About Nutrition:

Nutrition (also called nourishment or aliment) is the provision, to cells and organisms, of the materials necessary (in the form of food) to support life. Many common health problems can be prevented or alleviated with a healthy diet.

The diet of an organism refers to what it eats. Dietitians are health professionals who specialize in human nutrition, meal planning, economics, preparation, and so on. They are trained to provide safe, evidence-based dietary advice and management to individuals (in health and disease), as well as to institutions.

Poor diet can have an injurious impact on health, causing deficiency diseases such as scurvy, beriberi, and kwashiorkor; health-threatening conditions like obesity and metabolic syndrome, and such common chronic systemic diseases as cardiovascular disease, diabetes, and osteoporosis.

Overview

Nutritional science investigates the metabolic and physiological responses of the body to diet. With advances in the fields of molecular biology, biochemistry, and genetics, the study of nutrition is increasingly concerned with metabolism and metabolic pathways: the sequences of biochemical steps through which substances in living things change from one form to another.

The human body contains chemical compounds, such as water, carbohydrates (sugar, starch, and fiber), amino acids (in proteins), fatty acids (in lipids), and nucleic acids (DNA and RNA). These compounds in turn consist of elements such as carbon, hydrogen, oxygen, nitrogen, phosphorus, calcium, iron, zinc, magnesium, manganese, and so on. All of these chemical compounds and elements occur in various forms and combinations (e.g. hormones, vitamins, phospholipids, hydroxyapatite), both in the human body and in the plant and animal organisms that humans eat.

The human body consists of elements and compounds ingested, digested, absorbed, and circulated through the bloodstream to feed the cells of the body. Except in the unborn fetus, the digestive system is the first system involved. In a typical adult, about seven liters of digestive juices enter the lumen of the digestive tract. These break chemical bonds in ingested molecules, and modulate their conformations and energy states. Though some molecules are absorbed into the bloodstream unchanged, digestive processes release them from the matrix of foods. Unabsorbed matter, along with some waste products of metabolism, is eliminated from the body in the feces.

Studies of nutritional status must take into account the state of the body before and after experiments, as well as the chemical composition of the whole diet and of all material excreted and eliminated from the body (in urine and feces). Comparing the food to the waste can help determine the specific compounds and elements absorbed and metabolized in the body. The effects of nutrients may only be discernible over an extended period, during which all food and waste must be analyzed. The number of variables involved in such experiments is high, making nutritional studies time-consuming and expensive, which explains why the science of human nutrition is still slowly evolving.

In general, eating a wide variety of fresh, whole (unprocessed), foods has proven favorable compared to monotonous diets based on processed foods. In particular, the consumption of whole-plant foods slows digestion and allows better absorption, and a more favorable balance of essential nutrients per Calorie, resulting in better management of cell growth, maintenance, and mitosis (cell division), as well as better regulation of appetite and blood sugar. Regularly scheduled meals (every few hours) have also proven more wholesome than infrequent or haphazard ones.

Nutrients

There are seven major classes of nutrients: carbohydrates, fats, fiber, minerals, protein, vitamins, and water.

These nutrient classes can be categorized as either macronutrients (needed in relatively large amounts) or micronutrients (needed in smaller quantities). The macronutrients are carbohydrates, fats, fiber, proteins, and water. The micronutrients are minerals and vitamins.

The macronutrients (excluding fiber and water) provide energy, which is measured in Joules or kilocalories (often called "Calories" and written with a capital C to distinguish them from gram calories). Carbohydrates and proteins provide 17 kJ (4 kcal) of energy per gram, while fats provide 37 kJ (9 kcal) per gram. Vitamins, minerals, fiber, and water do not provide energy, but are necessary for other reasons.

Molecules of carbohydrates and fats consist of carbon, hydrogen, and oxygen atoms. Carbohydrates range from simple monosaccharides (glucose, fructose, galactose) to complex polysaccharides (starch). Fats are triglycerides, made of various fatty acid monomers bound to glycerol. Some fatty acids, but not all, are essential in the diet: they cannot be synthesized in the body. Protein molecules contain nitrogen atoms in addition to the elements of carbohydrates and fats. The nitrogen-containing monomers of protein are amino acids, and they include some essential amino acids. They fulfill many roles other than energy metabolism; and when they are used as fuel, getting rid of the nitrogen places a burden on the kidneys.

Other micronutrients include antioxidants and phytochemicals.

Most foods contain a mix of some or all of the nutrient classes. Some nutrients are required regularly, while others are needed only occasionally. Poor health can be caused by an imbalance of nutrients, whether an excess or a deficiency.

Carbohydrates

Carbohydrates may be classified as monosaccharides, disaccharides, or polysaccharides by the number of monomer (sugar) units they contain. They constitute a large proportion of foods such as rice, noodles, bread, and other grain-based products. Monosaccharides contain one sugar unit, disaccharides two, and polysaccharides three or more. Polysaccharides are often referred to as complex carbohydrates because they are long chains of sugar units, whereas monosaccharides and disaccharides are simpler. The difference is important: complex carbohydrates take longer to digest and absorb since their sugar units are processed one-by-one off the ends of the chains. The spike in blood-sugar levels after ingestion of simple sugars is thought to be involved in causing heart and vascular disease. Simple sugars form a greater part of modern diets, leading to more cardiovascular disease in populations. Simple carbohydrates are absorbed quickly, and therefore raise blood-sugar levels more rapidly.

