Nutrition Science, Assessment and Prescription Flashcards
How often are the Dietary Guidelines for Americans updated?
Every 5 years
Dietary Guidelines for Americans are based on recommendations by which advisory group?
the Dietary Guidelines Advisory Committee
Who is the Dietary Guidelines Advisory Committee made up of?
Experts from academia, government and industry
Dietary Guidelines for Americans are jointly issued by which 2 governmental departments?
Department of Agriculture
and
Department of Health and Human Services
What is the result of US food industries being in a position to influence public policy?
Some Dietary Guidelines involved a COMPROMISE and sometimes recommendations even contradict scientific evidence!
What EVIDENCE is there to demonstrate an INVERSE relationship between CVD risk and DAIRY consumption?
weak to no evidence of an inverse relationship
What evidence is there on the relationship between DAIRY and STROKE risk?
Mild association with reduced risk
What evidence is there on the relationship between YOGHURT and DIABETES risk?
Mild association with reduced risk
What associations have been demonstrated between YOGHURT & CHEESE and INFLAMMATION?
YOGHURT MAY reduce risk of inflammation
CHEESE shown to be pro-inflammatory (with increased plasma inflammatory biomarkers)
Eggs and diabetes / CVD risk?
> /= 3 eggs per week assoc with increased DIABETES risk
Not assoc with increased CVD risk
Eggs and CHOLESTEROL - what is the association?
Can increase LDL cholesterol
Can also improve function of HDL
(NB 2015-20 guidelines advise eating as little cholesterol as possible - no limit given due to inadequate evidence!)
What 7 broad food components do Americans eat too much of?
1) Added sugar / high fructose corn syrup (HFCS)
2) Cholesterol
3) Saturated fat
4) Sodium
5) Trans-fats
6) Processed Grains
7) Food high in calories
Define ‘free’ sugars
free or added sugars are any sugars added to foods by manufacturing companies AND sugars present in honey, syrup or unsweetened fruit juices
What percentage of the total calorific daily intake does the WHO recommend we do not exceed in free sugars?
Max 10%
Aim for <5% (6 tsp / 24g)
Ideally none
(NB the American Heart Association recommends 6tsp (100kcal) for women and children and 9tsp (150kcal) for men)
What percentage of daily calorific intake does the average American ingest in free / added sugars?
13% (13tsp / 52g)
What is the biggest culprit of added sugar in the american diet?
Sugar sweetened beverages (47% of total US sugar calories)
What major food groups are high in cholesterol?
eggs, dairy, cheese
organ meats, shellfish and other meats inc fish and poultry
(foods high in cholesterol are almost exclusively animal foods! except some fungi)
What is the biggest source of high cholesterol food in the american diet?
Eggs (25% total US cholesterol)
Chicken is 2nd 12.5%
What major food groups are high in saturated fats?
meats, dairy, eggs, processed foods and oils inc coconut oil and palm oil
HIGHEST: fat cuts of beef, pork, lamb. Salami, sausages and other processed meats, fast foods e.g. cheeseburgers, dried coconut / coconut oil
Give examples of foods moderately high (4-7g) in saturated fats?
MOD SAT FAT
Whole milk, leaner meat, cheese, full fat dairy, palm oil
Examples of foods with lower (1-3g per ounce) levels of saturated fat
Nuts and seeds; avocado; 1 x egg; fish
What is the biggest source of high saturated fat food in the american diet?
Burgers and sandwiches (esp with cheese, meat or both)
19% (snacks and sweets 2nd at 18%) (dairy 4th 13%)
What do the USDA dietary Guidelines list as MIXED DISHES which are deemed to incorporate 50% of dietary salt intake
Burgers, sandwiches and tacos Rice, pasta and grain dishes Pizza Meat, poultry and seafood Soups
Mixed dishes are Americans’ largest source of dietary salt, what percentage of overall sodium intake do such dishes account for?
(sandwiches, burgers, tacos, rice, pasta, grains, pizza, meat, soups, seafood)
44%
NB protein foods often have a significant amount of salt in them
What is the is the recommended daily sodium intake?
= / <2000mg
What quick and easy calculation may be adopted to ensure less than 2000mg of salt/sodium is ingested daily when reviewing food labels?
If the sodium per serving (in mg) is = / < the number of calories per serving (and you’re consuming 2000 calories or less a day!) you will be within the recommended guidelines of = / <2000mg salt / day
If mostly whole plant food diet on a 1600 kcal diet what MIGHT the sodium intake be?
may be <500mg (therefore even adding high salt condiments etc may still keep daily intake well below 2000mg)
What are trans-fats?
Naturally occurring (in meats /dairy) or artificially created fats in manufactured foods by hydrogenation of unsaturated fats e.g. solid oils, margarines etc
What are the benefits of trans-fats?
Shelf-life and food flavour stability
What disease process has evidence linked trans-fats to significantly?
CHD
When did the FDA mandate that trans-fats be removed from manufactured foods?
