KIN 346 Flashcards
What factors influence what we eat?
Individual factors (personal) < social environment (networks) < physical environment (settings) < macro-level environments (sectors)
What is nutrition?
The science of foods and the nutrients they contain, and of their action within the body (including ingestion digestion, absoprtion, transport, metabolism, and excretion). Also includes the study of the social, psychological, economic, and cultural factors of what we eat and the implications of what we eat
Clinical work deals with?
Special populations such as cancer or diabetes
Community work deals with?
Nutrition of populations, planning programs and initiatives
Sports nutrition work deals with?
Attaining the highest level of human performance
Nutrigenomics deals with?
Genetics and what we eat and how what we eat affects our genes
2 reasons why studying nutrition is important?
- Nutrition affects health (the WHO estimates that 2.8% of deaths every year are due to lack of fruits and veggies, and 4 out of the top ten leading causes of death are related to nutrition) 2. Nutrition is important for exercise and sport performance
What are nutrients?
Chemical substances acquired from food and used by the body to provide energy and structural materials and support growth, maintenance, and repair of body tissues and metabolic function. Nutrients can also decrease the risk of some diseases
What are essential nutrients?
Indispensable nutrients…the body cannot make in adequate quantities to meet needs, therefore, they must be supplied by the diet
How many essential nutrients are there for humans?
40 essential nutrients
What are some examples of essential nutrients?
Omega 3 and omega 6 FAs, vitamins and minerals, and some amino acids
What are non-essential nutrients?
Nutrients that the body can make from other materials…like glucose
6 major classes of nutrients?
Carbs, lipids, proteins, vitamins, minerals, water
What are the macronutrients?
carbs, fats, proteins
What are the roles of macronutrients?
Broke down for energy and used for other roles in the body such as structures, enzymes, etc.
Of the 6 major classes of nutrients which are organic?
Fats, proteins, carbs, vitamins
Of the 6 major classes of nutrients. which are micronutrients?
Vitamins and minerals
Of the 6 major classes of nutrients, which are inroganic?
Water and minerals
What is energy?
The capacity to dod work
Imperial unit for energy?
Kilocalories…measure of heat
What is the SI unit for energgy?
Joules or kJ
Conversion for kCals to kJoules?
x 4.2
Kcal/g for protein?
4
Kcal/g for fat?
9
Kcal/g for carbs?
4
Kcal/g for alcohol?
7
Energy density?
Measurement of how energy a food provides in relation to the quantity of food (kcal/grams of food)
Micronutrients?
Essential, non-energy yielding nutrients, needed in small quantities
How many essential vitamins are there?
13
Two major classes of vitamins?
Water soluble and fat-soluble
Water soluble vitamins?
B vitamins (thiamin, riboflavin, niacin, biotin, pantothenic acid, vitamin B6, foalte, vitamin B12), and Vitamin C
Fat soluble vitamins?
A, D, E, K
Can vitamins be destroyed easily?
YES due to light, chemicals, and heat
Minerals?
inorganic, essential nutrients found in bones, teeth, and body fluids
Major minerals?
More than 100 mg/day…Ca, P, K, Na, Cl, Mg, S
Trace minerals?
< 100 mg/day…Fe, I, Zn, Cr, Se, Fl, Cu, Mn, Mo
Can minerals be destroyed?
No, BUT they may be bound to other substances and consequently may not be properly absorbed into the body (iron in legumes) OR they can be lost via refining and cooking processes (leeched away in the water and discarded)
Nutrient density?
Measurement of the nutrients a food provides in relation to the amount of energy it provides
% of adult body made up of water?
60%
Role of water?
Takes part in metabolic reactions, transport of nutrients to cells and waste away from cells, plus many other functions including lubricating joints and temperature regulation
Tips for separating fact from quack?
Look at who is providing the info, where it is coming from, when it was made available, why it is being relased, and what is the message being presented.
DRI?
Dietary Reference Intake…a set of scientifically based nutrient refernence values for healthy populations. Can be used for assessing and planning diets for populations and individuals
DRIs are used to determine levels of intake that will…
prevent deficiency, support good health and prevent chronic disease, and avoid harmful effects of excess intake.
What are DRIs specific for?
Age, gender, and life stage
4 reference values fro nutrient intakes?
EAR, RDA, AI, and UL
EAR?
Estimated Average Requirement…average daily intake of a nutrient needed to meet the needs of 50% of healthy individuals
RDA?
Recommended Dietary Allowance…daily intake of a nutrient needed to meet the needs of 97-98% of healthy individuals. Calculated from teh EAR (2 SD above), and can be used as a goal for individuals
AI?
