"Current evidence indicates many chronic diseases can be largely prevented or treated by adhering to a plant-based diet, making health conscious lifestyle modifications and utilizing nutraceutical therapy as and when appropriate" – NutriSophic
Today, a discussion about morality of animal research among the public provokes a diverse range of strong feelings and opinions. However, the moral issues of animal research has only recently in the past century or so become a topic worthy of serious debate. Historical evidence informs us animals have been used as models for biomedical research for over 2000 years. Early Greek physicians such as Aristotle (384-322 b.c) and Erasistratus (304-258 b.c) often routinely experimented on animals(Hajar, 2011) which included the use of vivisection to advance their understanding of the human body. This practice of course continued throughout history and is now the backbone for a large proportion of the scientific research conducted and produced today (Understandinganimalresearch.org.uk, 2014). The necessity of animal experimentation as it stands today though is questioned now more than ever. Particularly with the use of primates and when experiments are very invasive and cause significant pain or suffering (Crueltyfreeinternational.org, 2016). Therefore the morality of animal experimentation at its most fundamental level tends to hinge on, 1) what animals are used for experimentation and why, and 2) the point at which we conclude the risk, or infliction of harm and suffering on animals is worth the benefits gained. The distinctions between what animals people believe should or shouldn’t be subjugated to animal research seems somewhat arbitrary but can be explained by several factors including cultural and social biases which differ between countries (von Roten, 2012) and personal characteristics and traits which differ between people. The latter point that dictates whether it is morally acceptable to use animals for research strongly resembles utilitarianism, whatever action results in the greatest good for the greatest number (Iep.utm.edu, 2016). These are arguably the two most salient points when questioning the ethics or morality of experimentation on animals. Efforts have been made to understand the views of the general public about the the ethical issues of animal experimentation, because ultimately, government policy and legislation, and in particular the direction and limits of scientific research and the majority public opinion are intimately tied (Shuttleworth and Frampton, 2015). Therefore several large surveys have been conducted to help investigate not just how the public feels about animal experimentation but why. This will help shape future research models and may change the way we use animals for research indefinitely. This review discusses a survey involving a sample of 100 members of the public of mixed demographics, somewhat representative of the population as whole, to investigate public opinions on what animals should be permitted for experimentation and any correlations present which may motivate such opinions.
The results taken from the survey showed a particular trend towards approving the use of “lower life forms” such as insects, slugs and reptiles and mammals we deem as food and pests. Nearly every subject condoned the use of slugs and insects with only three subjects opposing research on all animals altogether. Eighty-nine approved the use of reptiles whilst eighty-five approved the use of fish for research. Eighty-three people approved the use of food mammals and pest mammals for research. Only 10 people approved the use of primates and 20 people for the use of pet mammals for animal research.
(Fig 1) – Across a sample of 100 members of the public with various demographics representative of the general population, opinions on the use of particular animals for research are presented above.
A statistical analysis using Pearson Chi-squared test of independence (SPSS) was made to identify any correlations between owning a pet and the use of pet animals for research. The results found no significant correlation (p–value 0.544) between previously or currently owning a pet and using pet animals for animal research. The total number of pet owners compared to non pet-owners, as shown in (Table 1) were almost equally divided (42 and 43 respectively) but the largest group of thirty-six people were those against the use of pet animals for research who didn’t own pets, whilst the second largest group of thirty-three were also against the use of pet animals who did own pets. The largest group of people approving the use of pet animals for research were pet owners of which nine approved compared to seven non-pet owners which approved the use of pet animals for research.
(Table 1) – Shows the frequency of pet owners and non-pet owners who approved of the use pet animals for research.
A dramatic shift in opposition is seen in (Fig 1) when it came to opinions on using primates and pet mammals for animal research compared with food and pest mammals and even more so compared to species outside of our Mammalia class. A growing objection in the use of primates is likely motivated morally by the explicit similarities we identify between ourselves and them. A more recently growing objection to research on primates is in part due to the highly controversial deprivation experiments which has recently prompted David Attenborough and 21 other experts to call for an end in the use of primates for research (Ted Jeory, 2016). However our data doesn’t reflect much of the larger polls carried out which shows around 44% of the UK public condone the use of primates for experiments (ECEAE, 2010) compared to 10% shown in (Fig 1). This must be interpreted with caution though, since many surveys combine other animals such as dogs with primates. Therefore it’s difficult to get an accurate and definitive picture of public opinion relating to specific animals in the use of research. A slightly lesser number, although still a majority of people in (Fig 1) still objected to pet animals for use in research. This likely stems from our emotional attachments or our cultural perceptions of pet animals which underpins our biases towards them as an influential factor in objection to their use (Wells and Hepper, 1997). When the number of pet animals approved for animal research is compared to the number of food animals permitted for research we must question whether this discrepancy is grounded in a logically sound rationale, given that some food animals display much higher levels of intelligence that pet animals (PETA, 2012). The findings reported in (Table 1) showed marginally more people without pets were against the use of animals for research than people who owned pets. Similarly, there was a marginal amount of people more who owned pets who approved the use of pet animals in research compared to those who didn’t own pets. Based on the findings owning a pet doesn’t appear to bias a persons opinion about the use of pet animals in research although public perceptions of pet animals certainly has been shown to be distinct (Research, 2009). Since there was only one vegan and little more than a few vegetarians there was not a big enough sample size to draw meaningful inferences about whether or not there is a correlation between the amount of animals foods a person consumes and the types of animals they permit for research. Public attitudes towards animal research has shifted over the last few decades in support against animal research (Herzog et al. 2001; Moore 2003; Rowan and Loew 2001). A UK survey in 2014 found that out of 969 respondents questioned, 68% agreed that they “can accept the use of animals in research for medical purposes where there are no alternatives” (Gov.uk, 2014) compared to 76% who supported this notion in the 2010 survey (Understandinganimalresearch.org.uk, 2012). However when investigating public attitudes towards animal testing, survey questions each year are often rephrased and also fail to specify the types of animals used for research purposes which may mislead to the simplification of a much more complex issue, both in question and response. Some members of the public are also ignorant to anything more than a superficial understanding of animal research and therefore may not be able to make properly informed opinions to begin with thereby reducing the credibility of those opinions. This may be reflected by the fact that 40% of the public who were asked about animal research wanted to know more about it (Understandinganimalresearch.org.uk, 2012).
