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Lifestyle Medicine > Nutrition Science, Assessment and Prescription > Flashcards

Nutrition Science, Assessment and Prescription Flashcards

1
Q

How often are the Dietary Guidelines for Americans updated?

A

Every 5 years

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2
Q

Dietary Guidelines for Americans are based on recommendations by which advisory group?

A

the Dietary Guidelines Advisory Committee

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3
Q

Who is the Dietary Guidelines Advisory Committee made up of?

A

Experts from academia, government and industry

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4
Q

Dietary Guidelines for Americans are jointly issued by which 2 governmental departments?

A

Department of Agriculture
and
Department of Health and Human Services

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5
Q

What is the result of US food industries being in a position to influence public policy?

A

Some Dietary Guidelines involved a COMPROMISE and sometimes recommendations even contradict scientific evidence!

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6
Q

What EVIDENCE is there to demonstrate an INVERSE relationship between CVD risk and DAIRY consumption?

A

weak to no evidence of an inverse relationship

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7
Q

What evidence is there on the relationship between DAIRY and STROKE risk?

A

Mild association with reduced risk

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8
Q

What evidence is there on the relationship between YOGHURT and DIABETES risk?

A

Mild association with reduced risk

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9
Q

What associations have been demonstrated between YOGHURT & CHEESE and INFLAMMATION?

A

YOGHURT MAY reduce risk of inflammation

CHEESE shown to be pro-inflammatory (with increased plasma inflammatory biomarkers)

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10
Q

Eggs and diabetes / CVD risk?

A

> /= 3 eggs per week assoc with increased DIABETES risk

Not assoc with increased CVD risk

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11
Q

Eggs and CHOLESTEROL - what is the association?

A

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!)

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12
Q

What 7 broad food components do Americans eat too much of?

A

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

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13
Q

Define ‘free’ sugars

A

free or added sugars are any sugars added to foods by manufacturing companies AND sugars present in honey, syrup or unsweetened fruit juices

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14
Q

What percentage of the total calorific daily intake does the WHO recommend we do not exceed in free sugars?

A

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)

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15
Q

What percentage of daily calorific intake does the average American ingest in free / added sugars?

A

13% (13tsp / 52g)

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16
Q

What is the biggest culprit of added sugar in the american diet?

A

Sugar sweetened beverages (47% of total US sugar calories)

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17
Q

What major food groups are high in cholesterol?

A

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)

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18
Q

What is the biggest source of high cholesterol food in the american diet?

A

Eggs (25% total US cholesterol)

Chicken is 2nd 12.5%

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19
Q

What major food groups are high in saturated fats?

A

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

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20
Q

Give examples of foods moderately high (4-7g) in saturated fats?

A

MOD SAT FAT

Whole milk, leaner meat, cheese, full fat dairy, palm oil

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21
Q

Examples of foods with lower (1-3g per ounce) levels of saturated fat

A

Nuts and seeds; avocado; 1 x egg; fish

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22
Q

What is the biggest source of high saturated fat food in the american diet?

A

Burgers and sandwiches (esp with cheese, meat or both)

19% (snacks and sweets 2nd at 18%) (dairy 4th 13%)

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23
Q

What do the USDA dietary Guidelines list as MIXED DISHES which are deemed to incorporate 50% of dietary salt intake

A 
Burgers, sandwiches and tacos
Rice, pasta and grain dishes
Pizza
Meat, poultry and seafood
Soups
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24
Q

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)

A

44%

NB protein foods often have a significant amount of salt in them

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25
Q

What is the is the recommended daily sodium intake?

A

= / <2000mg

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26
Q

What quick and easy calculation may be adopted to ensure less than 2000mg of salt/sodium is ingested daily when reviewing food labels?

A

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

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27
Q

If mostly whole plant food diet on a 1600 kcal diet what MIGHT the sodium intake be?

A

may be <500mg (therefore even adding high salt condiments etc may still keep daily intake well below 2000mg)

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28
Q

What are trans-fats?

A

Naturally occurring (in meats /dairy) or artificially created fats in manufactured foods by hydrogenation of unsaturated fats e.g. solid oils, margarines etc

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29
Q

What are the benefits of trans-fats?

A

Shelf-life and food flavour stability

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30
Q

What disease process has evidence linked trans-fats to significantly?

A

CHD

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31
Q

When did the FDA mandate that trans-fats be removed from manufactured foods?

A

2018

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32
Q

What types of food typically have trans-fats in them?

A

snack foods (highest e.g. crisps / micro popcorn), fast foods (fries) dairy, oils, processed meats, red meat, reduced fat dairy and refined grains

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33
Q

What are the 3 major processed grain food types?

