Got Food? Recent Advances in Food Science and Technology docx

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Got Food?
Recent Advances in
Food Science and Technology








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An e-book co-authored by the Class of 2013
Massachusetts Academy of Math and Science
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Chapter 1 Diet and Nutrition 3
Ann Ming Samborski, Amanda Stevens, and Ingrid Marko

Chapter 2 Vitamins and Minerals 19
Barry Biletch, John deRivera, and Aniket Lachyankar

Chapter 3 Food Supplements 31
Patrick Aoude, Julia Knowles, and Derek Wegener

Chapter 4 Diet and Diabetes 44

Nora Murphy and Jay McCowan

Chapter 5 Diet and Heart Disease 55
Arjun Tanguturi and Rebecca Stolarczyk

Chapter 6 Vegetarian and Vegan Diets 62
Dhroova Aiylam and Cameron Root

Chapter 7 Childhood Obesity 70
Emma Hewett, Sierra Harris, Angelica Heeney, and Divya Satishchandra

Chapter 8 Global Food System 82
Ryan Thibodeau., Thomas Devlin, and Abigail Yu

Chapter 9 Green Revolution 94
Michael Andrews, Alexander Lee, and Sahit Mandala

Chapter 10 Food Preservation 105
Adam Carrier, Tony Trakadas, and Katherine McDonough

Chapter 11 GMO Crops 116
Rachel Maillet, Anish Athalye, George Han, and Osi Van Dessel

Chapter 12 Sustainability and Food 130
Dennis Giaya, Eric Williams, and Rohit Satishchandra

Chapter 13 Agriculture, Irrigation, Fertilization, and Pesticides 140
Ryan Fletcher and Aaron Hammond

Chapter 14 Food Additives 148

Naveena Shanmugam, Jacob Grotton, Daniel Huang, and Jeeva Jacob

Chapter 15 Cooking in Developing Countries 164
John Dymek, Deidre DiLiddo, and Mark Guertin

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Chapter 1
Diet and Nutrition
Ingrid Marko, Ann Ming Samborski, and Amanda Stevens

Diet
Societal values intimidate individuals to obtain the ideal physique. Often in order to achieve this, a
healthy lifestyle must be implemented. Unfortunately, such a simple solution is often taken to the
extreme. In fact, there are numerous diet plans on the market that may become a detriment to the lives of
many. Moreover, a sustainable way of life is without a doubt beneficial, but it is important to keep matters
in perspective.
The ever-changing rules of what defines a ―good diet‖ confuse people to the point that they are
uncertain of what foods to consume. There are so many different meal plans in existence that it is almost
impossible to decide on which one to follow. Yet, with the technology and knowledge of today, it should
be relatively easy for nutritionists to plan out a healthy meal. For instance, Dr. Oz (2011) writes that in
order to be healthy, people must abstain from diet soda and low fat foods because the present processed
sugars are the main contributors to an overweight population. Ultimately, the individual is the greatest
influence because each body works differently due to the dissimilarity among DNA. In fact, protein,
carbohydrates, and lipids satisfy the body enough that it may not require the remaining components to
sustain a healthy state (Liao, 2012).
When it comes to nutrients, the body regulates a certain amount that it needs each day. Skipping
any of these will result in over-consumption of another, which then leads to an unhealthy diet (Liao,
2012). Important substances to consume daily are eggs, nuts, lipids, and similar foods. Even drinking
whole milk and wine are a necessity according to Dr. Oz. It is overindulgence that leads to obesity.

Fats have unfortunately obtained a social stigma; however, in the correct amount, lipids are
actually beneficial to an individual‘s health. Monounsaturated fats, such as canola and olive oil, and
polyunsaturated fats, such as omega-3, have great health benefits. They can reduce the risk of developing
atherosclerosis, heart disease, and inflammation. However, trans fat does in fact cause complications if
consumed too frequently.
In moderation, sodium is a vital part of a good diet. The human heart cannot function without it,
and yet, too much will increase blood pressure (Oz, 2011). An increasing problem with salty foods is that
the sodium (Na) binds to certain elements found in processed food and causes a reaction that leads to a
stimulated appetite, meaning individuals consume more than what is necessary.
Ingesting antioxidants can help increase human health because it can result in rejuvenated skin and
lower dementia and resistance to Parkinson‘s disease and Type 2 diabetes (Oz, 2011). Good sources of
food to induce this prevention are dark chocolate, wine, and coffee.
Nutrigenomics have been linked to how the individual processes food. Certain aspects of the DNA
and the genes present in some people change how food is digested and how it affects the body. Another
important factor to staying healthy is exercise. Dr. Oz claims that there should be a balance between diet
and exercise; in fact, calories consumed must equal calories burned to maintain a perfectly healthy body.
If that scale is tipped so that there is an unequal balance, then the result will either be weight loss or
weight gain. Because the human brain is always looking for nutrients, not calories, eating a moderate
amount from every food group is essential. It is vital to eat in moderation, to ingest a certain amount of
fruits and vegetables, and to exercise (Oz, 2011).
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Nutrition

The most current food pyramid gives a detailed
account of what foods should be consumed.

The body uses nutrients for growth, maintenance, and energy (Wilson, 2007). Carbohydrates
yield the energy that the body requires. Sucrose and glucose are simple carbohydrates, while fiber and
starches are complex ones. Foods such as whole wheat bread, pasta, and rice contain primarily

carbohydrates. Unfortunately, it is easy to overindulge in these foods, but an effective way to avoid this
unhealthy habit is to eat until satisfied, not full.
Another key nutrient is protein because it stimulates growth, repairs cells, and maintains tissue.
These are extremely important for athletes who often induce stress on the bones and muscles. The
proteins are broken down into amino acids and peptides. Because they are so important for the function of
the body, protein levels can become dangerously low if there is an inadequate intake of carbohydrates or
fats. The body often uses protein as a substitute for missing nutrients to produce energy, but a low level of
any nutrient will lead to weakness and disease (Wilson, 2007).
Lipids, another source of energy, help maintain body temperature and are required for tissue
growth and hormone production. Too much of this group will lead to weight gain, as with any other
nutrient. In moderation, everything allows the body to function properly.
Vitamins help the immune system fight infection and regulate bodily functions. Minerals are
similar to vitamins because they aid the daily functions of the body. Water dissolves and carries nutrients;
it is not enough to consume nutrients alone because water is needed for transportation to every part of the
body. When all nutrients are present, their functions weave together in a seamless harmony.



