The Silent Shame of Health Institutions
J.R. Bruning
For how much longer will health policy ignore multimorbidity, that looming, giant elephant in the room, that propagates and amplifies suffering? For how much longer will the ‘trend’ of increasing diagnoses of multiple health conditions, at younger and younger ages be rendered down by government agencies to better and more efficient services, screening modalities, and drug choices?

Multimorbidity, the presence of many chronic conditions, is the silent shame of health policy.

All too often chronic conditions overlap and accumulate. From cancer, to diabetes, to digestive system diseases, to high blood pressure, to skin conditions in cascades of suffering. Heartbreakingly, these conditions commonly overlap with mental illnesses or disorders. It’s increasingly common for people to be diagnosed with multiple mental conditions, such as having anxiety and depression, or anxiety and schizophrenia.

Calls for equity tend to revolve around medical treatment, even as absurdities and injustices accrue.

Multimorbidity occurs a decade earlier in socioeconomically deprived communities. Doctors are diagnosing multimorbidity at younger and younger ages.

Treatment regimens for people with multiple conditions necessarily entail a polypharmacy approach – the prescribing of multiple medications. One condition may require multiple medications. Thus, with multimorbidity comes increased risk of adverse outcomes and polyiatrogenesis – ‘medical harm caused by medical treatments on multiple fronts simultaneously and in conjunction with one another.’

Side effects, whether short-term or patients’ concerns about long-term harm, are the main reason for non-adherence to prescribed medications.

So ‘equity’ which only implies drug treatment doesn’t involve equity at all.

Poor diets may be foundational to the Western world’s health crisis. But are governments considering this?

The antinomies are piling up.

We are amid a global epidemic of metabolic syndrome. Insulin resistance, obesity, elevated triglyceride levels and low levels of high-density lipoprotein cholesterol, and elevated blood pressure haunt the people queuing up to see doctors.

Research, from individual cases to clinical trials, consistently show that diets containing high levels of ultra-processed foods and carbohydrates amplify inflammation, oxidative stress, and insulin resistance. What researchers and scientists are also identifying, at the cellular level, in clinical and medical practice, and at the global level – is that insulin resistance, inflammation, oxidative stress, and nutrient deficiencies from poor diets not only drive metabolic illness, but mental illnesses, compounding suffering.

There is also ample evidence that the metabolic and mental health epidemic that is driving years lost due to disease, reducing productivity, and creating mayhem in personal lives – may be preventable and reversible.

Doctors generally recognise that poor diets are a problem. Ultra-processed foods are strongly associated with adult and childhood ill health. Ultra-processed foods are

‘formulations of ingredients, mostly of exclusive industrial use, typically created by series of industrial techniques and processes (hence ‘ultra-processed’).’

In the USA young people under age 19 consume on average 67% of their diet, while adults consume around 60% of their diet in ultra-processed food. Ultra-processed food contributes 60% of UK children’s calories; 42% of Australian children’s calories and over half the dietary calories for children and adolescents in Canada. In New Zealand in 2009-2010, ultra-processed foods contributed to the 45% (12 months), 42% (24 months), and 51% (60 months) of energy intake to the diets of children.

All too frequently, doctors are diagnosing both metabolic and mental illnesses.

What may be predictable is that a person is likely to develop insulin resistance, inflammation, oxidative stress, and nutrient deficiencies from chronic exposure to ultra-processed food. How this will manifest in a disease or syndrome condition is reflective of a human equivalent of quantum entanglement.

Cascades, feedback loops, and other interdependencies often leave doctors and patients bouncing from one condition to another, and managing medicine side effects and drug-drug relationships as they go.

In New Zealand it is more common to have multiple conditions than a single condition. The costs of having two NCDs simultaneously is typically superadditive and ‘more so for younger adults.’

This information is outside the ‘work programme’ of the top echelons in the Ministry of Health:

Official Information Act (OIA) requests confirm that the Ministries’ Directors General who are responsible for setting policy and long-term strategy aren’t considering these issues. The problem of multimorbidity and the overlapping, entangled relationship with ultra-processed food is outside of the scope of the work programme of the top directorates in our health agency.

New Zealand’s Ministry of Health’s top deputy directors general might be earning a quarter of a million dollars each, but they are ignorant of the relationship of dietary nutrition and mental health. Nor are they seemingly aware of the extent of multimorbidity and the overlap between metabolic and mental illnesses.

Neither the Public Health Agency Deputy Director-General – Dr Andrew Old, nor the Deputy Director-General Evidence, Research and Innovation, Dean Rutherford, nor the Deputy Director-General of Strategy Policy and Legislation, Maree Roberts, nor the Clinical, Community and Mental Health Deputy Director-General Robyn Shearer have been briefed on these relationships.

If they’re not being briefed, policy won’t be developed to address dietary nutrition. Diet will be lower-order.

The OIA request revealed that New Zealand’s Ministry of Health ‘does not widely use the metabolic syndrome classification.’ When I asked ‘How do you classify, or what term do you use to classify the cluster of symptoms characterised by central obesity, dyslipidemia, hypertension, and insulin resistance?’, they responded:

‘The conditions referred to are considered either on their own or as part of a broader cardiovascular disease risk calculation.’

This is interesting. What if governments should be calculating insulin resistance first, in order to then calculate a broader cardiovascular risk? What if insulin resistance, inflammation, and oxidative stress are appearing at younger and younger ages, and ultra-processed food is the major driver?

