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In this edition of Health Tech on the Horizon, host Mike Rugnetta welcomes Hakim Bouzamondo, divisional vice president of nutrition global research and development and scientific medical affairs at Abbott and Katharine Kreis, the director of strategic initiatives and lead for nutrition innovation at global nonprofit focused on improving public health, PATH. Listen as they discuss the past, current and future state of nutrition and how climate change and technology will impact the nutritional needs of a growing population.

Health. It is at the center of everything we are thinking about today – as citizens, as a nation, and as a global community. We live in a world where diabetes is an epidemic, where obesity is affecting both developed and developing countries, where an increasing number of countries around the world are facing super-aging populations, and yet the prevalence of stunting, undernutrition and malnutrition among children are increasing at staggering rates globally. It is for these reasons we must come together to secure the health of our communities – not just for today, but for the future.

READ THE TRANSCRIPT

Mike [00:00:00] What is the future of nutrition? How will we feed an ever growing worldwide population? What are the technologies being developed to address these issues and how does climate change play a role in all of this?

Hakim [00:00:13] The climate change problems and the extensive malnutrition. If we do not have a different approach, we will keep repeating the mistakes of the last hundred years.

Mike [00:00:25] Hello and welcome to Health Tech on the Horizon, where we talk with medical innovators, doctors and deep thinkers about the future of humanity, human health, the human body, and the future innovations that will shape our world. I'm your host, Mike Rugnetta, and today we'll be talking about the current and future state of nutrition. Specifically, the impacts of climate change on food supplies; how we might address the shifting nutritional needs of a growing global population; and the future innovations to support communities and nations either struggling to find enough food to eat, or experiencing malnutrition in the form of diet-based obesity.

Mike [00:01:00] Joining me are Doctor Hakim Bouzamondo, Divisional Vice President of Nutrition Global Research & Development at Abbott. Hakim is a medical doctor by training and is responsible for overseeing product development, education, clinical and pre-clinical research for pediatric and adult nutrition. Thank you for joining us, Hakim.

Hakim [00:01:19] Thank you for having me.

Mike [00:01:20] And Katharine Kreis, the Director of Strategic Initiatives and Lead for Nutrition Innovation at PATH, a global health organization based in Seattle, Washington. Katharine leads PATH's effort to develop and deploy new methods aimed at improving nutrition in 70 countries around the world. Thank you Katharine for joining us.

Katharine [00:01:40] Thank you for having me.

Mike [00:01:42] So to start, I was wondering if you could both tell us a little bit about the current state and recent history of nutrition and malnutrition, which I know is a really huge question. So, I think we’re gonna break it into two parts. First, Katherine: I was wondering if you could tell us just a little bit about the biggest factors, whether they're social or ecological or infrastructural, that guide whether or not a group of people can get the food that they need.

Katharine [00:02:13] Yeah. So that's a really complicated question when it comes to nutrition because there are, not surprisingly, many, many factors that go into people's ability to not only have the nutrition that they need, but also to be able to use that in a way that helps their bodies grow and develop. So you have a number of things that are working in collaboration in a system. And of course, the food system is probably the biggest system when we're thinking about nutrition. And that, of course, is very linked to the private sector. So you have issues around supply chain demand kinds of issues and really thinking about how you get and grow food and get it to different places and different people. There's the policy regulatory environment that's in and around that. So, whether you're talking about, you know, tariffs and trades for moving food, all the way down to things like taxation policies that are now up and coming with the obesity crisis, for example, around soda. And, you also have issues within the human body that are aiding or limiting the ability for the human body to uptake those nutrients that people are hopefully getting out of food.

Mike [00:03:28] And, Hakim, just to sort of flesh out what we mean when we say nutrition versus malnutrition. I wonder if you could just talk about how our understanding of nutrition has developed over the last century or so and, you know, how it works and where our current understanding is?

