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169 Cards in this Set
- Front
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. What are the seven nutritional characteristics or dietary indicators that have been adversely affected by food staples and food processing in the modern western diet compared to the hunter-gatherer diet? |
glycemic load, fatty acid composition, macronutrient composition, micronutrient density, acid-base balance, sodium potassium ratio, fiber content
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. Name the five categories of food that make up 72% of the total daily energy consumed by all people in the U.S. today.
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dairy products, cerials, refined sugars, refined vegetable oils, alcohol
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. What are the nutritional characteristics of milled grains compared to whole grains?
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Milled grains lose the germ and bran that are found in whole grain leaving mainly endosperm of small particulate size
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. Where does 75% of the total quantity of daily salt intake (total of 9.6g/d) in Western populations come from?
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it comes from salt added to processed foods by manufacturers
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. How does the fatty acid composition of wild animal or free-range/pasture-fed cattle differ from grain fed cattle?
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modern feedlot cattle have higher body fat percentages than free range and generally have high serum fatty acids, low n-3 and high n-6 fatty acid content, compared to free range cattle. These animals also reach the size for slaughter much faster (4 months) than those in the past
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What is glycemic load?
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glycemic load is the glycemic index x the carbohydrate content per serving size. Glycemic load serves to assess the blood glucose raising potential of a given food. Refined grains and sugars have a higher glycemic load than unprocessed fruits/veggies
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what can long term consumption of high glycemic load carbohydrates elicit and name some diseases related to this?
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chronic high glycemic load can result in insulin resistance due to chronic hyperglycemia and hyperinsulinemia. This can lead to the "diseases of civilization" (obesity, CHD, T2DM, HTN, dyslipidemia, etc…)
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How did the advent of oil-seed processing at the beginning of the 20th century affect polyunsaturated fat consumption?
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This increased the intake of vegetable fat. Causing a higher level of n-6 PUFAs and lower level of n-3 PUFAs due to the nature of vegetable oils. This was increased by the increased consumption of grain fed cattle, raising the ration in the us to 10:1 (n-6 : n-3) as opposed to our hunter gather ansestors 2:1/3:1
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1. Where are the six major sources of saturated fatty acids in the U.S. diet?
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fatty meats, baked goods, cheese, milk, margarine, butter
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1. What is the process and what results from the solidification of vegetable oils?
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Hydrogenation process. This introduces the trans FA (elaidic acid) into the diet. Trans fats increase blood cholesterol and are associated with an increased risk of CVD
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1. What macronutrient component was likely substantially higher than current values?
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dietary protein. (15.4% now 19-35% then)
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12. Name 5 micronutrients that at least half of the US population fails to meet the recommended daily allowance.
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B6, vitamin A, Mg, Ca, Zn (33% fail to meet RDA for folate as well)
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Name a few reasons why the typical U.S. diet may be lacking in micronutrient density
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whole grains/ milk are very low in micronutrients, we eat a lot of these products. Vegetables, lean meats, and fruits are higher, we eat less of these now.
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1. What foods are net acid producing? Alkaline or base producing?
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Acid producing foods include, fush, meat, poultry, eggs, shellfish, cheese, milk, cereal grains. Base producing foods include fresh fruit, veggies, tubers, roots, and nuts. Legumes are near neutral.
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What are some of the health benefits of a net base producing diet?
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Benefits of a base producing diet include prevention/tx of osteoporosis, age related muscle wasting, Ca kidney stones, HTN, exercise induced asthma, slow age/disease related renal insufficency
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1. Name three dietary factors primarily responsible for the high sodium to potassium ratio in Western diets
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90% of sodium in western diet comes from manufactured salts. Vegetable oils and refined sugars constitute 36% of food energy and have almost no potassium, displacing foods with higher potassium. 3, less veggies and fruit + more milk and grains further this displacement as theveggies have 4 to 12x more potassium than milk and grains respectively and the fruits have 2 to 5 x less potassium
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How do refined and whole grains differ in fiber content?
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refined grains have 400% less fiber than whole grains
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name some modern diseases associated with low dietary fiber intake
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constipation, appendicitis, hemorrhoids, DVT, varicose veins, diverticulitus, hiatal hernia, and GERD
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Low Carbohydrate Diet
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Restriction of total carbohydrate intake from all sources below a threshold (~45% of total daily calories)
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Low Fat Diet
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Restriction of total fat intake from all sources below some threshold (20% of total daily calories) can include vegetarian diets and traditional asian diets
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Low Glycemic Diet
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Focus is on limiting the glycemic load of the overall diet. Restriction of foods with high glycemic index/load. Usually leads to exclusion of some vegetables and almost all fruits. No threshold for glycemic load is typically invoked. Particularly of interest to diabetes management
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Mediterranean diet
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mimicks mediterranean countries. Emphasis on olive oil, vegetables, fruits, nuts, seeds, beans, selective dairy, whole grains, seafood and limited meat consumption, wine.
