Social Basis of Nutrition UPDATES

A sad story

Rose a Sudanese goat had been the focus of world wide interest since the report in the Juba Post in 2004 that she was forced into marriage with a Sudanese man. The forced marriage was the result of an intemperate relationship between a man who was drunk (so he claimed ) and the goat. To preserve Rose’s reputation the man was obliged to pay a dowry to the owner and “marry “the goat.
Everyone expected the happy couple to live happily ever afterwards. There are 178,000 returns for Google for “goat, Sudan, Marry “.

However the value of a varied balanced diet, even for a goat, was underlined when Rose died after swallowing and choking on a plastic bag as she scavenged for food scraps on the streets of Juba.
She left a grieving kid and the unrelated widow.
Times London Friday May 4th 2007

Adult Mortality Rates

Rajaratnam et al 2010 Worldwide mortality in men and women aged 15-59 years from 1970 to 2010: a systematic analysis . The Lancet vol 375 pp 1704-20 Adult deaths and causes of adult death are a crucial priority for global health. Yet, adult mortality has received little policy attention, resources, or monitoring studies. This study aimed to estimate worldwide mortality in men and women aged 15-59 years. A database of 3889 measurements of adult mortality for 187 countries from 1970 to 2010 used vital registration data and census and survey data for deaths in the household corrected for completeness, and sibling history data from surveys corrected for survival bias. Yearly estimates of the probability of death between the ages of 15 years and 60 years for men and women for every country were constructed. These showed that Adult mortality varied substantially across countries and over time. In 2010, the countries with the lowest risk of mortality for men and women are Iceland and Cyprus, respectively. In Iceland, male is 65 per 1000; in Cyprus, female is 38 per 1000. Highest risk of mortality in 2010 for men is found in Swaziland with 765 per 1000 and for women Zambia for women 606 per 1000. Between 1970 and 2010, there were substantial increases in adult mortality in sub-Saharan Africa because of the HIV epidemic and in countries in or related to the former Soviet Union. Other regional trends were also seen, such as stagnation in the decline of adult mortality for large countries in southeast Asia and a striking decline in female mortality in south Asia. The prevention of premature adult death is just as important for global health policy as the improvement of child survival. Routine monitoring of adult mortality should be given much greater emphasis.

Biofuels —

Private Eye has an important article on Biofuels. ( Private Eye 16th May 2008 p 15 )

Papers and Health Journals are beginning to feel unease about the use of valuable land to make these fuels. Last year the European Union decided to sell its remaining grain stocks at knockdown prices just before global grain prices doubled and the world faced its first serious food shortage for decades?

The EU has now been forced to become the world’s largest grain importer, buying in 18m tons of wheat at prices much higher than those it was selling for only a short time earlier.

The reason for this follows the criticism of the EU for piling up vast food mountains, consequent upon its protection of European farmers by buying their crops when prices fell below a certain level. The EU then paid further subsidies for those food mountains which were sold off to the Third World at rock-bottom prices, doing immense damage to the farmers of some of the poorest countries of the world, who could not compete with the EU’s dumping of its cheap surpluses.

In 2007, having changed from subsidising over-production and anticipating a bumper European harvest. Brussels decided to empty its warehouses, selling off millions of tons of grain for animal feed. Unfortunately, down came the rains, with disastrous effects on the harvest. Europe was thus forced to buy million tons of wheat at twice the price it had been at the start of the summer.

The price of a loaf of bread is now rising above £1, and wheat and other cereal prices have soared in the past year. One explanation is that, as China and India become richer, more of their people can afford to eat meat, and they must thus import more grain to feed their animals. Last year the imports of wheat by China and India, the world’s two largest wheat growers, scarcely rose.

By far the biggest increase in demand, came from the EU and America. US cereal consumption last year rose by 12 percent, almost entirely due to that country’s involvement with biofuels, using up no less than 30m tons of corn.

Biofuels cost 70 percent more energy to produce than they generate, laying waste to rainforests and adding to pollution . US farmers, receive a hefty subsidy to grow them, and the EU has decided that 10 percent of our transport energy comes from biofuels within 12 years. Every acre of land used to make biofuel is taken away from producing food.

In the EU alone it will be necessary to divert more than 30 percent of our grain-producing land to biofuel.

This diversion of crops into biofuels will affect the provision of food to poorer communities. Malnutrition is such a major problem for much of the world, to further aggravate this cannot be wise.

Book, End of Food

This book discusses a familiar them. That the World cannot sustain increasing numbers. That the food will run out.

The present crisis in fuel is maybe a fore taste. Who knows but this book is worth looking at. The End of Food
by Paul Roberts

Houghton Mifflin,
Paul Roberts writes “On nearly every level, we are reaching the end of what may one day be called the `golden age’ of food. The soaring cost of corn, wheat, rice and other basic grains, the fruit of record-high oil prices, panic hoarding, greedy speculation, climate change, soil degradation, water shortages, natural disasters, and the heavily subsidized rush to convert edible grains into biofuel. The results: malnutrition, mass protests, and disease. It’s not that the world is running short of plants and animals to fill nearly 7 billion bellies. Not yet, anyway.

But the system for distributing the calories required to keep us going is completely out of control. . At one extreme, it provides North Americans with a calorie rich diet, at the other, it denies even a pitifully adequate supply to at least a billion people.”

Child Poverty —

Poverty and the impact on children is a global problem. It is impossible to look at pictures of beautiful youngsters from anywhere in the world and not to feel a strong sense of protection and hope for their future. Of course there is also the adage “the trouble with a kitten is that it grows into a cat”. The adult population has problems of its own.

Poverty however can compromise child development in so many ways. A remarkable enterprise is being conducted by 235 scientific journals around the world to draw attention to the theme of poverty and human development. Amongst these are

1. New York Academy of Sciences Special Annals Volume which has with typical generosity made articles available on line for open access. These include articles on Tuberculosis, HIV, hookworm, education and access to health care.

