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153Nutrition and Health
Toxicity of Pesticides
The toxicity of a pesticide depends on its function and other
factors. For example, insecticides tend to be more toxic to
humans than herbicides. The same chemical can have different
effects at different doses, that is, the amount of chemical to
which a person is exposed. Toxicity can also depend on the
route by which the exposure occurs, such as by swallowing,
inhaling, or direct contact with the skin.
Since pesticides are intrinsically toxic and deliberately spread
in the environment, their production, distribution and demand
strict regulation and control. Regular monitoring of residues
in food and the environment is also required.
WHO has two objectives concerning pesticides:
i. To ban the pesticides that are most toxic to humans, as
well as pesticides that remain for the longest time in the
environment; and
ii. To protect public health by setting maximum limits for
pesticide residues in food and water.
The people at greater risk are those who are directly exposed
to pesticides. This includes agricultural workers who apply
pesticides and anyone else in the immediate area during and
shortly after pesticides are spread.
The general population—those not in the area where
pesticides are used—is exposed to significantly lower levels of
pesticide residues through food and water.
Prevention and Control
1. Nobody should be exposed to unsafe amounts of pesti-
cides.
2. People spreading pesticides on crops, in homes, or gardens
should be adequately protected. People not directly
involved in the spreading of pesticides should stay away
from the area while spreading takes place, and for some
time afterwards.
3. Food that is sold or donated (such as food aid) should
equally comply with pesticide regulations, in particular
154 Social Pharmacy
with maximum residue limits. People who use pesticides
when growing their food should follow instructions for
use and protect themselves by wearing gloves and face
masks as necessary.
4. Consumers can further limit their intake of pesticide
residues by peeling or washing fruit and vegetables, which
also reduces other food-borne hazards such as harmful
bacteria.
Pesticides can prevent large crop losses and will therefore
continue to play a role in agriculture. Let’s not forget that the
effects of exposure to pesticides on humans and the
environment pose a continuous threat to all life.
Genetically Modified Foods
Genetically modified foods, also known as ‘bioengineered foods,’
are produced by using genetically modified organisms (GMOs).
Genetically modified foods have modified genetic material
(DNA), from a different organism through genetic engineering.
The first commercially grown genetically modified whole food
crop was the tomato puree (called Flavr Savr), which was made
more resistant to rotting by Californian company, Calgene.
Genetically modified versions of many foods are currently
available.
Advantages
1. These impart desirable traits to foods.
2. Increased attractiveness, taste, and enhanced flavor.
3. Longer shelf life.
4. Greater tolerance to pesticides.
5. Increased nutritional value.
6. Need less use of pesticides due to greater resistance to
insects.
7. Ability to thrive in a harsh climate, such as drought or heat.
8. Ability to grow in salty soil.
9. Growing plants that are more resistant to diseases spread
by insects or viruses will likely result in higher yields for
farmers and a more attractive product.
155Nutrition and Health
Disadvantages
Food regulatory authorities require that GM foods receive
individual pre-market safety assessments. The principle of
‘substantial equivalence’ is used to mean that an existing food is
compared with its genetically modified counterpart to find any
differences between the existing food and the new product.
Toxicity assessment of GM foods: Toxicity of GM foods is
investigated using similar methods to those used for
conventional foods to assess:
1. Tendency to provoke any allergic reaction.
2. Stability of the inserted gene.
3. Whether there is any nutritional deficit or change in the
GM food.
4. Any other unintended effects of the gene insertion.
GMOs are capable of solving many of the world’s hunger
and malnutrition problems. They can also help to protect and
preserve the environment by increasing yield and reducing
reliance upon chemical pesticides and herbicides. However,
unintended harm to human health and the environment must
be avoided.
Dietary Supplements/Food Supplements
A dietary supplement is a product that contains nutrients to
supplement the diet. Dietary supplements are available in many
forms such as pills, tablets, capsules, energy bars, powders,
gummies, extracts, soft gels, liquids, etc. They contain vitamins,
minerals, fiber, amino acids, herbs, live microbial (probiotics)
and enzymes.
Nutraceuticals
A nutraceutical, also called medical food, is defined as any
substance with good nutritional value that provides health
benefits including the prevention and treatment of disease.
The term nutraceutical is derived from nutrition + pharma-
ceuticals. It is used synonymously for designer foods, health
foods, fortified foods, medifoods, functional foods, and dietary
supplements. In addition to its normal nutritional value,
156 Social Pharmacy
nutraceuticals also provide health benefits like prevention of
disease or promotion of health, for example, lycopene and beta
carotene. Thus a nutraceutical may be defined as “any non-
toxic food component that has scientifically proven health
benefits, including disease treatment or prevention.”
Nutraceuticals are non-specic biological therapies used to
promote wellness, prevent malignant processes, and control
symptoms.
Nutraceuticals provide their benefits in a wide range of
therapeutic areas such as cough and cold, anti-arthritis,
digestion, sleeping disorders, and treatment of cancers,
depression, diabetes, cholesterol, blood pressure, and pain
killers.
