“Every gun that is made, every warship launched, every rocket fired signifies in the final sense, a theft from those who hunger and are not fed, those who are cold and are not clothed”— Dwight D Eisenhower

I was pleasantly surprised to see Gujarat chief minister Narendra Modi last night (17 March 2013) holding forth on malnutrition in the wealthy segment of the population. I was really impressed by his insight into human nutrition at its subtlest level. In fact, his explanations were very convincing which even many of our people in the medical world might not be aware of. Malnutrition is our biggest problem what with nearly 67 million children suffering from Nutritional Immune Deficiency Syndrome (NIDS) dying by thousands every week for want of food. Poor, all over the world, have been paying for their poverty with their lives and Indians are no exception to that rule. This does not mean that the rich and powerful do not get malnutrition at all. Rather, they get the worse kind of malnutrition in the present set up, thanks to the wrong junk food getting popularized by the industry through the media—using our cinema and sports stars. How I wish these stars knew how they were being used to sell junk food to children. Let them read the definition of advertisement in the book Affluent Society written by John Kenneth Galbraith in 1956, before committing such crimes.

Dr C Gopalan in the fifties and sixties was immersed in real research into the causes of malnutrition, especially the two varieties seen commonly in Africa those days—Kwashiorkor and Marasmus. While in the first case the child gets bloated with water (anasarca), in the second the child is very thin and dry. Both, of course, eventually die prematurely. His work gave the world the lead to treat these two conditions correctly. I shall give the reader an insight into that work as I remember it now. In fact, we did replicate his work when I was a post graduate student at the CDRI, Lucknow.

Kwashiorkor in the African language means one who comes after. If the mother has children in quick succession she will not be able to feed them with her breast milk and so they get wrong milk (animal milk) which damages the liver first. The liver cell damage releases ferric iron into the circulation from the cells. Ferric iron is a stimulant of the posterior pituitary gland releasing plenty of anti-diuretic hormone. This results in water logging in the body thus diluting the blood. When this diluted blood reaches the kidney it secretes aldosterone, which starts retaining salt as well. This cycle goes on and the child eventually becomes fully oedematous!

 The other child with Marasmus gets mother’s milk (the right variety) but in very small quantities. So the child becomes emaciated but not oedematous as the liver does not get damaged first. The child eventually dies of starvation and calorie sub-nutrition. In short, the poor child in our country gets very little calories and dies of sub-nutrition while the rich child which lives on junk food that damages the liver and will get into the same vicious cycle like Kwashiorkor but not with so much oedema—the true mal-nutrition. While the nutritional Immune deficiency (NIDS) is the same in both groups of children, the rich one is true malnutrition while the poor one is only sub-nutrition. In fact, our rich children are the ones that fall prey to immune deficiency in every sphere—infections, asthma, autoimmune diseases and even lately unusual syndromes like the polycystic ovary syndrome, etc. I wonder if autism and many such ailments have something to do with immune deficiency. Narendra Modi on the TV that day was stressing the point that the rich also get malnutrition. I was amazed at his physiological insight into this enigma called malnutrition. We need such leaders to take this country out of the bottomless pit into which our netas have pushed it.

There is more to malnutrition than all these. Poor pregnant mothers in their first trimester do not get good nutritious food in our villages and even cities. It is in the first three months of pregnancy that the whole child is made in the mother’s womb. If that mother is malnourished, the foetus usually dies in utero. Nature many times is very kind. Nature tries to keep even such poor foetuses alive by making the mother’s placenta very big in comparison giving what little nutrition she gets to the baby inside. In that latter event the child is made very small in size. It will have small pancreas predisposing the child in post-natal life for diabetes early. Small heart and blood vessels make the child vulnerable to heart disease and hypertension precociously. Worse than all is that, these children inherit a very small hippocampus major, the part of the brain that is needed for memory, creativity, learning, etc, making the child incapable of going beyond primary school even with all the reservations! A sordid boon indeed! The ground breaking research in this area is done by a cardiologist in Southampton, David Barker. His book, Mothers, Babies and Heart Diseases, is a must read for all our politicians who have the good of the poor people at heart—a microscopic minority indeed!

Such children with pre-natal sub-nutrition do not get much benefit by extra feeding in post-natal life. That is why the Government of India’s ICDS programme in ten years hardly made any dent in the incidence of malnutrition. We need mid-day meal for all pregnant girls from day one of their missing their periods due to pregnancy. If there is any one out there who wants to eradicate poverty in India s/he should study all these in great detail. But Mr Mody gets his advice from ‘experts’, most of whom know how to complicate matters further. EF Schumacher, a big time guru, has now come to think that small is beautiful. He has this to say: “Any intelligent fool can make things bigger, more complex, and more violent. It takes a genius and a lot of courage to move in the opposite direction.” How very true, indeed?

The world suffers from two maladies—the majority of our poor brethren have very little to eat and die of sub-nutrition while the rich eat all kinds of junk food to eventually die of malnutrition. Our medical establishment also helps this process by wrongly labelling goods things as bad. Sunlight, the best life-giving elixir is being made into a demon, saturated fats, which in small amounts, are vital for growth are demonized, cholesterol the life breath of healthy living, is also demonized, and sedentary lifestyle which is a killer is being encouraged by our new western lifestyle. Health giving tonic—hard physical work—has become a rarity these days. Luckily our poor do not get the bad effects of any of the above but the rich segment of people who are malnourished are further damaged by these new lifestyles. Long live mankind with the help of our ancient wisdom.

 “Some people think luxury is the opposite of poverty. It is not. It is the opposite of vulgarity”— Coco Chanel

(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He is also Editor-in-Chief of the Journal of the Science of Healing Outcomes, Chairman of the State Health Society's Expert Committee, Govt of Bihar, Patna. He is former Vice Chancellor of Manipal University at Mangalore and former professor for Cardiology of the Middlesex Hospital Medical School, University of London.)