5 – Micro & Macro Nutrition: with Joel Fuhrman, MD

Nutrient density is the first fundamental principle of a nutritarian diet. When I say nutrient density, I’m talking about the ratio of micronutrients to calories in a certain food or in the diet as a whole. Macronutrients are called macro because they’re the nutrients the human body needs in large quantities. Water is, is one macronutrient. The other macronutrients are the nutrients that give us energy, the calorie containing nutrients: carbohydrate, fat, and protein. It’s well-established in the scientific literature that excess consumption of macronutrients, meaning calories, shortens human life span. To say that another way, most people eat more calories than they need, significantly shortening their potential life span. Eating less does extend primate life span, however, being too thin, such as in anorexia, is not healthy either. You need to eat enough to maintain a normal weight with appropriate skeletal and muscular strength, while at the same time maintain a favorably and relatively low body fat percentage. With proper weight bearing exercise to maintain appropriate musculature, one can maintain a healthy weight and still reduce calorie intake significantly. With moderate caloric reduction the body will slow its metabolic rate to maintain body muscle mass before becoming unhealthily thin. In other words, if our diet is well designed we can eat fewer calories, be muscular, and not get too thin. That’s the secret to life extension. When considering macronutrients, the goal is to eat less protein, less fat and less carbohydrate. That is, do not overeat. Do not eat food recreationally when not hungry. Generally speaking, strive to eat less as long as you don’t get too thin. Eating less as a means of extending human life span has solid scientific support, and we can eat somewhat less food and still have great musculature and strength if we combine a nutritarian diet with proper exercise. Of course, I’m explaining that if the nutritional quality of your diet is high you can be comfortably satisfied with fewer calories and maintain a perfect weight all through life, and not be hungry at all the same time. Eating less is not enough for excellent health and longevity. We also must consume optimal levels of micronutrients. Micronutrients are those nutrients needed in small quantities. Primary examples are vitamins and minerals, and phytochemicals, such as carotenoids and flavonoids are also considered micronutrients. Micronutrients have many different critical functions in the body. Many vitamins are coenzymes. They each drive hundreds of different chemical reactions that are essential to human health. Different vitamins take part in energy metabolism, immune function, bone health, vision, protecting cells from free radicals, and facilitating DNA synthesis. Similarly, minerals have a large number of different functions essential for human health, too. There are several different families of phytochemicals, such as carotenoids, which protect us against oxidative damage, and flavonoids, which benefit our health by affecting signaling pathways within our cells. With all these important functions, it’s no surprise that deficiencies and insufficiencies of micronutrients are known to be damaging to our health. Insufficient vitamin and mineral intake is common in Western populations. In the United States, more than half of the population takes in less than the recommended amount of vitamin C, and more than 75% of the population consumes less than the RDI, The Reference Daily Intake, for vitamins A and E. Average fiber and magnesium intake is way below the RDI. Over 90% of adults consume way more than the tolerable upper limit of sodium, while only about 2% meet the RDI for potassium. Most Americans also do not consume the recommended 400 micrograms per day of folate from food, though many exceed the tolerable upper limit for synthetic folic acid from fortified foods and supplements, which most likely increases the risk of cancer even further. In other words, synthetic folic acid is a cancer promoter. These broad spectrum micronutrient insufficiencies and imbalances exist ubiquitously largely because Amer-, the American diet is deficient in vegetables, fruits, beans, nuts, and seeds. These insufficiencies have far-reaching consequences and lead to chronic disease, premature aging, and an early death. Remember that vitamins and minerals don’t each have one job, they facilitate many different reactions throughout the body. For example, low magnesium intake, as seen in SAD eaters, is linked to increased risk for osteoporosis, type II diabetes, hypertension, stroke, cancer, and sudden cardiac death. However, there are hundreds of micronutrients that SAD eaters are low in, not just magnesium, and that’s not surprising when we take a look at the typical American diet. More than half of the calories in the American Diet come from processed foods, like bread, bagels, cookies, chips, breakfast cereals, and soft drinks. These foods have almost no antioxidants or phytochemicals. They don’t have significant amounts of vitamins and minerals either. Another 30% of calories in America comes from animal products, which also don’t contain a significant micronutrient load. Animal products are concentrated sources of macronutrients or calories, but they’re relatively low in micronutrients, and have no antioxidants or phytochemicals either. The amount of antioxidants and phytochemicals in someone’s diet is the major factor when determining their risk of developing cancer. Only about 10% of calories come from produce and a few percent from whole grains, plus most of these produce derived calories come from white potato and ketchup. The lack of natural plant foods, particularly fresh vegetables in the American diet contributes and causes our country’s high rate of heart disease, diabetes and cancer. Importantly, it’s not just vitamins and minerals most Americans are missing. We can’t just supplement the nutrient poor American diet to prevent diseases. We don’t really know all the thousands of other disease protective phytochemicals found in colorful plants, which even if we did, we couldn’t fit ’em all into the side of a pill to take. There’s a synergistic effect between vitamins, minerals, and phytochemicals. Natural plant foods provide us with a full spectrum of