Adequate Intake…established when there is too little data to establish and EAR/RDA. Based on average amount consumed by healthy individuals, can be used as a goal for an individual
UL?
Tolerable Upper Intake Level…highest regular intake from ALL sources likely to pose no risk of adverse health effects for most healthy individuals
In what range do you want to keep your DRIs?
Between the RDA.Ai and the UL
2 reference values for energy intakes?
Estimated Energy Requirement (EER) and Acceptable Macronutrient Distribution Range (AMDR)
EER?
Estimated energy requirement…average energy intake needed to maintain energy balance and good health for a healthy person
AMDR?
Acceptable Macronutrient Distribution Range…recommened ranges of carbs, fats, protein intake as a % of total energy. Meeting the AMDRs will help to ensure adequate energy and nutrients while decreasing the risk of chronic diseases
AMDRs for adults?
45-65% energy from carbs, 20-35% energy from fat, and 10-35% energy from protein
4 possible uses of DRIs by Health Canada?
1, assessments of diets of individuals and groups 2. design and evaluation of diets in a variety of institutions 3. creation of nutrition guidelines and education programs 4. development of regulations around the nutritional quality of the food supply
Points to consider when using the DRIs?
- DRIs apply to healthy individuals 2. Recommendations are for the majority 3. Goals should be met through a variety of foods 4. Recommendations are for average daily intakes and day to day variability is expected
Metabolism?
Process by which nutrients are broken down to yield energy or used to make body structures
Nutrigenomics?
the science of how nutrients affect the activities of genes
Nutrigenetics?
How genes affect the interactions between diet and disease
Examples of epidemiological studies?
Cross sectional studies, case control sutdies, cohort studies
What are epidemiological studies?
Determine the incidence and distribution of disease in a population
Strengths and weaknesses of epidemiological studies?
Strengths: can narrow down possible causes, can raise questions to pursue through other types of studies Weaknesses: cannot control variables that may influence the development of the prevention of the disease, cannot prove cause and effect
Examples of experimental trials?
Laboratory based studies and human intervention/clinical trials
What are lab based studies?
explore the efects of a specific variable on a tissue, cell, or molecule. Conducted in test-tubes (in vivo) and on animals (in vivo)
Strengths and weaknesses of lab based studies?
Strengths: can control conditions and can determine effects of a variable Weaknesses: cannot apply results from test tubes or animals to human beings
Human intervention or clinical trial strength and weaknesses?
Strengths: can control conditions for the most part and can apply findings to some groups of human beings Weaknesses: cannot generalize findings to all human beings, cannot use certain treatments for clinical or ethical reasons
Adequacy?
Diet provides al essential nutrients, fibre, and energy in amount sufficient for health
Balance?
Foods and food groups are obtained in appropriate proportions
Energy control?
Energy in is balanced with energy out
Nutrient density?
Nutrients provides by a food relative to the amount of energy provides
Empty calorie foods?
Foods that provide a lot of energy (kcal) but not any nutrients
Moderation?
Avoiding excess
Variety?
eating a wide selection of foods
What are the 6 principles of diet planning?
Adequacy, balance, energy control, nutrient density, moderation, and variety
What are food group plans?
Diet planning tools that sort foods into groups based on nutrient content and other common attributes (e.g. commodity group, common use) and then specify that people should eat certain amounts of foods from each group
Eating Well with Canada’s Food Guide provides guidance on both the ____ and ____ of food choices?
Quantity and Quality
Eating Well with Canada’s Food Guice is designed to meet?
DRIs
Following Eating Well with Canada’s Food Guide will help people to?
Get enough vitamins, minerals, and other nutrients. Reduce the risk of obesity, type II diabetes, heart disease, certain types of cancers, and osteoporosis. Achieve overall health and vitality.
Four food groups for EWWCFG?
Veggies and Fruit. Grain Products. Milk and alternatives. Meat and alternatives.
Serving size for fresh, frozen, or canned veggies?
125mL of 1/2 C
SS for leafy cooked leafy veggies?
125 mL or 1/2 C
SS for leafy raw veggies?
250 mL or 1 C
SS for fresh, frozen, or canned fruit?
1 fruit or 125 mL or 1/2 C
SS for 100% juice?
125 mL or 1/2 C
SS for bread?
1 slice or 35 g
SS for bagels?
1/2 bagel or 45 g
SS for flat breads?
1/2 pita and 1/2 tortilla or 35 g
SS for cooked rice, bulgur, or quinoa?
125 mL or 1/2 C
SS for cold cereal?
30 g
SS for cooked cereal?
175mL or 2/4 C
SS for cooked pasta or couscous?
125 mL or 1/2 C
SS for milk or powdered milk?
250 mL or 1 C
SS for canned milk?
