midterm 1 Flashcards
(249 cards)
1
Q
nutrition
A
Interdisciplinary science that studies food and health with a focus on the nutrient and chemical properties of foods
2
Q
How long can you survive without food
A
Weeks-month
3
Q
How long can you survive without water
A
3 days
4
Q
Food security
A
Access at all times to sufficient supply of safe nutritious foods (don’t have to scavenge or steal food)
5
Q
Food insecurity
A
limited or uncertain availability of safe, nutritious foods-or ability to acquire them in non socially acceptable ways
6
Q
What does food insecurity result in
A
-can lead to poor quality diet
-Greater risk of chronic disease ( due to less nutrious food)
7
Q
What is food insecurity due to
A
-poverty
-absence of supermarkets
-access to inexpensive, high calorie (low nutrition) foods
-limited cooking facilities
8
Q
Do you know where food insecurity is highest in Canada
A
Northern Canada, Nunavut, the more it costs to transport items the higher the price
9
Q
What are calories
A
a unit of measure that represents of the amount of energy supplied by food, can be released and used by body)
10
Q
nutrients
A
chemical substances used by the body help sustain growth and development
11
Q
6 categories of nutrients and which ones are energy nutrients
A
- Carbohydrates
- Protein
- Fat
4.vitamins - Minerals
6.water
First 3 are energy
12
Q
Poor nutrition can result from
A
Inadequate and excessive nutrient intake
13
Q
Vitamin A (inadequate intake)
A
-inadequate intake, reduced liver stores, blood levels, body will get rid of stores of vit A, so it moves to blood, increasing the levels in blood
-impaired ability to see in dim light
-long term:lead to loss of of vision
Blindness in developing countries
14
Q
Vitamin A (high intake)
A
-hypervitaminosis A (500 000 IU or 50 000 IU)
-Nausea, irritability, blurred vision, headache
-liver damage
-birth defects
Too much vitamin A acts on developing fetus
15
Q
RDA
A
- Recommended dietary allowance RDA, average daily intake level estimated to be meet the needs of of nearly all people (97%-98%) in a certain group.
16
Q
UL
A
The tolerable upper intake level (UL) is the highest average daily intake level likely to pose no health risks, do not exceed this amount on a daily basis
17
Q
What are 3 nutritional deficiencies
A
- Under consumption; developing nations (because of food scarcity)
- Over consumption-typical western diet (contributes to obesity)
3.Under nutrition- from refined foods, lack of micronutrients, enough calories but processed fast foods, limited minerals
18
Q
What groups of people are at higher risk of becomes malnourished than others
A
- Infants
- Pregnant
3.elderly - Recovering from illness
19
Q
Poor nutrition can influence the development of certain chronic diseases -true or false
A
T
20
Q
clean eating (orthorexia nervosa),
A
-unhealthy fixation with eating healthy
-can lead to nutritional deficits
-no specific category in DSM (diagnostics and statical manual) but falls under avoidant/restrictive food intake disorder (ARFID)
-do you feel in control when you stick to the correct diet
- cause psychological stress
21
Q
how do we know what is inadequate or high intake
A
Referring to the dietary reference intakes (DRI), the RDA ( recommended dietary allowance, and UL ( upper limit) most used
22
Q
Which dietary reference intakes are not used often
A
EAR ( estimated average requirement), average daily intake level to meet the needs of half the people in A CERTAIN GROUP
AI ( adequate intake)
23
Q
malnutrition can result from
A
poor diets, disease, genetic factors or a combination of these factors
24
Q
what foods must be labeled
A
-foods containing more than one ingredient (mostly processed foods)
- dietary supplements
-foods with claims of “low fat”, “low calorie” etc. must display nutritional information backing the claim
25
What are the specific guidelines for food labels with claims such as light, low sugar, reduced fat or calories and fat free
-light; no specific guidelines [light tasting]
-low sugar: no guidelines
-reduced fat or calories: 25% less than the original
-fat free <0.5g PER SERVING SIZE ( manipulated serving size)
26
foods that are not required to be labeled
-fresh fruits and vegetables
- raw, single-ingredient meat, poultry, fish and seafood
-very small packages, such as one bite candy
-items with insignificant calories and nutrients such a herbs and spices
-food sold t farmers markets
-food sold only in grocery stores where the product is prepared or packaged in store (bakery items and salads)
-alcoholic beverages
27
foods that are not required to be labeled
-fresh fruits and vegetables
- raw, single-ingredient meat, poultry, fish and seafood
-very small packages, such as one bite candy
-items with insignificant calories and nutrients such a herbs and spices
-food sold t farmers markets
-food sold only in grocery stores where the product is prepared or packaged in store (bakery items and salads)
-alcoholic beverages
28
Difference between nutritional labels in Canada
-in the newer nutritional label: calories is larger and stands out more with a bold line below
-mg amounts are stated for minerals and vitamins
-updated list of minerals of public health concern
-daily values are updated
-new % daily value for total sugars
-serving size stands out more and is more similar on similar foods
-new % daily value footnote
29
What happens when companies use the organic label inappropriately
Financial penalties
