Ok, I decided to outline it anyway. Must be the obsessive/compulsive gene in me. Lol.
Hunger
Hunger in the United States
I Facts
A. Hunger and food insecurity are widespread in the US
B. People living in poverty are especially vulnerable
C. Government and community programs bring some relief
II Defining Hunger in the US
A. Food insufficiency: having too little food
B. Food poverty: hunger resulting from inadequate access to food
C. Food security: access to enough food to support an active and healthy lifestyle
D. Food insecurity: limited or uncertain access to sufficient quantity or quality of food to sustain a healthy and active life.
III Relieving Hunger in the US
A. Federal food assistance programs
1. WIC: (Women, Infants, and Children) is for low income pregnant women, breastfeeding women, and children. (Check vouchers specify healthy foods and exactly what is allowed to be purchased.)
2. School breakfast, lunch programs, and child-care food programs (some provide grants for food in the summer)
3. Meals on wheels and congregate meals (for the elderly, indigent, and handicapped) (Healthy low fat, low sodium foods)
4. Food stamp program (Does not specify healthy food, just food)
B. National Food Recovery Programs
1. Second harvest serves food pantries, emergency shelters, and soup kitchens. (Take blemished foods that aren’t aesthetically pleasing and passes them on.)
2. food banks
C. Community efforts depend on volunteers, concerned citizens, local agencies and churches
World Hunger
I Facts
A. Extreme hunger and poverty are common in developing countries.
B. Natural causes, politics, armed conflicts and government policies have a big impact.
1. During conflicts citizens cannot stay in one place long enough to plant and reap crops.
C. Technology offers some solutions.
D. Overpopulation must also be controlled.
II Food Shortages
A. Political turbulence and government policies during famine affect food problems.
1. Famine is usually man made.
B. Armed conflicts may interfere with humanitarian efforts to get food to people.
C. Natural disaster areas accept food assistance from other countries.
1. In the US we assume assistance is coming immediately, not so in other countries. Compare the slow Katrina response with the super slow tsunami response.
III Malnutrition
A. Affects 850 million people
B. Iron, iodine, and VitA are the nutrients most lacking.
1. Iron is the most common deficiency worldwide.
2. Some places have severe cretinism because of iodine deficiency
C. Protein-kcalorie malnutrition
D. Oral rehydration therapy (ORT) can reverse dehydration.
1. Used worldwide to treat dehydration in children
2. Similar to gatoraid/pedialyte.
3. Salt and water recipe. Sugar is included to help K+ cross cell barrier to hydrate cells.
E. A diminishing food supply is a problem as populations continue to grow.
IV Poverty and Overpopulation
A. Poverty and hunger with more people to feed interrelate to each other.
B. To break this cycle requires:
1. improving the economy
2. providing education
a. education in farming
b. education in food storage
c. education in skills
3. providing health care, and counseling about family planning
C. Population growth leads to hunger and poverty
1. human carrying capacity: the maximum number of people the earth can support
2. increasing rate in developing countries where hunger and poverty already exist
a. In some places children = wealth
b. Hard to change people’s ways of thinking in regard to large families.
D. Hunger and poverty lead to population growth
1. poverty leads to inadequate food and shelter, physical abuse, forced marriages, and prostitution
2. Lack access to reproductive care and family counseling
3. families depend on children to farm the land, carry water, and care for the elderly
4. with high death rates in children, parents may choose to have more children with hopes that some will survive to adulthood
E. Breaking the cycle
1. curbing population growth
2. improvements in living standards
a. health
b. education
3. sharing of resources among groups
a. bartering
4. education becomes a higher priority
a. education for daily survival needs.
b. only 1% of the world population are college educated
V Environmental Degradation and Hunger
A. Environmental limitations in food production
1. soil erosion
2. compaction
3. salinization (adding of salt) caused by:
a. over tillage
b. over irrigation
4. deforestation and desertification (not replacing nutrients in soil)
a. caused by overgrazing
b. desertification is caused by planting the same crops over and over
5. air pollution
a. from the burning of fossil fuels
6. ozone depletion
B. Other limitations in food production
1. irrigation
2. fertilizers (most fertilizer is used on golf courses, not crops)
3. improved genetic strains are reaching their limits
4. harvests are falling short of consumption needs
5. World agriculture produces enough food (grain) to provide each person with 2720 kcal per day.
a. in addition to meat, fruit, and dairy products
6. distribution is a problem
7. population is a problem
VI Solutions
A. Governments, businesses, and all individuals have opportunities to make environmentally conscious choices.
B. Proper choices may help to relieve hunger, improve quality of life, and generate jobs.
C. Sustainable development worldwide:
1. hunger relief
2. population stabilization
3. environmental preservation
4. sustainable resources must be considered
5. Permanently improve the lives of people by helping them to help themselves
VII Progress toward Sustainable Food Production
A. Large agriculture enterprises are among the world’s largest resource users and polluters.
B. Techniques are being studied to employ sustainable agriculture
C. These techniques emphasize careful use of natural processes, computer technology, GPS, and biotechnology
D. Consumers can help by buying locally and eating low in the food chain
1. 1 sack of grain produces1 lb bread
2. 1 ½ sacks of grain produces 1 fish
3. 2 = 1 chicken
4. 3 = 1 hog
5. 7 = 1 cow
VIII Costs of producing food unsustainably
A. resource waste and pollution
1. fishing
a. over fishing and depleted stock
b. fishing is energy intensive
i. using fuel for boats
ii. refrigeration
iii. processing, packing, and transport
c. bioaccumulation of toxins in fish
2. Energy overuse
a. massive fossil fuel usage
b. food industry consumes 20% of all the energy of the nation
IX Sustainable Methods
A. Rotate crops
1. preserve nitrogen in the soil
2. decreases desertification
B. Reduce fertilizer use
1. use animal manure when possible
C. Maintain animal health
1. more resistant to disease
2. less chemicals in manure
D. Plant resistant crops
1. require less pesticides
E. Use irrigation effectively
1. excess irrigation concentrate salts in the soil
F. Use tilling and other precision techniques to control weeds
1. eliminates the use of herbicides
Wednesday, April 30, 2008
Friday, April 25, 2008
Last post
The only outline I have not done is the one on hunger. It is a pretty easy read, and I just don't feel the need to post it. Read it over, it is pretty self explanatory. I may take her class on World Hunger, I find it fascinating. Plus I want to travel and nurse in other countries that may need health care, the info could definately help.
Good luck on the last exam everybody!
Good luck on the last exam everybody!
Nutrition and Cancer
Nutrition and Cancer
I The immune system
A. lymphocytes
1. provide resistance to infection (b cells)
2. defends against viruses, bacteria and cancer cells (t cells)
II Nutrition and Cancer
A. Malnutrition compromises immunity.
B. Immunity and infectious disease increase nutrient needs and lower food intake
1. From a nutrition standpoint the pt needs more nutrients. They may die from malnutrition before they die from the disease.
2. Example: during fever a pts burns more calories, but doesn’t feel like eating. Cancer is 1000x worse. Pt needs more calories to fight disease, but doesn’t feel like eating. They can’t keep up with their caloric needs.
C. Opportunistic infections develop when the immune system is suppressed.
1. Long term effects of malnutrition = compromised immunity
D. Physiological stress: organs shutting down b/c of whatever disease or problem it is fighting.
E. Consequences of cancer:
1. cancer cachexia (can happen b/c of therapy itself)
a. loss of appetite
b. weight loss
c. nausea
2. cancer therapy
a. radiation therapy: can cause decrease in food intake
b. chemotherapy: systemic (throughout body)
i. nausea
ii. vomiting
iii. taste blindness (all tastes like carboard)
iv. taste acuity (everything tastes overly sweet)
v. loss of appetite
c. surgery: normal healing process can cause lack of appetite
d. bone marrow transplant: immune comprimization
III HIV and AIDS
A. HIV: human immunodeficiency virus is the infection that attacks the immune system and disables the body defenses
B. AIDS: acquired immune deficiency syndrome is the infectious disease that destroys health and life
C. Contributors to Wasting and Weight Loss
1. poor appetite/insufficient nutrition intake
a. causes:
i. fatigue, lethargy and dementia
ii. depression
iii. swallowing problems
iv. poor dentition
v. oral infections (candida: thrush)
2. GI tract compications
a. nausea and vomiting
b. belching
c. reflux esophagitis
d. gastritis and heartburn
e. diarrhea and consitpation
f. hepatitis
3. psychological stress and pain (from the stigma)
4. respiratory infections
a. pneumonia
b. tuberculosis
5. cancer
a. Kaposi’s sarcoma
6. medical treatments and medication
D. Medical Nutrition Therapy
1. increased kcalories
2. increased protein and fluid
3. food and water safety (any bacteria can kill b/c no immune system to fight it off)
a. cook meats well and avoid raw seafood
b. reheat food until piping hot (>140 F)
c. wash hands for 20 seconds before and after food prep
An interesting note: Healthy looking people that have AIDS may come to the er to be treated for pneumonia. That is where they are usually first diagnosed, and then they die from the pneumonia pretty quickly. Sickly, skinny, wasted AIDS pts usually die from cancer (Kaposi’s sarcoma).
I The immune system
A. lymphocytes
1. provide resistance to infection (b cells)
2. defends against viruses, bacteria and cancer cells (t cells)
II Nutrition and Cancer
A. Malnutrition compromises immunity.
B. Immunity and infectious disease increase nutrient needs and lower food intake
1. From a nutrition standpoint the pt needs more nutrients. They may die from malnutrition before they die from the disease.
2. Example: during fever a pts burns more calories, but doesn’t feel like eating. Cancer is 1000x worse. Pt needs more calories to fight disease, but doesn’t feel like eating. They can’t keep up with their caloric needs.
C. Opportunistic infections develop when the immune system is suppressed.
1. Long term effects of malnutrition = compromised immunity
D. Physiological stress: organs shutting down b/c of whatever disease or problem it is fighting.
E. Consequences of cancer:
1. cancer cachexia (can happen b/c of therapy itself)
a. loss of appetite
b. weight loss
c. nausea
2. cancer therapy
a. radiation therapy: can cause decrease in food intake
b. chemotherapy: systemic (throughout body)
i. nausea
ii. vomiting
iii. taste blindness (all tastes like carboard)
iv. taste acuity (everything tastes overly sweet)
v. loss of appetite
c. surgery: normal healing process can cause lack of appetite
d. bone marrow transplant: immune comprimization
III HIV and AIDS
A. HIV: human immunodeficiency virus is the infection that attacks the immune system and disables the body defenses
B. AIDS: acquired immune deficiency syndrome is the infectious disease that destroys health and life
C. Contributors to Wasting and Weight Loss
1. poor appetite/insufficient nutrition intake
a. causes:
i. fatigue, lethargy and dementia
ii. depression
iii. swallowing problems
iv. poor dentition
v. oral infections (candida: thrush)
2. GI tract compications
a. nausea and vomiting
b. belching
c. reflux esophagitis
d. gastritis and heartburn
e. diarrhea and consitpation
f. hepatitis
3. psychological stress and pain (from the stigma)
4. respiratory infections
a. pneumonia
b. tuberculosis
5. cancer
a. Kaposi’s sarcoma
6. medical treatments and medication
D. Medical Nutrition Therapy
1. increased kcalories
2. increased protein and fluid
3. food and water safety (any bacteria can kill b/c no immune system to fight it off)
a. cook meats well and avoid raw seafood
b. reheat food until piping hot (>140 F)
c. wash hands for 20 seconds before and after food prep
An interesting note: Healthy looking people that have AIDS may come to the er to be treated for pneumonia. That is where they are usually first diagnosed, and then they die from the pneumonia pretty quickly. Sickly, skinny, wasted AIDS pts usually die from cancer (Kaposi’s sarcoma).
Kidneys, renal diseases
Accessory Organs
Renal Diseases (kidney)
I Nephrotic Syndrome
A. cluster of symptoms which result in protein in the urine (albuminuria)
B. Consequences:
1. protein calorie malnutrition
2. anemia
3. infection
4. atherosclerosis: for unknown reasons blood lipid levels rise (CHO) and atherosclerosis develops as a result.
C. Medical Nutrition Therapy
1. adequate non-protein calories: leaves protein to do its own work, and not provide energy. Let carbs and fats provide energy.
a. normal protein intake (0.8 – 1.0 gm/kg)
2. low saturated fat/low CHO b/c of atherosclerosis
3. sodium restriction (~2 grams)
II Renal Failure
A. loss of the kidney’s ability to function
1. may be acute or chronic
B. Consequences
1. uremia (azotmeia): accumulation of waste products in the blood
2. electrolyte imbalance (hyperkalemia) (K+ is potassium)
3. changes in fluid balance
C. Medical Nutrition Therapy
1. Consider:
a. energy needs (non-protein kcals, don’t want to lose muscle weight)
b. protein restriction: depending on kidney function
c. electrolyte restriction: sodium, potassium, phosphorus (phosphorus should just be monitored, not restricted, b/c we have meds to lower)
d. fluid restriction: monitor intake and output
e. supplements: Ca, folate, B6, D
III Renal Calculi: kidney stones
A. calcium stones (75%)
1. causes:
a. hypercalciuria (idiopathic, unknown reasons...some people just excrete alot of Ca+ in their urine)
b. immobilization: hard/full body casts. When bones aren’t moving Ca+ leaves bones and is excreted through urine.
c. hyperoxaluria: oxalate binds to Ca+ and makes it unavailable. Diets high in oxalates bind with Ca+ and form a stone. (Ca+ is a cation and must have something to bind with, it choose oxalate)
2. medical nutrition therapy
a. Ca+ management
b. increased fluids to dilute urine
c. limit oxalate intake
B. Uric acid (10%)
1. common in gout where uric acid is distributed to distal joints
2. medical nutrition therapy
a. low purine diet: certain types of proteins break down into purines. Purines = uric acid. Rich proteins are caviar, sardines, red meat, liver, anchovies
b. increase fluids
C. Cystine (2-3%)
1. genetically linked
2. medical nutrition therapy
a. low methioninie diet (essential amino acid used to produce non-essential cystine)
b. increased fluids
Renal Diseases (kidney)
I Nephrotic Syndrome
A. cluster of symptoms which result in protein in the urine (albuminuria)
B. Consequences:
1. protein calorie malnutrition
2. anemia
3. infection
4. atherosclerosis: for unknown reasons blood lipid levels rise (CHO) and atherosclerosis develops as a result.
