|Fibre husk for lowering cholesterol, grapefruit juice and green tea for weight loss, dark chocolates for a healthy heart and detox water to burn fat and flush the liver.
Sound familiar? These are a few of the many growing trends that have taken the public by storm in the past few years and before you know it everywhere people are swearing by these “super foods”.
As Dietitians/Nutritionists it is critical for us to be aware of these trends and the scientific evidence behind the claims. Dr. Rubina Hakeem spoke at the 2015 Nutrition Refresher Course about “Food Issues in Clinical Nutrition” effectively filling the gap by not only introducing the world of Functional Foods but also providing a road map for the future. The following article is thus inspired by the said talk.
Functional Foods – the concept:
The culture of food remedies or “totkay” (as we call them locally) is centuries old. Using black pepper, honey, cloves, turmeric, rice water, banana to cure flu, cough, weakness, stomach cramps and constipation is very common and at one time or another we all have benefitted from these remedies.
It is therefore not surprising that the Asia-Pacific Report of Food and Agriculture Organization of the United Nations (FAO) found that many countries of Asia consume several foods with functional attributes as part of their daily intake. These foods include green leafy vegetables, fruits, legumes, whole wheat and many condiments. Although the concept exists, there is no formal definition of functional foods in these countries.1
Functional foods – the science:
All foods serve to nourish the body and are therefore functional (affecting the way a part of the body works). However the advancement in technology has revealed that some food components, e.g. flavonoids, not traditionally considered nutrients can provide health benefits. The foods that contain these components are called functional foods.2
Functional Foods – definition:
Various government agencies, national and international organizations define functional foods (FF) in their own way (see table 1 for selected definitions).
|Japanese Ministry of Health, Labour and Welfare
||Foods for Specified Health Uses (FOSHU) refers to foods containing ingredient with functions for health and officially approved to claim its physiological effects on the human body. FOSHU is intended to be consumed for the maintenance/promotion of health or special health uses by people who wish to control health conditions.2
|Academy of Nutrition and Dietetics (AND):
||Foods defined as whole foods along with fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis at effective levels.2
|Dietitians of Canada
||“Functional foods are foods that offer unique health benefits that go beyond simply meeting basic nutrient needs. Many also help to reduce chronic disease risk.”.3
|Functional Food Centre (FFC)*
||“Natural or processed foods that contain known or unknown biologically-active compounds; which, in defined, effective non-toxic amounts, provide a clinically proven and documented health benefit for the prevention, management, or treatment of chronic disease.”4
|*This is the most recent definition proposed at the 17th International Conference of FFC jointly organized with United States Department of Agriculture (USDA) and (Agriculture Research Service (ARS) in 2014.
In a nut shell all FF are:
- part of a usual diet
- are in food forms and
- contain an ingredient which provides health benefit.3
It is therefore critical to understand that FF do not replace the need of a balanced diet, rather they provide added support when taken with a balanced diet.
Nutraceuticals, medical foods and dietary supplement are taken in the form of supplement, as formulated by a Physician and in non-food form respectively. Whereas, FF are only in food form, thus differing greatly from the afore mentioned products which are sometimes used interchangeably with the term FF.2
Categories of FF:
Due to the difference in definitions FF are categorized differently. Agri Food Canada3 divides them into: (i) Basic Foods, (ii) Processed foods with added bioactives and (iii) foods enhanced to have more of a bioactive component.
According to AND2:
||Food Ingredients that help synthesis of protective bacteria
||Contain natural bioactive food compound
||Containing bioactive food compound through enrichment or fortification
||Such as indigestible carbohydrates
||Antioxidant vitamins in orange juice, isoflavones in soy-based foods, and probiotics* in yogurt
||n-3 fatty acids in margarine, spreads and eggs
||Oligosaccharides that provide substrate for growth of bacteria that act as prebiotics*
|*Probiotics are “good” bacteria that help keep our digestive system healthy by controlling growth of harmful bacteria. Prebiotics are carbohydrates that cannot be digested by the human body. They are food for probiotics.
The attraction of FF for the public:
FF is gaining popularity amongst the public through increased awareness and concerns about health. The understanding that prevention is better than cure has led them to be conscious of their food choices and health benefits of food.
No data is available on popularity of functional foods amongst the Pakistani population, however it is common observation shows that general public have increased their intake of dried fruits and nuts. Drinking Ispaghol husk or flax seeds is gaining popularity along with lemon water and green tea to name a few.
