Nutrition-ing: A Whole New World

On December 31st, 1995, Bill Watterson published the final Calvin and Hobbes comic strip. A timeless end and beginning for 2023!

An important lesson I’ve learned repeatedly: never underestimate what other industries and disciplines can help you with. Today, the world is evolving so quickly that our overtaxed brains struggle to keep up, unfortunately reducing the modern everyone/everything to unfair tropes:

Bro 1: “Yeah, I do finance.”
Bro 2: “Cool, I totally get you I’m a lawyer myself.”
Bro 3: “Uh-huh I’m an engineer so I’m trackin’.”

Never mind that bro 1 works on quantitative trading algorithms at Citadel, bro 2 in the field of space law, and bro 3 was involved in the mad scramble to erect the Chernobyl sarcophagus. If only folks had the mental bandwidth to explore.

Case in point.

Medically inclined folks are familiar with the phrase “drinking from a firehose.” This is perennially used to describe the tidal wave of information (especially as students) that’s force-fed daily. The best way to observe this informational deluge is by watching a medical team round. Now, facial expressions vary and are not always clearly telling, but the core reaction of everyone’s soul is one and the same – like that of this dog. Momentarily paralyzed by the sudden materialization of a bajillion tennis balls (read: pearls of medical knowledge), he then enters into a frenzied fracas trying (and failing) to fit every single precious ball/pearl of knowledge into his mouth/memory. This inevitably leads to the tragi-comedy that is life:

So what’s NOT (really) in that firehose of information? Nutrition. Below, I’ve “reinterpreted” the graph to help illustrate how docs doing nutritional counseling can still use a ton of help on the subject of nutrition.

While not the original intent of this graph, it can help illustrate that while medical education helps us help others increase life expectancy (black line), little nutrition is taught, as represented by proxy using the overweight/obesity trends (gray line). I.e. pure counseling doesn’t work well. Yes, I know someone is going to yell at me for explaining it in this way. Credit: https://doi.org/10.3389/fpubh.2021.655491.

Below, I’ve assembled a few curious, recent nutrition-related innovations and studies that were notable to me, as a medical guy with very little experience in that sector.

Odds & Ends: The Nutrition Edition

Ad Libitum = eating all they wanted. Folks on the ultra-processed diet ate ~500 kcal more per day despite equivalent nutritional value with the unprocessed foods. Read on, below! DOI: https://doi.org/10.1016/j.cmet.2019.05.008

We know from the above study that people on an ultra processed foods diet are likely to eat more than those on an unprocessed diet – despite both meals being equivalent in calories and nutrients. This past year, a new study featuring an ethnically diverse Brazilian population related eating highly processed foods to global cognitive decline. It seemed if > 20% of your daily calories derived from highly processed foods, one showed ~28% faster rate of global cognitive decline over the 5-10 years the group was followed.

In other news, global meat consumption is projected to continue growing. Venture capital deals in carbon dioxide (capture) tech are soaring. Within that mishmash, an innovative company called Kiverdi (and its subsidiary Air Protein) is using hydrogenotrophs that naturally “eat” CO2 – and are themselves high in protein and carbohydrates – as a basis for their meats. This idea arose from NASA in the 1960s while trying to discover sustainable foods for astronauts on longer missions.

You may have heard the trending term personalized medicine. Essentially, this is profiling one’s DNA to understand how to better prevent and treat disease (although it’s a much more complex/fascinating field than that). With obesity being a perpetual New Year’s topic of interest, it’s clear that “gym, tan, laundry and diet, bro” isn’t working well, nor is it even close to personalized medicine. That’s what’s fascinating about Li & Perelman et al.’s study. I’m not giving the study it’s due, but from the 35,000 foot level, they found differences in how diet type, respiratory quotient, various proteomic determined obesity/metabolism related proteins, and microbiome based bacterial families (Bacteroidaceae, Lachnospiraceae) contributed to short- and long-term weight loss. This is shown graphically in the image below. The kicker was that long-term weight loss appeared to be more related to baseline protein and microbiome profiles as opposed to diet. The excitement inherent in precision nutrition then, goes hand in hand with this precision weight loss study.

The respiratory quotient (RQ) can help categorize approach to weight loss. The different types of diet (HLC, HLF) mostly affect short-term weight loss. Long-term weight loss was less related to diet, and more so to obesity associated protein biomarker and microbiome profiles present *prior* to study initiation. DOI:https://doi.org/10.1016/j.xcrm.2022.100870

And finally, coconut water. A staple of the first world bougie market that’s even been used in emergencies as a human blood plasma substitute. But that’s old news. A new hydration trend is prickly pear cactus water, more or less billing itself as sustainable hydration with antioxidants. With multiple startups competing (Pricklee Cactus Water went through Shark Tank, True Nopal is “The Original”, Caliwater has Vanessa Hudgens as a co-founder, etc) I’d love for a nutritionist to comment after taking a hard look.

That’s all for now, folks!

Odds & Ends: The Nutrition Edition

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