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Economic Uncertainty
It is simply not enough to have a beneficial meal plan if one does not have the means to purchase
the food. Of course those with money have a clear advantage over the lower classes. In general, people
can afford what is required.
Food availability and resulting levels of consumption have increased throughout the years. The
food supply showed that the average American was consuming 3,800 calories per day in 2000; the highest
rate so far (USDA, 2001). The increase in calories directly means that there was a weight gain among the
people. Over 62 percent of the population was considered to be overweight; an increase of 46 percent
since 1980. These shocking statistics are a result of supply and demand, the availability of food. Other
than the calorie intake, another cause of weight gain is lack of exercise

Increase in calories and food intake between 1983 and 2000.
Food expenditures have risen in 2001 to $844.1 billion, a 3.8% increase then the 2001 counterpart
(USDA, 2001). This rise was a result of a 5.5% income expansion from 2000. The cost of processing,
transporting, and distribution from American farms rose to $121 billion. This only represents 20% of the
total food expenses (USDA, 2001).

What a dollar spent for food in 2000.

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Even given the strict diets followed by many consumers, America is on the path to having the
most obese population. The access Americans have to a sustainable food supply should result in a healthy
population. Yet, the opposite is true. Other countries in the world have people that struggle to survive on
what little food they can get. Diseases and malnutrition have spread around the globe due to a lacking
food supply in other countries.
The main problem with access is the need to spend immense amounts of money. Currently here is
national debt, and promoting a healthy diet is often ignored. The FDA is in charge of doing everything
food and drug oriented. Dr. McClellan, a business man and doctor of economics, introduced the idea of
efficient risk management where the FDA would only do things that have the most impact on society,
because it cannot complete every single task available (―Business: Food, drugs and economics; face
value‖ 2003). Challenges include how to inspect imports and medicine. These have to be completed, but
everything has a cost. The amount of money the FDA can spend is limited. After the most important task
has been accounted for, the nutritional problem can be assessed. Focusing on one aspect at a time will
yield better results.
Disease-Preventing Diets
Nutrition is a vital component of a healthy lifestyle, and many people forget how important it
actually is. An unhealthy diet can lower a person‘s life expectancy by decades, while a healthy diet can
extend a person‘s life above the average life expectancy. This in mind, it is crucial that people recognize

the nutrients that they are consuming and maintain a diet that will benefit their bodies.

Low-Carbohydrate Diets
People who have a low intake of carbohydrates are usually slimmer and have less fat. Some foods
containing this nutrient that are usually avoided and maintain body weight are white potatoes, rice, pasta,
and bread. Foods that are high in carbohydrates compel blood sugar levels to rise and, in result, insulin
levels as well. Eating foods that are composed of mainly carbohydrates leads to increased hunger levels,
and the best low-carb diets comprise a variety of whole foods. Although, crushed or refined fruits, beans,
vegetables, or whole grains are healthier than most foods, they have higher Glycemic Load (GL) levels.
Whole foods, such as All-Bran and Cornflakes have low GL‘s. A low-carb diet should also include foods
with healthy fats and protein (University of Maryland Medical Center, 2007)
Besides reducing fat in the body, a diet low in carbohydrates can improve sleep disorders and the
function of blood vessels. People who suffer from sleep apnea can benefit from this type of diet. Sleep
apnea is a disorder that is a result of abnormal pauses in breathing or swallowing while sleeping, and it is
a leading cause in daytime fatigue This disorder is more common in people who are overweight and
several researchers, from the Karolinska Institute, ran experiments which proved that low-carb diets have
a positive effect on sleep apnea (―Diet and sleep apnea‖, 2011.). In a similar way, a diet that is low in
carbohydrates improves blood vessel function by reducing fat, according to a study completed by Johns
Hopkins researchers. Loss of stomach fat allowed arteries to expand and helped the blood flow more
freely. Several overweight participants helped the researchers refine their idea that low-carb diets that
helped burn fat improved the overall health of the patient‘s vascular systems (―Improve blood vessel
function‖,2012).
Heart-Healthy Diets
Not only are fish tasty, but they are also important in lowering cholesterol levels. Oily fish such as
salmon, sardines, tuna, mackerel, and trout have omega-3 fatty acids that are very beneficial, unlike
saturated fats. Because of remarkable evidence from several studies on the subject, The Food and Drug
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Administration announced that Omega-3 fatty acids lower triglycerides and slow down plaque growth in
the bloodstream, as well as reduce inflammation. Although fish are relatively high in calories, eating

reasonable amounts will benefit the health. A four-ounce serving of salmon provides 83% of the omega-3
acids a person needs a day (Griffin, 2005a).
A diet with oatmeal and oat bran also benefits the heart. These two foods contain soluble fiber,
which brings down low-density lipoprotein (LDL) cholesterol levels without reducing high-density
lipoprotein (HDL). The fiber helps absorb cholesterol in the intestines and releases it as waste instead
placing it into the arteries. Research published in 2005 the American Journal of Clinical Nutrition
suggests that a diet with oatmeal lowered cholesterol levels almost as much as cholesterol drugs.
Approximately five to ten grams of soluble fiber added to a person‘s diet can increase the strength of his
or her heart (Griffin, 2005b)
Diets containing soy and tofu also assist the heart by lowering blood pressure levels. An
important compound that lowers blood pressure, isoflavone, is present in soymilk, tofu, green tea, and
peanuts. Isoflavones increase the production of enzymes, nitric oxide (NO) that dilates the blood vessels.
The increased amount of NO reduces pressure from blood against the vessel walls. A medical student at
Columbia University, Safiya Richardson, completed research that suggests systolic blood pressure levels
in people with pre-hypertension could decrease as much as 10 mmHg with a diet of soy protein and other
healthy foods. This type of diet could reduce their chances of advancing to hypertension (―Soy reduces
blood pressure‖, 2012).


Components of a diet that strengthen the heart.

Fruits and Vegetables
Although it is important to keep a balanced diet containing each component of nutrition, eating
fruits and vegetables seems to provide the most superior benefits. Consuming an adequate amount of
these foods can prevent certain diseases, according to the United States Department of Health and Human
Services‘ Healthy People 2010 objectives. Fruits and vegetables fill important dietary needs and provide
protection against chronic diseases such as hypertension, certain cancers, and Type Two Diabetes (―Eat
your fruits and vegetables‖, 2011). Research completed by Paolo Boffetta and his colleagues suggests that
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eating proper amounts of these foods can slightly reduce the overall risk of cancer. Boffetta showed that
there was a small inverse between eating many fruits and vegetables and reduced cancer risk, and several
other studies supported this discovery. While vegetables and fruits may have some ability to prevent
cancer, other unhealthy lifestyle choices, such as smoking, can nullify the benefits that a healthy diet
provides (―Cancer protective effects‖, 2010).

