00:20:37.600It's kind of a known enough issue that it has a local term.
00:20:42.000So she publishes this in 1933 in the Archives of Disease in Childhood, which is a journal that's widely read in Britain.
00:20:50.160And she basically proposes that, like, this is a new thing.
00:20:54.440And very fatefully, she mentions in the paper that because cassava and maize are relatively low in protein, as far as sort of, like, starchy staples go,
00:21:05.660she's like this might be a deficiency of protein and because she's like a woman in stem at the time
00:21:15.060there's all of this debate over her paper so immediately people published these counter
00:21:21.040articles saying that actually what she's seeing is pellagra which is a vitamin b deficiency
00:21:26.460and then she writes a paper in response where she's like um the maze that they're feeding these
00:21:33.080kids is fermented and when you ferment something it has more vitamin b so like i know what pellagra
00:21:39.000is this isn't pellagra yeah another guy he's actually praising her like he says this as a
00:21:45.480compliment he says williams being a lady and a very gracious lady at that she arrived by instinct
00:21:52.980at the correct answer and it's like uh or i saw like a hundred thousand patients you prick oh i
00:21:59.960I hate it. It's so weird because it's like the extreme misogyny that this lady comes up against0.92
00:22:06.300is really a cherry on the sundae. And the sundae is like staggering levels of global racism and0.88
00:22:13.240colonialism. Well, that's the thing. You're reading this and you're like, Cicely, do you know anyone
00:22:17.680else who might feel irritated at people constantly condescending to them? Cicely, does anyone come
00:22:23.520to mind anyone at all sicily okay sicily so okay this is the fateful paragraph in her article she
00:22:31.900talks about like the various forms of treatment that she's tried for the squashy orcora thing
00:22:35.760this is from john knott's article he says as for treatment williams tried varied diets without
00:22:41.240success combinations with butter eggs tomato orange liver marmite yeast b max iron and arsenic
00:22:48.620all failed to reverse the symptoms oh arsenic didn't do the trick i know weirdly
00:22:52.780heavy metals not the key interesting the only food that seemed to work and then in only a few
00:23:00.420cases was tinned milk nestle's sweetened condensed milk with cod liver oil and malt
00:23:06.900seemed to be the most successful line of treatment man i'll tell you what they lost
00:23:11.620me with the cod liver oil but then they got me back with the malt i would drink some malted
00:23:17.280milk that sounds good she was so impressed with this nestle milk product that she actually made
00:23:23.700a chart showing kids like recovery times and she wanted to put it up in doctor's offices
00:23:28.880oh neat good the only reason the colonial administrator wouldn't do it is because
00:23:33.220nestle isn't a british company they're like yeah yeah it seems like you're saving kids lives
00:23:38.300it's not a british way of saving kids lives yeah sorry we don't make any money off of this one
00:23:45.160So basically, Cicely's article and the sort of the follow-up and the debate begins this entire wave of putting protein at the center of developing world malnutrition.
00:23:57.780Like this is the main message that people take from her work is like we have to get protein to poor people.
00:24:04.300So there's a couple other things happening at the time.
00:24:06.900after world war ii there's a lot more awareness of like starvation and like there's these you
00:24:13.280know millions of refugees moving across borders and there's a lot more interest in like what are
00:24:18.380the minimum requirements that will keep people alive nutritionally this is actually how we get
00:24:24.440recommended daily allowances of like various nutrients really yeah like this this is the
00:24:29.740period right after world war ii when there's just a lot more interest in like okay how many like
00:24:34.920what milligrams of vitamin B do people actually need? This is also a time when we're setting up
00:24:40.540a lot of institutions. So this is when we get the World Health Organization. This is when we get the
00:24:44.680UN. This is when we get the Food and Agriculture Organization. So there's all of this sort of
00:24:49.180international action. And solving malnutrition is one of the first things that these organizations
00:24:55.900set out to do. Parallel to that, we're getting all these institutions set up. This is also when
00:25:01.000we get the Bretton Woods institutions, right? This is when we get the IMF. This is when we
00:25:05.480get the World Bank. So we've got sort of on the one hand, this sort of global health infrastructure
00:25:11.500that is paralleled by a global wealth infrastructure that is designed to consolidate
00:25:17.460wealth within nations and nation states that are like already wealthy, right?
00:25:22.960We need to feed the poor, but we also need to make sure that their countries owe us a lot of money.
00:25:28.320We talk a lot on the show of sort of a lot of like scientific findings are really just people not realizing that they're confirming their pre-existing beliefs.
00:25:37.480So around this time, as there's more sort of panic building about protein deficiencies in the developing world, people are coming into this with a lot of preconceived notions about protein.
00:25:50.400So at the time, like the sort of upper classes of throughout Europe, but especially in Britain, were like eating a lot of meat.
