Alcohol and Nutrition Flashcards
1
Q
What is alcohol?
A
a class of organic compounds containing hydroxyl groups (OH)
2
Q
What is ethanol (ethyl alcohol)?
A
A particular type of alcohol found in beer, wine, and distilled liquor
One of the most widely used and abused drugs in our society
A legal non-prescription drug that can produce euphoria
3
Q
What can alcohol do to cells?
A
Alcohol can rapidly enter cells and destroy cell structures . . .ultimately killing the cell
4
Q
What can be said about alcohol and toxicity?
A
Toxic in relatively small amounts which makes alcohol dangerous
Toxicity is also beneficial to kill microbial cells
Ethanol is less toxic than the other alcohols
When diluted and consumed in small quantities, ethanol can be used with low risk
5
Q
What is one standard drink of alcohol?
A
13.6 grams of alcohol (1/2 oz)
6
Q
Alcohols are made from what typically?
A
Starch or sugar
7
Q
What is a standard drink of wine?
A
142 ml (5 oz) of wine (approx 12% alcohol)
sometimes written as 150 ml
8
Q
What is a standard drink of hard liquor?
A
43 ml (1.5 oz) (approx 40% alcohol)
sometimes written as 45/50ml
9
Q
What is a standard drink of beer?
A
341 ml (12 oz) (approx 5%)
sometimes written as 350ml
10
Q
Distilled liquor is often stated in proof. What does this look like?
A
80 proof refers to 40% alcohol (double)
11
Q
Advertising occurs television, radio, print media, billboards, and point-of-sale display. What has 2/3 of alcohol advertising expanded to?
A
Product placement (tv and movies)
Event venues
Scholarship sponsorship
Alignment with charities
Merchandise
Contests
Internet and social media
12
Q
Alcohol enters the body and arrives in the brain. How does this happen? What does it look like?
A
Requires no digestion and can diffuse through the stomach wall - reaches the brain within a minute
High doses of alcohol trigger vomiting for protection
13
Q
How does a full stomach influence consumption?
A
Limits alcohol absorption through the stomach
Delays gastric emptying – thereby delays transit to intestine
14
Q
How does alcohol dehydrogenase (ADH) influence how females and males absorb alcohol?
A
It is made by the stomach
Females generally have less in the stomach than males, so they absorb more alcohol
Fasting promotes ADH breakdown – it’s a protein
15
Q
Most alcohol is absorbed in the small intestine. What happens here?
A
Once in the intestine, food intake is not relevant
Liver is a major site of alcohol metabolism (alcohol dehydrogenase (ADH) and approx 10% MEOS)
16
Q
What can be said about urine and alcohol?
A
10% of alcohol is excreted in breath and urine
Alcohol increases urine output - decreases production of antidiuretic hormone.
17
Q
What happens if alcohol intake exceeds what the liver can handle?
A
The alcohol circulates through the body and affects the body and brain
18
Q
What is MEOS?
A
Another system in the liver which metabolizes alcohol and some drugs.
- It handles about 10% of alcohol consumed
- It handles more in high concentrations or repeated exposure
- Results in better tolerance
19
Q
What are some challenges with drug metabolism?
A
Some drugs are metabolized by MEOS
MEOS deals with alcohol first if alcohol and drug taken at same time - Drugs build up - effects amplified
Heavy drinker - has more MEOS - handles drugs more quickly when not drinking
20
Q
Is alcohol a stimulant?
A
Drinking can relieve inhibitions, but it is not a stimulant
21
Q
Brain centres respond to alcohol in a particular order.* What is it?
A
Frontal lobe – judgement and reasoning
Speech and vision centres become sedated
Large muscle control is affected
Conscious brain is completely subdued so person passes out
Deepest brain – respiration and heart rate
22
Q
The more alcohol consumed…
A
The longer alcohol circulates in the body, the longer it takes before alcohol dehydrogenase can break it down
23
Q
Alcohol affects every organ but is most evident in the liver. Normally, what does the liver do?
A
Liver cells normally use fatty acids as fuel
Liver packages excess fatty acids into triglycerides and ship them to other tissues.
24
Q
What does the liver do with alcohol?
A
Fatty acids accumulate while the liver is busy breaking down the alcohol
Increased fat synthesis by the liver
Stages of liver deterioration seen in heavy drinkers: (Fatty liver, Fibrosis, Cirrhosis) but these conditions can develop from other causes too
25
What are some of alcohol's potential long-term effects?
