Nutrition

Nutrition is a complex and often controversial topic, but understanding the scientific concepts behind it is crucial for achieving optimal metabolic health. In this series of newsletters, I will not be making specific dietary recommendations but rather focusing on the principles of nutrition and metabolic health.

Why is nutrition so complex?

One of the main reasons why nutrition science is so complex is that it often relies on epidemiological, observational studies, which can be influenced by factors such as individual variability, dietary self-reporting, and confounding variables. Long-term randomized controlled trials, which are the gold standard for establishing cause-effect relationships, are difficult and expensive to conduct in the field of nutrition.

Nutrition and Metabolic Health

Metabolic Health is a multiplier of both life- and health-span.

When most people think about nutrition they’re usually thinking about it through the lens of weight management. But I think it would be better to stop thinking about weight and start thinking about metabolic health.

To illustrate this point, let's consider four groups of people: metabolically healthy and normal-weight, metabolically unhealthy and normal-weight, metabolically healthy and obese, and metabolically unhealthy and obese.

Research has shown that metabolically healthy obese individuals have only a 20% higher risk of mortality compared to their normal-weight, metabolically healthy counterparts. On the other hand, normal-weight individuals who are metabolically unhealthy have a staggering 300% higher risk of mortality compared to those who are metabolically healthy. This highlights the importance of addressing the underlying factors that contribute to metabolic health, rather than just focusing on weight.

Defining Metabolic Health

Metabolic health can be assessed using a set of five criteria, known as metabolic syndrome. These include:

1. Abdominal obesity: Waist circumference of > 100 cm in men, or > 90 cm in women.
2. High triglycerides: 150 mg/dL (1.7 mmol/L) or higher.
3. Low HDL cholesterol: Less than 40 mg/dL (1 mmol/L) in men, or less than 50 mg/dL (1.2 mmol/L) in women.
4. High blood pressure: 140/90 mm Hg or higher.
5. High fasting glucose: 100 mg/dL (5.6 mmol/L) or higher.

Should 3 or more of the conditions be out of balance you most likely suffer from metabolic syndrome which can lead to:

• Insulin resistance, which can lead to the development of type 2 diabetes
• Cardiovascular disease
• Non-alcoholic fatty liver disease (NAFLD), is a condition in which excess fat accumulates in the liver.
• Chronic kidney disease
• Sleep apnea

Fortunately, metabolic syndrome can be managed and even reversed with the help of a healthcare provider. By addressing the underlying risk factors it is possible to improve metabolic health and reduce the risk of chronic disease.

Nutritional Biochemistry

Nutrition is not about diets. It isn’t about Paleo, Keto, Vegan, Low-Carb, South Beach, etc. It is not about any of that stuff, nutrition is really about biochemistry.

What is food?

Well, food is largely composed of four macronutrients. At least that’s what gives food its caloric value. You have heard of all of these of course; carbohydrates, fats, proteins, and alcohol. I add alcohol as it is a significant contributor to calories.

What is a calorie?

Calorie is a unit of energy storage and it’s very specifically defined. We mostly talk about kilocalories, units that are 1000 calories at the time. So every time you hear somebody say I ate something that had a hundred calories it then means in reality 100 kilocalories.

Calorie breakdown of the macronutrients:

• Carbohydrates: ca. 4 calories per gram
• Proteins: ca. 4 calories per gram
• Fats: ca. 9 calories per gram
• Alcohol: ca. 7 calories (!) per gram

Why do we eat?

1.??? To generate and store energy in the form of ATP (Adenosine TriphosPhate) by eating carbohydrates, fats, and alcohol.

2.??? To build and maintain structure (cells, body) by eating protein (amino acids) and fats (cholesterol)

3.??? To digestion by eating fibre which is important for a healthy gut

All macronutrients except alcohol are essential!

What happens when we eat?

1. The food we eat is broken down into smaller pieces by our teeth, and mixed with saliva, which contains enzymes that help to break down carbohydrates
2. The food then travels down the esophagus and into the stomach, where it is mixed with stomach acid and digestive enzymes, which help to break down proteins and fats.
3. The food is then slowly released from the stomach into the small intestine, where it is further broken down by enzymes from the pancreas and bile from the liver.
4. The nutrients from the food, such as glucose, amino acids, and fatty acids, are then absorbed into the bloodstream through the walls of the small intestine.
5. The blood carries the nutrients to the liver, where they are processed and either stored for later use or released into the bloodstream to be used by the body's cells.
6. Any undigested food, such as fiber, is then passed into the large intestine, where it is fermented by bacteria and eventually eliminated from the body as feces.

This process of digestion and absorption allows the body to extract the nutrients it needs from the food we eat, and to use them for energy, growth, and repair.