Fat

A molecule of fat consists of several fatty acids (containing long chains of carbon and hydrogen atoms), bonded to a glycerol. They are typically found as triglycerides (three fatty acids attached to one glycerol backbone). Fats may be classified as saturated or unsaturated. Saturated fats have all of the carbon atoms in their fatty acid chains bonded to hydrogen atoms, whereas unsaturated fats have some of these carbon atoms double-bonded, so their molecules have relatively few hydrogen atoms. Unsaturated fats may be further classified as monounsaturated (one double-bond) or polyunsaturated (many double-bonds). Trans fats are a type of unsaturated fat with trans-isomer fatty acid, typically created in an industrial process called (partial) hydrogenation.

Many studies have shown that unsaturated fats, particularly monounsaturated fats, are best in the human diet. Saturated fats, typically from animal sources, are next, while trans fats are to be avoided. Saturated and trans fats are typically solid at room temperature (such as butter or lard), while unsaturated fats are typically liquids (such as olive oil or flaxseed oil). Trans fats are very rare in nature, but have properties useful in the food processing industry.

Essential fatty acids

Most fatty acids are non-essential, meaning the body can produce them as needed. However, in humans at least two fatty acids are essential and must be included in the diet. An appropriate balance of essential fatty acids—omega-3 and omega-6 fatty acids—is important for health. Both of these "omega" long-chain polyunsaturated fatty acids are substrates for a class of eicosanoids known as prostaglandins, which have roles throughout the human body. They are hormones, in some respects. The omega-3 eicosapentaenoic acid (EPA), which can be made in the human body from the omega-3 essential fatty acid alpha-linolenic acid (LNA), or taken in through marine food sources, serves as a building block for series 3 prostaglandins (e.g. weakly inflammatory PGE3). The omega-6 dihomo-gamma-linolenic acid (DGLA) serves as a building block for series 1 prostaglandins (e.g. anti-inflammatory PGE1), whereas arachidonic acid (AA) serves as a building block for series 2 prostaglandins (e.g. pro-inflammatory PGE 2). Both DGLA and AA can be made from the omega-6 linoleic acid (LA) in the human body, or can be taken in directly through food. An appropriately balanced intake of omega-3 and omega-6 partly determines the relative production of different prostaglandins: one reason a balance between omega-3 and omega-6 is important for cardiovascular health. In industrialized societies, people typically consume large amounts of processed vegetable oils, which have reduced amounts of the essential fatty acids along with too much of omega-6 fatty acids relative to omega-3 fatty acids.

The conversion rate of omega-6 DGLA to AA largely determines the production of the prostaglandins PGE1 and PGE2. Omega-3 EPA prevents AA from being released from membranes, thereby skewing prostaglandin balance away from pro-inflammatory PGE2 (made from AA) toward anti-inflammatory PGE1 (made from DGLA). Moreover, the conversion (desaturation) of DGLA to AA is controlled by the enzyme delta-5-desaturase, which in turn is controlled by hormones such as insulin (up-regulation) and glucagon (down-regulation). The amount and type of carbohydrates consumed, along with some types of amino acid, can influence processes involving insulin, glucagon, and other hormones; therefore the ratio of omega-3 versus omega-6 has wide effects on general health, and specific effects on immune function and inflammation, and mitosis (i.e. cell division).

Good sources of essential fatty acids include most vegetables, nuts, seeds, and marine oils. Some of the best sources are fish, flax seed oils, soy beans, pumpkin seeds, sunflower seeds, and walnuts.

Fiber

Fiber is a carbohydrate (or a polysaccharide) that is incompletely absorbed in humans and in some other animals. Like all carbohydrates, when it is metabolized it can produce four Calories (kilocalories) of energy per gram. But in most circumstances it accounts for less than that because of its limited absorption. Dietary fiber consists mainly of cellulose, a large carbohydrate polymer that is indigestible because humans do not have the required enzymes. There are two subcategories: soluble and insoluble fiber. Whole grains, fruits (especially plums, prunes, and figs), and vegetables are rich in dietary fiber. Fiber is important to digestive health and is thought to reduce the risk of colon cancer. It can help in alleviating both constipation and diarrhea. Fiber provides bulk to the intestinal contents, and insoluble fiber stimulates peristalsis: the rhythmic muscular contractions passing along the digestive tract. Some soluble fibers produce a solution of high viscosity: a gel, which slows the movement of food through the intestines. Fiber, especially from whole grains, may help lessen insulin spikes and reduce the risk of diabetes [type 2].

Protein

Minerals

Dietary minerals are the chemical elements required by living organisms, other than the four elements carbon, hydrogen, nitrogen, and oxygen that are present in common organic molecules. The term "mineral" is archaic, since the intent is to describe simply the less common elements in the diet: heavier than the four just mentioned; including several metals; and often occurring as ions in the body. Some dietitians recommend that these be supplied from foods in which they occur naturally, or at least as complex compounds, or sometimes even from natural inorganic sources (such as calcium carbonate from ground oyster shells). On the other hand, minerals are often artificially added to the diet as supplements, the most famous being iodine in iodized salt.