Alcohol is toxic to cardiac & skeletal muscle (weakness and deterioration which is greater with higher doses)
Brain cell destruction (contribute to dementia)
Cirrhoses
Cancer: mouth, throat, esophagus, breast, stomach, pancreas, liver, colorectal
Bladder, kidney, prostate damage
Bone deterioration and osteoporosis
Central nervous system damage and strokes
Type 2 Diabetes
Impaired immunity
Impaired memory and balance
Depression
Skin rashes and sores
Stomach ulcers
26
What can be said about tobacco and alcohol together?
Worse for you than either on its own
27
Drinking about 3.5 drinks a day doubles or even triples your risk of developing what?
cancer of the mouth, pharynx, larynx and esophagus.
28
Drinking about 3.5 drinks a day increases your risk of developing colorectal cancer and breast cancer by ___ times.
1.5
29
Alcohol abuse disrupts every tissue's metabolism. How does it affect stomach cells?
over secrete acid & histamine
(Inflammation)
30
Alcohol abuse decreases absorption of what?
thiamin, folate and B6 via intestinal cells
31
What does alcohol abuse do with vitamin D and A?
Less efficient activation of vitamin D by the liver & altered production & excretion of bile. Liver cells lose efficiency at converting vitamin D to active form
Reduced capacity to process and use vitamin A. Liver cells lose efficiency at converting vitamin A
32
Alcohol abuse does what with minerals?
Kidney excretion of minerals increases
(Magnesium, calcium, potassium, zinc)
33
Alcohol abuse can lead to folate deficiency (excess alcohol promotes folate excretion, inhibits its absorption, & interferes with its action). What does deficiency look like?
Liver loses the ability to retain folate
Folate excretion in the urine by the kidneys increases
Folate is secreted in the bile and reabsorbed in the intestines- intestines
damaged by folate deficiency and alcohol toxicity therefore decreasing folate absorption
Alcohol interferes with converting homocysteine to methionine-therefore increased homocysteine
34
Alcohol abuse also affects Thiamin deficiency (decreased absorption). What happens with this?
Inadequate intake and impaired absorption
Wernicke-Korsakoff syndrome
35
Alcohol abuse leads to B6 deficiency (decreased absorption). What does this look like?
Acetylaldehyde dislodges B6 from its binding protein causing deficiency and lowered production of red blood cells.
36
Alcohol causes increased acid production by the stomach cells. What can this lead to?
possible ulcer formation or irritating GERD
37
What is Wernicke-Korsakoff Syndrome?
thiamin deficiency with chronic alcoholism
Paralysis of eye muscles, poor muscle coordination, impaired memory, damaged nerves
May respond to treatment with thiamin supplements
38
People treated for alcohol addiction also often need nutrition therapy to reverse deficiencies. Like what?
Night blindness, Beriberi, Pellagra, Scurvy, Protein-energy malnutrition
39
What does Canada's Guidance on Alcohol and Health say for 0 drinks per week?
Not drinking has benefits, such as better health, and better sleep. During pregnancy, none is the only safe option. It is the best option when breastfeeding as well.
40
What does Canada's Guidance on Alcohol and Health say for 2 drinks or less per week?
You are likely to avoid alcohol-related consequences for yourself or others at this level.
41
What does Canada's Guidance on Alcohol and Health say for 3-6 drinks per week?
Your risk of developing several types of cancer, including breast and colon cancer, increases at this level.
42
What does Canada's Guidance on Alcohol and Health say for 7 drinks per week?
Your risk of heart disease or stroke increases significantly at this level.
43
What can be said about each additional standard drink according to Canada's Guidance on Alcohol and Health?
Each additional standard drink radically increases the risk of alcohol-related consequences.
44
Consuming more than 2 standard drinks per occasion is associated with what?
an increased risk of harms to self and others, including injuries and violence.
45
When is zero the limit according to these guidelines?
Driving a motor vehicle;
Using machinery and tools;
Taking medicine or other drugs that interact with alcohol;
Doing any kind of dangerous physical activity;
Being responsible for the safety of others;
Making important decisions."
46
In healthy adults, abstaining from alcohol or reducing intake to 2 drinks per day or less is recommended to prevent what?
Hypertension
47
In adults with hypertension who drink more than 2 drinks per day, a reduction in alcohol intake is associated with what?
Decreased blood pressure and is recommended
48
In adults with hypertension who drink 6 or more drinks per day, a reduction in alcohol intake to 2 or fewer drinks per day is associated with what?
