Monday, May 30, 2011


The ubiquitous Escherichia coli (E.coli) had never posed any danger to humans until new strains were discovered a few years ago with potential to be dangerous to consumers. Interestingly this bug was routinely being tested as a marker for testing foods for possible contamination with fecal matters during production and handling. The group of E.coli coming under the Enterohaemorrhagic (EHEC) category can cause serious food poisoning, if the food is not properly processed to kill them and it is known to cause even death if not immediately treated. One of the most virulent strains under EHEC is the notorious 0157:P7 which was found to be a major culprit in almost all food poisoning cases in the West.

E. coli belongs to bacterial species and it has been found commonly in the gut of humans and warm-blooded animals. Historically most strains of E. coli are harmless. Enterohaemorrhagic E. coli is an exception in that it can cause severe food borne disease. It is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat products and raw milk. Its significance as a public health problem was recognized in 1982, following an outbreak in the United States of America. EHEC produces toxins, known as verotoxins or Shiga-like toxins because of their similarity to the toxins produced by Shigella dysenteriae. EHEC has the amazing capacity to grow in a wide range of temperatures from from 7°C to 50°C, with the optimum temperature being 37°C. Some EHEC can grow in even in acidic foods, with pH as low as 4.4 and in foods with a minimum water activity (Aw) of 0.95. It can be destroyed completely by adequate cooking of foods to ensure that all parts reach a temperature of 70°C or higher. E. coli O157:H7 is the most important EHEC serotype in relation to public health, though other serotypes are also emerging causing occasional outbreaks.

Symptoms of the diseases caused by EHEC may include abdominal cramps, diarrhea, fever and vomitting. It may take any where from three to eight days for the bacteria to be fully incubated and act in human body though most cases can be diagnosed within three to four days. When properly treated the affected person can recover within 7-10 days, though in a few cases, especially when young children and old people are affected the infection can be life-threatening. Haemolytic uraemic syndrome (HUS) one of the diseases caused by this bug is characterized by acute renal failure, haemolytic anaemia and thrombocytopenia. It is believed that up to 10% of patients with EHEC infection may develop HUS, with a fatality rate ranging from 3% to 5%. It can cause neurological complications including seizure, stroke and coma in about 25% of HUS patients and chronic renal sequelae in around 50% of survivors. Some of the outbreaks due to EHEC have involved a high number of cases, such as in Japan in 1996, where an outbreak linked to contaminated radish sprouts in school lunches affected thousands of children. Data on the situation in most developing countries are limited, as surveillance for this pathogen is not done routinely and documentation practices are not in vogue.

Why is that EHEC infection is reported more commonly in Western countries and other affluent populations where hygiene and sanitation awareness is very high? Why is that this infection does not affect people in countries like India where food crops are cultivated in rural areas where open defecation is practiced with high probability of the crop getting contaminate? Probably because Indians consume almost all their foods in overcooked conditions while the salad eating practice based on raw vegetables is prevalent in the West.The serotype O157:H7 which has been studied extensively, is easily differentiated biochemically from other E. coli strains. Interestingly this bug is present in great numbers in cattle and other ruminants such as camels and is transmitted to humans primarily through consumption of contaminated foods, such as raw or undercooked ground meat products and raw milk.

Fecal contamination of water and other foods, as well as cross-contamination during food preparation containing beef and other meat products, contaminated surfaces and kitchen utensils, will also lead to infection. Examples of foods implicated in outbreaks of E. coli O157:H7 include undercooked hamburgers, dried cured salami, unpasteurized fresh-pressed apple cider, yogurt, cheese and milk. What is worrying the food safety experts is that increasing number of outbreaks are now being associated with the consumption of fresh horticultural produce like sprouts, lettuce, coleslaw, tomato, cucumbers, salad etc, which are eaten raw without thermal processing. Possibly these fresh produce materials are contaminated due to contact with feces from domestic or wild animals at some stage during cultivation, handling and storage.

EHEC has also been isolated from bodies of water (ponds, streams), wells and water troughs, and has been found to survive for months in manure and water-trough sediments. Waterborne transmission has been reported, both from contaminated drinking-water and from recreational waters. Organic foods which are produced using natural manure can be most vulnerable to infection by EHEC. Person-to-person contact is an important mode of transmission through the oral-fecal route. There are also instances where infected individuals show no clinical signs of disease but pass on the infection to others. The duration of excretion of EHEC from the body is about one week or less in adults, but can be longer in children. Visiting farms and other venues where the general public might come into direct contact with farm animals has also been identified as an important risk factor for EHEC infection.

