Nutrition in Medicine Education

Click Here for the Lecture for the Singapore Conference July 2002
The Clinical Application of Essential Fatty Acids in Treatment of Chronic Disease. 
 Dr Mel Sydney -Smith (Click here for his Curriculum Vitae)




June 2002 4 Day Workshop  Gold Coast Australia
Topic Abstracts
Diet & Illness -: this module will :
introduce the connection between poor dietary food choices and the development of chronic ill health.
overview the scientific literature relating to the impact of dietary food choices on basic physiological function and dysfunction, with particular respect to lipid metabolism, hyperinsulinism, free radical pathology, eicosanoid synthesis and balance and hormone production - (NOTE: these basic physiological mechanisms and their contribution to illness will be explored in other lectures).
define and classify food according to basic nutrient composition, with respect to the NH&MRC guidelines for healthy diet and the food pyramid
attendees will learn how to :
record patient diet records and analyse them according to the :
energy content of the diet with respect to patient energy expenditure andthe food pyramid with respect to patient food choices
synthesise a basic, balanced diet program in accordance with current NH&MRC guidelines and the food pyramid.
Nutritional Assessment -: this module will demonstrate how to clinically assess a patient for indications of nutrition-related illness according to :
family history, personal history and genetics - (e.g., hypertension & diabetes in Pacific Islanders & Indigenous Australians, lactose intolerance in Asian and Sicilian populations)
common disease categories related to nutritional intake (e.g. obesity, heart disease, diabetes, hypertension) and clinical symptoms and signs related to multiple and individual nutrient inadequacies (sourced from a) the Oxford Textbook of Medicine and b) Nutritional Influences on Illness)
discuss methods of determining body composition, such as :
body-mass index
skinfold thickness and body circumference
use of electrical impedance and DEXA
underwater weighing
discuss and demonstrate the use of computerised programs designed to :
assess dietary nutrient intake from diet food records
calculate body composition from multiple skinfold measurements
assess patient nutrient requirements according to clinical symptoms & signs
attendees will learn how to :
assess a person’s risk of developing a nutrition-related illness
identify symptoms and signs relating to nutritional disturbance, imbalance or inadequacy
measure/calculate body composition according to :
body-mass index
skinfold thickness and body circumference
demonstrate a familiarity with current computerised programs designed to assess patient nutrient adequacy
Impaired Digestion -: this module will :
review the research literature relating to the incidence of digestive disturbance in the population and the nutritional effects of impaired digestion on health status with respect to :
specific disease conditions encompassing impaired digestion (e.g. coeliac disease, cystic fibrosis, atrophic gastritis, peptic ulcer disease)
non-specific illness which appear responsive to diet and digestive treatment (e.g. hypochlorhydria, irritable bowel syndrome, diverticulitis, colitis)
specific physiological disturbance induced by impaired digestion (e.g. effects of bioactive food peptides on immune system function, CNS function and gut function)discuss/demonstrate clinical assessment and laboratory diagnosis of impaired digestion with respect to :
clinical symptoms and signs of digestive disturbance
pathology tests for gastric acid secretion -
blood tests - plasma pepsinogen I and II, Schillings test for intrinsic factor, anti-parietal cell antibodies
radiotelemetry devices - Heidelberg pH Gastronometerendoscopy & biopsy
Helicobacter pylori gastritis - serology, urea breath testing and endoscopy
pathology tests of pancreatic digestive enzyme sufficiency
stool microscopy for fatty acid crystals/meat fibres etc..
faecal fat testing, stool trypsin and trypsinogen
plasma amylase and lipase
define and discuss treatment options with respect to :
specific disease conditions (e.g. H. pylori gastritis, pernicious anaemia) and non-specific disease conditions (e.g. irritable bowel syndrome, reflux oesophagitis, arthritis, fatigue & fibromyalgia).
attendees will learn how to :
diagnose impaired digestive function in patients with both specific and non-specific disease conditions
determine appropriate therapeutic digestive support supplements and
synthesise and initiate appropriate therap eutic dietary protocols.