2. BMJ 2007, 27th October has an issue- Health in an unequal world devoted to the same subject. This includes Equitable access to health care ,including teenagers, poverty in Liverpool, school feeding programmes, Malaria and infant health . Articles are available on line.

3. The Lancet has a series of papers on this topic over a number of weeks.

This is true nutrition. Here are complex political, cultural , agricultural and nutritional problems. With millions dying in the sub African Sahara from HIV, tuberculosis and malaria the fate of the next generation in these countries is very indeterminate. The eldest child rears the others. This is far from ideal.

Eating meals as a family around a table may well be a practice or habit which is changing. People eat at a table in cafes and restaurants but less so in homes where the meal may be grazed or at the TV.

The benefits of a meal eaten around a table is that it has ritual, the food may be eaten slowly and there is a community feeling. It is also more rewarding to the cok when the food is appreciated rather than gulped down.

Slowly eaten food has advantages and glycaemic indices etc pale into insignificance compared to eating slowly.

Ethics Committee —

Ethics committees are central to all research. As the pressures increase on individuals to promote research then it is inevitable that short cuts may be taken. Also a few Ethics committees can be ponderous, pompous and very long winded. In an article in nature 9 Ledford H 2007 Trial and error Nature 2007 448, pp531-3 there is an interesting article on the problems confronting ethics committees in a litigious society.

I was for many years the chairman of an ethics committee and the problems were real. I remember once someone complaining to a friend and colleague that his project had been refused, the response was surely no one would ever do that to another human being. End of complaint.

The history of ethics committees is of brave knowledgeable people complaining that the famous and influential in the profession could do what they wanted to patients.

Ethics Committee 2 —

As with many well-intentioned efforts in the field of health care the legitimate concerns about protecting the rights and welfare of human subjects participating medical research have now assumed a life of their own.

Until the mid-part of the 20th century there were few concerns regarding medical ethics. This changed in 1946 when 20 high-ranking Nazi physicians were placed on trial in Nuremberg, Germany and charged with war crimes against humanity for performing experimental procedures on human beings without their consent.

In 1966, Henry Beecher, a physician from Harvard University and, in 1967, Maurice Pappworth, physician from London published evidence that there were significant abuses in the conduct of research involving human subjects at many of the leading medical research institutions in America and Britain. From this point many people gathered behind the need to have ethics committees.

Maurice Pappworth(1910-1994 ) suffered grievously at the hands of the Medical Establishment for his publications and out spoken approach. He is not mentioned in the paper. He wrote a very damning account of what was happening in Human Guinea Pigs, published in 1967. Many of the great in medicine mentioned in that book never forgave him.

At the “grass roots” level came to the creation of Human Subject Research Review Committees at medical facilities throughout the Britain and the United States. These Committees were originally organized for the expressed purpose of protecting the rights and welfare of patient participants in medical research projects and to make research and patient and volunteers safe.

Having written about human experimentation ethics committees and remembered Maurice Pappworth I looked at his book written in 1967 again. He was a very great and courageous man.
This was written some 12 years after eminent German physicians who had acted as wartime Nazi experimenters on Jewish captives.
The experiments he discusses on unwitting unknowing patients the young and babies, individuals with learning disabilities and prisoners can hardly be countenanced today. He carefully demolishes all logics for such experiments and this includes experiments on oneself. Yet many everyday clinical techniques date from those times. Though in fairness the first experiments on ultrasound were conducted on a piece of butchers steak. There can never be too much time spent in planning experiments, and explaining to the subjects if indeed they are involved .
Perhaps the question should always start, could these experiments be done on tissues isolates , preferably yeast.
I thought of having to explain to a family what went wrong, which is a painful thought. Even more so for the individual and the family.
This book
Human Guinea Pigs, experimentation on man MH Pappworth Routledge and Kegan Paul 1967 is a salutary read, at times very painful and brings back memories of experiments in a nearby Professorial Medical Unit when I was a junior doctor. So when one goes through the tedious pernickety process of an Ethics Committee be thankful.

Fibonacci Number —

A really interesting programme is the Melvin Bragg programme on the BBC Radio 4. He and guests talk about all manner of intelligent topics including mathematics

He sends on request a newsletter which summarises his programme. The Fibonacci sequence is one of those fascinating games which mathematicians indulge in. It struck me that the breeding rabbits and the numbers are not dissimilar to the number of unfortunate effects food can have on the unsuspecting public. These stick in the text books and like the rabbits never die only accumulate. The public meanwhile lives longer each century and enjoys food. .

Fibonacci introduced the number sequence through the analogy of breeding rabbits. He based his model on a world where the rabbits could never die or get ill, in other words nothing would stop them constantly reproducing.. Suppose a newborn pair of rabbits (one male and one female) are put in a field. These rabbits take a month to become sexually mature, after which time they produce a new pair of baby rabbits, one male and one female.

These babies will take a month to mature, so although in the third month the mature rabbits can produce yet another pair of baby rabbits, the other pair will only be ready in the fourth month to reproduce. The pattern continues in this fashion and every month there are increasing numbers of rabbits. – 1,1,2,3,5, 8,13_ And so the Fibonacci number sequence emerges from the breeding habits of rabbits. There is a strong interrelationship between the numbers in the Fibonacci sequence. For a start, you get the next Fibonacci number by adding the two previous ones together, so there is already a relationship between them. For example, if you square the first hundred Fibonacci numbers and add them together it is the same result as the hundredth Fibonacci number times the 101st Fribonacci number. It is curious that these connections between the squares of Fibonacci numbers connect with later numbers in the sequence and in fact, there are quite a lot of these weird connections between the numbers. For example, if you have the 100th Fibonacci number and you want to find out the 300th Fibonacci number there is a very simple way to do it. You cube the 100th Fibonacci number, multiply by 5 and then add 3 times the 100th Fibonacci number. This will give the answer to what the 300th Fibonacci number is. There are many formulas linked with the Fibonacci sequence. Melvyn Bragg Newsletter 30th November 2007

