Coronavirus may shock us into dealing with a leading cause of death – malnutrition

Current medical thinking has it that, as we eventually managed with Smallpox, we’ll get on top of Covid-19. Maybe not this year, possibly next, only a dim light at the end of this ever-lengthening tunnel. Sadly, many of mankind’s more pervasive enemies don’t give as much cause for optimism.

Here’s another issue to struggle with: the recently released 2020 Global Nutrition Report could not be clearer. Malnutrition is now categorically the leading cause of death and ill-health worldwide – and that’s more likely to mean a surfeit of bad food than the absence of anything to eat. Junk food, ultra-processed food, poor diet – however we label it, it’s filling us then killing us, at great cost too.

That wasn’t true even half a century ago. That’s why nutritional diseases might also be called “the diseases of civilisation”. Hence the modern paradox of people who are very full, but dangerously under-fed, with compromised immune systems that leave them vastly more susceptible to becoming critically ill from, say, coronavirus.

It’s increasingly clear that Covid-19 alone is not an especially effective killer. It is, though, excellent at revealing our fatal conditions, and accelerating their effect. It mainly works with old age, poor air quality and poor diet. While the first may not be preventable and the second is a complex challenge, the last should be relatively easy to address. Fat chance.

Malnutrition is defined as any non-communicable disease in humans either caused or reversible through a change of diet. Along with starvation, that covers the new headline epidemics of diabetes, heart disease, cancer and stroke, with hundreds of other conditions not far behind. To pick just a few from the A-list, try anxiety, arthritis and asthma: all are exacerbated by poor diet (health.harvard.edu is especially enlightening on this, as is our own NHS). Talking of the NHS, scratch the surface of the Covid-19 data and the same pattern emerges: the more overweight, the less likely to recover.

The link between weight and Covid-19 outcomes is now so widely accepted across the board that even the most perverse commercial or political agenda can’t succeed with the pernicious “alternative facts” treatment that sustained tobacco and sugar lobbies for years. But poor diet is also a powerful ally to countless other agents of premature death, often not linked to weight at all. Many a large person is healthier than many a thin one.

As for the “old” malnutrition, it’s still by no means a thing of the past. It’s being inventively addressed, with insects and “meat replacement” tech to the fore. Most of these new foods bang harder on the environment drum than health, as the truth is that, so far, they’re just not that healthy.

And while “fixing meat” is indeed critical for the environment, it won’t fix poor diet. Plants are just as much to blame for the “new” malnutrition, where people are “full but not fed”. Take sugar and over-processed wheat as two obvious contributors. Add in the side-effects of modern consumerism – more meals out, much more marketing, less routine exercise – and we have a recipe for an unsustainable species.

The NHS reports that, even putting Covid aside, the cost of treating a malnourished patient is two to three times more than treating one who eats healthily. We can’t afford to keep undoing all the harm we do ourselves. Prevention must be the solution. But how?

The pioneering nutritionist Robert Lustig boils his prodigious learning down to two pieces of advice: protect the liver; feed the gut. As the latest reports from China indicate that Covid-19 is particularly hard on the gut flora, leading to gastro-intestinal complications that hinder recovery, that apparently simple advice could not be more critical.

That means seeking foods actively good for your gut health while avoiding sugars and over-processed carbs. Easily said, but next to impossible to bring about. Most people couldn’t make different choices if they tried. On streets and supermarket shelves, nutrition has been edged out and tastes manipulated away from health. Decades before coronavirus, poor diet was already a humanity-wide curse causing millions of people to die early.

We may come to look back on Covid as the shock that forced poor diet to the top of the health agenda; that the silver lining ends up larger than the cloud. Modern political interventions are welcome but it’s sustained personal choice that’s going to make this stick, and a far older instinct tells us there’s an obvious place to begin.

We need to start trusting our guts.

Leo Campbell is co-founder of Modern Baker