Nutraceuticals
The term nutraceuticals was derived from the words ‘nutrition’ and ‘pharmaceutical’ way back in 1989 by Dr. Stephen Defilice, founder of the Foundation for Innovation in Medicine (FIM) established in USA. Nutraceuticals thus, are foods or parts thereof that provide medical or health benefits, now extensively prescribed for disease prevention or cure, also referred to as dietary supplements, functional foods and so on. The former include vitamins, minerals, herbs and spices, protein supplements and other compounds, extracted from different parts of plants or other live forms, whereas the latter include fatty acids, fortified foods, fermented beverages including juices, probiotic and energy drinks.
It was the Greek physician Hippocrates who focussed on disease prevention when he said … Let food be your medicine. Indian and Chinese systems of medicine also emphasise disease prevention rather than cure. The ancient Ayurvedic and other streams of medicine being globally accepted today as alternate medicine, are recorded in ancient texts, referred to as Samhitas in India. Home remedies using various spices, foods, inedible parts of plants like leaves, barks, saps and so on, have been used for centuries.
Development of Nutraceuticals Nutraceuticals are prepared using both animal and plant foods including marine sources, the bioactive compounds from which are biologically introduced into diets to enhance their nutritional content. Common food sources are meat, eggs, dairy and so on since these are considered nature’s complete foods and manipulated by dietary means to supplement nutrients. The extractives from inedible portions too, are used to engineer products for both preventive and curative medicine such as n-3 fatty acids, fat-soluble vitamins like A,D, E, K, precursors like carotenoids and minerals like selenium, that are usually in short supply in diets. For example, beta carotene, a precursor of vitamin A is introduced to products like skim milk powder, butter and oils to improve eye health; bacteria like lactobacilli and bifidobacteria to promote growth rates. Milk based bio-compounds are used as fortificants in the preparation of cheeses, yoghurts, icecreams and more. Meat and egg based ones are added in low fat, high fibre products such as protein and omega-3 enriched patties, micronutrient enhanced foods and so on.
A 2007 report revealed that scientists from Buckingham University, were developing formula milk to give life long protection against obesity. The product would be supplemented with leptin, a hormone that controls hunger. This may also encourage mothers to switch from breast to formula feeding, in spite of the former being a foolproof natural diet for newborns. Using a hormone to program children’s brains just to alleviate fears of obesity is really scary, since it was thought that in early life leptin can program the brain to burn off more energy from food than it would do in adults. How may babies are on formula feeds today for various reasons is anyone’s guess.
In India, health is fast becoming a chronic problem and in 2020 it was predicted that almost 66% of all deaths were likely to be from chronic diseases. Nutraceuticals are generally prescribed to prevent or treat conditions of health such as hypertension, high cholesterol levels, body weight imbalances that lead to heart afflictions, diabetes and other chronic illnesses. Many of the pressing problems today are neurological such as dementia, memory loss leading gradually to Alzhiemer’s disease, considered a state of living death.
Any visit to the doctor irrespective of reason starts with a check of body weight and height, blood pressure, oxygen level, temperature before one can reach a doctor, who asks about the problem? In fact, the mindset of professionals has become that of looking at routine checks and asking patient’s their problems rather than diagnosing them for cures. The next step is to order tests for diagnosing the stated problem even before the smile that builds confidence, which could start the cure. The most common parameters checked through blood and other tests are for hypertension, blood pressure (BP), cholesterol, and more. What are these conditions?
Hypertension – This is a condition in which the blood pressure increases to levels above the normal range, which if uncontrolled can lead to a number of cardiac problems. Consistent or uncontrolled high BP has been called a silent killer because, it usually presents no particular symptoms and therefore goes unnoticed. It is common today, to find people succumbing to sudden collapse and death, 30% of whom are between 35-64 years of age with no idea they had fluctuating BP or hypertension.
Foods that have a BP lowering effect are beetroot, banana, strawberry, spinach, garlic, onion, celery and nuts like walnuts. Foods that are natural blood thinners or substances that reduce the blood’s ability to clot are turmeric, ginger, cayenne peppers, garlic, cassia, cinnamon, ginko biloba, grape seed extract and foods rich in vitamin E. When suffering from hypertension it is advisable to limit salt intake and red meat.
