Flashcards: Nutrition Part 2

Genetic, social psychological, Family, individual, etc.

- history in dieting

- depression/anxiety, etc

- history of obeisity

- female

- genetics

- premature birth

- low self esteem

- perfectionism

- depression/anxiety

- previous obesity

- diabetes

- puberty

- socio-cultural pressures

- family

- pressure to achieve

- comments about weight

- refuse to maintain body weight at 85% of expected

- intense fear of gaining weight

- disturbance in body image

- amenorrhea (absence of 3 consecutive menstrual cycles)

- restricting type or binge eating/purging type

• Anemia

• Low bone density

• Depression

• Amenorrhea – absence of menstruation

• Impaired immune response

• Sensitivity to cold

• Soft, thick facial hair, thinning scalp hair

• Low blood pressure

• Irregular slow heart rate, loss of muscle tissue

• Individuals with anorexia nervosa typically severely restrict their food intake and may exercise intensely

• Some turn to self-induced vomiting after eating

• Family members and friends often report high levels of anxiety

• People with anorexia are often “model students” or “ideal children,” but in their personal lives may experience low self-esteem, social isolation, and unhappiness

• Approximately 1% of young women and <0.1% of young men have anorexia nervosa

• Reported in girls as young as five and women through their forties

• It usually begins during adolescence

• People at risk tend to be overly concerned about weight and food, and many attempted weight loss/dieted early

• There is no treatment that cures anorexia nervosa quickly

• The disorder takes a good deal of time and professional help to treat (often years). Ongoing therapy is important for continued recovery.

• Treating the disorder is difficult because few with anorexia believe their weight needs to be increased

Treatment programs focus on:

– Normalizing eating and exercise behaviors

– Nutritional health and body weight

– Psychological counseling for self-esteem

– Attitudes about body weight and shape

– Antidepressant or other medications

– Family therapy

Complete success in 25-50% (depending on the study) and partially successful in others

- Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:

• Eating, in a discrete period of time (e.g., a 2 hour period), an amount of food that is definitely larger than what most people would eat during a similar period of time and under similar circumstances.

• Lack of control over eating during the episode (e.g., a feeling that you cannot stop eating, or control what or how much you are eating).

- Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

- The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.

- Self-evaluation is unduly influenced by body shape and weight

• Bulimia nervosa occurs in 1-3% of young women and 0.5% of young men.

• Bulimia nervosa often starts with voluntary dieting to lose weight and at some point voluntary control over the dieting is lost.

• People feel compelled to engage in binge eating and vomiting

• The behaviors become cyclic, food binges are followed by guilt and/or depression, purging, and dieting

• Once a food binge starts, it is hard to stop

Bulimia!

• Unlike those with anorexia nervosa, people with bulimia usually are not underweight or emaciated

• They tend to be normal weight or overweight

• Bulimia nervosa is common among athletes

Exact cause not known with certainty

• Depression

• Feast-famine cycles: fasts and restrained eating (purposeful restriction in food to control weight) may cause feelings of deprivation that trigger binge

• Abnormal mechanisms controlling food intake

*A way for a person with bulimia to feel more in control over their lives

• Nutrition and counseling to break feast/famine cycles

• Eating regular meals

• Psychological counseling to improve self-esteem and attitudes toward body weight and shape

• Antidepressants may be useful

• Full recovery of women is higher than for anorexia

• Most women with bulimia achieve partial recovery

• 1/3 relapse to bingeing and purging within seven years

• Individuals are likely to have overweight or obesity, ⅓ are male

• Individuals eat several thousand calories’ worth of food during a solitary binge (within 2 hrs), feel a lack of control over the binges, and experience distress or depression after the binges occur

• People with binge-eating disorder do not vomit, use laxatives, fast, or exercise excessively in

an attempt to control weight gain = no compensatory behavior(s)

• Must have binges once a week over six months to be diagnosed

1. Eating much more rapidly than normal

2. Eating until uncomfortably full

3. Eating large amounts when not physically hungry

4. Eating alone because of feeling embarrassed by quantity of food being consumed

5. Feeling disgusted with self, depressed or guilty

• 9-30% of people in weight-control programs and 30-90% of individuals with obesity have binge-eating disorder

• Condition is far less common (2 to 5%) in the general population

• Stress, depression, anger, anxiety, and other negative emotions prompt episodes

• Binge eating disorder may be related to genetic mutation that impairs normal eating behavior

– MC4R gene mutation in 5% of individuals with the disorder

• Treatment focuses on disordered eating and underlying psychological issues

• Persons will be asked to record food intake and note feelings, circumstances, and thoughts related to each eating event

– Information identifies circumstances that prompt binge eating and alternative behaviors to prevent it

craving for non-food substances

The word pica comes from the Latin word for magpie, a bird known for its unusual eating habits.