30
Organic foods should be lower in
-hormones, antibiotics and pesticide and herbicide residues
31
Overview on organic plants
-must be grown i soils not treated with synthetic fertilizers, pesticides, herbicides for at least three years
-cannot be fertilized with sewer sludge
-cannot be treated by irradiation
-cannot be grown from genetically modified seeds or contain genetically modified ingredients
32
overview on organic animal products
-cannot be raised in factory like confinement conditions
-cannot be given antibiotics or hormones to prevent disease or promote growth
-must be given feed products that are 100% organic
33
on,y products with organic content of —— can be labeled as organic
GREATER THAN 95%
34
Organically grown, organically raised or organically produced all mean the same as organic TRUE or FALSE
True
35
If a multi-ingredient product has 70 to less than 95% organic content
-must declare the percentage of organic content on the label
-may not use the organic logo nor the claim organic
-if less than 70% organic content, can on,y indicate which ingredients are organic in the ingredient list
36
Is organic food always healthier than non organic
nutrient wise (protein/ vitamins etc) are similar. One difference is that organic fruits and vegetables can have higher antioxidant content, organic diets do lead to less pesticide exposure.
37
which foods do you have less of an advantage buying organic
avocados , cantaloupe, pineapple, broccoli, cabbage and corn, have low levels of pesticides so less advantage to buying organic
38
Which foods do you have a greater advantage buying organic
Strawberries, spinach, grapes, apples, tomato’s and celery have higher levels of pesticide residue
39
What do nutritionists say about organic foods
Given the cost of organic foods, it may not be feasible for many Canadians ( expensiveee) we should encourage Canadians to eat more fruits and vegetables closing the gap would be equally or more important for health
40
When a product only indicates which ingredients are organic in the ingredient list, What is the organic content?
organic content is less than 70%
41
Can companies put health claims onto their products
Yes there are 13 approved health claims, they can put them on their product,
42
health claims on food and oats?
Health Canada has determined that the eligible sources of beta-glucan (giving a cholesterol lower effect)j so the claim is “oatmeal helps reduce cholesterol” oat fibre; such as oat bran, rolled oats (oatmeal) and whole oat flour
43
What is increased by enrichment and fortification
Vitamin and mineral content of food
44
Enrichment
Pertains only to refined grain products where thiamine, riboflavin, niacin and iron lost in milling are added back in (whole wheat flour -> white flour), producers of bread, cornmeal, pasta and crackers from refined grains must use enriched flours ( enriched means vitamins/minerals that were originally there is placed back in after stripping the grain)
45
Parts of a whole grain
Bran- fibre rich outer layer that protects the seeed and contains B vitamins and trace minerals
Endosperm- middle layer that contains carbohydrates and proteins
Germ- small nutrient rich core that contains antioxidants, vitamin E, B vitamins and healthy fats
46
What 2 parts of whole grain are lost and remaining when converting whole grain to white flour
Bran and germ are lost and endo sperm is left
47
Fortification
-the addition of a vitamin or mineral not normally found in the food
48
Example of fortification
Added calcium in orange juice
49
Ingredient labels
All ingredients must be listed in descending order of amount present (by weight) heaviest —> lightest
Ingredients causing allergic (peanuts, tree nuts, milk, eggs, fish, shellfish, wheat , soy, sesame, and sulphites must also be listed on the ingredient label
50
Food additives must must be listed TRUE OR FALSE
True
51
What are Food additives
3000 chemicals are added to food to enhance its flavour, colour, texture, cooking properties, shelf life or nutrient content
52
Food additives with GRAS can be used
Without pre-approval (generally recognized as safe),
53
Food additives with GRAS examples
Sodium chloride, sucrose, corn starch, many vitamins/ minerals
54
Should new additives approved by health Canada
Yes
55
Irradiated foods must contain what?
Must contain radura symbol
56
Irradiated foods (3)
Put it through machines with high levels of radiation, food doesn’t retain radiation passes through food and kills what it needs to.
Foods do not retain radioactive particles
Doses 10-20x higher than lethal dose in humans
57
Irradiated foods uses
1. Prevent sprouting
2. Delay ripening (import vegetables)
3. Kill insects/ mold/ bacteria
4. potatoes, onions, wheat, flour, spices, ground beef, reduces E. coli)
58
Dietary supplement
Dietary supplement must be labeled, cannot claim the products,treat, cure, or prevent disease
not classified as a drug so no vigorous testing
59
Are dietary supplements classified as drugs
No, it’s considered as natural health products
60
For natural health products to be sold they need
Must have a product license and displayed natural product number
61
To get product and site licenses what must happen?
specific labeling and packaging requirements must be met, good manufacturing practices must be followed and proper safety and efficacy evidence must be provided
62
Do we generally seek out nutrients we are deficient in?
