Nutrients for All: Bioavailability, Food Fortification, and Insecurity
Good nutrition is about bioavailability.
It’s estimated that 35% of the global burden of disease could be eradicated by good nutrition. Despite food fortification initiatives and food aid, malnutrition remains an urgent problem worldwide, causing half of all child deaths, aggravating HIV and TB epidemics, and costing nations billions of dollars in health expenditures and lost human productivity.
What are the economic costs of poor nutrition? Here are a few numbers:
India: $10-$28 billion per year, or 3-9% of GDP
Guatemala: $3.1 billion per year, or 11% of GDP
Europe: 60 billion euros per year lost to poor nutrition, excluding obesity
USA: Overweight and obesity costs estimated at $147 billion per year.
There’s no magic bullet for poor nutrition. Case in point: South Africa. In 2004, the South African government launched a nationwide program to fortify corn and wheat flour with iron, zinc, vitamin A, B vitamins, and folic acid. While the program had some success in reducing neonatal deaths, malnutrition in children actually increased after 5 years. The painfully clear lesson: Not all forms of micronutrient supplementation are made equal.
Good nutrition is complex, because micronutrients (e.g. vitamins, minerals, and antioxidants) must be in bioavailable forms in order for the human body to absorb and benefit from them. Micronutrient supplements that are added back into food have been chemically isolated, and while some isolates are readily bioavailable (e.g. folic acid), many others are not. Iron and Vitamin A—two principle micronutrients that many malnourished people lack—are often poorly bioavailable as isolates.
The way food is stored and processed also directly affects levels of bioavailable micronutrients. Many micronutrients are at their highest levels in fresh produce but begin to degrade rapidly after harvest. Some forms of processing increase bioavailability. Freezing and canning help preserve Vitamin C in fruits and vegetables. And when tomatoes are processed into sauce, more lycopene becomes available to the human body. Cooking, soaking, and fermentation methods can also make micronutrients more bioavailable.
Other types of processing result in the loss of micronutrients. Stripping whole wheat of its bran and germ and milling it into white wheat flour removes many of the grain’s vitamins, minerals, and phytochemicals. Many convenience foods are ultra-processed, providing starchy or sugary calories with little nutritional value. They may have had micronutrients added back in after processing, but as South Africa demonstrated, food fortification alone isn’t wholly adequate to provide good nutrition.
How can we make nutrient-rich food available for all? Eradicating poverty, educating and marketing to the public, using nutrient-enhancing agricultural and food processing practices, and making nutrient-rich food affordable and readily available are critical steps. But the first step may be a simple shift in perspective--many experts are now focusing on the problem of nutrient insecurity and its relation to health, rather than hunger alone.
So what's being done on the ground to make "nutrients for all" a reality?
Basil Krandorff, an Ashoka Fellow, began initiating this shift while working with aid organizations in South Africa, where 70% of the population is infected with tuberculosis, and 80% of these patients are co-infected with HIV. Krandorff discovered a need for truly nutritious food for patients with chronic disease. Highly nutritious diets rich in bioavailable micronutrients (e.g. vitamins, minerals, and antioxidants) are critical for the recovery of HIV and TB patients. Not only do micronutrients strengthen compromised immune systems, but they also help patients absorb strong medications, thus preventing recurring illness and the emergence of drug resistant infections.
Unfortunately, much of the food aid sent to countries in need are cheaply fortified and lacking in crucial bioavailable micronutrients. Krandorff developed e’Pap, a locally produced nutritional supplement in the form of a modified version of a staple Southern African porridge called ‘pap’. Based on the latest science on bioavailable micronutrients, e’Pap contains precooked whole grains and the recommended daily allowance of 28 important micronutrients, in a bioavailable form. According to the South African Tuberculosis Association (SANTA), TB cure rates in patients have risen by 39% because of e’Pap.
Is nutrient-rich food accessible in your part of the world? What steps are needed to make your local food system more nutrient-secure? Share your thoughts with us below! And don’t forget to tune into the Nutrients for All Google+ Hangout today, March 14th from 11-11:30am EST , where experts will continue the discussion on food, nutrient security, and human vitality.