MALNUTITION AND HOMEOPATHIC MANAGEMENT
In India, 38% of children are born with Low Weight for Age. 36% of Urban and 44% of rural children are stunted. Bottle-feeding puts infants at a higher risk of illness, especially diarrheal diseases. Magnitude of the problem at global level is that malnutrition is responsible as underlying factor for 60% of the total 10 million deaths in children under 5 years of age.
One of the evident strength of homeopathy is its constitutional treatment wherein it reversers the inherent imbalances in the body system which is the major cause of several metabolic disorders. The constitutional care modulates the inability of the body to absorb or assimilate the micro nutrients. Thus, it provides curative care, offer long term prevention and promote health by correcting malnutrition and mal absorption disorders. This is one of the comprehensive ways to tackle nutritional disorders that is over reaching with substation therapy.
Malnutrition and mal absorption are the conditions in which the body does not receive enough nutrients for its proper functions. These are grouped under a broad category called Nutritional disorders. Nutritional disorder may be related to a deficiency of one particular nutrient or the inability to properly digest or absorb nutrients from the food they consume.
Malnutrition is defined as a pathological state resulting from a relative or absolute deficiency or excess of one or more essential nutrients; clinically manifested or detected only by biochemical, anthropometric or physiological tests. It is primary when there is deficiency of food available or secondary when food is available but the body cannot assimilate it for one or another reason. Malnutrition is common in children between age of 3 months and 3 years. Lack of proper nutrition caused by not having enough to eat, not eating enough of the right things or being unable to use the food that one does eat are all categorized under malnutrition. Disease and malnutrition are closely linked. Sometimes disease is the result of malnutrition, sometimes it is a contributing cause. Malnutrition in younger age shall lead to reduced physical and mental development. In fact, malnutrition is the largest single contributor to disease in the world, according to the UN's Standing Committee on Nutrition (SCN).Malnutrition remains a significant global problem, especially in developing countries. About 2.3 crore children in India, up to 6 years of age, are suffering from malnourishment and are under-weight.
On the other hand, mal-absorption is a condition in which the intestine can't adequately absorb certain nutrients into the bloodstream. It can slow down the absorption of macronutrients (proteins, carbohydrates, and fats), micronutrients (vitamins and minerals), or both. Proteins, carbohydrates, fats, and most fluids are absorbed in the small intestine (small bowel). Mal-absorption syndrome occurs when something prevents the bowel from absorbing important nutrients and fluids. The problem may be caused by inflammation, intrinsic disease, or injury to the lining of the intestine. Sometimes, the condition may be the result of the body’s failure to produce enzymes needed to digest certain foods or to adequately mix the food with the enzymes and acid produced by the stomach.
Facts for life (PDF) (4th ed.). New York: United Nations Children's Fund. 2010. pp. 61 and 75.
RajVir Bhalwar, Text Book of Public Health and Community Medicine, first Edition, 2009, Department of Community Medicine, AFMC, Pune
Major Malnutrition Conditions
Certain basic nutrients are required to maintain good health and mind. The energy yielding nutrients are proteins, carbohydrates, fats and dietary fibers. Vitamins and minerals such as calcium, iron, chloride, magnesium, phosphorus, potassium and sodium are other essential energy yielding nutrients. Apart from these certain micro nutrients such as chromium, copper, fluoride, iodine, manganese, molybdenum, selenium, sulpur and zinc are also required. All these at appropriate quantity is essential for maintenance of good health, enhancing immunity, speed up healing process and provide better sleep. Most of these are readily available in the food. During certain phases of life such as pregnancy, old age, recovering from illnesses, the requirement of the nutrients varies. If there is inadequate supply, it may lead to a verity of disorders. There are also certain conditions wherein the absorption of these nutrients get hampered and lead to deficiency. Thus, the quantitative or qualitative deficiency or inability to absorb the essential nutrients leads to malnutrition.
Protein–energy malnutrition (PEM) and micronutrient deficiencies are the two constituents of malnutrition. This continues to be a major health burden in developing countries. It is globally the most important risk factor for illness and death, with millions of pregnant women and young children particularly affected. PEM contributes to 60% of the total 10 million deaths of children of less than five years.