C. Medical Nutrition Therapy
1. adequate non-protein calories: leaves protein to do its own work, and not provide energy. Let carbs and fats provide energy.
a. normal protein intake (0.8 – 1.0 gm/kg)
2. low saturated fat/low CHO b/c of atherosclerosis
3. sodium restriction (~2 grams)
II Renal Failure
A. loss of the kidney’s ability to function
1. may be acute or chronic
B. Consequences
1. uremia (azotmeia): accumulation of waste products in the blood
2. electrolyte imbalance (hyperkalemia) (K+ is potassium)
3. changes in fluid balance
C. Medical Nutrition Therapy
1. Consider:
a. energy needs (non-protein kcals, don’t want to lose muscle weight)
b. protein restriction: depending on kidney function
c. electrolyte restriction: sodium, potassium, phosphorus (phosphorus should just be monitored, not restricted, b/c we have meds to lower)
d. fluid restriction: monitor intake and output
e. supplements: Ca, folate, B6, D
III Renal Calculi: kidney stones
A. calcium stones (75%)
1. causes:
a. hypercalciuria (idiopathic, unknown reasons...some people just excrete alot of Ca+ in their urine)
b. immobilization: hard/full body casts. When bones aren’t moving Ca+ leaves bones and is excreted through urine.
c. hyperoxaluria: oxalate binds to Ca+ and makes it unavailable. Diets high in oxalates bind with Ca+ and form a stone. (Ca+ is a cation and must have something to bind with, it choose oxalate)
2. medical nutrition therapy
a. Ca+ management
b. increased fluids to dilute urine
c. limit oxalate intake
B. Uric acid (10%)
1. common in gout where uric acid is distributed to distal joints
2. medical nutrition therapy
a. low purine diet: certain types of proteins break down into purines. Purines = uric acid. Rich proteins are caviar, sardines, red meat, liver, anchovies
b. increase fluids
C. Cystine (2-3%)
1. genetically linked
2. medical nutrition therapy
a. low methioninie diet (essential amino acid used to produce non-essential cystine)
b. increased fluids
Pancreas
Accessory Organs
Pancreas
I Pancreatitis: Inflammation of the pancreas
A. acute: due to organ auto digestion (pancreas digesting itself)
1. usually as a result of duct obstruction
a. enzymes become activated in duct instead of duodenum
b. The gall bladder and the pancreas share the common duct. If a patient eats a mixed meal of fat, carbs, and protein and the duct is blocked by a gall stone; bile and pancreatic enzyme will remain in the duct at the same time. Usually it is one or the other. The enzyme (to break down protein) is activated when it recognizes the pancreas as a protein. It then starts to digest itself. (auto digestion) Very painful.
2. alcohol abuse
3. gallstones (~45% of all cases)
4. Symptoms of acute pancreatitis
a. sudden, severe abdominal pain
b. nausea, vomiting
c. diarrhea
d. approximately 25% develop chronic pancreatitis
e. sometimes jaundice
f. acute can turn chronic, especially if alcohol involved.
5. Medical nutrition therapy
a. NPO with IV feedings ~ 48 hours (complete bowel rest)
b. jejunostomy feedings if longer (to bypass digestion)
c. clear liquid progress to low fat diet
d. provide pancreatic enzyme replacement
e. small frequent meals
f. no alcohol, caffeine
B. chronic pancreatitis
1. fibrotic, necrotic disease where cells suffer permanent damage.
2. decreased enzyme production
3. nausea, vomiting, abdominal pain
a. symptoms not as severe as acute
4. most common cause is alcohol abuse (~70%)
5. Other causes: pancreatic cancer, cystic fibrosis (lung disease, but starts in the pancreas)
6. Medical Nutrition Therapy
a. If unable to eat, high calorie, semi-elemental (hydrolyzed/pre-digested) tube feeding.
b. If able to eat:
i. low fat, high calorie, moderate protein
ii. low fiber
iii. six small meals per day
iv. no alcohol, caffeine, or gastric stimulants
v. vitamin and mineral supplementation
c. co morbidity in case of alcoholics. Make sure to look at the whole person, not just the disease (pancreatitis).
II Cystic Fibrosis
A. Starts in the pancreas
B. Consequences
1. pancreatic insufficiency (80-90%)
a. may require:
i. enzyme replacement (for protein digestion)
ii. insulin (for carb metabolism)(have a diabetic life state)
2. chronic lung disease
a. lung infections – major cause of death
b. thick secretions may cause bacterial growth
3. growth retardation (85%)
4. decreased bone density
5. abnormally high electrolytes in sweat
6. may live to 30’s or 40’s, but used to be 20’s
C. Medical Nutrition Therapy
1. High kcal, high protein (they lose a lot in digestion)
a. 20-50% above normal needs
2. Pancreatic enzymes
a. to control steatorrhea
3. multivitamin supplementation (water based so not passed in fatty stool)
4. liberal salt use (b/c a lot lost in perspiration)
5. encourage fluids
6. When body weight falls below 85% of standard, alternate feedings are indicated. (usually tube feedings) (Nocturnal feedings all night, then eat normally during the day)
7. Infant feeding
a. enzyme replacement during breast feeding
b. up to ¼ tsp salt daily given to replace losses
Pancreas
I Pancreatitis: Inflammation of the pancreas
A. acute: due to organ auto digestion (pancreas digesting itself)
1. usually as a result of duct obstruction
a. enzymes become activated in duct instead of duodenum
b. The gall bladder and the pancreas share the common duct. If a patient eats a mixed meal of fat, carbs, and protein and the duct is blocked by a gall stone; bile and pancreatic enzyme will remain in the duct at the same time. Usually it is one or the other. The enzyme (to break down protein) is activated when it recognizes the pancreas as a protein. It then starts to digest itself. (auto digestion) Very painful.
2. alcohol abuse
3. gallstones (~45% of all cases)
4. Symptoms of acute pancreatitis
a. sudden, severe abdominal pain
b. nausea, vomiting
c. diarrhea
d. approximately 25% develop chronic pancreatitis
e. sometimes jaundice
f. acute can turn chronic, especially if alcohol involved.
5. Medical nutrition therapy
a. NPO with IV feedings ~ 48 hours (complete bowel rest)
b. jejunostomy feedings if longer (to bypass digestion)
c. clear liquid progress to low fat diet
d. provide pancreatic enzyme replacement
e. small frequent meals
f. no alcohol, caffeine
B. chronic pancreatitis
1. fibrotic, necrotic disease where cells suffer permanent damage.
2. decreased enzyme production
3. nausea, vomiting, abdominal pain
a. symptoms not as severe as acute
4. most common cause is alcohol abuse (~70%)
5. Other causes: pancreatic cancer, cystic fibrosis (lung disease, but starts in the pancreas)
6. Medical Nutrition Therapy
a. If unable to eat, high calorie, semi-elemental (hydrolyzed/pre-digested) tube feeding.
b. If able to eat:
i. low fat, high calorie, moderate protein
ii. low fiber
iii. six small meals per day
iv. no alcohol, caffeine, or gastric stimulants
v. vitamin and mineral supplementation
c. co morbidity in case of alcoholics. Make sure to look at the whole person, not just the disease (pancreatitis).
II Cystic Fibrosis
A. Starts in the pancreas
B. Consequences
1. pancreatic insufficiency (80-90%)
a. may require:
i. enzyme replacement (for protein digestion)
ii. insulin (for carb metabolism)(have a diabetic life state)
2. chronic lung disease
a. lung infections – major cause of death
b. thick secretions may cause bacterial growth
3. growth retardation (85%)
4. decreased bone density
5. abnormally high electrolytes in sweat
6. may live to 30’s or 40’s, but used to be 20’s
C. Medical Nutrition Therapy
1. High kcal, high protein (they lose a lot in digestion)
a. 20-50% above normal needs
2. Pancreatic enzymes
a. to control steatorrhea
3. multivitamin supplementation (water based so not passed in fatty stool)
4. liberal salt use (b/c a lot lost in perspiration)
5. encourage fluids
6. When body weight falls below 85% of standard, alternate feedings are indicated. (usually tube feedings) (Nocturnal feedings all night, then eat normally during the day)
7. Infant feeding
a. enzyme replacement during breast feeding
b. up to ¼ tsp salt daily given to replace losses
Liver
Accessory Organs
Liver
I Hepatitis
A. Inflammation of the liver
B. 5 types, A being least severe
1. A is associated with food/water contamination and is highly contagious
C. Symptoms
1. jaundice: yellowness in palms, eyes, beds of nails
2. dark urine
3. elevated liver enzymes
4. tender, enlarged liver
D. Hepatitis is mainly acute, but sometimes chronic
1. Chronic may lead to cancer, liver failure, hepatic coma, and death
E. Medical Nutrition Therapy
1. regular diet
2. high protein, high kcal (if malnourished)
3. small frequent feedings
a. anorexia and nausea is common
b. anytime nausea is a symptom, we give small frequent meals
4. nutritional supplements
a. ensure
b. boost
II Cirrhosis
A. Chronic liver failure where scar tissues replace liver cells and there is a permanent loss of function. (cirrhosis = orange. Liver can regenerate itself, but not with cirrhosis)
B. Causes
1. alcohol abuse
2. billiary tract obstruction (billiary duct carries bile from the gall bladder to the liver)
3. infection
C. Consequences
1. portal hypertension (portal vein in liver)
2. esophageal varices (blisters inside esophagus)
3. ascites (excess fluid in abdomen)
4. elevated blood ammonia levels
5. hepatic coma
a. very little liver function taking place
6. changes in judgement, mood, personality, regression
7. sweet, musky or pungent fecal odor
8. flapping tremor of outstretched hand
D. Medical nutrition therapy
1. Energy: adequate carb and fat to spare protein (35-45 kcal/kg BW)
a. The function of protein is to build and repair tissue, and to provide energy.
b. Sparing protein: If the pt doesn’t have enough liver function to metabolize protein, a small amount is given to keep the liver from having to work too hard. If the pt does not receive enough protein he will burn it from the muscles, which is not good either. It is just as bad to have too much protein as not enough protein. Protein metabolism needs liver function. Provide just enough protein to do protein’s work, but not as a form of energy. Have an adequate amount of fat and carbs for energy. (non-protein calories)
2. protein (1.0 – 1.5 gm/kg BW)
a. enough to regenerate the cells, but not increase ammonia
b. impending coma (40 – 60 gm/day) ONLY
c. coma
i. vegetable protein
ii. branch chain amino acids (b/c metabolized in muscle)
iii. no animal protein at all
3. Hepatic formula diet
4. sodium (2 grams)
a. to control ascites
5. fluids (1.0 – 1.5 liters/day)
a. restricted to control ascites
6. vitamins and mineral supplementation
E. Drug therapy
1. antibiotics: to limit growth of intestinal bacteria (bacteria produces ammonia that will be absorbed)
2. laxatives: to decrease transit time
3. diuretics: to reduce fluid retention
Liver
I Hepatitis
A. Inflammation of the liver
B. 5 types, A being least severe
1. A is associated with food/water contamination and is highly contagious
C. Symptoms
1. jaundice: yellowness in palms, eyes, beds of nails
2. dark urine
3. elevated liver enzymes
4. tender, enlarged liver
D. Hepatitis is mainly acute, but sometimes chronic
1. Chronic may lead to cancer, liver failure, hepatic coma, and death
E. Medical Nutrition Therapy
1. regular diet
2. high protein, high kcal (if malnourished)
3. small frequent feedings
a. anorexia and nausea is common
b. anytime nausea is a symptom, we give small frequent meals
4. nutritional supplements
a. ensure
b. boost
II Cirrhosis
A. Chronic liver failure where scar tissues replace liver cells and there is a permanent loss of function. (cirrhosis = orange. Liver can regenerate itself, but not with cirrhosis)
B. Causes
1. alcohol abuse
2. billiary tract obstruction (billiary duct carries bile from the gall bladder to the liver)
3. infection
C. Consequences
1. portal hypertension (portal vein in liver)
2. esophageal varices (blisters inside esophagus)
3. ascites (excess fluid in abdomen)
4. elevated blood ammonia levels
5. hepatic coma
a. very little liver function taking place
6. changes in judgement, mood, personality, regression
7. sweet, musky or pungent fecal odor
8. flapping tremor of outstretched hand
D. Medical nutrition therapy
1. Energy: adequate carb and fat to spare protein (35-45 kcal/kg BW)
a. The function of protein is to build and repair tissue, and to provide energy.
b. Sparing protein: If the pt doesn’t have enough liver function to metabolize protein, a small amount is given to keep the liver from having to work too hard. If the pt does not receive enough protein he will burn it from the muscles, which is not good either. It is just as bad to have too much protein as not enough protein. Protein metabolism needs liver function. Provide just enough protein to do protein’s work, but not as a form of energy. Have an adequate amount of fat and carbs for energy. (non-protein calories)
2. protein (1.0 – 1.5 gm/kg BW)
a. enough to regenerate the cells, but not increase ammonia
b. impending coma (40 – 60 gm/day) ONLY
c. coma
i. vegetable protein
ii. branch chain amino acids (b/c metabolized in muscle)
iii. no animal protein at all
3. Hepatic formula diet
4. sodium (2 grams)
a. to control ascites
5. fluids (1.0 – 1.5 liters/day)
a. restricted to control ascites
6. vitamins and mineral supplementation
E. Drug therapy
1. antibiotics: to limit growth of intestinal bacteria (bacteria produces ammonia that will be absorbed)
2. laxatives: to decrease transit time
3. diuretics: to reduce fluid retention
Gall Bladder
Accessory Organs
Gall Bladder
I Cholelithiasis
A. gallstones: solid masses that form in the gallbladder from bile
1. bile: fat emulsifier produced in the liver and stored in the gall bladder
2. gallstones are:
a. Cholesterol stones, and are endogenous (body made) and not caused by eating too much CHO.
b. pigment stones
B. Risk factors:
1. body weight (obesity)
2. gender (female)
3. age (~ 40)
4. ethnicity (fair, fat, forty, female)
5. type II diabetes
6. short bowel syndrome
7. gastric bypass
8. certain medications
9. certain diets: fat free diets won’t stimulate the gall bladder so the bile just sits there and stones precipitate.
C. Medical Nutrition Therapy
1. low fat: weight reduction if appropriate
2. high fiber: soluble fibers bind bile acids
3. avoid gas formers: prevents distention
4. water based fat soluble vitamins
Gall Bladder
I Cholelithiasis
A. gallstones: solid masses that form in the gallbladder from bile
1. bile: fat emulsifier produced in the liver and stored in the gall bladder
2. gallstones are:
a. Cholesterol stones, and are endogenous (body made) and not caused by eating too much CHO.
b. pigment stones
B. Risk factors:
1. body weight (obesity)
2. gender (female)
3. age (~ 40)
4. ethnicity (fair, fat, forty, female)
5. type II diabetes
6. short bowel syndrome
7. gastric bypass
8. certain medications
9. certain diets: fat free diets won’t stimulate the gall bladder so the bile just sits there and stones precipitate.
