Health Matters newsletter: Of laddus and food contamination

(In the weekly Health Matters newsletter, Ramya Kannan writes about getting to good health, and staying there. You can subscribe here to get the newsletter in your inbox.)

In this country, the oddest things make it to the headlines, and stay there. Last week, there was all the kerfuffle about laddus, not any laddu, just a batch that is unrivalled not only for its value among certain sections of the religious, but also as a sweetmeat. The famous Tirupati laddu sailed into prominence for all the wrong reasons, there were charges that the laddus were made with ghee that was contaminated with beef tallow, and pig lard. “This ghee contains fish oil, beef tallow and lard, which is a semi-solid white fat product obtained by rendering the fatty tissue of a pig. This has been confirmed after the alliance government has sent the samples to the NDDB’s CALF,” a representation of the Telugu Desam Party, said. Backed by his entire party, the laddu soon took political colour, and it became a weapon against the former Chief Minister of Andhra Pradesh, Y.S. Jagan Mohan Reddy. The charges stood on a rather weak foundation, though, as the lab report provided an estimation of contaminants in the ghee – in the plural, not singular. There were both vegetable and animal fats in the criteria that were evaluated – the presence of palm oil, soya oil and fish oil were also evaluated along with beef tallow and lard. The result did not provide conclusive evidence for the presence of beef or pig fats.

What this incidence, still simmering silently proves, is that science and facts can also be twisted, and unless we look for the specifics we might be a far way off from the actual truth of the matter. Data can also be, if one is wiley, tailored to toe a particular narrative. While vigilance about contamination of food is key, there is far too much of it happening in daily life, it is important to let the facts speak for themselves, instead of being nudged to conform to a narrative. 

As always, this spun several angles. Bindu Shajan Perappadan reported that the Food safety authority issued a show cause notice to firm on contamination in Tirupati Laddus, and the Tirupati Devasthanam blacklisted the firm (G.P.Shukla), while the Dindigul-based firm itself claimed that there was no such contamination and they had last supplied ghee a couple of months ago, as L. Srikrishna reported.

As it stands, the Centre has ordered an investigation into the animal fat issue in the laddus, and one hopes, that at the end of this investigation, hopefully propelled by science, there will be adequate clarity.

Staying with contamination as a subject, even if you have not being eating the Tirupati laddu, did you know your body is host to possibly more than 3,600 food packaging chemicals? Around 100 of these chemicals are considered to be of “high concern” to human health. Some of these chemicals are relatively well-studied and have already been found in human bodies, such as PFAS and bisphenol A — both of which are the target of bans, but little is known about the health effects of others, the author of the study said. Clearly we are justified in calling for more research into how chemicals used in packaging end up being swallowed along with food.

This is consumer related too, so leaving it here with the rest. The Union Health Ministry has proposed mandatory, ‘non-skippable’ anti-tobacco spots on OTT platforms. According to the draft norms released earlier this month, anti-tobacco health spots and audio-visual disclaimers on the ill effects of tobacco have to be displayed as soon as someone opens the streaming platform. Statutory warnings have a role in public health, but only in as far as how well they are implemented. While the film industry seems to have towed the line, given that a censor clearance is required to release a film, it will be interesting to see how soon OTT platforms roll it out too.

Do read: Unsafe food causes 600 million cases of illnesses, 4,20,000 deaths annually: WHO chief. 

While not headliners, last week conversations about weight and its impact on health, what healthy diets are and at what cost they come also dominated our health section. In this The Conversation piece, Natalie Lister, Hiba Jebeile ask I think my child’s weight is affecting their health. How can I best support them? Not all children with high weight will have health consequences; however, as children get older, excess body fat may have health complications including sleep apnoea, bone or joint problems, liver disease, high blood pressure or cholesterol, or insulin resistance. Do hit the link to figure out how to help, in such a scenario.

Now, a Blood test that could identify children at risk of obesity-related conditions, lipid analysis suggests. “For decades, scientists have relied on a classification system for lipids that have split them into good and bad cholesterol, but now with a simple blood test we can assess a much broader range of lipid molecules that could serve as vital early warning signs for illness,” lead author Cristina Legido-Quigley, a group leader in Systems Medicine at the King’s College, London, which did the study, said.