No, nothing innate in us/ biological that we consume nutrients we need, select food on food preferences, culture, nutrition knowledge and beliefs, cost, hunger, availability, convenience. Humans and most animals will seek water and food, but not generally the best foods, unless they have learned how to eat a well-balanced diet
63
How do we decide when and how much to eat
-hunger, satiety and thirst centres are located in the “primitive” brain, hypothalamus- appetite centre
-inborn attraction to sweet and salty tasting foods, dislike of bitter and sour foods
64
Infants prefer
Sweet liquids to plain water, sweeter the liquid the higher the consumption
65
What makes us “like” or “dislike”
the strongest influence is food preference, a learned behaviour
We reject foods us that bring us discomfort, guilt and unpleasant memories (eating something that gave us food poisoning; as a child having to eat vegetables before leaving the table
Food preference is shaped by memory and memories are based on culture and the pleasure associated with the memory
66
Food marketing can influence food choices?
-create food trends; vegan, keto, carnivore
-encourage you to buy certain foods or drinks, buy foods in order to get promotional items such as loyalty points, tickets to movies or sports events, coupons for future food purchases
-create links between certain foods or brands and a particular lifestyle
-build brand loyalty so you will continue to purchase from a particular store or products with a brand name
67
Why do companies use red in products
companies use unique colour evoke emotion, red=enhance appetite, increased heart-rate
68
Why do companies use green in their products
Makes you think it’s healthy, natural, eco friendly
69
Why do companies use white
Evoke the thought that is reduced calories
70
Why do companies use yellow
associated with happiness, youthfulness, brain processes yellow very rapidly
71
Orange
Evoke that it’s good value, stimulates appetite and conversation
72
Why do companies use brown
Evoke rich flavour
73
Why do companies use blue
Directed to kids, blue suppresses appetite most unappetizing colour
74
conditions that contribute to death among adults under 75
-health care (10%)
-environmental exposures (20%)
-lifestyles (51%)
-genetic makeup (19%)
75
risk factors
condition or behaviour associated with an increased frequency of disease but not proved to be casual
76
Risk factors
1.dietary
2.genetics
3. age
4. sedentary lifestyle
5.smoking and tobacco use
6. Stress
7. Environmental contaminants
77
Western diets promote
Chronic diseases
78
Characteristics of western diets
-diets high in salt, refined grains, processed meats, refined sugars
-diets low in fruits, vegetables and fiber
79
top causes of death
Nutrition related diseases, heart diseases, cancers, strokes, obstructive lung disease
80
BMI
kg/m^2
<18.5 at risk
18.5-24.9= healthy
25-29.9 =overweight
>30 obesity
81
Prevalence in Canadians
Adult-36.3% have overweight +26.8% have obesity = 63.1% unhealthy weight
The greatest recent increase in obesity is in 20 to 39 year olds
Children- 17% overweight 9% obese 26% unhealthy weight
82
Obesity
Complex, multi factorial chronic disease calorie intake is just one contributor
83
Calorie dense foods
Foods with high calorie example burger, not much nutritional value
84
Are ancient diets the best
Claim; healthiest during paleolithic era 10 000 years ago
Paleo diet restricts what you eat to foods the hunter-gatherers of the Stone Age ate
Would overeat when food available to protect them during famine
Common cycle through periods of feasting and famine
85
Feast and famine then
Root vegetables (high in fibre) nuts seeds and wild game
86
Feast and famine now
Too much choice contributing to overeating
87
What are the biological processes in the body that make it hard to stay healthy
-we get hungry every 4-6 hours even in the presence of excess body fat stores (consuming more calories than what we burn)
-our bodies conserve sodium-historically diets were low in sodium and there was lots of vigorous activity sweating and diarrhea, so it was advantageous to conserve sodium for survival (high sodium salt diet leads to high bp)
88
We naturally prefer what kinds of foods
fatty and sweet tasting foods
89
What do we associate sweet taste with
Calories and nutrients that are safe for human consumption, help orient our behaviour to seek out and consume these foods
90
What is bitter associated with
Toxic products (lots of vegetables taste bitter therefore people consume less)
91
Today we over consume what and eat fewer what
Over consume- sugary foods and eat fewer vegetables
92
Was the Stone Age healthier
No, many died of starvation, vitamin deficiencies and food poisoning, died younger so less degenerative diseases (died younger)
93
Should we eat like they did in the past
No, meats differing (leaner back then)
Fruits and vegetables differ (different types causing nutrient level to vary)
Environment is different more pollution, sedentary behaviour etc
94
So instead of focusing on attempting to implement ancient diets
Exercise more and integrate wholesome foods into diet
95
Sources of nutritional information
Celebrities, influencers, media
96
Typical problems from nutritional information
Tight deadlines (rushed inconclusive not thorough)
Limited understanding
Single study
Report scientific findings prematurely
Half truths and hype are common in books, magazines, media internet, etc ( but what they are doing is not necessarily legal,y wrong because of our right of free speech
97
Nutrition in media (what is unlawful?)