There are no correlations between owning a pet and permitting pet animals for research. There are, however, clear distinctions between what the public deem as a justifiable animal model for research. Many people agree pet animals and primates are distinctly different from the rest of the animals in question and deserve exclusion from research use with non-mammalian species accounting for a much higher approval rate for use in research. These are in part due to a reservation of bias towards animals such as primates and pet animals. Whether this is a logically and morally justified basis for which animals are to be used for animal research is highly questionable. Wording and phrasing of the questions are also important in changing the answer perspective which may also either improve or impair the quality of data received.
Crueltyfreeinternational.org. (2016). Sir David Attenborough calls for end to brain experiments on monkeys | Cruelty Free International. [online] Available at: https://www.crueltyfreeinternational.org/what-we-do/breaking-news/sir-david-attenborough-calls-end-brain-experiments-monkeys [Accessed 11 Dec. 2016].
ECEAE, (2010). ECEAE | Eurobarometer survey shows public concern on animal testing. [online] Eceae.org. Available at: http://www.eceae.org/no/category/watching-brief/76/eurobarometer-survey-shows-public-concern-on-animal-testing [Accessed 12 Dec. 2016].
Gov.uk. (2014). Public attitudes to animal testing – Press releases – GOV.UK. [online] Available at: https://www.gov.uk/government/news/public-attitudes-to-animal-testing [Accessed 12 Dec. 2016].
Iep.utm.edu. (2016). Utilitarianism, Act and Rule | Internet Encyclopedia of Philosophy. [online] Available at: http://www.iep.utm.edu/util-a-r/ [Accessed 11 Dec. 2016].
Hagelin, J., Carlsson, H. and Hau, J. (2003). An overview of surveys on how people view animal experimentation: some factors that may influence the outcome. Public Understanding of Science, 12(1), pp.67-81.
Hajar, R. (2011). Animal testing and medicine. Heart Views, 12(1), p.42.
Herzog H, Rowan A, Kossow D. Social attitude and animals. (2001) In: Salem DJ, Rowan AN, editors. The State of the Animals. Washington, DC: Humane Society Press; pp. 55–69.
Ormandy, E. and Schuppli, C. (2014). Public Attitudes toward Animal Research: A Review. Animals, 4(3), pp.391-408.
PETA. (2012). If Your Dog Tasted Like Pork, Would You Eat Her?. [online] Available at: http://www.peta.org/features/dog-pig/ [Accessed 12 Dec. 2016].
Research, N. (2009). Use of Dogs and Cats in Research: Public Perception and Evolution of Laws and Guidelines. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK32668/ [Accessed 12 Dec. 2016].
Rowan AN, Loew FM. (2001) Animal research: A review of developments, 1950-2000. In: Salem DJ, Rowan AN, editors. The State of the Animals 2001. Washington, DC: Humane Society Press;. pp. 111–120.
Shuttleworth, S. and Frampton, S. (2015). Constructing Scientific Communities: Citizen Science. The Lancet, 385(9987), p.2568.
Ted Jeory, J. (2016). David Attenborough calls for end to ‘cruel’ brain tests on primates. [online] The Independent. Available at: http://www.independent.co.uk/news/uk/politics/david-attenborough-primates-neuroscientists-cruel-brain-tests-a7230711.html [Accessed 12 Dec. 2016].
Understandinganimalresearch.org.uk. (2014). Forty reasons why we need animals in research | Understanding Animal Research. [online] Available at: http://www.understandinganimalresearch.org.uk/about-us/science-action-network/forty-reasons-why-we-need-animals-in-research/ [Accessed 11 Dec. 2016].
Von Roten, F. (2012). Public perceptions of animal experimentation across Europe. Public Understanding of Science, 22(6), pp.691-703.
Wells, D. and Hepper, P. (1997). Pet Ownership and Adults’ Views on the Use of Animals. Society & Animals, 5(1), pp.45-63.
The first recommendations on carbohydrate intake were proposed in the 1980’s and 90’s by COMA which has since disbanded. Since then overwhelming evidence has mounted which shows carbohydrate consumption to be associated with many of today’s current health problems. More specifically, the type of carbohydrate and the consumption of simple sugars and refined carbohydrates has become an increasing concern. High sugar intake is implicated as a significant risk factor for diabetes, fatty liver disease and obesity and receives a large amount of focus for current health initiatives and government policy on the recommendations for sugar intake.
