Unlocking the hidden hunger crisis with effective nutrition

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 infections take hold. World Food ProgramWorld Food Program

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 infections take hold. World Food Program

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• Malnutrition is rampant throughout the world, with devastating impact on the global economy.

• The terms Nutrition and A Balanced Diet are bandied about with little understanding, while many communities are experiencing health problems not seen by their grandparents who, in many cases, lived in greater poverty.

• Science has done little to provide solutions to this problem. The malnourished are being fed highly refined foods with added highly refined vitamins and minerals. Highly refined means that most of the goodness has been removed. These foods are not the natural foods our bodies are designed to use, and they don’t work.

• The human body requires daily amounts of nutrients, including vitamins and minerals, from the food we eat. Obtaining these nutrients, in the right form, is beyond the capability of most people.

• People have moved away from their traditional foods, while modern agricultural practices and food processing remove essential nutrients from the food chain.

• In consequence, we can no longer rely on a balanced diet to deliver the nutrients our bodies require.

• The continued fortification of depleted food with a mixture of chemical isolates cannot address the issue of Hidden Hunger. Filling bellies and improving the Body Mass Index of children has nothing to do with nutrient repleteness.

The Crisis The Problem

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Current Solutions are not WorkingA Balanced DietThis is the traditional medical approach, but it ignores the reality that:• Most underdeveloped communities do not

have access to a balanced diet.• Where they do, they often cannot afford it.• When they can afford it, due to ignorance,

they usually do not choose it.• When they can afford and choose it, the

food is often depleted, so malnutrition persists.

Food Security This is the approach of the World Food Program.• Grain is grown on depleted soils and

harvests are deficient in vital trace minerals.

• The milling process results in the loss of fibre, vitamins, minerals and omega fats, due to the removal of the husk, membrane and germ. This removed goodness is usually sold as animal feed.

• Such food intervention is limited in its ability to strengthen the immune system.

Products containing micronutrients in an inorganic form cannot address daily nutritional needs• Isolates and food nutrients have different

structures, use different metabolic pathways and function differently in the body.

• The body needs these micronutrients as food or in a food form.

• Isolating nutrients and trying to get benefits equal to those of whole foods reveals an ignorance of how nutrition works in the body.

Body Mass Index (BMI)It is not sensible to use BMI to assess nutritional status.• Improvement in BMI can be achieved by

merely feeding high levels of carbohydrate and fat.

• Success does not even require the addition of cheap micronutrients that lack bio-efficacy.

• We see confirmation of this, not only in Africa, but in the USA and the UK, where there is a high prevalence of obesity in people eating refined, sterile food.

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Nutrient Rich Soil

Soils farmed responsibly are rich in bio-available nutrients. These are incorporated and make their way into the food chain.

Modern farming practices leave the soil depleted of nutrients. The resulting crops enter the food chain with insufficient vitamins & minerals

Nutrient Depleted Soil

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The Refining Process Further Reduces the Nutrient Content

Vital parts of the whole grain that contain fibre, vitamins, minerals & omega fats are discarded.

Refinery

Nutrients

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Food Fortification• Where there is awareness of

nutrient depletion, it is usually corrected by the addition of isolated chemical nutrients.

• In South Africa, the five most eaten foods are refined white maize and sugar, tea, milk and brown bread.

• Many children are seriously deficient in iron, zinc and Vitamin A.

• In response to these findings of the National Food Consumption Survey (2000), the Department of Health introduced mandatory food fortification of all maize and wheat flour from 2003.

• A repeat survey in 2005 showed no improvement, despite widespread use of these fortified foods. Why is this?

• The electrolytic iron has a bioavailability of less than 2%.

• Phytates in maize further reduce this.

• Inorganic iron and inorganic zinc compete for absorption.

• Electrolytic iron oxidises the vitamin A.

• Vitamins are denatured and destroyed by cooking.

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The Standard Approach The Best Approach

Chemical Micronutrients

Refined Grain

Little absorption of Vitamins &

Minerals

Bio-available Nutrients

Whole Grain

GutGutBloodBlood

GutGutBloodBlood

Good absorption of Vitamins & Minerals

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In Africa, we support e’Pap, a pre-cooked, whole grain food, based on maize and fortified with soya and a cocktail of 28 nutrients. e’Pap is produced in Africa where it’s composition and brand name are suited to Africa's taste and tradition. The formulation is based on a local understanding of nutritional need, and uses state of the art, first world fortification chemistry to ensure bio-availability and bio-efficacy.

The Solution We need whole foods with bio-available vitamins and minerals.

Where access to fruit and vegetables is limited, whole grain cereals need to be fortified

This is achievable, affordable, and it works!