- clay or dirt (geophagia)

- ice cubes (pagophagia) - one case study 10kg

- purified starch (amylophagia)

• Largely found in children and pregnant women

• Direct or indirect cause or symptom of iron deficiency anemia

• Information and services for eating disorders are available

• Services delivered by health care teams specializing and experienced

• Primary care physician, dietitian, or nurse practitioner is good start to the process

• Reliable sources for eating disorders, support groups, and treatment:

– Eating Disorder Support Network of Alberta https://edsna.ca

– Alberta Health Services https://www.albertahealthservices.ca/findhealth/service.aspx?Id=1080429&facilityid=1002752

– UCalgary Students Union Wellness Centre https://www.ucalgary.ca/wellness-services/services/mental-health-services

Whole grain whole wheat flower

complex = good: vegetables, oats, whole grain bread, fruit, potatoes, etc.

simple = bad: donuts, pop, gummies, cookies, chocolate, white bread, fries, etc.

- Monosaccharides

• Glucose (blood sugar or dextrose), Fructose (fruit sugar), Galactose

• Most abundant and nutritionally relevant is glucose

• Only monosaccharides are absorbed into bloodstream

- Disaccharides

• Two monosaccharides joined by a covalent bond

refers to monosaccharides and/or disaccharides

- Few are made by animals; most are plant sourced

Health Risk: rapidly absorbed into blood stream, increased insulin resistance and inflammation

sucrose, maltose and lactose

• Sucrose (cane sugar, beet sugar) is the most widely used natural sweetener

- Glucose + Fructose

• Maltose is formed from the partial breakdown of starch & is often used in malt beverages (e.g. beer = barley is malted, maltose is formed, bacteria ferment the maltose and make alcohol)

- Glucose + Glucose

• Lactose is “milk sugar,” one of the only animal sugars besides glucose

- Glucose + Galactose

- Oligosaccharides (most ~3 monosaccharide units)

• Short chains of monosaccharides joined by bonds that cannot be broken by human enzymes (i.e. they are a fiber source)

• Fructans and galacto-oligosaccharides

• Garlic, onions, wheat, artichokes, beans, lentils, chickpeas, inulin

- Polysaccharides (up to 1000’s)

• Long chains of monosaccharides joined by bonds (some digestible and some not) •

• Include glycogen, starch, and cellulose

• Potato, rice, pasta, corn, cereal, bread, apple peel, seeds, nuts

Starch – Energy storage in plants (digestible)

Glycogen – Energy storage in animals (digestible)

Cellulose – Provides structure in plants (non-digestible)

- Starch and glycogen are digestible = glucose polymers bonded with α glycosidic bonds that CAN be broken down by enzymes

- Cellulose is non-digestible = connected via β glycosidic bonds that can NOT be broken down by human enzymes

*Fiber is important to our health because of what happens to it in the colon.

COLON: Bacterial enzymes can break down fiber to form short chain fatty acids and gas as a byproduct.

*Fiber feeds our gut microbiota.

Brain: anxiety, depression, parkinson's

Intestinal: crohn's, ulcerative colitis, IBS

Metabolism: obesity, type 2 diabetes, fatty liver disease

Pathogens: clostridium difficile infection

Symbiosis: high fiber, whole natural foods

Dysbiosis: processed foods, low fiber

- In a grain of wheat, the outer bran layer is a rich source of dietary fiber

- The germ contains protein, unsaturated fats, thiamin, niacin, riboflavin, iron, and other nutrients

- The bran and germ are removed in the refining process (i.e. making white flour)

- The endosperm primarily contains starch, the storage form of glucose in plants = white flour

- Soluble fiber is good because it benefits health in several ways

- It slows down glucose absorption, thereby lowering peak blood levels of glucose, and reduces fat and cholesterol absorption

- Found in oats, barley, fruit pulp, peas, beans, citrus fruits, strawberries and psyllium - Lower calories than digestible carbohydrates (1-2 kcal/g typical)

- Insoluble fiber is good because it benefits health in several ways

• Moves bulk through gut, controls gut pH, removes toxic waste, prevents constipation

- Found in vegetables, wheat bran, whole grains, flax seed, popcorn, corn bran, seeds, nuts, apple peel

- Major sources of simple sugars in most diets are added during processing of food

- Labels contain information on total sugars per serving but do not distinguish between naturally occurring and added sugars yet. ‘Added sugars’ add calories without adding nutrients

*food labels must now have all sugars together

- Tooth decay

- Empty calories (calories without nutrients)

- Often mixed with fats in sweets

• Limit sweet and sticky foods; replace them with vegetables and fruits

• Overall quality of diet decreases when sugar intake increases

- Alcohol sugars (~2.6 kcal/g)

• Xylitol

• Mannitol

• Sorbitol

- Used in chewing gum and other candies and foods

- Can be used to mask the unpleasant aftertaste of some artificial sweeteners

- Are not well absorbed in the gut; large amounts can cause diarrhea

- Herbal Alternatives: Stevia (GRAS – generally recognized as safe - status)

- Initial studies with crude whole leave extracts of stevia = reproductive, renal and cardiovascular toxicity

