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Micronutrients, Phytonutrients, and Mental Health
As the pioneer and global leader of Functional Medicine, the Institute of Functional Medicine leads and catalyses the efforts of a large and expanding Functional Medicine ecosystem, including providers, educators, payers, industry leaders, regulators, and influencers.
2022
Abstract
The IFM provides some food for thought around the topic of micronutrient deficiency in the population today and how this is having a detrimental impact on our mental health. The many avenues of micronutrient depletion are explored including stress and the link between the coronavirus pandemic and the rise in mental health issues across the globe. They shine a spotlight specifically on magnesium and B vitamins where low levels have been linked to increased risk of depression, plus the importance of anti-inflammatory dietary phytonutrients and antioxidants such as vitamins A, C, D and E which have been associated with reduced levels of stress, anxiety and depression. Besides the evidence for a varied and nutrient dense diet, we are reminded that strategies for managing stress should also be considered with respect to both the direct impact on our mental and physical health, and the risk of micronutrient depletion.
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The Functional Medicine Approach to Ending Migraine
Dr. Mark Hyman is a practicing family physician and an internationally recognised leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Centre, the Head of Strategy and Innovation of the Cleveland Clinic Centre for Functional Medicine, a thirteen-time New York Times bestselling author, and Board President for Clinical Affairs for The Institute for Functional Medicine.
2022
Abstract
The causes of migraine appear to be multifactorial and can manifest in many different ways, so the importance of evaluating migraines from a Functional Medicine (FM) perspective to identify potential imbalances in the body is pivotal. Dr Mark Hyman speaks to Dr Todd LePine, an Institute for Functional Medicine Certificated Practitioner to discuss how to identify and eliminate migraines and the differences between the conventional and FM approach. They review the connection between migraines and gut health, nutrient deficiencies such as magnesium, histamine sensitivity, genetics, the role of mitochondria and also lifestyle factors such as sleep and stress which can exacerbate symptoms. Exploring dietary and sleeping patterns and stress exposure/management appears to be key for first line migraine prevention. However they also review functional testing that may be helpful to identify the root cause, and supplementing with Magnesium, CoQ10, and Vitamin B2.
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Vegan Diet Health Benefits in Metabolic Syndrome.
Marrone, G, Guerriero, C, Palazzetti, D, Lido, P, Marolla, A, Di Daniele, F, Noce, A
Nutrients. 2021;13(3)
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Plant-based diets (PBD) have grown in popularity in recent years and have been associated with better health outcomes especially with heart disease, however poorly planned PBD’s can result in nutrient deficiencies like vitamin B12. This review aimed to summarise the health benefits of PBD’s, especially vegan diets, compared to omnivorous diets when looking at risk factors associated with heart disease. The authors started by summarising three PBD’s obvious in the literature; vegan diet with no animal products, lacto-ovo-vegetarian (LOV) with dairy products and eggs, and fish-vegetarian including fish and seafoods. The study then highlighted the strengths and weaknesses of the vegan diet, highlighting that although the vegan diet represents a healthy way of eating rich in carbohydrates, omega-6 fats, fibre, vitamin C, vitamin E and magnesium it can be low in protein, omega-3 fats, vitamin B12, vitamin D, calcium, iron, zinc and iodine if not properly planned. Heart disease incidence was reported to be lower in individuals on a PBD, especially vegans, when compared to omnivorous diets possibly due to their improvement on risk factors associated with the disease. Metabolic syndrome, blood pressure, fat production, and blood sugar balance were all shown to be improved and reasons such as their high fibre content reducing energy intake and causing feelings of satiety and their low saturated fat content impacting cholesterol production were listed as possible mechanisms behind the improvements. It was concluded that a nutritionist led, vegan diet can improve risk factors for heart disease resulting in better health outcomes. This study could be used by healthcare practitioners to understand where vegan diets may lack certain nutrients and the Importance of a well-planned vegan diet in the prevention of heart disease in those at an increased risk.