It costs less than £2 per month to provide a vulnerable child or a TB patient with a daily nutritious meal.

supports

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Before After

The 3 Month e’Pap Effect

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• Plumpy’nut is promoted and marketed across Africa as a major breakthrough in the fight against malnutrition.o It was designed to be used for a

maximum of 2 to 3 weeks in cases of severe acute malnutrition.

o This is appropriate, but is not the reality on the ground, and therein lies the problem.

• For ongoing supplementary feeding, it is HETN’s contention that:o The high level of protein in Plumpy’nut

is not appropriate.o The milk powder base can cause

diarrhoea in the many who have lactase deficiency.

o The high level of oil and refined sugar (30%) would make such a product unacceptable in the UK.

o The high cost of the components makes it unaffordable, and therefore unsustainable in the African context, without donor funding.

• Plumpy’nut uses a micronutrient cocktail of chemical isolates. These are not effectively absorbed into the body and have little impact in addressing the nutritional needs of the malnourished. For example:o The recommended daily intake of

Plumpy’nut contains 13mg of inorganic iron with a bio-availability of about 0.26mg (2%).

o Where inorganic iron is combined with inorganic zinc, some 60% of the iron is blocked. This further reduces the absorbed iron to about 0.1mg.

o A healthy child requires 1mg per day of absorbed iron and, if malnourished or sick, could need 2mg.

o So, how can Plumpy’nut ever address iron deficiency when it delivers less than 10% of a child's daily needs?

HETN has Concerns about Plumpy’nut for Long Term Use

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• HETN is a Charitable Foundation, registered in the UK.

• Our goal is to address nutrient depletion, believing this to be crucial in health, education and social upliftment programmes.

• HETN’s approach is based on numerous scientific trials that demonstrate the importance of micronutrients in the prevention and management of chronic disease.

• Our projects have a single aim - to ensure that the recipients of feeding programmes receive a daily food portion that includes all the required micronutrients in a bio-available form.

How We Succeed• By partnering with NGOs in the field, to

ensure that their nutritional interventions are appropriate and cost effective.o Society of St Vincent de Paul (SSVP) -

Crèche Feeding

o South African National Tuberculosis Association (SANTA) - Community Based TB Support

o World Vision South Africa (WVSA) - Orphans & Vulnerable Children

• By providing wholegrain food, with all the cereal fats, fibres, vitamins and minerals intact, and with the addition of all the required micronutrients in a form that is bio-available (chelates or food form).o By comparing different formulations

and measuring outcomes, with the aim of increasing the evidence base that supports nutritional interventions in the management of chronic disease.

• Our projects are already benefiting several thousand people in South Africa.

• Excellent nutrition overcomes Hidden Hunger and improves immune function, reducing the impact of infectious diseases, such as TB, Malaria and HIV.

Health Empowerment Through Nutrition (HETN)

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Our most valuable asset is our staff. With this in mind, in 2003 we initiated Positive Health across the group. This programme is built around natural vitamins and minerals, affordable foodstuffs and the power of positive thinking. It is geared at preventive health care and improving the health of people living with chronic disease.

e’Pap is an important part of this initiative.

Not just another cereal, e'Pap is a nutritious and affordable meal-in-one, enjoyed by our staff at more than 45 safari camps and lodges. Positive Health champions from each lodge educate the local communities on the many benefits of this remarkable product.

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The e'Pap intervention with 70 of our employees cost the company R3 500 (£250) per month. By the third month, the cost saving to the company in reduced absenteeism and improved productivity was R34 000 (£2 430).

e’Pap Changes Lives

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• When e'Pap was introduced, no one believed that it would save lives. But we have seen miracles.

• Lenasia is surrounded by poverty-stricken places. When everyone was losing hope, this miracle pap came to save lives. We have 160 beneficiaries. 12 were bed-ridden, but today they have the power to cook and tell stories to their children. I used to cry and wonder why people should be so sick. Today, I walk with a smile and a song in my heart, because I have witnessed the dead brought back to life.

• Today, the volunteers at Odi walk, smiling and singing, because each day another patient wakes up from their death bed. We have 250 benefiting from e'Pap. 19 patients got up from their beds and walked again. When they see me bringing e'Pap, they cry and call their children, and then I know that nutrition is the most powerful medication on earth.

• People who live in poor circumstances at the Johannesburg branch get their daily nutrition through e'Pap. It has saved lives. Most can now feed their families by working. Their immunity is boosted and they respond positively to medication. Most are up and about, and their lives are now back to normal.

• At Etwatwa, some patients live in squatter camps, where their health is at risk. Now, most families are getting their daily nutrition from e'Pap. It gives them strength, children are concentrating in class, there is a better response to treatment and their skin has improved. We have seen e'Pap changing lives.

