Unit 12. Food and Nutrition Issues

12.3 Nutrition, Health and Disease

Disorders That Can Compromise Health

When nutrients and energy are in short supply, cells, tissues, organs, and organ systems do not function properly. Unbalanced diets can cause diseases and, conversely, certain illnesses and diseases can cause an inadequate intake and absorption of nutrients, simulating the health consequences of an unbalanced diet. Overeating high-fat foods and nutrient-poor foods can lead to obesity and exacerbate the symptoms of gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS). Many diseases and illnesses, such as celiac disease, interfere with the body getting its nutritional requirements. A host of other conditions and illnesses, such as food allergies, cancer, stomach ulcers, Crohn’s disease, and kidney and liver disease, also can impair the process of digestion and/or negatively affect nutrient balance and decrease overall health. Some illnesses that can compromise health are chronic and persist for a long time, some are communicable and can be transmitted between people, and some are non-communicable and are not infectious.

Gastroesophageal Reflux Disease

Gastroesophageal reflux disease (GERD) is a persistent form of acid reflux that occurs more than two times per week. Acid reflux occurs when the acidic contents of the stomach leak backward into the esophagus and cause irritation. It is estimated that GERD affects 25 to 35 percent of the US population. An analysis of several studies published in the August 2005 issue of Annals of Internal Medicine concludes that GERD is much more prevalent in people who are obese.[1] The most common GERD symptom is heartburn, but people with GERD may also experience regurgitation (flow of the stomach’s acidic contents into the mouth), frequent coughing, and trouble swallowing.

There are other causative factors of GERD that may be separate from or intertwined with obesity. The sphincter that separates the stomach’s internal contents from the esophagus often does not function properly and acidic gastric contents seep upward. Sometimes the peristaltic contractions of the esophagus are also sluggish and compromise the clearance of acidic contents. In addition to having an unbalanced, high-fat diet, some people with GERD are sensitive to particular foods—chocolate, garlic, spicy foods, fried foods, and tomato-based foods—which worsen symptoms. Drinks containing alcohol or caffeine may also worsen GERD symptoms. GERD is diagnosed most often by a history of the frequency of recurring symptoms. A more proper diagnosis can be made when a doctor inserts a small device into the lower esophagus that measures the acidity of the contents during one’s daily activities. About 50 percent of people with GERD have inflamed tissues in the esophagus.

The first approach to GERD treatment is dietary and lifestyle modifications. Suggestions are to reduce weight if you are overweight or obese, avoid foods that worsen GERD symptoms, eat smaller meals, stop smoking, and remain upright for at least three hours after a meal. People with GERD may not take in the nutrients they need because of the pain and discomfort associated with eating. As a result, GERD can be caused by an unbalanced diet and its symptoms can lead to a worsening of nutrient inadequacy, a vicious cycle that further compromises health. Some evidence from scientific studies indicates that medications used to treat GERD may accentuate certain nutrient deficiencies, namely zinc and magnesium. When these treatment approaches do not work surgery is an option. The most common surgery involves reinforcing the sphincter that serves as a barrier between the stomach and esophagus.

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is characterized by muscle spasms in the colon that result in abdominal pain, bloating, constipation, and/or diarrhea. Interestingly, IBS produces no permanent structural damage to the large intestine as often happens to patients who have Crohn’s disease or inflammatory bowel disease. It is estimated that one in five Americans displays symptoms of IBS. The disorder is more prevalent in women than men. Two primary factors that contribute to IBS are an unbalanced diet and stress.

Symptoms of IBS significantly decrease a person’s quality of life as they are present for at least twelve consecutive or nonconsecutive weeks in a year. Large meals and foods high in fat and added sugars, or those that contain wheat, rye, barley, peppermint, and chocolate intensify or bring about symptoms of IBS. Additionally, beverages containing caffeine or alcohol may worsen IBS. Stress and depression compound the severity and frequency of IBS symptoms. As with GERD, the first treatment approaches for IBS are diet and lifestyle modifications. People with IBS are often told to keep a daily food journal to help identify and eliminate foods that cause the most problems. Other recommendations are to eat slower, add more fiber to the diet, drink more water, and to exercise. There are some medications (many of which can be purchased over-the-counter) to treat IBS and the resulting diarrhea or constipation. Sometimes antidepressants and drugs to relax the colon are prescribed.

Oral Disease

Oral health refers not only to healthy teeth and gums but also to the health of all the supporting tissues in the mouth, such as ligaments, nerves, jawbone, chewing muscles, and salivary glands. Over ten years ago, the Surgeon General produced its first report dedicated to oral health, stating that oral health and health, in general, are not separate entities.[2]

Instead, oral health is an integral part of overall health and well-being. Soft drinks, sports drinks, candies, desserts, and fruit juices are the main “fermentable sugars” sources in the American diet. (Bacteria quickly metabolize fermentable sugars in a process known as fermentation. Glucose, fructose, and sucrose are three examples.) Bacteria in the mouth convert sugars and starches to acids that erode tooth enamel. The acid creates holes (cavities) in the teeth. The acid also damages the gums, leading to gingivitis (characterized by inflamed and bleeding gums). Saliva is a natural “mouthwash” that neutralizes the acids helping to prevent cavities.