00:25:56.800they're sort of like well obviously a high protein diet is the best for you and like protein builds
00:26:02.900muscle like a lot of the preconceptions that we have about protein now this is really like when
00:26:07.880they were forming was from basically a bunch of rich people who were already eating a lot of meat
00:26:13.080and they had like convinced themselves that like that was the best way to eat this is totally
00:26:17.920moon juice in a funny way all over again which is just like well i eat like this therefore it must
00:26:23.520be the best way to eat. Exactly. Where you're like, well, hang on a second. There's also a
00:26:28.840couple of, again, themes in our show, rat studies that come out in the 1920s. I guess these people
00:26:35.620are able to reproduce a version of kwashiorkor in rats by giving them like enough calories,
00:26:43.360but like super low protein calories. The rats come down with the same sorts of symptoms.
00:26:49.460So in 1949, the UN assigns two dudes, of course, to do a bunch of fieldwork in Africa,1.00
00:26:58.680finding out, like, what is the deal with this Quashiorcore thing?0.94
00:28:17.920Like, this becomes the guiding fix for this problem.
00:28:22.480It's one of those moments where you can see actively the exact dynamic of, like, racism making conditions materially worse for black and brown people,
00:28:32.500and also making white people feel better about ourselves, where we're like, ooh, we know!
00:28:36.220And we're talking about like dozens of people in rooms, like not aware that this is the dynamic at
00:28:41.560all. This is the other recommendation that they make from the report. Here, I'm sending another
00:28:47.160quote. The header here says immediate action, quote, in most hospitals, outpatient departments,
00:28:53.260medical centers, etc. skim milk powder is not at present available to the medical staff for
00:28:59.420purposes of treatment. Although the provision of skim milk is the most valuable form of treatment
00:29:04.520at present known for established cases of kwashiorkor.0.83
00:29:16.540So you mentioned a fetish for protein and it feels to me like just in the last, whatever,
00:29:22.02030 years of my conscious memory and engagement with diets and that kind of thing, of the
00:29:27.580three macronutrients, fat, carbohydrates, and protein, protein is the one that hasn't
00:29:32.540been blamed for people getting fat i know right it seems like this sort of safe zone where people
00:29:37.680can be like i just need to eat more protein i'll just protein's only good for you it'll only build
00:29:41.680muscle it'll only do all these things and i'm like man this is what happens right before something
00:29:45.680gets canceled we're about to cancel protein aren't we so basically this report comes out in 1952
00:29:53.460and this is like proof right like we have it protein malnutrition is the issue throughout
00:29:59.540the developing world. And for the next 20 years, there's just an explosion of interest in this
00:30:05.080problem. So I'm not going to go over it because it's really boring, but there's like conferences
00:30:10.740and symposiums and there's just more and more institutional momentum around this understanding
00:30:17.480of the problem. This is actually one of the reasons why UNICEF won the Nobel Peace Prize
00:30:23.500in 1965. It wasn't the boxes of pennies. It wasn't the cardboard boxes of pocket change
00:30:32.380that we gathered trick-or-treating as kids. That didn't do it. There's also an explosion
00:30:38.280in research and funding. So there's something called the Protein Advisory Group that is set
00:30:45.280up at the UN, and that sort of directs all of this research toward solving this. There's tons
00:30:51.580of laboratory research going on, trying to get higher protein versions of these staple crops.
00:30:59.780So this is an excerpt from an article called The History of Modern Nutrition Science
00:31:03.640by Darush Mozaffarian, who does a lot of work related to sort of food and history. And I've
00:31:08.760interviewed him for various things over the years. He says that this is the beginning of
00:31:13.240what we've talked about in other episodes, nutritionism, this idea that sort of what
00:31:18.740nutrition is and what food is, is just the delivery of individual vitamins that deal with
00:31:25.940individual health conditions. He says, a nutritional model developed to address deficiency
00:31:31.600diseases, identify and isolate the single relevant nutrient, assess its isolated physiological effect
00:31:38.120and quantify its optimal intake level to prevent disease. This was becoming the paradigm of
00:31:44.440nutrition. So two things. One, it feels like since then that has been not debunked, but like
00:31:50.060tempered, which is sort of like, Hey man, you can take a bunch of vitamins. Your body may or may not
00:31:55.520absorb them. And we've also spun it out into a whole industry that is like rooted in this idea
00:32:02.660of like optimization. And this is where you get like Huel and soil. It's like, we got everything
00:32:09.560you need into this one cup. All you have to do is drink this sludge and then you'll have your
00:32:14.100nutrition right it's like thank god we're finally gonna have food without all of like the culture
00:32:18.940yeah like hey man let's get rid of all that pesky flavor and enjoyment i don't want pleasure
00:32:25.120yeah one thing that bugged me actually about matzafarian's article is he sort of ends it
00:32:31.300by saying like you know who knows what the future holds we're still looking for the ideal balance
00:32:36.840of like macro and micronutrients right why would we want that right we're gonna find out that
00:32:42.640whatever 17 protein and like 22 starch is ideal like how would anyone even fucking do that right
00:32:49.500there's still this strange obsession with quantification even in a field where like
00:32:54.640people should absolutely know better i don't know i just think it's really weird yeah it's an
00:32:58.160obsession with quantification that then gets turned into mandates for individual behavior
00:33:03.600which then get turned into yes opportunities to sell stuff to people which is like we got your
00:33:09.260thing that's 22 percent protein and 17 percent blah blah blah and you know what i mean like the
00:33:13.680whole bit i feel very cynical about that cycle at this point me too yeah and also one of the things