• Atteridgeville is surrounded by squatter camps. On my first day, with 3 students, we just walked by silently and powerlessly, our eyes filled with tears. Bread winners had taken to their beds. When the miracle e'Pap was introduced, most families were back on their feet. They gained weight, and grew from strength to strength. Children now participate fully at school. Now we cry tears of joy.

• e`Pap changes lives. Hamanskraal is a rural area, where you see malnourished people everyday. Their lives have now changed. Patients are back on their feet. There are uncontrollable smiles on the faces of the volunteers, who have witnessed the power within the sachet. They sing and praise e`Pap as it works its miracles in their villages, proud that bedridden patients have got up from their death beds and returned to life. The patients gain weight and respond posit ively to medication. The children can concentrate at school. They now call the SANTA provincial coordinator wa e`Pap (e`Pap man).

South African National Tuberculosis Association (SANTA)Feedback from Care Workers

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!10 March 2009

Health Empowerment Through Nutrition Graham House, Chequers CloseMalvern WR14 1GP

Dear Geoff

On behalf of the South African National Tuberculosis Association, I would like to express our appreciation of the partnership enjoyed with HETN in the distribution of e’Pap to tuberculosis patients and related health care workers. The pilot project of 2 tons of e’Pap per month that we are distributing in various districts of Gauteng and North West Province is proving highly successful, as evidenced by the progress reports from these areas. Of significance, and probably understandably, the greatest impact is being seen on very ill / bedridden patients. In these cases the improved nutrition is having a rapid and significant impact. I suspect this is because their natural resilience is rising from virtually nothing to a level that enables the TB drugs to function effectively.

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Obviously personal feelings of wellbeing will also rise with food able to make them feel more replete. Similar reports of recipients growing stronger and more energized relate to those who are not quite as ill. Starting from a higher ‘base’, these results can take longer to become apparent and might even be ascribed to the TB disease becoming less virulent.

Other reports from recipients have indicated that the e’Pap being provided is far more beneficial than supposed enriched foods received before. This is a credit to the methodology and formulation of the product, which is certainly starting to achieve a major footprint in Africa.

Whatever the reasons, these e’Pap projects have proved most valuable and are well received. Their continuation and expansion is seen as one of the three major objectives of SANTA in the continuing fight against TB and HIV/AIDS, namely Nutrition, Awareness and Directly Observed Therapy (DOTS). We hope and believe that by actively extending these three activities SANTA can and will make a significant impact on the TB pandemic in South Africa.

We look forward to the possibility of extending our partnership and close relationship with HETN.

Yours sincerelyJohn HeinrichCEO - SANTA

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P O Box 51432Raedene

2124Gauteng

23 March 2009

Health Empowerment Through Nutrition Graham House, Chequers CloseMalvern WR14 1GP

Dear Geoff

On behalf of the Society of Saint Vincent De Paul Maryvale Conference we would like to offer our sincere thanks for the donations of e’Pap we have received from you and, more particularly, our appreciation for the partnership we have with HETN to distribute food to the crèches and the terminally ill whom we help from our Kholofelo Ya Josefa Centre in the township.

The current project of 2 tons of e’Pap per month that we are distributing is feeding twenty crèches with a total of 1800 children. The success of the feeding scheme is self evident - children who were lethargic and constantly tired are now full of energy, highly active and much more receptive to their teachers. The overall improvement in their early childhood development is astonishing as daily intake is only one 50 gram portion of nutritionally enhanced e’Pap.

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We have seen a significant improvement in general health and in concentration. The children previously had a bland diet - mainly mealie meal - with little or no nutritional value.

The success of the project is obvious from the requests we are getting from other crèches currently not receiving e’Pap who all want to become a part of it and get the obvious benefits for the children in their care. The benefits to the township as a whole from the creation of a healthy generation cannot be overemphasized.

Of equal benefit is the tremendous improvement in the health and quality of life of the terminally ill and bedridden patients whom we assist with our home based care service in the township. Our clients who were previously without hope and suffering from AIDS, cancer or TB now have much improved resistance and are able to function within their family groups.

There is growing evidence that the e’Pap being provided is a lot better than other food supplements that have been tried and by word of mouth the benefits of ‘ePap in the diet is getting around Alexandra.

We are grateful and proud to be able to assist HETN in this highly successful project and look forward to continuing our work with you and hopefully extending our partnership even further.

Yours sincerely

Patrick Lorentz - President SSVP Maryvale

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Health Empowerment Through NutritionGraham HouseChequers CloseMalvernWR14 1GPUnited Kingdom Phone: (+44) 1684 580 893email: info@hetn.org

A UK Charitable Foundation (1116097)

www.hetn.org

It is HETN’s role to establish a credible evidence base for appropriate intervention.

It is not HETN’s task to feed the hungry. That is the responsibility of Governments and International Agencies.

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