And
Is it rare to see these laws enforced
Unlawful to state false claims on a product label or in an ad
Unlawful yo use US or Canadian mail systems to send fraudulent products or receive payments for fraudulent products
Yes, penalties are minimal
98
What is the primary reason for nutrition misinformation
-profit
99
Why are fraudulent products very profitable
When people think there is a quick and easy way to lose weight, build muscle, slow aging and reduce stress, it results in a huge profit market for nutrition products and services
100
How much is the world market for vitamins
3 billion
101
What certifications does a registered dietitian need
BS in nutrition
Internship
National licensing exam
Registration (college of dietitians of Alberta)
RD
102
In September 2016 were people describing themselves as nutritionists without certification
Yes
103
What happened after September 2016
The title nutritionist can only be used by members of the college of dieticians if alberta
104
What are titles that need certifications
Registered dietitian
RD
Nutritionist
Dietician
Registered nutritionists
105
Sources of reliable nutrition info
Health organizations ( heart and stroke foundation, Canadian diabetes association)
Scientific organizations (Canadian nutritional society )
Professional organizations (dieticians of canada)
Government publications (health Canada)
Registered, licensed or certified dietitians
Nutrition textbooks (not diet books)
106
Importance of research in nutrition
Facts and evidence provided by scientific studies used to develop nutrition information and guidelines that affect public health
Peer reviewed papers published in scientific journals
pubmed
107
Nutrition deception
1.Too good to be true or a quick fix
2. Testimonial (before and after pictures)
3.Make you suspicious of food supply
4.fake credentials
5.elimination of whole food groups
6.use of the word, natural
7.supplements needed by all, megadoses
108
What are 8 concepts that serve as a foundation for our understanding of nutrition
1. Food is a basic need for human
2. Food provides energy nutrients and other substances required for health
3. Poor nutrition can result from both inadequate and excessive nutrient intake
4. Malnutrition can be a result of poor diets, disease, genetic factors or a combination of these factors
5. Some groups of people are at a higher risk of becoming malnourished than others
6. Poor nutrition can influence the development of certain chronic diseases
7. Adequacy, variety,balance are key points if a healthful diet
8. There are no good or bad foods
109
What are healthy diets characterized by
Adequacy, and balance
110
Adequate diets
Diet with a variety of foods that provide sufficient level of calories and essential nutrients, contains all nutrients necessary for long term survival but it may not be necessarily be optimal or have any variety
111
Balanced diet
Provide calories, nutrients and other components in the right proportions, a balanced diet has the six classes of nutrients in good proportion
112
2 types nutrients and examples of each
Essential- nutrients the body produce or produce in sufficient amounts, must be obtained in the diet example- iron, calcium
Nonessential- nutrients the body can manufacture in sufficient quantities example cholesterol
113
Recommended nutrient intake for carbohydrates
45%-65%
114
What is the recommended amount of fat?
20-35%
115
Recommended protein intake
10%-35%
116
Recommend fibre intake
25g-38g
117
Western diets are overloaded with and low in
-refined sugars
-refined grain
-salt
- saturated fats
Low in
-essential fatty acids
-vegetables and fruits
-fibre
118
High intakes of fat (saturated fats and trans fat) are risks for
Heart disease and metabolic syndrome
119
Low intake of dairy product and vitamin D are risks of what?
