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FOOD AS MEDICINE:THE RATIONALE
By
Kevin KF Ng, MD, PhDFormer Associate Professor of Medicine
Division of Clinical PharmacologyUniversity of Miami, FL, USA
email: [email protected]
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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