125 mL or 1/2 C
SS for fortified soy beverage?
250 mL or 1 C
SS for yogurt?
175 g or 3/4 C
SS for kefir?
175 g or 3/4 C
SS for cheese?
50g or 1.5 oz
SS for cooked fish, shellfish, poultry, lean meat?
75 g/2.5 oz or 125 mL/0.5C
SS for cooked legumes?
175 mL or 3/4 C
SS for tofu?
150 g or 175 mL or 3/4 C
SS for eggs?
2 eggs
SS for peanut butter or nut butters?
30 mL or 2 Tbsp
SS for shelled nuts and seeds?
60 mL or 1/4 C
How much unsaturated fats should be included in your diet each day?
20 to 40 mL or 203 Tbsp. This includes oils used for cooking, salad dressings, margarine, and mayo. Limit butter, hard margarine, and shortening/lard.
How many glasses of lower fat milk should you drink each day?
500 mL or 2 cups
How much of your grains should be whole grain?
About half
What 3 things should you liimit in your diet?
Fat, added sugars, and sodium
What should you eat at least one of each day?
One dark green (vitamin A and folate) and one orange vegetable (beta carotene)
How many food guide servings should you have a fish each week?
2…choose fatty fish like herring, char, salmon, etc.
2 overall recommendations from EWWCFG?
Enjoy a variety of foods from the four groups and satisfy your thirst with water
How much moderate to vigorous activity is recommended for adults?
2.5 hours per week
Mandatory nutrition info on a food label?
Nutrition facts table and ingredient/allergen list
5% daily value is considered?
A little
15% DV is considered?
a lot
Ingredients are listed in the ingredient list by what?
By weight, from the most to the least
What must be clearly displayed on the food ingredients list?
Food allergens, sulphites, and gluten
Exchange lists?
diet-planning tools that organize foods by their proportions of carbs, fats, and protein. Foods on any single list can be used interchangeably.
Processed foods?
Foods that have been treated to change their physical, chemical, microbiological, or sensory properties
Fortified foods?
The addition to a food of nutrients that were NOT originally present or present in insignificant amounts.
Refined?
The process by which the coarse parts of a food are removed. When wheat is refined into flour, the bran, germ, and huse are removed, leaving only the endosperm.
Bran?
protective coating around the kernel that is rich in nutrients and fibre
Germ?
seed that grows into a wheat plant, so it is especially rick in vitamins and minerals to support new life
Endosperm?
contains mostly starch and some protein
Enriched?
The addition to a food of nutrients that were lost during processing so that the food will meet a specified standard
Whole-grain?
A grain that maintains the same relative proportions of starchy endosperm, germ, and bran as the original
Examples of whole grains?
amaranth, barley, buckwheat, bulgur, corn, couscous, millet, oats, qunioa, rice, whole rye, whole wheat
Substitute foods?
Foods that have the same nutritional value as another food, but are not physically similar, such as stimulated egg products
Imitation foods?
Foods that substitute for and resemble another food in flavour, texture, appearance, and nutritional value. Must appear on food label.
Diet related nutrient claims?
Statements that characterize the quantity of a nutrient in food
Diet related claims?
statements that characterize the relationship between a nutrient or other component in a food and a disease or health related condition
Disease risk reduction claims?
These statements make clear well-established links between a nutrient or other component in a food and reduction in risk of developing a diet-related disease in the context of the total diet
Function claims?
these statements claim well-established benefits from consuming a nutrient or other component in a food on normal biological functions in the body
General health claims?
These are broad claims that provide dietary guidance or promote general health through healthy eating.
When you want to decrease the quantity of specific nutrients, look for…
Free, Low, Lower/Reduced, and Light
WHen you want to increase the quantity of specific nutrients, look for…
Source, High or good source, Very high or excellent course, and more or higher
What is a nutritional assessment?
Info used to determine the health status of an individual or population, as influences by their intake and utilization of nutrients
4 key components of a nutritional assessment?
Historical info, anthropometric measures, physical examinations, and lab tests
3 parts of historical infor
- Health history (disease/ilness, family, lifestyle factors) 2. Drug/Supplement History (OTC/prescribed/street) and Supplements 3. Socioeconomic history (education, income, occupation, ethnicity, food availability, number of people in household, etc)
Examples of some diet assessment methods?
24 hr recall, food frequency questionnaire, food records, observation, and duplicate portion analysis
Data obtained in a diet assessment are then analyzed against what standards?
Canada’s Food Guice and DRIs
24 hour recall?
Individuals are asked to recall all foods and beverages consumed in the previous 24 hour period…self administered or dietitian/health professional/researcher administered
Food Frequency Questionnaire?