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Mixed/Balanced diet
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diets that include both plant and animal food, coformig to authoritative guidelines from orginizations such as the WHO
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Paleolithic diet
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Focus on emulating diet of stone age ancestors. Focus on veggies fruits nuts seeds and lean meats. Avoi dairy grains and any processed foods
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Vegan Diet
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exclude all animal products
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1. What are the 2 reference value foods used to compare a food of interest when referring to the glycemic index (GI), and why are they used? What value are the reference foods assigned?
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Glucose and white bread. They are used because they cause the fastest and most dramatic rise in glucose levels. They are assigned a value of 100, the highest possible value.
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2. What is the relationship between increases in GI and postprandial blood glucose and/or insulin levels?
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Stepwise increase in glycemic index results in stepwise elevation in postprandial (after meal) glucose and insulin levels
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3. What is glycemic load (GL) and how it is different than GI?
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Glycemic load accounts for relative amounts of glucose in an average serving in addition to how rapidly the carbohydrate in the food raises blood sugar (GI). This is a more accurate measure of the effect on insulin and serum glucose
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4. What is the formula for calculating GL?
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GL = GI x grams of calories in an average serving divided by 100
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5. Use the offered example of the difference in GI and GL for watermelon (p.793) as an example to better appreciate how the concept affects blood glucose.
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Watermelon has a very high glycemic index, but a serving of watermelon has less available carbohydrate so the glycemic load is actually lower than some other lower GI fruits such as banana which have more available carbohydrate
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6. What is the association between the risk for type 2 diabetes, CVD, and certain cancers and the long term GL of a high GL diet?
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high GI/GL diets are associated with a worse post prandial profile for T2DM. For CVD, high GI/Gl is not a safe alternative to fat/lipid, in fact lower GL diets are associated with decreased postprandial TG/lipoprotein accumulation. Cancer, link is suggested betweel high GL and some colorectal, upper GI, and gastric cancers. High GI may be associated with an increased breast cancer risk (not for GL tho)
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7. What is the outcome of implementing a low GL diet on abdominal obesity, cholesterol, and glycemic control?
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improvement on all fronts
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8. What is the effect of high GL diets related to energy and fatigue?
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high GL diets result in a large insulin response which can result in a rebound hypoglcyemia (sugar crash) a few hours after eating
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9. What is the effect on subsequent meals when the prior meal is low GL?
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lower glycemic response to subsequent meals
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10. Is GL useful as a predictor of HDL levels in youth?
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yes???
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11. What affect does strict adherence to a Mediterranean diet have on CRP, IL-6, homocysteine, and fibrinogen levels as compared to individuals not on that diet (study of 3000 individuals in Greece)?
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it decreases these pro-inflammatory factors
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12. You are not responsible for memorizing the table of GI/GL, however, you should look up the foods you commonly eat, the foods your friends and family eat, or the ones about which you are most curious.
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ok. Ill do that.
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13. Compare the GI and GL of the following foods Bagel (white), Baguette (white), Rye-kernel (whole-grain pumpernickel), Wonder enriched white bread, Healthy choice Hearty 7-grain bread, pancakes, Lentils, raw strawberry, strawberry jam.
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Basically what youd think. For the breads Bagels, and baguettes had higher GI and GL than the rye and 7 grain breads while jam was significantly higher in GL than raw strawberries and moderately higher in GI as well.
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14. In a prospective study of 53,644 men and women, what was the effect on the risk of myocardial infarction when saturated fat was replaced with carbohydrates with a high GI? What was the effect when saturated fat was replaced by a low GI carbohydrates?
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The risk for MI was actually increased
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15. Summarize the current understanding about the relationship a low GL diet to inflammation.
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Hyperglycemia is linked to an increase in ROS which can result in lipid peroxidation/ athersclerosis. Can also rsult in triggering of inflammatory responses due to oxidative damage triggering response. CRP is a marker for for systemic inflammation and is increased in women with elevated BMI
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16. Learn the Practical Clinical Guidelines on p. 791.
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increase consumption of fruits/veggies/legumes. Consume underripe fruit as opposed to overripe. Eat traditional grains. Avoid puffed grains, fine ground flour. Acidic food lowers GI. Limit potatoes and concentrated sugars. Eat high GI foods with fat and protein to reduce their GI. Dont eat white foods (das rasist?) like bread/pasta/potatoes. instead eat diverse multicolored foods and non processed foods.
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1. What is definition of the new term “Meta-Inflammation”?
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chronic low grade metabolically induced inflammatory response that utilizes same pathways as classic inflammatory responses
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2. How do foods cause or inhibit inflammation? (This is in essence the focus of the entire chapter, however, the author asks and then summarizes 5 mechanisms in a bulleted list on page 795-796)
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eicosanoid balance is affected by PUFA ingestion an certain spices can have antiinflammatory activity. Pro and antioxidant balance, healthy diets contain more antioxidants and are correlated with lower CRP levels. Insulin and glucose levels, elevated serum glucose/insulin is associated with increased CRP and inflammation. Intracellular signaling and gene signaling, omega 3 fats can modulate inflammatory gene expression. GI dysbiosis, alteration in gut flora can alter inflammatory susceptability
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3. What common inflammatory marker is measured in serum and is an independent risk factor for diabetes and cardiovascular disease?
