Bits and Pieces
A representation of the Functional/Optimal reference ranges vs. conventional Lab ranges.
Standard lab “reference ranges” vary from lab to lab and can vary over time. They are generally based on Laboratory statistical averages indicating a 95% “confidence limit”, intending to represent the majority of a healthy population and when outside of that limit, identify/diagnose disease. Your doctor might prescribe pharmaceutical medications to treat “out of range” Laboratory reference Markers. (i.e. statins for high cholesterol)
“Functional or optimal” ranges use “tighter” markers and seek to identify early signs of dysfunction and imbalance which might precede disease. Optimal/Functional ranges could lead to dietary, lifestyle and natural supplements recommendations to restore function and balance to the body.
A blood chemistry report can provide valuable information. However, “normal” is often not “optimal”. This is why you might sometimes “feel ill” or out of sorts”, even though your results show “normal”.
Did you know:
That fibre is a complex carbohydrate? There are two types of fibre, Soluble and insoluble. Soluble fibre is dissolved in the stomach by fluids. It is then passed on and fermented by bacteria in the large intestine (the colon) producing short chain fatty acids. These SCFA metabolites, particularly butyrate, can interfere with the absorption of dietary fat and cholesterol, which in turn can help lower LDL levels in the blood. It also slows the rate of carbohydrate and other nutrient absorption, preventing rapid spikes in blood glucose after eating.
Insoluble fibre does not dissolve and passes through the GI tract fairly intact. It speeds the movement of food through the digestive system and provides bulk to stool.
what about resistant starch?
Resistant starch is a component of dietary fibre. Resistant starch is dietary starch that "resists" digestion in the small intestine. As with dietary fibre, resistant starch provides fuel for the “good” resident bacteria (gut microbiome), which is fermented to metabolites and help support a healthy digestive system. Protection is also established against gut and other diseases. (e.g., reduction of risk of type 2 diabetes by increasing the body’s sensitivity to insulin)
Miscellaneous writings:
The Double Burden of Malnutrition. (By Philip Odle)
In its Policy Brief the WHO/NMH/NHD/17.3, the World Health Organization describes the double burden of malnutrition as, “the coexistence of undernutrition along with overweight, obesity or diet related NCD`s, within individuals, households and populations, and across the life course. “In simple terms, this can also be explained as undernutrition, expressed as stunting, wasting and micronutrient deficiency; overnutrition, identified by diet related non-communicable diseases. Both instances, singularly can lead to malnutrition and when combined can lead to the double burden of malnutrition.
Four factors that contribute to the double burden are:
Societal: The socioeconomic wellbeing of a country. e.g., lesser developed countries which rely primarily on food imports, with little food production may have issues with the availability of food, leading to food insecurity. Dietary and lifestyle patters of lower income brackets, because of affordability and other issues can often lead to undernutrition; In the case of more affluent societies, a move to more processed and sweeter foods can lead to overnutrition.
Biological: Inheritability, epigenetic and early life experience. According to the Wageningen MOOC Nutrition and Health, micronutrients and undernutrition - An important biological feature still under study, is called fetal programming which describes, “the general idea that during development of the embryo and fetus important physiological parameters can be reset by environmental events—and of most importance—the resetting can endure into adulthood and even affect the following generation to produce a trans-generational non-genetic disorder.”
Environmental: Issues of food supply and cost as well as trade and trade policies, urbanization and the built environment. The worldwide growth of and access to processed foods has led to a reduction in the production of, and the systems for, whole and nutritious food development. With many populations now living in an urban environment, an increased importance is placed on infrastructural development. Access to clean water and sanitation are critical to the avoidance of disease.
Behavioural: Lifestyle, habit and psychological factors.