Five a Day —

The recommendation that we eat 5 different types of frit and vegetables a day is a real advance. I still worry though which 5 and how do we choose. The range is wide Nuts and seeds Pulses Grains and cereals Leaf vegetables Brassica Pods and seeds Shoot vegetables Bulb vegetables Root vegetables Tubers Fruit vegetables Cucumbers and squashes Mushrooms and truffles Sea vegetables Apples, pears and grapes Pitted fruit Berries and soft fruit Tropical and exotic fruit Melons Citrus fruit Herbs Spices And that is a cookery book classification not botanical. I think this is a challenge for nutrition research

Five Fruit a Day —

This paper describes the effect of fruit and vegetable intake on the chances of developing cancer. The population studied was 500, 000 people or so, aged 25 to 75 from 10 Western European countries. There is virtually no benefit of 5 fruit and vegetables a day for cancer protection. 200 g of fruit and vegetables reduce the risk by 3 %, five a day and the risk is reduced 9%. Though there is benefit in protection against mouth, oesophageal , colon and lung cancer. Fruit and vegetable ingestion protects against heart and stroke risk. ( for strokes a 26% reduction ) . These conflicting results form earlier studies may be a result of the type and number of control subjects. Boffetta et al (2010) Investigation into Cancer Nutrition Journal of National Cancer Institute April 6 2010. BMJ 17th April 2010 vol 340 p 830 Lancet 17th April 2010 vol 375 p 1320

Food Waste —

The affluent countries waste millions of tons of edible food. Supermarkets, restaurants, canteens and manufactures are identifiable in this respect. For example nearly 500 million pots of yoghurt are thrown away every year in Britain. 50% of food disappears between the plough and the plate. Up to a third of school meals are thrown away, A quarter of food products purchased are thrown away. The Cooperative Supermarket wastes the least food of the British Supermarkets, followed by Morrisons, Tesco, Asda , Waitrose and the worst is Sainsbury’s with over 50 % more waste than the Cooperative Supermarket. Poor and misunderstood labelling can lead to good food being thrown away. Obviously food poisoning is a real problem But one can be ultra cautious. EU food-labelling law require most pre-packed food to carry a “use-by” or “best-before” date, the “best-before” date is a mark of quality, “use-by” date of food safety. But the date may mean that the food could be past its prime but safe to eat. Sell by is for the convenience of the shop and does not reflect any nutritional. Value. All very confusing. A ridiculous example is bottled water which has been in the ground for thousands of years , but once in a bottle has a brief use by label. Tristam Stuart No appetite for waste Financial Times Weekend Magazine July 4/5 2009. p 30-35 Based on an important book Waste: uncovering the Global Food Crisis Author Tristram Stuart : Penguin Publication. Social Basis of Nutrition
Global Warming induced migration —

Migration from the farms has long been a feature of the dry areas of Western Africa. Rural life becomes more difficult and populations move to the cities and urban life. As Global Warming progresses so people will find farming impossible and will move in search of sustenance and work. 10 % of the population would have to move from their homes with a 1-metre rise in sea level. 1 billion live in dry lands vulnerable to drought. The number of people seeking new places to live may reach between 50 million to 1 billion of the world population of 9 billion by 2050. When Hurricane Katrina hit New Orleans 1.5 million people left in 14 days. Three times the number who moved in the great Dust Bowl migration of 1930s. The low lying Maldive Islands will disappear under the sea with consequent loss of habitation for the present population. These movements will overwhelm the refugee laws and humanitarian agencies. The rich and ecological stable countries will be under pressure from this migration. The global change will range from disasters as with Hurricane Katrina, drought and wildfires , loss of marginal land to desert, sea rises of possibly 3 meters Knight 2009 The human tsunami FT Weekend Magazine June 20/21 p 24-31 Social Basis of Nutrition

Geography —

Until 12000 years ago the south of England and the north of France were drained by a substantial river which passed through a vast shallow valley. Rivers which drained into this giant river included Rhine, Meuse, Thames and Schelde,

For most of the previous 50 million years the English Channel was a marine embayment but then the most recent glacier period changed the topography.

The level of the sea has varied considerably and was at some point 20000 years ago the sea was 100 meters below the present levels.

It is now suggested that the level of water in the English Channel is dependent upon the global climate and glacial periods when there is land contact between Britain and Europe.. The existence of the channel depends upon the general temperature and the presence of an ice age or not.

The development of the Channel has had profound effects on migration into Britain. It has also cut Europe adrift from Britain and they have been denied the glories of Cricket, wearing socks with sandals and fish and chips

Gibbard Europe cut adrift Nature 2007, vol 448, 259-60

Gupta S Catastrophic flooding origin of shelf valley systems in the English channel Nature 2007 vol 448 , 342-345
Another interesting paper discusses the origins of modern humans.

Manica et al The effect of ancient population bottle necks on human phenotypic variation , Nature 2007, vol 448, 346-8

This study using human skull measurements supports the hypothesis that modern humans originate from a single location in central or southern Africa. There is a smooth loss of genetic diversity with increasing distance from Africa. Extending as far as the most distant migration across Northern Europe into the Northern and then Southern Americas.

Global Economics and BRIC —

The emerging markets of Brazil, Russia , India and China ( BRIC) are important elements in the world economy especially agriculture.

Their economies are discussed in an article in the Times by Carl Mortished ( Times Wed July 30th 2008 p 43 ) in the current climate of inflation, slackening growth and the flight of hot money .

There is a world wide struggle for a global trade agreement that would open borders and reduce farming subsidies.

The needs of peasant farmers in these BRIC countries is seen to be a major factor in preventing this economic and global aspirations. These poverty stricken farmers live in communities close to starvation, relying on poor equipment, living on poor land , dogged by ill health and nutrition and need subsidies and high tariffs to keep out imported cheap food . India’s rural; population is 600 million.