Increasing health care cost and the growing trend to self-treat is also an important factor, giving consumers a greater control over their health at a reduced cost.2,6
Separating the fact from fiction:
As discussed above, the FF industry is gaining momentum2 but at the same time no single definition exists in both the developed2,3,4,5 and the developing countries1 to regulate the marketing of FF. Therefore it is imperative that Registered Dietitians/Nutritionists (RD/Ns) develop the skill to identify which FF claims are authentic and which are not in order to better guide the public.
A tool to help RDNs evaluate the FF is the Food Labelling Guide of the Food and Drug Association (FDA) and the “Summary of Health Claims Subject to Enforcement” document available on their website. Two examples of claims and FDA’s evidence statements7 relevant to the discussion are reproduced in table 2 below:
|Psyllium Husk & Diabetes
|Psyllium husk may reduce the risk of type 2 diabetes, although the FDA has concluded that there is very little scientific evidence for this claim.
|Walnuts & Heart Disease
|Supportive but not conclusive research shows that eating 1.5 ounces per day of walnuts, as part of a low saturated fat and low cholesterol diet and not resulting in increased caloric intake, may reduce the risk of coronary heart disease. See nutrition information for fat [and calorie] content.
Road Map for the Registered Dietitians/Nutritionists (8):
- Stay Informed: Make a habit of visiting FDA, AND and EAL (Evidence Analysis Library of AND), pakmedinet.com, doaj.org to develop and update your FF knowledge base. Share the knowledge you gain with your peers using platforms such as PNDS face book page, Newsletter and CNEs
- Educate the consumer and the client: Guide the consumer, i.e. the public, using evidence based messages and do not let them be blinded by marketing messages. Emphasize that FF is effective when it is taken with a balanced diet.
- Provide consultation to corporations: Provide the food industry sound scientific advice and assist them in developing products that truly benefit the public.
Conduct Research: It is the duty of each one of us to research, publish (articles/blogs) and present (in conferences) our findings in the field of FF to contribute to the expansion of FF knowledge base.
1. Food and Agriculture Organization of the United Nations Regional Office for Asia and the Pacific. Report of the Regional expert consultation of the Asia Pacific Network for food and nutrition on functional foods and their implications in the daily diet. Bangkok, Thailand: RAP Publication; 2004.
2. Crowe K, Francis C. Position of the Academy of Nutrition and Dietetics: Functional Foods. Journal of the Academy of Nutrition and Dietetics.[Internet]. 2013;113(8):1096-1103. [cited 25 October 2015]
3. Duncan A, Dunn H, Stratton L, Vella M. Translating knowledge into dietetic practice: a Functional Foods for Healthy Aging Toolkit. [Internet]. 2014 [cited 25 October 2015]. Available from
4. M. Martirosyan D, Singh J. A new definition of functional food by FFC: what makes a new definition unique?.Functional foods in health and disease [Internet]. 2015 [cited 25 October 2015];5(6):209-223. Available from:
5. Goetzke B, Nitzko S, Spiller A. Consumption of organic and functional food. A matter of well-being and health?.Appetite. 2014;77:96-105.
6. Ozen A, Pons A, Tur J. Worldwide consumption of functional foods: a systematic review. Nutrition Reviews. 2012;70(8):472-481.
7. US Food and Drug Administration. Summary of the Qualified Health Claims Subject to Enforcement Discretion.[Internet]. 2014 [cited 7 November 2015]. Available from http://www.fda.gov/food/ingredientspackaginglabeling/labelingnutrition/ucm073992.htm#cancer
8. Hakeem R. Food Issues in Clinical Nutrition. Lecture presented at; 2015; RLAK Govt.College of Home Economics, Karachi.
My Career Story: Salma Halai Badruddin
I was born in Karachi at home; a relative assisted my mother in her delivery. I was my mother’s 9th child.In all we were 5 brothers and 6 sisters and we had a wonderful childhood. My married brothers all lived with us and some of their children were very close to my age. Together we put up dramas, organized sports and never got bored.
Neither of my parents had formal education. My father went to school till 5th class and my mother had never been to school. My father taught her to read and write after they were married. She was 13 and he was 19
We were a fun loving family. My parents played Monopoly, cards, and other local board games with us. To this day we remain a fun loving family: picnics, fishing, singing sessions and games are a regular feature of our extended family
Both my father and mother were remarkable people. They encouraged each child to maximize their talents. In spite of having 11 kids they kept up with each ones’ activities, so in the evenings when we congregated in the garden they would ask each child
“baita aaj aapka math test kaisa giya”
Baiti app ka to netball match tha- kaun jeeta?