Pre-diabetes and Type 2 diabetes are driven by too much blood glucose. Type 1 diabetics can’t make insulin, while Type 2 diabetics can’t make enough to compensate for their dietary intake of carbohydrates. One of insulin’s (many) jobs is to tuck away that blood glucose into cells (as fat) but when there are too many dietary carbohydrates pumping up blood glucose, the body can’t keep up. New Zealand practitioners use the HbA1c blood test, which measures the average blood glucose level over the past 2-3 months. In New Zealand, doctors diagnose pre-diabetes if HbA1c levels are 41-49 nmol/mol, and diabetes at levels of 50 nmol/mol and above.

Type 2 diabetes management guidelines recommend that sugar intake should be reduced, while people should aim for consistent carbohydrates across the day. The New Zealand government does not recommend paleo or low-carbohydrate diets.

If you have diabetes you are twice as likely to have heart disease or a stroke, and at a younger age. Prediabetes, which apparently 20% of Kiwis have, is also high-risk due to, as the Ministry of Health states: ‘increased risk of macrovascular complications and early death.’

The question might become – should we be looking at insulin levels, to more sensitively gauge risk at an early stage?

Without more sensitive screens at younger ages these opportunities to repivot to avoid chronic disease are likely to be missed. Currently, Ministry of Health policies are unlikely to justify the funding of tests for insulin resistance by using three simple blood tests: fasting insulin, fasting lipids (cholesterol and triglycerides), and fasting glucose – to estimate where children, young people, and adults stand on the insulin resistance spectrum when other diagnoses pop up.

Yet insulin plays a powerful role in brain health.

Insulin supports neurotransmitter function and brain energy, directly impacting mood and behaviours. Insulin resistance might arrive before mental illness. Harvard-based psychiatrist Chris Palmer recounts in the book Brain Energy, a large 15,000-participant study of young people from age 0-24:

‘Children who had persistently high insulin levels (a sign of insulin resistance) beginning at age nine were five times more likely to be at risk for psychosis, meaning they were showing at least some worrisome signs, and they were three times for likely to already be diagnosed with bipolar disorder or schizophrenia by the time they turned twenty-four. This study clearly demonstrated that insulin resistance comes first, then psychosis.’

Psychiatrist Georgia Ede suggests that high blood glucose and high insulin levels act like a ‘deadly one-two punch’ for the brain, triggering waves of inflammation and oxidative stress. The blood-brain barrier becomes increasingly resistant to chronic high insulin levels. Even though the body might have higher blood insulin, the same may not be true for the brain. As Ede maintains, ‘cells deprived of adequate insulin ‘sputter and struggle to maintain normal operations.’

Looking at the relationship between brain health and high blood glucose and high insulin simply might not be on the programme for strategists looking at long-term planning.

Nor are Directors General in a position to assess the role of food addiction. Ultra-processed food has addictive qualities designed into the product formulations. Food addiction is increasingly recognised as pervasive and difficult to manage as any substance addiction.

But how many children and young people have insulin resistance and are showing markers for inflammation and oxidative stress – in the body and in the brain? To what extent do young people have both insulin resistance and depression resistance or ADHD or bipolar disorder?

This kind of thinking is completely outside the work programme. But insulin levels, inflammation, and oxidative stress may not only be driving chronic illness – but driving the global mental health tsunami.

Metabolic disorders are involved in complex pathways and feedback loops across body systems, and doctors learn this at medical school. Patterns and relationships between hormones, the brain, the gastrointestinal system, kidneys, and liver; as well as problems with joints and bone health, autoimmunity, nerves, and sensory conditions evolve from and revolve around metabolic health.

Nutrition and diet are downplayed in medical school. What doctors don’t learn so much – the cognitive dissonance that they must accept throughout their training – is that metabolic health is commonly (except for some instances) shaped by the quality of dietary nutrition. The aetiology of a given condition can be very different, while the evidence that common chronic and mental illnesses are accompanied by oxidative stress, inflammation, and insulin resistance are primarily driven by diet – is growing stronger and stronger.

But without recognising the overlapping relationships, policy to support healthy diets will remain limp.

What we witness are notions of equity that support pharmaceutical delivery – not health delivery.

What also inevitably happens is that ‘equity’ focuses on medical treatment. When the Ministry of Health prefers to atomise the different conditions or associate them with heart disease – they become single conditions to treat with single drugs. They’re lots of small problems, not one big problem, and insulin resistance is downplayed.

But just as insulin resistance, inflammation, and oxidative stress send cascading impacts across body systems, systemic ignorance sends cascading effects across government departments tasked with ‘improving, promoting, and protecting health.’

It’s an injustice. The literature solidly points to lower socio-economic status driving much poorer diets and increased exposures to ultra-processed food, but the treatments exclusively involve drugs and therapy.

Briefings to Incoming Ministers with the election of new Governments show how ignorance cascades across responsible authorities.

Health New Zealand, Te Whatu Ora’s November 2023 Briefing to the new government outlined the agency’s obligations. However, the ‘health’ targets are medical, and the agency’s focus is on infrastructure, staff, and servicing. The promotion of health, and health equity, which can only be addressed by addressing the determinants of health, is not addressed.

The Māori Health Authority and Health New Zealand Joint Briefing to the Incoming Minister for Mental Health does not address the role of diet and nutrition as a driver of mental illness and disorder in New Zealand. The issue of multimorbidity, the related problem of commensurate metabolic illness, and diet as a driver is outside scope. When the Briefing states that it is important to address the ‘social, cultural, environmental and economic determinants of mental health,’ without any sound policy footing, real movement to address diet will not happen, or will only happen ad hoc.