Many developing countries would like to export to India and China but politically this is a none starter .

We do not live in a world divided into North and South or rich and poor but in a world of powerful and conflicting interest groups.

As our world economy enters a period of decline protectionism is in the air The lot of the peasant farmer must be protected.

The cost of food in China absorbs more than a third of income.

All of this will have profound consequences for many poverty stricken families in these countries.

Global Warming —

The International Panel on Climate Change and the United Nations will publish predictions as to the effects of global warming in this coming week. It is predicted that the earth’s temperature will increase by 3 degrees centigrade by the end of this century. What happens after this in subsequent centuries is not clear.

The Financial Times of March 31 2007, p9reports that the warning will include

1. North America, Northern Europe and Russia – milder climates will benefit tourism, allow farmers to grow wider crop variety with increased crops and that melting ice will allow mineral and oil extraction form the Arctic. Heat will damage transport infrastructure ( e.g. road surfaces may melt ), housing structure have to change to cope with heat and plant and animal pests will spread North. Grapes will grow in northern countries e.g. Scotland.

2. Southern Europe Agricultural yields will fall , droughts will be widespread

3. East Asia. Increased cyclone activity and higher storm intensity.

4. Southern USA and Caribbean . Increased hurricane activity, lower agricultural yields and worsening droughts.

5. Africa. Further spread of malaria and dengue fever epidemics, reduced crops, droughts , mass migration and probably conflict.

6. Southern Asia. Floods as the Antarctic glaciers melt , spread of diseases in man , animals and plants. Australia. Droughts, spread of deserts and loss of agricultural land. Oceans. Higher content of CO2 and acidification of the water with consequences for fish and plant life. Global warming is constantly in the aware persons mind. As the spring comes with unusual warmth there will be many for whom the warmth means no rain, no water and all the consequences. The rich will for a while get richer and the poor well. let them get on with it. The immediately recent conference in Brussels has gone through the science and politics of global warming. It may be that there are two things happening, a natural fluctuation in the solar protective blanket accentuated by human activity. The natural protective adjustments of nature cannot operate as has happened in the past because mankind has so altered our environment that it is not easy.

Whilst scientists point out the dangers of global warming , Science must take full responsibility. For it is science which has given us the where withal to indulge in global warming. We scientists are the cause.

The politicians represent the people and have to adjust to our changes. Often very appealing. As the drought extends there will be large sale famines and water shortages. There will be massive movement or attempts at massive movements from the southern continents, Asia, Africa and South America. Quit a prospect. Global warming and climate change arc established facts with thoughts arising on the fate of the planet in the next few decades. One approach is through the computer models used by the Intergovernmental Panel on Climate Change. Another is to consider how conditions changed in warmer historical periods, notably AD 800-l300, the Medieval Warm Period. This book
THE GREAT WARMING: Climate Change and the Rise and Fall of Civilizations by Brian Fagan Bloomsbury is a sequel to another volume The Little Ice Age.which covered the global cooling from about 1430 to 1850 AD.

In Europe in the 12th and 13th centuries, England exported wine to France, and wine was also produced in southern Norway. The Norse settlement of Greenland in the AD 980s, enjoyed a flourishing economy for three centuries until it was abandoned to the ice around 1450.

The Medieval Warm Period was not however a discrete episode when climate was distinctly different from what came before.

The collapse of the Classic Maya civilisation in Central America in the ninth century was probably precipitated by successive droughts in a land where water supplies were always under stress.

The settlement of remote Easter Island (Rapanui) around 1200 by canoeists heading east from Polynesia with westerly winds may have been made feasible by the faltering of the usual northeasterly Pacific trade winds during El Nino events connected with warmer sea-surface temperatures.

Genghis Khan’s Mongol invasion in the early 13th century could have been prompted partly by drought wreaking havoc on the pastures of the steppes. This possibility is supported by the withdrawal of his grandson Batu Khan and the Golden Horde in the 1240s at the height of their military success with the return of cooler, wetter conditions.

These are suggestions are based on climatological studies of recent vintage, using ice-cores, deep-sea and lake cores, coral records and tree rings, and historical documents such as the reports of the flowering of cherry trees in Japan and Korea that date back a thousand years.

Five-hundred-year-old pines from the mountains of Mongolia have allowed experts to construct a climatic sequence back to AD850. The prolonged warm period detected in the Mongolian tree rings coincides with Genghis Khan’s conquests, Tree rings from multiple western locations agree that the four driest periods centred on AD935, 1034, 1150 and 1253. followed by an extended wetter period from 1300-1900. then a return to droughts.

Also important is the variation in solar irradiance caused by small tilts in earth’s orbit, sunspots and major volcanic eruptions the eruption of Mount Pinatubo in the Philippines in 1991, for example, counteracted current global warming for several years. The medieval warming was generally good for Europe, but it produced prolonged droughts in many parts of the world, including the Sahara. Peru, India and northern China.

In a review of this book Robinson in the Financial Times Weekend Magazine March 15/16 2008 p 29 points out that the in the future the much larger human population, many living close to starvation, will be peculiarly susceptible to global warming.

For many of us in the Western, more privileged world
It is possible that we have had the best of everything.
We are now to pay the cost of this life style.
We are the reason for that best of worlds to disappear or be severely modified.
Social Basis of Nutrition
Group Living and Hungry Lions —

A popular programme on TV is nature films showing lions, cheetahs , whales and sharks killing their food. Very dramatic and for some beats going round Tesco to buy the weeks food.

The assumption has always been that the predators gain by hunting in packs by being able to tackle larger prey.

The truth may not be a simple as this. Animals hunting on their own in the short term eat better. Group living influences individual food intake rates and the dynamics of the populations of predators and their prey. The grouping of prey and predators reduces the amount that each individual predator eats. The group allows a larger area to be swept looking for prey, allows the area to be defended from interloper groups.

What parallels this has in human nutrition I cannot immediately say, but eating together rather than on ones own can only be better.

