Hidden HungerA Global Crisis

Danone PresentationDr Geoff Douglas KStJ MSc MA FRCP MFOM

Johannesburg - February 2016

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 disease takes hold.

World Hunger Series 2007 - Hunger and HealthWorld Food Programme

There is a global nutrition crisis, with a dual problem of hunger and obesity Myth #1 - The escalation of food

insecurity makes it imperative to maximise agricultural yields 

Myth #2 - The escalation of obesity makes it imperative to promote a balanced diet

Nutrients

The human body needs sufficient nutrients for optimum health

On a daily basis, we require 17 minerals 14 vitamins 9 amino acids 2 fatty acids

Over tens of thousands of years, human beings developed sustainable ways 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

It was no different in Southern Africa, where people had less money than they 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 milk

UK Wartime Rationing

UK Wartime Rationing 1940-1954

Very little meat, fat, eggs or sugar 2 ounces (50g) of butter per week One egg per fortnight

The ‘National Loaf’ – wholegrain Home-grown vegetables - 'Dig For Victory' An apple a day keeps the doctor away

Children were allocated milk, cod-liver oil and orange juice Schoolchildren had a weekly dose of malt extract

Most people were better fed during wartime food rationing than before the war years Infant mortality rates declined Average age at which people died from natural causes

increased

California 1950

Nature’s Farming

Always grows mixed crops Never attempts to farm without livestock At great pains to preserve the soil and prevent

erosion The vegetable and animal wastes are converted

into humus The processes of growth and decay are in balance Large reserves of fertility are maintained Rainfall is stored Plants and animals protect themselves against

disease

Sir Albert Howard (1873 – 1947)

1905–1924 Imperial Economic Botanist to the Government of India

1940  ‘An Agricultural Testament’ How have our man-made systems of

agriculture fared in comparison with Nature’s?

Have we adopted Nature’s principles? Have we improved on them? What happens when we disregard them?

Beware Scientific Reductionism

Justus von Liebig (1803 – 1873) Myth #3 - Healthy plant growth depends

only on the correct balance of NPK (Nitrogen, Phosphorus and Potassium) – Death of Sustainable Agriculture

Myth #4 - Healthy human growth depends only on the correct balance of Protein, Carbohydrate and Fat – Death of Good Nutrition

Modern farming methods have conspired to maximise yields at the expense of nutrient content: Deep ploughing NPK fertilisers Pesticides & Fungicides Monoculture GM crops Hydroponics Early harvesting & Artificial ripening Factory farming Storage & Transport

Today, our food contains a fraction of the essential micronutrients it contained 100 years ago The Food Industry has compounded this problem by: Refining Milling Processing Additives Extensive use of sugar, corn syrup and

hydrogenated oils (trans fats)

Influence of Milling on Vitamin & Mineral Content of Maize

Wholegrain Milled % Loss

(μg/g) (μg/g)

Vitamin A 0 0 0Vitamin B1 - Thiamine 4.7 1.3 72.3Vitamin B2 - Riboflavine 0.9 0.4 55.6Vitamin B3 - Niacin 16.2 9.8 39.5Vitamin B6 - Pyridoxine 5.4 1.9 64.8Vitamin E 0 0 0Folate 0.3 0.1 66.7Biotin 0.073 0.014 80.8

Calcium 30.8 14.5 52.9Phosphorus 3100 800 74.2Zinc 21 4.4 79.0Iron 23.3 10.8 53.6

Feeding People what Rodents Reject

Sammy eats the maize germ, where the cereal fat and micronutrients are found.Human beings refine out the nutrient-rich maize germ and eat the sterile remains.

