Fed ≠ Nourished
Malnutrition today - 4th installment from my #IVICLS presentation
“…one can be overfed but undernourished.”
(Tarawali, 2021)
One can be overfed but undernourished. This is a major problem in North America where 60% of our calories now come from ultra processed foods.1 For children 2 - 19 years that figure is closer to 70%.2 Sixty one percent of the calories in the US per capita food supply come from just three categories: grains, sugar and sweeteners, and added plant-based fats and oils.3 These are indication of poor nutrition. Such a diet cannot provide the nutrients essential for proper human development and optimal health.
Just as with One Health, where health is not merely the absence of disease, human flourishing is multi-factored. Like animal husbandry, however, the foundation must be ensuring that human beings are receiving the nutrition that they need to develop their brains and bodies properly, and support metabolic health throughout their lives. Somewhere between 20 and 25% of children five years and under, globally, are stunted due to a lack of the essential nutrients best provided - in some cases solely provided - by animal source foods.4 Stunting is not merely reduced height, it’s also impaired brain development. If those critical stages of brain development are not met, these human beings will never catch up. By one estimate that could be as much as 11% of GDP drag on economic development in Sub-Saharan Africa.
Malnutrition today looks different than it did in the 1960s & 70s. It is estimated that 828 million that are calorically undernourished, and 2.6 billion people are overweight or obese. This is malnutrition. Undernutrition is not synonymous with caloric deficit. “Protein/Energy malnutrition is by far the most lethal form of malnutrition and children are its most visible victims.”5
Remember that these are pre-pandemic figures. They were published more recently, but the data was collected prior to the pandemic. Given that global governments’ responses to the pandemic did not improve global food security and nutrition, these are likely to be underestimates.
(Bikman, 2020; Crofts, 2015)6
Let’s extend the use of Liebeg’s Barrel analogy from soil fertility to public health. The preponderance of the highest-quality evidence from all scientific disciplines strongly suggests that the greatest insult to public health today is chronically elevated insulin and insulin resistance. Virtually every chronic disease you can name has a significant linkage with, if not causal relationship to, chronically elevated insulin and insulin resistance. Please note that obesity is listed as one of these diseases (or disorders) under the Endocrine System. Obesity is a manifestation of metabolic derangement, not a cause or “risk factor.” It is evidence of malnutrition, not “overnutrition,” as it is frequently labeled.7 Current research strongly suggests that reducing one’s fasting insulin level and improving insulin sensitivity will provide rapid, significant improvements in health for many, including a majority of United States adults.
Being a biological system, of course there are multiple causes and factors, but this condition has been estimated to be responsible for at least 80% of the global burden of chronic disease. Until this primary cause is addressed, effective policies and treatments are unlikely. Throughout the world, chronic diseases kill far more people than infectious diseases. Properly nourished organisms (as folks in the animal sciences understand) have immune systems that function better than those which are malnourished. Therefore, in addition to inhibiting human development and potential, malnutrition (properly understood) must be the preeminent focus of public health efforts.
(Chan, 2017)8
The failure to understand and incorporate this fundamental concept has led to, at best ineffective, policies. High-quality scientific evidence, however, suggests that these policies have actually exacerbated the problem. Clearly, no progress has been made in reducing the incidence of Type 2 Diabetes and related metabolic disorders. Research in animal agriculture isn’t prioritized, in part due to the mistaken belief that animal source foods “over-consumption” is the cause of these diseases.
This intellectual failure results in the worldview exhibited by the former Director-General of the World Health Organization. She and her colleagues can see what’s happening, but they can't imagine how to stop it. "We've tried everything we know to address it and it's not working." they seem to think. Scientists should think "Maybe we were wrong. Maybe we should try something else." But the majority of people in the communities of human nutrition and food policy seemingly think "if we just tried harder, if we just talk louder, if we dictate what people eat, it will work.“
This delusion then contaminates research, conversations, and policies regarding food systems.
Tarawali, S., 2021. ILRI's Jimmy Smith on the livestock controversies holding back greater use of milk, meat and eggs to nourish the undernourished. https://www.ilri.org/news/ilris-jimmy-smith-livestock-controversies-holding-back-greater-use-milk-meat-and-eggs-nourish.
Martínez Steele, E., Baraldi, L.G., Louzada, M.L.D.C., Moubarac, J.-C., Mozaffarian, D., Monteiro, C.A., 2016. Ultra-processed foods and added sugars in the US diet: evidence from a nationally representative cross-sectional study. BMJ Open. 6(3), e009892. https://doi.org/10.1136/bmjopen-2015-009892.
Wang, L., Martínez Steele, E., Du, M., Pomeranz, J.L., O’Connor, L.E., Herrick, K.A., Luo, H., Zhang, X., Mozaffarian, D., Zhang, F.F., 2021. Trends in Consumption of Ultraprocessed Foods Among US Youths Aged 2-19 Years, 1999-2018. JAMA. 326(6), 519. https://doi.org/10.1001/jama.2021.10238.
USDA ERS, Food Availability (Per Capita) Data System. https://www.ers.usda.gov/data-products/food-availability-per-capita-data-system/
Adesogan, A.T., Havelaar, A.H., McKune, S.L., Eilittä, M., Dahl, G.E., 2020. Animal source foods: Sustainability problem or malnutrition and sustainability solution? Perspective matters. Global Food Security. 25, 100325.
Hulett, J.L., Weiss, R.E., Bwibo, N.O., Galal, O.M., Drorbaugh, N., Neumann, C.G., 2014. Animal source foods have a positive impact on the primary school test scores of Kenyan schoolchildren in a cluster-randomised, controlled feeding intervention trial. British Journal of Nutrition. 111(5), 875-886. https://doi.org/10.1017/S0007114513003310.
Neumann, C.G., Murphy, S.P., Gewa, C., Grillenberger, M., Bwibo, N.O., 2007. Meat Supplementation Improves Growth, Cognitive, and Behavioral Outcomes in Kenyan Children. The Journal of Nutrition. 137(4), 1119-1123. https://doi.org/10.1093/jn/137.4.1119.
WHO, 2000. Turning the tide of malnutrition: Responding to the challenge of the 21st century. World Health Organization.
Bikman, B., 2020. Why We Get Sick: The Hidden Epidemic at the Root of Most Chronic Disease-and How to Fight It. BenBella Books, Inc.
Crofts, C.A.P., 2015. Hyperinsulinemia: A unifying theory of chronic disease? Diabesity. 1, 34. https://doi.org/10.15562/diabesity.2015.19.
Gómez, M.I., Barrett, C.B., Raney, T., Pinstrup-Andersen, P., Meerman, J., Croppenstedt, A., Carisma, B., Thompson, B., 2013. Post-green revolution food systems and the triple burden of malnutrition. Food Policy. 42, 129-138. https://doi.org/10.1016/j.foodpol.2013.06.009.
Chan, M., 2017. Obesity and Diabetes: The Slow-Motion Disaster. The Milbank Quarterly. 95(1), 11-14. https://doi.org/10.1111/1468-0009.12238.