Prescribing Nutrition Science


Feature Story

There is a remarkable evidence base now that should make dietary prescription a must for both primary and secondary prevention

By Blecenda Varona, DRPH, FACLM, DIPIBLM, RND, MPH


Americans pride themselves on being the best-fed nation on earth. But they are paying a high price for the privilege—in terms of preventable disease, disability, and premature death.

Like Americans, Filipinos are also eating too much of nearly everything – too much sugar, too much fat, and too much salt. Filipino’s intake of cholesterol can even be worst than Americans because of their high intake of fatty meats and internal organ delicacies. To name some popular delicacies are – bulalo, bopis, sisig, adobong atay, papaitan, chorizo, tapa, crispy pata, and more. Eating too often and with more merienda (snacks) can put person into high risk.

Such increase in eating has helped lay the foundation for coronary artery disease, stroke, high blood pressure, arthritis, adult-onset diabetes, obesity, and several kinds of cancer. These diseases are responsible for the leading causes of death.

Filipino diet before consists mainly of rice, vegetable, and fish. Food preparation was so simple and easy: boiled, broiled, and stewed. Now as technology improves, we imitate how Western countries prepare their food, no thanks to the American-dream mentality. Even food is adapted; later, sickness is also imitated.

Here are the worst offenders:

1. Sugar

The National Research Council reports that refined sugars and sweeteners account for up to 20 percent of many people’s daily calories. Devoid of fiber and nutrients, refined sugars are empty calories. But because of their caloric density, they are well suited to promote obesity.

Science has discovered the ill effect of consuming high fructose corn syrup (HFCS) on liver metabolism that leads to heart disease, lipidemia, fatty liver, and insulin resistance.

2. Refined foods

People used to think refinement was good because it gets rid of the useless roughage. Now we’re learning how necessary fiber is in protecting us from certain cancers, stabilizing blood sugar, controlling weight, and preventing gastrointestinal problems, such as gallstones, hemorrhoids, diverticulitis, and constipation.

3. Salt

People consume in excess of 10 grams (two teaspoons) of salt a day. This is much more than what is actually needed and contributes prominently to high blood pressure, heart failure, and kidney disease.

4. Fat

Most people don’t realize that they are consuming two to three times more fat, oil, and grease than its optimum for good health. As a result, blood vessels plug up, impotence sets in, so with suffering hearts and brains. A high fat diet also contributes to obesity, adult diabetes, and certain type of cancers.

5. Proteins

A diet heavy in meat and animal products provides more protein, fat, and cholesterol than they body can use. People eat twice as much protein than is recommended. Scientists now recognize that more natural, traditional diet containing less animal protein and much less fat and cholesterol is essential for improved health and longevity.

6. Beverages

Most people don’t drink enough water. Instead, they average several servings of soda, pop, beer, coffee, tea, milk shake, and sweet drinks every day. Because most of these drinks are loaded with calories from sugar and alcohol, they can play havoc with blood sugar levels and sabotage weight control efforts. Alcohol, caffeine, phosphates, and other chemicals found in beverages pose additional health risks, too.

7. Snacks

Engineered taste sensations are taking the place of real food. It has become fashionable for school, day-care centers, even hospitals to make snacks available. The coffee break has become the standard at work, and snacks weigh supreme after school and at home. Well-planned family meals are now the exception. Snacks disrupt digestion, overburdens the stomach, and are a frequent cause of bloating and indigestion.

The following are nutrient-dense foods which we should have more of:

1. Locally grown vegetables including mushrooms
2. Locally grown fruits
3. Legumes
4. Whole grains
5. Nuts
6. Seeds

Note that these plant foods are estimated to contain more than 100,000 natural phytochemicals which may protect against chronic disease like cancer, osteoporosis, and heart disease.

Locally grown fruits and vegetables have almost endless varieties, spectacular colors, and every imaginable texture and flavor. Enjoy the fruits in season like, papaya, pineapple, watermelon, guava, rambutan, mangoes, duhat, marang, santol, mangosteen, sinuguelas, aratiles, and many more.

Go for vegetables: leafy vegetables like moringa “malunggay”, sweet potato leaves, jute, spinach and all edible leaves. Include sweet potatoes, potatoes and yams. Include legumes all kinds of beans, monggo, lentils, chickpeas – in scores of shapes, colors and flavors. Include in your diet the delicious taste of lady finger okra, carrots, singkamas, chayote, bottle upo, kalabasa and many more.

