The biggest eyesore that defines modern Sub-Sahara Africans (SSAns) today is malnutrition: both childhood and by extension, adult malnutrition. The mass media is full of images of childhood malnutrition and extreme deprivation, including frequent images of overt starvation even in adults. Maize is the dietary staple for most communities across SSA. But maize (corn), wherever it has been domesticated as a significant part of the daily diet causes malnutrition, among both children and adults: kwashiorkor and marasmus in children, and pellagra in adults.

Both maize and current levels of malnutrition were unknown in the region just over 500 years ago. Maize is said to have been introduced on the continent’s coasts on a large scale during the era of Christopher Columbus. In what has come to be known as “the Columbian exchange,” many plants found new homes; maize was brought into the continent from South America, at a time when African slaves were being dispersed globally. It took well to the tropical climate, and the amount harvested per acre of land surpassed traditional grains. In time, it became a significant commodity of commercial exchange. In addition, it became the major dietary component of slaves, both during their travels, and wherever they settled. On the continent, the use of maize in the diet spread inwards from its coasts.

Imperial forces disseminated the crop on the continent further. And after independence, policies pursued by successive governments have tended to promote the entrenchment of the crop’s hybrids(considered to be nutritionally inferior to the native crop) in the diet for a majority of the people. Maize malnutrition, unless properly treated runs in families, and across generations. Maize imposes nutrient deficiencies, especially niacin, which impact negatively optimum system’s development in children, and metabolic dysfunctions in adults. Altered behavior and reduced life expectancy are common outcomes.

A maize diet imposes both micronutrient and protein malnutrition among consumers, because it is a poor source of both B vitamins, (especially niacin), and essential amino acids, (especially tryptophan and lysine). In affected communities, these deficiencies are responsible for a heightened disease burden, and poverty. Common behavioral problems include a violent tendency, a “witchcraft culture”, e.g. the belief in the evil eye, demon possession and curses. This is collectively regarded as the “spiritual” interpretations of disease, by a culture that is not in tune with the biomedical interpretations of disease. Food for example is valued for its “ability to satisfy rather than its nutritive value”.

Yet this has not always been so. There was a time when Africa discerned such things as food value, and had infact developed a very good food culture, based on such knowledge. Such indigenous knowledge has gradually been lost, as indigenous dietary staples have become marginal to hybrid maize, and or cassava, another alien crop that is a poor protein source. In affected consumers, nutrient deficiencies interfere with optimum development of certain key organs. In the brain for example, the forebrain is most affected. Individual brain cells (neurons) and their connecting fibers are reduced in numbers. Neurotransmitter chemicals are commonly unbalanced, leading to chemical imbalances. The immune system and its functions are weakened by malnutrition. This promotes a high disease burden, and interferes with learning and normal behavior in severe cases.

Tryptophan is both a niacin and serotonin precursor, serotonin is an important transmitter in the brain which controls brain development, mood, and normal psychological function. Niacin is central to normal food metabolism; its deficiency weakens the body and interferes with protein uptake and utilization. In children, this causes kwashiorkor and marasmus, while in adults, it causes the disease pellagra. This explains why a child may thrive on mothers’ milk (which is auto-digestible because of the enzymes and other immune boosting nutrients), but develops protein malnutrition when switched to cow’s milk, which is more difficult to digest.

Protein deficiency, absolute or relative, impacts negatively all body systems, including enzyme synthesis and function, the immune system function, among other dysfunctions. This weakens the function of all the body’s systems, (including the digestive system), and creates a vicious circle of maldigestion, diarrhea, malnutrition and more body weakening. In part, maize explains why malnutrition is common in the weaning African child, as they are unable to digest and properly utilize proteins, including nonhuman milks, e.g. cow’s milk, once they stop breastfeeding.

Research on this subject by this author and the findings of a post-graduate dissertation helped develop and shape this discourse: infants admitted into the hospital with recurrent diarrhea during a study period were noted to succumb to the same problem after repeated hospital admissions without improvement. The tendency to deteriorate, and finally succumb was observed in malnourished infants, whose nutritional status was noted to worsen, before they finally died. This outcome inspired continued interest in the subject by this author. It culminated after many years of research in the recognition that endemic infantile malnutrition in the African setting was linked to an endemic diet of maize in the community. A maize diet helps promote the lactose intolerance (due to lactase deficiency) that is rampant among many peoples of African descent (1a-g).

Chronic diarrhea leads to constant loss of nutrients in the stool, with Vitamin A, E, B vitamins, zinc (among other nutrients) most commonly lost. Lactase, the enzyme that helps digest milk, is one of the earliest to be adversely affected by nutrient deficiencies. This is why the weaning diet i.e. formula/cows milk, tends to precipitate and perpetuate “weaning diarrhea.” Mothers are then forced to give the only other food that is readily available in the home: maize porridge or cassava, both of which worsen the malnutrition.