The Mental Health and Wellbeing Commission, Te Hiringa Mahara’s November 2023 Briefing to Incoming Ministers that went to the Ministers for Health and Mental Health might use the term ‘well-being’ over 120 times – but was silent on the related and overlapping drivers of mental illness which include metabolic or multimorbidity, nutrition, or diet.

Five years earlier, He Ara Ora, New Zealand’s 2018 Mental Health and Addiction enquiry had recognised that tāngata whaiora, people seeking wellness, or service users, also tend to have multiple health conditions. The enquiry recommended that a whole of government approach to well-being, prevention, and social determinants was required. Vague nods were made to diet and nutrition, but this was not sufficiently emphasised as to be a priority.

He Ara Ora was followed by 2020 Long-term pathway to mental well-being viewed nutrition as being one of a range of factors. No policy framework strategically prioritised diet, nutrition, and healthy food. No governmental obligation or commitment was built into policy to improve access to healthy food or nutrition education.

Understanding the science, the relationships, and the drivers of the global epidemic, is ‘outside the work programmes’ of New Zealand’s Ministry of Health and outside the scope of all the related authorities. There is an extraordinary amount of data in the scientific literature, so many case studies, cohort studies, and clinical trials. Popular books are being written, however government agencies remain ignorant.

In the meantime, doctors must deal with the suffering in front of them without an adequate toolkit.

Doctors and pharmacists are faced with a Hobson’s choice of managing multiple chronic conditions and complex drug cocktails, in patients at younger and younger ages. Ultimately, they are treating a patient whom they recognise will only become sicker, cost the health system more, and suffer more.

Currently there is little support for New Zealand medical doctors (known as general practitioners, or GPs) in changing practices and recommendations to support non-pharmaceutical drug treatment approaches. Their medical education does not equip them to recognise the extent to which multiple co-existing conditions may be alleviated or reversed. Doctors are paid to prescribe, to inject, and to screen, not to ameliorate or reverse disease and lessen prescribing. The prescribing of nutrients is discouraged and as doctors do not have nutritional training, they hesitate to prescribe nutrients.

Many do not want to risk going outside treatment guidelines. Recent surges in protocols and guidelines for medical doctors reduce flexibility and narrow treatment choices for doctors. If they were to be reported to the Medical Council of New Zealand, they would risk losing their medical license. They would then be unable to practice.

Inevitably, without Ministry of Health leadership, medical doctors in New Zealand are unlikely to voluntarily prescribe non-drug modalities such as nutritional options to any meaningful extent, for fear of being reported.

Yet some doctors are proactive, such as Dr Glen Davies in Taupo, New Zealand. Some doctors are in a better ‘place’ to work to alleviate and reverse long-term conditions. They may be later in their career, with 10-20 years of research into metabolism, dietary nutrition, and patient care, and motivated to guide a patient through a personal care regime which might alleviate or reverse a patient’s suffering.

Barriers include resourcing. Doctors aren’t paid for reversing disease and taking patients off medications.

Doctors witness daily the hopelessness felt by their patients in dealing with chronic conditions in their short 15-minute consultations, and the vigilance required for dealing with adverse drug effects. Drug non-compliance is associated with adverse effects suffered by patients. Yet without wrap-around support changing treatments, even if it has potential to alleviate multiple conditions, to reduce symptoms, lower prescribing and therefore lessen side effects, is just too uncertain.

They saw what happened to disobedient doctors during Covid-19.

Given such context, what are we to do?

Have open public discussions about doctor-patient relationships and trust. Inform and overlay such conversations by drawing attention to the foundational Hippocratic Oath made by doctors, to first do no harm.

Questions can be asked. If patients were to understand that diet may be an underlying driver of multiple conditions, and a change in diet and improvement in micronutrient status might alleviate suffering – would patients be more likely to change?

Economically, if wrap-around services were provided in clinics to support dietary change, would less harm occur to patients from worsening conditions that accompany many diseases (such as Type 2 diabetes) and the ever-present problem of drug side-effects? Would education and wrap-around services in early childhood and youth delay or prevent the onset of multimorbid diagnoses?

Is it more ethical to give young people a choice of treatment? Could doctors prescribe dietary changes and multinutrients and support change with wrap-around support when children and young people are first diagnosed with a mental health condition – from the clinic, to school, to after school? If that doesn’t work, then prescribe pharmaceutical drugs.

Should children and young people be educated to appreciate the extent to which their consumption of ultra-processed food likely drives their metabolic and mental health conditions? Not just in a blithe ‘eat healthy’ fashion that patently avoids discussing addiction. Through deeper policy mechanisms, including cooking classes and nutritional biology by the implementation of nourishing, low-carbohydrate cooked school lunches.

With officials uninformed, it’s easy to see why funding for Green Prescriptions that would support dietary changes have sputtered out. It’s easy to understand why neither the Ministry of Health nor Pharmac have proactively sourced multi-nutrient treatments that improve resilience to stress and trauma for low-income young people. Why there’s no discussion on a lower side-effect risk for multinutrient treatments. Why are there no policies in the education curriculum diving into the relationship between ultra-processed food and mental and physical health? It’s not in the work programme.

There’s another surfacing dilemma.

Currently, if doctors tell their patients that there is very good evidence that their disease or syndrome could be reversed, and this information is not held as factual information by New Zealand’s Ministry of Health – do doctors risk being accused of spreading misinformation?

Government agencies have pivoted in the past 5 years to focus intensively on the problem of dis- and misinformation. New Zealand’s disinformation project states that

Disinformation is false or modified information knowingly and deliberately shared to cause harm or achieve a broader aim.
Misinformation is information that is false or misleading, though not created or shared with the direct intention of causing harm.
Unfortunately, as we see, there is no division inside the Ministry of Health that reviews the latest evidence in the scientific literature, to ensure that policy decisions correctly reflect the latest evidence.

