Research indicates that disease prevention and surgical recovery improve when supported by proper nutrition.1,2 However, clinicians are rarely offered even basic nutritional training in medical and osteopathic school, a study of incoming pediatric residency interns showed.3 Perhaps unsurprisingly, many patients do not have optimal nutrition,4 are experiencing record levels of chronic disease,5 and are most likely being treated with pharmaceuticals despite the availability of other less invasive but highly effective options.6,7
When high-quality nutrition is applied effectively and consistently, it can prevent future chronic disease in adolescents,8 enhance cognition in people with dementia,9 and improve outcomes in patients receiving colorectal and GI oncological surgeries,10 to name a few. Moreover, in patients who have hospital stays for any reason, nutrition support is associated with fewer infectious complications and shorter length of stays.1
Chronic diseases account for the majority of health concerns in middle-aged and older populations,11 and many of these conditions respond well to nutritional interventions. Risks of obesity, diabetes, hypertension, and cardiovascular disease are strongly linked to lifestyle, especially dietary choices.12,13
A 2018 study in the journal Nutrition found that a wider implementation of plant-based eating (specifically a Mediterranean-style diet and/or a diet with a daily portion of soy-containing foods) would lead to improved health outcomes.14 There are a variety of approaches for plant-based eating, from Mediterranean-type diets to vegetarian and vegan diets. Yet despite the strong body of evidence favoring plant-based diets, including studies showing a willingness of the general public to embrace them, many physicians are not stressing the importance of plant-based diets as a first-line treatment for chronic illnesses.12
In this video, IFM educator Michael Stone, MD, talks about Functional Nutrition and how clinicians can use high-quality foods that are rich in phytonutrients to address the clinical imbalances in their patients:
Plant-based diets aim to maximize the consumption of nutrient-dense plant foods (fruits, beans, peas, lentils, and nuts), and minimize processed foods, oils, and animal foods (including dairy and eggs).12 Studies indicate that a Mediterranean-style diet rich in vegetables and fermented milk products is associated with greater gut microbial diversity and a lower risk of hospitalization in patients with liver cirrhosis.15
Diet & Cognition
A May 2018 study published in Neurology found that a healthy diet increases total brain volume, potentially offsetting age-related shrinkage.16 The study established that people who eat a diet rich in vegetables, fruits, nuts, and fish may have bigger brains. Researchers found after adjusting for age, sex, education, smoking, and physical activity that a higher diet score was linked to larger total brain volume. Those who consumed a better diet had an average of two milliliters more total brain volume than those who did not. To compare, having a brain volume that is 3.6 milliliters smaller is equivalent to one year of aging.16
A series of six articles appearing in the March 2018 issue of The Journal of Gerontology, Series A: Biological Sciences and Medical Sciences found new correlations between a Mediterranean diet and healthy aging outcomes.17 The new studies report on the positive relationship between the Mediterranean diet and physical and cognitive function, the value of taking a coenzyme Q10 supplement while adhering to the diet, and the role of the diet in reducing inflammation.17
Diet & Inflammation
Inflammation is known to be associated with both the manifestation of several chronic diseases13 and the intake of foods with pro-inflammatory characteristics.18 In the last five years, clinical trials, case-controls, cohorts, and cross-sectional studies have demonstrated that carbohydrate-moderated, low glycemic index, protein-moderated, monounsaturated and polyunsaturated fatty acid–rich, omega-3-rich, and low-saturated fat diets reduce inflammatory biomarkers both in healthy individuals and in those with cardiovascular risk (although the second group seems to benefit more from changes in the dietary profile).13
How can clinicians use Functional Nutrition to effectively prevent and even reverse chronic disease, as well as support general health and wellness? Functional Nutrition is integrated into all of IFM’s courses, but is provided most comprehensively in the course called Applying Functional Medicine in Clinical Practice (AFMCP). In this five-day course, clinicians will learn evidence-based nutritional strategies to restore patients’ health and improve outcomes.
- Zhang H, Wang Y, Jiang ZM, et al. Impact of nutrition support on clinical outcome and cost-effectiveness analysis in patients at nutritional risk: a prospective cohort study with propensity score matching. Nutrition. 2017;37:53-59. doi:10.1016/j.nut.2016.12.004.
