ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

A+| A| A-

From 'Farms to Pharmacies': Beginnings of a Sad Decline

The notion that a cocktail of synthetic nutrients, manufactured by pharmaceutical agencies, is required for a balanced intake is a completely mistaken one. A diet of cereals, pulses, legumes, fruits and vegetables can meet these micronutrient requirements.

From ‘Farms to Pharmacies’: Beginnings of a Sad Decline

The notion that a cocktail of synthetic nutrients, manufactured by pharmaceutical agencies, is required for a balanced intake is a completely mistaken one. A diet of cereals, pulses, legumes, fruits and vegetables can meet these micronutrient requirements.

C GOPALAN

N
utrition science provides indisputable evidence that the optimal nutritional status of populations can be achieved and maintained through a judicious combination of natural foods. The policy that India has always followed for promoting the nutritional well-being of its people has been to advocate balanced diets based on locally available and traditionally acceptable foods. The nutritive value of foods available in the country has been extensively researched and reported [Gopalan et al 2002]. Balanced diets based on combinations of such foods have been carefully worked out and widely publicised [National Institute of Nutrition 1999].

Foods contain macronutrients (carbohydrates, protein and fats), and also several micronutrients that are essential for nutritional well-being. Pharmaceutical agencies have manufactured synthetic forms of a few of these micronutrients, but recent studies have revealed that there are several scores of other phyto nutrients and antioxidants present in natural foods, which play an important part in promoting health and preventing disease. A balanced diet, containing pulses and legumes, fruits and vegetables, apart from cereals, can adequately meet these micronutrient requirements.

Blunderbuss Polypharmacy

The misleading impression is now being created that while wheat and rice could supply our food energy requirements, micronutrient requirements can be met by a cocktail of synthetic nutrients through a blunderbuss polypharmacy approach. In our major national nutrition programmes, which involve supplementary feeding, such as the mid-day meal programme, and in supplementary feeding programmes of the Integrated Child Development Services (ICDS), cocktails of such synthetic nutrients provided by “sprinklers” are sought to be introduced. There is resistance to the use of vegetables in the mid-day meal programme. In the present Indian context, the so-called “food fortification” is nothing more than a euphemism for the use of such “cocktails” and the promotion of pharmaceutical products as substitutes for foods.

No arbitrary cocktail of synthetic nutrients can be a substitute for a judicious combination of natural foods. As Potter (1992, 1996) has pointed out, “the safest public health strategy seems to be to advocate increased intake of intact plant foods with the multiplicity of the agents that they contain. It is less likely that any clone of malignant cells can survive the polypharmacy of plant foods.” In three publications, I have presented detailed arguments in favour of a food-based approach for ensuring the nutritional well-being of our people [Gopalan et al 2003, Gopalan 1998 and 2000].

Historical Evidence

There is no evidence of any major public health nutritional problem, apart from iodine-deficiency goitre and, to a certain extent, iron-deficiency anaemia, that is being solved by the use of pharmaceutical agents. A quick scan of once-rampant nutritional deficiency diseases will bear this out. For instance, beriberi, which used to be rampant in parts of India, was eliminated not through distribution of vitamin B1 tablets but by the sensible approach of under-milling rice. Pellagra, which was once rampant in the Deccan, was solved not by distribution of nicotinic acid tablets, but through avoidance of exclusive reliance on jowar (sorghum) as the staple food.

More importantly, keratomalacia as a public health problem was overcome not through use of the Massive Dose of Vitamin A Prophylaxis Programme. As the first to introduce this Vitamin A Programme more than 30 years ago at the National Institute of Nutrition, I can testify that this programme was a failure, and that the decline in incidence of keratomalacia was certainly not achieved by this muchtouted approach. It is regrettable that while the once widespread extreme forms of

Economic and Political Weekly September 1, 2007 vitamin A deficiency have largely disappeared, the Massive Dose of Vitamin A Prophylaxis approach is firmly entrenched in our public health policy!

Vitamin A is no doubt an important nutrient, but it is certainly not necessary to resort to Massive Doses of Vitamin A Prophylaxis in order to ensure adequate vitamin A intake. In normal conditions, carotenes and carotenoids can be derived from natural foods. It is only in clinical situations where the patient has vitamin A deficiency, that administration of vitamin A in recommended levels should find use. In our poor communities in which, apart from deficiency of vitamin A, deficiencies of zinc, vitamin D and calcium may also be expected to be present, repeated massive doses of vitamin A could actually aggravate zinc deficiency and impair bone health. This would, in turn, contribute to the perpetuation of the problem of stunting arising from retarded skeletal growth.

The benefits of the Massive Doses of Vitamin A Prophylaxis have not been evaluated. We have data only about the “coverage”. We have no evidence that children who are being subjected to repeated massive doses of vitamin A right from their ninth month onwards are really better off than those who are not subjected to this treatment. While we do know that Massive Doses of Vitamin A Prophylaxis indiscriminately used have resulted in fatalities, we do not have any evidence of concrete benefits accruing through this approach. Clearly, a review of the Massive Dose of Vitamin A Prophylaxis Programme, which is now being universally recommended for children from the ninth month onwards, extending upto six years, is necessary.