Decreased BP and is recommended
49
What are some ways to limit alcohol according to the Canadian Cancer Society?
Hydrate with water (Do not quench thirst with alcohol)
Serve mocktails (Provide drinks without alcohol at parties)
Measure drinks (Keep track and don’t order doubles)
Wind down without alcohol
(Find a different way to relax - Go for a walk, read, do yoga)
Choose low salt snacks (Salt makes us thirsty)
Pace yourself (Have a non alcoholic drink between alcoholic drinks. 1 drink per hour)
Set reasonable goals
(I’ll have 3 days without alcohol. I’ll go out tonight and not drink. I’ll have one drink)
Don’t pre-drink
(Keep track and don’t order doubles
Cut down the alcohol content (Shandy or spritzer)
Take the focus off drinking
(Don’t just sit at a table or the bar and drink
Dance or play pool)
50
In young people, does alcohol benefit health?
No. Increased risk of death:
Car crashes, homicides, & other violent deaths
Increased breast cancer risk
51
What can be said about alcohol and heart disease?
1 - 2 drinks per day reduces the risk on those over 60 years of age who have an increased risk of heart disease (More alcohol than this increases the risk of heart disease).
Both wine & beer reduce heart attack risk in some populations
Researchers have also found after following 6000 men for 20 years that there was no benefit to mortality from cardiovascular disease at any level.
52
What are some potential benefits of alcohol?
Potential decrease in cardiovascular risk
(Improved lipid profile
Decreased coagulation
Increased insulin sensitivity)
Compounds in red wine
(Flavonoids – plant-based antioxidants
Quercetin
Non-flavonoids
Resveratrol)
Get them from something else. Consider age, frequency
53
What are some health effects of wine?
Antioxidant properties
High potassium in both wine & grape juice may lower high blood pressure
Flavonoids & antioxidants in wine may protect against events that are thought to trigger heart disease
(Wine delivers small amounts of antioxidant flavonoids as compared to onions & other vegetables)
Alcohol increases oxidation in the body
54
What can be said about alcohol and appetite?
Usually makes people unaware of their hunger
Small dose of wine may be beneficial in promoting appetite in the elderly
55
Alcohol disrupts the liver, as the liver accumulates fat which it cannot handle. The liver cells become less efficient at performing its regular tasks such as:
Activating vitamin D
Producing and releasing bile
Making glucose from protein
56
Synthesis of fatty acids increases with exposure to alcohol. The accumulation of fat can be seen even after 1 bought of heavy drinking. What does that do?
First stage of liver deterioration
Disrupts the distribution of nutrients and oxygen to the cells in the liver
Fatty liver is reversible with abstinence from alcohol
If fatty liver lasts (such as with continued alcohol consumption) liver cells die and scar tissue is formed
57
What is fibrosis?
The second stage of liver deterioration
Good nutrition and abstinence from alcohol can help some liver cells regenerate
58
What is cirrhosis?
The most advanced stage of liver disease. Cells harden and permanently lose their function. Least reversible
59
What happens with fatty liver and liver disease?
Gluconeogenesis decreases
Low blood glucose can occur
60
How does alcohol affect gout symptoms?
It worsens them due to uric acid metabolism
61
How does alcohol affect the synthesis of blood lipids?
It speeds it up. Increasing triglyceride concentrations and increasing HDL concentrations
62
Even with adequate protein intake, how does alcohol affect proteins?
Alters amino acid and protein metabolism
Depresses production of immune system proteins
63
How does alcohol affect the reproductive system in women and men?
In women, infertility and spontaneous abortion
In men, suppression of testosterone secretion, leading to decreased muscle and bone tissue, abnormal prostate, and decreased reproductive ability
64
What are the two things that are large in hangovers which cause headache, pain, and nausea?
Dehydration and formaldehyde
65
How does dehydration play a role in hangovers?
Reduced water content of brain cells and pain with rehydration
66
How does formaldehyde play a role in hangovers?
In the body methanol is produced as part of usual activities within the cell and...
These are the liver enzymes that process ethanol to acetaladehyde and then to carbon dioxide and water
Through competition for the enzymes there is a build up of formaldehyde
67
What can be said about moderate drinkers?
Alcohol adds extra calories (7kcal/g) & often stimulates appetite
Alcohol is efficiently metabolized in moderate doses therefore can contribute to body fat and weight gain
The body preferentially stores fat & uses alcohol for energy
Central obesity appears to accompany alcohol consumption "beer belly"
68
What can be said about heavy drinkers?
