Nutritional TRIAGE… or How humans survived starvation

Eating poorly impoverishes health and shortens life. For eons, every time there has been a nutritional shortage, the organism avoids death by deficiency of essential micronutrients by concentrating them in the organ most in need, i.e., the organs responsible for immediate survival and reproduction (in that order). If, for example, there is a shortage of bioflavonoids in the diet, the organism will distribute the few micrograms of carotenoids that it manages to rescue from the intestinal chyme and will proceed to an asymmetric and selective allocation of these, in the tissues most sensitive to their lack. This phenomenon was baptized "triage" by Bruce Ames (see video below) and constitutes a phenomenal adaptive resource of organisms to survive famine and periods of insufficient nutrition. This also implies that the organism even invests energy in accumulating certain substances - such as Zinc, Selenium or vitamin C - within a specific type of cells against a concentration gradient. Such is the case, for example, of neurons and leukocytes, which receive as a priority the few micronutrients available in periods of shortage. The marvelous ability of the organism-as-a-whole to census its own nutritional status and implement an asymmetric, organ-specific (sectorized) allocation of certain micronutrients has been of crucial importance for survival and reproduction throughout the evolution of the genus Homo.

Fig.1 Inundated with sugars and with very poor micronutrient concentrations (the very definition of hypercaloric malnutrition), most of urban humanity chronically suffers from pronounced vitamin insufficiencies.

Chronic malnutrition compromises mediated, post-reproductive functions, such as maintaining neurons in good condition and rebuilding vascular and joint tissues, or maintaining youthful red blood cell production at advanced ages. Due to the prioritized allocation of vitamins and trace elements, proteins and enzymes involved in organ repair do not receive their essential cofactors, so chronic malnutrition prevents healthy longevity. Thus, even in individuals with access to so many calories as to have even obesity, micronutritional deficiencies create targeted deficiencies. In our experience, these chronic conditions are the norm, not the exception. For such subclinical states of deficiency pathology even the normal plasma level of nutrilites - the reference range - is not a reliable indicator. Nutripharmacological supplementation must therefore far exceed the recommended daily allowance (RDA).

Note: The word "triage" comes from the French word trier, which means to sort, separate or select, and designates an administrative tactic used by military doctors on the battlefield. Confronted with a sudden influx of wounded personnel in excess of the available medical capacity at the time, medics prioritize the treatment of certain soldiers depending on the likelihood of survival of the wounded.

Nature favors immediate survival over future health. The triage hypothesis indicates that our short-term survival is achieved by prioritizing the allocation of scarce micronutrients. To prevent the organism from collapsing from lack of iron in the heart muscle, for example, iron is extracted from tissues of secondary relevance to immediate survival. The theory was first proposed in 2006 (Proceedings of the National Academy of Sciences, Vol. 103, p 17589-94) showing why age-related pathologies, such as Cardiovascular Disease, cancer and neuro-metabolic dementias, may arise as an unintended consequence of adaptive mechanisms favored in the course of evolution, serving as protection against episodic shortages of vitamins or trace elements. It should be considered here that in the genesis of the described degenerative diseases the mitochondria play a central role, being profoundly affected by malnutrition. In addition to the precursors of NADH+, FADH2 and Coenzyme A, we need CoQ-10, Carnitine and the R form of lipoic acid in abundance to avoid senescence and functional deterioration. If this hypothesis is correct - and all experimental and clinical evidence suggests that it is - micronutrient deficiencies that trigger the selective distribution response would accelerate cancer, aging and neuronal decay, but leave critical short-term metabolic functions, such as ATP production, intact.

In complex organisms there are interrelated systems that selectively allocate resources - vital substances, vitamins, etc. - to organs and tissues according to systemic need and demand and prioritizing the overall subsistence of the organism. Bruce Ames' theory of Micro-nutritional Triage or vitamin triage is a very practical and comprehensive generalization that describes how the body has developed a rationing response to micronutrient (vitamin and mineral) shortages over the course of evolution. When the blood lacks a vitamin or mineral, that scarce micronutrient is allocated to proteins essential for short-term survival. Proteins with enzymatic activity necessary for long-term health, including those that protect DNA, then lack the appropriate cofactors (coenzymes) at their prosthetic sites - the active sites of the proteins at which their specific function is carried out - and are incapacitated. This generalized absence of enzymatic capacity is congruent with the phenotype of accelerated aging.

This description is analogous to when, in a catastrophe, a hospital allocates available resources (doctors, operating rooms, oxygen, medicines, etc.) to an unusually large group of patients. Since the catastrophe has generated a large number of casualties, the usual resources are insufficient for everyone. Under acute logistical stress the hospital executes a special resource allocation protocol in the most rational, practical and efficient way possible. Our laboratory had described this organic phenomenon many years ago in an unhappy way (compared to the synthetic and emphatic way in which Ames defined it) with the following expression: "Asymmetric, organ-specific, sectorized, counter-gradient allocation of certain nutrients scarce in plasma, but of crucial importance for survival".

Fig.3 Emergency room in Japan, where priority care is given to the patients who score worst in the Triage scheme. In disaster circumstances - earthquakes, multiple shocks, etc. - the Triage classification technique saves lives by managing relatively scarce resources, giving priority to patients at imminent risk.

Note: Daily vitamin supplementation takes the body out of depletion mode and away from the accelerated aging phenotype. On the other hand, the analysis of the concentration of micronutrients in the blood plasma is often not useful to estimate their real concentration in a given organ or tissue. It is known that there are tissues that avidly concentrate certain nutrients to the detriment of other tissues. For example, leukocytes have up to 100 times more ascorbate than the surrounding plasma. The organism seems to have intricate physiological mechanisms that allow it to "census" the amount or requirement of functional substances of its different organs and tissues and decide which ones to supply.

Ernesto Prieto Gratacós

Laboratorio de Ingeniería Biológica

Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License

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