Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis

Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis

In fact, one more US-directed violent overthrow of an elected government has carved off the biggest country of Europe from next-door Russia. Yet Russia gets all the blame for "brute force" in reclaiming Crimea -although 96% of a voluntary turnout of 82% voted to rejoin its traditional mother country. While denounced as "violation of international law", the Crimea referendum choice expresses the "self-determination" of a society guaranteed under Article 2 of the United Nations Charter. Ukraine's coup government, in contrast, has prohibited any referendum on its rule -especially the Eastern regions where popular uprisings with no mass deaths or beatings (as in the Kiev coup) call for self-determination against illegal rule from Kiev.

The uprising cities of East Ukraine -beginning with Donetsk, then Kharkiv, Luhansk, Slavyansk (the Slav has been removed from the Westernized Sloviansk), Kramatorsk and other centers and villages -all demand a democratic referendum for their future status as equal citizens in a Ukraine federation. Integration with Russia is not favoured by Russia, but the dominant popular feeling unreported in the media is peaceful and pragmatic. Ukraine's government has been broken by the US-led coup and cannot provide what people need in jobs, healthcare, income security and pensions. Certainly "the Greek model" planned for Ukraine is not in its people's common life interests. Under the coup government of prime minister Arseniuy Yatsenyuk, a banker who is already prescribing mass dispossession by austerity programs, what will happen to Ukraine is foretold by has happened in Greece.

The EU's financial rule by banker mechanisms has already been almost as great a failure as the oligarch-marketization of Russia after 1990. It is a complex system of one-way powers of life deprivation and social ruin which I define in The Cancer Stage of Capitalism: From Crisis to Cure (1999Cure ( , 2013. Elected governments lose all control to the new absolute and overriding imperative of European rule -to grow and multiply private transnational money sequences. In accord with the ruling formulae, the Greek economy has been slashed by 25 per cent, unemployment is an official 28 per cent excluding the unpaid, the public health system is dismantled to pay foreign banks, wages are cut by a quarter, the public sector is sacked and privatized, and jobless youth rises to 60 per cent even with mass emigration. These outcomes now await Ukraine.

Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis

Those in Ukraine who are not under the spell of its father cult, oligarch riches, and post-1991 dispossession know better. Outside of Kiev they have had enough, and that is why the election and presidency of the Party of Regions and its allies whose popular support lies outside Kiev have been repeatedly overturned. It is also why their decentralized federal alternative has been removed from the table. The murderous insurrection in Kiev and violent coup of elected government reveals how far the Kiev oligarchy and plotters are prepared to go backed by the US. Yet this time Russia has drawn a red line. With near-unanimous support of the Crimean people and the uprising of the Eastern cities and villages as I write, Russia has stopped the US-led transnational corporate-machine and NATO from further expansion for the first time in 25 years.

It is true that Ukraine -the biggest country and bread basket of Europe -has now been pried wide open for transnational Western banks, agribusiness, Big Oil and NATO to feed on. And it is true that all talk of "land grab" has been projected onto Russia even as US Greystone and Blackwater mercenaries -now called "Academi" in the Big Lie lexicon -move on the ground in Ukraine as the US and NATO propagate ever more threats of force and embargo against "Russia's aggression". Reverse blame is always the US geostrategic game. "Russia's designs to take the whole of Ukraine" is again US projection of its own objective, as in the old days when "world rule plot" was attributed to the former USSR. Yet a line has been drawn at Crimea, and drawn again in Eastern Ukraine, and it is backed by a country that cannot be arm-twisted, propaganda invaded, or air-bombed with impunity. That is why the one-way threats never stop. It is the first line yet drawn by an historical power outside of China against the exponentially multiplying US-led private transnational money sequences devouring the world.

People now have a chance to reflect on who is the aggressor and who stands for democratic choice as events unfold. They can observe the patterns of Orwellian distortion day to day. Never is the other side presented. The US and NATO alone continuously denounce, lie and threaten. Financial contracts and assets are violated by one side alone. Hate campaigns without evidence go one way. Uprisings have been mass murderous from the US-coup side and without harm from the resisting side. Russia is behind its own borders, and the US deploys threats, covert operations and mercenaries from thousands of miles away. But this time US-NATO-led corporate globalization cannot destroy nations at will. Sometimes history Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis can happen as it should.

The Mechanisms of Reverse Blame to Justify Destroying Societies

Reversal of blame is always the US method of pretext and justification. This is why Russia is pervasively vilified in the mass media, and another significant Arctic actor, Canada's big-oil regime, joins in along with the UK. As always, denunciation rules without reasoned understanding. As always, the US-led financial and military forces of private money-power expansion move behind the abomination of designated enemies. Any nation or leader not serving transnational corporate control of resources and markets across borders is always the villain. This is the ruling meta program.

Thus too in Ukraine. When Europe tried to broker a peace deal between the opposition and elected government of Ukraine, the US Assistant Secretary of State Victoria Nuland continued to court the neo-Nazi coup leaders to overthrow the state, instructing "Yats" (appointed PM Yatsenyuk) to consult with the main putsch leader Oleh Tyahnybok "at least four times a week". When she is reminded of the EU peace talks and agreement to stop the bloodshed, her response is telling, "Fuck the EU". The coup peaked after three days of murder by the neo-Nazi faction. When former "Orange revolutionary" and gas oligarch leader of the Fatherland Party, Yulia Tymoshenko, then got out of jail for criminal embezzlement of state property, she expressed the logic of power shared with the US regarding Russia. She says without denial of the words: "take up arms and go and wipe out these damn katsaps" [Russian minority] ---so that not even scorched earth would be left of Russia." Yet in every Western media of record, it is Russia who remains "the aggressor", "the growing threat", "the source of the rising crisis", and "the out-of-control power that must be stopped".

There are exact thought governors at work throughout. I have analysed these structures of delusion in learned journals as 'the ruling group-mind' (collectively regulating assumptions that are false but taken for granted) and, sustaining it, the 'argumentum ad adversarium' (the diversion of all issues to a common adversary). The "escalating crisis in Ukraine"

Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis expresses these fallacious operations in paradigm form. So does the false claim of "Syrian use of chemical weapons" which almost led to US bombing of Syria's civilian infrastructures a few months earlier. The mind mechanics at work form the inner logic of the lies which never stop. The grossest operations go back to the Reagan regime naming Nicaragua as "a clear and present danger to the United States" to justify US war crimes against it which in turn fed the ever-growing corporate-military complex and murderous covert operations. Always the mind-stopping mendacity and criminal aggressions are justified through the ruling groupmind and enemy-hate switch which form the deep grammar of this thought system.

At the most general level, the "Russian threat to Ukraine" diverts public attention from the really fatal problems of the world and their global causal mechanism -transnational money sequencing -which is metastasising further in Ukraine. The air, soil and water cumulatively degrade from its transnational corporate looting and polluting. The climates and oceans destabilize from the same cause at the same time. Species too become extinct at a spasm rate, and the world's forests, meadows and fisheries are cumulatively destroyed. The global food system produces more and more disabling junk as commodity diseases multiply. The vocational future of the next generations is eliminated for a growing majority of people. All these trends and more are one-way, degenerate, and undeniable. All are driven by US-led private and transnational money-sequence multiplication which now moves into and through Ukraine. Without Russia's past financial and energy assistance worth tens of billions of dollars and completely destabilized by the US-led violent coup, Ukraine verges towards collapse. That is where the Greek model comes in -the stripping of Ukraine to pay for what it has lost from Russia by the US-led coup which further enables military advance to Russia's borders.