phytochemicals, some whose identities and functions haven’t even been found by scientists yet. For example, oranges don’t contain just vitamin C, and tomatoes don’t contain only lycopene. Many protective plant chemicals work together in these foods to maximize our health. This is the origin of my health equation: H equals N divided by C. The ratio of micronutrients to macronutrients is significant both for weight loss and long-term health and longevity. This equation is a visual reminder to eat a diet style striving for a high and wide micronutrient exposure without consuming excess calories. This is the true fountain of youth. When you get a sufficient quantity and variety of micronutrients without taking in too many calories, you age slower. You keep the bodies systems working in top condition and you push the envelope of human longevity. So, how do we apply this H equals N divided by C concept? The key is to choose foods with a high nutritional quality and minimize or omit foods that provide empty calories. To help you identify these high nutrient foods, I created a scoring system based on 36 important nutritional factors, such as fiber, folate, magnesium, alpha-carotene, plus antioxidant capacity derived from an equal caloric portion of each food. I call this system ANDI for Aggregate Nutrient Density Index. These calculations make it easy to see that green vegetables have the greatest nutrient density of all foods. Other colorful foods, such as tomatoes, mushrooms, eggplant, peppers, carrots are also rich in nutrients per calorie, and animal products, of course, are relatively low in nutrients and processed foods really low, but nutrient density isn’t the entire story, though. You see certain foods have salient features that grant them powerful anti-cancer benefits in spite of their less than stellar ANDI score. Foods such as mushrooms and flaxseeds may not, may not have the broad array of nutritional factors, give them, give them a high ANDI, but they’re super foods because their, of their unique and powerful anticancer nutrients that they contain, and we need micronutrient variety, too, in addition to micronutrient quantity. We need to include produce with different colors, high fiber carbohydrates, like beans, and seeds, and nuts, which have important benefits in spite of their higher caloric density. Combining these considerations, striving for generous amounts of micronutrients, as well as a variety of micronutrients should be the goal, while at the same time omitting empty calories and weight promoting foods, such as cheese, white flour, and oils. It’s also important to note that animal products are calorically dense, and not rich in micronutrients. They contain no fiber, no antioxidants, and no phytochemicals. A nutrient dense diet means it’s plant rich, and that it will naturally be high in fiber and lower in calories. Without doubt, this will result in a low percentage of body fat, which is essential for maximizing health and longevity. Data from Biosphere 2, an enclosed model ecosystem, provided human data on long term caloric restriction. In the early 1990s, eight crew members were sealed in the biosphere space for two years. The plan was that food would be grown inside the biosphere, but due to crop problems the food supply was smaller than expected. Consequently, for the 2 years the crew ate a low calorie nutrient dense diet, mainly of whole plant foods with small amounts of animal products. Their micronutrient needs were met and the crew maintained a high level of physical activity. They lost weight, about 18% in the men and 10% in the women, and saw a substantial reduction in blood pressure, body temperature, white blood cell count, insulin, blood sugar, and cholesterol. In biosphere 2 and other studies, the changes seen in caloric restricted humans have been similar to those seen in other species of animals. This suggests that caloric restriction will produce the life span benefit in humans as well, however, even with moderate caloric restriction the inclusion of too much animal products can weaken the potential benefits because of its effect on IGF-1. Reduced IGF-1 is thought to be heavily responsible for longevity promotion by caloric restriction. High IGF-1 levels are associated with increased cancer risk and reduced growth hormone signaling, or low IGF-1, is linked to longer life span. We want to keep IGF-1 relatively low to slow the aging process and inhibit cancer. Research has suggested that protein restriction even without restricting calories can mimic the effects of caloric restriction. Protein is the most important of the three macronutrients not to overdo because the amount and type of protein that we take in acts as a message to control cell growth through growth hormone and IGF-1. Animal protein because of its high biological value drives IGF-1 production the most, even restricting ones essential amino acids, in particular methionine, seems to mimic caloric restriction because methionine restriction in animals extends lifespan, improves insulin sensitivity, increases energy expenditure, reduces total visceral fat mass, and reduces inflammation and oxidative stress. Since methionine is one of the essential amino acids and there are much higher levels of methionine in animal protein, this is why a diet containing mostly plant proteins as opposed to animal protein is so longevity promoting. The optimal level of protein intake may be a bit higher as we age to prevent loss of muscle and bone mass, however on a nutritarian diet, we pay attention to consuming higher protein plant foods compared to other plant-based diets, emphasizing seeds and beans and vegetables over grains. Meeting our caloric needs with those higher protein plant foods will help us to consume a favorable amount of protein throughout life, even as we age. To sum up, my health equation, health equals nutrients over calories is a motivational symbol to guide and remind people to strive for a health and longevity promoting diet. We want to maximize high micronutrient foods, while considering nutritional variety without getting excess calories, especially animal protein calories. This means basing one’s diet on natural plant foods, emphasizing greens, beans, and other colorful vegetables, and avoiding processed foods, and refined sugars, and oil.

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