A

white flour, white rice, white pasta

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34
Q

List the 4 highest calorie food types

A

HIGHEST CALORIE FOODS

Fats and oils (e.g. butter/marg)
Confections
Snack foods
Processed meats

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35
Q

List the 7 food types lowest in calories

A

LOWEST CALORIES

Whole vegetables
Whole fruits
Whole grains
Legumes
Mushrooms 
Herbs and spices
low fat dairy
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36
Q

What 5 food groups make up 28% of total calories in the US diet (top 5 sources of high calorie foods in US)

A

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%)

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37
Q

List the 9 shortfall micro-nutrients in the US diet

A

9 SHORTFALL micro NUTIRENTS

Calcium
Fibre
Magnesium
Potassium
Vitamins A, C, D, E and K
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38
Q

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)

A

SOURCES CALCIUM (BESIDES DAIRY PRODUCTS)

some seeds (Chia, poppy and sesame)
Tofu
Calcium-fortified non-dairy drinks

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39
Q

What effect does oxalate have on calcium?

A

Limits calcium absorption

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40
Q

List foods moderately high (5-20% daily req) in calcium and low in oxalate

A

MOD CALCIUM, LOW OXALATE

almonds; beans; okra; low oxalate dark greens (kale, broccoli, cauliflower, lettuce, cucumber, peas, courgette)

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41
Q

List foods very high in calcium but also high in oxalate

A

HIGH CALCIUM, HIGH OXALATE

Spinach, Beet Greens, Swish Chard

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42
Q

What % of calcium can be absorbed from dairy compared to high calcium, low oxalate greens such as kale, bok choy and okra?

A

Dairy - 32-34%

Kale, bok choy and okra - 40-60%

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43
Q

Fibre is found EXCLUSIVELY in what food types?

A

Plant Foods

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44
Q

High fibre foods include…?

A

HIGH FIBRE

beans, split peas, lentils, avocados, bran cereals, raspberries, blackberries, pears, papaya, dried fruits, flaxseeds, some whole grains and whole wheat pasta

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45
Q

Moderately high fibre foods include…?

A

blueberries, strawberries, most other fruit, most veg, grains, whole grain bread, mushrooms, nuts and seeds

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46
Q

Foods high in magnesium include…?

A

MAGNESIUM

Brazil nuts, almonds, cashews, pine nuts, edamame and dark chocolate

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47
Q

Foods moderately high in Mg include…?

A

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

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48
Q

Foods high in potassium include…?

A

HIGH K+

skin-on potatoes, adzuki beans, avocado, soybeans, squash, plantains, bamboo shoots, passion fruit, dates and white beans

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49
Q

Foods moderately-high in potassium include…?

A

MOD HIGH K+

dairy, fish, legumes, nuts, mushrooms, poultry, veg and refined grains, also processed meats

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50
Q

Foods high in Vitamin A include…?

A

VIT A

Sweet potato, beef liver, spinach, RAW carrots, red peppers, black-eyed peas

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51
Q

Foods moderately high in Vitamin A include…?

A

MOD VIT A

daaaaaairy, tomato juice, herring, fortified cereals, hard-boiled eggs

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52
Q

Foods high in Vitamin C include…?

A

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

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53
Q

Foods moderately high in Vitamin C include…?

A

Most other vegetables and fruits

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54
Q

Foods high in Vitamin D include…?

A

VIT D FOODS

High fat fish (e.g. salmon); fortified dairy and non-dairy milks; fortified fruit juices

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55
Q

Foods moderately high in Vitamin D include…?

A

Dairy (vit D is added to milk), fortified margarines, eggs, beef liver, fortified cereal

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56
Q

What is the weekly recommended sunlight exposure without sunscreen for adequate Vit D synthesis?

A

5-30mins twice a week - large surface areas (face, arms, legs, back / chest) between 10am and 3pm

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57
Q

Describe the metabolic pathway for producing Vit D with sunlight exposure

A

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)

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58
Q

Foods high in Vitamin E include…?

A

VIT E

Sunflower seeeeeeeds and oils, almonds, hazelnuts

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59
Q

Foods moderately high in Vitamin E include…?

A

MOD VIT E

Peeeeeeanut butter
Avocado, spinach, broccoli

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60
Q

Foods high in Vitamin K include…?

A

HIGH VIT K

oils, leafy greens, kiwi, dried prunes, avocado, broccoli, brussel sprouts, asparagus

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61
Q

Foods moderately high in Vitamin K include…?

A

Herbs and (‘K’ick ass) spices

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62
Q

List the 7 most nutrient-dense foods (most ‘short-fall’ nutrients and least ‘over-consumed’ nutrients)

A

1) Veg including mushrooms
2) Herbs and spices
3) Fruits
4) Legumes
5) Whole grains
6) Nuts
7) Seeds

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63
Q

What are the 100,000 phytonutrients which plant foods are estimated to contain likely to protect against?

