Nutritional Medicine and Vital Nutrients

Nutritional medicine focuses on the nutrients and essential substances the body requires for growth, energy production, and the maintenance of all vital functions. In nutritional medicine, these substances are generally classified into macronutrients and micronutrients.

Macronutrients – carbohydrates, proteins and fats – are the main components of food and a key part of nutritional medicine. Micronutrients include vitamins, minerals (macro- and trace elements), (proteinogenic) amino acids, (essential) fatty acids and vitaminoids such as coenzyme Q10. In complementary medical therapies, phytochemicals, as well as prebiotics and probiotics, also play an important role as representatives of the micronutrients.

Choosing the right foods can offer a wide range of health-promoting effects, which are crucial in the prevention of serious illnesses. Additionally, immune processes may be positively influenced.

A balanced, whole-food diet provides not only carbohydrates, proteins and fats but also all of the essential micronutrients such as vitamins, minerals, phytochemicals, and dietary fibre.

The modern Western diet is characterised by a high-calorie and vitamin-poor composition. It often involves large quantities of low-molecular-weight carbohydrates in the form of refined flours, refined sugars, and low-quality, processed animal products. An increased intake of fatty foods, especially those with an unfavourable fatty acid profile, has also been linked to negative health effects. These effects are further aggravated by high salt consumption and a general lack of whole foods such as wholegrains, fruit, nuts, and vegetables.

Regular consumption of acid-forming foods – including animal-based, protein-rich and sugary products – may lead to increased formation and accumulation of organic acids. This can result in an acid-base imbalance, which may contribute to the development of various health problems, such as osteoporosis or kidney disease.

Surveys in Germany indicate that the recommendations of the German Nutrition Society (DGE) for intake of vitamins and minerals are often not met through diet alone. This primarily concerns vitamin D, folate, calcium, iron, and vitamin E. In certain life stages or lifestyles, vitamin B12, iodine, magnesium, and potassium may also be considered critical nutrients. Micronutrient deficiencies can progress through various stages over years before becoming clinically apparent. A latent micronutrient deficiency may cause non-specific symptoms such as low energy, increased susceptibility to infections, concentration problems, fatigue, or mild depression. Therefore, clinical symptoms alone are often insufficient to identify specific micronutrient deficiencies.

Overconsumption of fatty and sugary foods, as well as (chronic) stress and UV radiation, are everyday contributors to oxidative stress in the body. Smoking and alcohol can further exacerbate this condition. The result may be oxidative imbalance, which is characterised by increased production of free radicals and subsequent cell damage.

An adequate intake of antioxidants is essential for neutralising these reactive radicals. This can be achieved through a whole-food diet, which is rich in vegetables, fruit, and high-quality plant oils. It is best to consume fruit and vegetables with their skin, as the highest concentrations of antioxidant phytochemicals are found in or just beneath the peel. For example, one would need to eat 15 peeled apples to absorb the same amount of the phytochemical quercetin as found in a single unpeeled apple.

In addition to reducing fat intake overall, attention should also be paid to the fatty acid composition, particularly the balance between omega-3 and omega-6 fatty acids.

The omega-6/omega-3 ratio is a useful indicator of the body’s inflammatory tendency. Ideally, this ratio should be below 5:1, but in many cases it is around 15:1 or higher. The higher the ratio, the greater the inflammatory potential.

A high intake of omega-3 fatty acids can be achieved by using cold-pressed, virgin plant oils – preferably organic – and by consuming wild game, pasture-raised meat, and fish. High levels of α-linolenic acid (an essential omega-3 fatty acid) are found in chia, flaxseed, camelina, hemp, walnut and rapeseed oils, as well as in flaxseeds and walnuts.

Fatty fish such as salmon, herring, eel, and tuna, or medium-fat fish like sardines, are rich in EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Algae also provide high levels of omega-3 fatty acids.

In contrast, omega-6 fatty acids are mainly found in conventionally farmed meat and processed meats, as well as in vegetable oils such as safflower, sunflower, pumpkin seed, and grapeseed oil.

Just like a high intake of fatty, animal-based foods, a diet rich in low-molecular-weight carbohydrates has adverse effects. These include rapidly absorbed carbohydrates such as sucrose, glucose, and fructose. Overconsumption of foods rich in these carbohydrates and with a high glycaemic index (e.g. refined sugars, refined flours, sweets, soft drinks) can cause elevated blood sugar levels. Chronically raised blood sugar levels can lead to insulin resistance and impaired insulin secretion.

Vitamins are organic, essential nutrients that the human body cannot synthesise at all or only in insufficient quantities. Their primary function is to regulate and catalyse specific metabolic processes.

For example, B vitamins such as thiamine (B1) and pyridoxine (B6) are neurotropic vitamins, which means that they are vital for the function of the nervous system, brain, and energy metabolism. Some vitamins are considered conditionally essential, as the body can synthesise them to a limited extent:

• Vitamin D, produced in the skin under UV-B light
• Vitamin K2, formed in the large intestine as a bacterial metabolite
• Niacin (B3), which is produced in the liver from the amino acid tryptophan

Vitamins are found in both plant-based and animal-based foods – with the exception of vitamin B12 and vitamin D, which are only present in trace amounts in plant-based sources. Hence, they must be obtained from animal products or supplements. Vitamins are classified based on their solubility:

Water-soluble vitamins

• B Vitamins: Vitamin B1 (thiamine), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid), B6 (pyridoxine), B9 (folic acid), B12 (cobalamins), B7/H (biotin)
• Vitamin C

Fat-soluble vitamins

• Vitamin A (retinol)
• Vitamin D (calciferols)
• Vitamin E (α-, β-, γ-, δ-tocopherols and tocotrienols)
• Vitamin K (phylloquinone, menaquinone)

The body requires a continuous supply of water-soluble vitamins, as they are only stored to a limited extent. In contrast, fat-soluble vitamins are mainly stored in the liver, which means a constant intake is not always necessary. This also implies a higher risk of toxicity with fat-soluble vitamins compared to their water-soluble counterparts.

Amino acids are the basic building blocks of proteins. Put in other words, they are constituents of structural and transport proteins (e.g. collagen), enzymes, antibodies, hormones (e.g. insulin), and neurotransmitters (e.g. noradrenaline). Amino acids are divided into essential and non-essential ones:

• Essential amino acids: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, valine, histidine
• Non-essential amino acids: alanine, arginine, asparagine, aspartic acid, cysteine, glutamine, glutamic acid, glycine, serine, tyrosine, taurine, proline