Therapeutic food

Based on Wikipedia: Therapeutic food

Imagine a packet of peanut butter that can save a child's life. Not metaphorically—literally. A foil pouch containing a carefully calibrated paste of peanuts, oil, sugar, and milk powder can pull a severely malnourished child back from the edge of death in a matter of weeks. This isn't a fantasy or a future technology. It's being used right now, in clinics and homes across Africa, Asia, and the Caribbean, and it represents one of the most significant breakthroughs in humanitarian nutrition of the past three decades.

The product is called ready-to-use therapeutic food, or RUTF. And to understand why it matters so much, you first need to understand what it replaced.

The Old Way: Hospitals and Milk

For decades, the standard treatment for severe childhood malnutrition looked something like this: a desperately ill child would arrive at a hospital or feeding center, often too weak to eat solid food, sometimes fighting off infections that their wasted body couldn't resist. Medical staff would start them on a specially formulated milk-based liquid called F-75—the "F" stands for "formula," and the "75" refers to the 75 kilocalories per 100 milliliters it contains.

F-75 is deliberately modest. It provides just enough energy and protein (0.9 grams per 100 milliliters) to stabilize a child without overwhelming their fragile metabolism. A severely malnourished body has adapted to starvation mode, and flooding it with nutrients too quickly can be fatal—a grim phenomenon called refeeding syndrome.

Once the child stabilized and their appetite returned, they would graduate to F-100, a richer formula with 100 kilocalories and 2.9 grams of protein per 100 milliliters. This phase continued until the child was no longer "wasted"—the clinical term for a child whose weight is dangerously low relative to their height.

This approach worked. Children recovered. But it had devastating limitations.

The Problem with Hospitals

Consider what the milk-based treatment required: a hospital bed, trained staff, clean water to mix the formula, refrigeration to prevent spoilage, and enough time for the child to complete treatment—often weeks or months. In places where malnutrition is most common, these resources are scarce. Hospitals are overcrowded. Mothers have other children at home who need care. Families live hours from the nearest clinic.

The result was a tragic bottleneck. Millions of malnourished children couldn't access treatment at all. Others started treatment but left before completion. And the milk-based formulas themselves posed risks: mix them with contaminated water, and you've created a bacterial breeding ground that could make an already vulnerable child sicker.

What the world needed was a treatment that didn't require hospitals. Something that could be given at home, by parents with no medical training. Something that couldn't spoil, couldn't be contaminated, didn't need refrigeration or cooking or clean water.

In other words, the world needed peanut butter.

The Genius of RUTF

In 1996, a French pediatric nutritionist named André Briend, working with Michel Lescanne at a company called Nutriset, developed Plumpy'Nut—the first widely-used ready-to-use therapeutic food. The concept was elegantly simple: take the nutritional profile of F-100, the gold-standard hospital formula, and embed it in a paste that doesn't require water.

The key insight was using fat as the base instead of water. Bacteria need moisture to grow. By suspending all the nutritional components—proteins, carbohydrates, vitamins, minerals—in a lipid matrix (essentially, oil and peanut butter), you create a product that's inherently resistant to microbial contamination. No refrigeration needed. No cooking required. A child can eat it straight from the packet.

The manufacturing process is deceptively precise. You start by heating the fat component and stirring it vigorously. While it's being stirred, you slowly add powdered ingredients: dried milk, sugar, a vitamin and mineral premix. The particle size matters enormously—everything must be ground to less than 200 micrometers, about twice the width of a human hair. Any larger, and the mixture starts to separate. At that tiny scale, the powders stay suspended in the fat, creating a smooth, homogeneous paste.

The result is a product with a texture that's soft and crushable, a taste that children actually like (it's essentially sweetened peanut butter), and a shelf life measured in months rather than hours.

From Hospital to Home

The shift from facility-based treatment to home-based treatment sounds like a minor logistical adjustment. It was, in fact, a revolution.

Suddenly, a health worker could visit a village, identify malnourished children using a simple colored measuring tape around the arm, hand packets of RUTF to their mothers, and move on. The mother could feed her child at home, on her own schedule, without abandoning her other responsibilities. Weekly check-ups could replace constant hospitalization. Treatment that once required weeks of inpatient care could happen in the community.