Each child would be asked similar questions
They were also remarkable in that they changed with the times. My two elder sisters did their matric and then were schooled in the domestic arts. Both got married young. When I finished my matric at age 13 my mum had the same plans for me but I insisted that I would go to college. Some years later when my younger sister said she was tired of studies and would quit after her BSc. My mother came to me and said “Baiti un ko samjao aaj kal ka zamanay mai BSc kia hai kumaskum MSc to karlay”. I hugged her and said Ma you are remarkable.
At college I participated in every extracurricular activity possible- sports, drama, debate etc. As a result I did not do very well in Board Exams. Mrs. Ahmed one of my favorite teachers would keep telling me that if only I would concentrate on my studies I would be a first class student. Finally when I joined the Master’s program she said to me “Salma are you going to continue being Jack of all trades and master of none”. So I decided to pay more attention to my studies and thanks to Mrs. Ahmed I topped in the Masters exam. Of course my family was also behind me. From providing snacks for late night study sessions to going across town to borrow books from friends
By the time I finished my Masters my parents were all set for me to do my PhD. I went for my Phd on a 3 year Ford Foundation Scholarship although I was told that it would take 4 years to finish my PhD. I was very anxious as to what would happen when the scholarship ended but “Allah ka karam hai” I was given an Assistantship by the University plus I was awarded a Peace Scholarship for my efforts at creating an understanding of Islam and Pakistan by giving talks at various forums.
Coming back to Pakistan I was initially very disappointed. I had been sent to do my PhD so I could come back and start a specialized program of MSc in Nutrition. However while I was in the US the college had been nationalized and I had been transferred to Urdu College for women. Needless to say I never reported there for service.
I tried to set up a private practice as a consultant nutritionist but every doctor I talked to said something like “Why don’t you get in touch with PC or Sheraton.”
My lucky break came when I met Dr. Camer Vellani who was the Dean of AKU at a dinner. When he heard I had a PhD in nutrition he said ‘why don’t you start a private practice’. I told him the response of doctors and he said “I could really use your services.” Plus we will need you when the medical college starts, in the meantime why don’t you teach a course to the nurses so I don’t lose touch with you.
The next day I got a call from a lady who said Dr.Vellani had referred her to me for nutritional counselling. So there I was started in my private practice at home.
Then as soon as the Department was set up I got a call to come for an interview for a faculty position in the Department of Medicine. As my children were still young I agreed to a part –time position. I was told that even though my appointment was in Medicine I was free to work when any faculty member from any department who was interested in nutrition. I was also told that it was up to me to get nutrition into the medical curriculum. It was slow going but eventually I did manage to get nutrition into the curriculum. Getting started in research was easier as faculty in Pediatrics, Ob/Gyn, Surgery and Community Health Science gave me an opportunity to participate in research projects as a co-investigator. Soon I was writing proposals for funding myself and publishing research papers in international and local journals. During this time I got an opportunity to see the world – Korea, Australia, Canada, Malaysia, Thailand and Taiwan- to attend conferences to present my own research or as an invited speaker.
While working at AKU together with other colleagues from the RLAK College of Home Economics we formed the Pakistan Nutrition and Dietetic Society (PNDS) in 2003. The Society has grown in the last few years and we now have a chapter and Lahore and Islamabad
The rest is history I started as an assistant professor and retired as a full professor from AKU, thanks to the fore sight of one doctor.
Information regarding upcoming nutrition and dietetics events 2016
(Contributed by Sana Zaidi, student MSPH-Nutritional Sciences at School of Public Health, DUHS
- 18th International Conference On Global Food Security (Singapore)
January 7-8, 2016
- Nutritional Genomics: Essential Basics For Nutrition And Health Professionals (Webinar)
13 January 2016
- International Conference On Food Security And Nutrition (New Delhi, India)
February 7-8, 2016
- The Probiotic Congress: Asia (Kuala Lumpur, Malaysia)
29 February – 1 March 2016
- 5th Annual Middle East Congress on Clinical Nutrition, Cairo, Egypt.
March 22-24, 2016
- 5th International Conference On Vitamin D Deficiency And Human Health (Abu Dhabi, UAE)
24–25 March 2016
- 3rd International Conference On Food Security And Nutrition – ICFSN (Amsterdam, Netherlands)
23rd to 25th March 2016
- Statistics For Nutrition Research 2016 ( London)
19 April 2016
- Malaysian Dietitian’s Association (MDA) and American Overseas Dietetic Association (AODA) conference,
Kuala Lumpur,Malaysia. 26th-28th May 2016
- Nutrifood 2016 : International Conference On Advances In Human Nutrition , Food Science & Technology (Toronto, Canada)
June 26-27, 2016
- 17th International Congress of Dietetics Granada Spain
7th-10th September, 2016
Nutrition Courses and Trainings: