Nutrition is a science which studies the relationship between diet and states of health and disease. Dieticians are Health professionals who are specialized in this area of expertise. They are also the only highly trained health professionals able to provide safe, evidence-based and accurate dietary advice and interventions.
Between the extremes of optimal health and death from starvation or malnutrition, there is an array of disease states that can be caused or alleviated by changes in diet. Deficiencies, excesses and imbalances in diet can produce negative impacts on health, which may lead to diseases such as scurvy, obesity or osteoporosis, as well as psychological and behavioral problems. Moreover, excessive ingestion of elements that have no apparent role in health, (e.g. lead, mercury, PCBs, dioxins), may incur toxic and potentially lethal effects, depending on the dose. The science of nutrition attempts to understand how and why specific dietary aspects influence health.
The human body comprises chemical compounds such as water, amino acids (proteins), fatty acids (lipids), nucleic acids (DNA/RNA), and carbohydrates (e.g. sugars). These compounds in turn consist of elements such as carbon, hydrogen, oxygen, nitrogen, and phosphorus, and may or may not contain minerals such as calcium, iron, or zinc. Minerals ubiquitously occur in the form of salts and electrolytes. All of these chemical compounds and elements occur in various forms and combinations (e.g. hormones/vitamins, phospholipids, hydroxyapatite), both in the human body and in organisms (e.g. plants, animals) that humans eat.
The human body necessarily comprises the elements that it eats and absorbs into the bloodstream. The digestive system, except in the unborn fetus, participates in the first step which makes the different chemical compounds and elements in food available for the trillions of cells of the body. In the digestive process of an average adult, about seven litres of liquid, known as digestive juices, exit the internal body and enter the lumen of the digestive tract. The digestive juices help break chemical bonds between ingested compounds as well as modulate the conformation and/or energetic state of the compounds/elements. However, many compounds/elements are absorbed into the bloodstream unchanged, though the digestive process helps to release them from the matrix of the foods where they occur. Any unabsorbed matter is excreted in the feces. But only a minimal amount of digestive juice is eliminated by this process; the intestines reabsorb most of it; otherwise the body would rapidly dehydrate; (hence the devastating effects of persistent diarrhea).
Study in this field must take carefully into account the state of the body before ingestion and after digestion as well as the chemical composition of the food and the waste. Comparing the waste to the food can determine the specific types of compounds and elements absorbed by the body. The effect that the absorbed matter has on the body can be determined by finding the difference between the pre-ingestion state and the post-digestion state. The effect may only be discernible after an extended period of time in which all food and ingestion must be exactly regulated and all waste must be analyzed. The number of variables (e.g. 'confounding factors') involved in this type of experimentation is very high. This makes scientifically valid nutritional study very time-consuming and expensive, and explains why a proper science of human nutrition is rather new.
In general, eating a variety of fresh, whole (unprocessed) foods has proven hormonally and metabolically favourable compared to eating a monotonous diet based on processed foods. In particular, fresh, whole foods provide higher amounts and a more favourable balance of essential and vital nutrients per unit of energy, resulting in better management of cell growth, maintenance, and mitosis (cell division) as well as regulation of appetite and energy balance. A generally more regular eating pattern (e.g. eating medium-sized meals every 3 to 4 hours) has also proven more hormonally and metabolically favourable than infrequent, haphazard food intake.
Agriculture developed about 10,000 years ago in multiple locations throughout the world, providing grains such as wheat, rice, and maize, with staples such as bread and pasta. Farming also provided milk and dairy products, and sharply increased the availability of meats and the diversity of vegetables. The importance of food purity was recognized when bulk storage led to infestation and contamination risks. Cooking developed as a ritualistic activity due to efficiency and reliability concerns requiring adherence to strict recipes and procedures, and also contributed to demands for food purity and consistency.