There is no scientific agency outside the Ministry of Health that has flexibility and the capacity to undertake autonomous, long-term monitoring and research in nutrition, diet, and health. There is no independent, autonomous, public health research facility with sufficient long-term funding to translate dietary and nutritional evidence into policy, particularly if it contradicted current policy positions.

Despite excellent research being undertaken, it is highly controlled, ad hoc, and frequently short-term. Problematically, there is no resourcing for those scientists to meaningfully feedback that information to either the Ministry of Health or to Members of Parliament and government Ministers.

Dietary guidelines can become locked in, and contradictions can fail to be chewed over. Without the capacity to address errors, information can become outdated and misleading. Government agencies and elected members – from local councils all the way up to government Ministers, are dependent on being informed by the Ministry of Health, when it comes to government policy.

When it comes to complex health conditions, and alleviating and reversing metabolic or mental illness, based on different patient capacity – from socio-economic, to cultural, to social, and taking into account capacity for change, what is sound, evidence-based information and what is misinformation?

In the impasse, who can we trust?

Published under a Creative Commons Attribution 4.0 International License
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Author

J.R. Bruning is a consultant sociologist (B.Bus.Agribusiness; MA Sociology) based in New Zealand. Her work explores governance cultures, policy and the production of scientific and technical knowledge. Her Master’s thesis explored the ways science policy creates barriers to funding, stymying scientists’ efforts to explore upstream drivers of harm. Bruning is a trustee of Physicians & Scientists for Global Responsibility (PSGR.org.nz). Papers and writing can be found at TalkingRisk.NZ and at JRBruning.Substack.com and at Talking Risk on Rumble.

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The story of Yazan Kafarneh, the boy who starved to death in Gaza
Tareq S. HajjajMarch 25, 2024
Yazan Kafarneh after dying of starvation. (Photo: Rabee' Abu Naqirah)
Yazan Kafarneh after dying of starvation. (Photo: Rabee’ Abu Naqirah)
This is not a photo of a mummy or an embalmed body retrieved from one of Gaza’s ancient cemeteries. This is a photo of Yazan Kafarneh, a child who died of severe malnutrition during Israel’s genocidal war on the Gaza Strip.

Yazan’s family now lives in the Rab’a School in the Tal al-Sultan neighborhood in Rafah City. His father, Sharif Kafarneh, along with his mother, Marwa, and his three younger brothers, had fled Beit Hanoun in northern Gaza early on in the war.

Yazan Kafarneh died at the age of nine, the eldest of four brothers — Mouin, 6, Ramzi, 4, and Muhammad, born during the war in a shelter four months ago.

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Living in conditions not fit for human habitation, the grieving family had witnessed Yazan’s death before their eyes. It didn’t happen all at once but unfolded gradually over time, his frail body wasting away one day after another until there was nothing left of Yazan but skin and bones.

Sharif was unable to do anything for his son. He died due to a congenital illness that required a special dietary regimen to keep him healthy. Israel’s systematic prevention of food from reaching the civilian population in Gaza meant that severe malnutrition — suffered by most children in the besieged enclave — in the case of Yazan meant death.

“We first left from Beit Hanoun to Jabalia refugee camp,” Sharif told Mondoweiss. “Then the occupation called us again and warned us against staying where we were. So we left for Gaza City. Then, the occupation forced us to flee further south, and we did.”

Yazan Kafarneh's parents and three brothers in their shelter in Rafah. (Photo: Tareq Hajjaj/Mondoweiss)
Sharif Kafarneh’ (left), his wife Marwa (right), and their three surviving sons (center) in their shelter in Rafah. (Photo: Tareq Hajjaj/Mondoweiss)
“If it weren’t for Yazan, I would have never left my home,” Sharif maintained. “Yazan required special care and nutrition.”

Yazan suffered from a congenital form of muscular atrophy that made movement and speech difficult, but Sharif said that it never caused him much grief in his nine short years before the war.

“He just had advanced nutritional needs,” Sharif explained. “But getting that food for him was never an issue before the war.”

It was a point of pride for Sharif that he, a taxi driver, had never left his child wanting or deprived.

“That changed in the war. The specific foods that he needed were cut off,” he said. “For instance, Yazan had to have milk and bananas for dinner every day. He can’t go a day without it, and sometimes he can have only bananas. This is what the doctors told us.”

“After the war, I couldn’t get a single banana,” Sharif continued. “And for lunch, he had to have boiled vegetables and fruits that were pureed in a blender. We had no electricity for the blender, and there were no fruits or vegetables anymore.”

As for breakfast, Yazan’s regimen demanded that he eat eggs. “Of course, there aren’t any more eggs in Rafah City,” Sharif said. “No fruits, no vegetables, no eggs, no bananas, nothing.”

“But our child’s needs were never a problem for us,” Sharif rushed to add. “We loved taking care of him. He was the spoiled child of the family, and his younger brothers loved him and took care of him, too. God gave me a living so I could take care of him.”

Due to his special needs, charitable societies used to visit Yazan’s home in Beit Hanoun before the war, providing various treatments such as physical therapy and speech therapy. All in all, Yazan had a functional, happy childhood.

‘He got thinner and thinner’

The family continued to take care of Yazan throughout the war. They tried to make do with what they could find, trying as much as possible to find alternatives to the foods Yazan required. “I replaced bananas with halawa [a tahini-based confection], and I replaced eggs with bread soaked in tea,” Sharif said. “But these foods did not contain the nutrients that Yazan needed.”

