In our search for vitality and healthy longevity, the Anti-Aging paradigm is the most successful approach because our preventive and therapeutic strategies depend on understanding the physiologic harmony between the different organ-systems of the body and on respecting the biochemical identity of the individual.
Fadi Alshaban, M.D., Board-Certified Anti-Aging Medicine, Board-Certified General Surgery, M.Sc. Integrative Medicine, MBA, B.Sc. shares the first past of a six-part series.
We realise the importance of the delicate interaction between a fixed set of inherited genes with a changeable environment that shapes the final overall health status of the individual - whether as health or as the disease.
Besides this holistic personalised approach, we emphasize on the active role of the individual as an active player in reaching the objectives of the customized pro-active long term multimodal management plan: Independent, productive, healthy and happy life especially at older age.
This multimodal approach includes six distinct but interrelated modalities: healthy nutrition, healthy lifestyle choices, regular exercise, bioidentical hormone restoration, nutritional supplementation and detoxification.
Nutrient-Dense Food Is The Best Medicine
Many decades of studies have confirmed the importance of a healthy diet, normal weight and regular exercise in maintaining vitality, promoting wellbeing and preventing disease.
The quality and quantity of food are not only important determinants of energy balance, growth, development and repair but are key in driving metabolic pathways and gene expression.
Therefore, paying attention to the quality and quantity of the food we consume is the first step towards achieving vitality and optimal longevity. Nutrition is vital in curative and preventive medicine. The cure of today’s chronic killing diseases starts in the kitchen and not in hospitals. “Let food be thy medicine and medicine be thy food”, the time-honoured advice of Hippocrates (460-377 BC) is now more compelling than ever given the confusion of nutrition advice and food options available.
In the majority of cases weight management does not need pills, bariatric surgery or a sophisticated diet regimen, but it requires habit mindfulness and to respect our built-in delicate metabolic system, urging us to return to Mother Nature to rebuild the lost harmony between our hunger instinct, appetite and food. This is the only successful program. So the first step in this journey to healthy life is to introduce a radical change in our feeding habits that follows evidence-based scientific advice and to avoid complicated regimens and risky medications.
It’s important to overlook manipulated food products and processed foods in favour of seasonal, natural, preferably home cooked meals.
Basic Biological Principles (The Energy Balance)
There are three ways the body burn the food (fuel) we consume:
Resting Energy Expenditure: The calories burned in resting state to perform the different physiologic processes; it constitutes about 65%-75% of the total calories in consumed food. N.B. The resting energy expenditure decreases 5-10% every decade after the age of thirty. Part of this energy is expended as thermal energy.
Physical activity including daily activity and exercise; it constitutes about 20%-25% of the total calories. N.B. The resting energy expenditure is higher in an individual with larger lean mass so resistance or strength exercise will increase the lean mass and consequently increases resting energy expenditure.
Digestion of food; it constitutes about 5%-10%of total calories. It is possible to increase energy expenditure by eating healthy proteins and eating frequently.
The hormonal changes in fasting (hunger-feeding) cycle and its implications in health and disease
The fasting state after consuming a balanced diet that contains a balanced proportion of macro-nutrients i.e. protein, healthy fat and unrefined (low glycaemic index) carbohydrate is characterized by a rise in glucagon which stimulates the liver to pour glucose into circulation to maintain blood glucose level
But after consuming refined (high glycemic index) carbohydrates the post prandial stage is characterized by low glucagon and four hours later by the release of epinephrine causing exaggerated hunger. So this non-physiologic response in unbalanced food will push the individual to eat more and to crave more carbohydrates. So a vicious cycle starts that predisposes to overweight, obesity and lifestyle diseases
How nutrients act at the molecular level (gene expression)
According to Professor Berit Johansen, a biologist, nutrition contains bioactive nutrients (signals) that are detected by the cells through a specific sensory system that include transcription factors and other protein molecules.