Unhealthy Diets
Certain diets can improve health, while other diets cause negative effects. Some factors that cause
disease are out of a person‘s control, such as genetics, but eating well can provide your body with the
proper nutrients to prevent diseases. A diet low in nutrients is not able to protect the body against viruses
that lead to chronic diseases such as the common cold or the influenza. An unhealthy diet is a large factor
in obesity, disease, and decreased life expectancy (McLaughlin, 2011).

Negative Effects of Red Meat
A diet composed of red meat can have lasting negative effects. According to Nicholas Bakalar in
the New York Times, there is a link between red meat and mortality. Research conducted on 121,342 men
and women yielded interesting results; 5,910 people in the group died of cardiovascular disease and 9,464
people died from cancer. Accounting for the people who lived sedentary or dangerous lifestyle, the
researchers still found that a daily increase of three ounces of red meat was connected to a 12 percent
greater risk of dying, a 16 percent increased risk of cardiovascular death, and a 10 percent greater risk of
cancer-related death. Scientists deduced that if the patients had lowered their red meat consumption by a
half, mortality rates would have decreased 9.3 percent in men and 7.6 percent in women. These results
strongly suggest that consuming red meat is not only unhealthy, but can be deadly (Bakalar, 2012).
Another peril of having a diet with too much red meat is that it can increase chances of contracting gout, a
severely painful type of arthritis that causes joint inflammation. Frank Bruni, who is a meat-lover and a
frequent diner, once had a diet that included a surplus of red meat and alcohol. After being diagnosed with
gout, he had to quit eating most red meat and organ meat to avoid the excruciating burning and stabbing
feelings caused by the disease (Bruni, 2012).

White Rice

Research at the Harvard School of Public Health was conducted to determine the connection
between intakes of white rice and Type Two Diabetes. White rice is consumed worldwide and has a high
glycemic index (GI). Increased GI diets are known to heighten chances of becoming diabetic. The
participants of the study were taken from Asian countries, whose population consumes up to 4 servings of
white rice per day, and Western countries whose population eats much smaller amounts of white rice.
None of the participants were diabetic at the beginning of each study. With each additional serving of
rice, the study conducted separately on Asian and Western countries revealed that there is a 10 percent
higher risk of developing Type Two Diabetes. This research suggests that people in certain Asian
countries who eat a large amount of rice will have a higher risk of this type of diabetes (―Diabetes and
white rice‖, 2012).

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An example of nutritional information
printed on a box containing white rice.


Soft Drinks
Certain beverages also have the ability to affect a person‘s health in a detrimental way. Research
on soft drinks suggests that drinking too much can lead to vascular diseases or gout. Hannah Gardener
and her colleagues discovered that diet soft drinks were less healthy than regular ones. Her group studied
2,564 participants by inquiring how many soft drinks, diet and regular, that the people consumed and the
number of vascular problems that they had over a ten year time period. The study yielded surprising
information: people who drank diet soft drinks every day were 43 percent more likely to have a vascular
problem than people who drank none or people who chose regular soft drinks (―Soft drinks and vascular
disease‖, 2012). Research on regular soft drinks that are high in fructose suggests that frequent
consumption leads to an increased risk of gout in men. A study published in the British Medical Journal
investigates men 40 years or older with no previous history of gout. They were assessed on the amount of
regular soft drinks, diet soft drinks, and other fruit drinks high in fructose that they consumed over 12

years. Other health factors were analyzed and after the 12 year period the researchers found that, in the
group of men, 755 cases of gout arose. Among the men, there was an 85 percent increased risk of gout in
men who consumed five to six servings of soda per week. Both of these studies display the effects of
consuming any type of soft drink or drink high in fructose; the results are not desirable (―Sugary soft
drinks and gout‖, 2008).

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Soft drinks are a hazard to good health.

Effect of Diet on Epigenetic Expression
In addition to affecting a person‘s own health, certain nutrition habits have the ability to influence
future generations. Environmental factors, such as diet, are able to alter DNA through epigenetic
markings. These marks reform the ways in which genes are expressed without changing the DNA
sequence permanently by adding or subtracting methyl groups. S-Adenosyl methionine, folic acid, and B
vitamins are well-known nutrients that enter metabolic pathways, and when these nutrients are regularly
consumed, gene expression can easily be altered. The foods that people include in their diets have the
capability to affect their epigenetic expressions either negatively or positively, and in response, these
altered genes are passed on to the offspring (―Nutrition and the epigenome‖, 1969).
Chemicals and additives also have the ability to affect epigenetic marks. Bisphenol A (BPA),
which is a compound in the polycarbonate plastic used in water bottles, causes negative health effects in
offspring. Epigenetic research showed that when pregnant yellow mice were given BPA, some of the
mice gave birth to yellow, unhealthy mice. When the yellow mice that were fed BPA were given a diet
rich in methyl foods, the majority of their offspring were healthy and brown; they seemed to counter the
detrimental effects of the BPA exposure (―Nutrition and the epigenome‖, 1969).
A woman‘s nutrition during pregnancy has a large impact on her children, but a man can also
influence his offspring‘s health. Research by a preventive-health specialist, Dr. Bygren, aimed to discover
how the switch in the amount of food available affected the offspring of that particular generation in both
men and women. This research yielded intriguing information. The results revealed that boys who

switched from famine to feasting in a single season later fathered children and grandchildren whose life
spans were decreased from those who had not overeaten. Further research suggested that changing
nutrition also affected women‘s offspring in the same way (Cloud, 2012).
Knowledge of epigenetics has given scientists many new ideas on how to prevent and treat
diseases and genetic disorders. A study published in the journal Clinical Epigenetics suggests that
vegetables are made up of compounds that might have the ability to prevent and protect people from
diseases such as cancer. The scientists leading the investigation say that this so-called epigenetic diet
includes cauliflower, broccoli, cabbage, soybeans, kale, green tea, fava beans, thenspice turmeric, and
grapes. When mothers tell children to eat their vegetables, they‘re protecting them from fatal diseases.
The compounds in the vegetables that make up an epigenetic diet suppress gene abnormalities that cause
horrible diseases such as cancer and Alzheimer‘s (Blanchard, 2012).