In addition to his nutritional needs, Yazan had specific medicines to take. Sharif used to bring him brain and muscle stimulants that helped him stay alive and mobile, allowing him to move around and crawl throughout their home. Those medicines ran out during the second week of the war.

With the lack of nutrition and medication, his health took a turn for the worse. “I noticed him getting sick, and his body was becoming emaciated,” Sharif recounts. “He got thinner and thinner.”

His family took him to al-Najjar Hospital in Rafah, where his health continued to deteriorate over the course of eleven days.

“Even after we took him to the hospital, they couldn’t do anything for him,” Sharif continued. “All they were able to give him were IV fluids, and when his situation got worse, the hospital staff placed a feeding tube in his nose.”

“My son required a tube with a 14-unit measurement, but all the hospital had was an 8-unit,” he added.

When asked what was the most important factor that led to the deterioration of his son’s condition, Sharif said that it was the environment he lived in. “Before the war, he was in the right environment. After, everything was wrong. He was in his own home, but then he was uprooted to a shelter in Rafah.”

“The situation we’re living in isn’t fit for humans, let alone a sick child,” Sharif explained. “In the camps, people would light fires to keep themselves warm, but the smoke would cause Yazan to cough and suffocate, and we weren’t able to tell them to turn their fires off because everyone was so cold.”

Dr. Muhammad al-Sabe’, a pediatric surgeon in Rafah who works at the al-Awda, al-Najjar, and al-Kuwaiti hospitals, took a special interest in Yazan’s case.

“The harsh conditions Yazan had to endure, including malnutrition, were the main factors contributing to the deterioration of his health and his ultimate death,” Dr. al-Sabe’ told Mondoweiss. “This is a genetic and congenital illness, and it requires special care every day, including specific proteins, IV medicines, and daily physical therapy, which isn’t available at Rafah.”

“If things don’t change, if they stay the way they are, we’re going to witness mass death among children.”
Dr. Muhammad al-Sabe’normal
Dr. al-Sabe’ said that most foods administered to patients who cannot feed themselves through feeding tubes are unavailable in Gaza. “The occupation prevents these specific foods and medicines from coming in,” he explained. “Including a medicine called Ensure.”

Ensure is a special nutritional supplement used in medical settings for what is called “enteral nutrition” — feeding patients through a nasal tube.

“Special treatment for patients, especially children, is nonexistent,” Dr. al-Sabe’ added. “We don’t even have diapers, let alone baby formula and nutritional supplements.”

“If things don’t change, if they stay the way they are, we’re going to witness mass death among children,” he stressed. “If any child doesn’t receive nutrition for an entire week, that child will eventually die. And even if malnourished children are eventually provided with nutrition, they will likely suffer lifelong health consequences.”

“If medicine is cut off from children who need it for one week, this will also likely lead to their death,” he continued.

Yazan Kafarneh after dying of starvation. (Photo: Rabee' Abu Naqirah)
Images of Yazan Kafarneh’s emaciated body circulated widely on social media. (Photo: Rabee’ Abu Naqirah)
Children disproportionately affected by famine

According to a UNICEF humanitarian situation report on March 22, 2.23 million people in Gaza suffer at least from “acute food insecurity,” while half of that population (1.1 million people) suffers from “catastrophic food insecurity,” meaning that “famine is imminent for half of the population.”

An earlier report in December 2023 had already concluded that all children in Gaza under five years old (estimated to be 335,000 children) are “at high risk of severe malnutrition and preventable death.” UNICEF’s most recent March 22 report estimates that the famine threshold for “acute food insecurity” has already been “far exceeded,” while it is highly likely that the famine threshold for “acute malnutrition” has also been exceeded. Moreover, UNICEF said that the Famine Review Committee predicted that famine would manifest in Gaza anywhere between March and May of this year.

Dr. al-Sabe’ stresses that such dire conditions disproportionately affect children, who have advanced nutritional needs compared to adults.

“Their bodies are weak, and they don’t have large stores of muscle and fat,” he explained. “Even one day of no food for a young child will lead to consequences that are difficult to control in the future.”

“An adult male may go a week without food before signs of malnutrition begin to show,” he continued. “Not so with children. Their muscle mass increases whenever they eat, which in turn leads to a greater need for nutrients.”

The lack of nutrients means that children will grow weak, the pediatric surgeon said, and that they will quickly begin to exhibit symptoms such as fatigue, sleepiness, diarrhea, vomiting, anemia, sunken eyes, and joint pains. For the same reason, Dr. al-Sabe maintained, children also respond to treatment fairly quickly — but “on the condition that they have not experienced malnutrition for more than a week.”

After one week, reversing the effects of malnutrition becomes much more difficult. Al-Sabe’ asserts that children’s digestive tracts will slow down, they might begin to suffer from kidney failure, and their bellies can swell with fluids.

That is what is particularly devastating for Gaza — over 335,000 children have undergone varying degrees of extreme malnutrition for months on end. The consequences are difficult to fathom on a population-wide level and for future generations. As of the time of writing, over 30 children have already died due to malnutrition in northern Gaza, but the real number is likely much higher given the lack of reporting in many areas in the north.

‘He didn’t need a miracle to save him’

Yazan’s mother, Marwa Kafarneh, could barely contain her tears as she spoke of her son.

“He was a normal boy despite his illness,” she told Mondoweiss. “He played with his brothers. He crawled and moved about, and he could open closets and use the phone, and he would watch things on it for hours.”

“He could have lived a long life, a normal life,” she continued. “His father would have brought him everything that he needed. He wouldn’t have had to feel hungry for even a single day.”

