A dietary supplement, also known as food supplement or nutritional ... vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not.
Satellite Symposium - Avignon - 24 May 2013 Anthony Fardet Unité de Nutrition Humaine (INRA Clermont-Ferrand/Theix)
Complex foods vs. Supplements Influence of the food matrix on the nutritional effects of vitamins, minerals, trace elements and other biofactors in humans
What is a complex food? The different types of matrix
Raw materials
No technological processes
Natural food products (fruits, milk, crude vegetables,…)
Fruits Vegetables Cereal grains Meat Fish Milk …
Refining, fractionation, cooking, extrusion…
Cooked products (cooked meats, pasta, bread, cooked fruits,…)
Ingredients (starch, protein isolates, soluble fibres, isolated micronutrients,…) Formulation, re-assembling and processes
Natural food matrix
fibrous (muscles) fleshy (fruits) encapsulated embryos (cereal grains) complex fluid: milk
Processed food matrix
Colloidal dispersions Emulsions Amorphous or crystalline phases Gel networks
What is a dietary supplement?
A dietary supplement, also known as food supplement or nutritional supplement, is a preparation intended to supplement the diet and provide nutrients, such as vitamins, minerals, fiber, fatty acids, or amino acids, that may be missing or may not be consumed in sufficient quantities in a person's diet. In the United States, a dietary supplement is defined under the Dietary Supplement Health and Education Act of 1994 (DSHEA) as a product that is intended to supplement the diet and contains any of the following dietary ingredients: - a vitamin - a mineral - an herb or other botanical (excluding tobacco) - an amino acid - a concentrate, metabolite, constituent, extract, or combination of any of the above - a substance historically used by humans to supplement the diet It must also conform to the following criteria: - intended for ingestion in pill, capsule, tablet, powder or liquid form - not represented for use as a conventional food or as the sole item of a meal or diet - labeled as a "dietary supplement"
Why and when do nutritional supplements arrive on the market? The nutrition transition
● In Western countries: too much energy and not enough non-nutrient compounds - The role of the Nutritional Transition: from high-nutritional dense foods to highenergy dense foods - The occurrence of unbalanced diets (refined products, junk foods) lead to search for a compensation via supplements - The reductionist approach in nutrition research
● In developing countries: under/mal-nutrition and/or some local deficiencies (e.g. vitamin A….)
Globally, supplementation aims at curing deficiencies, but it does not cure the “original cause”, i.e. an unbalanced diet
Reductionist and pharmacological approach
Past
Diets, food groups, foods & nutrients
One nutrient vs. One physiological effect/biomarker
Functional foods Contradictory results
Objectives: global recommandations (include bioavailability?) Human populations
One food matrix vs. Integrative physiologal response/biomarkers profile
Future? Holistic and integrative approach
Translational results
Healthy diet/foods
Complex foods vs Dietary supplements
Structured matrix vs isolated compound(s) Different bioavailabilities and kinetics of nutrient release: Bioavailability: percentage available for exerting a defined physiological action in cells Kinetic of release: at equal amount, the way the nutrient is released impact physiology (e.g. slow vs rapid carbohydrates) Complex foods supply synergy, interactions and a complex environment:
hundreds of bioactive compounds that may interact and act in synergy at nutritional doses interaction with digestive tract (transit time, mucus secretion, satiety…) Dietary supplements supply a few (sometimes only one) bioactive compounds, generally at a supra-nutritional dose
An important issue Today, one does not really know how to answer the following issue:
« Are differences in micronutrients and biofactors
bioavailability/kinetics of release reflected in differential health effects? »
Complex foods
Both rapid and progressive release at nutritional doses
Supplements
Only rapid release at supranutritional doses
Body of the presentation
❶ Human studies investigating the preventing effects of supplements ❷ Studies showing the role of synergism in nutrition as regards with vitamins, minerals, trace elements and other biofactors ❸ The role of food structure ❹ The role of technological processes to modify food structure, compound interactions and to degrade antinutritional factors ❺ Practical and nutritional implications
❶ Supplements & Human studies State of the art ● Plant-based ingredients vs inflammation: « Not convincing and needs further studies » Lorenzo Cd, Dell'agli M, Badea M, et al. Plant food supplements with anti-inflammatory properties: a systematic review (II). Crit Rev Food Sci Nutr 2013;53:507-16. (6 botanical species) Dell’agli M, Di Lorenzo C, Badea M, et al. Plant Food Supplements with Anti-Inflammatory Properties: A Systematic Review (I). Crit Rev Food Sci Nutr 2012;53:403-13. (4 botanical species)
● Dietary supplements vs hypertension: « In this review of the many dietary supplements promoted for the management of hypertension, 4 products with evidence of possible benefits (coenzyme Q10, fish oil, garlic, vitamin C) and 4 that were consistently associated with increasing blood pressure were found (ephedra, Siberian ginseng, bitter orange, licorice) » Rasmussen CB, Glisson JK, Minor DS. Dietary Supplements and Hypertension: Potential Benefits and Precautions. The Journal of Clinical Hypertension 2012;14:467-71.