C. Medical Nutrition Therapy
1. low fat: weight reduction if appropriate
2. high fiber: soluble fibers bind bile acids
3. avoid gas formers: prevents distention
4. water based fat soluble vitamins
Thursday, April 17, 2008
Quiz tip
Here is a little tip on quizzes. Many of them are true and false. Make sure you know your stuff. One of our questions was if malnutrition could occur if NPO for over 5 days. Most of us said true. Well, it was false because it is 3 days or more. Not a trick question, just a tricky one.
Lower GI Disorders
GI Disorders
Lower GI
I Irritable Bowel Syndrome (IBS) (syndrome = don’t know the cause)
A. Approximately 5 million people in the US suffer with the syndrome
B. Also known as:
1. Colitis: colon inflammation
a. does not always include inflammation
2. Spastic colon:
a. does not always occur in the colon, just most commonly
3. not to be confused with Ulcerative Colitis
C. Characterized by:
1. pain: duration >3months (dull pain in the lower abdomen for more than 3 months)
D. Symptoms:
1. diarrhea, constipation or alternating episodes or both (spastic= fast diarrhea, slow constipation)
2. flatulence, bloating
3. indigestion, belching, heartburn, nausea
4. mucus in the stool
E. Medical Nutrition Therapy
1. acute:
a. elemental diet for persons with acute IBS (predigested)
b. Proteins in short amino acid chains (peptides...short peptides taste better than amino acids) Purpose of elemental diet is to provide nutrients in a form easy to absorb. Need to quickly absorb the nutrients before diarrhea rushes it out.
2. chronic:
a. low fat diet with liberal fruits and veggies
i. soluble fiber
b. avoid milk
i. lactose intolerance common
c. liberal lactose free liquids
d. avoid spicy foods
e. avoid gas-forming foods
f. avoid caffeine, alcohol, sorbitol (all stimulants)
i. sorbitol: sugar alcohol. Not absorbed, that’s why its used a a sweetener in diet food.
F. Client Education
1. Vit B-complex supplement may be necessary
2. Encourage regular bowel evacuation
3. Stress and coping mechanisms (frequently seen in patients who don’t deal well with psychological stress)
4. Regular exercise
5. Food diaries may help identify food sensitivities
6. Products that reduce intestinal gas (Bean-O)
II Diverticular Disease
A. Diverticula: the presence of outpouchings in the intestinal wall. (size of a pin)
1. diverticulum = 1
2. Diverticulitis: inflammation of the diverticula
3. Diverticulosis: the presence of diverticula
B. Medical Nutrition Therapy
1. Diverticulitis (inflamed state)
a. bowel rest – NPO for 1-2 days (IV only)
b. clear liquids (minimum residue and low fat)
c. progress to soft, low fat diet
d. no excess spices or fiber (to give a chance for healing)
e. Gradually progress to normal fiber intake as inflammation decreases
2. Diverticulosis (convalescent state)
a. high fiber - > 30 grams per day desirable
i. start with small amount and increase gradually because of gas
ii. add whole grains, raw fruits, and vegetables
b. increase fluid intake
c. low fat
3. in both conditions AVOID:
a. small seeds (strawberries, poppy)
b. nuts, chunky peanut butter
c. popcorn
d. corn
e. fibrous vegetables (celery, cabbage stems)
f. stress
4. Only cure is removal of that part of the intestine. Easier to manage with diet.
III Ulcerative Colitis
A. Inflammatory bowel disease: not to be confused with IBS (blood in stool)
B. Symptoms
1. diarrhea (resulting in malabsorption)
2. Rectal bleeding (resulting in anemia) (Stool will be red because blood is not absorbed. Black and tarry stools are absorbed blood from upper GI bleeding)
3. cramping, abdominal pain
4. anorexia (loss of appetite)
5. weight loss
C. Medical Nutrition Therapy
1. Dietary interventions do not lessen disease (but keep the pt more healthy so they can withstand the treatment)
2. low fiber (so not as much interaction in the lower GI, give it a rest so it can heal)
3. lactose free
4. vitamin and mineral supplementation
5. protein so they get enough calories to withstand treatment
IV Regional Enteritis (Crohn’s Disease)
A. Inflammation and ulceration of the GI tract
1. In severe cases, no digestion or absorption
2. Steatorrhea: fatty stools (foamy, smelly...saponification of fats)
B. Nutrition consequences
1. protein malnutrition
a. hypoalbuminemia (check albumin levels, low)
2. Vitamin deficiencies
a. Vit B12
b. folate
c. C
d. fat solubles ADEK
3. Mineral deficiencies
a. calcium
b. magnesium
c. zinc
d. iron
4. anemia
C. Medical Nutrition Therapy
1. high kcal, especially if losing 30%, eat 30% more
2. high protein (1-1.5g/kg...go up to 2x RDA)
3. fat restricted if steatorrhea is present
4. low fiber
5. vitamin and mineral supplementation, give liquid based when having diarrhea
6. avoid foods not well tolerated (i.e. lactose)
7. small, frequent meals recommended
V Celiac Disease
A. also known as Celiac Sprue
B. Inflammatory condition of the GI tract that affects the small intestines
C. Malabsorption due to a sensitivity to gliadin
1. gliadin: part of the protein gluten found in: wheat, buckwheat, rye, barley. Oats can usually be taken in small amounts
D. Consequences
1. protein malnutrition (low serum protein levels)
2. anemia: iron, folate, and B12 deficiency
3. steatorrhea, diarrhea (resulting in weight loss)
4. calcium deficiency (resulting in bone pain)
5. Vitamin and mineral deficiencies (fat soluble vitamins lost with steatorrhea)
E. Medical Nutrition Therapy
1. Gliadin-free/gluten restricted diet
a. no wheat, buckwheat, rye, barley
b. small amount of oats (be careful, they may have been contaminate with wheat during processing)
2. May have:
a. corn
b. rice
c. tapioca
d. potato
e. arrowroot
f. cassava (yuca)
g. gluten free flour
3. lactose restricted
4. vitamin and mineral supplementation
Lower GI
I Irritable Bowel Syndrome (IBS) (syndrome = don’t know the cause)
A. Approximately 5 million people in the US suffer with the syndrome
B. Also known as:
1. Colitis: colon inflammation
a. does not always include inflammation
2. Spastic colon:
a. does not always occur in the colon, just most commonly
3. not to be confused with Ulcerative Colitis
C. Characterized by:
1. pain: duration >3months (dull pain in the lower abdomen for more than 3 months)
D. Symptoms:
1. diarrhea, constipation or alternating episodes or both (spastic= fast diarrhea, slow constipation)
2. flatulence, bloating
3. indigestion, belching, heartburn, nausea
4. mucus in the stool
E. Medical Nutrition Therapy
1. acute:
a. elemental diet for persons with acute IBS (predigested)
b. Proteins in short amino acid chains (peptides...short peptides taste better than amino acids) Purpose of elemental diet is to provide nutrients in a form easy to absorb. Need to quickly absorb the nutrients before diarrhea rushes it out.
2. chronic:
a. low fat diet with liberal fruits and veggies
i. soluble fiber
b. avoid milk
i. lactose intolerance common
c. liberal lactose free liquids
d. avoid spicy foods
e. avoid gas-forming foods
f. avoid caffeine, alcohol, sorbitol (all stimulants)
i. sorbitol: sugar alcohol. Not absorbed, that’s why its used a a sweetener in diet food.
F. Client Education
1. Vit B-complex supplement may be necessary
2. Encourage regular bowel evacuation
3. Stress and coping mechanisms (frequently seen in patients who don’t deal well with psychological stress)
4. Regular exercise
5. Food diaries may help identify food sensitivities
6. Products that reduce intestinal gas (Bean-O)
II Diverticular Disease
A. Diverticula: the presence of outpouchings in the intestinal wall. (size of a pin)
1. diverticulum = 1
2. Diverticulitis: inflammation of the diverticula
3. Diverticulosis: the presence of diverticula
B. Medical Nutrition Therapy
1. Diverticulitis (inflamed state)
a. bowel rest – NPO for 1-2 days (IV only)
b. clear liquids (minimum residue and low fat)
c. progress to soft, low fat diet
d. no excess spices or fiber (to give a chance for healing)
e. Gradually progress to normal fiber intake as inflammation decreases
2. Diverticulosis (convalescent state)
a. high fiber - > 30 grams per day desirable
i. start with small amount and increase gradually because of gas
ii. add whole grains, raw fruits, and vegetables
b. increase fluid intake
c. low fat
3. in both conditions AVOID:
a. small seeds (strawberries, poppy)
b. nuts, chunky peanut butter
c. popcorn
d. corn
e. fibrous vegetables (celery, cabbage stems)
f. stress
4. Only cure is removal of that part of the intestine. Easier to manage with diet.
III Ulcerative Colitis
A. Inflammatory bowel disease: not to be confused with IBS (blood in stool)
B. Symptoms
1. diarrhea (resulting in malabsorption)
2. Rectal bleeding (resulting in anemia) (Stool will be red because blood is not absorbed. Black and tarry stools are absorbed blood from upper GI bleeding)
3. cramping, abdominal pain
4. anorexia (loss of appetite)
5. weight loss
C. Medical Nutrition Therapy
1. Dietary interventions do not lessen disease (but keep the pt more healthy so they can withstand the treatment)
2. low fiber (so not as much interaction in the lower GI, give it a rest so it can heal)
3. lactose free
4. vitamin and mineral supplementation
5. protein so they get enough calories to withstand treatment
IV Regional Enteritis (Crohn’s Disease)
A. Inflammation and ulceration of the GI tract
1. In severe cases, no digestion or absorption
2. Steatorrhea: fatty stools (foamy, smelly...saponification of fats)
B. Nutrition consequences
1. protein malnutrition
a. hypoalbuminemia (check albumin levels, low)
2. Vitamin deficiencies
a. Vit B12
b. folate
c. C
d. fat solubles ADEK
3. Mineral deficiencies
a. calcium
b. magnesium
c. zinc
d. iron
4. anemia
C. Medical Nutrition Therapy
1. high kcal, especially if losing 30%, eat 30% more
2. high protein (1-1.5g/kg...go up to 2x RDA)
3. fat restricted if steatorrhea is present
4. low fiber
5. vitamin and mineral supplementation, give liquid based when having diarrhea
6. avoid foods not well tolerated (i.e. lactose)
7. small, frequent meals recommended
V Celiac Disease
A. also known as Celiac Sprue
B. Inflammatory condition of the GI tract that affects the small intestines
C. Malabsorption due to a sensitivity to gliadin
1. gliadin: part of the protein gluten found in: wheat, buckwheat, rye, barley. Oats can usually be taken in small amounts
D. Consequences
1. protein malnutrition (low serum protein levels)
2. anemia: iron, folate, and B12 deficiency
3. steatorrhea, diarrhea (resulting in weight loss)
4. calcium deficiency (resulting in bone pain)
5. Vitamin and mineral deficiencies (fat soluble vitamins lost with steatorrhea)
E. Medical Nutrition Therapy
1. Gliadin-free/gluten restricted diet
a. no wheat, buckwheat, rye, barley
b. small amount of oats (be careful, they may have been contaminate with wheat during processing)
2. May have:
a. corn
b. rice
c. tapioca
d. potato
e. arrowroot
f. cassava (yuca)
g. gluten free flour
3. lactose restricted
4. vitamin and mineral supplementation
Upper Gastro Intestinal Disorders
GI Disorders
Upper GI
I Problems of the Mouth
A. Difficulty chewing:
1. AIDS
a. oral thrush
b. very painful
2. Parkinson’s Disease
a. Can affect mouth and throat muscles
b. Can take an hour to eat a normal meal which normally takes 10-15 minutes
3. Radiation Therapy
a. difficulty chewing
4. Missing (no) teeth
5. Ill fitting dentures
a. they may be loose after weight loss
6. Stroke
B. Dysphagia: difficulty swallowing
1. As a result of:
a. aging process
i. reflexes not as sharp
b. stroke
c. developmental disease
i. cerebral palsy
ii. severe Down’s syndrome (no swallowing reflex)
d. diseases of the nervous system (because reflexes are controlled by the nervous system)
2. Could lead to aspiration pneumonia
a. if too much food/liquid leaks down the throat the pt may not be able to cough it up
3. Signs of dysphagia:
a. repeated bouts of pneumonia (in elderly and disabled)
b. food “sticking” in the throat
c. pocketing food (keeping food in cheek, liquid will leak down into lungs)
d. wet, gurgled or hoarse sounding voice
e. coughing/choking during eating
4. Medical Nutrition Therapy (a speech and language pathologist/therapist will determine the degree of dysphagia. A nutritionist will suggest the diet therapy)
a. Adjust texture of food
i. mechanical soft (chopped or ground so they don’t need to chew as much)
ii. pureed
b. Adjust consistency of liquids
i. thin (normal)
ii. nectar consistency
iii. honey consistency
iv. spoon thick (yogurt) consistency
c. Food thickeners
i. made of starch
ii. do not provide taste/flavor
iii. potato flakes are a good thickener, but have taste
d. Patients are taught how to thicken foods and how to swallow.
C. Mouth Ulcers
1. Causes
a. poor dentition
b. radiation therapy
2. Medical Nutrition Therapy (the purpose is to get nutrition w/o aggravating the ulcers)
a. moist, soft textured foods (overcooked)
b. practice good oral hygeine
c. avoid salty foods and snacks
d. avoid “dry” foods
II Gastro-esophageal Reflux Disease (GERD or reflux esophagitis)
A. Occurs in the lower esophagus
B. The effect of acidic gastric reflux on the mucosa
1. stomach acid: 2.2 pH (very acidic)
C. Results from:
1. hiatal hernia:
a. outpouching occuring at junction of stomach and esophagus
b. stomach “burps” into hiatal hernia and acid burns the area
c. causes
i. overeating
ii. stress (psychological)
iii. pregnancy: as baby grows everything gets pushed up
2. increased abdominal pressure due to obesity or pregnancy
3. viral infection (not quite common)
4. Ingestion of an irritant, or recurrent vomiting
D. Medical Nutrition Therapy
1. small, frequent, low fat meals
2. do not lie down for 2 hours after eating
3. do not eat within 2-3 hours before bedtime
4. avoid stimulants
a. caffeine
b. alcohol
c. citrus
d. peppermint (people usually take this to calm an upset stomach, but it is a stimulant)
5. weight loss diet (if indicated)
6. wear loose, comfortable clothing
7. no smoking (stimulant)
III Gastritis
A. Inflammation of the gastric mucosa (stomach)
B. May be acute or chronic
1. acute (sudden and short term) caused by:
a. alcohol abuse
b. aspirin or other medication
c. food poisoning
d. radiation therapy
e. bacterial infection
2. chronic caused by:
a. gastric surgery
b. chronic stomach diseases
c. no known cause
C. Medical Nutrition Therapy
1. Acute
a. treat the cause
i. antibiotics for Helicobacter pylori
b. NPO for nausea/vomiting then progress diet
c. Avoid stimulants (see above)
2. Chronic (individual for each pt)
a. avoid foods that irritate gastric mucosa
b. vitamin B12 for pernicious anemia (b/c of extrinsic factor)
c. antacids, anti-ulcer medication and antibiotics as needed
IV Ulcers
A. Peptic Ulcers
1. In stomach or the duodenum, usually in the bend after stomach. Very rarely located by esophagus.
a. the duodenum is after the stomach, first part of small intestine.