A

Chronic diseases such as cancer, osteoporosis and heart disease

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64
Q

List the top food groups to limit or avoid (13 in total)

A

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)

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65
Q

What does ‘eating the rainbow’ help to ensure?

A

That we are consuming a wide range of flavinoids and vitamins essential to health and disease prevention

(increases microbiome, healthier gut)

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66
Q

Describe the ABCD or performing a nutrition assessment

A

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)

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67
Q

Give 3 examples of online / App dietary trackers

A

SuperTracker
NutritionQuest
Health body calculator from Ask the Dietician

My Fitness Pal
Healthwatch 360

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68
Q

Role of dietician (7 points)

A

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

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69
Q

Role of provider / medical physician

A

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

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70
Q

For treatment of what condition is the Portfolio diet used and what are its key principles?

A

Portfolio Diet

Hy’P’ercholesterolaemia

Principles: Very low saturated fat, high plant sterols, soy protein, viscous fibres and almonds

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71
Q

What are sterols?

A

Sterols

Substances in plants that help block cholesterol absorption - specifically LDL cholesterol
(no appreciable effect on HDL or triglycerides)

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72
Q

Compared with 20mg Lovastatin OD how much did the portfolio diet lower LDL cholesterol by?

A

Lovastatin = 30.9% decrease in LDL
Portfolio diet = 28.6% decrease in LDL
(no statistical difference :. equally efficacious)

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73
Q

For what condition was the DASH diet created?

What were the principles of the diet?

A

DASH = Hypertension

Principles: vegetables, low salt, low-fat dairy

(found to be as adequate in controlling HTN as 1st line medication 2003)

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74
Q

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?

A

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

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75
Q

Besides prostate cancer in what other condition has the Ornish Diet been proven beneficial, with evidence of disease reversal at 5yrs?

A

CAD stenosis

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76
Q

What was the Lyon Diet Heart Study designed to assess?

What did it demonstrate?

A

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

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77
Q

For reference what was the 2002 AHA step 1 diet and for what purpose was it designed?

A

AHA step 1 diet was designed to lower LDL cholesterol

max 30% daily energy from fat, <10% total daily energy intake form saturated fat

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78
Q

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?

A

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%!

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79
Q

What type of diet has been shown to be most effective for blood glucose control in diabetics?

A

Vegan diet

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80
Q

The addition of Brazil nuts, cashew nuts, almonds, pistachios, legume or soy to diet can help improve levels of what?

A

cholesterol

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81
Q

Cholesterol is an essential precursor for which 5 major classes of steroid hormone?

A

Glucocorticoids, mineralocorticoids, androgens, oestrogen and progestogens

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82
Q

What is the definition of a “Grade C” recommendation by the US Preventative Services Task Force?

A

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

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83
Q

What is the definition of a “Grade B” recommendation by the US Preventative Services Task Force?

A

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

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84
Q

SMART goals in nutrition prescriptions stands for…

A

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)

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85
Q

What is the suggested nutrition prescription format?

A

TAF:

Type of food (be specific)
Amount (be exact)
Frequency (e.g. once daily for 2 weeks)

86
Q

In what form are proteins more concentrated meat or plant-based?

A

Meat
e.g. Chicken breast approx 1/3 weight in grams = protein
Soy beans ~10th weight in grams = protein

87
Q

Give 3 advantages to animal-based protein consumption over plant-based protein

A

1) more concentrated
2) more readily digestible
3) more easily assimilated (absorbed) as more similar to human proteins

88
Q

For what reason are the sulphur-containing amino acids of meat potentially disadvantageous to health?

A

The metabolites are acidic and require buffering through extracting calcium from bones which can contribute to poor bone strength

89
Q

Soy beans, tofu, lentils, pinto beans, hempseeds, pumpkin seeds and whole wheat bagels are all sources of what plant-based macronutrient?

A

Protein

90
Q

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

A

Soy protein
Wheat gluten
Wheat flour

(other cereals and peas 80-90%; plants with intact cell walls 50-80% digestibility)

91
Q

True or false?

All plants contain all essential amino acids

A

True (as general rule)

However, proportions often not ideal

92
Q

How best might you ensure a full amino acid profile in a vegetarian diet?

A

Combination of:
Starch: rice, corn, potatoes, beans (legumes)
Mix of fruit and veg

93
Q

Which groups of people usually require greater protein intake?

A

Seniors
Children
Athletes

94
Q

For what reason do those >70 need more protein?

A

Poorer protein absorption

may need 25% more dietary protein than younger adults

95
Q

Monounsaturated / polyunsaturated fats can be found in what broad groups of food?

