Q&A with Jeffrey I. Mechanick, MD, editor Molecular Nutrition: The Practical Guide

Jeffrey I. Mechanick, MD, editor, Molecular Nutrition: The Practical Guide
Jeffrey I. Mechanick, MD, editor, Molecular Nutrition: The Practical Guide

“You are what you eat,” is a phrase that everyone has heard, but there really is some truth to the meaning behind this age-old adage; what you consume can have real effects on your health. This is certainly not a revelation to endocrinologists and other physicians, but as the complexities of nutrition are better understood, the importance of what patients consume is becoming even more apparent. To emphasize this realization, the Endocrine Society recently published Molecular Nutrition: The Practical Guide through its Endocrine Press book publishing imprint. Edited by Jefirey I. Mechanick, MD, Michael A. Via, MD, and Shan Zhao, PhD, this new volume aims to address the discrepancies between the ever-increasing rates of chronic disease with the enhanced knowledge of the interactions between the foodome and nutria-epigenome/ metabolome.

“Dr. Mechanick is a true expert in the art and science of nutritional medicine,” says Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief, the Mount Sinai Hospital, and who also wrote the book’s foreword. “this excellent book is a guide to how a patient’s nutritional status may be impacting their overall wellness and how we as physicians can better heal our patients. this book serves as a strong reminder that we must have the critical discussion with each of our patients about the importance of a healthy lifestyle and nutrition.”

Endocrine News reached out to Mechanick to discuss this intriguing new book that takes a fresh perspective on a well-researched topic, and which will no doubt be a vital tool for all practitioners in endocrinology and beyond. We asked him about what surprised him the most about the book as well as what might surprise readers, and why it should be in every endocrinologist’s library.

Endocrine News: Why was it important for a book like Molecular Nutrition to be published by the Endocrine Society?

Jeffrey Mechanick: Explaining the molecular and physiological underpinnings of endocrinology and metabolism has always been emblematic of activities of the Endocrine Society. The traditional teachings of nutritional medicine have now become invigorated with molecular biology and advances in biocomputational sciences, and moreover, have clearly demonstrated overlap with many aspects of endocrinology and metabolism, such as diabetes and obesity. Therefore, publishing Molecular Nutrition was a natural step toward this better understanding we all seek.

EN: Have lifestyle and dietary choices by patients been somewhat ignored too much by primary care physicians in the past?

JM: The issue is not whether lifestyle and dietary choices are ignored, for that would acknowledge their existence in formal and continuing medical education and a simple decision or act of omission. Rather, lifestyle medicine, healthy eating patterns, and the role of nutritional science in routine patient care have not risen to the level of even being included in standard medical curriculum, particularly in the clinic and/or bedside teaching settings. Admittedly, this is not a glaring knowledge gap historically, but looking forward, it is a necessary addition to our learning experience as part of furthering a preventive care paradigm and more effective healthcare delivery system.

EN: What will surprise readers the most when they pick up Molecular Nutrition?

JM: It should not be a surprise that the interaction of environmental factors (our diet) with our body (our metabolism) occurs at the molecular level. However, Molecular Nutrition may reveal new ways of comprehending these interactions and translating them into routine clinical recommendations. For instance, instead of recommending the standard fare of “healthy” foods gleaned from a library of consensus statements and guidelines, one could start with the patient and derive an individualized metabolic target, consider specific molecules that exert a beneficial role on that target, and then assemble a healthy eating pattern based on foods containing those healthy molecules. Perhaps the real wonder though is the use of molecular cooking, or gastronomy, to preserve those strategic molecules, which can be done in your home, outside of a restaurant setting, albeit with a little study and diligence.

EN: What do physicians and patients alike need to understand about food?

JM: That the nature of food is to provide substrate not only for energy and protein, but also to exert effects at a molecular level that can improve health and potentially prevent disease. This ability is not constant, of course, but as we learn more about the molecular effects of food compounds, these benefits can be better understood and predicted. Also, food should not be vilified, especially in the setting of obesity or diabetes, but rather viewed favorably and even passionately. It is not just about the molecular nature of foods, meals, and eating patterns, but also the benefits from associated socialization and pleasure.

EN: Why has nutrition not been emphasized in medical training as much as it should be?

JM: This is a critical question, and when we have convened various summits in the past to address this, the answers gravitated toward some mysterious deprioritization compared with the “hard” sciences. Perhaps this is due to softer, less precise evidence bases, or perhaps due to a more pervasive nature where many other professional stakeholders lay claim to the field. However, now, with the rising popularity of preventive medicine and the rapid emergence of molecular and technological advances, nutritional medicine, it is hoped, will find a more prominent place in medical education. Along with lifestyle medicine, it is clear we need to fill many gaps in medical education to optimize healthcare.

EN: You state in your preface that Molecular Nutrition is not simply a review of the literature, but, rather a presentation of new ideas and treatment protocols. Is that due to more recent advances in the science of molecular nutrition?

JM: Yes. The concepts asserted in Molecular Nutrition are of two types. First, we present a fairly large evidence base replete with very recent references that serve as a foundation for later sections. Second, we present a particular way of thinking about molecular nutrition as it directly relates to patient care. In fact, it is the translation of the molecular information into clinical context that is crucial; we provide four scenarios that weave through the book to continually remind the reader about clinical context: wellness, aging, cardiometabolic risk, and cancer (see graph, opposite page).

EN: What surprised you when you were in the process of compiling the various chapters of this book?

JM: Great question because as we speak of emergence in molecular biology, the process of developing this book was indeed emergent. Drs. Zhou and Via, as well as the invited authors, provided tremendous insight as the book progressed prompting many zigs and zags ultimately steering us toward a final protocol. The original intent was in fact to simply provide a high-quality review of molecular actions of nutrients in specific clinical contexts, but during the process, we realized that we could construct a cognitive pathway for clinicians to build healthy eating patterns and then communicate them to patients, while also incorporating practical tips on shopping and cooking. I should point out here that molecular nutrition in no way marginalizes traditional dietetics and basic nutritional precepts, but rather pulls all of this information together with new scientific discoveries to synthesize a more comprehensive portrayal of nutritional medicine.

EN: Finally, why is Molecular Nutrition a must-read for every endocrinologist?

JM: Our belief is that all elements of endocrinology and metabolism incorporate molecular principles that share important pathways with nutritional medicine. And therefore, understanding molecular nutrition can potentially drive insight and options when managing patients. The real answer will be the feedback received. This is not a standard “vanilla” textbook. This is more of a story, and it is the reader’s epilogue that I am interested in.

According to Fuster’s foreword, Molecular Nutrition presents nutritional medicine in a brand-new way, “one that not only offers up a great deal of valuable information for the clinician, but also one that inspires and causes one to ponder deeper questions about physiology and how we clinicians optimize care of our patients,” he writes. “We still are what we eat, but maybe now we are closer to understanding why.”

—Newman is the editor of Endocrine News. He wrote about why various endocrinology professionals chose this field in the March 2015 issue.

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