food as medicine: the rationale

FOOD AS MEDICINE:THE RATIONALE

By

Kevin KF Ng, MD, PhDFormer Associate Professor of Medicine

Division of Clinical PharmacologyUniversity of Miami, FL, USA

email: kevinng68@gmail.com

Outline of Presentation

Food and its components

Functions of Food and nutrients

What is a nutrient and its functions

Effects of lack of nutrients: malnutrition

Laboratory tests

Origin of food as medicine

What constitutes “Food as medicine” diet?

Nutrient recommendation RDI, RDA, AI, UI, DV

Diet Plans

Prevalence malnutrition in US

Causes of nutrition deficiency

Disorders of mineral and vitamin deficiency

Why USDA recommends increase intake of vegetables and fruits

Evidence from population studies: risk reduction, health benefits

Conclusions

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What is Food and What is Medicine ?

Food: a nourishing substance that is taken into the body to sustain life, provide energy and promote growth.

Medicine: the science or practice of the diagnosis, treatment and prevention of disease.

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“Let food be thy medicine and

let medicine be thy food”

Hippocrates

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Components of Food in a 2,000 calorie dietaverage daily food requirement

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Functions of Food, Nutrients & Water

Food

Allow body to function

Maintain health

Prevent disease

Maintain cell integrity

Nutrients Water

Provide energy

Promote growth

Regulate body functions

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What is a nutrient?

a substance that provides nourishment

essential for growth and the

maintenance of life.

"fish is a source of many important

nutrients, including protein, vitamins, and

minerals"

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Primary Functions of 6 Major Nutrients

Nutrient Primary functions

Water transport of nutrients, removes waste, temperature regulation

Carbohydrate provides energy

Protein growth and development, hormones, enzymes, anti-bodies, etc.

Fat energy storage, insulation

Minerals bone and teeth formation, nerve and muscle functions

Vitamins precursors to cofactors in vitamins or acts as coenzymes themselves

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Human Essential Nutrients(nutrients that body needs from external sources)

http://ajcn.nutrition.org/content/75/5/951.2.full%2211/12/2017

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Effects of lack of nutrients: malnutrition

malnutrition inflammation disease

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The Vicious Cycle of Undernutrition and Infection

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Laboratory Assessment of Malnutrition in Adults

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Food as Medicine: the origin

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Sheng Nong (ca 2695 BC): Father of

Chinese Medicine

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Hippocrates (460-370 BC):Father of

Western Medicine

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Some Healing plants and Herbs used by

Hippocrates (460-370 BC)

Rosemary

Thyme

Mint

Fennel

Caraway

Rose

Cinnamon

Clove

Anise

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Question: What constitutes a

“Food as Medicine” diet?

Answer: An adequate intake of

water, carbohydrate, protein, fat, fiber,

minerals, vitamins and Phytonutrients

based on Dietary Reference Intake

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Nutrient Recommendations: Dietary Reference Intakes (DRI)

Institute of Medicine

National Academy of Science

● Adequate food intake

● Nutrition

● Health

Recommended Dietary Allowance (RDA) for 97-98% healthy people

Adequate Intake (AI) level: not adequate for RDA but assumed

to ensure nutritional adequacy.

Tolerable Upper intake Level (UL) for vitamins and minerals

Office of Dietary Supplements: Daily Value (DV) regulated by FDA

Food and Nutrition Board

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List of Diet Plans

USDA recommended diet

Mediterranean diet

Atkins diet

South Beach diet

Dash diet

Crash diet

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Nutritional elements in the periodic table

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https://en.wikipedia.org/wiki/Mineral_(nutrient)

(14)

13 Essential Vitamins

9 Water soluble vitamin

Vitamin B1 (Thiamine) ...

Vitamin B2 (Riboflavin) ...

Vitamin B3 (Niacin) ...

Vitamin B5 (Pantothenic acid) ...

Vitamin B6 (Pyridoxine) ...

Vitamin B9 (Folic acid) ...

Vitamin B12 (Cobalamin) ...

Vitamin H (Biotin)

4 Fat soluble vitamin

Vitamin A

Vitamin D

Vitamin E

Vitamin K

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% of nutrients in a 1800 calories diet

carbohydrate 45-65% 201-291 g

protein 10-35% 47-157 g

Macronutrients fat 20-35% 40-70 g

fiber 25 g

Nutrients Water

vitamins (11) % daily value 0.01 g

Micronutrients minerals (18) % daily value 12.0 g

phytochemicals (>5,000) % daily value???

http://healthyeating.sfgate.com/daily-amounts-carbs-fat-fiber-sodium-protein-4230.html 11/12/2017

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What are the problems due to malnutrition?