The three main segments of the nutraceutical industry are
functional foods, dietary supplements, and herbal/natural
products. The consumption of potential nutrients and micro-
nutrients like Vitamin A, Vitamin D, Vitamin C, folate,
selenium, zinc, etc. has substantially increased for better
immunity. India’s nutraceutical market is expected to grow by
approximately USD 18 billion by 2025.
Classification
Nutraceutical foods can be classified as follows:
i. Functional foods: These provide the body with the required
amounts of all types of nutrients, e.g., whole foods,
fortified, and enriched foods.
ii. Medicinal foods: These are administered under the
supervision of a doctor to meet nutritional requirements.
Potential human health benefits of some nutraceuticals are
compared in Table 3.9.
Herbs as Health Food
Nowadays, incidences of various life-threatening diseases have
increased due to high work pressures and a sedentary lifestyle.
Thus, people are highly concerned about their health.
Moreover, they are frustrated with the costly disease treatment
and management approach. The demand for phytonutrients
has increased over the past few years and they are being used
by people for various therapeutic outcomes. Herbal foods are
157Nutrition and Health
known not only for their health benefits but also to prevent or
treat various diseases. Some examples of herbs and their uses
are as follows:
1. Alfalfa: It is used to lower cholesterol levels, asthma,
arthritis, diabetes, upset stomach, thrombocytopenic
purpura ( bleeding disorder) and to increase urine flow.
Table 3.9: Components and potential human health benefits of some
nutraceuticals
Sr. Components Sources Health benefits
no.
1. Carotenoids Carrots, Neutralizes free radicals;
-carotene various fruits bolsters cellular antioxidant
defenses
2. Dietary fiber Wheat bran Help maintain a healthy
Insoluble fiber digestive tract
3. Fatty acids Tree nuts May lower the risk of coro-
Monosaturated nary heart disease
fatty acids
4. Flavonoids Onions, apples, Neutralize free radicals;
Flavonols tea, broccoli bolster cellular antioxidant
defenses
5. Phenols Apples, pears, May bolster cellular anti-
Caffeic acid, citrus fruits, oxidant defenses; may help
ferulic acid some vegetables maintain vision and heart
health
6. Plant stanols/ Fortified table May lower the risk of heart
sterols stanols/ spreads, stanol disease
sterol esters ester dietary
supplements
7. Polyols (sugar, Some chewing May lower the risk of dental
alcohol, manni- gums and other caries (cavities)
tol, sorbitol, food application
lactitol)
8. Phytoestrogens Soyabeans and May help the maintenance
Isoflavones soy-based foods of bone health, healthy
(daidzein, brain, and immune func-
genistein) tions for women; mainte-
nance of menopausal health
9. Soy protein Soybeans and May lower the risk of coro-
Soy protein soy-based foods nary heart disease
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2. Chicory: It is used as an antioxidant, anti-inflammatory,
sedative, hypolipidemic, anticancer, prebiotic, anti-
protozoal, gastroprotective, antidiabetic, analgesic,
anthelmintic, antimicrobial, and bitter tonic.
3. Ginger: It is used in motion sickness, nausea, vomiting,
colic, upset stomach, flatulence, diarrhea, laxative, irritable
bowel syndrome (IBS), rheumatoid arthritis (RA),
osteoarthritis, menstrual pain, anti-gas, and antacid
medications.
4. Fenugreek: It is used as a spice, antidiabetic, antioxidant,
anticarcinogenic, hypocholesterolemic, antioxidant,
immunological activity, etc.
5. Garlic: It has cardioprotective, anticancer, antioxidant,
antibiotic, and antidiabetic properties. It is a natural
immunity booster.
6. Amla: It has antioxidant, anti-inflammatory, and anti-aging
effects. It is used in the treatment of anemia, jaundice, and
diarrhea.
7. Ginseng: It has antioxidant and anti-inflammatory, mood
elevator, and memory booster properties.
8. Ashwagandha: It is used to relieve conditions such as
anxiety, stress, leucoderma, constipation, insomnia,
rheumatism, anemia, and blood loss due to heavy periods,
nervous breakdown, and goiter. It has astringent, diuretic,
aphrodisiac, and anthelmintic properties.
Drug–Food Interaction
Drug-food interaction causes a change in a drug’s effect on the
body when the drug is taken together with certain foods (or
beverages). Not all drugs are affected by food, and some drugs
are affected by only certain foods. A drug-food interaction can
delay, decrease, or enhance the absorption of a drug. It is a
situation in which certain food substances affect the activity of
a drug, i.e. the drug effects on the body are either reduced or
increased. In some cases, adverse drug effects may also be
produced.
159Nutrition and Health
Some drug–food interactions are given in Table 3.10.
