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Nutrition and Digestion > Lecture 20- Human nutrition: diseases and conditions influencing nutrition > Flashcards

Lecture 20- Human nutrition: diseases and conditions influencing nutrition Flashcards

1
Q

What is fetal programming?

A
  • Process by which the environment encountered before birth (or in infancy) will shape the long term control of tissue physiology and homeostasis
  • Started in the ‘80’s after the discovery of strong associations between early life events & cardiac disease
  • But first reported in 1964 when noted that heart disease increased in individuals with siblings that were stillborn or died in infancy
  • Particularly susceptible during rapid growth phases
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2
Q

Is fetal programming present in all species?

A
  • Exists in all species
  • Sex of crocodilians is determined by programming NOT chromosomes
  • Via temperatures
  • Feeding a zinc deficient diet to pregnant mice has consequences that will last 3 generations!
  • Impaired immune function
  • Wool follicle growth is impacted by nutrition
  • First wave of secondary follicles develop in the last trimester
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3
Q

What is known about human fetal programming?

A
  • However growth of human fetus (unlike other species) is less susceptible to this and they are not particularly sensitive to variations in maternal diet
  • This is not to say that other factors are not influenced
  • Extensive famine will influence birthweight but the effects are relatively small
  • BUT restriction or deficiencies in the maternal diet will change physiology and the initiation of disease processes later in life
  • However, this is a COMPLEX process with nutrient-gene interactions during a period of plasticity
  • Associations can be crude and may not reveal true aspects of the programming event
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4
Q

Can non-nutrient components be involved in fetal programming?

A
  • Non-nutrient components may also be involved
  • E.g. hormone agonists such as Vinclozolin (a fungicide used in fruit production) has anti-androgenic properties and exposure can cause feminisation of male pups in rats
  • Effects not seen in humans but exposure can be associated with testicular abnormalities in adults
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5
Q

What was the dutch hunger winter?

A
  • Low protein diets in pregnant rats can reduce birthweight & increase blood pressure & impaired glucose tolerance in adult offspring
  • Similar responses in guinea pigs & sheep
  • Difficult to measure in humans
  • ‘Dutch Hunger winter’
  • 5 months of severe famine at the end of WW2
  • Limited duration & abrupt onset & relief
  • Ongoing studies
  • Showed altered birthweights, glucose intolerance, obesity, altered lipid profiles, altered coagulation, reduced cognitive function and increased risk of coronary heart disease
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6
Q

What was the dutch famine?

A
  • Grandmaternal famine exposure during gestation was associated with increased adiposity and poorer health
  • Can be passed onto future generations
  • Women conceived during the famine had 5 x increased risk of breast cancer
  • This was in small numbers
  • BUT there is evidence of a thrifty genotype
  • Women exposed to famine have more children, more twins & reproduced younger
  • Trade off – investment between increased fertility & body maintenance
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7
Q

Is maternal undernutrition in early pregnancy also as important?

A
  • However maternal undernutrition in early pregnancy is unlikely to result in growth issues for the fetus as the fetal nutrient requirements are low
  • Balance of nutrients is important
  • Protein to energy ratio
  • E.g. reduced folate can influence AA synthesis
  • Importance of taurine for pancreatic β cell development that cannot be reversed with supplemental taurine to β cells in culture but is reversed if supplemented to the mother
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8
Q

What is the connection of birthweight and obesity?

A

• Positive association between birthweight & adiposity later in life (BMI)
• Modest but consistent across populations
-heavier babies heavier later
• Also correlation between birthweight & adult height
• Breastfeeding is associated with lower risk of obesity later in life
• Maternal undernutrition can lead to the development of overeating and diminished exercise in offspring

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9
Q

What was the China study?

A

• Study between Oxford & Cornell
• In The China Study, Dr. T. Colin Campbell details the connection
between nutrition and heart disease, diabetes, and cancer.
• The report also examines the source of nutritional confusion produced by powerful lobbies, government entities, and opportunistic scientists.
• The New York Times has recognized the study as the “Grand Prix of epidemiology” and the “most comprehensive large study ever undertaken of the relationship between diet and the risk of developing disease.”
• The China Study is not a diet book. Dr. Campbell cuts through the haze of misinformation and delivers an insightful message to anyone living with cancer, diabetes, heart disease, obesity, and those concerned with the effects of aging.

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10
Q

What is the book that came out of the China study?