Once this interaction occurs, it induces specific gene expression that results in the production of specific protein. Thus different nutrients induce different gene expression. Understanding how nutrition influences genetic expression and metabolic pathway is useful to take measures that prevent the development of diet-related diseases such as obesity, coronary artery disease, type II diabetes mellitus and cancer.
Importance of gut microbiota
The interplay between diet, the gut Microbiota, and the metabolic and genetic individuality is significant. Equally, the gut microbial profile is unique to each individual.
Bacteria that live commensally in our gut plays are pivotal in regulating metabolic processes including the digestion and absorption of nutrients, synthesis of vitamins, modulation of mucosal immunity, as well as production of toxins and carcinogens. It also modulates the role of the nutrients on gene expression.
This Microbiota evolves over a lifetime, and can be altered by diet. For example, a diet rich in saturated fat increases one strain of bacteria that stimulates inflammation and increases the levels of inflammatory cytokines. We are now aware that gene expression can be influenced by modulating the quality of diet and the composition of gut Microbiota.
Also, modifying the composition of the gut microbiota is an effective tool to treat disease and to promote health. For example one form of obesity is linked to an overgrowth of the phylum Firmicutes over the Bacteroides and the correction of this imbalance (dysbiosis) between these bacterial strains leads to the control of obesity.
So knowing the biochemical and genetic individuality on one side and the composition of the Microbiota on the other will empower health-care providers to develop dietary interventions as personalized nutrition.
Nutrition as a major contributor to the development of diseases
70% of health care budgets are spent on treatment of preventable diseases. According to USDA, diseases associated with obesity costs annually about $ 117 billion and $112 billion for coronary artery disease. So it is too expensive to ignore prevention. Unhealthy eating associated with physical inactivity are leading causes of death in developed countries and many developing countries.
According to the Global Disease Burden Study, the three risk factors that account for the most disease burden in the United Arab Emirates are high BMI (body mass index), dietary risks and high fasting plasma glucose. All factors are related to the quality and quantity of consumed food.
Our typical food of today is too high in refined carbohydrates, unhealthy saturated fat and salt and too low in fibre, vegetables, fruits, whole grains and healthy proteins. Such a diet precipitates the development of killing diseases including obesity, heart disease, diabetes, hypertension, osteoporosis, and many cancers.
Besides causing killing disease, this unhealthy food is a leading cause of disability and loss of independent life. For example diabetes causes blindness and amputations, hip fractures are caused by osteoporosis and disabling heart failure secondary to heart attacks.
What should I eat? The bottom line: Re-defining healthy nutrition
Our aim is to improve health and prevent disease through adoption of proactive strategies that customize diet prescription among other modalities. The balance between nutrition, body weight and energy storage is determined by the interaction between genetic, environmental and psychosocial factors. Changes in body weight cause changes in energy needs. Supporting metabolism by healthy choices matters in the search of a healthy weight and vitality.
Guidelines To Healthy Eating
Connect with an Integrative (Health-Oriented) Physician to evaluate your nutritional history and to evaluate your adequacy of different nutrients, metabolic status, hormonal status and any biochemical defect.
Avoid refined carbohydrates, processed food and food containing trans-fats and limit sugary drinks and salt.
Adopt a diet rich in vegetables, fruits. Moderation in whole grains.
Choose healthy fats like olive oil, nuts and fish.
Choose healthy proteins in fish and beans. Eat meat, poultry, milk and dairy products in moderation.
Drink sufficient amounts of water, and drink alcohol in moderation if at all.
Future perspective: Improving health and preventing disease through tailored diet and lifestyle prescriptions.
Even though this technology is available on a narrow scale, it is worth mentioning. Personalized nutrition is the cutting edge technology regarding diet. The program provides information about your molecular identity. It allows modification of the diet based on one’s unique nutritional genetic profile. DNA testing is used to determine one’s variation in genes involved in detoxification pathways, bone health, heart health, anti-oxidant, inflammatory processes and insulin sensitivity. This technology has great potential in guiding patients to better choices not only in diet but in many different aspects that sustain vitality and prevent disease.