By Benjamin I. Brown
Cite as: Brown, B. (2022) Nutritional medicine in primary healthcare.Nutr. Med. J., 1 (1), 6-9.
Affiliation: B. Brown is with the Nutritional Medicine Institute, London, UK, and the British College of Nutrition and Health (BCNH), London, UK.
Corresponding author: Benjamin I. Brown (email: firstname.lastname@example.org)
Article history: Available online 31 March 2022.
Published by: The Nutritional Medicine Institute
Open Access: This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http:// creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial use please contact email@example.com
Dietary interventions and nutrient-based supplements can prevent disease, reverse established illness and improve health while being very safe and, in some cases, extraordinarily effective. Yet the scientific evidence for nutritional medicine is not well incorporated into medical training, and consequently nutritional therapy is underutilised in clinical practice to the detriment of good patient care.
What we eat is a major modifiable determinant of health. Dietary risk factors have been attributed to 11 million deaths amongst adults aged 25 years or older worldwide, 18% of all deaths in North America, and 22% of all deaths in Europe.1 Adoption of healthier eating predictably reduces the risk of death and major chronic diseases.2 A large number of studies assessing the impact of dietary interventions on metabolic risk markers and hard endpoints have demonstrated important disease-modifying effects in areas such as cardiometabolic disease3,4,5 autoimmune disorders6,7 functional gastrointestinal disease,8 endocrinological disease,9 cancers10,11,12 dermatological diseases13,14 psychiatric illness15,16,17 and neurodegenerative disease.18,19,20
The mechanisms by which food and food components such as micronutrients and other bioactive compounds prevent and treat disease include mitigation of DNA damage, maintenance of cell and tissue function, by acting as cofactors or components to thousands of metabolic processes, and involvement in biological processes intrinsic to health and longevity.21,22
Despite the importance of an optimal daily supply of nutrients from food, most of the population have nutritional inadequacies. Amongst participants of the Heath Survey for England, 72% did not achieve the recommendations for daily fruit and vegetable intake.23 Inadequate intake of micronutrients is a widespread public health problem globally.24 In the UK, young adults are typically deficient in several essential micronutrients,25 with the problem more pronounced in groups at higher risk of nutritional inadequacy, including children with poor-quality diets,26 people consuming vegan diets,27 pregnant women28 and older adults.29
Even when consuming a relatively healthy diet, suboptimal micronutrient intakes can occur due to environmental factors related to the industrialisation of the food supply that have reduced nutrient levels in foods. For example, over the last 80 years there have been significant declines in the mineral content of fruit and vegetable crops in the UK, likely due to factors such as choice of cultivar or plant variety, a shift from organic practices to industrial practices, deleterious changes in soil ecosystems, and increases in atmospheric carbon dioxide.30 Exacerbating the issue of suboptimal food quality, an individual’s metabolic requirements for many different nutrients may be higher due to inherent genetic variations,31 psychological and environmental stress,32 functional health status,33 medication use34 and age-related malabsorption,35 amongst other influences.
Nutrient-based supplements can optimise micronutrient intake and reduce the risk of nutritional deficiencies in the general population,36 as well as in groups at particularly high risk of suboptimal nutrient status.37,38 Intervention studies provide evidence for therapeutic applications of nutrient-based supplements in a wide range of areas, including mental health (e.g. magnesium,39 ω-3 polyunsaturated fatty acids,40 n-acetylcysteine41), cardiovascular disease (e.g. ubiquinone,42 vitamin C,43 carnitine44), type-2 diabetes (e.g. resveratrol,45 lipoic acid,46 zinc47) and dementia (e.g. B vitamins48), to cite just a few examples in which nutrient-based supplements have been shown to prevent and/or treat disease.
There is enough evidence to incorporate nutrition in medicine; however, its implementation is lacking, in part due to poor nutritional literacy resulting from inadequacies in training49 and longstanding bias against nutritional interventions.50 This is despite an increasing appreciation for the role of nutrition in primary healthcare amongst medical students and a desire for improved education.51,52 Better knowledge could facilitate the adoption of nutritional medicine and encourage interdisciplinary collaboration with clinical nutritionists, ultimately helping to bridge shortfalls in the management of nutrition-related disease.
