That is the idea behind Thanzi Coach.

Thanzi Coach is a WhatsApp-based nutrition and wellness service designed to make nutrition information easier to access and understand.

Instead of searching through different websites or trying to understand complicated nutrition databases, you can simply send a message on WhatsApp and ask about food, nutrition, or other nutrition-related topics.

Why Thanzi Coach?

We have access to a lot of nutrition information, but finding the right information can sometimes be difficult.

You might want to know:

• How nutritious is a particular food?
• How does one food compare with another?
• How much nutrition is in the amount I actually eat?
• What does the nutrition label on a product mean?
• What does research say about a nutrition topic?
• What are the recommended dietary amounts for different nutrients?
• What are drug–nutrient interactions?

Thanzi Coach is designed to make finding this type of information easier.

Powered by the Chakudya Nutrition Registry

Behind Thanzi Coach is the Chakudya Nutrition Registry (CNR).

CNR is much more than a food database.

It brings together different types of nutrition knowledge, including:

• Food and nutrient information
• Dietary reference values
• Clinical nutrition guidelines
• Drug–nutrient interactions
• Nutrition articles
• Research and scientific information
• Nutrition and dietetics resources

This means Thanzi Coach can connect people to different types of nutrition knowledge instead of relying on information about food alone.

How does it work?

The idea is simple:

You ask → Thanzi Coach finds the relevant information → You get a response.

For example, you could ask:

What nutrients are in nsima?

Or:

Nsima vs rice, which has more fibre?

You could also ask about a particular amount:

What is the nutrition in 200 g of rice?

Thanzi Coach can use information from the Chakudya Nutrition Registry to help answer these types of questions.

You can also use food labels

Packaged foods often contain a lot of information on their labels.

But not everyone knows what all those numbers mean.

Thanzi Coach can also work with barcodes and images of nutrition labels, helping turn information on a product into something easier to understand.

You can send a barcode or a picture of a nutrition label and interact with the information through WhatsApp.

Why WhatsApp?

There is no need to learn another complicated application.

Thanzi Coach brings nutrition information to a platform people already know how to use.

You simply open WhatsApp, send your question, and interact with the service.

That makes the experience simple while the more complex work happens behind the scenes.

Built for Malawi

One of the things that makes this project meaningful to me is its focus on the Malawian context.

Nutrition information should not always feel like it was created somewhere else and simply brought here.

We have our own foods, eating patterns, nutrition challenges, research, and health needs.

The Chakudya Nutrition Registry is being developed with this context in mind, and Thanzi Coach provides one way of making that knowledge accessible.

More than a chatbot

Although you interact with Thanzi Coach through conversation, the bigger idea goes beyond a chatbot.

The goal is to make nutrition knowledge more accessible and useful.

The Chakudya Nutrition Registry can potentially support:

• Consumers
• Nutrition professionals
• Students
• Researchers
• Developers
• Digital health services

Thanzi Coach is one way of putting that knowledge into people's hands.

What I learned from building it

Building Thanzi Coach has taught me that technology does not have to be complicated from the user's point of view.

Behind the scenes, there can be databases, research, software, and many different technologies.

But for the person using the service, the experience can remain simple:

Ask a question. Get useful information.

That is the kind of technology I want to keep building — technology that solves real problems without making the solution complicated for the people who use it.

What's next?

Thanzi Coach is still evolving.

There is more knowledge to add, more features to develop, and more ways to improve the experience.

The bigger vision is to continue developing the Chakudya Nutrition Registry and create more ways for people to access reliable, locally relevant nutrition knowledge.

Thanzi Coach is one step in that journey.

Final Thought

We often think of technology as something complicated.

But sometimes the best technology is the technology that feels simple.

You ask a question.

You get information.

And you can use that information to make a better decision.

That is what I hope Thanzi Coach can become.

Nutrition knowledge, made easier to access.

Don't eat less. Eat right.