As usual, such geostrategic intervention is life destructive at every level of its consequences, but the underlying causal mechanism is unspeakable in official culture. From Africa to Europe to the Middle East to Latin America, the unspoken master trend is systematic society destruction. Look, for example, forward and backward from the last manufactured crises geared to enable US-led destabilization to bombing -the "weapons of mass destruction of Iraq", the "genocidal plans of the dictator Gadaffi", "Assad's chemical weapons used on his own people", or, across the ocean, Venezuela's "despotism" which prioritizes the elimination of public education, healthcare and poverty elimination. Always the victim society has more developed social programs than its neighbours. The ultimate enemy is social life bases Observe the common pattern of social destruction. It begins with US covert forces sponsoring opposition forces in the society featuring fascist and jihadist terrorists, mounting global media campaigns against the targeted leader, murders committed by snipers pretending to be state agents, growing civil division and hate towards civil war, and absolutely one-sided reporting of the US point of view, and reverse-moral justifications for what ends as society destruction. The US bombing stage has not yet been reached in Syria because Russia led the alternative of UN chemical-weapons destruction, even though Syria had never used the weapon. Not long after destroying Iraq and Libya on known false pretexts, the US proclaimed again and again the mass-murderous gas used in Syria was by "Assad the war criminal" although the evidence kept disconfirming the big lie mega-phoned by John Kerry. It went all the way to a White House plan to bomb civilian infrastructures as in Iraq and Libya. In revealing contrast, Russia "the world bully" has never bombed a city. Yet US reverse projection rules. As for Assad's "war crime", the truth found by multiple analysis was that "kitchen sarin" manufactured in Turkey and crude-missile lobbed by the al Nusra jihadists allied with the US and funded by Saudi Arabia and Qatar was the source of the gas massacre (as Seymour Hersh has finally made public).

Much the same generic script of engineered civil conflict and war combined with false threat and crimes of the constructed foreign enemy has been used over and over again against Iran and its "nuclear threat" with no evidence, while Israel has an illegal stockpile of them threatening to use them to stop Iran's "nuclear threat". In all, the reverse-projection tactic has become the signature of everything the US and its allies allege of others to ruin them.

Ukraine in Motion as Another Paradigm Example of US-led Society Destruction

Serial false allegations and pretexts thus unfold again against Russia in regard to Ukraine. The US-led mayhem and violence varies widely, but the dots have not yet been joined on what is always achieved beneath the political-ideological shows -the tearing apart and

Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis dispossession of one society after another by US-led financial and armed means. Here it is Ukraine and the set-up of Russia at once. Not only is the society decapitated, as in Ukraine or Libya or Iraq or as demanded in Syria. That is the official script. Much more deeply the society's civil bonds are rent asunder, its productive base is sabotaged, its social life supports are stripped, its environment and resources looted and its future despoiled. Always. There is no objective fulfilled except social life-system destruction. But the connections still go unmade. As General Rick Hillier, commander of Canada's forces helping to bomb Libya said afterwards: "We did it because we could". As CIA executive director Buzzy Krongard acknowledges about the permanent US war, but still without the consequence named: "It will be won by forces you do not know about, in actions you will not see, and in ways you may not want to know about".

The supremely evil truth becomes testable by its continuous repetition. Dismantling or destroying society's very life bases is the innermost meaning of US-led "freedom" and "globalization". It includes even US society itself by ever more monstrous misallocation of public resources away from what serves life bases to what deprives them. If one reviews the post-1980 trajectory of ruin of nations, the objectively evil pattern becomes clear. No other actually working goal has been achieved since the Reagan-Thatcher turn. It is the DNA of the global cancer system. Try to think of exception. Since the war-criminal destruction of povertyridden Nicaragua's new schools and clinics by the signature method of covertly US funded and armed forces within, the society-destruction method has only grown and multiplied by terrorist as well as financial means. When Obama says "every society must chart its own course", he follows the reverse moral syntax at work. The deliberate mass-diseasing of 500,000 children in the first manufactured crisis of Iraq as the nearby Soviet Union collapsed revealed what we could expect from the US without another superpower to contain it. In all cases, there has been one underlying principle of outcome -US-led civil disintegration of societies across the world. That is how a cancer works at the transnational level of life organization.

Engineering civil war is the favored method with effective genocide the long consequence. This is true not only in Afghanistan, Iraq, Libya, Lebanon, and Syria, but Somalia, Sudan and the Congo. Direct US invasion may lose the war from Vietnam to Afghanistan, but its defeat is, more deeply, another US-led success at destroying another society. The Wall Street metastasis to EU banker-run Europe has worked without invasion or even proxy uprising, but society destruction is still achieved by the small print of corporate treaties and bank powers

Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis people never see. Greece, Spain and Italy are effectively ruined, and behind the dismantling of these and all victim societies is the same transnational corporate system multiplying itself through societies. Big Banks, Oil, Military Contracting, Big Agri-Food and Pharma are themselves only vehicles of the one underlying economic disease of transnational money sequences self-multiplying across all borders without life limits or functions. They feed on ruined societies as their carrion.

Ukraine follows this macro pattern. It comes into the fold of the EU through a US-led fascist coup posing as "freedom" and "revolution", but in fact hollowing out the society's lifeblood and bases as the US-led coup and EU financial straitjacket suck it dry. This is the unseen law of transnational money-demand multiplication to the top. In Ukraine the method features similar tools -increasingly armed and destructive oppositional forces on the ground, US bankrolling and direction of the opposition's factions in orchestrated destruction ($5 billion under aid guises, $20 million for the street reported by Secretary Nuland in a speech to business), and pervasive transnational corporate propaganda about the constructed civil war as a "struggle for Ukraine's freedom" -decoded, transnational corporate and bank freedom to loot and pollute. As always, inside allies include fascist and terrorist forces -the Svoboda and Pravy Sektor factions in Ukraine which now have key executive posts in the coup government and trace their history back to the Ukraine Insurgent Army (UPA) led by their hero Stephen Bandera who allied with the Nazi invasion of Ukraine in 1941 and helped to round up Jews.

The worst is yet to come. Never is there any US building of the victim society's economy and life support systems, and so too Ukraine. Again we might compare Russia here to the US in Afghanistan over 14 years. The self-multiplying corporate money sequences which reap all gains have no committed life function or obligation including to the imperial state itself. They pay ever fewer taxes to it, and bleed ever more public money and resources from it. There is only one pattern of consequence and Ukraine too is now almost occupied by its ruling mechanism to impoverish the people further to feed the rich. As always, society's common life capital bases will be further defunded, privatized for profit, and saddled by unpayable transnational bank debts. The real economy will be flooded with more junk foods, media products and social-dumping commodities, and bred to a violence culture already hatched by the coup. Collective life capital bases will be further laid waste for multiplying private money fortunes across borders.

Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis

The Life-Blind Thought System Behind Global Society Destruction

Since using the spectacular 9-11 event as pretext for the new PNAC plan of "full-spectrum domination", falling on the anniversary of the destruction of Chile's society in 1973, the U.S. has been on a non-stop crusade of destroying societies across the world. The hollowing out of social bonds and bases includes the US itself. Its impoverishment grows as non-productive riches multiply at the top, middle classes fall to ever new levels of debt, the growing majority of youth is without a future, public squalor spreads across the land, and over 2000 million dollars a day is spent on armed force threat and operations with no real enemy to justify them.

It all goes back to first principles. "There is no such thing as society" declared the fanatic Friedrich von Hayek who was mouth-pieced by his disciple Margaret Thatcher. "We owe our very lives to capitalism". But deeper than words, the principle of no-society is built into the ruling economic paradigm. Without notice, every life coordinate is erased from account. There are no life needs, no environment, no society, no children, no relations with others, and no history in this life model. All unpriced life goods from water and sewer infrastructures and services to universal public education, culture and healthcare to social security support in age, unemployment, and disability are blinkered out except as "cost burdens". The very terrestrial biosphere on which everything depends is ruled out of this moronic frame of reference. Demand itself is never people's needs or necessity. It is private money demand minted by private banks without the legal tender to back it to indebt the great majority and to gamble on their future means of life. 'Supply' is not the life means people require. It is ever more priced commodities for profit promoting more human and ecological ill-being as far as corporate globalization extends. Ukraine can look forward to this US-led thought system ruling over it from within the financialized European Union which is now as banker-run as America.

The ruling value mechanism can be crystallized into natural language equations: Freedom = Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis freedom for private money demand = in proportion to the amount controlled = ever less freedom for those with less of it = no right to life for those without it. Even more generally, the underlying master equations of the globalizing system now moving to rule Ukraine into Russia can be defined as follows: Rationality = Self-Maximizing Choice = Always More Money-Value for Self is Good = Self-Multiplying Sequences of Ever More Money to the Top = All Else is Disposable Means to this Pathogenic Growth. This is the innermost value logic of the US-led global system and it has no limit of dispossession and ruin if not stopped. It is perhaps emblematic irony that the favorite for Ukraine's post-coup President is a billionaire sugarcommodity maker producing no food value, but more and more obesity and diabetes.

