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Nutrition in Respiratory
Health & Disease
PCCHA 2014
Reaching New Heights in College Health
October 14, 2014
C. Alan Titchenal, PhD, CNS
Joannie Dobbs, PhD, CNS
Human Nutrition, Food & Animal Sciences
University of Hawaii at Manoa
Transition from Water to Air
Required Substantial Adaptation
Lungs: A delicate, and yet,
robust interface with our
dry external environment
Tiktaalik, Wikipedia
What was needed for this transition?
Moist tissue + Oxidative stress
= Lungs
Essential Nutrients
Provide energy
Form body structures
Regulate body processes
Essential for life
The Nutrients
Macronutrients
Protein
Carbohydrate
Fat
Water
Trace Minerals
Chromium, Cobalt, Copper,
Fluoride, Iron, Iodine,
Manganese, Molybdenum
Selenium, Zinc
Vitamins
Water Soluble
B1, B2, Niacin, B6, Folate, B12
Biotin, Pantothenate, C, Choline
Fat Soluble
A, D, E, K
Other Trace Minerals
Appear to be essential:
Arsenic, Boron, Nickel,
Silicon
Minerals (Ash)
Major Minerals
Calcium, Chloride
Magnesium, Phosphorus
Potassium, Sodium, Sulfur
Possibly essential:
Cadmium, Lead, Lithium,
Aluminium, Bromine,
Rubidium, Vanadium
Other Food Substances
Caffeine
Cholesterol
Dietary Fiber
Other Phytochemicals
Nutrients with Special
Importance for Lung Function
Macronutrients
Protein
Carbohydrate
Fat (omega-3 & 6 fatty acids)
Water
Trace Minerals
Chromium, Cobalt, Copper,
Fluoride, Iron, Iodine,
Manganese, Molybdenum
Selenium, Zinc
Vitamins
Water Soluble
B1, B2, Niacin, B6, Folate, B12
Biotin, Pantothenate, C, Choline
Fat Soluble
A, D, E, K
Other Trace Minerals
Appear to be essential:
Arsenic, Boron, Nickel,
Silicon
Minerals (Ash)
Major Minerals
Calcium, Chloride
Magnesium, Phosphorus
Potassium, Sodium, Sulfur
Possibly essential:
Cadmium, Lead, Lithium,
Aluminium, Bromine,
Rubidium, Vanadium
Other Food Substances
Caffeine
Cholesterol
Dietary Fiber
Other Phytochemicals
Nutrients Critical for Lung Integrity
Water – circulation & normal cell hydration
Protein – structure, immune function, hydration, etc
Essential Fatty Acids – anti-inflammatory, etc.
Vitamins – Many, many, many functions
Minerals – Many, many, many functions
Phytochemicals – ???
Many Nutrients Have Been
Potentially Implicated in Increased
Susceptibility to Respiratory Diseases
Nutrient Functions
Related to Lung Health
•
•
•
•
•
Structure – Homeostasis cell turnover
Tissue Lubrication
Media for Gas / Nutrient Exchange (Blood)
Anti-inflammatory
Antioxidant
Overly Simplistic View of Nutrient
Deficiency Symptoms
Malnutrition is Gradual
The Nutrient Journey
From Food to Cells
Food / Meal Form of Nutrient
↓
Digestion
↓
The Nutrient Journey
From Food to Cells
Food / Meal Form of Nutrient
↓
Digestion
↓
Absorption
The Nutrient Journey
From Food to Cells
Food / Meal Form of Nutrient
↓
Digestion
↓
Absorption
↓
Transport
↓
Cellular Uptake
The Nutrient Journey
From Food to Cells
Food / Meal Form of Nutrient
↓
Digestion
↓
Absorption
↓
Transport
↓
Cellular Uptake
↓
Nutrient Function in Cell
↓
Storage → → → Mobilization↺
The Nutrient Journey
From Food to Cells
Food / Meal Form of Nutrient
↓
Digestion
↓ → Unabsorbed (fecal loss)
Absorption
↓
Transport
↓
Cellular Uptake
↓
Nutrient Function in Cell
↓
Storage → → → Mobilization↺
The Nutrient Journey
From Food to Cells
Food / Meal Form of Nutrient
↓
Digestion
↓ → Unabsorbed (fecal loss)
Absorption
↓
Transport
↓
Cellular Uptake
↓
Nutrient Function in Cell
↓
Storage → → Mobilization↺
↓
→ Loss from Body (urine, feces, skin, etc.)
Nutrient Bioavailability
The amount of an ingested nutrient
that can be digested, absorbed, and
assimilated.
Amount consumed does NOT =
amount absorbed into the body
Spinach does not equal Beef in terms of Iron
Bioavailability
Bioavailability from Supplements is Complex
The Nutrient Journey
From Food to Cells
Food / Meal Form of Nutrient
↓
Digestion
↓ → Unabsorbed (fecal loss)
Absorption
↓
Transport
↓
Cellular Uptake
↓
Nutrient Function in Cell
↓
Storage → → Mobilization↺
↓
→ Loss from Body (urine, feces, skin, etc.)
Nutritional Status Reality
Simplistic
Realistic
Eating Styles of Potential Concern
for Lung Health
•
•
•
•
•
•
Weight Loss
Eating Sustainably and/or Vegetarian
Convenience (Fast or Take-out)
Affordable Eater
Paleo
Meal Replacements
Eating Styles of Potential Concern
for Lung Health
• “Healthy”
AHA
ACS
ADA presently AND
Autism
Dietary Guidelines- My Plate
Gluten Free
Organic/Environmental
Vegetarian
Eating Styles of Potential Concern
for Lung Health
Weight Loss
•
•
•
•
Decreased Calories
Decreased Variety
Non-Fat Foods
Decreased Animal
Protein (except fish)
• Excess Fruit
• Meal Replacements
Potential Issues
• Decreased energy intake and
decreased food variety can
decrease essential nutrient intake
• Skipping Breakfast  decreased
protein and  decreased body
hydration
• Increased caffeine intake 
decreased body hydration?