Prevalence of weight related disease
In the UK 57% of adults are overweight and obese which is predicted to reach around 70% by 2034 (Public Health England Obesity Knowledge and Intelligence team, 2016). Children in the UK are following a similar trend with 25% of them being over weight and obese. The prevalence of doctor-diagnosed diabetes in adults increased between 1994 and 2014 from 2.9% to 7.1% and 1.9% to 5.3% for men and women respectively. The cost of obesity to the NHS is £5.1 billion (Scarborough et al., 2011) and the cost of treating diabetes and the complications that result from it in 2010/11 was £9.8 billion a year which is projected to be over £16.9 billion by 2035/36 (Hex et al., 2012). However, the NHS has refuted claims about potential bankruptcy in the future (Nhs.uk, 2012) despite such claims circulating in the media (Google.co.uk, 2015).
Actual sugar consumption has fallen over the past 40 years while consumption of sugar-sweetened beverages and foods have risen. Children ages 4-10 are said to consume on average just over 60g of sugar a day, equating to 5,543 sugar cubes or 22kg of sugar in one year (Gov.uk, 2016). Sugar consumption is highest among school age children and low income families. However, a high consumption of sugary foods is not justified by a low income when you consider a bag of bananas or apples can be purchased at a lower price which contains natural sugars, as well as vitamins and minerals. The biggest source of sugar for kids are juices and soft drinks, although for ages 19-64 one of the biggest sources of sugar comes from table sugar. However, this may be attributed to Britain’s cultural obsession with Tea.
Parents perception of child weight status and health
The fact that 42% of parents do not recognise their children to be overweight or obese when they are (Public Health England, 2015) also contributes to the problem. A study showed parents of overweight and obese children considered happiness, diet and activity level to be more important than body weight as an indicator of health, despite the physical and mental health implications of being overweight or obese (Syrad et al., 2014). The same study found that parents also didn’t find the BMI scale to be a credible indicator of a child’s health, because according to parents it didn’t take into consideration the child’s lifestyle. This shows that despite the implicated health risks of being over weight or obese, parents do not acknowledge body weight to be a significant risk factor to their child’s health. This is a dangerous misperception that needs to be immediately corrected. A strategy to give parents a more accurate perception of ‘overweight’ as well as education on the diverse effects that being overweight or obese has on their children, must be part of the health initiative. Failure to do so will not address the wider context of the problem
Current health initiatives
Health initiatives are currently in place across Britain to reduce sugar intake. Public Health England compiled an evidence based report called “Sugar consumption: The evidence for action” (Public Health England., 2015) which expresses the need to drastically reduce sugar intake across the population, which even the British Dental Association stated would be reckless to ignore (BDJ Team., 2015). Change4Life has issued a new campaign that focuses on educating parents to be “sugar smart” and even encourages parents to download the new Sugar Smart app that measures the sugar content of every day food and drink (Nhs.uk., 2016). Action on Sugar have also proposed an evidence based, six point sugar reduction plan to David Cameron (Cameron’s Plan: A comprehensive approach to prevent obesity, 2015) and are also backing TV chef Jamie Oliver’s obesity plan too (Actiononsugar.org, 2015). Some of the actions proposed by Action on Sugar involve a 50% sugar reduction within the next five years starting with soft drinks, ceasing the promotion and all types of marketing of unhealthy food to children and adolescents and a 20% duty on all sugar sweetened soft drinks and confectionery. They also began promoting sugar awareness week between the 30thNov-6thDec (Actiononsugar.org, 2015). All health initiatives proposed involve the proposal of a sugar tax with 53% of the public being for it. Educational behavioural strategies
In review of five educational school intervention programmes that aim to reduce sugar-sweetened beverage consumption and investigate changes in body mass, three showed long term success (Avery et al., 2014). After 12 months, one of which found the percentage of overweight and obese children decreased while the control group increased by 7.5% (Stockman., 2006). Sugar tax doesn’t address the root causes or take into context the bigger picture. Research has also suggested calorie intake has dropped but activity levels have dropped further (Prentice et al., 1995). Evidence investigating marketing strategies such as the four P’s (promotion, price, product, place) framework is shown to influence consumption and purchase of sugar (Sugar Reduction: The evidence for action Annexe 3, 2015). These same principles can be applied to the marketing of healthy foods, but need to be marketed with equal if not more vigour than the marketing strategies used to promote unhealthy foods.
Conclusion Overall the dynamics of sugar consumption and its effects on the health of the population is complex. As such, this surely warrants an equal response and an approach that mirrors it’s complexity. The food industry needs to become a part of the solution and not part of the problem to shift the favour towards the goals of the initiatives. Whilst the government needs to do its part in enforcing change and aggressively working towards fulfilling the goals of the initiatives. However, reducing sugar consumption is just one step towards tackling a multi faceted problem. There are many other factors affecting the health of the public besides sugar. Significant, long term improvements in public health and reductions in dietary related diseases will ultimately be accomplished at an individual level without tactics of coercion. This change will come from parents having; realistic nutrition and bodyweight perceptions, better food awareness, practical guidance on calorie balance and portion control and education on the effects of overnutrition. This all of course needs to be followed up with parents putting knowledge into practice and implementing long term positive behaviour changes such as moderating portion sizes or increasing purchases of foods that contain natural sugars such as fruit, whilst decreasing or eliminating the purchase of foods that contain ‘free sugars’.
Actiononsugar.org. (2015). ACTION ON SUGAR BACKS JAMIE OLIVER’S OBESITY STRATEGY AND LAUNCHES ITS OWN EVIDENCE-BASED ACTION PLAN TO SAVE LIVES AND THE NHS. [online] Available at: http://www.actiononsugar.org/News%20Centre/Press%20Releases%20/2015/167492.html [Accessed 17 Mar. 2016].
Actiononsugar.org. (2015). Sugar Awareness Week. [online] Available at: http://www.actiononsugar.org/sugar-awareness-week/Sugar%20Awareness%20Week%202015/167198.html [Accessed 15 Mar. 2016].