2018
What types of food typically have trans-fats in them?
snack foods (highest e.g. crisps / micro popcorn), fast foods (fries) dairy, oils, processed meats, red meat, reduced fat dairy and refined grains
What are the 3 major processed grain food types?
white flour, white rice, white pasta
List the 4 highest calorie food types
HIGHEST CALORIE FOODS
Fats and oils (e.g. butter/marg)
Confections
Snack foods
Processed meats
List the 7 food types lowest in calories
LOWEST CALORIES
Whole vegetables Whole fruits Whole grains Legumes Mushrooms Herbs and spices low fat dairy
What 5 food groups make up 28% of total calories in the US diet (top 5 sources of high calorie foods in US)
28% TOTAL CALORIES US DIET
1) refined grain-based desserts (6.4%)
2) non-whole grain breads (6%)
3) Chicken (5.6%)
4) Sweetened beverages (5.3%)
5) Pizza (4.5%)
List the 9 shortfall micro-nutrients in the US diet
9 SHORTFALL micro NUTIRENTS
Calcium Fibre Magnesium Potassium Vitamins A, C, D, E and K
Other than dairy products what other food stuffs are high in calcium (>20% daily requirement in 1 serving)?
(list of 3 - food, topping and drink)
SOURCES CALCIUM (BESIDES DAIRY PRODUCTS)
some seeds (Chia, poppy and sesame)
Tofu
Calcium-fortified non-dairy drinks
What effect does oxalate have on calcium?
Limits calcium absorption
List foods moderately high (5-20% daily req) in calcium and low in oxalate
MOD CALCIUM, LOW OXALATE
almonds; beans; okra; low oxalate dark greens (kale, broccoli, cauliflower, lettuce, cucumber, peas, courgette)
List foods very high in calcium but also high in oxalate
HIGH CALCIUM, HIGH OXALATE
Spinach, Beet Greens, Swish Chard
What % of calcium can be absorbed from dairy compared to high calcium, low oxalate greens such as kale, bok choy and okra?
Dairy - 32-34%
Kale, bok choy and okra - 40-60%
Fibre is found EXCLUSIVELY in what food types?
Plant Foods
High fibre foods include…?
HIGH FIBRE
beans, split peas, lentils, avocados, bran cereals, raspberries, blackberries, pears, papaya, dried fruits, flaxseeds, some whole grains and whole wheat pasta
Moderately high fibre foods include…?
blueberries, strawberries, most other fruit, most veg, grains, whole grain bread, mushrooms, nuts and seeds
Foods high in magnesium include…?
MAGNESIUM
Brazil nuts, almonds, cashews, pine nuts, edamame and dark chocolate
Foods moderately high in Mg include…?
Mod Mg
whole grains, dairy, red meat, processed meat, fish, most other nuts, spinach, potatoes, tofu, some beans e.g. black beans, black-eyed peas and lima
Foods high in potassium include…?
HIGH K+
skin-on potatoes, adzuki beans, avocado, soybeans, squash, plantains, bamboo shoots, passion fruit, dates and white beans
Foods moderately-high in potassium include…?
MOD HIGH K+
dairy, fish, legumes, nuts, mushrooms, poultry, veg and refined grains, also processed meats
Foods high in Vitamin A include…?
VIT A
Sweet potato, beef liver, spinach, RAW carrots, red peppers, black-eyed peas
Foods moderately high in Vitamin A include…?
MOD VIT A
daaaaaairy, tomato juice, herring, fortified cereals, hard-boiled eggs
Foods high in Vitamin C include…?
HIGH VIT C
Bok Choy, broCColi, Cabbage, Cauliflower, Currents, Citrus fruits, guava, kale, kiwi, mango, papaya, parsley, peas, pineapple, radishes, red pepper, strawberries, sprouts, tomatoes
Foods moderately high in Vitamin C include…?
Most other vegetables and fruits
Foods high in Vitamin D include…?
VIT D FOODS
High fat fish (e.g. salmon); fortified dairy and non-dairy milks; fortified fruit juices
Foods moderately high in Vitamin D include…?
Dairy (vit D is added to milk), fortified margarines, eggs, beef liver, fortified cereal
What is the weekly recommended sunlight exposure without sunscreen for adequate Vit D synthesis?
5-30mins twice a week - large surface areas (face, arms, legs, back / chest) between 10am and 3pm
Describe the metabolic pathway for producing Vit D with sunlight exposure
VIT D PROD WITH SUNLIGHT
UVB plus skin 7-dyhydrocholesterol -> cholecalciferol D3
Liver 25-hydroxylation -> 25-hydroxyvitamin D3
Kidneys alpha-1 hydroxylation-> 1,25 dihydroxyvitamin D3
(increases calcium uptake, bone mineralisation, immune cell differentiation)
CYP24A1 -> Calcitroic Acid (metabolically active form)
Foods high in Vitamin E include…?
VIT E
Sunflower seeeeeeeds and oils, almonds, hazelnuts
Foods moderately high in Vitamin E include…?
MOD VIT E
Peeeeeeanut butter
Avocado, spinach, broccoli
Foods high in Vitamin K include…?
HIGH VIT K
oils, leafy greens, kiwi, dried prunes, avocado, broccoli, brussel sprouts, asparagus
Foods moderately high in Vitamin K include…?
Herbs and (‘K’ick ass) spices
List the 7 most nutrient-dense foods (most ‘short-fall’ nutrients and least ‘over-consumed’ nutrients)
1) Veg including mushrooms
2) Herbs and spices
3) Fruits
4) Legumes
5) Whole grains
6) Nuts
7) Seeds
What are the 100,000 phytonutrients which plant foods are estimated to contain likely to protect against?