The aim of the Nutritional Medicine Journal is to provide health professionals with authoritative and scientifically accurate articles on topics in nutritional medicine, with emphasis placed on publications relevant to the clinical application of patient-centred, integrative, personalised nutritional approaches that are focused on improving underlying pathophysiology or function to promote positive health outcomes.
Welcome to the inaugural issue.
Benjamin I. Brown
Editor, Nutritional Medicine Journal
1 GBD 2017 Diet Collaborators (2019) Health effects of dietary risks in 195 countries, 1990−2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet, 393 (10 184), 1958−1972.
2Jayedi, A., Soltani, S., Abdolshahi, A. & Shab-Bidar, S. (2020) Healthy and unhealthy dietary patterns and the risk of chronic disease: an umbrella review of meta-analyses of prospective cohort studies. Br. J. Nutr., 124 (11), 1133−1144.
3 Estruch, R. et al. and PREDIMED Study Investigators (2018) Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N. Engl. J. Med., 378 (25), e34.
4 Schwingshackl, L. et al. (2019) Comparative effects of different dietary approaches on blood pressure in hypertensive and pre-hypertensive patients: a systematic review and network meta-analysis. Crit. Rev. Food Sci. Nutr., 59 (16), 2674−2687.
5 García-Molina, L., Lewis-Mikhael, A. M., Riquelme-Gallego, B., Cano-Ibáñez, N., Oliveras-López, M. J. & Bueno-Cavanillas, A. (2020) Improving type 2 diabetes mellitus glycaemic control through lifestyle modification implementing diet intervention: a systematic review and meta-analysis. Eur. J. Nutr., 59 (4), 1313−1328.
6 Schönenberger, K. A. et al. (2021) Effect of anti-inflammatory diets on pain in rheumatoid arthritis: a systematic review and meta-analysis. Nutrients, 13 (12), 4221.
7 Comeche, J. M., Gutierrez-Hervás, A., Tuells, J., Altavilla, C. & Caballero, P. (2020) Predefined diets in patients with inflammatory bowel disease: systematic review and meta-analysis. Nutrients, 13 (1), 52.
8 Singh, R., Salem, A., Nanavati, J. & Mullin, G. E. (2018) The role of diet in the treatment of irritable bowel syndrome: a systematic review. Gastroenterol. Clin. North Am., 47 (1), 107−137.
9 Shang, Y., Zhou, H., He, R. & Lu, W. (2021) Dietary modification for reproductive health in women with polycystic ovary syndrome: a systematic review and meta-analysis. Front. Endocrinol. (Lausanne), 12, 735 954.
10 Frattaroli, J. et al. (2008) Clinical events in prostate cancer lifestyle trial: results from two years of follow-up. Urology, 72 (6), 1319−1323.
11 Castro-Espin, C. & Agudo, A. (2022) The role of diet in prognosis among cancer survivors: a systematic review and meta-analysis of dietary patterns and diet interventions. Nutrients, 14 (2), 348.
12 Moug, S. J., Bryce, A., Mutrie, N. & Anderson, A. S. (2017) Lifestyle interventions are feasible in patients with colorectal cancer with potential short-term health benefits: a systematic review. Int. J. Colorectal Dis., 32 (6), 765−775.
13 Fiedler, F., Stangl, G. I., Fiedler, E. & Taube, K. M. (2017) Acne and nutrition: a systematic review. Acta Derm. Venereol., 97 (1), 7−9.
14 Ford, A. R. et al. (2018) Dietary recommendations for adults with psoriasis or psoriatic arthritis from the Medical Board of the National Psoriasis Foundation: a systematic review. JAMA Dermatol., 154 (8), 934−950.