Read this article by Kalyani Raghunathan,Sudha Narayanan and Anita Christopher to understand how to capture the cost of healthy diets. Healthy nutritious diets are widely recognised as key to tackling the so-called ‘triple burden of malnutrition’, that is, the coexistence of undernutrition, overnutrition, and micronutrient deficiencies, as is the case in India. Unfortunately, most Indians do not consume healthy diets. The authors argue that one of the key barriers to better eating is the cost of healthy diets. Indeed, rising food prices have been in the news over the last several months, especially for nutritious foods such as vegetables, fruits, pulses, and eggs. Coming as real wages are stagnating, or even declining, this suggests that healthy diets are becoming more and more expensive. 

Instead of thalinomics, where the cost of a thali is taken as a standard measure for a healthy meal, the authors make a case for the Indian government to track the cost of a healthy diet, or the CoHD, to serve as a routine measure of the cost of meeting nutritional requirements. The CoHD captures the minimum per person per day expenditure needed to meet the daily food group-wise energy recommendations prescribed by national FBDGs, assuming the entire diet is purchased from the market. Our case rests on three facts: one, that the CoHD calculation uses price data that is already available and does not rely on expensive household consumption surveys, as the cost of a thali does. Two, the computations are not complex and can be easily automated and understood. Three, perhaps most importantly, the cost of a thali does not capture the same thing as the CoHD.

While we are at it, do read this story as well: WHO urges promotion of healthy diet, physical activity in Southeast Asia

Last week was also World Patient Safety Day, and at The Hindu, we went all out to tackle the issue of anti microbial resistance. Abdul Ghafur wrote this elaborate piece about The true cost of hospital-acquired infections. India faces unique challenges due to its diverse healthcare standards and high levels of AMR; despite many hospitals obtaining Joint Commission International accreditation, there is no obligation for these institutions to publicly disclose their hospital-acquired infection rates. HAIs are infections that patients acquire while receiving treatment for medical or surgical conditions, and as such questions arise, about whether patients should pay for this as well, or hospitals should subsidise care arising out of an infection acquired as an inpatient. 

Drug-resistant and difficult to treat urinary tract infections (UTIs), blood stream infections, pneumonia, and typhoid are among the diseases that are showing resistance to commonly used antibiotics, according to a report published recently by the Indian Council of Medical Research (ICMR)‘s Antimicrobial Resistance Surveillance Network (AMRSN). For more, read here.

And this, if you have been wondering: Are antibiotics responsible for inflammatory bowel diseases? A study showed that a course of antibiotics can damage the thin layer of mucus, and this allows the microbes to come in close contact with host tissues, triggering an immune response and predisposing the mice to intestinal inflammation. Breakdown of the mucus barrier, which separates the intestinal epithelium from the microbiota, is a hallmark of inflammatory bowel disease.

There is a grim scenario awaiting us in the future, but can be avoided by taking adequate precautions, beginning now. According to a global analysis estimate, infections of drug-resistant superbugs are projected to kill nearly 40 million people over the next 25 years, Superbugs — strains of bacteria or pathogens that have become resistant to antibiotics, making them much harder to treat — have been recognised as a rising threat to global health. If over prescription of antibiotics is one main reason, so are not conforming to prescribed dosages/schedules, and widespread use of antibiotics as a growth factor in the animal husbandry sector. 

Sneha Khedkar provides more sobering news: Vancomycin may not be able to treat MRSA infections for long. In 2019, methicillin-resistant Staphylococcus aureus (MRSA) — a strain that can resist several antibiotics — was responsible for more than 100,000 deaths. Fortunately, it is still significantly vulnerable to vancomycin, which has been doctors’ first-line treatment against MRSA infections for 40 years. MRSA rarely resists vancomycin. Only 16 such cases have been reported in India so far. This is because when S. aureus acquires vancomycin resistance (to become VRSA), it also grows slower and is less fit. Now, researchers have found S. aureus can adapt to vancomycin while overcoming this fitness cost. The study, published in the journal PLoS Pathogens.

This one is also about World Patient Safety Day, but slightly different. The WHO called for global action to reduce diagnostic errors, emphasising that delayed, incorrect, or missed diagnoses can prolong illness and, in some cases, result in disability or even death.