Chronic diseases such as cancer, osteoporosis and heart disease
List the top food groups to limit or avoid (13 in total)
1) Suger-sweetened beverages
2) Processed meats
3) Fried foods
4) Processed food and snacks (with added fat, sugar, salt)
5) Confections
6) High fat dairy (especially with added salt / sugar)
7) Red meats
8) Poultry
9) Eggs
10) Fish
11) Added fats and oils
12) Reduced-fat dairy
13) Refined grains (white flour, white rice and white pasta)
What does ‘eating the rainbow’ help to ensure?
That we are consuming a wide range of flavinoids and vitamins essential to health and disease prevention
(increases microbiome, healthier gut)
Describe the ABCD or performing a nutrition assessment
A: Anthropometric data (height, weight, BMI)
B: Biochemical data (bloods: K, Na, Hb, gluc, HbA1c, alb, total cholesterol, LDL/HDL, triglycerides - in some Vit D, B12, Fe and ferritin)
C: Clinical Assessment (Age, Gender, Med/Surg Hx, Activity level, Nutritional Hx - weight highs/lows, any nutritional insufficiencies or special considerations e.g. bariatric surgery or coeliac)
D: Dietary Assessment (detailed understanding of their usual diet; usually by dietician, tools/Q-aires e.g. 3 day food record, ‘good day’, ‘bad day’, how they prep food, working vs day off, snacks, sweet drinks etc)
Give 3 examples of online / App dietary trackers
SuperTracker
NutritionQuest
Health body calculator from Ask the Dietician
My Fitness Pal
Healthwatch 360
Role of dietician (7 points)
1) assess and monitor nutritional status
2) determine macro/micronutrient needs
3) develop individualised meal planning
4) Coach towards goals set with provider
5) Track progress
6) Provide ongoing support and education
7) Provide medical nutrition therapy
Role of provider / medical physician
1) Obtain baseline history and physical
2) determine pt risk factors and co-morbidities
3) Create framework for treatment
4) emphasise nutrition as primary role in disease treatment
5) Lead integrated team
6) help patients create short and longterm goals
7) Oversee recommendations made by dietician
For treatment of what condition is the Portfolio diet used and what are its key principles?
Portfolio Diet
Hy’P’ercholesterolaemia
Principles: Very low saturated fat, high plant sterols, soy protein, viscous fibres and almonds
What are sterols?
Sterols
Substances in plants that help block cholesterol absorption - specifically LDL cholesterol
(no appreciable effect on HDL or triglycerides)
Compared with 20mg Lovastatin OD how much did the portfolio diet lower LDL cholesterol by?
Lovastatin = 30.9% decrease in LDL
Portfolio diet = 28.6% decrease in LDL
(no statistical difference :. equally efficacious)
For what condition was the DASH diet created?
What were the principles of the diet?
DASH = Hypertension
Principles: vegetables, low salt, low-fat dairy
(found to be as adequate in controlling HTN as 1st line medication 2003)
What were the principles of the Ornish diet for newly diagnosed low-moderate grade prostate cancer?
What were the effects on PSA levels and prostate Ca cell growth compared with the control group at one year?
Low fat, plant-based
Ornish: PSA levels dropped from (av.) 6.3 to 6.0
Inhibition of prostate Ca cell growth by 70%
Control: PSA increased to (av.) 6.7 from 6.3
9% inhibited growth
Besides prostate cancer in what other condition has the Ornish Diet been proven beneficial, with evidence of disease reversal at 5yrs?
CAD stenosis
What was the Lyon Diet Heart Study designed to assess?
What did it demonstrate?
Lyon Diet Heart Study
Prevention of CHD with the Mediterranean diet vs AHA step 1 diet
That the Mediterranean diet showed protective effects which were maintained for 4 yrs post first MI
For reference what was the 2002 AHA step 1 diet and for what purpose was it designed?
AHA step 1 diet was designed to lower LDL cholesterol
max 30% daily energy from fat, <10% total daily energy intake form saturated fat
Esselstyn’s plant-based diet for CAD differs from the Ornish diet in what way?
What were the rates for compliant vs non-compliant subjects of major cardiac events with Esselstyn’s diet over 3.7yrs?
Esselstyn - no meat, dairy, sugars, fruit juice, nuts etc
VERY low-fat, plant-based rather than simply ow-fat
Compliant rate: 0.6%
Non-compliant rate: 62%!
What type of diet has been shown to be most effective for blood glucose control in diabetics?
Vegan diet
The addition of Brazil nuts, cashew nuts, almonds, pistachios, legume or soy to diet can help improve levels of what?
cholesterol
Cholesterol is an essential precursor for which 5 major classes of steroid hormone?
Glucocorticoids, mineralocorticoids, androgens, oestrogen and progestogens
What is the definition of a “Grade C” recommendation by the US Preventative Services Task Force?
Advice or counselling to be given based on readiness to change in those without disease or risk factors
e.g. nutrition and exercise counselling for those with no chronic disease or risk factors
What is the definition of a “Grade B” recommendation by the US Preventative Services Task Force?
