Goals for nutrition

A diverse diet, made up of a variety of grains, beans, vegetables, fruits, and animal products is the best way to get all the essential macro and micro nutrients.

Over at Agricultural Biodiversity Weblog, Jeremy has been critical of information coming out of the First Global Conference on Biofortification. He wonders if the organizers and attendees were/are too focused on a techno-fix rather than on diverse diets as a solution. This being a conference on biofortification, we talked about biofortification a lot, and it could be argued that biofortification is a techno-fix, whether by breeding or biotechnology.

However, we talked about a lot more at the conference, including supplementation and fortification, diverse diets and education, cooking and farming methods. To say that diverse diets were ignored would be incorrect. That obviously isn’t getting through in the materials coming out of the conference through the organizers or media, which is a problem.

If we polled each conference attendee, I think most if not all would say that a diverse diet for every human on the planet is the ultimate goal. Many of the sessions addressed this specifically, getting into the details of how diet and nutrition are intertwined. Here are just three examples:

Percentage of funds spent by families on different items before and after a 50% increase in food prices. The red and green blocks represent high-nutrient foods from plant and animal sources. Image from Howie Bouis's plenary talk at the Global Conference on Biofortification.

For example, Merideth Bonierbale, of the International Potato Center, described how consumption of some potatoes that are high in vitamin C but low in iron can assist with absorption of iron in other foods for low-income people in rural areas of Peru.

Mark Failla, Professor of Human Nutrition at Ohio State, talked about  how cooking methods can change bioavailability of nutrients. Pro-vitamin A in cassava is more bioavailable in fufu than in gari, possibly because the high temperature used in roasting gari breaks the nutrient down. Because pro-vitamin A is fat soluble, adding oil helps make the vitamin more bioavailable, but even the type of oil can make a big difference.

Howarth Bouis, Director of Harvest Plus, in his plenary The Five Big Challenges, reminded us that the percentage of the diet that has the most vitamins isn’t grains but the leafy greens, animal products, etc. When the price of grain goes up, consumption of nutrient rich foods goes down, because the grains provide more calories per dollar. The people buying these foods might still have full stomachs but the nutrients aren’t there. Ideally, people would be able to buy those nutrient rich foods and eat a diverse diet, but we know that’s not what is happening out there, especially when food prices are high.

Why vitamins and minerals matter

While starvation due to lack of food is a problem that certainly needs attention, malnutrition due to lack of vitamins and minerals has gone virtually unnoticed. The hidden hunger of malnutrition affects an astonishing 1 in 3 people worldwide, according to the Micronutrient Initiative. Lack of key micronutrients, especially in the first 1000 days of life (from conception to the second birthday), results in adverse effects to cognitive and physical development as well as a reduction in immune function. Those key nutrients include iodine, vitamin A, iron, zinc, and folate.

The sad truth is that, in many places, whole generations of people are growing up with brains and bodies that aren’t what they should be. How can we expect these people to find ways to bring themselves, their families, their villages, and their countries out of poverty? The truth is, they can’t, or at least the task is far more difficult than it would be for people who weren’t malnourished. This is the real tragedy of malnutition. If we can find ways to deliver nutrition to this generation’s mothers and their young children, those children will grow up strong and smart, and able to fight off disease as they should be. If we can improve the nutrition of just one or two generations then they will be able to make change for themselves and those around them, including those who do not have enough food. We need to help these people receive adequate nutrition through any methods that are appropriate for the situation. The goal is not just a healthy diet, but a self-sufficient healthy diet.

What can we do?

Impoverished people aren’t getting the nutrients they need because they don’t have access to a diverse diet, often because they can’t afford to purchase anything but grains. The long term goal is to enable people to have access to a diet that includes vegetables, fruits, and animal products. That will take global, regional, and national efforts to increase incomes for the poor. These changes are obviously something we all want to do but also obviously something that is going to take a very long time. While we work on reducing poverty, we can make nutritional improvements to the foods people are eating. In the mean time, there are a lot of people who are getting enough calories but who can’t afford nutrient dense foods.

Can we improve staple foods to meet more of the nutritional needs of the people eating them? The answer is, in a lot of cases, yes. In the developed world, we have fortified foods, including iodized salt, iron and folic acid fortified flour. These interventions have been successful in eliminating deficiencies of those nutrients. Similar efforts have worked in the developing world, but rural areas, distant from roads, have not received the benefits. Another problem with fortified foods is that they do add to the cost of the food, which doesn’t work well for rural or urban poor who can’t afford even a few extra pennies. Some government fortification initiatives have worked, but require constant monetary input.

