What is clinical nutrition?

Clinical nutrition is the study of the relationship between food and a healthy body. More specifically, it is the science of nutrients and how they are digested, absorbed, transported, metabolized, stored, and eliminated by the body. Besides studying how food works in the body, nutritionists are interested in how the environment affects the quality and safety of foods, and what influence these factors have on health and disease.

Nutrients are substances that the body needs to live and grow. The body requires more than 45 nutrients, and the ways they are used are as different as the molecules, cells, and tissues they help to create. The most important nutrient is water since our bodies are made up of more than 80% water, and water is required to break down other nutrients. Carbohydrates, proteins, and fats, called macronutrients, are broken down (metabolized) to provide energy. Vitamins and minerals, called micronutrients, are not used for energy, but are needed to help macronutrients be used for energy.

The study of nutrition dates back to the 18th century, when the French chemist Lavoisier discovered a relationship between our metabolism of food and the process of breathing. By the early 20th century, scientists had found that diseases, such as beri beri, rickets, scurvy, and pellagra, were associated with certain diets. By 1912, the Polish chemist Casimir Funk had found a substance (vitamin B1) that actually prevented beri beri, and he named it "vitamine." Later it was found that these diseases were caused by the lack of specific nutrients, vitamin B1 (thiamine), vitamin D, vitamin C, and vitamin B3 (niacin) respectively.

In the early 1940s, the National Research Council set Recommended Dietary Allowances (RDAs).

Researchers and scientists continue to find out more about how individual nutrients help prevent and treat disease, but they are also learning how whole foods may allow nutrients to work together. For example, antioxidants like beta carotene, selenium, vitamin E, and vitamin C, when consumed in foods, appear to protect against the development of heart disease, cancer, and other chronic degenerative diseases.

The old RDAs have been replaced by Dietary Reference Intakes (DRIs), which show how much of a nutrient we need every day to maximize health and lower the risk of chronic disease (in contrast to RDAs, which listed the minimum amount needed to prevent a deficiency). The field of clinical nutrition is now increasingly incorporated into mainstream medical treatment.

The term "nutritional supplement" refers to vitamins, minerals, and other nutrients that are used to support health and treat illness. For example, plant compounds known as phytochemicals have powerful disease-fighting properties. While it is best to get nutrients through the foods you eat, sometimes taking a supplement can help. For example, taking zinc supplements has been reported to shorten the duration of the common cold and lower the incidence of acute diarrhea in children.

Vitamins and minerals play an essential role in the body's normal metabolism, growth, and development. For example, while a vitamin is not a source of energy by itself, it can provide the key the body needs to unlock energy stored in food. Some vitamins and minerals work together, such as the mineral zinc and vitamin A. Zinc enables the body to use vitamin A to promote good vision. Not getting enough vitamin A may lead to night blindness, a condition in which the eyes have trouble adjusting to darkness. Zinc supplementation may help prevent this condition by helping the body use vitamin A. Another example is calcium and vitamin D. Calcium, which is very important in bone and heart health, is more readily absorbed if vitamin D is also present.

Taking supplements, however, is not the answer to long-term good health. Instead, combining a healthy diet with regular exercise and a positive mental attitude is the best bet for a healthy lifestyle.

The United States Department of Agriculture (USDA) food plate suggests that we fill half our plate with fruits and vegetables and divide the other half between protein sources and grains. But the plate does not tell the whole story. Our food needs are influenced by many factors, including age, gender, body size, pregnancy, and health. A registered dietitian, clinical nutritionist, or nutritionally-oriented doctor can help you determine which type of diet is best for you. No matter what, you can improve your diet by adding more fruits and vegetables and cutting back on overly processed foods and sugar.

First, the clinical nutritionist will ask questions about your medical history, family history, and personal lifestyle. The medical history might include questions about your diet, digestion, history of weight loss or gain, sleep and exercise patterns, and relaxation habits. Some clinical nutritionists will ask you to bring a 3-day food diary and a list of any herbs, supplements, or medicines that you take regularly. The nutritionist may order laboratory tests to determine if you are low in any nutrients and to test your organ function. This way, a nutritionist will get a full picture of your nutritional lifestyle.

