29 8th Ave
Melville. 2092
Johannesburg
South Africa.
Tel: 2711 726 5634
Fax: 2711 482 4769
Cell: 082 804 3818

E-Mail:info@epap.co.za
25^th August 2005

HIV and the Nutrition Debate

We all somehow know - good nutrition is fundamental to sustainable development, to community empowerment and primary health care. It is now becoming increasingly clear, GOOD NUTRITION will play a critically role in the management of the HIV pandemic.

Because of the importance of "GOOD NUTRITION" to so many of our community interventions, it is imperative that we all better understand with increased knowledge what this really means and what are the latest technological developments in this fast accelerating and changing science.

Tragically, the public media debate on nutrition verses medicine arguments around management tools to fight the HIV pandemic has polarized apart proponents of medication on the one hand and proponents of nutrition on the other hand. The "Either/Or" debates fail. It is dangerous, damaging, and unprofessional to set up one against the other without due regard for the complimentary not only of medication and nutrition, but also of psychological and socio, economic and environmental factors in the management tools necessary to fight the pandemic.

This article proposes what I am sure everybody will say is of course "quite obvious. We all know that both medicine and nutrition are two critically important tools in the war against HIV and AIDS. Neither science in their own right can claim exclusive solutions in this war. The polarization and lack of cooperation between these two important science components is an anomaly in the treatment of chronic disease. We seem to have no problem structuring wellness management programs for diabetes, osteoporosis, obesity and heart disease patients with both medical and nutritional components. Why would HIV be excluded from the existing well-used paradigm of chronic disease management? Why do we have to subject ourselves to debates on whether food can be considered a medicine or that good nutrition dressed up as food will create dependence and therefore cannot be distributed. Why are there arguments that conclude scientific medical investigations around the benefits of good nutrition are obvious and therefore inappropriate to be investigated? Why should investigating a nutrient component of the equivalent of a well balanced diet might prove to be unethical because of investigations that looked at excesses created by some obscure medical logic?

This article is a plea to say ‘enough is enough'. We cannot afford the delays to what must inevitably become a coordinated holistic approach to manage the crisis now upon us. We have no option but to stop, consider the scientific facts, and develop a more integrated approach to assisting those living with HIV and AIDS. It is time we start practical, affordable, multi dimensional and appropriate African developed interventions that will evolve out of combined therapy approaches. We need immediate effective and affordable solutions. The survival of our societies now depends upon this.

To do this, let's change direction by - declaring:

• The medical profession has important tools that we must use - where appropriate - on a proven cost dose response basis.
• The medical profession, however, do not have exclusive ownership and responsibility for health tools that manage illness.
• Nutritional interventions are not medicines and therefore should not be promoted, evaluated and treated as such, even by their proponents. Nor should they be considered alternatives to appropriate medical intervention.
• Medical practitioners need to acknowledge and revisit the obvious - molecular intervention tools require a well nutritional body to be more effective.
• The body itself can provide a part solution with the support of good nutrition.
• There is a good technical and scientific explanation to link a correlation between poverty and the spread of the disease. These links require investigation so that solutions can be tailor made to fit the paradigm.
• The nutritional approach is but one important component of an effective solution that can make other components more effective and without which many medical and other tools cannot be efficacious when dealing with malnourished people.
• The way forward is obvious - combining medicine, good nutrition and any other scientifically evaluated tools in conjunction with a positive mind that will create a unique African solution that all work as a combined unit more effectively together.
• Because of the magnitude of the HIV pandemic - our survival and a way forward has to be an integrated approach that utilizes all skills and professional expertise at our disposal. We have the intellectual capacity on our continent to develop our own tailor made solutions. Only with all possible components working together within a holistic approach will we be able to find and deliver an effective appropriate and affordable African Solution.

The Nutrition Component

People in Africa are not in the main dying from HIV but in fact from opportunistic infections and diseases. The strengthening of the immune system is therefore a fundamental requirement of a management approach if we are to halt the unnecessary deaths from opportunistic infections and diseases.

It is for this reason that the nutrition argument and component is so important and must be an integral component of a health management plan.

If we look at some of the symptoms of HIV progression - they could be:

• Diarrhea that removes nutrients
• Lack of appetite that reduces the intake of nutrients
• Thrush (candida infection) that inhibits the intake of food and therefore, nutrients
• Vomiting that expels food and nutrients prior to digestion and absorption.
• Compromised lining of the duodenum and jejunum that reduce the intake of nutrients
• Dermatological conditions such as lesions, cracked skin sepsis etc
• Wasting due to poor diets and the effect of the HIV-Virus

These issues and symptoms are linked to the reduction and mal-absorption of micronutrients that leads to starvation and wasting namely the opportunistic infections and disease. The result is the inevitable destruction of the body's defenses because of the compromise to the body's immune system. We therefore have a disease with many facets and mutations that can kill through malnutrition and starvation. This conclusion highlights that our response must include an effective nutritional component. The symptoms of nutrient depletion work synergistically with the HIV virus to compromise and destroy the immune system and result in the overall destruction of good health. The consequence therefore becomes obvious - the multidimensional attack all support the destruction of the body's ability to defend itself from viral and bacterial attack.

