7. NUTRITION AND HEALTH

NUTRITION AND HEALTH: A COMPLETE GUIDE FOR PHARMACY STUDENTS

Welcome, future pharmacists and healthcare professionals!

Nutrition is a branch of life sciences which deals with the process of receiving and utilising all the substances required for growth and development as well as keeping the body healthy. It includes all the steps starting from the intake and swallowing of food to the digestion of food as it passes through the GIT. The supply of materials (in the form of food) required for supporting life in cells and organisms is termed nutrition (or nourishment).

As a pharmacy educator with years of experience teaching Social Pharmacy, I have observed that students often underestimate the importance of nutrition in pharmacy practice. However, understanding nutrition and its impact on health is essential for every pharmacist because we counsel patients on diet, drug-food interactions, and nutritional supplements. In this comprehensive guide, I will walk you through the basics of nutrition, balanced diet, malnutrition, nutrition deficiency diseases, food fortification, nutraceuticals, and drug-food interactions. Let us begin our journey.

Dpharmguru’s exam insights:

Nutrition and health is one of the most frequently tested topics in social pharmacy exams. Remember: The seven major classes of essential nutrients are Carbohydrates, Proteins, Vitamins, Fats, Minerals, Fibres, and Water. Macronutrients (carbohydrates, proteins, fats) provide energy, while micronutrients (vitamins, minerals) are needed in smaller quantities. Understanding balanced diet, malnutrition, and deficiency diseases is essential for every pharmacist!

3.1. NUTRITION

Basics of Nutrition

A healthy diet prevents or improves a number of common health problems. Following are the seven major classes of essential nutrients:

• Carbohydrates
• Proteins
• Vitamins
• Fats
• Minerals
• Fibres/Dietary Fibres
• Water

Three Major Functions of Nutrients:

Types of Nutrition

1. Macronutrients

Macronutrients provide calories or energy to the body and are needed in large quantities for maintaining its functions and carrying out daily life activities.

• Carbohydrates: Source of energy (4kcal/gram). Divided into starch (bread, potatoes, rice) and sugar (provides calories but no other nutrients).
• Proteins: Essential for body growth, repair, and healing. Made up of amino acids. Nine essential amino acids: Histidine, Isoleucine, Leucine, Lysine, Methionine, Phenylalanine, Threonine, Tryptophan, and Valine.
• Fats: Source of energy and contain fat-soluble vitamins. Types include Saturated Fat (butter), Monounsaturated Fat (olive oil), Polyunsaturated Fat (corn oil), Trans Fat, and Omega-3 Fat (fish oils).
• Fibres/Dietary Fibres: Help keep bowels working regularly. Types include Soluble Fibres (pectins, gums) and Insoluble Fibres (cellulose, lignin).
• Water: Vital component of life—makes up 55-65% of body mass. Essential for transport of nutrients, temperature regulation, and digestion.

2. Micronutrients

Micronutrients are needed in smaller quantities but their deficiency may result in severe or life-threatening conditions.

• Vitamins: Fat-soluble (A, D, E, K) and Water-soluble (B complex, C).
• Minerals: Calcium, Magnesium, Sodium, Potassium, Phosphorus, Iron, Iodine, Fluoride, Zinc, and Selenium.

Dpharmguru’s exam insights:

Macronutrients and micronutrients are frequently tested. Remember: Macronutrients (carbohydrates, proteins, fats) provide energy. Micronutrients (vitamins, minerals) are needed in smaller amounts but are essential for body functions. Fibre helps in digestion, and water is the most essential nutrient!

3.2. BALANCED DIET

A balanced diet consists of an adequate amount of various nutrients which are essential for ensuring good health. It contains different food items in such quantities and proportions that the requirements for calories, proteins, minerals, vitamins, and alternative nutrients are met. A balanced diet should provide 60-70% of total calories from carbohydrates, 10-12% from proteins, and 20-25% from fat.