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CRP
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4. What are the names and molecular structure of 3 major classifications of fats?
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Saturated fats have full hydrogen saturation at all carbons and are solid at room temperature. Monounsaturated fats contain one double bond and are liquid at room temperature. Polyunsaturated have multible double bonds, are the healthiest but also have susceptiblity to rancidity and conversion to unhealthy fats
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5. Under which classification do dietary essential fatty acids fall and what are they?
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Pro inflammatory omega-6 and anti-inflammatory omega-3. these are both polyunsaturated fatty acids
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6. What is an essential fatty acid?
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must be obtained from the diet
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7. What are 3 examples of omega-3 fatty acids?
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Alpha linolenic acid, EPA and DHA, found in "SMASH" foods. Smash foods are salmon, mackeral, anchovies, sardines, and herring
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8. What are 3 examples of omega-6 fatty acids?
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linoleic acid is an omega 6 . This is found in corn soy and vegetable oil
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9. Which type of fat saturated, MUFA, PUFA, will oxidize and spoil quickly if left at room temperature for extended period?
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PUFAS
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10. What does “omega” mean in the naming of fatty acids?
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based on the location of a double bond relative to the last carbon in the chain. Omega 3 is the 3rd carbon from the end, omega 6 is the 6th
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11. What are partially hydrogenated oils and how are they related to trans-fatty acids? Why are they used in processed food?
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When PUFAs are converted by hydrogenation to a more solid, shelf stable fat, trans fats are made. These trans fats are proinflammatory and disrupt the cis alignment of membrane fats, and increses lipoprotein A and serum TG.
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12. How is inflammation and platelet aggregation related to the proportion of omega-3 verses omega-6 in the body? What is the approximate proportion in the American diet now verses during Paleolithic times?
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omega 3s go towards PGE1,3 DHA, and an anti-inflammatory response. Omega 6s go toward PGE2 and leukotrienes which is procoaguability and inflammation. These compete for the same enzymes so the ratio in which they are ingested is very important. Our ansestors ingested 6/3 in about a 2:1 ratio the SAD diet is between 10-25:1 for omega 6s due to increase in corn/soy and vegetable oil
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13. How does PGE2 verses PGE1 and 3 relate to the precursor fatty acid type and the ultimate inflammatory status in the body?
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PGE1 and 3 are derived from omega 3 acids such as ALA and are antiinflammatory. PGE2 is proinflammatory and is derived from omega 6 acids such as linoleic acid
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14. What affect does trans-fat in the diet have specifically on serum LDL levels, and on HDL levels?
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trans fat increases LDL and decreases HDL. Is bad for you
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15. How do trans-fats affect cell membrane fats?
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it disrupts their cis membrane alignments
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16. What is Deta-6 desaturase and why is it significant?
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is a common breakdown enzyme for omega 6 and 3s
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17. Why might farm raised fish not confer the same “antiinflammatory” benefit as wild cold-water fish?
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farm raised fish may be fed grains which can alter their omega 6/3 ratio. This change has occurred in grain fed cattle and is one of the reasons our 6 to 3 ratio has increased so much over time
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18. Are walnuts, flax seed a good source of omega-3 fatty acids?
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not really. Flax seeds have a lot of Alpha linoleic acid which is broken down ito EPA. However only 1% of the ALA makes it there. Fish oils contain EPA and DHA and are therefore more useful for anti-inflammatory
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19. How long will it take for an anti-inflammatory diet to change the ratio of omega-6 to omega-3 fatty acids and have a noticeable clinical effect?
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???????
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20. How might the fatty acid profile of grain fed beef and or milk be different then pasture fed beef/milk, and how might this influence inflammation in the person consuming those foods?
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More omega-6 in grain fed beef / milk. This will manifest in more of the ingested fats from these products being directed toward pro inflammatory factors
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21. Classify the following foods according to their predominant fat content classification and if they are a good source of a particular essential fatty acid and if they are a significant source of trans fats: avocado, olive oil, grain fed beef, walnuts, cold water fish (salmon, tuna, sardines), corn chips deep fried in corn oil, bacon grease, flax seed oil
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avocado and is higher in monounsaturated fats than saturated fat, and has more omega-6 than omega-3. Olive oil is rich in monounsaturated FA and doesn’t affect O6/O3 balance, the fats in olive oil are not susceptable to conversion to trans fats and olive oil in generally considered an anti inflammatory food. Grain fed beef corn oil, bacon greece are all pro-inflammatory and contain higher ratios of omega 6 and sautrated and trans fats. Walnuts and cold water fish are high in omega 3 FAs
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22. What effect did extra virgin olive oil but not regular olive oil or corn oil have on leukotrienes and thromboxanes in human subjects?
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it lowered them
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23. What is most likely the single most important factor that determines the inflammatory potential of a carbohydrate food?
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Glycemic load
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24. Which category of foods contains the highest concentrations of vitamins, minerals, and other protective phytochemicals, with a lower calorie density compared to other foods?