We have evidence of people now living for over 20 years in wellness programs that include both medical and nutritional components. David Patient - one such survivor - recently went onto ARV's after 23 years of living with the virus. He is living proof that diet and medicine when required actually work well together, and are complementary parts of a solution.

The e'Pap Nutritional and Technology Approach

The e'Pap approach uses the latest developments in nutritional science. The single food matrix is pre-cooked to preserve nutrients, affordable to even the poor, and is able to deliver in a bio-available and absorbable form most of the nutrients found in a well balanced diet. The purpose is to replenish the nutrients lost through the symptoms listed above, or unavailable due to lack of access to food, through poverty. Our approach is to deliver as many of the essential nutrients as possible in a single food matrix, in quantities indicated by scientific research as being critical for proper immune functioning during chronic viral and bacteria, fungal infection. We try to deliver the nutritional contents of a diet that a person such as David Patient has been able to eat on a regular basis that is called - a well balanced diet.

The problem with the concept of a balanced diet is that "nobody" can define exactly what this concept means - other than in "handfuls of different foods" for a particular person's needs. We therefore took the approach to use American (also used by South African authorities) RDA recommendations (10^th Edition 1989). It is important to understand, these numbers only represent what a typical average healthy American requires on a daily basis. It is a scientific fact - malnourished or sick people need more. In order not to get into a medical debate of whether more of a nutrient is better or worse and which would take us into the "minefield" of a therapeutic argument - we made the decision to formulate around RDA recommendations.

With this decision made - we then needed to overcome our next technical challenge which was one of nutrient interaction in the Duodenum It is the technical issues around bio availability, absorption to the body that arise when one is trying to create a single step approach to deliver 28 nutrient in such a dense food matrix.

To achieve this - we were forced to use "cutting edge technology" and the most expensive nutritional chemistry known to mankind (Chelated minerals that are devoid of salt, neutral in electric charge, and wrapped in amino acids with an extremely low atomic molecular weight). Using this unique and well-tested and clinically evaluated technology - we then applied our-selves to maximizing nutrient density in the product.

With this objective in mind we formulated around pre-cooked raw materials of maize and Soya to achieve cultural compatibility. We then developed in house technology to preserve and maximize all the naturally available nutritional components. Fiber and cereal fat are traditionally removed in most food processes for technical and commercial reasons. The polyunsaturated fatty acids found in cereal grains cleave and get destroyed if exposed to oxygen and if left untreated in the food. This would cause the food to go rancid. To address this problem we developed a cooking process that was able to stabilize the fatty acids and at the same time preserved as much of the amino acids as is possible.

In this way we have been able to maximize nutrient density by retaining the natural nutrients contained in the cereals used and by using "state of the art nutritional bio-chemistry" to fortify - we have implemented a strategy to maximize bio-availability and absorption of the added nutrients.

Africa's Nutritional Problem

Some of the mainline nutrient deficiencies in south Africa are highlighted.

1. Estimated Iron Deficiency Anemia in children under 5 years = 37%
2. Estimated Iron Deficiency Anemia in Women age 15 to 49 = 26%
3. Estimated No. of children born mentally impaired as a result of Iodine deficiency = 160,000
4. Estimated % of South Africa's GDP lost to all forms of micro nutrient deficiencies = 0.4%

The statistics in neighboring territories are similar if not worse. In a globally competitive modern economy - such statistics would warrant a national emergency being declared.

There are many causes for the nutritional crisis in Africa. We examine four as examples:

(a) Refined Maize and Soya:

Maize arrived on this continent in about 1760 from South America. Maize contains a phytate inhibitor enzyme that reduces the ability of the body to absorb both inorganic forms of iron and zinc. Over a 250 year period our continent has successfully converted itself away from traditional African foods such as millet (no phytate inhibitors) cassava, tubelors, green beans and peas and now eats commercially grown and processed refined maize. This new diet is "marketed" on a bandwagon that promotes "white and finer and more refined flours" as better, for ease of cooking.

Urbanized societies now depend on refined maize that originates from a commercial process. Commercial farmers send their maize to millers where the cereal fat contained in the maize germ is removed before processing. This healthy nutritional component is sold back to farmers as a stock feed. The essential polyunsaturated fatty omega 3,6 and 9's with many of the natural nutrients contained in the maize are therefore stripped out leaving sterile carbohydrates. The same goes for soya.

