Nutrition in Chinese medicine by Dr (TCM) Attilio D'Alberto Download Changes in global nutrition Changes in the world food economy are reflected in shifting dietary patterns, for example, increased consumption of energy-dense diets high in fat, particularly saturated fat, and low in unrefined carbohydrates. These patterns are combined with a decline in energy expenditure that is associated with a sedentary lifestyle; motorised transport, labour-saving devices in the home, the phasing out of physically demanding manual tasks in the workplace, and leisure time that is preponderantly devoted to physically undemanding pastimes. Because of these changes in dietary and lifestyle patterns, chronic non-communicable diseases (NCDs), including obesity, diabetes mellitus, cardiovascular disease (CVD), hypertension and stroke, and some types of cancer, are becoming increasingly significant causes of disability and premature death in both developing and newly developed countries. It has been calculated that in 2001, chronic diseases contributed to approximately 60% of the 56.5 million total reported deaths in the world and approximately 46% of the global burden of disease. The proportion of the burden of NCDs is expected to increase to 57% by 2020. Almost half of the total chronic disease deaths are attributable to cardiovascular diseases; obesity and diabetes are also showing growing trends, not only because they already affect a large proportion of the population, but also because they have started to appear earlier in life. It is clear that the earlier labelling of chronic diseases as ''diseases of affluence'' is increasingly wrong, as they emerge both in poorer countries and in the poorer population groups in richer countries. All essential nutrients must be present in our diets in certain quantities if we are to remain healthy. A shortage of anyone of these essential nutrients will lead to adverse symptoms, often a characteristic deficiency disease 3. In 1991 the COMA report devised a general term known as Dietary References Values (DRVs) as the RDAs were misinterpreted as the minimum requirement of value needed in a diet rather than its true meaning of representing a safe zone. However, both references values are pitched against healthy people and make no allowances for ill health. History of nutrition in Chinese medicine Nutrition lies at the heart of Chinese medicine. It is where the concept of Qi first originated. Qi is the master template from which all life derives. From Qi, came Yin and Yang and then everything else. Qi is defined as air, gas or vapour that's seen whilst cooking a bowl of rice over a fire. Theory of nutrition in Chinese medicine hasn't changed for over a millennium. The origins of nutrition theory are unknown as its invention came before methods of recording such as writing, but it is thought to have occurred some time after the discovery of fire. Later during the Shang dynasty (c.17th century - c.11th century B.C.) the first records were scratched onto bones and turtle shells. During the Tang dynasty (618-907), Sun Simiao wrote the famous book 'Food Therapy' in Prescriptions worth a Thousand Gold, in which he stated: 'Before a doctor treats a disease, he must be sure of the cause and pathogenesis of the disease, then treat the patient with diet before using any medications'. Classification of foods in Chinese medicine Within Chinese medicine, every food is classified as having a particular nature; cold, hot, warm, cool and neutral. Generally speaking, foods that take longer to grow such as carrots, parsnips, cabbage and ginseng are more warming than those that grow quickly, for example lettuce, radish and cucumber. Raw foods are more cooling than cooked food, whilst food eaten cold is also cooling. Foods with blue, green or purple colours are usually more cooling than similar foods that are red, orange or yellow, for example a green apple is more cooling than a red one. Chinese medicine believes that the seasons have a profound cyclical effect on human growth and wellbeing in which we are influenced by climatic changes and should live in harmony with them 6. Flavour is very important as it aids in sending nutrition via the meridians to a corresponding organ. The five flavours of foods are pungent (acrid), sweet, sour, bitter, and salty. Pungent and sweet are considered Yang as they tend to be warming and direct energy outward and higher in the body. Sour, bitter and salty are considered to be Yin and cooling as they conduct energy lower and inward. Each flavour corresponds to a paired set of internal organs: Sour flavour enters the Liver and Gallbladder, Bitter flavour enters the Heart and Small Intestine, Sweet flavour enters the Spleen and Stomach, Pungent flavour enters the Lung and Large Intestine, Salty flavour enters the Kidney and Bladder. In the diet of a healthy person the flavours should be balanced, with sweet flavour predominating, because its associated flavour corresponds to the Spleen and Stomach; our source of Qi and Blood. Therefore, each day the sweet flavour, the primary flavour of most carbohydrates such as grains, vegetables, legumes, nuts, seeds and fruit, should be accompanied with small amounts of bitter, salty, pungent and sour foods 7. The quantity of flavours is also important. If a flavour is generally helpful for an organ's function, too much of that flavour can have an opposite effect. Table 1. The Five flavours and their properties. Eating according to your climate This knowledge of nature and flavour of foods, allows the physician to formulate a nutritional strategy based upon the patient's pattern or disharmony. The key to health eating in Chinese medicine is to eat certain foods that correspond to your disharmony as well as your surrounding environment. For example, the UK has a very damp climate; therefore people that live within this environment are more likely to have more damp related disorders, such as joint pain, arthritis, asthma, M.E., IBS and other digestive disorders. It is therefore wise not to eat excessive amounts of damp causing foods within a damp environment, for example; dairy or raw foods. Generally speaking, everything in small quantities is fine, but eating excessive foods that are not traditional to a country is not always good for the body. An example of this is the millions of people that eat curry every Friday or Saturday night. Hot, spicy foods are pungent and aromatic in nature, they open and disperse and are eaten in their native countries to vent excessive heat in the body. If you eat hot, spicy food every weekend in a country that isn't hot, then you'll increase the quantity of heat or Yang in your body as you sweat and lose Yin (water). If you then mix that with a naturally damp climate as you have in the UK, it will lead to damp-heat, one of the most difficult conditions to treat in traditional Chinese medicine. The UK cuisine has evolved out of its surrounding climate. Foods are usually served hot, with sauces and hot deserts, because the surrounding climate is often cold. However, as the UK undergoes climate change, our traditional diet will need to adapt to reflect the new environment we live in. That doesn't mean to say we should start eating spicy curries every night, but rather look at other European countries where the climate is traditionally hotter and will reflect our climate in the future. In many respects this is already being done with many people eating a continental diet. Our diet should not only reflect our surrounding environment, but should also include locally grown, seasonal, organic foods that pertain to that region. Eating a diet that corresponds to your local environment also acts to reduce foods carbon footprint. Foods should also not be heated using a microwave. A microwave will badly damage a food's Qi leaving it with little or no energetic substance. Conclusions Chinese nutrition lies at the root of Chinese medicine and is fully integrated into social eating habits in China. This ancient cultural knowledge is now being spread into western society and with that, greater understanding of how food can be used as nutritional medicine. By applying the ancient theories of Chinese medicine to our modern society, we can learn how to live in better harmony with the surrounding environment, reduce our impact on the climate, improve our health and prevent disease. 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