World Empire or Globalizing Disease?

Left critics coalesce around "US imperialism" as the common cause of the global meltdown on organic, social and ecological levels. Yet it is strange to call a system an "empire" whose imperial center is increasingly hollowed out on every plane; whose interventions and wars destroy productive forces at every level; and whose outcome is not more amenities for the poor, as apologists like Leo Strauss claim, but ever more societies as black holes with life support systems cumulatively devoured. "Sometimes I think they feel like they're in a lab and they're running experiments on rats and not understanding the consequences of what they are doing," Vladimir Putin wonders in partial sense of the derangement at work.

More clearly, the states which the US planned to destroy in 2001 (as reported by General Wesley Clark in his memoirs) -Iraq, Lebanon, Libya, Somalia, Sudan, Iran and Syria -are now in fact destroyed societies. All but Iran are left with civil war and majority destitution where once they had been relatively prosperous and life secure. For example, before Western bombing of Iraq under the usual blame-the-enemy diversion to its leader (a paid CIA agent implanted in office by the US), Iraq led the Middle East in free public healthcare and higher education, and Libya provided free downpayments for young couples' housing as well prior to its bombing. U.S.-led interventions and aerial bombing have destroyed the social lifeorganization of both nations without even the electricity and water back on. Syria was also a middle-income quasi-socialist nation, but was independent, friendly with Russia, and capable

Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis of fighting an expanding Israel. So Syria too was marked for destabilization. Its internal protests received US-Israel covert support, and turned quickly into civil war with US special operation forces and orchestrated funding of rival camps including jihadists still incinerating the country. As usual the national leader is blamed for everything. All the while, Iran is periodically threatened with annihilation while Venezuela across the ocean is subjected to US-led destabilization too as in Ukraine, Syria, and Libya.

While gas bombs have been thrown freely in Venezuela and Ukraine with US support against democratically elected states, Venezuela's government serves the poor while Ukraine's has been oligarchic on both sides. Putin thus understands Ukraine's protestors as "tired of seeing one set of crooks replacing another". In contrast, no common life interest at all exists for the US. When bribes of officials, street gangs and press slander are not enough, US-led destabilization by financial system levers, covert operatives and civil war follow behind reverse-projection cover stories. One can imagine if Molotov cocktails were thrown during the Wall Street uprising as in US-financed protests in Ukraine and Venezuela. "Violencethreatening protestors" is all they can say about peaceful demonstrations at home however just the cause. Concern about people's lives, in short, never arises except as a media mask. This is why the US-led coup in Ukraine murdered people and usurped democratic process and legal warrant without a pause. It is also why it demanded the sieg-heiling violent thug Oleh Tyanybok of the Svoboda Party to be a chief advisor to the coup government although he blamed a "Muscovite/Jew mafia" for Ukraine's problems and "Germans, Kikes and other scum" who want to "take away our Ukrainian state". He is a symptom of the deep-structural derangement of US rule. In all cases -from Honduras to Paraguay, Egypt to Mali -covert funding, forces of destabilization and chaos are the modus operandi with US special operations leading the repertoire of financial destabilization, demonization of resistance, and armed civil-war training. Unlike classic imperialism, the system spreads by greed and fear, never by productive force development and universalizing rights and laws.

Invasive war in 2014 is not so acceptable to the world after the obliteration of the societies and life infrastructures of Iraq and Libya. So drones, suitcases of money, special operations, propaganda campaigns and whatever else can sabotage resistance are deployed to pry societies open for competitively self-multiplying transnational corporations to exploit foreign resources, labor and forced markets. This is known as "the free movement of private capital and commodities". Until 1991, the former Union of Soviet Socialist Republics was still the biggest block and resource treasure of all to US-led global financialization. Thus military Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis encirclement, pervasive international slander, ruinous armaments races and illegal embargoes followed for 50 years. It eventually worked to cause the intended collapse of the Soviet Union by spending it bankrupt on the armaments race, and forcing repression by perpetual war threats from richer societies. But US market magic and miracles for the world's biggest country and its neighbours did not work at all. So the GDP's of the Soviet republics fell by 60%, and polls today show that 56% of Ukrainians would prefer to be governed as before. Social priorities and universal life necessities matter more to them than majority dispossession and glitz for the rich. But no Western journalist dares say it. And so the spectacularly failed global capitalist experiment has passed without a word of notice from "the free world". It remains unspeakable to name.

Yet reality catches up. The US-led empire was itself unravelling in historical time without recognition. Its most gigantic failure has come back to haunt it -running the once relatively well-off societies of the USSR into productive and cultural ruin. "Well and good", one is taught to think. "The Soviet Union repressed free speech". But like Cuba today, a state which is continuously threatened with war, plague, assassination and hate by richer states reverts to tight control. But if one considers all the universal sciences, arts, pensions, education, and health-care provision of the Union of Socialist Republics which have been systematically destroyed, the meaning takes on a different complexion. It remains unspeakable but lies at the heart of the Ukraine-Russia crisis today. Nothing is better but only worse in collective life capital evolution.

Many prefer the language of the imperial past. In this way reality is categorized as familiar, not mutant, backward and chaotic. The repetitions are not from "tragedy" to "farce", as Karl Marx memorably observed in the case of Louis Bonaparte III of France. Today there is nothing but tragedy. It may all seem to be about oil and imperialism, what opponents focus on. Yet possessing others' oil and territory are comparatively rational objectives compared to the actual performance of metastasising destruction. Far more is spent on unproductive technologies of killing and terror than has been won in new oil and territory. Both land and energy sources have been largely despoiled and wasted. The oil produced in Iraq, for example, is not close to pre-1990 levels and the oil in Libya is the site of unending civil war. The pattern is destroying not producing through generational time. Corruption and insecurity are universalized, not life as human. Ukraine's coup now binds it in the pathological direction -more civil strife towards war, more mountains of bank debt, more lack of affordable energy, more ethnic hatred, more mass homicidal weapons, and more rot of dysfunctional wealth Can this be an advance of empire? Or is it the next sign of morbid overreach, corruption and fall? An empire has a unified center, a state in control of its subjects and private enterprises, a productive capacity that leads the societies within its imperial reach, an historical civilization of architecture, art, and culture, and most of all enduring public infrastructures and great works across its domains of command. The US global system has ever less of any of these. Its imperial center is divided into gridlock, its productive powers have been increasingly exported or surpassed elsewhere, its architecture, arts and culture are increasingly mindless and violence-ridden, its capacities of civilization and public infrastructures are defunded and collapse at every turn. The US now leads only in monopoly of world currency issue, capacities to destroy life and life conditions, and mass propaganda methods. Its transnational corporations are no longer subservient to any imperial center or purpose but multiply their private money sequences on the back of monopolies of force and money-issue paid for by increasingly impoverished citizens.

The collapsing US civilization cannot comprehend its derangement. Its money-party leaders can only see more opportunity for transnational corporate profits -the moral DNA of the cancer system. This is why the destruction of Russia has been long planned by the geostrategist Zbigniew Brzezinski -first in Afghanistan where he rallied the original jihadists to fight the Soviet Union along with tens of billions in US cash and weapons which developed into 9-11 and the 9-11 wars. In Ukraine the US continues the strategy. In Afghanistan the route to the ex-Soviet oilfields, the US funding was the beginning of the Taliban and al Qaeda forces whose US-manipulated function was and remains destroying societies by armed civil war to complement financial bleeding. This same method bled Yugoslavia and then the USSR dry and has worked from Afghanistan through Iraq and Serbian-Kosovo wars to Syria to Somalia, Mali and Nigeria under many names, but almost always it turns out the terror is manipulated by US money, arms and connections. Today Brzezinski has former Harvard graduate students who strategically game for the Obama administration to smash Russia into ungovernable pieces -the long game.

This is not an exaggerated sense of danger, but a long track record. Wrecking the society in crisis is the testable generalization of all US interventions. More exactly, the unseen law of Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis the ruling system across borders including those of the US is: Ever more public money is hemorrhaged into private money sequences with ever more ruined societies the result.