2. Erosion of the top layer of cells from the lining of the esophagus (<1%), stomach (15%) or small intestine (85%)
3. Underlying layers of cells are exposed to gastric juices.
a. Gastric juices reach the nerves causing pain.
b. Very painful when the acid hits nerves. If the capillaries are exposed, bleeding occurs.
4. Causes
a. bacterial infection (H pylori: makes stomach acid less acidic)
b. anti-inflammatory drugs
i. ibuprofen
ii. naproxen
c. disorders that cause excessive gastric acid secretion
5. Medical Nutrition Therapy
a. antibiotic therapy and antacids
b. avoid foods that may cause gastric irritation
c. correct anemia (B12) if present
d. avoid aspirin (can erode lining)
e. no smoking (stimulant)
f. An ulcer will heal no matter what you eat as long as you avoid the stimulants. (after treating bacteria)
V Foods that May Cause Gastric Irritation
A. Alcohol
B. Caffeine
C. Peppermint
D. Cola beverages including: Mt Dew, Mellow Yellow
E. High energy drinks
F. Coffee, tea, decaf
G. Pepper and spicy foods
H. Any foods not tolerated
VI Gastric Surgery
A. Gastrectomy
1. removal of a portion or all of the stomach
a. because of disease
2. Side effects
a. Dumping syndrome
i. dizziness and weakness (due to rapid fall in circulating blood volume)
ii. rapid heart rate and sweating (due to hypoglycemia)
iii. diarrhea (hyper peristalsis due to large volume of hypertonic fluids)
iv. The stomach is a pouch that is made to hold food for a few hours while it mixes with acid. When food is dumped all at once, insulin is secreted in high amounts. Normally food would enter the small intestines as small bolus’. In gastrectomy food enters si all at once. Diarrhea b/c food is not digested or absorbed. Dumping occurs EVERYTIME the pt eats. The syndrome is so unpleasant that the pt may stop eating. If the pt has gastrectomy b/c of cancer the pt will have to deal with cancer and dumping syndrome.
3. Medical Nutrition Therapy
a. Goal
i. to provide energy (avoid weight loss)
ii. slow the passage of foods through the stomach
iii. minimize diarrhea
iv. avoid anemia: iron deficiency b/c not converted to a usable form. Malabsorption leads to folate and B12 anemia.
v. prevent bone disease: VitD and Calcium malabsorption lead to Osteomalacia.
b. Higher protein
c. Complex carbs (50-60%) Avoid mono and di-saccharides. They increase the amount of insulin being excreted b/c absorbed quickly.
i. simple sugars (0-15%)
d. moderate fat (30% of kcalories)
i. use medium chain triglycerides (MCT) Long chains take longer to digest. Use MCT so fat can be absorbed before diarrhea occurs. Fat soluble vitamins also have a chance to be absorbed.
e. Low (no) lactose: b/c you need the lactase in the stomach to break down lactose. If no/reduced stomach, can’t break it down. No supplements contain lactose because of this, just to avoid complications.
f. moderate sodium intake
g. vitamin and mineral supplementation
h. frequent small meals, fluids between meals (Dividing diet into small meals mimics the small bolus)
i. No more than 4oz of fluids with meals, remaining taken between
4. Client education
a. stress the importance of self-care
i. stress
ii. eating away from home
b. discuss
i. artificial sweeteners
ii. eating slowly in an upright position
iii. social significance of food and alcohol
iv. dumping syndrome and how to overcome reluctance and fear of pain with eating
VII Bariatric Surgery
A. Goal is weight loss
1. banded
2. stapled (gastric sleeve)
3. holds about 4oz after surgery
4. after years of overeating, can stretch back
B. Complications
1. ruptured staples
2. bowel obstruction from eating low residue diet
3. infections, nausea (from overeating), vomiting, dehydration
4. dumping syndrome
5. esophageal reflux
6. depression
C. Medical Nutrition Therapy
1. clear liquids: 4oz per hour
a. to clear residue
b. can’t have sugar because of dumping
i. diet jello
ii. crystal light
iii. water
iv. broth
2. progress to full liquids (after a week): low lactose
3. pureed, high protein
4. no sugar, very low carbs
5. common deficiencies
a. vitamins B12, D
i. if Vit D deficient, Ca+ deficiency is not far behind
b. iron
Upper GI
I Problems of the Mouth
A. Difficulty chewing:
1. AIDS
a. oral thrush
b. very painful
2. Parkinson’s Disease
a. Can affect mouth and throat muscles
b. Can take an hour to eat a normal meal which normally takes 10-15 minutes
3. Radiation Therapy
a. difficulty chewing
4. Missing (no) teeth
5. Ill fitting dentures
a. they may be loose after weight loss
6. Stroke
B. Dysphagia: difficulty swallowing
1. As a result of:
a. aging process
i. reflexes not as sharp
b. stroke
c. developmental disease
i. cerebral palsy
ii. severe Down’s syndrome (no swallowing reflex)
d. diseases of the nervous system (because reflexes are controlled by the nervous system)
2. Could lead to aspiration pneumonia
a. if too much food/liquid leaks down the throat the pt may not be able to cough it up
3. Signs of dysphagia:
a. repeated bouts of pneumonia (in elderly and disabled)
b. food “sticking” in the throat
c. pocketing food (keeping food in cheek, liquid will leak down into lungs)
d. wet, gurgled or hoarse sounding voice
e. coughing/choking during eating
4. Medical Nutrition Therapy (a speech and language pathologist/therapist will determine the degree of dysphagia. A nutritionist will suggest the diet therapy)
a. Adjust texture of food
i. mechanical soft (chopped or ground so they don’t need to chew as much)
ii. pureed
b. Adjust consistency of liquids
i. thin (normal)
ii. nectar consistency
iii. honey consistency
iv. spoon thick (yogurt) consistency
c. Food thickeners
i. made of starch
ii. do not provide taste/flavor
iii. potato flakes are a good thickener, but have taste
d. Patients are taught how to thicken foods and how to swallow.
C. Mouth Ulcers
1. Causes
a. poor dentition
b. radiation therapy
2. Medical Nutrition Therapy (the purpose is to get nutrition w/o aggravating the ulcers)
a. moist, soft textured foods (overcooked)
b. practice good oral hygeine
c. avoid salty foods and snacks
d. avoid “dry” foods
II Gastro-esophageal Reflux Disease (GERD or reflux esophagitis)
A. Occurs in the lower esophagus
B. The effect of acidic gastric reflux on the mucosa
1. stomach acid: 2.2 pH (very acidic)
C. Results from:
1. hiatal hernia:
a. outpouching occuring at junction of stomach and esophagus
b. stomach “burps” into hiatal hernia and acid burns the area
c. causes
i. overeating
ii. stress (psychological)
iii. pregnancy: as baby grows everything gets pushed up
2. increased abdominal pressure due to obesity or pregnancy
3. viral infection (not quite common)
4. Ingestion of an irritant, or recurrent vomiting
D. Medical Nutrition Therapy
1. small, frequent, low fat meals
2. do not lie down for 2 hours after eating
3. do not eat within 2-3 hours before bedtime
4. avoid stimulants
a. caffeine
b. alcohol
c. citrus
d. peppermint (people usually take this to calm an upset stomach, but it is a stimulant)
5. weight loss diet (if indicated)
6. wear loose, comfortable clothing
7. no smoking (stimulant)
III Gastritis
A. Inflammation of the gastric mucosa (stomach)
B. May be acute or chronic
1. acute (sudden and short term) caused by:
a. alcohol abuse
b. aspirin or other medication
c. food poisoning
d. radiation therapy
e. bacterial infection
2. chronic caused by:
a. gastric surgery
b. chronic stomach diseases
c. no known cause
C. Medical Nutrition Therapy
1. Acute
a. treat the cause
i. antibiotics for Helicobacter pylori
b. NPO for nausea/vomiting then progress diet
c. Avoid stimulants (see above)
2. Chronic (individual for each pt)
a. avoid foods that irritate gastric mucosa
b. vitamin B12 for pernicious anemia (b/c of extrinsic factor)
c. antacids, anti-ulcer medication and antibiotics as needed
IV Ulcers
A. Peptic Ulcers
1. In stomach or the duodenum, usually in the bend after stomach. Very rarely located by esophagus.
a. the duodenum is after the stomach, first part of small intestine.
2. Erosion of the top layer of cells from the lining of the esophagus (<1%), stomach (15%) or small intestine (85%)
3. Underlying layers of cells are exposed to gastric juices.
a. Gastric juices reach the nerves causing pain.
b. Very painful when the acid hits nerves. If the capillaries are exposed, bleeding occurs.
4. Causes
a. bacterial infection (H pylori: makes stomach acid less acidic)
b. anti-inflammatory drugs
i. ibuprofen
ii. naproxen
c. disorders that cause excessive gastric acid secretion
5. Medical Nutrition Therapy
a. antibiotic therapy and antacids
b. avoid foods that may cause gastric irritation
c. correct anemia (B12) if present
d. avoid aspirin (can erode lining)
e. no smoking (stimulant)
f. An ulcer will heal no matter what you eat as long as you avoid the stimulants. (after treating bacteria)
V Foods that May Cause Gastric Irritation
A. Alcohol
B. Caffeine
C. Peppermint
D. Cola beverages including: Mt Dew, Mellow Yellow
E. High energy drinks
F. Coffee, tea, decaf
G. Pepper and spicy foods
H. Any foods not tolerated
VI Gastric Surgery
A. Gastrectomy
1. removal of a portion or all of the stomach
a. because of disease
2. Side effects
a. Dumping syndrome
i. dizziness and weakness (due to rapid fall in circulating blood volume)
ii. rapid heart rate and sweating (due to hypoglycemia)
iii. diarrhea (hyper peristalsis due to large volume of hypertonic fluids)
iv. The stomach is a pouch that is made to hold food for a few hours while it mixes with acid. When food is dumped all at once, insulin is secreted in high amounts. Normally food would enter the small intestines as small bolus’. In gastrectomy food enters si all at once. Diarrhea b/c food is not digested or absorbed. Dumping occurs EVERYTIME the pt eats. The syndrome is so unpleasant that the pt may stop eating. If the pt has gastrectomy b/c of cancer the pt will have to deal with cancer and dumping syndrome.
3. Medical Nutrition Therapy
a. Goal
i. to provide energy (avoid weight loss)
ii. slow the passage of foods through the stomach
iii. minimize diarrhea
iv. avoid anemia: iron deficiency b/c not converted to a usable form. Malabsorption leads to folate and B12 anemia.
v. prevent bone disease: VitD and Calcium malabsorption lead to Osteomalacia.
b. Higher protein
c. Complex carbs (50-60%) Avoid mono and di-saccharides. They increase the amount of insulin being excreted b/c absorbed quickly.
i. simple sugars (0-15%)
d. moderate fat (30% of kcalories)
i. use medium chain triglycerides (MCT) Long chains take longer to digest. Use MCT so fat can be absorbed before diarrhea occurs. Fat soluble vitamins also have a chance to be absorbed.
e. Low (no) lactose: b/c you need the lactase in the stomach to break down lactose. If no/reduced stomach, can’t break it down. No supplements contain lactose because of this, just to avoid complications.
f. moderate sodium intake
g. vitamin and mineral supplementation
h. frequent small meals, fluids between meals (Dividing diet into small meals mimics the small bolus)
i. No more than 4oz of fluids with meals, remaining taken between
4. Client education
a. stress the importance of self-care
i. stress
ii. eating away from home
b. discuss
i. artificial sweeteners
ii. eating slowly in an upright position
iii. social significance of food and alcohol
iv. dumping syndrome and how to overcome reluctance and fear of pain with eating
VII Bariatric Surgery
A. Goal is weight loss
1. banded
2. stapled (gastric sleeve)
3. holds about 4oz after surgery
4. after years of overeating, can stretch back
B. Complications
1. ruptured staples
2. bowel obstruction from eating low residue diet
3. infections, nausea (from overeating), vomiting, dehydration
4. dumping syndrome
5. esophageal reflux
6. depression
C. Medical Nutrition Therapy
1. clear liquids: 4oz per hour
a. to clear residue
b. can’t have sugar because of dumping
i. diet jello
ii. crystal light
iii. water
iv. broth
2. progress to full liquids (after a week): low lactose
3. pureed, high protein
4. no sugar, very low carbs
5. common deficiencies
a. vitamins B12, D
i. if Vit D deficient, Ca+ deficiency is not far behind
b. iron
How to Print My Outlines
How to Print Outlines
Sometimes when I copy and paste the outlines into the blog, the tabbing does not transfer. My suggestion to you is to copy the blog into Microsoft Word and then add the tabs yourself. Hopefully I can figure out how to overcome this glitch...but I don't have the time right now with exams coming up.
Tab 1x before every capital letter. Tab 2x before every numeral. Tab 3x before every lower case letter. Tab 4x before every lower case Roman numeral.
Sometimes when I copy and paste the outlines into the blog, the tabbing does not transfer. My suggestion to you is to copy the blog into Microsoft Word and then add the tabs yourself. Hopefully I can figure out how to overcome this glitch...but I don't have the time right now with exams coming up.
Tab 1x before every capital letter. Tab 2x before every numeral. Tab 3x before every lower case letter. Tab 4x before every lower case Roman numeral.