Try Thanzi Coach

Chat with Thanzi Coach on WhatsApp

Send a nutrition question, ask about a food, compare foods, or send a barcode or nutrition label.

Thanzi Coach — powered by the Chakudya Nutrition Registry (CNR).

Artificial intelligence is increasingly being used to work with large amounts of information. In nutrition, this can include food composition data, clinical guidelines, research literature, exchange lists, packaged foods, and other nutrition resources.

One approach for connecting this information with generative AI is Retrieval-Augmented Generation (RAG).

While developing Chakudya Nutrition Registry, I explored how RAG can be used to retrieve relevant nutrition knowledge and make it available to applications through an API.

What is RAG?

Retrieval-Augmented Generation, commonly known as RAG, is an approach that combines information retrieval with generative AI.

A typical RAG workflow involves retrieving information relevant to a user's query and then using that information as context for generating a response.

A simplified workflow looks like this:

User question
      ↓
Query processing
      ↓
Information retrieval
      ↓
Relevant knowledge
      ↓
Context
      ↓
AI generation
      ↓
Response

The retrieval and generation components can be implemented separately. This allows the knowledge layer to be maintained independently from the language model.

Why RAG for nutrition?

Nutrition information exists in many different formats and sources.

These may include:

• Food composition tables
• Clinical nutrition guidelines
• Research articles
• Diabetes exchange lists
• Renal exchange lists
• Enteral nutrition resources
• Packaged-food data
• Nutrition reference documents

A nutrition application may need to work with several of these sources at the same time.

Traditional database queries are useful when the structure of the data and the query are known. However, natural-language questions can be more difficult to handle with exact keyword matching alone.

For example:

What foods could be included when planning a meal for someone with diabetes?

The wording of the question may differ from the terminology used in the underlying knowledge.

Semantic retrieval provides another way of finding relevant information by considering the meaning of the query.

Chakudya Nutrition Registry

Chakudya Nutrition Registry is a food and nutrition data platform designed to provide nutrition information through APIs.

The registry brings together several types of nutrition resources, including:

• Malawi food composition data
• Diabetes exchange lists
• Renal exchange lists
• Enteral formula information
• Packaged foods
• External food data sources
• General nutrition textbooks and reference books
• Clinical nutrition guidelines Research articles and scientific literature
• Dietary references
• Nutrition assessment resources
• Therapeutic nutrition references

The platform provides structured endpoints for applications that need specific information.

For example, an application can query a food endpoint when it needs information about a particular food.

However, not every nutrition question can be represented as a simple food lookup.

This is where the RAG component provides another method of accessing the available knowledge.

The /rag/retrieve endpoint

One of the RAG components in Chakudya Nutrition Registry is:

POST /rag/retrieve

This endpoint provides semantic retrieval for nutrition knowledge.

A submitted query is converted into an embedding and compared with information stored in the RAG knowledge base.

Chakudya uses Cohere's embed-multilingual-v3.0 model for embeddings.

This allows the system to perform semantic similarity searches rather than relying only on exact keyword matches.

For example:

"foods suitable for diabetes"

and:

"foods that can be included in a diabetic meal plan"

use different wording but have closely related meanings.

Semantic retrieval can help identify information relevant to both queries.

How the retrieval process works

A simplified representation of the retrieval process is:

Nutrition documents
        ↓
Text extraction
        ↓
Document chunking
        ↓
Embeddings
        ↓
Vector storage
        ↓
User query
        ↓
Query embedding
        ↓
Similarity search
        ↓
Relevant information

Documents are processed into smaller sections so that relevant portions can be retrieved instead of providing an entire document as context.

The text is represented as embeddings and stored for semantic search.

When a query is submitted to /rag/retrieve, the query is embedded and used to identify relevant information from the knowledge base.

The endpoint can return retrieved context that can then be used by another application or AI workflow.

