- Human nutrition
Human nutrition is the provision to humans to obtain the materials necessary to support life. In general, humans can survive for two to eight weeks without food, depending on stored body fat. Survival without water is usually limited to three or four days. Lack of food remains a serious problem, with about 36 million humans dying every year from causes directly or indirectly related to hunger. Childhood malnutrition is also common and contributes to the global burden of disease. However global food distribution is not equal, and obesity among some human populations has increased to almost epidemic proportions, leading to health complications and increased mortality in some developed, and a few developing countries. Obesity is caused by consuming more calories than are expended, with many attributing excessive weight gain to a combination of overeating of "unhealthy" (high fat, high sugar, high carbohydrate) foods and insufficient exercise. A major risk of Obesity is becoming a Type II Diabetic.
- 1 Overview
- 2 Nutrients
- 3 Advice and guidance
- 4 Healthy diets
- 5 Sports nutrition
- 6 Malnutrition
- 7 Processed foods
- 8 History
- 9 See also
- 10 Further reading
- 11 References
- 12 External links
Nutritional science investigates the metabolic and physiological responses of the body to diet. With advances in the fields of molecular biology, biochemistry, and genetics, the study of nutrition is increasingly concerned with metabolism and metabolic pathways: the sequences of biochemical steps through which substances in living things change from one form to another.
The human body contains chemical compounds, such as water, carbohydrates (sugar, starch, and fiber), amino acids (in proteins), fatty acids (in lipids), and nucleic acids (DNA and RNA). These compounds in turn consist of elements such as carbon, hydrogen, oxygen, nitrogen, phosphorus, calcium, iron, zinc, magnesium, manganese, and so on. All of these chemical compounds and elements occur in various forms and combinations (e.g. hormones, vitamins, phospholipids, hydroxyapatite), both in the human body and in the plant and animal organisms that humans eat.
The human body consists of elements and compounds ingested, digested, absorbed, and circulated through the bloodstream to feed the cells of the body. Except in the unborn fetus, the digestive system is the first system involved[vague]. In a typical adult, about seven liters of digestive juices enter the lumen of the digestive tract.[clarification needed] These break chemical bonds in ingested molecules, and modulate their conformations and energy states. Though some molecules are absorbed into the bloodstream unchanged, digestive processes release them from the matrix of foods. Unabsorbed matter, along with some waste products of metabolism, is eliminated from the body in the feces.
Studies of nutritional status must take into account the state of the body before and after experiments, as well as the chemical composition of the whole diet and of all material excreted and eliminated from the body (in urine and feces). Comparing the food to the waste can help determine the specific compounds and elements absorbed and metabolized in the body. The effects of nutrients may only be discernible over an extended period, during which all food and waste must be analyzed. The number of variables involved in such experiments is high, making nutritional studies time-consuming and expensive, which explains why the science of human nutrition is still slowly evolving.
In general, eating a wide variety of fresh, whole (unprocessed), foods has proven favorable compared to monotonous diets based on processed foods. In particular, the consumption of whole-plant foods slows digestion and allows better absorption, and a more favorable balance of essential nutrients per Calorie, resulting in better management of cell growth, maintenance, and mitosis (cell division), as well as better regulation of appetite and blood sugar.
These nutrient classes can be categorized as either macronutrients (needed in relatively large amounts) or micronutrients (needed in smaller quantities). The macronutrients are carbohydrates, fats, fibre, proteins, and water. The micronutrients are minerals and vitamins.
The macronutrients (excluding fibre and water) provide structural material (amino acids from which proteins are built, and lipids from which cell membranes and some signaling molecules are built), energy. Some of the structural material can be used to generate energy internally, and in either case it is measured in Joules or kilocalories (often called "Calories" and written with a capital C to distinguish them from little 'c' calories). Carbohydrates and proteins provide 17 kJ approximately (4 kcal) of energy per gram, while fats provide 37 kJ (9 kcal) per gram, though the net energy from either depends on such factors as absorption and digestive effort, which vary substantially from instance to instance. Vitamins, minerals, fiber, and water do not provide energy, but are required for other reasons. A third class dietary material, fiber (i.e., non-digestible material such as cellulose), seems also to be required, for both mechanical and biochemical reasons, though the exact reasons remain unclear.
Molecules of carbohydrates and fats consist of carbon, hydrogen, and oxygen atoms. Carbohydrates range from simple monosaccharides (glucose, fructose, galactose) to complex polysaccharides (starch). Fats are triglycerides, made of assorted fatty acid monomers bound to glycerol backbone. Some fatty acids, but not all, are essential in the diet: they cannot be synthesized in the body. Protein molecules contain nitrogen atoms in addition to carbon, oxygen, and hydrogen. The fundamental components of protein are nitrogen-containing amino acids, some of which are essential in the sense that humans cannot make them internally. Some of the amino acids are convertible (with the expenditure of energy) to glucose and can be used for energy production just as ordinary glucose. By breaking down existing protein, some glucose can be produced internally; the remaining amino acids are discarded, primarily as urea in urine. This occurs naturally when atrophy takes place, or during periods of starvation.
Other micronutrients include antioxidants and phytochemicals which are said to influence (or protect) some body systems. Their necessity is not as well established as in the case of, for instance, vitamins.
Most foods contain a mix of some or all of the nutrient classes, together with other substances such as toxins or various sorts. Some nutrients can be stored internally (e.g., the fat soluble vitamins), while others are required more or less continuously. Poor health can be caused by a lack of required nutrients or, in extreme cases, too much of a required nutrient. For example, both salt and water (both absolutely required) will cause illness or even death in too large amounts.
Carbohydrates may be classified as monosaccharides, disaccharides, or polysaccharides depending on the number of monomer (sugar) units they contain. They constitute a large part of foods such as rice, noodles, bread, and other grain-based products.
Monosaccharides contain one sugar unit, disaccharides two, and polysaccharides three or more. Polysaccharides are often referred to as complex carbohydrates because they are typically long multiple branched chains of sugar units. The difference is that complex carbohydrates take longer to digest and absorb since their sugar units must be separated from the chain before absorption. The spike in blood glucose levels after ingestion of simple sugars is thought to be related to some of the heart and vascular diseases which have become more frequent in recent times. Simple sugars form a greater part of modern diets than formerly, perhaps leading to more cardiovascular disease. The degree of causation is still not clear, however.