Macrominerals

Many elements are essential in quantity; also called "bulk minerals". Some are structural, but many play a role as electrolytes. Elements with recommended dietary allowance (RDA) greater than 200 mg/day are the following, in alphabetical order (with informal or folk-medicine perspectives in parentheses):

• Calcium, a common electrolyte, but also structural (for muscle and digestive system health, builds bone, neutralizes acidity, clears toxins, helps blood stream)
• Chlorine as chloride ions; very common electrolyte; see sodium, below
• Magnesium, required for processing ATP and related reactions (builds bone, causes strong peristalsis, increases flexibility, increases alkalinity)
• Phosphorus, required component of bones; essential for energy processing
• Potassium, a very common electrolyte (heart and nerve health)
• Sodium, a very common electrolyte; not generally found in dietary supplements, despite being needed in large quantities, because the ion is very common in food: typically as sodium chloride, or common salt
• Sulfur for three essential amino acids and therefore many proteins (skin, hair, nails, liver, and pancreas)

Trace minerals

Many elements are required in trace amounts, usually because they play a catalytic role in enzymes. Some trace mineral elements (RDA < 200 mg/day) are, in alphabetical order:

• Cobalt required for biosynthesis of vitamin B12 family of coenzymes
• Copper required component of many redox enzymes, including cytochrome c oxidase
• Chromium required for sugar metabolism
• Iodine required for the biosynthesis of thyroxin; needed in larger quantities than others in this list, and sometimes classified with the macrominerals
• Iron required for many enzymes, and for hemoglobin and some other proteins
• Manganese (processing of oxygen)
• Molybdenum required for xanthine oxidase and related oxidases
• Nickel present in urease
• Selenium required for peroxidase (antioxidant proteins)
• Vanadium (Speculative: there is no established RDA for vanadium. No specific biochemical function has been identified for it in humans, although vanadium is found in lower organisms.)
• Zinc required for several enzymes such as carboxypeptidase, liver alcohol dehydrogenase, carbonic anhydrase

Vitamins

As with the minerals discussed above, twelve vitamins are recognized as essential nutrients, necessary in the diet for good health. (Vitamin D is the exception: it can alternatively be synthesized in the skin, in the presence of UVB radiation.) Certain vitamin-like compounds that are recommended in the diet, such as carnitine, are indispensable for survival and health; but these are not strictly "essential" because the human body has some capacity to produce them from other compounds. Moreover, thousands of different phytochemicals have recently been discovered in food (particularly in fresh vegetables), which may have desirable properties including antioxidant activity (see below). Other essential nutrients not classed as vitamins include essential amino acids, choline, essential fatty acids, and the minerals discussed in the preceding section.

Vitamin deficiencies may result in disease conditions: goitre, scurvy, osteoporosis, impaired immune system, disorders of cell metabolism, certain forms of cancer, symptoms of premature aging, and poor psychological health (including eating disorders), among many others. Excess of some vitamins is also dangerous to health (notably vitamin A); and deficiency or excess of minerals can also have serious health consequences.

Water

It is not clear how much water intake is needed by healthy people, although some experts assert that 8–10 glasses of water (approximately 2 liters) daily is the minimum to maintain proper hydration. The notion that a person should consume eight glasses of water per day cannot be traced back to a scientific source. The effect of water intake on weight loss and on constipation is also still unclear. Original recommendation for water intake in 1945 by the Food and Nutrition Board of the National Research Council read: "An ordinary standard for diverse persons is 1 milliliter for each calorie of food. Most of this quantity is contained in prepared foods." The latest dietary reference intake report by the United States National Research Council in general recommended (including food sources): 2.7 liters of water total for women and 3.7 liters for men. Specifically, pregnant and breastfeeding women need additional fluids to stay hydrated. According to the Institute of Medicine—who recommend that, on average, women consume 2.2 litres and men 3.0 litres—this is recommended to be 2.4 litres (approx. 9 cups) for pregnant women and 3 litres (approx. 12.5 cups) for breastfeeding women since an especially large amount of fluid is lost during nursing.

For those who have healthy kidneys, it is rather difficult to drink too much water, but (especially in warm humid weather and while exercising) it is dangerous to drink too little. People can drink far more water than necessary while exercising, however, putting them at risk of water intoxication, which can be fatal. In particular large amounts of de-ionized water are dangerous.

Normally, about 20 percent of water intake comes in food, while the rest comes from drinking water and assorted beverages (caffeinated included). Water is excreted from the body in multiple forms; including urine and feces, sweating, and by water vapor in the exhaled breath.

Other nutrients

Other micronutrients include antioxidants and phytochemicals. These substances are generally more recent discoveries which: have not yet been recognized as vitamins; are still under investigation; or contribute to health but are not necessary for life. Phytochemicals may act as antioxidants, but not all phytochemicals are antioxidants.

Antioxidants

Antioxidants are a recent discovery. As cellular metabolism/energy production requires oxygen, potentially damaging (e.g. mutation causing) compounds known as free radicals can form. Most of these are oxidizers (i.e. acceptors of electrons) and some react very strongly. For normal cellular maintenance, growth, and division, these free radicals must be sufficiently neutralized by antioxidant compounds. Some are produced by the human body with adequate precursors (glutathione, Vitamin C) and those that the body cannot produce may only be obtained through the diet through direct sources (Vitamin C in humans, Vitamin A, Vitamin K) or produced by the body from other compounds (Beta-carotene converted to Vitamin A by the body, Vitamin D synthesized from cholesterol by sunlight). Phytochemicals (Section Below) and their subgroup polyphenols are the majority of antioxidants; about 4,000 are known. Different antioxidants are now known to function in a cooperative network, e.g. vitamin C can reactivate free radical-containing glutathione or vitamin E by accepting the free radical itself, and so on. Some antioxidants are more effective than others at neutralizing different free radicals. Some cannot neutralize certain free radicals. Some cannot be present in certain areas of free radical development (Vitamin A is fat-soluble and protects fat areas, Vitamin C is water soluble and protects those areas). When interacting with a free radical, some antioxidants produce a different free radical compound that is less dangerous or more dangerous than the previous compound. Having a variety of antioxidants allows any byproducts to be safely dealt with by more efficient antioxidants in neutralizing a free radical's butterfly effect.

