Nutrition Notes Topics
Books to Read
Re-Thinking the Nutrition Paradigm
Food and nutritional issues are complex and genuinely difficult to understand. But often, it is conventional nutritional advice, turned into dogma that opposes intelligent, well-thought-out methods of diet revision. For too many years we lived with the "four food groups," a nutritional dogma taught at universities for over four decades. We recommend studying the US official guide to our students. We suggest that they approach the guidelines as a theoretical structure and as advice to a population of people with diverse needs. The advice may not be applicable to individuals whose nutritional needs are not met by these recommendations and whose health may be at risk if they follow the food selection advice. A skillful nutritional therapist will know the guidelines as one way to organize food selection but will also know the many exceptions to these rules and use other methods of diet design such as the Alpha Nutrition Program. The biggest mistake made by general nutrition advice is ignoring the fact that each person has individual needs. Human molecular biology has revealed an incredible complexity of biochemical activity in every cell. The input to this biochemical complexity enters the body through the mouth.
Food-Related Diseases are Prevalent
Diseases generally acknowledged to be diet related, are atherosclerosis, hypertension, alcoholism, obesity, diabetes 2 and immune-mediated diseases. Changing patterns of food-related illness are recognized. Food contains both old and new problems; the new food-related illnesses are a consequence of our changing, maladaptive food-production and consumption habits.
The improvement in the diversity and availability of foods has been a mixed blessing with major problems emerging to negate the potential benefits. Food is the most intimate part of the environment because food is ingested. When something goes wrong, it makes good biological sense to look at the flow of substances through the mouth for the source of the problem. Adverse reactions to food are common and produce many disturbances by a variety of mechanisms. Diagnosing adverse reactions to food is an important task of clinical medicine and needs to be taught in medical schools.
Often, the potential benefits of diet revision in the solution of health problems are ignored. Many food and nutritional issues are complex and genuinely difficult to understand. The four food groups (meat, milk, grains, and vegetables-fruit) were promoted by the U.S. Department of Agriculture in the 1950's as the proper, official method of achieving a "balanced diet". The US FDA collaborated, teaching this system to the nation, and a remarkably strict nutritional dogma emerged in the USA and Canada. However, the four food groups can now be viewed as an obsolete set of recommendations with a poor health record
In 1995 official dietary recommendations in the USA and Canada were changed to a food pyramid which gave more value to eating fruits, vegetables and grains. Harvard's Walter Willet reviewed the new recommendations and stated: " The dietary pyramid released by the U.S. Department of Agriculture attempts to translate current nutritional knowledge to a recommended eating pattern in terms of food groups. Inevitably, such a document represents a mix of well-supported findings, educated guesses, and political compromises with powerful economic interests such as the dairy and meat industries." Willet's conclusion is that "...optimal health can be achieved from a diet that emphasizes a generous intake of vegetables and fruit. Such plant-enriched diets, as embodied by other cultures can be not only healthy, but interesting and enjoyable as well." This approach has been taken in designing the Alpha Nutrition Program
Diet Revision is Nutritional Therapy
In medical practice, rationally designed diets are offered for weight-loss, salt-restriction, fat-restriction or specific illnesses such as diabetes. Medical therapy has in the past included diets for special needs, but no method of diet revision emerged in medical practice to investigate and treat food-related illnesses. The media and commercial sectors, on the other-hand are prolific with diet advice and schemes for improvised diet revision.
Nutrition can be thought of as an idealized, abstract look at the possible (but not real) outcomes after eating foods. The role of foods themselves, as objects of behavior and regulators of internal body dynamics, are relatively ignored. The possibility of things going wrong with digestion, absorption, metabolism, and with immune surveillance of these processes, while considered in medical science, is seldom a concern in medical practice. The dietitian often assumes that nothing will go wrong with food-body interactions - nutrients that are in the food are available to the body without complications. The physician generally assumes that nothing will go wrong or will consider a small number of adverse effects, ignoring a number of pathological possibilities which may be the keys to enigmatic diseases.
To pursue a strategy of nutritional therapy, the assumption is that things routinely go wrong with food-body interactions. The non-nutrient structure of food is relevant to the consideration of the total interaction of food with body systems. A key question in rethinking nutrition is: "What role do foods have in body dynamics while they are broken down into carbohydrates, fats and proteins?" This is a challenging question and proves to be difficult to answer. This re-examination introduces many inconvenient complications. In the first instance, there is an overburden of non-nutritional substances in food. Changes in the quality if the food supply and the role of food additives and toxic contaminants are factors to be considered. Changes in eating behaviors and food combinations have occurred rapidly in the past few decades with unknown consequences and the eclectic eating habits of many modern citizens ranges from the whimsical and bizarre to frankly pathological eating patterns. Aberrations in eating behaviors are now common enough to be considered "normal" and the traditional three-meals a day ideal postulated by dietitians has all but vanished from the culture.
We think that delayed patterns of food allergy are common but often ignored or denied by physicians. Food allergy is a logical consequence of eating food and develops when immune surveillance responds adversely to the flow of molecules through the digestive tract. There are several mechanisms and unlimited possibilities for the production of disease.