Consider Ukraine with this diagnostic principle in mind. We can predict from this system law that only more disintegration of society and mutual life support systems will occur in Ukraine with more US-EU bank and corporate feeding on the post-coup remains. US and EU countries themselves will come apart more in the process, and the US will bleed vastly more public resources to keep metastasising the unrecognized fatal disorder while 90% of its own people and the world grow poorer, more malnourished and life insecure.

US Script of Democracy and Freedom versus Facts of Violence and Society Destruction

To put the matter in one sentence, the collapse and overthrow of Ukraine's elected government has been financed and directed by the U.S, cored in violence by the Nazi roots of the uprising linked with the US-selected coup leaders now in power, and after the swift takeback of Crimea by Russia fanned into hysteria by the corporate media. Revealingly, the Bandera-loving Nazis on the street leading the chaotic terror of Feb 22-24 caused the overthrow of the legitimate government exactly when the civil battle had already been won. The elected President Yanukovych made concessions on everything -his PM was fired, the new protest laws against helmets, metal shields, and masks were revoked (even although banned everywhere else), with legitimate democratic turnover of government plainly in sight and further brokered by the EU in presidential succession. But there was no assurance of electoral victory of the US-allied Kiev forces. They had already lost two elections to the federalist Party of Regions and its alliance governments. It was then the US-led violent overthrow happened in bloodshed return of the Nazi past proclaimed as "freedom" and "revolution". The violent coup was instantly validated by the US state, but the EU paused for days before diverting blame to Russia too. No media of record appeared to notice that the US had criminally led the coup, and selected and instructed the new coup-government leaders with no vote, no election, and no public discussion. All the while the democratic referendum so abused in Crimea was never imagined for Ukraine by "the free press" and Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis "leaders of the democratic world" even when eastern Ukraine popular uprisings demanded it.

The coup was precisely rushed ahead to avoid any election. The US-backed forces had already lost two in a row. No reports mentioned this in the Free World. The track-switch of attention was instead to Russia. How could the strategy fail? If Putin draws the line at Crimea, he forwards the plan of blaming Russia. If he does not, the long game to dismantle Russia moves faster. If Putin calls a sudden referendum in Crimea to show its citizens' overwhelming support, he can be ridiculed for "the farce", "the region under military occupation", "the gun to the head". If almost all the people of Crimea want in fact to join the historic mother country in a peaceful vote, just keep repeating "Russia's annexation of Crimea", "brute force", "Russian aggression". The violent putsch in Ukraine is thus erased from view. It disappears into reverse projection. The most basic reality test is always blocked -Does the society rise or fall in life means available and produced, social life infrastructures and services, employment levels, youth life purpose, and ecological integrity after US-induced "regime change". It always falls. Is there any exception?

Crimea joining historic Russia again after it was won from the Ottoman Empire centuries ago revealingly goes the opposite way. Bridges, roads and tunnels are promised and planned in immediately in the wake of the Olympic building spree. Pensions, minimum wages and healthcare are invested in to "raise life standards". Exposure of the world to Crimea's historical treasure begins. In contrast, the opposing US-led forces silence the EU agreement for presidential succession in Ukraine, lead coup of the elected government with neo-Nazi snipers and violent chaos, direct IMF austerity and social dispossession for the people's collapsing life support systems, set the main languages, cultures and identifications of citizens into irreparable division and civil war footing, and proclaim virulently against Russia taking an opposite path.

Dividing society from within with no common or productive goal but only more tearing apart is the generic meaning -as in Yugoslavia before it, Libya and Syria in between, Honduras, Paraguay, where does it stop? Direct the destabilizing in the street with billions for the purpose, play on real and invented problems, insert special forces to lead the mounting violence, bribe the people with dollars and bananas, divide classes and cultures to the death, proclaim freedom and prosperity, and run the country into the ground with no life To complete the destruction of democratic legitimacy of Ukraine took only a few hours. But public panic and appointing banker presidents has already been managed in Italy and Greece, why not here too? With no mass media noticing the growing reversal of democracy and freedom in their name, Putin-bashing is the corporate-press game.

Media Censorship and the Violation of International Law

Crimea joining Russia was the lightning rod for the defining US operation of reverse projection, always blaming the other side for what one is doing oneself as the reason for attacking it. Since the Reagan regime made this the signature operation of US propaganda which is always repeated by the media as fact , an Orwellian rule of big lies has been normalized. Reverse projection combines with the earlier defined ad adversarium fallacy and ruling group-mind to overwhelm all reasoned understanding with cartoon-like masks of good (US) and evil (Them) where fact never interferes. Media-conditioned publics are in this way stampeded through one US-led war and civil war after another with official oppositions rationalizing the same belligerent stupefaction. With only the point of view of the US or its allies reported, only the US story line and point of view can be seen or heard by the great majority.

So too in "the Ukraine crisis". That Russia "invaded Crimea and annexed it against international law" has been the basic story for global denunciation of Russia. In fact over 80% of Crimeans voted, over three times the electorate participation in the US, and almost all of them for integration with Russia not "annexation by it". The striking fact is that given the accuracy of these figures which is not denied, it is far more than could enable Quebec to

Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis legally secede from Canada even with universal language rights lacking in Ukraine. By mathematical deduction, the referendum also included the great majority of the nearly 40% identified as Ukrainians and Tatars. How is it that all you ever heard or saw in the mass media were selected opposing voices from Ukrainian and Tatar minorities? This is the ruling censorship by unseen means -selecting out of public view all facts that are not consistent with the ruling script. More exactly, the corporate media select for public showing only what sells the transnational money-sequence system. This is why we never hear of the US placing itself above all international laws as it enforces this ruling program. Its entire record here is blinkered out a-priori. So blame of others easily enters the ruling group-mind internalized by mass media audiences

This point is worth pausing on because the US is the very "rogue state", "international outlaw", "criminal violator of human rights" and, above all, perpetrator of "war crimes" and "crimes against humanity" which it is always projecting onto other states. It has refused to ratify the International Criminal Court to uphold the law against war crimes and crimes against humanity, and publicly repudiated the Court's right to investigate US criminal violations including the "supreme crime" of a war of aggression. While it is always invoking international laws to falsely blame others of violating them (e.g., Syria's use of chemical weapons), the US has systematically undermined virtually all international laws to protect human life -treaties and conventions against landmines, against biological weapons, against international ballistic missiles, against small arms, against torture, against racism, against arbitrary seizure and imprisonment, against military weather distortions, against biodiversity loss, and against climate destabilization. Even international agreements on the rights of children and of women have been sabotaged. Yet this unrelenting profile of lawless US right to terror and destruction is nowhere published. This is how censorship by selection works without people knowing it.

What then are we to say about "Russia's brutal invasion and seizure of Crimea"? In fact the number of Russian soldiers in Crimea were fewer than agreed by contract with Ukraine long prior to the referendum. Crimea is and was also an historic Russian port and strategic peninsula even under Ukraine's interregnum, and its place in Ukraine occurred only by a 1954 decree of the now-defunct Soviet Union. All of these facts are selected out by corporate media and states which only repeat "Russian brute force", "illegal seizure of territory", "war of invasion", and even "what Hitler did back in the 1930's" (Hilary Clinton). There is no limit to the absurd hypocrisy of accusation. Thus attention is diverted again and again onto the Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis latest enemy as lawless and the US as law-abiding in contradiction to the facts.

In reality, no injury occurred in the peaceful and overwhelmingly popular integration of Crimea with Russia. Ukrainian troops yielded in peaceful transition and were extended offers to stay. There was no bloodshed with one exception -a soldier in Sebastopol murdered by two men at night in masks and a getaway car tied back to the Ukraine coup leaders. They called it "the entry into the stage of military conflict" and the corporate media reported it without evidence or question. But the sniper murders of 21 people in the Kiev uprising by USled coup agent was already diplomatically registered by March 4. Predictably, every detail was gagged in 'the free press' and the official 'Free World'. Even the EU's Foreign Minister Catherine Ashton to whom the facts of the mass murder were communicated by a fellow Foreign Minister, Urmas Paet of Estonia, remained silent. He reported that in fact the medical and forensic evidence proved all 21 murders were by "the same type of bullets" and from "the same handwriting" which could only be from "the new coalition" [of the coup government]. "The new coalition", concluded Foreign Minister Paet in English, "don't want to investigate what exactly happened. So that there is now stronger and stronger understanding that behind the snipers, it was not Yanukovich, but it was somebody from the new coalition."