Friday, April 11, 2008
Water
Water
Water and Body Fluids
I H2O, Functions and roles of Water:
A. The main role of water is to maintain an appropriate water balance to support vital functions.
B. To maintain water homeostasis, intake from liquids, foods, and metabolism must equal losses from the kidneys, skin, lungs, and feces. (I & O’s = intake and output)
C. Functions;
1. Carries nutrients and waste products.
2. Maintains the structure of large molecules
3. Participates in metabolic reactions
4. Solvent for minerals, vitamins, amino acids, glucose and others
5. Lubricant and cushion around joi8nts, inside the eyes, the spinal cord, and in amniotic fluid during pregnancy
6. Regulation of body temperature (shiver and sweats)]
7. Maintains blood volume
II Water Balance
A. Intracellular fluid (inside the cells) makes up about 2/3 of the body’s water. (Adults have more intracellular fluid)
B. Extracellular fluid (outside the cells) has two components: (infants have more extracellular fluid)
1. Interstitial fluid
i. every pint of interstitial tissue = 1 lb on scale
2. Plasma
C. Water intake: thirst is a conscious desire to drink and is regulated by the mouth, brain and nerves.
III Water Deficiency
A. Dehydration: water output exceeds input due to an inadequate intake or excessive losses.
1. 1-2% loss of body weight:
a. thirst, fatigue, weakness
b. loss of appetite
2. 3-4%
a. impaired physical performance
b. dry mouth
c. reduction in urine
d. flushed skin
e. impatience
f. apathy
3. 5-6%
a. difficulty in concentrating
b. irritability
c. sleepiness
d. impaired temperature regulation
e. increased respiratory rate
4. 7-10%
a. dizziness
b. spastic muscles
c. loss of balance
d. delirium
e. exhaustion
f. collapse
IV Toxicity
A. Water Intoxication: excessive water contents in all body fluid compartments.
1. rare
V Water Sources
A. Water intake is from 3 sources:
1. liquids
a. water
b. other beverages
2. solids
a. fruits
b. vegetables
c. meat
d. cheese
3. by product of metabolism
a. CHO = CO2 & H2O (Carbs in the Krebs cycle release energy, the waste or left over byproducts are CO2 and H2O)
B. An intake of 1450 to 2800 ml of water is usually represented by:
1. liquids: 550-1500 ml
2. foods: 700-1000 ml
3. metabolic water: 200-300ml
4. Recommended intake:
a. 1 ml per kcal (2-3 liters)
b. those with increased needs are:
i. athletes
ii. infants and children
C. Water losses (output of 1450 to 2800 ml)
1. kidneys (urine output) 500 to 1400 ml
2. skin (sweat) 450 – 900 ml
3. lungs (vapor) 350 ml
4. intestines (feces) in GI tract 150 ml
5. alcohol and caffeine create a diuretic effect
VI Health Effects
A. Meeting fluid needs
1. protect against cancer of the bladder, prostrate, and breast
2. protect against kidney stones
Water and Body Fluids
I H2O, Functions and roles of Water:
A. The main role of water is to maintain an appropriate water balance to support vital functions.
B. To maintain water homeostasis, intake from liquids, foods, and metabolism must equal losses from the kidneys, skin, lungs, and feces. (I & O’s = intake and output)
C. Functions;
1. Carries nutrients and waste products.
2. Maintains the structure of large molecules
3. Participates in metabolic reactions
4. Solvent for minerals, vitamins, amino acids, glucose and others
5. Lubricant and cushion around joi8nts, inside the eyes, the spinal cord, and in amniotic fluid during pregnancy
6. Regulation of body temperature (shiver and sweats)]
7. Maintains blood volume
II Water Balance
A. Intracellular fluid (inside the cells) makes up about 2/3 of the body’s water. (Adults have more intracellular fluid)
B. Extracellular fluid (outside the cells) has two components: (infants have more extracellular fluid)
1. Interstitial fluid
i. every pint of interstitial tissue = 1 lb on scale
2. Plasma
C. Water intake: thirst is a conscious desire to drink and is regulated by the mouth, brain and nerves.
III Water Deficiency
A. Dehydration: water output exceeds input due to an inadequate intake or excessive losses.
1. 1-2% loss of body weight:
a. thirst, fatigue, weakness
b. loss of appetite
2. 3-4%
a. impaired physical performance
b. dry mouth
c. reduction in urine
d. flushed skin
e. impatience
f. apathy
3. 5-6%
a. difficulty in concentrating
b. irritability
c. sleepiness
d. impaired temperature regulation
e. increased respiratory rate
4. 7-10%
a. dizziness
b. spastic muscles
c. loss of balance
d. delirium
e. exhaustion
f. collapse
IV Toxicity
A. Water Intoxication: excessive water contents in all body fluid compartments.
1. rare
V Water Sources
A. Water intake is from 3 sources:
1. liquids
a. water
b. other beverages
2. solids
a. fruits
b. vegetables
c. meat
d. cheese
3. by product of metabolism
a. CHO = CO2 & H2O (Carbs in the Krebs cycle release energy, the waste or left over byproducts are CO2 and H2O)
B. An intake of 1450 to 2800 ml of water is usually represented by:
1. liquids: 550-1500 ml
2. foods: 700-1000 ml
3. metabolic water: 200-300ml
4. Recommended intake:
a. 1 ml per kcal (2-3 liters)
b. those with increased needs are:
i. athletes
ii. infants and children
C. Water losses (output of 1450 to 2800 ml)
1. kidneys (urine output) 500 to 1400 ml
2. skin (sweat) 450 – 900 ml
3. lungs (vapor) 350 ml
4. intestines (feces) in GI tract 150 ml
5. alcohol and caffeine create a diuretic effect
VI Health Effects
A. Meeting fluid needs
1. protect against cancer of the bladder, prostrate, and breast
2. protect against kidney stones
Trace Minerals
Trace Minerals
Trace Minerals
A. Trace minerals are needed in very small quantities in the body.
B. They perform many essential functions important to health.
C. Toxic levels can easily be reached with the use of supplements.
I Iron (Fe)
A. Functions
1. utilization of energy in cell metabolism
2. part of the protein hemoglobin which carries oxygen in the blood
3. part of the protein myoglobin in the muscles which makes O2 available for muscle contractions.
B. Deficiency (iron deficiency anemia)
1. the most common nutrition deficiency worldwide
2. vulnerable stages of life:
a. women in reproductive years due to menstruation
b. pregnant women due to the needs of the infant, increases in blood volume, and loss of blood during the nursing process. (needs are tripled)
c. infants, young children, and teenagers due to rapid growth
3. Fe deficiency and anemia symptoms:
a. fatigue
b. weakness
c. headaches
d. apathy
e. pallor
f. poor resistance to cold temperatures
4. Fe deficiency and pica
a. generally found in women and children from low income groups
b. eating ice, clay, paste, and other nonfood substances
c. eating nonfood substances will not correct the deficiency
C. Toxicity (iron overload)
1. hemochromatosis is generally a genetic disorder that enhances iron absorption.
2. can also be caused by:
a. repeated blood transfusions
b. massive doses of supplemental iron
c. rare metabolic disorders
3. symptoms:
a. apathy
b. lethargy
c. fatigue
4. problems include:
a. liver tissue damage
b. infections
c. higher risk of:
i. diabetes
ii. liver cancer
iii. heart disease
iv. arthritis
D. Sources
1. heme sources (blood…absorbed better) (iron in ferrous form)
a. liver
b. beef
c. pork
d. poultry
2. non heme sources (less absorbed) (iron in ferric form)
From plant and animal derived foods.
a. dried beans
b. prunes
c. apricots
d. spinach
E. Factors affecting absorption
1. ferritin level
a. determines the amount of iron that is absorbed
b. phytates and fivers from legumes, grains, and rice
c. vegetable proteins in soybeans, legumes, and nuts
d. calcium in milk
e. tannic acid and other polyphenols in tea, coffee, grains, oregano, and red wine
F. Highlights
1. cooking in iron pots increase iron content of food
2. vitamin C increases absorption
3. best absorbable form is ferrous (Fe++)
4. Ferric (Fe+++) not well absorbed
II Zinc (Zn)
A. Functions 1. necessary for energy metabolism
a. necessary component of insulin
2. required for the activation of many enzymes
a. essential fatty acid metabolism
3. necessary component of sperm
4. necessary for fetal development and growth
5. necessary for wound healing
B. Deficiencies (remember pic with 17yo looking like 8)
1. growth failure
2. delayed sexual maturation
3. slow wound healing
4. loss of taste and appetite
5. low birth weight
C. Toxicity
1. nausea and vomiting
2. weakness and fatigue
3. increased blood lipids (fatty acid metabolism)
4. kidney failure
5. altered immune system
D. sources
1. animal sources are better absorbed
a. shellfish
b. meat of all kinds
c. milk, cheese
2. plant sources
a. grains
b. nuts
III Iodine
A. Function
1. component of thyroid hormone
2. regulates growth and energy
B. Deficiency
1. goiter in adults
2. cretinism in children
a. mental retardation
b. growth failure
c. hearing loss
C. Toxicity
1. goiter-like symptoms
D. Sources
1. iodized salt
2. seafood
3. bread and dairy products
4. plants grown in iodine rich soils
5. animals that feed on plants grown in iodine rich soils
IV Fluoride
A. Roles in the body
1. formation of teeth and bones
2. helps to make teeth resistant to decay (only known function)
B. Deficiency
1. tooth decay
C. Toxicity
1. mottled teeth
2. fluorosis: irreversible pitting and discoloration of the teeth
D. Sources
1. fluoridated water
2. tea
3. seafood
V Phytochemicals
A. Phytochemicals are non-nutrient substances we find in food.
B. Phytochemicals give foods:
1. taste
2. aroma
3. color and other characteristics
C. Defending against cancer
1. mimic estrogen
2. found in:
a. soybeans
b. legumes
c. flaxseeds
d. whole grains
e. fruits
f. vegetables
3. antioxidant activity
4. slow the growth of breast and prostrate cancer
5. supplements may stimulate the growth of cancers that depend upon estrogen.
6. lycopene inhibits the growth of cancer cells
D. Defending against heart disease
1. flavinoids (same family as B Vitamin Riboflavin)
2. prevents LDL oxidation
VI Functional Foods (give color to foods)
A. Foods as pharmacy
1. margarine enhanced with a phytosterol may lower cholesterol
2. may be more useful in prevention of mild cases of disease
3. drugs are used for severe cases of disease
Trace Minerals
A. Trace minerals are needed in very small quantities in the body.
B. They perform many essential functions important to health.
C. Toxic levels can easily be reached with the use of supplements.
I Iron (Fe)
A. Functions
1. utilization of energy in cell metabolism
2. part of the protein hemoglobin which carries oxygen in the blood
3. part of the protein myoglobin in the muscles which makes O2 available for muscle contractions.
B. Deficiency (iron deficiency anemia)
1. the most common nutrition deficiency worldwide
2. vulnerable stages of life:
a. women in reproductive years due to menstruation
b. pregnant women due to the needs of the infant, increases in blood volume, and loss of blood during the nursing process. (needs are tripled)
c. infants, young children, and teenagers due to rapid growth
3. Fe deficiency and anemia symptoms:
a. fatigue
b. weakness
c. headaches
d. apathy
e. pallor
f. poor resistance to cold temperatures
4. Fe deficiency and pica
a. generally found in women and children from low income groups
b. eating ice, clay, paste, and other nonfood substances
c. eating nonfood substances will not correct the deficiency
C. Toxicity (iron overload)
1. hemochromatosis is generally a genetic disorder that enhances iron absorption.
2. can also be caused by:
a. repeated blood transfusions
b. massive doses of supplemental iron
c. rare metabolic disorders
3. symptoms:
a. apathy
b. lethargy
c. fatigue
4. problems include:
a. liver tissue damage
b. infections
c. higher risk of:
i. diabetes
ii. liver cancer
iii. heart disease
iv. arthritis
D. Sources
1. heme sources (blood…absorbed better) (iron in ferrous form)
a. liver
b. beef
c. pork
d. poultry
2. non heme sources (less absorbed) (iron in ferric form)
From plant and animal derived foods.
a. dried beans
b. prunes
c. apricots
d. spinach
E. Factors affecting absorption
1. ferritin level
a. determines the amount of iron that is absorbed
b. phytates and fivers from legumes, grains, and rice
c. vegetable proteins in soybeans, legumes, and nuts
d. calcium in milk
e. tannic acid and other polyphenols in tea, coffee, grains, oregano, and red wine
F. Highlights
1. cooking in iron pots increase iron content of food
2. vitamin C increases absorption
3. best absorbable form is ferrous (Fe++)
4. Ferric (Fe+++) not well absorbed
II Zinc (Zn)
A. Functions 1. necessary for energy metabolism
a. necessary component of insulin
2. required for the activation of many enzymes
a. essential fatty acid metabolism
3. necessary component of sperm
4. necessary for fetal development and growth
5. necessary for wound healing
B. Deficiencies (remember pic with 17yo looking like 8)
1. growth failure
2. delayed sexual maturation
3. slow wound healing
4. loss of taste and appetite
5. low birth weight
C. Toxicity
1. nausea and vomiting
2. weakness and fatigue
3. increased blood lipids (fatty acid metabolism)
4. kidney failure
5. altered immune system
D. sources
1. animal sources are better absorbed
a. shellfish
b. meat of all kinds
c. milk, cheese
2. plant sources
a. grains
b. nuts
III Iodine
A. Function
1. component of thyroid hormone
2. regulates growth and energy
B. Deficiency
1. goiter in adults
2. cretinism in children
a. mental retardation
b. growth failure
c. hearing loss
C. Toxicity
1. goiter-like symptoms
D. Sources
1. iodized salt
2. seafood
3. bread and dairy products
4. plants grown in iodine rich soils
5. animals that feed on plants grown in iodine rich soils
IV Fluoride
A. Roles in the body
1. formation of teeth and bones
2. helps to make teeth resistant to decay (only known function)
B. Deficiency
1. tooth decay
C. Toxicity
1. mottled teeth
2. fluorosis: irreversible pitting and discoloration of the teeth
D. Sources
1. fluoridated water
2. tea
3. seafood
V Phytochemicals
A. Phytochemicals are non-nutrient substances we find in food.
B. Phytochemicals give foods:
1. taste
2. aroma
3. color and other characteristics
C. Defending against cancer
1. mimic estrogen
2. found in:
a. soybeans
b. legumes
c. flaxseeds
d. whole grains
e. fruits
f. vegetables
3. antioxidant activity
4. slow the growth of breast and prostrate cancer
5. supplements may stimulate the growth of cancers that depend upon estrogen.