The result is a global pandemic ofHidden Hunger

(Type B Malnutrition) which afflicts

the hungry and the obese

Hidden Hunger In Southern Africa, 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 (trans fats)

Hidden Hunger

Iron Deficiency - Children < 5 years: Mozambique - 95% Tanzania - 65% South Africa - 37% Worldwide - 1.2 billion (1988) - 3.5 billion (2000)

Zinc Deficiency Worldwide - 2 Billion (2001)

In the Third World, fortification of depleted staple foods has become commonplace: Myth #5 - we can get essential

micronutrients from chemicals added to our food, but: They are often toxic They are often poorly absorbed (low bioavailability) They use different metabolic pathways They rarely act in the body in the way intended (low

bioefficacy) With the exceptions of iodine and folic acid,

this hope has not been realised

The South African Experience The National Food Consumption Survey (1999) showed

that South Africans were deficient in iron, zinc, vitamin A and most of the B vitamins

After 5 years of mandatory wheat and maize flour fortification, the National Food Consumption Survey (2005) - Published 2008 – showed: The prevalence of poor vitamin A status in children

had increased The prevalence of poor iron status in children had

increased Almost one third of women and children were

anaemic A high prevalence of poor zinc status among children

Why Fortification in SA has Failed

The iron salts used have a bioavailability of less than 2%

Iron and zinc salts compete for absorption sites Phytic acid in grain blocks the absorption of iron,

zinc, calcium and magnesium Iron salts oxidise the vitamin A The vitamins are denatured and destroyed by

cooking The RDAs are based on adult, not child food

portions – which reduces the intake for the most vulnerable

What About Sprinkles?

Nepal Study (2009) – 8500 children – no control group. After 6 months of intervention: Nutritional status had deteriorated Prevalence of anaemia (c.43%) remained unchanged

Pakistan Study (2013) – 2746 children – Cluster RCT. After 12 months of intervention: Haemoglobin improved marginally, but all remained

anaemic Serum zinc and retinol showed little change The improved growth in one group was paltry Side effects were serious (diarrhoea and respiratory) and

militated against any benefit

So What is Going Wrong?

Myth #6 - It is generally believed that all vitamins and minerals come from food

Myth #7 - And many health professionals believe that different forms of vitamins and minerals are the same

But, both beliefs are wrong!

Abundant Evidence 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.

Recent work shows that USP vitamins and inorganic minerals are sub-optimal delivery systems for the micronutrients we need.

Dr Paul Clayton Isolating nutrients and trying to get benefits equal to

those of whole foods reveals an ignorance of how nutrition works in the body. Relying on the use of isolated nutrients to maintain health is not only a waste of money, but potentially dangerous.

Prof T Colin CampbellThe China Study - 2005

Nutrient Form Food

The ideal, but our food is depleted of nutrients Food Form

Food State or Re-Natured are vitamins and minerals in a form as close as possible to food

Amino Acid Chelates are minerals in a form that the body accepts as food

High bioefficacy and non-toxic Isolates

Vitamins and minerals that are synthesised in the laboratory

Bioefficacy is low The vitamins are notoriously unstable

Vitamin C In the 1930s, Szent-Györgyi was awarded the

Nobel Prize for the discovery of Vitamin C He demonstrated that the active material in

paprika was ascorbic acid When, with repeated distillation, he extracted

crystalline ascorbic acid, he expected a strong reaction

But it did nothing - the concentrated whole foods he had used in his research were far more effective

Calcium

Elephants - their skeletons are maintained with the Calcium they get each day from leaves and grass

Pettifor showed that 30mg of Calcium in Calcium-rich yeast is better absorbed than 300mg of Calcium Carbonate

The former went to bone; the latter to kidney

Apparently, we are not designed to eat chalk!