Once established in the family, lactose intolerance becomes a heritable condition. Undigested lactose (milk sugar) causes digestive injury and sets in motion a vicious circle of malnutrition and disease because “lactose enhances mineral absorption in infancy”. In other words, undigested lactose promotes loss of minerals (among other nutrients) in the stool of the affected; thus, milk weakens instead of nourishing the body among affected individuals. The severity of disease symptoms due to lactose intolerance varies from person to person even in the same family; this makes it difficulty for the problem to be easily recognized as arising from the same cause.

Maize differs fundamentally from traditional African staples like the millets, sorghum and rice because they have more “useable B vitamins, and protein”. Niacin in maize is bound, making it difficult for the body to access it through ordinary digestion. Cultures that have thrived on maize have learnt to pre-chemically process maize before cooking, in order to improve availability of micronutrients, including niacin. Because Africans no longer use traditional methods of food preparation, like munyu mkereka, or fermentation methods (many such methods were discarded during the colonial period as they were termed primitive and unhygienic by the new political order), many nutrients are lost.

Niacin deficiency is the main reason high cholesterol and hypertension are both common among Africans, making heart disease a common cause of premature death. Maize malnutrition induces “muscle wasting” which is a common condition among Africans, both adults and children. Infact the pathophysiology of kwashiorkor/marasmus is similar to that of pellagra; the difference is in the degree of the disorder, and the developmental aspect in children. Malnutrition imposes a nutrient stress on the body, as does any other form of chronic stress, including chronic disease and even emotional stress. Africans find it difficult to withstand prolonged stress because of poor nutrient reserves; this in part explains the shortened life expectancy of modern Africans.

The word kwashiorkor was derived from the Gha language in Ghana, and was first coined by Pediatrician Cicely Williams, about 1930. The word was used to describe ‘the sickness the older child gets when the next baby is born.’ This description does not address the weaning diet directly, and may help explain why the problem has remained unaddressed. This author has done extensive research in this area including intervention strategies; the experience is covered in the book A HEALTHY YOU: Tame Africa’s Infant Malnutrition which is available at Infinity Publishers (2a-d, 3a-c). Insights gained from this research enabled me to understand the metabolic dysfunctions that are associated with niacin deficiency, and which have far-reaching consequences on the ability for the affected to obtain a “balanced diet”, even in the absence of extreme poverty. For example many relatively well-off Africans are unable to thrive on what would be considered a “balanced diet”.

This “middle-class curse” (relatively well off Africans are more diseased than their peasant counterparts) is recognizable both in Diaspora and continental Africa. And in the child population, the nutrient deficiencies associated with endemic malnutrition explains the “feeding dilemma”. Increasingly, African mothers are unable to feed their babies e.g. HIV positive mothers. They are told not to breast feed for fear of passing the HIV to their babies, yet their babies cannot survive on non-human milks. Many hospitalized babies therefore depend of donated milks, usually from the West. Research has shown that women who feed on a maize diet have low niacin levels in their milk. Many also tend to have vitamin B12 deficiency. The increasing maternal mortality in well equipped hospitals noted in Kenya recently needs to be evaluated with pellagra in mind. (4a-e).

In Kenya, malnutrition is generally blamed on poverty and ignorance. Indeed, there is a historical economic disparity that tends to over shadow other factors. Yet discerning observers may have noticed that in Western Kenya where child malnutrition is endemic (Western Kenya is the home of hybrid maize in Kenya) there exists a nutrition disparity that cuts across class. This author’s experience during patient care (HIV/AIDS patients) was that there appeared to be an obvious nutritional divide between certain Kenyan communities: patients from Western Kenya tended to respond more slowly to treatment, and their overall outcome was less favorable, compared to say patients in Central Kenya. It is this realization which in part enabled me to make the pellagra connection (5a-e).

The problem of pellagra (and childhood protein malnutrition) is complex and it imposes many burdens on affected communities, including a reduced human development index, economic stagnation and population decline. Other emerging problems in affected communities include an escalation of heart disease in previously unaffected communities, many types of cancer, diseases like diabetes, arthritis, a growing burden of developmentally challenged children, premature osteoporosis etc. The high disease burden, including HIV/AIDS can directly be attributed to endemic malnutrition due to maize.

