Nutrient and food based approaches to health

FNN302

Nutrient based reccommendations

• often used to assess health potential of individual foods for nutrition policy

• reductive (focusing on only one part)

• emphasis on specific nutrient targets/recommendations

• prevention of specific deficiencies

• often focuses on fortification/supplementation to target specific health outcomes

• Examples

  • fibre, sat fats, sodium

Food/dietary pattern based

• basis of dietary guidelines around the world

• integrative focus on the whole

• recognizes synergies between nutrients within foods

• emphasis on whole foods and dietary patterns

• takes into account other preferences and culinary habits/traditions

• Examples:

  • mediterranean, DASH

Nutrient-nutrient interactions

• influenced by complex structures and or form

  • chemical form/structure

  • processing

  • nutrient structure (folate vs folic acid)

  • Supplements vs food based

  • timing of meal consumption

• anti-nutrients

• may be unidirectional or bidirectional

Enhancers of iron bioavailability

• vitamin C → non-heme iron

  • makes ferous iron from ferric iron

• Copper → Iron mobilization (Hephaestin, ceruloplasmin)

• Vit A → absorption, mobilization, use

  • deficiency → iron deficient anemia (microcytic)

Inhbitors of iron absorption

• Calcium → effects transient

  • those treated for iron-deficiency should take into account

• Zn → 2:1 ratio Zn:Fe supplements

  • possible transporter competition

Zn supplement and iron absorption

• may reduce intestinal absorption of non-heme iron if co-ingested in 2:1 ratio of Zn:Iron with supplements but likely not when mixed with food

• 2:1 ratio of iron:zinc but can also inhibit the absorption of zinc

• too much of either will impac tthe absorption of the other one

Vitamin A and iron

• involved in iron absorption, mobilization and utilization

• deficiency → causes iron to accumulate in lier and spleen, decreased availability for erythropoiesis

  • result decreased plasma iron Hb and hematocrit

• deficiency leads to iron-deficiency anemia (microcytic anemia) → needs to be treated with vitamin A supplementation

Calcium and iron

• transiently decreases iron absorption

• promotes the temporary reoocation of ferroportin to the cytosol

• context matters

  • could be a concern if someone is iron deficient and consuming large calcium doses + iron

Calcium and vitamin D bi-directional effects

• Ca2+ absorption: TRPV6, calbindin, Ca2+-ATPase

• Ca2+ mobilization: eg. Regulation by PTH

• Vit D activation

• bone homeostasis osteoperosis

Calcium forms

• supplemental form of calcium salts impacts nutrient absorption/interaction

  • Ca-carbonate → requires stomach acid for absorption

    • most affected by acidic foods

  • Ca-citrate → less affected by stomach acid

    • good for people with limited Gi acid production

  • Ca-phosphate → contains calcium and phosphorous

    • may be appropriate for people with phosphate deficiency

Substances that enhance calcium absorption

• vitamin D

• sugars and sugar alcohols

• protein

Substances that inhibit calcium absorption

• oxalic acid

• phytic acid

• fibre

• excessive divalent cations

• unabsorbed fatty acids

Nutrient enhancing urinary calcium excretion

• sodium

• protein

• caffine

Nutrient absorption may be inhibited by excessive calcium

• phosphorous

• iron

• fatty acids

Zinc bidirectional effectson copper

• zn stimulates metallothionein whcih can lead to copper deficiency

• has a greater affinity for Cu

Anti-nutrients

• nutrients naturally found in plant based foods can interfere with absorption and use of other nutrients in the body

• can have positive and negative impacts on the body

• usually only problematic if they have prolonged exposure to excessive intakes

Oxalates

• green leaft vegetables, tea, legumes, nuts

• bind to minerals (Ca, Iron, Zn) and make insoluble salts which inhibit absorption

• absorbed may contribute to calcium-oxalate kidney stones

Tannins

• tea, coffee, fruit, legumes, whole grains

• inhibit iron absorption

  • negative impacts on iron stores

• possible health benefits:

  • polyphenols-antioxidants

  • anticancer

  • cardioprotective

Phytates

• seeds, nuts, grains, legumes

• bind to minerals and make insoluble salts (Zn, Ca, Mg) and prevent absorption

• Possible health benefits

  • antioxidant, anticancer activity

  • may help lower blood glucose and cholesterol

Lectins

• legumes, seeds, nuts, fruits and vegetables

• interfere with absorption of minerals (Ca, Fe, Ph, Zn)

