Nutritional Immune Deficiency Syndrome

The irony of it all is that the whole world knows and worries about AIDS whose total universal load is only about 30 to 33 million in all in contrast to the Indian load alone of NIDS of 67 million—it is on the rise!

“Our lives begin to end the day we become silent about things that matter”— Martin Luther King, Jr

Immune system is the one that keeps us alive in this complicated world, dominated by human greed as the driving force. That is our inbuilt doctor that could correct any deviation from the normal if we look after the immune system well. Good nutrition is an essential part of immune system health. Poverty, with the associated hypoproteinaemia, is at the root of all immune deficiency. India, unfortunately, has the highest load of childhood immune deficiency resulting in all kinds of illnesses in our children sending them to meet their maker in heaven prematurely in thousands almost daily. I had labelled this as Nutritional Immune Deficiency Syndrome (NIDS) ten years ago in a paper in a leading journal to attract the attention of the powers that be and the well-meaning general public. Since then I have been talking and writing about it on innumerable occasions. Except for two thinking chief ministers of Indian states, no one could care less. Those two states, which took my advice seriously, are on the way to improving their children’s immune status whose efforts, unfortunately, begin almost from the time the child is made in the mother’s womb!

The irony of it all is that the whole world knows and worries about AIDS whose total universal load is only about 30 to 33 million in all in contrast to the Indian load alone of NIDS of 67 million—it is on the rise! The whole of sub-Saharan Africa has a load of 42 million. There is a reason for this anomaly. While drug companies are pushing their costly drugs to treat the evanescent AIDS costing millions of dollars and billions of dollars are available for people who claim to be AIDS researchers, the poor NIDS has no sponsor at all. The man who reported the first case of AIDS in 1981 got the Nobel Prize recently for just an ordinary case report where his group showed a virus in the bone marrow of that young man who died due to the disease in Paris. There is no proof that the said virus is the cause of that syndrome as immune deficient patients could harbour all kinds of germs in their body. One would now realise as to how disease mongering goes on in this era of prospering sickness industry. 

Poverty, with its consequent nutritional deficiency, does not seem to be easing in the near future, either. Economist Utsa Patnaik in her lecture recently in Chennai testified that between 1991 and 2001, the first post-liberalisation decade, the per capita consumption of foodgrain had gone down by at least 25 to 30 kgs. 75% of protein and calorie energy come from foodgrain for the rural poor; the fall in consumption will have serious impact on their nutritional status. This, as explained later, will impact the childhood malnutrition load seriously. The liberalization policy has reversed the trend of improvement of per capita consumption achieved in the first 40 years post-independence. The National Sample Survey showed that while official records were used for the published nutrition norms of 2004-2005, the actual poverty lines were almost double the official ones. The situation for the rural poor is very bleak indeed what with official inflation rates in double digits! The poor, even today, pay for their poverty with their own lives! Please be warned that our rich kids are having a new epidemic of malnutrition due to junk food habits which could be our next problem in the years to come. While the poor suffer from protein sub-nutrition the rich kids suffer from protein malnutrition. In the latter case liver damage will be a curse in addition.

To compound this we have an exclusive education system that makes the successful students that manage to fill our administrative posts as also those that go to make our thought leaders oblivious to the needs of their peers who are denied even primary education for want of food, clothing and shelter. Adult malnutrition as depicted above seriously impacts the lives of young children. When a lady becomes pregnant, if she falls into the malnutrition class, the growing foetus in her womb suffers irreparable life-long damage, especially in the first trimester. All the human organs are made before the 20th week of gestation. If at that time the mother is impoverished, most children die in the womb (stillbirth). Many a time nature tries to keep these children alive at the cost of their development by enlarging the size of the placenta which could supply some extra blood to the child from the mother. Such a child, when born alive, will be too small and would have all the organs less well developed. The vital organs here are the hippocampus major in the brain needed for learning, creativity, memory etc, and the heart and vascular tree and the pancreas. When these children grow up they are liable to die young of heart disease, diabetes and more than all that, they will not be able to achieve any academic goals as their hippocampus major is very small to begin with. These are called prenatal causes of adult diseases. Feeding these kids after birth will be of not much use in changing that position as shown by the governmental efforts through ICDS for decades.