00:33:20.240i came across researching this is that you know human requirements for protein are actually a
00:33:25.920bell curve oh interesting so like it's kind of silly to say that like you need x number of grams
00:33:30.920of protein because like you might need more than me and like i might need more than somebody else
00:33:36.020and there aren't great ways to measure that right now it's usually just like how does it make you
00:33:41.660feel yeah which is like generally a pretty good measure anyway and so even if we do come up with
00:33:48.380some sort of quote-unquote ideal mix it's not going to be ideal for everyone it's going to be
00:33:53.560an average ideal so we're all gonna have to eat the food that makes us feel good anyway
00:33:58.780we should all just do that yeah unless and until we know a shit ton more than we do right now yeah
00:34:06.480just eat what you want eat with you know use your best instincts all that kind of stuff right yes
00:34:12.380so there's this massive explosion in research most of the work that's actually being done at
00:34:18.860this time is like weird frankenfoods this is from john knott's article about the history of this
00:34:26.040entire thing he says in this environment and in the shadow of the impending protein crisis
00:34:31.260international agencies and western governments concentrated on the high-tech production of
00:34:35.680protein foods british petroleum for instance created single cell proteins grown on oil what
00:34:41.920i know others created leaf protein concentrate green jelly-like substances that were produced
00:34:47.920by putting inedible leaves through a centrifuge fish protein concentrate offal left over from
00:34:54.020filleting, or the hole of a junk fish proved fairly popular. Chlorella, a single-cell form
00:35:00.760of algae that was grown on sewage, was less so. Nonetheless, as food grown entirely on waste,
00:35:08.220it did represent the crowning achievement of modernist nutrition and is still available
00:35:13.120marketed as a health food. They're really working overtime to make that sound as gross
00:35:18.440us as humanly possible we grew it on oil we grew it on garbage dude the minute he said that i heard0.88
00:35:26.080like an audible click in my head where i'm like gwyneth is going to be hawking like the poop
00:35:31.740protein in like a week you're like you know it's grown on poop it has to be good for you
00:35:38.000so the first way that the world is solving this problem is with like the franken poop foods
00:35:44.300The second way is by spreading baby formula around the world.
00:35:50.860So this is a long history that had kind of been running for a while.
00:35:55.100So as part of this whole nutritionism wave in the 1920s and 1930s, one of the understandings,
00:36:02.020especially among like the British upper classes, was this idea that breast milk isn't optimized
00:36:07.300and that store-bought baby formula is actually better for kids than breast milk.
00:36:13.520whoa this i mean in their defense like the colonialists were telling everybody not to
00:36:19.680breastfeed like not just poor women i will say i have a number of friends who have given birth
00:36:24.900in the last five years and the uniform experience that all of them have had has been going to see
00:36:32.920lactation counselors and feeling massively ashamed and massively shamed about not being able to like
00:36:41.440produce breast milk in the right way at the right times in the right volumes all that kind of stuff
00:36:45.680that the pendulum has swung so far in the other direction now i know that it feels kind of wild
00:36:52.020to think about like anyway there was a time when no one was supposed to be breastfeeding because
00:36:56.220it is such a it is such an emphasis now and like i was so aware doing the research on this that
00:37:02.800like there's such a culture of morality around especially mothering in a way that there
00:37:08.160conspicuously isn't with fathering but also super duper around breastfeeding yeah and like there's
00:37:15.580actually a huge you're wrong about story of this entire field that we're going to get to but like
00:37:22.440there's plenty of people who can't breastfeed for whatever reason and like their kids are fine
00:37:29.460like i think like there's lots of science saying that like at the aggregate level breastfeeding is
00:37:36.500good for kids and that kids have advantages like there's weird enzymes in breast milk that help
00:37:42.860with immunity and all kinds of other things that like we don't know how to synthesize but also
00:37:47.880people seem to have taken that science as like if your kid breastfeeds he's gonna go to harvard
00:37:54.740and if he doesn't breastfeed he's gonna die and it's like these are very overlapping circles right
00:38:00.620this is the thing that is like a particular bee in my bonnet lately this sort of like use of
00:38:07.360research that seems to indicate a population level trend gets turned into research definitely found
00:38:16.680this rule for people and then that turns into an individual mandate for personal behavior in your
00:38:24.620life. All of that kind of stuff just like feeds into this bizarro machine that just produces
00:38:31.520anxious people. This was one of my revelations reading this article too, that I had always seen
00:38:38.760this shift away from breastfeeding that happened in poor countries. It happened in rich countries,
00:38:44.280over 50 years, people were breastfeeding much less than they had been before.
00:38:49.300And I had blamed the marketing of the corporations.
00:38:54.000Like, this has always been sold to me as a, like, corporate greed story where companies like Nestle had marketed these products to women basically by lying to them.
00:39:05.920And that is true, but it is not the full story.0.87
00:39:10.460So a lot of women around this time, and the reason why this happened so quickly around 1900, was industrialization.0.94
00:39:17.420a lot of women had to work and you can't breastfeed when you're at work. And if you're1.00
00:39:22.520working long hours, oftentimes you leave your kid with like your sister or your mom
00:39:27.220who oftentimes can't breastfeed. So it's also really frustrating that there's this like
00:39:31.660moralizing around breastfeeding at a time when like the world was making it harder
00:39:37.280for women to breastfeed. It's like a double capitalism. Yes, exactly.
