Non–alcoholic fatty liver disease is one of those ubiquitous mysteries of modern living. It used to manifest itself in overweight people, but is now increasingly invading those who are not fat, seemingly en route to more serious diseases like diabetes and heart disease. Its precise causes are not known. Neither is a pill available that can be given as a cure. Losing weight is not always helpful, especially if you were lean to begin with. Abbott Nutrition, part of pharma major Abbott, has decided to look for an unconventional solution: a food that can fight this disease.

Abbott Nutrition recently opened a new R&D centre in Bangalore, inside the campus of Syngene, a Biocon subsidiary. It has the mandate of developing nutritional products meant to treat specific diseases. This field, called medical nutrition or pharma nutrition, is an emerging area with promising results worldwide. Abbott has chosen three diseases for its Bangalore lab: fatty liver disease, inflammatory diseases of the lung, and diabetes. The choices were not difficult: fatty liver disease and diabetes were common while ingredients to fight lung inflammation were easily available.

Scientific research has shown that inadequate nutrition can be one of the causes of fatty liver disease. For example, lack of dietary choline and methionine, the first a quasi–vitamin and the other an amino acid, have been seen to result in fatty liver. Studies have also shown that a large percentage of the population, especially vegetarians, consume insufficient quantities of these nutrients. Abbott is now developing a food formulation containing these two substances and a few other nutrients that can help in overcoming fatty liver disease. "Their benefits are incremental in the short term," says Swaminathan Subramaniam, head of R&D at Abbott Nutrition India, "but in the long term they add up to something significant." Medical nutrition products fall in between traditional nutrition and drugs. They are becoming increasingly popular in developed markets because of one reason: the drug approach has been seen to be completely ineffective in treating modern chronic diseases. A drug attacks one biochemical pathway in the body. Chronic health problems like diabetes and heart disease are caused by defects in more than one biochemical pathway. Treating such diseases with drugs is a simplistic approach with little chances of success in the long term. Nutritional products, being complex mixtures themselves, have a better chance of affecting multiple pathways in the body. But private firms are only beginning to see the potential of medical nutrition, and some of the early birds are not pharma companies.

Take OmniActive, a Mumbai–based company that develops nutritional ingredients. Since 2007, it has been extracting nutritionally–significant molecules from plants common in India, but they go into the products of other companies as OmniActive does not sell its own formulations directly to the consumer. One of its products is a set of molecules called capsaicinoids found in chillies. They give their characteristic burning sensation, which reduces the amount human beings can consume. However, capsaicinoids are found to be good for treating some diseases. They seem to reduce fat, kill prostrate and lung cancer cells, decrease pain, and probably do several other useful things. "We have used tech to convert this molecule into a form that can be tolerated by the body," says Abhijit Bhattacharya, COO of OmniActive. It now supplies this to Indian and foreign nutrition firms.

OmniActive makes similar formulations of other molecules as well. They include lutein and zeaxanthin for eye health, curcumin (extracted from turmeric) for multiple health benefits, and a few other products. The company was set up in 2005, and is now known as one of the leading suppliers of all forms of lutein. Nutrition companies use them to make products with specific health benefits. "Nutrition used to be a low–level science," says Dilip Ghosh, director of the Sydney–based NutriConnect, a consulting firm that specialises in regulatory advice to pharma companies. "In India , it is becoming part of medicine." Ghosh runs another company, Flordis Natural Medicines, which develops medical nutrition products. The science of nutrition, despite getting a head–start, has begun to blossom only recently. This is because modern techniques of molecular biology are now letting scientists study the relationship between food and nutritional pathways intensely. Meanwhile, pharma companies have also begun to realize the importance of nutrition in treating diseases.

"Pharma and nutrition are now coming close," says Johan Garssen, director of Danone Research, Centre for Specialised Nutrition in the Netherlands, "because pharma has realised that food is cheap." Garssen’s lab has developed several nutrition products for particular diseases, which includes an amino acid formula for allergies in infants. Recent research, part of it from Garssen’s lab, has shown the close link between the gut and immune system, and the possibilities of boosting this immunity through special foods like prebiotics. Prebiotics is the focus of another Mumbaibased startup called Nutrahelix, set up by Suman Khanuja, a geneticist and former director of the Central Institute of Medicinal and Aromatic Plants, Lucknow. Khanuja believes in the power of the gut in subduing diseases and the power of novel foods in energising the gut. "Food should look and taste like food" says Khanuja. But there ends the similarity of contemporary foods and those being developed by Nutrahelix. Some scientists call them fabricated foods, but Khanuja prefers the term designer foods. And they could become staple one day. Take wheat, for example. This grain has a binding substance called gluten that is implicated in many allergies in people sensitive to it. There is a growing body of scientific opinion that prolonged consumption of gluten by such people can lead to diseases in later life. Khanuja is looking at ways to replace gluten with a harmless or useful substance in foods, and yet not change the texture and taste of the dish. "The mucilage of fruits can give the same texture as gluten," says Khanuja, who is developing foods that can replace gluten in wheat with mucilage from fruits and not let people know the difference. Developing this product, however, needs substantial research.

Foods like these that make a medical claim now come under the purview of the regulators, as they require clinical trials before launch. Regulators insist on clinical trials if companies want to make a medical claim. Abbott Nutrition is planning such trials soon for its products from Bangalore. Europe and the US have now created the regulatory framework for medical nutrition. India has also set up a Food Safety and Standards Authority of India, which will ultimately regulate medical nutrition products. It will be busy for a long time.