‘The Career of Hunger: Critical Reflections on the History of Nutrition Science and Policy’
- indianutritionz
- Feb 4, 2024
- 11 min read
Image courtesy: Indianexpress.com
Dr Veena Shatrugna, retired Deputy Director, National Institute of Nutrition (NIN) has written a two part series published in Infochange. This link no longer exists. The two articles are available on Ahara Namma Hakku blogsite.
These articles are excerpted from ‘The Career of Hunger: Critical Reflections on the History of Nutrition Science and Policy’, by Veena Shatrugna, in Towards a Critical Medical Practice: Reflections on the Dilemmas of Medical Culture Today. Orient Blackswan; 2010. Reprinted with permission of the author and editors
In this part, Dr. Veena Shatrugna explains how nutrition research in 1920-30 ‘extracted’ about 10-15 nutrients (carbohydrates, proteins, fats, vitamins etc.) out of nearly 900 foods.
She says “By 1950, Indian scientists were estimating people’s requirements based on their own largely vegetarian diets, prioritising cost and recommending a diet of cereal for the nation and excluding animal protein. This exclusively cereal diet underlies the profile of malnutrition and disease today.”
Because of rapid advances in analytical techniques in the late 19th and early 20th century, foods such as grains, milk, pulses, vegetables, meats, fish, nuts etc. began to be classified as rich in one or the other nutrient. By 1937, more than 300 foods had been analysed and categorised (Health Bulletin No 23, 1st edition). The lead author of this bulletin, Dr W R Aykroyd is the director of Nutrition Research Laboratories, Coonoor, under the Nutrition Research Fund Association of the Government of India.
The objective of this Bulletin was to summarise nutrition information that would help administrators, doctors and others to work with the concept of balanced diets and estimate nutrient requirements. However the focus was primarily on calories in relation to work – the relationship between food requirements of workers and the intensity of work. If the allowance for a sedentary worker is 2400 calories, then this can be met even with cheap energy foods like cereals.
The Bulletin recognises that cereals provide bulk, provide satiety and are the staple diet of Indians, but it also recognises the importance of animal proteins and “expresses the doubt that perhaps no combination of vegetable proteins is adequate for healthy development”. The League of Nations report had already argued in favour of the higher biological value of animal protein. The Bulletin had asserted that growing children and pregnant and lactating mothers need more protein and that “calculations of cheap balanced diets must include adequate quantities of protein." This aspect was ignored in the following decades. The Bulletin, recognising that many poor people have ill-balanced diets because they cannot afford milk and other flesh foods, advocates milk for children, replacement of milled rice with parboiled rice and the addition of oil or ghee to the children’s diet.
Based on these principles, an officially recommended diet was formulated stressing on “essential nutrition through the non-cereal portion of the diet” and recognising “the importance of proteins for growth in children, for mothers during pregnancy, and for the replacement of tissue wear-and-tear in adults”
They specifically caution that “proteins derived from vegetable foods had less value for the body than proteins derived from animal foods.”
This has of course been ignored as can be seen with most of the food related interventions.
Eggs and milk protein were set as the standard of high biological value (BV) of over 90. The BV of pulses was around 60 and that of cereals falls between 60 and 70. The 1944 report also reiterated the importance of protein from animal sources.In order to ensure adequate protein intake, the group tried to include milk, fish, meat and eggs, in addition to vegetables and fruit. The crucial element in this report is an insistence on 10 oz (280 ml) of milk, hoping to double the recommendation to 20 oz as soon as possible.
Reducing food to numbers and calculations divorced it from the daily lives of people. Since calories gained centre stage in these calculations, cheaper foods became the norm, irrespective of their other nutritional value.
In the search for “low-cost vegetable sources of proteins that were nutritionally as useful as milk proteins, the biological values of a large number of foods were calculated.”
“In the late-1930s, ’40s and ’50s, experiments were carried out on children from economically backward communities where one group was given milk powder (1 oz providing 10 gm of protein) and the control groups received an extra helping of the usual rice and vegetables. It was found that children given milk had significant increases in height and weight when compared to the control group (Aykroyd and Krishnan 1937; Someshwar Rao, 1961). A daily addition of 1 oz of skimmed milk powder proved to be a valuable supplement to cereal-based diets.”
