PHM-Exch> A note on Eat lancet and its relevance to India

[Ted Greiner]

 It is misleading to say only that fortifying rice with iron has no effect on anemia. That is rarely if ever the goal, keeping in mind that half or more of anemia is usually not related to iron deficiency. 
More relevant, but not mentioned below, is that the Cochran review found that iron fortified rice may reduce iron deficiency and increase mean hemoglobin. In my experience, when it does not have an impact on hemoglobin, it usually does have an impact on serum ferritin or storage iron, which is not reported on in the Cochran review.
Many countries now fortify wheat or maize with iron and folic acid (to prevent neural tube defects). In a heavily rice eating population (which includes many countries in LA and Africa and most of Asia), this approach misses the opportunity offered by doing the same with rice--which is rarely fortified today. 
The simpler approach for fortifying rice (cold extrusion) increases the cost by about 3%, far less than normal market price fluctuations. Much of the global donor community is instead mainly promoting the much more costly and extremely complex hot extrusion method owned by DSM--who also gave WFP one million dollars to use their technology.  
Regards,
Ted Greiner
    On Wednesday, December 4, 2019, 09:02:16 AM GMT-3, Claudio Schuftan <cschuftan at phmovement.org> wrote:  
 
 
From: Sylvia Karpagam <sakie339 at gmail.com>

excerpts
The Eat Lancet Commission report, launched on April 4,2019 the at the Food Safety and Standards Authority of India (FSSAI)headquarters, New Delhi, India had its premise on the question “Can we feed a future population of 10billion people a healthy diet within planetary boundaries?’. The eventaimed to ‘spark conversations’ amongall stakeholders and deliberate on the five global strategies to bring aboutthe ‘Great Food Transformation’. Eat-Lancet‘stakeholders’ 
Neither of the two ‘experts’representing India on the Eat Lancetcommission have any experience or expertise on nutrition.  The alacrity with which FSSAI is ready to promote and project the EATLancet report does away with all democratic consultation processes and allowsfor unilateral decisions with ‘equal stakeholders’ such as companies,corporates and students. That the Right to food campaign, which has been aconsistent proponent of food security and a vocal critic of fortification and industry,has been left out from the report release shows the tilt of the FSSAI towardscommercialising food in India. 
Itis of concern that neither the Eat Lancetgroup nor their government supporters in India, have taken any cognisanceeither of the research or the recommendations by the National Institute ofNutrition (NIN), the 100 year old government nutrition research body in thecountry. Is it because the evidence from NIN strongly points in favour ofanimal source foods? 

TheEat Lancet report has beencritiqued  for methodological flaws in assumptions,data collection and modelling, substantial enough to alter the conclusions ofthe report. Theyobserve that some of the described relative risks, such as the associationbetween red meat and type 2 diabetes do not match the values in the sourcestudies or were based on a different definition of meat consumption (e.g.conflating effects from red and processed meat) 
 Some observations about the EatLancet report  Ondiet related morbidity and mortality
 
Thereport, by clubbing undernutrition and obesity as ‘low dietary quality whichcauses persistent micronutrient deficiencies’, fails to take into account the complexitiesaround nutrition in India.
 

 Thereport claims that ‘traditional diets’in countries like India include ‘littlered meat which might be consumed only on special occasions or as minoringredients of mixed dishes’. In India there is a vast difference betweenwhat people would like to consume and what they consume in reality because ofinnumerable barriers around caste, religion, culture, cost, geography etc. Thereport feeds into the false premise that a majority of people in India consumeless meat by choice.
 
Taxes and subsidiesTheymake dangerous recommendations that ‘foodprices should fully reflect the true costs of food. Subsidies on fertilisers,water, fuels, electricity, and pesticides should be critically reviewed, withsome authorities arguing for their removal, and environmental and societalhealth costs of food supply and consumption should be fully reflected inpricing by introducing taxes. As a result, food prices might increase”.Increase in food costs would be the death knell for small farmers in India whoare already reeling with loans they are unable to repay and an increase in foodprices would be death knell for the poor in India who have chronic energydeficiency, stunting, undernutrition, anemia and a host of other vitamin andmineral deficiencies.Thesolution offered by the Eat Lancet group is ‘Therefore, where appropriate, social protection or safety nets (e.g.,increasing income through cash transfers) can be established to protectvulnerable populations, particularly children and women, while keeping tradeopen”  Keeping ‘trade open’ and‘protecting vulnerable populations’ do not go hand in hand. The market has beenrelentless in its greed and pretending to have a social goal is blatantlyflawed.Cashtransfers have failedmiserably in India and it only shows the level of marketization thatthe ill-informed Eat lancet Commission is pushing for.
 
Conflictof interest
The conflict of Interest of theEat Lancet Commission is too blatant to ignore. It was founded by GunhildStordalen, an animal rights activist and one of Europe’s richest and whosesupporters include companies that develop fake meat and dairy. The underlying agendaseems to be to use cheap plant based materials such as protein extracts,starches and oils to market a ‘plant based lifestyle’ through a network oflarge multinationals. 
FSSAI has been embroiled in controversies andblatant conflictof interest with its scientific panel being populated with‘experts’ from the food and beverage industry. 
 

Global Alliancefor Improved Nutrition (GAIN) which co-hosted this event are pushing for largescale fortification of grains/oilswhich FSSAI is promoting on a large scale such that it will benefit 5 big  international firms.  This large scalefortification has been criticised widely. A Cochranereview shows that fortification of rice makes little or nodifference to addressing anemia or Vitamin A deficiency.. The body requires a combination ofgood quality proteins, minerals, vitamins and fats. Instead of addressingchronic hunger and malnutrition through enabling better foods that includemeats, milk, eggs, dairy products, fruits and vegetables, that willautomatically address issues of malnutrition and micronutrient deficiency,  the government is opening the door forcompany dependent solutions. What is not being disclosed or discussed is the cost of fortification,the environmental or economic cost of shifting tonnes of micronutrients fromWestern countries on a permanent basis because local food economies would havebeen completely destroyed by this model.  
Dr. Sylvia Karpagamhttps://independent.academia.edu/SylviaKarpagam
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Jan Swasthya Abhiyan (JSA) is the Indian Chapter of the People's Health Movement. JSA brings together organisations and individuals in India working to promote health equity across all population groups. Also visit our website: www.phmindia.org
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