The most recent episode of EHEC food poisoning comes from Austria where many consumers were infected by consuming organically grown vegetables from Spain and that country's food safety agency has cautioned the consumers about the dangers of consuming these tainted fresh produce, advising them further to destroy such dangerous bacteria containing products. Some of the vegetables under the scanner include cucumbers, tomatoes and aubergines. There are reported to be 10 casualties in Germany due to this episode and other member countries of EU are gearing up to tackle this contingency without causing major damage to their citizens. The classical belief that only animal products are contaminated by EHEC needs to be reexamined in the context of such episodes involving fruits and vegetables. Probably predominantly meat consuming countries are vulnerable because of improper management of production farms due to shortage of personnel and over mechanization of many operations. Though meat products are segregated during storage, distribution and retailing there can be cross contamination from these foods affecting fresh produce like fruits and vegetables.


Friday, May 27, 2011


Low consumer awareness about food, nutrition and health provides an opportunity for food processing industry, especially those who are socially irresponsible, to seduce the consumer through many unsubstantiated health claims for the products from their stable. It is true that there are food laws and regulations in some countries purportedly to prevent such frauds, but the defaulters still get away through ineffective implementation or exploitation of the loopholes in the statute books. If such things happen in countries like the US, the UK, Australia and other well regulated markets, one can imagine the situation in some of the developing countries with vast illiterate population with very inefficient safety vigilance regime.

Probiotics are supposed to offer many health advantages if one goes through the published literature, most of them being of academic nature with very little hard and reliable evidence. According to FAO/WHO definition, the probiotics constitute a group of "microorganisms when administered live in adequate quantities can confer a health benefit to the host". Unfortunately the industry takes advantage of the vagueness inherent in the above definition, especially regarding the nature of health benefits, and makes unsustainable claims to attract unsuspecting consumers. Lactobacillus bacteria(LAB) and Bifidus bacteria are commonly used in probiotic food products and in order to qualify to be called probiotic, the concerned products should have not less than 4 billion live cells of the organism used. Besides the above two, a few other bacteria and yeast strains are also said to have beneficial health effects though to the same extent as LAB and Bifidus.

According to claims made by some manufacturers, probiotic microbes provide protection to the beneficial intestinal bugs while inhibiting pathogens that cause many diseases related to Gastrointestinal tract in human beings. Other claims include alleviation of chronic intestinal inflammation and prevention of pathogen induced diarrhea, urogenital infection and atopic diseases. Claims are also made that probiotics can give relief to lactose intolerance, fight colon cancer, reduce cholesterol and blood pressure, improve immuno functions, fight against infections, bring relief to Intestinal Bowel Syndrome (IBS) and colitis etc. While thousands of papers have been published in international scientific journals about some or the other beneficial uses of probiotic microorganisms based on laboratory studies, there is still many unanswered questions regarding their effect under actual field conditions on live human subjects.

It is against this context that one has to see the recent action taken by the The European Food Safety Authority (EFSA) in forcing the industry in its member countries to obtain permission for making such claims for which scientific proof was demanded. About 8000 health claims made by various manufacturers regarding the beneficial impact of their products on human health were assessed deploying competent independent scientists and the agency brought out the shocking fact that most of these claims were unproven though industry has been making these claims to attract unsuspecting consumers for years. EFSA concluded that the evidence the industry had submitted to support its claims that various food additives could strengthen the body's defenses, improve immune function, effective against common cold and reduce gut problems were either so general that they were not acceptable or the claimed effect could not be demonstrated. In some countries like the UK more than half the population regularly buy probiotic products believing the claims made and there are over 44000 such products that are marketed world over with all types of claims.

If the above assessment is confirmed there is no justification to use the term probiotics on labels unless there is proper understanding about the meaning it carries, conveyed to the consumers unequivocally. Here is where bodies like the FAO and WHO have lot to do in cooperation with the scientific institutions of the member countries. Sooner it is done better it would be for the consumer community which has been using these products, paying a premium price but unsuspecting about the actual impact of these products on their health. .