Such mass murder is grounds for prosecution of war crimes and crimes against humanity under international law and prosecution by the International Court. But due process of law and criminal prosecution are repressed at the same time as the known diplomatic evidence is silenced in the public sphere. Group-mind, reverse projection and blame-the-enemy operations have become so automatic that the most important historical facts and heinous crimes do no register through their prism. Thus Russia goes on being accused of the "violations of law" and "international law" with John Kerry bawling loudest against the evidence. That the violent coup itself was propelled by mass murder of protestors perpetrated by the US-led insurrection to blame on the elected government has thus never made the news. The murderous logic was again evident in microcosm when troops of the coup state opened fire on unarmed citizens approaching their barracks to talk on the Easter eve of the Geneva agreement to repudiate armed violence. The day after the Geneva accord a worse attack exploded in Slavyansk with gunmen (named as Right Sector, the fascist armed group behind the coup whose activities the accord banned) racing up in jeeps to a checkpoint killing at least three people including a bus-driver before disappearing. As always the US-orchestrated government in Kiev projected all attacks onto Russia with no evidence.

Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian Crisis

All the while heavy Ukraine armed forces moved into eastern Ukraine blocked by citizens while Kiev's own central street still remains occupied by coup forces. "Putin's threats" continue to be manufactured along with "Russia's forcible annexation of Crimea" despite the inhabitants voting peacefully and overwhelmingly for re-unification with Russia in affirmation of a relationship over two centuries old. Altogether erased from reports are the facts that the Supreme Council of Crimea referred to the United Nations Charter and "the right of nations to self-determination" (Article 2, Chapter 1), the very right Ukraine invoked in seceding from the USSR in 1991, and the same right invoked for the separation of Kosovo from Serbia. Also erased is the UN International Court ruling in July 2010 that "general international law contains no prohibition on declarations of independence" Once again we find on closer inspection that what is proclaimed as fact and law by US leaders and allied states is yet another level of a big lie system.

Conclusion

The Ukraine crisis is another variation on the great crisis of the world -the undeclared global war of transnational corporate money sequences to multiply themselves through human societies and life on earth in the diagnosable form of an invasive cancer. Yet what is different in Ukraine is that eastern Ukrainian citizens and the world's largest nation have stood against the new metastasis across traditional borders and cultural regions. Activists with weapons and massive local support across Donetsk region hoist their own flag and demand referendum for constitutional independence from the fascist-led coup state. The elected Federal Assembly of the Russian Federation, the equivalent of the US Congress, has given unanimous approval for defense of eastern Ukraine protestors against armed assault from the coup government, already underway with NATO flexing armed power all around. Yet this time the resistance cannot be just overrun or bombed. And this time the system DNA begins to be recognized -US-led destruction of societies to ensure their servile dependency and open borders for hollowing out.

Meaning of the Ukrainian Crisisconstruction undertaken nor any life base any longer secure for 90% of the people. The special forces at work here incredibly included Israelis trained in Gaza allying with the legacy of Ukraine Nazism. But the stakes are large and undiscussed. Ukraine is the biggest land mass of Europe, a leading global grain producer, and home to newly found gas-reserves of possibly trillions of cubic feet. The US-led lockdown on all of it is clear in the new coup state. A neo-liberal banker is Prime Minister, a violence script-writer and chief aide to the Fatherland Party is President, and various neo-fascists are in cabinet positions with none elected.
Beyond the Cold-War Reprise of the Arctic Super-Powers. Decoding the Structural Meaning of the Ukrainian CrisisThe very words "Russia" and "Putin" may provoke ruling group-mind reactions pro or con, so analysis here sticks to track records, trends and policy directions -the defining past, present and future lines of system decision on both sides. What is clear now are set-point differences and shifts towards recognition of the society-destroying forces. The most visible shift has been set into motion by the overthrow of Ukraine's elected government, big-lie pretexts and serial murders in another US-made civil chaos. But Russia has moved decisively to stop it in the historical process still unfolding. The never-named enemy behind the coup and behind the collapse of evolved social and natural life systems across the planet has been blocked on the ground. Neither Putin nor Russia are a model, but like Venezuela and much of Latin America, they now stand against the invasive disorder overrunning life bases and needs in every region. The deepest issue is the US money-cancer system. In murderously destabilizing and overthrowing Ukraine's elected government and advancing towards Russia's borders in the latest metastasis, the pathogenic forces are now confronted by the world's largest country, the longest-tested army and once socialist superpower. All the lies in the world cannot overwhelm this resistance. Everywhere the US-led collapse of world life security is being decoded outside corporate states and media. The Ukraine crisis, perhaps linked to Russia-China movement from the US oil-dollar, could be a new turning point against the Great Sickness of our world.N.B. This contribution is based largely on an essay by John McMurtry published previously on GlobalResearch.ca.Share this:Share


Multiple micronutrient supplementation improves vitamin B 12 and folate concentrations of HIV infected children in Uganda: a randomized controlled trial

Grace Ndeezi
James K Tumwine
Christopher M Ndugwa
Bjørn J Bolann
Thorkild Tylleskär
Multiple micronutrient supplementation improves vitamin B 12 and folate concentrations of HIV infected children in Uganda: a randomized controlled trial
R E S E A R C H Open Access
Background: The effect of multiple micronutrient supplementation on vitamin B 12 and folate has hither to not been reported in African HIV infected children. This paper describes vitamin B 12 and folate status of Ugandan HIV infected children aged 1-5 years and reports the effect of multiple micronutrient supplementation on serum vitamin B 12 and folate concentrations. Methods: Of 847 children who participated in a multiple micronutrient supplementation trial, 214 were assessed for vitamin B 12 and folate concentrations pre and post supplementation. One hundred and four children were randomised to two times the recommended dietary allowance (RDA) of a 14 multiple micronutrient supplement (MMS) and 114 to a 'standard of care' supplement of 6 multivitamins (MV). Serum vitamin B 12 was measured by an electrochemiluminescence immunoassay and folate by a competitive protein-binding assay using Modular E (Roche) automatic analyzer. Vitamin B 12 concentrations were considered low if less than 221picomoles per litre (pmol/L) and folate if < 13.4 nanomoles per litre (nmol/L). The Wilcoxon Signed Ranks test was used to measure the difference between pre and post supplementation concentrations.Results: Vitamin B 12 was low in 60/214 (28%) and folate in 62/214 (29.0%) children. In the MMS group, the median concentration (IQR) of vitamin B 12 at 6 months was 401.5 (264.3 -518.8) pmol/L compared to the baseline of 285.5 (216.5 -371.8) pmol/L, p < 0.001. The median (IQR) folate concentrations increased from 17.3 (13.5 -26.6) nmol/L to 27.7 (21.1 -33.4) nmol/L, p < 0.001. In the 'standard of care' MV supplemented group, the median concentration (IQR) of vitamin B 12 at 6 months was 288.5 (198.8 -391.0) pmol/L compared to the baseline of 280.0 (211.5 -386.3) pmol/L while the median (IQR) folate concentrations at 6 months were 16.5 (11.7 -22.1) nmol/L compared to 15.7 (11.9 -22.1) nmol/L at baseline. There was a significant difference in the MMS group in both vitamin B 12 and folate concentrations but no difference in the MV group.Conclusions: Almost a third of the HIV infected Ugandan children aged 1-5 years had low serum concentrations of vitamin B 12 and folate. Multiple micronutrient supplementation compared to the 'standard of care' supplement of 6 multivitamins improved the vitamin B 12 and folate status of HIV infected children in Uganda.

Background

Vitamin B 12 and folate deficiency are relatively common in low income countries compared to high income countries, particularly in communities where the diet is predominantly vegetarian [1][2][3][4], where major sources of vitamin B 12 such as meat, fish, poultry, milk and fortified breakfast cereals [5] are consumed in small amounts or are not readily available. Dietary sources of folate, on the other hand, are more prevalent as they include green leafy vegetables, fruits and dried beans and peas [6]. During infancy and childhood folate and vitamin B 12 deficiency have been associated with failure to thrive, reduced physical activity and cognitive function and megaloblastic anaemia [7,8]. However many of the symptoms are non-specific and may result from a variety of medical conditions. A significant number of HIV-infected children in lowincome countries remain at risk of increased morbidity due to immunodeficiency related to HIV infection in addition to micronutrient deficiencies. Low vitamin B 12 status has been associated with poor immunological status and HIV disease progression in adults [9]. In follow up studies of HIV infected pregnant women micronutrient supplementation resulted in improved child growth, haematological indices and vitamin B 12 levels [10].

