Nutrition: Impact on Health and Disease

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Nutrition Impact on Health and Disease
Dean P. Jones, Ph.D. Department of
Medicine Director, Clinical Biomarkers
Laboratory Emory University School of Medicine
dpjones_at_emory.edu 4131 Rollins Research
Center X7-5970
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Self-management of health
Assessment-more options available
More exercise programs personal trainers
More dietary options
Better environmental controls
Products and help groups for risky behaviors
Supplements are available to promote healthmore
available and less costly than assessment
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Self-management of health in partnership with
health professionals
Compliance is an important aspect of health care
It is generally good for a patient to take an
active role in their own well being
Natural products and remedies are readily
available and often actively promoted through
advertising
Sometimes there is a benefit, sometimes a
beneficial placebo effect, sometimes no benefit
but no harm, and sometimes there is harm
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Nutrition is a key component in self-management
of health
Public health recommendations are based on the
principle of maximal impact for a population or
subgroup
"One-size fits all"
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Recommended Dietary Allowance
Established by Food and Nutrition Board of the
National Academy of Sciences in 1941
These nutritional standards provided reference
points to aid in planning diets to eliminate
nutritional deficiencies
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Dietary Reference Intakes
Estimated average requirement
Tolerable upper limit
Recommended dietary allowance
Risk of deficiency
Risk of toxicity
Adequate Intake
Dietary intake
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Food Guides
Intended to translate recommendations on
nutrient requirements into recommendations on
food intake
Early guides emphasized variation to avoid
nutrient deficiencies
1916 5 food groups
1943 Basic 7 food groups
1956 Basic 4 food groups Milk,
etc Meats, etc Fruits and
Vegs Grain products
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Food Guides continue to evolve
In 1979, a shift in philosophy occurred. In
addition to the Basic 4 Food Groups, which were
defined to eliminate deficiencies, a 5th group
(Fats, Sweets, Alcohol) was introduced as foods
to avoid or consume in moderation
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More recent shift Nutrition Guidelines and Food
Guides include non-nutritive components
Dietary fibers Components of food that cannot
be broken down by human digestive
enzymes. cellulose hemicelluloses lignins muci
laginous fibers Fiber is a helpful dietary
ingredient that facilitates movement of contents
through the gut and absorption of macronutrients.
An increase from about 15 g average to at
least 25g/d may be beneficial.
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The Prudent Diet Fat intake
Reduce total fat intake to 30 or less of
calories saturated fatty acid intake to less
than 10 of calories intake of cholesterol to
less than 300 mg daily.
Goals Reduce risk of atherosclerotic
cardiovascular disease, obesity and associated
risks, and certain types of cancer
Implementation Curtail consumption of oils,
fats, egg yolks, and fried and other fatty
foods. (Also, increase w-3 relative to w-6 fatty
acids.)
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Prudent Diet Fruits and Vegetables
Every day eat 5 or more servings (1/2 cup)of a
combination of vegetables and fruits, especially
green and yellow vegetables and citrus fruits.
Goals to reduce risk of atherosclerotic
cardiovascular disease, certain types of cancer,
age-related degenerative diseases, stroke help
controlweight
Implementation The goal should probably be
7-9 servings fruits and vegetables are good
substitutes for calorie-dense foods and source of
vitamins, minerals, complex carbohydrates and
fiber.
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Prudent Diet Protein
Maintain protein intake at moderate levels.
Goals to reduce risk of certain cancers and
coronary artery disease
Implementation Avg protein consumption (99 g/d)
in US greatly exceeds RDA (50-60 g/d). There are
no known benefits from diets high in animal
protein risks of high consumption is not clearly
linked to protein (as opposed to animal fat or
iron) in humans but is clearly linked in
laboratory studies. Portion size of meat should
be decreased.
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Prudent Diet Calorie Balance
Balance food intake and physical activity
to maintain appropriate body weight.
Goals Increase moderate, regular exercise to
reduce risks associated with excess weight,
including NIDDM, hypertension, coronary heart
disease, gallbladder disease, osteoarthritis and
endometrial cancer.
Implementation Cardiovascular conditioning can
be achieved with 3X15 min aerobic workouts per
week but increased duration may be needed to
effectively burn excess fat. Avoid calorie-dense
foods.
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Calorie Expenditure
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Prudent Diet
Avoid alcohol
Limit salt intake
Maintain adequate calcium
Avoid dietary supplements
Supplement with fluoride if needed
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Daily Reference Values (DRV)
Food component DRV
Fat 65 g Saturated fatty acids 20
g Cholesterol 300 mg Total Carbohydrate 300
g Fiber 25 g Sodium 2.4
g Potassium 3.5 g Protein 50 g
Based on 2000 Cal/day for adults and children
over 4 y. Children under 4, pregnant women and
nursing mothers have higher protein requirements
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One Size Fits All Nutrition Facts
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Healthy Eating Pyramid
from Willett, Eat, Drink and be Healthy
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Health Claims on Food Labels
These were prohibited prior to 1993 because of
conflict with drug regulations. As of August
1999, Federal regulations allowed claims for the
following diet-disease relationships
Calcium-Osteoporosis Sodium-Hypertension Sat.
Fat/Cholesterol- CHD Dietary fat-Cancer Fiber-Canc
er Fiber-CHD
Fruits/Vegs-Cancer Folate-Neural tube
defects Sugar Alcohols-Dental
caries Sol.Fiber Oats-CHD Sol Fiber
Psyllium-CHD
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Labeling of Dietary Supplements
Dietary Supplement Health and Education Act of
1994 defines dietary supplement and allows
manufacturers to make claims about a products
ability to affect the structure or function of
the body or to affect a persons general well
being.
The act puts the burden of proof on the FDA to
remove unsafe products. This policy is
significantly different from that required for
food additive and drug manufacturers, who must
demonstrate safety before products can be
marketed.
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Self-management of health
Most people are not interested in a
one-size-fits-all approach
Common desire is to optimize ones health for
individual needs
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Genetic Variations

