Module 1D: Nutrition

Question 1

6 Primary Nutrients

Answer 1

water, carbohydrates, protein, fat, minerals, and vitamins

Question 2

Nutrition

Answer 2

The field of study focused on food and the substances in food that help people grow, recover from illnesses, and stay healthy.

Question 3

Dietary Guidelines Source

Answer 3

MyPlate (myplate.gov) is a resource developed and managed by the U.S. Department of Agriculture, which takes the most up-to-date Dietary Guidelines for Americans and creates patient-centered resources to distribute the information.

Question 4

Water

Answer 4

The human body is 50% to 80% water. People can survive longer without food than water.

It is recommended that people still drink 2 to 3 L (64 to 96 oz) each day for optimal health.

Functions:
- transporting nutrients and oxygen throughout the body
- helping remove waste
- regulating body temperature through perspiration
- providing the basic component of blood and other bodily fluids.

The body loses water throughout the day in urine, stool, sweat, and water vapor in breath—a total of 1,750 to 3,000 mL each day. Ideally, the body needs to balance intake and output, replenishing fluids the body eliminates with drinking water.

Question 5

Protein

Answer 5

Large, complex molecules the body makes from amino acids, which are the natural compounds that plants and animal foods contain.

Functions:
- repair and build tissues
- energy if other sources (carbohydrates and fats) are unavailable
- structure
- fluid balance
- creation of transport molecules

Question 6

3 types of amino acids

Answer 6

• Essential amino acids are ones the body cannot produce.
• Nonessential amino acids are ones the body can make from essential amino acids or as proteins break down.
• Conditional amino acids are not usually essential but might become essential when the body is undergoing stress or illness.

Question 7

Carbohydrates

Answer 7

Organic compounds that combine carbon, oxygen, and hydrogen into sugar molecules and come primarily from plant sources

Types (depending on structure):
1. Simple sugars (honey, candy, cane sugar)
2. Complex carbohydrates (fruits, vegetables, cereal, pasta, rice, beans, whole-grain products).

Functions:
- primarily for energy for its cells and all their functions

Glucose is the simple sugar the body requires for energy needs, and the body burns it more completely and efficiently than it does protein or fat. Through digestion, the body converts all other digestible carbohydrates into glucose. When the supply of glucose exceeds the demand, the body stores glucose in the liver as glycogen, a ready energy source when the body needs it.

Question 8

Fats

Answer 8

(AKA lipids) Highly concentrated source of energy the body can use as a backup for available glucose. Fat molecules contain fatty acids.

Functions:
- essential for the absorption of fat-soluble vitamins.
- structure for cell membranes
- promote growth in children
- maintain healthy skin
- assist with protein functions
- help form various hormone-like substances that have important roles (ex: preventing blood clots and controlling blood pressure)
- stored fat has the protective function of insulating and protecting organs

Question 9

Types of Fats

Answer 9

The difference is the degree of saturation:

1. Unsaturated fatty acids are less dense and heavy. They are oils and have less potential for raising cholesterol levels (thus causing heart disease) than saturated fats. Unsaturated fats can be monounsaturated (olive, canola, and peanut oil) or polyunsaturated (corn, sunflower, and safflower oil).
2. Trans fat is a fatty acid used to preserve processed food products. It is a byproduct of solidifying polyunsaturated oils (a process called hydrogenation) and raises LDL (“bad”) cholesterol levels.
3. Saturated fats are solid at room temperature. Primarily from meat products as well as palm and coconut oil, this type of fat also raises LDL. There is no cholesterol in other plant foods.

Question 10

Vitamins

Answer 10

Organic substances the body needs for various cellular functions.

Vitamins do not provide energy, but they are necessary for the body to metabolize energy.

Classification (according to solubility):
1. Fat-soluble vitamins: A, D, E, K
2. Water-soluble vitamins: B1, B2, B3, B6, folate, B12, pantothenic acid, biotin, C

Each vitamin has a specific role. Except for vitamins D, A, and B3, the body cannot make them or cannot make enough of them, so they have to be part of dietary intake to promote health and avoid deficiencies.

Question 11

Minerals

Answer 11

Inorganic substances the body needs in small quantities for building and maintaining body structures.

They are essential for life because they contribute to many crucial life functions:
- like those of the musculoskeletal, neurological, and hematological systems
- provide the rigidity and strength of the bones and contribute to muscle contraction and relaxation
- help regulate the body’s acid-base balance and are essential for normal blood clotting and tissue repair
- cofactors for enzymes, which means they assist those substances in performing their metabolic functions.