Research suggests that malnutrition increases the risk of HIV transmission from mothers to babies and the progression of HIV infection ... The relationship between malnutrition and (Acquired Immune Deficiency Syndrome) i.e. AIDS is well recognized. Infact, in Africa, AIDS was initially known as ‘slim disease’. Changes in immune function due to malnutrition are strikingly similar to those induced by HIV/AIDS ...the impairment to immune function caused by malnutrition has been referred to as the “Nutritionally Acquired Immune Deficiency Syndrome (NAIDS)”. It has been documented that ‘slim disease’ “resembles AIDS in many ways.” The HIV can therefore be considered opportunistic to the underlying malnutrition. This is discussed in greater detail in a book to be released later: The Heritage of Maize Is Killing Africans-The Kenyan Story. Topics covered include the politics, history, geography, economics, socio-cultural and health impacts of maize. In addition, the role of maize as an imperialistic tool for ethnic marginalization are discussed (5c, 6a-e).

Selected References

1a. Scott Lee: Contested Meanings, Contested lives: Interpretations of AIDS in a rural community. University Committee on Human Rights.

1b.Oburra N.M. A study of some factors influencing The Outcome of Acute Childhood Diarrhea at the Pediatric Observation Ward of Kenyattta National Hospital an M.Med. Dissertation (Pediatrics), 1986. University of Nairobi Library.
1c. McCann James: ‘Maize and Grace: Africa‘s encounter with a new World crop 1500-2000.’ Harvard University Press.

1d. WB Saunders et al, ‘Textbook of Pediatric Nutrition’, Third Edition, 1991 Churchill Livingston.

1e. E. Ziegler, LJ Filer: Present Knowledge in Nutrition, 7nth Edition, Ilsi Press, 1996.

1f. Crosby AW, ‘The Columbian Exchange: Biological and Cultural Consequences of 1492’. 2nd Edition Westport, CT.

1g. Hersor LA: ‘A case of Childhood pellagra with psychosis.’ Journal of Mental Science (1955) 101:878-883.

2a. Noel W Solomon, MD. ‘Lactose containing foods in malnourished individuals: Beneficial or dangerous’ Nutrition International 2(2): 85-93, 1986.

2b. Ziegler EE, Formon SJ: Lactose Enhances Mineral Absorption in Infancy. J. Pediatr Gastro Enterology and Nutrition 2:288-294, 1983.

2c. Weaning: Enzymatic adaptation. A J Clin Nutr 41(17): 319, 1971.

3a. MRC . Food composition tables, Third edition, 1991.

3b. Tang AM, et al ‘Low Serum Vitamin B concentrations are associated with faster progression of HIV’. J Nutr 127 (2): 345, 1997.

3c. Kanter AS et al, ‘Supplemental vitamin B complex significantly delays progression to AIDS and deaths in Black South African patients infected with HIV.’ J Nutr 127 (2): 345, 1997.

3d. Ernandes M et al, ‘Maize based diets and possible nuero-behavioral after-effects among some populations in the world.’ Human evolution 11(1): 67-77, 1996.
3e. H. L. Gordon: The mental capacity of the African: A paper made before the African circle. J. Royal African Society 33(132): 226-242, 1934.

4a. Oburra N.M. A Healthy You, 1996- 1st Edition

4b. Dr. Nelly MO, ‘A HEALTHY YOU: Tame Infant Malnutrition in Africa.’ 2nd Edition 2008*

4f. Sunday Nation: Many maternal Deaths Reported in Well Equipped Hospitals.29nth October,2006.

5a. Shankar AS et al, ‘Zinc and immune function: The biologic basis of altered resistance to infection.’ Am J Clin Nutr 68:4478, 1998.

5b. Leon Chailow N.D, Simon Martin: A World Without AIDS. Thorsons publishers, 1988.

5c. E.G. Piwoz E. A. Preble. HIV/AIDS and Nutrition: A Review of the Literature and Recommendations for Nutritional Care and Support in SSA. USAID, 2000. 5d. Neville Hodgkinson, : AIDS: The failure of Contemporary science. How a virus that never was deceived the world.

5e. Chandra RK, ’Fetal malnutrition and post-natal immuno-deficiency.’ Am J Dis Child 1975; 525:450-455.

5f. Savage et al, ‘Vitamin B12 deficiency is the primary cause of megaloblastic anemia in Zimbabwe.’ Br J Hematol 86 (4): 844-850, 1994.

6a. Reuters Washington: Heart Disease Explained. Daily Nation 3rd December, 1998.

6b. Elizabeth Njeri: Heart Specialists Meet in Nairobi. The standard, May 14th, 2007.

6c. Dr. Price Weston: ‘Nutrition and Physical Degeneration.’ Price Pottenger Nutrition, 7th Edition, 2006.<./p> 6d. Walker ARP, ‘Low niacin concentration in the breast milk of Bantu on a high maize diet.’ Nature 173: 405-6 22 Feb. 1954.

6e. Okpewho et al, ‘The African Diaspora: African Origins and New World Identities.’ Indiana University Press.

6f. Serwadda D et al, ‘Slim Disease: A new disease in Uganda, and its association with HTLV-111 infection.’ The Lancet. Saturday 19 October 1985.