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vegetables and fruits
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25. What was the effect of four servings of legumes per week in obese subjects on CRP and complement C3 levels?
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it lowered them, it also lowers LDL cholesterol
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26. What was the effect of the consumption of five or more servings of nuts and seed per week on CRP, IL-6, and fibrinogen in a multiethnic study of more than 6000 patients?
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it lowers them
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27. What is the effect of the spice Turmeric on Cox-2 enzyme and the lipoxygenase enzyme?
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it down regulates them, resulting in less production of pro inflammatory factors such as TNF, IL-6
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28. Figures 86-2 & 86-4 in the Integrative Medicine Text are important. Visualize and understand the biochemical pathway. This material carries over to your biochemistry textbook’s chapter on Metabolism of Eicosanoids.
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ok
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29. Understand Table 86-1 Medical Conditions that May Improve With the Antiinflammatory Diet.
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Atopic diseases such as atopic dermatitis may be alieved with high O3 diets. Asthma incidence is greater in high O6 preschool children. O3 FA have been linked to chemoprotective/anti cancer functions. High meat/dairy consumption is linked to increased risk of prostate cancer. Vegan diets can improve fibromyalgia. May be due to PLA2 (which is very active in lumbar disks) if you are high in OO6 this can be more active. Depression improves with a more O3 diet
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30. Review the Patient Handout on page 802.
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ok
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1. What is the DASH diet?
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stands for dietary approaches to stop hypertension. Designed to lower BP but can modify several disease risk factors, such as lower cholesterol and greater insulin sensitivity. Favors meals low in animal fats, rich in fruits veggies and whole grains
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2. In the first DASH study, how much did systolic/diastolic blood pressure drop in individuals that did not have hypertension? How much did blood pressure drop in individuals with high blood pressure? How long did it take for these effects to take place?
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For patients who followed DASH the drops were 5.5/3 for non HTN pts. And 11.6/5.3 for HTN pts. This took only 2 weeks
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3. In the second DASH trial, what was the effect of reducing sodium levels on participants consuming a normal American diet and the DASH diet? How did the different sodium levels affect results?
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lower sodium lowered BP progressively. Those on DASH saw further drops at each level of sodium intake
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4. What effect does the DASH eating plan have on inflammatory markers IL6, and C-reactive protein?
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has been found to be lower
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5. The importance of potassium, magnesium, calcium, fiber from the fruits and vegetables for blood pressure results in the diet has been postulated after. What were the results and conclusions in a crossover study in which obese and lean individuals consumed a usual diet, the DASH diet and the usual diet supplemented with potassium, magnesium, and fiber that match the DASH diet and also matched calcium and sodium?
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That K,Mg, fiber, and Ca were not contributing to the lowering of blood pressure and must have other health benefits. A
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6. Look at Table 87-1. on page 804 and look at the food group, examples, and significance of each food group to the DASH eating plan.
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sure. Ill do that
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7. How does the diet lipid and glucose levels in diabetic individuals?
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all of the good things (decrease in A1C, fasting glucose, LDL, TG, Cholesterol) increase in HDL
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8. What effect does a low salt DASH diet have on bone health?
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less bone turnover. Stronger bone structure
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9. What foods are emphasized in the DASH diet?
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high in fruits in vegetables, high in nuts seeds and beans. Low in dairy animal meat, saturated fats
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10. What improvements to the DASH diet are suggested by the author?
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be wary of cooking oils and avoid trans fats from vegetable oils and partially hydrogenated oils, instead use olive or canola oil. Also be sure to eat fish more than meat of poultry, particularly the Omega 3 cold water fish
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11. Where would you find more information and a patient resource/handout? Here are 2 links. Please visit and remember they are available for your future patients http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
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ok
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http://dashdiet.org/
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ok
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12. According to this patient handout, what foods are reduced on the DASH diet?
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Reduced in lean red meat, sweets, added sugars, and sugar containing beverages
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1. How many kcals/g are found in carbohydrates, proteins, fats, and alcohol?
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Fats 9kcal/g Proteins and Carbs 4kcal/g, Alcohol = 7kcal/g
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2. Discuss the basics of dietary carbohydrates.
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Broken into monosaccurides, more complex take longer to break down so increase blood sugar slower but longer. Glycemic Index/Load measure this
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3. Discuss the basics of dietary proteins.
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Proteins are broken into peptides and Amino acids. There are 9 essential AA's. Body uses protein for tissue production and protien ingestion results in a net nitrogen gain. In starvation this works the opposite. EAA content of foods are rated for how closely it matches our needs. Egg protein is perfect 100. This is refered to as the Biological Value of the protein. RDAs for protein assume an average BV of ~70
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4. Discuss the basics of dietary fats including essential fatty acids. How are most Trans-fatty acids produced? What effect do Trans-fatty acids have on LDL, HDL, risk of coronary artery disease?