00:39:42.080It was capitalism all along in that companies like Nestle were doing this sort of like0.79
00:39:46.240predatory shitty advertising and also it was capitalism all along in that people had to0.95
00:39:51.680fucking be at work yeah and what are you gonna do i found a really interesting 1981 new york0.98
00:39:55.940times article about this entire controversy and it has this paragraph with two sentences0.98
00:40:01.440that perfectly encapsulate the dichotomy of the different explanations it says infant formula is0.79
00:40:09.440popular with some low-income women because they see it as a kind of status symbol says judith0.98
00:40:14.520gordon formerly a researcher at the city's bureau of maternity services but doctors believe that a
00:40:20.100more significant contributing factor is the need for many of these women to return to work soon
00:40:25.640after giving birth which makes formula the simplest feeding method yeah i wonder which one of those0.99
00:40:31.380really carried the day was it the idea of a status symbol or was it i have to be at fucking work and0.98
00:40:37.820i have a baby that needs to eat right there is some classism baked into that narrative as well0.98
00:40:42.880Yeah. Which is just like, we're smart and we would never fall for that. That's why we drink moon juice. Like, okay.
00:40:51.660The reason women buy sex dust is because they think it's a high status item.
00:40:58.380So I think it's important to stress that the existence of formula is not the problem. The issue is when this happens in poor countries where women cannot afford enough formula.
00:41:11.720Yeah. One of the things they mentioned in Ghana is that baby formula tends to cost roughly half a day's labor for like the average worker. Good God. In Seattle, the minimum wage is $15 an hour. So that would be 60 bucks for one bottle of baby formula, which lasts one day. Jesus Christ.
00:41:31.620So like in that context, what do people do? They buy one can of baby formula and they stretch it out. So like there's a study in Indonesia that finds that only a quarter of people are diluting the baby formula with water, which you have to do anyway. Only a quarter of people are diluting it at like the recommended amounts.
00:41:51.600everybody else is stretching one day of formula to like two three four or five days there's also
00:41:57.420this the sort of the the ethical question of selling a product where it's basically impossible
00:42:03.920to administer it safely so one of the things that says on all of the packaging for the baby formula
00:42:09.880is like after you open it after you put it in the bottle refrigerate it after that well a lot of
00:42:15.420people in west africa don't have refrigerators so they're leaving it out which is like a completely
00:42:20.440predictable outcome and then they're getting bacteria on it and then they give it to their
00:42:24.700kids and their kids get infections the fundamental problem isn't even just refrigeration it's just
00:42:30.520like people need to make more money or this thing needs to cost less that's the central tension here
00:42:34.980exactly just in case anybody thinks that i'm like letting nestle off the hook there's a
00:42:41.060congressional hearing in 1978 where they interrogate the i believe ceo of nestle who is like0.77
00:42:49.520a fucking weasel personified really reason we are watching this clip is just because the dude is0.89
00:42:56.900like so gross you know i love to judge a ceo this sounds great exactly just like i don't mean like0.99
00:43:03.920his physical appearance i just mean his entire demeanor is just like slime all right i'm all
00:43:10.020queued up and ready to hit play when you are would you agree with me that your product should
00:43:16.380not be used where there is uh impure water yes or no uh we give all the instructions just just
00:43:24.780answer what would you what is your position but we cannot cope with that well as i understand
00:43:30.620what you say is where there's impure water it should not be used yes where the people are so
00:43:36.780poor that they're not going to realistically be able to continue to purchase that and which is
00:43:41.020going to mean that they're going to dilute it to a point which is going to endanger the health that
00:43:45.500it should not be used yes all right now then my final question is is what do you do or what do
00:43:51.100you feel is your corporate responsibility to find out the extent of the the use of your product in
00:43:58.420those circumstances in the developing part of the world do you feel that you have any responsibility
00:44:02.560we can't have that responsibility sir may i make a reference to you can't have that responsibility
00:44:09.000no no no what do you think two things before we get into the actual content of this
00:44:16.620one ted kennedy is a young buck of i don't know i assume like 48 i guess two this clip is made so
00:44:25.180clearly in 1978 not because of anything but the glasses frames although you can barely make them
00:44:32.120out past all the sideburns it's hard to see the glasses behind the bushes uh yeah no he seems
00:44:41.720this guy the nestle ceo what's his name do we know i have no idea i don't care this guy i don't0.98
00:44:48.420frankly care either fuck that guy he just seems so equivocating so like well just let me get a0.98
00:44:58.060word in let me do you know like that sort of like trying to sort of brush everything off like we0.99
00:45:04.400can't do that we can't do this yeah dude just give an answer just give an answer and like this is
00:45:09.640their entire strategy for this whole thing is just like well we baby formula is good like we had no
00:45:15.580idea that people wouldn't have refrigerators like it's just it's the typical sort of like how could
00:45:21.220we a giant multinational corporation possibly understand the market that we're operating in
00:45:26.780It's a strategy that seems likelier to have been advised by risk averse attorneys than it is to be advised by like optics aware communications people.