Avery, A., Bostock, L. and McCullough, F. (2014). A systematic review investigating interventions that can help reduce consumption of sugar-sweetened beverages in children leading to changes in body fatness. Journal of Human Nutrition and Dietetics, 28, pp.52-64.
BDJ Team (2015)2, Article number: 15157. Ignoring Public Health England report on sugar reduction would be reckless. BDJ Team, 2(10), p.15157.
Butland B, Jebb S, Kopelman P. (2007). Tackling obesities: future choices – project report 2nd Ed. London: Foresight Programme of the Government Office for Science, 2007.
Cameron’s Plan: A comprehensive approach to prevent obesity. (2015). [pdf]. UK: Action on Sugar. Available at: http://www.actiononsugar.org/News%20Centre/Press%20Releases%20/2015/167492.html [Accessed 16 Mar. 2016].
Google.co.uk. (2015). diabetes threatens bankrupt NHS UK 2015. [online] Available at: https://www.google.co.uk/gfe_rd=cr&ei=e3PpVo_DEenS8AesxIKIDg&gws_rd=ssl#q=diabetes+threatens+bankrupt+NHS+UK+2015 [Accessed 16 Mar. 2016].
GOV.UK. (2016). 5 year olds eat and drink their body weight in sugar every year – Press releases – GOV.UK. [online] Available at: https://www.gov.uk/government/news/5-year-olds-eat-and-drink-their-body-weight-in-sugar-every-year [Accessed 15 Mar. 2016].
Hex, N., Bartlett, C., Wright, D., Taylor, M. and Varley, D. (2012). Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine, 29(7), pp.855-862.
Nhs.uk. (2012). Massive rise in diabetes costs predicted – Health News – NHS Choices. [online] Available at: http://www.nhs.uk/news/2012/04april/Pages/nhs-diabetes-costs-cases-rising.aspx [Accessed 16 Mar. 2016].
Nhs.uk. (2016). Let’s get Sugar Smart! Download the Change4Life Sugar Smart app for free today. [online] Available at: https://www.nhs.uk/change4life-beta/campaigns/sugar-smart/sugar-facts [Accessed 15 Mar. 2016].
Obesity Knowledge and Intelligence team. (2016). Public Health England. [online] Noo.org.uk. Available at: http://www.noo.org.uk/slide_sets [Accessed 4 Mar. 2016].
Prentice, A. and Jebb, S. (1995). Obesity in Britain: gluttony or sloth?. BMJ, 311(7002), pp.437-439.
Public Health England. (2015). [pdf]. Sugar Reduction: The evidence for action. Available at: https://www.gov.uk/government/publications/sugar-reduction-from-evidence-into-action [Accessed 15 Mar. 2016].
Scarborough, P., Bhatnagar, P., Wickramasinghe, K., Allender, S., Foster, C. and Rayner, M. (2011). The economic burden of ill health due to diet, physical inactivity, smoking, alcohol and obesity in the UK: an update to 2006-07 NHS costs. Journal of Public Health, 33(4), pp.527-535.
Sugar Reduction: The evidence for action Annexe 3: A mixed method review of behaviour changes resulting from marketing strategies targeted at high sugar food and non-alcoholic drink. (2015). 1st ed. England: Public Health England, pp.pg 7-8.
Stockman, J. (2006). Preventing Childhood Obesity by Reducing Consumption of Carbonated Drinks: Cluster Randomised Controlled Trial. Yearbook of Pediatrics, 2006, pp.407-408.
Syrad, H., Falconer, C., Cooke, L., Saxena, S., Kessel, A., Viner, R., Kinra, S., Wardle, J. and Croker, H. (2014). ‘Health and happiness is more important than weight’: a qualitative investigation of the views of parents receiving written feedback on their child’s weight as part of the National Child Measurement Programme. Journal of Human Nutrition and Dietetics, 28(1), pp.47-55.
Our understanding of the human genome has improved exponentially over the past century. With the completion of the human genome project in 2003 humans have sequenced the entire molecule of life, deoxyribonucelic acid (DNA), estimating the presence of 20,500 genes and 1.42 million single-nucleotide-polymorphisms (SNP’s) (Sachidanandam, Ravi et al 2001). This of course has led to a much clearer understanding of our genes and with it, a deeper cognizance for the information stored within them. Because of this, we are now able to much more thoroughly interpret our own genetic information which may hold the key to the future door of human health. Genetic analysis can be used to indicate an individuals susceptibility to specific diseases by identifying certain SNP’s that are associated with a persons risk of developing that particular disease. Similarly a person can even become familiar with their bodies own capacity to metabolise certain drugs and learn how well they respond to them. People are also able to build a social network with long distance relatives through the analysis of the ethnic composition of ones genome. However concerns have been raised regarding the interpretation and use of personal genetic information by the general public. This article will discuss both positive and negative implications of the use of a genetic analysis service 23andMe, as an accessible health screening device for the general public.