When she saw that the images of her son’s emaciated body had gone viral on social media, Marwa said that she preferred death over looking at the photos. “My eldest son died in front of my eyes, in front of all of our eyes,” she said. “We weren’t able to save him. And he didn’t need a miracle to save him either. All he needed was the food that we’ve always been able to provide for him.”

Reflecting as she cried, she added: “But finding that food in Gaza today takes nothing less than a miracle.”

Tareq S. Hajjaj
Tareq S. Hajjaj is the Mondoweiss Gaza Correspondent and a member of the Palestinian Writers Union. He studied English Literature at Al-Azhar University in Gaza. He started his career in journalism in 2015, working as a news writer and translator for the local newspaper Donia al-Watan. He has reported for Elbadi, Middle East Eye, and Al-Monitor. Follow him on Twitter at @Tareqshajjaj.

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https://mondoweiss.net/2024/03/the-story-of-yazan-kafarneh-the-boy-who-starved-to-death-in-gaza/

From this article about the collapse of #Haiti (https://www.dailystar.co.uk/news/world-news/haiti-cannibal-gang-eating-people-32281273), when it says, "Cannibalism is not widespread, but definitely an indication of the worsening situation. It definitely happens on a few occasions." It kind of reminds me of when CNN covers radical left-wing Antifa uprisings where they're burning police vehicles and throwing Molotov cocktails, and CNN says it's, "mostly peaceful."

Now the #cannibalism is just "occasional."

As in, hey, we mostly eat breakfast, lunch and dinner WITHOUT consuming human flesh, but from time to time, there's a human meat burger thrown into the mix, no big deal.

Whaaah?

When people in your city start EATING OTHER PEOPLE, it's a big deal. Major sh#t has gone wrong. Probably worth having an exfil plan at the ready.

The U.S. government is poised to withdraw longstanding warnings about cholesterol
Peter Whoriskey

Time to put eggs back on the menu? (Deb Lindsey for The Washington Post)
The nation’s top nutrition advisory panel has decided to drop its caution about eating cholesterol-laden food, a move that could undo almost 40 years of government warnings about its consumption.

The group’s finding that cholesterol in the diet need no longer be considered a “nutrient of concern” stands in contrast to the committee’s findings five years ago, the last time it convened. During those proceedings, as in previous years, the panel deemed the issue of excess cholesterol in the American diet a public health concern.

The finding follows an evolution of thinking among many nutritionists who now believe that, for healthy adults, eating foods high in cholesterol may not significantly affect the level of cholesterol in the blood or increase the risk of heart disease.

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The greater danger in this regard, these experts believe, lies not in products such as eggs, shrimp or lobster, which are high in cholesterol, but in too many servings of foods heavy with saturated fats, such as fatty meats, whole milk, and butter.

[Scientists have figured out what makes Indian food so delicious]

The new view on cholesterol in food does not reverse warnings about high levels of “bad” cholesterol in the blood, which have been linked to heart disease. Moreover, some experts warned that people with particular health problems, such as diabetes, should continue to avoid cholesterol-rich diets.

While Americans may be accustomed to conflicting dietary advice, the change on cholesterol comes from the influential Dietary Guidelines Advisory Committee, the group that provides the scientific basis for the “Dietary Guidelines.” That federal publication has broad effects on the American diet, helping to determine the content of school lunches, affecting how food manufacturers advertise their wares, and serving as the foundation for reams of diet advice.

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The panel laid out the cholesterol decision in December, at its last meeting before it writes a report that will serve as the basis for the next version of the guidelines. A video of the meeting was later posted online and a person with direct knowledge of the proceedings said the cholesterol finding would make it to the group’s final report, which is due within weeks.

After Marian Neuhouser, chair of the relevant subcommittee, announced the decision to the panel at the December meeting, one panelist appeared to bridle.

“So we’re not making a [cholesterol] recommendation?” panel member Miriam Nelson, a Tufts University professor, said at the meeting as if trying to absorb the thought. “Okay ... Bummer.”

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Members of the panel, called the Dietary Guidelines Advisory Committee, said they would not comment until the publication of their report, which will be filed with the Department of Health and Human Services and the Department of Agriculture.

[Here’s what the government’s dietary guidelines should really say]

While those agencies could ignore the committee’s recommendations, major deviations are not common, experts said.

Five years ago, “I don’t think the Dietary Guidelines diverged from the committee’s report,” said Naomi K. Fukagawa, a University of Vermont professor who served as the committee’s vice chair in 2010. Fukagawa said she supports the change on cholesterol.

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Walter Willett, chair of the nutrition department at the Harvard School of Public Health, also called the turnaround on cholesterol a “reasonable move.”

“There’s been a shift of thinking,” he said.

But the change on dietary cholesterol also shows how the complexity of nutrition science and the lack of definitive research can contribute to confusion for Americans who, while seeking guidance on what to eat, often find themselves afloat in conflicting advice.

Cholesterol has been a fixture in dietary warnings in the United States at least since 1961, when it appeared in guidelines developed by the American Heart Association. Later adopted by the federal government, such warnings helped shift eating habits -- per capita egg consumption dropped about 30 percent -- and harmed egg farmers.

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Yet even today, after more than a century of scientific inquiry, scientists are divided.

Some nutritionists said lifting the cholesterol warning is long overdue, noting that the United States is out-of-step with other countries, where diet guidelines do not single out cholesterol. Others support maintaining a warning.

The forthcoming version of the Dietary Guidelines -- the document is revised every five years -- is expected to navigate myriad similar controversies. Among them: salt, red meat, sugar, saturated fats and the latest darling of food-makers, Omega-3s.