Hakim [00:03:46] So I'd like to start by saying that the interest of people in nutrition is not something new and actually started probably more than two or three thousand years ago. Now, having said that, the modern nutrition really started around the year of 1920. And this is where the concept of a single nutrient is born. And what I mean by that is that by identifying these single vitamins, there was a proven track to provide patients with single vitamins that would fix some serious epidemic deficiency diseases. Afterwards, around 1950, we started coming up with recommended daily allowances for proteins, for carbohydrates, for lipids, fats, but also for minerals. Then the third phase, if I may say, is the introduction of the notion of calories. So, until 1960/70, the notion of calories was not very much prevalent in our countries. At the same time, or maybe around 1980, 1990, we started to face what we call the dual-burden of malnutrition, where people realized that this was a major issue in our world and specific actions on hunger did start.

Mike [00:05:22] So, Katharine, I know that you have worked in the Peace Corps with the United States Agency for International Development and the Bill and Melinda Gates Foundation. You spent a lot of time living and working in low- and middle-income countries. I was wondering if you could talk a little bit about the current line of thinking as far as how we get those populations of people the resources that they need to eat healthily?

Katharine [00:05:47] Yeah. So addressing issues in low- and middle-income countries is a challenge, just as it is in many countries all over the world. I mean, malnutrition, whether you're talking about underweight or overweight or micronutrient deficiencies, are complex. But you're also really dealing with some systems kinds of issues. So whether we're talking about getting them to change their behavior around, say, eating fruits and vegetables, or whether we're doing it in a way, for example, through fortified products—products like Ultra Rice or fortified grains like we eat in the United States all the time—these are ways that we've been able to get higher quality foods, you know, higher quantities of vitamins and minerals, into people's diets in a way that helps them achieve palatability, but also do it in a way that's cost effective.

Mike [00:06:35] Katharine, can you just tell us a little bit about fortification?

Katharine [00:06:37] Sure. Fortification, which has been around since the 1920s. I mean, people's grandmothers will remember this. Fortification efforts in the United States were fortified salt with iodine, and that was to prevent goiter and, in very severe cases, mentally-challenged kids who were not getting enough of this early in life. From there, policymakers recognized that, for very little cost, they could work with and through the private sector to add vitamins and minerals to staple (usually staple) grains. You want to find a product that is a good quality product, things like milk, wheat flour, corn flour, rice. These are the types of things that people eat all over the world. They're eaten in regular quantities, and they're eaten almost every day. So if you fortify them with vitamins and minerals, you're getting a certain level of vitamin and mineral into the human system in a very regular kind of way.

Mike [00:07:42] You mentioned Ultra Rice, which was created as part of a research and development partnership between Abbott and PATH. And, from what I understand, it is an example of how fortification technology can help get needed nutrients into the foods that people eat regularly. And I was wondering if you could just talk a little bit more about what Ultra Rice is?

Katharine [00:08:03] So Ultra Rice is a fortified rice product and it is made by taking regular rice and grinding it into a powder, adding vitamins and minerals, running that powder and mineral mixture through a pasta maker to make it look like any number of types of rice that are sold all over the world. And then, adding those fortified kernels in a ratio of about 1 to 100 to regular rice.

Mike [00:08:32] And I wonder if either of you have sort of opinions or ideas about where Ultra Rice fits into a suite of problems that need solving. Like what, what level problem is this solving? How is it most effectively used?

Hakim [00:08:43] Simply put, if you think about a staple, the rice here, that is offering bio-available iron that is three to five times higher than what people usually get, then you have a quick and nice solution to fix the anemia epidemic in the world. When you think of all these vitamins that are added to the rice, we're also addressing a major issue that was encountered 50, 60, 70 years ago, fixing all these vitamin deficiencies that were observed in the past centuries and unfortunately still now.