Health Benefits of a Balanced Diet

• Improved Functioning: Increases energy, improves body functioning, boosts immune system.
• Prevention of Nutritional Deficiencies: Meets nutritional needs to avoid deficiencies.
• Prevention of Diseases: Prevents risk of developing diabetes, cancer, and heart disease.
• Treatment of Diseases: Helps in treating diabetes and high blood pressure.
• Increased Energy: Makes an individual energetic, manages weight, and helps fight stress.

Recommended Dietary Allowance (RDA)

The recommended daily levels of nutrients for fulfilling the demands of all healthy individuals of a particular age and gender group is termed Recommended Dietary Allowances (RDA).

Key RDA Values:

• Men (18-29 years): 2,550 kcal/day
• Women (18-29 years): 2,000 kcal/day
• Pregnant Women (Full activity): +285 kcal/day
• Lactating Women (First 6 months): +500 kcal/day

Dpharmguru’s exam insights:

RDA values are frequently tested. Remember: Men require more calories than women; pregnant women need additional 285 kcal/day; lactating women need additional 500 kcal/day. Iron requirement for women is 19mg/day compared to 6mg/day for men—due to menstruation!

3.3. MALNUTRITION

Malnutrition is defined as an imbalance between the nutrients required by the body and the nutrients offered to it. It may be classified as over nutrition and under nutrition.

Under Nutrition

Under nutrition is caused by a lack of protein, calories, or micronutrients. When people do not eat (or absorb) enough nutrients to meet their energy and growth demands, they are said to be undernourished.

Causes of Malnutrition:

• Inadequate food supply.
• Disorders or medicines that prevent nutrients from being consumed, metabolised, or absorbed.
• Significant rise in the need for calories.
• Illnesses like AIDS, cancer, or depression causing loss of appetite.
• Certain drugs causing nausea, reduced appetite, or inhibiting nutrient absorption.

Signs of Malnutrition:

• Loss of body fat (adipose tissue).
• Thin, dry, inelastic, pallid, and chilly skin.
• Hollow cheeks and sunken eyes.
• Dry, sparse hair that readily falls out.
• Fatigue, inability to stay warm, diarrhoea, loss of appetite, irritability, and apathy.
• In extreme circumstances—stupor, liver, heart, and/or respiratory failure.

Over Nutrition

Over nutrition is a condition in which the consumption of essential nutrients is too high in a specific diet. Extreme dieting or excessive food consumption can lead to over nutrition.

Signs of Over Nutrition:

• Cloudy urine
• Increased rate and amount of urination
• Heartbeat irregularities
• Eye irritation or sensitivity to light
• Cracked, dry lips
• Extreme weight gain
• Diabetes, high blood pressure, increased cholesterol levels

Dpharmguru’s exam insights:

Malnutrition is frequently tested. Remember: Under nutrition (calorie/protein deficiency) and Over nutrition (excessive nutrient intake). Key signs include weight loss, dry skin, fatigue (under); weight gain, diabetes, high blood pressure (over). Pharmacists can counsel patients on balanced diet and appropriate supplementation!

3.4. NUTRITION DEFICIENCY DISEASES

Vitamin Deficiency Diseases

Fat-Soluble Vitamins:

Water-Soluble Vitamins:

Protein Deficiency Diseases

Kwashiorkor: Protein deficiency with adequate calorie intake. Occurs in children between 6 months and 3 years. Symptoms: Growth failure, oedema, enlarged fatty liver, low serum proteins, anaemia.

Marasmus: Starvation in infants due to calorie deficiency. Occurs in infants under 1 year. Symptoms: Growth failure, wasting of all tissues, no oedema, monkey-like face, bulging abdomen, thin limbs.

Mineral Deficiency Diseases

• Calcium Deficiency: Osteopenia, osteoporosis, muscle cramps, numbness.
• Iron Deficiency: Anaemia, weakness, fatigue.
• Magnesium Deficiency: Fatigue, weakness, nausea, muscle cramps.
• Potassium Deficiency: Muscle cramping, weakness, constipation, irregular heart rhythms.
• Zinc Deficiency: Loss of appetite, decreased immune function, retarded growth, hair loss.