Cholesterol Regulation – This is required since consistently high levels of cholesterol can develop heart blockages and affect health of other organs too. What is little known is that 75% of cholesterol comes from our genes and only 25% from food. Statin drugs are not the only ones that lower blood cholesterol, nature too has provided products for controlling the levels to those desired for health. Today, there are a number of health food stores offering natural products to bring high blood cholesterol levels under control. However, allopathic doctors do not have faith enough in the ancient systems of medicine to include them in their prescriptions, even though the products provide less side-effects than pharma products, and have been experientially time-tested. They may have their reasons, unknown to patients, who act as their research subjects for modern world research. Foods for cholesterol control are generally those that inhibit its absorption from diets, such as those rich in fibre and low in fat. Some examples are nuts, edible seeds, fruits and vegetables including roots and tubers.
Diabetes control – Diabetes is fast becoming an invisible epidemic and needs to be controlled on a war footing. It is estimated that by 2025, around 300 million people will be affected worldwide by diabetes of which 72m would be in western societies and 228m in developing countries of which India has the largest number. Compared to the West, people from India, China and Brazil develop diabetes at a lower age and at lower levels of obesity. Small changes in age structure, bodyweight and physical activity lead to more dramatic increases in risk of diabetes.
Apart from reducing the consumption of high sugar diets and affordable availability of insulin, one needs to spread awareness of the psycho-social issues of diabetes. A program focussing on Diabetes Attitudes, Wishes and Needs (DAWN), is based on the largest ever study conducted on these issues. It demonstrated that both patients and health care professionals need to feel more comfortable about the initiation of insulin to provide optimum care, enabling patients to manage their condition effectively at home. (Lars Rebein Sorenson, at the Global Diabetes Leadership Forum, New York. 2007).
A study published in the BMJ Open Diabetes Research and Care suggests that marriage is linked to low blood sugar. Data studied from 2004-2013 revealed that more than 3000 non-diabetics were asked over a decade about their relationship transitions. An average of 0.2% decrease in blood sugar levels over 3 months was observed when they moved into marriage or relationships. (Agencies in D.Times. 10 Feb. 2023).
Bodyweight – Diet, exercise and sleep patterns play important roles in bodyweight management. Diet - Throughout the day one is active and can digest and utilise the energy and other nutrients from meals, for body processes effectively hence, the practice of having a good breakfast. Dinner should always be light, because a heavy one contributes to weight gain. It needs therefore to be low in fats, sugars and carbohydrates especially in refined forms, with the last meal of the day being over at least 2 hours before sleeping. At the end of the day, it is time for the body to slow down for rest and repair. Exercise - It is important to exercise all parts of the body to keep muscles toned and organs serviced, and therefore a routine needs to be set that the body can comfortably endure. Rigorous exercise when the body is not used to it ends up in injuries, so light mobility exercises are recommended. Besides physical exercise, research from Duke University Medical Centre, has established that diet and exercise might reverse ageing too, and improve performance on cognitive tests. Today, sharpening the intellect is of prime concern among professionals, and brain workouts have become extremely popular. So along with the body jogging the brain too helps to prevent memory loss and increase focus. Any activity releases endorphins and thereby lifts the mood too. Sleep - When asleep the basal metabolic rate (BMR) drops hampering the digestion and absorption activity so that it becomes inefficient and most of the food remains partly undigested causing gut problems. If a heavy dinner needs to be digested and absorbed it disturbs the rhythm of the body, diverting it into active mode and is therefore discomforting. This leads to disturbed sleep that reflects on how fresh we wake up from it, and the resulting productivity during the day. On the other hand, too much sleep can also lead to adverse health effects. Research shows that people who sleep 9-11 hours a day are 21% more likely to become diabetic, 38% more likely to suffer from coronary heart disease with increased risk of death. According to natural health experts 7-9 hours of sleep is sufficient. (Daily Mirror).