As we have discussed numerous times here, climate change is here, to stay and the effects from it will be aggrandized and negatively impact the world, and health of humans in many ways. Bill Gates recently said that Climate change will escalate child health crisis due to malnutrition. Around 90% of the negative effect of climate change works through the food system, Mr. Gates said, speaking ahead of the publication of the Bill and Melinda Gates Foundation’s annual Goalkeepers report, which tracks progress on the UN SDGs. Between now and 2050, 40 million more children will have stunted growth and 28 million more will suffer from wasting, the most extreme and irreversible forms of malnutrition, as a result of climate change, the report said. “Unless you get the right food, broadly, both in utero and in your early years, you can never catch up,” Gates told Reuters in an online interview last week, referring to a child’s physical and mental capacity, both of which are held back by a lack of good nutrition. Children without enough of the right food are also more vulnerable to diseases like measles and malaria, and early death.

The Lancet published the results of a study that showed air pollution and high temperatures are driving up the number of strokes, globally. Researchers found that the contribution of high temperatures to poor health and early death due to strokes has increased 72 per cent since 1990, and is likely to continue increasing in the future, thereby highlighting how environmental factors can impact the growing stroke burden. Further, for the first time, particulate matter or PM air pollution was found to have the same contribution as smoking towards causing a fatal form of brain bleed, according to the researchers forming the Global Burden of Disease, Injuries, and Risk Factors Study group.

Here is something from the future, perhaps what we have dreamt of, particularly those with a phobia of needles. No doctor or jab is necessary: U.S. okays nasal spray flu vaccine for self-use. Anyone over 18 will be authorised to administer the vaccine to themselves or another person. It is approved for use on anyone from age two to 49.

Here’s yet another innovation in technology that can aid health care, this time, with diagnosis. IIT-Madras researchers develop portable ultrasound scanner for diagnosis of sports injuries. this device, from the institute’s Centre of Excellence in Sports Science and Analytics (CESSA), could potentially allow for on-field diagnosis of injuries and an immediate assessment of the extent of injury that will allow for medical professionals to take a call on whether to permit the sportsperson to continue playing. The researchers have already been granted several patents for the technologies that went into this device. The Artificial Intelligence-powered scanner has a wide range of applications in sports medicine. It has the benefits of safety – no radiation – and sufficient resolution compared to other modalities.

Once again India rises to the occasion, and Patent applications for HIV prevention drug have been opposed in India. Remember, it was last year that a patent evergreening application filed by Johnson and Johnson was opposed successfully by two TB survivors, Nandita Venkatesan and Phumeza Tisile. The Indian Patent Office is set to hear the objections against the grant of patent claims filed by U.S.-based pharmaceutical company Gilead Sciences on the HIV drug Lenacapavir later this week. Lenacapavir, administered as twice-yearly injections, has garnered attention for its potential in HIV prevention after multiple clinical trials demonstrated superior efficacy to standard oral preventive medicines, known as pre-exposure prophylaxis.

In our tailpiece for this week, let’s look at the wonder that is human brain, and all the more wondrous, a female human brain. Study shows how a woman’s brain reorganizes during pregnancy. Researchers said they have for the first time mapped the changes that unfold as a woman’s brain reorganises in response to pregnancy, based on scans carried out 26 times starting three weeks before conception, through nine months of pregnancy and then two years postpartum. The study documented a widespread decrease in the volume of cortical gray matter, the wrinkled area that comprises the brain’s outermost layer, as well as an increase in the microstructural integrity of white matter located deeper in the brain. Both changes coincided with rising levels of the hormones estradiol and progesterone. “The maternal brain undergoes a choreographed change across gestation, and we are finally able to observe the process in real time,” said University of California, Santa Barbara neuroscientist Emily Jacobs, senior author of the study published in the journal Nature Neuroscience.

As for the explainers section, here is our offering:

C. Maya writes on How Kerala reduced mortality from amoebic meningoencephalitis

Abdul Latheef Naha  tells you about the Nipah protocol in Kerala. 

Michael Henry,Lorimer Moseley in The Conversation ask, and explain: Why is pain so exhausting?

Shrabana Chatterjee has a detailed story: In the Sundarbans, a group of mothers are arming their toddlers against accidental drowning

If you have a few extra moments, do read:

Afshan Yasmeen on World Alzheimer’s Day: International survey finds 80% of people think dementia is normal part of ageing

R. Prasad on Commercialisation of health services can be a recipe for disaster, says Sujatha Rao