From retrieval to /rag/ask

Chakudya Nutrition Registry also includes a higher-level RAG endpoint:

POST /rag/ask

While /rag/retrieve focuses on semantic retrieval, /rag/ask acts as a broader RAG search orchestrator.

The workflow can include:

User query
     ↓
Intent detection
     ↓
Search across relevant sources
     ↓
Semantic retrieval
     ↓
Structured nutrition searches
     ↓
Reranking
     ↓
Context construction
     ↓
Grounded AI response

The search process can work across multiple nutrition data sources, including the Malawi Food Composition Table, packaged and OCR-derived foods, exchange lists, renal information, enteral formulas, barcode-related data, and external food-data fallbacks.

The retrieved results can then be reranked before being used to construct the context for the generated response.

Chakudya uses Cohere reranking for this part of the workflow, with a heuristic fallback available when required.

Retrieval and generation are separate components

An important part of the architecture is the separation between retrieval and generation.

The /rag/retrieve endpoint focuses on finding relevant information.

A separate application or AI workflow can then decide how that retrieved information should be used.

For example:

Application
     ↓
/rag/retrieve
     ↓
Relevant nutrition knowledge
     ↓
AI model
     ↓
Natural-language response

This means the retrieval layer does not have to be limited to a chatbot.

It can potentially be used by different types of nutrition software, including:

• Nutrition education applications
• Research tools
• Clinical software
• Nutrition search systems
• AI assistants
• Meal-planning applications

RAG and structured nutrition data

RAG does not replace structured nutrition databases.

The two approaches serve different purposes.

A structured food database can answer questions such as:

How much protein does this food contain?

A retrieval system can help find information related to a broader question such as:

What nutrition information is relevant to this dietary condition?

The two approaches can therefore work together.

Structured nutrition data
          +
Nutrition knowledge
          +
Semantic retrieval
          +
Artificial intelligence

This allows applications to use precise structured data when appropriate and semantic retrieval when a broader knowledge search is needed.

Nutrition data sources

One of the important aspects of a nutrition RAG system is the information available to retrieve.

Chakudya Nutrition Registry is designed around nutrition resources that can include local and external sources.

The system can work with information related to:

• Malawi Food Composition Table
• Diabetes exchange lists
• Renal exchange lists
• Enteral formulas
• Packaged foods
• OCR-derived food information
• Barcode-related food information
• External food databases

External sources can also be used as fallbacks in the wider food-search architecture, including USDA FoodData Central, Open Food Facts, and FatSecret.

This allows the system to combine locally relevant nutrition information with broader food-data coverage.

Why local nutrition data matters

Chakudya Nutrition Registry also focuses on nutrition data relevant to Malawi.

Many digital nutrition systems depend heavily on international datasets. These resources are useful, but local food composition data and dietary information can provide additional context for applications serving Malawian users.

A local nutrition data layer can make it easier for developers to build applications that work with foods and nutrition information relevant to the local population.

The RAG component provides another layer through which this knowledge can be accessed.

Source and context matter

Retrieval quality depends on the quality of the information being retrieved.

For a nutrition system, important considerations include:

• Reliability of the source
• Quality of document processing
• Quality of embeddings
• Retrieval relevance
• Metadata and source information
• Freshness of the underlying knowledge
• How retrieved information is presented to the AI model

RAG does not by itself guarantee that a generated response is correct.

The retrieved information still needs to come from appropriate sources, and generated responses may require validation depending on the application.

This is particularly important when developing systems that may be used in nutrition or healthcare contexts.

What I learned from building the system

Working on the RAG component highlighted several parts of AI application development that are easy to overlook.

The language model is only one part of the system.

Other components include:

Data
  ↓
Knowledge processing
  ↓
Indexing
  ↓
Retrieval
  ↓
Reranking
  ↓
Context construction
  ↓
AI generation
  ↓
Response

Each stage can affect the quality of the final result.

This approach also changes how an AI application can be designed. Instead of treating the language model as the entire system, it can be treated as one component within a larger information architecture.

