1.4: Nutrition Research and Advice

Scientific Research to Determine the Health Effects of Food and Nutrients

In the same way that a police detective finally charges a criminal with a crime, nutritional scientists discover the health effects of food and its nutrients by first making an observation. Once observations are made, they come up with a hypothesis, test their hypothesis, and then interpret the results. After this, they gather additional evidence from multiple sources and finally come up with a conclusion on whether the food suspect fits the claim. This organized process of inquiry used in forensic science, nutritional science, and every other science is called the scientific method.

Below is an illustration of the scientific method at work—in this case, to prove that iodine is a nutrient.^1-2 In 1811, French chemist Bernard Courtois was isolating saltpeter to produce gunpowder to be used by Napoleon’s army. To achieve this isolation, he burned some seaweed and, in the process, observed an intense violet vapor that crystallized when he exposed it to a cold surface. He sent the violet crystals to an expert on gases, Joseph Gay-Lussac, who identified the crystal as a new element. It was named iodine, the Greek word for violet. The following scientific record reveals some of the process leading to the conclusion that iodine is a nutrient.

• Observation. Eating seaweed is a cure for goiter, a gross enlargement of the thyroid gland in the neck.
• Hypothesis. In 1813, Swiss physician Jean-Francois Coindet hypothesized that the seaweed contained iodine, and he could use just iodine instead of seaweed to treat his patients.
• Experimental test. Coindet administered iodine tincture orally to his patients with goiter.
• Interpret results. Coindet’s iodine treatment was successful.
• Gathering more evidence. Many other physicians contributed to the research on iodine deficiency and goiter.
• Hypothesis. French chemist Adolphe Chatin proposed that the low iodine content in food and water of certain areas far away from the ocean was the primary cause of goiter and renounced the theory that goiter resulted from poor hygiene.
• Experimental test. In the late 1860s, the program “The stamping-out of goiter” started with people in several villages in France being given iodine tablets.
• Results. The program was effective, and 80% of goitrous children were cured.
• Hypothesis. In 1918, Swiss doctor Bayard proposed iodizing salt as a good way to treat areas in which goiter was endemic.
• Experimental test. Iodized salt was transported by mules to a small village at the base of the Matterhorn where more than 75 percent of schoolchildren were goitrous. It was given to families to use for six months.
• Results. The iodized salt was beneficial in treating goiter in this remote population.
• Experimental test. Physician David Marine conducted the first experiment of treating goiter with iodized salt in America in Akron, Ohio.
• Results. This study conducted on over 4,000 schoolchildren found that iodized salt prevented goiter.
• Conclusions. Seven other studies similar to Marine’s were conducted in Italy and Switzerland that also demonstrated the effectiveness of iodized salt in treating goiter. In 1924, US public health officials initiated the program of iodizing salt and started eliminating the scourge of goiterism. Today, more than 70 percent of American households use iodized salt, and many other countries have followed the same public health strategy to reduce the health consequences of iodine deficiency.

Iodized Salt is a Primary Iron Source for Americans

 

 

Figure \(\PageIndex{1}\): "Morton Salt Iodized 100th Anniversary Birthday. 'when it rains it pours' advertising slogan umbrella girl pics by Mike Mozart of TheToyChannel and JeepersMedia on YouTube. #MortonSalt #Salt #WhenItRainsItPours #MortonIodizedSalt #Iodized #IodizedSalt" by JeepersMedia is licensed under CC BY 2.0.³

Evidence-Based Approach to Nutrition

It was more than one hundred years from iodine’s discovery as an effective treatment for goiter until public health programs recognized it as such. Although a lengthy process, the scientific method is a productive way to define essential nutrients and determine their ability to promote health and prevent disease. The scientific method is part of the overall evidence-based approach to designing nutritional guidelines. An evidence-based approach to nutrition includes:^4-5

• Defining the problem or uncertainty (e.g., the rate of colon cancer is higher in people who eat red meat)
• Formulating it as a question (e.g., Does eating red meat contribute to colon cancer risk?)
• Setting criteria for quality evidence
• Evaluating the body of evidence
• Summarizing the body of evidence and making decisions
• Specifying the strength of the supporting evidence required to make decisions
• Disseminating the findings

The Food and Nutrition Board of the Institute of Medicine, a nonprofit, nongovernmental organization, constructs its nutrient recommendations (i.e., Dietary Reference Intakes, or DRI) using an evidence-based approach to nutrition. The entire procedure for setting the DRI is documented and made available to the public. The same approach is used by the USDA and HHS, which are departments of the US federal government. The USDA and HHS websites are great tools for discovering ways to optimize health; however, it is important to gather nutrition information from multiple resources as there are often differences in opinion among various scientists and public health organizations. While the Dietary Guidelines have been well-received by some, there are nongovernmental public health organizations that are convinced that some pieces of the guidelines may be influenced by lobbying groups and/or the food industry. For example, the Harvard School of Public Health (HSPH) feels the government falls short by being “too lax on refined grains.”⁶ The guidelines recommend getting at least half of grains from whole grains—according to the HSPH, this still leaves too much consumption of refined grains.