Dpharmguru’s exam insights:

Nutrition deficiency diseases are frequently tested. Remember: Night blindness (Vitamin A), Rickets (Vitamin D), Beriberi (Vitamin B₁), Pellagra (Niacin), Scurvy (Vitamin C), Anaemia (Iron/Folic Acid/B₁₂), Kwashiorkor (Protein deficiency), Marasmus (Calorie deficiency). These are frequently asked in exams!

3.5. JUNK FOODS

Junk foods are food items with very small or no nutritional value (e.g., cold drinks, burgers, oily food, bakery products, candies, etc.). They are rich in fat, salt, and calories.

Ill Effects of Junk Food

• Reduced Appetite: Fills stomach quickly and for longer duration.
• Digestive Disorders: Damages blood sugar levels due to excessive carbohydrates.
• Respiratory Problems: Obesity caused by junk food leads to breathing problems.
• Dull and Lifeless Skin: Affects skin due to high carbohydrate content.
• Erosion of Teeth: Affects teeth enamel.
• Heart Diseases: Increases cholesterol levels, causing diabetes and obesity.
• Increased Blood Pressure: Significantly increases blood pressure.
• Obesity: Adds unwanted fat on the waist.
• Diabetes: Food items rich in sugar increase glucose levels.

Dpharmguru’s exam insights:

Junk food effects are frequently tested. Remember: Junk foods are high in fat, salt, and calories but low in nutritional value. They cause obesity, diabetes, heart disease, high blood pressure, and dental problems. Pharmacists should educate patients on the harmful effects of junk food!

3.6. CALORIFIC AND NUTRITIVE VALUES OF VARIOUS FOODS

Cereals and Millets

About 100gm of cereals yield 350kcal of energy.

Pulses and Legumes

Pulses contain 20-25% of protein. Soyabean is a rich source of protein (40%).

Vegetables

Green leafy vegetables (spinach, methi, cholai) are rich sources of Vitamin C, pro-vitamin A, riboflavin, folic acid, calcium, iron. Around 150-200gm of vegetables should be added in our per day diet.

Fruits

Fruits are protective food, rich in vitamins and minerals. Daily intake of 85-100gm of fruits is recommended. Amla is the richest source of Vitamin C (600mg/100gm).

Milk and Milk Products

Milk contains proteins (casein, lactalbumin, lactoglobulin), fat, carbohydrate (lactose), minerals (best source of calcium), and vitamins (all except Vitamin C).

Comparison of Nutritive Values of Milk (per 100gm):

Dpharmguru’s exam insights:

Nutritive values of foods are frequently tested. Remember: Cereals yield 350kcal/100gm; Pulses contain 20-25% protein; Soyabean has 40% protein; Amla is richest in Vitamin C (600mg); Buffalo milk has highest fat (6.5%) and calcium (210mg). These values are often asked in MCQs!

3.7. FORTIFICATION OF FOODS

Fortified foods are those in which nutrients that do not naturally occur in the food are added. These foods are intended for improving nutrition and enhancing health.

Types of Fortification

• Biofortification: Breeding crops to increase their nutritional value (plant breeding and genetic engineering).
• Microbial Biofortification: Addition of probiotic bacteria.
• Commercial and Industrial Fortification: Flour, rice, oils.
• Home Fortification: e.g., Vitamin D drops.

Examples of Fortified Foods:

• Salt: Iodine, iron, flour
• Flours, Bread, Rice: Vitamins B₁, B₂, niacin, iron
• Milk, Margarine: Vitamins A and D
• Sugar: Vitamin A
• Orange Juice: Calcium

Benefits of Food Fortification:

• Improved health of large population
• Safe method of improving nutrition
• Widely-acceptable—does not require changes in food habits
• Unchanged food characteristics (taste, feel, appearance)
• Cost-effective with high benefit-to-cost ratio

Dpharmguru’s exam insights:

Food fortification is frequently tested. Remember: Fortification adds nutrients to foods; Salt iodisation is the most common mandatory fortification; Benefits include improved health, safety, cost-effectiveness, and unchanged food characteristics. Common examples: Vitamin D in milk, Iodine in salt, Iron in flour!