15 Jacka, F. N. et al. (2017) A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial). BMC Med., 15 (1), 23.
16 Aucoin, M. et al. (2021) Diet and anxiety: a scoping review. Nutrients, 13 (12), 4418.
17 Aucoin, M., LaChance, L., Clouthier, S. N. & Cooley, K. (2020) Dietary modification in the treatment of schizophrenia spectrum disorders: A systematic review. World J. Psychiatry, 10 (8), 187−201.
18 Buckinx, F. & Aubertin-Leheudre, M. (2021) Nutrition to prevent or treat cognitive impairment in older adults: a GRADE recommendation. J. Prev. Alzheimers Dis., 8 (1), 110−116.
19 García-Casares, N., Gallego Fuentes, P., Barbancho, M. Á., López-Gigosos, R., García-Rodríguez, A. & Gutiérrez-Bedmar, M. (2021) Alzheimer’s disease, mild cognitive impairment and Mediterranean diet. A systematic review and dose-response meta-analysis. J. Clin. Med., 10 (20), 4642.
20 Liu, Y. H. et al. (2021) Diet quality and risk of Parkinson’s disease: a prospective study and meta-analysis. J. Parkinsons Dis., 11 (1), 337−347.
21 Ames, B. N. (2003) The metabolic tune-up: metabolic harmony and disease prevention. J. Nutr., 133 (5 Suppl 1), 1544S−1548S.
22 Ames, B. N. (2018) Prolonging healthy aging: longevity vitamins and proteins. Proc. Natl Acad. Sci. USA, 115 (43), 10 836−10 844.
23 National Health Service (NHS) (2020) Health Survey for England 2019.
24 Péter, S. et al. (2014) Selected nutrients and their implications for health and disease across the lifespan: a roadmap. Nutrients, 6 (12), 6076−6094.
25 Derbyshire, E. (2018) Micronutrient intakes of British adults across mid-life: a secondary analysis of the UK National Diet and Nutrition Survey. Front. Nutr., 5, 55.
26 Gibson, S. & Boyd, A. (2009) Associations between added sugars and micronutrient intakes and status: further analysis of data from the National Diet and Nutrition Survey of Young People aged 4 to 18 years. Br. J. Nutr., 101 (1), 100−107.
27 Fallon, N. & Dillon, S. A. (2020) Low intakes of iodine and selenium amongst vegan and vegetarian women highlight a potential nutritional vulnerability. Front. Nutr., 7, 72.
28 Rees, G. A., Doyle, W., Srivastava, A., Brooke, Z. M., Crawford, M. A. & Costeloe, K. L. (2005) The nutrient intakes of mothers of low birth weight babies – a comparison of ethnic groups in East London, UK. Matern. Child. Nutr., 1 (2), 91−99.
29 Bailey, A. L., Maisey, S., Southon, S., Wright, A. J., Finglas, P. M. & Fulcher, R. A. (1997) Relationships between micronutrient intake and biochemical indicators of nutrient adequacy in a ‘free-living’ elderly UK population. Br. J. Nutr., 77 (2), 225−242.
30 Mayer, A. B., Trenchard, L. & Rayns, F. (2021) Historical changes in the mineral content of fruit and vegetables in the UK from 1940 to 2019: a concern for human nutrition and agriculture. Int. J. Food Sci. Nutr., Oct 15, 1−12.
31 Ames, B. N., Elson-Schwab, I. & Silver, E. A. (2002) High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased K(m)): relevance to genetic disease and polymorphisms. Am. J. Clin. Nutr., 75 (4), 616−658.
32 Lopresti, A. L. (2020) The effects of psychological and environmental stress on micronutrient concentrations in the body: a review of the evidence. Adv. Nutr., 11 (1), 103−112.
33 Maggini, S., Pierre, A. & Calder, P. C. (2018) Immune function and micronutrient requirements change over the life course. Nutrients, 10 (10), 1531.
34 Mohn, E. S., Kern, H. J., Saltzman, E., Mitmesser, S. H. & McKay, D. L. (2018) Evidence of drug-nutrient interactions with chronic use of commonly prescribed medications: an update. Pharmaceutics, 10 (1), 36.