Abstract
Plant-based diets (PBDs) are increasingly consumed by the Italian population and around the world. In particular, among PBDs, the vegan diet is a food pattern characterized by the exclusion of all animal-origin foods. What drives people to adopt this model are mainly ethical, health and environmental reasons. A vegan diet, if well-balanced and varied, can help in achieving and maintaining an optimal state of health. However, this nutritional approach, if not well-balanced, can cause deficiencies in proteins, ω-3 fatty acids, iron, vitamin D and calcium, zinc, iodine and, above all, vitamin B12. Oral food supplements especially fortified foods are recommended in these cases to restore the nutritional deficiencies. A vegan diet generally reduces the risk of developing chronic non-communicable degenerative diseases, such as metabolic syndrome (MetS) and, in addition, requires fewer natural resources for food production than an omnivorous diet. The aim of this review is to analyze the possible impact of the vegan diet on MetS onset and its treatment.
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Total estimated usual nutrient intake and nutrient status biomarkers in women of childbearing age and women of menopausal age.
Devarshi, PP, Legette, LL, Grant, RW, Mitmesser, SH
The American journal of clinical nutrition. 2021;113(4):1042-1052
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Nutritional needs vary depending on the stage in a woman’s lifecycle. Women of child-bearing age (WCBA) and women of menopausal age (WMENO) are at high risk of not meeting required nutrient amounts, yet data is limited on nutrient intakes in these groups. This observational study of 4134 WCBA and 3438 WMENO aimed to determine any nutrient gaps and if associations exist between dietary intake and blood levels of key nutrients. The results showed that WCBA and WMENO had inadequate dietary intakes of calcium, magnesium, and vitamins A, C, D and E, which was allevaited by supplementation. Women who had lower levels of folate, vitamins D, B12 and essential fatty acids had lower dietary intakes of these nutrients, indicating a risk of deficiency. It was concluded that many women of WCBA and WMENO may have inadequate dietary nutrient intake and supplementation may improve this. This study could be used by healthcare professionals to understand that nutrient intakes may be inadequate in WCBA and WMENO. Dietary recommendations to increase nutrient intake would be advisable, however if individuals are still not meeting nutrient requirements, nutrient supplementation may be advisable.
Abstract
BACKGROUND Women of childbearing age (WCBA) and women of menopausal age (WMENO) have distinct nutritional needs. Understanding nutrient intake and status in these life stages is critical for tailoring dietary recommendations. OBJECTIVES The objectives of this study were to evaluate total estimated usual nutrient intakes from food and food plus supplements and to compare these to established recommendations for WCBA and WMENO life stages and examine associations between self-reported estimated usual intakes and nutrient status biomarkers. METHODS Twenty-four-hour dietary recall data from 2011-2016 NHANES were used to estimate usual intake of nutrients from food and food plus supplements for WCBA (aged 15-44 y, n = 4,134) and WMENO (aged 40-65 y, n = 3,438). Estimates of mean usual intake were derived and compared across clinically defined nutrient biomarker categories. RESULTS Both young (aged 15-30 y) and older (aged 31-44 y) WCBA had intakes from food below the Estimated Average Requirement (EAR) for calcium (49% and 44%, respectively), magnesium (62%, 44%), and vitamins A (50%, 44%), C (47%, 46%), D (>97%, >97%), and E (92%, 88%). Similarly, perimenopausal (aged 40-50 y) and menopausal (aged 51-65 y) women had intakes from food below the EAR for calcium (48% and 74%, respectively), magnesium (50%, 49%), and vitamins A (44%, 37%), C (44%, 41%), D (>97%, >97%), and E (88%, 86%). Nutrient gaps decreased with supplement usage. For folate, vitamins D and B-12, and DHA, women in the lowest biomarker category (indicating increased risk of deficiency) had significantly lower intake from food (315.2 ± 25.9 compared with 463.8 ± 5.2 µg dietary folate equivalents, 3.5 ± 0.1 compared with 4.2 ± 0.1 µg, 3.6 ± 0.2 compared with 4.3 ± 0.1 µg, and 0.037 ± 0.005 compared with 0.070 ± 0.006 g, respectively; P < 0.01) of the corresponding nutrient compared with the highest biomarker category. CONCLUSIONS Substantial percentages of WCBA and WMENO are not meeting recommendations for multiple nutrients, whereas supplement usage partially fills nutrient gaps. Dietary intake was positively associated with most nutrient status biomarkers. Specific guidance is needed to ensure adequate nutrient intakes and nutrient status during these critical life stages.