Katharine [00:09:28] Yeah, I think that that's exactly right. When you think about the types of things to get, you know, vitamins and minerals into people, fortification is a way that allows us to do things in a very, very cost efficient manner. Fortifying a staple grain—rice or wheat or maize—it costs about 13 to 15 cents per person per year. So it's very, very cost effective. And then, the third way that you can do it is getting people to eat more fruits and vegetables to have a more diversified diet. But that has issues in countries where fruits and vegetables are more expensive; you may not have refrigeration, so they may go bad more quickly. So, it's really trying to to meet people where they are.

Mike [00:10:12] I wonder, could you talk a little bit about how climate change is contributing to the spread of malnutrition?

Hakim [00:10:17] So, our ecosystem is changing. This is not a myth. As the results of rising temperature, agriculture, hyper productivism, there's an impact to the quality and the quantity of nutrients that is delivered to the populations, creating food insecurity, but also increasing costs.

Katharine [00:10:47] Yeah, I couldn't agree more. I mean, I think that the systems issues where we as a global community look at this science, look at the data, and make the best conclusions based on the evidence is imperative. And policymakers, you know, is part of it. But there are those systems issues that have to be coupled with targeted interventions. And, in fact, in many ways, the targeted interventions—the ability, for example, to better, you know, have crops that are more resilient to drought and floods and pests that allow people to stay in communities and farm their land, that allow people to have have better access and affordability to higher quality foods—those types of targeted interventions are also, I think, really important when we're thinking about the effects of climate change.

Mike [00:11:40] How do we not repeat the problems of the past, while also producing all of the food that we need for a growing population? Like, how do we get better at agroecology where we aren’t overproducing in some places, and we’re making sure to maintain the quality of the lands that we farm, while also making sure everyone has enough food supplies?

Hakim [00:12:01] I believe that we need to have a diversified approach to this production and have a more agro-ecological system that would help us to combine the need of this growing population, but also making sure that we come up with new solutions and systems that would help us to develop diverse crops, which would help the microbiomes soil diversity, and would reduce the need for irrigation.

Mike [00:12:37] When you think about the next 50 to 100 years, what are the things that you see on the horizon, you know, on the horizon of whether it's food systems thinking, regulatory thinking, our understanding of nutrition—where are we headed? What is the thing that is just barely in view now that we'll get to in 2100?

Katharine [00:13:01] Well, I have to say personally, I'm very optimistic because I think, you know, we are beginning to recognize...I mean the first step in dealing with any problem is to recognize that you have a problem. So just the beginnings of recognizing that these are issues. And then, along with climate change and other things that are making it difficult, we also are really moving forward with incredible technologies that are helping us better address these and more specifically address these kinds of problems. Everything from new farm technologies that allow us to use less water and to grow things on less land, to technologies that are helping us better diagnose and track where these problems are so that we can better pinpoint our interventions. So, how do we use the information technology that we have, the diagnostic technologies that we have, the intervention technologies that we have throughout the food system in order to better hone our interventions and make them more relevant for people?

Mike [00:14:07] And could I get you to speculate about what would, more specifically, be the types of technologies you think will arise and make a positive impact?

Katharine [00:14:17] Yeah. So, I mean, I think with the advent of things like being able to edit genes, for example, that might help you get better yields for crops or may be able to help you make them more pest-resistant or more drought-tolerant or flood-tolerant. You know, that's a type of a technology. The other types of technology that are coming up are really due to understanding of the human body and how we are absorbing the food that we eat and what the role of inflammation has on us to be able to use the nutrients that we consume. And then it'll be things like dealing with issues around supply chain that has to do with, you know, changes in patterns of migration. So we're going to see a lot more urbanization all over the world in the future. How do we meet the needs of those more urbanized populations?

Hakim [00:15:07] And I'd like to add to that maybe three aspects. So the one that you just covered, which is making land more accessible for people who are interested in farming, especially in the context of urbanization. So if we can bring the land close to the large cities, then we would make these products closer to the consumers. The second point is really around the microbiome. And without going into too much detail, if we better understand in the future and we will better do that, understand how diet affects this large organ, then we will better anticipate and prevent multiple chronic diseases. And finally, there's an aspect today around personalized nutrition where I believe that personalized nutrition will help us get the right nutrient at the right time in our lives.

