The Building Blocks of Life Within the United Kindom (UK), most mainstream healthcare practitioners receive little or no nutrition education during their years of training. As a consequence, the understanding of nutrition amongst primary care practitioners such as general practitioners, pharmacists, midwives, and practice nurses is limited and is largely focused on energy consumption and obesity. There is little knowledge of the wealth of micronutrients that underpin health, nor of the ticking timebomb of insufficient intakes of those micronutrients amongst a significant proportion of the population in the UK. The Building Blocks of Life: A Nutrition Foundation for Healthcare Professionals is a step towards redressing that balance. It sets out an informative and engaging narrative on how and why nutrition is the basis for good health. It discusses UK- specific issues with regard to diet and intakes of vitamins, minerals, essential fatty acids and other micronutrients. It also raises concerns about the potential negative health implications of the generally poor UK diet and suggests ways that healthcare practitioners can support patients in improving their long-term health outlook. Nutrition policy in the UK needs to be dragged into the 21st century and this book sets out evidence-based arguments which challenge current public health myths such as the idea that 10 micrograms of vitamin D is all anyone needs or the messaging around the consumption of saturated fat vs highly processed seed oils or that everyone can get all the nutrients they need from a varied and balanced diet. Although The Building Blocks of Life: A Nutrition Foundation for Healthcare Professionals focuses on concerns around poor diet and the consequent micronutrient inadequacies in the UK, the nutritional detail is relevant no matter where you are in the world. Everyone eats, all the time. It is time that mainstream medicine looked towards food as both a cause and a solution to many of the chronic degenerative conditions that plague modern life. The Building Blocks of Life A Nutrition Foundation for Healthcare Professionals TC Callis Designed cover image: Illustrator, Adam Speigl-James; Design Consultant: Rachael Mustoe First edition published 2023 by CRC Press 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742 and by CRC Press 4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN CRC Press is an imprint of Taylor & Francis Group, LLC © 2023 Taylor & Francis Group, LLC Reasonable efforts have been made to publish reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the consequences of their use. 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For works that are not available on CCC please contact [email protected] Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identification and explanation without intent to infringe. ISBN: 978-1-032-27112-5 (hbk) ISBN: 978-1-032-27111-8 (pbk) ISBN: 978-1-003-29140-4 (ebk) DOI: 10.1201/b22900 Typeset in Times by MPS Limited, Dehradun Dedication For my parents who enabled me to write this. Thank you for telling me I could be anything I wanted to be. I wish you could have been here for this. Contents Acknowledgements.................................................................................................xiii Author......................................................................................................................xv Introduction..............................................................................................................1 References............................................................................................3 Chapter 1 Nutrition Basics...................................................................................5 The Basics............................................................................................5 Macro- and Micronutrients Are Split up into Smaller and More Complex Groups..................................................................................5 Macronutrients.....................................................................................5 Fats...............................................................................................5 Proteins........................................................................................6 Carbohydrates..............................................................................6 Fibre.............................................................................................7 Water............................................................................................7 Micronutrients......................................................................................7 Vitamins.......................................................................................8 Minerals.......................................................................................8 Omega-3 Fatty Acids..................................................................8 Phytonutrients..............................................................................8 Deficiency or Insufficiency.................................................................9 Nutrient Intakes – Terminology..........................................................9 National Diet and Nutrition Survey..................................................10 Government Guidelines.....................................................................10 There Is Nothing Simple about Nutrition.........................................11 References..........................................................................................12 Chapter 2 Malnutrition.......................................................................................15 What is Malnutrition?........................................................................15 Definitions..................................................................................15 Prevalence of Malnutrition in the UK..............................................15 The Difference between Macronutrient and Micronutrient Malnutrition.......................................................................................16 Undernutrition Is Part of Malnutrition..............................................17 Vitamin D..................................................................................17 Omega-3 Fatty Acids................................................................18 What Are the Health Implications of These Nutrient Shortfalls?...18 Vitamin A..................................................................................18 vii viii Contents Vitamin D..................................................................................19 Riboflavin (Vitamin B2)............................................................19 Folate (Folic Acid)....................................................................19 Calcium......................................................................................20 Magnesium.................................................................................20 Iron.............................................................................................21 Iodine.........................................................................................21 Selenium....................................................................................21 Zinc............................................................................................22 Omega-3.....................................................................................22 Real Life............................................................................................23 Other Issues.......................................................................................23 Confusing Public Health Messages..................................................24 Solutions?...........................................................................................25 Education...........................................................................................25 Social Prescribing..............................................................................26 Clear Messages..................................................................................26 A Quick Fix?.....................................................................................26 References..........................................................................................27 Chapter 3 Digestion............................................................................................35 Digestion and Absorption..................................................................35 Fat Soluble Vitamins.................................................................37 Water Soluble Vitamins............................................................38 Minerals.....................................................................................38 Immunity............................................................................................40 The Microbiome................................................................................41 The Microbiome in the Mouth..................................................42 The Microbiome in the Gut......................................................42 Fibre...................................................................................................44 Short Chain Fatty Acids....................................................................45 Fermented Foods...............................................................................46 The Second Brain..............................................................................46 The Nervous Systems in the Gut..............................................48 Neurotransmitters.......................................................................49 Glutamate and GABA...............................................................49 The Centrality of the Gut to Health.................................................50 References..........................................................................................50 Chapter 4 Obesity...............................................................................................63 Obesity and Poverty..........................................................................64 Ultra-Processed Food........................................................................65 The Glycaemic Index........................................................................67 How Our Relationship with Food Impacts Obesity.........................68 Insulin and Carbohydrate..................................................................69 Contents ix Hunger and Appetite.........................................................................70 Satiety Value......................................................................................71 Fat Is Not the Enemy........................................................................71 Saturated Fat – Really Not So Bad..................................................72 Trans Fats and Omega-3...................................................................73 Obesity and the Microbiome.............................................................76 There Is No Single “Best Way” to Lose Weight.............................78 References..........................................................................................79 Chapter 5 Immunity............................................................................................91 Immunity Requires Both Micronutrients and Macronutrients.........92 Nutrients Fund Immunity..........................................................93 Omega-3 and Omega-6.....................................................................93 Vitamins.............................................................................................95 Vitamin A..................................................................................95 Vitamin D..................................................................................96 Vitamin E...................................................................................97 The B Vitamins.........................................................................97 Vitamin C..................................................................................98 Minerals.............................................................................................99 Iron.............................................................................................99 Zinc..........................................................................................100 Selenium..................................................................................101 Calcium....................................................................................102 Other factors....................................................................................103 β-Glucans.................................................................................103 Flavonoids and Polyphenols....................................................103 The Microbiome and GALT...................................................104 References........................................................................................105 Chapter 6 Vitamin D........................................................................................115 Vitamin D from Food......................................................................115 Vitamin D from Sunlight................................................................116 Safety...............................................................................................118 Situation in the UK.........................................................................118 Vitamin D Deficiency Rates in the UK..........................................119 Bones................................................................................................119 Mental Health..................................................................................121 Immunity..........................................................................................121 Autoimmune Disease.......................................................................122 Multiple Sclerosis....................................................................123 Diabetes....................................................................................123 Inflammatory GI Diseases.......................................................124 Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA)..........................................................................124 Some Cancers..................................................................................125