The role of RAG in the wider Chakudya project

The RAG system is one part of the broader Chakudya Nutrition Registry architecture.

The registry provides both structured and knowledge-oriented access to nutrition information.

A simplified view is:

Food data
Exchange lists
Renal information
Enteral formulas
Packaged foods
Nutrition knowledge
        ↓
Chakudya Nutrition Registry
        ↓
Structured APIs + RAG
        ↓
Nutrition applications

Developers can therefore choose the appropriate interface depending on the type of information their application needs.

A structured endpoint may be appropriate for a precise food lookup.

The /rag/retrieve endpoint may be appropriate when searching for relevant knowledge based on a natural-language query.

The /rag/ask endpoint can provide a higher-level workflow that combines retrieval and response generation.

RAG query caching

Another part of the implementation is query caching.

The RAG retrieval process uses an embedding request before searching the knowledge base. Repeated or similar queries can therefore result in repeated processing.

Chakudya includes a Cloudflare KV-backed query cache for /rag/retrieve.

The cache can store complete retrieval responses for a limited period.

This can reduce repeated embedding requests and database searches for identical or normalized queries.

The result is an architecture that considers not only retrieval quality, but also performance and resource usage.

Looking ahead

The development of the RAG component is part of a broader effort to make nutrition data more accessible to software.

Future nutrition applications could combine:

• Local food composition data
• Clinical nutrition resources
• Research literature
• Semantic search
• Structured APIs
• Artificial intelligence

Such systems could support different areas of nutrition education, research and digital health.

The quality of these applications will depend not only on the AI model, but also on the quality, organization and provenance of the underlying nutrition information.

Conclusion

RAG provides an architecture for connecting generative AI with external knowledge sources.

In Chakudya Nutrition Registry, the /rag/retrieve endpoint provides a semantic retrieval layer that applications can use to find relevant nutrition information.

The /rag/ask endpoint builds on this retrieval capability by orchestrating searches across different nutrition sources, reranking results, and using the retrieved information as context for response generation.

This architecture allows structured food data, nutrition knowledge, semantic search, and AI to work together while keeping the retrieval layer separate from the language model.

Chakudya Nutrition Registry is an ongoing project exploring how food data, nutrition knowledge, APIs, semantic retrieval, and artificial intelligence can work together, with a particular focus on making locally relevant nutrition information accessible from Malawi and beyond.

When most people hear the word "malnutrition," they picture a child with a swollen belly, thinning hair and a visibly wasted body.

That image is not wrong, but it is dangerously incomplete.

Malnutrition can affect adults too, including people who look well-nourished and are about to undergo major surgery.

A 2018 observational study conducted at Queen Elizabeth Central Hospital (QECH) in Blantyre examined the nutritional status of 25 adult patients undergoing laparotomy. The findings were striking. Only 20% of the patients were classified as well-nourished. The remaining 80% had some degree of malnutrition, with 52% moderately malnourished and 28% severely malnourished.

These were not children. They were adults undergoing surgery at a time when their bodies needed adequate nutritional reserves to cope with the stress of an operation and support recovery.

The study raises an important question: How often do we actually recognise malnutrition in surgical patients?

It also challenges several assumptions about what malnutrition looks like, where it comes from and why it matters.

Malnutrition is not just a childhood problem

Malnutrition is often discussed in the context of children, particularly because inadequate nutrition during childhood can have serious consequences for growth and development. But adults can become malnourished too.

For surgical patients, there are several possible pathways to malnutrition. Chronic illness can affect nutritional status, while inadequate food intake can lead to starvation-related malnutrition. Surgery and acute illness can make the situation even worse.

The body responds to surgical injury with a metabolic stress response. Energy expenditure increases, and the body begins breaking down muscle protein. At the same time, patients may eat less and move less during their hospital stay. Together, these factors can result in a rapid loss of lean body mass and physical function.

So malnutrition in a surgical patient is not simply a matter of whether someone has had enough food throughout their life. It can develop or worsen because of the illness and the treatment itself.