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Role of Minerals and Trace Elements in Diabetes and Insulin Resistance.
Dubey, P, Thakur, V, Chattopadhyay, M
Nutrients. 2020;12(6)
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Minerals and trace elements have several functions within the body and deficiencies, or excesses may contribute to disease. Type 2 diabetes mellitus (T2DM) is often associated with an imbalance of damaging oxidants within the body and deficiencies of certain minerals and trace elements which act as antioxidants may contribute to this disease. This review paper aimed to determine trace element deficiencies, which may be related to the development of type 2 diabetes. The role of selenium in the development of diabetes is difficult to determine, as studies are conflicting. Magnesium, iron, and iodine may play a role in maintaining blood sugar levels. Chromium supplementation may improve T2DM through improvements to the functioning of the hormone insulin, which acts to process sugar in the blood. Boron may indirectly impact T2DM through its ability to act as an antioxidant. Dietary intake of calcium may prevent the development of T2DM, and finally cobalt and zinc deficiency may contribute to the development of T2DM. It was concluded that trace element deficiencies are associated with oxidative stress which may eventually lead to T2DM. This study could be used by healthcare professionals to understand the importance of dietary intakes of all trace elements in order to limit oxidative stress and decrease the risk of development of T2DM.
Abstract
Minerals and trace elements are micronutrients that are essential to the human body but present only in traceable amounts. Nonetheless, they exhibit well-defined biochemical functions. Deficiencies in these micronutrients are related to widespread human health problems. This review article is focused on some of these minerals and trace element deficiencies and their consequences in diabetes and insulin resistance. The levels of trace elements vary considerably among different populations, contingent on the composition of the diet. In several Asian countries, large proportions of the population are affected by a number of micronutrient deficiencies. Local differences in selenium, zinc, copper, iron, chromium and iodine in the diet occur in both developed and developing countries, largely due to malnutrition and dependence on indigenous nutrition. These overall deficiencies and, in a few cases, excess of essential trace elements may lead to imbalances in glucose homeostasis and insulin resistance. The most extensive problems affecting one billion people or more worldwide are associated with inadequate supply of a number of minerals and trace elements including iodine, selenium, zinc, calcium, chromium, cobalt, iron, boron and magnesium. This review comprises various randomized controlled trials, cohort and case-controlled studies, and observational and laboratory-based studies with substantial outcomes of micronutrient deficiencies on diabetes and insulin resistance in diverse racial inhabitants from parts of Asia, Africa, and North America. Changes in these micronutrient levels in the serum and urine of subjects may indicate the trajectory toward metabolic changes, oxidative stress and provide disease-relevant information.
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Effect of Supplemental Parenteral Nutrition Versus Enteral Nutrition Alone on Clinical Outcomes in Critically Ill Adult Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
Alsharif, DJ, Alsharif, FJ, Aljuraiban, GS, Abulmeaty, MMA
Nutrients. 2020;12(10)
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For individuals who are critically ill and cannot eat, the use of a tube through the mouth is the preferred way to ensure nutrition needs are met. However, complications such as diarrhoea and vomiting often means that these individuals still do not achieve optimal nutrition. In these instances, giving individuals nutrients directly into a vein alongside the feeding tube is an option to ensure they do not become nutrient deficient. This is known as a combination of enteral and parenteral nutrition. However, studies on the use of this combination are limited. This systematic review and meta-analysis of 5 studies aimed to determine the effects of a combination of enteral and parenteral feeding on clinical outcomes compared to a feeding tube alone. The results showed that compared to enteral feeding alone the combination decreased infections and intensive care unit (ICU) mortality. There was a very small effect on duration of ventilation and no effects were seen on length of hospital stay nor length of ICU stay. It was concluded that enteral feeding alone is insufficient to meet the nutritional needs of critically ill patients. Supplementing in parenteral nutrition may be of benefit to these individuals and help decrease infections and improve ICU mortality. This study could be used by healthcare professionals to understand that the health of patients who are being fed through a tube may be compromised through malnutrition and that supplemental ways of getting more nutrients into these individuals is of importance.