- Purified stevioside preparations show no toxic effects

- In 2012 Health Canada approved its use in foods

- A dipeptide (2 amino acids = aspartic acid + phenylalanine)

- Digestion releases methanol (10%), aspartic acid (40%) and phenylalanine (50%)

- Methanol converted to formaldehyde and then formic acid

- 200 times sweeter than sucrose (sugar)

- Products containing it bear a “contains phenylalanine” label for people with PKU (phenylketonuria)

- “Nutrasweet” & “Equal”

- Acceptable daily intake 40 mg/kg BW

- Not compatible with high temperatures (> 30ºC)

- Made from sugar = chlorinated sugar (body can't break apart)

- 600x sweeter than sugar

- Safe when heated

- “Splenda”

- Often used in combination with other artificial sweeteners

- Stable at high temperatures

- Discovered in 1879 by accident by chemist working on coal tar derivatives

- 300x sweeter than sucrose

- Banned in Canada in 1977 due to bladder cancer fears, returned to market once it was discovered the mechanism by which it caused cancer in rats is not present in humans

*NOT GOOD

• Reduced insulin sensitivity

• Altered mesolimbic reward pathway in the brain (promotes food seeking behavior)

• Altered gut microbiota composition and function

• Offspring had 25% higher fat mass at 3 weeks of age

* sugar is sole food for bacteria --> produce acid

* bacteria form sticky white plaque

* acid is produced by bacteria for 20 min after sugar is eaten

- increased frequency of sticky foods

- acidic beverages

- excessive cleaning/polishing of teeth

- nursing bottle syndrom

- cheese (incr. pH of plaque - decr. acidity)

- protein (with calcium it strengthens enamel)

- low calorie sweeteners such as sorbitol, mannitol, xylitol (stimulate saliva)

* promote remineralization of eroded enamel

* water, toothpastes, dental rinses

* excess leads to fluorosis or “mottled” enamel during tooth development

* cosmetic condition that can only form in children ≤8 years when permanent teeth are developing

- 2011 City of Calgary voted to remove fluoride from water supply

- 2016 study compared rates of tooth decay in grade 2 children from Calgary (removed fluoride) and Edmonton (kept fluoride)

• Compared 2004/2005 and 2013/2014 data

• Both cities had high rates of tooth decay but was increasing more rapidly in Calgary - 2021 study shows gap is widening: “Of the approximately 2,600 Grade 2 students in each city who took part in the study, 55.1% of Edmonton participants had one or more cavities in their baby teeth. In comparison, the number was 64.8% of Calgary children.”

- November 2021 City of Calgary voted to reintroduce fluoride into water supply (set to start by September 2024

Only during pregnancy

- Typically diagnosed before 40, abruptly

- Treatment is with insulin, diet and exercise

- Lifestyle related

- Treatment is weight reduction

- Blurred vision

- Frequent urination

- Weight loss (usually Type 1)

- Increased susceptibility to infection

- Slow healing sores

- Extreme hunger and thirst

- Heart disease and stroke (type 2 commonly)

- Kidney damage (nephropathy)

- Blindness (retinopathy)

- Nerve damage (neuropathy)

- Loss of limbs due to poor circulation

- Alzheimer’s disease

- Insulin is a pancreatic hormone

- Reduces blood glucose

- Facilitates passage of glucose into cells

- Low/no insulin (T1D) starves cells

- Cells can also starve if cell membranes become insulin-resistant (T2D)

- 5 to 6% of women develop gestational diabetes

- Indigenous and Black, women with obesity, women over 35 years, and women with low physical activity have greater risk

- Women with gestational diabetes are insulin resistant

- Control blood glucose levels with an individualized diet and exercise plan

- Infants of women with diabetes may have increased body fat at birth & have blood glucose control problems after delivery

• At greater risk for diabetes later in life

• 6 to 20% will have a physical abnormality that may threaten survival or a high quality of life

• e.g. cleft palate, club foot, heart defects

- Some women require daily insulin injections for blood glucose control

- Gestational diabetes disappears after delivery

- But type 2 diabetes may appear later in life in the mom

- Exercise, maintenance of normal weight, and a healthy diet reduce the risk that diabetes will return

- Type 1 diabetes results from a deficiency of insulin

- Accounts for about 5-10% of all diabetes and is increasing yearly (2x as high as children in ’80s)

- Diagnosis of type 1 peaks around the ages of 11 to 12 years and usually occurs before age 40

- Autoimmune disease that destroys pancreatic beta-cells that produces insulin

- Breastfeeding for first four months may protect infants against type 1 diabetes

- Environmental factors are more important than genetics in type 1 diabetes

• Candidates have included: early exposure to cow’s milk proteins; vitamin D deficiency; early exposure to gluten; certain viruses (rubella, rotavirus, mumps, cytomegalovirus, enteroviruses); gut microbiota

- Finland has the highest rate of type 1 diabetes in the world. Across the border in the Karelia region of Russia, 8 times lower incidence.

- Share similar genes and language but vastly different hygiene/microbial exposure (especially antibiotic use in early life).