• Mutations in genes affecting nutrient
  availability or utilization
• Homozygous
• Heterozygous

2. Mutations in genes affecting nutrient
function Homozygous Heterozygous
3. Polymorphisms
4. Altered gene-expression control elements
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Nutritional Habits
Coffee, tea, chocolates Food intolerances Food
allergies (egg, peanut, milk, soy, wheat, fish,
tree nuts, shellfish) Mineral supplements/imbalan
ces Vitamin excesses Artificial sweeteners Fat
substitutes Salt-cured foods Contaminated foods
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Behavioral and Health Habits
Strenuous exercise Irregular sleep habits Alcohol
consumption High Stress Smoking Drug abuse
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Environment
Ozone, particulate matter, smoke Chlorinated
compounds in drinking water Contaminated well
water Lead, asbestos, etc Solvents,
fuels Pesticides Pets Sun exposure
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Self-management of health
Goal is to optimize health
Assessment-determine needs
Adopt a balanced diet
Adopt an appropriate exercise regimen
Avoid environmental and behavioral risks
Supplementsmore available and less costly than
assessment
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Health maintenance often addresses lifes
irritations and changes with aging
Jet lag Insomnia Aching joints Stiffness PMS Skin
appearance Wrinkles Speed of Recovery
Memory loss Mental alertness Headaches Decline in
vision Fatigue Muscle cramps Allergies Viral
infections
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Natural Products Have Pharmacologic Actions
Many if not most drugs in use today were derived
from natural products separated from toxic
compounds, modified for potency, stability,
biologic half-life, specificity and safety and
delivered in defined doses

• Natural remedies are available
• Often less expensive than pharmaceuticals
• Usually less effective
• Often have greater risk