A

• Best selling nutrition book (USA)
• Examines relationship between consumption of animal products &
illness
• Conclude that vegan diets (0 mg cholesterol) escape or reduce the risk of many diseases
• Book is loosely based on the study
• 1973-1975
• Mortality rates from cancer & other chronic diseases from 65 counties in China
• Correlated to data from 1983-1984 dietary surveys (& blood work) from 100 people in each county
-Is it true???, another study:• “women’s health initiative” USA
• Data from ~160,000 women (50-79 years)
• Concluded that low dietary fat (including animal fats) does not reduce the incidence of breast & colorectal cancer or coronary heart disease, stroke or vascular disease= refuted the china study

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11
Q

What is to remember about data manipulation?

A
  • 50% relative difference is a headline grabber, (compared to 1%) but can be misleading
  • From below data you could also say 99% of group A & 98% of group B did not develop the disease
  • Would you alter your lifestyle fro 1% reduced risk?
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12
Q

What is the nutrition in disease management?

A
  • Malnutrition can contribute to increased vulnerability to infection (of all diseases)
  • Virus increases nutritional needs?
  • But decreases appetite & intake
  • Impairs digestion & causes malabsorption
  • Results in weight loss • “thindisease’
  • ‘perfect’ diet unknown
  • Including animal derived foods results in better health outcomes • Roleoffunctionalfoods?
  • People without constant access to food are more vulnerable to HIV
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13
Q

What are the detox diets?

A

• Do our bodies really get clogged up with toxins?
• Do we not have a liver for that? • 1800 + books on amazon
• 5,630,000 google hits
• Liver needs energy (etc.) to function and
cleanse so would a nutrient restricted (e.g. lemon water) diet assist this?
• High calorie juices?= not that good for you
-marketing only
-fat, sick and nearly dead= watch
-liver needs energy to function!

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14
Q

What are the nutritions myths surrounding dairy?

A
  1. Dairy consumption increases mucus production
    • Dates back to the 12th century (wives tale!)
    • No evidence (2004 review)
    • Not linked to asthma
  2. Lactose intolerance Vs lactose maldigestion
    • Different conditions
    • People with maldigestion can drink ~2 glasses of milk and feel ok & can eat cheese etc.
  3. Dairy products cause acne
    • No scientific link
    • Acne is not caused by diet (generally)
  4. Actually, dairy consumption may improve insulin sensitivity (T2 diabetes)
  5. Meta-analysis demonstrated either no effect of dairy when consumed for
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15
Q

What is the myth about carbs after 5pm?

A
  • Not-eating carbs after 5pm will help you lose weight • No evidence (review of 4800 papers)
  • But yes it will if you are reducing intake overall • Timing is not important, total consumption is
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16
Q

What is marasmus?

A
  • Marasmus
  • Protein-energy malnutrition
  • Starvation of infant or young child
  • Marasmus = wasting
  • Little to no adipose tissue, weight
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17
Q

What is Kwashiorkor?

A
  • Kwashiorkor
  • Recognised in the ‘50’s
  • Generalised oedema
  • Miserable / ill children
  • Changes to skin pigmentation which later cracks & peels • Hair thins, turns blonde/red/grey
  • Diarrhoea
  • Enlarged liver which fails to make albumin
  • Develops faster than marasmus
  • Child may not be underweight
  • Acute depletion of liver protein?
  • Due to very low protein diet? Free radical damage?
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18
Q

What is the connection between cancer and nutrition

A

• Because carcinogenesis occurs over years, most data linking diet and cancer is epidemiological (case control, cohort, or cross-sectional studies)
• It is estimated that one third of the cancer deaths each year in the US can be attributed to nutrition and other lifestyle factors (not including smoking)
• Complex relationship
• Dietary carcinogens: naturally occurring and added in food preparation and
preservation
• Inhibitors of carcinogenesis: antioxidants, phytochemicals
• Enhancers of carcinogenesis
• Latency period between initiation and promotion

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19
Q

What is the connection between energy intake and cancer?

A
  • Energy restriction inhibits cancer and extends life span in animals
  • Positive associations between overweight and cancers of the breast, endometrium, kidney, colon, prostate, and others
  • Overweight increases risk of cancer recurrence and decreases survival • Physical activity is inversely associated with cancer
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20
Q

What is the connection between protein and cancer?

A
  • Protein
  • Difficult to isolate effects of protein, as↑ protein diets are ↑ in fat &↓ in fiber
  • Low protein diets seem to reduce the risk of cancer, while risk is ↑by very high protein intakes
  • ↑ meat intake is associated with ↑ risk of colon cancer and advanced prostate cancer
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21
Q

What is the connection of fiber and cancer?