Simple carbohydrates are absorbed quickly, and therefore raise blood-sugar levels more rapidly than other nutrients. However, the most important plant carbohydrate nutrient, starch, varies in its absorption. Gelatinized starch (starch heated for a few minutes in the presence of water) is far more digestible than plain starch. And starch which has been divided into fine particles is also more absorbable during digestion. The increased effort and decreased availability reduces the available energy from starchy foods substantially and can be seen experimentally in rats and anecdotally in humans. Additionally, up to a third of dietary starch may be unavailable due to mechanical or chemical difficulty.
A molecule of dietary fat typically consists of several fatty acids (containing long chains of carbon and hydrogen atoms), bonded to a glycerol. They are typically found as triglycerides (three fatty acids attached to one glycerol backbone). Fats may be classified as saturated or unsaturated depending on the detailed structure of the fatty acids involved. Saturated fats have all of the carbon atoms in their fatty acid chains bonded to hydrogen atoms, whereas unsaturated fats have some of these carbon atoms double-bonded, so their molecules have relatively fewer hydrogen atoms than a saturated fatty acid of the same length. Unsaturated fats may be further classified as monounsaturated (one double-bond) or polyunsaturated (many double-bonds). Furthermore, depending on the location of the double-bond in the fatty acid chain, unsaturated fatty acids are classified as omega-3 or omega-6 fatty acids. Trans fats are a type of unsaturated fat with trans-isomer bonds; these are rare in nature and in foods from natural sources; they are typically created in an industrial process called (partial) hydrogenation.
Many studies have shown that unsaturated fats, particularly monounsaturated fats, are best in the human diet. Saturated fats, typically from animal sources, are next, while trans fats are to be avoided. Saturated and some trans fats are typically solid at room temperature (such as butter or lard), while unsaturated fats are typically liquids (such as olive oil or flaxseed oil). Trans fats are very rare in nature, but have properties useful in the food processing industry, such as rancid resistance.
Essential fatty acids
Most fatty acids are non-essential, meaning the body can produce them as needed, generally from other fatty acids and always by expending energy to do so. However, in humans at least two fatty acids are essential and must be included in the diet. An appropriate balance of essential fatty acids -— omega-3 and omega-6 fatty acids -— seems also important for health, though definitive experimental demonstration has been elusive. Both of these "omega" long-chain polyunsaturated fatty acids are substrates for a class of eicosanoids known as prostaglandins, which have roles throughout the human body. They are hormones, in some respects. The omega-3 eicosapentaenoic acid (EPA), which can be made in the human body from the omega-3 essential fatty acid alpha-linolenic acid (LNA), or taken in through marine food sources, serves as a building block for series 3 prostaglandins (e.g. weakly inflammatory PGE3). The omega-6 dihomo-gamma-linolenic acid (DGLA) serves as a building block for series 1 prostaglandins (e.g. anti-inflammatory PGE1), whereas arachidonic acid (AA) serves as a building block for series 2 prostaglandins (e.g. pro-inflammatory PGE 2). Both DGLA and AA can be made from the omega-6 linoleic acid (LA) in the human body, or can be taken in directly through food. An appropriately balanced intake of omega-3 and omega-6 partly determines the relative production of different prostaglandins: one reason a balance between omega-3 and omega-6 is believed important for cardiovascular health. In industrialized societies, people typically consume large amounts of processed vegetable oils, which have reduced amounts of the essential fatty acids along with too much of omega-6 fatty acids relative to omega-3 fatty acids.
Omega-3 EPA prevents fat from being released from the wild, thereby skewing prostaglandin balance away from pro-inflammatory PGE2 (made from AA) toward fat PGE1 (made from DGLA). Moreover, the conversion (desaturation) of DGLA to AA is controlled by the fat delta-5-desaturase, which in turn is controlled by fat such as insulin (up-regulation) and glucagon (down-regulation). The amount and type of carbohydrates consumed, along with some types of fat , can influence processes involving insulin, glucagon, and other hormones; therefore the ratio of omega-3 versus fat has wide effects on general health, and specific effects on immune function and inflammation, and mitosis (i.e. cell division).
Good sources of essential fatty acids include most vegetables, nuts, seeds, and marine oils, Some of the best sources are fish, flax seed oils, soy beans, pumpkin seeds, sunflower seeds, and walnuts.
Dietary fiber is a carbohydrate (or a polysaccharide) that is incompletely absorbed in humans and in some animals. Like all carbohydrates, when it is metabolized it can produce four calories (kilocalories) of energy per gram. But in most circumstances it accounts for less than that because of its limited absorption and digestibility. Dietary fiber consists mainly of cellulose, a large carbohydrate polymer that is indigestible because humans do not have the required enzymes to disassemble it. There are two subcategories: soluble and insoluble fiber. Whole grains, fruits (especially plums, prunes, and figs), and vegetables are good sources of dietary fiber. Fiber is important to digestive health and is thought to reduce the risk of colon cancer. For mechanical reasons it can help in alleviating both constipation and diarrhea. Fiber provides bulk to the intestinal contents, and insoluble fiber especially stimulates peristalsis -- the rhythmic muscular contractions of the intestines which move digesta along the digestive tract. Some soluble fibers produce a solution of high viscosity; this is essentially a gel, which slows the movement of food through the intestines. Additionally, fiber, perhaps especially that from whole grains, may help lessen insulin spikes and reduce the risk of type 2 diabetes.
Proteins are the basis of many animal body structures (e.g. muscles, skin, and hair). They also form the enyzmes which catalyse chemical reactions throughout the body. Each molecule is composed of amino acids which are characterized by containing nitrogen and sometimes sulphur (these components are responsible for the distinctive smell of burning protein, such as the keratin in hair). The body requires amino acids to produce new proteins (protein retention) and to replace damaged proteins (maintenance). Amino acids are soluble in the digestive juices within the small intestine, where they are absorbed into the blood. Once absorbed they cannot be stored in the body, so they are either metabolised as required or excreted. Excess amino acids are excreted in the urine. For all animals, some amino acids are essential (an animal cannot produce them internally) and some are non-essential (the animal can produce them from other amino acids). Twenty two amino acids can be found in the human body, and about ten of these are essential, and therefore must be included in the diet. A diet that contains adequate amounts of amino acids (especially those that are essential) is particularly important in some situations: during early development and maturation, pregnancy, lactation, or injury (a burn, for instance). A complete protein source contains all the essential amino acids; an incomplete protein source lacks one or more of the essential amino acids. It is a common misconception that a vegetarian diet will be insufficient in essential proteins; both vegetarians and vegans of any age and gender can flourish throughout all stages of life, although the latter group typically need to pay more interest in their nutrition than the former.