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Malnutrition and Disease
A growing problem with natural disasters and tyrannical rulers has led to a renewed interest in
malnutrition. By its roots, the condition implies a state of poor nourishment (Jackson, 2008). According to
John Saunders and his colleagues, ―the term malnutrition is used to describe a deficiency, excess, or
imbalance of a wide range of nutrients, resulting in measurable adverse effects on body composition,
function, and clinical outcome‖ (Saunders, Smith, & Stroud, 2011). Several recent polls have shown that
approximately one in three people is suffering from malnutrition. In fact, half of the adolescent deaths in
underdeveloped countries are attributed to insufficient nourishment (Jackson, 2008). Malnutrition impacts
the lives of approximately 3.5 million mothers and children, the elderly population, and those with
chronic diseases. It is a common assumption that malnutrition acts as a harbinger of oncoming death;
however, it can also cause life-long effects such as growth stunting. This phenomenon actually affects
roughly 178 million children worldwide (Saunders, Smith, & Stroud, 2011).
The condition is mainly caused by an inadequate diet, difficulty or inability to absorb consumed
nutrients, or particular medical conditions. This is actually a secondary effect of a primary cause, namely
civil circumstance, natural disaster, impoverished conditions (NY Times
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, 2011), alcoholism, or addiction
(Saunders et al., 2011). Other groups that are likely to develop a state of malnutrition are young children,
pregnant women, those with diseases such as cystic fibrosis and liver disease, those taking appetite
reducing medicine, and those living in low-income housing (Malnutrition, 2011). Additionally, the rise of
malnutrition because of any circumstance is a risk factor for other diseases (Cathleen Samborski, personal
communication, April 7, 2012). In fact, the prime contributor for this condition, in relation to disease, is
neglecting to consume enough calories and nutrients (Saunders et al. 2011).


Malnutrition results from multiple health problems.

As the body begins to deteriorate because of malnutrition, fat, muscle, and organ mass
also depart. This visible change, technically referred to as cachexia, is often not observed in obese
patients because they appear to be healthy rather than malnourished. Nevertheless, if the correct amount
of nutrients is not being consumed, the body will suffer in numerous ways (Saunders et al. 2011).
Common symptoms of malnutrition include irritability, stunt in growth, rapid loss of weight, pain in
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muscles and joints, abnormally colored hair and skin, broken nails, and loss of hair (Malnutrition, 2011).
From an internal view, the muscle function will often deteriorate at a faster rate than the actual muscle
mass. Also, when calcium, magnesium, and vitamin D intake levels decrease, the bones become fragile
and are difficult to strengthen.
Without a proper diet, the digestive tract has difficulty performing its normal functions. Organs
such as the pancreas and intestines suffer, and often processes such as the pancreatic exocrine function or
the intestinal permeability begin to break down. Enzymes used to digest consumed food are less
abundant, and this can even result in secondary lactose intolerance on certain occasions. In addition,
diarrhea is a leading cause in loss of water and electrolytes, which can result in death in severe cases.
The immune response becomes less effective early in a state of malnutrition. This causes the
individual to be highly susceptible to infection especially respiratory tract viruses and bacteria and/or
parasites. Oftentimes, the common symptoms of these pathogens (such as fever) do not occur because of

the suppressed immune system. Also, wounds, particularly those caused by surgery, can take longer to
heal than a normally functioning defense system.

Effects of malnutrition affect every part of the body;
even psychological effects can occur.

The endocrine complex fights to help the body preserve and use what nutrients it has. This leads
to reduced levels of hormones because the materials needed to manufacture them are no longer present.
Hormones begin to disappear from the body, and sometimes, when production of insulin becomes
severely stunted, a form of diabetes can occur.

When the body is forced into pure starvation, with absolutely no sustenance, the membranes that
transport sodium and potassium (which are dependent on energy metabolized by the body) stop
functioning. In a circumstance where nourishment is occasionally ingested, this process takes more time
to occur; however, in the meantime, other bodily functions and processes cease to operate in an attempt to
allow the body to remain alive. It is important to note that after an individual has been without proper
nutrients for an extended period of time or the condition has become severe in a short time span,
providing the afflicted with a balanced diet is complicated. The new amount of food must be introduced
in a meticulous manner because too much can have a negative effect on the overall patient‘s health, even
if it is what he or she technically requires (Saunders et al. 2011).
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Malnutrition Globally
Although a great deal of the world is modern, there still remain large portions that are developing.
In addition, some populations are affected by malnutrition because they must flee their native countries.
For example, poor nutrition has been widely noted in the incoming population of refugee children. It is a
great relief that within 4 to 6 months of arriving in the U.S.A., the children have usually reached normal
weight and growth rate. However, an adverse affect to the dramatic change in culture often results in
obesity. Populations that arrive from low socioeconomic backgrounds tend to experience obesity within a
few months of arriving in the U.S. This is most prevalent in families from Latin America, Central Eastern

Europe, the Caribbean, the Middle East, Northern Africa, Sub-Saharan Africa, and the once-lively Soviet
Union. The condition is common in both adults and children. This new phenomenon is mainly attributed
to the length of stay in the country, different cultures, original cultural beliefs, and low quality of housing.
This new population is now at risk for both malnutrition that affects overall growth and for obesity that
can cause further health problems such as diabetes. Deficiency in vitamin B12, folate, and vitamin A may
also contribute to iron deficiency (Center for Disease Control and Prevention, 2011).
Also, certain situations involving malnutrition occur because of political circumstance. For
instance, a sole leader has ruled North Korea for decades. This form of government has not resulted
favorably for majority of the population; one in three children in North Korea suffers from malnutrition.
Food is hard to obtain because the state stores are not properly stocked, and the remainder of goods is sold
in private markets. In addition, the price of food is drastically inflated so many cannot afford what they
can find (NY Times
1
, 2012). Similarly, Haiti suffers from severe economical and political stress. In fact,
riots occurred earlier in the year because of the inflated food and fuel prices (Klarreich, 2008). Another
instance, Niger, an African country bordering the Sahara desert, is globally one of the poorest territories.
Due to civil unrest, it is not uncommon to find malnourished children in rural areas as well as settled
cities (NY Times
3
, 2010).
In addition, overpopulation plays a large role in the high percentage of malnourished people. Not
only are certain countries struggling to feed its entire people, but also, it is the sudden rise in population
that causes the country distress. According to the latest Global Hunger Index, the levels of hunger in India
have increased over the past two decades. Out of the entire population, 42% of Indian children (who are
five and under) are underweight (NY Times
2
, 2012). Also, approximately 30% of Pakistani children are
malnourished, and 40% have been stunted in their growth; this, in turn, affects their future ability to learn
(Jilani, 2012). One of the most prominent problems currently is the overpopulation of refugee camps,
particularly in Kenya. One of the most severe cases, Dabaad refugee complex contains four times as many