More alcohol leads to less food consumed which causes them to be less likely to consume adequate nutrients
Consumed as a substitute for food
Alcohol is a type of "empty calories"
69
What are some of the acute (short-term) risks of alcohol?
impulsive behaviour
impaired attention, concentration and judgement
drowsiness
aggressiveness and violent behaviour
slowed reaction time
slurred speech
double or blurred vision
flushed skin
nausea and vomiting
frequent urination
impaired memory or loss of memory
70
Severe alcohol intoxication can lead to alcohol poisoning, which can result in what?
Stupor (lack of critical mental function and a level of consciousness, in which an affected person is almost entirely unresponsive and responds only to intense stimuli such as pain)
Coma
Respiratory arrest
Death
71
How can fetal damage occur with alcohol?
Every drink during pregnancy is also received by the fetus within minutes
A dose of alcohol can temporarily stop oxygen to the fetus via the umbilical cord
Alcohol slows cell division – causing abnormalities
Brain cells may also be reduced in number
Alcohol affects mother’s nutrient supply and thereby delivery to fetus
Even before pregnancy both the egg and sperm can be damaged by alcohol
72
A low birthweight baby is common in those who...
drink two drinks/day during pregnancy
73
What is fetal alcohol spectrum disorder?
Fetal alcohol spectrum disorder describes the impacts on the brain and body of someone exposed to alcohol in the womb.
Prevented by abstaining from alcohol
Irreversible
Not genetic
Estimated to be present in 1% to 5% of Canadians
74
People with FASD may need support with what?
learning
memory
attention
social skills
motor skills
physical health
communication
emotional regulation
75
The impact of alcohol on a developing fetus depends on what factors?
How often alcohol was consumed
How much alcohol was consumed
When during the pregnancy the alcohol was consumed
76
What other factors can affect fetus development?
Stress
Age during pregnancy
Smoking or other drug use
Nutrition status prior to and during pregnancy
77
What is considered 1 standard drink of wine?
5 oz (143 ml) of wine
78
Which of the following produces enough alcohol dehydrogenase to digest a significant amount of alcohol?
The stomach, the liver, the pancreas, a and b, or a, b, and c
The liver and the stomach
79
Which of the following is not a water soluble vitamin?
Vitamin A, B12, Thiamin, Riboflavin, or vitamin C
Vitamin A (fat soluble are A, D, E, K)
All B vitamins and vitamin C are water soluble
80
The major site of nutrient absorption is which of the following?
The stomach, the small intestine, the large intestine, the liver, or the pancreas?
The small intestine
81
Which of the following is a poor source of iron?
Milk
Red meat
Legumes
Fish
Poultry
Milk & milk products are a very poor source
Even though zinc & iron were v similar, milk is a good source of zinc
82
Which of the following is a good source of calcium?
Calcium
Spinach
Canned salmon w bones
Soft Drinks
Red meat
Canned salmon w bones
83
Which of the following helps prevent neural tube defects?
Vitamin A
Vitamin C
Riboflavin
Folate
Folate -- 400 micrograms for anyone who might be pregnant every day due to this risk.
Needed prior to the individual probably knowing they were pregnant
84
Prenatal vitamins are low in which vitamin because high amounts during pregnancy can cause malformations to the infant?
Vitamin A
Vitamin C
Riboflavin
Folate
Vitamin D
Vitamin A. It can be harmful to the fetus.
May see beta-carotene in infant vitamins, so it doesn't convert to vitamin A fast enough typically. Can cause skin to turn orange. Increase in lung cancer for smokers, even though antioxidant
85
Which of the following removed in new nutrition facts tables?
Vitamin A
Vitamin C
Calcium
a and b
b and c
Vitamin A
86
AI for females for total water is 2.7 litres per day. What is included in total water?
Water from foods
Water from caffeinated beverages
Water from non-caffeinated beverages
All of the above
All of the above
* Water and fiber have an AI, not an RDA (not enough info for EAR so not for RDA, so there is an AI instead)
87
Linoleic acid (6) is which of the following
Polyunsaturated fatty acid
88
Which of the following is not an essential nutrient for someone near the equator?
Vitamin D
89
Which mineral is not essential but is beneficial?
Fluoride
90
Eating behaviour seems to be regulated by what?
Signals and mechanisms that stimulate eating
Signals and mechanisms to stop eating or lead on to refrain from eating
91
Which exerts weaker control, hunger or satiation/satiety?
