From Basil Kransdorff: I wonder how many people out there who are responsible for funding and distributing Plumynut would consider giving their child a huge dose of sugar daily. I know - if we do this in our own household - our son would trash the place. As a result we have banned for our son all products with high levels of sugar in our own home.
I ask the question - just how much of what is viewed as recovery when a malnourished child eats Plumpynut is nothing more than a sugar drug induced high similar to what we see in our own kids when drinking a sugar drink. Perhaps we should look at the Plumpynut clinical evidence that I am told is available to see just how the micronutrient status improves or maybe gets worse for the kids eating Plumpynut. Lets compare the micronutrient status of kids eating Plumpynut to kids eating other commonly used products like CSB that are distributed as nutrition to kids in malnourished enviroments. I am sure the results will be illuminating. The known science says - - inorganic nutrients used to fortify products just cannot bring back the kids to nutrient repleteness. Because children have a daily requirement, all shortfalls will compound themselves making the children more nutrient defecient. The argumenet that a little is better than nothing is therefore not appropriate when trying to address the nutrient needs of children.
Has anybody wonder why products like CSB and Plumpynut are not sold and eaten in the USA and the European Common Market as a nutritional suppliment. Certainly I know the answer in the case of Plumynut. Plumpynut would fall foul of the UK advertising laws which bans advertising of food products with high level of sugar and fat to children.
The clinical evidence based on outcome based science will certainly clarify the debate. Is the 'waking up' of malnourished children in Africa who are given donor funded Plumpynut as a result of a sugar drug induced high or is it as a result of the children being brought back into nutrient repleteness.
I believe the cause of the concern that has been raised is around a flaw in the logic of the way and for whom the formulation Plumpynut has been created. I am told by Andre Briend the inventor of Plumpynut (now employed by the WHO) that the Plumynut food product is safe because it has been based on the well tested and excellent F100 formulation. As a therapeutic food used to rescue a severely malnourished children, he tells me, Plumpynut should only be used for about 2 weeks and therefore concerns around the high levels of sugar and fat are not appropriate. For me, this explanation could be acceptable. Using Plumpynut with its high levels (30% sugar) for a very short period would be similar to a "sugar drip" used for injured traumatized patients that saved many lives of wounded soldiers in the Vietnam War. What does not make sense is to use such a formulation as a tool to address malnutrition over several months. Copying the formulation approach of F100 formulation and using the same approach in a food that is specified and marketed (using donor funding) as a "miracle food supplement" that will address malnutrition in young children over longer periods of more than two weeks does not make logical sense. F100 is used in a therapeutic emergency by medically trained personal over a short period. Using Plumpynut for long periods is rather like putting a malnourished child onto a sugar drip for several months. Plumpynut is not an appropriate formulation for a community managed food approach to address the nutritional condition of malnourished children in a community based environment if the objective is to ensure the children come back to nutrient repleteness. The high levels of sugar and fat for long periods are inappropriate as are the milk solids which could cause diarrhea (lactose intolerance). The selection of micro nutrient form has already been articulated by HETN. The nutrient form specified in Plumpynut cannot address the daily nutrient requirements of any child never mind one that is severally malnourished. The known science says - this is impossible because of known nutrient clashes and low evidence of bio-availability. What amazes me the most about the whole Plumpynut debate is the deafening silence from many professionals (nutritionists). I have even heard arguments given by a few that the high levels of sugar for a product for Africa is okay because malnourished kids in Africa are different to kids in Europe. There is even debate about using Plumpynut in HIV and TB programs. I shudder at the consequence with these high levels of sugar feeding thrush. Basil Kransdorff |