Moonshot _ 02

chronic diseases

General nutritional recommendations are increasingly being criticised. New scientific findings show more and more clearly that uniform concepts with regard to human nutrition are an aberration. Because the metabolism of every human being is as individual as his genome or microbiome. Nutritionists and leading organisations now agree that the crucial question should no longer be “How should I eat?” but “How should I eat?

“Let food be thy medicine and medicine be thy food.”
Hippocrates, 460 – 370 BC

USA: nutritionists sound the alarm

A press release on 25 November 2019 hit the nutritional science community like a bomb: five renowned American nutrition organisations[1] had joined forces to form the American Nutrition Association (ANA). This new professional association wants to intensively deal with the science and practice of personalised nutrition in order to finally make progress in the fight against chronic diseases. According to the ANA, the merger is necessary in order to speak with a strong voice. For too long, nutritionists have resigned themselves to the idea that the state-promoted uniform nutrition pyramid is the ideal basis for people’s health.

 

Poor nutrition as a cause of chronic diseases

The new nonprofit professional association notes that more than half of Americans suffer from chronic conditions. One of the main causes: poor nutrition. In contrast to the outdated food pyramid, the new concept of Personalized Nutrition focuses on the individual prerequisites and needs of each person. This enables the development of tailor-made nutrition strategies that not only prevent and treat diseases, but also improve the general state of health.

Michael Stroka, CEO of ANA, sees a “huge nutritional gap”: “In relation to its potential as a health factor, nutrition plays far too small a role in our culture as well as in our health system. This is partly due to the fact that a large proportion of medical staff do not have the necessary expertise. As a professional association, the ANA aims to counteract the dramatic increase in chronic diseases by providing medical professionals with scientific and practical knowledge about the concept of personalized nutrition.

 

Personal responsibility beats genetics

ANA CEO Dr. Jeffrey Blumberg added: “We now have extensive scientific evidence that underscores the fact that nutrition is a critical and influenceable factor in our health. While only a small proportion of the risk of chronic disease is genetic, the vast majority is due to everyday actions that we can influence ourselves. The use of personalized nutrition has the potential to achieve fundamentally positive effects”.

 

Science instead of ideology

Corinne Bush, ANA board member, commented: “As a coalition of forward-thinking nutritionists, health professionals and thought leaders, we recognize that we need a comprehensive solution that addresses all the causes of the “nutrition gap. For this reason, our associations have made the historic decision to unite to speak with one voice in the future. In doing so, we have created a strong platform – for training and certification, as a lobby and network, and to work together to promote the concept of Personalised Nutrition. What I personally find particularly exciting is that our approach is not based on any ideology, but is deeply rooted in science. Science shows us the right way.”

Largely unnoticed by the media in Europe, a revolution is on the way in America, which wants to put an end to outdated dogmas in nutrition. But also in Europe the supposedly eternal nutritional truths are slowly coming under pressure.

 

What is the right nutrition – for me?

What is the healthier breakfast: white bread with chocolate cream or muesli? Most people would probably spontaneously choose muesli. But it’s not that simple. “The body’s reaction to food is a very individual matter,” says Professor Christian Sina from the Institute of Nutritional Medicine at the University of Lübeck. He researches how the human organism reacts to certain foods and is convinced that “the future of nutrition lies in personalization”. The decisive question is no longer “What is the right diet for people”, but “What is the right diet for me?

 

EFSA’s role backwards

Professor John C. Mathers, published an article in the official EFSA Journal on 29 May 2019 with the significant title “Paving the way to better public health through personalised nutrition”. The article summarised a presentation Mathers had given at an EFSA conference: “As each individual is different from the others in many ways, it is a compelling notion that our individual nutritional needs are also different. The results of nutrition intervention studies show that there are significant inter-individual differences in the same diet. (…) Research in the field of personalised nutrition is expanding its scope to include both the effects mediated by the intestinal microbiome and the many aspects of genotype and phenotype. Such research has the potential to explain inter-individual differences in response to certain nutritional factors and may provide a scientific basis for refined approaches to Personalised Diet”[2].