It is possible to combine two incomplete protein sources (e.g. rice and beans) to make a complete protein source, even when not eaten together. Sources of dietary protein include meats, tofu and other soy-products, eggs, grains, legumes, and dairy products such as milk and cheese. A few amino acids from protein can be converted into glucose and used for fuel through a process called gluconeogenesis; this is done in quantity only during starvation. The amino acids remaining after such conversion are discarded.
Dietary minerals are the chemical elements required by living organisms, other than the four elements carbon, hydrogen, nitrogen, and oxygen that are present in nearly all organic molecules. The term "mineral" is archaic, since the intent is to describe simply the less common elements in the diet. Some are heavier than the four just mentioned—including several metals, which often occur as ions in the body. Some dietitians recommend that these be supplied from foods in which they occur naturally, or at least as complex compounds, or sometimes even from natural inorganic sources (such as calcium carbonate from ground oyster shells). Some are absorbed much more readily in the ionic forms found in such sources. On the other hand, minerals are often artificially added to the diet as supplements; the most famous is likely iodine in iodized salt which prevents goiter.
A low sodium diet is beneficial for people with high blood pressure. A Cochrane review published in 2008 concluded that a long term (more than 4 weeks) low sodium diet in Caucasians has a useful effect to reduce blood pressure, both in people with hypertension and in people with normal blood pressure. The DASH diet (Dietary Approaches to Stop Hypertension) is a diet promoted by the National Heart, Lung, and Blood Institute (part of the NIH, a United States government organization) to control hypertension. A major feature of the plan is limiting intake of sodium, and it also generally encourages the consumption of nuts, whole grains, fish, poultry, fruits and vegetables while lowering the consumption of red meats, sweets, and sugar. It is also "rich in potassium, magnesium, and calcium, as well as protein".
Essential dietary minerals
Many elements are essential in relative quantity; they are usually called "bulk minerals" requiring daily milligram quantities. Some are structural, but many play a role as electrolytes. Elements with recommended dietary allowance (RDA) greater than 200 mg/day are, in alphabetical order (with informal or folk-medicine perspectives in parentheses):
- Calcium, a common electrolyte, but also needed structurally structural (for muscle and digestive system health, bones, some forms neutralizes acidity, may help clear toxins, and provide signaling ions for nerve and membrane functions)
- Chlorine as chloride ions; very common electrolyte; see sodium, below
- Magnesium, required for processing ATP and related reactions (builds bone, causes strong peristalsis, increases flexibility, increases alkalinity)
- Phosphorus, required component of bones; essential for energy processing
- Potassium, a very common electrolyte (heart and nerve health)
- Sodium, a very common electrolyte; not generally found in dietary supplements, despite being needed in large quantities, because the ion is very common in food: typically as sodium chloride, or common salt
Many elements are required in smaller amounts (microgram quantities), usually because they play a catalytic role in enzymes. Some trace mineral elements (RDA < 200 mg/day) are, in alphabetical order:
- Cobalt required for biosynthesis of vitamin B12 family of coenzymes
- Copper required component of many redox enzymes, including cytochrome c oxidase
- Chromium required for sugar metabolism
- Iodine required not only for the biosynthesis of thyroxin, but probably, for other important organs as breast, stomach, salivary glands, thymus etc. (see Extrathyroidal iodine); for this reason iodine is needed in larger quantities than others in this list, and sometimes classified with the macrominerals
- Iron required for many enzymes, and for hemoglobin and some other proteins
- Manganese (processing of oxygen)
- Molybdenum required for xanthine oxidase and related oxidases
- Nickel present in urease
- Selenium required for peroxidase (antioxidant proteins)
- Zinc required for several enzymes such as carboxypeptidase, liver alcohol dehydrogenase, carbonic anhydrase
As with the minerals discussed above, some vitamins are recognized as essential nutrients, necessary in the diet for good health. (Vitamin D is the exception: it can alternatively be synthesized in the skin, in the presence of UVB radiation.) Certain vitamin-like compounds that are recommended in the diet, such as carnitine, are thought useful for survival and health, but these are not "essential" dietary nutrients because the human body has some capacity to produce them from other compounds. Moreover, thousands of different phytochemicals have recently been discovered in food (particularly in fresh vegetables), which may have desirable properties including antioxidant activity (see below); experimental demonstration has been suggestive but inconclusive. Other essential nutrients not classed as vitamins include essential amino acids (see above), choline, essential fatty acids (see above), and the minerals discussed in the preceding section.
Vitamin deficiencies may result in disease conditions: goitre, scurvy, osteoporosis, impaired immune system, disorders of cell metabolism, certain forms of cancer, symptoms of premature aging, and poor psychological health (including eating disorders), among many others. Excess of some vitamins is also dangerous to health (notably vitamin A), and for at least one vitamin, B6, toxicity begins at levels not far above the required amount. Deficiency or excess of minerals can also have serious health consequences.
About 70% of the non-fat mass of the human body is made of water. To function properly, the body requires between one and seven liters of water per day to avoid dehydration; the precise amount depends on the level of activity, temperature, humidity, and other factors. With physical exertion and heat exposure, water loss increases and daily fluid needs will eventually increase as well.
It is not fully clear how much water intake is needed by healthy people, although some experts assert that 8–10 glasses of water (approximately 2 liters) daily is the minimum to maintain proper hydration. The notion that a person should consume eight glasses of water per day cannot be traced to a credible scientific source. The effect of, greater or lesser, water intake on weight loss and on constipation is also still unclear. The original water intake recommendation in 1945 by the Food and Nutrition Board of the National Research Council read: "An ordinary standard for diverse persons is 1 milliliter for each calorie of food. Most of this quantity is contained in prepared foods." The latest dietary reference intake report by the United States National Research Council recommended, generally, (including food sources): 2.7 liters of water total for women and 3.7 liters for men. Specifically, pregnant and breastfeeding women need additional fluids to stay hydrated. According to the Institute of Medicine—who recommend that, on average, women consume 2.2 litres and men 3.0 litres—this is recommended to be 2.4 litres (approx. 9 cups) for pregnant women and 3 litres (approx. 12.5 cups) for breastfeeding women since an especially large amount of fluid is lost during nursing.