Advice or service should be provided due to a high certainty of mod-substantial benefit
e.g. Recommendation for intensive behavioural health nutrition counselling and physical activity for overweight individuals with chronic disease risk factors
SMART goals in nutrition prescriptions stands for…
Specific (rather than a food group / category)
Measurable (give numbers)
Achievable (will the pt have control over the focus)
Realistic (improvement rather than perfection)
Time connected (frequency / duration)
What is the suggested nutrition prescription format?
TAF:
Type of food (be specific)
Amount (be exact)
Frequency (e.g. once daily for 2 weeks)
In what form are proteins more concentrated meat or plant-based?
Meat
e.g. Chicken breast approx 1/3 weight in grams = protein
Soy beans ~10th weight in grams = protein
Give 3 advantages to animal-based protein consumption over plant-based protein
1) more concentrated
2) more readily digestible
3) more easily assimilated (absorbed) as more similar to human proteins
For what reason are the sulphur-containing amino acids of meat potentially disadvantageous to health?
The metabolites are acidic and require buffering through extracting calcium from bones which can contribute to poor bone strength
Soy beans, tofu, lentils, pinto beans, hempseeds, pumpkin seeds and whole wheat bagels are all sources of what plant-based macronutrient?
Protein
Which of the following plant sources of protein have a similar digestibility to meat? (>90% ileal digestibility of amino acids)
Peas - Wheat gluten
Soy - Wheat flour
Cereals
Soy protein
Wheat gluten
Wheat flour
(other cereals and peas 80-90%; plants with intact cell walls 50-80% digestibility)
True or false?
All plants contain all essential amino acids
True (as general rule)
However, proportions often not ideal
How best might you ensure a full amino acid profile in a vegetarian diet?
Combination of:
Starch: rice, corn, potatoes, beans (legumes)
Mix of fruit and veg
Which groups of people usually require greater protein intake?
Seniors
Children
Athletes
For what reason do those >70 need more protein?
Poorer protein absorption
may need 25% more dietary protein than younger adults
Monounsaturated / polyunsaturated fats can be found in what broad groups of food?
Plants and seafood
Processed foods, meat, dairy and tropical oils contain what sorts of fat?
Saturated and trans fats
Omega-3 and Omega-6 polyunsaturated fats, which are considered generally anti-inflammatory and which pro-inflammatory?
Omega-3 = antiinflammatory Omega-6 = pro-inflammatory (usually)
(NB: relationship between omega-3 and -6 still not well understood)
To say Omega-6 polyunsaturated fats are pro-inflammatory is oversimplification. Why?
Those with arachidonic acid tend to have an inflammatory effect
Those with dihomo-linolenic acid usually considered anti-inflammatory
What types of oils contain monounsaturated fats?
Generally oils that are liquid at room temperature
e.g. Olive, Canola, Peanut, Sunflower, Seseme oils
If monounsaturated fatty acids are used in place of saturated and trans fats what may this help to lower?
LDL cholesterol, risk of cardiovascular events and all-cause mortality
Lauric acid (saturated fat) is predominantly found in what food source and has what effect on cholesterol?
Coconuts
Lauric Acid:
Increases total, HDL and LDL cholesterol
Increased LDL known to increase heart disease risk
Increased HDL may not lower heart disease risk
Stearic Acid (saturated fat) is found in what food sources and has what endothelial effect?
Associated with what type of cancer?
Meat, poultry, cheese, dairy and dark chocolate
Stearic Acid:
Decreases endothelial cell function resulting in cell damage/death
Associated with colorectal cancer
What is the most common saturated fat and in what food products is it found?
Palmitic Acid
Palm oil, butter, cheese, milk and meat
MAY lead to increase heart disease risk
Myristic acid (saturated fat) is found in what main group of food product and is known to be harmful to health?
Dairy products (cheese, butter, milk) Also coconut oil, palm kernel oil - lesser extent nutmeg and palm oil
Trans fats (banned in US and assoc with increase risk of MI and Stroke) are found in partially hydrogenated vegetable oils - describe briefly the process by which these are created and give examples of foods found in
Hydrogenation is the process by which a liquid unsaturated fat is turned into a solid fat by adding hydrogen. When partially hydrogenated produces trans fats which are harmful. (^LDL & vHDL)
Added to many processed foods - improves shelf life, saves money, adds texture and increases stability e.g. margarine, veg shortening, packaged snacks, ready-made foods, fried foods, creamers etc)
NB: Fully hydrogenated fats -> saturated rather than trans not as harmful
Healthy carbohydrates are found in which types of food?
Vegetables, fruits, legumes, tubers (potatoes, artichokes, malanga, ginger etc) and whole grains
What are the components of carbohydrates?
Fibre
Sugars
Starch
What health benefits are associated with fibre ingestion?
Improves constipation (stool bulking) Lowers cholesterol Stabilises blood sugar Improves satiety / suppresses hunger Reduces risk of diabetes Decreases risk of colon cancer Improves gut microbiome (healthier gut bacteria)
What are the current US recommendations regarding daily fibre intake?
Women: >25g/day (greater benefits if >40g)
Men: >38g/day (greater benefits if >45g)
What are the best sources of fibre?