6. lycopene inhibits the growth of cancer cells
D. Defending against heart disease
1. flavinoids (same family as B Vitamin Riboflavin)
2. prevents LDL oxidation
VI Functional Foods (give color to foods)
A. Foods as pharmacy
1. margarine enhanced with a phytosterol may lower cholesterol
2. may be more useful in prevention of mild cases of disease
3. drugs are used for severe cases of disease
Proteins
Proteins
I Proteins
A. 3rd energy nutrient
B. only significant source of nitrogen in our bodies
C. composed of CHO N
D. Break down into amino acids (aa)
1. 20 total
2. 9 essential (indispensible)
I Proteins
A. 3rd energy nutrient
B. only significant source of nitrogen in our bodies
C. composed of CHO N
D. Break down into amino acids (aa)
1. 20 total
2. 9 essential (indispensible)
Major Minerals
Major Minerals
Minerals
A. Major minerals
1. found in large quantities in the body
2. > 5 grams
B. Trace minerals
1. found in small quantities
C. They may bind with other substances and interact with other minerals, thus affection absorption. (They may be in a bound form because it is inorganic. The mineral may show high on tests, but not be available because it is in the bound form)
D. Inorganic elements
Major Minerals
I Sodium (Na+) (a cation, needs an anion to work)
A. Roles in the body:
1. maintains normal fluid, electrolyte, and acid-base balance
a. major extracellular electrolyte
2. assists in nerve impulse transmission and muscle contraction
3. filtered out of the blood by the kidneys
B. Deficiency (hyponatremia)
1. sodium and water must by replaced after:
a. vomiting
b. diarrhea
c. heavy sweating
2. symptoms include:
a. muscle cramps
b. mental apathy
c. loss of appetite
C. Toxicity ( hypernatremia) and excessive intakes
1. edema
2. acute hypertension
3. prolonged high intake may contribute to chronic hypertension
D. Food sources
1. large amount in processed foods (approx 75% of sodium in the diet)
2. table salt (approx 15% added sodium in the diet)
3. may be present in surprisingly high amounts if chloride is removed
4. moderate amounts in meats, milks, breads, and vegetables (approx 10% of sodium in the diet)
E. Health Effects
1. sodium and hypertension:
a. salt restriction does help to lower bp
b. salt sensitivity is a term to describe individuals who respond to a high salt intake with high bp
c. Dietary Approaches to Stop Hypertension (DASH) is a diet plan that helps to lower bp
2. Sodium and bone loss (osteoporosis)
a. high sodium intake is associated with calcium excretion
II Chloride (Cl-) (anion)
A. Roles in the body
1. maintains normal fluid and electrolyte balance
2. part of hydrochloric acid found in the stomach
3. necessary for proper digestion
B. Deficiency
1. rare
2. losses can occur with vomiting, diarrhea or heavy sweating
C. Toxicity
1. dehydration due to water deficiency can concentrate Cl- to high levels
2. the toxicity symptom is vomiting
D. Sources
1. abundant in most foods
2. abundant in processed foods
III Potassium (K+)
A. Roles in the body
1. maintains normal fluid and electrolyte balance
a. major intracellular electrolyte
2. facilitates many reactions
3. supports cell integrity
4. assists in nerve impulse transmission and muscle contractions
5. maintains the heartbeat
B. Deficiency (hypokalemia)
1. symptoms:
a. muscular weakness
b. paralysis
c. confusion
d. increased bp
e. salt sensitivity
f. kidney stones
2. later signs include:
a. irregular heartbeats
b. muscle weakness
c. glucose intolerance
C. Toxicity (hyperkalemia)
1. results from supplements or overconsumption of potassium salts
2. can occur with certain diseases or treatments
3. symptoms include:
a. muscular weakness
b. vomiting
4. if given in a vein, K+ can stop the heart
D. Health effects
1. low K+ intakes increase bp
2. high K+ intakes prevent and correct hypertension when taken as food not supplements
IV Calcium (Ca+)
A. Most abundant mineral in the body
B. Most of Ca+ (99%) is found in the bones. (1 ½ lbs in body)
C. The remaining 1% is found in the blood and has many functions. Necessary for:
1. muscle contraction
2. nerve functioning
3. blood clotting
4. bp and immune defenses
D. Deficiency symptoms:
1. stunted growth in children
2. bone loss in adults
E. Toxicity
1. hypercalciuria (high urinary Ca+ levels)
2. kidney stones
F. Sources
1. milk and dairy products
2. small fish with bones, oysters
3. broccoli, chard
4. tofu, legumes
5. Ca+ fortified foods
G. Health effects
1. Ca+ and disease prevention:
a. may protect against hypertension
b. DASH diet that is rich in Ca+, Mg, and K+
c. may be protective relationship with blood cholesterol, diabetes, and colon cancer
2. Ca+ and obesity:
a. maintaining healthy body weight
b. Ca+ from dairy foods has better results than Ca+ from supplements
c. more research is needed to prove effective in weight loss
3. Ca+ and osteoporosis:
a. healthy people 2010 aims to reduce the proportion of adults with osteoporosis
b. men at lower risk than women b/c of hormonal changes
c. rapid bone loss happens in nonmenstruating women
d. medications can be used that inhibit bone loss
e. soy offers some protection
H. Osteoporosis:
1. prevention
a. genes my play a role
b. environment, also diet and Ca+
c. muscle strength and bone strength go together
d. heavy body weights and weight gains place a stress on bones and promote bone density
e. physical activity helps to prevent
2. risks
a. smokers
i. less dense bones
ii. damage can be reversed when smoking stops
b. alcohol abuse
i. enhances fluid excretion, thus increases Ca+ losses
ii. upsets hormonal balance for healthy bones
iii. slows bone formation
iv. stimulates bone breakdown
v. increases risks of falling
I. Absorption
1. factors that enhance absorption:
a. stomach acid
b. Vitamin D
c. Lactose
d. growth hormones
2. factors that inhibit absorption:
a. lack of stomach acid
b. Vit D deficiency
c. high phosphorus intake
d. high-fiber diet
e. phytates in seeds, nuts, and grains
f. oxalates in beet greens, rhubarb, and spinach (will precipitate to a kidney stone)
V Phosphorus (P)
A. Roles in the body
1. mineralization of bones and teeth
2. part of every cell
3. genetic material (DNA and RNA)
4. part of phospholipids
5. energy transfer (krebs cycle… the P in ATP)
6. maintain acid-base balance
B. Deficiency
1. weakness
2. bone pain
C. Toxicity
1. calcification of soft tissue
D. Sources
1. all animal sources: meat, fish, poultry, eggs
VI Magnesium (Mg)
A. Roles in the body
1. bone mineralization
2. building of protein
3. enzyme action
4. normal muscle contraction
5. nerve impulse transmission
6. maintenance of teeth by preventing dental caries
7. functioning of the immune system
8. blood clotting
B. Deficiency
1. rare
2. symptoms include:
a. weakness
b. confusion
c. convulsions in extreme cases
d. bizarre muscle movements of the eye and face
e. hallucinations
f. difficulty in swallowing
g. growth failure in children
3. develops from alcohol abuse, protein malnutrition, kidney disorders and prolonged vomiting and diarrhea (b/c its an electrolyte)
C. Toxicity
1. symptoms from non-food Mg are:
a. diarrhea
b. alkalosis
c. dehydration
D. Food sources
1. nuts and legumes (overwhelmingly our largest food source)
2. whole grains
3. dark green vegetables
4. seafood
5. chocolate and cocoa
6. hard water and some mineral waters
E. Health effects
1. Mg and hypertension
a. low Mg restricts walls of arteries and capillaries
b. protects against heart disease and hypertension
Minerals
A. Major minerals
1. found in large quantities in the body
2. > 5 grams
B. Trace minerals
1. found in small quantities
C. They may bind with other substances and interact with other minerals, thus affection absorption. (They may be in a bound form because it is inorganic. The mineral may show high on tests, but not be available because it is in the bound form)
D. Inorganic elements
Major Minerals
I Sodium (Na+) (a cation, needs an anion to work)
A. Roles in the body:
1. maintains normal fluid, electrolyte, and acid-base balance
a. major extracellular electrolyte
2. assists in nerve impulse transmission and muscle contraction
3. filtered out of the blood by the kidneys
B. Deficiency (hyponatremia)
1. sodium and water must by replaced after:
a. vomiting
b. diarrhea
c. heavy sweating
2. symptoms include:
a. muscle cramps
b. mental apathy
c. loss of appetite
C. Toxicity ( hypernatremia) and excessive intakes
1. edema
2. acute hypertension
3. prolonged high intake may contribute to chronic hypertension
D. Food sources
1. large amount in processed foods (approx 75% of sodium in the diet)
2. table salt (approx 15% added sodium in the diet)
3. may be present in surprisingly high amounts if chloride is removed
4. moderate amounts in meats, milks, breads, and vegetables (approx 10% of sodium in the diet)
E. Health Effects
1. sodium and hypertension:
a. salt restriction does help to lower bp
b. salt sensitivity is a term to describe individuals who respond to a high salt intake with high bp
c. Dietary Approaches to Stop Hypertension (DASH) is a diet plan that helps to lower bp
2. Sodium and bone loss (osteoporosis)
a. high sodium intake is associated with calcium excretion
II Chloride (Cl-) (anion)
A. Roles in the body
1. maintains normal fluid and electrolyte balance
2. part of hydrochloric acid found in the stomach
3. necessary for proper digestion
B. Deficiency
1. rare
2. losses can occur with vomiting, diarrhea or heavy sweating
C. Toxicity
1. dehydration due to water deficiency can concentrate Cl- to high levels
2. the toxicity symptom is vomiting
D. Sources
1. abundant in most foods
2. abundant in processed foods
III Potassium (K+)
A. Roles in the body
1. maintains normal fluid and electrolyte balance
a. major intracellular electrolyte
2. facilitates many reactions
3. supports cell integrity
4. assists in nerve impulse transmission and muscle contractions
5. maintains the heartbeat
B. Deficiency (hypokalemia)
1. symptoms:
a. muscular weakness
b. paralysis
c. confusion
d. increased bp
e. salt sensitivity
f. kidney stones
2. later signs include:
a. irregular heartbeats
b. muscle weakness
c. glucose intolerance
C. Toxicity (hyperkalemia)
1. results from supplements or overconsumption of potassium salts
2. can occur with certain diseases or treatments
3. symptoms include:
a. muscular weakness
b. vomiting
4. if given in a vein, K+ can stop the heart
D. Health effects
1. low K+ intakes increase bp
2. high K+ intakes prevent and correct hypertension when taken as food not supplements
IV Calcium (Ca+)
A. Most abundant mineral in the body
B. Most of Ca+ (99%) is found in the bones. (1 ½ lbs in body)
C. The remaining 1% is found in the blood and has many functions. Necessary for:
1. muscle contraction
2. nerve functioning
3. blood clotting
4. bp and immune defenses
D. Deficiency symptoms:
1. stunted growth in children
2. bone loss in adults
E. Toxicity
1. hypercalciuria (high urinary Ca+ levels)
2. kidney stones
F. Sources
1. milk and dairy products
2. small fish with bones, oysters
3. broccoli, chard
4. tofu, legumes
5. Ca+ fortified foods
G. Health effects
1. Ca+ and disease prevention:
a. may protect against hypertension
b. DASH diet that is rich in Ca+, Mg, and K+
c. may be protective relationship with blood cholesterol, diabetes, and colon cancer
2. Ca+ and obesity:
a. maintaining healthy body weight
b. Ca+ from dairy foods has better results than Ca+ from supplements
c. more research is needed to prove effective in weight loss
3. Ca+ and osteoporosis:
a. healthy people 2010 aims to reduce the proportion of adults with osteoporosis
b. men at lower risk than women b/c of hormonal changes
c. rapid bone loss happens in nonmenstruating women
d. medications can be used that inhibit bone loss
e. soy offers some protection
H. Osteoporosis:
1. prevention
a. genes my play a role
b. environment, also diet and Ca+
c. muscle strength and bone strength go together
d. heavy body weights and weight gains place a stress on bones and promote bone density
e. physical activity helps to prevent
2. risks
a. smokers
i. less dense bones
ii. damage can be reversed when smoking stops
b. alcohol abuse
i. enhances fluid excretion, thus increases Ca+ losses
ii. upsets hormonal balance for healthy bones
iii. slows bone formation
iv. stimulates bone breakdown
v. increases risks of falling
I. Absorption
1. factors that enhance absorption:
a. stomach acid
b. Vitamin D
c. Lactose
d. growth hormones
2. factors that inhibit absorption:
a. lack of stomach acid
b. Vit D deficiency
c. high phosphorus intake
d. high-fiber diet
e. phytates in seeds, nuts, and grains
f. oxalates in beet greens, rhubarb, and spinach (will precipitate to a kidney stone)
V Phosphorus (P)
A. Roles in the body
1. mineralization of bones and teeth
2. part of every cell
3. genetic material (DNA and RNA)
4. part of phospholipids
5. energy transfer (krebs cycle… the P in ATP)
6. maintain acid-base balance
B. Deficiency
1. weakness
2. bone pain
C. Toxicity
1. calcification of soft tissue
D. Sources
1. all animal sources: meat, fish, poultry, eggs
VI Magnesium (Mg)
A. Roles in the body
1. bone mineralization
2. building of protein
3. enzyme action
4. normal muscle contraction
5. nerve impulse transmission
6. maintenance of teeth by preventing dental caries
7. functioning of the immune system
8. blood clotting
B. Deficiency
1. rare
2. symptoms include:
a. weakness
b. confusion
c. convulsions in extreme cases
d. bizarre muscle movements of the eye and face
e. hallucinations
f. difficulty in swallowing
g. growth failure in children
3. develops from alcohol abuse, protein malnutrition, kidney disorders and prolonged vomiting and diarrhea (b/c its an electrolyte)
C. Toxicity
1. symptoms from non-food Mg are:
a. diarrhea
b. alkalosis
c. dehydration
D. Food sources
1. nuts and legumes (overwhelmingly our largest food source)
2. whole grains
3. dark green vegetables
4. seafood
5. chocolate and cocoa
6. hard water and some mineral waters
E. Health effects
1. Mg and hypertension
a. low Mg restricts walls of arteries and capillaries
b. protects against heart disease and hypertension
Lipids
Lipids
Triglycerides, Phospholipids, and Sterols
I Lipids aka: fats
A. organic compounds, insoluble in water
B. Building blocks: fatty acids
C. Include:
1. fats and oils
2. phospholipids
3. sterols
D. functions of fat
1. provides a concentrated source of energy
a. 9 kcal/g
2. provides the essential fatty acids
a. linoleic
b. linolenic
3. carries fat-soluble vitamins (A, D, E, K and photochemicals)
4. provides insulation
5. serves as a shock absorber
6. serves as a component of cell membranes
a. provides flexibility to cell membranes
7. increases flavor and palatability of food
E. composed of:
1. carbon
2. hydrogen
3. oxygen
II Types of fat: Triglycerides
A. triglycerides
1. 3 fatty acids + 1 glycerol base
2. 98% of our fat intake is in this form
3. most of the body fat stores are triglycerides
4. transport form of fat
5. used for energy and tissue maintenance
B. saturated fats
1. hard by nature
2. animal product
3. tropical oils: palm, coconut
4. hydrogenated
5. raises blood cholesterol
C. polyunsaturated fat
1. liquid
2. vegetable product
3. more than one double bond
4. lowers total blood cholesterol
D. monounsaturated fat
1. liquid
2. vegetable product
3. 1 double bond
4. lowers bad cholesterol
III Hydrogenation
A. the addition of hydrogen to unsaturated fatty acids
1. necessary to make liquid fats solid
B. Benefits:
1. improves shelf life, taste, cooking properties
C. disadvantages:
1. increase in amount of saturated fats
2. increase in amount of trans fats
D. cis and trans fatty acids
1. cis fats are the most common, naturally occurring fatty acids
2. trans fats occur when cis fats are changed during hydrogenation
3. trans fats increase blood cholesterol and heart disease risk
IV Fatty acids in fish oils
A. Omega 3
B. omega 6
C. provides protection against
1. heart disease, stroke
2. certain types of cancer
3. arthritis
D. over-consumption may lead to;
1. GI upsets
2. vitamins A and D toxicity
3. easy bruising and increased bleeding
4. mercury poisoning
E. fatty acid deficiency
1. Essential fatty acids: linoleic and linolenic
2. deficiency:
a. dry, scaly skin
b. poor growth in infants
c. impaired vision and hearing (infants)
d. liver abnormalities
e. poor healing of wounds
V Types of Fats: Phospholipids
A. phospholipids in foods
1. contain glycerol, two fatty acids and a phosphate group with a molecule of choline
2. used as emulsifiers in food industry
3. a well known phospholipid is lecithin
4. food sources of lecithin include eggs, liver, soybeans, wheat germ, and peanuts
B. functions of phospholipids
1. enable transport of lipids across cell membranes
2. emusifiers
3. lechithin is made by the liver
4. supplementes increase energy intake and can cause GI upset
VI Types of Fats: Sterols
A. Sterols in foods
1. found in plant and animal foods
2. cholesterol is found ONLY in animal foods. (meat, eggs, fish, poultry, dairy. Exogenous)
B. Cholesterol: a well known sterol
1. not an essential nutrient, but essential to the body
2. structural component of all cells
3. necessary for the formation of many hormones
a. estrogen
b. testosterone
4. necessary for the formation of Vit D
5. major component of bile
6. major component of nerves and brain
7. does not contribute to kcalories (same family as fat, but no kcal)
8. made in the liver
a. liver produces 800-1500mg/day (endogenous)
9. stored in the liver
10. transported in the body as lipoproteins
11. Low Density Lipoproteins (LDL) aka bad cholesterol
a. carries much cholesterol for body storage
b. increases risk of heart disease. increased by:
i. inactivity and obesity
ii. smoking
iii. high saturated fat, high cholesterol diet
12. High Density Lipoproteins (HDL) aka good cholesterol
a. provides protection from heart disease. Increased by:
i. regular exercise
ii. weight (fat) reduction
iii. smoking cessation
iv. saturated fats reduction
v. moderate alcohol intake (<2 drinks/day)
VII Cardiovascular disease
A. Coronary heart disease
1. #1 cause of death in US
2. Risk factors
a. diet and physical activity are modifiable risk factors
b. age, gender, and family history
i. cannot change these factors
ii. men higher risk than women
iii. men older than 45 years of age
iv. women older than 55 years of age
v. immediate family history of premature heart disease
c. obesity and physical inactivity
d. body mass index:
i. desirable: 18.5 – 24.9
ii. borderline: 15 – 29.9
iii. high: >30
e. weight loss and regular physical activity are protective
f. cholesterol (see below)
3. Cigarette smoking
a. powerful increase risk
b. increases blood pressure and the workload of the heart
4. atherogenic diet
a. a diet high in saturated fats, trans fats, and cholesterol an low in fruits and vegetables elevates LDL cholesterol.
