For some it’s an attractive prospect to think that there’s a relatively simple explanation for every disease and condition with a linear process from a gene, virus or bacteria, which can be healed with a prescription drug. While this is certainly vital with infectious and emergency medicine, with chronic conditions this process is not working and the drugs prescribed often only address symptoms while creating other problems in the body, such as gastrointestinal issues with non-steroidal anti-inflammatories (NSAIDs) like ibuprofen (Vanderstraeten, 2016) and the numerous nutrient deficiencies caused by Proton Pump Inhibitors (PPIs) (Wilhelm, 2013).
I believe that the chronic illness epidemic can be solved, in large part, by diet and lifestyle changes and that if we merge conventional medicine with nutritional therapy this can be achieved.
The Functional Medicine (FM) model, which uses personalised nutrition, is being pushed forth to encourage this merging of practices. FM proposes that the same disease in two different people might not have the same root cause. So the idea of using a certain drug for each disease, if looked at from this perspective, makes much less sense. FM looks at the network of systems and how they all work together and interact in a dynamic function that all affect each other. Dr. Jeffrey Bland writes about the current medical model in his book The Disease Delusion:
‘…the way health-care professionals are trained and the strategy of therapy they apply is not based in such systems thinking. Precisely because it derives from the germ theory, it is based in reductionist thinking: find the bug and nuke it with a drug developed for just that purpose. As brilliantly as the model works in providing acute care, it clearly does nothing to restore or maintain balance among functional systems or the networks that connect them’. (Bland, 2014)
Medicine is the science and practice of the diagnosis, treatment and prevention of disease.
In 1912 Casimir Funk identified that a lack of certain vitamins caused deficiency diseases. It is therefore surprising how little consideration is given in conventional medicine to using nutrition or at the very least identifying deficiencies. Instead of considering nutrition as a factor in a matrix of potential triggers and drivers, nutrition is often ignored altogether or considered far less important to treatment with drugs.
Currently, if a nutrient is advised, out-dated science is often still being used. For example, calcium is often given for osteoporosis, but the form prescribed is poorly absorbed, such as calcium carbonate. A meta-analysis provided evidence that supplemental calcium does not support bone health and calcium in food form should be encouraged (Bischoff-Ferrari et al, 2007). Another problem here is that other important complimentary nutrients are not prescribed and/or diet is not modified for optimal bone health, such as the addition of vitamin D and K and other co-factors. An example of this balance between other nutrients is explained with the example of phosphate:
‘Calcium carbonate or calcium citrate supplements can reduce phosphate absorption which may be detrimental, because a balanced ratio of calcium to phosphate is needed for bone remineralisation’ (Bischoff-Ferrari et al, 2007).
Increasingly people are questioning the paradigm of conventional medicine and asking whether the current approach is working effectively. Combine this with the large numbers of graduating practitioners in nutrition and many other alternative fields, and there seems to be a slow but certain drive towards change.
The difficulty when studying nutrients and their effects on the body, is that we are often looking to create the absence of a problem or disease or the prevention of a disease before the person becomes unwell; as the saying goes ‘Prevention is better than a cure’. But an absence of something is much more difficult to measure. Yet with a pharmaceutical intervention a drug is meant to alter pathology giving clear and measurable results.
In some cases nutrient interventions can be slower to take effect than a drug. An article in The Journal of Infectious Disease writes about nutrient studies being largely forgotten due to antimicrobial drugs and vaccines, yet often simple interventions can be effective in the treatment and prevention of serious diseases. In developing countries, for example, children with clinical vitamin A deficiency had increased mortality due to a variety of infectious diseases.(Kosek, 2007) With the modern processed diet there are large amounts of people in the western world with nutrient deficiencies. Is this one reason why chronic disease numbers are increasing?
Here, the argument of merging the two paradigms becomes more obvious and compelling. Dealing with an immediate emergency, pain or symptom, if there is one, while addressing the person’s overall wellness with nutrition so they heal quicker and the condition is less likely to reoccur.
Nutrients can be used to slow the speed at which a disease progresses in a patient. A promising study used CoQ10 in the early onset of Parkinson’s Disease to slow down functional decline. (Shults, 2002) This merges conventional medicine for diagnosis while using a nutrient to slow the decline.
But, there is much confusion about nutritional studies, including some that have been reported heavily in the media. An example of this is a 2005 meta-analysis completed on vitamin E supplementation, (Miller, 2005) which was followed by alarming media headlines such as ‘Vitamin E may kill you’. The meta-analysis concluded that ‘High-dosage (400 IU/d) vitamin E supplements may increase all-cause mortality and should be avoided’. I could not find where it details the types of vitamin E used but it is very likely to be synthetic vitamin E rather than naturally occurring vitamin E found in food or Food-Grown supplements. It seems rather a waste of money to test an isolated synthetic nutrient when the research funds could be put to better use.