Question 12

Food Labels

Answer 12

The USDA requires food products to contain labels containing details about their contents. These nutritional facts must include specific elements:

• Serving size
• Calories per serving
• Grams of different types of fat
• Amounts of sodium, potassium, cholesterol, total carbohydrates, sugar, and protein
• Percentage of recommended daily values for some vitamins and minerals

Question 13

What aspect(s) of food labels gives necessary context to all other information found on the label?

Answer 13

serving size

When teaching a patient about food labels, they must understand how to check the serving size. Serving sizes vary by manufacturer and can be misleading. Understanding the serving size will help the patient to know how much they are truly consuming in terms of all other categories listed on the food label.

Question 14

Vitamin A

Answer 14

Function/Intended Benefit: Night vision, cell growth and maintenance, the health of the skin

Safety Considerations: Toxicity can occur if levels are too high, leading to headaches, peeling skin, and bone thickening.

Question 15

Vitamin D

Answer 15

Function/Intended Benefit: Calcium absorption, bone and tooth health, heart and nerve function

Safety Considerations: Toxicity can occur if levels are too high, leading to kidney failure, metastatic calcification, and anorexia.

Question 16

Vitamin E

Answer 16

Function/Intended Benefit: Protection of cells (including skin and brain), formation of blood cells

Safety Considerations: N/A

Question 17

Vitamin K

Answer 17

Function/Intended Benefit: Blood clotting, bone growth

Safety Considerations: Can counteract blood clotting medications, reducing their efficiency

Question 18

Vitamin B1

Answer 18

Function/Intended Benefit: Carbohydrate metabolism, heart, nerve, and muscle function

Safety Considerations: N/A

Question 19

Vitamin B2

Answer 19

Function/Intended Benefit: Fat and protein metabolism

Safety Considerations: N/A

Question 20

Vitamin B6

Answer 20

Function/Intended Benefit: Enzyme assistance in the amino acid synthesis

Safety Considerations: Toxicity can occur if levels are too high, leading to peripheral neuropathy.

Question 21

Vitamin B12

Answer 21

Function/Intended Benefit: Protein and fat metabolism, nerve-cell maintenance, cell development

Safety Considerations: N/A

Question 22

Vitamin C

Answer 22

Function/Intended Benefit:
Immunity, iron absorption, the structure of bones, muscle, and blood vessels

Safety Considerations: N/A

Question 23

St. John’s wort

Answer 23

Function/Intended Benefit: Treatment for depression, anxiety, and sleep disorders

Safety Considerations: Some studies found it ineffective in its intended benefits (similar results to a placebo). No long-term safety studies have been conducted.

Question 24

Black cohosh

Answer 24

Function/Intended Benefit: Relief of menopause symptoms, including hot flashes, night sweats, headaches, heart palpitations, and mood changes

Safety Considerations: Large doses can cause vomiting, dizziness, and headaches. Long-term studies have yet to be conducted (recommended to take for less than 6 months).

Question 25

Melatonin

Answer 25

Function/Intended Benefit: Melatonin is a naturally occurring hormone in the brain. Also can be taken as a supplement to potentially help with sleep regulation and combat aging (studies validate the support of sleep regulation but do not support anti-aging benefits).

Safety Considerations: Can result in drowsiness and headaches. May interfere with conception

Question 26

Willow bark

Answer 26

Function/Intended Benefit: Pain relief (one of the main ingredients of aspirin comes from willow bark)

Safety Considerations: Do not exceed 240 mg/day. Not safe for those who cannot tolerate aspirin

Question 27

Glucosamine sulfate

Answer 27

Function/Intended Benefit: Promote healthy cartilage formation to maintain or replace wear and tear on joints

Safety Considerations: No safety concerns. Recent studies found glucosamine sulfate to be no more effective than a placebo in knee osteoarthritis.

Question 28

Gingko biloba

Answer 28

Function/Intended Benefit: Improve memory and mental function by increasing blood flow to the brain

Safety Considerations: Extremely high doses can lead to nausea, vomiting, and diarrhea.

Question 29

Dietary Needs for Diabetes

Answer 29

Type II diabetes is a chronic condition often connected to an individual’s food intake. In the most general terms, diabetes is defined by the body’s inability to turn food into energy properly.

General dietary guidelines for patients who have diabetes include the following:
- Eating several small, nutrient-dense meals consistently throughout the day.
- Avoiding or severely limiting foods high in added sugars. Properly balancing blood sugar is essential when high-sugar foods are consumed.
- Limiting foods high in carbohydrates, especially those with refined grains.
- Consuming more fiber. Fiber is an essential nutrient to help break down carbohydrates.