Abstract
Enteral nutrition (EN) is considered the first feeding route for critically ill patients. However, adverse effects such as gastrointestinal complications limit its optimal provision, leading to inadequate energy and protein intake. We compared the clinical outcomes of supplemental parenteral nutrition added to EN (SPN + EN) and EN alone in critically ill adults. Electronic databases restricted to full-text randomized controlled trials available in the English language and published from January 1990 to January 2019 were searched. The risk of bias was evaluated using the Jadad scale, and the meta-analysis was conducted using the MedCalc software. A total of five studies were eligible for inclusion in the systematic review and meta-analysis. Compared to EN alone, SPN + EN decreased the risk of nosocomial infections (relative risk (RR) = 0.733, p = 0.032) and intensive care unit (ICU) mortality (RR = 0.569, p = 0.030). No significant differences were observed between SPN + EN and EN in the length of hospital stay, hospital mortality, length of ICU stay, and duration of mechanical ventilation. In conclusion, when enteral feeding fails to fulfill the energy requirements in critically ill adult patients, SPN may be beneficial as it helps in decreasing nosocomial infections and ICU mortality, in addition to increasing energy and protein intakes with no negative effects on other clinical outcomes.
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Multifactorial Etiology of Anemia in Celiac Disease and Effect of Gluten-Free Diet: A Comprehensive Review.
Martín-Masot, R, Nestares, MT, Diaz-Castro, J, López-Aliaga, I, Alférez, MJM, Moreno-Fernandez, J, Maldonado, J
Nutrients. 2019;11(11)
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Anaemia is a common clinical expression of Celiac Disease (CD) alongside vitamin B12, iron and folate deficiencies. This review looks at the latest evidence and effects of a gluten free diet, the mainstay of treatment for CD. Typically, symptoms subside whilst adhering to a GF diet however in 20% of people anaemia and nutrient deficiencies can persist. Some of this is attributed to lack of adherence to the diet, oftentimes accidental given the wide range of foods containing gluten. This in turn leads to further damage of the intestine and can be difficult to detect and monitor effectively. Inflammation of the gastrointestinal tract, and malabsorption, are the main reasons for nutrient deficiencies leading to anaemia in CD. Iron is a critical nutrient which can easily be affected by damage to the intestinal villi, common in CD, and over time lead to iron deficiency anaemia as the body is unable to absorb dietary iron and the body’s iron stores are depleted. Likewise, absorption of vitamins B12 and B9 (folate) are also impaired by damaged villi and vitamin B12 is further affected by small intestine injuries including decreased gastric acid production, bacterial overgrowth and reduced intrinsic factor efficiency. Deficiencies of these two nutrients can lead to macrocytic anaemia with low blood cell volumes. Overall a gluten free diet is shown to reduce symptoms of CD in a matter of weeks. The more patients adhere to the diet, the more the risk of nutrient deficiencies and anaemia reduces.
Abstract
Celiac disease (CD) is a multisystemic disorder with different clinical expressions, from malabsorption with diarrhea, anemia, and nutritional compromise to extraintestinal manifestations. Anemia might be the only clinical expression of the disease, and iron deficiency anemia is considered one of the most frequent extraintestinal clinical manifestations of CD. Therefore, CD should be suspected in the presence of anemia without a known etiology. Assessment of tissue anti-transglutaminase and anti-endomysial antibodies are indicated in these cases and, if positive, digestive endoscopy and intestinal biopsy should be performed. Anemia in CD has a multifactorial pathogenesis and, although it is frequently a consequence of iron deficiency, it can be caused by deficiencies of folate or vitamin B12, or by blood loss or by its association with inflammatory bowel disease (IBD) or other associated diseases. The association between CD and IBD should be considered during anemia treatment in patients with IBD, because the similarity of symptoms could delay the diagnosis. Vitamin B12 deficiency is common in CD and may be responsible for anemia and peripheral myeloneuropathy. Folate deficiency is a well-known cause of anemia in adults, but there is little information in children with CD; it is still unknown if anemia is a symptom of the most typical CD in adult patients either by predisposition due to the fact of age or because biochemical and clinical manifestations take longer to appear.
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Effects of eight weeks of time-restricted feeding (16/8) on basal metabolism, maximal strength, body composition, inflammation, and cardiovascular risk factors in resistance-trained males.