occupants as it was originally intended to hold. Numerous children are malnourished, and since January,
the numbers have risen from 20 malnourished children to more than 130. This affliction accounts for 30%
of all children located in the outskirts of the camp. Children as old as ten are malnourished, which is
incredibly rare. It is this phenomenon that truly displays the severity of the crisis in Kenya (Loewenberg
& Dadaab, 2011).
In short, many of these populations that suffer from malnutrition die because of diarrhea,
pneumonia, or preventable diseases (NY Times
4
, 2011). This can easily be remedied by providing
sufficient diet so that inability to absorb consumed nutrients may be avoided. However, civil
circumstance, natural disasters, and poverty contribute to the worldwide condition of poverty that is
prominent in every nation.



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Diseases Caused as a Result of Malnutrition
As malnutrition becomes widespread across an area, multiple diseases become prominent shortly
after. Without the correct amount of nutrients, conditions develop because of a lack of vitamins, minerals,
and/or amino acids. Malnutrition causes myriad physical detriments; however, the onslaught of disease
results in further complications to the human body.

Vitamin Deficiencies
Vitamin D deficiency is found in all areas of the world. This condition can lead to further damage
such as rickets and osteoporosis. According to Saunders et al. (2011), ―the etiology of vitamin D
deficiency is multifactorial and heavily dependent on non-dietary determinants such as limited sun
exposure (protective or religious clothing, moving to temperate climates, and the tradition of keeping
infants indoors), increased skin pigmentation, reduced in-utero exposure, and reduced capacity to
synthesize vitamin D with increasing age.‖ Those with dark skin, pregnant or nursing women, those

living in mild climates, the elderly, and those with conditions such as celiac disease are particularly at risk
(Saunders et al. 2011).
Rickets is caused by poor diet and lack of fresh air and sunshine. The main cause is a deficiency
in Vitamin D, calcium, or phosphorus. Without enough of these minerals in the blood, the body removes
stored minerals from the bone. This, in turn, weakens bone structure. Common symptoms are skeletal
deformities such as bowed legs, bent spin, pelvic deformities, fragile bones, stunted growth, bone pain,
and muscle fatigue. Children usually stop growing, and adults develop osteoporosis. Rickets is still found
in the US. In fact, it seems to be reappearing in many areas. In October 2008, American Academy of
Pediatrics doubled the recommended amount of vitamin D for infants and children. It can be produced
when in direct sunlight; however, it can also be obtained through fish, milk, fortified cereal, and eggs
(Jackson, 2008).
Vitamin A deficiency is not commonly seen in developed countries but is relatively common in
refugee populations. It is the primary cause for blindness in children and approximately 500,000 lose their
sight annually. Vitamin A deficiency creates a myriad of visual changes that can include loss of night
vision, Bitot spots, which according to Saunders, Smith, and Stroud (2011), are ―areas of abnormal
squamous cell proliferation and keratinization of the conjunctiva, xerophthalmia, keratomalacia, corneal
perforation, and permanent blindness.‖ It also retards bone growth as well as produces dry skin, fragile
hair, and weakened humoral and cell-mediated immune response.
Deficiency in Vitamin B12 occurs when animal products cease to be consumed in addition to
inability to absorb the nutrient (i.e. intrinsic factor deficiency) and malabsorption (which may be called by
the presence of Helicobacter pylori). Fatigue, unproductivity, memory loss, irritability, and depression are
often symptoms that are not recognized as official but are associated with it. Essentially, this deficiency
affects neurological functions. Other symptoms include weakness, numb extremities, inability to smell,
imbalance, and in the most severe instances, degeneration of the spinal cord.
Vitamin C or ascorbic acid deficiency occurs in individuals with malnutrition, alcoholism, or
diets that exclude fruits and vegetables. The symptom is also known as scurvy and results in stunted
collagen synthesis. Ecchymoses, petechiae, bleeding gums, hyperkeratosis, and difficulty in healing
wounds may occur as well as fatigue, malaise, pain in the joints, edema, anxiety, and neuropathy.
Thiamine (vitamin B1) assists in energy metabolism and assembling tissues. Deficiency occurs
from lack of intake (such a excessive consumption of milled rice), sudden difference in metabolism

(fever, pregnancy, liver disease, hyperthyroidism), severe diarrhea, or ingestion of food with anti-
15

thiamine compounds. Deficiency can result in beriberi (Saunders et al. 2011). The condition originated
because a vitamin B1 was missing from processed rice, and therefore, whole populations were not
receiving the proper dosages. Thiamine is located in the outer layer of rice, which is often removed for
products such as white rice as opposed to brown rice. Also, foods such as tea and fish contain chemicals
that render the thiamine useless to the body (Jackson, 2008). Symptoms include no appetite, constipation,
tiredness, anger, amnesia, peripheral neuropathy, weakness, areflexia, foot drop, tachycardia, and heart
failure. However, there are multiple types of this disease (Saunders et al., 2011). Wet beriberi is caused by
the lack of thiamine in the body (Jackson, 2008) and often leads to cardiac failure (Saunders, Smith, &
Stroud, 2011). Common symptoms of Wet beriberi are swelling of the lower leg, fast heart rate,
congestive heart failure, engorged heart, and shortness of breath (Jackson, 2008). Dry beriberi affects the
multifocal peripheral/nervous system and is caused by the inability of the body to absorb the nutrient
(Saunders et al. 2011). Dry beriberi displays tingling of limbs, lack of feeling in hands and feet, vomiting,
unnatural eye movement, disorientation, coma, and possibly death (Jackson, 2008). More severe cases
occasionally become better diagnosed as Wernicke encephalopathy and Korsakoff syndrome (Saunders et
al., 2011). Wernicke-Korasakoff is commonly seen in Europe; it is another form of beriberi and displays
itself via irritability, confusion, and amnesia. The condition can be easily remedied if a person is given
thiamine via injection or orally within a reasonable amount of time (Jackson, 2008).
Pellagra is a deficiency in niacin or Vitamin B3. This was first observed in 1735 in Spain when a
physician noticed symptoms in peasants eating a heavy corn diet. However, Latin America appears to
have avoided this condition because the tortillas were allowed to soak in lime juice before they were
cooked. The citrus released the niacin that is normally not accessible to the human digestive acids.
Pellagra was discovered to result directly from the lack of niacin or vitamin B1 and even the amino acid
tryptophan. If the body receives enough tryptophan, it can generate niacin. The chemical is used in the
body to release energy from carbs, fats, and proteins. It is also used to make nucleic acids in RNA and
DNA. Symptoms involve diarrhea, dermatitis, and dementia. In the West, this is rarely seen except for
alcoholics because of their tendency to neglect nutrition. India suffers from this especially because
sorghum is consumed as a staple crop. The product contains the amino acid leucine, which interferes with

