We are all sadly familiar with the images of emaciated children in the developing world with swollen bellies ironically distended by a lack of food. This is type A malnutrition and is caused by a combined lack of nutrients and calories. The UK Food Ethics Council estimates that nearly a billion people globally are suffering with this type of malnutrition and that a fifth of these are children under five.
However, examples of people suffering with what has come to be known as dysnutrition or type B malnutrition are to be found in every street, shopping centre and office throughout the developed world. The signs are possibly less obvious but in a sense no less devastating.
So what is type B malnutrition?
In a nutshell, type B malnutrition is caused by adequate or excessive calorie intake of nutrient deficient foods so that people suffering with this type of malnutrition manifest all sorts of chronic and degenerative diseases that are fundamentally deficiency diseases.
Many now consume a diet of 'empty calories' primarily incorporating refined foods, sugar, fat and alcohol. Experts maintain that as a consequence while many in the developed world have overt signs of clinical malnutrition, all of us are suffering with some degree of subclinical malnutrition. Half of all people being admitted to hospital in the UK are found to be malnourished and approximately one-third of the population are believed to be suffering with the effects of type B malnutrition according to the British Association for Applied Nutrition.
We are starving in the midst of plenty.
"Dysnutrition is prevalent."
World Health Organisation, 2008
"Nearly the entire U.S. population consumes a diet that is not on par with recommendations. This adds to the rather disturbing picture that is emerging of a nation’s diet in crisis."
S M Krebs-Smith, Journal of Nutrition, 2010
Malnutrition and reduced consumption
A part of the problem is that, counter-intuitively, we are not eating enough. We are currently eating less than any of our ancestors, but we are also considerably less active courtesy of the conveniences of modern life. This means that we are simply not consuming enough food to obtain the nutrients we require to function in good health. And in spite of the fact that our bodies have not significantly changed, compared to our Stone Age ancestors we are estimated to consume 75% less flavonoids, 50-60% less vitamin C and omega 3, 95% less methyl groups and 40% less carotenoids.
In the 40 years from 1940 to 1980 the number of calories burnt each day dropped on average from 2,700 calories a day to 2,000 calories a day according to the US National Institute of Health and National Center for Health Statistics (2003 and 2440 respectively). This is due to less physical labour, automobiles and other forms of transport and a host of labour saving devices.
And whilst appetite and consumption have also decreased over this time, this has not kept pace with the drop in calorie expenditure such that in 1980 we consumed on average 2,350 calories a day. This leaves us with a calorific surplus of 350 calories a day. Since a pound of body fat (0.45 kilos) represents overconsumption of 3,500 calories this means that in just 10 days the average person will gain one pound in weight, which is 36 lb (16 kilos) a year!
Malnutrition and poor food choices
Processed foods which were first introduced in the 1920s became became popular in the 1950s and have become increasingly dominant ever since. Compared to the diet our great-grandparents ate who predated this change we consume more refined carbohydrates, processed food, salt and alcohol and eat less fruit, vegetables, pulses, oily fish, whole grains and fibre.
In the 50 years from 1950 the world consumption of calories from complex carbohydrates and fresh vegetables has fallen by 38% and 24% respectively and those derived from meat, vegetable oil, and sugars and refined carbohydrates has increased by 36%, 46% and 35% respectively.
Added to which in just the last 50 years, the nutritional content of foods has fallen dramatically and nutrients such as phospholipids, selenium, prebiotic fibre, sterol, calcium and copper are all estimated to have fallen by at least 50%.
The average person is now not meeting the requirements for many nutrients and has an intake of vitamin D and selenium that is only about half of the RDA (Reference Daily Allowance). In turn the RDA only represents levels below which deficiency symptoms occur and so should be regarded as a minimal, not an optimal figure.
The food preferences of most teenagers mean that they tend to live on a diet consisting primarily of bread, savoury snacks, potatoes in all their various guises, biscuits (cookies), and chocolate confectionary. Less than half of teenagers eat 5 portions of fruit and vegetables a day and approximately one-quarter eat no fruit a day. One in seven teenage girls is already on a diet.