Satiation and satiety exert weaker control (can be ignored) than hunger
92
Hunger is the unpleasant sensation that signals need for food. How long after eating does it occur?
4-6 hours
Food has left stomach & much of the nutrient mixture has been absorbed.
93
What is hunger triggered by?
Contracting empty stomach and an empty small intestine
The stomach hormone ghrelin produced between meals as
well as chemical & nervous signals in the brain
94
What are some other factors influencing hunger?
Nutrients in the bloodstream
Size & composition of the previous meal
Weather: Heat reduces food intake and cold increases food intake. People living in air conditioned environments during summer may explain why weight is not lost during summer anymore
Exercise
Sex hormones
Illnesses
95
The hunger response quickly adapts to changes in food intake. What can happen with restriction?
Hunger lessens but does return
Can lead to bouts of overeating that overcompensate for the calories lost during the deprivation period.
96
Appetite differs from hunger. What is appetite and what can affect it?
The psychological desire to eat. Can be experienced without hunger (even when satiated). Sight & smell of food can stimulate the brain's endorphins, molecules that create an appetite despite an already full stomach. Illness or stress may result in the loss of appetite in a person in physical need of food.
97
What are some other things that affect appetite?
Hormones
Inborne appetites (preferences for fatty, salty and sweet)
Learned preferences, aversions (negative experiences), timings
Customary eating habits
Social interactions
Some disease states
Appetite stimulants, depressants, mood-altering drugs
Environmental conditions (prefer cold foods in hot
weather)
98
What is satiation and what does it determine?
The perception of fullness that builds THROUGHOUT a
meal eventually reaching the degree of fullness &
satisfaction that halts eating
Generally determines how much food is eaten at one sitting
Stretch receptors in the stomach send signals to the brain that tell it that the stomach is full. The brain also detects nutrients in the blood
99
What is satiety and what does it determine?
The perception of fullness that lingers after a meal and inhibits until the next mealtime
Generally determines the length of time between meals as it suppresses hunger
100
What is sensory specific satiety (SSS)?
The concept that we tend to get bored of a food as we eat it. The more variety there is, the more likely it is that we will increase overall consumption.
101
Hunger and satiety are not equal in strength. Hunger is stronger. What is leptin?
An appetite-suppressing hormone
May also contribute to satiety
*Produced by adipose tissue and stomach
Travels to the brain
Directly linked to appetite control & body fatness
102
How does gain or loss of body fat affect leptin production?
Gain of body fatness stimulates leptin production, reducing food consumption; resulting in fat loss
Loss of body fat reduces leptin secretion...increasing appetite
103
Does the glycemic index affect hunger?
Studies mixed for the glycemic index
- Some show that a low-glycemic index diets reduced or delayed hunger
- Some have found the opposite or no effect
104
Of the energy-yielding nutrients, which are the most satiating?
Protein. May account for the popularity of high-protein diets
Protein affects both satiety and satiation.
105
Which macronutrient is known for its effect on satiety but not satiation?
Fat (fat provides a lot of kcalories in a small volume).
106
What else can help delay hunger?
High-fibre foods and water
107
Why do protein and fat promote satiety?
Protein and fat trigger the release of an intestinal hormone (CCK) that slows stomach emptying and prolongs feelings of fullness.
108
What are some selected metabolic theories?
Set point theory
Fat cell number theory
Thermogenesis 1: Brown fat theory
109
What is the set point theory?
Body somehow attempts to maintain a stable body weight
110
What is the fat cell number theory?
Fat cells may increase faster in children who are obese contributing to obesity as adults
111
What is the thermogenesis 1: Brown fat theory?
Brown fat has abundant energy wasting proteins. Lean people may have more brown fat. Infants have abundant brown fat.
Brown fat produces more heat than storing energy (insulation)
112
What are the intestinal microbiota?
Investigations undergoing looking for links between intestinal bacterial and bodyweight
113
What can be said about genetics and obesity?
In rare instances, the primary cause of obesity is genetic
Influence how efficiently body stores and uses energy
Can be inherited tendency toward developing obesity but genes are not solely responsible
Children with at least 1 parent who is obese have a 40-70 % chance of becoming obese
Adopted children tend to be similar in weight to their biological parents, not the adoptive parents
Identical twins are twice as likely as fraternal twins to weight the same when reared apart
If it is genetics, why have obesity rates skyrocketed when gene pool remains the same?
