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Hidden Hunger

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An updated presentation on Hidden Hunger for Danone in Johannesburg.

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Hidden Hunger

  1. 1. Hidden Hunger A Global Crisis Danone Presentation Dr Geoff Douglas KStJ MSc MA FRCP MFOM Johannesburg - February 2016
  2. 2. 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 Health World Food Programme
  3. 3. 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
  4. 4. 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
  5. 5. 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
  6. 6. 1889
  7. 7. 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
  8. 8. UK Wartime Rationing
  9. 9. 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
  10. 10. California 1950
  11. 11. 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
  12. 12. 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?
  13. 13. 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
  14. 14. 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
  15. 15. 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)
  16. 16. Influence of Milling on Vitamin & Mineral Content of Maize Wholegrain Milled % Loss (μg/g) (μg/g) Vitamin A 0 0 0 Vitamin B1 - Thiamine 4.7 1.3 72.3 Vitamin B2 - Riboflavine 0.9 0.4 55.6 Vitamin B3 - Niacin 16.2 9.8 39.5 Vitamin B6 - Pyridoxine 5.4 1.9 64.8 Vitamin E 0 0 0 Folate 0.3 0.1 66.7 Biotin 0.073 0.014 80.8 Calcium 30.8 14.5 52.9 Phosphorus 3100 800 74.2 Zinc 21 4.4 79.0 Iron 23.3 10.8 53.6
  17. 17. 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.
  18. 18. The result is a global pandemic of Hidden Hunger (Type B Malnutrition) which afflicts the hungry and the obese
  19. 19. 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)
  20. 20. 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)
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. 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
  25. 25. 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!
  26. 26. 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 Campbell The China Study - 2005
  27. 27. 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
  28. 28. 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
  29. 29. 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!
  30. 30. Forms of Selenium Form IC50 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
  31. 31. Comparing the Bioefficacy of Combined Vitamin & Mineral Supplements
  32. 32. 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
  33. 33. 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)
  34. 34. 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
  35. 35. The Elephant in the Room Sugar – 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
  36. 36. Sheffield 1887
  37. 37. Sheffield 2007
  38. 38. 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
  39. 39. 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
  40. 40. 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
  41. 41. The Pharmaceutical Model Is 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
  42. 42. The Pharmaceutical Model Is 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
  43. 43. Beware Dualism  Drugs v. Nutrition  Only drugs can claim to cure, mitigate or treat a disease  Food and food supplements cannot claim this  They may make health claims but only if substantiated by RCTs FDA & EU Food Supplements Directive
  44. 44. 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
  45. 45. 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
  46. 46. Thank You for Your Interest Health Empowerment Through Nutrition A UK Registered Charity concerned with The alleviation of Hidden Hunger