Fryxell et al (2007) Nature vol 449, 1041-1043
Coulson (2007 ) Group living and hungry lions Nature vol 449 996-7

Healthy Life Years —

How enjoyable old age is depends on many factors. In old age we reap the benefits and disadvantages of what has gone before. Diet, smoking, alcohol intake, exercise, family life, financial prudence and all the other boring things for young people.

Jagger et al in the Lancet discuss this aspect of life.
Life expectation is slowly increasing throughout the European Union (EU), both at birth and at 65 years. a greater number of elderly people are living longer. There is a significant gap between Eastern and Western EU countries.

Increasing life expectation does not necessarily mean a healthier population. Health expectation is a concept developed to bring a quality of life measure of life expectation (Healthy life years (HLY). People should have a healthy active old age. Not an extension of morbidity.

In 2005, an average 50-year-old man in the 25 EU countries could expect to live until 67 years free of activity limitation, and a woman to 68 years. HLYs at 50 years for both men and women varied more between countries than did life expectancy (HLY range for men: from 9-1 years in Estonia to 23-6 years in Denmark; for women: from 10 years in Estonia to 24 years in Denmark). Gross domestic product and expenditure on elderly care were both positively associated with HLYs at 50 years in men and women); however, in men alone, long-term unemployment was negatively associated and life-long learning positively associated with HLYs at 50 years of age.

The authors concluded that substantial inequalities in HLYs at 50 years exist within EU countries. That, without major improvements in population health, the target of increasing participation of older people into the labour force will be difficult to meet in all 25 EU countries- Jagger et al 2008 Inequalities in healthy life years in the 25 countries of the European Union in 2005: a cross-national meta-regression analysis Lancet 2124-2131

Institutionalised Mulnutrition —

One of the most common causes of population wide malnutrition is the indifference of governments or a deliberate plan by governments to use food as a political weapon. One good example of this was the policy introduced by Stalin in the 1920s. The successful plan allowed starvation in the Ukraine in order to bring the protesting peasants into control through starving millions to death.

This State tyranny has been followed in the extermination camps of the Nazis and elsewhere. In the report of the Solidarity Peace Trust reported in Medicine, Conflict and Survival 2007, vol 23, 153-171, similar tactics are being followed in Africa by the Zimbabwe. The use of food as a political weapon.

This method of subjugating populations still goes on.

International Health

This paper (Backman et al ) is a mine of information from many countries and their Health standards.

60 years ago, the Universal Declaration of Human Rights laid the foundations for the right to the highest attainable standard of health. This right is central to the creation of equitable health systems. We identify some of the right-to-health features of health systems, such as a comprehensive national health plan, and propose 72 indicators that reflect some of these features. We collect globally processed data on these indicators for 194 countries and national data for Ecuador, Mozambique, Peru, Romania, and Sweden. Globally processed data were not available for 18 indicators for any country, suggesting that organisations that obtain such data give insufficient attention to the right-to-health features of health systems. Where they are available, the indicators show where health systems need to be improved to better realise the right to health. We provide recommendations for governments, international bodies, civil-society organisations, and other institutions and suggest that these indicators and data, although not perfect, provide a basis for the monitoring of health systems and the progressive realisation of the right to health. Right-to-health features are not just good management, justice, or humanitarianism, they are obligations under human-rights law.

Backman et al 2008 Health systems and the right to health: an assessment of 194 countries Lancet vol 372 pp 2047-2083

Life Expectation —

Christopher Cladwell has written an illuminating article in Financial Times April 26,27th 2008 p 13 discussing the wide expectation of life in the developed world.

Since 1983 life expectancy has declined for women in hundreds of US counties, most of them in the south, and for men in a dozen counties.

. In post-communist Russia men die at about the age of 59, largely related to alcohol. In Namibia the lifespan has dropped 10 years since independence in 1990 due to AIDS.

But since US life expectancy continues its modest rise (from 77.8 years in 2003 to 77.9 in 2004)

Life expectancy fell among poor US men in the early 1960s, for unknown reasons, and in the late 1980s, probably because of Aids and crack cocaine.

Where US healthcare and hygiene work, they are incomparably the best in the world. The 10m healthiest Americans have “one of the highest levels of life expectancy on record -three years better than Japan for females and four years better than Iceland for males”. Asian females in Bergen County, New Jersey, can expect to live an astounding 91 years. But the mortality rates of poor Appalachian whites resemble those of Panama or Mexico.

That is mortality inequality. In 1980 the US rich lived 2,8 years longer than the poor (75.8 versus 73); today they live 4.5 years longer (79.2 versus 74.7).

In Glasgow Scotland men in Glasgow’s pleasant East Dunbartonshire suburbs lived on average to be 81; in Calton, where 60 per cent of residents were unemployed, the life expectancy for men was 54,

Despite the conquest of contagious diseases in the early 20th centur and the reduction in heart-attack deaths in the past four decades.

A recent book by the journalist Bill Bishop, The Big Sort,” shows how like-minded Americans have congregated according to similarities in education, political ideology, wealth and various other attributes.

New Yorkers live longer not because they are doing different things than in 1990 but because they are a different set of people. Certain people have moved in -disproportionately young, employed elites with health insurance, good diet habits and health club memberships. Others have moved out.
Published online by the journal PLoS Medicine: Http:j/medicine, plosjou rnals. orgiperlservi Trequest =mdex-fitml&issn=1549-l676 ** Houghton-Mifflin, $25

Malnutrition Review —

The Lancer has run a most important series of 5 review articles on malnutrition finishing with the February 6th edition of the Journal. The final editorial reads
Later this month, the first batch of seeds will be stored in the Svalbard Global Seed Vault to ensure that should a major catastrophe ever hit the planet, survivors should at least have access to a seed bank and so may be able to grow food. Eventually, over 200 000 crop varieties will be hidden in this Arctic ice sanctuary deep in a mountain near the village of Longyearbyen, built by the Norwegian Government for the benefit of mankind. And last week, the Bill & Melinda Gates Foundation announced a S20 million grant to develop hardy rice crops to help poor farmers cope with the effects of climate change. While these visionary philanthropic works are admirable, what about doing something to help the millions of people throughout the world who are starving right now?