00:45:37.660I know. And also, they were like blanketing these products across Africa.
00:45:42.840So there's there's a study in 1960 that showed one in eight radio advertisements in Kenya was for Nestle lactogen, which is their baby formula.0.99
00:46:13.380There's also, I mean, the big story that goes around from this case, as well it should,
00:46:18.980is the fact that they had what were called milk nurses who were women who were dressed like
00:46:25.640nurses who would hang out in hospitals and give mothers free samples of baby formula.
00:46:33.180So it's like, you got to hook them on this. Like you give them a sample and they'll stay with our
00:46:37.300brand. And oftentimes telling them that formula is healthier than breast milk.
00:46:43.380It reminds me of the Fen Fen episode when they put a bunch of their like pharmaceutical sales
00:46:48.800reps in lab coats yeah yeah exactly the power of like a white uniform yes totally like i'm gonna
00:46:55.120make myself look like i'm part of a power structure it's like a medical stolen valor or something
00:47:01.260this is so aggressively shitty to be like i'm gonna cosplay as a health care provider and then0.97
00:47:09.200actually just be selling you shit and then be like i never said i was a health care provider0.97
00:47:13.540yeah i was just in a nurse's uniform in a hospital hey man that's on you if you drew0.99
00:47:17.980that conclusion that's on you okay this is this is from the infamous report that comes out about
00:47:25.160this later in the 1970s that's like the big expose that kind of makes this an international issue
00:47:29.580it says in many third world hospitals the staff routinely separates the mother and baby at birth
00:47:35.040and feeds formula to the baby during its entire stay in the pediatrics ward on discharge the mother
00:47:40.440receives a free tin of formula and a feeding bottle by the time the mother has finished her
00:47:44.900free tin of formula she may be a confirmed bottle feeder and her baby accustomed to the easy sucking
00:47:49.860on an artificial nipple may rebel at the more demanding task of drawing milk from a breast
00:47:54.600or says dr carl taylor chairman of the department of international health at johns hopkins the
00:47:59.520mother's milk can dry up and then the baby is hooked on formula so like part of this is women
00:48:05.780who can't breastfeed but there's also they're preventing women from being able to breastfeed0.67
00:48:12.540like come on like totally indefensible yeah and again this is one of those things where it's like
00:48:18.360maybe they didn't mean to maybe they did mean to and ultimately that doesn't matter yes you did
00:48:23.380the thing you did the thing and you made this a whole lot harder for a whole lot of people yes
00:48:28.580who are in an extremely vulnerable period of their lives which is right after giving birth
00:48:33.240to like a tiny person the other thing that i think has been underplayed in this entire
00:48:37.620like Nestle versus Africa story, is the fact that there are women who could not breastfeed
00:48:43.400throughout human history. And there are other fixes for this. Baby formula is just cow's milk
00:48:50.400with like a lot of the fat removed. And then like they put in some sugar and like some vitamins.
00:48:55.100Like it's not actually like super technologically advanced as a substance. Like you can make
00:48:59.920versions of it relatively easily. So this is an excerpt from the New York Times article from 1981.
00:49:04.100In 1971, a team of international health workers began distributing supplies of powdered milk and corn-soymilk mixtures to mothers of undernourished children in Nepal.
00:49:14.360But because many mothers prepared it under unsanitary conditions, the food caused diarrhea.
00:49:19.660Medical workers then discovered that even the poorest homes had an ample supply of grains.
00:49:24.640The nutritionists concocted a flower from local corn, wheat, and soybean supplies and then taught Nepalese women how to prepare it.