3.8. INTRODUCTION TO FOOD SAFETY

Food safety involves the procedures followed at the time of preparation, handling, and storage of food to prevent food-borne illness and injury.

Tips for Safe Food Handling

• Wash hands frequently while handling food.
• Use a soap dispenser instead of a soap bar.
• Dry hands with a paper towel.
• Wear clean and washable protective clothing while cooking.
• Read labels carefully for advisory statements and expiry dates.
• Do not leave food uncovered for a longer period.
• Store food not to be used immediately in a refrigerator.
• Do not cough, spit, smoke, or sneeze near food.
• Do not touch nose, teeth, ears, or hair while handling food.
• Do not taste food with fingers or with the same spoon repeatedly.

3.9. ADULTERATION OF FOODS

Food adulteration is the practice of adulterating food or contaminating food materials by adding adulterants, which are poor quality substances added to food items for economic and technical benefits.

Common Adulterants and Their Harmful Effects

• Milk: Water and starch powder → Stomach disorders.
• Pulses: Dyes, chemical and lead chromate → Stomach disorders.
• Sugar: Chalk powder, washing soda, urea → Stomach disorders, kidney failure.
• Edible Oils: Mineral oil, Karanja oil → Gallbladder cancer, allergies, paralysis.
• Turmeric Powder: Sawdust, chalk dust, industrial dyes → Cancer, stomach disorders.
• Chilli Powder: Red brick powder, lead, soluble salts → Metal toxicity, cancer, lead poisoning.

Prevention of Adulteration:

• Avoid consumption of dark coloured, junk, and other processed foods.
• Clean and store all grains, pulses, and other food products.
• Wash fruits and vegetables thoroughly in running water before use.
• Check FSSAI label, license number, list of ingredients, manufactured date, and expiration date before buying food products.

Dpharmguru’s exam insights:

Food adulteration is frequently tested. Remember: Common adulterants include water in milk, dyes in pulses, chalk powder in sugar, and lead in spices. Prevention includes checking FSSAI labels and washing fruits/vegetables. Pharmacists should educate patients about food adulteration!

3.10. ARTIFICIAL RIPENING OF FRUITS

Artificial ripening is the method of regulating ripening to provide uniform ripening characteristics for consumer acceptance and increased sales.

Artificial Ripening Agents

• Ethylene: Main naturally occurring ripening agent. Used for bananas, mangoes, avocados.
• Calcium Carbide: Greyish black solid—hazardous. Causes severe irritation, burns, skin ulcers, and pulmonary oedema.
• Ethephon: Commonly used and better artificial ripening agent than calcium carbide. Fruits have stronger shelf-life.

Effects of Artificial Ripening:

• Ethylene Glycol: Highly toxic → acute renal failure.
• Ethephon: Monochloroacetic acid → burn injury, fatal systematic poisoning.
• Kerosene: Sulphur dioxide → pulmonary injuries.
• Calcium Carbide: Arsenic and phosphorous hydride → fluid accumulation in lungs, vomiting, diarrhoea.

3.11. PESTICIDES

FAO defined pesticide as any substance or mixture of substances intended for preventing, destroying, or controlling any pest.

Types of Pesticides

• Based on Pests: Insecticides, Herbicides, Rodenticides, Bactericides, Fungicides, Larvicides.
• Based on Biodegradability: Biodegradable (broken down by microbes), Persistent (take months/years to break down).
• Based on Chemical Composition: Organophosphates, Carbamates, Organochlorine Insecticides (DDT, chlordane), Pyrethroid, Sulfonylurea Herbicides, Biopesticides.