While genetics influences a person's tendency to become obese, lifestyle choices determine if the tendency is realized.
People tend to seek out the easy way and as a result, decrease energy expended in activities of daily living.
114
What are some external cues to overeating?
Variety leads people to eat even when they are not hungry (i.e., a wide variety of appealing foods such as sweets)
Overeating also occurs in response to loneliness, craving, addiction, compulsion, depression, time of day, stress. Varies from day to day.
115
How do food price, availability, and advertising affect eating?
High-calorie fast foods are relatively inexpensive, widely available, heavily
advertised & arguably delicious
Availability & advertising can attract consumers of fast foods, can they also
attract consumers of healthy foods?
Moderation is key
116
What can be said about physical activity and obesity?
Obesity for some may be mainly a lack of activity
Diet histories of those who are obese often report
energy intakes similar to, or even less than, others
Current inactivity levels are a recent phenomena
- Lack of physical work required for most people
- Physical inactivity is approaching epidemic proportions
- Built environment: “environment the buildings, roads,
utilities, homes, fixtures, parks, and other human-made
entities that form the physical characteristics of a
community”
117
Physical activity is made up of what two things?
Exercise-related
activity thermogenesis (EAT) and non-exercise activity
thermogenesis (NEAT).
118
What does NEAT correspond to?
All the energy expended with occupation, leisure time activity, sitting, standing, stair climbing, ambulation, toe-tapping, shoveling snow, playing the guitar, dancing, singing, cleaning, and more
119
What is the obesogenic environment?
All the factors surrounding a person that promote weight gain
120
There is no absolute evidence as to which factor(s) are responsible. For some people, what is the best way to obtain a healthy body weight?
Maintain a healthy balanced diet
Engage in daily physical activity
Practice behaviour modification
Maintain a healthy relationship with food
Consider pharmacological therapy or bariatric surgery in addition to the above
Remember, "eat less and move more" is very oversimplified and the issues surrounding body weight and weight changes are extremely complex (barriers, finances, etc)
121
The balance between energy intake & energy output determines whether you gain, lose, or maintain body fat. A slight change or rapid change in body weight may not indicate a change in body fat. What might it reflect?
Body fluid content
Bone minerals
Muscles
Bladder or digestive tract contents
Change often correlates with time of day
122
What can be said about smoking and weight?
Nicotine blunts feelings of hunger
Smokers tend to weigh less than nonsmokers
Many smokers gain weight when they stop smoking BUT quitting smoking is still more important and has significantly more benefits
123
What can be said about moderate weight loss versus rapid weight loss?
When you take in insufficient food energy, body will draw on energy stores
Exercise, moderate calorie restriction & a balanced diet -- body will use its stores of fat -- gradual weight loss
Moderate calorie restriction promotes fat loss and better retention of lean tissue compared to a severely restricted fast
124
What is the body's response to fasting?
Less than a day into fast: liver glycogen stores are used up
Protein is broken down in order to meet the brain's need for glucose
125
What happens to the body with continued fasting?
Breakdown of protein (skeletal muscle, muscle of heart, liver, etc.)
To slow down breakdown, the body converts fat into ketone bodies, to fuel the nervous system can adapt to using.
126
What happens with ketosis?
The body takes partially broken-down fat fragments & combines them to form ketone bodies.
After 10 days of fasting, most of the nervous system's energy needs are met by ketone bodies
Survival mechanism - a healthy person starting with average body fat content can live totally deprived of food for 6-8 weeks
127
There is no evidence that fasting "cleanses" the body. In some cases, fasting may harm the body. How?
Ketosis upsets the acid-base balance of the blood, promoting excessive mineral loss in the urine
24 hours of fasting and the intestinal lining can begin to lose its integrity
Food deprivation can lead to overeating/ binge eating. This effect may last beyond the point at which normal weight is restored
Fasting degrades the body’s lean tissues
The body also adapts to fasting by decreasing metabolic rate
128
Ketogenic diets (low-carb, high-protein) bring about large initial weight losses. Glycogen holds a lot of water and a lot of water loss to urinate out urea. What happens when a person begins to eat normally? Why might weight loss occur?
Weight loss rapidly reverses. It is restoring glycogen stores and it reinforces the idea that carbs are bad.
Limited variety (go and eat a bagel versus a chicken breast)
Protein rich foods are often slow to prepare
Energy rich desserts and snacks are often high in carbs
129
What is the body's response to a low-carbohydrate diet?