The World Food Programme continues to raise awareness of current food insecurity emergencies. Last week’s target was Tajikistan, where the coldest winter in five decades and rising world food prices have resulted in a disastrous situation. If past experience is anything to go by, the Programme’s pleas for emergency funding will fall on deaf donor ears, and many people in Tajikistan will starve. So why can’t the same attention, energy, innovation, and financial and technical resources, reserved to mitigate the effects of potential future disasters, be channelled into tackling current hunger crises? Although not immediately relievable by a scientific quick-fix, it should not be beyond the bounds of possibility to redistribute the abundance of global food resources and tackle wider socioeconomic factors often involved in food security issues.

The final article in our under nutrition Series clearly outlines what needs to be done. The global architecture of the international nutrition system needs to be radically reformed and become more accountable and inclusive. And everyone from major donors to the editors of academic journals all have their part to play. It is absurd and profoundly unjust that, as many countries are putting their resources into tackling the obesity epidemic, many people throughout the world are continuing to starve to death. We must all act now and turn the Series’ realistic recommendations into robust action. ¦

The core problems were identified as
Lack of high level interest
Inadequate human sources
Unpredictable and inflexible funding
Inadequate strategies
Limited sticking power of policies
Structures that impede collaboration
Weak coordination
Weak linkages with countries

Their recommendations were
The international nutrition system—made up of international and donor organisations, academia, civil society, and the private sector—is fragmented and dysfunctional. Reform is needed so that it can perform key stewardship functions, mobilise resources, provide services in emergencies, and strengthen capacity in low-income and middle-income countries

Current processes for producing normative guidance are laborious and duplicative, and fail to produce guidance that is prioritised, succinct, and evidence-based.

Programme evaluation is weak, and insufficient resources are devoted to analysing and responding io major global challenges (including the evolving epidemiology of nutrition)

The funding provided by international donors to combat under nutrition is grossly insufficient and poorly targeted, and is inappropriately dominated by food aid and supply-led technical assistance. Much more investment is needed in human and institutional capacity for nutrition in low-income and middle-income countries

The problems of the international nutrition system are long-standing and deeply embedded in organisational structures and norms. The international community needs to identify and establish a new global governance structure that can provide greater accountability and participation for civil society and the private sector

Linkages with national-level processes need to be significantly enhanced, so that priorities that are felt at country level are better reflected in international normative guidance, donor funding, research, and advanced training

Morris et al 2008 Effective international action against under nutrition : why has it proven so difficult and what can be done to accelerate the progress. Lancet vol 371 pp 608-621

Leader Lancet 2008 Tackling global food insecurity Lancet vol 371 p 532

Malnutrition —

Starvation is one of the terrible scourges of our world. In the words of the old song, it’s the rich that get the gravy and the poor……. Humiliating, deadly and unnecessary Malnutrition is such a complex problem and has so many answers to the insoluble. James Vernon has written a masterly book Hunger a modern History published by Harvard University Press which has an equally masterly review in Nature Michael Sargent 2008 Starvation crime and punishment. Nature vol 451 pp 524-5

Amongst past theories are
Povery is a criminal act
Malthus‘s a God given discipline for the profligate
Charles Trevelyan on the Irish potato famine , a sharp and effectual remedy
A political weapon
Poor economic management and distribution

Malnutrition results from the availability of nutrients to individuals being insufficient.. Often but not always too many people for too little food.

The lack of nutrients may be total or in certain nutrients.

Availability may be a result of
1. geography, being located remote from the food supply.
2. transport
3. war and strife
4. economics ability to pay for the food
5. poor farming techniques and wrong crops
6. destruction of crops by disease or weather
7. political connivance and corruption
8. poor education
9. pathology e.g. celiac disease.

Nutrients are the total macro nutrient need
1. calories,
2. energy ( carbohydrates and fat )
3. proteins
4. maybe fibre, maybe not.

the micro nutrient needs
1. vitamins
2. trace metals

Insufficient for
1. pregnancy
2. growth of body and brain
3. energy
4. resistance to infections

population means those who are requiring food. This may be the usual areas, Africa and Asia. But any population may be drawn into this problem by war, global change or any other lack of food.

There is a small group who because of some disease or bodily malfunction are unable to absorb or utilise nutrients e.g. coeliac disease.

Obesity is the converse.

The availability of nutrients being more than sufficient for the population at risk.. Too much food for too few people.

Maternal Mortality in India

No one could dispute the central place that a mother has in the upbringing of young children particularly in unsophisticated societies.

In Victorian times a pregnant woman would in addition to preparing clothes for the baby prepare her shroud for the strong possibility that she would die during the delivery or shortly after.

In India the Maternal Mortality Rate has fallen over the last 10 years from 407 per 100,000 live births to 301 per 100,000 life births.

Some 77,000 women die a year from causes related to pregnancy. Many could be prevented. The more remote and less structure the society the higher the death rate. An exception is Kerala which has a high literacy rate and Maternal Mortality Rae of 100 deaths per 100,000 live births.

Critical to the care of these women is awareness of the danger and transport to medical care. Anaemia is widespread

In Aberdeeen in the early 20th century there were many women with a haemoglobin of under 5 g/100ml. Simple iron therapy restored their blood concentrations Chattergee P,(2007) India addresses maternal deaths in rural areas Lancet vol 370, 1023-4 Giving the poor an opportunity to permanently work their way out of poverty. This often requires money and is where the microfinance system ha proved to be so invaluable.

Microfinance —

A history of microfinance Since 1300 AD forms of microfinance and collective lending have existed. These include the “susus” of Ghana, “chit funds” in India, “tandas” in Mexico, “arisan” in Indonesia and “tontines” in west Africa.