Legumes, whole grains, vegetables, fruits, nuts and seeds
NB: no fibre in dairy / meat
List legumes
Peas Beans Chickpeas Lentils Peanuts
Legumes have a rich nutritional profile (calories, protein, fibre, carbs, Fe, Mg, folate, K, Vit B1, 3, 5&6, phos, zinc and copper)
What antioxidant do ALL legumes contain?
What disadvantage does this carry?
Phytic Acid
Impairs absorption of:
Fe, Zinc, Ca++
(if eat meat in same meal less likely to risk deficiency - NB this fact came for Healthline not LM TB)
Starch, harmful or protective?
Neutral to protective from whole food e.g. corn / potatoes
Harmful from processed sources e.g. corn syrup / crisps
Briefly define micronutrients and beneficial non-nutrients
Micronutrients: vitamins and minerals
Beneficial non-nutrients: beneficial to health but not proven essential for life
(antioxidants, anti-inflammatory molecules, phytochemical, polyphenols, phytosterols, glucosinolates and carotenoids)
Micronutrient balance is more easily achieved with supplements than whole food diet - True or False?
False
Variety of whole foods achieves better balance
NB: Vit B12 should be taken if on a plant-only diet! Found in meat and dairy as well as fortified cereals
List 2 identified benefits of diets high in antioxidants
1) Decreased inflammation (by decreasing oxidation)
2) Improves immune system function
(in-so-doing reduces cancer and most chronic disease risk)
List 5 groups of antioxidant containing fruits / veg
ANTIOXIDANT GROUPS
- Cruciferous veg: broccoli, cauliflower, sprouts, kale
- Dark berries / fruits: blue-, rasp-, straw-, cranberries, pomegranate
- Allium veg: Garlic, onions, leeks
- Orange, yellow, dark green veg: carrots, yams, mango
- Dark green leafy veg: spinach, collards, Swiss chard, turnips, mustard, bok choy
What foods commonly increase inflammation?
PRO-INFLAMMATORY FOODS
> Processed grains and flours
(high glycemic index and increase insulin secretion)
Processed meats (group 1 carcinogens) and red meat
Group 1 carcinogens increase risk of which cancers?
Colon, stomach, pancreatic, prostate
List at least 5 group 1 carcinogens (not just foods)
Alcohol, tobacco, X- & gamma radiation, Hep B and C viruses, Processed meat, benzene, aflatoxin (e.g aspergillus), coal-tar, formaldehyde
What are Advanced Glycation End Products (AGEs) and what effects are they known to have on humans?
AGES = OX STRESS AND INFLAMMATION -> Chronic D
Formed by spontaneous reactions between amino acid and monosaccharide (e.g. glucose)
>Oxidative stress inducers
(physiological stress caused by cumulative effects of damage by free radicals not neutralised)
>Pro-inflammatory -> may lead to chronic disease
Where do most AGEs come from?
Tobacco and consumed foods
though body does produce small amounts daily
Order in which AGEs are most commonly found in terms of macronutrient food groups?
Protein rich foods > fats > carbohydrate rich foods
List 5 things that make occurrence of AGEs in foods more likely
Protein rich Higher cooking temperatures Heat applied for longer Dry foods (moisture lowers AGE formation) pH further from neutral Higher trace minerals
What cooking methods increase AGEs?
Broiling, grilling, roasting, searing, frying
What cooking methods decrease AGEs?
Boiling, steaming, stewing (moisture and lower heat)
What specific groups of cell are particularly vulnerable to damage by AGEs?
Nerve and brain cells, collagen proteins in kidneys, blood vessels and eye cells
(increased AGEs linked to: DM, Atherosclerosis, CKD, slow wound healing)
To help avoid / reduce consumption of AGEs what general rules may be followed?
Reduce consumption of:
- Highly processed foods, fatty meats, solid fats, full dairy products (cream/butter/cheese)
- less frying, grilling, baking and more boiling, stewing, steaming in food prep
What general nutritional principles should be followed to treat / prevent hyperlipidaemia?
(portfolio diet for hypercholesterolaemia)
Avoid: 3
Increase: 4
- Avoid trans fats (partially hydrogenated oils, fried foods, commercially baked snacks, creamers etc)
- Reduce saturated fats (most commonly consumed in cheese and pizza in US)
- Limit Omega-6 fatty acids (not as harmful as sat fat)
Eat more:
- unsaturated (esp.polyunsaturated fats)
- high quality complex carbohydrates (\/ risk of heart and vasc disease)
- increase fibre intake to at least 40-45g/day
- Increase nut and Omega-3 intake (almonds, walnuts, pecans; flax, chia seeds, walnuts and fish)
- Increase plant sterols and stanols (soybeans, peas, legumes, nuts, seeds, sprouts, avocados)
What general nutritional principles should be followed to treat / prevent hypertension?
Reduce:
- Sodium
- Saturated fat
- Alcohol
- Caffeine / tobacco / stress / weight
Increase: >Physical activity >Potassium >Calcium >Mg >Garlic NB 1) water-only fasting has shown improvement in BP 2) only 7% of vegans have HTN vs 23% meat-eaters
What general nutritional principles should be followed to treat / prevent Type 2 diabetes?