Question 30

Dietary Needs for Kidney Disease

Answer 30

Chronic kidney disease (CKD) is the gradual decrease in kidney function, and it impacts millions of Americans. (Medications are typically not recommended in early stages, and diet is the primary intervention.)

Dietary Modification Actions:
Step 1: Limit salt/sodium.
- High blood pressure is a primary contributing factor to worsened kidney function. ​​​​​​​
- Limiting sodium intake to less than 2,300 mg/day is optimal for those with CKD to prevent extra strain on the kidneys.

Step 2: Be cautious with protein.
- Protein is essential in any diet but also creates waste, which strains the kidneys.
- Eat protein-rich foods with meals.

Step 3: Protect your heart.
- Eating heart-healthy foods will help prevent fat and cholesterol from building up in your heart, blood vessels, and kidneys.

Step 4: Minimize phosphorus intake.
- As kidney function decreases, kidneys will no longer effectively filter out excess phosphorus levels.​​​​​​​
- Excess phosphorus in the blood can damage bones, leading to a higher risk of fractures, and can also damage blood vessels.

Step 5: Control potassium levels.
- Severe kidney damage can lead to increased potassium in the bloodstream.
- Potassium levels that are too high or too low can be very dangerous and damaging to the heart, muscles, and nerves. ​​​​​​​
- Understanding potassium levels in food and discussing dietary changes related to potassium with a doctor are essential in late-stage CKD.

Question 31

Dietary Needs for Celiac Disease

Answer 31

Celiac disease is an autoimmune disorder in which individuals cannot safely consume gluten, a protein substance found naturally in wheat, barley, and rye. Those with celiac disease will incur damage to their small intestine if gluten is consumed.

The primary treatment for celiac disease is eating a gluten-free diet.

Question 32

Anorexia nervosa

Answer 32

Affects people of all ages, genders, and races. Characteristically, patients are high achievers who exert severe control over their eating patterns. Often, there is a family history of anorexia and alcohol use disorder. Some patients have histories of childhood trauma, depression, major life changes, and high stress levels.

CAN BE LIFE THREATENING

Warning signs and symptoms:
- Self-starvation
- Perfectionism
- Extreme sensitivity to criticism
- Excessive fear of weight gain
- Weight loss of at least 15%
- Amenorrhea (no menstrual periods)
- Denial of feelings of hunger
- Excessive exercising
- Ritualistic eating behavior
- Extreme control of behavior
- Unrealistic image of the self as obese

Treatments:
- hospitalization with parenteral nutrition or nasogastric feedings
- psychotherapy

Question 33

Bulimia nervosa

Answer 33

Involves eating large amounts of food (binging) and then purging by self-induced vomiting, laxatives, or diuretics.
It is controlling behavior, usually aimed at gaining control of weight. Sometimes it is caused by gaining some weight and dieting unsuccessfully to lose weight.
People who have bulimia can feel guilty when they overeat or eat high-calorie foods and then attempt to alleviate the guilt by eliminating the food they eat

*Not life-threatening but can cause lesions in the esophagus, erosion of tooth enamel, and electrolyte and hormone imbalances.

Warning signs and symptoms:
- Buying and consuming large amounts of food
- Purging after eating excessive amounts of food
- When dining with others, using the bathroom immediately after eating
- Using laxatives and diuretics
- Keeping weight constant while overeating fattening foods
- Mood swings
- Depression and guilt after binging and purging

Treatments:
- psychotherapy
- medication for anxiety and depression
- dental work
- nutrition counseling
- support groups.

Question 34

Binge Eating Disorder

Answer 34

Similar to bulimia nervosa, without the purging behavior. With this disorder, people chronically overeat. The major manifestation is weight gain and obesity.

With binge eating disorder, patients do not restrict their diet between bingeing episodes, often eat quickly until they are uncomfortably full, eat when not hungry, and eat alone due to feelings of shame and guilt about overeating. Food becomes an addiction or a coping mechanism, predisposing patients to alcohol and substance use disorders.

Treatments:
- focusing on eating healthy food
- self-acceptance
- awareness of hunger and fullness
- engaging progressively in enjoyable physical activity
- keeping a food diary helps provide a realistic picture of how much food they consume
- Discussion with a counselor about their feelings and emotions about eating can also help
- Psychotherapy is effective in reducing the frequency and severity of binge episodes.