Abstract
Nutrition and laboratory medicine are two sides of the same coin, inextricably connected in cause and effect. Any student of clinical biochemistry will be familiar with the poster Metabolic Pathways published by Sigma Chemicals. For me, as an undergraduate studying biochemistry and human physiology at Liverpool University, it was an inspiration. James Watson's book The Double Helix fired my enthusiasm for the molecular basis of life, and the study of biochemistry and physiology began to cement the bricks together.
Nutrition and its impact on health and disease holds a lifelong fascination. The food we eat is the substrate for all those biochemical pathways. The excitement of the mapping of the human genome and the rapidly opening doors of nutriomics and nutrigenetics continue to tantalize through their likely impact on therapeutics in the not too distant future. ‘We are what we eat’, has never been better understood.
Ayling and Marshall are physicians, but, unusually, physicians with a profound and lasting interest in nutrition. They are also very experienced clinical biochemists. Throughout their careers, they have been involved in applying their knowledge of nutrition and metabolism to the management of disease. This book is a practical and comprehensive ‘canter’ through the practical knowledge needed to deliver support for nutritional care. It successfully joins up the vital activities of clinical laboratory scientists, physicians, dieticians and everyone else involved in nutrition support.
The breadth of coverage that Ayling and Marshall have managed to squeeze into 200 pages is huge. Inevitably, it is impossible to cover each topic area in a great deal of depth, but it is to be hoped that this book will inspire and direct the reader to further study. It is an excellent reference for all in the clinical workplace. For the physician, it describes a considerable amount of basic nutrition. For the clinical laboratory scientist, it describes the links between assays and nutritional care. For the dietician, it describes the basic laboratory science and serves as a prompt for interpreting day-to-day laboratory tests and physiological assessments. Each topic is covered succinctly and with a view to being applicable in day-to-day practice.
This is not an ‘in depth’ text – covering the nutritional implications of cardiovascular disease in one page, diabetes in two pages or dietary assessment in less than one page. It is not the key resource for pursuing one's continuing professional development in these areas. Rather, its strength lies in the fact that it provides an ‘interdisciplinary glue’ to help clinical laboratory scientists, physicians, dieticians and others work together to deliver nutritional care. Nutrition support and care, particularly in the challenging environment of critical illness, is complex and requires teamwork if it is to be delivered safely and effectively.
Thankfully, the days when starving the critically ill was thought to be ‘a good thing’ are largely behind us. Poorly applied nutritional support, however, has great potential to do harm and this book will help to reduce this risk.
The human organism is subject to the second law of thermodynamics as are all ordered molecular structures. This tendency toward increasing entropy has to be counteracted and the raw materials required to do this are nutrients. The entire molecular composition of the human body turns over in about seven years. (This is something I must have read somewhere: perhaps your readers have a reference.) New substrate comes from food. Would that we could persuade the human body to regenerate more rapidly: were this to be possible, supplying adequate nutrients would be critical to success. In real life, the supply of nutrients in health and disease is no less critical. As a result of continuing advances in our understanding of metabolism, molecular genetics and nutrition, those metabolic pathways that inspired me have never seemed so accessible and so meaningful to health and well-being.
Ruth Ayling and William Marshall's book is a timely contribution to the multidisciplinary nature of the modern clinical workplace and should be on the bookshelves of all dieticians, clinical scientists and doctors with an interest in nutrition (which should be all doctors).