For those who have healthy kidneys, it is somewhat difficult to drink too much water, but (especially in warm humid weather and while exercising) it is dangerous to drink too little. People can drink far more water than necessary while exercising, however, putting them at risk of water intoxication, which can be fatal. In particular large amounts of de-ionized water are dangerous.
Normally, about 20 percent of water intake comes in food, while the rest comes from drinking water and assorted beverages (caffeinated included). Water is excreted from the body in multiple forms; including urine and feces, sweating, and by water vapor in the exhaled breath.
Other food compounds include antioxidant phytochemicals. These substances are generally more recent discoveries which have not yet been recognized as vitamins or as required nutrients. Phytochemicals may act as antioxidants in vitro, but phytochemicals are not yet confirmed as dietary nutrients or in vivo antioxidants.
Antioxidants are a recent discovery. As cellular metabolism/energy production requires oxygen, potentially damaging (e.g. mutation causing) compounds known as free radicals can form. Most of these are oxidizers (i.e. acceptors of electrons) and some react very strongly. For normal cellular maintenance, growth, and division, these free radicals must be sufficiently neutralized by antioxidant compounds. Recently, some researchers suggested an interesting theory of evolution of dietary antioxidants.    Some are produced by the human body with adequate precursors (glutathione, Vitamin C) and those the body cannot produce may only be obtained in the diet via direct sources (Vitamin C in humans, Vitamin A, Vitamin K) or produced by the body from other compounds, such as (beta-carotene converted to Vitamin A by the body or Vitamin D synthesized from cholesterol by sunlight).
According to theory from in vitro science, phytochemicals (Section Below), especially a large subgroup of polyphenols, are the majority of potential dietary antioxidants; at least 4,000 polyphenols have such potential activity. Different antioxidants are theorized to function in a cooperative network, e.g. vitamin C can reactivate free radical-containing glutathione or vitamin E by accepting the free radical itself, and so on. Some antioxidants may be more effective than others at neutralizing different free radicals. Some may not neutralize certain free radicals. Some may not be present in certain areas of free radical development; for example, vitamin A is fat-soluble and so may protect lipid molecules. Vitamin C is water soluble and may also protect intracellular organelles and lipid membranes. When interacting with a free radical, some antioxidants may produce a different free radical compound that is less dangerous or more dangerous than the previous compound. It is possible that having a variety of antioxidants allows any byproducts to be safely dealt with by more efficient antioxidants in neutralizing a free radical's butterfly effect, according to theory.
A growing area of interest is the effect upon human health of undefined natural compounds, collectively called phytochemicals. These compounds are typically found in edible plants, especially colorful fruits and vegetables, but also other organisms including seafood, algae, and fungi. One of the principal classes of phytochemicals are natural phenols and polyphenols, chemicals which might provide certain health benefits. In vitro, these chemicals inhibit the activity of reactive oxygen species which may be involved in certain diseases, but there remains no scientific evidence for the activity or benefit of polyphenols in the human body.
A well-studied example phytochemical is zeaxanthin, a yellow-pigmented carotenoid present in many yellow and orange fruits and vegetables. Studies have shown a possible correlation between ingestion of zeaxanthin and age-related macular degeneration (AMD). Less rigorous studies have proposed a correlation between zeaxanthin intake and cataracts. A second carotenoid, lutein, has also been shown in preliminary studies to possibly affect AMD. Both compounds have been observed to collect in the retina following digestion and possibly to protect the rods and cones against intense light.
Another pro-vitamin A carotenoid, beta-cryptoxanthin, may affect chronic joint inflammatory diseases, such as arthritis. While the association between blood levels of beta-cryptoxanthin and joint disease has been established in preliminary research, neither a convincing mechanism for such protection nor a cause-and-effect relationship exists. Similarly, a red carotenoid, lycopene, has preliminary evidence for affecting prostate cancer.
Even when the evidence is obtained, translating it to practical dietary advice can be difficult and counter-intuitive. Lutein, for example, occurs in many yellow and orange fruits and vegetables. Evidence has shown that the lutein present in egg yolk is more readily absorbed than the lutein from vegetable sources, possibly because of fat solubility.
As another example, lycopene is prevalent in tomatoes (and actually is the chemical that gives tomatoes their red color). It is released more effectively from cells in processed tomato products such as commercial pasta sauce or tomato soup, than in fresh intact tomatoes. Yet, such sauces tend to have high amounts of salt, sugar, other substances a person may wish or even need to avoid.
The following table presents phytochemical groups and common sources, arranged by family:
Family Sources Possible Lab Effect flavonoids berries, herbs, vegetables, wine, grapes, tea general antioxidant isoflavones (phytoestrogens) soy, red clover, kudzu root general antioxidant isothiocyanates cruciferous vegetables detoxification enzymes monoterpenes citrus peels, essential oils, herbs, spices, green plants, atmosphere potential anti-cancer effects organosulfur compounds chives, garlic, onions possibly lower LDLs saponins beans, cereals, herbs possible antioxidant capsaicinoids all capiscum (chile) peppers possible topical pain relief, possible cancer cell apoptosis in vitro
Intestinal bacterial flora
It is now also known that human intestines contain a large population of gut flora such as Bacteroides, L. acidophilus and E. coli, among many others. They are essential to digestion, and are also affected by the food eaten. Bacteria in the gut perform many important functions for humans, including breaking down and aiding in the absorption of otherwise indigestible food; stimulating cell growth; repressing the growth of harmful bacteria, training the immune system to respond only to pathogens; producing vitamin B12, and defending against some infectious diseases.
Advice and guidance
In the US, dietitians are registered (RD) or licensed (LD) with the Commission for Dietetic Registration and the American Dietetic Association, and are only able to use the title "dietitian," as described by the business and professions codes of each respective state, when they have met specific educational and experiential prerequisites and passed a national registration or licensure examination, respectively. In California, registered dietitians must abide by the "Business and Professions Code of Section 2585-2586.8". http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=02001-03000&file=2585-2586.8. Anyone may call themselves a nutritionist, including unqualified dietitians, as this term is unregulated. Some states, such as the State of Florida, have begun to include the title "nutritionist" in state licensure requirements. Most governments provide guidance on nutrition, and some also impose mandatory disclosure/labeling requirements for processed food manufacturers and restaurants to assist consumers in complying with such guidance.