Sunday, May 22, 2011


Food industry is continuously under attack for allegedly making wrong basket of foods, most of them considered unhealthy. It is not disputable that catering to the taste buds of the consumer can only generate profit for the industry and unfortunately the three food ingredients viz salt, sugar and fat can make foods with maximum organoleptic qualities. Of course if at all the industry is to be blamed it can be for not innovating enough to create foods with lower levels of the above ingredients without compromising too much on the sensory quality. There are many suggestions and guidelines for individuals to follow to cut down intake of foods so that their intake of calories is brought down significantly. There are also commercial out fits that offer a variety of diets claiming they have the ability to bring down body weight significantly within a reasonably short time.

Satiety is the feeling of satisfaction or not feeling the pangs of hunger and can be the key to future development of designer foods targeting those vulnerable to over eating or indisciplined consumption of all types of foods. Though it was known that there are some foods that can lessen the desire to eat more and others that promote further eating, most consumers have very little interest in such facts, focus being best foods agreeing to their palate. But countries all over the world are concerned about the health of their population and inappropriate and nutritionally unbalanced foods, offered mostly by the food industry, are considered the main culprits for almost all health afflictions experienced. Over weight and obesity are conditions that can lead to many health disorders which affect the quality of life besides the life span.

While governments can do very little to do to bring about any dramatic changes in the food consumption habits of people, industry is in a better position to help the society at large by changing their product portfolio to include products that are satiety oriented. Adequate scientific information is available regarding the factors that create satiety and based on these scientific findings many new products can be developed combining satiety inducing and low caloric dense food ingredients. Digestive track in humans produces several special proteins after the ingestion of a meal that provide the feeling of satiety and these appetite regulatory proteins, one of the important ones being cholecystokinin (CCK), serves the twin purpose of shutting the stomach valve that permits transfer of ingested food into the intestine and simultaneously sending message to the appetite center in the brain to generate a feeling of fullness.

Out of the three major constituents of food, certain fats and proteins are considered good for creating satiety while carbohydrates are least effective. Long chain fatty acids, mono unsaturated, contained in oils from corn, canola, peanut, olive, safflower, sunflower and soybean are good appetite suppressors while soy and whey proteins have also this property. Effectively combining food ingredients which are low in caloric density and high in dietary fiber like whole wheat, oats, barley, legumes and pulses, it should be possible to evolve foods which can reduce the appetite very significantly. As a strategy, consumption of almonds, peanuts, cheese etc before a meal has been claimed to be considerably effective to reduce the quantity of food consumed by an individual.

According to a recent scientific study eating wheat flour and almonds can significantly increase the feeling of fullness which can result in reduced tendency to take food and consequently prevent overeating. Through out the day hunger pangs can occur making people reach for the pantry and it is this urge that needs to be slowed down to maintain or reduce body weight. Whole grains, such as oats, barley, rye and corn are known to have the ability to prevent weight accumulation because of their high-volume, low-energy density and the relatively lower palatability. Resistant starch escapes digestion in the small intestine of healthy individuals and delivers the benefits of both soluble and insoluble fiber. It has been found that the quantity of resistant starch in foods correlates with blood glucose response and reduced food intake after two hours. Oligosaccharides which are complex carbohydrates, are found in beans and legumes, and they help maintain stable blood glucose levels when eaten as part of a meal. Like resistant starch, they are not digested by the small intestine and end up being metabolized and expelled from the large intestine. Proteins, considered good for creating satiety include soy, which have been shown to stimulate the release of cholecystokinin (CCK), a hormone that plays a role in appetite suppression. Similarly whey is also an effective satiety promoter by stimulating several gastrointestinal hormones that are thought to regulate appetite control in the brain. Same is true with egg and egg products.

As the area of satiety promotion is a relatively new one, considerable insight about various facets of this unique phenomenon needs to be understood more clearly. In one of the recent studies it was found that chewing a few Almonds forty times before swallowing increases excretion of appetite controlling hormones considerably while same Almonds chewed for less time had smaller impact. What is to be made of this finding is still not clear though the fine particles resulting from thorough chewing has been suggested as responsible for the effect. There are products like Badam Halwa, Badam Kheer etc derived from Almonds which find extensive use in Indian households and probably these finely ground products may have significant influence on satiety promotion. When late Morarjee Desai, former Prime Minister of India was known to have a diet containing Almonds, many wondered as to how he was living on a frugal diet without feeling the pangs of hunger. Similarly many Sadhus, Sanayasis , Ascetics and Godmen in India live on sparse diets containing small quantities of regular foods, apparently with no signs of any ill effect. It is time that Indian Food Scientists revisit the area of ancient food habits in the country to gain better insight into this important field of health and nutrition.