00:49:31.540malnourished children were usually well on the way to recovery within five weeks of starting on the
00:49:36.220mixture whoa so at the same time that all of these institutions are pouring millions of dollars into0.55
00:49:42.580like poop grown proteins a lot of indigenous cultures had ways of dealing with this problem0.60
00:49:49.960and like those projects were not getting funded seems like our uh white lady public health
00:49:55.920official was listening but not listening hard enough but not listening enough part of what
00:50:00.900sort of feeds into this is this concept from folks in the west that there couldn't possibly
00:50:07.240be any knowledge amongst any indigenous culture they need me to find the solution because they
00:50:15.020can't possibly know a friend of mine has a metaphor that i use a lot of that he was talking
00:50:19.280about wonder bread that sort of to make wonder bread you do all of this processing to remove
00:50:24.240the fiber from the wheat you bleach it you take out all of these vitamins like you take away
00:50:29.460everything that sort of makes it food. And then once you make it, then you like re-fortify it
00:50:35.200with all the stuff you took out. Yeah. You enrich it. Yeah. And I feel like it's a little bit
00:50:39.000the process of colonialism. It's like, you're sort of trying to wipe the slate clean and sort
00:50:44.920of like take away, discard all of these indigenous customs. Like you should probably breastfeed if1.00
00:50:51.100you're able to do that. Right. You're like sweeping all of that away. And then you're0.99
00:50:55.440like, no, no, no. We're going to give you something that's like better than breastfeeding.0.98
00:50:59.460right? Like we're going to optimize all of this. Like you're putting back in all of this knowledge,
00:51:03.500but in this way that is like completely inefficient. And like a lot of the knowledge
00:51:06.920that you're putting back in is garbage. And I also think, I don't want to say that Cicely0.79
00:51:12.440Williams and the sort of the protein deficiency is like the only reason for this, because there's
00:51:16.560a lot of other historical trends happening at the same time. But this idea of baby formula
00:51:22.200instead of breastfeeding is intimately wrapped up with this protein deficiency, because the entire
00:51:28.740idea is that people are getting enough calories but they're not getting enough protein like that
00:51:35.140is essential to the reason why these formulas are being pushed on mothers because otherwise they
00:51:40.740would just be eating the local food yeah this entire understanding of protein is like well if
00:51:44.960you eat the local food your kid is going to get kwashiorkor so it's really important that you buy
00:51:50.400this nestle stuff instead of the food that you already have access to and like doesn't cost 60
00:51:55.600bucks so the sort of okay this is where we're getting into like the slightly better news
00:51:59.960part of the episode oh okay there's a huge backlash to this that starts forming and do you
00:52:06.080want to guess who began the backlash to bottle feeding oh who began the backlash to bottle
00:52:12.460feeding cicely williams what so she she gets kicked out of ghana after seven years because0.51
00:52:20.360she has a big fight with her boss because Sicily is trying to admit an infant to the hospital
00:52:25.420with a form of tuberculosis that's in your tummy. And so it's not contagious. And her boss is like,
00:52:31.400we don't allow patients with tuberculosis because it's so contagious. And Sicily's like, right,0.52
00:52:36.140but this kid isn't contagious. We should admit him. And they get into like a huge fight over
00:52:40.080this. Sicily either leaves or she's fired or whatever, but she like storms out of Ghana in a0.99
00:52:44.960huff. She ends up going to Malaysia. And in Malaysia, she kind of looks around and she's0.99
00:52:51.780seeing all of these like infant problems, like infections, bacteria, like kids having all kinds
00:52:58.160of malnutrition problems. And she notices that it's like mostly in mothers who are using bottle0.98
00:53:04.240feeding. She sort of like starts asking around and she finds out that a lot of these women
00:53:08.240have been visited by these nurse people who were selling them sweetened condensed milk
00:53:14.400to use as baby formula oh whoa and like telling them that it's better than breastfeeding oh whoa0.99
00:53:19.660and so sicily like again not trying to do some girl boss shit but like she is incensed by this0.99
00:53:27.160like even even sicily can be like that's fucked up yeah you should not be telling these moms this0.99
00:53:32.420i would say being a health care provider for a child and not wanting that child to die0.97
00:54:01.380that misguided propaganda on infant feeding
00:54:04.140should be punished as the most criminal form of sedition
00:54:07.660and that those deaths should be regarded as murder whoa and the talk is called milk and murder holy1.00
00:54:14.900shit bold choices she's like fuck nestle fuck yeah like don't give this shit to kids and again like1.00
00:54:23.840nobody was saying this at the time this was still like this like scientific paradigm and like people1.00
00:54:29.120weren't even really questioning that like formula is better than breast milk yet yeah and so this
00:54:34.540backlash gets taken up you will not believe this by conservative christians what so in the 1960s
00:54:42.180and the 1970s there's these massive campaigns against nestlates it's one of the longest consumer
00:54:47.280boycotts in history and it's led by like people who want to have like conservative families and
00:54:54.120they want to bring back breastfeeding whoa isn't that weird because like we are so used to the
00:55:00.600christian movement being totally aligned with the political right but this was not the case then
00:55:06.640yeah the only actions against corporations that i've only seen christians do in my lifetime is
00:55:12.300like when disney has like a gay pride parade or something but like taking action on behalf
00:55:18.940of african kids against a giant corporation way to go christians totally also kind of makes sense
00:55:26.800in terms of sort of like the history of missionary work amongst like white western christians yeah
00:55:32.800once you find out that this is the position that they took you can sort of get there in
00:55:36.960your brain to like oh right here's how they would have gotten there but it is so different than our
00:55:41.640current like faith-based anti-breastfeeding like don't breastfeed in public don't breastfeed at
00:55:47.300work it's just fascinating what is what a strange what a strange turn so sicily is pushing back
00:55:53.540against bottle feeding. There's kind of this movement against Nestle and the other companies
00:55:58.840that are selling these products in the developing world. Meanwhile, nobody is questioning this
00:56:04.840protein stuff. Everything is just moving under its own momentum around like protein deficiency
00:56:10.080as the most important issue in global hunger. But then it's actually kind of amazing to me how
00:56:16.560quickly this all comes crashing down. So in 1974, a guy named Donald McLaren, who's also a field
00:56:23.400worker. He's doing work around Beirut in Lebanon. He publishes an article called The Great Protein
00:56:31.160Fiasco. And he basically tears down this entire field. He just sets the whole thing on fire.
00:56:39.400And it's like one of the best debunking articles I've ever read because the whole thing just has
00:56:46.700this air of bafflement of like, hang on, what is the evidence that protein deficiency is a problem?
