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Fact check on nutrition of health drinks like Bournvita and Horlicks

Malt-based drinks like Bournvita, Complan & Horlicks are top supplements in India, especially for children, but growing awareness, stricter norms may put an end to that.

In the late 1800s, British pharmacist James Horlick and his brother William immigrated to the US where they began experimenting with a powdered form of nutritional supplement for infants, derived from malt and barley.

In Chicago, they founded the Horlick Food Company, where a malt-based powder was created to be eventually trademarked as “malted milk”.

Fast forward 100 years to 1987 and Horlicks emerged as the biggest selling malt-based drink in India — its biggest market. It has held onto this position since.

That may explain Unilever’s decision to buy GlaxoSmithKline (GSK) Plc’s nutrition business in India, which includes the latter’s most prominent product — Horlicks.  Unilever has reportedly offered to pay roughly $3 billion for about 70 per cent of GSK’s India division.

While there is scepticism about the deal, sparked by fears that Indians may be increasingly losing their affinity for malt-based drinks such as Horlicks, for now, however, the malt-based beverages are yet to be knocked off their pedestal.

The rise of the milk substitute

India is the largest consumer market for malt-based drinks in the world.

The malt-based products are marketed as ‘health drinks’ here and are specifically targeted at children. Apart from Horlicks, the other top recognised and well-loved names include Bournvita, Complan, Boost and Milo.

Such is the market here that Horlicks, according to this report, ranks only 56th globally in the health-and-wellness beverage category, despite being at the top position in the country.

The rise of malt-based drinks in India was fuelled by the country’s struggles with malnutrition at the time of Independence. In an under-nourished nation, the brands capitalised on milk shortage in the northern and eastern parts of India, shortly after Independence, by positioning themselves as substitutes for milk.

Today, they also make specific claims targeting children. While Horlicks claims it is “clinically proven to help kids grow taller, stronger and sharper”, Complan claims it is “clinically proven” that it aids “2x faster growth” in children.

At times, these claims can border on the outlandish. Bournvita says the product contains “inner strength formula” that can help develop the brain, bones and muscles.

But experts argue that these drinks don’t really deserve their ‘healthy’ tag and more importantly, may not even be the right supplements for children.

Macronutrients and sugar 

As with most packaged food products, the ingredients of the malt-based drinks are a dead giveaway. While the primary ingredient is clearly malt — often a barley or cereal derivative — the subsequent ingredient is almost always sugar.

Take Complan for instance. A 100g of the malt-based powder contains 18g of protein, 11g of fat and 62g of carbohydrates, of which 24g is sugar. Using the same metric, Bournvita is 7g protein, 1.8g fat and 85.2g carbohydrates, of which 32g is sugar. Horlicks is 11g protein, 2g fat, and 79g of carbohydrates, which includes 13.5g of sugar.

Complan recommends a 33g serving, which would make one serving contain nearly 8g of sugar. Bournvita recommends 20g, making it 6.5g of sugar, and Horlicks doesn’t explicitly recommend serving sizes.  

“Horlicks Classic Malt has 21.3g of carbohydrates of which added sugar is 3.7g per serve that is well within the NIN recommendation,” said a GSK spokesperson.

India doesn’t have recommendations for sugar consumption but the latest WHO mandate recommends a cap of 100 calories (5 per cent) in a 2,000-calorie diet.

A gram of sugar provides four calories. At 8g of sugar, Complan provides 32 calories; at 20g, Bournvita provides 80 calories, and Horlicks provides 17 calories.

All of these are well within the upper allowed limit of 100 calories from sugar but this would mean that someone consuming Bournvita, for example, is allowed only 20 additional calories to stay within the prescribed sugar limit. That rules out even another serving of Bournvita.

And considering how modern diets are filled with sugary junk food, these malt-based drinks may add to consuming sugar above the prescribed limit.

“All the nutrition children get from these beverages is actually from milk,” said Priya Kathpal, nutritionist and founder of Nutrify. “These products only serve the purpose of enhancing the taste of milk that children tend not to like. Constantly feeding such products to children is utterly an ill-informed decision by parents.”

The primary reason why Kathpal says so is the fact that sugar is addictive. “This also leads to children never drinking milk by itself and always associating it with a sugary, chocolate-filled taste,” she added.