b. antioxidants and omega 3 fatty acids lower the risk of CHD
5. Metabolic syndrome
a. aka syndrome x or insulin resistance syndrome
b. insulin resistance is a risk factor
c. Any three of the following factors = syndrome X
(3 aspects of this syndrome: high BP, High blood sugar, high cholesterol)
i. abdominal obesity
men waist > 40”
women waist >35”
ii. triglycerides: >150 mg/dL
iii. HDL: <40mg/dL in men, <50 mg/dL in women
iv. blood pressure: >130/85
v. fasting glucose: >100mg/dL
6. Recommendation for reducing CHD
a. cholesterol screening
b. lifestyle changes
i. low fat, low cholesterol diet
ii. limit sodium and sugar intake
iii. exercise
iv. moderate alcohol intake
v. avoid tobacco smoke
B. Atherosclerosis
1. formation of plaques in the arteries
2. How developed:
a. blood pressure and atherosclerosis
i. arteries are narrowed due to plaque, clots,or both
ii. the heart must generate more pressure to deliver blood to the tissues.
iii. higher blood pressure results in further damages.
3. the result
a. angina: pain or pressure feeling around the area of the heart
b. heart attack: restricted blood flow to the heart
c. transient ischemic attack or stroke (mini stroke): restricted blood flow to the brain
C. hypertension
1. elevated blood pressure >120/80
2. essential hypertension
a. develops without identifiable cause
b. affects more than 60 million
c. major risk factor in CHD
d. the silent killer
3. risk factors
a. age: risk increases with age
b. genetics: family history, African American, hisp, Ameri. Indi, Pacific islanders
c. obesity: 60% of those with hypertension are obese
d. salt sensitivity (genetic)
e. alcohol may raise bp and is associated w/strokes
4. treatment
a. weight control is one of the most effective treatments
b. physical activity will help. Moderate aerobic for 30-60 minutes most days
c. the DASH diet. Dietary approaches to stop hypertension
i. grains: 6-8 oz
ii. vegs: 2 -2 ½ cups
iii. fruits: same
iv: milk (low fat or fat free): 2-3 cups
v. meat (lean): 6 oz or less
vi. nut, seed, legumes: 4-5 oz per week
vii. 2000 kcal
d. drug therapy
i. diuretics and antihypertensive agents
ii. watch potassium
D. Risks for cardiovascular disease (coronary heart disease)
1.Cholesterol
a. total levels:
i. desirable <200mg/dL
ii. borderline: 200-239
iii. high: >240 mg/dL
c. HDL cholesterol
i. desirable >60 mg/dL
ii. borderline: 59-40 mg/dL
iii. high: < 40 mg/dL
d. LDL
i. desirable <100 mg/dL
ii. above optimum level : 100-129
iii. borderline: 130-159
iv. high: 160-189
v. very high: 190
VIII Lipids in the body
A. the triglycerides have important roles in the body (transport and store fat)
1. energy reserve when stored
2. use carbs and protein efficiently
3. insulation
4. shock protection
B. essential fatty acids also play important roles
C. The body can store unlimited amounts of fat when fat is consumed in excess
D. the liver can also convert excess carbohydrate and protein to fat (after glycogen stores filled)
E. fat needs carbohydrate to break down efficiently
F. inefficient breakdown of fat forms ketone bodies
IX Guidelines to groceries
A. fat replacers
1. ingredients derived from carb, protein or fat
2. replace fat in foods
3. artificial fats offer sensory and cooking qualities but no kcals
4. decreases the absorption of fat-soluble vitamins and may cause digestive distress
B. read food labels
1. provide info on fat grams and % DV
2. % DV are not the same as % of kcal from fat
Triglycerides, Phospholipids, and Sterols
I Lipids aka: fats
A. organic compounds, insoluble in water
B. Building blocks: fatty acids
C. Include:
1. fats and oils
2. phospholipids
3. sterols
D. functions of fat
1. provides a concentrated source of energy
a. 9 kcal/g
2. provides the essential fatty acids
a. linoleic
b. linolenic
3. carries fat-soluble vitamins (A, D, E, K and photochemicals)
4. provides insulation
5. serves as a shock absorber
6. serves as a component of cell membranes
a. provides flexibility to cell membranes
7. increases flavor and palatability of food
E. composed of:
1. carbon
2. hydrogen
3. oxygen
II Types of fat: Triglycerides
A. triglycerides
1. 3 fatty acids + 1 glycerol base
2. 98% of our fat intake is in this form
3. most of the body fat stores are triglycerides
4. transport form of fat
5. used for energy and tissue maintenance
B. saturated fats
1. hard by nature
2. animal product
3. tropical oils: palm, coconut
4. hydrogenated
5. raises blood cholesterol
C. polyunsaturated fat
1. liquid
2. vegetable product
3. more than one double bond
4. lowers total blood cholesterol
D. monounsaturated fat
1. liquid
2. vegetable product
3. 1 double bond
4. lowers bad cholesterol
III Hydrogenation
A. the addition of hydrogen to unsaturated fatty acids
1. necessary to make liquid fats solid
B. Benefits:
1. improves shelf life, taste, cooking properties
C. disadvantages:
1. increase in amount of saturated fats
2. increase in amount of trans fats
D. cis and trans fatty acids
1. cis fats are the most common, naturally occurring fatty acids
2. trans fats occur when cis fats are changed during hydrogenation
3. trans fats increase blood cholesterol and heart disease risk
IV Fatty acids in fish oils
A. Omega 3
B. omega 6
C. provides protection against
1. heart disease, stroke
2. certain types of cancer
3. arthritis
D. over-consumption may lead to;
1. GI upsets
2. vitamins A and D toxicity
3. easy bruising and increased bleeding
4. mercury poisoning
E. fatty acid deficiency
1. Essential fatty acids: linoleic and linolenic
2. deficiency:
a. dry, scaly skin
b. poor growth in infants
c. impaired vision and hearing (infants)
d. liver abnormalities
e. poor healing of wounds
V Types of Fats: Phospholipids
A. phospholipids in foods
1. contain glycerol, two fatty acids and a phosphate group with a molecule of choline
2. used as emulsifiers in food industry
3. a well known phospholipid is lecithin
4. food sources of lecithin include eggs, liver, soybeans, wheat germ, and peanuts
B. functions of phospholipids
1. enable transport of lipids across cell membranes
2. emusifiers
3. lechithin is made by the liver
4. supplementes increase energy intake and can cause GI upset
VI Types of Fats: Sterols
A. Sterols in foods
1. found in plant and animal foods
2. cholesterol is found ONLY in animal foods. (meat, eggs, fish, poultry, dairy. Exogenous)
B. Cholesterol: a well known sterol
1. not an essential nutrient, but essential to the body
2. structural component of all cells
3. necessary for the formation of many hormones
a. estrogen
b. testosterone
4. necessary for the formation of Vit D
5. major component of bile
6. major component of nerves and brain
7. does not contribute to kcalories (same family as fat, but no kcal)
8. made in the liver
a. liver produces 800-1500mg/day (endogenous)
9. stored in the liver
10. transported in the body as lipoproteins
11. Low Density Lipoproteins (LDL) aka bad cholesterol
a. carries much cholesterol for body storage
b. increases risk of heart disease. increased by:
i. inactivity and obesity
ii. smoking
iii. high saturated fat, high cholesterol diet
12. High Density Lipoproteins (HDL) aka good cholesterol
a. provides protection from heart disease. Increased by:
i. regular exercise
ii. weight (fat) reduction
iii. smoking cessation
iv. saturated fats reduction
v. moderate alcohol intake (<2 drinks/day)
VII Cardiovascular disease
A. Coronary heart disease
1. #1 cause of death in US
2. Risk factors
a. diet and physical activity are modifiable risk factors
b. age, gender, and family history
i. cannot change these factors
ii. men higher risk than women
iii. men older than 45 years of age
iv. women older than 55 years of age
v. immediate family history of premature heart disease
c. obesity and physical inactivity
d. body mass index:
i. desirable: 18.5 – 24.9
ii. borderline: 15 – 29.9
iii. high: >30
e. weight loss and regular physical activity are protective
f. cholesterol (see below)
3. Cigarette smoking
a. powerful increase risk
b. increases blood pressure and the workload of the heart
4. atherogenic diet
a. a diet high in saturated fats, trans fats, and cholesterol an low in fruits and vegetables elevates LDL cholesterol.
b. antioxidants and omega 3 fatty acids lower the risk of CHD
5. Metabolic syndrome
a. aka syndrome x or insulin resistance syndrome
b. insulin resistance is a risk factor
c. Any three of the following factors = syndrome X
(3 aspects of this syndrome: high BP, High blood sugar, high cholesterol)
i. abdominal obesity
men waist > 40”
women waist >35”
ii. triglycerides: >150 mg/dL
iii. HDL: <40mg/dL in men, <50 mg/dL in women
iv. blood pressure: >130/85
v. fasting glucose: >100mg/dL
6. Recommendation for reducing CHD
a. cholesterol screening
b. lifestyle changes
i. low fat, low cholesterol diet
ii. limit sodium and sugar intake
iii. exercise
iv. moderate alcohol intake
v. avoid tobacco smoke
B. Atherosclerosis
1. formation of plaques in the arteries
2. How developed:
a. blood pressure and atherosclerosis
i. arteries are narrowed due to plaque, clots,or both
ii. the heart must generate more pressure to deliver blood to the tissues.
iii. higher blood pressure results in further damages.
3. the result
a. angina: pain or pressure feeling around the area of the heart
b. heart attack: restricted blood flow to the heart
c. transient ischemic attack or stroke (mini stroke): restricted blood flow to the brain
C. hypertension
1. elevated blood pressure >120/80
2. essential hypertension
a. develops without identifiable cause
b. affects more than 60 million
c. major risk factor in CHD
d. the silent killer
3. risk factors
a. age: risk increases with age
b. genetics: family history, African American, hisp, Ameri. Indi, Pacific islanders
c. obesity: 60% of those with hypertension are obese
d. salt sensitivity (genetic)
e. alcohol may raise bp and is associated w/strokes
4. treatment
a. weight control is one of the most effective treatments
b. physical activity will help. Moderate aerobic for 30-60 minutes most days
c. the DASH diet. Dietary approaches to stop hypertension
i. grains: 6-8 oz
ii. vegs: 2 -2 ½ cups
iii. fruits: same
iv: milk (low fat or fat free): 2-3 cups
v. meat (lean): 6 oz or less
vi. nut, seed, legumes: 4-5 oz per week
vii. 2000 kcal
d. drug therapy
i. diuretics and antihypertensive agents
ii. watch potassium
D. Risks for cardiovascular disease (coronary heart disease)
1.Cholesterol
a. total levels:
i. desirable <200mg/dL
ii. borderline: 200-239
iii. high: >240 mg/dL
c. HDL cholesterol
i. desirable >60 mg/dL
ii. borderline: 59-40 mg/dL
iii. high: < 40 mg/dL
d. LDL
i. desirable <100 mg/dL
ii. above optimum level : 100-129
iii. borderline: 130-159
iv. high: 160-189
v. very high: 190
VIII Lipids in the body
A. the triglycerides have important roles in the body (transport and store fat)
1. energy reserve when stored
2. use carbs and protein efficiently
3. insulation
4. shock protection
B. essential fatty acids also play important roles
C. The body can store unlimited amounts of fat when fat is consumed in excess
D. the liver can also convert excess carbohydrate and protein to fat (after glycogen stores filled)
E. fat needs carbohydrate to break down efficiently
F. inefficient breakdown of fat forms ketone bodies
IX Guidelines to groceries
A. fat replacers
1. ingredients derived from carb, protein or fat
2. replace fat in foods
3. artificial fats offer sensory and cooking qualities but no kcals
4. decreases the absorption of fat-soluble vitamins and may cause digestive distress
B. read food labels
1. provide info on fat grams and % DV
2. % DV are not the same as % of kcal from fat
Carbohydrates
Carbohydrates
I Functions
A. main source of kcalories
1. 4 kcal/gram
B. necessary for the formation of nerve tissue
C. necessary for the formation of RNA/DNA
D. necessary for the structure of cells
II Composition
A. carbon
B. hydrogen
C. oxygen
III Simple Carbohydrates
A. Monosaccharides
1. glucose: blood sugar
2. fructose: fruit sugar
3. galactose: part of milk sugar
B. Disaccharides
1. maltose (malt sugar): glucose + glucose
2. sucrose (table sugar): glucose + fructose
3. lactose (milk sugar): glucose + galactose
IV Complex Carbohydrates
A. Oligosaccharides
1. oligo: scant
2. short chains of monosaccharides (3-10) units
3. virtually tasteless
B. Polysaccharides
1. glycogen: animal storage form
a. storage form of glucose in the body
b. provides a rapid release of energy when needed
2. starches: plant storage form
a. storage form of sugar in plants
b. found in grains, tubers and legumes
3. fiber
a. cannot be digested by humans (chemical)
b. provides form and structure to plants
c. insoluble fiber (visual plant fibers)
i. adds bulk, aids in elimination
d. soluble fiber ( clear, gel like)
i. prebiotics (digested by bacteria. Ex: Activa)
ii. functional fibers: lowers risk of certain chronic diseases. (heart disease, diabetes, obesity)
e. health benefits of fiber
i. heart disease: lowers risk, lowers cholesterol
ii. diabetes: slows glucose absorption
iii. GI health: decrease transit time of food through colon, holds moisture/softens stools, prevents diverticulosis
iv. cancer: helps prevent colon cancer, decreased transit time = less carcinogens.
v. weight management: displaces energy dense foods
V Glucose in the body
A. A preview of carbohydrate metabolism
1. the body stores glucose as glycogen in liver and muscle cells
2. the body uses glucose for energy if glycogen stores are available
3. if glycogen stores are depleted, the body makes glucose from protein.
a. gluconeogenesis: the conversion of protein to glucose (“new glucose creation”)
b. protein-sparing action is having adequate carbohydrate in the diet to prevent the breakdown of protein for energy.