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How do we store and access nutrients?

• Carbohydrates:

Carbohydrates are stored as glycogen in the liver and muscles, with the liver storing about 100 grams and the muscles storing about 500 grams. When the body needs energy, the liver can convert glycogen back into glucose, while the muscles cannot release glucose back to the body. If glycogen storages are full, excessive glucose can be converted into fatty acids through de novo lipogenesis and stored in adipose tissue as triglycerides. The body uses carbohydrates for energy through cellular respiration, which requires oxygen and is most efficient during high-intensity, short-duration exercise.

• Proteins:

The body does not have a specific storage system for proteins. Instead, it breaks down proteins into amino acids and uses them for various purposes, such as building and repairing tissues, synthesizing hormones and neurotransmitters, and producing energy or excreted as waste (urine).

• Fats:

The body stores fats in the form of triglycerides in adipose tissue, which is located under the skin and around organs. The body can store an almost unlimited amount of fat. When the body needs energy, it can break down triglycerides into fatty acids and glycerol and use them for energy. Just as an example: I weigh 75kg and currently have 12% body fat. In other words, I do have an energy reserve of 81,000 calories. That is why we theoretically can stay about 3 weeks without food. What is your depot :)? Every storage has its limits. When the amount of fat that’s entering the fat cell becomes excessive for the capacity of that cell and it spills over into these other storage areas (organs) it will produce inflammation. The body uses fats for energy through beta-oxidation, which does not require oxygen and is most efficient during low-intensity, long-duration exercise.

• Vitamins and minerals:

The body stores some vitamins and minerals in various tissues and organs. For example, the liver stores vitamins A, D, E, and K, and the bones store calcium and phosphorus. The body regulates the levels of vitamins and minerals to maintain homeostasis, and any excess amounts are excreted.

• Alcohol:

Although alcohol is not an essential nutrient, it is calorie-dense and can be stored as fat in the body. Fatty liver disease can result from the accumulation of fat in the liver, which can lead to a range of health problems such as inflammation, fibrosis, cirrhosis, liver cancer, and insulin resistance. Excessive alcohol consumption can be very harmful to our health

Nutrition in an Evolutionary Context

Most of the time food was scarce for our ancestors. The phenomenon of our genes adapting to the situation of scarce food is known as the "thrifty gene" hypothesis. It suggests that in the past when food was scarce and unpredictable, our ancestors evolved genetic adaptations that allowed them to efficiently store and use energy.

However, in modern times, when food is abundant and easily accessible, these genetic adaptations can become a problem. Our bodies are still programmed to store and use energy efficiently, which can lead to weight gain and obesity. Our preference for sweet and high-calorie foods can also contribute to overeating and poor dietary choices. And this explains - for example - why eating sugar (primarily fructose) makes us want to eat more sugar. Our genetic makeup, which was once beneficial for survival, is now contributing to the rising rates of obesity and chronic diseases in our modern society.

What are the characteristics of modern food?

The best way to describe the modern diet is the standard American diet, with the appropriate abbreviation SAD. You do not have to live in America to consume SAD, as it has meanwhile been exported to almost anywhere on this globe.

What exactly does SAD mean?

It is basically the solution of a five-part problem

1. Give me food at massive scale
2. Make it easy to transport
3. Make it very inexpensive
4. Make it highly palatable
5. Give me lots of variety

It appears that the issue of feeding 8 billion people has been addressed. However, the downside is that if most of us consume the Standard American Diet (SAD) without considering portion sizes, frequency, or the type of food we eat, we will likely become metabolically unhealthy. There are two main issues with SAD, and the combination of these problems makes it highly detrimental to our health.

1. Problem: It is generally very high in sugar, high in salt, and high in the types of fats that our brain likes to eat.
2. Problem: It is very abundant with unlimited access to these foods that hijacks our appetite centers and leaves us in the state asking for more and more.

As a result of this fat storages overflow into places where we don't want to be storing fat (organs!), which as we know leads to inflammation and as the inflammation goes up so too does blood pressure, and so too does the lipid metabolism become dysregulated and we see the cardiometabolic risks, all of these things negatively impact our life- and health-span.

Every extra kilogram you carry can put additional strain on your knee joints, equivalent to an extra 2 kg when walking, 3 kg when climbing stairs, and 4 kg when running. While this may not seem like a significant issue in your 30s, it can have a greater impact as you age. Investing in a healthy lifestyle now can lead to improved health and quality of life in your later years.

Eat smart and enjoy it.

Keep it up!

P.S.

In the next newsletter, I will talk about general principles for good nutrition as well as how to develop a personalized nutrition framework.

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