Another option for nutrient delivery is supplementation as pills, shots, vitamin packets that can be added to foods, or food products like Plumpy’nut. These can be very effective in certain circumstances, such as for disaster relief, or while longer-term fortification programs are being initiated. But they have some significant drawbacks, including the requirement for frequent delivery of often perishable products, low acceptance rates by the people who might benefit from them, side effects like nausea, and health problems from over-supplementation. And again, rural people often don’t have access to such products.

What can we do for those people in rural areas who don’t have access to fortified foods? Most people in rural areas farm, even if only a small plot of land. Can they farm more diverse foods? In some cases, yes, depending on soil and rain and other factors. In some cases, the people are lucky if they get a few potatoes or cassava or a few ears of corn or stalks of rice out of the ground, and adding additional crops isn’t possible. One of the speakers at the conference said that many farmers in developing countries only produce enough food for part of the year, and must purchase the rest (I unfortunately don’t remember who said this). If we can put the ability to accumulate more nutrients in the seeds themselves (or cuttings, in the case of potatoes and cassava), then those few staple foods can be that much more valuable nutritionally.

Biofortified crops

Biofortified crops have many advantages over fortified foods or supplements. First, the nutrients can be packaged in biological molecules are easily absorbed by the body yet recognized by the body so over-consumption (within reason) won’t result in overdose of the nutrient. Second, the seeds only have to be distributed once, if they are non-hybrid varieties, and each generation the seeds will still have increased nutrients. If they are hybrids, the seeds can be distributed via existing seed distribution channels (if they exist – obviously hybrids would not be a good solution where there is no way to purchase or otherwise obtain seed each year). Finally, the improved seed can be bred or engineered to contain not only improved nutrients but also disease resistance, stress tolerance, and other traits that will help the plants be more productive without additional inputs. The same is true for plants propagated by cuttings or tubers, but even more so because each plant is clonal so there is no chance of genetic drift reducing nutrient content or other traits.

Biofortified and otherwise improved plants would allow farmers to have a higher income due to greater yields, as well as providing nutrients to allow the farmer’s family to be strong and healthy. Biofortified crops have the potential for big impacts on urban and non-farming malnourished persons as well. If all someone can afford is a bowl of rice or a little corn for arepas, and biofortified varieties are available, then their food dollar can go much further nutritionally. Biofortified crops aren’t just useful for people in the developing world, either. We in the developed world often don’t get the nutrients we need despite access to a diverse diet, fortified foods, and supplements.

Of course, biofortification isn’t without problems. For example, there are unique economic issues that could arise. There is potential for biofortified varieties of a crop to be considered more valuable than non-biofortified varieties, so the biofortified food would actually be more expensive, just like the fortified food can be more expensive. This would benefit farmers but wouldn’t help non-farmers. However, unlike fortified food, after some time, the seeds could be passed from farmer to farmer until most of the available food is biofortified, so the price differential would no longer be there. Another option would be for a country to make rules about new seed varieties, such as saying that they must contain certain levels of a nutrient, so that over time all seed would be biofortified.

Moving forward

Ideally, biofortified crops would be developed in ways that would benefit small farmers in developing countries the most. There are many issues to consider but I think there are two that are the most important.

Golden Rice, just another improved rice strain, yet it has a great potential to cover micronutrient needs of rural, rice-based societies. Photo from Goldenrice.org.

First, the traits must be developed with the intent for free distribution to those who need it most. Governments and non-profit organizations like Harvest Plus are doing good work, but partnerships with corporations have a lot of potential. Golden rice (set to debut in 2012 with enough pro-vitamin A to meet nutritional needs with regular rice consumption levels) is the first example of a public-private partnership, although because it was the first, securing a humanitarian license wasn’t quite as smooth as it could have been.

Now, there is evidence that corporations see value in such partnerships, and the process is much smoother. The method being pursued by the Gates Foundation and Monsanto with Water Efficient Maize for Africa (PDF) could be used as a model for new public-private partnerships. They plan to distribute improved seed with the water efficient trait to low income farmers at no cost, while relatively wealthy farmers may be required to pay for the seed.

Second, the plants must come with education. In Kenya, for example, education of the health benefits of orange sweet potato over white sweet potato has been key to acceptance. One way to distribute information that was discussed at the conference is to train one trusted person in each village who will then be able to disseminate the information. If a foreigner just drops off some stuff, whether it’s seeds, medicine, or anything else, without information, the items might not be accepted.

I think it was Denis Kyetere, Director General of the National Agriculture Research Organisation in Uganda who said – imagine an African villager walking into your neighborhood and telling you what you need to do to be healthy, to exercise and eat more vegetables. Would you listen to an outsider? We don’t even listen to our doctors, but we might listen to a friend.

Community based education has been shown to work. One example is Living Goods, an Avon style service that provides life-saving medicines, supplements, condoms, and more at a low cost. Education comes along with the products. The “Health Promoters” who sell the goods are members of the community so are much more likely to be trusted.

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