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partial hydrogenation of unsaturated FA's results in the formation of trans fats which are bad as they increase LDL, cholesterol and lower HDL. EFAs are not supplied in the diet. Some examples are linoleic acid and linolenic acid
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5. From what are eicosanoids derived?
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these are derived from EFAs Some examples of eicosanoids are prostoglandins, prostacyclins, leukotrienes, thromboxines
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6. What are some of the functions of dietary fiber? Recommendations for fiber vary. For individuals consuming a typical Western diet, increasing fiber to ______ grams/day is recommended by this resource by consuming more ____________, ________________, and ______________. |
about 30g/day from ~12/day. We should consume more vegetables, fruits, and high fiber cereals to do this
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1. Table 1.7 Mark’s Biochemistry, this is extremely high yield material. Study the table and read sections on vitamins and minerals. This is question number one to emphasize the importance!
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ill just summarize below
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Vitamin C
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water soluble, found in citrus potatoes, peppers, broccoli, spinach, strawberries. Deficit results in scurvy which is a defecit in collagen formation
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Thiamin
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water soluble, found in enriched cereals and breads, unrefined grains, pork, legumes, seeds and nuts. Deficit results in beriberi. Beriberi presents with wet edema, weight loss, apathy, confusion, weakness and enlarged heart
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Riboflavin
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riboflavin is water soluble. you get riboflavin from dairy, fortified cereals, meats, poultry, fish and legumes. Ariboflavinosis is a lack of riboflavin. Symptoms include sore throat hyperemia edema of mucosal membranes, maenta tongue, suborrheic dermatitis and normochromic/normocytic anemia
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Niacin
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niacin is water soluble. You get it from meat enriched cereals whole grains. Lack results in pellagra which is a pigmented rash in sunlight exposed areas, vomiting, GI issues, bright red tongue, neurologic issues
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Pyridoxine (B6)
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B6 is water soluble. You get it from chicken,fish, pork, eggs, fortified cereals, unmilled rice and oats, non citrus fruits walnuts and peanuts. Deficit results in suborrheic dermatitis and microcytic anemia. Severe can lead to convulsions depression and general confusion.
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Folate
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water soluble. You get it from citrus fruits and dark green veggies, also from some fortified cereals and leumes. Deficit results in megloblastic anemia, impaired cell division, and in pregnant women can result in a child with an NTD
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Vitamin B12
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water soluble lack results in megaloblastic anemia and neurologic symptoms
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Biotin
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water soluble, found in liver and egg yolk, lack results in conjuctivitis and CNS abnormalities, glossitis, alopecia and dermatitis
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Pantohenic Acid
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water soluble, widely distributed in foods, lack results in irritibility fatigue, apathy and restlessness. Also can cause GI and neurologic symptoms
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Choline
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water soluble, found in milk, liver,eggs, peanuts. Lack results in liver damage
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Vitamin A
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fat soluble, found in carrots dark green leafy veggies sweet potatoes, squash and broccoli, deficit can cause night blindness, xerophthalmia. Also can cause keratinization of GI and respiratory epithelium
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Vitamin K
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fat soluble, found in green leafy veggies, cabbage and intestinal flora, lack can result in defective clotting and hemmorhagic anemia of the newborn
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Vitamin D
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vitamin D is fat soluble and found in fortified milk, it can also be produced when one is exposed to adaquate sunlight. Lack of vitamin D results in ricketts in children which is an improper bone mineralization (osteomalacia)
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Vitamin E
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fat soluble, found in vegetable oils, margarine, wheat, nuts, green leafy veggies, lack results in muscular dystrophy, and neurogenic abnormalities
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2. Page 1 of chapter. What are the two basic metabolic requirements for survival? To meet these requirements, we metabolize our dietary components through what 4 basic types of pathways?
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we must be able to synthesize everything that we need that isnt in our iet, and we must be able to protect our internal environment from the external environment. The 4 types of pathways are fuel oxidative, fuel storage, mobilization, and biosynthetic pathways
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3. What are detoxification pathways?
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metabolic pathways that remove toxins from our body that we acquire in various ways
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4. From what nutrient category do we obtain our fuel for metabolism?
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carbohydrate , fat, protein
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5. How do we obtain fuel stores?
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fuel that is in excess of what is needed to support our energy needs is stored mainly as triacylglycerol and glycogen, and muscle protein
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6. What are the other dietary precursors for the biosynthesis of compounds necessary for cellular and tissue structure, function, and survival?
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essential fatty and amino acids, vitamins, minerals, water
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7. What is a “calorie”/kcal?
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1 kcal is the amount of energy required to heat one L of H20 by 1 degree celcius (1kcal = 4.18 kJ)
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8. What are the major carbohydrates in the human diet?
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starch, sucrose, lactose, fructose, glucose
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9. Table 1.1 What is the caloric content of carbohydrate, fat, protein, and alcohol?
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protein/carbohydrate= 4 fat=9 alcohol=7
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10. Are sucrose and fructose monosaccharides or disaccharides?
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sucrose is a disaccharide and fructose is a monosaccharide
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11. What is diet-induced thermogenesis?