Phytochemicals

A growing area of interest is the effect upon human health of trace chemicals, collectively called phytochemicals. These nutrients are typically found in edible plants, especially colorful fruits and vegetables, but also other organisms including seafood, algae, and fungi. The effects of phytochemicals increasingly survive rigorous testing by prominent health organizations. One of the principal classes of phytochemicals are polyphenol antioxidants, chemicals which are known to provide certain health benefits to the cardiovascular system and immune system. These chemicals are known to down-regulate the formation of reactive oxygen species, key chemicals in cardiovascular disease.

Perhaps the most rigorously tested phytochemical is zeaxanthin, a yellow-pigmented carotenoid present in many yellow and orange fruits and vegetables. Repeated studies have shown a strong correlation between ingestion of zeaxanthin and the prevention and treatment of age-related macular degeneration (AMD). Less rigorous studies have proposed a correlation between zeaxanthin intake and cataracts. A second carotenoid, lutein, has also been shown to lower the risk of contracting AMD. Both compounds have been observed to collect in the retina when ingested orally, and they serve to protect the rods and cones against the destructive effects of light.

Another carotenoid, beta-cryptoxanthin, appears to protect against chronic joint inflammatory diseases, such as arthritis. While the association between serum blood levels of beta-cryptoxanthin and substantially decreased joint disease has been established, neither a convincing mechanism for such protection nor a cause-and-effect have been rigorously studied. Similarly, a red phytochemical, lycopene, has substantial credible evidence of negative association with development of prostate cancer.

The correlations between the ingestion of some phytochemicals and the prevention of disease are, in some cases, enormous in magnitude.

Even when the evidence is obtained, translating it to practical dietary advice can be difficult and counter-intuitive. Lutein, for example, occurs in many yellow and orange fruits and vegetables and protects the eyes against various diseases. However, it does not protect the eye nearly as well as zeaxanthin, and the presence of lutein in the retina will prevent zeaxanthin uptake. Additionally, evidence has shown that the lutein present in egg yolk is more readily absorbed than the lutein from vegetable sources, possibly because of fat solubility. At the most basic level, the question "should you eat eggs?" is complex to the point of dismay, including misperceptions about the health effects of cholesterol in egg yolk, and its saturated fat content.

As another example, lycopene is prevalent in tomatoes (and actually is the chemical that gives tomatoes their red color). It is more highly concentrated, however, in processed tomato products such as commercial pasta sauce, or tomato soup, than in fresh "healthy" tomatoes. Yet, such sauces tend to have high amounts of salt, sugar, other substances a person may wish or even need to avoid.

The following table presents phytochemical groups and common sources, arranged by family:

Family	Sources	Possible Benefits
flavonoids	berries, herbs, vegetables, wine, grapes, tea	general antioxidant, oxidation of LDLs, prevention of arteriosclerosis and heart disease
isoflavones (phytoestrogens)	soy, red clover, kudzu root	general antioxidant, prevention of arteriosclerosis and heart disease, easing symptoms of menopause, cancer prevention
isothiocyanates	cruciferous vegetables	cancer prevention
monoterpenes	citrus peels, essential oils, herbs, spices, green plants, atmosphere	cancer prevention, treating gallstones
organosulfur compounds	chives, garlic, onions	cancer prevention, lowered LDLs, assistance to the immune system
saponins	beans, cereals, herbs	Hypercholesterolemia, Hyperglycemia, Antioxidant, cancer prevention, Anti-inflammatory
capsaicinoids	all capiscum (chile) peppers	topical pain relief, cancer prevention, cancer cell apoptosis

 

Intestinal bacterial flora

It is now also known that animal intestines contain a large population of gut flora. In humans, these include species such as Bacteroides, L. acidophilus and E. coli, among many others. They are essential to digestion, and are also affected by the food we eat. Bacteria in the gut perform many important functions for humans, including breaking down and aiding in the absorption of otherwise indigestible food; stimulating cell growth; repressing the growth of harmful bacteria, training the immune system to respond only to pathogens; producing vitamin B12, and defending against some infectious diseases.

Sports nutrition

Protein

Protein is an important component of every cell in the body. Hair and nails are mostly made of protein. The body uses protein to build and repair tissues. Also protein is used to make enzymes, hormones, and other body chemicals. Protein is an important building block of bones, muscles, cartilage, skin, and blood.

The protein requirement for each individual differs, as do opinions about whether and to what extent physically active people require more protein. The 2005 Recommended Dietary Allowances (RDA), aimed at the general healthy adult population, provide for an intake of 0.8 grams of protein per kilogram of body weight, with the review panel stating that "no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise". Conversely, Di Pasquale (2008), citing recent studies, recommends a minimum protein intake of 2.2 g/kg "for anyone involved in competitive or intense recreational sports who wants to maximize lean body mass but does not wish to gain weight".

Water and salts

Water is one of the most important nutrients in the sports diet. It helps eliminate food waste products in the body, regulates body temperature during activity and helps with digestion. Maintaining hydration during periods of physical exertion is key to peak performance. While drinking too much water during activities can lead to physical discomfort, dehydration in excess of 2% of body mass (by weight) markedly hinders athletic performance. Additional carbohydrates and protein before, during, and after exercise increase time to exhaustion as well as speed recovery. Dosage is based on work performed, lean body mass, and environmental factors, especially ambient temperature and humidity.