Uses a scale to report how often an individual eats or drinks certain items over a specific time…collects data on usual consumption patterns over longer periods of time…may focus on specific food categories
Food records?
A detailed lsit of all foods consumed (including type, amount, preparation method over a designiated period of time)…can be completed on paper or electronically and estimated or weighed
Limitations of Diet Assessment Methods?
Recall error, inaccurate estimation of portion sizes, poor food preparation knowledge (restaurant foods), response bias due to factors such as underrporting and participant burden
Strategies to overcome limitations in diet assessment?
- Prompts to assist with memory 2. Visuals to assist with portion size estimation 3. Multiple pass technique 4. Multiple days 5. Detailed instructions and sample day 6. Ensure anonymity and confidentiality
What are anthropometrics?
Body measurements
What are the purposes of anthropoemetrics?
- Assess gorwth (infants, children, adolescents, and pregnant women) 2. Detect under/over nutrition 3. To track changes over time
Anthropometric measures can be compared to?
Growth charts (adolescents/children), WHO BMI cutoffs (for adults), and other measures measures taken on the same individual
Is training necessary to take anthropometric measures?
YES!
What are growth charts?
Used in children 0-19 to compare anthropometric measures to a reference population of the same sex and age. Used to track growth and development. WHO growth charts adapted for use in Canada.
Key anthropometric measures?
Length/height (length for children 2y), weight, and head circumference
What is BMI?
Body Mass Index…kg/m^2
What are some issues with using BMI?
- Doesn’t distinguish between fat and muscle 2. DOesn’t give info on fat distribution
Increased risk for obesity related diseases happens at what waist circumference for men and women?
Men is > or equal to 102 cm. Women is greater than or equal to 88 cm
Components of a physical examination?
- External check (hair, eyes, posture, teeth and gums, tongue, glands, skin, nails) 2. Internal check (heart rate, blood pressure, digestive function, reflexes, mental status) 3. Muscle and Bone
What types of lab tests are there?
- Blood (glucse, blood lipids, hemoglobin, retinol binding protein, albumin, vitamin and mineral status) 2. Urine (nitrogen losses) 3. Feces (fat malabsoprtion)
Primary deficiency caused by inadequate diet is revealed by?
Diet history
Secondary deficienct caused by problem inside the body is revealed by?
Health history
Declining nutrient stores (subclinical) or Abnormal functions inside the body (covert) are made known by?
Lab tests
Physical signs and symptoms (overt) are made known by?
Physical exams and anthropometric measures
Nutrition screening?
Used to identify individual who may be malourished or at risk fro malnutrition
Digestion?
Breaking down food into smaller pieces/units which can then be absorbed by the body (Food –> Nutrients)
Absorption?
The uptake of nutrients into the blood and lymph via intestinal cells for transport to other cells around the body
What is the digestive systeM?
Tube that goes from the mouth to rectum/anus as well as other organs/glands which allows food/drink to be ingested and digested and its nutrients to be absorbed
Lumen?
Space inside the GI tract
DIgestive enzymes?
Proteins secreted throughout the digestive system that help break down food into absorbable units (and nutrients)
Carbohydrase?
Pancreatic enzyme that breaks down carbs
Lipase?
Breaks down fats
Pepson and Protease?
Breaks down proteins
Mastication, and what it does?
Chewing, the teeth mechanically break down food which increases its surface area (this allows digestive enzymes to have better access to the food)
Salivary glands?
Secretes saliva (mix of water, salts, mucus, and ezymes) which provides lubrication/fluid and helps to iniate carbohydrate digestion
Tongue’s job?
Contains taste buds, helps move food around in the mouth, and assists with chewing and swallowing
Swallowing?
Movement of the bolus (lump of food swallowed at one time) from the mouth (via the pharynx) to the esophagus
What closes to prevent food/liquids from entering the trachea/choking?
The epiglottis
What is the esophagus?
Tube that passes the bolus of food from the mouth to the stomach. Upper and lower esophageal sphincters (bands of muscles) regulate flow and prevent backflow)
Job of the stomach?
Muscular sack that churns and grins foods to a semi-liquid mass and adds gastric juices (water, enzymes, HCl) that is secreted by the gastric glands in the stomach (pH = 2)
What is the stomach a key site for?
Protein digestion…the acid ucoild proteins to allow digestive enzymes to better access the protein and activates a key protein digestive enzyme called Pepsinogen, which is cleaved into Pepsin (the active enzmye)
What is the main site for digestion and absoprtion?
The small intestine
3 segments of small intestine
Duodenum, jejunum, and ileum
What does the pancreas secrete into the small intestine via the pancreatic duct?