“Aykroyd and Krishnan (1937) too had investigated the value of cheaper foods like cooked soya beans, and found it inferior to skimmed milk. This failure of soya was ascribed to the low biological value of soya proteins, and all studies on soya were terminated. Meanwhile, with advances in technology, processed milk from various oilseeds, pulses and vegetable products was also tried.”
“In 1955, a special report on milk substitutes of vegetable origin was published by the Indian Council of Medical Research (ICMR, 1955). This report reviews all the studies using milk made from various vegetarian products such as soya, groundnut, pulses, from mixed plant products, and concludes that such processed milk should only be used in regions where it has been found difficult to rear mulch cattle, as in Assam and the Western Ghats. They however do not comment on the additional cost of such processing.”
“By 1955 it was clear that whatever the sources of vegetable proteins, when they were compared to milk protein in trials feeding sick or undernourished children, it was obvious that milk protein was far superior.” These conclusive findings notwithstanding, the search for cheap, and preferably vegetarian, solutions to the country’s state of undernutrition continue.
A paper titled ‘Treatment of Nutritional Oedema Syndrome (Kwashiorkor) With Vegetable Protein’ (Venkatachalam et al, 1956) argued that though skim milk protein may be unsurpassed in its biological value in treatment of Kwashiorkor, underdeveloped countries could not use it as a basis for large-scale solutions. It conducted an experiment comparing skim milk protein and other vegetarian substitutes.
The results of this study clearly pointed to the superior efficacy of the skim milk protein when evaluated by the two biochemical criteria adopted for assessing satisfactory recovery: the rise in serum proteins and albumin. In spite of this, the authors concluded, “the ‘slight inferiority’ of vegetable proteins should not obscure the fact that remarkable clinical improvement almost as striking as with skim milk was noticeable in cases treated with these diets”. They further state that, “the real importance of this study would lie in that it has revealed such satisfactory therapeutic possibilities with cheap vegetable protein diet in this disease,” (Venkatachalam et al, 1956:544).
“This was the first major attempt to wean the nutritionists away from advocating milk for poor, sick undernourished children, and justifying inferior quality foods, thus shrinking and redefining the range of foods for the children of the poor in India.”
A revised and updated publication in 1968 confidently states: “In devising cheap well-balanced diets in India, economic considerations often preclude the inclusion of milk or other animal foods in adequate amounts… A judicious mixture of vegetable foods like cereals and pulses can be cheap and at the same time can provide nearly as good an amino acid pattern as that of the costly animal food,” (Gopalan, 1968:6-7).
This balanced diet was separated for the vegetarian and non-vegetarian groups and the latter were given an allowance of 45 gm of pulses and 100 gm of milk with added 30 gm of meat or fish and 30 gm of eggs.
Another committee to revise the recommended dietary allowances was set up in 1978 (ICMR, 1980). The preface states: “The most important change has been with regard to suggested balanced diets… (which) have been formulated using linear programming techniques to arrive at the least-cost formulations.” This diet is based on cereals as the major source of calories and proteins, with reduced milk and no separate diet provided for non-vegetarians. It does not recommend fruits, flesh foods, eggs, nuts and oilseeds… in the name of economy.
Dr. Veena Shatrugna argues that “in hindsight, it is difficult not to be critical about this eradication of flesh foods from normative diets, in spite of their proven superior efficacy as proteins for the body. The entire debate on RDA is directed at finding the theoretically adequate but most economical solution to a difficult problem. However, the specific governmental solution arrived at clearly draws on a culture of vegetarianism common to the planners who thought on behalf of the nation. Food options and crucial dietary diversity for the majority of poor, dalits, BC, tribals, minorities, etc, in fact for 80-85% of the population, had been closed in the structure of plan thinking. Thus, it was enough to provide for distribution of cereals with little scientific consideration about what these cereals were eaten with.”