Food supplementation and multiple micronutrient fortification of foods and beverages in children with unknown HIV status living in low income countries have shown improved haemoglobin levels and concentrations of deficient micronutrients [2,[11][12][13][14].

We hypothesised that supplementation with two recommended dietary allowances (RDA) of 14 multiple micronutrients (MMS) would increase serum vitamin B 12 and folate concentrations compared to a 1 RDA of 6 multivitamin (MV) 'standard of care' supplement. We here report the baseline vitamin B 12 and folate status in Ugandan HIV infected children aged 1-5 years and the effect of multiple micronutrient supplementation on serum concentrations of vitamin B 12 and folate.

Methods

Design

The study was a randomised controlled trial conducted between 2005 and 2008 at 7 paediatric HIV clinics in Uganda. Participants were allocated to the intervention or 'standard of care' supplement in a 1:1 ratio.

Participants

HIV infected children aged 1-5 years presenting at the study clinics for follow up visits were eligible for the trial. Children who had enrolled in other studies or were unable to adhere to a regular follow up schedule and those whose mothers or guardians declined consent were excluded. There were no other micronutrient supplementation studies going on at the time so the exclusion for those who were participating in other studies was done to avoid participant fatigue and interference with procedures. Multivitamin supplementation was routinely practiced at the study clinics but this was not an exclusion criteria. Eligible participants were consecutively enrolled, assigned to the study intervention or 'standard of care' supplement and followed for one year.

The study sites have been previously described [15]. Three sites were located in the capital city of Uganda (Kampala) and these were Mulago (the national referral hospital), Mildmay Centre and Nsambya hospital. The other sites were situated in the regional hospitals in the east, south-west, central and north of the country. For logistical reasons, transport and storage, it was not possible to collect samples for biochemical tests from all the sites. Therefore blood samples for biochemical tests were only collected from the three Kampala sites. The samples were subsequently shipped to the clinical chemistry laboratory at Haukeland University Hospital, Bergen (Norway), where vitamin B 12 and folate were analysed.

The trial enrolled 847 children at all the seven study sites. Out of 705 children from whom blood samples could be stored for micronutrient tests, 261 had no sufficient samples, 230 had other micronutrient tests done or had either baseline but no result at the second sampling. Because of multiple analyses 214 children had both baseline and 6 months results for vitamin B 12 and folate concentrations. There were no significant differences in demographic and clinical characteristics such as age, sex, anthropometric measurements and other laboratory measurements like CD4 + cell count among those who had results for vitamin B 12 and folate compared to those who did not.

The study was approved by the College of Health Sciences Research and Ethics Committee, Makerere University, Kampala, Uganda; the Uganda National Council for Science and Technology, and the Regional Committee for Medical Research Ethics, Western Norway.

Cotrimoxazole prophylaxis, initiation of ART, management of common illnesses and opportunistic infections was offered using the national guidelines for Paediatric HIV care.

Intervention

The trial supplements were manufactured in powder form and packaged by NUTRISET, France using a formula that was determined by the investigators based on twice the recommended dietary intake for a 4 year old category [6]. We decided to use 2 RDA based on the fact that many children were malnourished despite routine supplementation with multivitamins. Secondly some previous studies of HIV infected adults had indicated that HIV infected persons may require multiples of RDA in order to achieve normal serum concentrations of micronutrients. Thirdly, looking at the tables of the nutritional requirements for children [6] we noted that there are 2 age bands where our participants belonged, 1-3 and 4-8 years of age. We noticed that there were minor variations in dosages of some micronutrients while others like iodine and vitamin D did not vary. We therefore decided to use the 4 year old category for our study. In addition it was easier to administer a uniform intervention. There were no similar studies in the region and there was no literature to guide us on the micronutrient status of Ugandan HIV infected children. Also there were no food composition tables based on the local foods so we could not estimate how much micronutrients children get from the usual diet. The MMS comprised of 800 mcg vitamin A, 1.2 mg vitamin B 1 , 1.2 mg vitamin B 2 , 16 mg niacin, 1.2 mg vitamin B 6 , 2.4 mcg vitamin B 12 , 50 mg vitamin C, 400 IU vitamin D, 14 mg vitamin E, 40 mcg folate, 60 mcg selenium, 10 mg zinc, 800 mcg copper and 180 mcg iodine. The multivitamin 'standard of care' supplement contained 400 mcg vitamin A, 0.6 mg vitamin B 1 , 0.6 mg vitamin B 2 , 8 mg niacin, 25 mg vitamin C and 200 IU vitamin D. The contents and formula for the MV supplement was based on the regular multivitamins supplied at the study clinics as routine care of HIV infected children. The daily dose was 4 g and this was equivalent to a levelled scoop supplied by the manufacturer. The powder was mixed with 10 to 20 ml of milk or water. The first dose of the supplement was administered at the study clinic following a demonstration and under observation by the study nurse. At the time of administering the first dose we counselled the mother on the importance of completing the dose and ensuring that the daily dose was given. Whenever the child vomited during or within 30 minutes of administering the dose a repeat dose was given. Mothers were given calendar charts and instructed to tick on the appropriate date whenever a dose was given. They would return to the clinic with the container/remaining supplement together with the calendar charts on routine follow up visits. The remaining amount of supplement was measured using a light weight scale and the level of compliance determined using the proportion of the supplement consumed against the expected. The supply for one month was 140 grams and the expected dose for 30 days was 120 grams. The remaining 20 grams was to cater for vomited doses or in case there was spillage. The mothers administered the subsequent doses from home and it was not possible to observe them. The supplements were given for a period of 6 months when the second sample of blood was drawn.

Outcomes

The outcome measures were serum vitamin B 12 and folate concentrations pre and post supplementation and factors associated with low concentrations at baseline. These were secondary objectives of the trial. Survival was assessed as the primary objective whose findings have been previously reported [15].

Randomisation and blinding

The randomisation sequence was generated using the stata soft ware in variable blocks of 4 to 20. The supplements were manufactured and packaged in 140 g plastic containers which were sequentially numbered. RB generated the randomisation sequence at Geneva and sent it to the manufacturers in France. The randomisation code was kept at Geneva and by the manufacturers. The treatment assignment was revealed upon completion of the study.

Participants were enrolled by the principal investigator and the other study doctors. The trial nurse at the study sites dispensed the supplement in serial order. The colour, consistency and odour of the intervention and 'standard of care' supplement were similar. The principal investigator, study personnel including doctors and nurses and the caretakers/participants were all blinded to treatment assignment.

Clinical and laboratory measurements

At enrolment demographic information, history of the child's illness and findings on physical examination were recorded. Non fasting blood samples were drawn for CD4+ cell count and micronutrient analysis using procedures previously described in the same cohort [15]. Vitamin B 12 was measured by electrochemiluminescence immunoassay, and folate by a competitive protein-binding assay on Modular E (Roche) automatic analyzer. The coefficient of variation for the assays was less than 5%. To determine cut off values for low vitamin B 12 and folate, we considered what other researchers have used since there were no reference values for Ugandan children. Vitamin B 12 concentrations were considered low if less than 221 picomoles per litre (pmol/L), combining both very low (<148 pmol/L) and marginal (148 -221 pmol/L) status. Concentrations equal or > 221 pmol/L was considered to be normal. Folate concentrations were low if < 13.4 nanomoles per litre (nmol/L), similarly combining both very low (<6.8 nmol/L) and marginal (6.8 -13.4 nmol/L) status. Concentrations ≥ 13.4 nmol/L were regarded as being normal [16,17].

Statistical analysis

Change in micronutrient concentrations of each participant was computed in SPSS as follows: concentration at 6 months minus concentration at baseline. Medians and their interquartile ranges were used for summarising the data. Because vitamin B 12 and folate concentrations were not normally distributed the Wilcoxon Signed Ranks test was used to measure the difference between baseline and 6 months in each group. Differences in categorical variables were tested with the Pearson chisquare or Fischer's exact test. Differences were considered significant if a two-sided p-value was less than 0.05. Multiple regression analysis was performed to examine factors associated with low vitamin B 12 or folate concentrations at baseline assessment.