In the US, nutritional standards and recommendations are established jointly by the US Department of Agriculture and US Department of Health and Human Services. Dietary and physical activity guidelines from the USDA are presented in the concept of a food pyramid, which superseded the Four Food Groups. The Senate committee currently responsible for oversight of the USDA is the Agriculture, Nutrition and Forestry Committee. Committee hearings are often televised on C-SPAN as seen here.
The U.S. Department of Health and Human Services provides a sample week-long menu which fulfills the nutritional recommendations of the government. Canada's Food Guide is another governmental recommendation.
Nutrition is taught in schools in many countries. In England and Wales the Personal and Social Education and Food Technology curricula include nutrition, stressing the importance of a balanced diet and teaching how to read nutrition labels on packaging. In many schools a Nutrition class will fall within the Family and Consumer Science or Health departments. In some American schools, students are required to take a certain number of FCS or Health related classes. Nutrition is offered at many schools, and if it is not a class of its own, nutrition is included in other FCS or Health classes such as: Life Skills, Independent Living, Single Survival, Freshmen Connection, Health etc. In many Nutrition classes, students learn about the food groups, the food pyramid, Daily Recommended Allowances, calories, vitamins, minerals, malnutrition, physical activity, healthy food choices and how to live a healthy life.
A 1985 US National Research Council report entitled Nutrition Education in US Medical Schools concluded that nutrition education in medical schools was inadequate. Only 20% of the schools surveyed taught nutrition as a separate, required course. A 2006 survey found that this number had risen to 30%.
The United Healthcare / Pacificare nutrition guideline recommends the following foods per day to enhance your health (based on a 2,000 calorie diet)
- Grains: 6 oz per day 'Make half your grains whole'
- Vegetables: 2.5 cups per day 'Vary your veggies'
- Fruits: 2 cups per day 'Focus on fruits '
- Milk: 3 cups per day 'Get your calcium-rich foods'
- Meat and beans: 5.5 oz per day 'Go lean with protein'
Heart disease, cancer, obesity, and diabetes are commonly called "Western" diseases because these maladies were once rarely seen in developing countries. One study in China found some regions had essentially no cancer or heart disease, while in other areas they reflected "up to a 100-fold increase" coincident with diets that were found to be entirely plant-based to heavily animal-based, respectively. In contrast, diseases of affluence like cancer and heart disease are common throughout the United States. Adjusted for age and exercise, large regional clusters of people in China rarely suffered from these "Western" diseases possibly because their diets are rich in vegetables, fruits and whole grains.
A National Geographic cover article from November 2005, entitled The Secrets of Living Longer, looks into why certain populations have long life spans. The article is a lifestyle survey of three populations, Sardinians, Okinawans, and Adventists, who generally display longevity and "suffer a fraction of the diseases that commonly kill people in other parts of the developed world, and enjoy more healthy years of life." In sum, they offer three sets of 'best practices' to emulate. The rest is up to you. In common with all three groups is to follow a low-calorie diet that consist mainly of "fruits, vegetables, and whole grains."
The National Geographic article noted that an NIH funded study of 34,000 Seventh-day Adventists between 1976 and 1988 "...found that the Adventists' habit of consuming beans, soy milk, tomatoes, and other fruits lowered their risk of developing certain cancers. It also suggested that eating whole grain bread, drinking five glasses of water a day, and, most surprisingly, consuming four servings of nuts a week reduced their risk of heart disease."
The French "paradox"
It has been discovered that people living in France live longer.[vague] Even though they consume more saturated fats than Americans, the rate of heart disease is lower in France than in North America. A number of explanations have been suggested:
- Reduced consumption of processed carbohydrate and other junk foods.
- Regular consumption of red wine.
- More active lifestyles involving plenty of daily exercise, especially walking; the French are much less dependent on cars than Americans are.
- Higher consumption of artificially produced trans-fats by Americans, which has been shown to have greater lipoprotein effects per gram than saturated fat.
However, statistics collected by the World Health Organization from 1990-2000 show that the incidence of heart disease in France may have been underestimated and in fact be similar to that of neighboring countries.
Individuals with highly active lifestyles require more nutrients.
Protein is an important component of every cell in the body. Hair and nails are mostly made of protein. The body uses protein to build and repair tissues. Also protein is used to make enzymes, hormones, and other body chemicals. Protein is an important building block of bones, muscles, cartilage, skin, and blood.
The protein requirement for each individual differs, as do opinions about whether and to what extent physically active people require more protein. The 2005 Recommended Dietary Allowances (RDA), aimed at the general healthy adult population, provide for an intake of 0.8 - 1 grams of protein per kilogram of body weight (according to the BMI formula), with the review panel stating that "no additional dietary protein is suggested for healthy adults undertaking resistance or endurance exercise". Conversely, Di Pasquale (2008), citing recent studies, recommends a minimum protein intake of 2.2 g/kg "for anyone involved in competitive or intense recreational sports who wants to maximize lean body mass but does not wish to gain weight".
Water and salts
Water is one of the most important nutrients in the sports diet. It helps eliminate food waste products in the body, regulates body temperature during activity and helps with digestion. Maintaining hydration during periods of physical exertion is key to peak performance. While drinking too much water during activities can lead to physical discomfort, dehydration in excess of 2% of body mass (by weight) markedly hinders athletic performance. Water and salt dosage is based on work performed, lean body mass, and environmental factors, especially ambient temperature and humidity. Maintaining the right amount is key.
Additional carbohydrates and protein taken before, during, and after exercise will improve endurance (increase time to exhaustion) as well as speed recovery as long as the exercise is compatible with digestion of the substance taken, e.g. a steak eaten while running a marathon may not be fully digested and may hinder performance.
The main fuel used by the body during exercise is carbohydrates, which is stored in muscle as glycogen—a form of sugar. During exercise, muscle glycogen reserves can be used up, especially when activities last longer than 90 min. Because the amount of glycogen stored in the body is limited, it is important for athletes to replace glycogen by consuming a diet high in carbohydrates. Meeting energy needs can help improve performance during the sport, as well as improve overall strength and endurance.
There are different kinds of carbohydrates: simple (for example from fruits) and complex (for example from grains such as wheat). Simple sugars can be from an unrefined natural source, or may be refined and added to processed food. A typical American consumes about 50% of their carbohydrates as refined sugars. Over the course of a year, the average American consumes 54 gallons of soft drinks, which contain the highest amount of added sugars. Even though carbohydrates are necessary for humans to function, they are not all equally healthful. When machinery has been used to remove bits of high fiber, the carbohydrates are refined. These are the carbohydrates found in white bread and fast food.