In 1988, RDA was revised with specific focus on energy, fats and other trace elements and occupation was classified based on nature of work and intensity (ICMR, 1990). This least cost recommendation, devoid of flesh foods, fruits, nuts eggs etc. was opposed by trade unions, hostels etc.
She says “The amount of milk recommended for children was not more than 300 ml, and as in the case of adults no recommendations were made for eggs, fish, flesh foods, oilseeds and fruits. The children were expected to eat an adult diet in quantities proportionate to their age. There was minimal allowance of milk (proteins) for their growth, though the actual consumption of milk in all the surveys is less than 100 ml. If children have managed to grow to their present heights, it is clear that they do so despite the RDA that the government has declared is adequate for them.”
By advocating for vegetable proteins in the form of cereal to pulse ratios, the importance of animal/milk proteins was minimised, thus ‘endorsing vegetarianism for the poor’ and pushing the country into a ‘cereal trap’.
In the late 60s, there was food shortage and famine like situation in India leading to pressure from the West to accept food aid, specially milk powder for starving children. In response, the Nutrition Research Laboratories published a report which concluded that pre-school children had a calorie deficit and that “if the children consume the same type of diets on which they have been subsisting, in amounts sufficient to satisfy their calorie needs, the problem of protein calorie malnutrition would be greatly minimised. It is clear by the same token that provisions of protein concentrates in the face of existing calorie deficiency would perhaps be a wasteful approach towards solving this problem in these children,” (Gopalan, 1970:36). They however suggest that supplements of Vitamin A and iron are essential.
Calculating that each 100 gm of cereal contained 6-8% protein, a largely cereal based diet with inadequate or virtually no pulses, milk, eggs or meat was recommended. So to get the required 25-30 gm protein, children were expected to eat 300-400 gm of cereal !! The fact that children cannot consume such large amounts was ignored. 1 gm cooked cereal provides 0.5 -1 calorie whereas 1 gm fat provides 9 calories.
“The giants of nutrition research who computed the most economic options could not see that at least 30-40% of children’s calorie requirement must be derived from fat.”
Shatrugna Veena (2012) The career of hunger: Critical reflections on the history of nutrition science and policy-Part 1. Infochange. Republished in https://aharanammahakku.home.blog/2019/02/11/the-career-of-hunger-critical-reflections-on-the-history-of-nutrition-science-and-policy-part-1/ [Last accessed on 4th February 2024]
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Dr. Veena Shatrugna
Dr. Veena Shatrugna explains in detail how the focus on cheap sources of calories was responsible for the “shamefully low poverty line, a minimum wage to meet these low dietary requirements, a public distribution system limited to cereals, and high-input monoculture to produce these cereals.” She attributes the ‘undernutrition and catastrophic health profiles of Indians today’ to these policy decisions and that micronutrient programmes are the natural extension of this policy.
The assumption that ‘adequate calories are the solution to the country’s food problem’ ‘despite the fact that the foods eaten across the length and breadth of India consisted of vegetables, fruit, greens, wild berries, roots, tubers and leaves, mushrooms, eggs, lamb, pork, beef, birds, insects, fish, frog, small jungle animals like rabbits, snails and tortoises and many such sources’ reflected on the fact that those who based their calculations in this had ‘no experience or understanding of the quality of life and culture among the marginalised.’ It affected the calculation of the poverty line, minimum wages etc.
This emphasis of RDA based on cheap sources of calories fed into the large scale investment into the Green Revolution. Dr. Veena categorically states “It is my argument that this dietary monoculture that has been fostered and inculcated as the single and only choice by government policy has been instrumental in producing undernutrition and, as its consequence, the catastrophic health profiles we see today.”
While scientists continued to argue that the main issue was calorie deficiency, the extent of malnutrition had reached unacceptable levels of 60-80% among the poor, and especially among children. “The Supplementary Nutrition Program (SNP) was originally designed to be a cereal, pulse, oil and sugar mixture for children, but very soon a cereal-based 300-calorie food which provided 10 gm of protein (100 gm of any cereal provides 6-10 gm of protein anyway) began to be provided in these programmes.”
