This post is the second of two written by Dr Caroline Hodges, University of Brighton. The first post discussed student preceptions and animal experiments.
In the 1930’s Cecily Williams identified a condition of advanced malnutrition which she called kwashiorkor, or ‘disease of the deposed child’. She made a cautious suggestion that the disease was associated with the loss of protein when a mother weans a toddler abruptly on the arrival of a new baby.
Little attention was paid to this discovery until the 1949 FAO/WHO Committee became involved in nutrient deficiency diseases and announced kwashiorkor was ‘one of the most widespread nutritional disorders in tropical and subtropical areas’. The condition was treated with skimmed milk, so it was assumed that it must be caused by a deficiency of protein (Brock and Autret, 1952). Sathyamala (2016) is one of several with an interesting take on this:
‘This discovery of the cure coinciding with the availability of dry skimmed milk in the USA was a fortunate by-product of a domestic surplus-disposal problem. It was clearly more satisfactory in every respect to dump [skimmed milk] in developing countries than to have to bury it in the United States as was contemplated by the Department of Agriculture at one point’ (McLaren, 1974).’
Thereafter the contentious term ’the protein gap’ or ‘crisis’ was born. This was first advocated when different committees believed child protein requirements were high in comparison with currently accepted values, but successive downward adjustments of the value over the years made it clear that children in areas where kwashiorkor was prevalent did not have a protein deficiency unless their overall energy intake was low (Briend, 2014). So although the symptoms of this disease are ‘persuasively consistent with protein deficiency rather than energy deficit, acute shortage of energy would, however, lead to use of protein as an energy source’ (Webb 2012, 283).
To her credit Williams later wrote ‘For the last 20 years I‘ve been spending my time trying to debunk kwashiorkor’ (McLaren, 1974). Even today its aetiology and pathogenesis remain unclear, although textbooks authoritatively report it as a protein deficiency disease.
This apparent enormous ‘protein gap’ initiated a whole new field of research which also satisfied many commercial interests, specifically the mass production of protein-rich functional foods from sources such as fishmeal and microbes. In 1972 a ‘Protein Advisory Group’ was established to monitor this research. Sathyamala (2016) summarises the situation as follows:
‘..once the marketing of the surplus of skimmed milk in the USA had ceased to be a problem and given that the meat industry was unlikely to be able to play a role because of the levels of poverty in countries that were said to be afflicted with this condition, industry turned its attention to developing new, synthetic protein foods and exploiting them commercially….. Despite heavy funding and promotion, with few exceptions most of the protein-rich foods never reached commercial viability, with some products costing four times more than the original they were said to replace (McLaren, 1974).
One product which did succeed was Quorn but this is now marketed as a meat substitute for vegetarians in the West, rather than the high-protein food for needy children in developing countries (Webb, 2012).
Unfortunately, as McClaren noted (1974), ‘As a result, (of the protein gap) measures to detect protein deficiency and treat and prevent it by dietary means have been pursued until the present time. The price that has had to be paid for these mistakes is only beginning to be realised.’ Newman (1995) suggests ‘the unwarranted attention to protein ended up by wasting a great deal of time, money and lives’ and more recently Webb (2012, 279) refers to ‘The huge costs both financial and medical, of exaggerating human needs’. He suggests ‘much of this effort was wasted and ‘directed towards solving an illusory problem’. McClaren (1974) went so far as to entitle his historically important article describing the so called protein gap: ‘The great protein fiasco’.
Sathyamala (2016) explains the focus on kwashiorkor in the 1960’s by describing it as ‘the construction of a pure protein deficiency disease’, which shows how ‘scientific discourses in nutrition are shaped by the needs of capital and capital determines scientific truth’. She describes how:
’The entry of the pharmaceutical and food industries into functional food and supplements has created a new epistemic authority for truth claims whose strength lies in the ability to convince through propaganda with little pretence of a scientific base’.
The recommended dietary intake of protein has been progressively lowered, and Infant protein requirements decreased significantly from approx. 40g g/day in 1943 to 13g/day in 2005. In the 1970’s a recalculation at the stroke of a pen unwittingly closed the ‘protein gap’ and shattered the theory of the pandemic of ‘protein malnutrition.’
The former director of India’s Institute of Nutrition (Gopalan, 2007) made the following comment in his evocatively entitled article ‘Farms to Pharmacies: Beginnings of a Sad Decline’. ‘No arbitrary cocktail of synthetic nutrients’ — which he called a ‘blunderbuss pharmacy’ approach to undernutrition — ‘can substitute for a judicious combination of natural foods. What an undernourished or overnourished population requires is access to appropriate and adequate amounts of conventional, regular foods and not their allegedly superior functional products… a diet of cereals, pulses, legumes, fruits and vegetables can meet these micronutrient requirements’. Of course natural disasters and civil war etc., may deny this basic requirement to many, but supplements should not be the norm.