35 Rémond, D. et al. (2015) Understanding the gastrointestinal tract of the elderly to develop dietary solutions that prevent malnutrition. Oncotarget, 6 (16), 13 858−13 898.
36 Blumberg, J. B., Frei, B. B., Fulgoni, V. L., Weaver, C. M. & Zeisel, S. H. (2017) Impact of frequency of multi-vitamin/multi-mineral supplement intake on nutritional adequacy and nutrient deficiencies in U.S. adults. Nutrients, 9 (8), 849.
37 Blumberg, J. B., Frei, B., Fulgoni, V. L., Weaver, C. M. & Zeisel, S. H. (2017) Contribution of dietary supplements to nutritional adequacy by socioeconomic subgroups in adults of the United States. Nutrients, 10 (1), 4.
38 Blumberg, J. B., Frei, B., Fulgoni, V. L., Weaver, C. M. & Zeisel, S. H. (2017) Contribution of dietary supplements to nutritional adequacy in various adult age groups. Nutrients, 9 (12), 1325.
39 Botturi, A., Ciappolino, V., Delvecchio, G., Boscutti, A., Viscardi, B. & Brambilla, P. (2020) The role and the effect of magnesium in mental disorders: a systematic review. Nutrients, 12 (6), 1661.
40 Guu, T. W. et al. (2019) International Society for Nutritional Psychiatry Research Practice Guidelines for omega-3 fatty acids in the treatment of major depressive disorder. Psychother. Psychosom., 88 (5), 263−273.
41 Deepmala et al. (2015) Clinical trials of N-acetylcysteine in psychiatry and neurology: a systematic review. Neurosci. Biobehav. Rev., 55, 294−321.
42 Rabanal-Ruiz, Y., Llanos-González, E. & Alcain, F. J. (2021) The use of coenzyme Q10 in cardiovascular diseases. Antioxidants (Basel), 10 (5), 755.
43 Guan, Y., Dai, P. & Wang, H. (2020) Effects of vitamin C supplementation on essential hypertension: a systematic review and meta-analysis. Medicine (Baltimore), 99 (8), e19274.
44 DiNicolantonio, J. J., Lavie, C. J., Fares, H., Menezes, A. R. & O’Keefe, J. H. (2013) L-carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis. Mayo Clin. Proc., 88 (6), 544−551.
45 Liu, K., Zhou, R., Wang, B. & Mi, M. T. (2014) Effect of resveratrol on glucose control and insulin sensitivity: a meta-analysis of 11 randomized controlled trials. Am. J. Clin. Nutr., 99 (6), 1510−1519.
46 Han, T., Bai, J., Liu, W. & Hu, Y. (2012) A systematic review and meta-analysis of α-lipoic acid in the treatment of diabetic peripheral neuropathy. Eur. J. Endocrinol., 167 (4), 465−471.
47 Wang, X. et al. (2019) Zinc supplementation improves glycemic control for diabetes prevention and management: a systematic review and meta-analysis of randomized controlled trials. Am. J. Clin. Nutr., 110 (1), 76−90.
48 Smith, A. D. & Refsum, H. (2016) Homocysteine, B vitamins, and cognitive impairment. Annu. Rev. Nutr., 36, 211−239.
49 Devries, S. et al. (2014) A deficiency of nutrition education in medical training. Am. J. Med., 127 (9), 804−806.
50 Hemilä, H. & Chalker, E. (2022) Bias against vitamin C in mainstream medicine: examples from trials of vitamin C for infections. Life (Basel), 12 (1), 62.
51 Schoendorfer, N., Gannaway, D., Jukic, K., Ulep, R. & Schafer, J. (2017) Future doctors’ perceptions about incorporating nutrition into standard care practice. J. Am. Coll. Nutr., 36 (7), 565−571.
52 Cresci, G., Beidelschies, M., Tebo, J. & Hull, A. (2019) Educating future physicians in nutritional science and practice: the time is now. J. Am. Coll. Nutr., 38 (5), 387−394.