00:56:55.420He goes over all of the available evidence. He's like, okay, Cicely Williams, 1933,
00:57:02.220she didn't even say that it was protein deficiency. All she said was that kids have
00:57:06.900these symptoms and they get better when we give them this Nestle milk. Literally the wording from
00:57:12.440her article is we cannot rule out protein deficiency as an explanation. He also says
00:57:18.700there's all these studies from all over the world that like people with kwashiorkor don't get better0.99
00:57:26.200when you give them higher protein diets. There's like a really comprehensive study in India where
00:57:32.600they find like there's certain populations there with like very low protein diets and certain
00:57:36.600populations with like normal protein diets. They have exactly the same incidence of kwashiorkor.
00:57:42.440whoa so this research is like they didn't even pour the foundation but they started building
00:57:47.180the house anyway that's this is the thing and then what's amazing is i went back and i read
00:57:52.340the 1952 paper that was like the like final nail in the coffin like it's protein and like it doesn't
00:57:59.240even say that in the paper like in the actual text of their article they don't actually really find
00:58:05.080a pattern and they're just like yeah it's in some places and it's not but then in the conclusion
00:58:09.260it's like this is the biggest issue facing world nutrition you're like what this was the thing that
00:58:16.440came up a bunch in the obesity epidemic stuff too that like the data around rising body weights is
00:58:23.760way more complicated and goes up in some demographics and goes down in others and
00:58:29.360that's a thing not saying it's not a thing but there's way more complexity to it than that and
00:58:33.820I'm so fascinated by these sort of moments. And it seems like they're coming up more and more
00:58:39.500on the topics that we talk about here, where even the researchers themselves are developing
00:58:46.600these sort of narratives that may or may not actually fit the data that's in front of them.
00:58:51.700I think a huge part of it is just bias, like confirmation bias and other forms of bias.
00:58:56.400Sure. Because this, I mean, not only are they finding it in some places and not others in
00:59:00.060Africa, but they're also applying this to the entire world. They're saying like, this is a
00:59:03.980global problem. And it's like, well, all you've surveyed is Africa and you didn't even find it
00:59:08.680that much in Africa. The other major thing that again, they had found in 1952, but like didn't
00:59:15.700do anything with was that what Cicely Williams described in 1933 was extremely specific. These
00:59:22.520people are eating enough, but they are still showing signs of a malnutrition disorder. What
00:59:28.840the investigators find in 1952 is that like people are not eating enough so in the paper they say
00:59:36.020the diets of africans and especially african children are never deficient in only one nutrient
00:59:41.920in addition to the very marked deficiency in animal protein there is a deficiency in vegetable
00:59:46.800proteins in minerals in vitamins so it's like people need food that's the thing it's like
00:59:51.220they don't have enough food so like right you can't talk about a deficiency of protein if people
00:59:57.040are not eating enough of anything jesus christ and again this is in the paper in 1952 and all
01:00:04.320donald mclaren in his like super big old fiasco debunking is like excuse me like this is all right
01:00:11.240in front of us i'm not sure why we're all talking about protein all the time right unless we're also
01:00:16.200saying it's protein and calories and fat and carbohydrates and b vitamins and yes if you're
01:00:22.060gonna start listing things just list everything or just be clear like hey man it turns out the
01:00:26.780problem here is hunger and food access so like this article causes a firestorm within one year
01:00:34.820there's an article called the protein gap in nature like super prestigious it says the concept
01:00:41.860of a worldwide protein gap is no longer tenable the problem is mainly one of quantity rather than
01:00:48.580quality and like that's it so within two more years the protein advisory group like doesn't
01:00:56.240exist anymore whoa apparently there's like some big food summit something something and they're
01:01:02.160just not invited i guess there's like uh i guess i think we don't exist anymore you guys like it's
01:01:08.800gone snubs and flubs the protein advisory group my god the last like nail in the coffin in this
01:01:15.720is in 1975, Cicely Williams writes a paper where she's like, this is on you. I never said it was
01:01:23.500protein punk. Like all I did was describe my medical interactions with some patients.
01:01:30.580You did all of this. Like, don't put this on me. She says, nutritional disorders cannot simply be
01:01:36.140met by supplying the missing food stuff. For although primary nutrition is due to a deficiency
01:01:40.820in the food, we must always find out why this deficiency exists. And like, I interviewed John
01:01:46.640Knott, the guy that wrote these two really good papers about the impact of colonialism on this
01:01:51.280whole protein panic rise and fall. And he said that like going back through all of the literature on
01:01:57.700this, it's actually really striking how much the sort of field work people on the ground, people
01:02:02.360who know these populations and who see like patients clinically, we're actually getting it
01:02:07.640right the entire time oh interesting like sicily williams was actually right the the area of southern
01:02:12.920ghana where she was working was like actually relatively affluent at the time and people really
01:02:17.620did have enough food and they were showing these symptoms of this potentially protein deficiency
01:02:23.420it's actually we we don't totally understand what causes this condition but like some sort
01:02:28.060of deficiency in a context of not starvation but like that's a very specific context applying that
01:02:36.320to the rest of Africa is absurd and the rest of the world is like double absurd. So like most of0.98
01:02:41.600the people who were doing this kind of work were actually fine. It's just when this work got
01:02:47.360translated into like international institutions and into like guidelines and recommendations
01:02:53.400that like the break happened. It's so tricky, right? Because ostensibly at this point,
01:02:59.540the purpose of nutrition research is to come up with guidelines and recommendations.