Food Sensitivity -: this module will :
introduce the concept of "food sensitivity" reactions (as defined by Dr. Robert Loblay & Anne Swain (Sydney), Dr. Rob McEvoy (Perth) and Dr. Colin Little (Melbourne) discuss/describe the acknowledged physiological and putative psychological mechanisms involved in food sensitivity reactions
review the literature regarding the epidemiology of food sensitivity in the population and its effects upon symptom induction, health status and illness
discuss/demonstrate the clinical symptoms and signs indicative of food sensitivity reactions (sourced from a) Nutritional Influences on Illness- Prof M Werbach, b) Food Allergy- Dr. R McEvoy, c) Australian Family Physician- Nov93) review the role of current laboratory and clinical tests for food sensitivity and allergy, as well as the role of psychometric testing
IgE tests - skin and RAST
IgG and IgA tests against food antigens - gliadin antibodies & cow’s milk protein antibodieschallenge tests - for food and environmental chemicals
demonstrate how to synthesise and initiate a therapeutic trial of a "hypo-allergenic" diet with specific reference to :
food elimination - common "allergenic foods" - what to remove maintaining adequate energy intake and balanced nutrition in a "low allergy, elimination diet"
re-introduction of suspect foods on a challenge basis
the "double-blind" & "single-blind" challenge test -
clinical parameters to be measured -
what constitutes a valid reaction
long-term maintenance of a "low-allergy" diet -
ensuring nutritional balance and energy intake -
identifying prospective dangers and side-effects
attendees will able to :
understand the physiological and psychological components relating to food sensitivity
be informed about the current research regarding food sensitivity reactions enabling them to discuss food sensitivity from a sound and scientific knowledge base
test for and diagnose food sensitivity reactions
organise and supervise a safe, therapeutic trial "elimination diet" with clinically-based challenge tests to determine sensitivity reactions to specific foods
synthesise and initiate a balanced, nutritionally adequate "low allergy diets" for short-term therapeutic trials and long-term maintenance.
Bowel Dysbiosis & Probiotics -: this module will :
introduce the concepts of a healthy gut flora as opposed to dysbiosis
discuss the research evidence pertaining to the role of a toxigenic gut flora in the induction and maintenance of chronic illness
tropical sprue - in Northern Territory, North Queensland & Pacific Islands - overt problems of bowel dysbiosis
small bowel bacterial overgrowth
immune system activation -
stimulation of mucosal macrophages & CD4 cells
enhanced complement activation
augmented production of pro-inflammatory eicosanoids
enhanced production of TGF and PAF cytokines
discuss the causal factors in the development of bowel dysbiosis
effect of residency in tropical climates
indiscriminate use of broad-spectrum antibiotics
long-term use of steroid therapy & cytotoxic agents
define the clinical symptoms and signs related to bowel dysbiosis
localised gut symptomatology
systemic symptoms
specific disease states causally related to bowel dysbiosis
examine the use of laboratory tests in the identification of bowel dysbiosis
stool examination and culture -
testing for shigella, campylobacter, salmonella, yersinia, enteropathogenic E.coli, Proteus, Klebsiella
parasites - chronic giardia, dinoflagellates, amoebae, strongyloides, ancylostoma, ascariasis
mycelial candida growth, candida antibodies, candida antigen testing
testing for faecal B-glucuronidase and butyrate
breath testing for bacetrial breakdown products :
hydrogen breath test for small bowel dysbiosis &
urea breath test for H.pylori
absorption/excretion tests for altered mucosal permeability - lactulose/mannitol test,
xylose absorption test
discuss/demonstrate how and when to normalise gut flora - pros & cons :
use of probiotic powders -
is it worth it - does it work - how much to use - how longantibiotic and anti-candida therapy -
is it worth it - does it work - how much to use - how long
herbal antibiotic agents -
what are they - how do they work - do they work - what are the side-effects
is there any evidence of efficacy, if yes, how credible is itattendees will be able to :
understand the scientific evidence relating to the health effects of the bowel flora, both for and against, enabling them to discuss/explain this controversial topic with/to patients from a sound scientific background
test for and diagnose bowel dysbiosis appropriately
synthesise a therapeutic probiotic protocol for patients who have been appropriately and medically assessed Antioxidants in Disease -: this module will :
introduce and define the concepts of :
free-radical pathology, its role in the aging process, degenerative disease and acute & chronic inflammation
the antioxidant cascade and its tissue protective role against oxidant pathology -
Vitamins C, E, A and B-carotene
endogenously synthesised antioxidants - uric acid, caeruloplasmin, superoxide dismutase, glutathione, catalase
bioflavonoids - quercetin, lycopene, hesperidin, catechins and proanthocyanidins
explore the mechanism of action of electron-transport, free radical genesis and antioxidant quenching of free-radicals
lipid-soluble and water-soluble antioxidants
conversion of antioxidants to pro-oxidants and recycling
importance of maintaining a balanced relationship between the various antioxidants
identify the basic food groups and specific foods which are high in antioxidant nutrients - brassica foods, tea polyphenols, fruits & vegetables etc…
discuss the scientific evidence relating to antioxidant intake and prevention of free-radical related disease, including :
cardiovascular disease - coronary and peripheral
degenerative disorders of the musculo-skeletal system
neurological disorders - Alzheimers, Parkinsons, Multiple Sclerosis and cerebro-vascular disease
demonstrate clinical methods of assessing adequacy of antioxidant intake :
from the personal history
symptoms and signs
the dietary record and
computerised dietary and symptom analysis
laboratory assessment of oxidant load
serum lipid peroxidation products