• In high amounts can be harmful-link to increased gut permeability and autoimmune diseases

  • shown potential in anticancer treatment

Minimizing antinutrient risk

• method of cooking and food prep

  • reduce by soaking, boiling and steaming

  • tannins reduce by peeling skin

• Meal timing

  • eg. for tannins- drink tea between meals, instead of with meals

  • eg. consider timing calcoium supplements + high fibre wheat bran cereal containing phytates

  • avoid eating large quantities of antinutrients in one meal

• Increase meal variety and have balanced diets throughout the day

Reductionist approaches in nutrition are limited

• variable nutrient absorption

• food context matters

• timing matters

  • Because of this it is hard to use nutrient approaches in nutrition

When imbalance occurs it causes

• impacts stress management/metabolic response

• impacts energy levels

• impacts food choices/decisions

• impacts chronic disease risk

Comparison of macropatterns of 14 popular name dietart programmes for weight and cardiovascular risk factor reduction in adults - systematic review

• Compared the effectiveness of popular dietary programs for weight loss and CVD risk reduction

• Main findings

  • all diets had similar effects at 6 months vs normal diet on weight loss

  • at 12 month follow up

    • weight reduction diminished for all diets

    • improvements in CVD risk factors disappeared

    • mediterranean diet still showed benefits for LDL cholesterol reduction

Chronological age

• how old you are based on time

Biological age

• how old your body is physically

• can be effected by lifestyle

  • positive: exercise, everyday activity, sleep, nutrition, relaxation

  • Negative: sedentary behaviour, lack of sleep, smoking, fast food, strress

Measurements of biological age

• Telomere shortening can happen with cellular death

• Chemical parameters:

  • blood biochemistry

• Molecular and genetic markers

  • transcriptome-based age predictors

  • peripheral blood proteome-based prodicters

  • metabolone based predictors

  • t-cell DNA rearrangements-based age predictor

  • microbiome based age predictors

• Epigenetic clocks

  • DNA markers that show changes

Paper: DNA clocks of methylation and the effects of vitamin D, omega 3 and exercise

• looked at baseline blood measures of DNA methylation

• Had groups of omega 3 supplements, vitamin D supplements, at home exerciese or a combination

  • 3 year follow-up appointments

• Showed results from the supplementation and combined with exercise than only one

• MAIN FINDINGS

  • Omega-3 was most consistant aging reduction across clocks

  • additive benefits of vitamin D + 30 mins of exercise 3x a week

  • 3 treatments together slowed aging by a couple months

  • cannot make conclusions abotu lifespan or health span

Daily multivitamin study results

• slowed ticking of epigenetic clocks

• 2 year intervention of multivitamin showed results on 2/5 epigenetic clocks

  • modest delay in biological aging especially in biologically older individuals

  • cannot tell you things about lifespan

You cant out run a bad diet study

• prospective cohort study on 350,000 people in the UK followed for 11 years

• examined independent and interactive associations of physical activity, diet quality with outcomes of disease and mortality

  • risk is associated with

    • low PA and low diet

    • Moderat to low PA and low diet quality

    • Low PA and high diet quality

    • Moderate to vigorous PA and high diet quality

• Main findings

  • Compared to highest risk combo the others has a 14% lower risk of disease

  • combinations with lowest risk were good activity and good diet

  • high diet quality did not offset lack of PA

  • High PA did not counteract effects of poor diet on mortality risk

Diet diversity impacts

• total diet diversity lowered risk of all-cause mortality and was inversely associated with incident cancer

• diversity across healthy foods

  • inversely associated with all cause mortality

• Diversity within fruit and veg had no major outcomes

  • all that mattered was having fruits

Key points on diet

• diet/lifestyle for health and weight loss was unrealted to specific dietary patterns

  • more with the ability to sustain the dietary pattern

    • strongly impacted by social and environmental support

• Variety and balance are critical

  • minimize nutrient-nutrient interactinos

  • avoid toxicities and eficiencies

  • may override the impact of diets that restrict macronutrients

• How does recommeneded dietary pattern impact cultures

• Sleep + exercise + diet are all important