You don't have to be underweight to be malnourished

This is perhaps the most important lesson from the QECH study.

When the researchers looked at BMI, 76% of the patients had a normal weight. Only 6% were overweight, and none were classified as underweight. Yet when the patients were assessed using the Subjective Global Assessment (SGA), only 20% were considered well-nourished. The other 80% were classified as moderately or severely malnourished.

That is a remarkable difference.

BMI measures weight in relation to height, but nutritional assessment is more complicated than that. The SGA considers factors such as recent weight changes, dietary intake, gastrointestinal symptoms, functional capacity, metabolic stress and physical examination findings.

This is particularly important in hospitalised patients. Acute illness can cause changes in metabolism and fluid balance that make body weight a poor reflection of what is happening to the patient's nutritional status.

The researchers therefore noted that BMI may be less sensitive for identifying malnutrition in acutely ill and medically complicated patients.

In simple terms, a normal BMI does not necessarily mean a patient is nutritionally healthy.

Surgery itself can make nutritional status worse

A patient does not necessarily enter the operating theatre malnourished and remain in the same condition throughout their hospital stay.

Major surgery places considerable metabolic stress on the body. The response involves increased energy expenditure and breakdown of muscle protein. If nutritional intake does not keep up with these demands, the loss of lean body mass can continue.

The QECH researchers measured handgrip strength before surgery and again three days after surgery. Handgrip strength is useful as a simple measure of functional capacity and can provide an indication of changes in muscle function.

The median handgrip strength fell from 22.3 kg before surgery to 18.4 kg on the third postoperative day. The decrease was statistically significant.

Patients who were better nourished also had greater handgrip strength than those who were moderately or severely malnourished.

This matters because nutritional status was not just associated with muscle strength. Handgrip strength was also associated with postoperative complications and length of hospital stay.

Malnutrition can affect what happens after the operation

The consequences become even clearer when we look at hospital outcomes.

In the study, 72% of participants developed either an incision-wound infection or wound dehiscence. Severely malnourished patients had a median hospital stay of eight days, compared with four days among well-nourished patients.

This does not mean the study proved that malnutrition directly caused every complication. It was a small observational study, so the findings demonstrate associations rather than causation.

However, the findings are consistent with a wider body of evidence linking poor nutritional status with complications, impaired healing and longer hospital stays.

Nutrition therefore deserves to be considered part of surgical care, not something that can be dealt with only after the operation.

Are surgical patients being given enough food?

Another important finding from the study concerns the nutritional content of the hospital diet.

The standard diet at QECH consisted of porridge with sugar in the morning, followed by nsima with beans, cabbage or both for lunch and supper.

The researchers estimated that this diet provided approximately:

• 1,280 kilocalories per day
• 31.5 grams of protein per day

The estimated requirements were considerably higher, at approximately:

• 1,564 kilocalories per day
• 72 grams of protein per day

None of the patients met their estimated energy and protein requirements through the hospital diet alone.

This is important because surgical patients may actually require more nutrition, not less. The metabolic stress associated with surgery increases energy and protein requirements. Evidence-based recommendations cited in the paper encourage appropriate feeding as soon as possible after surgery when clinically appropriate.

Food in a surgical ward is therefore not simply about satisfying hunger.

It is part of the patient's recovery.

The problem is bigger than food

It would be easy to look at these findings and conclude that the solution is simply to give surgical patients more food.

It is more complicated than that.

Malnutrition can be caused or worsened by disease, inadequate intake, metabolic stress and reduced physical activity. Identifying it is therefore the first step.

At the time of the study, the researchers reported that there was no formal nutritional screening or assessment for adult inpatients at QECH. This meant that patients who might have benefited from nutritional support before surgery could go unidentified.

The paper highlights several established tools that can be used to identify patients at nutritional risk, including the Subjective Global Assessment, the Malnutrition Universal Screening Tool and the Nutrition Risk Score 2002.