In 1865 Friedrich Wilhelm Raiffeisen developed the concept of the credit union. From 1870, unions expand across the German states. The co-operative movement spreads to Europe, north America and developing countries. In 1895 the Indonesian People’s Credit Banks or The Bank Perkreditan Kakyat (BPR) opened , specialising in an early form of microfinance. Today it is the largest microfinance system in Indonesia, with 9,000 operations.

With $90,000 raised from private companies, Joseph Blatchford ( 1961 ) founded Accion International in Venezuela. Initially concerned with building schools and water-systems, it turned to roierofmance in 1973. It becomes one of the premier microfinance organisations in the world. In 1971 Al Whittaker and David Bussau began lending to micro-entrepreneurs in Indonesia and Colombia. In 1979 they formed Opportunity International, lending across south-east Asia and South America.

Of great significance in 1976 Muhammad Yunus discovered that a loan of $27 could change the lives of 42 families in an impoverished village in Bangladesh. They pay him back with interest and begin to lift themselves out of poverty. In 1983 Yumis created the Grameen Bank. To date, it has lent more than $983m. Its methods have become the basis for modern micrafmance.

In 1992 Accion helps found BancoSol of Bolivia, the first commercial bank dedicated solely to microfinance. It now has more than 70,000 clients. And in 1997 The National Microfinance Bank in Tanzania (NMB) is created. Meanwhile, Deutsche Bank enters microfinance as part of its drive to embrace social investing. By 2001 the Access to Banking Services initiative in the Philippines helps integrate rural banks’ microfinance loan clients into the credit, system. In 2005 The UN names 2005 the International Year of Microcredit. Citibank opens Citi microfinance. Based in London, New York, India and Colombia, its goal is to broaden the outreach of its financial services.

In 2006 The microfinance Summit Campaign Report estimates that there are more than 3,000 microfinance institutions serving 100 million poor people in developing countries. The total cash turnover of these institutions worldwide is estimated at S2.5bn. Yunus is awarded the Nobel Peace Prize. Barclays Launches Ghanaian Microfinance, tapping into one of Africa’s most ancient forms of banking, “Susu collection”. International Finance Corporation, part of the World Bank, announces a S45m investment in credit-linked notes to be issued via Standard Chartered bank to facilitate microfinance lending in Africa and Asia.

In 2OO7 JP Morgan launches a microfinance unit.

All heady stuff and maybe this is a most encouraging sequence. Maybe the advent of real business is not good. Time will tell

FT Weekend December 6/7 2008 pp 16-22

Nutrition, Logic —

From time to time,one reads a truly exciting article. Such an article is printed in Nature written by Paul Nurse ( Nature 2008 Life, logic and information vol 454 pp 424-5) and has made me think how nutrition fits into his massive picture of the future.

Biology has over the recent decades learnt so much of how genes, cells and organisms function.

However the connecting networks, general cellular homeostasis, maintenance of cellular integrity, the generation of special and temporal order, inter and intra-cellular signalling , cell memory and reproduction are not fully understood. Nutrition has lagged behind this revolution and has less to contribute than the central position of our science merits.

Nutrition has a central role in such thinking.

There is too much emphasis on the effects of nutrition on the aetiology of disease and not on normal function. Maybe the grant giving boards are to blame.

Living organisms are complex. To understand the interconnections of living systems we need a new language and logic, drawn from systems analyses of living organisms. The needs are

To describe molecular interactions and biochemical transformations as logic circuits showing how information is managed. The cell is the basis for such a description. Logic circuits need to broken down into individual segments , eg negative feed back loop and positive feed back loops. The control of the cells intake of nutrition and how it asks for more of this and that nutrient is important here. What happens in excess circumstances and in reduced circumstances.

Detailed biochemical descriptions are required for this. Knowledge of the anatomy of the cell, rate constants , strengths of integration allow interaction models to be built and differential equations to be created.

How these modules operate and link together allows us to understand the flow of information. How is information gathered. For nutritionists this is a long path from the plant seed and animal foetus to the farm to the shop to the consumer to the table, to the mouth , intestine, to the storage and transport systems and then allocated to a cellular system.

The basis of the cellular systems are the nucleic acids information storage and the DNA and histone methylation , protein kinase and phosphatases which act antagonistically as switches. Detailed modelling might show that certain molecules are associated together in particular ways. The interactions of vitamin B12 and folic acid is a good example.

This would enable pathways and the limiting factors and interactions to be identified. Such logics have been used in other fields of endeavour eg transportation , flight routes Biological systems are more flexible and constantly changing.

The temporal organisation and dynamics of the biological process would then make more sense.

In nutrition this system analysis would be enriched by behavioural analysis. A brilliant prospect. Which requires a group of thinkers akin to the splitting of the atom and to better purpose.

Nutrition by Joan Eardley —

When I came to Edinburgh in 1954 and arrived on the overnight train I was struck by the small stature of the workmen in Princes Street. This is no longer the case.

There is a wonderful exhibition of paintings by Joan Eardley in the Scottish Gallery at the bottom of the Mound. . In addition to her masterly sea and landscapes there are paintings of Glasgow children after the 2nd world war. Despite the improved nutrition with rationing and a more equitable distribution of food they are still very underweight. The fat boy, there always was a fat boy, would be, at the most, plump in modern day parlance.

Our Food, Our Future —

I listened yesterday morning to a wonderful programme on BBC Radio 4 “ Our Food, our future” presented by Tome Hean. The participants included young mothers short of money and cooking skills and some very articulate and contributing Nutritionists and Dieticians. ( BBC Radio 4 Monday 9 am August 4th available to hear on the BBC web site ). One contributor made a very good point. He differentiated between the value of food and the values of food.

The Value being the price at the shop

The Values being the whole of nutrition, the nutrition value of a food , its economic history and its ability to add to the well being of the consumer with minimal disturbance of the world’s being.