As of 2005, twelve vitamins and about the same number of minerals are recognized as "essential nutrients", meaning that they must be consumed and absorbed - or, in the case of vitamin D, alternatively synthesized via UVB radiation - to prevent deficiency symptoms and death. Certain vitamin-like substances found in foods, such as carnitine, have also been found essential to survival and health, but these are not strictly "essential" to eat because the body can produce them from other compounds. Moreover, thousands of different phytochemicals have recently been discovered in food (particularly in fresh vegetables), which have many known and yet to be explored properties including antioxidant activity (see below). Other essential nutrients include essential amino acids, choline and the essential fatty acids.
The rate of conversions of omega-6 DGLA to AA largely determines the production of the respective prostaglandins PGE1 and PGE2. Omega-3 EPA prevents AA from being released from membranes, thereby skewing prostaglandin balance away from pro-inflammatory PGE2 made from AA toward anti-inflammatory PGE1 made from DGLA. Moreover, the conversion (desaturation) of DGLA to AA is controlled by the enzyme delta-5-desaturase, which in turn is controlled by hormones such as insulin (up-regulation) and glucagon (down-regulation). Because different types and amounts of food eaten/absorbed affect insulin, glucagon and other hormones to varying degrees, not only the amount of omega-3 versus omega-6 eaten but also the general composition of the diet therefore determine health implications in relation to essential fatty acids, inflammation (e.g. immune function) and mitosis (i.e. cell division).
The state of obesity clearly contributes to insulin resistance, which in turn can cause type 2 diabetes. Virtually all obese and most type 2 diabetic individuals have marked insulin resistance. Although the association between overfatness and insulin resistance is clear, the exact (likely multifarious) causes of insulin resistance remain less clear. Importantly, it has been demonstrated that appropriate exercise, more regular food intake and reducing glycemic load (see below) all can reverse insulin resistance in overfat individuals (and thereby lower blood sugar levels in those who have type 2 diabetes).
Obesity can unfavourably alter hormonal and metabolic status via resistance to the hormone leptin, and a vicious cycle may occur in which insulin/leptin resistance and obesity aggravate one another. The vicious cycle is putatively fuelled by continuously high insulin/leptin stimulation and fat storage, as a result of high intake of strongly insulin/leptin stimulating foods and energy. Both insulin and leptin normally function as satiety signals to the hypothalamus in the brain; however, insulin/leptin resistance may reduce this signal and therefore allow continued overfeeding despite large body fat stores. In addition, reduced leptin signalling to the brain may reduce leptin's normal effect to maintain an appropriately high metabolic rate.
There is debate about how and to what extent different dietary factors -- e.g. intake of processed carbohydrates, total protein, fat, and carbohydrate intake, intake of saturated and trans fatty acids, and low intake of vitamins/minerals -- contribute to the development of insulin- and leptin resistance. In any case, analogous to the way modern man-made pollution may potentially overwhelm the environment's ability to maintain 'homeostasis', the recent explosive introduction of high Glycemic Index- and processed foods into the human diet may potentially overwhelm the body's ability to maintain homeostasis and health (as evidenced by the metabolic syndrome epidemic).
Antioxidants are another recent discovery. As cellular metabolism/energy production requires oxygen, potentially damaging (e.g. mutation causing) compounds known as radical oxygen species or free radicals form as a result. For normal cellular maintenance, growth, and division, these free radicals must be sufficiently neutralized by antioxidant compounds, some produced by the body with adequate precursors (glutathione, Vitamin C in most animals) and those that the body cannot produce may only be obtained through the diet through direct sources (Vitamin C in humans, Vitamin A, Vitamin K) or produced by the body from other compounds (Beta-carotene converted to Vitamin A by the body, Vitamin D synthesized from cholesterol by sunlight). Different antioxidants are now known to function in a cooperative network, e.g. vitamin C can reactivate free radical-containing glutathione or vitamin E by accepting the free radical itself, and so on. Some antioxidants are more effective than others at neutralizing different free radicals. Some cannot neutralize certain free radicals. Some cannot be present in certain areas of free radical development (Vitamin A is fat-soluble and protects fat areas, Vitamin C is water soluble and protects those areas). When interacting with a free radical, some antioxidants produce a different free radical compound that is less dangerous or more dangerous than the previous compound. Having a variety of antioxidants allows any byproducts to be safely dealt with by more efficient antioxidants in neutralizing a free radical's butterfly effect.