For a list of reliable sources that advocate good nutrition to promote health and prevent disease using evidence-based science, see Table \(\PageIndex{1}\). In subsequent sections, we will further discuss distinguishing criteria that will enable you to wade through misleading nutrition information and instead gather your information from reputable, credible websites and organizations.

Table \(\PageIndex{1}\): Reliable Web Resources for Nutrition and Health

Organization
Governmental
US Department of Agriculture
USDA Center for Nutrition Policy and Promotion
US Department of Health and Human Services
Centers for Disease Control and Prevention
Food and Drug Administration
Healthy People
Office of Disease Prevention and Health Promotion
Health Canada
International
World Health Organization
Food and Agricultural Organization of the United Nations
Nongovernmental
Harvard School of Public Health
Mayo Clinic
Linus Pauling Institute
American Society for Nutrition
American Medical Association
American Diabetes Association
The Academy of Nutrition and Dietetics
Dietitians of Canada

Types of Scientific Studies

Many types of scientific studies can provide supporting evidence for a particular hypothesis. These include epidemiological studies, interventional clinical trials, and randomized clinical interventional trials.

Epidemiological studies are observational studies that look for health patterns and are often the front-line studies for public health. The CDC defines epidemiological studies as scientific investigations that define the frequency, distribution, and patterns of health events in a population. Thus, these studies describe the occurrence and patterns of health events over time. The goal of an epidemiological study is to find factors associated with an increased risk for a health event, though these sometimes remain elusive. An example of an epidemiological study is the Framingham Heart Study, a project of the National Heart, Lung, and Blood Institute and Boston University that has been ongoing since 1948. This study first examined the physical health and lifestyles of 5,209 men and women from the city of Framingham, Massachusetts, and has now incorporated data from the children and grandchildren of the original participants. One of the seminal findings of this ambitious study was that higher cholesterol levels in the blood are a risk factor for heart disease.⁷

Epidemiological studies are a cornerstone for examining and evaluating public health, and some of their advantages are that they can lead to the discovery of disease patterns and risk factors for diseases, and they can be used to predict future healthcare needs and provide information for the design of disease prevention strategies for entire populations. Some shortcomings of epidemiological studies are that investigators cannot control environments and lifestyles, a specific group of people studied may not be an accurate depiction of an entire population, and these types of scientific studies cannot directly determine if one variable causes another. Scientists regard epidemiological studies as a starting place for ideas about what types of lifestyle choices MAY contribute to a disease. They can show a correlation between two things happening but not whether one factor CAUSED the other. My favorite example of this is a thought experiment where a make-believe scientist observes (through epidemiological studies) that grey hair often goes along with Alzheimer's Disease. Wouldn't it be silly for that scientist to predict that grey hair CAUSES Alzheimer's Disease? Could that scientist easily test that silly prediction? Suppose that scientist dyed gray the hair of a group of people to see if the color gray truly increased their risk of Alzheimer's disease. The whole thing is silly, but I think you get the point. Epidemiological studies may give us ideas but those ideas need clinical trials to determine what the patterns mean.

Interventional clinical trial studies are scientific investigations in which a variable is changed between groups of people. When well done, this type of study allows one to determine causal relationships. An example of an interventional clinical trial study is the Dietary Approaches to Stop Hypertension (DASH) trial published in the April 1997 issue of The New England Journal of Medicine.⁸ In this study, 459 people were randomly assigned to three different groups; one was put on an average American control diet, a second was put on a diet rich in fruits and vegetables, and the third was put on a combination diet rich in fruits, vegetables, and low-fat dairy products with reduced saturated and total fat intake. The groups remained on the diets for eight weeks. Blood pressures were measured before starting the diets and after eight weeks. Results of the study showed that the group on the combination diet had significantly lower blood pressure at the end of eight weeks than those who consumed the control diet. The authors concluded that the combination diet is an effective nutritional approach to treat high blood pressure. The attributes of high-quality clinical interventional trial studies are:

• those that include a control group, which does not receive the intervention, to which you can compare the people who receive the intervention being tested;
• those in which the subjects are randomized into the group or intervention group, meaning a given subject has an equal chance of ending up in either the control group or the intervention group. This is done to ensure that any possible confounding variables are likely to be evenly distributed between the control and the intervention groups;
• those studies that include a sufficient number of participants.

What are confounding variables? These are factors other than the one being tested that could influence the study's results. For instance, in the study we just considered, if one group of adults did less physical activity than the other, then it could be the amount of physical activity rather than the diet being tested that caused the differences in blood pressures among the groups.