Nutritional Therapy and the Environment
Basic biology teaches that we are creatures of the environment. We live in a chemical soup made of food, air and water; we breathe it in; we swallow it. We are nodes in a continuum, but we like to think of ourselves as separate unique individuals. We take illness personally and tell stories designed to emphasize our uniqueness. There are, therefore, discrepancies when we try to understand the whole by examining its parts.
I have always tried to teach the interconnectedness of things. However, we like compartments, and neatly packaged concepts. People like catchwords, simple explanations, fads and fashions. My efforts to deal with the food issues have been influenced to some extent this tendency to compartmentalize and label. Thus, we have "Nutritional Therapy" appearing as a separate method - a fashionable but arbitrary separation of things that are interconnected.
Food problems are, in part, a feature of environmental problems. Food tolerance will change with different environments - tolerance also changes seasonally. Patients in northern and temperate climates tend to be sicker in the winter. They are more exposed to indoor air quality problems, increased air pollution because of inversions, high humidity, increased consumption of fossil fuels and wood. The food supply shifts in the winter- "fresh" produce comes from further away and probably is more contaminated and less nourishing. The loss of sunlight has profound biological effects - seasonal depression and changes in immune responses are obvious effects. People eat more in the winter and are less physically active. Most of the patients I see report intolerance to airborne chemicals as they recover from food-related illness. We seldom get away with just fixing the food supply; the other environmental issues show up and need to be addressed
Diet Revision Therapy, DRT
Since food ingestion creates dysfunction and disease by a variety of mechanisms, nutritional therapy is based on removing the causes of illness by correcting a faulty food supply. The supreme technique of nutritional therapy is, therefore, Diet Revision Therapy (DRT). DRT refers to specific strategies of correcting disease by modifying food choices, and eating behaviors. Proper diet revision must restore control over a confusing, chaotic set of circumstances and symptoms. Careful application diet revision therapy will reveal the fundamental significance of the food supply in the production of disorder.
The Alpha Nutrition Concept
A systematic method of diet revision with full participation of the patient in evaluating and selecting foods has never before been introduced into medical practice nor dietetics. There are important difficulties in attempting diet revision. Any attempt to fundamentally alter a patient's lifestyle is bound to encounter resistance from many directions. More time and effort is required to educate, motivate, and support any patient who wants to change. The use of an elemental formula to replace food or the deployment of a strict hypoallergenic diet requires the full participation of patient and requires understanding of psychosocial dynamics that are not usually monitored in medical practice. The reintroduction of foods to establish a nourishing well-tolerated diet calls for knowledge and skills that go beyond routine dietetics. The effort to change a patient's food supply also encounters all the irrational elements of eating behavior - a routine case of irritable bowel syndrome, for example, may turn into a struggle with food addictions, emotional issues, family and societal issues.
I recognized 20 years ago that a standard program of diet revision was needed - a prototype which could encourage the further development of nutritional therapy as a systematic study. Since resolving the problems of food allergy in common disorders such as eczema, migraine, asthma, and irritable bowel were my priorities, the method of diet revision that I developed was influenced by allergy practice. The basic idea was that patients began with a few foods until symptoms cleared and then were "challenged" with suspected foods to demonstrate that symptoms would recur. The idea of food challenge soon after improvement had endured in allergy practice for many years and eventually I decided was not in the best interest of most patients. What is really required as therapy is a retreat to a safer, healthier diet, complete with clear definition of boundaries that separated safe-eating practice from illness-producing food choices.
Advice to physicians.... the main points to consider
The patient just wants to get better. Many patients begin with poor eating habits, often have emotional issues around food, and often experience cravings and compulsive eating. They need to learn a whole new system of food selection, meal preparation and planning. Staples foods such as milk, wheat, and eggs are often involved in delayed patterns of food allergy and long-term success depends on creating an alternate diet that featured other staple foods. At least, these foods should not be considered as essential. The effort then shifted toward creating a standard algorithm of diet revision that would:
The idea of a "core diet" is that everyone has a small set of best-fit foods that results in normal if not optimal function. A standard diet revision method emerged over many years, the "Core Program". The venerable Core program has becomeAlpha Nutrition Program (ANP) in 1998. ANProutines are based on numerous decisions, which amount to a set of policies to do four important things:
The core-concept also made nutritional and economic sense. Human diets all over the world are based on a set of staple foods. Most human beingsrely on a few foods to supply most of their daily calories. In poorer areas of the world a single staple tuber, grain, or vegetable may be the principle food supplying up to 80% of daily calories. A return to simpler food intake may have important biological advantages. Bodies seem to work better when they have a simple, regular food supply - no surprises. The core of a new, healthy, modern diet should be a small number of staple foods. But which staple foods?
The food allergy literatureidentified cow's milk proteins, gluten, and egg white as three of the most allergenic components of staple food in North America. The top three are followed by nuts, soya, citrus, corn, and then a scattering of other foods. The best foods overall were cooked vegetables and rice was staple grain with a lower incidence of problems. By using food lists in the allergy literature, and then keeping score of food reactions as patients reintroduced food, a critical path emerged with a list of foods which offered the best nutrition and the highest probability of tolerance. This list eventually evolved into a standard path of food introduction.
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