Perhaps the most rigorously tested phytochemical is zeaxanthin, a yellow-pigmented carotenoid present in many yellow and orange fruits and vegetables. Repeated studies have shown a strong correlation between ingestion of zeaxanthin and the prevention and treatment of age-related macular degeneration. Seddon JM et al. JAMA. 1994; 272: 1413-1420; Schepens Eye Institute/Harvard Medical School, Nov. 11, 2003. See http://www.mdsupport.org/library/zeaxanthin.html. Less rigorous studies have proposed a correlation between zeaxanthin intake and cataracts. Lyle, B. J., J. A. Mares-Perlman, et al. (1999). "Antioxidant intake and risk of incident age-related nuclear cataracts in the Beaver Dam Eye Study." Am J Epidemiol 149(9): 801-9; Yeum, K. J., A. Taylor, et al. (1995). "Measurement of carotenoids, retinoids, and tocopherols in human lenses." Invest Ophthalmol Vis Sci 36(13): 2756-61; Chasan-Taber, L., W. C. Willett, et al. (1999). "A prospective study of carotenoid and vitamin A intakes and risk of cataract extraction in US women." Am J Clin Nutr 70(4): 509-16; Brown, L., E. B. Rimm, et al. (1999). "A prospective study of carotenoid intake and risk of cataract extraction in US men." Am J Clin Nutr 70(4): 517-24. A second carotenoid, lutein, has also been shown to lower the risk of contracting AMD. Both compounds have been observed to collect in the retina when ingested orally, and they serve to protect the rods and cones against the destructive effects of light.
Another caretenoid, beta-cryptoxanthin, appears to protect against chronic joint inflammatory diseases, such as arthritis. While the association between serum blood levels of beta-cryptoxanthin and substantially decreased joint disease has been established, neither a convincing mechanism for such protection nor a cause-and-effect have been rigorously studied. Am J Clin Nutr, Vol. 82, No. 2, 451-455, August, 2005 (inflammatory polyarthritis); Am J Epidemiology 2006 163(1). Similarly, a red phytochemical, lycopene, has substantial credible evidence of negative association with development of prostate cancer.
The correlations between the ingestion of some phytochemicals and the prevention of disease are, in some cases, enormous in magnitude. For example, several studies have correlated high levels of zeaxanthin intake with roughly a 50% reduction in AMD. The difficulties in demonstrating causative properties and in applying the findings to human diet, however, are similarly enormous. The standard for rigorous proof of causation in medicine is the double-blind study, a time-consuming, difficult and expensive process, especially in the case of preventative medicine. While new drugs must undergo such rigorous testing, pharmaceutical companies have a financial interest in funding rigorous testing and may recover the cost if the drug goes to market. No such commercial interest exists in studying chemicals that exist in orange juice and spinach, making funding for medical research difficult to obtain.
Even when the evidence is obtained, translating it to practical dietary advice can be difficult and counter-intuitive. Lutein, for example, occurs in many yellow and orange fruits and vegetables and protects the eyes against various diseases. However, it does not protect the eye nearly as well as zeaxanthin, and the presence of lutein in the retina will prevent zeaxanthin uptake. Additionally, evidence has shown that the lutein present in egg yolk is more readily absorbed than the lutein from vegetable sources, possibly because of fat solubility. Am J Clin Nutr, Vol. 70, No. 2, 247-251, August 1999. At the most basic level, the question "should you eat eggs?" is complex to the point of dismay, including misperceptions about the health effects of cholesterol in egg yolk, and its saturated fat content.
