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Clinician Home  >  Nutritional Foundation Program  >  Pain & Inflammation Basics
What is The Nutritional Foundation?
A Health Care Professional’s Protocol for Dietary Changes & Nutritional Supplementation

1. The Science
2. The Protocols
3. The Tools

1. The Science
Reduced cellular energy production, free radical activity, and chronic inflammation

The process by which we transition from a healthy to a diseased state is characterized by consistent biochemical changes, no matter the condition. According to the Pathological Basis of Disease (13), the biochemical theme that is common to most ailing tissues manifests as a “chronic pro-inflammatory state” and includes: 1) a reduction in mitochondrial viability and ATP synthesis, 2) an increase in free radical activity, also called oxidative stress, and 3) chronic inflammation involving an excess production of pro-inflammatory autocoids & cytokines by immune cells, and other cells, such as fibroblasts and chondrocytes.

The Nutritional Foundation Program focuses on reversing these biochemical changes. Clinicians can feel confident with this approach because substantial evidence indicates that our diet can either reduce or augment the chronic pro-inflammatory state and subsequently modulate disease expression (1-12,14).

In addition to a pro-inflammatory diet, we now know that the following diverse behaviors/life style choices will all lead to the generation/maintenance of a chronic pro-inflammatory state and so must be considered during patient care:

• A lack of healthy sun exposure = a lack of vitamin D production (15).
• A lack of exercise (16).
• A lack of sleep (17).
• Poor dental hygiene (18).
• Chronic stress caused by the diverse psychological stressors associated with our high-paced modern lifestyle (19).
• Tobacco use (20).
• Alcohol abuse (21).

Knowledge that inappropriate lifestyle choices leads to chronic inflammation, will allow clinicians to streamline their communications with patients, so that patients understand that unhealthy behaviors lead to chronic inflammation and disease expression. As mentioned previously, The Nutritional Foundation Program has been designed to assist clinicians in this process by addressing the various pro-inflammatory dietary/nutritional behaviors.

2. The Protocol
Dietary changes, nutritional supplementation, lifestyle education

The Nutritional Foundation Program focuses on dietary changes and nutritional supplementation to help reduce the chronic pro-inflammatory state. Diet is the foundation to which key nutritional products should be supplemented. The protocol is based on evidence found in peer-reviewed journals:

             Cordain L, Eaton SB, Sebastian A et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81:341-54.

Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol. 2006;48(4):677-85. 

Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Exp Biol Med. 2008;233:674-88.

Ames BN. Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage. Proc Nat Acad Sci. 2006;103(47):17589-94.

Ames BN. Supplements and tuning up metabolism. J Nutr. 2004;134(11):3164S-68S.

Cannell JJ, Hollis BW. Use of vitamin D in clinical practice. Alt Med Rev. 2008;13(1):6-20. 

Each of the above papers is available as a free full text article from pubmed.gov, and so we have linked PDF versions of the articles to each of the above references.

3. The Tools
Nutritional foundation booklet, audio CD & other tools

The Nutritional Foundation tools are designed to facilitate the application of the nutritional protocols into your practice. As a clinician, a challenge is to maintain an office flow that allows for the effective delivery of procedures unique to your profession’s practice and to additionally provide nutritional guidance. From a patient’s perspective, the challenge is to obtain a scientifically accurate and clinically effective treatment plan/recommendations to pursue. The Nutritional Foundation provides professionally produced patient education materials to satisfy the needs of both the clinician and patient to achieve clinical success.

The key tools of The Nutritional Foundation Program include the following:

1. The Nutritional Foundation Booklet that guides patients to proper eating and supplementation.
2. The Nutritional Foundation Audio that supports the information in the booklet.
3. Additional patient education materials.
4. Email updates.
5. Resources and Links for ongoing self-education.

1. Esposito K, Marfella R, Ciotola M et al. Effect of a Mediterranean-style diet on endothelial markers of vascular inflammation in the metabolic syndrome: a randomized trial. J Am Med Assoc. 2004;292(12):1440-46.
2. Esposito K, Giugliano D. Diet and inflammation: a link to metabolic and cardiovascular diseases. Eur Heart J. 2006;27:15-20.
3. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the metabolic syndrome. J Am Coll Cardiol. 2006;48(4):677-85.
4. Esmaillzadeh A, Kimiagar M, Mehrabi Y, Azadbakht L, Hu FB, Willet WC. Dietary patterns and markers of systemic inflammation among Iranian women. J Nutr. 2007;137:992-98.
5. Holt EM, Steffen LM, Moran A, et al. Fruit and vegetable consumption and its relation to markers of inflammation and oxidative stress in adolescents. J Am Diet Assoc. 2009;109:414-21.
6. Basu A, Devaraj S, Jialal I. Dietary factors that promote or retard inflammation. Arterioscler Thromb Vasc Biol. 2006;26(5):995-1001.
7. Nicklas BJ, You T, Pahor M. Behavioural treatments for chronic system inflammation: effects of dietary weight loss and exercise training. Can Med Assoc J. 2005;172(9):1199-209.
8. Joseph J, Cole G, Head E, Ingram D. Nutrition, brain aging, and neurodegeneration. J Neurosci. 2009;29(41):12795-12801.
9. Wall R, Ross RP, Fitzgerald GF, Staton C. Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids. Nutr Rev. 68(5):280-89.
10. O’Keefe JH, Gheewala NM, O’Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008;51:249-55.
11. Enwonwu CO, Ritchie CS. Nutrition and inflammatory markers. J Am Dental Assoc. 2007;138(1):70-73.
12. Seaman DR. The diet-induced pro-inflammatory state: a cause of chronic pain and other degenerative diseases? J Manipulative Physiol Ther. 2002;25:168-79.
13. Kumar V, Abbas AK, Fausto N. Robbins and Cotran: pathologic basis of disease. 7th ed. Philadephia: Elsevier Saunders; 2005: p.4-86.
14. Danaei G et al. The preventable causes of death in the United States: Comparable risk assessment of dietary, lifestyle, and metabolic risk factors. PLOS Medicine. 2010; 6(4):e1000058.
15. Holick MF, Chen TC. Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr. 2008;87(suppl):1080S-86S.
16. Mathur N, Pedersen BK. Exercise as a means to control low-grade systemic inflammation. Mediators Inflamm. 2008;2008:109502.
17. Simpson N, Dinges DF. Sleep and inflammation. Nutr Rev. 2007(II):S244-52.
18. Quijano A, Shah AJ, Schwarcz AI, Lalla E, Ostfeld RJ. Knowledge and orientations of internal medicine trainees toward periodontal disease. J Periodontol. 2010;81(3):359-63.
19. Bierhaus A, Humpert PM, Nawroth PP. Linking stress to inflammation. Anesthesiol Clin N Am. 2006;24:325-40.
20. Menzies D, Nair A, Williamson PA et al. Respiratory symptoms, pulmonary function, and markers of inflammation among bar workers before and after a legislative ban on smoking in public places. J Am Med Assoc. 2006;296(14):1742-48.
21. Kendrick SF, O'Boyle G, Mann J, et al. Acetate, the key modulator of inflammatory responses in acute alcoholic hepatitis. Hepatology. 2010 Feb 1. [Epub ahead of print]

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