3.12. GENETICALLY MODIFIED FOODS

Genetically Modified (GM) foods are derived from organisms whose genetic material (DNA) has been modified by using modern biotechnology.

Positive Impacts of GM Crops

• Wider selection of traits (pest/disease resistance, drought tolerance, improved nutrition).
• Faster and low priced.
• Greater precision in selecting traits.
• Improved agricultural yield with less labour and cost input.
• Decreased usage of pesticides and herbicides.
• Removal of allergens or toxic components.

Negative Impacts of GM Crops

• Environment: Harm to non-target species, development of resistant pests, creation of superweeds.
• Health Concerns: Allergens, antibiotic resistance, decreased nutrients, introduced toxins.

3.13. DIETARY OR FOOD SUPPLEMENTS

Dietary supplements include vitamins, minerals, amino acids, enzymes, herbs, and other botanicals. These supplements are marketed as tablets, capsules, soft gels, gel caps, powders, and liquids.

Types of Dietary Supplements

• Natural: Extracted from plants, animal tissues, or inorganic materials.
• Semi-synthetic: Extracted from natural sources and then changed chemically.
• Synthetic: Produced by artificial methods.

Indications of Dietary Supplements

• Ensuring health and wellness (antioxidants).
• Improving athletic performance (sports supplements).
• Enhancing personal appearance (weight management).
• Avoiding pharmaceuticals (arthritis supplements—chondroitin, glucosamine).

3.14. NUTRACEUTICALS

In 1989, Stephen Defelice discovered the term “nutraceuticals” from nutrition and pharmaceutical. He defined nutraceutical as a substance that is considered as a food or its part, which provides nutritional value and other health benefits, including disease prevention or health promotion.

Classification of Nutraceuticals

• According to Food Source: Plants (ascorbic acid, quercetin, lycopene), Animals (CLA, EPA, DHA), Microbes (yeast, lactobacillus).
• According to Mechanism of Action: Antioxidant, antibacterial, antihypertensive, anti-carcinogenic, etc.
• According to Chemical Nature: Isoprenoid derivatives, Phenolic substances, Fatty acids, Carbohydrates, Amino acid-based substances, Microbes, Minerals.

Categories of Nutraceuticals

• Traditional Nutraceuticals: Natural—no changes in food. Includes chemical constituents (nutrients, herbals, phytochemicals), probiotic microorganisms, and nutraceutical enzymes.
• Non-traditional Nutraceuticals: Artificial foods formed through biotechnology—fortified nutraceuticals and recombinant nutraceuticals.

Benefits of Nutraceuticals:

• Increase the health value of human diet.
• Help people to live longer.
• Help people to avoid specific medical conditions.
• More natural than traditional medicine with fewer side effects.

Dpharmguru’s exam insights:

Nutraceuticals are frequently tested. Remember: Nutraceuticals provide health benefits beyond basic nutrition. Traditional nutraceuticals are natural; non-traditional are artificial (biotechnology). Examples: Lycopene (tomatoes), Omega-3 fatty acids (salmon), Probiotics (yogurt). Pharmacists should be knowledgeable about nutraceuticals as patients frequently ask about them!

3.15. DRUG-FOOD INTERACTIONS

When a food/nutrient alters the effects of a drug, the alteration is considered a food-drug interaction. Food-drug interaction can occur with prescription drugs, over-the-counter drugs, herbal products, and dietary supplements.

Common Food-Drug Interactions

Dpharmguru’s exam insights:

Drug-food interactions are frequently tested. Remember: Grapefruit juice interacts with calcium channel blockers and carbamazepine; Warfarin interacts with Vitamin K; Tetracycline with dairy; Iron with Vitamin C (enhances) and dairy (decreases); Alcohol with metronidazole causes disulfiram reaction. Pharmacists must counsel patients on these interactions!

FREQUENTLY ASKED QUESTIONS (FAQs)

1. What are the seven major classes of essential nutrients?

The seven major classes of essential nutrients are: Carbohydrates, Proteins, Vitamins, Fats, Minerals, Fibres, and Water.