Pancreatic juice into duodenum through the pancreatic duct which contains pancreatic enzymes to help break down macronutrients (carbs, fat, and protein) AND sodium bicarb to neutralize the chyme to a pH of 8
What is bile, where is it produced, and where is it stored?
Bile is produced in the liver and stored in the gallbladder and is delievered via the bile duct to the small intestine in response to the presence of fat. It emulsifies fat to allow enzymes to break it down. Intestinal cells also produce some digestive enzymes on their surfaces.
How is the chyme broken down and moved through the GI tract?
Peristalsis (churning) and Segmentation (moving)
PRocess of absorption?
Process by which simple nutrient components produced by digestion migrate out of the GI tract, to the cells lining the GI tract, into the blood or lymph, to the cells of the body
What are features of the SI surface that provide huge surface area for absorption?
Circular folds, villi, microvilli
3 ways nutrients can be absorbed?
Simple diffusion, facilitated diffusion, active transport
Steps in water soluble substance absorption?
Lumen –> intestinal cell –> capillaries –> hepatic portal vein –> liver –> circulation
Steps in fat soluble substance absorption?
Lumen –> intestinal cell (repackaged into chylomicrons) –> lymph –> enter bloodstream near the heart –> circulation
Large intestine?
Lower portion of the intestine (aka the colon)…separated from the small intestine by the ileocecal sphincter
What is the large intestine the main site for?
Water and mineral re-absorption, left with semi-solid waste containg fibre, some bile acids, minerals, additives and contaminants which leave the GI tract via the rectum and anus
What does fibre do?
Helps hold water –> softer fecal mass and increased fecal bulk, binds some minerals, additives, contaminants, fat, and cholesterol
Role of bacteria in the colon?
Can ferment some fibre producing gas, short chain fatty acids, which are used for local energy in the colon cells. Also, can produce small quantities of vitamin K and some B vitamins
Gut processes are regulated by?
- GI bacteria 2. Nerves 3. Hormones
Pathway of food once it enters the mouth?
Mouth –> down the esophagus –> through the upper and lower esophageal sphincters to the stomach –> through the pyloric sphoncter –> to the small intestine –> on through the iliocecal sphincter –> large intestine –> past the appendix to the rectim —> the anus…Along the way, secetions from the salivary glands, stomach, pancreas, liker (via the gallbladder), and glands in the wall of the small intestine deliver fluids and digestive enzymes
What does gastrin respond to?
Food in the stomach
Where is gastrin secrete from?
Stomach wall
What stimulates the release of gastrin?
Stomach glands
What does gastrin do?
HCl acid secreted into the stomach
What does secretin respond to?
Acidic chyme in the small intestine
Where is secretin secreted from>
Duodenal wall
What stimulates secretin release?
Pancreas
What does secretin do?
Releases bicarb-rich juices into the small intestine
What does cholecystokinin respond to?
Fat or protein in the small intestine
Where is cholecystokinin secreted froM?
intestinal wall
What does cholecystokinin stimulate?
The galbladder to secrete bile into the duodenum. The pancreas to secrete bicarb and enxyme rich juices into the small intestine. Also slows gut motility to allow for fat and protein digestion because they take longer.
What separates the small and large intestine?
The iliocecal sphincter
What is the role of the large intestine?
Site for water and mineral re-absoprtio…left with semi-solid waste containg fibre, some bile acids, minerals, additives and contaminants which will leave the GI tract via the rectum and anus
What does fibre do?
Helps hold water, which leads to softer fecal mass and increased fecal bulk. Binds some minerals, additives, contaminants, fat, and cholesterol
What do the bacteria in the large intestine do?
Can ferment some fibre producing water, gas, short chain fatty acids, which is used for local energy for colon cells. Also produce some vitamin K and B vitamins
What regulates the GI tract?
- Gastrointestinal bacteria 2. Nerves 3. Hormones
Factors that can influence intestinal flora?
Diet, pH, peristalsis, other microorganisms, antibiotics
What are prebiotics?
A non digestible food component which can be used as fuel for bacteria in the large intestine to promote their growth and/or activty
What are fructo-oligosaccharides?
Prebiotics that contain inulin such as chicory root, onions, bananas, asparagus, artichokes, leeks, barley, and rye
What are galacto-oligosaccharides?
Prebiotics that are fermented dairy products such as yogurt and kefir
What are probiotics?
Live microorganisms which when adminisztered in sufficient quantities confer a health benefit on the host
What do probiotics do?
Able to survive “on the shelf,” in the GI tract, and can grow in the lower GI tract. Proposed health benefits are that they improve constipation, diarrhea, lactose itoelrance, inflammatory bowel disease, increase GI immune function, colon cancer protection, all of which vary depending on the probiotic type
What do GI hormones do?