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metabolic rate increases after we ingest food because energy is required to digest, absorb, distribute, and store nutrients. This requirement is roughly 10% of calories ingested
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12. What does “essential” mean in the context of dietary requirements?
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we cannot synthesize it and therefore must obtain it in our diets
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13. What is the RDA and the AI for nutrient requirements?
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recommended dietary allowance is the average daily intake required to meet the requirements of ~97-98% of healthy individuals and adequate intake. AI (adaquate intake) is used when there is not sufficient data for a RDA
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14. What are the specific essential fatty acids and in what food are they found? For what hormone-like molecules are they precursors?
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alpha linoleic and alpha linolenic acids are found in plant oils and EPA and DHA are found in fish oils. They are precursors of eicosanoids (which include prostaglandins, thromboxanes, leukotrienes…)
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15. What are xenobiotics? Do they have nutritional value? What recommendations are made from the American Institute for Cancer Research relevant to the ingestion of xenobiotic compounds? What are their recommendations about consumption of salt cured, smoked and charred foods and why?
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chemicals which have no nutritional value and are of no use to the body. They say we should reduce consumption of these things and eat a variety of foods like fruit and veggies to protect us from potential carcinogens
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1. What mediates the active transport process of calcium absorption in the small intestine? What mediates urinary absorption of calcium?
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calcitriol mediates uptake from the duodenum and jejunum. Resorption from the kidneys depends on PTH and calcitriol
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2. What are the main functions of calcium in the body?
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Calcium functions as a mineral matrix for bone tissue. It is also important for nervous system function, blood clotting, and muscular contractions
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3. Identify several substances that may impair calcium absorption or increase calcium excretion (through urine or feces).
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excess dietary fat may impair calcium absorbtion. Excess dietary protein can increase renal loss of calcium. Glucose and aspartame can increase urinary loss as well. Fecal loss can be induced by excess fiber, caffeine and ethanol.
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4. Name several categories of nondairy high-calcium foods. What plant family specifically has very absorbable calcium? Is spinach a good source of calcium, and why? What substances enhance calcium absorption?
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cabbage family (kale and collards) have high absorbable calcium, oxalic acid in spinach reduces its absorbable calcium. Certain types of fiber can enhance absorbtion. Absorbtion in enhanced by subatances that increase its solubility, including HCL, ascorbic acid, citric acid, glycine, lysine
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5. What are risk factors for osteoporosis?
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elderly individuals, females, family history, white/asian, small bones, short, lack of exercise, nulliparity (never been pregnant), smoking, excess O2, low estrogen
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6. What are the new IOM calcium recommendations for men 50-70 years old and what are the recommendations for women 50-71 years old? New information since publication of this book chapter is provided: Link for discussion of IOM 2010 Vitamin D and Calcium updated recommendations and comment by Harvard Department of Nutrition Chair Dr. Walter Willet www.hsph.harvard.edu/nutritionsource . Link to IOM PDF -this link is for your convenience you are not required to read this www.iom.edu/PDF Calcium Vit D .
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new recommendations for men are reduced to 1000mg per day from 1200mg and for women 1200mg/day for women
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7. How does the typical American diet affect phosphorus to calcium ratios?
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americans take in a lot of phosphorus from sources like fast foods, animal tissues, and soft drinks. This can reduce calcium absorbtion.
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8. Name several important functions in which magnesium is necessary. [Of note, serum magnesium levels are often used clinically to determine sufficiency of magnesium in the body, however, maintaining normal levels of serum magnesium is a tightly controlled physiologic process and does not necessarily reflect intracellular magnesium levels. One can be depleted overall in magnesium but still have normal serum levels. A red blood cell magnesium is a closer approximation to actual intracellular levels]
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Magnesium is required for production for glucose mediated ATP production. It is also needed for fatty acid synthesis and oxidation. It is required in cAMP formation and many protein kinase reactions. It is an important modulator of cardial physiology
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9. Name some signs and symptoms that may be related to magnesium deficiency.
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deficiencys occur in elderly and pregnant women and signs/symptoms include weakness, heart irregularities, muscle cramps , twitches, insomnia, mental confusion, fatigue, irritibility, and lowered appetite.
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10. Name some conditions or diseases that may involve magnesium deficiency
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diseases associated with low magnesium are diabetes and systeic lupis
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11. What is chromium’s role related to blood sugar levels?
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chromium is the major component of Glucose tolerance factor (GTF) which has a strong insulin enhancing activity
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12. What are some important functions that involve zinc?
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it is important to enzyme and hormone activites, essential to immune function
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13. What other mineral can become deficient if a patient is taking long-term high doses of zinc?
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zinc competes with absorbtion with copper. If you have too much zinc over time you well develop a copper deficiency
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14. What are the main storage compounds of iron? What compounds can alter iron absorption? What is the most absorbable form of iron?
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ferritin and hemosidrin are the main storage compounds. Absorbtion inhibited by phytic acid, polyphenolic compounds, calcium and partially digested proteins. Ascorbic acid and cysteine enhance iron absorbtion. Heme iron is more absorbable form
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15. What can iron deficiency result in?