 

Foods are not per se healthy of unhealthy

Even the major nutrition societies are moving more and more in the direction of personalised nutrition in their formulations: “Although almost all essential questions in nutrition research are unclear, the decisive scientific consensus has been in place since summer 2019 – and this is the “ecotrophological key question” par excellence: Are there healthy and unhealthy foods? No! The seven major nutritional scientific D-A-CH institutions unanimously hold the same opinion in this respect – and so the consensus of DGE (D), SGE (CH), ÖGE (A), DIfE (D), BZfE (D) as well as VDOE (D) and VEÖ (A) is clearly unanimous: This rigid categorisation is neither up-to-date nor scientifically tenable, in short: “We do not need a classification of healthy or unhealthy food“[3].  This statement sensational in its clarity and openness is a long overdue break with outdated dogmas of the nourishing science and a death blow for so make nourish-scientific study and their incorrect interpretation.

 

The problems of nutrition science

Despite decades of dietary fashions and state-funded food pyramids, we know surprisingly little about the science of nutrition. One reason is that it is difficult to conduct high-quality randomized studies. This is because the test persons must adhere strictly to a special diet, sometimes for years, before significant health effects can be seriously assessed.

But even if it is possible for people to follow a given diet for years or even decades, the scientific evaluation and interpretation of the data is anything but trivial. For example, one of the world’s largest nutrition studies came to the conclusion that a “Mediterranean diet” reduces the risk of heart attacks and strokes. After fierce criticism, the study had to be withdrawn and republished with muted conclusions.

 

The mistaken belief that all people are equal

Most nutrition studies are backward observations based on the shaky memories of the participants. Many such studies involving hundreds of thousands of subjects wanted to find out what effects the consumption of carbohydrates or fibre, salt or artificial sweeteners has. The results are spurious: A correlation between diet and health is possible and probable, but a concrete cause-and-effect relationship cannot be proven.

No surprise. Because it is a widespread misconception in nutritional science that we humans are all equal. So it is also a misconception that a low-salt diet would be fundamentally healthier. Figure 1 shows the effect of a low-salt diet on the blood pressure of 82 healthy men:

Although blood pressure falls in one third of men, it does not change in another third and even rises in the last third. Perhaps the simple rule of moderate salt consumption is not so simple after all. In individual cases, the nutritional science demand for a salt-restricted diet could even be harmful.

Fig. 1: Change in blood pressure of healthy adults who have been on a low-salt diet[4]
Comparable results can be seen in almost every intervention study: Some patients react very strongly to a drug (high responder), others do not react at all (non-responder) and some even react in the opposite direction (negative responder). We, however, want simple truths and for this we fall into black and white thinking. We fade out the colourful and complex reality. Günther Jonitz, President of the Berlin Medical Association, said at a congress in 2018: “In the 19th century clean water was the most important resource for health, in the 21st century it is clean knowledge.

 

The problem of average values

Average values have one major weakness: they say nothing about the individual case. For a non-swimmer, for example, wading through a river with an average water depth of one meter is life-threatening. Doesn’t that mean anything other than that the water is perhaps only half a metre deep at one point, but a little further it is 3.50 metres.

In terms of nutritional science, this means that for the perfect average person, general nutritional recommendations are certainly good. But who is? It is possible that different nutrition studies come to so many contradictory results because the test persons are not average, but individuals who are different from each other.

Fig. 2: Why nutritionists should not rely on average values.

 

The solution: Personalised food

It is therefore a naive error of thought to believe in a universally optimal diet for all people. This assumption is neither biologically nor physiologically plausible. It contradicts the remarkable heterogeneity of human metabolism, the microbiome and the environment – to name but a few of the dimensions that make each of us unique. Good nutrition must therefore be just as individual as each of us.