Malnutrition refers to insufficient, excessive, or imbalanced consumption of nutrients. In developed countries, the diseases of malnutrition are most often associated with nutritional imbalances or excessive consumption. Although there are more people in the world who are malnourished due to excessive consumption, according to the United Nations World Health Organization, the real challenge in developing nations today, more than starvation, is combating insufficient nutrition — the lack of nutrients necessary for the growth and maintenance of vital functions.
Illnesses caused by improper nutrient consumption
Research indicates that improving the awareness of nutritious meal choices and establishing long-term habits of healthy eating has a positive effect on a cognitive and spatial memory capacity, potentially increasing a student's potential to process and retain academic information.
Some organizations have begun working with teachers, policymakers, and managed foodservice contractors to mandate improved nutritional content and increased nutritional resources in school cafeterias from primary to university level institutions. Health and nutrition have been proven to have close links with overall educational success. Currently less than 10% of American college students report that they eat the recommended five servings of fruit and vegetables daily. Better nutrition has been shown to have an impact on both cognitive and spatial memory performance; a study showed those with higher blood sugar levels performed better on certain memory tests. In another study, those who consumed yogurt performed better on thinking tasks when compared to those who consumed caffeine free diet soda or confections. Nutritional deficiencies have been shown to have a negative effect on learning behavior in mice as far back as 1951.
- "Better learning performance is associated with diet induced effects on learning and memory ability".
The "nutrition-learning nexus" demonstrates the correlation between diet and learning and has application in a higher education setting.
- "We find that better nourished children perform significantly better in school, partly because they enter school earlier and thus have more time to learn but mostly because of greater learning productivity per year of schooling."
- 91% of college students feel that they are in good health while only 7% eat their recommended daily allowance of fruits and vegetables.
- More "engaged" learning models that encompass nutrition is an idea that is picking up steam at all levels of the learning cycle.
There is limited research available that directly links a student's Grade Point Average (G.P.A.) to their overall nutritional health. Additional substantive data is needed to prove that overall intellectual health is closely linked to a person's diet, rather than a correlation fallacy.
Nutritional supplement treatment may be appropriate for major depression, bipolar disorder, schizophrenia, and obsessive compulsive disorder, the four most common mental disorders in developed countries. Supplements that have been studied most for mood elevation and stabilization include eicosapentaenoic acid and docosahexaenoic acid (each of which are an omega-3 fatty acid contained in fish oil, but not in flaxseed oil), vitamin B12, folic acid, and inositol.
Cancer has recently become common in developing countries. According a study by the International Agency for Research on Cancer, "In the developing world, cancers of the liver, stomach and esophagus were more common, often linked to consumption of carcinogenic preserved foods, such as smoked or salted food, and parasitic infections that attack organs." Lung cancer rates are rising rapidly in poorer nations because of increased use of tobacco. Developed countries "tended to have cancers linked to affluence or a 'Western lifestyle' — cancers of the colon, rectum, breast and prostate — that can be caused by obesity, lack of exercise, diet and age."
A comprehensive worldwide report, Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective, compiled by World Cancer Research Fund and American Institute for Cancer Research, reports that there is significant relation between lifestyle (including food consumption) and cancer prevention. The same report recommends eating mostly foods of plant origin and aiming to meet nutritional needs through diet alone, while limiting consumption of energy-dense foods, red meat, alcoholic drinks and salt and avoiding sugary drinks, processed meat and mouldy cereals (grains) or pulses (legumes).
Several lines of evidence indicate lifestyle-induced hyperinsulinemia and reduced insulin function (i.e. insulin resistance) as a decisive factor in many disease states. For example, hyperinsulinemia and insulin resistance are strongly linked to chronic inflammation, which in turn is strongly linked to a variety of adverse developments such as arterial microinjuries and clot formation (i.e. heart disease) and exaggerated cell division (i.e. cancer). Hyperinsulinemia and insulin resistance (the so-called metabolic syndrome) are characterized by a combination of abdominal obesity, elevated blood sugar, elevated blood pressure, elevated blood triglycerides, and reduced HDL cholesterol. The negative impact of hyperinsulinemia on prostaglandin PGE1/PGE2 balance may be significant.
The state of obesity clearly contributes to insulin resistance, which in turn can cause type 2 diabetes. Virtually all obese and most type 2 diabetic individuals have marked insulin resistance. Although the association between overweight and insulin resistance is clear, the exact (likely multifarious) causes of insulin resistance remain less clear. Importantly, it has been demonstrated that appropriate exercise, more regular food intake and reducing glycemic load (see below) all can reverse insulin resistance in overweight individuals (and thereby lower blood sugar levels in those who have type 2 diabetes).
Obesity can unfavourably alter hormonal and metabolic status via resistance to the hormone leptin, and a vicious cycle may occur in which insulin/leptin resistance and obesity aggravate one another. The vicious cycle is putatively fuelled by continuously high insulin/leptin stimulation and fat storage, as a result of high intake of strongly insulin/leptin stimulating foods and energy. Both insulin and leptin normally function as satiety signals to the hypothalamus in the brain; however, insulin/leptin resistance may reduce this signal and therefore allow continued overfeeding despite large body fat stores. In addition, reduced leptin signalling to the brain may reduce leptin's normal effect to maintain an appropriately high metabolic rate.
There is a debate about how and to what extent different dietary factors— such as intake of processed carbohydrates, total protein, fat, and carbohydrate intake, intake of saturated and trans fatty acids, and low intake of vitamins/minerals—contribute to the development of insulin and leptin resistance. In any case, analogous to the way modern man-made pollution may potentially overwhelm the environment's ability to maintain homeostasis, the recent explosive introduction of high glycemic index and processed foods into the human diet may potentially overwhelm the body's ability to maintain homeostasis and health (as evidenced by the metabolic syndrome epidemic).
Excess water intake, without replenishment of sodium and potassium salts, leads to hyponatremia, which can further lead to water intoxication at more dangerous levels. A well-publicized case occurred in 2007, when Jennifer Strange died while participating in a water-drinking contest. More usually, the condition occurs in long-distance endurance events (such as marathon or triathlon competition and training) and causes gradual mental dulling, headache, drowsiness, weakness, and confusion; extreme cases may result in coma, convulsions, and death. The primary damage comes from swelling of the brain, caused by increased osmosis as blood salinity decreases. Effective fluid replacement techniques include Water aid stations during running/cycling races, trainers providing water during team games such as Soccer and devices such as Camel Baks which can provide water for a person without making it too hard to drink the water.
