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55   The Disease of Malnutrition
     The Washington Post, July 29, 1967

     Malnutrition is the most prevalent disease of the human species.
It is primarily associated with poverty and ignorance.  Many
populations somehow subsist on marginal diets barely sufficient in
total calories to sustain life -- and fail to acquire enough of the
special nutrients needed for normal body development and resistance
to disease.

     The result, in vast areas of the world, is a heavy toll of infant
mortality, stunting of growth, easy vulnerability to otherwise
nonlethal diseases like malaria and measles, and, in all likelihood,
irreversible setbacks in the development of the brain and its
intellectual functions.

     Reliable statistics on malnutrition are nonexistent.  It is a
reasonable guess that a third of the world's population is suffering
a substantial penalty that could be alleviated by improved foods. 
Reduction in vigor and capacity to produce is of course a crucial
element in the vicious cycle of non-productivity, poverty, disease
and undereducation.

     Malnutrition has been regarded as mainly an economic problem, but
we do not begin to use and develop the scientific information that
could alleviate malnutrition even within pressing limitations of cost.

     For example, a Senate committee has recently rediscovered
malnutrition in the United States, in pockets of poverty in
Mississippi and Appalachia.  The evidence is compelling, but it is
nonspecific.  We see pictures of unhealthy children, but we do not
know exactly what deficiency they are suffering.

     The families live on welfare payments that constitute miserable
standards of living by United States norms, yet greatly exceed the
budgets for nutrition even dreamed of by planners for the
underdeveloped world.  In an economic framework not geared to
efficient provision for the poor, these families simply do not know
how to stretch their food dollars: malnutrition on a diet that
includes canned meats is a paragon of economic absurdity.  The grocery
shelves do not stock the foods most appropriate to this economic
level.

     If we knew the specific nutritional deficits of these children,
they could be made up with synthetic nutrients for a few dollars a
year.

     For many years, vitamins were the main targets of nutritional
supplementation.  Diseases like beri-beri, scurvy, rickets and
pellagra, were global scourges, but they could be prevented by public
education about balanced diets and by inexpensive enrichment of flour
and other staples.  And vitamins are too readily available in a wide
variety of foods in the very small quantities needed for human
nutrition, to represent a serious economic problem.

     However, vitamin deficiencies, and diseases from insufficient
iron, calcium or iodine, are still too prevalent to be dismissed
as public health problems.  Although American science has made an
enormous contribution to world health through the biochemical research
that led to our present knowledge of these factors, there remains a
great deal more that we can do through technical assistance to
countries that are still struggling to understand and solve these
nutritional problems.

     Patience and understanding of local traditions are often more
helpful than profound scientific expertise in communicating the
essentials of good nutrition to other people.  Much of the success
of the Peace Corps is founded on this principle.

     But the main challenge to world nutrition are the essential
amino acids, the so-called animal protein problem.  Any number of
technical solutions deserve a detailed discussion, and many are being
implemented.  Nevertheless we still have only the vaguest idea of
the quantitative magnitude of the problem.

     We do know that the human biochemical machinery can fabricate
only 9 or 10 of the 20 amino acids.  The others must be furnished
in the diet.  A deficiency of any one prevents the cells from making
the full range of proteins needed for growth and life.  Four of these
amino acids, lysine, threonine, tryptophan and methionine, are
especially critical since they are likely to be under-represented
in the proteins of many food crops.

     Food animals, fowl and fish produce more balanced proteins --
they concentrate these essential molecules from their own plant
diets, or, in the case of the ruminant cattle, maintain a built-in
fermentation plant for microbial production.

     Hence, it is the meat-poor diets of countries with subsistence
agricultures that suffer from amino acid deficiencies.  We are,
however, making wild guesses when we try to assess just how much
of which amino acids must be included in various diets.

     A crucial difficulty is that the nutritional standards
established for middle class Americans may be totally irrelevant to
the underdeveloped world.  Differences in the residual diet, climate,
work demands and racial composition may all play an important part.
The scientific analysis of nutritional needs should be recognized
as an essential part of our long range plans on how the world can
feed itself.

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