Place of Pharmaceutical Products

All this is not to deny the important role that pharmaceutical industries are now playing in combating diseases. Pharmaceutical products have a legitimate place in prevention and control of iodine deficiency; in treatment of anaemias and other nutritional deficiency diseases; in providing nutritional support to hospitalised patients and in the clinical management of several diseases. However, synthetic nutrients cannot be used as a substitute for natural foods in national supplementary feeding programmes. These programmes should not be looked upon just as relief operations, but as a means of educating the community in wholesome dietary practices so as to improve household diets; and they should be based on combination of natural foods.

India’s Past Record

India had been successfully resisting attempts at commercial exploitation of the undernutrition of its people. For instance, a suggestion to introduce fish protein concentrates as a solution to the problem of protein-calorie malnutrition was thwarted. The kwashiorkor problem was overcome through the use of local foods and not through fish protein concentrates being pushed by commercial firms from abroad. Efforts to introduce lysine fortification of wheat as a substitute for pulses and legumes were also successfully resisted, by clearly showing that lysine could be no substitute for pulses and legumes. Attempts to promote the intake of lactase tablets, on the basis of the argument that Indians suffer from lactose intolerance and therefore cannot tolerate milk, were also successfully resisted. A robust scientific community and an honest and efficient bureaucracy had helped to successfully resist these attempts.

Unfortunately, times have changed. The disarray in the farm sector; the relatively poor performance with regard to food production of even staple foods; the steep fall in the production of pulses and legumes; the failure to promote consumption of horticultural products as part of daily diets; the failure to arrest the ongoing loss of vegetables and fruits for lack of adequate means of preservation and their low consumption in households, have all contributed to the decline in our food/nutrition situation and the emergence of an unscientific, quick-fix, “drug-based approach” to bridge micronutrient shortfalls.

Even some sections of our scientific community seem to have fallen prey to the overall sense of defeatism. They seem to have lost hope of any revival on the agricultural front, and are looking for soft options and un-scientific shortcuts.

The Challenge

The battle is not lost. The current demoralisation among farmers will be overcome not through the tokenism of “relief” programmes, but through bold land reforms. Our agricultural scientists who did us proud in the past should recapture the élan of the exciting days of the Green Revolution. Soil productivity, which has been impaired by the techno logy of the Green Revolution, needs to be combated through a vigorous programme of soil replenishment. A forwardlooking food production programme, aimed at broadening the food base and reversing the sole reliance on just two cereals, must be vigorously promoted. The production of pulses and legumes, which has seriously declined, has to be encouraged. The ongoing loss of horticultural produce, because of lack of adequate methods of preservation and storage, has to be arrested. In an earlier publication, I had drawn attention to the need for nutrient orientation in India’s food production policies [Gopalan 2004].

This battle against malnutrition never ceases. New adversaries appear and need to be countered with new weaponry. Nutrition scientists should continue to update their knowledge with regard to the nutritive value of locally available foods, and should widely publicise appropriate balanced diets suitable for different regions of the country and for different seasons. Our food technologists should help to promote cottage-based industries for the preservation of horticultural produce and their conversion into ready-to-eat forms. It is only with such concerted and focused efforts from our scientists, and the commitment of a supportive administrative machinery, that the current unfavourable trends can be reversed and the earlier momentum of our food/nutrition movement restored.

EPW

Email: nfi@nic.in

References

Gopalan, C (1998): ‘Micronutrient Malnutrition in SAARC – The Need for a Food-based Approach’, NFI Bulletin, 19.

  • (2000): ‘Multiple Micronutrient Supplementation in Pregnancy’, NFI Bulletin, 21.
  • (2004): ‘India’s Food Production Policies – Need for Nutrition Orientation’, NFI Bulletin, 25.
  • Gopalan, C and B Tamber (2003): ‘Food-based Approaches to Prevent Micronutrient Malnutrition: Scientific Evidences and Policy Implications’, World Review of Nutrition and Dietetics, Vol 91.

    Gopalan, C, B V Shastri and S C Balasubramanian (2002): ‘Nutritive Value of Indian Foods’, Indian Council of Medical Research, National Institute of Nutrition, Hyderabad, India. Revised and updated by B S Narasinga Rao, YG Deosthale and K C Pant.

    National Institute of Nutrition (1999): ‘Dietary Guide lines for Indians – A Manual’, Indian Council of Medical Research, Hyderabad.

    Potter, J D (1992): ‘The Epidemiology of Diet and Cancer: Evidence of Human Maladaption’ in T E Moon and M S Mi-cozzi (eds), Nutrition and Cancer Prevention. Investigating the Role of Macronutrients, New York, Dekker, pp 55-84.

    – (1996): ‘Chemo Prevention: Pharmacology or Biology’, Oncology, 10:1487-488.

    Economic and Political Weekly September 1, 2007

    To read the full text Login

    Get instant access

    New 3 Month Subscription
    to Digital Archives at

    ₹826for India

    $50for overseas users

    Comments

    (-) Hide

    EPW looks forward to your comments. Please note that comments are moderated as per our comments policy. They may take some time to appear. A comment, if suitable, may be selected for publication in the Letters pages of EPW.

    Back to Top