Genetic analysis from 23andMe can indicate an estimated risk of disease according to the identification of mutation SNP’s and could be used effectively to encourage healthier behaviour patterns in the right minded individuals. This could lead to an individual taking preventative measures to reduce their disease risk (Milne et al 2000) and thus resulting in positive health improvements. However, such information can also be misinterpreted and misleading for some, creating panic and anticipation about a disease that may never occur. This could create a rush for unnecessary screening and testing in healthy asymptomatic people that may never develop disease especially with regards to those who test positive for BRCA mutation genes associated with breast cancer. Conversely in the case of Rita Rubin, she found out through genetic analysis 23andMe that she had a smaller chance of developing Crohns disease than the average person but yet had lived with the condition all her life (Nextavenue.org). Genetic testing could also lead an individual into a false sense of security promoting an indulgence in unhealthy behaviours that may actually encourage disease, even though they are not genetically susceptible to it (Chapman and Bilton 2004) . Some of the disease susceptibility included in the service are diseases for which there is no cure or effective treatment. A concern remains in the question of whether psychologically and emotionally unstable individuals will respond well to finding out they are at a high risk for developing a disease they can not manage or treat. Conversely a strong minded and proactive individual being made aware they have a small chance of developing a disease will most likely take preventative actions to minimise their risk and make positive lifestyle changes.
Positive implications also exist for the testing of genetic variations that indicate drug metabolism. For example patients that use drugs to prevent heart attacks or blood clotting may benefit from knowing how well they respond to a certain drug and how sensitive they are to it. This information of course could potentially save lives, but may have to be used, in the context of public health, under the guidance of all relevant qualified health care professionals including emotional counsellors (Allyse and Michie 2013).
Data from genetic analysis can be both useful and detrimental to a persons physical and psychological welfare, depending on the individual and their interpretation of the data. Although data from such an analysis can not be currently used to determine exhaustive and definitive susceptibility to disease, it can nonetheless serve as a platform for the progression of this type of technology so more accurate interpretations can be made from this type of data in the future. Also until the reliability of the data from genetic analysis improves and its interpretation can be given more accurately, it should serve as ‘information of interest’ for the public, rather than a tool to discover the fate of one’s health. It should be made explicit to anyone using genetic analysis that genetics are only one factor in disease risk and not the only factor. Genetic analysis could ensue more concern and worry for some than the significance and reliability of the data deserves credit for. It does, however, have the ability to prosper as a device used for public health screening and for personalised health improvement at an individual level.
References Allyse, Megan, and Marsha Michie. (2013). ‘Not-So-Incidental Findings: The ACMG Recommendations On The Reporting Of Incidental Findings In Clinical Whole Genome And Whole Exome Sequencing’. Trends in Biotechnology 31.8 (2013): 439-441. Available from: http://www.nature.com/gim/journal/v15/n7/full/gim201373a.html [15 March 2015]
MILNE, S et al (2000) ‘Prediction And Intervention In Health-Related Behavior: A Meta-Analytic Review Of Protection Motivation Theory’. J Appl Social Pyschol 30.1: 106-143. Available from: file:///C:/Users/User1/Downloads/JASP-PMTMeta.pdf[15 March 2015]
Nextavenue.org. (2013) ‘The Pros And Cons Of Genetic Testing’. N.p. Available from: http://www.nextavenue.org/article/2013-04/pros-and-cons-genetic-testing [15 March 2015]
Prokaryotic organisms such as single celled bacteria, are the simplest of all life forms. They contain very little biological material and even their DNA floats freely within a bacterial cell. This is where the name prokaryote comes from as the name implies “before the nucleus”, ie these cells existed before organisms had evolved to organise their DNA within a nucleus. The roles of prokaryotes in the fabrication of our very existence and the dependence the ecosystem has on them is often under appreciated. Very little thought or respect is given to these microscopic organisms who remain elusive to the naked eye but yet have laid the basis for life on this planet. Bacteria are often viewed upon as infectious entities that are bad for us. But bacteria also play a huge role in the maintenance of the biosphere and the promotion of our good health as well as being a causal factor for ill health. As insignificant as they seem their significance to life as we know it is immense.
Here’s some E.coli we studied with an electron microscope in one of our lab experiments…
Veterans of the earth
We homosapiens like to consider ourselves the most dominant species on the planet and to some extent we are, we have definitely laid our footprint down and made our presence universal. We have the ability to adapt to our environment and we have done that efficiently over the span our evolutionary timescale. But we have only been on this planet for a fraction of the time bacteria has and its thanks to their existence we even exist. Bacteria can adapt to their environment too but on a much more efficient scale. Not only can they adapt thriving in anything from extreme icy cold to hot spring temperatures to extreme PH levels in acidic habitats, environments humans could only imagine living in. But when we humans have exhausted our resources or when our creations become tools of our demise, bacteria will continue to undoubtedly reign.
The scientific consensus is that the earth was formed 4.5 billion years ago and based on evidence this is what science agrees on(1). The earliest evidence suggests life first existed as chemoautrophs, basic single celled anaerobic organisms, these cells were the first prokaryotic bacteria and they dominated the planet in an atmosphere absent of oxygen around 3.8 billion years ago(2). But their dominance was short lived as around 3 billion years ago evolution took place where a new type of prokaryotic cell called cyanobacteria started to photosynthesise(3).
These new pioneer species laid the foundations for life on this earth as we know it and it was the start of a chain of ecological succession. This was a revolution in the world of prokaryotes. Using only water, carbon dioxide and energy from the sunlight they were able to release small amounts of oxygen into the atmosphere as a waste product of photosynthesis. Oxygen killed many anaerobic organisms on contact and cyanobacteria became the dominant prokaryote species.