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Prevalence of Malnutrition in the United States

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Percent of population with usual intakes below

estimated average requirement (EAR) 2015

https://health.gov/dietaryguidelines/2015-scientific-report/06-chapter-1/d1-11.asp

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Comparison of calorie intake and

micronutrient sufficiency in Diet Plans

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905334/

Disorders caused by Vitamin Deficiency

VITAMIN DISEASE

Vitamin A Night blindness

Vitamin B₁ Beriberi

Vitamin B₁₂ Megaloblastic anemia

Vitamin C Scurvy

Vitamin D Ricketts, Osteoporosis

Vitamin E Nerve and muscle damage

Vitamin K Hemorrhage

Folic acid Megaloblastic anemia

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Disorders caused by Mineral Deficiency

NUTRIENT DISORDER

Sodium Hyponatremia

Potassium Hypokalemia

Calcium Tetany, osteoporosis

Magnesium Muscle weakness, insomnia, memory loss

Iron Anemia

Iodine Hypothyroidism, goiter

Chromium Diabetes, hypertension, hypercholesterolemia

Zinc Acrodermatitis enterpathica

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Major causes of Nutrient Deficiency

Malnutrition (lack of intake)

Drug-nutrient interaction : ● decreased nutrient absorption (alcohol,

laxative, colchicine, neomycin)

● mineral depletion (alcohol, diuretics,

antacids, aspirin)

● Vitamin depletion (vitamin antagonist, contraceptive)

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Drug-nutrient interactions

https://www.diet.com/g/nutrientdrug-interactions11/12/2017

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Drug-nutrient interactions (continued)

https://www.diet.com/g/nutrientdrug-interactions11/12/2017

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Why USDA recommends increased intake of

Vegetables and Fruits?

https://naldc.nal.usda.gov/naldc/download.xhtml?id=46104&content=PDF11/12/2017

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Introduction of micronutrients into a 2,000-calorie diet:

minerals, vitamins and phytochemicals

Introduction of minerals and vitamins Introduction of phytochemicals

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Percent Daily Value (DV) on the Nutrition Facts label

“Daily Value (DV)” is a term used and set by the FDA. It replaced the FDA's term “US RDA”. ... The

Institute of Medicine has been releasing new reports called Dietary Reference Intakes (DRIs). The report

sets recommended dietary allowance (RDA), adequate intake (AI) and upper intake levels (UL) for

vitamins and minerals. 11/12/2017

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Evidence in support of risk reduction in disease

by fruit and vegetable

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Vegetables and fruits in the prevention of chronic diseases:

meta analysis

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419346/11/12/2017

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What makes whole vegetable and fruit

beneficial for good health?

Minerals

Vitamins

Fiber

Phytochemicals ?

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What are phytochemicals?

Phytochemicals are bioactive substances

found in plants.

Phytochemicals are found in roots, barks,

stems, leaves, flowers, fruits, nuts, seeds.

Phytochemicals protect plants from microbes

Phytochemicals are beneficial for health.

Phytochemicals are not vitamins.

Phytochemicals are non-essential nutrients.

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Bioactive functions of phytochemicals

Anti-inflammatory

Anti-oxidant

Anti-aging

Anti-cancer

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Population studies on health benefits of

fruit and vegetable

Hung HC, Joshipura KJ, Jiang R, et al. Fruit and vegetable intake and risk of

major chronic disease. J Natl Cancer Inst. 2004;96(21):1577-1584.

World Cancer Research Fund/American Institute for Cancer Research.

Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global

Perspective. Washington, DC: American Institute for Cancer Research,

2007.

Slavin JL, Lloyd B. Health benefits of fruits and vegetables. Adv Nutr.

2012;3(4):506-516.

US Department of Agriculture Nutrition Evidence Library.

http://www.nel.gov/search.cfm?keywords=fruits+and+vegetables

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Current status of Phytochemicals

More than 5,000 phytochemicals have been identified with more to come.

Phytochemicals are non-essential micronutrient but beneficial to health.

Isolated Phytochemicals appear to act differently from intact botanical

products.

Network pharmacology shows that phytochemicals act synergistically.

USDA has not established the Dietary Value of phytochemicals yet.

USDA recommends phytochemicals to be derived from whole vegetables

and whole fruits.

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Conclusions

Food as Medicine is known more than 5000 years ago.

Nutrients in food are essential for energy, growth and health.

Lack of nutrients is a cause of inflammation and diseases.

Phytochemicals emerge as recent micronutrients.

Food as medicine requires adequate intake of essential nutrients :

carbohydrate, protein, fat, fiber, water, minerals, vitamins and phytochemicals.

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Any Questions?

Contact

Kevin KF NG, MD, PhD

Email: kevinng68@gmail.com

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