• High intake of protein powders 
redirects hydration to digestion and
may decrease good iron sources
Questions to Identify Weight Loss
•
•
•
•
•
Do you skip Breakfast?
Do you use meal replacements?
Have you eliminated foods from your diet?
Do you count calories? What # do you aim to achieve?
Are you consuming increased coffee or tea or energy
drinks?
• Do you eat red meat or chicken thigh?
• Do you take a dietary supplement? What type?
Eating Styles of Potential Concern
for Lung Health
Eating Sustainably
and/or Vegetarian
• Reduced or No
Red Meat
• Organic
• No GMO
• No Pesticides
• “Clean”
Potential Issues
• SHIFT IN NUTRIENT INTAKE
• Decreased nutrients for blood
production (Iron, B12, protein etc.)
• Increased mineral inhibitors –
polyphenols and fiber
• Excess water consumption w/ low
sodium  hyponatremia tendency
Questions to Identify
Sustainable and Vegetarian Eating
• What are your sources of protein, iron, B12?
• Do you count calories? What # do you aim to
achieve?
• Do you salt your food?
• How much fluid do you drink?
• Do you take a dietary supplement? What
type?
Take Home Messages About Eating Styles
• Too much of a “good thing” isn’t always good.
– Too many foods considered “healthy” can
cause imbalances in essential nutrients.
• Too much of a “good thing” can be harmful to
critical functions needed for lung health.
• It takes months or years for most nutrient
deficiencies to become clearly symptomatic.
Iron Deficiency is the most common
micronutrient deficiency
in the world and the U.S.
Based on Our Analysis of
National Health and Nutrition
Examination Survey (NHANES) data,
iron deficiency is greatly under-diagnosed.
Effect of Vegetarian Diet on Iron RDAs
(For Adult Females and Males19 to 50 yrs of age)
Iron RDA (mg/day)
Omnivore
Females
Pregnant
Lactating
Males
18
27
9
8
Vegetarian*
33
49
16
14_____
* 1.8 times greater
Source:
Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, . . . .
Food & Nutrition Board, Institute of Medicine, National Academy of Sciences, National Academy Press,
2001.
Effects of Heavy Endurance Exercise
on Iron Needs
Potential Daily Iron Loss
(mg/day)
Sedentary
Athlete
Difference
↑ Dietary Need*
Male
1
1.8
0.8
8
*Assumes 10% absorption efficiency
Female
1.5
2.5
1.0
10
Based on Our Analysis of
National Health and Nutrition
Examination Survey (NHANES) data:
Iron deficiency is greatly under-diagnosed
Brian Hill, MS Thesis, 2014
So what?
 H&H is worse than
flipping a coin
 H&H, MCV, and RDW
depends on age
group – misses at
least 1/3
http://www.doconomics.com/blog/wp-content/uploads/2012/03/coin-flip3-191x300.jpg
3-20-14
One Nutrient Deficiency
Can Affect Other Seemingly
Unrelated Health Problems
High Incidence of Vitamin D Deficiency
May Be Due to Low Iron Status
Vitamin D status is assessed by 25-OH Vitamin D
The liver hydroxylase is iron-dependent.
Iron deficiency is common and poorly diagnosed.
Normalizing vitamin D status may require
normal iron status.
Thyroid Function Is Affected by Iron Status
Thyroid Hormone Synthesis
Involves an Iron-Dependent Enzyme.
Iron Deficiency Impairs Iodine Utilization for
Thyroid Hormone Synthesis.
People with Thyroid Problems Should Be
Thoroughly Evaluated for Iron Status.
Carotenoid Craze Reflects Iron Deficiency
Catabolism of
carotenoids is
iron-dependent
Orange palms
may indicate
poor iron status
Fingernails – Window to Nutritional Health Status
Zinc Deficiency
Inadequate
Protein / Hydration
Iron Deficiency
Ferritin Levels of Clinical Significance
Serum Ferritin
(ng/mL)
Cognitive achievement in school aged children and adolescents
(Halterman et al., 2001)
<12
Behavior performance in non-anemic infants (Oski et al, 1983)
<12
Cognitive effects non-anemic girls (Bruner et al., 1996)
≤12
Thyroid function adolescent girls (Eftekhari et al., 2007)
<12
Body temperature maintenance (Martinez-Torres et al., 1984)
≤15
Depression (Vahdat Shariatpanaahi, 2007)
<15
Aerobic adaptation in non-anemic women (Brownlie et al., 2002)
<16
Fatigue resistance in exercise non-anemic (Brutsaert et al., 2003)
<20
ADHD in non-anemic children (Konofal et al, 2004)
<30
Restless legs syndrome (Sun et al., 1998)
≤50
Unexplained fatigue in non-anemic women (Verdon et al., 2003)
≤50
Alopecia (Rushton, 1993, Rushton et al., 2002)
≤70
What About Supplements?
Very Popular
Better Choice
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scientific references.
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This work is supported in part by
USDA Smith Lever Funding for
Project 289H
HNFAS
Human Nutrition, Food & Animal Sciences
Questions/Comments?
HNFAS
Human Nutrition, Food & Animal Sciences