Tuesday, May 17, 2011


One single issue that dominates the health scenario in the world is the increasing population which are being adversely affected by wrong diets, loaded with calories, fat and salt, considered too high for maintaining good health. On an average a balanced diet is expected to deliver about 2000 kC, 50 gms of fat, 50 gms of protein, 30 gms of dietary fiber, less than 10 gms of salt, besides minerals, vitamins, essential amino acids and essential fatty acids. As against the above, populations in many affluent countries consume diets with 50% more calories, much less proteins than prescribed, rich in saturated fat, low in fiber, high salt and too much meat products. The result is there for all too see with the population of over weight and obese people predominating the landscape. The inevitable consequences include high mortality due to life style disorders like Cardiovascular disease, blood pressure, cancer, diabetes and a host of other diseases.

A substantial part of the health care budget in these countries is spent to treat these health disorders and governments invariably are finding it difficult to correct the distortions in the eating habits of their citizens. Campaigns and incentives do not seem to be having any effect on this unfortunate phenomenon while food processing industry is not responding to calls and pressures to change their product portfolio to include more balanced food products. Logically food industry cannot take the health quality of a product alone into consideration while investments are made because the economic viability of a venture depends largely on the degree of acceptance of the products by the consumer and the organoleptic quality plays a critical role in product acceptability. High sugar, high fat, adequate salt laced products with good mouth feel and high palatability will only sell in the market. Thus it is a pull between viability and social responsibility that confronts the industry and it is difficult to enforce any health standards for processed foods legally binding on the manufacturers.

According to a recent Global Obesity survey by Imperial College, London, rising levels of BMI
(Body Mass Index-Kg/m2), a measure of the over weight and obesity, is closely related to high economic wealth of a country and within a country this phenomenon is increasingly being noticed amongst rich people, though the countries such as Brazil and South Africa are still considered poor by world standards. What is disturbing is that between 1980 and 2008 the obesity incidence has doubled to 10%. Congo, one of the poorest countries in Africa can boast of an average BMI of just under 21 while the little known Nauru is the habitat for fattest people with average BMI of about 34! It may make sense that richer the people more would be the disposable income to buy foods which contribute to obesity. Look at the petroleum rich countries where people have relatively high BMI varying between 28 and 33. They include UAE, Qatar, Kuwait etc.

What about India? Though India is being praised for its economic development, especially after the launching of the 1990 liberalization regime which raised the GDP per capita substantially through the next two decades making people wealthier, it is the only country that has bucked the global trend of increasing the BMI of its population in parallel with rising income. The average national BMI in the US is 28.46 while the corresponding figure for China is reported to be about 23. Do these figures make any sense at all? Despite the above findings it is predicted that India will become the diabetic capital of the world within two decades in terms of absolute number of people affected by this disease called Metabolic Syndrome which is closely related to over weight and obesity. It is possible that those afflicted by obesity might be belonging to top income groups of people whose life style and eating habits can be comparable to average citizen in the US. This has to be elucidated by an India-specific study by the Indian Council of Medical Research of GOI.


Tuesday, May 10, 2011


Plastics, most of them made from by-products of fossil fuel industry is ubiquitous by its presence in practically every activity modern man is pursuing and it is very difficult to imagine a world without this synthetic marvel. Though during its early stages of popularity, not much of a problem was foreseen in expanding the use of plastics, it is now that the world is facing a crisis on two fronts in continuing with plastics without any moderation. While exhaustible fossil fuel supply and its ever escalating cost make it impossible to produce and use plastics same way as before, disposal of the used plastics poses an environmental danger of immense dimension because of their lack of bio-degradable credentials.

By far the most critical issue to day is the need to curb use of thin disposable plastic bags ( less than 40 microns thickness), used by millions of households all over the world to ferry their purchases from the market to their homes. As more and more restrictions are put in place against use of plastic shopping bags, consumers are forced to carry with them re-usable cloth bags and according to some reports these reusable cloth bags can be a dangerous source of pathogenic microorganisms as they are not cleaned regularly. Now comes the news that an enterprising entrepreneur has created a reusable carry bag made from fabric which is treated with Chitin, a by-product of Shrimp processing industry.