- Certain bacteria, when present in early life can strengthen immune response and prevent type 1 diabetes.

- Estonia, once much lower, is now catching up with Finland.

- Insulin

• Injections

• Pump

• Islet transplant

- Diet

- Exercise

- Occurs in individuals with overweight or obesity and a sedentary lifestyle

- Most common in people over 40 – but increasingly seen in young children

- Increasingly common in children and adolescents

- Strong genetic component

- Runs in families (Black, Hispanic, Indigenous and Asian); associated with ”apple” obesity

- Individuals with type 2 diabetes are insulin-resistant

- Type 2 diabetes can be managed with diet & exercise - most of the time

- If not, there are 8 different classes of diabetes medications that can be prescribed to manage diabetes

- Elevated fasting blood glucose levels below the cut-off point used to diagnose type 2 diabetes

- 20% of Canadian adults, and 314 million people worldwide have prediabetes - Prediabetes is a major risk factor for type 2 diabetes

- Obesity

- Low levels of physical activity

- Genetics

- When blood glucose levels become high, the pancreas secretes more insulin to keep glucose levels under control

- Pancreas becomes exhausted from over-work and insulin production slows or stops

- When fasting blood glucose levels reach 7 mmol/L or higher, type 2 diabetes has developed

- Weight loss alone significantly improves blood glucose control

- Proper diets are crucial

• Complex carbohydrates including whole-grain breads and cereals, and other high-fiber foods, vegetables, fruits, low-fat milk and meats, and fish

• Unsaturated fats

• Regular meals and snacks

• Protein at every meal (particularly bedtime)

- High intakes if simple sugars do NOT directly cause diabetes - but can contribute to obesity

- Sugar does not have to be eliminated from the diet of individuals with diabetes, but total carbs should be reduced

- High-sugar diets increase blood triglyceride levels and the risk of heart disease in people with metabolic syndrome

- foods that elevate blood glucose require more insulin to live glucose into cells

- foods that affect blood glucose are given a glycemic index value

• Blood glucose elevation caused by 50g of a good, compared to the elevation caused by eating 50g of glucose

- low-glycemic index foods decrease triglyceride levels and insulin needs in type 2 diabetes

70-100

56-69

55 or lower

Jelly beans, donut

Hummus, milk, yogurt

Sticky rice: 86

Brown rice: lower

Both a food and a drug:

- a food because it is made from carbohydrate

- a drug because it modifies various body functions

Alcohol forms when yeast ferments sugars in different foods.

• Wine - sugar in grapes

• Beer - sugar in malted barley

• Cider - sugar in apples

• Vodka - sugar in potatoes

- At low dose, acts as stimulant (e.g. increase talkativeness)

- At high dose, depresses the central nervous system (e.g. drowsiness, respiratory depression

• beer (4-6% alcohol) == 355 ml can

• wine (8-14% alcohol) ~just over half a cup == 148 ml

• distilled liquor (many around 40%) == 44 ml shot

*know percent and volume!!

• requires no digestion

• 10% absorbed directly across empty stomach wall

• reach brain in 1 minute

- 1 (women) – 2 (men) standard drinks per day

- Moderate consumption (may) protect from heart disease in men over 45 and women over 55

- Increases high-density lipoprotein (HDL), the “good cholesterol” (take cholesterol out of blood stream)

- May protect against Type 2 diabetes (in nondiabetics) and ischemic stroke (but not hemorrhagic)

- Wine consumption was found to be cardioprotective but not beer (Circulation 2002;105:2836–44). More recent research, wine and beer but not spirits

- Red wine’s pigments act as an antioxidant and inhibit blood clot formation

• Purple grape juice also works

- May decrease the ability of LDL cholesterol to stick to plaques in the arteries

- Heavy drinking, ~5 or more drinks/day threatens drinkers’ health and those of others

- Alcoholism – chronic and progressive disease

- Passing out

- Semi-conscious

- Cold, pale, or bluish skin

- Vomiting while sleeping

- Slow or irregular breathing

- Seizures

*functional: drink so much body can hide it

Breast cancer risk increases with increased alcohol consumption

High blood pressure, stroke, heart attack, cirrhosis, throat and stomach cancer, breast and bladder cancer, vitamin and mineral deficiencies, fetal alcohol syndrome, accidents, drownings, violent behavior, etc...

- getting hurt or even death—alcohol-related injury is the major cause of death in teens and young adults

- sexual risk-taking—this includes unwanted sex, unplanned pregnancy, and sexually transmitted infections

- suicide and self-harm—higher risk in teens and young adults who drink heavily or often

- Children born to women who drink during pregnancy can develop fetal alcohol syndrome.

- Children with FASD experience impaired growth and mental development.

- May have distinct FASD associated facial features although this is only present in about 10% of individuals with FASD

- 4% of Canadians have FASD

- 2.5× more prevalent than autism spectrum disorder

- ~11% of Canadian mothers report consuming alcohol during pregnancy (3% report alcohol binges)

- Mental health disorders are seen in >90% of individuals with FASD, compared to 20% of general population (depression and anxiety most common)

- There is no cure for FASD, but research shows that early intervention can improve a child’s development.

