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Clinical Nutrition For Dummies
By Michael J. Rovito
John Wiley & SonsCopyright © 2014 John Wiley & Sons, Ltd
All rights reserved.
Getting Clinical about Nutrition
In This Chapter
* Conceptualizing clinical nutrition
* Understanding the fundamentals of clinical nutrition
* Becoming aware of the growing international focus on proper nutrition
The fact that you are reading this book means that you are at least partially tuned into the connection between what you eat and how it affects your health. Congratulations! Either through a course you are taking or through your own personal curiosity, you are choosing to get better acquainted with the study of diet and how it influences your overall status of health and wellness.
The relationship between what you eat and how healthy you are can be complex, but it's not impossible to understand. In fact, this text focuses on a few simple guidelines:
[check] You must eat fruits, vegetables, and whole grains.
[check] You must moderate your fat, salt, and sugar intakes.
[check] You must exercise.
If you follow all these guidelines, you'll find yourself more healthy than not and will realize the truth behind the adage that you are what you eat.
This chapter takes you on a quick tour of the fundamental principles related to the study of clinical nutrition. Retaining a basic understanding of the concepts I introduce you to here is a great foundation for all the chapters that follow.
Pillars of the Practice: Recognizing the Links between Nutrition and Health
To state the obvious, food is essential for human survival. Since humans — or some form thereof — first started to walk the earth, the human body has evolved to benefit from the foods available in a given environment.
Generations of trial and error, in which we sampled literally tens of thousands of different species of potential food, enabled us to obtain from nature the nutrients needed for life. Our bodies adapted over thousands of years to both the bounty and the scarcity of what existed in the environment — what we were able to gather, hunt, and farm.
Recently, however, that relationship has been altered, and along with that change is a realization that modern eating habits aren't necessarily better. From that realization have sprung efforts to return to a healthier way of eating.
Revisiting traditional views of food and health
Just up until the middle of the last century, people ate a variety of foods that were in balance with the major food groups. Through the process of evolution, humans naturally gravitated toward a diet that was relatively in tune with what the body needed to survive. The availability of — and our preferences for — food were naturally balanced in a way that provided a healthy diet. Whether the available diet and the human body's needs evolved together is uncertain, but one thing we do know for sure is that, back then, humans didn't overeat as much.
A snapshot of the past
Before industrialization, globalization, and modern farming and transportation techniques, food was scarcer than today. You ate what you needed — not what you wanted — and what was available.
Convenience stores selling all kinds of processed foods didn't dot every city corner. Nor were there gigantic supermarkets holding thousands of items to choose from. If you wanted a grape grown in Chile or an apple grown in New Zealand, you needed to live in (or pretty darn close to) those countries, because systems for transporting fresh food around the globe didn't exist.
Basically, you had yourself to rely on: You had to grow and harvest your own food, and prepare it yourself — all tasks that involve lots of manual labor. Of course, hunger was an issue (as it still is for too many people today), but the overabundance of food that's common today simply did not exist back then.
Fast forward to today
Today, the food landscape is very different. You can walk into a supermarket and buy almost any fresh product from any corner of the world. You can swing by a convenience store for a quick snack and a mega-gulp. You can go to a fast-food restaurant and buy a meal packed full of a day's worth of calories and gobble it down within 15 minutes of walking in the door. You have the world at your culinary disposal.
Ample quantities of food are available, and you don't have to exert much physical labor to procure it. Before, if you wanted a special type of walnut from some distant land, you'd probably have to go there yourself, or order it and wait four months for it to arrive at the dock. You wouldn't be able to find it prepackaged in plastic in aisle 10 of your local megamart.
Never has such a scenario existed in the course of human history. Consider yourself lucky — and then recognize the health trade-off that's occurred due to the abundance of unhealthy, highly processed foods.
Diets that are high in fat, salt, and sugar have become more commonplace. Public health and nutrition researchers theorize that this phenomenon has promoted epidemic levels, perhaps even pandemic (worldwide) levels, of adverse health effects. Whereas the rates of obesity, heart disease, and diabetes (and even some type of cancers) occurred at drastically lower levels before the mid-20th century, today those conditions occur at an alarming rate.