A

• Fiber
• Observational studies & case control studies indicate that fiber-rich diets are
associated with a protective effect in colon cancer
• Higher intakes of vegetables were inversely associated with colon cancer risk in 1 study
• But high fiber diets also tend to be lower in meat, fat, and refined carbohydrates
• 2 intervention trials evaluating the effect of fiber on polyp and adenoma recurrence failed to show an effect of high fiber vs low fiber diets

22
Q

What is often true of people who develop cancer (diet-wise)?

A
  • People who develop cancer tend to have low intakes of
  • Raw and fresh vegetables
  • Leafy green vegetables
  • Lettuce, carrots, raw and fresh fruit
  • Cruciferous (cabbage family) vegetables
  • Flavenoids and lignans (soy, grains, vegetables) are associated with lower risk of sex hormone-related cancers
23
Q

What can vegetable consumption do for cancer?

A

• Vegetable consumption may reduce cancer by:
• Inhibiting hormone-dependent steps in tumor formation and protecting
genetic material from carcinogenic agents
• Suppressing free radical production
• Serving as bulking agents to dilute carcinogens and decrease gastrointestinal transit time
• Stimulators of physiologically active and anti-cancer enzymes

24
Q

What about calcium and cancer?

A
  • Several studies suggest that foods high in calcium may reduce the risk for colorectal cancer and that calcium supplements may reduce the formation of colorectal polyps
  • However, there is evidence that high calcium intake, especially supplements, is associated with increased risk of prostate cancer
  • Bottom line: get calcium from food sources
25
Q

What about lycopene and cancer?

A
  • Lycopene is a red-orange carotenoid found in tomatoes and tomato- based foods
  • Several studies show that consuming tomato products reduces the risk of some cancers, but unclear whether lycopene is responsible
  • Absorption of lycopene is enhanced when lycopene containing vegetables are cooked and eaten with fat
  • No evidence that supplements are safe and effective in cancer prevention.
26
Q

What about meat and coffee intake and cancer?

A

• Some studies link eating large amounts of preserved meat to increased risk of colorectal and stomach cancers
• May or may not be due to nitrites
• Nitrites can be converted in the stomach to carcinogenic nitrosamines, which may
increase the risk of stomach cancer
• Vegetables and fruit retard the conversion of nitrites to nitrosamines
• Coffee has been investigated as a possible risk factor for a variety of cancers
• Does not appear to be associated with increased cancer
• Regular drinking of green tea and other sources of polyphenols may reduce the risk of stomach cancer

27
Q

Are food allergies on the rise?

A
  • On the rise?
  • Believed to be but hard to be sure
  • Are they just better reported or diagnosed? • Likely to be true however
28
Q

What is the gluten free fad?

A

• >16,400 books on Amazon (this was >8,500 LAST YEAR!!!)
• “the gluten connection: how gluten sensitivity may be sabotaging your health and what you
can do to take control now”
• “Grain Brain: The Surprising Truth about Wheat, Carbs, and Sugar–Your Brain’s Silent Killers” • “Wheat Belly: Lose the Wheat, Lose the Weight, and Find Your Path Back To Health”
• A renowned cardiologist explains how eliminating wheat from our diets can prevent fat storage, shrink unsightly bulges, and reverse myriad health problems.
• On of the top 50 diseases searched on google

29
Q

What are the celiac disease incidence?

A
  • Celiac disease effects ~1% US population • 18% of adults buy gluten free products
  • 30% want to eat less gluten
  • GF industry tipped to be worth >$15 billion by 2016
  • First discussed in a Lancet paper in 1978
30
Q

What are the gluten free claims?

A
  • Emerging belief that low gluten diets can reduce symptoms of IBS
  • High mass media coverage
  • Official data are lacking
  • Number of hits on google is a factor of 4000 higher than the number of hits on pubmed
  • Popular in blogs, forums etc.
  • WebMD? / Self diagnosis
  • Grains believed to be unhealthy
  • Based on grains being introduced to human diets 10,000 years ago (300 generations) – not long enough to evolve
31
Q

What is celiac disease?