- 7 calories/gram in pure alcohol

- For adults who drink, 3-9% of calories come from alcohol, and 50% of calories come from alcohol in heavy drinkers

- As alcohol consumption from alcohol-containing beverages increases, the quality of the diet generally decreases

- Empty calories – calories but no nutrients

- Alcohol is easily and rapidly absorbed in the stomach and small intestine

- Once in the body, alcohol remains in the blood and body tissue until it is broken down by the liver and used for energy or is converted into fat and stored

- Blood levels of alcohol build up as drinking continues

- Unlike carbohydrates (glycogen in liver and muscle) and fat (triglycerides in adipose tissue and liver), alcohol is NOT stored and remains in the body until eliminated

- Body treats alcohol as a toxin and begins elimination immediately ---- up to 10% eliminated directly without being metabolized - exhaled via lungs and the rest via sweat, saliva and urine

- At least 90% of alcohol that enters body is eventually completed oxidized

- Because the stomach has alcohol dehydrogenase, a very small amount of alcohol is metabolized there but the majority remains the job of the liver

1. Stomach alcohol dehydrogenase begins breakdown (women have lower amounts of the enzyme – therefore less first pass metabolism and more alcohol can reach bloodstream)

2. Alcohol is dispersed among body tissues but very little alcohol enters adipose tissue due to poor fat solubility. Women have more body fat and less body water – because alcohol is dispersed in body water, women reach higher peak blood alcohol concentrations than men

3. Women also have lower blood volume

1) Amount of alcohol consumed

2) Presence or absence of food

3) Rate of alcohol metabolism

1. Drinking on an empty stomach speeds up alcohol absorption

2. The higher the concentration of alcohol in the beverage the faster the absorption (peak at about 20% alcohol)

3. Carbonated beverages tend to speed up absorption (champagne, sparkling wines, mixed with soft drinks, tonic mixers)

1. Eating before or while drinking (slows down absorption of alcohol into bloodstream)

2. Diluting drinks with water or fruit juice

A drink or two in an hour raises blood levels to 0.03% in a person of about 140 lbs (mild intoxication)

- Impaired driving limit is 0.08% in most places

- 0.08 - 0.10%: impairment in all driving skills, coordination, balance & speech

- 0.13%: more severe slurred speech, double vision, dulled reflexes, unsteadiness, dangerously impaired decisions making, vomiting

- >0.35%: loss of consciousness, alcohol poisoning, can cause death

- Liver can process ~1 drink per hour

- Alcohol circulates in body until liver can process it

- Therefore, consume no more than 1 drink per hour

- Amount of alcohol dehydrogenase depends on genetics & how recently you’ve eaten (alcohol metabolism higher in fed versus fasted state)

1. Fatty liver - fat accumulates

2. Fibrosis - liver cells die & form scar tissue

3. Cirrhosis - damage least reversible

is based on how many g given based on alcohol percent.

- Depresses the behavioral inhibitory centers - The person becomes more talkative, more self-confident and less socially inhibited.

- Slows down the processing of information from the senses - The person has trouble seeing, hearing, smelling, touching and tasting; also, the threshold for pain is raised.

- Inhibits thought processes - The person does not use good judgment or think clearly.

- muscle can't metabolize alcohol, only liver

- time alone will do the job

- stimulant but won't speed up metabolism of alcohol

- wide-awake drunk

- Sleeping pills, antidepressants, and pain killers interact harmfully with alcohol

- Alcohol metabolism competes for detoxification system in liver and drug builds up

- Aspirin or ibuprofen: stomach ulcers & bleeding (irritate stomach lining as does alcohol)

- Acetominophen (“Tylenol”): liver damage

- Sedatives, narcotics: severe sedation

fhesbdiyvugbs

• Proteins are chains of amino acids

• The body cannot produce sufficient essential amino acids

• The body can produce non-essential amino acids

• If a cell is building a protein & cannot find a needed amino acid, synthesis stops

20

NE: 11

E: 9

Primary: sequence of AA

Secondary: fold

Tertiary: 3D

Quaternary: 1+ AA

*All proteins have primary, secondary and tertiary structure.

*Some also have quaternary (e.g. hemoglobin, DNA polymerase, ion channels)

Can occur due to exposure to: heat, acids, bases, alcohol, heavy metals

Good:

- cooking denatures food proteins (e.g. egg white)

- stomach acid open’s protein structure for digestion

Bad:

- fever can denature body proteins - heavy metals (mercury) can destroy body proteins

* produces toxic effects by protein precipitation, enzyme inhibition, and generalized corrosive action

• HCl denatures (unfolds) proteins & converts pepsinogen into pepsin

• Pepsin cleaves large polypeptides into smaller polypeptides

• Pancreatic proteases break polypeptides into di- and tripeptides and some amino acids

• Intestinal di- and tri-peptidases complete the break down of peptides into amino acids

• Once in the enterocyte, di- and tri-peptides are broken down to free amino acids which are absorbed into the blood stream.