The World Bank estimates that India is one of the highest ranking countries in the world with children suffering from malnutrition. The prevalence of underweight children in India is among the highest in the world, and is nearly double that of Sub Saharan Africa with severe consequences for mobility, mortality, productivity and economic growth. Apart from marasmus and kwashiorkor (the 2 forms of protein– energy malnutrition), deficiencies in iron, iodine, vitamin A and zinc are the main manifestations of malnutrition in developing countries
The main cause of primary malnutrition is the failure of lactation of the infants. Improper weaning practices, poverty, food taboos, reduced space between child berths, death of lactating mother, incompetent/ ignorant motherhood due to illiteracy or early child marriage are the main factors leading to primary malnutrition. Secondary malnutrition may be because of repeated attack of preventable illnesses due to lack of immunization, congenital diseases such as Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) or cleft palate, celiac disease, lactose intolerance, giardiasis, cystic fibrosis, inborn errors of metabolism, chronic renal failure, renal tubular acidosis and so on. Chronic infections such as tuberculosis which is common in India may also lead to malnutrition.
Vitamin A deficiency is the leading cause of blindness in children. It also increases the risk of disease from severe infections. The clinical feature of Vitamin A deficiency includes those concerning the xerophthalmia, night blindness. Pellagra, beriberi, scurvy, rickets and osteomalacia are some other clinical conditions associated with vitamin deficiency.
Fluoride deficiency leads to dental caries.
Obesity is emerging as another major nutritional disorder of the modern world.
Anemia is another common disorder due to inadequate iron intake, poor absorption and bio availability of iron, excess loss of iron, increased demand of iron and other micronutrients at certain phases of life.
Iodine is an element that is required by the thyroid gland to make thyroid hormones. If the diet is deficient in iodine, the thyroid gland will enlarge as it tries to increase the production of thyroid hormones. This condition is called goiter. As thyroid levels fall, hypothyroidism develops.
Seriousness of the Problem
Malnutrition adversely affects the nervous system, both centrally and peripherally, leading to problems in thinking and other brain functions as well as in the brain’s regulation of the body. In developed countries, the major causes of nutritional deficiency are alcoholism, diseases that cause mal-absorption of particular nutrients, chronic illnesses that involve general physical wasting, psychiatric illnesses, food faddism, infantile malnutrition, and, rarely, genetic disorders.
Management of Malnutrition
Malnutrition is linked with high rates of new mothers and infants who die shortly after birth. New mothers especially those living in rural and tribal areas are vulnerable because many are malnourished and anemic when they get pregnant, often as teenaged brides. Low literacy levels, particularly among young tribal women, also contribute to the high mortality rates. The mortality rate for tribal children under five is higher in many parts of the country. The tribal families can face marginalization and exclusion from health and other services. Many women have not had access to safe health facilities and trained assistants for childbirth. New mothers and babies are exposed to infection and malnutrition from traditions that discourage breastfeeding for several days after birth, and enforce fasting and purification rituals for women. Health education and outreach of the services at the point of living these tribal’s are best options to overcome this issue.
The strategy for control of anemia includes detection and appropriate management; prophylaxis against parasitic diseases and supplementation with iron and folic acid; and improved obstetric care and management of women with severe anemia. There is importance of preventing and treating all forms of anemia, as the number of deaths associated with mild to moderate anemia is potentially greater than the number associated with severe anemia. The need of the hour is correct the anemia of an adolescence girl so that the subsequent impact on health and economy can be prevented.
Iron supplement is the essential component of management of anemia. But as far as iron supplement are concern, many issues have come up when dealing with mass level. Many times the appropriate doses for sufficient times are not received by anemic person. Non –compliancy issues due to nausea, vomiting, constipation & strong metallic taste act as obstruction & many times medicines are discontinued prematurely. Irrational intake of iron supplement also has its own problems. Iron not only stimulates bacterial growth but it also interferes in Zinc absorptions leading to weakening of person’s immune system.
Prevention of malnutrition includes proper health promotion, nutrition education on food, hygiene, family planning, good weaning practices. Specific protection measures are adequate diet. Growth monitoring, early diagnosis and treatment of infections and hospitalization of the critical case are measures that will help tackling the problem. Dietary improvement with dark green leafy vegetables, deep yellow fruits, eggs, milk and meat, fresh, exposure to sunlight and moderate exercise shall help to overcome the problems associated with malnutrition to a great extent.
Though milk is not a rich source of iron, but the bio availability of iron from breast milk is exceptionally good. Thus breast milk is a source that in itself is adequate to suffice the iron requirement of young infants. Dietary modifications, de worming, control of infections, supplementation, iron fortification in certain food, nutrition education, care of pregnant women and lactating mothers are some of the measures adopted to control and prevent anemia.