Results

Baseline characteristics of participants

Other clinical and haematological findings

Eight of the 214 children had signs of neurological disease, 6 with delayed or loss of developmental milestones, 3 of whom had low or marginal vitamin B 12 status.

There was a significant increase in the haemoglobin status in both groups as shown in table 2. There was no significant change in the CD4 cell counts in either the MMS or MV group.

HAART strata and initiation of HAART during the study

Of the 44 children on HAART at enrolment, 15 (34.1%) and 10 (22.7%) had low vitamin B 12 and low folate concentrations, respectively. The prevalence of low micronutrient status of these two was not significantly different between the HAART and non-HAART treated children. Of the 170 HAART naïve children, 21 started HAART during the study; 13 in MMS and 8 in MV group. This difference was not significant, p = 0.35. Seven of the 21 children who initiated HAART during the study had low vitamin B 12 concentrations at enrolment.

Factors associated with low vitamin B 12 or folate concentrations

Vitamin B 12 status was not closely associated with most of the baseline characteristics (Table 3). However being male, age less than 24 months and a haemoglobin < 11 g/dl were associated with low folate concentrations. At multivariate analysis only age and the male sex remained significantly associated with low serum folate concentrations.

Discussion

This paper describes the vitamin B 12 and folate concentrations of HIV-infected Ugandan children aged 1-5 years and the effect of 2RDA of 14 multiple micronutrients that contained vitamin B 12 and folate versus the 'standard of care' multivitamins in 1RDA without vitamin B 12 and folate. Almost a third of the children had low vitamin B 12 and low folate concentrations at baseline. Very low serum concentrations were uncommon. MMS containing vitamin B 12 and folate improved both vitamin B 12 and folate concentrations compared to the 'standard of care' multivitamins. Vitamin B 12 and folate concentrations in our study are comparable or slightly lower than what has been reported in children living in other low-income countries [1,2,4,17]. Our findings are also comparable to what other studies in HIV infected adults reported before the HAART era. These studies showed that low vitamin B 12 concentrations were relatively common with a prevalence ranging between 10 and 35% [18][19][20][21][22].

There are few studies that have examined vitamin B 12 and folate in HIV infected children in Africa. The prevalence of low vitamin B 12 concentrations in our study was much higher than the prevalence of 5% reported in South African HIV infected children [23]. Contrary to our findings a study of HIV infected children in New York showed elevated vitamin B 12 and folate status [24]. Our study included younger children, the majority of whom were symptomatic and not on HAART compared to the New York study. In our study the lack of differences between the HAART and non-HAART stratum in baseline vitamin B 12 or folate concentrations could be explained by the short duration of HAART compared to other studies.

Twice the recommended dietary allowance of multiple micronutrients improved vitamin B 12 and folate status compared to the 'standard of care'. This is not surprising since the standard of care supplement did not contain vitamin B 12 and folate. This implies that the standard of care multivitamin is not enough and many more micronutrients may be required to correct micronutrient deficiencies. A significant number of children still had low concentrations of vitamin B 12 and folate at the end of 6 months, implying that the duration of supplementation needed to be extended.

Low vitamin B 12 could be related to folate deficiency or to low vitamin B 12 binding proteins. Although we did not find an association between low vitamin B 12 and white blood cell count this does exclude the possibility that low vitamin B 12 concentrations could be related to neutropenia.

We observed that there was an association between low folate concentrations and low haemoglobin which indicates that the anaemia could partly be attributed to low folate concentrations. In both treatment groups the haemoglobin improved compared to baseline levels. We could not conclusively attribute the anaemia to low folate concentrations since we did not measure red blood cell folate concentrations. Measuring both serum folate and Red cell folate would have yielded more diagnostic information of folate deficiency. However sub-normal serum folate is a useful indicator of folate status that warrants reporting. In a landscape of multiple deficiencies, such as HIV-infected children in a low-income country, there is always the potential for other deficiencies to alter the response, for instance, iron deficiency (the supplement did not contain iron). Folate deficiency has been reported in almost one in two anaemic HIV infected patients [25]. Other authors have reported associations between anaemia, gender and folate deficiency in children whose HIV infection status was not known [26].

Neither MMS nor the 'standard of care' MV improved the immunological status of the study children. In fact there was a slight deterioration in the CD4+ cell counts among the HAART naïve MMS group. This was contrary to findings of a trial in HAART treated HIV infected adults living in the USA where multiple micronutrient supplementation was associated with improved CD4+ cell count compared to a placebo [27]. The lack of effect on CD4+ cell count in our study could be explained by the natural immunological deterioration or it may be apparent due to the small numbers in the HAART group. It is also possible that the supplementation was not long enough to show an impact on CD4+ cell count since one in five children still had low vitamin B 12 and folate concentrations at 6 months of follow up. In our setting it is possible that low concentrations of vitamin B 12 and folate may be related to consumption of marginal or low levels of vitamin B 12 and folate since twice the recommended dietary intakes increased serum concentrations as opposed to the multivitamin supplement which did not contain vitamin B 12 or folate. Some authors have shown that Vitamin B 12 deficiency is rare in HIV infected persons consuming vitamin B 12 well above the recommended nutrient intakes [28]. In Uganda one third of children aged between 6 and 24 months are likely to be getting diary products in their diet and very few are likely to be getting other animal source foods [29].

We are not certain whether our findings are similar to children in the general population since we had no control group of HIV uninfected children. A study of both HIV-infected and exposed uninfected children in Brazil showed no differences in micronutrient status [30]. However another study indicated that HIV infected children had significantly lower folate levels than the reference children while vitamin B 12 was similar [31].

We were unable to measure serum homocysteine and methyl malonic acid concentrations which are more reliable indicators of vitamin B 12 deficiency because of the limited amount of blood that we could draw from the children as we had multiple micronutrients to test for. We also did not conduct absorption studies to examine the impact of malabsorption on baseline micronutrient and post-supplementation status. This paper does not describe the dietary habits of the study children and whether they had an impact on the outcome.

Conclusion

Low vitamin B 12 and folate concentrations are common in Ugandan HIV infected children aged 1-5 years. Twice the recommended dietary allowance of 14 multiple micronutrients as opposed to the 6 multivitamin 'standard of care' supplement improved the vitamin B 12 and folate status of HIV-infected children in Uganda.

Of the 214 children with both baseline and 6 months results for vitamin B12 and folate, 104 (48.6%) received MMS while the rest received the 'standard of care' MV supplement. The distribution of children by arm and strata is presented in figure 1. Males and females were equally represented. The median age (IQR) was 33.2 months (19.6 -44.4) in the MMS and 30.3(19.8 -45.5)   in the MV group. Baseline characteristics are described in table 1. There were no significant differences between the two treatment groups.Overall, 60 children (28.0%) had low vitamin B 12 concentrations less than 221.0 pmol/L, and 62 (29.0%) had low folate concentrations less than 13.4 nmol/L. Among the children with low vitamin B 12 status, 13 (6.serum vitamin B12 and folate concentrations were similar in the two groups. Following supplementation with multiple micronutrients (MMS) vitamin B 12 concentrations increased from a median (IQR) of 285.5 (216.5 -371.8) to 401.5 (264.3 -518.8) pmol/L at 6 months. This difference was statistically significant (p < 0.001). Similarly folate concentrations increased from 17.3 (13.5 -26.6) to 27.7 (21.1 -33.4) nmol/L and this difference was also significant, p < 0.001 (Table 2). There was no significant difference in the MV 'standard of care' group. Of the 44 children who were on HAART, 19 received MMS while 25 received MV. In this stratum the median (IQR) concentration of vitamin B 12 in the MMS arm at baseline was 262.0 (215.0 -342.0) compared to 453.0 (261.0 -594.0) pmol/L at 6 months, p = 0.002. The median (IQR) folate concentrations increased from 18.6 (13.8 -23.9) to 25.0 (21.3 -32.9) nmol/L, p = 0.040.Although the numbers were small these were significant differences. There was no significant difference in the MV group. Median (IQR) baseline vitamin B 12 concentrations were higher in the HAART stratum [306

Figure 1
1Study 372.8) pmol/L] compared to the non-HAART stratum [280.0 (218.0 -386.3) pmol/L], but not significantly so. Folate concentrations were almost the same [16.1 (13.5 -22.0) nmol/L] in the HAART and [16.0 (12.1 -24.9) nmol/L] non-HAART stratum. Thirteen out of 40 children (32.5%) who were on HAART had CD4+ cell percent < 25 compared to 100/159 (63.5%) who were HAART naïve, p = 0.001 (Fisher's exact test). Median (IQR) duration of anti-retroviral therapy was 9 (6.0 -14.3) months.