niacin absorption. This disease is rarely seen in most developed countries because grain is fortified. It
does, however, occur in emergencies such as natural disasters or civil war. Niacin is hard to access by the
body, but if the grain is soaked in alkali, then it is capable of being absorbed. Meat, poultry, yeast, fish,
grain, flour, peanuts, lentils, milk, greens, and coffee/tea contain this vitamin (Jackson, 2008).

Mineral Deficiencies
Iron deficiency is most prevalent in children. This mainly affects infants and toddlers, but
women of childbearing age are also at risk. Iron deficiency anemia occurs from a lack of dietary iron. The
lack of ingestion of meat or frequent ingestion of tannins or phytates causes internal problems that results
in intestinal parasites, hemoglobinopathies, and chronic infections. Lack of iron can lead to stunted
psychomotor abilities in infants and cognitive impairment in youth. Adults who are affected become
fatigued, unproductive, and may lose the ability to reproduce. Severe anemia is categorized once the Hb
level falls below 80.0 g/L.
Iodine deficiency affects approximately 2 billion individuals. It is the greatest cause of thyroid
disease and is found in soil and seafood. It regulates the metabolic process of the body. If Iodine is not
ingested, physical and mental growth can stop. Hypothyroidism, goiter, and other conditions can also
occur. By iodizing salt, this deficiency has drastically dropped, but extremely high amounts of iodine
have been found in refugee populations. This can cause IIH (iodine-induced hyperthyroidism), which
mainly occurs in females over the age of 40 after introduction to iodized salt. The body is so accustomed
to lacking levels that the sudden surge causes further complications.
16

Zinc deficiency is most common in areas where plants are a staple to the diet. Zinc catalyzes
more than 100 enzymes and helps fetus development during pregnancy and growth throughout
adolescence. Stunted growth, lacking appetite, and weakened immune system are all symptoms of the
condition. Hair loss, loose stools, stunted sexual maturation, infertility, hypogonadism, weight-loss, slow-
healing wounds, skin and eye lesions, difficulty tasting, and fatigue are all more severe symptoms
(Saunders, Smith, & Stroud, 2011).

Amino Acid Deficiencies

Pellagra is a deficiency in niacin or tryptophan. It is usually accompanied by a lack of amino
acids and micronutrients. The condition may occur because of severe diarrhea, cirrhosis, or alcoholism.
High-leucine diets are normally seen in cases of Pellagra. Symptoms include photosensitive dermatitis
(i.e. Casal‘s necklace or face rash) in addition to diarrhea, stomatitis, and neurological abnormalities. In
children, symptoms differ and may appear as anorexia, irritability, anxiousness, and apathy.

General Diseases Caused by Malnutrition
Micronutrient deficiencies are also observed due to scarce resources. Rare deficiencies are
commonly seen because of the rapid change in diet that these individuals go through during a stay in
refugee camps, etc. (Saunders et al., 2011).
PEM (protein-energy malnutrition) or protein-calorie nutrition is a deficiency in macronutrients,
proteins, and carbohydrates. Another form of the deficiency, known as Kwashiorkor, refers to a lack of
protein but a sufficient calorie intake. Marasmus is the lack of calories in addition to protein. The liver
becomes enlarged, which makes the individual appear to be gaining weight. Symptoms include edema,
swollen stomach, enlarged liver, peeling, white skin, and reddish pigmentation of the hair. These
symptoms also result in fatigue, apathy, and irritability. This condition occasionally accompanies AIDS
or other traumas. It is most seen in undeveloped countries that suffer from natural disaster or lack of
resources. Majority of the cases are found in Asia, Africa, Latin America, and the Caribbean (Jackson,
2008).
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HRCA&sw=w

&u=mlin_c_worpoly&it=r&p=HRCA&sw=w
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uploads/20 12/02/heart- healthy-diet-plan.gif


c
bb2c799464af190e07f.jpg

19

Chapter 2
Vitamins and Minerals
Barry Biletch, John deRivera, and Aniket Lachyankar


Introduction
Organic molecules that are required in small amounts by organisms are called vitamins, and they
can be divided into two groups: water soluble and fat soluble. Water soluble vitamins include the B
vitamins and vitamin C. These vitamins are flushed out of the body through urine on a daily basis. As a
result, there are no known cases of water soluble vitamin toxicity. Water soluble vitamins act largely as
coenzymes in the body, allowing certain important enzymes to function properly. The fat soluble
vitamins, A, D, E, and K, are stored in the body for longer durations of time, and the accumulation of
these vitamins in the body can cause serious side effects. For example, Vitamin A is stored mainly in the
liver. When arctic explorers ate the livers of seals and polar bears, acute toxicity occurred because of the
massive amounts of vitamin A that they were ingesting (Vitamin A, 2007). Not all vitamins need to be
ingested in their final form because the body can synthesize some vitamins from other molecules.
Vitamin A is produced from beta-carotene and other carotenoids (Vitamin A, 2007), vitamin D is
synthesized in the skin when in direct contact with UVB radiation (Vitamin D, 2007), and vitamin K is
made by bacteria living in the intestines when insufficient doses are ingested orally (Vitamin K, 2007).

