By Dr. Loretta Lanphier, ND, CN, HHP, CH

As tragic and disheartening as it can be, malnutrition is a fascinating topic. It can make folks appear emaciated, or it can cause weight gain. It can occur due to a lack of food, or it can be the result of too much food. It happens around the world, and around the corner. It takes the lives of far too many, and robs others of the health and wellness of their families. It is also a huge socioeconomic problem that seems to defy solutions. Malnutrition is a curse in nations rich and poor. Let’s see if we can gain a degree of understanding regarding this complex and far-reaching issue.

What is Malnutrition?

Malnutrition is, by definition, a condition in which the body does not get enough of the proper building blocks from the foods we consume to have healthy tissues and properly functioning organs. The prefix “mal” means “bad” or “lack of.”  Some forms of malnutrition are caused by a lack of sufficient amounts of food. Others are caused by a shortage of the right kinds of foods. Still other forms of malnutrition occur due to diseases that keep an individual from absorbing and utilizing foods properly.  When we hear the word malnutrition, most of us probably first think of starving children and adults in third world nations. Malnutrition is clearly a devastating problem in these parts of the world. But it also occurs at alarming levels here in this “land of plenty,” where glitzy 24-hour supermarkets and a glut of fast food restaurants dominate the landscape. There are many in the Western World who either cannot afford to eat properly or experience malnutrition due to ignorance and poor dietary choices based on cultural and familial patterns that dictate their lifestyle.

There are basically two major types of malnutrition: Overnutrition and undernutrition.

Overnutrition is primarily a problem in wealthier nations of the Industrialized World, such as the United States and Western Europe. This form of “mal”-nutrition is not based on a lack of the quantity of food, but on the ingestion of too much of the wrong kinds of foods, and too few of the proper kinds of foods. While there is a significant amount of undernutrion in these countries as well, the majority of malnutrition is due to a diet that is lacking in quality nutrients and heavy on an excess of empty calories.

The Standard American Diet (SAD) is aptly named because it is truly sad that with all the affluence that most Americans enjoy, we are a very malnourished nation for the most part. SAD is high in fat, salt, sugar, protein, and prepared foods, and low in fruits and vegetables, whole grains, vitamins, minerals, and fiber. We have become a lazy people that have forgotten what good food is and have chosen to forsake the time and effort it takes to prepare nutritious, wholesome meals. Most Americans are so busy trying to keep up with the rat race, that fast food from a hamburger stand or prepared “mush” from the grocery store is what they consistently exist on. In this land where the standard of living is so high, as compared to much of the rest of the world, most people have the financial resources to eat well, but they do not have (or make) the time or desire to choose healthily when it comes to nutrition. To compound the problem, it is becoming harder to find real food even it you chose to look for it. Unless you grow your own vegetables or shop at a local farmer’s market in season, it is very difficult to find fruit and veggies that are not nutritionally deficient or, even worse, genetically altered. And the major source of protein for most Americans, meat, is increasingly chock full of toxins, harmful drugs, and additives. Obesity is an epidemic in this country, combined with nutritional deficiencies that result in a classic case of overnutrition. These dietary imbalances have led to most of the leading causes of death and critical illness in the United States, including heart disease, cancer, stroke, and diabetes. The really “SAD” thing about it all is that it does not have to be that way. We are not the first nation in history to be suffering from the negative effects of affluence, but perhaps we can become the first nation to turn things around and bring some sanity back to our diets and lifestyles. It all starts with personal responsibility for ourselves and our families.

Before we move on to undernutrition, one final word about our situation here in America. Unfortunately, in recent decades the economy has suffered to the point that many families here in the U.S. do not have enough food (or enough quality food) to put on their tables. This is especially true of the elderly and others on a fixed income. It is estimated that 25% of senior citizens in this country suffer from malnutrition. It’s a complex problem because many folks have to make difficult choices like paying the rent or having enough food. This often leads to paying the necessary bills first and buying food with the money that’s left. Living on macaroni and cheese and hot dogs is better than ending up on the street, so a more subtle form of malnutrition is affecting many American families that have never known hunger before. Just ask anyone familiar with a food bank. The demand for food assistance is rising every year, often in communities that have never before suffered from a lack of resources for food.