GI tract releases >20 hormones, they assist with digestion/absorption as well as satiation
Underweight?
BMI <18.5
Normal weight?
BMI 18.5-24.9
Overweight?
25.0-29.9
Class I obesity?
30-34.9
Class II obesity?
35-39.9
Class III obesity?
> or equal to 40
Super obesity and super, super obesity?
greater than or equal to 50, greater than or equal to 60
What is bariatric surgery?
Surgical treatment to manage obesity
Who is bariatric surgery considered for?
For individuals with a BMI greater than or equal to 40 or greater than or equal to 35 with comorbidities, cannot achieve enough weight loss with diet and exercise therapy, can comply with the post-surgical plan, no medical and psychological contraindications
What principles doe bariatric surgeries work on?
Restriction of food intake and/malabsorption
What are the benefits of bariatric surgery?
Weight loss 20-32% in year 1, 12-25% at 10 years. Huge improvements in diabetes, blood lipids, and BP control
What is laparoscopic adjustable gastric banding?
A type of bariatric surgery…an adjustable band is placed in the upper portion of the stomach, drastic reduction in food intake. Reversible, works the worst of all the options
What is a sleeve gastrectomy?
A type of bariatric surgery in which 60-80% of the stomach is removed, pyloric sphincter remains intact, and there is a drastic restriction in the amount of food a person can eat. Also decreases ghrelin.
What is roux-en-Y gastric bypass?
A type of bariatric surgery in which a small stomach pouch is created and attached to the lower part of the jejenum (duodenum and part of jejunum is bypassed). Restricts the amount of food a person can eat and causes malabsorption in the small intestine.
Dietary considerations following bariatric surgery?
Diet progression after surgery (liquids –> pureed foods –> soft foods –> normal foods). Eating and drinking at the same time can be problematic. Nutrient deficiencies are common (lifelong careful dietary planning and monitoring is neede dto ensure nutrient needs are met, and lifelong vitamin/mineral supplementation is needed)
What is lactose intolerance?
The inability to digest and absorb lactose due to a deficiency in lactase
What decreases lactase activity?
Age, but may also decrease due to damage of the villi from medications, malnutrition, and disease
What is the prevalence of lactose intolerance?
approx. 70%. Varies depending on ethnicity (10% for Northern Europeans, and 80% for Southeast Asians)
What are the symptoms of lactose intolerance?
Undigested lactose molecules in the intestine attract water and cause bloating, gas, abdominal discomfort and siarrhea. Tolerance varies widely: some small amounts of dairy and/or fermented dairy products (yogurt) tolerated by some. Hard cheeses and cottage cheese often well tolerated, too.
Treatment for lactose intolerance?
Avoidance of lactose or use of lactase. Need to ensure adequate source of calcium, vitamin D, and riboflavin
Some hidden sources of lactose?
Luncheon meats and sausages, biscuits, bread, medications, protein concentrate, whey
What is celiac disease?
An autoimmune disoder that causes inflammatory injury to the mucosa of the upper small intestine caused my gluten.
What is gluten?
A storage prtein found in wheat, barley, rye and helps give structure to baked goods. Wheat: gliadin. Barley: hordein. Tye: Secalin
Pathology of Celiac’s disease?
Mucosa lining usually appears flat with atrophy or total loss of villi, loss of mircovillous brush border, and decreased surface area for nutrient absoprtion. Increased # of intraepithelial lymphocytes. Diffuse inflammation of the mucosal lining of the small intestine.
How is Celiac disease diagnosed?
Intestinal biopsy
Complications from Celiac disease?
Osteoporsis, gut lymphoma, increased risk of other autoimmune diseases
Treatment for Celiac disease?
Lifetime withdrawl of gluten from diet (no wheat barley, or rye products and caution with oats, medications, food additives, emulsifiers). May need to avoid foods containing lactose. Careful of cross contamination. Ensure adequate nutrients and fiber (many gluten free products are low in nutrients and fibre and may not be fortified)
Non-celiac gluten sensitivity?
A sensitivity to gluten where both celiac disease and wheat allergy have been ruled out. Gluten can trigger similar symptoms to individuals with celiac disease, but without the intestinal damage and immune response. Same treatment as celiac disease.
What are carbohydrates?
Molecules containing carbon, hydrogen, and oxygen and usually have the ratio of 1:2:1.
Main sources of carbs?
grains, legumes, veggies, fruit, and dairy
Primary role of carbs?
Supply the body with energy
Two major categeories of carbohydrates?
Sugars (mono and disaccharides) and polysaccharides (starch, fibre, glycogen)
What are the monosaccharides?
Glucose, fructose, galactose
What are disaccharides?
