The Whole Is Greater Than the Sum of Its Parts

Nutritional science is fairly new, researchers have only begun to unlock the micronutrients[14] that are beneficial to our health.  As Professor David AdelsonDirector of the Zhendong Australia – China Centre for the Molecular Basis of Traditional Chinese Medicine,  said:[30]

"If we broke down and tested the components of many Traditional Chinese Medicines, we would find that individual compounds don’t have much activity on their own. It’s the combination of compounds which can be effective, and potentially means few side-effects as well."


Reductionist Approach


Reductionism is a philosophical position which holds that a complex system is nothing but the sum of its parts, and that an account of it can be reduced to accounts of individual constituents.  The history of Reductionist approach in nutrition begins with James Lind's studies of scurvy in the 1700s and the discovery of the first vitamin, thiamine, in 1913. Iodine was added to table salt in 1924, vitamin D to milk in 1933, and thiamine, riboflavin, niacin, and iron to flour in 1941. The NIH report stated that in America, 20–30% of the population used a multivitamin daily such that the supplement industry reported 2005 annual sales of $23 billion[21].


Since beginning, reductionists[1,17] have tried hard to analyze the components of the French diet, hoping to identify the X factor responsible for its healthfulness: Is it the red wine?  The olive oil? The foie gras (liver)? The only way to profit from the wisdom of a dietary pattern such as French diet is to break them down using reductionist science and then sell them for their nutrient parts.  If the secret ingredient could be identified, then processed foods could be reengineered to contain more of it, and we can go on eating much as before (i.e. eating the unhealthy Western diets). 


Yet when researchers extract a single food (or a single nutrient) from a diet (or a food) of proven value, it usually fails to adequately explain why the people living on that diet (or food) live longer or healthier.  The whole of a dietary pattern (or food) is evidently greater than the sum of its parts.  Jacobs et al[20] have concluded that: 

"Because the benefit of these dietary patterns does not appear to be definable by the action of simple nutrients, research and policy should focus on foods and nutrients."



Food Synergy[19]


Nutrition research has traditionally focused on single nutrients in relation to health. However, recent appreciation of the complex synergistic interactions among nutrients and other food constituents has led to a growing interest in total dietary patterns[9,13,19].

In 2003 the American Journal of Clinical Nutrition published an unusually nonreductionist study[4] demonstrating that no one of those nutrients alone (i.e., the fiber in the bran, the folic acid, and other B vitamins in the germ, or the antioxidants or the various minerals) can explain the benefits of whole-grain foods: The typical reductive analysis of isolated nutrients could not explain the improved health of the whole-grain eaters.


The authors concluded that the whole food might be more than the sum of its nutrient parts and the various grains and their parts act synergistically.  In the following, we show more evidences of the whole is greater than the sum of its parts:
  • When the entire carotene family[14] is used together as it is found naturally in foods it strengthens the immune system and reduces the risk of cancers, but when a single member of the family, beta-carotene, is used alone it can actually cause lung cancer to spread more rapidly.
  • In one study, increasing the intake of vitamin E from food sources was shown to reduce the risk of Alzheimer's disease. However, intake of vitamin E supplements was not significantly associated with reducing the risk of Alzheimer's disease.
  • In a meta-analysis of 19 randomized controlled trials involving more than 135,000 participants [22], high-dosage vitamin E supplementation (≥400 IU/d for ≥1 y) increased all-cause mortality.
  • Folate in B vitamins may promote cancer progression [23], although the mechanisms are unclear.
  • Micronutrients[14] in food help our bodies use antioxidants and get them to the places they're needed. Supplements don't.
  • People who take antioxidants as supplements don't reap the same benefits as those who eat foods rich in an antioxidant-rich diet.
  • Researches have shown that fruits and vegetable phytochemical extracts exhibit strong antioxidant and antiproliferative activities and that the major part of total antioxidant activity is from the combination of phytochemicals[2,3,14]
    • Acting cooperatively, those newly identified micronutrients work together to fuel and assortment of mechanisms that both prevent cell damage and also kill heavily damaged cells that cannot be adequately repaired, before they become dangerous to the body.
    • This explains why no single antioxidant can replace the combination of natural phytochemicals in fruits and vegetables to achieve the health
  • Taking a large doses of vitamin C or vitamin E is not very effective, especially if no deficiency existed prior to dosing[2].
    • Even compounds generally recognized as safe (GRAS) can have problems at high doses: for example, vitamin C intake at several grams can result in gastrointestinal effects, such as osmotic diarrhea[24]
    • Adding supplements in the nutrient-replete Western studies may not have been efficacious because they did not correct a deficiency[25].
      The whole is greater than the sum of its parts
  • Fat itself is not a villain
    • When there is fat present in the meal, the most powerful micronutrients found in vegetables are absorbed more readily into the body.
  • Several trials have found striking protective effects in more traditional, plant-based dietary patterns that no single nutrient can adequately explain[5].
  • In the D.A.S.H. (Dietary Approaches to Stop Hypertension) study, a diet rich in fruits and vegetables and low in saturated fat reduced blood pressure even when salt intake and weight remained unchanged[6].
  • The Lyon Diet Heart Study[7] found that the Mediterranean diet, when compared to a Western diet, offered protection against a second heart attack during the four years patients were followed.
  • Studies report that supplement use may have adverse health effects [10,16]. In contrast, carefully conducted intervention studies have demonstrated the efficiency and advantage of whole diet trials when searching for preventive strategies to chronic disease [8, 9, 11, 12].
  • Foods with high quantities of unsaturated fats, such as nuts, have high amounts of compounds with antioxidant properties, which protect against the instability of these fats[20]
  • One aspect of food synergy may be a buffer effect: the food matrix slows absorption of the nutrient, which lowers the likelihood of a bolus effect.
    • As intakes increase, it seems likely that the possibility of overwhelming normal metabolic processes also increases, resulting in unexpected and potentially adverse effects[26].