The need for better research methodologies is evident here as is the need to ensure the correct evidence is being assessed and reported. There is a definitive need to ensure studies are completed by scientists who understand how the nutrients are absorbed and utilised. Many studies use synthetic forms of nutrients such as the studies in this vitamin E meta-analysis. dl-alpha-tocopherol was used rather than the natural form, such as that found in an avocado, which would contain a range of vitamin E forms such as alpha, beta, delta and gamma tocopherols and tocotrienols. The bioavailability and effect on the body of a synthetic nutrient compared to a naturally occurring nutrient is usually very different.
In a study that compared the bioavailability of ascorbic acid alone or in a citrus extract, they found that 35% more was absorbed by the body when within a citrus extract vs stand alone. (Vinson, 1988) The form of the nutrient is vital for accurate testing, otherwise the results are wrongly recorded and not comparable.
The synergistic nature of food must not be underestimated and therefore testing isolated nutrients should be a lesser consideration along with detailed studies of the effects of whole foods. The significance of food synergy is explained well in an article in The Journal of Clinical Nutrition. They propose that food ‘results in more effective nutrition research and policy’.
‘This significance is dependent on the balance between constituents within the food, how well the constituents survive digestion, and the extent to which they appear biologically active at the cellular level. Many examples are provided of superior effects of whole foods over their isolated constituents’. (Jacobs, 2009)
The need for further studies on the synergy of nutrients is vital but also adds extremely complicated variables to the mix. But these important variables must be explored and the data extrapolated, if we are to provide Evidence Based Medicine (EBM) in nutrition.
Guidance on nutrient dosage, such as Reference Nutrient Intake (RNI) or dietary reference intake (DRI) was decided based on the deficiency diseases such as scurvy for vitamin C and rickets for vitamin D. Roger J. Williams was one of the scientists who challenged the dietary allowances and wrote about each person having a unique biochemical profile in his 1956 paper Biochemical Individuality. Clearly ahead of his time, Williams explains that a person’s profile is based upon their own genetic structure, nutrition and environment and there is a definitive need to apply nutrition according to genetic variations which ‘offers the solution to many baffling health problems’. (Williams, 1956)
More recently Bruce Ames, PhD has supported Williams work and continues to further the theories and research in his lab involving various aspects of tuning-up metabolism to optimise health. Ames’s triage theory is that most populations have an inadequate intake of one or more of the 30 essential vitamins and minerals, that are used as cofactors by proteins and enzymes of metabolism. This causes a rationing response in the body where the nutrients are retained for survival and reproduction while nutrients for long-term health are less available. (Ames, 2014)
‘Mechanistic, genetic, and epidemiological evidence suggests that this metabolic trade-off /accelerates aging-associated diseases, such as cancer, cardiovascular disease, immune dysfunction, and cognitive decline’.
He later writes about the Estimated Average Requirement (EAR) and how the majority of the U.S. population are not even managing to achieve the low EAR target for nutrients such as vitamin A, D, E, K, C, zinc and magnesium:
‘These low intakes are especially true for children, adolescents, elders, and the obese. The U.S. population also has a very low intake of DHA/EPA omega-3 intake’. (Ames, 2014)
Studies in nutrition show great promise and as they are refined and improved there is a great deal of hope for the future of healthcare.
Lastly, a piece of writing from the Institute of Functional Medicine that summarises very well:
“The transformation of 21st century medicine from the prevailing acute-care model to a far more effective chronic-disease model will succeed only if we attack the underlying drivers of the epidemic—the complex, lifelong interactions among lifestyle, environment, and genetics—and if we engage the entire healthcare system in a concerted effort to implement a unified, flexible approach that can readily adapt to shifting needs and emerging evidence”. (Jones, 2009)
Bischoff-Ferrari HA, Dawson-Hughes BD, Baron JA, Burckhardt P, Li R et al (2007). Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials. The American Journal of Clinical Nutrition. 86 (6), 1780-1790.
Bland, Dr. J (2014). The Disease Delusion. USA: Harper Wave. p4-5.
Miller E.R., Pastor-Barriuso R, Dalal D, Riemersma R.A., Appel L.J., Guallar E. (2005). Meta-Analysis: High-Dosage Vitamin E Supplementation May Increase All-Cause Mortality. Annals of Internal Medicine. 142 (1), 37-46.
Shults CW, Oakes D, Kieburtz K, Beal MF, Haas R, Plumb S, Juncos JL, Nutt J, Shoulson I, Carter J, Kompoliti K, Perlmutter JS, Reich S, Stern M, Watts RL, Kurlan R, Molho E, Harrison M, Lew M. (2002). Effects of coenzyme Q10 in early Parkinson disease: evidence of slowing of the functional decline. Archives of Neurology. 59 (10), 1541-50.
Vanderstraeten G, Lejeune TM, Piessevaux H, De Bacquer D, Walker C, De Beleyr B. (2016). Gastrointestinal risk assessment in patients requiring non-steroidal anti-inflammatory drugs for osteoarthritis: The GIRANO study. Journal of Rehabilitation Medicine. 48, 1-6.ethical, food, health, medicine, nutrition, nutritional therapy, nutritious roots
August 20, 2016 10:51 pm