The researchers also highlighted the limited availability of dietetic services and nutritional support within Malawi's government hospitals at the time of publication.

This means that addressing surgical malnutrition requires more than telling patients to eat better. It requires nutritional screening, appropriate assessment, access to adequate food and, where necessary, specialised nutritional support.

What should change?

The findings from QECH point towards several practical steps.

First, nutritional assessment should become part of routine surgical care.

A patient being admitted for surgery should not be assessed only for their surgical diagnosis and fitness for anaesthesia. Their nutritional status also matters.

Second, BMI should not be used as the only indicator of nutritional status.

The QECH study provides a particularly striking example of why. None of the patients were underweight according to BMI, yet four out of five were classified as malnourished using SGA.

Third, nutritional support should continue after surgery.

The metabolic demands of surgery do not end when the operation is over. Patients need adequate energy and protein to support recovery, maintain lean body mass and support normal physiological functions.

The bigger picture

The QECH study was small, involving only 25 patients, and it was conducted at a single hospital. The researchers themselves acknowledged these limitations and called for larger studies involving other hospitals and patient populations in Malawi.

But despite those limitations, the study raises an important issue that is easy to overlook.

Malnutrition in surgical patients can be hidden in plain sight.

The patient may not look thin.

Their BMI may be normal.

They may even appear physically well.

Yet beneath the surface, illness and surgical stress may be contributing to muscle loss and declining nutritional reserves.

The question, therefore, should not simply be whether a surgical patient looks malnourished.

The better question is:

Have we actually assessed their nutritional status?

Because surgery is only one part of recovery. The body still needs the resources to heal after the operation is over.

And sometimes, one of the most important interventions in surgical care is not another drug or another procedure.

It is making sure the patient has enough nutrition to recover.

Source

Katundu KGH, Mutafya TW, Lozani NC, Nyirongo PM, Uebele ME. An observational study of perioperative nutrition and postoperative outcomes in patients undergoing laparotomy at Queen Elizabeth Central Hospital in Blantyre, Malawi. Malawi Medical Journal. 2018;30(2):79-85.

Electrolytes are often associated with sports drinks, athletes and intense exercise. However, these minerals are essential for everyone. They help regulate fluid balance, support nerve function and allow muscles to contract normally.

But there is an important distinction between needing electrolytes and simply consuming more salt or electrolyte drinks.

In Malawi, this topic is particularly relevant because hydration, physical activity, climate, dietary patterns and salt consumption all influence electrolyte intake.

What are electrolytes?

Electrolytes are minerals that carry an electrical charge when dissolved in body fluids.

Important electrolytes include:

• Sodium
• Potassium
• Chloride
• Calcium
• Magnesium
• Phosphate
• Bicarbonate

They are involved in fluid balance, nerve transmission, muscle contraction and other physiological processes.

For most healthy people, a balanced diet and adequate fluid intake provide the electrolytes needed for normal daily activities.

Sodium: essential, but too much can be harmful

Sodium is an essential mineral. The body needs it for normal nerve and muscle function and to help regulate fluid balance.

However, excessive sodium intake is associated with increased blood pressure and cardiovascular risk.

The World Health Organization recommends that adults consume less than 2,000 mg of sodium per day, equivalent to less than 5 g of salt per day.

This does not mean that salt should be completely eliminated. Sodium is necessary for normal physiological function. The goal is to avoid excessive intake.

What does this mean for Malawi?

This becomes particularly interesting when we look at available national data.

The Malawi National STEPS Survey reported an average salt intake of approximately 10.4 g per day among adults aged 18–69 years.

That is more than twice the WHO recommended maximum of 5 g of salt per day.

The survey also reported that 17.4% of adults reported adding salt always or often before or while eating.

These findings do not mean that every Malawian consumes too much salt. However, they highlight why sodium deserves greater attention in nutrition education and dietary counselling.

Where can sodium come from?