Table 1
1Characteristics of 214 Ugandan HIV infected children analysed for vitamin B 12 and folate by intervention groupNumber (N)
MMS n (%)
'Standard of care' MV n (%)
p-value

Sex: Male
100
49 (49.0)
51 (51.0)
>0.99

Age less than 24 months
70
33 (47.1)
37 (52.9)
0.77

Mother as carer
146
73 (50.0)
73 (50.0)
0.56
On HAART
44
19 (43.2)
25 (56.8)
0.50

Routine CTX
193
93 (48.2)
100 (51.8)
0.82

Routine MV
144
68 (47.2)
76 (52.8)
0.66

WHZ < -2
28
14 (50.0)
14 (50.0)
>0.99

HAZ < -2
113
56 (49.6)
57 (50.4)
0.89

WHO stage 3 or 4
56
26 (46.4)
30 (53.6)
0.76

CD4+ T cells < 25%
114
50 (43.9)
64 (56.1)
0.20

Elevated CRP (> 6 g/dl)
67
33 (49.3)
34 (50.7)
0.42
Low haemoglobin (< 11 g/dl)
127
61 (48.0)
66 (52.0)
0.89

Low vitamin B 12 (< 221 pmol/L)
60
29 (48.3)
31 (51.7)
0.96

Low folate (< 13.4 nmol/L)
62
25 (40.3)
37 (59.7)
0.13

MMS = multiple micronutrient supplementation
HAART = Highly active anti-retroviral therapy
CTX = Cotrimoxazole
MV = 'standard of care' multivitamins
WHZ = Weight for height z-score
HAZ = Height for age z-score
WHO = World Health Organisation
CD4+ = Cluster of differentiation 4
CRP = C-reactive protein

Table 2
2Biochemical and haematological measurements at baseline and at 6 months of supplementation by intervention group Wilcoxon Signed Ranks test was used to measure the difference between baseline and 6 months.Multiple Micronutrient Supplementation
group (n = 104)

Comparative 'standard of care' multivitamins
group (n = 110)
Measurement
Median (IQR)
P-value
Median (IQR)
p-value

Vitamin B 12 (pmol/L)

Baseline
285.5 (216.5 -371.8)
<0.001
280.0 (211.5 -386.3)
0.78

6 months
401.5 (264.3 -518.8)
288.5 (198.8 -391.0)

Change
90.5 (-0.8 -203.5)
10.0 (-73.8 -83.8)

Folate (nmol/L)

Baseline
17.3 (13.5 -26.6)
<0.001
15.7 (11.9 -22.1)
0.44

6 months
27.7 (21.1 -33.4)
16.5 (11.7 -22.1)
Change
8.0 (-0.3 -17.1)
-0.6 (-3.5 -5.8)

Haemoglobin (g/dl)

Baseline
10.0 (8.7 -11.2)
0.04
9.8 (8.8 -11.2)
<0.001

6 months
10.9 (9.4 -11.7)
10.6 (9.6 -11.7)

Change
0.3 (-0.4 -0.9)
0.6 (-0.2 -1.4)

CD4+ count (cells/μL)

Baseline
1201 (822 -1556)
0.16
1033 (728 -1406)
0.52

6 months
1039 (725 -1358)
1043 (704 -1484)
Change
-137 (-348 -254)
35 (-278 -352)

Table 3
3Factors associated with low vitamin B 12 and folate among HIV infected children in UgandaBaseline characteristics
Number N
Low vitamin B 12 status a n (%) Un adjusted OR (95% CI)
Adjusted OR (95%CI)

Vitamin B 12 status

Age < 24 months
70
19 (27.1) 0.9 (0.6 -1.5)

Age ≥ 24 months
144
41 (28.5)

Male
100
33 (33.0) 1.4 (0.9 -2.1)
1.6 (0.8 -3.1)

Female
114
27 (23.7)

Weight for height z score < -2
28
7 (25.0) 0.9 (0.4 -1.7)

Weight for height z score ≥ -2
182
52 (28.6)

Haemoglobin < 11 g/dl
127
37 (29.1) 1.1 (0.7 -1.7)
Haemoglobin ≥ 11 g/dl
87
23 (26.4)

CD4+ < 25%
114
33 (28.9) 1.1 (0.6 -2.1)

CD4+ ≥ 25%
85
23 (27.1)

On HAART
44
15 (34.1) 1.3 (0.8 -2.1)

HAART naïve
170
45 (26.5)

Routine CTX prophylaxis
193
56 (29.0) 1.5 (0.6 -3.8)

No routine CTX prophylaxis
21
4 (19.0)

Previous routine multivitamins
144
40 (27.8) 1.0 (0.6 -1.5)
No routine multivitamins
70
20 (28.6)

Folate status
Low folate

Age < 24 months
70
27 (38.6) 1.6 (1.1 -2.4)
2.2 (1.1 -4.5)

Age ≥ 24 months
144
35 (24.3)

Male
100
36 (36.0) 1.6 (1.0 -2.4)
2.1 (1.1 -4.0)

Female
114
26 (22.8)

Weight for height z score < -2
28
7 (25.0) 0.8 (0.4 -1.7)
Weight for height z score ≥ -2
182
54 (29.7)

Haemoglobin < 11 g/dl
127
45 (35.4) 1.8 (1.1 -2.9)
1.9 (0.9 -4.6)

Haemoglobin ≥ 11 g/dl
87
17 (19.5)

CD4+ < 25%
114
36 (31.6) 1.2 (0.7 -1.9)

CD4+ ≥ 25%
85
22 (25.9)

On HAART
44
10 (22.7) 0.7 (0.4 -1.3)

HAART naïve
170
52 (30.6)

Routine CTX prophylaxis
193
58 (30.1) 1.6 (0.6 -3.9)
No routine CTX prophylaxis
21
4 (19.0)

Previous routine multivitamins
144
44 (30.6) 1.2 (0.7 -1.9)

No routine multivitamins
70
18 (25.7)

a

Low vitamin B 12 < 221 pmol/L,
Low folate < 13.4 nmol/L

Ndeezi et al. Nutrition Journal 2011, 10:56 http://www.nutritionj.com/content/10/1/56 Page 2 of 9
Ndeezi et al. Nutrition Journal 2011, 10:56 http://www.nutritionj.com/content/10/1/56 Page 3 of 9
Acknowledgements and fundingWe thank the children and their mothers/caretakers without whose participation the study would have been impossible to carry out. We are very grateful to all the participating hospitals and HIV care institutions, the paediatricians and other study personnel for making this study a success.The study was carried out as part of the 'Essential Child Health and Nutrition Project in Uganda', a collaboration between the Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences and the Centre for International Health, University of Bergen. The Norwegian Council for Higher Education's Programme for Development Research and Education (NUFU) funded the study.Authors' contributions GN participated in the conception, design and implementation of the study, statistical analysis, interpretation and writing of the manuscript. JKT participated in the conception, design and implementation of the study, statistical analysis, interpretation and drafting of the manuscript. CMN participated in the design and implementation of the study. BJB participated in the design, supervised the laboratory work and drafting of the manuscript. TT participated in the conception, design and implementation of the study, statistical analysis, interpretation and drafting of the manuscript. All the authors read and approved the final manuscript.Competing interestsThe authors declare that they have no competing interests.
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Multiple micronutrient supplementation improves vitamin B 12 and folate concentrations of HIV infected children in Uganda: a randomized controlled trial. Ndeezi, Nutrition Journal. 1056Cite this article asCite this article as: Ndeezi et al.: Multiple micronutrient supplementation improves vitamin B 12 and folate concentrations of HIV infected children in Uganda: a randomized controlled trial. Nutrition Journal 2011 10:56.