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microcytic anemia
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16. In assessing someone with iron deficiency, what should be explored in the patient history? What severe condition is associated with iron excess and iron deposition in soft tissues?
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frank or occult bleeding, vegearian diet, malabsorbtion, hypochlorhydria. Hemochromatosis is associated with deposition into soft tissues, alcoholics are at risk for this
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17. What is selenium’s role as an antioxidant?
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works with vitamin E as a component of the glutathione peroxidase enzyme
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18. What nut has high selenium content?
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brazil nuts have a high selenium count
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19. What role does selenium play in thyroid function? (hint: see section on functions of iodine)
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selinium is required for the deiodinase enzyme to converte T4 to T3 in the liver. Deficiency can result in thyroid enlargment
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20. What is the principal therapeutic use of vanadium?
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vanadium may be involved in protection against cancer, and in the management of glucose tolerance, cell division. Study has shown improvement of insulin sensitivity with vanadium supplementation
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1. What are consequences of vitamin A deficiency? What changes are observable in the eye upon physical examination?
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vitamin A deficiency results in impaired vision, particularly in reduced light (night blindness). Long term defecit in A results in epithelial de-differentiation (epithelial metaplasia) and keritinization. Changes in eyes can in clude corneal ulcers, keratomalacia, and bitot spots
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3. Briefly, compare and contrast marasmus, Kwashiorkor, and Cachexia include underlying mechanisms, physiological abnormalities, and physical signs.
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Marasmus is a Protein energy malnutrition disease. For marasmus body weight must fall to below 60% of normal and caloric deficit and protein deficit are of relativ equality. Severe emaciation. Kwashiorkor is where the deficit in protein is greater than the caloric deficit and is most commonly seen in african children who subsist on a carbohydrate dependant diet. Cachexia arises in patients with AIDS or advanced cancers most commanly lung GI and pancreatic. It is characterized by extreme weight loss fatigue muscle atrohy anemia anorexia edema and death.
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1. Describe the generation of reactive oxygen species: the radical nature of O2 and some characteristics of reactive oxygen species (ROS)
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ROS are generated accidently from nonenzymatic/enzymatic reactions. They are also deliberately synthesized in enzyme-catalyzed reactions. UV radiation and pollutants can cause increases in toxic oxygen containing compounds. Radicals have single unpaired electrons and a free radical escapes the confines of an enzymatic reaction and can interact with other molecules. ROS are highly reactive free radicals or are readilly converted to free radicals in the cell. The free radicals take electrons from other compounds to complete their orbitals forming chain reactions.
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2. What cellular components react with free radicals/ROS? Are there diseases in which free radical damage is the primary cause or in which it enhances the complications of the disease?
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ROS can combine with lipids proteins carbohydrates and DNA. There are diseases where ROS are primary cause and others where it causes additional complications
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3. How does selenium assist in the prevention of free radical injury?
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Selenium works in the glutathione peroxidase family to reduce hydrogen peroxide to water. It is also a component that assists with vitamin E's free radical scavenging
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4. Understand Nonenzymatic Antioxidants (Free Radical Scavenger): Vitamin E, ascorbic acid, carotenoids, flavonoids.
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Vitamin E is the most abundant antioxidant in nature. It works primarily to protect from lipid peroxidation in membranes by terminating chain reactions. When it donates an electron to a free radical its own radical form is resonence stabalized, terminating the chain reaction. Ascorbic acid (vit C) can regenerate the reduced form of vitamin E. Carotenoids (Beta carotene) can quench singlet O2 radicals and may slow progression of cancers and other degenerative diseases. Can also possibly assist in slowing Age related Macular degeneration. Flavonoids contain spacially seperated aromatic rings and are found in red wine, green tea, chocolate, and other plant derived foods. They can act as inhibitors of radical generating enzymes such as Xanthine Oxidase, or act as metal chelators, preventing irons such as Fe from participating in the Fenton reaction. They mmay also donate electrons to stabilize free radicals
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5. What is the second layer of defense that protects ozone derived oxidative damage in the lungs?
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The second layer of defense is vitamin E, glutathione peroxidase, and superoxide dismutase. Vitamin E works primarilly on lipid peroxide while superoxide dismutase generates H2O2 from superoxide and glutathione peroxidase generates water from H2O2
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6. What minerals are required for the function of superoxide dismutase?
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Copper and Zinc also Manganee
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1) In what ways are acute diseases different than chronic diseases? What two things underlie almost all chronic diseases? How should treatment strategies be different when approaching chronic diseases
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Chronic disease is almost always caused by poor eating habits and tobacco use. Treatment strategies should no longer be reactive and instead should focus on educating patients to engage in healthier lifestyles to prevent these conditions from ever developing in the first place. Acute diseases are episodic and and can be cured, there are rarely cures for chronic disease
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2) What has been the trend for the percentage of the U.S. population that is considered obese over the last decade (Body Mass Index > 30)? What pattern is seen as immigrants move to the U.S.?