B. primary function of glucose is to provide energy to the cells
C. glucose homeostasis: maintenance of normal blood sugar levels
D. regulating hormones (pancreatic)
1. insulin: decreases blood sugar
a. blood glucose “into” cells
2. glucagon: increases blood sugar
a. release glucose from liver glycogen (makes glucose gone from the liver, and into blood)
E. Diabetes Mellitus
1. diabetes: to pass through
2. mellitus: honey
3. a metabolic disorder characterized by high blood sugar levels resulting from insufficient insulin, ineffective insulin, or a combination of both.
F. When blood sugar rises, insulin is secreted by the pancreas and it lowers the blood sugar. If you don’t eat lunch and the blood sugar drops, glucagon stimulates the liver to release glucose which raises blood sugar levels. (homeostasis) If no insulin is available, blood sugar (glucose) remains high.
VI Carbohydrate-related disorders (Diabetes)
A. Insulin dependent diabetes (juvenile diabetes/ type 1 diabetes)
1. pancreas produces little or no insulin
2. only 10% of all diabetics
3. cause:
a. genetic susceptibility
b. viral infection
B. Non-insulin dependent diabetes (type 2 diabetes)
1. aka: adult onset
2. most common type
3. the cells fail to respond to insulin
4. cause: unknown
5. associated with:
a. obesity (central)
b. heredity
c. ethnicity: Native Americans, Hispanics, African Americans, Asians.
C. Symptoms
1. polydipsia: excessive thirst
2. polyphagia: excessive hunger
3. polyuria: excessive urination
4. hyperglycemia: high blood glucose
5. unexplained weight loss
D. Chronic complications
1. neuropathy: degeneration of nerve tissue
2. nephropathy: degeneration of kidneys
3. retinopathy: degeneration of retina
4. metabolic syndrome aka: syndrome X
a. high cholesterol
b. high triglycerides
c. hypertension
E. Consequences
1. atherosclerosis, heart disease, hypertension, stroke
2. kidney failure
3. loss of limb
4. blindness
F. Management (3 fold management system)
1. diet
2. medication
a. insulin: injection, pump, powder
b. oral hypoglycemic agents
3. physical activity (exercise)
G. Medical nutrition therapy
1. carbohydrate
a. controlled, consistent
b. high fiber
2. dietary fat
a. low fat, low cholesterol
3. protein
a. 15-20% of total calories (relatively low)
4. weight loss (NIDDM)
VI Health effects and recommended intakes of sugars
A. sugar poses no major health problem except dental caries
B. excessive intakes may displace nutrients and contribute to obesity
C. consuming foods with added sugars should be limited
D. naturally occurring sugars from fruits, vegetables, and milk are acceptable sources.
E. Controversies surrounding sugars
1. excessive sugar intake can contribute to the development of body fat
2. sugar may be able to alter blood lipid levels and contribute to heart disease in some.
3. there is no scientific evidence that sugar causes misbehavior in children and criminal behavior in adults.
4. there is a theory that sugar increases serotonin levels, which can lead to cravings and addictions
F. recommended intakes of sugars
1. the USDA food guide states that added sugars can be included in the diet as part of discretionary kcalories
2. dietary guidelines state to limit intake of foods and beverages that are high in added sugars
3. DRI suggest added sugars should contribute no more than 25% of a day’s total energy intake
VII Health Effects and recommended intakes of starch and fibers
A. May be some protection from heart disease and stroke
1. soluble fibers bind with bile and thereby lower blood cholesterol levels
2. fiber may also displace fat in the diet
B. reduce the risk of type 2 diabetes by decreasing glucose absorption
C. Enhance the health of the GI tract which can then block the absorption of unwanted particles
D. may protect against colon cancer by removing potential cancer-causing agents from the body.
E. Promote weight control because complex carbohydrates provide less fat and added sugar.
F. Harmful effects of excessive fiber intake
1. displaces energy and nutrient-dense foods
2. abdominal discomfort and distension
3. may interfere with nutrient absorption
G. recommended intakes of starch and fibers
1. RDA for carbohydrate is 130 g/day, or 45-65% of energy intake
2. daily value is 300 g/day
3. dietary guidelines encourage a variety of whole grains, vegetables, fruits and legumes daily.
4. healthy people 2010 recommends six servings of grains and 5 servings of fruits and vegetables
5. FDA recommends 25 grams of fiber for a 2,000 kcalorie diet
VIII Alternatives to sugar
A. Artificial sweeteners aka: nonnutritive sweeteners
1. saccharin
a. used primarily in soft drinks and as a tabletop sweetener
b. rapidly excreted in urine
c. does not accumulate in the body
d. has been removed from list of cancer-causing substances
2. aspartame (Nutra-sweet, Equal)
a. general purpose sweetener
b. warning about phenylalanine for those with PKU
c. controversial finding that aspartame may have caused cancer in rats
d. excessive intake should be avoided by those with epilepsy
3. Acesulfame-K (acesulfame potassium, aka: ACK)
a. research confirms safety
4. sucralose (Splenda)
a. made from sugar
b. passes through digestive tract
c. only one you can sprinkle on food
5. neotame (acts like equal)
a. most recent on the market
b. very sweet
c. phenylalanine not an issue
B. Sugar replacers
1. also called nutritive sweeteners, sugar alcohols, and polyols
2. malitol, mannitol, sorbitol, xylitol, isomalt, and lactitol
3. absorbed more slowly and metabolized differently in the body. (most not absorbed)
4. low glycemic response
5. side effects include GI discomfort
I Functions
A. main source of kcalories
1. 4 kcal/gram
B. necessary for the formation of nerve tissue
C. necessary for the formation of RNA/DNA
D. necessary for the structure of cells
II Composition
A. carbon
B. hydrogen
C. oxygen
III Simple Carbohydrates
A. Monosaccharides
1. glucose: blood sugar
2. fructose: fruit sugar
3. galactose: part of milk sugar
B. Disaccharides
1. maltose (malt sugar): glucose + glucose
2. sucrose (table sugar): glucose + fructose
3. lactose (milk sugar): glucose + galactose
IV Complex Carbohydrates
A. Oligosaccharides
1. oligo: scant
2. short chains of monosaccharides (3-10) units
3. virtually tasteless
B. Polysaccharides
1. glycogen: animal storage form
a. storage form of glucose in the body
b. provides a rapid release of energy when needed
2. starches: plant storage form
a. storage form of sugar in plants
b. found in grains, tubers and legumes
3. fiber
a. cannot be digested by humans (chemical)
b. provides form and structure to plants
c. insoluble fiber (visual plant fibers)
i. adds bulk, aids in elimination
d. soluble fiber ( clear, gel like)
i. prebiotics (digested by bacteria. Ex: Activa)
ii. functional fibers: lowers risk of certain chronic diseases. (heart disease, diabetes, obesity)
e. health benefits of fiber
i. heart disease: lowers risk, lowers cholesterol
ii. diabetes: slows glucose absorption
iii. GI health: decrease transit time of food through colon, holds moisture/softens stools, prevents diverticulosis
iv. cancer: helps prevent colon cancer, decreased transit time = less carcinogens.
v. weight management: displaces energy dense foods
V Glucose in the body
A. A preview of carbohydrate metabolism
1. the body stores glucose as glycogen in liver and muscle cells
2. the body uses glucose for energy if glycogen stores are available
3. if glycogen stores are depleted, the body makes glucose from protein.
a. gluconeogenesis: the conversion of protein to glucose (“new glucose creation”)
b. protein-sparing action is having adequate carbohydrate in the diet to prevent the breakdown of protein for energy.
B. primary function of glucose is to provide energy to the cells
C. glucose homeostasis: maintenance of normal blood sugar levels
D. regulating hormones (pancreatic)
1. insulin: decreases blood sugar
a. blood glucose “into” cells
2. glucagon: increases blood sugar
a. release glucose from liver glycogen (makes glucose gone from the liver, and into blood)
E. Diabetes Mellitus
1. diabetes: to pass through
2. mellitus: honey
3. a metabolic disorder characterized by high blood sugar levels resulting from insufficient insulin, ineffective insulin, or a combination of both.
F. When blood sugar rises, insulin is secreted by the pancreas and it lowers the blood sugar. If you don’t eat lunch and the blood sugar drops, glucagon stimulates the liver to release glucose which raises blood sugar levels. (homeostasis) If no insulin is available, blood sugar (glucose) remains high.
VI Carbohydrate-related disorders (Diabetes)
A. Insulin dependent diabetes (juvenile diabetes/ type 1 diabetes)
1. pancreas produces little or no insulin
2. only 10% of all diabetics
3. cause:
a. genetic susceptibility
b. viral infection
B. Non-insulin dependent diabetes (type 2 diabetes)
1. aka: adult onset
2. most common type
3. the cells fail to respond to insulin
4. cause: unknown
5. associated with:
a. obesity (central)
b. heredity
c. ethnicity: Native Americans, Hispanics, African Americans, Asians.
C. Symptoms
1. polydipsia: excessive thirst
2. polyphagia: excessive hunger
3. polyuria: excessive urination
4. hyperglycemia: high blood glucose
5. unexplained weight loss
D. Chronic complications
1. neuropathy: degeneration of nerve tissue
2. nephropathy: degeneration of kidneys
3. retinopathy: degeneration of retina
4. metabolic syndrome aka: syndrome X
a. high cholesterol
b. high triglycerides
c. hypertension
E. Consequences
1. atherosclerosis, heart disease, hypertension, stroke
2. kidney failure
3. loss of limb
4. blindness
F. Management (3 fold management system)
1. diet
2. medication
a. insulin: injection, pump, powder
b. oral hypoglycemic agents
3. physical activity (exercise)
G. Medical nutrition therapy
1. carbohydrate
a. controlled, consistent
b. high fiber
2. dietary fat
a. low fat, low cholesterol
3. protein
a. 15-20% of total calories (relatively low)
4. weight loss (NIDDM)
VI Health effects and recommended intakes of sugars
A. sugar poses no major health problem except dental caries
B. excessive intakes may displace nutrients and contribute to obesity
C. consuming foods with added sugars should be limited
D. naturally occurring sugars from fruits, vegetables, and milk are acceptable sources.
E. Controversies surrounding sugars
1. excessive sugar intake can contribute to the development of body fat
2. sugar may be able to alter blood lipid levels and contribute to heart disease in some.
3. there is no scientific evidence that sugar causes misbehavior in children and criminal behavior in adults.
4. there is a theory that sugar increases serotonin levels, which can lead to cravings and addictions
F. recommended intakes of sugars
1. the USDA food guide states that added sugars can be included in the diet as part of discretionary kcalories
2. dietary guidelines state to limit intake of foods and beverages that are high in added sugars
3. DRI suggest added sugars should contribute no more than 25% of a day’s total energy intake
VII Health Effects and recommended intakes of starch and fibers
A. May be some protection from heart disease and stroke
1. soluble fibers bind with bile and thereby lower blood cholesterol levels
2. fiber may also displace fat in the diet
B. reduce the risk of type 2 diabetes by decreasing glucose absorption
C. Enhance the health of the GI tract which can then block the absorption of unwanted particles
D. may protect against colon cancer by removing potential cancer-causing agents from the body.
E. Promote weight control because complex carbohydrates provide less fat and added sugar.
F. Harmful effects of excessive fiber intake
1. displaces energy and nutrient-dense foods
2. abdominal discomfort and distension
3. may interfere with nutrient absorption
G. recommended intakes of starch and fibers
1. RDA for carbohydrate is 130 g/day, or 45-65% of energy intake
2. daily value is 300 g/day
3. dietary guidelines encourage a variety of whole grains, vegetables, fruits and legumes daily.
4. healthy people 2010 recommends six servings of grains and 5 servings of fruits and vegetables
5. FDA recommends 25 grams of fiber for a 2,000 kcalorie diet
VIII Alternatives to sugar
A. Artificial sweeteners aka: nonnutritive sweeteners
1. saccharin
a. used primarily in soft drinks and as a tabletop sweetener
b. rapidly excreted in urine
c. does not accumulate in the body
d. has been removed from list of cancer-causing substances
2. aspartame (Nutra-sweet, Equal)
a. general purpose sweetener
b. warning about phenylalanine for those with PKU
c. controversial finding that aspartame may have caused cancer in rats
d. excessive intake should be avoided by those with epilepsy
3. Acesulfame-K (acesulfame potassium, aka: ACK)
a. research confirms safety
4. sucralose (Splenda)
a. made from sugar
b. passes through digestive tract
c. only one you can sprinkle on food
5. neotame (acts like equal)
a. most recent on the market
b. very sweet
c. phenylalanine not an issue
B. Sugar replacers
1. also called nutritive sweeteners, sugar alcohols, and polyols
2. malitol, mannitol, sorbitol, xylitol, isomalt, and lactitol
3. absorbed more slowly and metabolized differently in the body. (most not absorbed)
4. low glycemic response
5. side effects include GI discomfort
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