In an effort to contain bodyweight at normal levels or go with slimming trends, excessive use of gym supplements can be risky, as there is a strong possibility that significant muscle breakdown may result in depletion of calcium. A recent case from PSRI Hospital in South Delhi, stated that a 22 year old with a history of taking excessive gym supplements and protein powder, was admitted through emergency in critical comatose condition. He was in ICU for one week before being thankfully discharged. Dr. Kadam Nagpal, senior consultant Neurology stated:
…the patient was found to be suffering from multiple severe metabolic derangement, with very high level of muscle enzymes, creatine phosphokinase, suggesting breakdown of muscle tissue. Investigations revealed extremely low calcium levels responsible for the deteriorating state. The patient was diagnosed as having toxic encephalopathy (brain dysfunction) and rhabdomyolysis, a serious condition that can be fatal or lead to permanent disability.
Citing this case, doctors cautioned against excessive use of fitness supplements as they can cause serious neurological damage besides proving fatal. (TOI. Feb. 19, 2023).
Chronic stress – The adrenal glands located on top of the kidneys release cortisol, epinephrine and other hormones into the blood stream producing physical effects like nervousness, anxiety, insomnia and panic attacks. Surveys reveal that 80% Americans say they are afflicted. The bark of the Arjuna tree (Terminalia arjuna) is known to release anxiety and stress. This thick red bark is used to treat angina, and other CVDs as well as high cholesterol and BP, according to the world’s oldest healing system. The tree is therefore considered auspicious in India, and seen in front of homes, lining roads, at holy places for easy access.
Neurological problems - There is a strong connection between heart and brain so neurological problems manifest in the presence of any of the above conditions described. The most important nerve in the body is the vagus nerve that begins in the brain and extends downwards to serve the lungs and all the organs in the abdomen. It thus, regulates the functions of digestion, heart and respiratory rates. When organs or their processes are affected symptoms may show as nervousness, tremors, loss of memory which if unattended may lead to more serious problems. Sometimes these may be diagnosed as nutrient deficiencies in which case supplements or neutraceuticals may be prescribed, in others they may require specialised medical intervention.
In Ayurvedic medicine Bacopa monnieri has been used as a staple to preserve memory, for thousands of years. Recent studies have supported its ability to treat thyroid conditions and anxiety while combating the progression of Alzhiemer’s disease, sometimes referred to as Type 3 diabetes, the two conditions being related. This occurs when neurons in the brain are unable to respond to insulin, which is essential for memory and learning. It is estimated that 80% of alzheimer’s patients also have heart disease.
Detoxifying the body – The blood brain barrier (BBB) is made up of a network of tissues and closely spaced cells that allow only water, carbon dioxide, oxygen and necessary nutrients to pass through for functioning of the healthy brain. Thus, it protects the brain from toxins in the blood stream by blocking bacteria, fungi, viruses and parasites from entering it.
Acidity - Acid is naturally produced through the stomach wall in anticipation of protein digestion when food is ingested. If the diet lacks protein this acid is not fully utilised and a burning sensation results called acidity, which causes distress in the gut. Taking acid blocking medicines has been shown to completely stop the production of nitric oxide in the body, that is essential for the flexibility of the arteries, without which these can suffer significant damage.
The traditional dahi or yoghurt is a boon to counteract acidity and gut discomfort. In the north it is taken in many forms both sweet and salt, in the south it forms an ‘end of the meal’ dish for keeping the microbiome in health. Today, it has become fashionable to add fruits, and flavours to it in modern households. Yoghurt is the predigested form of milk, a complete food except for iron which it does not contain in its natural form. One cup contains 370mg calcium equal to 30-40% of adult daily needs besides being rich in protein, B vitamins especially folic acid, and minerals like phosphorus, and potassium, almost as much as in a banana. A 2021 Japanese study suggests people who live past 100 share a distinct “signature” gut bacteria shown to prevent infections. So all one needs to do is to maintain a healthy gut, for which functionally designed foods in the form of neutraceuticals would not be necessary, except under severe disease conditions, which require a prop like a walking stick.
India’ s per capita expenditure on health was estimated as the equivalent of 6.1% of its GDP according to a study conducted by Assocham and Price water-house Coopers (PwC). As globalisation and urbanisation converge, there will be an increased need to set up more cardiac and other health and wellness centres to cope. The study recommends that wellness programmes be conducted in leading work places to spread awareness of healthcare, so that chronic diseases do not affect overall productivity and economy of the country. It would be wiser therefore, to focus on wellness centres spreading awareness of preventive rather than only curative health.