Chitin is the second most abundant polymer occurring naturally and though it was known that chitin is a component of cell wall of fungi, exoskeletons of anthropoids such as crustaceans including crabs, lobsters and shrimps, its industrial importance emerged only during the last 3-4 decades. Like cellulose which is a polymer of glucose, chitin is a polymer of N-acetylglucosamine with structure similar to cellulose while functionally it resembles more like the protein keratin. The deacetylated product from chitin, achieved through reaction with sodium hydroxide has found several uses in food, pharmaceutical, medical and other industries. Establishment of shrimp processing industry has opened up an avenue for profitable commercial extraction of chitin from the inedible parts of the crustacean and both chitin and chitosan are globally traded industrial chemicals.

Use of chitin/chitosan as a thickener and stabilizer is common in foods and pharmaceuticals. It also finds use as a binder in dyes, fabrics and adhesives. Besides these bio-degradable substances also find extensive use as plant protectants in agriculture and in fertilizers. As chitosan is water soluble, surgical sutures made from it are preferred by the medical industry, avoiding the need for post surgical procedure to remove sutures. Though many people are allergic to shell fish and crustaceans, chitin extracted from them do not possess the proteins responsible for the allergy. Chitosan at levels of 50-200 ppm has significant antimicrobial activity which has been made use of for making reusable fabric bags into which the material is woven.

According to scientific findings chitosan can be effective against microorganisms like B.cereus, E.coli, Listeria, Psuedomonas, Shigella, Staphylococcus aureus and Vibriocholerae though higher concentrations only can have any effect against fungal infection. This property of chitosan has been exploited to make reusable cloth bags that will be resistant to bacterial contamination and proliferation during repeated use. Most people keep the reusable bags in their scooters, motor bikes and cars and under the hot and humid climate prevalent in tropical countries like India , right environment is created for the breeding of undesirable bacteria. When such pre-contaminated bags are used again and again to bring purchased foods to homes where they may or may not go into the refrigerator immediately, there exists the possibility of cross contamination, seriousness of which depends on the moisture and nutrient content of the products.

According to commercial claims made by the manufacturers of safe reusable cloth bags using chitosan, unlike others these new innovative bags are lead-free and triclosan-free. Triclosan is an antibacterial and anti-fungal agent that's used in a number of consumer products like soaps, deodorants, toothpastes, cleaning supplies, even trash bags, though its safety credentials are still suspect and may become a part of reusable bags also if laws involving ban of plastic bags are enforced rigorously. Whether a product containing chemicals derived from shrimp can be acceptable to consumers in India, many of them vegetarians, may put a damper to any plans to bring the technology to this country. Of course the best and the least costly approach to the problem of cross contamination from reusable bags is to wash them regularly after every use.


Saturday, May 7, 2011


Way back in late nineteen sixties, Indian food industry was excited about the import of several dehydration plants from Bulgaria with many features lacking in the locally fabricated driers. These were used mainly to dehydrate onions, largely for export as domestic market for dried foods was limited to some dry fruits and nuts. Amongst fruits grapes, dates and a few high value products were popular,most of which were imported. As for vegetables the only product commanding some market was dehydrated peas, probably because of the short season when fresh peas could be obtained. To day the market for dehydrated products has shrunken to a very low volume because of the arrival of many new technologies which are better suited to give a product of superior quality. Freezing technology which can preserve almost all foods with very little change in the original quality has become the new mascot of food industry in many countries and it is a question of time before it gets established nation-wide in India also.

It is true that human beings were using for hundreds of years the drying process utilizing the abundantly available sun light to preserve many high moisture foods for long time. These included fruit, vegetables, nuts and meat which are all dried to keep them stable and usable for consumption when their growing is not possible due to unfavorable weather conditions. In northern India farmers preserve their surplus potato crop by slicing and sun drying and the dried slices with low moisture content can keep well for an year, being consumed as and when needed by frying. The two major steps involved in sun drying are well known, viz blanching and drying in thin layers under the sun till the moisture level comes down to safe level. Water activity in a food determines its vulnerability to microbial spoilage and low moisture products have low water activity making them safe for storage under clean environment without exposure to moisture and insects.