- Centers for Disease Control, National Center for Chronic Disease Prevention and Health Promotion. Physical activity and good nutrition: essential elements to prevent chronic diseases and obesity 2003. Nutr Clin Care. 2003;6(3):135-138.
- Castillo M, Feinstein R, Tsang J, Fisher M. Basic nutrition knowledge of recent medical graduates entering a pediatric residency program. Int J Adolesc Med Health. 2016;28(4):357-361. doi:10.1515/ijamh-2015-0019.
- Wannairachige D. Malnourished patients often unacknowledged. CMAJ. 2015;187(4):242. doi:10.1503/cmaj.109-4991.
- Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev Chronic Dis. 2014;11:E62. doi:10.5888/pcd11.130389.
- Robbins R. Big pharma’s big push to get patients to take their meds. STAT News. https://www.statnews.com/2016/02/04/big-pharma-medication-adherence. Published February 4, 2016. Accessed August 18, 2017.
- Cochran A. Does your doctor have ties to big pharma? How you’ll be able to find out. CBS News. http://www.cbsnews.com/news/does-your-doc-have-ties-to-big-pharma-how-youll-be-able-to-find-out. Published March 4, 2014. Accessed August 18, 2017.
- Ozdemir A. Macronutrients in adolescence. Int J Caring Sci. 2016;9(2):1162-66.
- Anderson JG, Lopez RP, Rose KM, Specht JK. Nonpharmacological strategies for patients with early-stage dementia or mild cognitive impairment: a 10-year update. Res Gerontol Nurs. 2017;10(1):5-11. doi:10.3928/19404921-20161209-05.
- Williams JD, Wischmeyer PE. Assessment of perioperative nutrition practices and attitudes—a national survey of colorectal and GI surgical oncology programs. Am J Surg. 2017;213(6):1010-1018. doi:10.1016/j.amjsurg.2016.10.008.
- St Sauver JL, Warner DO, Yawn BP, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clin Proc. 2013;88(1):56-67. doi:10.1016/j.mayocp.2012.08.020.
- Tuso PJ, Ismail MH, Ha BP, Bartolotto C. Nutritional update for physicians: plant-based diets. Perm J. 2013;17(2):61-66. doi:10.7812/TPP/12-085.
- Silveira B, Oliveira T, Andrade P, Hermsdorff H, Rosa C, Franceschini S. Dietary pattern and macronutrients profile on the variation of inflammatory biomarkers: scientific update. Cardiol Res Pract. 2018;2018:4762575. doi:10.1155/2018/4762575.
- Schepers J, Annemans L. The potential health and economic effects of plant-based food patterns in Belgium and the United Kingdom. Nutrition. 2018;48:24-32. doi:10.1016/j.nut.2017.11.028.
- Bajaj J, Idilman R, Mabudian L, et al. Diet affects gut microbiota and modulates hospitalization risk differentially in an international cirrhosis cohort [published online January 19, 2018]. Hepatology. doi:10.1002/hep.29791.
- Croll P, Voortman T, Ikram MA, et al. Better diet quality relates to larger brain tissue volumes: the Rotterdam Study. Neurology. 2018;90(24):e2166-e2173. doi:10.1212/WNL.0000000000005691.
- European Association for the Study of the Liver. Mediterranean-style diet improves gut microbial diversity and reduces hospitalization. Press Release. https://www.eurekalert.org/pub_releases/2018-04/eaft-mdi041218.php. Published April 12, 2018. Accessed June 18, 2018.
- Del Mar Bibiloni M, Maffeis C, Llompart I, Pons A, Tur JA. Dietary factors associated with subclinical inflammation among girls. Eur J Clin Nutr. 2013;67(12):1264-1270. doi:10.1038/ejcn.2013.196.
The 2018 free Grand Rounds video series, presented by IFM in collaboration with Cleveland Clinic Center for Functional Medicine, now includes a lecture by John P.A. Ioannidis, MD, DSc, and a Q&A with Mark Hyman, MD, director of Cleveland Clinic Center for Functional Medicine and IFM board president of clinical affairs.Read More