As with cholesterol, the dietary panel’s advice on these issues will be used by the federal bureaucrats to draft the new guidelines, which offer Americans clear instructions -- and sometimes very specific, down-to-the-milligram prescriptions. But such precision can mask sometimes tumultuous debates about nutrition.

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“Almost every single nutrient imaginable has peer reviewed publications associating it with almost any outcome,” John P.A. Ioannidis, a professor of medicine and statistics at Stanford and one of the harshest critics of nutritional science, has written. “In this literature of epidemic proportions, how many results are correct?”

Now comes the shift on cholesterol.

Even as contrary evidence has emerged over the years, the campaign against dietary cholesterol has continued. In 1994, food-makers were required to report cholesterol values on the nutrition label. In 2010, with the publication of the most recent “Dietary Guidelines,” the experts again focused on the problem of "excess dietary cholesterol."

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Yet many have viewed the evidence against cholesterol as weak, at best. As late as 2013, a task force arranged by the American College of Cardiology and the American Heart Association looked at the dietary cholesterol studies. The group found that there was “insufficient evidence” to make a recommendation. Many of the studies that had been done, the task force said, were too broad to single out cholesterol.

“Looking back at the literature, we just couldn’t see the kind of science that would support dietary restrictions,” said Robert Eckel, the co-chair of the task force and a medical professor at the University of Colorado.

The current U.S. guidelines call for restricting cholesterol intake to 300 milligrams daily. American adult men on average ingest about 340 milligrams of cholesterol a day, according to federal figures. That recommended figure of 300 milligrams, Eckel said, is " just one of those things that gets carried forward and carried forward even though the evidence is minimal.”

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"We just don't know," he said.

Other major studies have indicated that eating an egg a day does not raise a healthy person’s risk of heart disease, though diabetic patients may be at more risk.

“The U.S. is the last country in the world to set a specific limit on dietary cholesterol,” said David Klurfeld, a nutrition scientist at the U.S. Department of Agriculture. “Some of it is scientific inertia.”

The persistence of the cholesterol fear may arise, in part, from the plausibility of its danger.

As far back as the 19th century, scientists recognized that the plaque that clogged arteries consisted, in part, of cholesterol, according to historians.

It would have seemed logical, then, that a diet that is high in cholesterol would wind up clogging arteries.

In 1913, Niokolai Anitschkov and his colleagues at the Czar’s Military Medicine Institute in St. Petersburg, decided to try it out in rabbits. The group fed cholesterol to rabbits for about four to eight weeks and saw that the cholesterol diet harmed them. They figured they were on to something big.

“It often happens in the history of science that researchers ... obtain results which require us to view scientific questions in a new light,” he and a colleague wrote in their 1913 paper.

But it wasn’t until the 1940s, when heart disease was rising in the United States, that the dangers of a cholesterol diet for humans would come more sharply into focus.

Experiments in biology, as well as other studies that followed the diets of large populations, seemed to link high cholesterol diets to heart disease.

Public warnings soon followed. In 1961, the American Heart Association recommended that people reduce cholesterol consumption and eventually set a limit of 300 milligrams a day. (For comparison, the yolk of a single egg has about 200 milligrams.)

Eventually, the idea that cholesterol is harmful so permeated the country's consciousness that marketers advertised their foods on the basis of "no cholesterol."

What Anitschkov and the other early scientists may not have foreseen is how complicated the science of cholesterol and heart disease could turn out: that the body creates cholesterol in amounts much larger than their diet provides, that the body regulates how much is in the blood and that there is both “good” and “bad” cholesterol.

Adding to the complexity, the way people process cholesterol differs. Scientists say some people -- about 25 percent -- appear to be more vulnerable to cholesterol-rich diets.

“It’s turned out to be more complicated than anyone could have known,” said Lawrence Rudel, a professor at the Wake Forest University School of Medicine.

As a graduate student at the University of Arkansas in the late 1960s, Rudel came across Anitschkov’s paper and decided to focus on understanding one of its curiosities. In passing, the paper noted that while the cholesterol diet harmed rabbits, it had no effect on white rats. In fact, if Anitschkov had focused on any other animal besides the rabbit, the effects wouldn't have been so clear -- rabbits are unusually vulnerable to the high-cholesterol diet.

“The reason for the difference -- why does one animal fall apart on the cholesterol diet -- seemed like something that could be figured out,” Rudel said. “That was 40 or so years ago. We still don’t know what explains the difference.”

In truth, scientists have made some progress. Rudel and his colleagues have been able to breed squirrel monkeys that are more vulnerable to the cholesterol diet. That and other evidence leads to their belief that for some people -- as for the squirrel monkeys -- genetics are to blame.

Rudel said that Americans should still be warned about cholesterol.

“Eggs are a nearly perfect food, but cholesterol is a potential bad guy,” he said. “Eating too much a day won’t harm everyone, but it will harm some people.”

Scientists have estimated that, even without counting the toll from obesity, disease related to poor eating habits kills more than half a million people every year. That toll is often used as an argument for more research in nutrition.

Currently, the National Institutes of Health spends about $1.5 billion annually on nutrition research, an amount that represents about 5 percent of its total budget.

The turnaround on cholesterol, some critics say, is just more evidence that nutrition science needs more investment.

Others, however, say the reversal might be seen as a sign of progress.

“These reversals in the field do make us wonder and scratch our heads,” said David Allison, a public health professor at the University of Alabama at Birmingham. “But in science, change is normal and expected.”

