Scientific Evidence for Musculoskeletal, Bariatric, and Sports Nutrition PDF

Preface

Scientists and clinicians who want to broaden their understanding of the musculoskeletal system should read this book, whether their patients are top-placed marathon runners or persons for whom taking ten steps out of bed is a marathon.

As a society, we are very accustomed to the visible functions of muscle, fat, bone, and connective tissue. We frequently refer to the musculoskeletal system when describing a person — frail, strong, brittle-boned, big, lean, short, agile, muscular, skinny, fit, and so on. Minutes after a child's birth we proudly announce those two key musculoskeletal parameters of height and weight.

Contrast what meets the eye to the unseen critical functions of the musculoskeletal system. The human body is a veteran of famine, deprivation, and procreation. In its millennia of experience, maintaining blood pH and temperature, fueling the brain and vital organs, and defending against foreign invaders have been afforded top priority and receive minute-by-minute attention. One may think of it like this: the musculoskeletal system is analogous to a bank account on which the body draws to satisfy its top priorities. Millions of "transactions" occur each second and are known collectively as our metabolism. Only if funds are available does the body maintain muscle for strength, bone for structure, fat for shape, and connective tissue for motion.

Insufficiency of nutrients for muscle and bone health usually has a gradual onset. In some circumstances, the process begins in the womb. Then one day, seemingly out of the blue, the gradual process reveals itself: the favorite jeans are too tight, the rotator cuff tear does not heal, the small slip results in a hip fracture, the dentist diagnoses periodontal disease, or the muscle strain does not heal in time for the last game of the season. Discovering a musculoskeletal weakness can be as upsetting as finding out that the bank account is not FTC (Federal Trade Commission) insured. Neither is the musculoskeletal system FTC (fitness and total conditioning) insured, except with strategic nutrition.

The treatment of musculoskeletal conditions is widely shared among specialties:

• Preventive medicine corrects short-term dips in the musculoskeletal reserves, while integrative medicine corrects longer-term dips in the musculoskeletal reserves associated with pathology. Furthermore, preventive, integrative, functional, holistic, antiaging, complementary, naturopathic, and alternative medicine practitioners are championing the transition from an acute health care system to a system of chronic disease management more inclusive of nutrition.

• Sports, military, aerospace, and occupational medicine anticipate the extreme environment of their patients, and optimize muscle and bonesparing nutrition accordingly.

• Pediatricians diligently monitor patients' growth; abdominal girth, weight and height are important health indicators at all ages. Early environments of the womb, infancy, and childhood shape future musculoskeletal health.

• Endocrinologists have identified the pathways that build muscle and bone and metabolize fat. Adipose tissue is now credentialed as an endocrine organ. Bariatricians and bariatric surgeons similarly pioneer ways to metabolize fat.

• Surgeons pioneer understanding of how nutrition enhances outcomes and have said, "Repairing a shoulder without muscle is like nailing a chiffon pie to the wall." Dentists are surgeons for a uniquely visible component of the musculoskeletal system. They can identify nutritional deficiencies by keenly observing oral markers on the initial visit, and dentists are credited for first warning how sugar harms bone (tooth) health.

• Pain management specialists, osteopathic physicians, physical therapists, massage therapists, chiropractors, and acupuncturists have partnered with nutrition specialists to relieve pain, especially for fibromyalgia.

• Life expectancy is increasing, and at the same time degenerative conditions of the muscles, joints, and tissues are beginning earlier. Consequently, the fields of antiaging medicine and geriatrics both focus on treating sarcopenia, obesity, osteoporosis, and arthritis.

• Nutritionists work tirelessly to help patients navigate through a dizzying array of boxes and cans and when needed, voice the verdict "That's not food!" Behavioral medicine buttresses the efforts of nutrition specialists; many people who set out to make healthy choices are thwarted by food cravings, habits, social norms, and marketing schemes.

• Public health has long advocated good nutrition and identified community risk factors for practicing clinicians. Food processing techniques and contamination with xenobiotics pose new broad-sweeping challenges to the musculoskeletal system. Recently, anthropologists have stepped into public health nutrition with an insightful variation on the turn of phrase "You are what you eat." The health of bones from our evolutionary ancestors coincides with dietary history.

Nutrition has long been the missing link in the daily treatment of the various musculoskeletal conditions by the health professionals listed above. The oftenstated reason for giving nutrition short shrift is the lack of evidence. Here it is!

This textbook is a reference for the evidence-based integration of nutrition into medical treatment. It includes the biologic rationale, animal studies, epidemiology, clinical trials, ongoing research initiatives, and food industry statistics. Several contributors have privileged and intimate knowledge of the food industry. Most of us in medicine are not taught how our food is prepared, neither is the information readily available in our peer-reviewed journals. Dramatic shifts in food quality in recent decades have led to pervasive and quantifiable shifts in the very nutrients needed for musculoskeletal health, and provide extremely compelling evidence not customarily found in medical textbooks.

The most important advances in the science of medicine may be those that enhance the art of medicine. Knowledge of the molecular processes that underlie chronic disease equips a clinician to help patients walk their unique path back to health.

Putting nutrition into practice can be straightforward. This textbook explains how new technology can be integrated. It elaborates on foods and nutraceuticals with effects similar to medications. Information is organized into 100 tables and figures designed for easy reference. The text also includes pearls from clinicians who have achieved world renown for nutritional innovations in fibromyalgia, sports medicine, extreme environments, osteoporosis, and obesity.

This intellectual work generously contributed by 40 scientists and clinicians seems analogous to a mosaic or impressionist painting; as one steps away from it, a masterful image of musculoskeletal health emerges.