01:03:03.820yeah and also it feels like the more that you and i get into this stuff the more it's like
01:03:08.480anyway the place it really fell apart was the guidelines and the recommendations
01:03:12.380putting this car together was going great until the car was put together and then it was a bad
01:03:18.600car it just it it feels so challenging and frustrating and understandable and human how
01:03:27.000all of this happened yeah we're looking for making sense out of a big scary thing which is both our
01:03:32.440health and our mortality and we're not very good at it as it turns out and it also this is what
01:03:39.200john knott's articles emphasize the the main reason why it got taken up by these institutions
01:03:45.020right the the original 1952 report is like 200 and something pages long they could have taken
01:03:50.060all kinds of things from that report they could have emphasized all kinds of things the reason
01:03:54.740why colonial administrators and the international institutions emphasized protein was because it
01:04:01.720doesn't implicate poverty oh no he quotes somebody as saying like no one is starving in the british
01:04:07.720empire oh no if people are starving you have to look at the way that your policies contributed
01:04:16.520to that starvation or like you're not fixing that starvation like there's an implication of you
01:04:22.100whereas if you're saying oh these people are eating enough it's just they don't know that
01:04:26.820they're eating this cassava that happens to be low in protein. That completely lets you off the
01:04:33.320hook. And I don't think anyone was doing this consciously, but it's like they're reading
01:04:38.240through these reports. There were all kinds of other academic articles that they could have
01:04:42.600made a big deal out of, but they plucked Cicely Williams' work out of relative obscurity and
01:04:48.500called that the center of nutrition problems in the world because it was like, ah, here's one that
01:04:55.740doesn't make us look like the bad guys yeah well and again if it's all research that's being
01:05:02.080produced by and interpreted by white people it's also going to be like uh i don't want to lean into
01:05:08.500this stuff that makes me feel bad about myself as a white person as well right like i don't want to
01:05:13.980feel like i'm part of this machine that has created all of these health disparities and
01:05:18.660deaths of children right like that's horrible you don't want to feel like you're part of that
01:05:22.400So, of course, of course, of course, people like gravitate toward the narratives that provide them with comfort, whether or not that's a thing that they feel like they're doing or are intending to do.
01:05:33.860And also, it makes sense that like state entities would also lift up the research that makes them look altruistic in some ways.
01:05:43.600It's also important of like, I think some of this was operating at a subconscious level, but some of this was also operating at a like cartoon evil level.
01:05:51.140So John Knott mentions in his history of this episode that people were actually telling the colonial administrators that, like, it's poverty, and they were being actively censored.
01:06:02.380He says, over the course of the year, representative preliminary reports were depoliticized by the colonial office to remove any suggestion that low wages, inadequate returns from cash crops, and declines in food production were complicit in the pervasive pattern of malnutrition.
01:06:19.260oh it's so gross and so in retrospect so predictable right exactly that's what power
01:06:26.380does is preserve itself and also this whole thing of education does the same thing because if you
01:06:32.460have to educate these populations of like oh apparently the cassava is too low in protein
01:06:36.720it allows you to save these populations by like fortifying the cassava that they eat like this
01:06:43.340this this kind of research continues now of you know crops like you know basic rice basic yams
01:06:49.100whatever that are higher in vitamin a higher in beta carotene kind of like supercharged
01:06:53.640staple foods and what john knott pointed out to me when we spoke was it's like people who have
01:06:59.860more money generally feed themselves a more varied diet like in that 1952 report where they did this
01:07:06.720big survey they found that like beans and fish and a wide array of vegetables were like pretty
01:07:12.960widely available in the places where people were starving if they had money they would just be
01:07:19.520eating beans and fish like they don't need franken cassava that has like a two gram higher protein
01:07:27.620count like if they just had money they would feed themselves a more varied diet because like
01:07:32.960if there's one thing that's like i think probably universal to 100 of humans is like people don't
01:07:38.860like to eat the same thing all the time yes one of the first things that happens as people start
01:07:44.200to move up the income ladder is they eat more varied diets and especially more protein so like
01:07:49.600we don't need like weird like fish scale concentrate and stuff it's like just give
01:07:54.860people money and they'll buy fish yeah they don't need some like magical new engineered thing and
01:08:00.700they certainly don't need it to be like nestle branded i know talk about learning the words but
01:09:05.380So I just want to end with a quote from John Knotts' paper.
01:09:08.520I think this is the opening sentence of the paper, actually.
01:09:12.280He says, eating has always been political and dietetics, the implementation of a certain dietary regime, has always reflected the ideals of a given political economy.
01:09:22.080Anytime we're talking about the food of populations that we don't know that much about, anytime we're giving food recommendations, we're making political statements and we're making value statements and we're not always aware that that's what we're doing.
01:09:39.520If we don't check those implicit biases and if we don't acknowledge them and if we don't structure research and policy decisions around the idea that that exists and is something we need to account for, then we're just going to keep replicating.