Low-carbohydrate diets bring about responses similar to those seen when fasting.
As carbohydrate runs low the body breaks down fat & protein
for energy & ketones form to feed the brain
130
To prevent ketosis, the DRI committee has set recommendations
for carbohydrates. What are they?
*Minimum of 130 grams/day (RDA over 1 year of age)
*45%-65% of total energy intake is recommended for health
(AMDR
131
Energy yielding nutrients contribute to excess body fat stores. What happens to protein, fat and carbohydrates?
Protein: excess amino acids have their nitrogen removed & are used for energy or converted to glucose or fat
Fat: fatty acids can be broken down for energy or converted to triglycerides and stored as body fat with great efficiency
Carbohydrate : excess sugars may be built up to glycogen & stored, used for energy, or converted to fat & stored
Alcohol: used for fuel or converted to body fat & stored. Slows down the body’s use of fat for fuel by as much as ≈ 33%, causing
more fat to be stored - Primarily as visceral fat (dangerous central fat)
(All can be stored as fat when exceeding need)
132
How can the body lose weight?
Energy in must be less than energy expended. A balanced diet may be the safest in the long term (adequate essential nutrients & limiting saturated, trans fat and refined carbohydrates). Increase physical activity. Set appropriate goals for weight loss (reasonable goal may be to prevent weight gain, reduce body weight by 5-10% over a year. Can be argued weight loss goals are not ideal -- focus on healthy behaviours).
133
How should one set goals for weight loss?
Determine if weight maintenance or loss is most appropriate
Set and overall goals (SMART specific, measureable, achievable,
relevant, time-based)
Set smaller goals for diet, physical activity & behaviour changes
Slow weight loss is less likely to result in a rapid regain of
weight
134
How can one keep records of weight loss?
A tool for spotting trends & identifying areas in need of
improvement
Measure waist circumference to track changes in central
obesity
135
What are some other strategies for weight loss?
Weight loss need to be individualized (no particular food must be included or excluded. Adopt a healthy eating plan)
Choosing realistic calorie intakes (Intakes lower than about 800 calories (very low calorie diets/VLCD) are unsuccessful at achieving lasting weight loss, lack necessary nutrients, and may promote eating disorders)
Balancing carbohydrates, fats and proteins (AMDRs: C 45-65%, F: 20-35%, P: 10-35%) and choosing good sources of each.
Portion sizes (eat until satisfied)
Strictly limit alcohol intake (provides abundant calories but very few nutrients, reduces inhibitions & can sabotage healthy eating and exercise plans)
Energy density (review kcalories per serving)
Consider milk and milk products (higher calcium intake, especially from low-fat milk & milk products, correlates with lower body fatness
Meal spacing (frequent small meals are more successful at weight loss & management for some. Make sure mild hunger, not appetite, prompts eating)
136
What can be said about physical activity for weight loss?
Activity should be greater than current activity level if
weight loss is desired
Diet, in combination with exercise, promotes fat loss,
promotes muscle retention, inhibits weight gain
Exercise helps people follow diet plans more closely
Exercise improves blood pressure, insulin resistance,
heart & lung fitness, even without weight loss
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What are some of the physical activity benefits for weight loss?
Increasing metabolism and reducing appetite (short-term increase in energy expenditure from exercise & a slight rise in metabolism)
More physical activity benefits (appetite control, stress reduction & control of stress eating, physical & psychological well-being, improved self-esteem)
**Spot reducing (exercising a particular area CANNOT target fat from that area. Aerobic activity promotes the release of abdominal fat. Improves the strength & tone of muscle in problem areas). You cannot control where you lose the fat
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What are the three pillars to support medical nutrition therapy and physical activity for weight loss?
Psychological intervention
Pharmacotherapy
Obesity surgery
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What is Medical Nutrition Therapy (MNT)
Used in managing chronic diseases and focuses on nutrition assessment, diagnostics, therapy and counselling, MNT should:
- be personalized and meet individual values, preferences, and treatment goals to promote long term adherence
- be administered by a registered dietitian to improve weight-related health outcomes
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Surgery is an option for obesity management. What can be said about it?
High BMI with coexisting disease ccording to CPG.
Must be fit for surgery
Leads to significant weight loss in most patients. Often improves hypertension, high cholesterol, diabetes, sleep apnea
Not always a cure for excess adiposity. Some do not lose the expected weight or lose and then gain it back over time.