*can't absorb whole proteins

1. Building materials (muscle, fetus, scar tissue, red blood cells, intestinal cells)

2. Enzymes

3. Hormones

4. Fluid balance

5. Transport (lipoproteins)

6. Acid-base regulation (blood proteins buffer blood pH by picking up hydrogen ions)

7. Antibodies

8. Energy

*Don't need to know

4 kcal/gram but unlike carbohydrate and fat, protein contains nitrogen (free nitrogen can be used for protein formation or if there is an excess, excreted as urea by kidney)

NO!

Glucose stored as glycogen; fat stored as triglyceride but protein consumed in excess cannot be stored. There is no storage form of protein.

- Amino acids can be converted to glucose – fat can’t

** If blood glucose levels drop and there is no glucose from food available, and liver and muscle glycogen are used up; the body will break down protein stores (i.e. muscle) to replenish blood glucose [called gluconeogenic amino acids]

Digestibility

- Animal proteins (>90%)

- Legume protein (80%)

- Grains & other plants (60-90%)

Protein Quality

- EAA limit protein synthesis

Complete: Contains all the essential amino acids in amounts to sustain protein formation in the body.

Incomplete: Lack some of the essential amino acids.

Meat, fish, poultry, cheese, eggs, milk & many soybean products (quinoa by some standards falls just short of the lysine needed to be classified as a complete provider of all essential amino acids)

**ANY MEAT PRODUCT

Plants Lower nutritional quality due to low levels of select EAA and presence of antinutritional factors, such as protease inhibitors that decrease protein digestibility.

- Grains do not contain sufficient lysine

- Legumes do not contain enough methionine

Grains and Legumes together

• All essential amino acids are present.

• Complete protein!

- Growing child

- Pregnant women

- Person building muscle

Normal healthy individuals

- Trauma patient

- Astronaut

Sedentary 0.8g/kg

Strength-trained (maintenance) 1.2-1.4g/kg

Strength-trained (gaining) 1.6-1.8g/kg

Endurance-trained 1.2-1.4g/kg

Weight-restricted 1.4-1.8g/kg

Infant (up to 6 mth) 2.2g/kg

Child (1-6 yr) 1.2g/kg

Chicken or beef (3 ounces) 21g

Egg 7g 1 cup milk 11g

1 serving yogurt (Greek) 6-10g (up to 23 g)

Lentils (1/2 cup) 8g

Peanut butter (1 Tbsp) 3g

* can be contaminated

* interfere with absorption of other EAA

* excess consumption of methionine worsens the symptoms of schizophrenia, promotes hardening of the arteries, impairs fetal and infant development, and leads to nausea, vomiting, bad breath, and constipation

* in sports: glutamine & branched chain amino acids may have some performance benefits

* Milk protein = 20% whey + 80% casein

* immune enhancing properties

* low in fat and nutrient dense

* may improve body composition

NO!

Although sufficient protein intake is necessary, extra strength training is what leads to muscle growth — not extra protein intake.

*body can't store protein, so once needs are met, any extra is used for energy needs or stored as fat.

* adding excess protein or amino acids to an adequate diet usually leads to putting on pounds of body fat not muscle

• Protein-rich foods are often high-fat foods (saturated)

- Excessive red meat linked to colon cancer

• Calcium : protein ratio ----- good is 20 : 1 --- actual 9 : 1

- High protein intake increases Ca loss in the urine

• Dehydration

- Burden the kidney to excrete excess nitrogen (requires water)

- In healthy individuals, the kidney generally adapts

- Exceptions: kidney disease or diabetes

exclude all animal derived foods

include milk products

include milk & egg

excludes red meat

excludes poultry & red meat

1. Lower body weight

2. Lower blood pressure

3. Less heart disease

4. Lower mortality from cancer especially colon

1. protein

2. iron

3. zinc

4. calcium

5. vitamin D

6. vitamin B12

a) Complete protein: animal sources

b) Incomplete: plant protein

*Grains: not enough lysine

*Legumes: not enough methionine

*Complementary Proteins:

- Grains & Legumes

- Milk & Grains

- Milk & Legumes

- iron in plant foods, legumes, dark green leafy vegetables, iron-fortified cereals, whole grain breads & cereals more poorly absorbed than animal source iron

- but vitamin C enhances absorption of non-heme (plant sources of iron)

*Iron absorption from mixed diet with meat, fish and poultry = 14-18%

*Iron absorption from vegetarian diet = 5-12%

- meat is rich source

- seafood also good source

- whole grains, nuts, legumes

- critical for immune function and growth

*In developing countries, zinc deficiency is caused by high cereal protein intake, rich in phytates (anti-nutrition factor), which makes zinc unavailable for absorption.