Vitamins to Combat Malaria
Research being conducted at the University of Southampton might lead to the synthesis of
malaria-combating drugs. Malaria is a disease spread by parasites that affects approximately 250 million
people annually and causes the deaths of approximately 1 million people each year. Scientists hope to
disrupt the production of vitamins in malaria-producing protists. They hope to learn more about the
enzymes that are used to manufacture vitamins in these parasites. By targeting these particular vitamin-
making enzymes, the production of these essential vitamins can be stopped, leading to deficiencies and

the death of the parasite. Drugs that target B
9
production have been used very successfully in the past, but
resistance to this particular drug in the parasites has increased, stimulating new research for a drug which
is as effective. Scientists at the University of Southampton are currently researching the enzyme complex
that produces vitamin B
6-
in malaria causing parasites. If successful, a new drug to treat malaria could be
made and millions of lives saved (University of Southampton, 2012).

Malaria parasites have become resistant to several types of malaria combating drugs.
20

Vitamin Supplements
In many cases, whether it is due to dietary habit or location, people can have vitamin deficiencies.
Some vitamins, like vitamins C, B
12
, and D, are necessary for very important functions and can cause
devastating effects for deficient individuals. To combat these effects, people usually choose to take
vitamin supplements. There are many different forms of these supplements, the most popular being the
pill. Another difference between different vitamin supplements is the purpose that each one serves.
Today, companies have specifically targeted vitamin supplements to particular groups of people or
deficiencies. For example, One-A-Day Products markets vitamins that are targeted at specific stages of
life and genders ranging from vitamins for teenage girls to vitamins for men over the age of 50. Vitamin
supplements ensure that the consumer lives their life to the fullest without any vitamin deficiencies.
However, the process of accepting a supplement is very intricate and involves many organizations.
One of the most involved parts of the supplement discovery and distribution process is the
specification and regulation of the product itself. Organizations like the United States Pharmacopeial
Convention (USP) and the U.S Food and Drug Administration are highly influential in setting the
standard for vitamin supplements; industrial companies that look to manufacture supplements utilize this

benchmark. The full list of standards can be found in the USP Dietary Supplements Compendium (DSC),
an amalgamation of different monographs that specify identity, strength, quality, and purity of various
dietary supplements. Again, manufacturers that hope to utilize these dietary supplements look to the DSC
to make sure that their product conforms to the standards set by the USP‘s compendium (Dietary
Supplements Compendium, 2009).
Vitamins supplements, as previously stated, come in many different forms. Some come for
singular vitamins; supplements for simply vitamin C can be found on the shelf for those who do not think
they consume enough of this essential vitamin. However, the most popular vitamin supplement has
quickly become the multivitamin. This supplement variant is specifically designed to supply consumers
with enough vitamins such that the consumer does not have any deficiencies. These vitamins cannot
completely substitute for the vitamins in food because they are usually created for the purpose of
accommodating a healthy diet. As noted above, companies like One-A-Day and Centrum are widely
known for supplying multivitamins that serve very specific purposes. Some of the specialized formulae
that do not apply to sex or age include vision, heart, energy, and prenatal support. Each multivitamin is
specially formulated to ensure that the consumer is correctly treated (One-a-day Multivitamins, n.d.;
(Centrum Multivitamins, n.d.).


Vitamin supplements can be beneficial,
but their misuse can cause harm.


21

The Dangers of Multivitamins and Supplements
It was long believed that vitamins were a cure-all supplement to healthy living, but recent studies
have yielded results that contradict this. While it is known that extreme doses of vitamins can have
serious effects on the body, it has only recently been suggested that doses even slightly higher than the
recommended amount (in the form of artificial vitamins present in supplements and multivitamins) can
pose health risks. It was found that men who took excess amounts of vitamin E had a 17% higher risk of

developing prostate cancer than those who did not take the vitamin. The study did not originally conclude
this result when it was ended in 2008, but follow up research revealed this striking result. A second
study, in Iowa, on the effects of the use of multivitamins, folic acid, vitamin B
6
, magnesium, copper, zinc,
and iron concluded that users of these supplements had an increased risk of death. Other studies since
then have yielded similar results (Parker-Pope, 2011).

A New Way to Ingest Vitamins
Vitamins can be harmed by stomach acids, so it is necessary to provide protection to the vitamins
when designing vitamin supplements. Currently, pharmaceutical companies use materials such as
cyclodextrin, which is a sugar molecule in the shape of a torus (see image). Scientists at Penn State did a
series of experiments in which they developed cornstarch pouches which can hold oil soluble vitamins,
such as A and C. The starch protects the vitamins from the acid in the stomach so that it can remain
unharmed when they reach and is absorbed by the small intestine. The type of corn starch used forms
coils with a hydrophilic outer surface and a hydrophobic inner surface. The fat-soluble vitamins are
attracted to the inner surface of the starch coil where they are protected. This technique could lead to
vitamin enriched starch foods, which would be a cheaper and more environmentally friendly way of
manufacturing food supplements (Penn State, 2011).

This is the structure of cyclodextrin molecule.

New technology is emerging to make getting a daily dose of vitamins easier. David Edwards, a
biomedical engineer at Harvard University, has invented a product he calls ―Le Whif.‖ The liver and
intestinal tract can damage vitamins and are also slow to absorb the vitamins into the bloodstream. To
combat this, Le Whif grinds vitamins into aerosol particles that can be packaged into spray cans and then
inhaled. Inhalation provides a more direct route to the bloodstream without the altering effects of the
liver or intestines (Dyer, 2011).
22