During the second part of the visit, the nutritionist will suggest ways you can fill the gaps and reduce the nutritional "overloads" in your diet. For example, your nutritionist may suggest you eat your meals at different times or cut down on the amount of carbohydrates you eat. The nutritionist will also offer advice on specific nutritional supplements if necessary (see below). The nutritionist will then schedule follow up visits to monitor your health. In the future, nutritionists may even be able to tailor nutrition advice to your genes.

Studies show that eating habits play a major role in the development of certain chronic diseases, including heart disease, obesity, cancer, and diabetes. Making changes to your diet can help prevent and treat these conditions. For example, lowering certain fats and cholesterol and adding whole grains to your diet can help prevent atherosclerosis (plaque build up in the arteries), which can lead to heart disease or stroke. Eating fewer calories will help you lose weight. Cutting down on simple sugars (glucose, sucrose, fructose, and lactose) can help prevent diabetes, and diets high in fiber (especially soluble fiber) can help control diabetes.

Scientists have found many other connections between diet and disease. In a clinical study of 20,000 men, for example, eating one fish meal per week was linked to a 52% reduction in the risk of sudden death from a heart attack. Fish is high in omega-3 fatty acids, which can protect the heart from fatal arrhythmias (abnormal heart rhythm).

In another clinical study of more than 42,000 women, those who ate lots of fruits, vegetables, whole grains, low-fat-dairy, and only lean meats lived longer. High intake of fruits, vegetables, and legumes is associated with a lower risk of developing heart disease.

There are many ongoing studies regarding clinical nutrition. Some interesting results show that:

• Diets high in folate (found in leafy greens, dry beans and peas, fortified cereals and grain products, and some fruits and vegetables) may lower risk of stroke and heart disease.
• Eating small amounts of fish when pregnant may protect against early delivery and low birth weight infants. Some fish may contain higher amounts of mercury and should only be eaten in moderation. Ask your obstetrician which types of fish are best for you when pregnant.
• Taking iron supplements improves aerobic training ability in iron-depleted women.
• Lutein and zeaxanthin (carotenoids) in the diet may reduce risk of cataracts.
• Lutein from dietary sources (such as kale and spinach) may protect against colon cancer.
• Flavonoids (found in apples, blueberries, broccoli, cabbage, carrots, citrus fruits, onions, and teas) may protect against cancer.
• Omega-3 fatty acids found in cold-water fish (such as herring, tuna, and salmon) help reduce inflammation and help prevent certain chronic diseases, such as heart disease, cancer, and arthritis.
• Vitamin E (in the diet from fruits and vegetables) may reduce the risk of angina (chest pain) and heart attack in people with atherosclerosis.
• A higher ratio of sodium to potassium is associated with an increased risk of heart disease.

In hospitals, nutrition is used to improve the overall health of patients with a wide range of conditions. Examples of these conditions are AIDS, cancer, osteoporosis, lung disease, obesity, burns, metabolic disorders, and kidney, liver, and pancreatic disorders. Peoples who need surgery are also supported with clinical nutrition.

Some nutritional supplements can interact with medications. It is very important to tell your doctor about any dietary supplements you are considering taking. Always take supplements according to label directions, unless otherwise directed by a qualified health care practitioner.

There is little scientific information about the effect of so called functional foods, foods to which vitamins, minerals, herbs, or other dietary substances are added, despite their growing popularity in the marketplace. Examples include calcium-fortified orange juice or snacks containing echinacea.

Some common foods, including nuts, wheat gluten, dairy products, fish, shrimp, soy, bananas, and eggs, may trigger allergic reactions. Your doctor can test for such possible allergies if he suspects you have them.

To find a clinical nutritionist in your area, contact:

• The American Clinical Board of Nutrition: www.acbn.org
• The American College of Nutrition: www.americancollegeofnutrition.org
• The Clinical Nutrition Certification Board: www.cncb.org
• Academy of Nutrition and Dietetics: www.eatright.org/

Specialists in many alternative health systems (including Traditional Chinese Medicine, ayurveda, and naturopathy) also consider food a vital part of preventing and treating illness.