This means that according the National Diet and Nutrition Survey 2000:
93% all teenage girls fall below recommended nutritional intake for iron and 48% fall below the lowest levels recommended
70% teenagers fall below recommended intake of vitamin A and 12% are below the lowest recommended intake and
72% of all teenage girls fall below recommended intake of zinc and 10% are below lowest recommended intake.
In addition, only approximately half of preteen children now meet the minimum guideline of an hour of moderate activity a day and in teenagers that figure rises to two-thirds.
Having established these shaky foundations, type B malnutrition also tends to worsen with age for a variety of reasons including the fact that the elderly may become less active, be living on an institutional diet, be unable to afford fresh foods, have lost their appetite or sense of taste and may have difficulty chewing. The elderly tend to subsist on a diet primarily consisting of hot drinks, potatoes, white bread, biscuits (cookies), cakes and buns.
The other problem created by this diet is that these high calorie highly refined foods do not satiate and create blood sugar fluctuations that provoke passive overeating and lead to type II diabetes.
A lack of nutrients means that there is a decreased in tissue repair throughout the body leading to diseases such as osteoporosis and cardiovascular disease. Protective factors are also depleted such that there are an increasing number of mutations creating cancerous cells which are not disabled and can establish and spread. Cancer has now become a major cause of death in the developed world.
The generational effects of malnutrition
According to recent reports, some parents and especially young parents have no idea what to feed their babies and have been weaning their infants on pureed junk food. Babies are reported to have been given crisps (potato chips), chocolate (candy), fizzy drinks and pureed chips with milk. As a result obesity clinics in the UK are reporting seeing one year old babies who are twice the normal weight.
And whilst some may consider this baby weight that will later come off all evidence suggests that this is not the case. The chances are that these infants will continue being overweight and one in three children in the UK aged 11 are now classified as being obese.
These early years programme the fat cells and also set up eating habits and taste preferences that inform the tastes of the individual for life. It is also now thought that the lifestyle of the parents prior to conception and during pregnancy may have pre-programmed the foetus in the womb for the life it is likely to encounter.
As a result children as young as 6 have been reported as suffering from strokes and the other chronic and degenerative diseases that do not normally appear until much later in life. In the UK 400 children under the age of 5 are being treated at specialist clinics for clinical obesity and 40 babies under the age of 1 have been admitted to hospital for obesity-related problems. However, this is probably the tip of the iceberg and the true level of this problem is going undocumented.
We are, in short, digging our own graves and those of our children with our knives and forks at every mealtime.
The cost of malnutrition
Quite apart from the personal suffering and misery of blighted lives there are also the massively rising health costs.
The cost of treating malnutrition in the UK in all its forms is estimated by the British Society of Parenteral and Enteral Nutrition (BAPEN) to be around £7.3 billion ($12 billion) per annum - twice the cost of treating obesity.
Total US healthcare costs have risen from $16 billion (£10 billion) in 1960 to $1 trillion (£617 billion) in 1994 and in the UK from £1 billion ($1.6 billion) in 1960 to £46 billion ($75 billion) in 1994. As a percentage of gross domestic product (GDP) costs have nearly doubled in the UK and nearly trebled in the US (WHO 2000).
There are currently 2.6 million diagnosed type II diabetics in the UK and treatment costs £9 billion ($15 billion) accounting for 10% of NHS costs. There are estimated to be another 500,000 undiagnosed diabetics and these figures are predicted to double by 2020 to 6 million. One quarter of all adults are expected to be diabetic within 10 years when treatment of diabetes alone will increase NHS costs by 50%.
The incidence of asthma has increased 250% in the last 20 years and since the 1950s we have seen dementias, hypertension, cancer, osteoporosis and ADD/ADHD all increase dramatically. These changes cannot be genetic and must be environmental and our disastrous concept of what constitutes a 'normal diet' is definitely in the docks. We are collectively putting the wrong fuel in our tanks and the evidence is everywhere hidden in plain sight.