Carbohydrates

The main fuel used by the body during exercise is carbohydrates, which is stored in muscle as glycogen—a form of sugar. During exercise, muscle glycogen reserves can be used up, especially when activities last longer than 90 min. Because the amount of glycogen stored in the body is limited, it is important for athletes to replace glycogen by consuming a diet high in carbohydrates. Meeting energy needs can help improve performance during the sport, as well as improve overall strength and endurance.

There are different kinds of carbohydrates—simple or refined, and unrefined. A typical American consumes about 50% of their carbohydrates as simple sugars, which are added to foods as opposed to sugars that come naturally in fruits and vegetables. These simple sugars come in large amounts in sodas and fast food. Over the course of a year, the average American consumes 54 gallons of soft drinks, which contain the highest amount of added sugars. Even though carbohydrates are necessary for humans to function, they are not all equally healthful. When machinery has been used to remove bits of high fiber, the carbohydrates are refined. These are the carbohydrates found in white bread and fast food.

Longevity

Whole plant food diet

Heart disease, cancer, obesity, and diabetes are commonly called "Western" diseases because these maladies were once rarely seen in developing countries. One study in China found some regions had essentially no cancer or heart disease, while in other areas they reflected "up to a 100-fold increase" coincident with diets that were found to be entirely plant-based to heavily animal-based, respectively. In contrast, diseases of affluence like cancer and heart disease are common throughout the United States. Adjusted for age and exercise, large regional clusters of people in China rarely suffered from these "Western" diseases possibly because their diets are rich in vegetables, fruits and whole grains.

The United Healthcare/Pacificare nutrition guideline recommends a whole plant food diet, and recommends using protein only as a condiment with meals. A National Geographic cover article from November, 2005, entitled The Secrets of Living Longer, also recommends a whole plant food diet. The article is a lifestyle survey of three populations, Sardinians, Okinawans, and Adventists, who generally display longevity and "suffer a fraction of the diseases that commonly kill people in other parts of the developed world, and enjoy more healthy years of life." In sum, they offer three sets of 'best practices' to emulate. The rest is up to you. In common with all three groups is to "Eat fruits, vegetables, and whole grains."

The National Geographic article noted that an NIH funded study of 34,000 Seventh-day Adventists between 1976 and 1988 "…found that the Adventists' habit of consuming beans, soy milk, tomatoes, and other fruits lowered their risk of developing certain cancers. It also suggested that eating whole grain bread, drinking five glasses of water a day, and, most surprisingly, consuming four servings of nuts a week reduced their risk of heart disease."

The French "paradox"

It has been discovered that people living in France live longer. Even though they consume more saturated fats than Americans, the rate of heart disease is lower in France than in North America. A number of explanations have been suggested:

• Reduced consumption of processed carbohydrate and other junk foods.
• Ethnic genetic differences allowing the body to be harmed less by fats.
• Regular consumption of red wine.
• Living in a mild climate requires the body to produce less heat, allowing a slower, and therefore healthier, metabolic rate.
• More active lifestyles involving plenty of daily exercise, especially walking; the French are much less dependent on cars than Americans are.
• Higher consumption of artificially produced trans-fats by Americans, which has been shown to have greater lipoprotein effects per gram than saturated fat.

However, a growing number of French health researchers doubt the theory that the French are healthier than other populations. Statistics collected by the World Health Organization from 1990-2000 show that the incidence of heart disease in France may have been underestimated and in fact be similar to that of neighboring countries.

Malnutrition

Malnutrition refers to insufficient, excessive, or imbalanced consumption of nutrients. In developed countries, the diseases of malnutrition are most often associated with nutritional imbalances or excessive consumption. Although there are more people in the world who are malnourished due to excessive consumption, according to the United Nations World Health Organization, the real challenge in developing nations today, more than starvation, is combating insufficient nutrition — the lack of nutrients necessary for the growth and maintenance of vital functions.

Illnesses caused by improper nutrient consumption

Nutrients	Deficiency	Excess
Energy	Starvation	Obesity, diabetes mellitus, Cardiovascular disease
Simple carbohydrates	Marasmus, starvation	diabetes mellitus
Complex carbohydrates	Marasmus, starvation	Obesity
Saturated fat / trans fat	none	Cardiovascular disease,
Unsaturated fat	Rabbit starvation	Obesity
Cholesterol	none	Cardiovascular disease
Protein	Marasmus	Ketoacidosis, Rabbit starvation, kidney disease
Sodium	hyponatremia	Hypernatremia, hypertension
Iron	Anemia	cirrhosis, heart disease
Iodine	Goiter, hypothyroidism	Iodine Toxicity (goiter, hypothyroidism)
Vitamin A	Xerophthalmia and Night Blindness	Hypervitaminosis A (cirrhosis, hair loss, birth defects)
Vitamin B1	Beri-Beri
Vitamin B2	Cracking of skin and Corneal Unclearation
Niacin	Pellagra	dyspepsia, cardiac arrhythmias, birth defects
Vitamin B12	Pernicious Anemia
Vitamin C	Scurvy	diarrhea causing dehydration
Vitamin D	Rickets	Hypervitaminosis D (dehydration, vomiting, constipation)
Vitamin E		Hypervitaminosis E (anticoagulant: excessive bleeding)
Vitamin K	Hemorrhage

 

Mental agility

Research indicates that improving the awareness of nutritious meal choices and establishing long-term habits of healthy eating has a positive effect on a cognitive and spatial memory capacity, potentially increasing a student's potential to process and retain academic information.