Osteoporosis
120
What adults regularly consume broccoli, dark leafy greens,
6%
121
What are dark leafy greens associated with
Reduced cancer risk
122
Most commonly consumed vegetable in Canada
Potato in the form of fried
123
Whole grains reduce the risk of what diseases
-cancer
-type 2 diabetes
-heart disease
124
What % of Canadian do not consume any whole grains
50% Canadian children 54% Canadian adults
125
Guides to healthy diets
-Canada food guide
- My Plate (USDA)
- Mediterranean food pyramid
126
The previous food guide focused 4 groups
1. Grain products
2. Vegetables and fruits
3. Milk products
4. Meat and alternative
127
Canada food guide reccomendations NEW
Plate instead of rainbow, the new food guide focuses on broader statements and no longer uses the food group categories
Make your drink of choice water
Eat protein foods (1/4 of plate)
Eat whole grain foods (1/4)
Have plenty of fruits and vegetables (1/2)
128
Healthy food choices ( choose foods with blank instead of blank)
Healthy fats over saturated
129
USDA MY plate
Grains- 1/4 plate grains and at least half should be whole grains
Protein- vary your protein
Vegetables and fruits, more veg than fruit (focus on whole fruit)
Dairy; move to low fat or fat fee dairy milk or yogurt
130
Mediterranean diet pyramid
WHO, developed guide in 1994 to help popularize a diet associated with reduced risk of heart disease and cancer
-emphasizes olive oil, bread, whole grain cereals, nuts,fish dried beans, vegetables and fruits and wine in moderation
- intake of red meats limited to monthly and sweets and poultry to weekly intake
131
Mediterranean diet pyramid Key features
Rich in plant foods, olive oil, limited red meat
132
Our bodies are in a continuous state of what
State of renewal
133
Materials used to renew body tissues come from the food we eat in the form of nutrients T or F
T
134
Digestive system is made up of the following ( main organs )
- mouth
-pharynx
-epiglottis
-esophagus
-stomach
-small intestine
-large intestine
- rectum
-anus
135
Digestive system accessory organs
-liver
- galbladder
-pancreas
136
What does the gut do
Approximately 92-99% of the protein, fat and carbs that we. Consume is digested and absorbed here
137
Dietary fibre is not digested by humans True or false
True most is fermented by bacteria
138
When did we discover bacteria can cause infections
-late 1800s
139
What is higher levels of antibiotic use coincided with
Higher levels of childhood asthma and obesity
140
Types of microbiota
-viruses
-bacteria
- fungi
- protozoan
141
Types of microbiota
-viruses
-bacteria
- fungi
- protozoan
142
The body part with the most densely colonized ecosystem
Gut
143
Baseline gut bacteria is associated with
-Predicting weight loss in response to diet intervention
-response to chemotherapy and immunotherapy (influence of the effectiveness of this treatment)
-responder/ non responder to artificial sweeteners Artificial sweeteners like aspartame and saccharin can alter the gut microbiota, which may lead to metabolic changes. Some individuals are “non-responders” because their microbiota composition isn’t significantly altered by sweeteners, while others may experience negative metabolic effects like insulin resistance.
144
Why is age 3 significant in a infants microbiota
Starts to resemble the diversity and stability of an adults
145
Why is the gut microbiota important
-train immune system
-harvest energy from fiber
-intestinal barrier and motility
-produce vitamins such as vitamin K
146
What causes dysbiosis
Microbiota (helpful bacteria and microorganisms living in the gut) can become imbalanced
-A low-fiber, high-sugar, high-fat diet disrupts gut microbiota by killing helpful bacteria and promoting harmful ones. This damages the gut lining, allowing harmful bacteria and LPS (lipopolysaccharides) to leak into the bloodstream. LBP (lipopolysaccharide-binding protein) binds to LPS, triggering an immune response that causes chronic inflammation. This affects the liver and brain (via the gut-brain axis), leading to neuroinflammation linked to anxiety, and also causes inflammation in fat tissue, contributing to insulin resistance.
147
Fecal microbiota transplant
Profile in gut can cause disease
(Rat-rat and interspecies tests from humans to rats ran)
-when doing a FMT with a rat that is obese onto a regular rat, body fat in recipient mouse increased
-FMT associated with patients with colorectal cancer increased tumour incidence
-FMT from patients with depression induces depressive live behaviours in recipient mice
148
What is a major modifier of the gut microbiota
Diet
-promote symbiosis (mutualistic relationship with gut bacteria and us)
149
How do we promote symbiosis with our gut
-High fiber diet
-include whole natural foods
150
Without fibre
The thick mucous layer that protects are intestinal cells from bacteria get eaten by pathogens/harmful bacteria and carbohydrates and proteins are in direct contact with intestinal cells 9disrupting digestion and causing inflammation)
151
Dysbiosis can be caused by
1. High fat high sugar foods
2. Artificial sweeteners
3.dietary emulsifiers polysorbate 80 and carbosymethocellulose
4. Ultra processed foods
152
Mechanical digestion
Physical breakdown of food,
Chewing, grinding and mixing food either mouth,tongue and teeth
153
Chemical breakdown of food
Use enzyme, bile and hydrochloric acid
Over 100 enzymes that are secreted by the digestive system
154
Stomach ——- chyme into ——-
Percolates chyme into the small intestine
155
Stomach ——- chyme into ——-
Percolates chyme into the small intestine
156
Solid foods stay in stomach for —-and liquids pass through in —-
Hours, 20 minutes
157
Amount of solid food passed to small intestine at a time
1-2 teaspoons
158
How long is the small intestine and parts
6 meters long composed of jejenum, duodenum and ileum
159
Surface area of small intestine
675 square feet
160
Intestinal cells turn over every
4-5 days due to high nutrient needs
161
Where are the end products of digestion taken by
Blood vessels (carbohydrates and protein breakdown products) are taken up for distribution to the body