From fossils of bacterial mats, otherwise known as stromatolites, we know that initially the oxygen was bound to dissolved iron ions and other reducing substances that could react with oxygen. These ions precipitated as iron oxide (shown as rust) and prevented the accumulation of free oxygen. It wasn’t until 2.5 billion years ago precipitation exhausted the dissolved iron which led to the oceans and atmosphere becoming saturated with oxygen(4). This was the beginning of what scientists called the great oxidation event (GOE). The increase in oxygen was toxic to many anaerobic bacterial and protist species, as it still is to many forms today. However this also led to adaptation by some cells in which they evolved to harness the oxygen to render it harmless to them by using a similar system to photosynthesis called cellular respiration or aerobic respiration. This produced more energy for the cell thus also allowing for bigger more complex life(5). We owe bacteria our gratitude for providing us with a stable oxygen steady state eco-system.
Photosynthetic prokaryotes are also responsible for the cause of our plant life. Evidence suggests chloroplasts are descendants of cyanobacteria that some time in the past entered into a symbiotic mutualistic relationship with a primitive plant like organism, becoming a part of it through endosymbiosis(6). This gives entry to the perfect relationship between oxygen releasers and oxygen consumers. Humans breathe in oxygen and release carbon dioxide where as these oxygen givers recycled carbon dioxide to make usable oxygen. Now its easier to see the significance of our dependence on them. Without oxygen we would die, without plant life we would die.
Another life giving aspect that bacteria has provided us with is nitrogen. The role of nitrogen in the biosphere is crucial to all living things. Nitrogen is important for the synthesis of proteins, nucleic acids and other fundamental components associated with growth. Nitrogen is all around us, 78% of the air we breathe is in fact nitrogen, however its in the unusable form of N2, the triple bond between the two atoms makes it almost inert. Therefore nitrogen needs to be fixed and converted to a usable form NH4 (ammonium) or NO3 (nitrate) ions. Free-living cyanobacteria were initially responsible for biological nitrogen fixation in soils but now prokaryotic bacteria have also formed a symbiotic relationship with legumes in which the nitrogen-fixing bacteria called Rhizobium, subside in the root nodules of the legumes, fixing nitrogen for them there. Biological nitrogen fixation is performed exclusively by prokaryotes and is yet another positive and vital impact they have on our existence and the biosphere(7).
Its easy to forget that we are covered by mostly harmless bacteria inside and out (roughly 100 trillion of them) and all the cells in our body are out numbered by them. But a type of bacteria that is beneficial to us, one that we have formed a type of mutualistic symbiosis with is the microbial flora in our guts. There is between 500-1000 bacterial species in the human gut flora. These anaerobic prokaryotic bacteria help us breakdown sugars and lipids increasing the bio-availability of nutrients(8). The metabolic substrates they leave behind are also beneficial to us, they give us vitamins such as vitamin B12, K and short chain fatty acids. Our friendly bacteria also play an important role in acting as a barrier to harmful pathogenic organisms(9).
The negative impacts bacteria has on humans we all know too well. Anything from infection to disease is due to bacteria, some of which we know can be fatal. E.coli, Salmonella, Tetanus and Staphylococcus are just a few deadly examples of how Bacteria can impact us negatively by invading our bodies, destroying our cells and breaking down our immune system.
Prokaryotes have great genetic diversity and this has led to them being beneficial to us and our environment as well as being the cause of many human deaths. They truly are the dominant species and will most likely continue to be so for many years beyond our existence. They laid the foundations for us to live and now maintain the structure of that biosphere. They hold the potential to eradicate us and have the capability of thriving in conditions we couldn’t dream of surviving in. In essence they are our friend and foe. Most would love to live without them but we certainly couldn’t.
At least 2 billion people worldwide are currently affected by micro-nutrient deficiencies and despite the UK being a developed country with high food availability, some British children still suffer deficiencies. During pregnancy and childhood where physiological growth occurs at a rapid rate, its well known an intake of Vitamin D is required in sufficient amounts during these crucial periods of growth. Mothers with low 25-OHD serum levels who fail to intake or supplement the recommended amounts of vitamin D during pregnancy and who breastfeed past 6 months without supplementation are the biggest causes of childhood vitamin D deficiency. Other factors that affect vitamin D status in children is inadequate UVB exposure and/or low intake of dietary sources include fortified foods or supplements. Vitamin D deficiencies seems to be a problem of our awareness about the importance of nutrition and of the availability of supplementation or food sources that could be improved with fortification rather than a problem of race and age.
Micro-nutrients are organic and inorganic substances composed of vitamins and minerals that we need from our diet which are necessary for cellular function, physical growth and tissue repair during all stages of life (Merson, Black and Mills, 2012). At least 2 billion people worldwide are currently affected by micro-nutrient deficiencies (Unitedcalltoaction.org, 2016) and despite the UK being a developed country with high food availability, some British children still suffer deficiencies. Currently many children and adolescents across the whole of Europe including Britain have all shown the same consistent deficiencies of at least six micro-nutrients (Kaganov et al., 2015).
Micro-nutrient deficiencies can affect all age groups but children are a particularly vulnerable group, especially those from low income families (Casey et al., 2001). The social and economic costs of micro nutrient deficiencies in women and children are also thought to be significant (Darnton-Hill et al., 2005). During pregnancy and childhood where physiological growth occurs at a rapid rate, it is well known an intake of micro-nutrients are required in sufficient amounts during these crucial periods of growth. Adverse effects from nutrient deficiencies are well documented (Viteri and Gonzalez, 2002) (SCN.,2004) and the effects of a prolonged deficiency is catastrophic.
One micro-nutrient deficiency that has made a come back since the industrial revolution is vitamin D. Deficiencies in vitamin D results in serious physical growth deformities (Abrams., 2002). Vitamin D deficiencies (VDD’s) are now being frequently observed children as a result of poor intake, inadequate sunlight exposure or because of a deficiency in the mother during pregnancy or breastfeeding. The long term outcomes from these deficiencies can lead to limitations in the quality of a childs future. So the importance of an adequate intake of vitamin D during pregnancy and childhood cannot be overstated, although requirements are often not being met. Therefore the focus of this review will be based on the prevalence and causes of vitamin D deficiency during pregnancy and among British children. This review will derive from recent research mainly within the last 15 years.
