From Meals to Medicine
Introduction title according to scientists Davy and Davy (2019), “The amount and composition of the diet has a profound influence on disease risk.” Scientists at Tufts agree. According to the Tufts, Food is Medicine Initiative, the food system in the U.S. plays a major role in the development of chronic illness. What we eat—and don’t eat—has a complex interplay with metabolic processes and the functioning of body systems. Some foods have known deleterious effects on health (e.g., trans fats), and every food choice displaces something else in the diet. When consuming too many of foods that may damage health, we also may eat too little of foods that benefit health.
A wealth of scientific evidence points to a growing role of nutrition in mitigating the risk of illness and achieving wellness. Rather than focusing on individual nutrients or foods, Davy and Davy emphasize understanding “the impact of dietary patterns and/or overall diet quality on chronic disease risk.” Healthy dietary patterns that have received considerable investigation include the Mediterranean Diet and the Dietary Approaches to Stop Hypertension (DASH) diet. In this course, you’ll learn about the Western diet and its impact on disease risk. You’ll learn what components of foods, beyond nutrients, appear to impact health. You’ll learn more about the role of the gut microbiome, as well as specific findings related to chronic diseases. You’ll also learn about nutrigenomics and future directions for continuing research on diet and wellness. These topics have taken center stage in discussions about nutrition, and the Academy of Nutrition and Dietetics now has a professional practice group devoted to these ideas called Dietitians in Integrative and Functional Medicine.
Nutrition scientists, healthcare leaders, and legislators alike are seeking to apply what we know to advance the health of our population. Congress created a Food Is Medicine working group in 2018. University was quoted in TIME (Park, 2019) saying, “The idea of food as medicine is not only an idea whose time has come. It’s an idea that’s absolutely essential to our healthcare system.”
Objectives
Upon completing this course, you’ll be able to: meals to medicine objectives Explain why protein is essential to human nutrition. Name at least six functional food components and common food sources for each. Explain the impact of dietary patterns on the gut microbiome. Identify functional foods with benefits associated with diabetes, cardiovascular disease, cancer, and cognitive decline. Describe the concept of a food pharmacy.
• Nutraceutical
Terms to Know
Many terms are tossed around in the discussion about food as medicine. While there is not solid agreement in the professional community, here are some terms and their common definitions. female scientist looking through microscopeFunctional foods contain biologically active compounds that can impact metabolic processes and offer physiologic benefits. These can come from plant sources (e.g., lycopene in tomatoes) or animal sources (e.g., omega3 fatty acids in salmon or tuna).
is a term that describes a component of food that provides health benefits, including prevention or treatment of disease. This term does not have an ironclad definition. The coined term speaks to the pharmacological power of some food components. Typically, a nutraceutical uses one or more concentrated food components backed by clinical studies. This means it functions somewhat like a drug and may be marketed with a brand name in the same way that a pharmaceutical product is marketed. Experts such as Daliu and colleagues (2018) and Santini and colleagues (2018) acknowledge there is a grey area between food, food supplements, and drugs. Generally a component of a functional food has been extracted, purified, and concentrated
•Integrative and functional nutrition
•is based on the concept of integrative and functional medicine. This approach focuses on the whole person, with attention to causes and prevention of illness. It uses evidence-based methodologies that involve many disciplines and modalities, including whole foods, tailored supplements, and mind body modalities in clinical practice. (Dietitians in Integrative and Functional Medicine, 2019). •Some Nutrigenomics anterm emerging field of study that combines knowledge of a person’s individual people use is this interchangeably with holistic genetic make-up with nutrition science to regulate how genes are expressed. This means tailoring nutrition. dietary advice to the individual in order to prevent disease and advance wellness. •“-omics” is a related but broader term that refers to applying large amounts of data to influence the interplay of genetics with molecular biology and other sciences.