Vitamin D and Eyesight
A very recent study on the effects of vitamin D on mouse vision has yielded encouraging results.
Mice that were given vitamin D supplements showed less aging in their eyes, and older mice who were
given the supplement exhibited improved vision. This could lead to future drugs that slow the
deterioration of the human eye and combat age-related macular degeneration. The retina of the human
eyes builds up debris and inflames as it ages, which can lead to a 30% decline in photoreceptor cells. The
study found that older mice which were given vitamin D supplements experienced an improvement in
vision as well as a decrease in inflammation and the removal of some debris from the retina. It is
believed that the vitamin D reduced the number of macrophages, which can cause damage and
inflammation in the retina, and also changed some of the macrophages‘ structure so that the cells actively
decreased inflammation and debris buildup. A second benefit seen in the mice was a decrease in the
amount of amyloid beta present in the eye. It is known that amyloid beta increases the risk of age-related
macular degeneration (Biotechnology and Biological Sciences Research Council, 2012).
The history of humans suggests why poor eyesight becomes a problem as we age and why it is
more common now than in human ancestors. Vitamin D is ingested via certain foods, but the quantities
found in most diets are insufficient for the body to function. Human bodies manufacture vitamin D in the
skin when hit by UVB rays from the sun. This alternate form of production makes up the dietary gap in
vitamin D consumption. Human ancestors lived in Africa, where they were exposed to direct sunlight
daily, prompting adequate vitamin D production. Since then, humans have moved to less sunny areas of
the globe and have clothed themselves in an attempt to block out the sun. The changes have occurred so
quickly that the human body has not yet adapted to reduced sunlight exposure, explaining the
degeneration of the retina due to a lack of vital vitamin D (Biotechnology and Biological Sciences
Research Council, 2012).
Vitamin D and Parkinson‘s Disease.
Vitamin D is an essential component of life and its deficiency has very bad effects. Deficiencies
have been linked to various conditions, including asthma, cancer, and multiple sclerosis; these various
effects show that vitamin D affects numerous facets of human life. A study done by Paul Knekt at the
National Institute for Health and Welfare in Finland attempted to connect the levels of vitamin D to
Parkinson‘s disease. This study took a population of Finnish men and women over the age of 50 and
checked the levels of vitamin D in these people over a 29-year period. In the group studied, 50 instances

of Parkinson‘s disease occurred, and with these instances, the vitamin D levels of each subject that
contracted Parkinson‘s were significantly lower than that of those without. The results suggest a peculiar
relationship between the function of vitamin D in the nervous system and Parkinson‘s disease, which
again strengthens the need for a healthy dosage of vitamin D in one‘s daily diet (Knekt et al., 2010).

Parkinson's disease can cause uncontrollable shaking,
muscle stiffness, and movement issues among other things.

23

Vitamin A and Osteoporotic Hip Fractures.
One of the functions that Vitamin A affects is bone metabolism. When taken in normal doses, the
vitamin can promote healthy bone growth; however, excess amounts can cause adverse effects on bone
structure. Research at the Harvard Medical School, conducted by Diane Feskanich and colleagues,
attempted to connect diets with high vitamin A values to osteoporotic hip fractures in older women. The
study consisted of over 30,000 postmenopausal females, some of which had sustained hip fractures with
noticeable trauma. After screening the levels of vitamin A in all of the women, the quartile with the
highest dosage of vitamin A in daily diet had a significantly higher risk of hip fracture than those women
with a normal vitamin intake. With the transition to life after menopause, women will have to be careful
to strike a keen balance between a healthy dosage of vitamin A and a excess (Feskanich et al., 2002).

Increased vitamin A intake has been
linked to increased risk of hip fracture.


The Effects of Antioxidants on Pre-eclampsia
A condition known as pre-eclampsia can develop in women who are pregnant for the first time, causing
hypertension and other negative effects. This condition, which appears in approximately 5% of first-time
pregnancies, is dangerous to both the mother and child. Luckily, research conducted at a Mexico City
hospital has yielded a possible method for preventing pre-eclampsia, thought to be caused by a deficiency

of L-arginine, an amino acid essential in blood circulation. The study consisted of three groups of
pregnant women. The first group was given food bars containing L-arginine and antioxidant vitamins
(Vitamin A, C, and E are all antioxidants). The second group was given bars containing just the vitamin
supplements and the third group was given a placebo, which contained neither L-arginine nor vitamin
supplements. Of first group of women, only 12.7% were diagnosed with preeclampsia compared with the
22.5% of the second group and the 30.2% of the third group. The results show that the best preventative
procedure is to take both L-arginine and vitamins, although simply taking the vitamins can also have
beneficial effects (British Medical Journal, 2011).

24


Antioxidants such as vitamin C and E
neutralize harmful free radicals.


Vitamin B
12
and Cancer
A study of patients in Norway pointed to an interesting pattern that connected vitamin B
12
and
cancer proliferation. Previous studies that involved B
12
and cancer had produced results towards the
conclusion that B
12
deficiencies were instrumental in cancer onset. However, during the study done in
Norway, where the government does not necessitate folic acid and B
12

supplements, there was a
difference between the amounts of people who contracted cancer after treatment with the vitamins when
compared to those who were not treated with the B
12
vitamins and folic acid. There were 53 more B
12

treated patients that were diagnosed with the cancer, a 21 percent increase from those who were not
treated and still diagnosed with cancer. Of those diagnosed with the cancer, 36 more died of that same
cancer, which was a 38 percent increase in risk. Of the forms of cancer that were diagnosed, scientists
noted that lung cancer occurred most frequently in these subjects. This study suggests an interesting
relationship between the levels of B
12
and certain stages of cancer. It may be the case that low doses of
vitamin B
12
may cause early carcinoma onset, while on the other hand, higher doses of B
12
later in life
may cause cancer cells to proliferate.

Minerals in Type II Diabetes
In an experiment done at the Shiraz University in Iran, scientists compared the levels of 4
minerals, zinc, copper, iron, and chromium, between normal children and children with Type II diabetes
mellitus. One characteristic of all of these minerals is that they are mainly found in trace amounts in the
human body and are therefore not widely recognized for importance in nutrition. Results showed that
there was a significant decrease in 3 mineral levels for the diabetes patients: zinc, copper, and chromium.
This shows that each of these three may play a role in the onset of childhood diabetes. Chromium is
known to be a facilitator of insulin function in the human body. This points to a more direct relation
between the functions of the mineral and the onset of diabetes. With more research, chromium may be

used as a treatment for some forms of diabetes (Basaki et al., 2012).

25


Type II diabetes is caused by the inadequate
production of insulin or the inability to use insulin.

Magnesium Treatment for Migraines
Magnesium is a commonly found ion and can be found in a supplemental form because it is an
essential mineral for body functions. In a study done by the New York Headache Center, scientists
observed that magnesium levels of patients with migraine symptoms were significantly higher than those
of the controls. Magnesium plays a part in migraine pathogenesis. With this difference in magnesium
levels, the scientists concluded that magnesium supplements could be used to treat migraine symptoms.
This connections proves to make a much simpler and more available treatment than a manufactured
medicine because it is so accessible and usable (Mauskop & Varughese, 2012).


Migraine headaches are caused when arteries in the brain enlarge,
causing the adjacent nerves to release chemicals that trigger adverse effects.


The vast majority of calcium consumed by humans is distributed to the bones and teeth, but the
1% used by the rest of the body is very important to overall health. Although it is widely accessible,