Download - Hidden Hunger - Dr Douglas
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Hidden HungerA Physician’s Perspective
Health Empowerment Through NutritionSouth Africa - August 2011
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 Hunger Series 2007 - Hunger and HealthWorld Food Program
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
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1919 California 1950
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
Kalahari 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)
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Hidden Hunger
After Burkitt’s work in Uganda, the medical advice (late 1960s) was High unrefined carbohydrate (fibre) Moderate protein (pulses good) Low fat (traditional margarine still healthier
than butter) No supplements
It is interesting that Ugandans were healthier (no appendicitis, diverticulitis, diabetes, gallstones, ischaemic heart disease, hypertension and certain cancers)
Hidden Hunger
Today, the medical advice is Myth #6 - 5 fruit and veg Moderate unrefined carbohydrate Moderate protein Low fat (but omegas essential)
Modern margarine healthier than butter Traditional margarine (trans fats) extremely
bad No supplements
Antioxidant Comparison of Plant and Animal foods
Nutrient: 500 Cal Plant Based Animal Based
Cholesterol mg 0 137Fat mg 4000 36000Protein mg 33000 34000Beta Carotene mg 29.9 0.017Dietary Fibre mg 31000 0Vitamin C mg 293 4Folate mg 1.17 0.004Vitamin E mg 11 0.5Iron mg 20 2Magnesium mg 548 51Calcium mg 545 252
These nutrients are universally acknowledged as vital to protect against cancers of all kinds
Plant Based Foods = Equal parts of tomatoes, spinach, lima beans, potatoes and peas
Animal Based Foods = Equal parts of beef, pork, chicken and whole milk
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
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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.
Thiamine – Vitamin B1
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 of polished rice and beriberi
Sugar – A Natural Food – Myth #7
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?
Positive energy balance
DoH ’98, USDA ’02, NIH ’03, NCHS ‘04
1940 50 60 70 80
The result is a global pandemic ofHidden Hunger (Type B
Malnutrition) which afflicts
the hungry and the obese
This is manifest in an explosion in the prevalence of chronic degenerative disease: Obesity & Diabetes Hypertension & Heart disease Mental Illness & Dementia Impaired immunity
Cancer TB Asthma Arthritis
Myth #8 - We are living longer. Few of us are living healthier.
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Sheffield 1887
Hardee’s ‘Monster Thickburger’
1420 calories, 107g fat: $5.49
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Sheffield 2007
2001
Body Mass Index (BMI)
BMI is not a sensible measure of nutritional status: An improvement in BMI can be achieved by eating
just carbohydrate and fat – which does not equate to good nutrition
Having a BMI within the normal range does not mean you are healthy or nutrient replete
We see confirmation of this, not only in Africa, but also in the USA and UK, where there is a high prevalence of obesity in people eating refined, nutritionally sterile food
We are bombarded with nutrition guidelines that promote a balanced diet: MyPlate 5-a-Day (fruit & veg) Traffic light labelling (fat, sugar & salt)
Some believe that Organic and Free Range are best
All these guidelines assume that our food contains the nutrients we need for health
But 5-a-Day won’t cut it. Nor will 10!
Hidden Hunger
In SA, today, the staples are Refined maize meal (empty calories) Bread (mostly refined) White sugar (empty calories)
Soft drinks SweetsMost processed foods
Traditional margarine (trans fats) Cooking oil
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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)
Hidden Hunger
The National Food Consumption Survey (1999) showed that South Africans were deficient in iron, zinc, vitamin A and most of the B vitamins
Is it any wonder that immunity is impaired?
In the Third World, fortification of depleted staple foods has become commonplace: Myth #9 - We can get essential
micronutrients from chemicals added to our food They are often toxic They are poorly absorbed They rarely act in the body in the way intended
With the exceptions of iodine and folic acid, this has not been achieved
Why it has Failed
The electrolytic iron used has a bioavailability of less than 2%
Phytates in maize block the absorption of iron, zinc, calcium and magnesium
Electrolytic iron oxidizes 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 of the most vulnerable
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.