Reduce: (Fats and Sugars)
- Simple carbohydrates (-ose sugars, artificial sweeteners)
- Processed grains (white flour & rice, flaked cereals, puffed rice / grains, crackers, baked goods)
- high glycemic index foods (raise blood sugar fast)
- Saturated / trans fats
- total caloric intake (XS calories leads to ^ triglycerides)
Increase:
> Dietary fibre
> Low glycemic index foods
What are the main aims of a diet to reduced risk of cancer?
- Decrease inflammation
(reduce sat fat, processed sugar / meat / foods, red meat) - Support immune system
(increase whole foods, anti-oxidant rich foods)
Increase fibre to 40-45g/day
Anti-oxidant supplements appear to reduce cancer risk
True or False?
False
Anti-oxidants from whole foods do
What two things have been demonstrated to increase risk of Breast Ca?
1) BMI >30
2) Increased meat intake
What foods have been demonstrated to decrease risk of Breast Ca?
soy
fruit
veg
What two antioxidants have been demonstrated to reduce risk of Prostate Ca?
Lycopene (tomatoes, watermelon, guava, pink grapefruit)
Selenium (brazil nuts, sunflower seeds, fish, mushrooms)
What two foods have been most associated with increased risk of Colon and Gastric Ca?
Processed meat Red meat (more assoc with colon)
What foods are thought to reduce colon Ca risk?
High fibre
Calcium
Folate
What foods are thought to reduce Gastric Ca risk?
Fruit and Veg
In 1972 Dr Dennis Burkitt wrote a Canadian Journal of Family Medicine article which highlighted WHICH dietary factor to be the most common cause for the following diseases/conditions :
IHD, gallstones/cholecystitis, Appendicitis, Diverticular disease, colorectal ca, haemorrhoids, Varicose veins, Hiatus hernia, obesity
Lack of dietary fibre
(follow up articles in 1982 “Western Diseases and their emergence related to diet” LANDMARK article recognising that 21st century dieases are lifestyle-related and 1987 - fibre)
What 4 interventions demonstrated a 70% cancer cell growth suppression rate in those with early-stage prostate Ca? (Frattaroli / Ornish - sep publications 2008 - diet only accounts for one!)
a) Whole food plant-based diet
b) Exercise
c) Stress management
d) Group support sessions
What type of diet has been shown to reduce growth and increase apoptosis of breast cancer cells?
Low-fat, high-fibre diet
(also IGF-1 dropped and IGF-1 binding protein increased;
diet and exercise both play a role in inhibiting growth)
The major study “Diabetes Prevention Program trial” concluded that lifestyle interventions were how much more effective than medications?
Almost twice as effective
What did the “Diabetes Prevention Program trial” show the diabetes prevalence to be among Vegans and Non-vegetarians?
Vegans = 0.22 Non-vegetarians = 1.00
(Stepwise depending on plant based consumption
>IMPORTANT: incidence of diabetes drops the more plants individuals consume even if controlling for BMI!)
The most plant-based diets have been shown to have the lowest risk for which common ophthalmic condition?
Cataracts
Increasing consumption of what two major food types have been proven to improve COPD mortality rates and lung function?
Fruit; Fruit and Veg respectively
What are the 3 major dietary risk factors for kidney function decline?
- animal protein
- animal fat
- cholesterol
Arachidonic acid found in poultry and eggs has been linked to what mental health complaint?
Low mood (secondary to neuro-inflammation)
What two major food groups have been linked to increased immune response WITHOUT overstimulating the immune system?
Fruit and Veg
A semi-vegetarian diet has produced 80% remission rates in what GI condition?
Crohn’s Disease
Restriction of what specific dietary macronutrient halted disease progression in MS sufferers 34yrs after diagnosis?
Saturated Fat
Average total cholesterol Uganda, Rural China, US?
Uganda = 3.75 (Veg, whole grain, plant proteins)
Rural China = 3.28 (1/2 fat, 10th meat, 3x fibre of US)
US = 5.25
CHD almost nil in Uganda!
MI = 0.2% incidence vs 22% in Caucasian Americans
Name the only DIRECT risk factor for atherosclerosis
Hypercholesterolaemia
List the INDIRECT risk factors for atherosclerotic plaques (5)
Smoking Diabetes HTN Inactivity Obesity
What is the optimal LDL level?
1.2-1.8mmol/L
Evidence suggests atherosclerosis does not progress when LDL <1.8 mmol/L
What % of our diet does the American Heart Association recommend saturated fats comprise?
= 5-6% of total calories
(Very difficult on non-veggie diet)
(NB: any intake of trans fats, sat fats or cholesterol may increase LDL)
At what level of total cholesterol has progression of atherosclerosis been proven to cease? (1995)
3.88mmol/L (average vegetarian total cholesterol)
What is considered to be the best way to manage coronary artery disease?
Lower LDL and triglycerides
To do so a vegetarian diet works best
A very-high-fibre vegetable, fruit and nut diet was shown to be less, equal to or more efficacious in lowering cholesterol than therapeutic statin?
Equally effective
Dr Dean Ornish found what combination of Intensive Lifestyle Changes to cause regression of coronary plaque stenosis at 1 and 5 years?
(5 elements)
Vegetarian diet, aerobic exercise, stress management training, smoking cessation and group psychosocial support
Following 12wks of 10% fat plant-based diet, 3 hours moderate exercise and 1-hr daily stress management in individuals with angina what % were attack free?