“These beverages might work for children because they’re so active,” said Ishi Khosla, a clinical nutritionist at the Centre for Dietary Counselling, Delhi, and founder of The Celiac Society of India. “But if these beverages are consumed regularly, especially in adults, the excess sugar, which comes with small amounts of supplemental value, needs to be factored in and accounted for.”

The micronutrients question 

Another of the ‘healthy aspects’ that these malt-based drinks play up is their micronutrient content. Micronutrients are essential in small quantities as they enable the human body to perform and enhance physiological functions.  

Calcium, for example, is beneficial to the bones, vitamins of type B are necessary for energy production, Vitamin C for creation of collagen and neurotransmitters, Vitamin D for immunity, magnesium for regulating blood pressure, potassium for maintaining fluid in cells, zinc for healing wounds, iodine for thyroid regulation, among others.

The lack of these micronutrients, in our diets, leads to nutrient deficiency, malnutrition and can even lead to diseases.

According to this report, two heaped tablespoons of Bournvita mixed with a mug of milk provides around 45 mg of potassium, 25 mg of sodium, 1 g of protein, 6 g of sugars, 8 per cent of the daily Vitamin A, 10 per cent of the daily iron, 30 per cent of the daily Vitamin C, 15 per cent of daily Zinc, and 10 per cent of daily Magnesium necessary to the body. It also reportedly contains pro-health vitamins such as B9, B12, B2 and Vitamin D.

Complan claims to have “34 vital nutrients” including calcium, iron, iodine, vitamins A, E, C, and vitamin B12 to “help improve memory and math ability”. Horlicks “combines the natural goodness of cereals and milk with the promise of science to help give your kid wholesome nutrition”.

But even then, other factors are at play. Take Vitamin D for instance. It is recommended that all individuals, including children and adults, consume 15 micrograms (or 600 units) of Vitamin D a day. Bournvita Lil Champs, for example, contains 10 micrograms of Vitamin D per 100g. This does not even come close to daily requirements for children, who would otherwise have to consume nearly 10 tablespoons of it per day to meet norms.

Complex chemistry plays out here too. Sugar is an inhibitor for the absorption of both Vitamin D and Calcium. Furthermore, it is well documented that cow milk inhibits absorption of iron and its consumption is actually a leading factor for anaemia among infants. So even if Bournvita is fortified with Vitamin D and iron, and milk with Calcium, the sugar and milk will suppress the absorption of other minerals, nullifying their value.

Micronutrient deficiency or “hidden hunger”, however, will cause the body to quickly absorb micronutrients. So these quantities are beneficial to children who suffer from the deficiency of these nutrients but not for the ones who are otherwise healthy.

“Our body is very efficient at absorbing such tiny amounts of nutrients when a person suffers from hidden hunger,” says Khosla. “There are definitely other better sources of obtaining these micronutrients. These might provide supplemental value but very minimal.”

Where is the independent research?

Zero — this is the number of independent studies that have investigated the human absorption of micronutrients from malt-based drinks.

The figure, however, is with a caveat.

Horlicks makes the following claims: “Horlicks give the Assurance of Clinically Proven 5 signs of Growth that help kids grow +Taller, Stronger and Sharper.

More Bone Area: Increases density of minerals such as *Calcium to make their bones bigger and stronger.

More Muscles: Clinically proven to increase* lean tissues that make children “stronger”.

Better Concentration: Makes children sharper by improving their attention and concentration*.

Healthier Blood: Clinically proven to increase* levels of blood health-related nutrients like Vitamin A and Folate in the circulation.

Healthy Weight gain: Horlicks is clinically proven to increase* Fat-free mass, making the child stronger.” 

The asterisks above refer to a study conducted in 2006, from which five papers were published in the journal Elsevier Nutrition. Horlicks has relied on these papers to back up its claims.

“The study was a large (869 children) double-blind, placebo-controlled, randomised clinical study, conducted in apparently healthy school-going children (aged 6-16years) to evaluate the effect of intervention with a micronutrient-fortified beverage (Horlicks) on growth and development,” a GSK Consumer Healthcare spokesperson told ThePrint.

“In the study, children were divided into two groups in random order. In the test group, children received Horlicks with micronutrients (in 150ml of toned milk) and placebo group received an energy matched identical looking non-fortified nutritional beverage (in 150ml toned milk).”