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Abundant Scientific EvidenceThe 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 body
Wartime Rationing
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
Nutrient Form
Myth #10 - Many health professionals believe that different forms of vitamins and minerals are the same, but isolates and food nutrients have different structures use different metabolic pathways function differently in the body
With supplements or fortification, the crucial consideration is bio-availability and bio-efficacy
Selenium, for example, is an important antioxidant. Where there is deficiency, it has become commonplace to fortify bread or salt with sodium selenate or selenite
Forms of Selenium
Form IC50
Selenium 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 OxidationBy Different Forms of Selenium
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
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Calcium
Elephants - their skeletons are maintained with the Calcium they get each day from leaves and grass
Pettifor showed that 30mg of Calcium in Ca-rich yeast is better absorbed that 300mg of Calcium Carbonate
The former went to bone; the latter to kidney
Apparently, we are not designed to eat chalk!
Tuberculosis
Tuberculosis is caused by a mycobacterium
One third of the world’s population is infected
Infected people don't usually get sick It is only sick people who can infect others
TB – The Global Situation
Of all infectious diseases, TB is the leading killer of adults - c.2 million people per year
Someone in the world is newly infected with TB every second
Between 2002 and 2020 over 150 million people will become ill and 36 million will die if there is not better control
The evolution of drug resistant strains of TB have had an even greater impact on morbidity and mortality in the face of the global HIV pandemic
An Impending SA Crisis
It is generally accepted that over 60% of the South African population has TB infection in its latent state
As HIV infection weakens immunity, the latent TB is likely to become active over the next few years, giving a potential TB prevalence of 12 million
The potential impact on society and the economy 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
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Methods of Control
1854 - Sanatorium treatment began 3 months resting
Initial confinement to bed Periods of increased activity slowly introduced
Fresh air at all times and in all weathers Enormous amounts of food
1935 – Pasteurisation of milk introduced in UK 1944 – First use of Streptomycin 1952 – First use of Isoniazid 1953 – BCG vaccination introduced in UK
Deaths from Tuberculosis – New York
Year Deaths per 100,000
1910 10029 382
1920 7084 244
1930 5043 178
1940 3569 119
1950 2287 57
A Lesson from History
This dramatic shift in TB mortality was not achieved with: Antibiotics Early detection through mass chest x-ray
programmes Or BCG immunisation
All of which came into widespread general use after 1950
TB & Nutrition
The association between TB and malnutrition has long been known
Malnutrition weakens immunity, increasing the chance that latent TB will develop into active disease
Malnutrition increases drug side effects, making treatment interruption more likely
Treatment interruption results in relapse and drug resistance
Good nutrition enhances the efficacy of TB drugs
HIV/AIDS & Nutrition
More than 50 peer reviewed journal articles show that: Micro-nutrients, including the vitamins A, B6, B12 and E,
and the minerals selenium and zinc, play a critical role in the maintenance of immune function and overall metabolism.
The HIV virus encodes the seleno-enzyme glutathione peroxidase, thereby robbing the host of selenium and the amino acids, cysteine, glutamine, and tryptophan.
Persons living with AIDS suffer from extreme deficiencies of all of these nutrients, which are responsible for depressed CD4 counts, vulnerability to infections and cancers, dementia, depression, diarrhoea, muscle wasting, neuropathy and skin diseases.
SeleniumHETN does not support single issue environmentalism, nor single fixes, but by way of illustration: In Kupka’s study of 949 HIV+ pregnant
Tanzanian women, low plasma selenium was significantly associated with increased mortality.
Each 0.1µmol/l increase in plasma selenium was related to a 5% decreased mortality over 5.7 years of follow up.
In PLWHA, the plasma selenium levels is a better indicator of morbidity and longevity than the CD4 counts.
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Odunukwe studied the impact of selenium yeast in Nigerians with advanced disease (CD4 cell counts < 50) who were on ART. 170 participants received 200µg of Se daily
and 170 received ARV therapy alone. Patients were followed for 72 weeks.
The rate of CD4 cell recovery was significantly higher and the median CD4 count increment was over twofold higher in patients on Se supplementation (+120 cells/mm3 v. +50 cells/mm3).