Salt can enter the diet in several ways.

In the Malawian context, this may include:

• Salt added during cooking
• Salt added at the table
• Seasoning powders and stock cubes
• Processed meats
• Instant noodles
• Bread and baked products
• Sauces and condiments
• Packaged snacks
• Other processed foods

The amount varies depending on the food, brand, recipe and portion size.

Therefore, asking someone whether they add salt to their food does not necessarily tell us their total sodium intake.

What about potassium?

Potassium is another important electrolyte.

It contributes to normal nerve and muscle function and helps maintain fluid and electrolyte balance.

Many naturally occurring foods provide potassium, including:

• Bananas
• Oranges and other fruits
• Leafy green vegetables
• Tomatoes
• Beans and other legumes
• Potatoes and sweet potatoes
• Avocado
• Other locally available fruits and vegetables

Rather than searching for a special "electrolyte food", a varied diet containing fruits, vegetables and legumes can naturally provide potassium and other important nutrients.

However, people with certain medical conditions, particularly some kidney disorders, may need individualized potassium advice.

Do you need an electrolyte drink after exercise?

Not necessarily.

For ordinary daily activities and many forms of moderate exercise, water and a balanced diet are generally sufficient for healthy individuals.

Electrolyte replacement becomes more relevant when there are substantial losses of fluid and electrolytes, such as during:

• Prolonged strenuous exercise
• Heavy sweating
• Exercise in hot environments
• Significant vomiting
• Significant diarrhoea

This distinction is important because electrolyte products are often marketed as if everyone needs them after exercising.

A person completing a short workout does not automatically need an electrolyte drink.

An endurance athlete exercising for several hours in hot conditions is a different situation.

Malawi's climate and physical activity

Malawi experiences periods of significant heat, while many people also undertake physically demanding activities.

Farmers, construction workers, athletes and other manual workers may spend long periods working or exercising outdoors.

During prolonged activity, sweating causes the body to lose water and electrolytes.

Fluid and electrolyte requirements therefore depend on factors such as:

• Duration of activity
• Exercise intensity
• Environmental temperature
• Individual sweating rate
• Food intake
• Access to fluids
• Individual health status

There is no single electrolyte requirement that applies equally to everyone.

What about diarrhoea and vomiting?

Electrolytes become particularly important when large amounts of fluid are lost through diarrhoea or vomiting.

In these situations, drinking plain water alone may not adequately replace the glucose and electrolytes lost from the body.

Oral rehydration solution (ORS) is specifically designed to help replace these losses by providing an appropriate combination of glucose and electrolytes.

This is different from a typical sports drink.

For significant diarrhoea or vomiting, particularly in children and other vulnerable individuals, appropriate medical assessment and rehydration guidance are important.

More salt does not automatically mean better hydration

A common misconception is:

"If I am sweating, I should just add more salt."

This is an oversimplification.

Sweat contains sodium, but electrolyte requirements vary considerably between individuals and situations.

Adding large amounts of salt to food or consuming salty mixtures without considering the actual cause of fluid loss is not a universal solution to dehydration.

For everyday hydration, adequate safe water and a balanced diet are generally more appropriate.

Sports drinks vs energy drinks

Sports drinks and energy drinks are not the same thing.

Sports drinks are generally formulated to provide fluid, carbohydrate and electrolytes during or after prolonged physical activity.

Energy drinks are primarily marketed for stimulation and may contain substantial amounts of caffeine and sugar.

Neither should automatically be considered necessary for hydration.

For many people, particularly during normal daily activities, water remains a simple and appropriate hydration option.

Practical tips for Malawian households

Reducing excessive sodium intake does not mean abandoning traditional Malawian foods.

Instead, practical changes can include:

1. Taste food before adding extra salt

Avoid automatically adding salt at the table.

2. Gradually reduce salt during cooking

Reducing salt gradually can allow taste preferences to adapt.