plasma glutathione / reduced glutathione measurement
urinary Vit C excretion post-loading
serum Vit E / total fat ratio
discuss/demonstrate methods of increasing antioxidant nutrient intake by -
enhancing dietary intake -
increasing intake of fruits and vegetables
use of tea polyphenols & whole food extracts
nutrient supplementation - with reference to specific high-risk disease categories, both prevention and treatment
attendees will be able to :
understand the scientific evidence relating to the health effects of the antioxidant therapy enabling them to discuss/explain this topic with/to patients from a sound scientific background
test for and diagnose antioxidant adequacy
synthesise a therapeutic antioxidant protocol based on diet modification-enhancement and nutrient supplementation, for patients who have been appropriately and medically assessed Essential Fatty Acids and Disease -: this module will :
introduce and define the concepts of :
eicosanoid synthesis and its pivotal modulating role in
cell membrane fluidity & function, the inflammation process (both acute & chronic)platelet & vascular endothelial function and neuro-hormonal function & integration
explore research on the arachidonic acid cascade and its role inenhancing the inflammatory process, increasing cytokine production, intestinal secretory and motor function and neuro-humoral dysfunction -
define the common dietary sources of AA & other types of EFAsmetabolic pathways involved in AA synthesis
factors affecting AA synthesis
saturated fat intake and trans-fatty acids
competitive inhibitory effects of other EFAs such as DHGLA and omega-3-EFAs
xenobiotic chemicals/drugs affecting AA metabolism
identify the basic food groups and specific foods which are high in omega-3-EFAs - linseed, flaxseed and seafoods etc.
discuss the scientific evidence relating to dietary EFA intake, eicosanoid balance and prevention of inflammatory disease, including :
cardiovascular disease - coronary and peripheral
inflammatory disorders - asthma, eczema, arthritis
auto-immune disorders - Rheumatoid arthritis, SLE, etc…demonstrate clinical methods of assessing adequacy of EFA intake :
from the personal history
symptoms and signs
the dietary record and
computerised dietary and symptom analysis
laboratory assessment of eicosanoid balance
serum lipid analysis - omega-3/omega-6 ratio
plasma AA/EPA ratio
plasma or red cell PGE2/PGE1/PGE3 balance
discuss/demonstrate methods of enhancing EFA nutrient intake by -
increased dietary intake of foods high in EFAs -
increasing intake of seafood, nuts, seeds, use of monounsaturated oils and omega-3 oils, seafood and Evening Primrose oil & whole food extractsnutrient supplementation - with reference to specific high-risk disease categories, both prevention and treatment
attendees will be able to :
understand the scientific evidence relating to the health effects of the EFA-modulating therapy enabling them to discuss/explain this topic with/to patients from a sound scientific background
test for and diagnose EFA inadequacy and eicosanoid imbalance
synthesise a therapeutic EFA-modulating protocol based on dietary modification-enhancement and specific nutrient supplements, for patients who have been appropriately and medically assessed
Environmental Toxicity & Health -: this module will :
introduce and define the concept of :xenobiotic chemical accumulation and the role of chemicals in the precipitation of cellular membrane dysfunction an cell metabolism
explore the scientific evidence relating to the mechanisms of action of chemically-induced dysfunctionenhanced free radical genesis disruption of cell membrane lipid structures interference with essential cell enzyme structure and function identify the basic and common sources of environmental chemicals and heavy metals
demonstrate methods of assessing possible xenobiotic chemical toxicity :
from the personal history
symptoms and signs
laboratory assessment of chemical & heavy metal load
serum measurement of insecticide levels
"double blind" chemical challenge testing
DMPS urinary mercury & lead excretion
hair analysis - is it reliable & credible ?
discuss/demonstrate methods of reducing levels of xenobiotic chemicals and heavy metals by -
enhancing hepatic & renal clearance -
countering health effects of chemicals by supplementation with cell-protectant antioxidants -
attendees will be able to :
understand the scientific evidence relating to the health effects of xenobiotic chemicals and heavy metals enabling them to discuss/explain this topic with/to patients from a sound scientific background
test for and diagnose environmental-induced illness synthesise & supervise a basic therapeutic detoxification protocol based on diet modification/enhancement and nutrient supplementation, for patients who have been appropriately and medically assessed
Inflammation, Asthma & Eczema -: this module will :
introduce and define the physiological disturbances which are causally related to chronic inflammatory disease, with particular reference to asthma and eczema :
immune system activation - bioactive peptides, food chemicals and food allergy
augmented inflammatory reactions related to eicosanoid imbalance
enhanced tissue cellular free radical pathology related to antioxidant inadequacy
explore the scientific evidence relating to nutritional treatment protocols designed to reduce chronic inflammation in asthma & eczema
food allergy and chemical sensitivity identification and avoidance
response to gastro-intestinal digestive support protocols
modulation of inflammation and immune system reactivity by improved EFA intake and eicosanoid balanceeffect on disease activity of increased antioxidant nutrient intake
demonstrate how to synthesise a dietary and nutritional regimen to reduce inflammatory disease -
attendees will be able to :
understand the scientific evidence relating to the nutrition-related factors in inflammatory disease states enabling them to discuss/explain this topic with/to patients from a sound scientific background
initiate & supervise a basic dietary and nutritional protocol for patients with inflammatory disorders, after appropriate medical assessment, and
integrate this protocol into their ongoing general family medicine management.