Very good news for all Indians and the World Health Organisation (WHO) is that India has been officially declared free from Wild Polio for one long year and hope that Wild Polio will join history books for ever. I am not that enthusiastic about it as we have to keep vaccinating our children for some more years to come. Even today in India we have vaccine-related serious polio disease and deaths recorded. While the official figures are not alarming they have to be taken seriously. The target is the poor child that is malnourished. Even the textbooks of medicine proclaim from house-tops that a malnourished child SHOULD NEVER be given attenuated live polio virus by mouth (that is exactly what we are doing) we have given more than 30 such doses to the children majority of whom are malnourished. In such children the virus, instead of enhancing immunity, will only make the virus mutate in the child’s gut into the serious P1 and P3 variety to be excreted in their faeces. Our sanitation being what it is in the slums and villages, other malnourished children could be easy prey for those deadly viruses. If I remember right, Dr Pushpa Bhargava had written some years ago that we had several thousand such cases even then. Much more must have been added to the list. I was told that we had seven such cases recently. Let me make an earnest appeal to the powers that be that at least now let us spend a little extra money to give our poor children dead virus vaccines by injection so that India will be free of all kinds of polio. After all, for the hapless patient and the family it does not matter what virus causes the disease. It is sad for them in any case. Let us save some money that our people in power are supposed to eat instead to save a few lives. 

In conclusion, one could say that malnutrition and the attendant NIDS are our major problems in the healthcare arena. India needs clean drinking water, three square meals for every one which are free from human and/or animal excreta, a roof on top at night, in place of the star-lit sky (which could save poor from the ravages of bitter cold), proper sanitation to avoid deadly hookworm infestation and many other water-borne infections, opportunity for everyone for good primary education, avoiding cooking smoke with carbon monoxide from coming into the house (which kills children below five of pneumonia and women of heart attacks), and finally economic empowerment of village women with job opportunities for all. Curiously, even the deadly chronic diseases are more prevalent among the poor. We need not have such expensive hospitals in such large numbers if we had the above-mentioned facilities in all villages. Healthcare is not synonymous with disease care. Our present efforts are all aimed at disease care and we do not even think of healthcare.

“He is ever manifest as Love in all beings. What other God — the creation of your mind — are you then going to worship! Let the Vedas, the Koran, the Puranas, and all scriptural lumber rest now for some time—let there be worship of the visible God of Love and Compassion in the country. All idea of separation is bondage, that of non-differentiation is Mukti. Let not the words of people dead-drunk with worldliness terrify you. Be fearless; ignore the ordinary critics as worms!”— Swami Vivekananda 

(Professor Dr BM Hegde, a Padma Bhushan awardee in 2010, is an MD, PhD, FRCP (London, Edinburgh, Glasgow & Dublin), FACC and FAMS. He is also the editor-in-chief of the Journal of the Science of Healing Outcomes, chairman of the State Health Society's Expert Committee, Govt of Bihar, Patna. He is former vice-chancellor of Manipal University at Mangalore and former professor for cardiology of the Middlesex Hospital Medical School, University of London. Prof Dr Hegde can be contacted at [email protected])

Jayant chaudhari
10 years ago
studious article by an Authority & written with earnest concern. As usual it will no be given heed by people in power.
Definately it is an eye opener for Doctors in general and especially health departments of governments.
P M Ravindran
10 years ago
'The irony of it all is that the whole world knows and worries about AIDS whose total universal load is only about 30 to 33 million in all in contrast to the Indian load alone of NIDS of 67 million—it is on the rise!'

Ask why is it an irony? And the answer is simple and short: because the people in government will never be victims of NIDS but you can't say that about AIDS, can you?
Dr Merchant M S
10 years ago
Your article is very informative. Not long our country was having Marasmus and Kwashiorkor, I don't remember when it disappeared from the national fronts. The amount of money spend on AIDS, its prevention and treatment can feed a highly nutritious diet to almost 25-50% of our population. AIDS is disease where the patient has purchased it while NIDS is the gift of poverty.
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