Added values being the cooking so that raw materials are presented as delicious food. Also the importance of sit down meals, not grazing. The importance of the communal family unit.. Many of the young women confessed to being ignorant of cooking skills. Also with their economies failing, the cost of made up food and less food for cooking had to be balanced against preparation costs and time and cooking costs.,

Stacking Fruit —

Whilst careful logic applied to science is the hall mark of science, observation and chance also play a significant in new discoveries.

When Jenner listened to the milk maid talking about the protective abilities of cow pox against small pox a new era entered social medicine. Similarly Withering responded to an account of the therapeutic benefits of digitalis in heart failure , an infusion from the fox glove flower.

The clue is the listening and then testing.

Chance is Fleming who was studying the ability of tear drops to inhibit the growth of bacteria seeing by chance that a penicillin fungal infection killed bacteria growing on the same agar plate.

The time interval used for many dietary fibre studies is three weeks, the reason for this being that in the first experiment on bran three weeks was chosen because the experiment could then be finished between the Edinburgh Faculty Ball and Christmas.

The subsequent promotion of the idea and observation must then be subjected to careful scientific studies and abandoned if the experiments don’t fit the inspired thought.

Such was the discovery of the tranquilliser drug largactil. This drug met theoretical requirements of an ideal drug. When tested in all organ tests it was without effect. So in exasperation one of the scientists who was quite agitated drank the potion and felt very calm. A new drug was found.

The Meaning of Life —

A recent letter to the Times by Martin Waters tells of the accidental finding of the Universal Truth. The length of Martin Water’s leg ( 37 ins ) is exactly 4.7 times the length of his hand ( 7.9 ins ) .

The circumference of his head when multiplied by 4.7 equals exactly the height of their house porch. (9 feet ) .

Is 4.7 the new 42 ?

Recurrently in Nutrition there come these new meanings of life which are exactly 4.7.

The Potato —

Propitious esculent : The potato in World History John Reader Publisher William Heinemann Reviewed in Nature by Sandra Knapp Potatoes and poverty Nature 2008 vol 455 pp 170-71 This book is devoted to a most important vegetable , the potato which has sustained impoverished populations world wide. Originating in South America. One of the great sights in a country such as Bolivia is to see farmers wife’s sitting by heaps of potatoes in the markets, each pile a different potato.

The reviewer does not gush about this book, but it must be a valuable contribution to our knowledge of this important item of food.

The Potato —

CAMIRE, KUBOW, DONNELLY (2009) Potatoes and Human Health Critical Reviews in Food Sciences and Nutrition vol 49 823-840
The potato (Solanum tuberosum L.) tuber follows only rice and wheat in world importance as a food crop for human consumption. Cultivated potatoes have spread from the Andes of South America where they originated to 160 countries around the world. Consumption of fresh potatoes has declined whilst processed products have increased in popularity. As the potato becomes a staple in the diets of an increasing number of humans, small differences in potato nutritional composition will have major impacts on population health. The potato is a carbohydrate-rich. energy-providing food with little fat. Potato protein content is fairly low but has an excellent biological value of 90-100. Potatoes are particularly high in vitamin C and are a good source of several B vitamins and potassium. The skins provide substantial dietary fibre. Many compounds in potatoes contribute to antioxidant activity and interest in cultivars with pigmented flesh is growing. This review will examine the nutrient and bioactive compounds in potatoes and their impact on human health.

Theobromine —

Chocolate is a delicacy which is enjoyed by most people and also other animal species. Chocolate is not healthy for dogs who love this treat.

The reason is their slow metabolism of the methyl xanthnine alkaloid Theobromine. The amount of theobromine in a product depends on whether it is bakers chocolate (390-450 mg / oz chocolate ) or dark chocolate or milk chocolate ( 44-60 mg / oz chocolate ) in decreasing order. Dogs take some 20 hours to eliminate a dose of theobromine.

The toxicity of theobromine is dose dependent. The toxic dose is of the order of 100-200 mg / kg though lower doses have been shown to be toxic. If a 40 lb weighing dog was to eat say an 8 oz ( 240 g ) bar of dark chocolate it would within a few hours develop severe abdominal symptoms. Eating more may lead to death. The theobromine is a cardiovascular and central nervous system stimulant. While theobromine and caffeine are similar in that they are related alkaloids, theobromine is weaker in both its inhibition of cyclic nucleotide phosphodiesterases and of adenosine receptors.

The advise and care of a Vet is essential in these cases. Intravenous fluids, activated charcoal to diminish absorption and anti seizure drugs may be required.

World population growth

The BMJ records an interesting description of how the world population has grown out of control.

The first modern human was about in about 160000 BC.

In AD 1 the world population was 250 million

1776 – 1 billion
1945 – 2.3 billion
2006 – 6.5 billion
The human population has quadrupled in less than 100 years.

The annual increase in population of the world is 79 million

This has profound implications for the future of the world

So we worry abut whether or not we eat too much of this and that. Or the millions of starving and quietly and surely we are driving the human race into extinction by over populating the globe

BMJ picture of the week 2008 vol 337, This week , Editorial and Research p 279

World Wide Infant Mortality —

The annual number of deaths of children aged under 5 years has dropped to less than 10 million last. Still a terrible figure. Of these half were in sub Saharan Africa. ( 4.8 million ( due to HIV and AIDS) and 3.1 million from south Asia.

The figure for West and Central Africa is 186 deaths per 1000 children under 5 years compared with 6 per 1000 in Western industrial countries China and India has made great advances in caring for the young Achieved by simple procedures such as Immunisation against measles Exclusive breast feeding Vitamin A supplements Use of bed nets treated with insecticide against insect carrying malaria.

Treatment of malaria, pneumonia, diarrhoeal diseases and severe malnutrition , HIV and Aids.

Murray CJL et al 2007 Can we achieve Millenium Development Goal 4? New analysis of country trends and forecasts of under-5 mortality to 2015. Lancet, vol 370, 1040-54


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