❶ Supplements & Human studies State of the art ● Carotenoids and Vitamins
C and E vs oxidative stress:
Riccioni G, D'Orazio N, Salvatore C, Franceschelli S, Pesce M, Speranza L. Carotenoids and Vitamins C and E in the Prevention of Cardiovascular Disease. International Journal for Vitamin and Nutrition Research 2012;82:15-26. « several large, randomized controlled trials have failed to confirm the benefits of vitamin C and E in cardiovascular prevention »
Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C. Antioxidant supplements for prevention of mortality in healthy participants and patients with various diseases. Cochrane Database of Systematic Reviews 2012 « We found no evidence to support antioxidant supplements for primary
or secondary prevention. Beta-carotene and vitamin E seem to increase mortality, and so may higher doses of vitamin A. Antioxidant supplements need to be considered as medicinal products and should undergo sufficient evaluation before marketing. »
A question of synergy…
❶ Supplements & Human studies The example of antioxidants
Risk Cardiovasc. diseases
Flavonoids
Cancers
Carotenoids Zn, Se Flavonoids
Diabetes
Vitamin E
Vitamin C
No effect
Supplements vitamin E
Risk Supplements -carotene
Convincing Possible Insufficient WHO Technical Report Series 916 (2003)
❷ An emphasis on synergism ● Rayalam S, Della-Fera MA, Baile CA. Synergism between resveratrol and other phytochemicals: Implications for obesity and osteoporosis. Mol Nutr Food Res 2011;55:1177-85.
1 +1 > 2
● Wang S, Meckling KA, Marcone MF, Kakuda Y, Tsao R. Synergistic, Additive, and Antagonistic Effects of Food Mixtures on Total Antioxidant Capacities. J Agric Food Chem 2011;59:960–8.
❷ An emphasis on synergism Thompson HJ, Heimendinger J, Diker A, et al. Dietary botanical diversity affects the reduction of oxidative biomarkers in women due to high vegetable and fruit intake. J Nutr 2006;136:2207-12.
LBD: Low Botanical Diversity (n = 5) HBD: High Botanical Diversity (n = 18)
“botanical diversity plays a role in determining the bioactivity of high-vegetable & fruit diets and that smaller amounts of many phytochemicals may have greater beneficial effects than larger amounts of fewer phytochemicals”
❷ An emphasis on synergism Ye X, Bhupathiraju SN, Tucker KL. Variety in fruit and vegetable intake and cognitive function in middle-aged and older Puerto Rican adults. Brit J Nutr 2013;109:503-10.
❷ An emphasis on synergism ● The antioxidant effect Extraction
All antixodiants behave differently: to isolate one to extract from its environment and to suppress synergism
Extraction
Whatever its skills, an isolated football player has no chance to exert his full abilities
❸ The role of food structure: From food matrix to bioavailability
Parada, J. and Aguilera, J.M., 2007. Food microstructure affects the bioavailability of several nutrients. J. Food Sci., 72(2): R21-R32.
❸ The role of food structure: Its effect on glycaemic index Study by Haber et al. on apple structure (Haber GB, Heaton KW, Murphy D, Burroughs LF. Depletion and disruption of dietary fibre. Effects on satiety, plasma-glucose, and serum-insulin. Lancet 1977;2:679-82.)