74% angina free
What is the projected proportion of the US population that will have diabetes by 2050?
1/3
Approx 10% currently (2020)
In 2016 where did diabetes rank in leading causes of death in the US?
6th
What was the ACCORD study assessing?
Effects on cardiovascular risk in diabetes through aggressively lower blood sugars to tightly controlled levels with medications
What did the ACCORD study results demonstrate for high-risk T2DM patients when tightly and aggressively controlling blood sugars with medications?
Intensively reducing blood sugars below guidelines with meds produced harm in high-risk patients:
- increased insulin assoc with cancer risk, CVD and weight gain
Summarise the pathogenesis of Type 2 Diabetes
> Excess calories leads to increase in adipose tissue fatty infiltrate of muscle and liver and leptin production.
Leads to weight gain and inflammatory mediators
Western diet (and Abx) lead to dysbiosis and decreased SCFAs inc butyrate (useful in blood sugar Mx)
Fatty deposits in the liver lead to increased blood sugar due to failure of liver to suppress gluconeogenesis and triacylglycerols
Insulin resistance: inflammatory mediators damage liver and beta cells & muscle and adipocyte cells resist further fat storage. Intramyocellular fat accumulation disrupts insulin receptors via lipotoxic mediators
to overcome insulin resistance pancreas secretes more insulin; insulin increases appetite (the above repeats causing further fatty liver deposits)
Beta cells become damaged by fatty acids - > suppresses insulin secretion :. unable to push glucose in to cells - BMs rise further. If beta cells stop insulin production completely pt becomes insulin dependent
What determines the rate of fatty liver progression in T2DM?
Muscle insulin resistance
What are fatty liver progression and the deposit of fatty acids in the pancreas responsible for causing?
Hepatic insulin resistance (failure to respond to blood glucose levels) and beta cell dysfunction
What is the cornerstone of T2DM control, treatment and reversal? (single best intervention)
Diet - can undo almost all medical treatments
In what way can exercise be helpful in T2DM?
Exercise can: - acutely lower blood sugar - improve weight control - help with insulin resistance - lower percentage fat in muscles and liver in the treatment of T2DM
In what way can stress management be helpful in T2DM?
Stress management can:
- help LOWER BLOOD SUGAR by DECREASING the amount of CORTISOL exposure
(cortisol raises blood sugar levels on secretion)
Describe the insulin resistance cascade starting with adipocyte hyperplasia and hypertrophy
-Weight gain - > Adipocyte hyperplasia and hypertrophy and accumulate in ECTOPIC tissues (muscle/liver)
-Leads to IMPAIRED INSULIN SIGNALLING
-Adipocyte growth ^ INFLAMMATION & lipolysis which ^ inflammatory mediators/macrophage recruitment/FFA
-FFA/inflam - > DECREASE in ADIPONECTIN
-Adiponectin is PROTECTIVE -> clears triglycerides and TNF-a protecting endothelium
also ^ hippocampal growth and decreases depression
-TNF-a ^ inflammation
-Lipolysis and lipotoxicity produce DAG and TAG -> CER and Sph (all assoc with INSULIN RESISTANCE!)
How is insulin resistance associated with depression?
Adipocyte-related insulin resistance cascade results in (among other things) reduced levels of adiponectin.
ADIPONECTIN is involved in REDUCING DEPRESSION
Name 3 proteins / hormones produced by adipocytes
1) Leptin
2) Epithelium derived factor
3) Retinol binding protein
What is leptin and what two significant negative impacts can it have on the body when in excess?
Hormone and marker of obesity and inflammation, it is involved with satiety signalling
1) Excess leptin can lead to leptin resistance which results in satiety detection inability (consume more!)
2) Leptin is proangiogenic - > increases cancer cell growth risk and provides metastases opportunities
(also increases cytokine prod further inflammatory)
What does epithelium derived factor do? (produced by adipocytes)
Desensitises cells to insulin
What does retinol binding protein do? (produced by adipocytes)
Prevents activation of glucose carrying proteins
How is the NF-kB pathway initiated?
Through inflammation and free radicals (which comes from food, radiation and toxins
NF-kB pathway is assoc with worsening inflammation and which (disease) processes?
NF-kB Pathway (immune response and cytokine regulation) assoc with these conditions:
Atherosclerosis, cancer, diabetes, asthma, allergies, aging, colitis, GI diseases, autoimmune diseases, Alzheimer’s, Arthritis
Diet modifies and regulates NF-kB through which two beneficial non-nutrient groups?
Antioxidants and phytonutrients
Macrophages are recruited as part of the immune system when what general process takes place?
Inflammation
List 2 inflammatory pathways which result in macrophage recruitment
Inflammatory pathways that result in macrophage recruitment:
1) cytokine pathway activation (IL-6, IL-1 Beta, TNF-a)
2) NF-kB, JNK inflammatory cytokine pathways
Macrophages can cause what if recruited near beta cells?
Beta cell death
Beta cell injury/death can lead to insulin deficiency and hyperglycaemia. Beta cell death can occur due to multiple genetic, environmental and lifestyle factors - list 5
1) Dyslipidaemia (VLDL/LDL pro-apoptotic)
2) Glucotoxicity (IL-1 beta -> beta-cell apoptosis)
3) Cytokines (NF-kB, JNK pathways)
4) Leptin (stimulates cytokine pathways - > apoptosis)
5) Oxidative Stress (endothelial injury from ^BM)
In 2009 research by The USDA what percentage of US food consumption comprised processed food (added fats, oils, sugars and refined grains)?