Hyperinsulinism, Syndrome X and Diabetes -: this module will :
introduce and define the nutrition-related risk factors which are causally related to the development of hyperinsulinism and Syndrome X -
insulin-receptor resistance and its relationship to diet,
saturated fat intake & trans-fatty acids
lipid peroxidation & impaired cell-membrane fluidity
the role of high refined sugar/simple carbohydrate intake homocysteine metabolism & its role in insulin resistancechromium, vanadium & arginine in insulin resistance
discuss the role of Hyperinsulinism in the development of chronic disease
cardiovascular disease
hypertension & cerebrovascular disease
Non-Insulin Dependent Diabetes
protein glycation, ophthalmic disease and CNS disease
hormonal imbalance/disturbance related to hyperinsulinism
demonstrate the assessment and diagnosis of insulin receptor resistance :
body fat composition, upper body fat deposition and increased waist/hip ratio
blood lipid abnormalities
measurement of HbA1c and clinical signs of increased glycation products
measurement of post-challenge blood glucose and serum insulin levels
explore the scientific evidence relating to nutritional treatment protocols designed to restore insulin receptor sensitivity by :
reduction of glucose absorption by using :
a low-fat, low-CHO, high fibre diet vs high-starch, high-fibre diet - have we got it right ?
Dr Robert Atkins vs Dr Dean Ornish
reduction of cell membrane peroxidation and improved membrane fluidity by :
increased monounsaturated oil & omega-3-Fatty Acid intake increased antioxidant nutrient intake, Vitamins C & E, bioflavinoids, catechins and proanthocyanadins
demonstrate how to synthesise a dietary and nutritional regimen to :
restore insulin receptor sensitivity, improve glucose tolerance and reduce insulin levels
reduce the risk factors related to cardiovascular disease -reduce/reverse the level of protein glycation
attendees will be able to :
understand the scientific evidence relating to the nutrition-related factors involved in the development of insulin-resistance, enabling them to discuss/explain this topic with/to patients from a sound scientific background
initiate & supervise a basic dietary and nutritional protocol for patients with insulin resistance and Syndrome X, after appropriate medical assessment, and
integrate this protocol into their ongoing general medicine management.
Immune System Regulation -: this module will :
introduce and define the nutrition-related factors which are causally related to the development immune system deficiency -
impaired digestive function, especially related to :
advancing age,
chronic, unidentified food allergy
chronic stress
poor dietary intake related to :
improper food selection
fad diets
inadequate financial resources
impaired mobility related to chronic disease / aging
poor nutrient utilisation related to :
genetic enzyme impairment
poor anabolic hormone activity
age-related changes in metabolism & body function
drug-nutrient interactions
discuss and review the scientific literature related to enhancement of immune system function with specific targeted nutritional protocols particularly relating to the research work of Prof. Prasad in aged population -
improved CD4 activity
improved cytokine production in response to antigenic challenge
improved cell-mediated immunity
improved clinical outcomes and health status with reduced expenditure on drug therapy and hospital expenses
demonstrate the clinical assessment and diagnosis of nutrition-related immune system dysfunction :
personal health history
clinical examination
laboratory assessment of immune system parameters and nutrients
lymphocyte population study - CD4, CD8 & NK-cells
Cell-Mediated Immunity test
measurement of urinary Vit C & zinc excretion
erythrocyte Vit B6 & B1 activity
Vit B12 and red cell folate
plasma Vit E / fatty acid ratio
explore & review the scientific evidence relating to nutritional treatment protocols designed to retard aging processes and restore age-related changes in protein synthesis and immune system function by :
improving dietary protein uptake and protein utilisation reducing cell membrane peroxidation and enhancing membrane fluidity
demonstrate how to formulate a dietary and nutritional regimen to
enhance immune system function
reduce the risk factors related to cardiovascular disease and other age-related disease processes
attendees will be able to :
understand the scientific evidence relating to the nutrition-related factors involved in immune system dysfunction, enabling them to discuss/explain this topic with/to patients from a sound scientific background
initiate & supervise basic dietary and nutritional protocols for patients with age-related and nutrient immune system dysfunction, after appropriate medical assessment, and
integrate these protocols into their ongoing general family medicine management.