The double burden of malnutrition has brought about concerns about the fairly rapid escalation in non-communicable diseases, which in turn, have triggered concerns about declining productivity and rising cost of health care. For example, the World Health Organization in an article dated March 4th. 2022 stated: “More than 1 billion people worldwide are obese - 650 million adults, 340 million adolescents and 39 million children. This number is still increasing. The W.H.O estimates that by 2025, approximately 167 million people - adults and children – will become less healthy because they are overweight or obese.” They suggest that countries work to ensure access and affordability of a healthy diet. They also recommend the restricting of “marketing to children of food and drinks high in fats, sugar and salt, taxing sugary drinks, and providing access to affordable, healthy food. Cities and towns need to make space for safe walking, cycling and recreation and schools need to help households teach healthy habits from early on.”
Although it appears as though countries are generally sympathetic to the WHO proposals, many, for whatever reasons are hesitant in implementing some of the proposals, particularly the “Sugar Tax”. Those that have implemented the “Sugar Tax” have used the argument that being pro-active in the fight against continued non-communicable diseases is a more desirous approach that trying to fix an ongoing negative end result. The financial argument is that savings in health care expenditure, can then be redirected to productive areas of the economy. The “sugar Tax” is thought of as, the easiest to implement. In a paper published by The World Bank Group, (Taxes on Sugar- Sweetened Beverages, September 2020) 3.3 Summary of Evidence, it was stated that growing evidence “clearly demonstrated” that the tax reduced sales and purchases and consumption of taxed beverages. Amongst other things, the magnitude of effects varied depending on tax size and the range of products covered. It also stated that “There is very little evaluation evidence available on the awareness-raising (signalling) effect of SSB taxes, although this mechanism is thought to be important.” It also went on to point out the effect of product substitution on the overall effectiveness of the tax. I am not convinced, that over time, the “sugar tax” will be effective in reducing non communicable diseases, without first implementing a protracted educational campaign on the dangers of simple carbohydrate overuse. Given the confounding variable of product substitution, attempts to bring all sweetened beverages and foods under legislation may well be strongly objected to in the name of “freedom of choice”, which could result in the lack of political will for implementation by legislators. With a simple “sugar tax”, we might uncover correlation, but probably no causation.
Although genes play a role in the microbiome development of children from the same parents, it is not the only factor. Diet, environment and method of birth will play an important role in the microbiota of the individuals within a family. Dietary habits both in the short and long term will influence the individual’s microbiota, resulting in good health, over or under nutrition. Undernutrition is a particular type of malnutrition. It does not mean that the individual is not eating enough food but that their diet does not consist of enough essential nutritional content. This can lead to underweight which can also include, stunting and or wasting. The microbiome of these individuals is lower in the quantity of butyrate producing bacteria needed for releasing the energy from food, particularly oligosaccharide sources. Likewise, it has been shown that diet plays a major role in overweight and obesity. This diet is characterised by the consumption of processed and refined foods, high sugar, salt and fat and high protein mainly from animal sources. This type of diet is generally also low in both the soluble and non-soluble fibre needed to feed and support gut microbiome.
Since the microbiota can be manipulated through diet to alleviate an underweight condition, the same can apply to addressing an overweight condition. This also explains why an individual, through changes in diet, could go from being underweight to overweight. It also explains how the double burden of malnutrition could be visible in a single household. The microbiota of both over and underweight individuals, though different in microbial dominant types, will both be low in richness and diversity.
We know that in undernutrition there is not necessarily a lack of food, but a lack of essential nutrients in the diet. We also know that the gut microbiota can be manipulated by diet to bring about beneficial change to the individual. It stands to reason therefore, that for undernourished children in particular, dietary intervention, through food, micronutrients, pro and pre-biotic supplementation, would be a practical solution. In countries with both scares financial and real resources, an institution such as the World Health Organisation could be invited to propose and implement nutritional programmes and education. However, the W.H.O may well be in a position to provide research and evedence based, educational content worldwide, no matter the economic status of a country.
References: WHO/NMH/NHD/17.3, the World Health Organization. The World Bank Group, (Taxes on Sugar- Sweetened Beverages, September 2020). Wageningen University and Research: MOOC, Micronutrients and Under nutrition.