 

The demand on science is clear: since time immemorial, people have been preached what is bad and wrong in terms of nutrition. Now it is finally time to talk about what is right. This is explicitly not about inventing new functional special foods. Personalised nutrition has the sole aim of providing people with the right food at the right time.

 

Segal and Elinav: a pioneering study

The first major gain in knowledge in the field of personalised nutrition took place a few years ago: Professors Eran Segal and Eran Elinav from the Weizmann Institute of Science in Israel published a groundbreaking article in the journal “Cell” entitled “Personalized nutrition by predicting the glycemic response”. They examined the individual blood sugar peaks that occur after the consumption of food and are considered an indicator of diabetes risk and metabolic syndrome.

The Israeli study included 800 healthy people. The participants ate almost 47,000 meals of their usual food intake as well as more than 5,000 meals compiled by the researchers, including chocolate and ice cream. The time of eating, the amount and content of food and beverages, as well as physical activity, height, weight and sleeping times of the participants were documented.

In addition, blood and intestinal microbiom were analyzed and the blood sugar level was monitored for one week. A total of more than 1.5 million glucose measurements were performed. With the help of this huge data set, the researchers wanted to find out exactly what drives the glucose reaction of each individual person to certain foods. They used artificial intelligence (AI) to develop an algorithm for the individual blood sugar response from the collected data.

It turned out that over one hundred factors are involved in the glycemic response and that the participants reacted differently to the consumption of the same foods. Surprisingly, it was not the diet that had the greatest influence, but the intestinal microbiome. Nevertheless, the increase in blood sugar can be significantly reduced by choosing the right food. Which foods have this effect, however, is different for each person.

 

Requirements for personalised nutrition

Personalised nutrition has the potential to trigger a whole new public health debate. In order to fulfil this role, the novel concept has to reach people’s everyday lives. People must change their lifelong learned behavior and not only question their automated decision-making processes regarding their own nutrition, but also break them down and realign them. In order for the concept of personalized nutrition to become established in the long term, people must feel the most concrete benefits possible and find an emotional approach.

 

Trend towards self-optimization

A potential driver of this development is the current megatrend towards self-optimization. Young people in particular like to check themselves and their bodily functions frequently and with pleasure. Every second European between 18 and 39 years counts steps and calories, measures blood pressure or heart rate with apps, Smartwatch or fitness bracelets. In the past, illness was fate, but today for many it is the self-inflicted consequence of an unhealthy lifestyle. Overweight? High blood pressure? Diabetes? More and more people think it’s their own fault. The food sector and the digital world are colliding. Disruption takes place at the interface of food, health & wellness and technology.

Meanwhile, new scientific findings are also overtaking the current reformulation strategy of politics and the food industry – a national strategy for reducing sugar, fat and salt in finished products. It has long been time to think beyond quotas for sugar and sodium and move from blanket bans and restrictions to a positive diet. Generalisations like “eat more fruit and vegetables” will no longer be enough tomorrow. The next stage of self-optimization is about concrete and functional benefits for each individual.

 

Nutrition of the future

How personal must and can the nutrition of the future be? At present, the food industry is focusing on segmentation and on developing products for specific groups with similar needs, such as senior citizens and infants or protein-rich power foods.

 

For proponents of personalised nutrition, the answer lies in technological developments that meet the increased expectations of future consumers. There is no question that the age of personalised nutrition has begun and it will change the food industry dramatically in the coming decades.

[1] American College of Nutrition, Board for Certification of Nutrition Specialists, Center for Nutrition Advocacy, Accreditation Council for Nutrition Professional Education, American Nutrition Association Foundation

[2] https://efsa.onlinelibrary.wiley.com/doi/pdf/10.2903/j.efsa.2019.e170713

[3] https://www.yumda.de/news/1164261/es-gibt-weder-gesunde-noch-ungesunde-lebensmittel.html

[4] Miller JZ, et al., Heterogeneity of blood pressure response to dietary sodium restriction in normotensive adults., J Chronic Dis. 1987;40(3):245-50

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