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News - Health Empowerment through Nutrition

By Geoff Douglas

Health Empowerment Through Nutrition (HETN) is a registered charity, based in Malvern, UK, which is dedicated to combating poor nutrition, particularly in the African sub-continent. In this interview with CEO Geoff Douglas, he explains the background to the charity, the issues they face with TB and HIV in Africa and what they are doing to help. 

What does HETN do?

HETN sees itself as a philanthropic networking organisation, serving as the nutritional conscience of existing structures and assisting those structures to carry out relevant and effective nutrition programmes. HETN is a UK registered charity.

Goals and Objectives:

  • Goal - nutrient repleteness
  • Means - effective nutrition
  • Purpose - combating chronic disease through effective nutrition
  • Focus – global (although currently South Africa)
  • Method - developing evidence base, generation of knowledge and evolution of consciousness around effective nutrition

HETN is not:

  • A traditional ‘fill bellies’ charity
  • Trying to feed the hungry
  • Investing in infrastructure

HETN is about:

  • Collaboration
  • Shifting cognisance
  • Partnering
  • Educating
  • Learning
  • Enabling
  • Supporting
  • Facilitating understanding
  • Networking

How did you get involved with HETN initially?

I’m a physician and occupational health specialist with many years of experience working with HIV in an African context. I made the first HIV+ diagnosis in Swaziland in 1986. I am not a nutritionist.

Three years ago, I was headhunted for the position of CEO of HETN – a new UK charitable trust that believes nutrition plays a pivotal role in health.

I was particularly impressed by the:

  • Senegal statistics: Despite widespread, unprotected, promiscuous sexual activity in Senegal, where soil selenium levels are naturally high, HIV is diffusing very slowly, if at all, amongst the population. In contrast, Swaziland, where soil selenium levels are low, has the highest HIV prevalence in the world.
  • World Bank Report (2006): Put micronutrient deficiency at the heart of their approach to global economic growth - ‘Probably no other technology available today offers as large an opportunity to improve lives and accelerate development at such low cost and in such a short time.’
  • Views of the Copenhagen Consensus: These Nobel Prize winning economists agreed that AIDS and micronutrient deficiency were the two biggest world issues.
  • WFP: World Hunger Series 2007 - Hunger and Health – ‘Hidden hunger affects more than two billion people. Even when a person consumes adequate calories and protein, if they lack one single micronutrient - or a combination of vitamins and minerals – their immune system is compromised and infections take hold.’

As a specialist physician who has always held the orthodox view that we need a balanced diet - not supplements - I am on a fast learning curve. 

Why do you think TB and HIV are such an issue in Africa?

There is no doubt that TB and HIV (and malaria, hypertension and diabetes) are escalating out of control in Africa.

When I was a child in rural Africa, people knew how to feed themselves. They were healthy and lived successfully with TB and malaria. Today, the staples are refined white maize meal, white bread, white sugar, traditional margarine and cooking oil. People have moved away from their traditional foods, while modern agricultural practices and food processing remove essential nutrients from the food chain. Primary micronutrient deficiencies are widespread and severe.

 How are TB and HIV linked to malnutrition?

  • Chronic malnutrition is the biggest cause of immune suppression in humans
  • The association between TB and malnutrition has long been known
  • TB makes malnutrition worse
  • Malnutrition weakens immunity, increasing the chance that latent TB will develop into active disease
  • People living with HIV/AIDS suffer from extreme deficiencies of many micronutrients
  • Malnourished individuals are more susceptible to HIV infection and have a worse prognosis
  • Food nutrients, particularly the antioxidant micronutrients, have therapeutic benefit

How does supplementation help?

Systematic reviews of micronutrient supplementation conclude that there is no convincing evidence that micronutrient supplementation effectively reduces morbidity and mortality in people living with HIV/AIDS. However:

  • The trials that have been done concentrate on single supplement intervention, or supplementation with a small group of micronutrients. Neither can be expected to correct the type of nutrient deficiency seen in HIV/AIDS
  • The problem is compounded by the fact that the dose of supplement is often not physiological and the form of supplement is often not considered
  • Much of the research is done in the West, where baseline nutrition is higher

Nevertheless, the consensus remains that, for health, we need a balanced diet – but most people in Africa have no access to a balanced diet.

What are your objectives regarding providing diets as healthy and balanced as possible, especially in Africa?

If it is the consensus that the maintenance of health is conditional on eating a balanced diet, this should be the first priority in any health initiative:

  • It is the responsibility of health workers to ensure that their patients are nutrient replete
  • Advising patients to eat a balanced diet where they have no access, or no understanding, is unethical
  • Where people have multiple micronutrient deficiencies, any scientific research that attempts to determine the benefit of this or that micronutrient is unethical and bound to fail, because it runs counter to the prevailing truth that we need balanced nutrition
  • Adding isolated chemical nutrients to refined, sterile food, in an attempt to get benefits equal to those of whole foods, is not effective and reveals an ignorance of how nutrition works in the body
  • People everywhere, malnourished or not, need a diet that is based on whole grains
  • It should be low in fat and sugar
  • It should contain all the vitamins and minerals that would ideally be sourced from fruit and vegetables in a form that is bio-available

In Africa, HETN supports e’Pap, a pre-cooked, wholegrain food, based on maize and fortified with soya and a mix of 28 micronutrients. The object is to provide the entire RDA of bio-available micronutrients in a small meal portion.

Can you give a brief overview of how your work has helped people in Africa?

Alexandra Township, in north eastern Johannesburg, is a sprawling ghetto. A Presidential Node, it has been identified by the South African Government as an area of exceptional need. Over half a million people live in an area of approximately two square kilometres. HIV/AIDS, TB and malnutrition are rife. There are many orphans and vulnerable children. Patrick Lorentz – President, Society of St Vincent de Paul, Maryvale, writes:

“The current HETN project of two tons of e’Pap per month is feeding 20 crèches with a total of 1,800 vulnerable children.

“The success of the scheme is self- evident - children who were constantly tired are now full of energy, highly active and much more receptive to their teachers. The overall improvement in their early childhood development is astonishing.

“The benefits to the township as a whole, from the creation of a healthy generation, cannot be overemphasised. e’Pap is a lot better than other food supplements that we have tried.”

e’Pap Improves TB Cure Rates by 39%. John Heinrich, CEO, South African National Tuberculosis Association (SANTA), writes:

“The HETN pilot project of two tons of e’Pap per month is proving highly successful. The greatest impact is being seen on very ill / bedridden patients. e’Pap is far more beneficial than supposed enriched foods received before. 

“These e’Pap projects have proved most valuable and are well received. Their continuation and expansion is seen as one of the three major objectives of SANTA in the continuing fight against TB and HIV/AIDS - namely nutrition, awareness and Directly Observed Therapy (DOTS). SANTA is in no doubt that improved nutrition can revolutionise the fight against both TB and HIV/AIDS.”

The SANTA care workers write:

“When e’Pap was introduced, no one believed that it would save lives. But we have seen miracles. We used to cry and wonder why people should be so sick. Today, we walk with a smile and songs in our hearts, because we have witnessed the dead brought back to life.

“Bread winners had taken to their beds. When e’Pap was introduced, most were back on their feet. They gained weight, and grew in strength. Patients now respond positively to medication. The children can concentrate at school. They sing and praise e’Pap as it works miracles in their villages.

With this little sachet we can heal the nation; we can change the world.”

For more information on the work of the HETN go to www.hetn.org.

For an extensive list of references on the roles of vitamins A, B6, B12 and E, and the minerals selenium and zinc in immune function email: advancingnutrition@higher-nature.co.uk.


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