Vitamin D intake and recommendations
Two main forms of vitamin D exist as vitamin D2 (ergocalciferol) which can be attained predominantly from animal foods and vitamin D3 (cholecalciferol) which is photochemically synthesised cutaneously in human and animal skin. Vitamin D converts into one of its active forms 25-hydroxyvitamin D (25-OHD) of which serum levels can be measured and is the main clinical method used for assessing vitamin D status. Clinical deficiency is classed as a 25-OHD serum level of <25 nmol/L and a vitamin D insufficiency <50nmol/L, both inadequate levels for good health (Thurston et al., 2015). VDD (vitamin D deficiency) is now proving to be associated with many health problems (Macneil, 2008) (Gominak and Stumpf, 2012) (Zoler, 2012) (Reid, 2015) but is more widely known for effects on bone metabolism. This is important particularly for children and adolescents as 90% of bone density is laid during the first two decades of life (Eufic.org, 2014).
Vitamin D measurements and recommendations of intake can be confusing too as food labels and recommendations often use both µg and IU of units of measurements, which both have different equivalences. To avoid confusion it’s important to remember that every 1µg of vitamin D is equivalent to 40IU of vitamin D. Recommendations on vitamin D intake was set out by the Committee on Medical Aspects of Food and Nutrition Policy (COMA) in 1991. It was based on the assumption that the population would receive sufficient vitamin D intake in the summer resulting in sufficient stores for winter. Therefore, reference nutrient intakes (RNI’s) were only issued for vulnerable groups such as Infants and children aged under 4 years, who were advised an intake of 7-8.5µg/day (280-340IU/day), and pregnant women and breastfeeding women, advised an intake 10 μg/day (400 IU/day) via supplementation (Panel on Dietary Reference values of the Committee on Medical Aspects of Food Policy., 1991). However, these dietary values are not being met by these groups today and may also not be in line with the lifestyle and cultures of today’s population who spend more time indoors or out of sunlight exposure and inactive than is recommended (Matsuoka et al., 1993) (Certain and Kahn, 2002).
Young women in the UK, from mixed ethnic backgrounds, also only average a daily intake of only 3μg of vitamin D and less than 1% of young women consume more than the RNI of 10μg/day (Marriott and Buttriss, 2003). This is worrying considering 10μg/day is the recommended intake advised during pregnancy and breastfeeding to prevent deficiency which can lead to growth impairments or osteoporotic bone injuries later on in life. Mothers with low 25-OHD serum levels who fail to intake or supplement the recommended amounts of vitamin D during pregnancy and who breastfeed past 6 months without supplementation are the biggest causes of childhood VDD (Thomas et al., 2011) (Aljebory, 2013). Nutritional rickets is regarded as a disease of VDD which results in serious bone deformity and the prevalence of rickets, is currently at its highest since 1963 (Goldacre, Hall and Yeates, 2014).
Vitamin D deficiency in cultural and ethnic groups
Culture and ethnicity are other factors that exacerbate childhood VDD prevalence in the UK, especially when dietary intake of vitamin D is already low and British weather is notoriously unreliable as a sustainable source of sunlight (UVB) exposure. Six Infants aged 10-28 months born in the UK of mothers that failed to supplement vitamin D during pregnancy and during breastfeeding were referred to a paediatric clinic. All infants presented with low serum 25-OHD levels and were subsequently diagnosed with florid rickets as a result of VDD. Some of the mothers were postgraduate students and some were immigrants but most of the mothers were traditional Muslims who concealed their skin in public for religious reasons (Mughal et al., 1999).
Since VDD is particularly prevalent among sunlight deprived individuals, such as women practising religions that require skin concealment, the current dietary recommendations may be inadequate for these individuals to attain sufficient 25-OHD levels who receive little to no UVB exposure (Glerup et al., 2000). Results from a UK study on 78 women aged 18-36 of South Asian origin showed 94% of these women to have VDD evident by low serum 25-OHD levels (Dobson, 2007). Further research supports the UK recommendations of UVB exposure in the summer to be inadequate for adults of South Asian ethnicity (Farrar et al., 2011) which means compensations must be made through dietary intake. Repeated research has also shown children of ethnic minority groups tend to be at a higher risk of vitamin D deficiency than caucasians (Shaw, 2002) (Brenner and Hearing., 2007) with high prevalence of VDD among Somali children (Modgil et al., 2010) and asian children (Zlotkin and Blumsohn, 1999). This obviously raises concerns for children born in the UK of mothers who are of a particular religion or ethnicity and of Mothers who are likely to have VDD before, during and after pregnancy while breastfeeding, unless of course specific dietary needs are met.
Vitamin D deficiency in Caucasians and general population
Many Caucasian women and children of the population however despite differing levels of ethnic susceptibility to VDD are still vitamin D deficient and studies have even shown even those in sunlight rich countries are susceptible to VDD (Bettica et al., 1999) (Gannagé-Yared et al., 2000) .
A study involving 1414 Caucasian women has shown females in the UK with fair skin have lower serum 25-OHD levels than Caucasian females with dark skin (Glass et al., 2009). This outlines variability in responsiveness to UVB exposure which ultimately affects vitamin D status and since the effects of VDD on bone health in Caucasian and non-Caucasian women are the same (SA, 2011) the prevalence of VDD in Caucasian women should not be overlooked either.