Long-term safety & effectiveness of gastric surgery primarily depends on
compliance with dietary instructions
Long-term complications can include vitamin & mineral deficiencies and
psychological problems
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What are the different types of surgery treatments?
Gastric banding
Gastric bypass
Duodenal switch
Sleeve gastrectomy (gastric sleeve)
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What is gastric banding?
Provides a restrictive method to weight loss
An adjustable "band" is placed where the esophagus and the stomach meet
The band is a silicone ring filled with saline with a port placed in the muscle of the abdominal wall - adjusted with saline
Need to know how weight loss is caused by each surgery
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What is gastric bypass (roux-en-y)?
Provides a RESTRICTIVE and MALABSORPTIVE method to weight loss because the stomach and small intestines are reconfigured.
A small stomach is created by dividing the stomach, creating stomach pouch that can hold a few bites of food.
The intestines are cut and the entire duodenum and part of the jejunum are bypassed
Need to know how weight loss is caused by each surgery.
144
What is the duodenal switch?
Provides a restrictive and malabsorptive method to weight loss because the stomach and small intestines are reconfigured.
The stomach reduction is less than the gastric bypass but more of the small intestine is bypassed
Like the bypass but even more of the small intestine is bypassed. So, greater weight loss but greater risk of vitamin and mineral deficiencies.
Need to know how weight loss is caused by each surgery.
145
What is the sleeve gastrectomy (gastric sleeve)?
Provides a RESTRICTIVE approach
A long slender sleeve is stapled
"other part” of stomach is removed
Stomach is “banana-sized
Not reversible (part of stomach taken out)
(Creates smaller stomach)
Need to know how weight loss is caused by each surgery.
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In gastric bypass, a nutritional supplement regimen is necessary. What does this look like?
Multivitamin/multi-mineral 2 tablets/day
Vitamin B12
Calcium citrate
Vitamin D
Iron
Must be crushed, chewable or liquid for the first 2 months
Specific brands are generally recommended because of their
vitamin and mineral make up
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What does the gastric bypass surgery diet look like?
Clear fluids for a day
Full Fluids for about 10 days
Pureed diet
Overall, very small amounts – about 4 tablespoons per meal
Need to ensure adequate:
– protein supplement
– liquids
– vitamin and mineral supplements
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Medications are not a quick fix (long term strategy - if stopped, weight gain occurs) but why are they something that need to be considered earlier?
Obesity related health
conditions tend to increase or worsen over time
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What prescription medication is off the market?
Sibutramine
- Suppresses appetite by inhibiting serotonin reuptake
- Maximum weight loss was achieved after 6 months in 2 year
studies – regained when therapy stopped
- Taken off market in Canada in 2010
- SCOUT found that certain patients with pre-existing heart disease had a 16%
greater chance of experiencing a non-fatal cardiac adverse event
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What are some available drugs for weight loss?
Xenical Orlistat
Saxenda liraglutide
Contrave naltrexone & bupropion
Wegovy Semaglutide
Some are meant for diabetes with weight loss as a side effect
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For many, herbal products' effectiveness & safety have not been proven. What is important then when using them?
Informing
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What are the two conditions ephedrine are allowed in Canada?
Short periods of time as nasal decongestants
There are also approved products that contain ephedra for use as traditional medicines.
Authorized products carry an 8 digit Drug Identification Number (DIN), indicating Health Canada Approval
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What is ephedrine not allowed for?
Weight loss
Increased energy
Body-building
Euphoria
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Herbal laxatives or "dieter's tea" are not really efficient. What do they do?
May dehydrate you & result in water loss
155
A key to weight maintenance is what?
Accepting it as a lifelong endeavour of healthy habits. Healthy diet, portion control and exercise. Be mindful that this is not as possible for everyone.
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If someone has a BMI of under 18.5, how can one gain weight?
Physical activity (muscle mass).
Diet alone can bring about weight gain - fat. Generally, this is not ideal. May be a good idea for someone with a wasting disease. Eat enough to support activity, to gain muscle and fat. May take 700-1,000 calories/day above normal energy needs
Choose nutritious energy-dense foods (peanut butter instead of lean meat, avocado in place of cucumber, olives instead of pickles).
Portion size & meal spaces (increase, expect to feel full, eat frequently, make foods appealing, start with main course, drink milk (alternatives) or smoothies between meals
Weight gain supplements (typically useless without physical activity)
Avoid tobacco (suppresses appetite and makes taste buds and olfactory organs less sensitive).