Community orientation in the management of Malnutrition
Dealing with nutritional disorder is not just giving nutrients and micro nutrient supplements. Malnutrition is not a simple nutritional deficiency issue, but associated with several social, economical factors. Creating awareness about nutritional deficiency is the major 'thrust issue' for the society. Along with creating awareness, there is need to ensure that resources for supplement are identified, generated and maintained by society themselves. This will happen only when there is community participation. Community participation will take place when the community is made aware about it. Therefore it is important to have proper training to the community. This will help to reach at mass level especially where medical facility is limited.
Homoeopathic approach on Malnutrition
Homeopathy advocates that when there is an imbalance in nutritional requirement and its supply, the deficient nutrients should be supplied in adequate quantity through natural food, provided the body can assimilate and absorb the same. In cases where there is deficiency of supply or the body is so wakened to absorb the natural nutrients, then it need to be supplied artificially. In cases where the malnutrition is not due to the deficiency of nutrients alone, but the body’s inability to use the available nutrients, then it is identified as a constitutional error in the system and advised its rectification through a constitutional medication. In short, homeopathy sees the malnutrition due to deficient supply of the nutrients and mal nutrition due to mal absorption differently.
Mal absorption is considered due to diseased individual’s constitutional error. Homoeopathic treatment allows the system to use available nutritional supply from food to an optimum extent. It takes care of the adverse effects produced due to external supplements. More importantly, it is seen that in case of malnutrition, when the supplements are stopped, gradually the deficiency re appear.
In Homeopathy there are two ways of addressing this problem.
First way is to give constitutional remedy that takes care of basic constitutional error of absorption & improper utilization of existing nutrients. Simultaneously the underlying cause, if any like parasitic infection, chronic alcoholism, inadequate availability of micro nutrients shall also be assessed and appropriate remedial measures taken. The other is introducing biochemic medicine that acts according to the concept of tissue deficiencies.
Both these approaches help the body to use the nutritional supply from food to an optimum extent & helps to maintain normal nutritional status. Hence, it is curative and provide long term benefits.
Abrotanum, Argentum nit, Barytacarb, Calcarea phosphorica, Calcarea carbonica, Cina, Chamomilla, Hepar sulphur, Iodine, Magnesia carbonica, Natrum muriaticum, Silica, Sulphur and Tuberculinum are the common remedies to be thought of in malnutrition. Some indications of these remedies are given below. However it is strongly recommended not to resort to self medication as the underlying cause and its effective management is possible only through qualified homeopaths.
Abrotanum: Marasmus. Impaired nutrition, defective digestion and assimilation. Marked emaciation of lower limbs, ascending type. Great weakness, ravenous appetite with rapid emaciation. Chilly patient. Constipation and diarrhoea alternate.
Calc-carb: Marasmus, defective nutrition, sour stools and vomiting of milk, sweat on scalp, head and face, the feet are damp and cold, Enlargement of the glands, voracious appetite. Dwindled body, prominent abdomen. morbid appetite, craving indigestible articles. Engorgement of mesenteric glands. Scrofulous infants. Diarrhoea on beginning to eat or drink; Rapid emaciation with a harsh and dry skin. The debility, weariness and irritable restlessness
Calc .phos: Emaciation. Predisposition to glandular and osseous disease. Large heads, defective bony development, open fontanelles and tardy development of the teeth, weak spine, curved, thin neck. Sallow complexion, persistent vomiting and diarrhoea of green, slimy and undigested stools, accompanied with much offensive flatus. Engorgement of glands, enlarged tonsils. Scrofulous tendency.
Iodium: Dark complexion, hot baby, ravenous hunger, anxiety. Better in open air. Glandular enlargement.
Magnesia carbonica: Puny children, marasmus, milk <, undigested vomiting; griping and colicky pains; sour green grassy stools, improperly nourished; ulcers in the mouth, swollen glands, bloated abdomen. Jaundice, offensive sweat.
Natrum mur: Marasmus from defective nourishment, thin neck, ravenous appetite. The child grows thin. Excess thirst and craves water all the time. Gets intermittent fever frequently. Dry mouth and throat, constipated. Skin is scurfy with oozing eruptions. Craving for salt and salty food.
Tuberculinum: Light complexion, blue eyes, mental activity, ravenous hunger with rapid emaciation and anxiety.