The Science of Nutrition in Medicine and Healthcare

The inaugural Science of Nutrition in Medicine and Healthcare (SNMH) in Sydney May 2011 was a tremendous collaboration of expertise from a variety of medical specialties and research fields. What conversation could possibly unite and be relevant to the practice of genetics, epidemiology, cardiology, orthopedics, oncology, and general practice? The answer; Nutrition: The topic human nutrition has clearly attracted the attention of medicine and healthcare.

Administering nutritional and nutraceutical compounds to patients may not be as benign as sometimes assumed. How do we know as clinicians when the application of a nutritional prescription is likely to yield a preventative or therapeutic benefit? Acquiring a good medical history, family history and systems review are foundational to clinical decision making in all health care practice including nutritional medicine. However the theme throughout the SNMH that certain nutrients are a double edge sword and knowing when those nutrients should be applied to a patient can be challenging without pathology reports. Functional pathology provides evidential support the implementation of nutritional intervention. I have profiled the pathology assessment of some of the thematic micronutrients discussed to support you in your nutritional medicine clinical decision making.

Fatty Acids Assays

A one size fits all approach to fatty acid supplementation is problematic as highlighted by a number of the presenters at SNMH. Metametrix has several tests that evaluate fatty acid levels and ratios, including plasma, erythrocytes, and bloodspot. The erythrocyte and plasma tests include extensive data on individual fatty acids, including; polyunsaturated, monounsaturated, saturated, and trans fatty acid levels, as well as several ratios including; LA/DGLA, AA/EPA, EPA/DGLA, and Triene/Tetraene. The easy-to-use bloodspot test can be collected by the patient and measures key omega-3 and omega-6 PUFAs, as well as trans fats, and calculates indicators to establish an optimal balance. Fatty acid profiles are an ideal way to track patient progress or response to treatment and can help clinicians determine if he/she is giving too much or too little fatty acid supplementation. Clinical management of fatty acid supplementation is aided by testing for antioxidant status as well. This can be done by measuring markers of oxidant damage, such as lipid peroxides and urinary 8-hydroxy-2'-deoxyguanosine. Simply having these pieces of information can make a significant difference in your ability to guide your patient in diet and supplementation recommendations while modulating their inflammatory cytokines.

Lipid peroxidises and Oxidative stress

It has been hypothesised for a number of years the role of lipid oxidation in chronic degenerative illness. Lipid peroxides are the products of chemical damage done by oxygen free radicals to the polyunsaturated fatty acids of cell membranes. This test is an assay of total thiobarbituric acid-reactive substances (TBARS) in serum using HPLC. The HPLC separation step isolates the TBARS from potential interfering compounds that can give false elevations in a simple colorimetric assay. The results provide a measure of total serum lipid peroxidation, an indicator of whole body free radical activity. High levels of lipid peroxides are associated with cancer, heart disease, stroke, and aging.
It is undebatable that oxidative stress plays a role in many chronic illnesses from a number of Oxidative of guanosine produces 8-hydroxy-2'-deoxyguanosine (8OHdG). The concentration of 8OHdG in urine has been shown to be an accurate measure of the rate of polynucleotide oxidative damage. Elevated 8OHdG is a sign that antioxidant nutrient intake may need to be increased. Toxicants and lifestyle stress factors may contribute to increased oxidative challenge.

Fat Soluble Vitamins

The Fat-Soluble Vitamins Profile is a great tool to gain an overall perspective of a patient's health, nutrient processing, and dietary insufficiencies. Serum levels of the fat-soluble vitamins A, D, E, K plus beta-carotene and coenzyme Q10 are measured to evaluate total body status of these antioxidant nutrients.

Erythrocyte nutrient status

Erythrocyte element levels are good indicators of body pools of essential elements such as magnesium, potassium, and zinc. Often referred to as minerals, the chemical elements are fundamental to every function in the body. They join together in crystalline structures to form bone. They shuttle independently across membranes, resulting in nerve impulses, or serve at the heart of many enzyme molecules to direct chemical processes.
The importance of calcium and phosphorus to bone formation and the electrolyte role of sodium and potassium are commonly understood. Magnesium is involved in over 300 chemical reactions in the body, including all ATP transformations and therefore all cellular energy production. Depletion from food sources has resulted in a near epidemic of magnesium insufficiency.
Selenium is required by the enzyme glutathione peroxidase, which maintains the oxidative balance in all tissue. Low selenium, therefore, can directly influence an individual's antioxidant protection.
Zinc deficiency has been implicated in a variety of disorders, including sexual impotence, retarded growth, hair loss, and immune system depression. Because of rapid depletion of all elements, analysis should be standard protocol before and throughout chelation therapy.
Nutrient element analysis is critical for identifying both the need for and monitoring the adequacy of either oral or IV supplementation. It is because of their diverse and vital roles that nutrient element imbalances are frequently found to be factors in degenerative diseases. Since the body cannot manufacture the elements-and daily losses are unavoidable-the nutrient elements are all "essential" and must regularly be taken in through the diet. But they are easily lost in food processing, so it's easy to see how deficiencies can occur.

Methylation factors

Another recurrent theme of the SNMH was the double edge sword of folic acid. Folic acid is known for its role in cellular differentiation and cell division. Its role in prevention of cancer namely bowel cancer is well documented however when administered to a patient with an established cancer it may have a proliferative effect. Part of the reason some patients may have an ‘adverse’ response to folic acid is partly due to whether they are under methylating or over methylating.
Markers of functional folate status and functional B12 markers may lead to a more prudent application of these nutrients. Urinary organic acid metabolites forminoglutamate (FIGLU)as a functional folic acid marker and methylmalonate as a functional B12 marker can be assessed by a simple fasting overnight urine sample.

For detailed information on available nutritional biochemical and environmental testing please go to www.diagnosticinsight.com.au or simply call us on 02 9966 9990 for comprehensive clinical support.