The incidence of opportunistic infections was lower resulting in fewer hospital visits.
Weight gain was significantly higher (p = 0.004).
Haemoglobin increment from baseline to 64 weeks was 3-fold higher (+30 g/l v. +10g/l).
Hurwitz followed 174 HIV+ patients over 9 months. 91 of them received 200µg/day of selenium yeast Serum Se increased significantly in the Se-
treated group but not in the placebo-treated group (+32.2μg/l v. +0.5μg/l) (P<0.001)
Greater levels of Se (in the ‘responders’) were significantly associated with decreased HIV viral load (P<0.02) compared with controls
This correlated with a significantly increased CD4 count (P<0.04)
Selenium ‘non-responders’ did not differ from the placebo group in HIV levels and CD4 counts
Parallel Evidence
The HIV/AIDS pandemic is only one of several, involving viruses that encode the seleno-enzyme glutathione peroxidase.
Hepatitis B and C viruses, the Coxsackie B virus and HIV do likewise.
The Chinese are winning a battle against the Coxsackie B virus which causes Keshan disease, a fatal cardiomyopathy that has been common for many years in inhabitants of the great selenium-deficiency belt that crosses China.
Finland has shown that selenium supplementation can have a major beneficial impact on the incidence of HIV/AIDS.
Despite widespread, unprotected, promiscuous sexual activity in Senegal, where soil selenium levels are naturally high, HIV is diffusing very slowly, if at all, amongst the population.
In the UK there is an epidemic of TB among badgers, which is infecting cattle. It has been shown that organic herds fed on clover, which is rich in selenium, are not susceptible. When badgers and traditional herds are given maize supplemented with selenium, they are no longer susceptible.
The Scientific Position Systematic reviews conclude that there is no
evidence that micronutrient supplementation reduces morbidity and mortality in people living with HIV/TB. But: Trials concentrate on single supplement
intervention, or supplementation with a small group of micronutrients
Neither can be expected to correct the type of nutrient deficiency seen in HIV/TB
The dose of supplement is often not physiological
The form of supplement is often not considered
Much of the research is done in the West where baseline nutrition is higher
Academy of Science of SA
The pre-antibiotic phase of dealing with TB was characterised by strengthening the immune defences with diet, improved environmental conditions and every other conceivably helpful measure
After the discovery of effective drugs, this aspect of TB therapy quickly became secondary
The Panel is appalled by the dearth of reliable and informative studies of the nutritional influences / interventions on the course and outcomes of the pandemic chronic diseases (HIV & TB) addressed in this report
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TB / HIV Management
Drugs such as antibiotics and ARVs are essential elements in controlling and hopefully, in the case of TB, curing disease
But without the basics of good nutrition to sustain or rebuild natural health and immunity, we are fighting a losing battle
Something has to change and be done differently to avoid yet more failure in fighting TB and HIV, as well as most other health / wellness problems
It is time to give proper nutrition a full spin
John HeinrichSouth African National Tuberculosis Association
The Challenge If it is the consensus that the maintenance of
health is conditional on eating a balanced diet. -this should be the first priority in any health initiative It is the responsibility of health workers to ensure
that their patients are nutrient replete Advising patients to eat a balanced diet where they
have no access , or no understanding , is unethical Where people have multiple micronutrient
deficiencies, any scientific research that attempts to determine the benefit of this or that micronutrient is unethical and bound to fail, because it runs counter to the prevailing truth that we need balanced nutrition
Beware Dualism
Science v. Religion Copernicus (1530) and Galileo (1610) - The
Heliocentric View Dawkins (2006) - The God Delusion
Germ Theory v. Milieu Interieur Louis Pasteur v. Claude Bernard Robert Koch - Anthrax (1877), Tuberculosis
(1882), Cholera (1883) 1884 – Takaki (1884) & Eijkman (1897) -
Thiamine
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
Politics In South Africa there has been a damaging
public media debate, polarising the proponents of drug treatment and the proponents of nutrition Some politicians have argued that HIV & TB are
diseases of poverty, overcrowding and poor nutrition. They are.