Composed of pairs of monosaccarides all containing glucose…
What is maltose?
glucose + glucose
What is sucrose?
Glucose + fructose
What is lactose?
Glucose + Galactose
How are disaccharides formed?
Condensation reaction
How are disaccharides broken apart?
Hydrolysis reaction
What are some sources of naturally occurring sugar?
Sugars that occur naturally as part of foods…milk, fruit, veggies, grain
What are some sources of added sugars?
Sugars that are addded during processing and preparation of foods, and sugars eaten by themselves or added at the table
In North America, how much of our sugar intake is added?
50%
1 tsp of sugar = how many grams?
4g
What are the DRIs about sugar?
DRI for added sugar is less than 35%, WHO recommends added sugars should be <10% of energy. Canadian Diabetes Association recommends added sugars should be less than 10% of energy for people with diabetes provided they maintain good blood glucose and lipid control
What are the health risks surrounding added sugars?
They can displace intake of important nutrietnts, cause cavities, and contribute to obesity.
What are polysaccharides?
Chains of many (>10) glucose units attached together
What are the polysaccharides?
Glycogen, starch, and fibre
What is glycogen?
Storage form of glucose in animals…stored in liver and muscles as highly branched chains and allows for quick energy release when needed. Not obtained in the diet.
What is starch?
Storage form of glucose in plants. Long, branched or unbrahced chains
What is amylose?
Long, unbranched chains of starch
What is amylopectin?
Long, branched chains of starch
Primary dietary sources of starch?
Grains, legumes, tubers, and root crops
DRIs for total digestible carbs?
RDA: 130 g/day MIIMUM recquirement…AMDR: 45-65% energy
What is fibre?
Non-starch polysaccharide…provides structure to plants, chains of glucose molecules joined together, but they differ from starches because their bonds cannot be hydrolyzed by digestive enzymes (i.e. nondigestible)
2 major sources of fibre?
soluble and insoluble fibres
What is soluble fibre?
dissolves in water, forms gels and can be fermented by bacteria…gums and pectin
Dietary sources of soluble fibre?
oats, legumes, barley, and citrus fruits
Health benefits of soluble fibre?
dec blood cholesterol, stabilize blood sugars
Insoluble fibre?
Does not dissolve in water, does not form gelS, and is not fermentable
Examples of insoluble fibres?
Cellulose and hemicellulose…whole grains and veggies
Health benefits of insoluble fibres?
Prevent diverticular disease, promotoes healthy bowel movements and decreases constipation
What are resistant starches?
Starches that escape digestion and absoprtion in the SI
Examples of resistant starches?
Whole or partially milled grains, legumes, just ripened bananas
DRIs for fibre?
Total Fibre AI for females is 25g/d and males 38g/d. WHO adives less than 40 g per day
What happens with too much fibre?
GI distress, filling before nutrient needs are fulfilled, and may interfere with mineral absorption
What are the cardiovascular health benefits of soluble fibre?
Soluble fibre (oats) binds bile (made from cholesterol) in the intestine for removal from the body. Because bile is lost, the liver uses body cholesterol to synthesize more bile which helps to decrease blood cholesterol levels. Also, bacterial by-products from fibre fermentation in the large intestine are also thought to decrease hepatic cholesterol synthesis
Diabetes health benefits of soluble fibre?
Soluble fibre decreases the rate of glucose absorption which helps to control blood glucose levels
How does fibre improve gastrointestinal health?
Increases fecal bulk, which speeds up fecal passage through the GI tract and decreases constipation, hemorrhoids and diverticulitis
How does fibre decrease risk of colon cancer?
Binds and removes potential cancer causing agents. Bacterial fermentation of fibre in colon produces short chain fatty acids which decrease pH in the large intestine and may provide anti-cancer benefits
How are glucose and galactose absorbed?
Active transport
How is fructose absorbed?
facilitiated diffusion
What are the 3 hormones that regulate blood glucose?
Insulin, glucagon, and epinephrine
What does insulin do?
Helps facilitate transfer of glucose from the blood into body cells
What does glucagon do?
Brings glucose out of storage
What does epinephrine do in terms of blod glucose levels?
“Fight or flight” ensures glucose availability during times of stress
What is the glycemic response?
how much a food causes blood glucose concentrations to rise and to bring about an insulin response
WHat is the glycemic index?
An index (0-100) to classify foods based on the ability to raise blood glucose levels compared to a standard food (glucose or white bread)
Gylcemic index is influenced by?
Type of carb, ripeness of food, cooking/processing/storage of food, other constituents in the food and other foods eaten with the food
Low GI foods are characterized by?
Slow absorption, a small rise in blood glucose, a gradual return to baseline
Examples of low GI foods?
legumes and milk products
High GI foods are characterized by?