Some organizations have begun working with teachers, policymakers, and managed foodservice contractors to mandate improved nutritional content and increased nutritional resources in school cafeterias from primary to university level institutions. Health and nutrition have been proven to have close links with overall educational success. Currently less than 10% of American college students report that they eat the recommended five servings of fruit and vegetables daily. Better nutrition has been shown to have an impact on both cognitive and spatial memory performance; a study showed those with higher blood sugar levels performed better on certain memory tests. In another study, those who consumed yogurt performed better on thinking tasks when compared to those who consumed caffeine free diet soda or confections. Nutritional deficiencies have been shown to have a negative effect on learning behavior in mice as far back as 1951.

"Better learning performance is associated with diet induced effects on learning and memory ability".

The "nutrition-learning nexus" demonstrates the correlation between diet and learning and has application in a higher education setting.

"We find that better nourished children perform significantly better in school, partly because they enter school earlier and thus have more time to learn but mostly because of greater learning productivity per year of schooling."

91% of college students feel that they are in good health while only 7% eat their recommended daily allowance of fruits and vegetables.

Nutritional education is an effective and workable model in a higher education setting.

More "engaged" learning models that encompass nutrition is an idea that is picking up steam at all levels of the learning cycle.

There is limited research available that directly links a student's Grade Point Average (G.P.A.) to their overall nutritional health. Additional substantive data is needed to prove that overall intellectual health is closely linked to a person's diet, rather than just another correlation fallacy.

Mental disorders

Nutritional supplement treatment may be appropriate for major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder, the four most common mental disorders in developed countries.

Cancer

Cancer is now common in developing countries. According a study by the International Agency for Research on Cancer, "In the developing world, cancers of the liver, stomach and esophagus were more common, often linked to consumption of carcinogenic preserved foods, such as smoked or salted food, and parasitic infections that attack organs." Lung cancer rates are rising rapidly in poorer nations because of increased use of tobacco. Developed countries "tended to have cancers linked to affluence or a 'Western lifestyle' — cancers of the colon, rectum, breast and prostate — that can be caused by obesity, lack of exercise, diet and age."

Metabolic syndrome

Several lines of evidence indicate lifestyle-induced hyperinsulinemia and reduced insulin function (i.e. insulin resistance) as a decisive factor in many disease states. For example, hyperinsulinemia and insulin resistance are strongly linked to chronic inflammation, which in turn is strongly linked to a variety of adverse developments such as arterial microinjuries and clot formation (i.e. heart disease) and exaggerated cell division (i.e. cancer). Hyperinsulinemia and insulin resistance (the so-called metabolic syndrome) are characterized by a combination of abdominal obesity, elevated blood sugar, elevated blood pressure, elevated blood triglycerides, and reduced HDL cholesterol. The negative impact of hyperinsulinemia on prostaglandin PGE1/PGE2 balance may be significant.

The state of obesity clearly contributes to insulin resistance, which in turn can cause type 2 diabetes. Virtually all obese and most type 2 diabetic individuals have marked insulin resistance. Although the association between overweight and insulin resistance is clear, the exact (likely multifarious) causes of insulin resistance remain less clear. Importantly, it has been demonstrated that appropriate exercise, more regular food intake and reducing glycemic load (see below) all can reverse insulin resistance in overweight individuals (and thereby lower blood sugar levels in those who have type 2 diabetes).

Obesity can unfavourably alter hormonal and metabolic status via resistance to the hormone leptin, and a vicious cycle may occur in which insulin/leptin resistance and obesity aggravate one another. The vicious cycle is putatively fuelled by continuously high insulin/leptin stimulation and fat storage, as a result of high intake of strongly insulin/leptin stimulating foods and energy. Both insulin and leptin normally function as satiety signals to the hypothalamus in the brain; however, insulin/leptin resistance may reduce this signal and therefore allow continued overfeeding despite large body fat stores. In addition, reduced leptin signalling to the brain may reduce leptin's normal effect to maintain an appropriately high metabolic rate.

There is a debate about how and to what extent different dietary factors— such as intake of processed carbohydrates, total protein, fat, and carbohydrate intake, intake of saturated and trans fatty acids, and low intake of vitamins/minerals—contribute to the development of insulin and leptin resistance. In any case, analogous to the way modern man-made pollution may potentially overwhelm the environment's ability to maintain homeostasis, the recent explosive introduction of high glycemic index and processed foods into the human diet may potentially overwhelm the body's ability to maintain homeostasis and health (as evidenced by the metabolic syndrome epidemic).

Hyponatremia

Excess water intake, without replenishment of sodium and potassium salts, leads to hyponatremia, which can further lead to water intoxication at more dangerous levels. A well-publicized case occurred in 2007, when Jennifer Strange died while participating in a water-drinking contest. More usually, the condition occurs in long-distance endurance events (such as marathon or triathlon competition and training) and causes gradual mental dulling, headache, drowsiness, weakness, and confusion; extreme cases may result in coma, convulsions, and death. The primary damage comes from swelling of the brain, caused by increased osmosis as blood salinity decreases. Effective fluid replacement techniques include Water aid stations during running/cycling races, trainers providing water during team games such as Soccer and devices such as Camel Baks which can provide water for a person without making it too hard to drink the water.

Processed foods

Since the Industrial Revolution some two hundred years ago, the food processing industry has invented many technologies that both help keep foods fresh longer and alter the fresh state of food as they appear in nature. Cooling is the primary technology used to maintain freshness, whereas many more technologies have been invented to allow foods to last longer without becoming spoiled. These latter technologies include pasteurisation, autoclavation, drying, salting, and separation of various components, and all appear to alter the original nutritional contents of food. Pasteurisation and autoclavation (heating techniques) have no doubt improved the safety of many common foods, preventing epidemics of bacterial infection. But some of the (new) food processing technologies undoubtedly have downfalls as well.

