Re: [pronut-hiv] Andre Briend on RUTF (2)

["Basil Kransdorff" <basilb@iafrica.com>]

Hi Ted,

Thanks for that.  Yes - Andre Briend from the WHO 
refers to my enquiry which I posed to the 
WHO  and which I received the same answer that 
such an approach was specified in standard WHO manuals going back 30 years.

It is the procedure of feeding malnourished 
children such high levels of sugar, protein and 
oil that I am questioning. I have not yet 
received a satisfactory answer.  Just because 
such practice has been researched or have been 
specified in manuals from over 30 years ago does 
not make it either correct or the right approach 
from a health point of view in the context of the 
latest understandings and technology 
developments. Certainly, 30 years ago, there was 
little understanding about  bio-availability of 
nutrients and many of the new cutting edge 
developments in this field have only emerged in the past 20 years.

Living in South Africa in 2007 we have lots of 
examples of apartheid procedures that were well 
researched and contained in apartheid era manuals 
that were bizarre in the extreme. That said -  it 
is my view that most nutritional interventions in 
Africa have failed dismally over the past 60 
years.  I believe that sustainable political and 
economic development can only succeed with 
functional human beings participating. Because 
the poverty and lack of economic development 
continue to this day - I lay much of the causes 
of the continents demise on the failure of the so 
called traditional nutritional approaches - many 
of which are found in the manuals that Mr Briend from the WHO refers.

I highlighted the issue in my last posting 
when  both Alice Ojwang-Ndong and Dr. Robert 
Mwadime suggested that sharing examples of real 
success stories might be valuable for all to see 
what in fact was actually working.  I shared the 
example of an e'Pap intervention at Gode Hospital in Somalia:
===========================================================================================================
Project GODE in SOMALIA run by ADRA

Dear Basil:

I can tell you my observation.

The ePap was distributed to 250 children and 
adults in Gode Hospital. Some of the 
beneficiaries were people living with HIV/AIDS 
and most of them were severely  malnourished 
women and children with medical complication and 
were admitted to the Hospital for more than a 
month. Several of them were outpatient. We have 
seen dramatic changes with most of the 
beneficiaries. There was very significant weight 
gain, improved appetite and very good medical 
response to the medicine that they were taking as 
compared with those who were not taking ePap. I 
have seen a child for example who is 8 years old 
and weighs 11kg!! he was not able to walk for 
several months,  and was being considered as 
neurologically incapable of walking. I saw him 
three weeks after ePap treatment and did a 
medical examination. I found his nervous system 
functioning well and he was able to stand up with 
out support and walk with a support. He was 
improving very fast. The reason he was not 
walking, I learned, was he has no muscle mass to 
support him to stand and walk. I later learned 
that the child walked out of hospital. There are 
many such case studies that I remember of. The 
monitoring in the hospital was excellent, with 
good follow up. It was distributed in daily 
basis. Those who were discharged out of the 
hospital used to come daily to the distribution place.

Regards

Mesfin H
======================================================================================================
What is important about this real live example is 
that it highlights the importance of 'good 
nutrition' and its relevance where drugs regimes 
are being used on malnourished people.  In the 
context of the PLUMPINUT debate, it highlights 
that it is not necessary to feed malnourished 
children high levels of refined sugar, protein 
and oil to address the terrible damage that malnutrition causes.

I see many examples of products that are called 
'energy' drinks.  When you look at the formulas 
they invariable contain high levels of sugar and 
or caffeine.  Such a lethal mix can result in a 
drug induced 'high' which in my humble opinion is 
not something that a product that is sold as an 
energy drink should in any way create.

I have a  paper headed  - 124 ways excess sugar 
can ruin your health.  It is an interesting 
document with references to all the clinical 
evaluations and references that created the list 
all linked to excess refined sugar.  Anybody 
wanting a copy - I would be happy to email 
them.  In an environment where HIV further 
exasperates nutrient deficiencies and where 
thrush will feed on high sugar diets, I want to 
know from the experts - why they feel it is 
necessary to specify, recommend and fund such 
high levels of sugar in products they use in their interventions.

Perhaps one could argue that the enormous damage 
excess sugar can cause to health was not known 30 
years ago. Today - we all should know better.

Kind Regards,

Basil Kransdorff
basilb@iafrica.com

-------Ted wrote:


>I sent Andre Briend Basil's message of Dec 6 
>(which mentions Andre) and he asked me to post 
>the following letter to the group:
>
>   Dear Ted,
>
>   I am not registered in this forum.
>
>   Can you kindly forward the following 
> statement (you could quote me) to this forum:
>
>   The ready to use therapeutic food referred to 
> in this forum has about the same nutritional 
> composition in terms of protein, lipid, and 
> sugar content as the F100 diet which has been 
> recommended by WHO since 1999. See: 
> http://www.who.int/nutrition/publications/en/manage_severe_malnutrition_eng.pdf 
> p. 13 Table 7.
>
>Similar diets, high fat high protein high sugar, 
>have been recommended by WHO since 1980. RUTF 
>and F100 are the result of a long standing 
>evolution based on more than 30 years of 
>research. They have been used literally on 
>millions of children over the last 20 years.
>
>   These diets indeed are recommended by WHO 
> only for severe acute malnutrition, but they 
> are very well adapted for this specific use. 
> Health warnings mentioned in this mail do not seem warranted.
>
>   Best regards,
>
>   André
>
>   André BRIEND, MD, PhD
>Medical Officer
>Department of Child & Adolescent Health and Development
>World Health Organization, CH-1211 Genève 27, Switzerland
>Tel: ++ 41 22 791 14 47
>http://www.who.int/child-adolescent-health/