An updated presentation on Hidden Hunger for Danone in Johannesburg.

1. Hidden Hunger
A Global Crisis
Danone Presentation
Dr Geoff Douglas KStJ MSc MA FRCP MFOM
Johannesburg - February 2016

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. 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. 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. 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. 1889

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

9. UK Wartime Rationing

10. 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

11. California 1950

12. 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

13. 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?

14. 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

15. 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

16. 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)

17. 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

18. 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.

19. The result is a global pandemic of
Hidden Hunger
(Type B Malnutrition)
which afflicts
the hungry and the obese

20. 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)

22. 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)

23. 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

25. 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

26. 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

27. 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

28. 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!

29. 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

30. 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

31. 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

32. 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!

33. 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

34. Comparing the Bioefficacy of Combined
Vitamin & Mineral Supplements

35. 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

36. 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)

37. 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

38. 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

39. Sheffield 1887

44. Sheffield 2007

47. 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

48. 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

49. 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

50. 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

51. 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

52. 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

53. 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

54. 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

55. Thank You for Your Interest
Health Empowerment Through Nutrition
A UK Registered Charity concerned with
The alleviation of Hidden Hunger
www.hetn.org