Modern separation techniques such as milling, centrifugation, and pressing have enabled concentration of particular components of food, yielding flour, oils, juices and so on, and even separate fatty acids, amino acids, vitamins, and minerals. Inevitably, such large scale concentration changes the nutritional content of food, saving certain nutrients while removing others. Heating techniques may also reduce food's content of many heat-labile nutrients such as certain vitamins and phytochemicals, and possibly other yet to be discovered substances. Because of reduced nutritional value, processed foods are often 'enriched' or 'fortified' with some of the most critical nutrients (usually certain vitamins) that were lost during processing. Nonetheless, processed foods tend to have an inferior nutritional profile compared to whole, fresh foods, regarding content of both sugar and high GI starches, potassium/sodium, vitamins, fiber, and of intact, unoxidized (essential) fatty acids. In addition, processed foods often contain potentially harmful substances such as oxidized fats and trans fatty acids.

A dramatic example of the effect of food processing on a population's health is the history of epidemics of beri-beri in people subsisting on polished rice. Removing the outer layer of rice by polishing it removes with it the essential vitamin thiamine, causing beri-beri. Another example is the development of scurvy among infants in the late 1800s in the United States. It turned out that the vast majority of sufferers were being fed milk that had been heat-treated (as suggested by Pasteur) to control bacterial disease. Pasteurisation was effective against bacteria, but it destroyed the vitamin C.

As mentioned, lifestyle- and obesity-related diseases are becoming increasingly prevalent all around the world. There is little doubt that the increasingly widespread application of some modern food processing technologies has contributed to this development. The food processing industry is a major part of modern economy, and as such it is influential in political decisions (e.g. nutritional recommendations, agricultural subsidising). In any known profit-driven economy, health considerations are hardly a priority; effective production of cheap foods with a long shelf-life is more the trend. In general, whole, fresh foods have a relatively short shelf-life and are less profitable to produce and sell than are more processed foods. Thus the consumer is left with the choice between more expensive but nutritionally superior whole, fresh foods, and cheap, usually nutritionally inferior processed foods. Because processed foods are often cheaper, more convenient (in both purchasing, storage, and preparation), and more available, the consumption of nutritionally inferior foods has been increasing throughout the world along with many nutrition-related health complications.

Advice and guidance

Governmental policies

In the US, "dietitians" are registered (RD) or licensed (LD) with the Commission for Dietetic Registration and the American Dietetic Association, and are only able to use the title "dietitian," as described by the business and professions codes of each respective state, when they have met specific educational and experiential prerequisites and passed a national registration or licensure examination, respectively. In California, registered dietitions must abide by the "Business and Professions Code of Section 2585-2586.8". Anyone may call themselves a nutritionist, including unqualified personnel, as this term is unregulated. Some states, such as the State of Florida, have begun to include the title "nutritionist" in state licensure requirements. Most governments provide guidance on nutrition, and some also impose mandatory disclosure/labeling requirements for processed food manufacturers and restaurants to assist consumers in complying with such guidance.

In the US, nutritional standards and recommendations are established jointly by the US Department of Agriculture and US Department of Health and Human Services. Dietary and physical activity guidelines from the USDA are presented in the concept of a food pyramid, which superseded the Four Food Groups. The Senate committee currently responsible for oversight of the USDA is the Agriculture, Nutrition and Forestry Committee. Committee hearings are often televised on C-SPAN as seen here.

The U.S. Department of Health and Human Services provides a sample week-long menu which fulfills the nutritional recommendations of the government.

Canada's Food Guide is another governmental recommendation.

Teaching

Nutrition is taught in schools in many countries. In England and Wales the Personal and Social Education and Food Technology curricula include nutrition, stressing the importance of a balanced diet and teaching how to read nutrition labels on packaging. In many schools a Nutrition class will fall within the Family and Consumer Science or Health departments. In some American schools, students are required to take a certain number of FCS or Health related classes. Nutrition is offered at many schools, and if it is not a class of its own, nutrition is included in other FCS or Health classes such as: Life Skills, Independent Living, Single Survival, Freshmen Connection, Health etc. In many Nutrition classes, students learn about the food groups, the food pyramid, Daily Recommended Allowances, calories, vitamins, minerals, malnutrition, physical activity, healthy food choices and how to live a healthy life.

A 1985 US National Research Council report entitled Nutrition Education in US Medical Schools concluded that nutrition education in medical schools was inadequate. Only 20% of the schools surveyed taught nutrition as a separate, required course. A 2006 survey found that this number had risen to 30%.

History

Humans have evolved as omnivorous hunter-gatherers over the past 250,000 years. The diet of early modern humans varied significantly depending on location and climate. The diet in the tropics tended to be based more heavily on plant foods, while the diet at higher latitudes tended more towards animal products. Analysis of postcranial and cranial remains of humans and animals from the Neolithic, along with detailed bone modification studies have shown that cannibalism was also prevalent among prehistoric humans.

Agriculture developed about 10,000 years ago in multiple locations throughout the world, providing grains such as wheat, rice, and maize, with staples such as bread and pasta. Farming also provided milk and dairy products, and sharply increased the availability of meats and the diversity of vegetables. The importance of food purity was recognized when bulk storage led to infestation and contamination risks. Cooking developed as an often ritualistic activity, due to efficiency and reliability concerns requiring adherence to strict recipes and procedures, and in response to demands for food purity and consistency.