When our view of the cosmos shifted from Ptolemy to Copernicus to Newton and Einstein, Allison said, “the reaction was not to say, ‘Oh my gosh, something is wrong with physics!’ We say, ‘Oh my gosh, isn’t this cool?’ ”

Allison said the problem in nutrition stems from the arrogance that sometimes accompanies dietary advice. A little humility could go a long way.

“Where nutrition has some trouble,” he said, “is all the confidence and vitriol and moralism that goes along with our recommendations.”

Did the government’s dietary guidelines help make us fat?

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5 simple Indian recipes to make at home

Scientists have figured out what makes Indian food so delicious

Ghee has been an Indian staple for millennia. Now the rest of the world is catching on.

https://www.washingtonpost.com/news/wonk/wp/2015/02/10/feds-poised-to-withdraw-longstanding-warnings-about-dietary-cholesterol/?utm_term=.1982832f86fa

The Ultimate Keto Meal Plan

The ketogenic diet, or keto for short, has gained immense popularity for its ability to help individuals shed excess weight by encouraging the body to burn fat for fuel. Central to the success of the keto lifestyle is a well-structured meal plan that keeps carbohydrates at bay while embracing healthy fats and moderate protein. Here's a guide to the ultimate keto meal plan to help you navigate this low-carb, high-fat journey.

Breakfast:

Kickstart your day with a keto-friendly breakfast that is both satisfying and nourishing. Consider scrambled eggs cooked in butter, topped with avocado slices and a sprinkle of feta cheese. This protein and fat-rich breakfast will keep you satiated, helping to curb mid-morning cravings.

Lunch:

For a midday meal that aligns with the keto principles, opt for a hearty salad featuring leafy greens, grilled chicken or salmon, and an assortment of low-carb vegetables like cucumbers and cherry tomatoes. Enhance the flavor with a generous drizzle of olive oil or avocado dressing for a dose of healthy fats.

Snacks:

Incorporate keto-friendly snacks to keep energy levels stable between meals. Nuts, such as almonds or macadamias, are an excellent choice, providing healthy fats and a satisfying crunch. Cheese slices or celery sticks paired with guacamole are also convenient and delicious options to keep hunger at bay.

Dinner:

A well-rounded dinner is crucial for sustaining the ketogenic lifestyle. Opt for a protein-rich dish like grilled steak or baked salmon, accompanied by a side of non-starchy vegetables such as broccoli or asparagus. Cooking with olive oil or butter ensures an ample supply of healthy fats to maintain ketosis.

Dessert:

Indulge your sweet tooth without derailing your keto journey. Consider a dessert made with keto-friendly sweeteners such as stevia or erythritol. A simple yet satisfying option is dark chocolate dipped in nut butter or a creamy avocado chocolate mousse.

Beverages:

Stay hydrated with water, herbal teas, and black coffee. Be cautious with fruit juices and conventional sodas, as they often contain high levels of hidden sugars. If you're craving a creamy option, choose unsweetened almond or coconut milk.

Tips for Success:

Monitor Macros: Keep a close eye on your macronutrient intake, aiming for a daily distribution of approximately 70-75% fat, 20-25% protein, and 5-10% carbohydrates.

Plan and Prep: Planning and preparing meals in advance can help you stay on track and avoid impulsive food choices.

Choose Quality Fats: Opt for healthy fats such as avocados, olive oil, coconut oil, and nuts to ensure your body receives essential nutrients.

Listen to Your Body: Pay attention to hunger and fullness cues. The keto diet encourages mindful eating, so eat when hungry and stop when satisfied.

Stay Consistent: Consistency is key when following the keto lifestyle. Stick to the plan, and over time, your body will adapt to burning fat for energy.

In conclusion, the ultimate keto meal plan emphasizes a balance of healthy fats, moderate protein, and minimal carbohydrates. By incorporating a variety of nutrient-dense foods, staying hydrated, and being mindful of macronutrient ratios, you can enjoy the benefits of the ketogenic diet while savoring delicious and satisfying meals.
Join the keto community, share your experiences, and find inspiration from others on the same journey. Whether you're looking to lose weight, boost energy, or improve overall health, the keto lifestyle could be the key to unlocking your full potential.-- https://shrinkme.info/UZsJe

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Quick lunch at the office..... too much work

This is one of our port of call "JUNEAU" upon our arrival here in Juneau at 1pm.


dockside at the gangway*

we arrive here late compare to other ports this port is one of the busiest place due to other cruise ships docked and anchored with us here, there are 4 cruise ships and one was anchored and cannot manage to dock alongside.


After my duty in the morning I had a quick break again for a about 2 hours only I rushed going out with my co workers, along the way to our destination I saw the place where most of the crew are staying this is an Asian street food where Filipinos are who prepare / cook and sell food for all the crew onboard to different ships docked. They became so famous to all the seafarers.


*known as "Bernadette"
This street food serving rice meals or "lutong bahay" what we call in Tagalog a local language of Philippine people means home made dishes.


as you can see this how close their place to our ship, it is a matter of a 3 minutes only. so for those crew have a contact number to this street food seller they can order and deliver the food only in front of the gangway.

So after we check this area we went to a grocery store where we will buy our necessities onboard, and I saw thing catch my attention and bought it, a Yamaha cap MOnster edition.

so we are almost going back to the ship for work we need to maximize our time and we cannot waste time. So I purchase something from the Ace Hardware I bought some office supplies and etc.


When we have our lunch here after that we rushed going back to the ship, the time though not enough but there is still a next time. because we will keep doing this itinerary of Alaska for two months.


going back to the ship

Got to Honolulu and had this Ahi sushi bowl and musubi for lunch! So good????

Looks like lunch time!

Looks like lunch time!