Mike [00:16:09] Can you talk a little bit more about that Hakim? Specifically, what is the microbiome and how could studying the microbiome lead to nutrition solutions?

Hakim [00:16:19] The microbiome is really an organ. There are more than a hundred trillion microorganisms in our body: in the skin; in our upper respiratory system. But also, and importantly, in the gut, where we find the largest number of these bugs. And the importance of microbiome is related to the fact that microbiome is helping to stimulate our immunity. But not only, it also helps producing fats and vitamins and also have an impact on our behavior through the gut-brain axis. So, by studying your microbiome, by assessing the level of nutrients in your diet and in your body, we would be able to come up with a solution for each and everyone.

Katharine [00:17:16] It's fascinating talking about this because it is the next generation of nutrition science I think that we're going into. But if you look at a group like Open Biome that's based out of Cambridge, they're looking to see if this microbiota transplant that is taking the microbiota from a well person and putting it into an unwell person would actually address some of these issues. And they're in the process right now of doing a study to see if microbiota transplants could actually also help to address acute malnutrition. So kids that don't respond to the current treatment for acute malnutrition, which is basically a peanut butter paste and antibiotics. Some kids just don't respond to that. They just, they don't recover. And these are kids at a very, very high risk of dying.

Mike [00:18:04] Putting a bunch of these ideas in line next to one another, it makes me think of an eventual future where you supply the table in your home with dinner from food from your local farm, maybe as local as your roof or your backyard. That has been sufficiently genetically-engineered to your particular microbiome so that, you know, you've sort of solved all of these or a at least a number of supply and biological problems that, you know, if you are able to essentially tailor your food supply to your own body and then, you know, have it travel a short a distance as possible, you've solved a lot of problems. Maybe we're a while from that. To both of you, wondering if you think that people will still eat meat in the future?

Hakim [00:18:52] I believe the answer is yes. But, people will probably eat meat in a more responsible manner, not the way we do it today. So are we all going to eat lab grown meat? Maybe, yes; maybe, not.

Katharine [00:19:09] Yeah, I would agree with that. I do think that it's very unlikely that we will move away from eating meat completely. But, I think we're already seeing shifts in diets towards more sustainable diets. You know, certainly the production technologies, traditional farm technologies of producing chickens and eggs and fish, in some areas edible insects even, are...those provide the same kinds of proteins as beef and pork without the same kinds of environmental impacts that those larger animals produce.

Mike [00:19:44] When we think about products like Ultra Rice, you know, what are your hopes for additional inventions or technologies, as we put it, that look like that in the future? What are the next, you know, dozen steps past Ultra Rice?

Katharine [00:19:56] Well, I think one of the real positive things about fortification and Ultra Rice, in particular, is that consumers don't have to make a huge behavior change to accept it. You know, it tastes about the same. It looks about the same. It costs about the same. It cooks about the same. These plant-based proteins that are made into burgers, you know, the sort of next generation of burger technology that's made out of plants, I think is really having quite a bit of success.

Mike [00:20:30] Love the phrase burger technology. Love it. A plus.

Katharine [00:20:34] I'm going to get...Someone's going to send me hate mail for that.

Mike [00:20:37] No way. Are you kidding me? Burger technology....I feel like that should be something that brands and restaurants adopt like “the latest in burger technology.”

Katharine [00:20:48] Yeah I know.

Mike [00:20:52] But, for now, the development of fortified products and microbiome research are just a few of the innovations that help address malnutrition and improve food production for a growing global population. Though, it does seem that the future holds many more opportunities for improving food production and nutrition, like environmentally-friendly agro-ecological solutions and even hyper-customized diets to ensure we are getting the exact right nutrients at the exact right times of our lives.

Hakim and Katharine, thank you for joining us. Thank you all for tuning in.

For more on the innovative thinking driving the future of human health, check out our Health Tech on the Horizon episodes wherever you get your podcasts.