A
  • Chronic enteropathy caused by a state of heightened immunological responsiveness to ingested gluten
  • Results in small intestinal villous atrophy
  • Increases intestinal permeability
  • Leads to malabsorption in the SI and can cause anaemia, arthritis, bloating etc.
  • Diagnosed by a MD – biopsy, endoscopy & genetic testing
  • A very real condition that is treated by strict adherence to a low gluten diet
32
Q

What is the pathogenesis of celiac disease?

A
  1. A component of gluten, gliaden, interacts with a specific genetic form of HLA receptor on an antigen presenting cell.
  2. Tissue transglutaminase converts glutamine residues to glutamic acid residues making an even more potent antigen.
  3. T helper cells are activated and, in turn, activate B and killer T cells. 4. Plasma cell antibodies bind to gliadin bound to enterocytes, tissue transglutaminase and reticular fibers surrounding gut smooth muscle (endomysial ab’s).
  4. T cells release (inappropriate) inflammatory cytokines as well as inflict tissue damage.
33
Q

What do the biopsies look like if celiac and not?

A
  • the villi are missing in celiac

- absorption is problematic

34
Q

What is non-celiac gluten sensitivity?

A
  • Non-celiac gluten sensitivity (NCGS)
  • Intestinal symptoms (bloating, diarrhea, pain)
  • And/or extraintestinal symptoms (headache, fatigue, lethargy) • Significant overlap to irritable bowel syndrome (IBS)
  • No established definition of NCGS
  • Subjective symptoms
  • Wheat allergies also exist
35
Q

What was the Monash study 2011 about gluten free?

A
  • Recent double blind placebo controlled studies (2011) • Monash Uni / Alfred hospital
  • Non-celiac patients with IBS symptoms that are improved on a GF diet (n=34) • Patients randomized for gluten or placebo diet
  • Baseline data & 7-day food diary collected in 2 week ‘run in’ period
  • Patients remained on GF diet for the 6 week trial
  • Patients & investigators blinded to treatments
  • Blood, urine, fecal samples & intestinal permeability observed • Questionnaire with symptoms completed throughout
36
Q

What were the results of 2011 study?

A
  • Results
  • No changes to physiological or biomarker measures
  • All patients had increased symptoms in response to gluten within 1st week • Placebo also had symptom induction but it was slower & less severe
  • There is something there causing symptoms but not celiac
37
Q

Is it the gluten or the grain with gluten free?

A
  • Fermentable, olgio-, di-, monosaccharides, and polyols- FODMAPS • Found widely in grains
  • Trigger GI symptoms
  • Many gluten studies use wheat
  • Gluten is not the only component!
38
Q

What was the follow up study 2013 with gluten free?

A
  • Double blind placebo controlled cross over (2013)
  • Monash Uni / Alfred hospital
  • Non-celiac patients with IBS symptoms that are improved on a GF diet (n=37)
  • Patients randomized for 1 of 2 treatments: High gluten, low gluten or placebo for 1 week
  • 2 week wash out then crossover into next diet
  • Re-challenge diet (as above but over 3 days not 1 week) (n=22)
  • Low FODMAPS throughout
39
Q

What were the results of the follow up? (2013)

A
  • Results
  • Overall pain & symptoms increased during the last week for all diet treatments
  • Bloating & tiredness increased in low gluten and placebo treatment arms ONLY
  • Only 16% of patients increased abdominal symptoms on high gluten diet
  • 30% responded to placebo
  • Reduced FODMAPS and NOT gluten reduced symptoms
  • Results of 3 day trial showed diet responses were NOT repeatable in individuals
  • Strong anticipatory symptomatic ‘nocebo’ response
40
Q

What was another study done in 2014?

A
  • Study questionnaire of 147 people (2014)
  • Symptoms: describe them, are you in control?
  • Diet: GF?
  • How long have you been GF?
  • Where did you find out about GF?
  • Have you had tests for celiac diagnosis?
  • etc
41
Q

What were the results of the 2014?

A

• 44% patients self initiated a GF diet
• Prescribed by alternative health professional in 21%, dietitians in 23% • Only 12% diagnosed by GP
• 15% had undertaken no testing for celiac
• 1 in 4 who self judged to be gluten intolerant remained symptomatic
despite a GF diet
• Gluten had little to do with symptoms?
• 2/3 had not adequately excluded celiac disease
• Dietitians best at suggesting testing
• Many were confused by the condition & the difference between gluten (protein) & fructan (carb)
• A higher % (60%) of supplement use was reported in these subjects compared to Australian ave (16-45%)

42
Q

What are the risks of gluten free diets?