References

  1. In Defense of Food by Michael Pollan
  2. Super Immunity by Joel Fuhrman, MD
  3. Liu RH. Potential synergy of phytochemicals in cancer prevention: mechanism of action.  J Nutr 2004; 134(12 Suppl): 3479S-3485S.
  4. David R. Jacobs and Lyn M. Steffen, "Nutrients, Foods, and Dietary Patterns as Exposures in Research: A Framework for Food Synergy," American Journal of Clinical Nutrition, 2003; 78(suppl):5085-135. (good)
  5. Christopher Gardner et al.  "The Effect of a Plant-Based Diet on Plasma Lipids in Hypercholesterolemic Adults," Annals of Internal Medicine, 2005; 142: 725-33.
  6. Lawrence J. Appel, et al., "A clinical Trial of the Effects of Dietary Patterns on Blood Pressure," New England Journal of Medicine, Vol. 336, No. 16, April 17, 1997.
  7. Michel de Lorgeril et al., "Mediterranean Diet, Traditional Risk Factors, and the Rate of Cardiovascular Complications after Myocardial Infarction," Circulation, 1999:99; 779-85.
  8. Jacobs DR, Jr, Tapsell LC. Food, not nutrients, is the fundamental unit in nutrition. Nutr Rev. 2007;65:439–50. 
  9. Tucker K. Dietary patterns, approaches, and multicultural perspective. Appl Physiol Nutr Metab. 2010;35:211–8.
  10. Martínez M, Jacobs E, Baron J, Marshall J, Byers T. Dietary supplements and cancer prevention: balancing potential benefits against proven harms. J Natl Cancer Inst. 2012;104:732–9.
  11. Appel LJ. Lifestyle modification as a means to prevent and treat high blood pressure. J Am Soc Nephrol. 2003;14(7 Suppl 2):S99–102.
  12. de Lorgeril M, Salen P. The Mediterranean-style diet for the prevention of cardiovascular diseases. Public Health Nutr. 2006;9:118–23. 
  13. What do review papers conclude about food and dietary patterns?
  14. Classification of Dietary Phytochemicals
  15. Western Diets and Western Diseases
  16. Taking Supplements or Not?
  17. Michael Pollan - on the reductionist paradigm of nutritionism (Youtube)
  18. Health-promoting components of fruits and vegetables in the diet.  (PubMed)
  19. Food synergy: the key to a healthy diet. (PubMed)
  20. Food synergy: an operational concept for understanding nutrition (PMC)
  21. National Institutes of Health NIH State-of-the-Science Conference Statement on Multivitamin/Mineral Supplements and Chronic Disease Prevention. Ann Intern Med 2006;145:364–71. (PubMed)
  22. Miller ER, III, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med 2005;142:37–46. (PubMed)
  23. Kim YI. Folic acid fortification and supplementation—good for some but not so good for others. Nutr Rev 2007;65:504–11. (PubMed)
  24. Mulholland CA, Benford DJ. What is known about the safety of multivitamin-multimineral supplements for the generally healthy population? Theoretical basis for harm. Am J Clin Nutr 2007;85:318S–22S. (PubMed)
  25. Blot WJ, Li JY, Taylor PR, Guo W, Dawsey SM, Li B. The Linxian trials: mortality rates by vitamin-mineral intervention group. Am J Clin Nutr 1995;62:1424S–6S. (PubMed)
  26. What is known about the safety of multivitamin-multimineral supplements for the generally healthy population? Theoretical basis for harm (PubMed)
  27. Food, not nutrients, is the fundamental unit in nutrition
  28. How to think about food: Annemarie Colbin at TEDxManhattan 2013
  29. Association Between Dietary Whole Grain Intake and Risk of Mortality
    • An interesting finding of this study is that intakes of bran but not germ were significantly associated with reduced CVD mortality.
    • The observed significant associations for bran are in line with proposed mechanisms that attribute the benefits of whole grains primarily to nutrients and phytochemicals that exist in the bran portion.
      • Bran is a rich source of fiber, B-group vitamins, vitamin E, magnesium, and phytochemicals, which may potentially explain whole grains’ favorable effects.
  30. Study shows how Chinese medicine kills cancer cells

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