It appears that the ‘diverse, largely plant-based, diet of people in colonial territories was regarded as deficient in comparison to the flesh-based diet of the colonizers’ (Arnold, 1994), a notion which has fuelled the ‘protein gap’ and still influences us today.
My interactions with students reinforce my fear this attitude cannot be readily divested, and the notion is, metaphorically speaking, in our genes.
After 10 years of lecturing in biochemistry and nutrition, when discussing plant based diets, I am still asked by the majority of students the question, ‘but where do they get their protein’? After 10 years of lecturing on proteins I am met with stunned faces when I say all foods (except gelatine) contain all essential amino acids. After 10 years of lecturing I still see exam answers saying we cannot survive without animal protein and 10 years of lecturing I am asked by some young men if 300 grams of protein a day will increase their muscle mass, despite the fact that only approx. 56g/day is recommended?
The rat experiments unwittingly started the train and perhaps Kwashiorkor was the fuel remorselessly pumped in. It thundered along on tracks built by corporations and vested interests until it was finally derailed in the 1970’s. The trouble is, some people are still sitting on that train, undeterred, oblivious it may be heading on a collision course, unaware or indifferent to the reality that our choice of food can no longer be a personal matter, and the future of our grandchildren may depend on it. The N8 AgriFood founding director Sue Hartley said: “We cannot grow our way out of this problem; we have to try to change the way that we behave.”
It is a widely-cited statistic that it takes ten kilograms of feed to produce one kilogram of beef, meaning an overall loss of nine kilograms of food produce. Increasing populations and climate change, which is partly due to our voracious appetite for animal produce (the so-called complete proteins), will have an explosive impact if they continue unabated. So how should we proceed? If we do nothing and global warming is as bad as predicted, our grandchildren will surely suffer the consequences. If, on the other hand, the deniers were correct, we may have wasted yet more time and money, but in this case, at least the next generations will have a future.
Sometimes pictures say it all and this is my favourite.
Arnold, D. (1994) ‘The Discovery of Malnutrition and Diet in Colonial India’, The Indian Economic and Social History Review, 31:1, 1–26
Bell, G. (1959) Textbook of Physiology and Biochemistry, 4th ed., Williams and Wilkins, Baltimore, p. 12
Bender, D. (2014) Introduction to Nutrition and Metabolism, 5th ed. Chapter 9 (CRC press) p255
Briend, A. (2014) Kwashiorkor: still an enigma – the search must go on. In: CMAM Forum Technical Brief
Brock, J.F. and Autret, M. (1952) Kwashiorkor in Africa, World Health Organization Monograph, Series No. 8. Geneva: WHO
Gopalan, C. (2007) From ‘Farms to Pharmacies’: Beginnings of a sad decline. Econ Pol Wkly, 42: 3535-3536
Hartley, S. (2016) Scientists hungry to deliver food system paradigm shift, BBC article
Ioannidis, J. (2012) Extrapolating from animals to humans, Sci Transl Med, 4: 151
McLaren, D.S. (1974) ‘The Great Protein Fiasco’, Lancet, 304(7872), 93-96
McLaren, D.S. (2000) ‘The Great Protein Fiasco Revisited’, Nutrition, 16: 464-5
Miller, D and Payne, P. (1969) Assessment of protein requirements by nitrogen balance. Proceedings of the Nutrition Society, 28: 2, 225-234
Newman, J.L. (1995) ‘From Definition, to Geography, to Action, to Reaction: The Case of
Protein-Energy Malnutrition’, Annals of the Association of American Geographers, 85: 2,233–45
Osborne, T. and Mendel, L. (1914) Amino-acids in nutrition and growth. J Bio Chem, 17: 325-49
Rand, W.M, Pellett, PL. Young, V.R. (2003) Meta-analysis of nitrogen balance studies for estimating protein requirements in healthy adults, American Journal of Clinical Nutrition, 77: 109-127
Reeds, P.J. (2000) Protein nutrition of the neonate, Proc Nutr Soc, 59:1, 87-97
Rose, W. (1948) Comparative growth of diet containing ten and nineteen amino acids, with further observation upon the role of glutamic and aspartic acid, J Bio Chem, 176: 753-62
Sathyamala, C. (2016) Nutritionalizing Food: A Framework for Capital Accumulation. Development and Change 47:4, 818-839.
Webb, G. (2012) Nutrition: Maintaining and improving health, 4th ed. Chapter 11, Taylor & Francis Group, LLC
Young, V and Pellett P. (1994) Plant proteins in relation to human protein and amino acid nutrition. Am J Clin Nutr, 59 (suppl):1203S–1212S