Insulin response
Satiety
❸ The role of food structure: Particle size and cohesiveness Burton, P. and Lightowler, H.J., 2006. Influence of bread volume on glycaemic response and satiety. Brit. J. Nutr., 96(5): 877-882.
Saulnier et al (2012). Glycaemic indices measured for different types of French baguettes.
❸ The role of food structure: Interaction with fibre and antinutrients Antinutrients are generally accumulated by plants to fight against different kinds of stress (temperature, salt, water deficit, insects…) Chelated minerals and trace elements in plant-based foods (Lopez, H.W., Leenhardt, F., Coudray, C. and Remesy, C., 2002. Minerals and phytic acid interactions: is it a real problem for human nutrition? Int. J. Food Sci. Technol., 37(7): 727-739.) e.g. Wholemeal vs white bread Bound and free vitamins/polyphenols The example of bioavailability of wholegrain wheat compounds
Iron: 1-20% in humans Magnesium: 21-28% in humans fed brown bread diet Zinc: 17-20 in humans Fardet, A., 2010. New hypotheses for the health-protective mechanisms of whole-grain cereals: what is beyond fibre? Nutr. Res. Rev., 23(1): 65-134.
❸ The role of food structure: “Slow” vs “Rapid” micronutrients Macronutrients: - Starch encapsulation - Lipid droplet size - Lactoserum vs. casein Fibres: - Soluble vs. insoluble - Fibre porosity, water-holding capacity… Micronutrients & biofactors: - Free vs. bound form (e.g. B vitamins & phenolic acids) - Can we extrapolate the concept of “slow” vs. “rapid” to Biofactors and micronutrients?
❸ The role of food structure: The new concept of fibre co-passengers
Vitaglione P, Napolitano A, Fogliano V. Cereal dietary fibre: a natural functional ingredient to deliver phenolic compounds into the gut. Trends Food Sci Technol 2008;19:451-63. Jones, J.M., 2010. Dietary fibre's co-passengers: is it the fibre or the co-passengers? Dietary fibre: new frontiers for food and health, 365-378 pp.
❹ Technological processes to modify food structure/compound interactions, to degrade anti-nutritional factors and to yield new compounds Germination, soaking and/or fermentation
The release of free forms from bound forms: - B vitamins - Phenolic acids Degradation of anti-nutrients and pre-hydrolysis of some compounds: - Phytic acid - Gluten - Fibre Katina, K. et al., 2007. Fermentation-induced changes in the -… nutritional value of native or germinated rye. J. Cereal Sci., 46(3): 348-355.
Mainly applied to grain products: - Cereals - Pseudo-cereals - Leguminous seeds
❹ The role of technological processes to modify food structure, compound interactions and to degrade antinutritional factors The role of minimal processing
A good compromise between highly processed foods, generally too refined, and natural foods, sometimes difficult to digest or not tasty: …the search for a “middle way” but also for sustainability…
To preserve micronutrients content via: - wheat milling: less refined flours, aleurone layer addition… - less drastic thermal treatments: e.g. muesli - steam cooking - micro-wave…
❺ Practical and nutritional implications The food guide pyramid is based primarily on grain products (the basis of nutrition all over the world). However, grain products are complex foods with numerous partially bio-available micronutrients and biofactors
The updating of Dietary Recommended Intakes and other nutritional recommendations when integrating bioavailability factors? (currently under consideration)
Conclusions & Perspectives Supplements did not succeed in stopping obesity and diabetes “epidemics” and in preventing cancers and CVD A body of evidence showing that the whole is best than the sum of the parts, because of: Synergism (1+1 > 2) Interactions with digestive environment Satiety effect : supplements are not satiating! … To develop minimal processing instead of nutritional supplements? Probably the more significant lever to rapidly improve food nutritional quality (e.g. more rapid than genetic selection, and more efficient than supplements) There is a lot to develop in this technological sector, e.g. to produce less refined wheat flour (preservation of the pool of micronutrients and biofactors) Lyophilized vs intact food:
To compare on a long term, at equivalent dose(s), the nutritional effects of micronutrients and biofactors in either a lyophilized/ground or intact complex food to study the effect of the kinetic of release on health upon a long period of time From a reductionist and pharmacological to a holistic and integrative approach in nutrition research (because foods are not drugs!)
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