The Economic and Public Health Impact of Diet
Lifestyle choices, including dietary patterns, have a Tufts University, in its Food Is Medicine major impact on illness, according to Veselkov and Initiative, states, “10 foods are estimated colleagues (2019). They say, “With rapidly aging to cause nearly half of all U.S. deaths populations, the world is experiencing an from heart disease, stroke, and diabetes unsustainable healthcare and economic burden each year.” More specifically, they say we from chronic diseases such as cancer, have deaths from eating too much: cardiovascular, metabolic, and neurodegenerative sodium, processed meat, sugary disorders.” They note that 30-40% of cancers can beverages, and unprocessed red meat. In be prevented by dietary and lifestyle measures. addition, deaths come from eating too The National Conference of State Legislators little of: nuts/seeds, seafood omega-3s, (2019) reports that nearly half of adult Americans vegetables, fruits, whole grains, and suffer from at least one chronic condition, such as polyunsaturated fats. Tufts also concludes heart disease, hypertension, cancer, arthritis, that “diet-related disease is a leading chronic respiratory disease, asthma, or diabetes. driver of skyrocketing healthcare costs.” They explain that 75% of healthcare spending in For example, cardiovascular disease the U.S. is devoted to care of chronic conditions. In incurs $316 billion per year in healthcare addition, they say, chronic illness has an economic costs, while diabetes incurs $327 billion. They say that advances in nutrition science provides a “road-map” for improving our health and cost in lost productivity, equaling $1 trillion suggest that “the number-one cause of poor health [diet] should be the priority of the healthcare annually. system.” For example, they estimate that providing free fresh food as a treatment for diabetes can reduce the risk of serious complications by 40%. HealthDay News (2019), reporting on research from Tufts and Brigham and Women's Hospital, said, “Healthier eating could save the United States more than $50 billion a year in health care costs associated with heart disease, stroke, type 2 diabetes, and related illnesses.”
The Western Diet and Disease Consumption of ultraprocessed foods has been on an upswing, representing almost 58% of caloric intake in the U.S., according to Martinez Steele et al. (2016). In addition, people who rely heavily on ultraprocessed foods also have higher sugar intakes. Many researchers associate this dietary pattern with poor diet quality and poor health outcomes (Davy and Davy, 2019; Martinez Steel et al., 2016). For example, Canadian research (Nardocci et al., 2019) indicates that adults consuming the highest amounts of ultraprocessed foods as a proportion of their energy intake had 31%
Ultra-processed foods defined NOVA, an internationally accepted classification system, places foods in four groups based on level of processing. Ultra-processed foods are defined as industrial formulations which, besides salt, sugar, oils and fats, include substances not used in culinary preparations. These may be additives used to make food look, feel, or taste like fromscratch preparations. Examples are frozen prepared dishes, prepared sauces, dried mixes, soft drinks, chips, packaged cookies, candy, breakfast cereals, and more. “Ultra-processed” is different from “processed” foods, which are packaged, whole-food ingredients like canned beans or cheese (Rosenbloom, 2018). Zinocker and Lindseth (2018), researchers in Norway, say that “the dietary pattern that characterizes the Western diet is strongly associated with obesity and related metabolic diseases, but biological mechanisms supporting
Functional Food Components “The human diet contains thousands of bioactive molecules which modulate a variety of metabolic and signaling processes, drug actions, and interactions with the gut microbiota in health and disease,” according to Veselkov and colleagues (2019). As mentioned earlier, functional foods contain biologically active compounds that can impact metabolic processes and offer physiologic benefits. Here is an Prebiotics, probiotics: fiber and overview of some of theseDietary compounds. resistant starches, which are indigestible to humans, are called prebiotics because they serve as food for health-promoting gut flora. These proliferate in vegetables, fruits, and whole grains. Probiotics added to food or taken as supplements are live bacteria and yeasts that are considered beneficial to human health. Examples of food sources are fermented foods, kombucha, yogurt, and kefir. Synbiotics are
Functional Food Components, continued
Polyphenols: This is a large group of compounds that includes flavonoids, ellagitannins, lignans, resveratrol, and isoflavones. According to Fraga and colleagues (2019), polyphenols have a positive impact on the gut microbiota, which in turn confers health benefits. For example, they say, polyphenols in green and black tea inhibit growth of pathogenic bacteria. They also explain that flavonoids in cocoa increase production of butyrate by beneficial gut microbes. Butyrate is a metabolic byproduct of gut microbes, one of the short-chain fatty acids thought to have health benefits. Flavonoids in tea and cocoa reduce the risk for cardiovascular disease, reduce blood pressure and reduce fasting blood sugar levels, according to the Fraga group. In addition, they note that polyphenols appear to improve cognitive functioning. Food sources of flavonols (a type of polyphenol) include tea, cocoa, nuts, grapes, apples with skin, and legumes. One type of flavonoids, isoflavones, found in soybeans and other legumes, have estrogen-like effects and have been promoted for relief of menopause symptoms. Isoflavones are a type of phytoestrogen, meaning a plant-based compound that has effect similar to estrogen. In a review of the research, though, Chen and colleagues (2019) state, “There is still no consensus on the effects of isoflavones despite over two decades of