Table 3.10: Drug–food interactions
Drugs Food Drug–food interaction
Warfarin Foods rich in Decrease the effectiveness
vitamin K of warfarin therapy
Monoamine Tyramine-containing Hypertensive crisis
oxidase food
inhibitors
Tetracyclines With milk products Delay and reduced
absorption of antibiotics
Acetaminophen Alcohol Liver toxicity
NSAIDS Alcohol Liver damage
Theophylline High-fat meal and Increase in bioavailability
grapefruit juice
Levothyroxine Grapefruit juice Delay in absorption
The most common food–drug interactions occur with fruits
(especially grapefruit), dairy, vitamin K, tyramine-containing
foods, and alcohol. Patient counseling and collaboration
between healthcare teams can help patients avoid food–drug
interactions.
Some of the common drug–food interactions are explained
below.
1. Grapefruit juice alters the way the body absorbs statins
(cholesterol-lowering drugs) like Lipitor in the blood. It
Fig. 3.4: Possible effects of drug–food interaction
160 Social Pharmacy
can cause these drugs to be absorbed in higher than normal
amounts resulting in a greater risk of side effects.
2. Green leafy vegetables (high in vitamin K) can decrease
how well aspirin thins the blood. Consuming the same
amount of green leafy vegetables each day will decrease
this interaction.
3. Dairy products such as milk, yogurt, and cheese decrease
the absorption of antibiotics. This interaction can be
avoided by eating the meals one to two hours before taking
dairy products.
4. Calcium channel blockers are prescribed for high blood
pressure and are also affected by grapefruit juice.
Grapefruit juice changes the way this drug breaks down in
the body and may cause overly high levels of the drug in
the blood, raising the risk of side effects.
5. Alcohol affects insulin or oral diabetic pills. Alcohol
prolongs the effects of these drugs, which leads to low
blood sugar.
6. Moderate pain reliever drugs with acetaminophen should
not be taken with alcohol because it has a higher chance of
causing severe liver damage. Antihistamines, like
Benadryl, should not be taken with alcohol because it will
cause increased drowsiness.
Pharmacists should always be willing to guide the public
and patients regarding drug–food interactions and answer
questions.
In every healthcare setting pharmacists need to be vigilant
in monitoring the potential drug–food interactions. Pharmacists
must advise patients regarding foods or beverages to avoid
when taking certain medications. Pharmacists must keep up-
to-date on potential drug–food interactions of medications,
especially the modern new drugs, so that they may counsel
the patients properly.
Important Tips to Avoid food–drug interactions:
1. Read the prescription label on the container. In case of
doubt, ask your doctor or pharmacist.
2. Read all directions, warnings, and interaction precau-
tions because even OTC medicines can cause problems.
161Nutrition and Health
3. Take all medicine with a full glass of water unless
directed otherwise by a doctor.
4. Do not stir medicine into your food or take capsules
unless directed otherwise. This can change the way the
drug works.
5. Do not mix medicine into hot drinks because heat may
influence the working of the drug.
6. Do not take vitamins simultaneously with other
medicines. Vitamins and minerals can cause problems
if taken with some drugs.
7. Never take medicine with alcohol.
Drugs.com is a popular App that can be used as a drug
interactions checker, including drug–food interactions.
REVISION QUESTIONS
Long Answer Questions (10 Marks)
1. Define foods and give their classification.
2. Discuss briefly the nutritional requirements of adults.
3. What diseases are caused due to the deficiency of proteins?
What is the RDA of proteins? How can protein deficiency
diseases be treated?
4. What are fat-soluble vitamins? Name diseases that result
from a deficiency of fat-soluble vitamins. How can you
control such diseases?
5. Discuss the source, functions, and uses of vitamin A and
describe the associated deficiency and toxicity issues.
6. Discuss the source, functions, and uses of water-soluble
vitamins and describe the associated deficiency and
toxicity issues.
7. Describe major food sources, functions, deficiency, and
toxicity symptoms of minerals.
8. What minerals are required by the body? Discuss their
food sources, and role in the maintenance of health and
give their RDI.
9. Define a balanced diet and give the balanced diet for adult
males and females as recommended by ICMR.
162 Social Pharmacy
10. Explain the importance of pantothenic acid, ascorbic acid,
and folic acid in human health.
11. Describe the function, sources, daily requirements, and the
associated deficiency diseases of the following:
a. Calcium
b. Magnesium
c. Phosphorus
d. Sodium and potassium
e. Fluoride
Short Answer Questions (5 Marks)
1. What measures should be taken to prevent protein-energy
malnutrition?
2. What is PEM?
3. What is the difference between marasmus and
kwashiorkor?
4. Give a classification of vitamins.
5. Discuss the source, functions, daily requirements, and over
consumption of vitamin D.
6. Discuss the functions of vitamin E and describe the
associated deficiency diseases.
7. Give the sources, daily requirements, and overconsump-
tion of vitamin C.
8. Discuss the functions of vitamin K and describe the
associated deficiency diseases.
9. Write about sources, daily requirements, and overconsum-
ption of vitamin K.
10. Discuss drug–food interaction.
Very Short Answers Questions (2 Marks)
1. What are micronutrients and macronutrients?
2. Write about iodine and iron deficiency diseases.
3. What is the role of biotin and niacin in human health?
4. Give examples of herbs that are used as foods.
5. Define nutraceuticals.
6. Define dietary supplements.