Quick absorption, a rapid increase in blood glucose, a quick insulin response–often resulting in an over compensatory drop in blood glucose
Examples of high GI foods?
White bread and corn flakes
Standards for low, medium, and high GI?
Low = less than or equal to 55. Medium = 56-69, high = greater than or equal to 70
What is the glycemic load?
Takes into account both the GI and the quantity of available carbohydrate a good contains
Low, medium, and high glycemic loads?
Low <10, medium 11-19, high is greater than or equal to 20
Total carbohydrates = ?
fibre + sugars (added and naturally occurring) + starch
Recommended servings of fruit/veggies, grain products, milk and alternatives, and meat and alternatives for a female age 19-50?
7-8, 6-7, 2, 2
Recommended servings of fruit/veggies, grain products, milk and alternatives, and meat and alternatives for a male age 19-50?
8-10, 8, 2, 3
What age groups need 3-4 milk and alternative servings per day?
9-13, 14-18, 51+
Overall recommendations regarding fruits and veggies for Canada’s food guide?
- eat at least 1 dark green and 1 orange veggie per day 2. Choose veggies and fruit with little added salt, sugar, and fat 3.have veggies and fruit more often than juice
Overall recommendations regarding grains for Canada’s food guide?
make at least 1/2 whole grain and choose ones that are low in fat, salt, and added sugar
Overall recommendations regarding fmilk and alternatives for Canada’s food guide?
Drink milk errryday and select lower fat milk alternatives
Overall recommendations regarding meat and alternatives for Canada’s food guide?
Have alternatives such as tofu and beans and lentils frequently, eat at least 2 food guider servings of fish each week, select lean meat and alternatives prepared with little or no added fat or salt
3 types of alternate sweeteners?
Artificial sweetners, herbal products, sugar alcohols
What are artificial sweeteners?
Non-nutritive sweeteners. Sweetness without adding calories. Very sweet, so only very small amounts are needed
What is saccharin?
Artificial sweetner, 450X sweeter than sucrose, only used as a tabletop sweetener in Canada, ADI: 5 mg/kg (10 packets)
What is sucralose?
Splenda. 600X sweeter than sucrose. Available as a tabletop sweetener and permitted to be added to many different foods in Canada. Similar in structure to sucrose (Cl- replaces OH groups). ADI: 8,8 mg/kg (6 cans diet pop)
What is aspartame?
NutraSweet, Equal. 200X sweeter than sucrose, 4kcal/g. Approved fro use in many different food products and as a tabletop sweetener. 2 amino acids (phenylalanine and asprtic acid with a methyl group)
Is aspartame bad for you?
Health Canada does NOT support allegations that aspartame may be linked to cancer, tumours, etc. No evidence of adverse health effects. Safe during pregnancy–in moderation. Not suitable for people with PKU. ADI: 40mg/kg (18 cans diet pop)
What is stevia?
South American plant leaf that contains compounds that are very sweet. 0 kcals, 300X sweeter than sugar. Available in products and as a tabletop sweetener.
What are sugar alcohols?
Sorbitol, Mannitol, Xylitol, Maltitol, Lactitol. Used to increase sweetness and bulk in food products. Less sweet or a similar sweetness compared to sugar. Nutritive “sugar free” but not “kcal free” NO DENTAL CARIES. Can cause diarrhea, bloating, cramps if eaten in large amounts because of it is absorbed, but others go into colon and get fermented.
Fasting plasma glucose for a diabetes diagnosis?
greater than equal to 7 mmol/L
2 hr plasma glucose levels from a 75 g oral glucose tolerance test for a diabetes diagnosis?
greater than or equal to 11.1 mmol/L
Random plasma glucose levels for a diabetes diagnosis?
greater than or equal to 11.1 mmol/L
What is pre-diabetes?
When blood glucose values are higher than normal, but are not high enough to be diagnosed with Type 2 diabetes. A risk factor for diabetes.
Percentage of Canadians with diabetes? Worldwide?
2008-2009 there were 6.8% of Canadians. 8.3% worldwide
Complications of diabetes?
Acute or chronic. Chronic and long term complications include atherosclerosis, blindness, amputations, renal failure, erectile dysnfunction
Dietary guidelines for diabetes management?
Regular balanced meals (spread CHO over day), Saturated fat <7% total energy, limit trans fat and cholesterol intake. Quench thirst with water indtead of soft drinks or juice. Regular physical activity.Limit intake of refined/added sugars to less than 10%. Increase fibre intake, including soluble fibre sources. Emphasize slow glycemic foods. Small amounts of protein at each meal to stabilize blood sugar. Alcohol can be consumed in moderation. Weight management.
