More ingredients please! Why we need complex solutions to achieve sustainable nutrition.

There is something beguilingly beautiful about creating simple solutions to complex problems, but for inherently complicated problems, such as the chronic malnutrition that remains depressingly common throughout India today, simplistic solutions are useless: at best they act as temporary sticking plasters covering up the problem, and at worst can exacerbate issues in the long term. To solve malnutrition we need to understand the ‘causes behind the causes’ – including socio-economic, medical, emotional, environmental, and, above all, political [1].

In principle providing people with a nutritiously balanced diet is simple. The US prison system, for example, has a ‘nutraloaf’ – a single block that provides all the nutrients needed to stay alive, available for as little as US$ 0.15 – 0.3.

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But this approach to nutrition misunderstands food. Food is more than a physiologically appropriate set of nutrients. Our understandings of good food include taste, culture, emotion, habit and religion.

For example in South Africa recently, my driver today told me that he hadn’t eaten the previous night, although I’d seem him eat an enormous plate of rice and chicken. When I asked him about this, he patiently explained that meals based on anything except pap – a dense, porridge-like dish made from maize – don’t fill you up. This is similar to the refrain I regularly hear in Tamil Nadu about meals that aren’t based on rice.

Returning to the Nutraloaf – while it may be nutritionally balanced, it can’t be described as food or a solution to malnutrition. In fact it’s so unattractive to eat that it’s used as a punishment, and prisoners voluntarily starve rather than consume it.

This is not to say that the medicalisation of nutrition hasn’t generated important benefits. It has brought critical issues such as sanitation into the nutrition discussion, and this detailed understanding of nutrition has allowed a more precise information about what we need to eat – especially at different points in our lives. However, it has been used by some to advocate simplistic, over-technical solutions – especially visible in the inappropriate promotion of fortified products. Fortification has been highly successful in improving health throughout the world, but fortification alone should not be seen as the long term solution to the complexities of malnutrition. Nonetheless, many commercial organisations are fortifying numerous products – ranging from biscuits and chocolate milk products, to instant noodles and bouillon stock cubes – to both feel good whilst also increasing sales. The pre-existing popularity of these products makes them very effective ‘carriers’ of vitamins and minerals – which child won’t eat chocolate milk or a biscuit?

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However this solution to malnutrition generates its own problems. The US Food and Drug Administration (FDA) has a “jelly bean rule” – you should not call a food healthy just because you stick some nutrients in it; fortified sugar is still sugar. Pepsi’s Maizoro ‘Choco-cronchi’ chocolate cereal – aimed at children – is over 30% sugar. Britannia’s Tiger biscuits –  advertises “A delicious biscuit, fortified with 25% Daily Growth Nutrients like Iron, Calcium and Vitamins, help moms keep their little Tigers strong and roaring”- yet they are 24% sugar. These are sold in Mexico and India respectively – Mexico has the second highest rate of obesity worldwide, and India has the third largest number of obese people in the world [2]. Disease switching between different non-communicable diseases – from micro-nutrient deficiencies to obesity, is already an increasing problem in India.  And adding insult to injury the power of advertising – cleverly aimed at mothers and ‘motherhood’ as in the Britannia biscuit example – encourages poor mothers to feed expensive junk at the expense of cheaper, more nutritious, home-prepared foods [3].  I’m not dismissing fortification of all biscuits – if people are going to eat rubbish, give them healthier rubbish and as a short-term sticking plaster solution, fortified biscuits may well have a role, but you need a pretty good imagination to see fortified sugar as the solution to malnutrition.

One alternative to fortification is diversification, which is itself complicated as it brings in wider aspects of the food system. Diversification of diets relies upon adequate physical, social and economic access to different foods. It can also be associated with increasing agricultural diversity, an important environmental goal that may in turn feed-back to improved nutrition [4]. For example through habitat simplification and insecticides we are seeing a widespread loss of pollinators. While many flowering food plants can be pollinated without insects, there is increasing evidence that pollination by insects increases the nutritional quality of the fruits/vegetables [5]. Thus increasing agro-biodiversity could simultaneously improve the nutritional qualities of foods. At its simplest, we need a diverse diet to provide good nutrition, and from the environment’s perspective a diverse system helps to maintain ecosystem function.market

We don’t yet have all the solutions to malnutrition, and we won’t find them until we embrace its complexity including issues such as social power as well as the harder sciences of nutrition and ecology. We should recognise that the food system is both the main driver of many environmental problems, as well as the key victim of much environmental change. Above all, we should recognise the need to have a vision and work back from there: food can be a complex, delicious, nutritious, stimulating, culturally important, exciting and varied part of our lives, but for too many people it remains poor and simple, in the worst way.

 

  1. Lawrence, M., Food Fortification: The evidence, ethics, and politics of adding nutrients to food. 2013: Oxford University Press.
  2. Ng, M., et al., Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 2014. 384(9945): p. 766-781.
  3. Kimura, A.H., Hidden hunger: Gender and the politics of smarter foods. 2013: Cornell University Press.
  4. Johnston, J.L., J.C. Fanzo, and B. Cogill, Understanding sustainable diets: a descriptive analysis of the determinants and processes that influence diets and their impact on health, food security, and environmental sustainability. Advances in Nutrition: An International Review Journal, 2014. 5(4): p. 418-429.
  5. Brittain, C., et al., Pollination and Plant Resources Change the Nutritional Quality of Almonds for Human Health. PLoS ONE, 2014. 9(2): p. e90082.

 

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