- calcium-fortified juices or soy milk

- other sources:

*calcium-set tofu*some legumes (navy & white beans)

*almonds

*tahini and chia seeds

*Lower oxalate vegetables like turnip greens, broccoli, and kale are considered better sources than higheroxalate vegetables, such as spinach, beet greens, and Swiss chard. Boiling can reduce oxalate levels by 30–87% (more effective than steaming or baking).

- vitamin D fortified milk

- exposure to sunlight (northern climates limited)

- supplement likely necessary

- only in animal foods

- fortified soy milk or breakfast cereals or supplement

*important one as it is only in animal products

1. Pregnancy & lactation

2. Infancy

3. Childhood & adolescence

• Symptoms of food allergies range from mild to serious

• They involve the immune system

• Typically, allergy begins when a person eats a food containing an allergen (typically a protein, but not always)

• Incidence is on the rise

• After one or more exposures, the person forms antibodies to the allergen

• Antibodies attach to various cells including the mucous membranes of the mouth and gut, the lungs, nose and eyes, etc.

• Upon re-exposure to the allergen, the allergen binds to the antibodies and triggers histamine release and other immune responses

• Reaction time is usually seconds to ~2 hrs

Injecting a gene-based vaccine may help patients tolerate peanuts by avoiding IgE-activated response.

Scientists are using proteins from helminth parasites that block the activity of mast cells and other immune players to suppress allergies.

Eating tiny amounts of peanut protein to gradually retrain the immune system to tolerate allergens by avoiding IgE antibody-mediated response

-Nuts

-Eggs

-Peanuts

-Soy

-Wheat

-Milk

-Seafood

-Fish

Young children

• Incidence of allergy is higher (6-8%) in children three years of age or less

• Children can grow out of cow’s milk, eggs and soy, but often don’t outgrow peanut, nut, fish or shellfish allergies

– Allergy appears before 3 yrs - 80% outgrow them – Allergy appears after 3 yrs - 33% outgrow them

• Incidence of documented allergy in adults is about 3% (20-30% of general public believe they have allergies) (often food intolerence)

• Skin eruptions, skin rash, hives 84%

• Upset stomach or intestinal tract, vomiting, cramps, nausea, diarrhea 52%

• Respiratory problems: congestion, runny nose, cough, wheezing, asthma 32%

• Anaphylactic shock (Rare) - most severe

*Do not need to know percentages

* low blood pressure

* respiratory and GI distress

* can be fatal

* most commonly eggs, wheat, milk, soy, nuts, peanuts, seafood, fish

***Peanuts responsible for 62% of food anaphylaxis deaths, with tree nuts causing 30% of deaths and the rest due to shellfish, fish, milk, eggs and fruit.

can be used to suggest allergies or rule them out but aren’t as good as eating the food.

can be used to look for antibodies to specific allergens. Not completely definitive since finding IgE doesn’t always mean someone is allergic.

Elimination diets are another key approach to determine food allergies and are usually used when there are chronic symptoms (e.g. dermatitis, not anaphylaxis)

• People with food allergies have to be careful and should have a plan ready in case they develop a serious reaction

• They have to become students of food ingredient labels

• A preloaded syringe of epinephrine is essential for people who develop anaphylactic shock (EpiPen)

“blue to sky; orange to thigh”

1. Constituents of certain foods

2. Synthetic compounds

3. Food contaminants

4. Deficiencies

(red wine, aged cheese)

- Histamine in wine blamed for headaches

- Tyramine (aged cheese, soy sauce) linked to migraines in sensitive people

added to food (sulfites, food-coloring, MSG)

- Sulfites are great antimicrobials but affect our tissues adversely too

- Although sulfites do not cause a true allergic reaction, sulfite-sensitive people may experience similar reactions as those with food allergies

e.g. coating on grapes

- MSG (monosodium glutamate) is a flavor enhancer whose intolerance is linked to dizziness, sweating, flushing, rapid heartbeat and ringing in the ears

(chemicals used in production, insect parts)

in digestive enzymes (lactase)

No!

The type of fat is as important as total fat

– Some fats are better for you than others

Keep fat intake at 20-35% of total caloric intake

– Excessive caloric intakes causes weight gain

– Fats are calorically dense (9 kcal/gram)

1. Triglycerides = glycerol + fatty acids2. Phospholipids (lipid bilayer; eg. lecithin)3. Sterols (e.g. cholesterol; vitamin D)

98% of our dietary fat intake and majority of fat stores• Triglycerides are used by cells for energy and for tissue maintenance• Fatty acids in fats determine the type of triglyceride– Major ones are “saturated” or “unsaturated”

Saturated: no double bonds, completely saturated with hydrogen - solid

Monounsaturated: one unsaturated bond (double bond) - liquid

Polyunsaturated bond: multiple unsaturated bond (2+) - more liquid

- Animal fats and tropical oils are mostly saturated (butter and lard)

- vegetable oils **Should be majority consumed (olive, canola) *olive oil unstable at high temp. (mostly monosaturated)

- some vegetable oils are mostly polyunsaturated (sunflower, corn, soybean) (BEWARE)