One of the main constraints in marketing dried foods is the loss of texture during drying and inability of dried foods to regain the original weight on reconstitution. This naturally affects the eating quality, with many consumers preferring not to patronize them. Even Freeze Drying technology could not deliver a product without adversely affecting the texture, though the flavor quality of the final product was superior. No wonder this technology is largely restricted to manufacture of soluble coffee and tea products with high flavor profile.

Dried foods, especially sun dried ones are relatively less expensive though quality wise mechanical drying has better controls. If horticulture produce materials like Chilli, Black Pepper, Turmeric, Ginger, Cardamom and many spices and herbs are still dried in the field it is because of economic considerations. Attempts in the past to use automated/continuous driers were not successful because of cost considerations. It is often claimed that sun dried products are brighter in color because of the action of ultraviolet rays in the sun light. Conventional drying also uses sulfite to protect the color and sulfite allergy is becoming increasingly becoming common place forcing the industry to preclude this chemical. Advent of freeze drying process gave the dehydration industry a short respite but both capital investment in the plant and the exorbitant processing cost made it some what irrelevant for the main stream food industry. If texture and taste can be compromised to some extent, sun drying is still the most affordable preservation technique but increasing affluence amongst the population in many emerging developing countries makes dried foods some what unpopular. It is because of the food ingredients industry, which is supporting dried foods for use in products like soups, baked foods and low cost curry mixes, that dehydrated food industry is still surviving..


Monday, May 2, 2011


Food industry these days are facing multiple challenges from many quarters and the most serious issue concerns the real mindset of the captains of food industry vis-a-vis consumer welfare. While there is widespread view that food industry is playing only lip sympathy to consumer safety without really caring about the same, the situation is further complicated by the ever expanding knowledge about the food that makes the life of the industry more miserable. Recent findings by Swedish food scientists that baby foods fed to young infants of less than 6 months in Europe contain deadly trace minerals like Arsenic are startling indeed. Industry cannot be faulted entirely because they have been following well laid down standards which now are being challenged.

The limits of poisonous metals like Arsenic, Lead, Cadmium etc present in foods have been set a few years ago without much of a thought about their impact on young infants. Breast feeding, considered most desirable way of protecting the health of the baby, has become the standard norm for mothers and since mother has the necessary wherewithal to filter these poisonous minerals, baby can be expected to have zero exposure to them. However industrially processed baby foods, made from raw materials coming from different sources with varying content of heavy metals, cannot escape being tainted to some extent and such products cannot stand in comparison to breast milk. The main concern is that infants up to six months age depend heavily on milk based foods and if breast milk is not available they have to depend on the commercial products exposing them to poisonous minerals continuously with enormous damage potential.

That almost all major manufacturers of baby foods have been cited for presence of Arsenic and other heavy minerals is a cause for great concern. It is a good thing that safety agencies in Europe have woken up to this new development and probably new norms will be evolved on a priority basis. While Arsenic can cause significant DNA damage, Cadmium is implicated in neurological and kidney damage. Rice has been found to be the main culprit as far as Arsenic is concerned and since manufacturers were focusing on keeping this mineral at levels less than stipulated under law, infant foods based on rice invariably have presence of Arsenic. It is only now industry is being asked to strive to eliminate Arsenic altogether which may not be easy. Procuring rice from sources where Arsenic level is very low, may be the only option for the industry.

To read the conclusions of the Swedish researchers is indeed scary and according to them feeding infants twice a day on manufactured baby foods such as rice porridge can increase their exposure to arsenic by up to fifty times when compared to breast feeding alone. Exposure to other toxic metals such as cadmium, can increase by up to 150 times in some of the foods, while lead increase may be up to eight times more. With the recent Tsunami disaster in Japan and the collapse of two of the nuclear reactors releasing deadly radiation all around, further problem may await the industry. It may be desirable for FAO and WHO to undertake urgent studies immediately as to how agricultural crops are going to be affected by the radiation leak. Many countries including India have put an embargo on import of any food from Japan, fearing for the worst though Japan is not a major exporter of foods in the global market.

One of the favorable outcomes of the above findings may be creation of increased awareness amongst mothers about the risks involved in rearing their infants on commercial products while they possess the needed "elixir of life" in the form of breast milk.