Since the Industrial Revolution some two hundred years ago, the food processing industry has invented many technologies that both help keep foods fresh longer and alter the fresh state of food as they appear in nature. Cooling is the primary technology used to maintain freshness, whereas many more technologies have been invented to allow foods to last longer without becoming spoiled. These latter technologies include pasteurisation, autoclavation, drying, salting, and separation of various components, and all appear to alter the original nutritional contents of food. Pasteurisation and autoclavation (heating techniques) have no doubt improved the safety of many common foods, preventing epidemics of bacterial infection. But some of the (new) food processing technologies undoubtedly have downfalls as well.
Modern separation techniques such as milling, centrifugation, and pressing have enabled concentration of particular components of food, yielding flour, oils, juices and so on, and even separate fatty acids, amino acids, vitamins, and minerals. Inevitably, such large scale concentration changes the nutritional content of food, saving certain nutrients while removing others. Heating techniques may also reduce food's content of many heat-labile nutrients such as certain vitamins and phytochemicals, and possibly other yet to be discovered substances. Because of reduced nutritional value, processed foods are often 'enriched' or 'fortified' with some of the most critical nutrients (usually certain vitamins) that were lost during processing. Nonetheless, processed foods tend to have an inferior nutritional profile compared to whole, fresh foods, regarding content of both sugar and high GI starches, potassium/sodium, vitamins, fiber, and of intact, unoxidized (essential) fatty acids. In addition, processed foods often contain potentially harmful substances such as oxidized fats and trans fatty acids.
A dramatic example of the effect of food processing on a population's health is the history of epidemics of beri-beri in people subsisting on polished rice. Removing the outer layer of rice by polishing it removes with it the essential vitamin thiamine, causing beri-beri. Another example is the development of scurvy among infants in the late 19th century in the United States. It turned out that the vast majority of sufferers were being fed milk that had been heat-treated (as suggested by Pasteur) to control bacterial disease. Pasteurisation was effective against bacteria, but it destroyed the vitamin C.
As mentioned, lifestyle- and obesity-related diseases are becoming increasingly prevalent all around the world. There is little doubt that the increasingly widespread application of some modern food processing technologies has contributed to this development. The food processing industry is a major part of modern economy, and as such it is influential in political decisions (e.g. nutritional recommendations, agricultural subsidising). In any known profit-driven economy, health considerations are hardly a priority; effective production of cheap foods with a long shelf-life is more the trend. In general, whole, fresh foods have a relatively short shelf-life and are less profitable to produce and sell than are more processed foods. Thus the consumer is left with the choice between more expensive but nutritionally superior whole, fresh foods, and cheap, usually nutritionally inferior processed foods. Because processed foods are often cheaper, more convenient (in both purchasing, storage, and preparation), and more available, the consumption of nutritionally inferior foods has been increasing throughout the world along with many nutrition-related health complications.
Humans have evolved as omnivorous hunter-gatherers over the past 250,000 years. The diet of early modern humans varied significantly depending on location and climate. The diet in the tropics tended to be based more heavily on plant foods, while the diet at higher latitudes tended more towards animal products. Analysis of postcranial and cranial remains of humans and animals from the Neolithic, along with detailed bone modification studies have shown that cannibalism was also prevalent among prehistoric humans.
Agriculture developed about 10,000 years ago in multiple locations throughout the world, providing grains such as wheat, rice, maize, and potatoes, with staples such as bread, pasta, and tortillas. Farming also provided milk and dairy products, and sharply increased the availability of meats and the diversity of vegetables. The importance of food purity was recognized when bulk storage led to infestation and contamination risks. Cooking developed as an often ritualistic activity, due to efficiency and reliability concerns requiring adherence to strict recipes and procedures, and in response to demands for food purity and consistency.
From antiquity to 1900
Around 3000 BC the |Vedic texts| had mentions of scientific research on nutrition.
The first recorded nutritional experiment is found in the Bible's Book of Daniel. Daniel and his friends were captured by the king of Babylon during an invasion of Israel. Selected as court servants, they were to share in the king's fine foods and wine. But they objected, preferring vegetables (pulses) and water in accordance with their Jewish dietary restrictions. The king's chief steward reluctantly agreed to a trial. Daniel and his friends received their diet for 10 days and were then compared to the king's men. Appearing healthier, they were allowed to continue with their diet.
Around 475 BC, Anaxagoras stated that food is absorbed by the human body and therefore contained "homeomerics" (generative components), suggesting the existence of nutrients. Around 400 BC, Hippocrates said, "Let food be your medicine and medicine be your food."
In the 16th century, scientist and artist Leonardo da Vinci compared metabolism to a burning candle. In 1747, Dr. James Lind, a physician in the British navy, performed the first scientific nutrition experiment, discovering that lime juice saved sailors who had been at sea for years from scurvy, a deadly and painful bleeding disorder. The discovery was ignored for forty years, after which British sailors became known as "limeys." The essential vitamin C within lime juice would not be identified by scientists until the 1930s.
Around 1770, Antoine Lavoisier, the "Father of Nutrition and Chemistry" discovered the details of metabolism, demonstrating that the oxidation of food is the source of body heat. In 1790, George Fordyce recognized calcium as necessary for fowl survival. In the early 19th century, the elements carbon, nitrogen, hydrogen and oxygen were recognized as the primary components of food, and methods to measure their proportions were developed.
In 1816, François Magendie discovered that dogs fed only carbohydrates and fat lost their body protein and died in a few weeks, but dogs also fed protein survived, identifying protein as an essential dietary component. In 1840, Justus Liebig discovered the chemical makeup of carbohydrates (sugars), fats (fatty acids) and proteins (amino acids.) In the 1860s, Claude Bernard discovered that body fat can be synthesized from carbohydrate and protein, showing that the energy in blood glucose can be stored as fat or as glycogen.
In the early 1880s, Kanehiro Takaki observed that Japanese sailors (whose diets consisted almost entirely of white rice) developed beriberi (or endemic neuritis, a disease causing heart problems and paralysis) but British sailors and Japanese naval officers did not. Adding various types of vegetables and meats to the diets of Japanese sailors prevented the disease.