*NONE are 100% saturated vs unsaturated

Healthier fats lower LDL (low density lipoprotein – bad cholesterol) and raise HDL (high density lipoprotein – good cholesterol)– Mono-unsaturated fats– Poly-unsaturated fats

both polyunsaturated

– Alpha-linoleic acid (omega-6 fatty acids)

– Alpha-linolenic acid (omega-3 fatty acids)

• α Linoleic acid (n-6) is one of the essential fatty acids• Food sources are sunflower, corn, and safflower oils

• α Linolenic acid (n-3) is an essential fatty acid• Good plant sources of ‘short-chain’ n-3’s are walnuts, flaxseed, canola oil, soybeans, dark leafy green vegetables

• Eicosapentaenoic acid (EPA)• Docosahexaenoic acid (DHA)

- reduce heart disease risk- reduce tendency for blood to clot- Inuit have impaired blood clotting- risk for uncontrolled bleeding & hemorrhagic stroke- recommend fish 2x per week

• DHA is a structural component of the brain and is found in high amounts in the retina• DHA promotes intellectual and visual development during last 3 months of pregnancy and during infancy• EPA forms biologically active compounds involved in blood pressure regulation, blood clotting, and anti-inflammatory action• DHA is added to many infant formulas

• Ratio of n-6 to n-3 is important• Functions of one are adversely modified by high amounts of the other• People should consume n-6:n-3 at 4:1 or less because high n-6 intake increases inflammation• Canadians n-6:n-3 ratio is over 9:1 === inflammation– We need to increase intake of n-3 fatty acids

• Less healthy fats elevate LDL cholesterol levels– Trans fats– Saturated fats• Less healthy fats are usually solid at room temperature– Meat– “Block” margarine– Lard

• Unsaturated fats are unstable

• They turn rancid with time, oxygen and heat

• Solid fats last longer than oils during frying

• Therefore, the solution is/was “hydrogenation”

• Adding hydrogen to liquid unsaturated fats (oils) makes them more saturated and solid• Shelf life, cooking properties, and taste improve• Hydrogenation has two drawbacks:– Hydrogenated vegetable oils have more saturated fat:* Corn oil contains 6%* Corn margarine has 17%– Hydrogenation changes structure of the unsaturated fatty acids• Converts some fats into trans fats

*WORST

• Trans fat comes from hydrogenated vegetable oils

• Trans fats raise blood cholesterol levels more than other types of fat and promote inflammation

• Increase LDL & lower HDL (worse than saturated fats)

• Not made by body & limited amount naturally in beef & dairy

• Increase the risk of heart disease, stroke, sudden death from heart disease, and type 2 diabetes

* margarines, shortening, peanut butter

* fried fast foods* salad dressing, mayonnaise

* cookies, cakes, crackers, doughnuts

* fried snacks & chips

On September 15th, 2017 Health Canada announced its notice to prohibit Partially Hydrogenated Oils in food in Canada. This prohibition took effect on September 15, 2018.

• Cholesterol is found only in animal products

• Tasteless, odorless, clear liquid

• Plants do not contain cholesterol because they can’t produce it and don’t need it

– Endogenous: 2/3 is produced by the liver

– Exogenous: 1/3 comes from the diet

****KNOW STUPID

• Cholesterol is not an essential nutrient

• Dietary cholesterol does not increase LDL to the same extent as saturated fat does (more modest effect)

– Found in every cell in your body

– Serves as the building block for estrogen, vitamin D and testosterone

– A major component of nerves and the brain

– Cannot be used for energy (0 kcal/gram)

*BUILDING BLOCK

- eggs (yolk) (29%)

- meats (36%)

- fats

- milk and milk products

Liver!!!!-eggs

• smoking

• heredity

• lack of exercise

• glucose intolerance (diabetes)

• obesity, especially central

• high LDL / low HDL

• hypertension

• gender - men more likely to develop earlier

• menopause in women

• Conditions that increase plaque formation in the arteries:

– Elevated blood cholesterol & TGs

– Chronic inflammation

• These two conditions are interrelated and work together to increase atherosclerosis

Chylomicron: 80% triglyceride

VLDL: 50% triglyceride, some of the rest

LDL: 50% cholesterol

HDL: 50% protein (healthy)

• HDL helps remove cholesterol from the blood

– Escorts it to the liver for excretion

– High HDL protects against heart disease

• LDL cholesterol gets incorporated into plaque

– narrows blood vessels

• Elevated LDL increases chances of atherosclerosis and heart disease

• Triglycerides are transported attached to VLDL cholesterol

• High blood levels of triglycerides increase heart disease risk

• The efforts to prevent and treat heart disease should include a focus on blood triglyceride levels

- decrease intake of cholesterol

- increase intake of fiber

- lose weight if necessary

- decrease intake of SAT (<10% of calories) & trans fat (0g/d)

• increase activity• quit smoking• lose weight if necessary

• decrease intake of sugar, alcohol, total fat (<30% of calories)• lose weight if necessary• increase activity