From antiquity to 1900

The first recorded nutritional experiment is found in the Bible's Book of Daniel. Daniel and his friends were captured by the king of Babylon during an invasion of Israel. Selected as court servants, they were to share in the king's fine foods and wine. But they objected, preferring vegetables (pulses) and water in accordance with their Jewish dietary restrictions. The king's chief steward reluctantly agreed to a trial. Daniel and his friends received their diet for 10 days and were then compared to the king's men. Appearing healthier, they were allowed to continue with their diet.

In around 475 BC, Anaxagoras stated that food is absorbed by the human body and therefore contained "homeomerics" (generative components), thereby deducing the existence of nutrients. Around 400 BC, Hippocrates said, "Let food be your medicine and medicine be your food."

In the 1500s, scientist and artist Leonardo da Vinci compared metabolism to a burning candle. In 1747, Dr. James Lind, a physician in the British navy, performed the first scientific nutrition experiment, discovering that lime juice saved sailors who had been at sea for years from scurvy, a deadly and painful bleeding disorder. The discovery was ignored for forty years, after which British sailors became known as "limeys." The essential vitamin C within lime juice would not be identified by scientists until the 1930s.

Around 1770, Antoine Lavoisier, the "Father of Nutrition and Chemistry" discovered the details of metabolism, demonstrating that the oxidation of food is the source of body heat. In 1790, George Fordyce recognized calcium as necessary for fowl survival. In the early 1800s, the elements carbon, nitrogen, hydrogen and oxygen were recognized as the primary components of food, and methods to measure their proportions were developed.

In 1816, François Magendie discovered that dogs fed only carbohydrates and fat lost their body protein and died in a few weeks, but dogs also fed protein survived, identifying protein as an essential dietary component. In 1840, Justus Liebig discovered the chemical makeup of carbohydrates (sugars), fats (fatty acids) and proteins (amino acids.) In the 1860s, Claude Bernard discovered that body fat can be synthesized from carbohydrate and protein, showing that the energy in blood glucose can be stored as fat or as glycogen.

In the early 1880s, Kanehiro Takaki observed that Japanese sailors (whose diets consisted almost entirely of white rice) developed beriberi (or endemic neuritis, a disease causing heart problems and paralysis) but British sailors and Japanese naval officers did not. Adding various types of vegetables and meats to the diets of Japanese sailors prevented the disease.

In 1896, Baumann observed iodine in thyroid glands. In 1897, Christiaan Eijkman worked with natives of Java, who also suffered from beriberi. Eijkman observed that chickens fed the native diet of white rice developed the symptoms of beriberi, but remained healthy when fed unprocessed brown rice with the outer bran intact. Eijkman cured the natives by feeding them brown rice, discovering that food can cure disease. Over two decades later, nutritionists learned that the outer rice bran contains vitamin B1, also known as thiamine.

From 1900 to the present

In the early 1900s, Carl Von Voit and Max Rubner independently measured caloric energy expenditure in different species of animals, applying principles of physics in nutrition. In 1906, Wilcock and Hopkins showed that the amino acid tryptophan was necessary for the survival of rats. He fed them a special mixture of food containing all the nutrients he believed were essential for survival, but the rats died. A second group of rats to which he also fed fed an amount of milk containing vitamins. Gowland Hopkins recognized "accessory food factors" other than calories, protein and minerals, as organic materials essential to health but which the body cannot synthesize. In 1907, Stephen M. Babcock and Edwin B. Hart conducted the single-grain experiment. This experiment runs through 1911.

In 1912, Casimir Funk coined the term vitamin, a vital factor in the diet, from the words "vital" and "amine," because these unknown substances preventing scurvy, beriberi, and pellagra, were thought then to be derived from ammonia. The vitamins were studied in the first half of the twentieth century.

In 1913, Elmer McCollum discovered the first vitamins, fat soluble vitamin A, and water soluble vitamin B (in 1915; now known to be a complex of several water-soluble vitamins) and names vitamin C as the then-unknown substance preventing scurvy. Lafayette Mendel and Thomas Osborne also perform pioneering work on vitamin A and B. In 1919, Sir Edward Mellanby incorrectly identified rickets as a vitamin A deficiency, because he could cure it in dogs with cod liver oil. In 1922, McCollum destroyed the vitamin A in cod liver oil but finds it still cures rickets, naming vitamin D Also in 1922, H.M. Evans and L.S. Bishop discover vitamin E as essential for rat pregnancy, originally calling it "food factor X" until 1925.

In 1925, Hart discovered that trace amounts of copper are necessary for iron absorption. In 1927, Adolf Otto Reinhold Windaus synthesized vitamin D, for which he won the Nobel Prize in Chemistry in 1928. In 1928, Albert Szent-Györgyi isolated ascorbic acid, and in 1932 proves that it is vitamin C by preventing scurvy. In 1935 he synthesizes it, and in 1937 he wins a Nobel Prize for his efforts. Szent-Györgyi concurrently elucidates much of the citric acid cycle.

In the 1930s, William Cumming Rose identified essential amino acids, necessary protein components which the body cannot synthesize. In 1935, Underwood and Marston independently discover the necessity of cobalt. In 1936, Eugene Floyd Dubois showed that work and school performance are related to caloric intake. In 1938, Erhard Fernholz discovered the chemical structure of vitamin E. It was synthesised by Paul Karrer.

In 1940, rationing in the United Kingdom during and after World War II took place according to nutritional principles drawn up by Elsie Widdowson and others. In 1941, the first Recommended Dietary Allowances (RDAs) were established by the National Research Council.

In 1992, The U.S. Department of Agriculture introduced the Food Guide Pyramid. In 2002, a Natural Justice study showed a relation between nutrition and violent behavior. In 2005, a study found that obesity may be caused by adenovirus in addition to bad nutrition.