered pandemic chronic diseases (HIV & TB) addressed  Much of the research is done in the West in this report where baseline nutrition is higher 11
  • 12. TB / HIV Management The Challenge  If it is the consensus that the maintenance of Drugs such as antibiotics and ARVs are essential health is conditional on eating a balanced diet. - elements in controlling and hopefully, in the case this should be the first priority in any health of TB, curing disease initiative But without the basics of good nutrition to  It is the responsibility of health workers to ensure sustain or rebuild natural health and immunity, that their patients are nutrient replete we are fighting a losing battle  Advising patients to eat a balanced diet where they Something has to change and be done differently have no access , or no understanding , is unethical to avoid yet more failure in fighting TB and HIV,  Where people have multiple micronutrient as well as most other health / wellness problems deficiencies, any scientific research that attempts It is time to give proper nutrition a full spin to determine the benefit of this or that micronutrient is unethical and bound to fail, John Heinrich because it runs counter to the prevailing truth that South African National Tuberculosis Association we need balanced nutritionBeware Dualism Beware Dualism Science v. Religion  Drugs v. Nutrition  Copernicus (1530) and Galileo (1610) - The  Only Drugs can claim to cure, mitigate Heliocentric View or treat a disease  Dawkins (2006) - The God Delusion  Food and food supplements cannot Germ Theory v. Milieu Interieur claim this  Louis Pasteur v. Claude Bernard  They may make health claims but Robert Koch - Anthrax (1877), Tuberculosis  only if substantiated by RCTs (1882), Cholera (1883)  1884 – Takaki (1884) & Eijkman (1897) - Thiamine FDA & EU Food Supplements DirectivePolitics Scientific Arrogance In South Africa there has been a damaging public media debate, polarising the  Justus von Liebig (1803 – 1873) proponents of drug treatment and the proponents of nutrition  Healthy plant growth depends on the  Some politicians have argued that HIV & TB are correct balance of Nitrogen, diseases of poverty, overcrowding and poor Phosphorus and Potassium – Death of nutrition. They are.  The medical profession continues to argue that Sustainable Agriculture micro-nutrition is in the research domain, while  Healthy human growth depends on promoting a balanced diet that is supported by even less scientific evidence. the correct balance of Protein, This debate is specious. Nutrition is key – but Carbohydrate and Fat – Death of it needs definition. It is not a question of Good Nutrition ‘either/or’, but ‘both/and’. 12
  • 13. Remember the Heretics Is the Pharmaceutical Model still relevant? Copernicus (1530) and Galileo  100 years of research has generated a (1610) - The Heliocentric View wide range of potent & specific drugs Semmelweis (1847) - Hand  Anti-microbials Washing  Pathogens allow differential metabolic targeting – ‘weak link’ Barry Marshall & Robin Warren  Wide therapeutic index, curative (1982) - Helicobacter Pylori  But resistance is now widespreadIs the Pharmaceutical Model Is the Pharmaceutical Modelstill relevant? still relevant? Almost all drugs for CDDs are designed to  CDDs are generally not due to an suppress symptoms, and do not treat the infectious agent, nor a single gene underlying disease  No single ‘weak link’ Narrow therapeutic index, palliative  Multiple metabolic / physiological Iatrogenic illness is now a major cause of imbalances morbidity and mortality  Multiple nutritional / lifestyle factors The CDDs still have no cures … contribute to risk, therefore …  They are increasing in frequency  Multiple nutrient regimes are necessary  The age of onset is falling to modify the course of diseasePharmaco-Nutrition Cumulative Risk Reduction (CVD) Wald & Law, BMJ 326:1419, ‘03  No magic bullets  Drugs – the ‘Poly-Pill’  Identify as many critical metabolic  A statin errors as possible  A thiazide, a beta blocker & an ACE inhibitor  Cross-reference these against the  Aspirin known pharmacology of food derivates  Folic acid  Initiate a multiple support programme  Would reduce IHD events 88%, strokes 80%  The aim is to make people nutrient  Adverse effects in 8 – 15% replete  Cost: €43.91/ month (NHS)* * Ashcroft JS, bmjjournals.com 13
  • 14. Cumulative risk reduction (CVD) Cumulative risk reduction (CVD)  Food – the ‘Poly-Meal’  Pharmaco-Nutrition programme  150ml red wine  150 ml wine: flavonoids @ 1 – 1.5 g  Oily fish - 4 / week  Oily fish 4 / week: omega 3’s @ 1 – 2 g  Dark chocolate 100mg: flavonols @ 1 g  Dark chocolate 100mg  Fruit & veg 400g: carotenoids 25 mg,  Fruit & veg 400g fibre(s) 10g, aa’s, cyanogens etc  Garlic 2g, almonds 68g  Garlic 2g, almonds 68g: B vitamins etc  Would reduce IHD events 76%  Would reduce IHD events 75%  Adverse effects – none  Adverse effects – none  Cost: €22.44 / week  Cost: € 2.66 / week Franco, Bonneux et al: BMJ 329:1447-1450, ‘04HETN recommends FoodState Productsfor addressing Hidden Hunger Combating Hidden Hunger You can buy products that sound similar at  It is the contention of HETN that people a lower cost, but they will not give the everywhere - malnourished or not - same beneficial results need a diet that is based on whole FoodState nutrients are beneficially grains combined into a food medium which  It should be low in fat and sugar naturally contains all the phytonutrients  It should contain all the vitamins and and other food factors necessary for minerals that would ideally be sourced absorption and use of each nutrient within from fruit and vegetables in a form that is the body bio-availableA Call to Action A Call to Action  Stop feeding hungry children in the Third Remunerate producers on the nutritional World with CSB (refined cereal) or content of the food they produce Plumpy’Nut (high fat, high sugar) Eat fresh, local and seasonal  Stop using BMI as a measure of nutritional Stop refining grain status Ban trans fats  Stop believing that we can correct micronutrient deficiencies by adding these Reduce sugar, fat and salt consumption to food in the form of chemical isolates Traffic light label all processed foods  Question whether the RCT is appropriate in nutritional science 14
  • 15. Lest We Forget Thank You for Your Interest In 1940 the UK could not wait for the science  They were at war  They had to act on the RDA information they had  In the process, they improved the health of all Today there is no time to waste  We are at war  Our front line is dying of TB and AIDS while we sit in ivory towers arguing science Health Empowerment Through Nutrition is a The time is now UK Registered Charity concerned with the alleviation of Hidden Hunger www.hetn.org 15

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