As another example, lycopene is prevalent in tomatoes (and actually is the chemical that gives tomatoes their red color). It is more highly concentrated, however, in processed tomato products such as commercial pasta sauce, or Tomato Soup, than in fresh "healthy" tomatoes. Such sauces, however, tend to have high amounts of salt, sugar, other substances a person may wish or even need to avoid.
Probably the best practical solution is to follow mother's advice: eat your fruits and veggies.
Nutrition is very important for improving sports performance. Contrary to popular belief, athletes need only slightly more protein than an average person. These needs are easily met by a balanced diet, and the recommended daily servings are generous enough to meet these needs. Additional protein intake is broken-down to be used as energy or stored as fat. Excess protein consumption can lead to acidification of the blood and kidney problems and should be avoided.
Endurance, strength and sprint athletes have different needs. Endurance athletes may require an increased caloric intake.
Maintaining hydration during periods of physical exertion is key to good performance. While drinking too much water during activities can lead to physical discomfort, dehydration hinders an athlete’s ability. It is recommended that an athlete drink about 400-600mL 2-3 hours before activity, during exercise he or she should drink 150-350mL every 15 to 20 minutes and after exercise that he or she replace sweat loss by drinking 450-675 mL for every .5 Kg body weight loss during activity. Studies have shown that an athlete that drinks before they feel thirsty stays cooler and performs better than one who drinks on thirst cues. Sports drinks are not necessary unless endurance-type sports are performed.
The main fuel used by the body during exercise is carbohydrates, which is stored in muscle as glycogen- a form of sugar. During exercise, muscle glycogen reserves can be used up, especially when activities last longer than 90 min. When glycogen is not present in muscles, the muscle cells perform anaerobic respiration producing lactic acid, which is responsible for fatigue and burning sensation, and post exercise stiffness in muscles. Because the amount of glycogen stored in the body is limited, it is important for athletes to replace glycogen by consuming a diet high in carbohydrates. Meeting energy needs can help improve performance during the sport, as well as improve overall strength and endurance.
Meeting energy needs is a top priority for any athlete. Studies have shown that consuming carbohydrates in the period of 30 minutes immediately after termination of the activity improves and speeds up recovery period.
Research has not shown significant increases in muscle mass due to consumption of commercial protein supplements or creatine. There is indication of a placebo affect on athletes. Some health concerns have been associated with these products and due to limited government controls many products have been shown to contain a smaller percentage of the active ingredient than advertised. Adverse effects and even deaths as a result of the use of some supplements have been reported.
Underlying this research was the hypothesis that oxidative damage was the agent which accelerated aging, and that aging was retarded when the amount of carbohydrates (and thereby insulin release) was reduced through dietary restriction.
However, recent research has produced increased longevity in animals (and shows promise for increased human longevity) through the use of insulin uptake retardation. This was done through altering an animal’s metabolism to allow it to consume similar food-energy levels to other animals, but without building up fatty tissueBluher, Khan BP, Kahn CR, Extended longevity in mice lacking the insulin receptor in adipose tissue. Science 299(5606): 572-4, Jan 24, 2003..
This has set researchers off on a line of study which presumes that it is not low food energy consumption which increases longevity. Instead, longevity may depend on an efficient fat processing metabolism, and the consequent long term efficient functioning of our organs free from the encumbrance of accumulating fatty depositsDas M, Gabriely I, Barzilai N.Caloric restriction, body fat and aging in experimental models. Obes. Rev. 2004 Feb;5(1):13-9.. Thus, longevity may be related to maintained insulin sensitivity. However, several other factors including low body temperature seem to promote longevity also and it is unclear to what extent each of them contribute.
Antioxidants have recently come to the forefront of longevity studies which have included the Food and Drug Administration and Brunswick labs.