The limitations of these types of scientific studies are that they are difficult to carry on for long periods, are costly, and require that participants remain compliant with the intervention. Furthermore, it is unethical to study certain interventions. (An example of an unethical intervention would be to advise one group of pregnant mothers to drink alcohol to determine the effects of alcohol intake on pregnancy outcome because we know that alcohol consumption during pregnancy damages the developing fetus.)

Randomized clinical interventional trial studies are powerful tools to provide supporting evidence for a particular relationship and are considered the “gold standard” of scientific studies. A randomized clinical interventional trial is a study in which participants are randomly assigned to separate groups that compare different treatments. Neither the researchers nor the participants can choose which group a participant is assigned. However, from their limitations, it is clear that epidemiological studies complement interventional clinical trial studies, and both are necessary to construct strong foundations of scientific evidence for health promotion and disease prevention.

Other scientific studies that provide supporting evidence for a hypothesis include laboratory studies conducted on animals or cells. An advantage of this type of study is that it typically does not cost as much as human studies and requires less time to conduct. Other advantages are that researchers have more control over the environment, and the amount of confounding variables can be significantly reduced. Moreover, animal and cell studies provide a way to study relationships at the molecular level. They are also helpful in determining the exact mechanism by which a specific nutrient causes a change in health. The disadvantage of these types of studies is that researchers are not working with whole humans, and thus, the results may not be relevant. Nevertheless, well-conducted animal and cell studies that can be repeated by multiple researchers and obtain the same conclusion are definitely helpful in building the evidence to support a scientific hypothesis.

Evolving Science

Science is always moving forward, albeit sometimes slowly. One study is not enough to make a guideline or a recommendation or cure a disease. Science is a stepwise process that builds on past evidence and finally culminates into a well-accepted conclusion. Unfortunately, not all scientific conclusions are developed in the interest of human health, and it is important to know where a scientific study was conducted and who provided the funding. Indeed, just as an air quality study paid for by a tobacco company diminishes its value in readers' minds, so does one on red meat performed at a laboratory funded by a national beef association.

Science can also be contentious, even among experts who don’t have any conflicting financial interests. Contentious science is actually a good thing as it forces researchers to be of high integrity, well-educated, well-trained, and dedicated. It also instigates public health policymakers to seek out multiple sources of evidence in order to support a new policy. Agreement involving many experts across multiple scientific disciplines is necessary for recommending dietary changes to improve health and prevent disease. Although a somewhat slow process, it is better for our health to allow the evidence to accumulate before incorporating some change in our diet. Beware of Social Media claims that they have found a cure or new way to treat a health condition that is based on personal experience rather than evidence-based science research!

Nutrition Research: Nutrigenomics

One of the newest areas in the realm of nutritional science is the scientific discipline of nutritional genetics, also called nutrigenomics. Genes are part of DNA and contain the genetic information that makes up all our traits. Genes are codes for proteins, and when they are turned “on” or “off,” they change how the body works. While we know that health is defined as more than just the absence of disease, there are currently very few accurate genetic markers of good health. Rather, there are many more genetic markers for disease. However, science is evolving, and nutritional genetics aims to identify what nutrients to eat to “turn on” healthy genes and “turn off” genes that cause disease. Eventually, this field will progress so that a person’s diet can be tailored to their genetics. Thus, your DNA will determine your optimal diet. Check out this video on Nutritional genomics.⁹

Video \(\PageIndex{1}\): Nutritional Genomics (PHG Foundation)

Using Science and Technology to Change the Future

As science evolves, so does technology. Both can be used to create a healthy diet, optimize health, and prevent disease. Picture yourself not too far into the future: you are wearing a small “dietary watch” that painlessly samples your blood and downloads the information to your cell phone, which has an app that evaluates the nutrient profile of your blood and then recommends a snack or dinner menu to assure you maintain adequate nutrient levels. What else is not far off? How about another app that provides a shopping list that adheres to all dietary guidelines and is emailed to the central server at your local grocer, who then delivers the food to your home? The food is then stored in your smart fridge, which documents your daily diet at home and delivers your weekly dietary assessment to your home computer (Figure \(\PageIndex{2}\)). At your computer, you can compare your diet with other diets aimed at weight loss, optimal strength training, reduction in risk for specific diseases, or any other health goals you may have. You may also delve into the field of nutritional genetics and download your gene expression profiles to a database that analyzes yours against millions of others.

Figure \(\PageIndex{2}\): LG Smart Refrigerator - CES 2011 - Consumer Electronics Show - Las Vegas, NV¹⁰ by David Berkowitz is licensed under CC BY 2.0.

