The Nutrition Agenda - An Interview with Jeffrey Blumberg
Following up on yesterday’s post (Questioning the Usefulness of Nutritional Supplementation) that quotes Jeffrey Blumberg, professor of nutrition and director of the Antioxidants Research Laboratory at Tufts University, here’s an interesting recent interview with Professor Blumberg.
Some excerpts…
Current nutrition use in health care:
Something is terribly wrong. We know so much today about the “good” and “bad” fats and carbohydrates, nutrient density, caloric balance, glycemic load, and the role of micronutrients in promoting health, but we see a population that is carrying a burden of chronic disease that should be readily preventable by applying our current knowledge. It seems that our cornucopia of convenience foods and a lifestyle that has been engineered to make physical activity unnecessary have created a toxic environment that is very difficult to overcome.
As the key healthcare provider, the physician can and should play a major role in correcting this situation, but there is a regrettable lack of nutrition education and current nutrition knowledge among many physicians. There are, of course, other healthcare providers, including dieticians, nurses, and pharmacists, who can and should play a vital role in counseling and guiding their patients. But we face a fundamental problem that our whole healthcare system is still geared principally toward repair and recovery as opposed to health promotion and disease prevention.
This is where the real power of nutrition lies. We must treat patients with diabetes and heart disease and we must put pins in fractured osteoporotic hips, but we must not lose site of the fact that we must work harder to prevent these conditions in the first place. And the critical tools to doing so are nutrition and physical activity. There is a great deal of discussion regarding preventive medicine, but one need only review how medical care is insured and reimbursed to see how little recognition is granted to the value of health promotion…
…It is helpful to appreciate that much of health promotion is directed to reducing the risk or delaying the onset of age-related chronic diseases. But mainstream medicine is still too focused on treating these conditions after they have become manifest instead of preventing them. Nonetheless, there are a growing number of integrative clinicians who are adopting diet and nutrition as one of the mainstays of their practice. There is certainly a segment of practicing dietitians as well that are strong advocates for health promotion through diet and the use of supplements, but many are based in hospitals and directed to nutritional support of patients.
Nutrient needs at all ages:
We need to appreciate that there are lifecycles for nutrient requirements, and one of those cycles includes older adults and the elderly. Of course, aging does not begin at 50 or any other single age but is segmented by physiological systems. For example, immunological reserves begin to decline with the involution of the thymus at puberty, reduction of bone mineral density occurs in the middle of our fourth decade, and loss of lean body mass (sarcopenia) becomes apparent when we’re in our 60s.
Elderly nutrient needs:
When dealing directly with the elderly, we find a marked increase in nutrient inadequacies for many reasons, including a lack of attention to nutrient density, no use or misuse of supplements, and drug-induced nutrient deficiencies. Importantly, in contrast to earlier beliefs that because older people are smaller and more sedentary they have lower nutrient needs, we now know that the requirements for several nutrients increase with age.
The increased requirement for many nutrients with age often translates into the rational application of dietary supplements.
Drug-nutrient interactions:
One other thing that I would stress is that older people as a group take more medications more frequently and for longer periods of time than any other age group. And yet we know there are many drug-induced nutritional deficiencies. This is a problem that is significantly underappreciated and that often goes unrecognized despite the simple solution available to prevent it.
The medical establishment’s understanding and acceptance of supplement research and supplements in general:
[E]ven when there are successes with supplement trials—and there certainly have been several—there seems to be reluctance to adapt the actual evidence to practice. For example, when folic acid supplements were proven to reduce neural tube birth defects or when supplements of marine omega-3 fatty acids were shown to lower the risk of cardiovascular disease, the strongest recommendations were to eat more vegetables and fish, respectively, even though the trials were conducted with supplements. Similarly, the dramatic reduction in fractures obtained with calcium and vitamin D supplements resulted largely in the recommendation for greater consumption of dairy products, not of the supplements with demonstrated efficacy…
…Perhaps many physicians do not feel knowledgeable enough about nutrition to make the recommendation, or they simply do not have the time to assess each patient’s dietary pattern and nutritional status. This only suggests to me the need for a healthcare team approach, actively involving dietitians and pharmacists to contribute to this effort.
Evidence-based medicine:
[W]e are required to use our best medical and scientific judgment on the totality of available evidence, including basic research and observational studies as well as clinical trials, and reach conclusions today about what to recommend as food choices and supplement use. Why would we want to ignore the data derived from in vitro and cell culture experiments, animal models, case reports, population-based studies, and millennia of traditional medical and dietary practices and presume that a single research approach, randomized clinical trials, is the only way we can come to know about the value of nutritional interventions? Holding out for this single “gold standard” is not only too limiting to a full understanding of nutrition but holds out the false promise that all the necessary trials will be done in our lifetime or even in our grandchildren’s lifetimes.
Check out the entire interview. It’s well worth the time.
