What is Health & What Role

Does Nutrition Play

What was last weeks lecture?

Key Points

• Biochemistry doesn't need to be daunting

• Elements from the periodic table are chemical building blocks• Some of them make up most of our body

• The four most common are…

• ATP is the energy currency of the human cell

• Calories are really important but its not an exact science

• Don't stress over pH, just eat fruit and vegetables

• You only need a basic grasp of cell biology• To be a good practicing nutritionist, that is

RECAP FROM LAST WEEK

AIMS

What is complete health?

The role of genetics in health

Maternal epigentics

Nutrigenomics and Nutrigenetics

• Can these improve our practice?

Nutrition and health

What is Health?

Whole health

What is Health?

A person's mental or physical condition?

The state of being free from illness or injury?

The MNU mantra of health:Promoting health does not mean we merely seek the absence of disease but instead requires us to encourage physical, psychological, emotional, social, economic and intellectual wellbeing.

TASK: What role does nutrition play?

What role does nutrition advice and support play in the 6 facets of health?

Client Health: What role do YOU play?

Physical health

• We can improve many facets of this

• We should also ‘first do no harm’

Psychological health

• Psycho-Physical cross over e.g. cognition

• Decision making and empowerment (link to Intellectual)

• Aim to reduce obsessive tendencies (link to Emotional)

Social health

• Take a clients lifestyle into account

• Reduce time limited goal setting?

• Recommendations that do not exclude a social life

Client Health: What role do YOU play?

Emotional health

• Sometimes referred to as spiritual health

• Finding a ‘path’ that suits your ‘being’ e.g. vegetarianism?

• Promote a healthy relationship with food

Economic health

• Appropriate advice on use of supplements?

• Benefit of ‘high quality’ food vs economic cost

Intellectual health

• Empowered to make own decisions

• Honesty & integrity around the information you are providing

Optimal health – Living long and full lives?

BLUE ZONES - Its not just about nutrition

• Physical activity

• Close-knit community & family

• Sun exposure

• Stress

• Smoking

• Religion & sense of purpose

• Pollution

But it almost certainly plays a role!

Physical health

A primary target

What dictates physical health?

Genetics

• Simply cannot be ignored

• We are all on natures ‘scale’ that we can nurture!

• Maternal epigenetics • The maternal diet is a powerful genetic primer

Lifestyle

• Nutrition

• Exercise

Genetics – Nature vs Nurture

Type 1 vs Type 2 – Family History

• Type 1 diabetes Odds Ratio of 8.58

• Type 2 diabetes Odds Ratio of 4.04

Concordance rate in monozygotic twins is 70%

• Compared to 20-30% in dizygotic twins (Kaprio et al. 1992)

Significant proportion of this heritability reflects obesity, rather than diabetes…

Sipetic-Grujicic et al (2008)

Genetics – FTO Gene

FTO Gene

• Does increase tendency but nurture is far more powerful

Polymorphisms in the fat mass and obesity-associated gene (FTO) are associated with human obesity and obesity-prone behaviours – Reuter et al

(2016)

In adiposity-matched, normal-weight humans, subjects homozygous for the FTO “obesity-risk” have dysregulated circulating levels of the orexigenichormone acyl-ghrelin and attenuated postprandial appetite reduction. – Karra et al (2013)

Twin studies – The role of genetics

Interindividual vs Intraindividual

• Twin studies provide an amazing insight

1000kcal/day overfeeding Twins study

• 6 days out of 7 for a total of 100 days

Weight gain ranged from 9 - 30 pounds between pairs

• Weight gain within each twin pair was similar

• Between twin variance in weight gain was three times the variance within pairs.

• When looking at gains in visceral fat, the between twin variance was six times greater than within pairs.

Bouchard et al, (1990)

Twin Overfeeding Study

Bouchard et al, (1990)

Maternal Epigenetics

“If postnatal nutrition is abundant, then the programmed metabolic adaptations that occur in utero will become detrimental and likely result in excess energy storage, altered postnatal growth, altered body composition (e.g. increased fat mass:lean mass) and subsequent metabolic dysfunction in later life”

Laker et al. (2013)

These effects continue into later life

Mother’s weight associated with altered methylation patterns in the child’s DNA and later infant adiposity (studied up to age 9) - Sharp et al. (2015)

Higher birth weight directly correlated to higher BMI in later life – Oken & Gillman (2003)

Offspring born of GDM pregnancies are more likely to develop childhood and adult obesity, and T2 diabetes – Gillman et al. (2003)

• 1.4 x more likely to develop obesity for every 1-kg increment in birth weight

Its that question again – Nature vs Nurture

Nutrigenomics vs Nutrigenetics

Nutrigenetics

• The science of the effect of genetic variation on dietary response

Nutrigenomics

• The science of the effect of nutrients and bioactive components on gene expression

Personalized recommendations given to the Nutrigenetic

test patient group in addition to base diet 3/3

Low saturated fat, low GI Mediterranean diet vs a nutrigenetically determined modified diet study

Arkadianos et al (2007)

Personalized recommendations given to the Nutrigenetic

test patient group in addition to base diet 1/3

Arkadianos et al (2007)

Personalized recommendations given to the Nutrigenetic

test patient group in addition to base diet 2/3

Arkadianos et al (2007)

Limitation…

“Our data could be explained by a difference in compliance levels between groups. As there is no placebo arm in this study, it is not possible to evaluate any physiological improvements due to the specific nutritional advice targeted to the patient's genotype.”

Snowflake analogy

Personalisation and support bolsters ‘buy in’

Worth bearing as part of your motivational interviewing and communication skills

• ‘We recommend everyone takes a fish oil”

• “In your situation a fish oil would be really useful”

Nutrition and Physical Health

There are no unhealthy foods, there aren’t even unhealthy meals, there are only unhealthy diets

• True to an extent e.g. trans-fats

No single food can ‘make’ you unhealthy

Health is a factor of the long-term cumulative effect of dietary choices made over time

Overplayed nutritional benefits

Dietary adequacy is often all that is needed for physical health to be achieved

Genetic tendencies combined with a western diet may undermine this

• Good eating + a multi?

The Theme of Optimal Eating

Is essentially ‘less Westernised/industralised’

Limited refined starches

Limited added sugars

Limited processed foods

Limited intake of certain processed fats

Emphasis on whole grain foods, with or without lean meats, fish, poultry, seafood

“And all potentially consistent with: Food, not too much, mostly plants”

Katz & Meller (2014)

‘Dieting’ Support – The complete picture

Psychologically prepare/coach your client to live

• Diets are temporary

‘Living’ is the big picture and requires ‘maintenance’

Weight loss often leads to improved Physical Health

Weight regain can lead to

• Emotional, Psychological, Social and Physical health reduction

Health is multifaceted

• Our practice needs to promote or protect all facets

Genetics/Nature plays a huge role in health

• However, lifestyle/nurture can alter the phenotype dramatically

Nutrigenetics and Nutrigenomics are certainly

very interesting areas of development

• Currently there is not enough understanding for them to be of significant benefit to practitioners

SUMMARY

Go back over the lectures from this module• Pick out any areas that you feel unsure of or areas you’d like

more insight into and put them forward for the Check-In Week

HOMEWORK

Research papers associated with key presentation

areas

• See Learn for downloadable PDFs

Further Reading