Without iron, there is no oxygen in the blood. Without zinc, none of over 200 enzymatic processes can work optimally. Without the essential polyunsaturated omegas 3, 6, and 9, there can be no cellular activity for many nutritional processes.

Zinc deficiency and copper deficiencies cause the skin to go brittle and crack. HIV spreads through a lesion in the skin. One can only speculate what the impact of such deficiencies is on the vaginal wall, or the thin skin of the penis.

(b) Refined Sugar

Chromium deficiency causes sweetness craving. Are malnourished people chrome deficient? Why do poor people eat mounds of refined sugar? Excess sugar significantly reduces the effectiveness of the immune system, stops the absorption of copper, causes thrush, and dozens of other detrimental health problems. A full list with references is available.

(c) Agricultural Practices

In the USA, over the past 40 years, nutrient densities in vegetables and fruit have decreased by over 76% in some States because of intensive commercial farming. This is in part due to the development of rapidly growing hybrid and genetically modified strains of grains and other food types, which, because of their commercially driven efficiencies, rapidly deplete the soil of essential nutrients.

Similar effects can result through intensive farming of the same soil due to growing population densities in Africa. Little attention is given to improving soil quality, and thus the nutritional quality of the foods produced. Bigger, faster, and more production - is not necessarily better from a nutritional point of view because the soil is depleted of nutrients at a faster rate.

(d) Incorrectly Fortified Food and Poverty

A product called CSB (Corn Soya Blend) was developed for the USA Cattle Industry to enhance feed conversion ratios at low input cost. CSB is provided as aid to poverty-stricken human populations - via various aid programs on our continent. It is described as a nutritional supplement that is even sometimes promoted to people living with HIV.

The CSB product is fortified with inorganic nutrients - for example iron and zinc. Inorganic forms of iron such as electrolytic iron, ferrous sulfate/glutamate and zinc oxide all have low bioavailability and absorption to the body of about 2%. (Electrolytic Iron has an absorption factor of less than 0.2% in a high phytate diet). When inorganic zinc and iron are included in the same food matrix in different ratios, the zinc is antagonized and interfered with to get to its receptor site due to higher Iron values that compete for the same and similar receptor sites. The end result - malnourished people - fed such a life saving food in a famine or crisis - end up more malnourished from a nutrient deficiency point of view - by the end of the intervention.

(e) Ignorance

It also needs to be pointed out that the public's ignorance of simple nutritional facts and the lack of understanding of the latest developments in food fortification is now part of our nutritional crisis. Food Label laws do not require manufacturers to state the form of the compound nutrients added. People sometimes read a label claim and believe that this product will assist them nutritionally. We now have many "copy cat" products on the market that present themselves as "upgrades" or "new forms" of e'Pap which confuse the public further because of the lack of understanding of the nutritional issues. Many sensitive vitamins (vitamin A and Folic Acid) are destroyed by heat (e.g., cooking) and the oxidative effects of inorganic minerals added.

Inorganic minerals have extremely low absorption properties to the body and when mixed together compete as macro, micro and trace elements to the required receptor sites. This interference and antagonism prevent the body from absorbing the essential nutrients. Just because a mineral is declared on the label of a "fortified' foods is no guarantee that the body is able to receive the nutrients declared or that it will in any way address nutrient deficiencies.

Explaining the e'Pap Effect.

The product e'Pap is a state of the art food technology that is tailor made as an African solution to address micro nutrient deficiencies and at the same time - it fills empty stomach. It is therefore no surprise that feeding malnourished people with a pre-cooked food containing a variety of 28 bio-available nutrients that include chelated forms of iron, zinc, selenium, chromium and others and combined with polyunsaturated omega fatty acids, results in a dramatic improvement in wellness for malnourished people.

David Patients has been diagnosed with HIV for almost 23 years. Each time he takes his meds, he now eats 50 grms of e'Pap, twice daily. Since eating e'Pap, he has put on over 10kgs and has gone from a size 32 to a size 34. In his words, the product works and he is happy to endorse it.

We would be happy to respond to any questions and to send you more information on e'Pap.

Should you require more technical information, contact details of where to purchase e'Pap or a presentation - please contact us - the details are below.

Basil Kransdorff or Henry Ndlovu
Econocom Foods cc
29 8th Avenue
Melville. 2092
Johannesburg
South Africa

Tel: 27 11 726 5634
Fax: 27 11 482 4769
Cell: 082 804 3818
Email: info@epap.co.za

(Do you want to see related pages, the whole site or the non-frames Sitemap?)