Lymphatic vessels (fatty acids from fat breakdown) this empties into the subclavian veins which feed back to the heart
162
The large intestine
Water, sodium and some of the end products of bacterial digestion are absorbed from the large intestine
Bacteria digest fibre and complex carbohydrates that we can’t digest
These bacteria excrete gas and short chain fatty acids that can be absorbed in large intestine
Substances that cannot be absorbed are excreted as feces
163
Pancreas
The enzymes produced by the pancreas act to breakdown all of the major energy nutrients
164
Enzymes and their associated macronutrients produced by the pancreas
Carbohydrates- amylases
Proteins- proteases
Fats- lipases
When broken down these small molecules are transported into cell lining the small intestine
165
Heartburn
Caused by excessive stomach acid or defective lower esophageal sphincter- causes burning sensation in the esophagus
166
Acid reflux
Common medical condition that can range in severity from mild to serious/ Gastrophagael reflux disease GERD is the chronic, more severe form of acid reflux. Heartburn is a symptom of acid reflux and GERD
167
What is factors involved in heartburn
Stress, anxiety, frequent, use of aspirin and other anti inflammatory medicines, fatty foods, spicy foods coffee, alcohol, citrus fruits, soft drinks and other foods are involved
168
What increases the symptoms of heartburn
Weight gain and eating within 3 hours prior to going to bed increase symptoms, , weight gain of 10-20 pounds associated with a 3 fold increase in heartburn symptoms
169
What protects against development of heartburn
High fibre diets
170
Treatments include (heartburn)
Stress reduction
Elimination of offending foods (spicy)
Eating small and frequent meals
Mild occasional heartburn can use over the- the counter antacids but with persistent symptoms (prescription medications may be needed (proton pump inhibitor)
171
When do ulcers develop
develop when protective stomach or duodenum lining is damaged. HCLs lowers the pH of the stomach to about 1.5-2 stomach acid and digestive enzymes erode the lining and cause an ulcer
Duodenal ulcers are closely associated with heavy NSAID use and or the presence of H pylori bacteria
Rates of H pylori infection are highest in countries with poor sanitary conditions
Classified as Class I carcinogen- stomach cancer
172
Class 1 carcinogens
1. Alcoholic beverage
2.Asbestos
3. Cadmium
4. Engine exhaust, diesel
5.epstein bar virus
6. HPV
7. Radiation
8. Paint fumes
9. Tobacco smoke, secondhand, smokeless
10. Radon
173
Constipation, hemorrhoids
-Constipation and hemorrhoids are due to diets with too little fibre
-adults need fibre intakes of 25g/day females to 38 (males) g/day plus plenty of fluids
- this regimen will help prevent constipation and hemorrhoids in healthy people
174
Diarrhea
-severe diarrhea leads to dehydration, heart and kidney, malfunction and death
-most due to bacterial- or viral-contaminated food or water, lack of immunizations aganist infectious diseases and deficiencies
3.5 million deaths from diarrhea occur annually in children five years old or less
175
Most foods contain a mixture of…
-energy nutrients and other substances
176
Kilocalorie
The amount of heat required to raise the temperature of 2kg of water 1 degree
177
Carbohydrates and proteins are how many calories per gram
4kcal/gram
178
How many calories per gram of alcohol
7 cal/gram
179
How many calories come from fat
9kcal/gram
180
How much energy do we need
-Thermal effect of food 10% of basal and physical activity
-physical activity (20%)
-basal metabolism (60-75%)
181
Factors that affect basal metabolic rate
1. Age (increased age reduced metabolic rate)
2. Height ( increased height increased metabolic rate
3. Growth= increased metabolic rate
4.Body composition= increased lean mass= increased BMR
5.Fever= increased metabolic rate every 1 degree= 7%increase in BMR
6.Stress= increased stress increased BMR
7.environment temperature increased BMR
8.fasting/starvation lower BMR
9. Malnutrition decreased BMR
10. Thyroxine increased BMR
182
Basal metabolism
Men= body weight (lbs) x 11kcal
Women= body weight x 10kcal
183
Physical activity
-activity tables; sum of all activity for the day),
-activity factors
Inactive= basal metabolism x 1.3
Average= basal metabolism x 1.5
Active= basal metabolism x 1.75
Dietary thermogenesis total ( Basal + PA) x 0.1 add this to the sum of basal and PA and this is the total calorie need
184
Physiological influences for hunger
Empty stomach, gastric contractions, absence of nutrients, GI hormones ( elevated gherlin), endorphins (brain pleasure compounds)
185
What is the process of hunger
Hunger—> Seek food—> continue meal —>satiation—> meal ends—-> satiety
186
Why do we stop eating
-presence of food triggers stretch receptors
-nutrients in intestine elicit satiety hormones
GLP-1
CCk both are released
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Why do we not start eating yet
-nutrients in blood signal brain
-as nutrients diminish, satiety diminishes and hunger develops
-hunger hormones increase ghrelin
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Fat % in body , importance of body composition
-essential fat: men 3% women 12%
Bone marrow, central nervous system, internal organs
-Acceptable % body fat
Men 18-25% (> 26% classified as obesity)
Women 25-31% (>32% classified as obesity)
Fitness % body fat
(Men 14-17%)
(Women 21-24%)
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Below certain threshold of fat% may experience
Infertility, develop depression,abnormal hunger regulation and unable to keep warm
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Apple shaped body compostion
Excess fat in the chest and stomach areas , visceral/central and abdominal fat) causes a higher risk for diabetes, heart disease and hypertension than pear shaped bodies apple shape most likely place to gain weight in men
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Pear shaped body composition
Excess fat i the hips, thighs and buttocks =, subcutaneous fat most likely place to gain weight in women
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When are men at risk when waist size is..