A longitudinal study involving 99 British Caucasian women who were pregnant showed 44% of the women were vitamin D deficient (25-OHD <25nmol/L) at 20 weeks gestation and 96% of women were vitamin D insufficient (25-OHD <50nmol/L) at 12 and 20 weeks . All women seemed to have improved vitamin D status by 35 weeks compared to 12 weeks gestation, but even then 16% were still vitamin D deficient and 75% still had insufficient levels. Some women also took vitamin D supplements which led to higher serum 25-OHD levels than those who didn’t, but vitamin D insufficiency was still present even with supplementation (Holmes et al., 2010).
A study conducted on children born of vitamin D deficient mothers showed all children were born deficient in vitamin D. However, vitamin D status in the infants quickly normalised after receiving an intake of 10μg/day (400 IU/day) at 2 weeks of age (Bergström, Blanck and Sävendahl, 2013) which intake is the RNI recommended for pregnant and breastfeeding women. Research shows that when baseline serum levels from groups were < 75 nmol/L, for every 1μg of vitamin D supplemented 25-OHD levels are raised by 2 nmol/L. However, when groups were clinically deficient (<25nnmol/l 25-OHD) or insufficient (<50nnmol/l 25-OHD) in vitamin D, there was significant value in providing an additional 10μg per day of vitamin D.
In a longitudinal UK study nearly a third of women studied had insufficient maternal 25-OHD levels (<50nmol/L) and 18% had maternal levels of 25-OHD levels indicative of deficiency (<25nnmol/L). These low 25-OHD levels during pregnancy resulted in reduced bone mass in their children at the age of 9 (Javaid et al., 2006). A cohort study showed the same results of reduced bone density observed in their offspring at 20 years of age born of mothers who were vitamin D deficient during pregnancy (Zhu et al., 2014). This highlights the need for national preventative and educational strategies aimed at the entire population with particular focus towards UK women of child bearing age.
Given the current rise in VDD It seems logical to make vitamin D supplements available to pregnant women through their GP in the same way folic acid is, although it was concluded by The National Institute for Health and Care Excellence in 2003 that vitamin D should not be routinely administered to all pregnant women (NICE, 2003). Since then though clear relationships between maternal 25-OHD status and offspring health have been made apparent (Sabet, 2012) (Young et al., 2012) (Rebecca et al., 2013). Research has shown doses of 50μg/day of vitamin D supplementation taken by mothers during pregnancy and during breastfeeding has shown to protect infants from being born into deficiency and up until 8 weeks of age (March et al., 2015). Firm recommendations on vitamin D supplementation intakes as high as the maximum upper tolerable level (UL) to prevent deficiency has also been suggested (Holick et al., 2011). However others state the evidence is still insufficient to support definitive clinical recommendations of vitamin D supplementation during pregnancy (Harvey et al., 2014) even though supplementation does raise serum 25-OHD levels to recommended amounts, larger randomised controlled trials have been prompted (Pérez-López et al., 2015).
Vitamin D status among children
Apart from mothers with low maternal vitamin D status during pregnancy and breastfeeding and ethnic susceptibility, other factors that affect vitamin D status in children are inadequate UVB exposure and/or low intake of dietary sources including fortified foods or supplements (Hartman, 2000). Excessive sunscreen use has been recognised as a factor in causing VDD in Caucasian children (Galibois, Rhainds and Gagné, 2001) which unfortunately mimics the same problem ethnic groups face who have low UVB absorption rates due to dark skin pigmentation and its use on children has been put into question (Norval and Wulf, 2009). This makes dietary intake or supplementation of vitamin D seem like the only plausible option for achieving ample vitamin D status. Although intakes of dietary sources among children are poor especially in countries where optional or no mandatory fortification policy is in place (Prentice, 2008). The diets of 755 children aged 18 months-3.5 years from the Avon Longitudinal Study of Parents and Children (ALSPC) in the UK were analysed. It was found that all of the childrens diets were low in dietary sources of vitamin D and were all below the recommended intake for vitamin D. It also found that milk was the main source of what little vitamin D they did consume and it was suggested that an increase in fortification levels of vitamin D would most likely help children receive adequate intakes (Cribb et al., 2014). In a study involving 252 Irish children and adolescents, more than half had 25-OHD serum levels at <50nmol/L which is considered insufficient (Carroll et al., 2014). Educational methods and health promotion have proven effective at increasing intakes of dietary sources of calcium and vitamin D among children (Spence et al., 2013) (Pampaloni et al., 2015) and may work in concert with a similar educational programme aimed at parents that could reinforce what’s being taught in children.
Children pay the price because of their Mothers inadequate nutritional intakes during pregnancy and breastfeeding and largely because of their Mother’s lack of awareness about the importance of vitamin D. Awareness and education early on in pregnancy may lay the foundations for a vitamin D sufficient future for future generations in the hope that the message of vitamin D importance is passed on to prevent an issue of the past and present becoming an issue of the future. An improved national fortification policy aimed at frequently consumed foods may help resolve vitamin D deficiency, as will national supplementation recommendations on vitamin D during pregnancy and breastfeeding which has shown to improve vitamin D status. Research is showing vitamin D deficiencies and rickets to be on the rise and vitamin D deficiency is clearly being observed in pregnant and breastfeeding women and in children of all ages and ethnicities. Vitamin D deficiencies seems to be a problem of our awareness about the importance of nutrition and of the availability of supplementation or food sources that may be improved with fortification rather than a problem of race and age.
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