With the discovery of the direct relationship between the foods we eat and these (and other) health conditions, people are beginning to return to a more simplistic, healthier, and, dare I say, natural way of eating food. (For details on the relationship between diet, nutrition, and a variety of conditions and diseases, head to Part II.)
Introducing the key tenets of clinical nutrition
Clinical nutrition is the study of the connection between your body's overall state of wellness and the foods you eat each day. What's so interesting about this field is that, if you go beyond the details (how particular nutrients do particular things or what proportion of what kinds of foods produces optimal results, for example), you realize that it really matters: Because of this awareness, clinical nutrition, in a sense, seeks to re-establish the connection people used to have with food, in which their diets provide the nutrients necessary to ensure adequate nourishment and to build and maintain healthy, strong, and resilient bodies.
If you took all the tips and tricks mothers, fathers, grandparents, and others have passed down about what to eat to maintain healthiness or to prevent disease, and distilled those nuggets into a science, you would end with many of the key tenets of clinical nutrition. Here are some things that Grandma may have said and what modern science shows (I delve into these tenets in more detail throughout this book):
[check] You are what you eat: If you eat too much fat and calories without being active, you'll put on weight. If you eat healthy foods, you'll be healthy. If you eat lots of carrots, you'll be ... okay, well this one doesn't quite work, but interestingly you can get beta-carotene poisoning, which makes your skin turn orange ... like a carrot! Silly example aside, the point is still a good one: What you put into your body has a direct affect on your body and your health.
[check] An apple a day keeps the doctor away: The quality of the food you eat has a direct impact on your health. (I cover the role of diet in a variety of diseases in the chapters in Part II ).
Ask yourself this question: Would you put sand into the fuel tank to make the vehicle run? Of course not. Not unless you want to irreparably damage the inner workings of your car. A car needs gasoline, not sand, just as your body needs healthy, whole foods for better health outcomes. Both need the best sources of fuel to optimally perform.
[check] Don't eat anything you don't recognize as food: Your body evolved to digest food, not food products, to maintain health. You want to eat as many simple, whole foods as possible. Eating oranges is better than drinking orange juice, and drinking orange juice is better than eating orange popsicles.
Here's a tip to help you avoid foods that are overly processed: Avoid or find alternatives for food that
Has more than five ingredients
Has ingredients you cannot pronounce
Contains high-fructose corn syrup or hydrogenated oils
If a food falls into two of these three categories, it may be processed and not one your ancestors would have recognized. Steer clear as much as possible from these products.
[check] To lengthen your life, shorten your meals: One key to a healthy life is to eat in moderation. Research suggests that, on average, the more energy (calories) you consume, the worse health outcomes you have compared to people who eat a moderate amount of food. I delve more deeply into this concept in Chapter 2.
[check] A little dirt never hurt anybody: Did you ever hear your mother or father say, "Germ him up!" Maybe not, but my father said it numerous times about me to my mother. They knew that children, and adults, benefit from certain bacteria in dirt and other external sources. Being exposed helps train your body to become resistant to these microbes in the future. In other words, food doesn't have to be sterile to be good for you.
Now, don't take this advice too far and eat random, dirty objects. That is not the best thing to do. You will get sick. (Head to Chapter 10 for information on food contaminants you need to protect yourself from.) Still, as the phrase suggests, a little dirt will never hurt. Many beneficial microbes vital to the human body are ones that you can only get through external sources — your food and things on your food. Be sure to check out Part III for more information on specific diets and how they benefit specific systems of the body.
Although clinical nutrition is a comprehensive, advanced science, a simplified version of the tenets of clinical nutrition can be learned from talking to older members (grandparents or even great-grandparents) of your family. Ask them how or what they used to eat, their exercise habits when they were younger, and how they eat now. You'll be surprised at the similarities between what your older family members used to eat (or maybe still do) and what the most advanced clinical nutrition research suggests for a healthier life. The terms may be more complicated on the clinical nutrition side, but the premises are very similar.
Taking a New(-ish) Approach to Medical Care and Public Health
Clinical nutrition is mainly concerned with two overarching goals — disease prevention and therapies used to treat particular diseases — which it seeks to achieve by focusing on the following areas:
[check] Dietetics:Dietetics is the study of food and its regulation, and proper nutrition, and how these factors influence health outcomes in both behavioral settings (public health, community-wide applications) and clinical settings (laboratory or hospital-based applications).