Moro, T, Tinsley, G, Bianco, A, Marcolin, G, Pacelli, QF, Battaglia, G, Palma, A, Gentil, P, Neri, M, Paoli, A
Journal of translational medicine. 2016;14(1):290
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Time-restricted feeding (TRF) allows subjects to consume ad libitum energy intake within a defined window of time, which means a fasting window of 12–21 h per day is employed. The aim of the present study was to investigate the effects of an isoenergetic TRF protocol on body composition, athletic performance, and metabolic factors during resistance training in healthy resistance trained males. The study enrolled thirty-four resistance-trained males. The participants were randomly assigned to a TRF group (n = 17) or standard diet group (n = 17). Training was standardized for both groups. Results indicate that after 8 weeks, a significant decrease in fat mass was observed in the TRF group, while fat-free mass was maintained in both groups. The same trend was observed for arm and thigh muscle cross-sectional area. Leg press maximal strength increased significantly, but no difference was present between treatments. Authors conclude that TRF can maintain muscle mass, reducing body fat, and reducing inflammation markers and anabolic hormones. This kind of regimen could be adopted by athletes during maintenance phases of training in which the goal is to maintain muscle mass while reducing fat mass.
Abstract
BACKGROUND Intermittent fasting (IF) is an increasingly popular dietary approach used for weight loss and overall health. While there is an increasing body of evidence demonstrating beneficial effects of IF on blood lipids and other health outcomes in the overweight and obese, limited data are available about the effect of IF in athletes. Thus, the present study sought to investigate the effects of a modified IF protocol (i.e. time-restricted feeding) during resistance training in healthy resistance-trained males. METHODS Thirty-four resistance-trained males were randomly assigned to time-restricted feeding (TRF) or normal diet group (ND). TRF subjects consumed 100 % of their energy needs in an 8-h period of time each day, with their caloric intake divided into three meals consumed at 1 p.m., 4 p.m., and 8 p.m. The remaining 16 h per 24-h period made up the fasting period. Subjects in the ND group consumed 100 % of their energy needs divided into three meals consumed at 8 a.m., 1 p.m., and 8 p.m. Groups were matched for kilocalories consumed and macronutrient distribution (TRF 2826 ± 412.3 kcal/day, carbohydrates 53.2 ± 1.4 %, fat 24.7 ± 3.1 %, protein 22.1 ± 2.6 %, ND 3007 ± 444.7 kcal/day, carbohydrates 54.7 ± 2.2 %, fat 23.9 ± 3.5 %, protein 21.4 ± 1.8). Subjects were tested before and after 8 weeks of the assigned diet and standardized resistance training program. Fat mass and fat-free mass were assessed by dual-energy x-ray absorptiometry and muscle area of the thigh and arm were measured using an anthropometric system. Total and free testosterone, insulin-like growth factor 1, blood glucose, insulin, adiponectin, leptin, triiodothyronine, thyroid stimulating hormone, interleukin-6, interleukin-1β, tumor necrosis factor α, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides were measured. Bench press and leg press maximal strength, resting energy expenditure, and respiratory ratio were also tested. RESULTS After 8 weeks, the 2 Way ANOVA (Time * Diet interaction) showed a decrease in fat mass in TRF compared to ND (p = 0.0448), while fat-free mass, muscle area of the arm and thigh, and maximal strength were maintained in both groups. Testosterone and insulin-like growth factor 1 decreased significantly in TRF, with no changes in ND (p = 0.0476; p = 0.0397). Adiponectin increased (p = 0.0000) in TRF while total leptin decreased (p = 0.0001), although not when adjusted for fat mass. Triiodothyronine decreased in TRF, but no significant changes were detected in thyroid-stimulating hormone, total cholesterol, high-density lipoprotein, low-density lipoprotein, or triglycerides. Resting energy expenditure was unchanged, but a significant decrease in respiratory ratio was observed in the TRF group. CONCLUSIONS Our results suggest that an intermittent fasting program in which all calories are consumed in an 8-h window each day, in conjunction with resistance training, could improve some health-related biomarkers, decrease fat mass, and maintain muscle mass in resistance-trained males.