2. What is the difference between macronutrients and micronutrients?

Macronutrients (carbohydrates, proteins, fats) provide energy and are needed in large quantities. Micronutrients (vitamins, minerals) are needed in smaller quantities but are essential for body functions.

3. What is a balanced diet?

A balanced diet consists of adequate amounts of various nutrients—60-70% calories from carbohydrates, 10-12% from proteins, and 20-25% from fat.

4. What is the difference between Kwashiorkor and Marasmus?

Kwashiorkor is protein deficiency with adequate calorie intake (oedema, fatty liver). Marasmus is calorie deficiency (wasting of all tissues, no oedema).

5. What are nutraceuticals?

Nutraceuticals are foods or food ingredients that provide medical or health benefits, including disease prevention or health promotion. They range from isolated nutrients to genetically engineered designer foods.

6. What is the drug-food interaction with grapefruit juice?

Grapefruit juice increases blood levels of calcium channel blockers (felodipine, nifedipine) and carbamazepine, leading to harmful effects.

7. What is the role of a pharmacist in nutrition?

Pharmacists counsel patients on balanced diet, recommend nutritional supplements, educate on drug-food interactions, and promote healthy eating habits.

SUMMARY

Nutrition is the foundation of health and well-being. The seven major classes of essential nutrients—carbohydrates, proteins, fats, vitamins, minerals, fibres, and water—are essential for energy, growth, and body functions. A balanced diet provides these nutrients in appropriate proportions and prevents malnutrition and deficiency diseases.

Malnutrition can be under nutrition (lack of protein/calories) or over nutrition (excessive intake). Vitamin deficiency diseases include night blindness (Vitamin A), rickets (Vitamin D), beriberi (Vitamin B₁), pellagra (Niacin), scurvy (Vitamin C), and anaemia (Iron/Folic Acid/B₁₂). Protein deficiency causes Kwashiorkor and Marasmus.

Junk foods are low in nutrition and high in fat, salt, and calories—causing obesity, diabetes, and heart disease. Food fortification adds nutrients to foods to improve public health. Nutraceuticals provide health benefits beyond basic nutrition. Drug-food interactions are critical for pharmacists to counsel patients on safe medication use.

As I always tell my students: “Food is medicine—what we eat directly impacts our health. Pharmacists must understand nutrition to counsel patients effectively and promote holistic health.”

REFERENCES AND FURTHER READING

• World Health Organization (WHO). (2022). Nutrition Guidelines. Retrieved from https://www.who.int.
• Park, K. (2022). Park’s Textbook of Preventive and Social Medicine (25th ed.). Banarasidas Bhanot Publishers.
• Ministry of Health and Family Welfare. (2022). National Nutrition Policy. Government of India.
• Food Safety and Standards Authority of India (FSSAI). (2022). Food Safety Guidelines. Government of India.
• International Pharmaceutical Federation (FIP). (2022). Role of Pharmacists in Nutrition. Retrieved from https://www.fip.org.

Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare professionals for medical concerns.

written by:
Dr. N. Sujith Kumar

Dr. N. Sujith Kumar is a pharmacy educator, Pharm.D graduate, and academic content creator from Jawaharlal Nehru Technological University Kakinada (JNTUK), where he completed his Doctor of Pharmacy (Pharm.D) degree between 2015 and 2021. He has more than 7 years of experience creating pharmacy educational content, writing study materials, and reviewing academic articles for pharmacy students. He has also contributed guest articles to pharmacy education platforms, including PharmD Guru. At D.PharmGuru, his work focuses on simplifying complex Diploma in Pharmacy (D.Pharmacy) subjects into easy-to-understand notes, practical explanations, and exam-oriented educational resources for students across India. His areas of focus include Human Anatomy and Physiology, Pharmaceutics, Pharmacology, Pharmaceutical Chemistry, Hospital and Clinical Pharmacy, and other core D.Pharmacy subjects.

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