[check] Nutritional genomics: Nutritional genomics is an expanding field in clinical nutrition. Professionals are placing more and more emphasis not only on the immediate effects of a poor diet on the body but also on the long-term effects, including those passed through generations. Nutritional genomics studies how your diet affects your genes and how possible differences in genetic components of the human body can affect your health. Essentially, nutritional genomics is the study of how your ancestors ate and how their diets possibly affect your health outcomes. It is interesting — maybe even alarming — to think that what you're eating now could have an impact upon your great-great-grandchildren's health!
In this section, you get a general look at how the field of clinical nutrition helps prevent disease and can be used to improve treatment therapies. For detailed information on the connection between diet and disease, head to Part II ; Part III explores the role nutrition plays on the organ systems in the body.
Most dietary recommendations from the majority, if not all, governing health bodies aim to prevent the following three major conditions and the diseases associated with them:
[check] Obesity: Obesity is caused by eating more calories than the body burns, a situation that leads to increases in body fat. Research suggests that weight gain is at the root of many of the risk factors leading to a variety of different diseases, including heart disease, diabetes, sleep apnea, arthritis, hypertension (high blood pressure), gout, and certain types of cancers, to name just a few.
People who are obese tend to have other diseases associated with obesity, a situation referred to as being comorbid. Clinical nutritionists are working with public health officials to alter public dietary behaviors by providing individual counseling, promoting policy changes (such as banning, or limiting, trans-fats in foods), and modifying school lunch programs to offer more fruit and vegetable choices in place of processed carbohydrate-dominated foods (like pizza and french fries), to name a few.
[check] Heart disease: Heart disease is the number one cause of death worldwide, and it is largely the result of poor dietary choices and physical inactivity. Research suggests that people who live sedentary lives and eat high-fat, low-fiber foods have a higher risk for developing heart disease than those who are active and eat a low-fat, high-fiber diet. Clinical nutritionists work with individual patients and public health officials to help promote heart-healthy behaviors, like exercising regularly and eating low-fat diets.
[check] Malnutrition: The World Health Organization (WHO) currently emphasizes malnutrition as one of the most important public health concerns the world faces today. According to WHO, malnutrition consists of under-nutrition (chronically not getting enough nutrition through food or supplements, or the body's inability to process certain nutrients to support normal bodily functions) and overweight/obesity — both major global health concerns. Clinical nutritionists are implementing various educational campaigns aimed at raising awareness and limiting the spread and effects of these diseases.
Devising therapeutic measures to treat disease
As I note earlier, clinical nutrition is the study of how foods you eat each day impact your body's overall state of wellness, and it's yielded all sorts of information that health professionals can use to design more effective treatment programs for those suffering from disease. Specifically, clinical nutrition has made possible a therapeutic approach for treating health conditions and their associated symptoms by using a therapeutic, or specialized, diet.
A therapeutic diet is specifically designed to promote optimum wellness for an individual, based upon that individual's immediate dietary needs. This tailored diet is based upon the patient's entire medical history profile. Such treatments aim to reduce the risk of developing complications for conditions such as diabetes and to ameliorate the effects of conditions like high cholesterol.
Many of these modern-day recommendations stem from knowledge our ancestors had about different foods and their potential curative properties. Following are some examples of folk wisdom that research has shown to be effective:
[check] Orange juice assists immune system response. Orange juice is high in vitamin C, an antioxidant that helps protect your body from cell damage and plays a key role in your immune system.
[check] Honey can be used as an antiseptic. Honey has antimicrobial qualities and forms a protective barrier over a wound to prevent other microbes from getting into the cut. To find out more about the medicinal and antibacterial properties of honey, check out the article "Honey: its medicinal property and antibacterial activity," by Manisha Deb Mandal and Shyamapada Mandal at http://www.ncbi.nlm.nih.gov/pmc/ articles/PMC3609166/.
Excerpted from Clinical Nutrition For Dummies by Michael J. Rovito. Copyright © 2014 John Wiley & Sons, Ltd. Excerpted by permission of John Wiley & Sons.
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