Physionutrition: a new approach to care in 4D
The prevention and support of pathologies are becoming increasingly important in the concerns of health professionals, the general public and of course public health officials.
In a medicine that is becoming more and more functional and explanatory, the importance of a satisfactory supply of micronutrients is becoming a priority.
Thus, the notions of additional micronutritional needs caused by a physiological or pathological situation, a dietary behaviour, the lifestyle, should now be part of the therapeutic approach of all health professionals.
Physionutrition is a new approach to care that encompasses clinical, physiological and biological studies, as well as the management of imbalances and deficiencies in macro- and micronutrients, their synergies and antagonisms of actions.
More specifically, it studies the role of essential fatty acids, vitamins, trace elements, amino acids, probiotics and neuromediators, as well as biochemical and clinical phenomena linked to oxidative stress, physical exercise, the balance of the intestinal flora, immunology, etc. Physionutrition also integrates more recent sciences such as nutrigenetics or anti-ageing hormone therapy.
Physionutrition is based on 3 fundamental pillars: Nutrition, Micronutrition and Endocrinology, regrouping 10 equilibria:
- dietary equilibrium,
- microbiome equilibrium,
- intestinal permeability equilibrium,
- detox equilibrium,
- oxido-inflammatory equilibrium,
- essential fatty acid equilibrium,
- acid-base equilibrium,
- neuromediator equilibrium,
- mitochondrial equilibrium,
- metabolic and hormonal equilibrium
For each of these pillars, validated questionnaires have been created by the various scientific committees of the II2P, bringing together academics, researchers and expert practitioners in Physionutrition. They allow a global and optimal treatment. All of these questionnaires are available on the II2P professional space.
Understanding micronutrient imbalances
The daily diet must provide each individual with a sufficient quantity of macronutrients (proteins, fats, carbohydrates) and micronutrients (vitamins, minerals and trace elements) to ensure that all their needs are covered.
For each nutrient, the intake required to cover the physiological needs of almost the entire population has been defined at European level. These are called ‘Dietary Reference Values (DRV)’, as proposed by a scientific panel of the EFSA (European Food Safety Authority).
In 2011, the study “Projected prevalence of inadequate nutrient intakes in Europe1 ” and, more recently in 2013, the study “Mapping low intake of micronutrients across Europe2 ” demonstrated that a large part of the European population was not receiving the recommended intakes of vitamins, minerals and trace elements.
To give an example, a study published in the “Cahiers de Nutrition et de Diététique” “Nutrition and Dietetic notebook” in 1999 by Darmon and Briend shows that it is difficult, if not impossible, to ask the French to respect the recommended nutritional intakes without deviating considerably from their eating habits.
The diet in industrialised countries presents several apparent paradoxes, it seems :
- healthier (accidents due to food poisoning are rarer, preservation methods are improved)
- less deficient (diseases such as beriberi or scurvy have disappeared),
- less rich (the average caloric intake has decreased significantly over the last century).
However, obesity and overweight are on the rise and a large proportion of the population has micronutrient deficiencies, as shown by the studies already mentioned.
Food provides fewer micronutrients
Two factors explain the decrease in micronutrients in our diet:
- Reduced caloric intakes at the expense of micronutrient-rich foods,
- a decrease in the micronutrient density of foods.
Micronutrient-rich foods are less consumed. The WHO (World Health Organisation) has estimated that in more than half of the countries in the WHO European Region, the consumption of fruit and vegetables is less than 400g per day3. Another EFSA analysis, based on national dietary surveys, suggests that the recommended amount of fruit and vegetables is only met in 4 of the participating EU Member States4 .
The average caloric intake decreases
In France, a 15% reduction in caloric intake was recorded between 1965 and 1981.
This reduction in caloric intake is explained by a reduction in energy expenditure due to a change in lifestyle: reduction in working hours, mechanisation of many manual activities, journeys made by car, generalisation of lifts, free time spent in front of the television…
The decrease in caloric intake partly explains the micronutritional deficits observed.
Indeed, it is easy to see that while we can easily get our vitamin C intake from 3500 calories per day, it is more difficult to get it from 1800 calories. Even if the concentration of micronutrients in our caloric intake was constant, halving the caloric intake arithmetically results in halving the micronutrient intake.
The micronutrient density of our diet has decreased
Today, 60% of energy intake is provided by foods that are high in calories and low in vitamins and minerals. More specifically, a person living in Europe consumes almost 1 kg of simple sugars per month5.
Changing lifestyles (less time spent cooking, unstructured meals, meals eaten outside the home, ever-increasing snacking, TV trays, almost exclusive distribution of food by supermarkets, etc.) make this phenomenon even worse: 70% of our food now comes from industrial products.
To illustrate this, between 2009 and 2019, the consumption of frozen Chips in Europe has continued to grow, with the UK, Germany and France in the top three places in terms of consumption6.
Industrial foods are significantly less rich in micronutrients as a result of processing: sterilisation, spray drying, pasteurisation, ionisation, skimming, cooking, extrusion, washing, refining.
The micronutrient density of fruits and vegetables has decreased significantly due to:
- Excessive watering of crops which “leaches” the soil and reduces its mineral content,
- Excessive use of fertilisers and intensive agriculture which, by increasing the speed of plant growth, reduces the time taken to fix micronutrients,
- Excessive use of pesticides and herbicides, which reduces the vitamin content of plants by preventing the transformation of minerals by micro-organisms, a transformation necessary for better absorption,
- Refining, which removes most of the minerals from plants,
- Harvesting of fruit and vegetables before they are fully ripe and the time spent between harvesting and consumption (e.g. four weeks on average for tomatoes),
- Preservation treatments (canning, freezing and reheating destroy vitamin stocks).
The II2P’s main mission is therefore to train and inform health professionals on the basics and foundations of this new preventive and therapeutic approach, while working with public authorities and universities to make Physionutrition an integral part of nutrition.
It is likely that future research efforts will focus on the knowledge of metabolic pathways at the genomic level and in particular on possible modifications of gene transcription by macro- and micronutrients.
In this respect, the study of the physiology of micronutrients, the cornerstone of our metabolism, seems to be a promising avenue for the future.
- Mensink GBM, Fletcher R, Gurinovic M, et al. Mapping low intake of micronutrients across Europe. British Journal of Nutrition. 2013;110(4):755-773. doi:10.1017/S000711451200565X
- Roman Viñas B, Ribas Barba L, Ngo J, et al. Projected prevalence of inadequate nutrient intakes in Europe. Ann Nutr Metab. 2011;59(2-4):84-95. doi:10.1159/000332762
- Elmadfa I, Meyer A, Nowak V, et al. European Nutrition and Health Report 2009. Forum Nutr. 2009;62:1-405. doi:10.1159/000242367