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It may be natural but that does not necessarily
mean that it is safe
With natural products, burden of proof is on the
FDA to prove that something is toxic
Product liability provides some protection
against toxic products from reputable companies
There is little or no protection from
invisible, overly zealous or unscrupulous
suppliers
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Supplements and Functional Foods
Daily multivitamin/mineral supplements Based
upon RDA
Antioxidant cocktailsusually in excess of RDA
Biochemically required compounds that are not
nutritionally required
Functional foodsconsumed for a specific function
other than nutrient content
Natural products used as therapeutic agents
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Multivitamin and Mineral Supplements
Provide a sound foundation for all who do
not consistently eat a balanced diet
Different formulas for men and women, children
and elderly Men and women past menopause do not
normally need iron supplements and excess iron
may contribute to cardiovascular disease,
degenerative diseases and cancer
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Antioxidants
Vitamin C 250-500 mg saturates renal
reabsorption Vitamin E 200-800 IU have benefits
in trials Carotenoids (Over 400
known) b-carotene gt10,000 IU vit A increases
birth defects, common supplements can contain
20,000 gt100,000 IU toxic in children Lycopene
(tomatoes) more potent antioxidant protection
against prostate cancer Lutein highest
carotenoid in retina Zeaxanthin (corn,
spinach) Cryptoxanthin (oranges)
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Antioxidants
Selenium Component of GSH peroxidase,
thioredoxin reductase dose 50-100 mg/day
gt1000/day is toxic
Zinc has antioxidant-like activity but the basis
for this effect is not clear usual dietary
intake is about 10 mg per day while RDA is 15.
Often provided in combination with Cu at a ratio
of about 101 to avoid Cu deficiency. Cu, like
Fe, is a pro-oxidant metal ion and excess Cu is
toxic. Amount of Zn given as antioxidant is
usually 15-30 mg/day.
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Antioxidants
Co-enzyme Q10 Supplements 30-60 mg/day as
antioxidant. Endogenous synthesis inhibited by
HMG-CoA reductase inhibitors and 100 mg needed
for normal electron flow in mitochondria
Lipoic acid antioxidant effects at 20-50 mg
used in Germany at 600 mg/day to treat diabetic
neuropathy
Glutathione 50-150 mg in diet may function in
epithelia and lining fluids of GI tract, upper
airways
NAC (N-acetylcysteine) Cys precursor used as
mucolytic agent in cystic fibrosis
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Antioxidants
Flavonoids (4000 known) normal diet contains
150-200 mg/day Quercetin (rutin and
hesperidin) citrus flavonoids Green tea
polyphenols Blueberries, bilberry Proanthocyanidin
sgrapeseed extract, French maritime pine
bark Curcuminfound in turmeric Silymarin--thistle
seed extract
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Phase 2 Enzyme Inducers
Broad group of compounds that induce protective
detoxification enzymes (GSH synthesis, GSH
S-transferases, quinone reductase, cystine
transport)
Cruciferous vegetables Sulforaphane in
broccoli, cauliflower, Brussels sprouts,
cabbage, kale
Allyl sulfide in garlic, onion
Polyphenols from many plants
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Biochemically required compounds that are not
nutritionally required
Creatineenergy transfer in muscle,
brain Carnitinefatty acid transfer into
mitochondria S-Adenosylmethionine
(SAMe)protection against mitochondrial damage
in alcoholics DHEAcell protection, increase
androgens Melatonin-regulation of sleep,
antioxidant Glucosamine, chondroitin
sulfatemaintain cartilage, lubricants in
joints ATP, SOD, 5-hydroxytryptamine, DNA, RNA,
inosine, lactoferrin, lecithin, NADH, etc.
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Functional foodsconsumed for a specific function
other than nutrient content
Fiberbrans (oat, rice, wheat), psyllium, guar
gum, glucomannan, etc
Fructo-oligosaccharides (FOS)promotes healthy
intestinal flora Jerusalem artichoke, endive
Cultured foods with lactobacillus
acidophilus promote healthy colonic microflora
Phase 2 enzyme inducers--Broccoli sprouts, other
cruciferous vegetable, garlic
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Neutraceuticals Off The Shelf
Gingko Biloba memory, cancer flavonoids
Ginseng fatigue, rejuvenation saponins
Kava anxiety kavalactones, cinnamic acid
Echinacea purple coneflower immune function
St. Johns Wort hypericin, antidepressant
DMSO arthritis organic solvent
Methylsulfonylmethane (MSM) metabolized in bowel
to methylated compounds that are absorbed
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Medline Citations Focused on Nutraceuticals
Gingko Biloba
Ginseng
Kava
Echinacea
St. Johns Wort
DMSO
MSM
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Self-management of health in partnership with
health professionals
The "prudent diet" provides a foundation for
health Need to distinguish good from bad in
food groups
The market for nutritional supplements,
nutraceuticals and functional foods has outpaced
the research to establish safety and beneficial
health effects for many of these products
An increasing number of options are becoming
available for assessment of specific nutritional
needs