The medical profession continues to argue that micro-nutrition is in the research domain, while promoting a balanced diet that is supported by even less scientific evidence.
This debate is specious. Nutrition is key – but it needs definition. It is not a question of ‘either/or’, but ‘both/and’.
Scientific Arrogance
Justus von Liebig (1803 – 1873) Healthy plant growth depends on the
correct balance of Nitrogen, Phosphorus and Potassium – Death of Sustainable Agriculture
Healthy human growth depends on the correct balance of Protein, Carbohydrate and Fat – Death of Good Nutrition
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Remember the Heretics
Copernicus (1530) and Galileo (1610) - The Heliocentric View
Semmelweis (1847) - Hand Washing
Barry Marshall & Robin Warren (1982) - Helicobacter Pylori
Is the Pharmaceutical Model still relevant?
100 years of research has generated a wide range of potent & specific drugs
Anti-microbials Pathogens allow differential metabolic
targeting – ‘weak link’ Wide therapeutic index, curative But resistance is now widespread
Is the Pharmaceutical Model still relevant?
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 The CDDs still have no cures …
They are increasing in frequency The age of onset is falling
Is the Pharmaceutical Model still relevant?
CDDs are generally not due to an infectious agent, nor a single gene
No single ‘weak link’ Multiple metabolic / physiological
imbalances Multiple nutritional / lifestyle factors
contribute to risk, therefore … Multiple nutrient regimes are necessary
to modify the course of disease
Pharmaco-Nutrition
No magic bullets Identify as many critical metabolic
errors as possible Cross-reference these against the
known pharmacology of food derivates Initiate a multiple support programme The aim is to make people nutrient
replete
Cumulative Risk Reduction (CVD)
Drugs – the ‘Poly-Pill’ A statin A thiazide, a beta blocker & an ACE inhibitor Aspirin Folic acid
Would reduce IHD events 88%, strokes 80%
Adverse effects in 8 – 15% Cost: €43.91/ month (NHS)*
Wald & Law, BMJ 326:1419, ‘03
* Ashcroft JS, bmjjournals.com
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Cumulative risk reduction (CVD)
Food – the ‘Poly-Meal’ 150ml red wine Oily fish - 4 / week Dark chocolate 100mg Fruit & veg 400g Garlic 2g, almonds 68g
Would reduce IHD events 76% Adverse effects – none Cost: €22.44 / week
Franco, Bonneux et al: BMJ 329:1447-1450, ‘04
Cumulative risk reduction (CVD)
Pharmaco-Nutrition programme 150 ml wine: flavonoids @ 1 – 1.5 g Oily fish 4 / week: omega 3’s @ 1 – 2 g Dark chocolate 100mg: flavonols @ 1 g Fruit & veg 400g: carotenoids 25 mg,
fibre(s) 10g, aa’s, cyanogens etc Garlic 2g, almonds 68g: B vitamins etc
Would reduce IHD events 75% Adverse effects – none Cost: € 2.66 / week
HETN recommends FoodState Products for addressing Hidden Hunger
You can buy products that sound similar at a lower cost, but they will not give the same beneficial results
FoodState nutrients are beneficially combined into a food medium which naturally contains all the phytonutrients and other food factors necessary for absorption and use of each nutrient within the body
Combating Hidden Hunger
It is the contention of HETN that people everywhere - malnourished or not -need a diet that is based on whole grains It should be low in fat and sugar It should contain all the vitamins and
minerals that would ideally be sourced from fruit and vegetables in a form that is bio-available
A Call to Action
Remunerate producers on the nutritional content of the food they produce
Eat fresh, local and seasonal Stop refining grain Ban trans fats Reduce sugar, fat and salt consumption Traffic light label all processed foods
A Call to Action
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
Stop believing that we can correct micronutrient deficiencies by adding these to food in the form of chemical isolates
Question whether the RCT is appropriate in nutritional science
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Lest We Forget
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 The time is now
Thank You for Your Interest
Health Empowerment Through Nutrition is aUK Registered Charity concerned with the
alleviation of Hidden Hungerwww.hetn.org