Close up of teeth showing signs of gingivitis
Figure 12.1 Gingivitis
“Gingivitis” / CC0 1.0

According to Healthy People 2010, 23 percent of US children have cavities by the age of four, and by second grade, one-half of all children in this country have at least one cavity.[3]

Cavities are an epidemic health problem in the United States and are associated with poor diet, but other contributors include poor dental hygiene and the inaccessibility to regular oral health care. A review in Academic Pediatrics reports that “frequent consumption of fast-releasing carbohydrates, primarily in the form of dietary sugars, is significantly associated with increased dental caries risk.”[4] In regards to sugary soft drinks, the American Dental Association says that drinking sugary soft drinks increases the risk of decay formation.[5]

Colon Health

A substantial health benefit of whole grain foods is that fiber actively supports digestion and optimizes colon health. (This can be more specifically attributed to the insoluble fiber content of whole grains.) There is good evidence supporting that insoluble fiber prevents the irritating problem of constipation and the development of diverticulosis and [6] Ten to 25 percent of people who have diverticulosis go on to develop diverticulitis.[7] Symptoms include lower abdominal pain, nausea, and alternating between constipation and diarrhea.

The chances of developing diverticulosis can be reduced with fiber intake because of what the breakdown products of the fiber do for the colon. The bacterial breakdown of fiber in the large intestine releases short-chain fatty acids. These molecules have been found to nourish colonic cells, inhibit colonic inflammation, and stimulate the immune system (thereby providing protection of the colon from harmful substances). Additionally, the bacterial indigestible fiber, mostly insoluble, increases stool bulk and softness increasing transit time in the large intestine and facilitating feces elimination. One phenomenon of consuming foods high in fiber is increased gas, since the byproducts of bacterial digestion of fiber are gases.

Many studies have found a link between high dietary-fiber intake and a decreased risk for colon cancer. [8] There is some evidence that specific fiber types (such as inulin) may protect against colon cancer, but more studies are needed to conclusively determine how certain fiber types (and at what dose) inhibit colon cancer development.


Learning Activities

Technology Note: The second edition of the Human Nutrition Open Educational Resource (OER) textbook features interactive learning activities.  These activities are available in the web-based textbook and not available in the downloadable versions (EPUB, Digital PDF, Print_PDF, or Open Document).

Learning activities may be used across various mobile devices, however, for the best user experience it is strongly recommended that users complete these activities using a desktop or laptop computer.



  1. Hampel H, Abraham NS, El-Serag HB. (2005). Meta-Analysis: Obesity and the Risk for Gastroesophageal Reflux Disease and Its Complications. Annuals of Internal Medicine, 143(3), 199–211. http://www.ncbi.nlm.nih.gov/pubmed/16061918. Accessed April 12, 2018.
  2. Office of the Surgeon General (US). National Call To Action To Promote Oral Health. National Institute of Dental and Craniofacial Research (US). 2003; 03-5303. https://www.ncbi.nlm.nih.gov/books/NBK47472/. Accessed April 15, 2018.
  3. Continuing MCH Education in Oral Health. Oral Health and Health Care. http://ccnmtl.columbia.edu/projects/otm/index.html. Accessed April 12, 2018.
  4. Mobley C, Marshall T. (2009). The Contribution of Dietary Factors to Dental Caries and Disparities in Caries. Academy of Pediatrics, 9(6), 410–14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862385/. Accessed April 15, 2018.
  5. Foods that Affects your Teeth. American Dental Association. https://www.mouthhealthy.org/en/nutrition/food-tips. Accessed April 15, 2018.
  6. [pb_glossary id="3715"]diverticulitis[/pb_glossary]. Diverticulosis is a benign condition characterized by outpouches of the colon. Diverticulitis occurs when the outpouches in the lining of the colon become inflamed. Interestingly, diverticulitis did not make its medical debut until the early 1900s, and in 1971 was defined as a deficiency of whole-grain fiber. According to the National Digestive Diseases Information Clearinghouse, 10 percent of Americans over the age of forty have diverticulosis, and 50 percent of people over the age of sixty have the disorder.[footnote]Diverticular Disease. National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/. Accessed April 15, 2018.
  7. Diverticular Disease. National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Health. http://digestive.niddk.nih.gov/ddiseases/pubs/diverticulosis/. Accessed April 15, 2018.
  8. Ma Y, Hu M, Zhou L, Ling S, Li Y, Kong B, Huang P. Dietary fiber intake and risks of proximal and distal colon cancers: A meta-analysis. Medicine (Baltimore). 2018 Sep;97(36):e11678. doi: 10.1097/MD.0000000000011678. PMID: 30200062; PMCID: PMC6133424.


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