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Were getting fat. People who move here who were skinny are getting fat too. Its not just us. Lots of people in other countries are fat too.
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3) The incidence of what diseases are greater in obese individuals?
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Family tree of obesity. Slide 58. GERD, CHD, Stroke, CHF, Arthritis, Gout, Sleep Apnea, Infertility, Depression, T2DM, Colon cancer to name a few
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4) What are some of the general mechanisms by which obesity may result in the above diseases (see slides 57-60)
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SAD diet contains many oxidant producing compounds and omega 6s which can influnec transcription of pro inflammatory genes which can lead to autoimmunity and oxidative damage and even cell cycle genes that can result in cancer
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5) Name some general mechanisms impacted by bioactive food components that influence health (slide 71)?
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can metabolize to carcinogen, can affect hormone regulation, can affect cell differentiation, can affect DNA repair, cause or inhibit apoptosis, or cell cycle, and induce inflammatory response
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6) According to Dr. Leiber’s “Basic Rules”, what should not be in your meal for optimization of health?
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caloric rich, nutrient poor food. High glycemic load foods, refined carbs, simple sugar, saturated fat from animal sources, high mucury fish corn and vegetable oils, microwaved food, plastic containers
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7) According to Dr. Leiber’s “Basic Rules”, what should be in your meal for optimization of health?
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veggies and plant based foods. High quality proteins, low glycemic carbohydrates, fiber
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8) According to Dr. Leiber’s “Basic Rules”, what cooking methods should you use for optimization of health? avoid?
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cooking with corn oils, microwaves.
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9) With the understanding that processed foods have strongly contributed to the poor health of the nation, what has become the food industry’s marketing strategy?
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Shift blame to you (ie you have the choice to eat healthy we can help), use vague or confusing terminology when describing what not to eat.
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10) According to an evolutionary perspective, what is the primary reason for the diseases of modern civilization?
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we are genetically adapted to the environment of our anscestors. We advanced too fast for our genome to adapt and thus there is discordance between what our bodies are designed to eat and what we actually eat
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11) Name the 7 imbalanced food patterns. Name the resulting clinical imbalances.
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Glycemic load, Fatty acid composition, macronutrient composition, macronutrient density, acid/base balance, sodium potassium ratio, fiber content. These imbalances result in oxidative stress (rust), inflammation (heat), impaired detoxification (waste), overconsumption/undernutrition (sludge), insulin resistance (crust), mitochondrial energy dysfunction (burnout), digestive dysfunction (weakened defene), and hormonal imbalance (chaos)
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12) How does the refinement of sugar cane affect its nutritional content?
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it diminishes its nutritional content by removing fibers, phytochemicals, vitamins, and trace elements
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13) What is the surprising conclusion when comparing intense sweetness to cocaine reward?
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more additive than cocaine in mice
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14) How does the milling of grains alter its nutrient content?
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milling removes the bran and the germ. The bran which is the outer shell has fiber and b vitamins as well as trace minerals, the germ is the nourishment for the seed. It contains antioxidants, vitamin E and b vitamins.
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15) Why is the enrichment of grains after refinement insufficient for restoring the nutrient content?
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Enrichment replaces 4 nutrients, milling removes 40
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16) What part of a whole grain contains the fiber?
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the bran
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17) Name some whole grains other than whole wheat.
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barley, rye, amarath, brown rice, flaxseed, oats, spelt
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18) Why might decreased fiber in the diet and increased stool transit times contribute to cancer development?
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insoluble fiber is partially digested by gut flora which produce small chain fatty acids which nourish cells of the colon and may prevent colon cancer. Additionally if you ingest too little fiber you are increasing the stool transit time, allowing the toxins you ingest to remain in your body longer, which may lead to cancer as well.
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19) What is the cut-off point for a food company to legally state that there are zero grams of trans-fats in their product?
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you can round down to zero provided there is less than .5 g per serving. Ingrediants must state that there is partially hydrogenated oil tho.
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20) Describe the difference between the old and new paradigms of nutritional deficiencies
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In the old paradigm there were major nutritional problems resulting from major deficiency syndromes like beriberi from thiamine or rickets from vitamin D or pellegra from niacin. Now the SAD results in minor combined nutritional deficiencies which present as long term latent chronic conditions.
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21) According to a 1996 USDA survey, what percentage of people are getting the Recommended Daily Allowance (minimum amount needed to prevent classic deficiency diseases) for all nutrients from their diet? |
nobody.
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22) At what Vitamin D level does risk of rickets increase? At what Vitamin D level is there an increased risk of bone loss, muscle pain, diabetes, depression, migraines, preeclampsia, and back pain? At what level does risk of breast cancer decrease? What is considered to be optimal levels? At what level is there an increased risk of toxicity from hypercalcemia?
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vitamin D levels of less than 15ng/ml you have an increased risk of rickets. At less than 30 ng/ml you have a risk of all of the other diseases listed in the question. At greater than 50ng/dl you get the protective benefits of a decreased risk of all soli cancers. 50-80 is considered optimal, >100 is a risk for hypercalcemia toxicity |