63%
In 2009 research by The USDA what percentage of US food consumption comprised unprocessed plant foods?
6%
With decreased pancreas and liver tricyglycerol levels normalisation of what can occur?
Beta cell function
Blood sugar and HbA1c levels can reduce with what intentional bodily change?
Weight loss
Murine tests have shown that fasting can promote regeneration of what?
B-cell regeneration
Reducing weight can have what effect on inflammation and insulin sensitivity?
reduce inflammation
increase insulin sensitivity
Gastric bypass surgery, when weight loss achieved, has shown a reduction in what 3 things?
1) HbA1c
2) all-cause mortality
3) medication requirement
(29-30% remission rates at 5yrs - STAMPEDE Sweden)
A high protein, low carb diet can achieve what in T2DM?
Weight loss
reduced insulin
Reduced HbA1c
HOWEVER - health prof follow up study demonstrated 37% increased risk of diabetes in low carb diet!
A Mediterranean diet has been shown to achieve what 3 results?
1) Reduced HbA1c levels
2) reduced incidence of diabetes
3) improved insulin sensitivity
20-30% reduced risk of developing T2DM
What did the Diabetes Prevention Program consist of?
Diabetes Prevention Program
- 12-month intervention program
- 6 months of weekly meetings
- 6 months monthly meetings
- Instructions to meet physical activity guidelines of moderate intensity exercise 150mins per week
- sustainable lifestyle change - gym memberships etc
- Dietary change advice - less fat, fewer calories ‘MyPlate’
- Virtual or live support
What were the 3 conclusions of the Diabetes Prevention Plan?
1) Lifestyle habits can prevent diabetes
2) the DPP offers effective clinical applications
3) Lifestyle preferable for mx diabetes - no side effects
The DPP lessons learned for clinicians were:
i) talk with pts about prediabetes and need to treat
ii) screen with lab work / Q’aires
iii) discuss longterm implications
iv) discuss all tx options -> informed consent
What positive aspects of lifestyle are clinicians encouraged to focus on in these discussions?
a) cost effectiveness
b) co-morbid risk reduction
c) general well-being / daily health
d) provide success stories
e) encourage / support healthier ideas, minimise fear
A 22-week randomised trial showed what reduction in diabetes meds compared with ADA diet?
48% med reduction compared with 23%
HbA1c dropped 1.23% vs 0.38%
A low-fat vegan diet in non-insulin dependent diabetics has been associated with reduction in what 2 things?
Weight
Fasting glucose
91% of T2DM cases in the Nurses’ Health Study contradicted 5 factors shown to be evidenced in 3300 low-risk candidates. What were they?
1) BMI <25
2) Diet high in cereal fibre and polyunsaturated fat and low in fat and glycemic load
3) Mod-vigorous exercise 30+ mins / day
4) Non-smoking
5) Average 1/2 serving alcohol / day
The Adventist Health Study showed that regular meat consumption increased the risk of diabetes in men and women by what %?
Men 97%
Women 93%
The Nurses’ Health Study showed what link between egg consumption and CVD risk?
> 1 egg / day doubled CVD risk compared to those who ate <1 egg / week
The Nurses’ Health Study showed what link between egg consumption and diabetes risk?
> 5 eggs / week assoc with increased risk of developing diabetes
The NIH study showed what 4 attributes associated with a plant-based diet vs ADA diet?
1) HbA1c dropped 3x as much on plant-based diet
2) LDL dropped twice as much
3) Weight dropped >twice the amount
4) Medication requirement reduced by twice the amount
Vegetarian versus American Diabetes Association diet showed what improvements in the veg group?
- Increased reduction in weight & meds
- Improved insulin sensitivity
- Increased adiponectin, Vit C and SOD
- Decreased leptin
Red and particularly processed meat is associated with an increased risk of diabetes. That risk reduces by 16-35% (according to 2011 meta-analysis) if one serving of red meat per week substituted with what?
One serving of nuts, low fat dairy or whole grains
3 large cohort studies evidenced a 20% lower risk of diabetes if diets emphasised plant foods and were low in animal foods.
How did this % alter in HEALTHY plant-based foods and less healthy processed plant-based foods?
Healthy plant-based - 34% lower risk Less healthy (processed) - 16% INCREASED risk
What is epigenetics?
Study of non-DNA sequence components of genetic inheritance
What do non-DNA sequence components do to genes
modify and control gene expression
What are the 4 key influencers of epigenetics?
Diet (high-fat rat foetuses)
Exercise (GLUT4 receptor / improves glucose uptake)
Sleep deprivation (>700 genes)
Obesity
T2DM is associated with what two gene expression altering processes?
DNA methylation and histone micro-RNA
assoc with insulin sensitivity
Name 4 positive influencers of the epigenome
a) polyphenols (present in plant foods)
b) exercise
c) stress reduction
d) maternal / paternal diet
Name 4 negative influencers of the epigenome
z) Sugar
y) Alcohol
x) Saturated fat
w) Processed food