“While it may be argued that nobody was aware at the time of the possible molecular damage caused by excess cereals, it is difficult to evade the manner in which scientists thought of implementing solutions for the poor that they under no circumstance would have accepted for themselves or for their own kind.”
“Subsisting on cereals was naturally associated with large-scale anaemia (incidence of anaemia: 90% in pregnancy, 60-70% in children, and 50-60% in non-pregnant non-lactating women; even men were anaemic). The vicious cycle of anaemia with undernutrition in children and even adults cannot be addressed with either iron-fortified foods or iron tablets, or even kilograms of green leafy vegetables. It is known that a small amount of meat protein can help solve the problem of anaemia in a large number of cases, because meat proteins help absorb food iron. Vegetarian foods have high phytates, which inhibit iron absorption. There is also obviously a need for foods other than cereals for the poor such as milk, meat, eggs and fish, which have by now become illegitimate desires in the governmental perspective. With characteristic tunnel vision, public health measures addressed anaemia, which is not just a result of iron deficiency, but also due to deficiency of other nutrients such as protein, folic acid, B12, copper and many other nutrients, with a programme to distribute iron and folic acid to semi-starved pregnant women (and giving a smaller dose to children) in 1970. Today, this tunnel vision manifests itself in proposals and strategies to fortify wheat and rice with iron.”
“By the 1990s, scientists have ‘discovered’ newer micronutrient deficiencies because of the cereal overload and virtual absence of any protective food in the diets of the poor. Technologies are now in place for the fortification of cereals (rice or wheat) with a range of micronutrients by the food and drug industry. Studies are also in place to push for multiple micronutrient fortification which include iron, zinc, iodine, Vitamin A, riboflavin, Vitamin B12, Vitamin D, etc.”
She says “The nutrition and food policies of this country were set on this disastrous course in the ’50s and ’60s when ‘vegetarian sources of protein are adequate’ studies were followed by the ‘myth of the protein gap’ in the ’60s, and the 300 calories for children in the SNP. These steps were taken on the basis of strong and authoritative arguments by scientists of repute. The fixation of minimum wages, the shamefully low poverty line datum and the BPL and APL categories have remained unchallenged. The PDS/Green Revolution/food programmes further contributed to the problem because they dealt with only cereal. The molecular damage to the body when energy from cereals burns without the necessary nutrients such as vitamins and minerals is only now recognised. It is now known that excess cereal results in a particular kind of fat accumulation in Indians called triglyceride with abdominal obesity in men and women (Esmaillzadeh, Mirmiran, Azizi, 2005; Merchant et al, 2007). This is associated with early onset of diabetes or of what is called the metabolic syndrome. At even normal weights Indians have a higher fat content in their bodies especially around the abdomen. The only way of avoiding this is to increase muscle mass during childhood, and this means we must move away from the cereal trap.”
“Many studies carried out in the ’40s and ’50s showed that children consuming milk grow tall as compared to children on rice diets. It is known that the only way to lay down more muscle mass is through consumption of milk or animal proteins such as flesh foods, meat extracts, eggs and perhaps some nuts in infancy and childhood (Rogers et al, 2006). Recent studies at the National Institute of Nutrition have confirmed the important role of milk proteins with abundant sources of nutrients like vitamins and minerals for increase in muscle mass, heights and weights of school children (Shatrugna et al, 2006).”
“Diabetes, blood pressure and cardiovascular diseases in Indians have been produced in epidemic proportions with the overemphasis on cereals in the diets of the poor. When short, lean children without adequate muscle mass put on weight as adults it is known that their weight increase happens due to fat increase (Kurpad, 2005; James, 2005).'
Shatrugna, Veena (2019) The wider effects of nutrition research: History of nutrition science and policy-Part 2. Infochange. Republished on https://aharanammahakku.home.blog/2019/02/11/the-wider-effects-of-nutrition-research-history-of-nutrition-science-and-policy-part-2/ [Accessed on 4th February 2024]
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