A
  • Expensive
  • Not to be dismissed as this is a big factor for true celiac patients
  • Reduced availability of GF foods • Though they are increasing
  • Malnutrition?
  • GF products can be imbalanced
  • Low folate
  • Vitamin deficiencies
  • Diagnosed celiac’s have lower BMI than ave population • But BMI increases when GF diet is initiated
43
Q

What is the connection of gluten and autism (the claims)?

A
  • Popular media suggests that children on the autistic spectrum should be fed dairy & gluten free diets
  • Research is limited (
44
Q

What are GMO’s?

A

• Genetically modified organisms • ‘buzz word’
• Particularly in America
• Many common misconceptions & false claims
• GMO’s revolutionised food production in the ‘60’s & 70’s
• Norman Borlaug won the Nobel prize in 1970 for contributing to the ‘green revolution’ & his
impact on food production in Asia & Latin America by developing high yielding cereal grains • Accredited to preventing starvation in >1billion people
• Generally refers to advanced cross breeding or using gene mutations to improve productivity or increase pest resistance
• Mostly used in crops

45
Q

Are GMOs safe?

A

• GMO foods are tested more rigorously than traditional foods
• In Aus regulated by ‘office of the gene technology regulator – OGTR’ a federal agency
• Existed for >30years
• State specific legislation also exists
• In Vic the ‘control of GM crops act 2004’ allows the minister to prevent the
use of GM crops

46
Q

What was the pig experiment with GMOs?

A

• 2013 paper in pigs
• “A long-term toxicology study on pigs fed a combined genetically modified (GM) soy and GM maize diet’ in the Journal of Organic Systems (Journal of Organic Systems, 8 (1), 2013 ).
• Claim pigs fed GM have more stomach inflammation & ↑ uterine weights • NO differences in intake, weight gain, mortality & pathology
-• Study deemed poor quality
• Diets not sufficiently standardised or quantified
• Limited replication
• Only one GM diet included (no dose response)
• Animal husbandry was poor
• Not all tissues collected from all animals
• No microscopic examination of stomach, redness was deemed ‘inflammation’
• ↑ uterine weight was based on the exclusion of1 outlying pig from the non- GM group, if included this becomes non-significant.

47
Q

What are superfoods?

A

• Superfood:
• A food with a high phytonutrient (antioxidant, fibre, omega 3 etc) that may
confer health benefits
• No legal definition
• Marketing tool?
• Mostly just refer to fruits and veggies

48
Q

What are gogi berries?

A
  • ‘wolfberry’, Grown widely in Asia
  • Most research in cellular & animal studies
  • Claims relate to anti-cancer activity, aging, vision, insulin resistance & fertility
  • Few clinical trials of methodological quality in humans
  • Most show improvements in antioxidants & increased subjective feelings of wellbeing
  • Claims to have the highest levels of vitamin C (500 x orange). FALSE same as orange!
  • Can interfere with blood clotting medications
49
Q

What are acai berries?

A

• Purple berry fruit of the acai palm
• Lab studies suggest it may have anti-cancer & anti-inflammatory
properties & may be useful for treating heart disease
• No human studies published
• “It is a poster child of the power of the internet to promote products for which only a limited phytochemical and pharmalogical information is available”

50
Q

What is wheatgrass?

A
  • Claims to be a blood cleanser and ‘detoxifier’ • Natural plant enzymes & chlorophyll
  • Common claim that 30 mL is the nutritional equivalent of 1 kg of vegetables • MYTH – similar nutrients to broccoli & spinach
  • Floret of broccoli or tbsp spinach contain more folic acid & vitamin C
  • Chlorophyll is not absorbed by the body it requires sunlight for activation & supposed high levels in wheatgrass are no higher than other green vegies.
51
Q

What is the cost of superfoods?

A
  • 5 serves of Goji (~$10) = 1 red delicious apple
  • 3 serves of Acai (~$2) = 1 red delicious apple
  • Superfoods do contain a wide range of nutrients but marketing exaggerates their health benefits
  • Sold at high costs
  • Unless better science proves otherwise it is cheaper & wiser to get antioxidants from traditional foods
52
Q

Summary of superfoods?

A
  • Remember I am not saying they are bad – far from it
  • BUT check claims
  • More $ is not always better
  • Different or exotic is not always better
  • Too good to be true probably means it is!
  • Remember in animal production we calculate the cost of a diet for a specific nutrient
  • As seen in superfoods Vs. an apple

Nutrition and Digestion (24 decks)

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