Credible Nutrition Professionals

Finding credible nutrition information can begin with evidence-based resources, as noted earlier in this chapter (Table 1.4.1). Some professions serve to translate the science into practical use for the consumer. In addition to a college degree, supervised practice (internship), and national board exam, credentialed nutrition professionals must complete continuing education coursework to ensure they practice under the most current science-based evidence. Professional credentials and licenses are in place to protect the public from harm. Many professionals, such as personal trainers and teachers, are encouraged to promote healthy eating habits but should take caution to not exceed their scope of practice by avoiding medical or prescriptive nutrition principles. In many states, to practice in the area of nutrition specific to medical nutrition therapy and prescriptive nutrition, you need the Registered Dietitian credential and a state license. A weekend seminar may provide a "certificate," but this is not equivalent to a "credential." Also note that there are many research scientists, such as those associated with science departments and major universities and healthcare institutions, who are also experts in the field of nutrition and are considered credible nutrition sources. Below are two examples of credible credentialed nutrition professionals:

Registered Dietitian-Nutritionist

"RDs are food and nutrition experts who have met the Commission on Dietetic Registration’s (CDR) criteria to earn the RD credential. RDs work in a wide variety of employment settings, including health care, business and industry, community/public health, education, research, government agencies, and private practice." Earning this credential includes:

1. Completion of a minimum of a graduate degree by a university accredited by a USDE recognized accrediting agency (or foreign equivalent).
2. Completion of an Accreditation Council for Education in Nutrition and Dietetics (ACEND) accredited Didactic Program in Dietetics (DPD).
3. Completion of an ACEND accredited Dietetic Internship (DI) or  ACEND Coordinated Program (CP). There are additional options for graduate and doctoral degreed applicants through ACEND.
4. Obtain state license in states in which it is required.¹¹

Diplomate, The American Clinical Board of Nutrition

The "DACBN certification program is to enact change on the traditional health care industry in the United States by certifying advanced, doctoral-level professionals who are focused on providing a nutritional model of preventative health care in a variety of professional settings."¹² In addition to an earned doctorate and working as a healthcare professional, candidates for this credential must complete 300 clock hours of professional practice in the area of nutrition, write a paper that is submitted to a research journal, pass a credentialing exam, and complete continuing education hours.

Attributions

CC BY-NC-SA 3.0. The original material was reorganized and updated. A new subsection on credentialed nutrition professionals was added. New references were added.

References

1. Zimmerman MB. Research on iodine deficiency and goiter in the 19th and early 20th centuries. J Nutr. 2008;138(11):2060-2063. https://jn.nutrition.org/article/S0022-3166(22)09700-0/fulltext. Accessed July 12, 2023.
2. Carpenter KJ. David Marine and the problem of goiter. J Nutr. 2005;135(4):675-680. doi:10.1093/jn/135.4.675.
3. Mozart M. Morton Salt Iodized 100th Anniversary Birthday "when it rains it pours" advertising slogan umbrella girl. Flickr. https://www.flickr.com/photos/39160147@N03/14096625896. Published May 6, 2014. Accessed June 21, 2023.
4. Briss PA, Zaza S, Pappaioanou, et al. Developing an evidence-based guide to community preventative services--methods. Am J Prev Med. 2000;18(1)supplement 1:35-43. doi:10.1016/s0749-3797(99)00119-1.
5. Myers E. Systems for evaluating nutrition research for nutrition care guidelines: do they apply to population dietary guidelines? J Am Diet Assoc. 2003;103(12)supplement 2:34-41. doi:10.1016/j.jada.2003.09.035.
6. Harvard Health Publishing. The new federal dietary guidelines: are they good for your heart? Published March 8, 2016. Accessed July 11, 2023. https://www.health.harvard.edu/heart-health/the-new-federal-dietary-guidelines-are-they-good-for-your-heart.
7. Mahmood SS, Levy D, Vasan RS, Wang TJ. The Framingham heart study and the epidemiology of cardiovascular disease: a historical perspective. Lancet. 2014;383:999-1008. https://commed.vcu.edu/Chronic_Disease/Heart/2015/HXFramingham_Lancet.pdf. Accessed July 3, 2023.
8. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. N Eng J Med. 1997;336:1117-1124. doi:10.1056/NEJM199704173361601.
9. PHG Foundation. Nutritional Genomics [Video]. YouTube. https://www.youtube.com/watch?v=4D1cxajbbLo. August 23, 2021. Accessed June 25, 2023.
10. Berkowitz D. LG Smart Refrigerator-CES 2011-—Consumer Electronics —ShowLas Vegas, NV. Flickr. https://www.flickr.com/photos/davidberkowitz/5343789473/. Published January 10, 2011. Accessed June 6, 2023.
11. Committee on Dietetic Registration. RD Examination—Eligibility Requirements. Accessed September 18, 2024. https://www.cdrnet.org/RDNeligibility.
12. Policies and Procedure Manual. American Clinical Board of Nutrition. Accessed July 31, 2023. Available at: https://www.acbn.org/.