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The knowing-doing gap in nutrition

Despite enormous advances in nutrition science and a deepening understanding of the role of nutrition as a disease trigger, a global epidemic of lifestyle diseases rages around us. Why do we have this knowing-doing gap in the translation of nutrition science to the control of lifestyle diseases? asks Swaminathan Subramaniam.

Nutrition science has evolved tremendously over the last few decades to throw light on the role of nutrition as a trigger for lifestyle diseases. However, despite the 10-fold increase in publications on the topic of nutrition over the last four decades, there has been a concurrent three-fold rise in lifestyle diseases like obesity and type 2 diabetes. Nutraceutical interventions have had a negligible impact on the epidemic rise of these diseases. Why do we have this knowing-doing gap in the translation of nutrition science to the control of lifestyle diseases?

“Nutraceutical interventions have had a negligible impact on the epidemic rise of these diseases. Why do we have this knowing-doing gap in the translation of nutrition science to the control of lifestyle diseases?”

The science that drives nutrition recommendations is mostly based on observational studies. Subsequent prospective randomised controlled studies have more often than not contradicted the results of the original observational study. As a result, the use of observational studies to base nutritional recommendations has been questioned. Even a prospective study like the large PREDIMED study of the Mediterranean diet has suffered retraction due to improper randomisation procedures. Clinical nutrition studies experience a minefield of problems due to their complex methodology, making execution difficult if not impossible. Even if the execution is successful, the methodological peculiarities bear no resemblance to the context or practice of nutrition in real life.

Given these challenges, it is unlikely that the shifting sands of evidence in nutrition science will stabilise any time soon. The pendulum in nutrition science has swung from the extreme of untrammelled hubris to pessimistic nihilism. The prevailing nihilism is disappointing for consumers who have been conditioned by advertising to expect miracles from nutrition products. Is there a way out of this funk?

Several alternatives exist to the current model by which nutrition science is developed and applied to the development of nutrition products. One method is to treat nutrition within the context of the environment within which it is presented to the consumer – the nutrition ecology approach. Nutrition ecology is an integrative approach encompassing the entire food chain and its related elements. It has great explanatory power when applied to the nutrition of animals living in their native habitats. Application to human nutrition, either in generating new hypotheses or producing new answers has been limited and difficult.

The “beneficence” of phytochemicals inherent in our diets can be explained by the fact that they have co- evolved with our genome over thousands of years. The “beneficence” is not manifested as a clinical benefit in days, weeks or even months. It is expressed after decades of consumption of a particular diet. One way to detect these effects in the short-term is to use biomarkers of disease process (processes that are ongoing every day, such as tissue inflammation) rather than disease outcome (e.g. myocardial infarction). Validated biomarkers of disease process are robustly associated with disease outcome. Once this link is established, the biomarker can be used as a screening tool to discover disease-modifying nutraceuticals with potential clinical benefit following long-term consumption. Such biomarker technologies will allow us to run shorter prospective trials with the biomarker acting as a near-term surrogate for the desired long-term outcome. Using the biomarker as an inclusion criterion in these trials would also allow targeting nutraceutical interventions to the relevant population. These tools may help us avoid the Scylla and Charybdis of the small, impotent observational study and the long-term and impossible to do prospective study. The development and validation of disease process biomarkers should be high on the agenda for the global nutrition science community.

Listen to talk 

The knowing-doing gap in nutrition: Why it exists and how to fix it

Wednesday 12 September, Global Health Theatre, Vitafoods Asia 2018
30 min
  • Supporting mental and physical wellbeing
  • Despite advances in nutrition science, there is a vast knowing-doing gap, as attested to by the epidemic of obesity ravaging most societies
  • Difficulties in translating nutrition science into marketplace innovation is a result of failures at multiple levels – from the research laboratory to the end-consumer
  • Discussing key elements that contribute to this failure and offering a fresh perspective on how the translational gap in nutrition innovation can be bridged


Jon Benninger, vice president – Health & Nutrition Network (US)


Swaminathan Subramaniam, principal consultant – Nutrea

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About the Author

Swaminathan Subramaniam, MD, PhD

Principal consultant, Nutrea , India

“Dr Swami,” is a physician-scientist who started as a pharma R&D executive and has recently turned an entrepreneur. His current interests include preventive and wellness based interventions to optimise health, primarily focused on Nutrition and Sleep.

Swami completed his degrees in Medicine (M.B., B.S. Madras University) and Clinical Pharmacology (M.D. Postgraduate Institute of Medical Education and Research, Chandigarh) before moving to the University of Pennsylvania where he studied for a PhD in Molecular Pharmacology. He then worked at the National Institute of Neurological Disorders and Stroke in Bethesda where he carried out electrophysiological studies of NMDA receptors in hippocampal slices in the context of epilepsy.

Swami returned to India in 1995 to take up a position at Dr Reddy’s Research Foundation as Head of Clinical Research and DMPK. He led the team that filed the first IND from Dr Reddy’s for a new molecule. Dr Swami subsequently moved through different roles including marketing and strategy. He initiated Dr Reddy’s Contract Chemistry services business and then set up an independent subsidiary company of Dr Reddy's – Aurigene Discovery Technologies. He moved to Bangalore as the first MD and COO of Aurigene. He led the team responsible for the construction of a greenfield drug discovery facility occupying over 200000 SFt of space – the first structure-based drug discovery services CRO in India. Subsequently, Dr Swami has held leadership roles at Sanmar (Chief Executive – Research Businesses), Rheoscience A/S (Head – India operations and Business Development), Merck and Co., Inc. (Head, Licensing – India, and SE Asia) and Abbott Nutrition (Head – R&D, India). He has recently founded Nutrea a start-up nutrition company based in Bangalore, India. Dr Swami actively engages in a consulting role with life science companies in India.

In his current role at Nutrea, he has championed product concepts for lifestyle diseases wherein functional ingredients are multiplexed to derive optimal benefits. Nutrea has developed products in the Meal Replacement space and for Diabetes for third parties. Nutrea is also building an affordable (less than Rs 5 per serve) mass market nutrition product - PoshanDhan - funded by the Government of Karnataka Grand Challenges Grant Program.

He has published and presented extensively in the areas of nutrition, cancer, neuropharmacology, drug discovery, DMPK, entrepreneurship, and innovation strategy. He was awarded a research fellowship at the University of Pennsylvania and was a Chevening scholar of the British Foreign Commonwealth office at the London School of Economics in 1999. He has attended executive programs at Stanford GSB, Indian School of Business and Indian Institute of Management.

Articles mentioning Swaminathan Subramaniam, MD, PhD

One Response to The knowing-doing gap in nutrition

  1. Vikas September 5, 2018 at 8:43 am #

    You have hit the bulls eye, unfortunately a major part of focus in nutrition science has been on the standardization of universally accepted methodologies rather than the purpose..



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