3. Pay attention to packaged foods

Where nutrition labels are available, check the sodium or salt content.

4. Be mindful of seasonings

Stock cubes, seasoning powders, sauces and other condiments can contribute significant sodium depending on the product and quantity used.

5. Eat a variety of fruits and vegetables

These foods can contribute potassium and many other essential nutrients.

6. Hydrate according to your needs

Water is an important source of hydration during everyday life.

During prolonged physical activity or heavy sweating, fluid and electrolyte requirements may increase.

Salt is not the enemy

Salt itself is not inherently "bad".

Sodium is an essential nutrient.

The concern is excessive intake.

The goal is to achieve an appropriate balance: enough sodium to support normal physiological function without consistently consuming excessive amounts.

Reducing population sodium intake is an important public-health strategy for reducing the risk of hypertension and cardiovascular disease.

A Malawi nutrition perspective

Electrolytes are not simply a sports nutrition topic.

They connect several areas of nutrition and public health:

Hydration → physical activity → heat exposure → diarrhoeal illness → dietary intake → salt consumption → hypertension → cardiovascular health.

This is why electrolyte advice should be based on context rather than marketing.

The more useful question is not:

"Which electrolyte drink should I buy?"

Instead, ask:

"What is causing the fluid or electrolyte loss, and what does this person actually need?"

For one person, the answer may simply be water and a balanced diet.

For an endurance athlete exercising for several hours in the heat, a planned fluid and electrolyte strategy may be appropriate.

For someone experiencing significant diarrhoea, oral rehydration therapy may be required.

For someone consuming excessive amounts of salt every day, the priority may be sodium reduction rather than adding more electrolytes.

Context matters.

Final takeaway

Electrolytes are essential minerals that help the body function normally. But more is not always better.

For most healthy Malawians, adequate hydration and a varied diet can provide the electrolytes required for everyday life.

Special electrolyte products have a more specific role, particularly during prolonged strenuous activity or situations involving substantial fluid and electrolyte losses.

At the same time, sodium deserves particular attention. Available national data from Malawi indicate that average salt intake has been considerably higher than the WHO recommended maximum.

The practical message is simple:

Hydrate appropriately. Eat a varied diet. Be mindful of salt. And use electrolyte replacement when there is a genuine physiological need—not simply because a product is marketed as one.

References

American Heart Association. (2024). Electrolytes can give the body a charge, but try not to overdo it. Available online: https://www.heart.org/en/news/2024/06/19/electrolytes-can-give-the-body-a-charge-but-try-not-to-overdo-it

Centers for Disease Control and Prevention. (2024). About Sodium and Health. Available online: https://www.cdc.gov/salt/about/index.html

Food and Drug Administration. (2023). Sodium in Your Diet. Available online: https://www.fda.gov/food/nutrition-education-resources-materials/sodium-your-diet

Government of Malawi, Ministry of Health. (2017). Malawi National STEPwise Survey for Non-Communicable Diseases Risk Factors 2017. Lilongwe: Ministry of Health.

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Why screening gets deprioritized

On a busy ward, screening competes with everything else that needs doing. Tools like MUST, NRS-2002, and PG-SGA take a few minutes each, minutes that feel expendable when a patient isn't visibly wasting. The cost of skipping it doesn't show up immediately. It shows up two weeks later, as delayed wound healing, a longer admission, or a readmission that traces back to something a five-minute screen would have caught early.

What gets missed most often

• Recent unintentional weight loss that wasn't asked about
• Reduced intake over the days before admission, not just during it
• Patients who look adequately nourished but have lost significant lean mass

None of these are visible at a glance. All of them are caught by a structured screen.

The fix isn't more training

Most staff already know these tools exist. The gap is rarely knowledge, it's time and workflow. Screening needs to be built into admission routines as a default step, not an optional one that depends on whether someone remembers.

That's the gap tools like structured NCP generation and screening prompts are meant to close: making the correct action the path of least resistance, not an extra task competing for attention.