102cm
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What waist size are women at risk for
88
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Metabolic syndrome exist in the presence of 3 of the following
-abdominal obesity; waist circumference greater than 102 cm in men or greater than 88cm for women
-elevated levels of triglycerides (1.7mmol/L)
-Low levels of HDL (<1.0 mmol/l for men and 1.3 mmol/L in women)
-high blood pressure/hypertension (>130/85)
-impaired fasting glucose (>6.1mmol/L) pre diabetic state
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What are the measurements. Of body composition
Fat fold measure, DXA, underwater weighing, bioelectrical impedance
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Fat fold measure
Use caliper to gauge thickness of a fold of skin on tricep,sub scapular, chest, abdomen or thigh
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Underwater weighing
measure body density by weighing person first on land then submerged in water amount of water displaced and and the known density of fat mass, and lean mass. By volume, fat weighs less than muscle and and muscle each have a constant mass and displace a specific amount of water
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Bioelectrical impedance
Use low intensity electrical current. Lean tissue conduct more current, fat, more resistant to current (when current passes through fat mass, fat mass is resistant) a limitation is the calibration of the machine
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DXA
Use low dose x ray absorption to measure lean and fat mass and bone density
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Lean mass heavier than
Heavier than fat mass
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Limitation of BMI
These men have the same BMI but different health risk
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Underweight in the US usually results from
Genetics or from poverty, lines or voluntary restriction of food
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Fad diets
- short because people can’t stick to it example raw food diet, juice cleanse, paleo
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Greatest weight loss
During 1st week of dieting
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What do you lose in the first week of dieting
-CHO, H20, (70% H20, 25% fat 5% lean mass)
Lose primarily glycogen 1 gram glycogen 3G h20
Water weight
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True or false rapid weight regain when you resume normal eating after 1 week
True
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In 2nd week of dieting
20% h20
Fat and lean mass
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In 3rd week of dieting
Minimal h20 loss
Fat and lean mass
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Why does weight loss becomes increasingly difficult
You need to fewer kcal to maintain new lower body weight (basal energy needs are tied to body weight) and they go down as the body weight goes down
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How do we gain adipose tissue
-fat cell development
Hyperplasia ( increase in number of fat cells)
Hypertrophy (increase in the size of fat cells)
Critical periods for fat cell increase
- late childhood
-puberty
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Critical enzyme affecting fat storage
LPL promote fat storage in adipose and muscle
People with high LPL store fat very efficiently
-individuals with obesity have more LPL activity per fat cell and more fat cells even modest excess in energy intake has more dramatic effect in an individual with obesity versus lean (easier for them to gain weight)
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LPL as a gender specific hormones
In women, fat cells in breasts, hip and thighs produce more LPL and in men cells in the abdomen produce more LPL (where there is LPL is where excess energy will go gain fat in specific area)
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After weight loss what happens to LPL
LPL increases
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Why do we lose weight and regain it easily
LPL increases after weight loss
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Leptin
Made in adipose cells
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An increase in leptin
Negative energy balance
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Decrease in leptin
Positive energy balance
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What happens in increase in leptin
-gain of body fat
-blood leptin increases
-hypothalamus responds to diminishing
Food intake decreases and energy expenditure increases
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Result of an increase in leptin
Negative energy balance
When leptin levels are high the hypothalamus produces proteins called melanocortins which dampen appetite
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What happens when there is a decrease in leptin
Loss of body fat—> blood leptin decreases—> hypothalamus responds stimulating appetite
Food intake increases and energy expenditure decreases
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Result of positive energy balance
When leptin levels are low the hypothalamus produces a protein called neuropeptide Y which stimulates appetite and slows energy expenditure leptin inhibits neuropeptide production
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Four prescription medication are available for the treatment of overweight and obesity
-xenical (orlistat)
-semiaglutide, wegovy, ozempic
-linaglutide; saxenda
-contrave (naltrexone x bupropion)
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How does xenical work