The study requires some examination. It compared the effects of 14 months of daily consumption of 54g of “micronutrient-enriched beverage” against a control of non-fortified placebo (plain milk) in a residential school in Hyderabad.

Off the bat, the study was funded by Glaxo SmithKline, which owns Horlicks. The numbers of students also vary in the papers published as several students dropped out and those who completed Class 10 moved on.

In the five papers, the student numbers were 268 for the study on bones, 608 for mental function, two unclear and 869 children in the growth and morbidity studies.

Milk behind benefits: Researcher

Veena Shatrugna, former deputy director and head of the clinical division at the National Institute of Nutrition, and lead author of the paper that examined bone density in children, said that she attributes all the positive results seen in her paper to consumption of milk.

“We used a micronutrient-enriched mixture that was meant to be given with milk but it was primarily milk whose consumption produced these results,” she clarified. “The micronutrients simply provided a digestible taste to the milk. I’m sure the small micronutrients might have had an effect but our study didn’t require us to study them. Our results of improved calcium clearly indicate that it’s just the milk that was responsible for it.”

Shatrugna also stressed that the study was performed only on children who otherwise had good nutrition, saying that the results should not be applied to those who lack proper food and nutrition.

The micronutrient mixture was sold to the scientists by Glaxo SmithKline, which also funded the study and subsequently claimed that Horlicks increased bone size and strength. Yet the study concludes thus: “Amounts of calcium and other nutrients contained in the supplement were inadequate for tissue growth with density increases.”

Similarly, the mental ability study concluded that the nutrient-enriched beverage improved attention-concentration, but not IQ, memory, or school achievement. Horlicks uses this study to claim that it “makes children sharper by improving their attention and concentration.”

What works in Horlicks’ favour is that of the malt-based beverages in the market today, it has the least sugar content.

There are no publicly available scientific papers to back the claims of the other products such as Bournvita and Complan. Queries to Mondelez, the owner of Cadbury Bournvita and Kraft Heinz, the owner of Complan, went unanswered. This article will be updated when their responses are received. 

The food labelling problem

A 2013 study that analysed the nutritional information on 20 major malt-based drinks in India found that different products disclose different amounts of nutrient information depending on who they’re targeting.

All of them disclose macros (carbohydrates, protein, fats) and some primary nutrients (vitamins, iodine, calcium, iron), but several disclosed only the nutritional information that was beneficial for marketing to the target consumer.

Complan Nutri Grow, which targets young children, aged two to four, disclosed only 26 nutrients while Abbott PediaSure, another infant product classified as a malt-based drink, disclosed 44.

The study came to the conclusion that “the difference in information content across health drinks imply that there is no standard regulation for disclosing the nutritional information and therefore such information is provided by the organisation on a voluntary basis”.

Another study showed that several beverages over or understated the actual nutritional information in their labels. For example, it showed that the Horlicks contained fat, protein and niacin (which converts food to energy) below the declared value, Complan had calcium, protein, and niacin below declared value, Bournvita, Boost, and PediaSure declared niacin below declared value, and Protinex astonishingly contained carbohydrates, protein, and fats below declared value.

Dehydroascorbic acid (DHA) is an important nutrient for the brain and the heart. The paper states that three brands – Amul (pro), Bournvita (Li’l Champs), and Complan (NutriGro) –claimed to contain DHA but none of them actually do at all.

The study claimed that Protinex even contains 9.67 per cent of ash when the permissible limit is 5 per cent. It also stated that Complan weighs over 2g less than what the product actually claims to weigh, although the margin of error is permissible under Legal Metrology Rules of 2011. (Note that the study is from 2013. It is likely that the numbers are different today, although updated tests, since then, are not available yet).

All of this is because malted beverages just did not have regulations or standards, especially when it came to labelling until earlier last year.

“The state must ensure that adequate food and milk is available to children during their growth phase,” said Shatrugna.

Times are changing for these drinks in the market today. Euromonitor International showed that malted beverages have seen a slowdown in growth from 13.2 per cent to 8.6 per cent between 2014 and 2017.

Consumers seem to be more aware today, making more informed choices. As a result, there has been an upward trend in the growth of beverages that have increased protein content or are to be consumed as meal replacements. Several consumers are also mixing syrups in milk instead of consuming powders.

As a result, big brands are actually exiting the market as the future of malted drinks in India finally seems to be on shaky ground. Little wonder then, that even GSK has put Horlicks on the block.

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