Forms of Selenium

Form I C50

Selenium Rich Yeast 3.0 μM

Selenomethionine 52.8 μM

Blank Yeast > 100 μM (Not an Antioxidant)

Sodium Selenite > 1000 μM (Not an Antioxidant) Inhibition Of LDL+VLDL Oxidation

By Different Forms of Selenium

Selenium is an important antioxidant. Where there is deficiency, it has become commonplace to fortify bread or salt with sodium selenate or selenite

Comparing the Bioefficacy of Combined Vitamin & Mineral Supplements

HETN supports e’Pap in Africa Suited to Africa’s taste and tradition Whole grain Pre-cooked Based on maize, and fortified with soya and a

cocktail of 28 nutrients The formulation uses state of the art, first world

fortification chemistry to ensure bioavailability and bioefficacy

There is now a wealth of data confirming that e’Pap can achieve nutrient-repleteness

Hidden Hunger The science of nutrition is less than 150

years old, and the ‘best evidence’ keeps shifting.

In the early 1960s, the dietary advice was Myth #8 - High protein (animal best) Low carbohydrate (unspecified) Low fat (Myth #9 - Traditional margarine

healthier than butter) No supplements (expensive urine)

Hidden Hunger Today, the medical advice is

Myth #10 – 5-a-Day fruit and veg Moderate unrefined carbohydrate Moderate protein (vegetable is OK) Low fat (but omegas essential)

Myth #11 - Modern margarine healthier than butter

Traditional margarine (trans fats) extremely bad

No supplements

The Elephant in the RoomSugar – A Natural Food – Myth #12 Every human cell can use glucose, but only the

liver can metabolise fructose Fructose increases:

Blood fat levels: Triglycerides Total blood cholesterol LDL (bad) cholesterol

The prevalence of: Type 2 diabetes High blood pressure Abnormal blood clotting Heart disease

Sheffield 1887

Sheffield 2007

Scary Global Statistics

Obesity prevalence has doubled worldwide in the past 25 years

In 2005, 1.6 billion adults were overweight and 400 million of them were obese

By 2015, WHO predicts there will be 2.3 billion overweight adults and 700 million of them will be obese

Shocking UK Statistics

Nutrient deficiencies afflict every group of the UK population

The greatest deficiencies are among those who need the most (the young, the elderly and pregnant women)

Sub-optimal intake of vitamins and minerals is prevalent in every group

All groups failed to meet the recommended intake of omega 3

We are witnessing a global explosion in the prevalence of chronic degenerative disease (CDD): Metabolic Syndrome

Obesity & Diabetes Hypertension & Heart disease

Mental Illness & Dementia Impaired immunity

Cancer TB Asthma Arthritis

Myth #13 - We are living longer Few of us are living more healthily

The Pharmaceutical ModelIs it still relevant?

100 years of research has generated a wide range of potent & specific drugs

Antimicrobials Pathogens allow differential metabolic

targeting – ‘weak link’ Wide therapeutic index - curative But resistance is now widespread

The Pharmaceutical ModelIs it still relevant?

The CDDs still have no cures … They are increasing in frequency Their age of onset is falling

Almost all drugs for CDDs are designed to suppress symptoms, and do not treat the underlying disease

Narrow therapeutic index - palliative Iatrogenic illness is now a major cause of

morbidity and mortality

Beware Dualism

Drugs v. Nutrition Only drugs can claim to cure, mitigate or

treat a disease Food and food supplements cannot

claim thisThey may make health claims but

only if substantiated by RCTs

FDA & EU Food Supplements Directive

A Call to Action Remunerate producers on the nutritional

content of the food they produce Eat fresh, local and seasonal Stop refining grain Reduce sugar, fat and salt consumption Tax sugar Ban trans fats Traffic light label all processed foods Stop believing in part solutions – we need

nutrient-replete human beings – nothing less

A Call to Action Stop believing that we can correct micronutrient

deficiencies by adding these to food in the form of chemical isolates

Stop feeding hungry children in the Third World with CSB (refined cereal) or Plumpy’Nut (high fat, high sugar)

Stop using BMI as a measure of nutritional status, unless we believe that fat kids are healthy kids

In the face of repeated failure, we should be conducting robust research

But we need to question the validity of the RCT in nutrition research

Thank You for Your Interest

Health Empowerment Through NutritionA UK Registered Charity concerned with

The alleviation of Hidden Hungerwww.hetn.org