The research makes a good case that animal protein is "one of the most toxic agents" in our diets. Evidently, it's better for our bodies to break plant proteins down into amino acids and then piece them together slowly to form human proteins, versus quickly as when one eats animal proteins containing amino acids very closely matching our own needs. Also, “the richer the diet is in the kinds and amounts of nutrients and antioxidants provided by foods of plant origin, the lower the risk of chronic degenerative diseases.”
The cover article of the November 2005 issue of National Geographic is titled The Secrets of LIVING LONGER.
The article starts out with the sentence "What if I said you could add up to ten years to your life?" It's basically a lifestyle survey of three populations ... Sardinians, Okinawans, and Adventists (right here in America) ... who generally display longevity and "suffer a fraction of the diseases that commonly kill people in other parts of the developed world, and enjoy more healthy years of life. In sum, they offer three sets of "best practices" to emulate. The rest is up to you."
In common with all three groups is to "Eat fruits, vegetables, and whole grains."
The article noted that a NIH funded study of 34,000 Seventh-Day Adventists between 1976 and 1988 "...found that the Adventists' habit of consuming beans, soy milk, tomatoes, and other fruits lowered their risk of developing certain cancers. It also suggested that eating whole wheat bread, drinking five glasses of water a day, and, most surprisingly, consuming four servings of nuts a week reduced their risk of heart disease. And it found that not eating red meat had been helpful to avoid both cancer and heart disease." Searching “34,000 Seventh-Day Adventists” will take you to several interesting study related sites.
It has been discovered that people living in Southern France live longer. Even though they consume a comparable amount of saturated fats, the rate of heart disease is lower in Southern France than in North America. A number of explantions have been suggested:
Modern separation techniques such as milling, centrifugation, and pressing have enabled upconcentration of particular components of food, yielding flour, oils, juices and so on, and even separate fatty acids, amino acids, vitamins, and minerals. Inevitably, such large scale upconcentration changes the nutritional content of food, saving certain nutrients while removing others. Heating techniques may also reduce food's content of many heat-labile nutrients such as certain vitamins and phytochemicals, and possibly other yet to be discovered substances. Because of reduced nutritional value, processed foods are often 'enriched' or 'fortified' with some of the most critical nutrients (usually certain vitamins) that were lost during processing. Nonetheless, processed foods tend to have an inferior nutritional profile than do whole, fresh foods, regarding content of both sugar and high GI starches, potassium/sodium, vitamins, fibre, and of intact, unoxidized (essential) fatty acids. In addition, processed foods often contain potentially harmful substances such as oxidized fats and trans fatty acids.
A dramatic example of the effect of food processing on a population's health is the history of epidemics of beri-beri in people subsisting on polished rice. Removing the outer layer of rice by polishing it removes with it the essential vitamin thiamine, causing beri-beri. Another example is the development of scurvy among infants in the late 1800's in the United States. It turned out that the vast majority of sufferers were being fed milk that had been heat-treated (as suggested by Pasteur) to control bacterial disease. Pasteurisation was effective against bacteria, but it destroyed the vitamin C.
As mentioned, lifestyle- and obesity-related diseases are becoming increasingly prevalent all around the world. There is little doubt that the increasingly widespread application of some modern food processing technologies has contributed to this development. The food processing industry is a major part of modern economy, and as such it is influential in political decisions (e.g. nutritional recommendations, agricultural subsidising). In any known profit-driven economy, health considerations are hardly a priority; effective production of cheap foods with a long shelf-life is more the trend. In general, whole, fresh foods have a relatively short shelf-life and are less profitable to produce and sell than are more processed foods. Thus the consumer is left with the choice between more expensive but nutritionally superior whole, fresh foods, and cheap, usually nutritionally inferior processed foods. Because processed foods are often cheaper, more convenient (in both purchasing, storage, and preparation), and more available, the consumption of nutritionally inferior foods has been increasing throughout the world along with many nutrition-related health complications.
"Artificial" interventions in food production and supply:
Sociological issues:
Research Issues:
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