And don’t forget the grains, such as unpolished rice, rolled oats, and corn, which are a mainstay of a good diet and a gold mine of delectable and healthful foods. And add a few nuts every day.

Evidence-based nutrition prescription

There is so much science in the form of major nutrition studies that are now the basis for nutrition prescription. Examples of these are:

1. The Portolio Diet for hypercholesterolemia. The combination of four dietary interventions found to be equivalent to pravastatin 20 mg.
2. DASH diet for hypertension. Combination of vegetables, low salt and low-fat dairy found adequate as first–line treatment for essential hypertension.
3. Ornish diet for prostate cancer. A plantbased diet has been shown to reverse the progression of early stage prostate malignancy.
4. Mediterranean diet for secondary prevention of coronary artery disease (CAD). A diet rich in fruits, vegetables, legumes, whole grains, marine fish, minimal meat and alcohol was found superior to prudent western diet in preventing recurrence of CAD events.
5. Plant-based diet for CAD. A very low-fat diet shown to reverse and prevent CAD (CAD is labelled as a food-borne illness by some authors.)
6. CHIP (Complete Health Improvement Program) and diet for diabetes. CHIP multifactorial lifestyle intervention found to be effective in treating type 2DM and other cardiovascular problems.
7. Vegetarian and vegan diets for diabetes. This was shown to help achieve glycemic control in type 2 DM.
8. Walnuts for hyperlipidemia and hypertension

The good news is that a healthy diet and lifestyle help delay, arrest, reverse, and often prevent, the onset of most killer diseases. Eating whole plant –based food not only allows people to eat larger quantities of food without having to worry about weight gain, but also promotes optimum health and energy for a lifetime.

A good night’s sleep is important in maintaining healthy skin. A study has shown that elderly women who slept for less than 5 hours a day had compromised transepidermal water loss and skin barrier recovery after UV-induced erythema. Likewise, poor sleep quality results in disruption of the circadian rhythm, leading to cellular dysfunction and changes in various tissues, including the skin.

With the increase in life expectancy, we expect its related comorbidities including its effects on the skin. Having a thorough understanding of the causes of skin aging can help us manage the skin problems of our patients.

“Locally grown fruits and vegetables have almost endless varieties, spectacular colors, and every imaginable texture and flavor”


References:

Jenkins, D.A., et al., Effects of a dietary portfolio of cholesterol-lowering foods vs lovastatin on serum lipids and C-reactive Protein. JAMA 2003. 290 (4): p. 502-510) and Jenkins, D.A., et al., Assessment of the longer-term effects of a dietary portfolio of cholesterol-lowering foods in hypercholesterolemia. Am J Clin Nutr. 2006. 83 (3): p. 582-91)

Appel, L.J., et al., Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003. 289(16): P.2083-93.) and (Appel, L.J., et al., Lifestyle modification as a means to prevent and that high blood pressure. J Am Soc Nephol, 2003. 14(7 Suppl 2 ): p S99-s 102.

Ornish, D., et. al., Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proceedings of the National Academy of Sciences of the United States of America, 2008 105(24): p. 8369-8374. Ornish, D., et al., intensive lifestyle changes for reversal of coronary hart disease. JAMA, 1998. 280(23): p. 2001-7.

de Lorgeril, M., et al., Mediterranean diet, traditional risk factors, and the rate of cardiovascular complication after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation, 199.99(6): p. 779-85

Esselstyn, C. B., A plant-based diet and coronary artery disease: a mandate for effective therapy. Journal of Geriatric Cardiology: JGC, 2017. 14(5): p. 317-320.

Shurney, D., S Hyde, et al., CHIP lifestyle program at Vanderbilt University demonstrates an early ROI for a diabetic cohort in a workplace setting: a case study. Journal of Managed Care Medicine, 2012.) (Source: Barnard, N.D., et., Vegetarian and vegan diets in type 2 diabetes management. Nutr. Rev. 2009. 67(5): p. 255-63.

Sabate. J.,et al., Effects of Walnuts on Serum Lipid Levels and Blood Pressure in Normal Men. New England Journal of Medicine, 1993. 328(9): p. 603-607.

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