The numbers tell the story. Before RUTF, community-based treatment of severe acute malnutrition was essentially impossible. By 2013, Plumpy'Nut alone had been used to treat thousands of children across Africa, earning approval from the World Health Organization as a legitimate therapeutic intervention.

Research comparing RUTF to alternative dietary approaches found that children treated at home with ready-to-use therapeutic food showed improved weight gain and recovery rates. The evidence on long-term outcomes—whether children were less likely to relapse, whether overall mortality decreased—remained less clear. But for acute treatment, the approach worked.

What's Actually in This Stuff?

The ingredient list for most RUTFs is surprisingly short: peanuts (or peanut paste), vegetable oil, sugar, dried skimmed milk, and a vitamin and mineral supplement. That last component—the premix—is where the nutritional precision lives. It contains carefully measured amounts of zinc, iron, copper, selenium, iodine, and a full complement of vitamins.

The World Food Program and UNICEF maintain strict specifications for these premixes, including a list of authorized vendors: DSM Nutrition (formerly Fortitech), the Piramal Group in India, Hexagon Nutrition, BASF's SternVitamin division, and the GAIN premix facility. This quality control matters because the margins for error are slim. Too little zinc and immune function suffers. Too much iron and you risk toxicity in an already stressed system.

Fifty percent of the protein in a standard RUTF must come from dairy—a requirement that ensures high biological value. Plant proteins alone don't provide the same amino acid profile that a recovering body needs.

A Brief History of Therapeutic Foods

Plumpy'Nut wasn't the first attempt to create emergency nutrition in a portable form. The history of therapeutic foods stretches back decades, with each innovation building on the last.

In the 1960s, UNICEF developed K-Mix 2, a high-energy food designed for emergency feeding programs. A decade later, in 1971, an organization began using Citadel spread—a paste of peanuts, oil, sugar, and milk powder that anticipated the RUTF concept by twenty-five years.

After Plumpy'Nut's success in 1996, variations proliferated. In 2003, a nonprofit called Meds and Food for Kids began producing Medika Mamba in Haiti—"Medika Mamba" means "peanut butter medicine" in Haitian Creole. The World Health Organization developed BP-100, a nutrient-fortified wheat-and-oat bar designed to provide F-100's nutritional profile in solid form. The United States Agency for International Development created Nutribun, a fortified bread distributed through the Food for Peace program.

Each product serves slightly different needs: bars for older children who can chew, pastes for the youngest and weakest, different formulations for different deficiency patterns. But they share the same underlying principle—concentrate nutrition into a form that can survive the supply chain challenges of the developing world.

The Bigger Picture

Therapeutic foods exist in a strange space between medicine and food, between emergency intervention and everyday nutrition. They're not meant to replace normal eating. They're designed to rescue a body from crisis, to provide a bridge back to health.

And they work remarkably well at that specific task. A child with severe acute malnutrition—technically defined as having a weight-for-height z-score below negative three, meaning they weigh far less than they should for their height—can be brought back to a healthy weight with weeks of RUTF treatment. The paste provides roughly 500 kilocalories in a 92-gram packet, enough to fuel recovery without requiring the child to consume large volumes of food their shrunken stomach can't handle.

But RUTF isn't a solution to malnutrition. It's a response to the failure of everything else—of food security, of healthcare access, of economic systems that leave families unable to feed their children. Every packet of Plumpy'Nut represents a child who shouldn't have needed it in the first place.

What Comes Next

The field continues to evolve. Researchers are exploring whether RUTF can be made with local ingredients in different regions, reducing costs and dependence on imports. (Peanuts work well in Africa, where they're widely cultivated, but other legumes might be better suited to South Asia.) There's ongoing debate about optimal formulations—whether the current recipes are truly ideal, or whether different populations need different nutrient profiles.

And there are harder questions about the entire approach to malnutrition. Is it better to pour resources into emergency treatment, or into prevention? Into individual packets of therapeutic food, or into agricultural development and social safety nets? These aren't questions with easy answers.

What we do know is this: for a child in crisis, a packet of specially formulated peanut paste can mean the difference between life and death. It's not a perfect solution. But it's a solution that exists, that works, and that can reach children who would otherwise be beyond help.

Sometimes the most profound innovations don't look revolutionary at all. Sometimes they look like peanut butter.