In 1896, Baumann observed iodine in thyroid glands. In 1897, Christiaan Eijkman worked with natives of Java, who also suffered from beriberi. Eijkman observed that chickens fed the native diet of white rice developed the symptoms of beriberi, but remained healthy when fed unprocessed brown rice with the outer bran intact. Eijkman cured the natives by feeding them brown rice, discovering that food can cure disease. Over two decades later, nutritionists learned that the outer rice bran contains vitamin B1, also known as thiamine.
From 1900 to the present
In the early 20th century, Carl Von Voit and Max Rubner independently measured caloric energy expenditure in different species of animals, applying principles of physics in nutrition. In 1906, Wilcock and Hopkins showed that the amino acid tryptophan was necessary for the survival of rats. He fed them a special mixture of food containing all the nutrients he believed were essential for survival, but the rats died. A second group of rats to which he also fed fed an amount of milk containing vitamins. Gowland Hopkins recognized "accessory food factors" other than calories, protein and minerals, as organic materials essential to health but which the body cannot synthesize. In 1907, Stephen M. Babcock and Edwin B. Hart conducted the single-grain experiment. This experiment runs through 1911.
In 1912, Casimir Funk coined the term vitamin, a vital factor in the diet, from the words "vital" and "amine," because these unknown substances preventing scurvy, beriberi, and pellagra, were thought then to be derived from ammonia. The vitamins were studied in the first half of the 20th century.
In 1913, Elmer McCollum discovered the first vitamins, fat soluble vitamin A, and water soluble vitamin B (in 1915; now known to be a complex of several water-soluble vitamins) and names vitamin C as the then-unknown substance preventing scurvy. Lafayette Mendel and Thomas Osborne also perform pioneering work on vitamin A and B. In 1919, Sir Edward Mellanby incorrectly identified rickets as a vitamin A deficiency, because he could cure it in dogs with cod liver oil. In 1922, McCollum destroyed the vitamin A in cod liver oil but finds it still cures rickets, naming vitamin D. Also in 1922, H.M. Evans and L.S. Bishop discover vitamin E as essential for rat pregnancy, originally calling it "food factor X" until 1925.
In 1925, Hart discovered that trace amounts of copper are necessary for iron absorption. In 1927, Adolf Otto Reinhold Windaus synthesized vitamin D, for which he won the Nobel Prize in Chemistry in 1928. In 1928, Albert Szent-Györgyi isolated ascorbic acid, and in 1932 proves that it is vitamin C by preventing scurvy. In 1935 he synthesizes it, and in 1937 he wins a Nobel Prize for his efforts. Szent-Györgyi concurrently elucidates much of the citric acid cycle.
In the 1930s, William Cumming Rose identified essential amino acids, necessary protein components which the body cannot synthesize. In 1935, Underwood and Marston independently discover the necessity of cobalt. In 1936, Eugene Floyd Dubois showed that work and school performance are related to caloric intake. In 1938, Erhard Fernholz discovered the chemical structure of vitamin E. It was synthesised by Paul Karrer.
In 1940, rationing in the United Kingdom during and after World War II took place according to nutritional principles drawn up by Elsie Widdowson and others. In 1941, the first Recommended Dietary Allowances (RDAs) were established by the National Research Council.
In 1992, The U.S. Department of Agriculture introduced the Food Guide Pyramid. In 2002, a Natural Justice study showed a relation between nutrition and violent behavior. In 2005, a study found that obesity may be caused by adenovirus in addition to bad nutrition.
- Food Balance Wheel
Dangers of poor nutrition
- Eating disorders
- Illnesses related to poor nutrition
- Diets (list)
- List of food additives
- List of illnesses related to poor nutrition
- List of life extension related topics
- List of publications in nutrition
- List of unrefined sweeteners
- List of antioxidants
- List of phytochemicals
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- ^ Heinemann 2e Biology Activity Manual by Judith Brotherton and Kate Mundie
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- ^ "Can a virus make you fat?" at BBC News; "Contagious obesity? Identifying the human adenoviruses that may make us fat" at Science Blog
- Diet, Nutrition and the prevention of chronic diseases by a Joint WHO/FAO Expert consultation (2003)
- United States Department of Agriculture (USDA) Frequently asked questions
- Nutrition Facts and Foods Source of Nutrients, based on USDA National Nutrient Database Release 21, Complete Nutrients Version
- Nutritional Status Assessment and Analysis - e-learning from FAO
- UN Standing Committee on Nutrition - In English, French and Portuguese
- Health-EU Portal Nutrition
Databases and search engines
- Nutrition Data
- Recipe Nutrition - extends USDA database with friendly names for common ingredients, recipe nutrition calculator and additional specialized ingredients
- German Nutrition Data with fast search on www.lexolino.de
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medicineHealth promotion • Family planning • Human nutrition • Hygiene (Hand washing • Food safety • Infection control • Oral hygiene) • Occupational safety and health (Occupational hygiene • Ergonomics • Injury prevention) • Patient safety (organization) • Pharmacovigilance • Safe sex • Sanitation (Community-led total sanitation • Sanitary sewer • Waterborne diseases • Water management) • Smoking cessation • Vaccination • Vector control
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organizationsWorld Health Organization • European (European Centre for Disease Prevention and Control • Committee on the Environment, Public Health and Food Safety) • India (Ministry of Health and Family Welfare) • U.S. (U.S. Public Health Service (Centers for Disease Control and Prevention) • Public Health - Center for Public Health Practice • Center for Minority Health • Council on Education for Public Health • Public Health – Seattle & King County) • World Toilet Organization • Globalization and Health
EducationHealth education • Bachelor of Science in Public Health • Master of Public Health • Doctor of Public Health • European Programme for Intervention Epidemiology Training (EPIET) • Professional Further Education in Clinical Pharmacy and Public Health History History of medicine Basic sciencesHistory of anatomy • History of biochemistry • History of biology • History of biotechnology • History of chemistry • History of embryology • History of genetics • History of immunology • History of medical diagnosis • History of microbiology • History of molecular biology • History of neuroscience • History of nutrition • History of pathology • History of pharmacology • History of physiology • History of viruses • History of virology Medical specialties Other topicsAncient Egyptian medicine • Ancient Greek medicine • Ancient Iranian Medicine • Black Death • Byzantine medicine • Egyptian medical papyri • History of psychiatric institutions • History of tracheal intubation • Humorism • Medicine in ancient Rome • Medicine in medieval Islam • Medieval medicine • Prehistoric medicine
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