On Tuesday, October 06, 2015 this newspaper in its Lahore section reported that: "Government to make law on fortification of staple food, says minister". The news item mentioned the need for adding ‘micronutrients’ to staple foods. Experts expounded on all the reasons for such addition as well as the problems with lack of micronutrients in diet of poor people in Pakistan.

One of the more important observations made over the last few years is that inadequate diets may not kill but rather produce children as well as young adults that are physically and intellectually incapable of becoming productive members of society. Based upon this observation, the consensus of the government minister and the experts was, let’s do it.

Of course, like all such high level meetings, there was no mention in the newspaper report how such a major change in processing and distribution of food was going to be accomplished and who was going to pay for it. Of course, even a poor undernourished and underdeveloped person knows that he or she needs to eat more food that is of a better quality. Don’t need some minister or foreign expert to tell these poor people about this. Sort of like the apocryphal statement attributed to Marie Antoinette that: "if they don’t have bread, why don’t they eat cake".

All of us that follow the healthcare policies of the government of the Punjab know well enough that if the addition of micronutrients to food could be accomplished by building another road to anywhere, the addition of micronutrients would have been a done thing by now. Since road building can only have a very indirect effect on providing the ‘masses’ with necessary micronutrients therefore we in the Punjab will have to wait a while before what was said by the minister mentioned above ever happens.

Micronutrients are vitamins, minerals and trace elements that are needed to keep the body healthy. The old adage that man does not live on bread alone is correct in the context of these substances that are required in small amounts by the body and its different systems to keep humming along. More importantly if some of these nutrients are lacking especially in pregnant women and in small children, severe long term health problems can and often do occur.

So what are some of these micronutrients? First the ‘trace minerals’; these include Boron, Cobalt, Chromium, Copper, Fluoride, Iodine, Iron, Manganese, Molybdenum, Selenium and Zinc. Then there are the Vitamins, Vitamins A, B-Complex, C, D, E, K followed by a group of substances known as Carotenoids. The important thing about all these substances is that a human body requires only small or ‘micro’ amounts of them in daily diets. That of course is why they are called micronutrients in contrast with other food items that are consumed in large amounts. Clearly even the most conscientious government can’t really go around putting every one of the things mentioned above in dietary staples like milk, flour, the water supply, and nor does it need to.

In general, pregnant women and young children are most susceptible to the deficiency of many different micronutrients. Anaemia or a low blood haemoglobin count due to Iron deficiency is probably one of the commonest problems that afflicts a large number of young women and as a consequence can have bad effects on their pregnancies as well as their children. Many different types of food have been fortified with Iron with good results. Other than Iron, Iodine deficiency can also be extremely dangerous to young children leading to severe developmental problems. Besides retardation, Iodine deficiency also produces enlargement of the thyroid gland in the neck. Most of Iodine deficiency problems have disappeared after virtual universal use of ‘Iodised’ table salt.

After Iron and Iodine, the most important mineral is Calcium. Calcium is needed for bone growth as well as bone strength. Without adequate Calcium intake as children, bone problems will occur leading eventually to weak bones that tend to break easily. In older people, inadequate calcium intake makes them much more likely to develop life threatening fractures of their leg bones. Here again, Calcium is added to many types of food and beverages. Zinc is now also being thought of as a vital micronutrient, its deficiency is probably due to soil depletion of Zinc where different crops are being grown.

The other group of micronutrients are different vitamins. They are all ‘vital’ for our good health and that is why they are called vitamins. Some major medical problems that were quite common a century or more ago were subsequently found to be related to vitamin deficiencies. Considering Vitamin A, many problems are associated with its deficiency, the most commonly known is probably ‘night blindness’. Here again many foods and beverages are fortified with Vitamin A. After this come different members of the Vitamin B family also known as Vitamin B Complex.

Some of the more famous diseases related to Vitamin B complex deficiency are Beriberi that is due to Vitamin B1deficiency and Pellagra that is due to Vitamin B3 deficiency. Some forms of severe anaemia are also related to B9 and B12 deficiency. However, these vitamins have not been added to any major food staples. Vitamin C deficiency can lead to Scurvy. This was common among sailors in the past but once it was found that lime juice could prevent it, sailors received a daily ration of lime juice. It is for this reason that British sailors were also called ‘limeys’.

Deficiency of Vitamin D is associated with bone deformations called Rickets. Vitamin D is routinely added to different beverages and foods. Interestingly, Vitamin D deficiency has become a recent ‘epidemic’. Even well fed people are found to have low Vitamin D levels. Since Vitamin D is synthesised in the body from exposure to sunlight, it is presumed that lessened exposure to the sun and use of sun block creams might be responsible. Vitamin D deficiency is difficult to diagnose but it can lead to weakening of the bones and related problems even in adults. Other vitamins are also important but there has rarely been any attempt to add them to staple foods.

The important end result of this discussion is that deficiencies of certain micronutrients can have bad effects on human health. Deficiencies that are common especially in poor countries can be addressed with addition of some of these micronutrients to flour, salt, milk, or even to fertiliser so that minerals can be taken up by plants. But the most important message is that a varied diet provides most of these micronutrients.

As far as the recent emphasis on malnourishment as a predictor of poor intellectual and physical function among children and young adults is concerned, it can only be partially blamed on micronutrient deficiency. The more common reason for such ‘failure to thrive’ is inadequate caloric intake and dependence on a limited type of food. In a country where forty million people live on less than a dollar a day, fortifying food staples cannot do much good if poor people don’t have the money to buy these food staples.