Block fat absorption in the testing so that you absorb fewer calories,capsule taken after or during every meal (results in diarrhea, fatty stool)
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Contrave
Low dose naltrexone used for addiction and bupropion used for depression, work on two separate areas of the brain to control hunger and cravings
Oral tablet
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Semaglutide
Wegovy and ozempic,
-GLP-1 glucagon like peptide-1 is a satiety hormone found naturally in the body acts by decreasing appetite
- pre-filled pen self inject once a week
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Liraglutide
Saxenda
-GLP 1 receptor agonist
-pre-filled pen that you self inject daily
Long acting
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Why is semaglutide and liraglutide super effective weight loss drugs
They overcome appetite signals levels of ghrelin and PYY
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Is ozempic a long term drug
Yes because it manages obesity not treats it
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Organized weight loss programs
- weight watchers
Works as a point system cook their own food
-Jenny Craig
Helps people to track their food with proportioned, pre established serving sizes and meals
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Why are diets unsuccessful
-hard to follow
-different than what we are accustomed to
-easy to slip off and “cheat”
-people want a quick and easy fix
-persistent obesity changes the biology of the body
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What does it mean by persistent obesity changes the biology of the body?
- the body makes metabolic changes hard to go back to old weight
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Full year after significant weight loss
-ghrelin was 20% higher
-PYY 20% lower
-body acted as if starving “post dieting syndrome”
- appetite hormones are not reaching equilibrium, metabolic adaptation persist over a longtime
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Is willpower enough to overcome biological signals
NO
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Post weight loss
-muscle biopsy- burns 20-25% less energy during low intensity exercise and activities of daily living (after weight loss we burn less calories)
-skeletal muscle work efficiency increased
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Following calorie restriction
-functional MRI activation in the attention and reward regions in response to food ( which areas of the brain will light up in response)
-caloric deprivation increased the reward value of high calorie foods increase cravings and can result in a binge ED
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More invasive and drastic measures of weight loss
1. Prolonged fasting
2. Bariatric surgery
3.Liposuction
Each of these carries risk and the last 2 are expensive af
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Prolonged fasting
Causes intestinal starvation
- 50-80% of intestinal nutrients are provided by the food we eat
-mucous and cells are lost from GI tract lining
-
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Difference of prolonged fasting and intermittent fasting
-caloric restriction and intermittent fasting result in similar degrees of weight loss and improvement in insulin sensitivity
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Surgery available which clinical population
-over 28years old
-bmi over 40
-bmi less than 35 plus 1 or more (high bp, high cholesterol, diabetes, sleep apnea)
-have tried different ways of trying to lose weight
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Surgery can reduce weight by ——- and most can maintain ———
50% maintain the weight loss
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Limitation
Risk and complications during and after surgery
-expensive
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Bariatric surgery 3 types
-adjustable gastric band
-gastric bypass
-vertical sleeve gastrectomy
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What is gastric band
- safest type of Bariatric surgery requires follow up for band adjustments (removable)
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Gastric bypass
-greatest weight loss
- reduce stomach size from football to egg bypass first section of small intestine stomach contents automatically move directly to duodenum
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Vertical sleeve gastrocteomy
About 2/3 of stomach removed leaving a sleeve/tube behind, ghrelin removed giving a metabolic response
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Liposuction
Max amount of fat removed=5L (4.5kg)
- purely cosmetic not intended for WL
- risk include bumpy skin, due to uneven fat removal, poor skin elasticity and unusual healing, changes may be permanent
-liposuction removes fat cells for targeted areas of the body, so if you gain weight the fat will be stored in different parts of the body
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Maintainers of weight loss
-exercise regularly
-make small;; and comfortable changes in diet and PA
-eat breakfast (contribute to appetite regulation throughout the day)
-choose low fat options
-keep track of their weight, dietary intake, PA level
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Regainers of weight
-exercise little
-use fad diets
-make drastic and unpleasant changes in diet and PA levels
-take diet supplements
-cope with problems by stress eating
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National weight loss registry
Largest observational study of weight maintenance and includes individuals who have maintained a weight loss of at least 30 lbs for at least 1 years
-identifies behaviours associated with long term weight loss success
