Food as medicine,rationale, origin, lack of nutrition, disorders of nutrient deficiencies, diet plans, introduction of minerals, vitamins and phytochemicals into diet

1. FOOD AS MEDICINE:
THE RATIONALE
By
Kevin KF Ng, MD, PhD
Former Associate Professor of Medicine
Division of Clinical Pharmacology
University of Miami, FL, USA
email: kevinng68@gmail.com

2. 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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3. 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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4. “Let food be thy medicine and
let medicine be thy food”
Hippocrates
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5. Components of Food in a 2,000 calorie diet
average daily food requirement
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6. 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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7. 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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8. 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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9. Human Essential Nutrients
(nutrients that body needs from external sources)
http://ajcn.nutrition.org/content/75/5/951.2.full%22
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10. Effects of lack of nutrients: malnutrition
malnutrition inflammation disease
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11. The Vicious Cycle of Undernutrition and Infection
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12. Laboratory Assessment of Malnutrition in Adults
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13. Food as Medicine: the origin
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14. Sheng Nong (ca 2695 BC): Father of
Chinese Medicine
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15. 11/12/2017
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16. 11/12/2017
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17. Hippocrates (460-370 BC):Father of
Western Medicine
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18. Some Healing plants and Herbs used by
Hippocrates (460-370 BC)
 Rosemary
 Thyme
 Mint
 Fennel
 Caraway
 Rose
 Cinnamon
 Clove
 Anise
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19. 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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20. 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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21. 11/12/2017
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22. List of Diet Plans
 USDA recommended diet
 Mediterranean diet
 Atkins diet
 South Beach diet
 Dash diet
 Crash diet
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23. Nutritional elements in the periodic table
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https://en.wikipedia.org/wiki/Mineral_(nutrient)
(14)

24. 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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25. % 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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26. What are the problems due to malnutrition?
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27. Prevalence of Malnutrition in the United States
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28. 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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29. Comparison of calorie intake and
micronutrient sufficiency in Diet Plans
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905334/

30. 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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31. 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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32. 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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33. Drug-nutrient interactions
https://www.diet.com/g/nutrientdrug-interactions
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34. Drug-nutrient interactions (continued)
https://www.diet.com/g/nutrientdrug-interactions
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35. 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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36. 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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37. 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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38. Evidence in support of risk reduction in disease
by fruit and vegetable
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39. Vegetables and fruits in the prevention of chronic diseases:
meta analysis
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3419346/
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40. What makes whole vegetable and fruit
beneficial for good health?
Minerals
Vitamins
Fiber
Phytochemicals ?
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41. 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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42. Bioactive functions of phytochemicals
Anti-inflammatory
Anti-oxidant
Anti-aging
Anti-cancer
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43. 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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44. 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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46. 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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47. Any Questions?
Contact
Kevin KF NG, MD, PhD
Email: kevinng68@gmail.com
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