Undernutrition is a form of malnutrition that is found mainly, but not exclusively, in developing nations where there is either not enough food or a very limited diet, or both. The most common form of undernutrition is called protein-energy malnutrition (PEM). PEM is an epidemic in some nations, and is in fact the leading cause of death amongst children in many parts of the developing world. This form of undernutrition is sometimes referred to as protein-calorie nutrition. Technically, PEM can occur in persons who have enough calories without enough protein, but it usually is a combination of both insufficient energy (calories) and protein. PEM occurs most often in poor nations that have a diet heavily based on carbohydrates like rice or other grains with few sources of regular protein. It is also sometimes found in poor folks here in the United States, especially the elderly.

PEM, and malnutrition in general, is classified as either primary or secondary. Primary forms of malnutrition are the direct result of a poor or insufficient diet, whether the problem is quantity of food, quality of food, or both. Secondary malnutrition is indirectly caused by diseases and conditions that prevent individuals from properly absorbing enough calories and/or nutrients. Some common maladies that can cause secondary forms of malnutrition include:

  • Alcohol and drug abuse
  • Cancer
  • Stroke
  • Coma
  • Kidney disease
  • Bowel conditions such as inflammatory bowel disease
  • Heavy infestations with parasites that rob the body of nutrients

There are two major types of PEM: Kwashiorkor and Marasmus.

  • Kwashiorkor, also known as “wet PEM,” is characterized primarily by a lack of protein in the diet, even if there is enough energy (calories). It most often affects infants at about the age of 12 months who discontinue breastfeeding, but it can occur in later childhood as well. Kwashiorkor produces tissue swelling due to fluid retention (edema), often in the liver and abdomen, combined with a very thin body. It also can lead to growth retardation.
  • Marasmus is a condition caused by energy or calorie deficiency—basically not enough food. Often found in children under the age of one who have stopped breastfeeding, marasmus leads to stunted growth and the deterioration of muscle mass. Some marasmus is secondary, the result of other conditions that lead to excessive diarrhea or other symptoms that prevent proper absorption of nutrients.

What Are the Symptoms of Malnutrition?

When the body is not supplied with enough nutrients, whatever the reason may be, it begins to literally consume itself. Once all the body fat is gone, muscle and other organs begin to be torn down in a desperate attempt to stave off starvation. This can be very damaging to the entire body. Common symptoms of malnutrition (in increasing intensity) include:

  • Anemia
  • Diarrhea
  • Constipation
  • Goiter (enlarged thyroid)
  • Pale, dry skin that bruises easily
  • Increased infections due to a weakened immune system
  • Mental confusion and disorientation
  • Muscle twitches
  • Difficulty with reflexes and coordination
  • Hypothermia (low body temperature)
  • Hypotension (low blood pressure)
  • Bleeding gums
  • Brittle hair that pulls out easily
  • Major organ failure, such as the heart, liver, kidneys
  • Starvation and ultimate death

What Can Be Done to Treat or Prevent Malnutrition?

The problem of malnutrition is a complex one, and the solutions are not easy either.

Probably the one factor that could make the biggest dent in early childhood malnutrition around the world is the increased occurrence and length of breastfeeding. Mother’s milk is the best source of nutrition and calories for babies. It also helps prevent many childhood diseases that can aggravate the issue of malnutrition. Programs that encourage breastfeeding should be supported, both in this country and abroad. Programs that provide infant formula and discourage breastfeeding should be eliminated. The only exception is in areas where hunger and malnutrition are so widespread that mothers are not able to provide sufficiently nutritious breast milk, or in cases where mothers have other serious health problems such as HIV/AIDS.

In the wealthier nations, the best way to prevent malnutrition is to educate people to the benefits of choosing a healthier diet and lifestyle that leads to wellness rather than disease. Nutrition and exercise should be encouraged. Perhaps one way to do this would be to offer financial incentives in the form of lower health insurance rates to folks who maintain certain standards of weight and lifestyle, very similar to what the life insurance industry does.

Ultimately, the most affective measures are personal responsibility and mentoring of one’s own family and circle of influence. What we do can influence more people on a personal basis than we can possible imagine. Like they say, a few dedicated people who believe in a cause, in this case living and eating responsibly, and practice what they preach, can change the world. Let it begin with us.

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