A

Plants and seafood

96
Q

Processed foods, meat, dairy and tropical oils contain what sorts of fat?

A

Saturated and trans fats

97
Q

Omega-3 and Omega-6 polyunsaturated fats, which are considered generally anti-inflammatory and which pro-inflammatory?

A 
Omega-3 = antiinflammatory
Omega-6 = pro-inflammatory (usually)

(NB: relationship between omega-3 and -6 still not well understood)

98
Q

To say Omega-6 polyunsaturated fats are pro-inflammatory is oversimplification. Why?

A

Those with arachidonic acid tend to have an inflammatory effect
Those with dihomo-linolenic acid usually considered anti-inflammatory

99
Q

What types of oils contain monounsaturated fats?

A

Generally oils that are liquid at room temperature

e.g. Olive, Canola, Peanut, Sunflower, Seseme oils

100
Q

If monounsaturated fatty acids are used in place of saturated and trans fats what may this help to lower?

A

LDL cholesterol, risk of cardiovascular events and all-cause mortality

101
Q

Lauric acid (saturated fat) is predominantly found in what food source and has what effect on cholesterol?

A

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

102
Q

Stearic Acid (saturated fat) is found in what food sources and has what endothelial effect?

Associated with what type of cancer?

A

Meat, poultry, cheese, dairy and dark chocolate

Stearic Acid:
Decreases endothelial cell function resulting in cell damage/death
Associated with colorectal cancer

103
Q

What is the most common saturated fat and in what food products is it found?

A

Palmitic Acid

Palm oil, butter, cheese, milk and meat
MAY lead to increase heart disease risk

104
Q

Myristic acid (saturated fat) is found in what main group of food product and is known to be harmful to health?

A 
Dairy products (cheese, butter, milk) 
Also coconut oil, palm kernel oil - lesser extent nutmeg and palm oil
105
Q

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

A

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

106
Q

Healthy carbohydrates are found in which types of food?

A

Vegetables, fruits, legumes, tubers (potatoes, artichokes, malanga, ginger etc) and whole grains

107
Q

What are the components of carbohydrates?

A

Fibre
Sugars
Starch

108
Q

What health benefits are associated with fibre ingestion?

A 
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)
109
Q

What are the current US recommendations regarding daily fibre intake?

A

Women: >25g/day (greater benefits if >40g)
Men: >38g/day (greater benefits if >45g)

110
Q

What are the best sources of fibre?

A

Legumes, whole grains, vegetables, fruits, nuts and seeds

NB: no fibre in dairy / meat

111
Q

List legumes

A 
Peas
Beans
Chickpeas
Lentils
Peanuts
112
Q

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?

A

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)

113
Q

Starch, harmful or protective?

A

Neutral to protective from whole food e.g. corn / potatoes

Harmful from processed sources e.g. corn syrup / crisps

114
Q

Briefly define micronutrients and beneficial non-nutrients

A

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)

115
Q

Micronutrient balance is more easily achieved with supplements than whole food diet - True or False?

A

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

116
Q

List 2 identified benefits of diets high in antioxidants

A

1) Decreased inflammation (by decreasing oxidation)
2) Improves immune system function
(in-so-doing reduces cancer and most chronic disease risk)

117
Q

List 5 groups of antioxidant containing fruits / veg

A

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
118
Q

What foods commonly increase inflammation?

A

PRO-INFLAMMATORY FOODS

> Processed grains and flours
(high glycemic index and increase insulin secretion)
Processed meats (group 1 carcinogens) and red meat

119
Q

Group 1 carcinogens increase risk of which cancers?

A

Colon, stomach, pancreatic, prostate

120
Q

List at least 5 group 1 carcinogens (not just foods)

A

Alcohol, tobacco, X- & gamma radiation, Hep B and C viruses, Processed meat, benzene, aflatoxin (e.g aspergillus), coal-tar, formaldehyde

121
Q

What are Advanced Glycation End Products (AGEs) and what effects are they known to have on humans?

A

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

122
Q

Where do most AGEs come from?

A

Tobacco and consumed foods

though body does produce small amounts daily

123
Q

Order in which AGEs are most commonly found in terms of macronutrient food groups?

A

Protein rich foods > fats > carbohydrate rich foods

124
Q

List 5 things that make occurrence of AGEs in foods more likely

A 
Protein rich
Higher cooking temperatures
Heat applied for longer 
Dry foods (moisture lowers AGE formation)
pH further from neutral
Higher trace minerals
125
Q

What cooking methods increase AGEs?

A

Broiling, grilling, roasting, searing, frying

126
Q

What cooking methods decrease AGEs?

A

Boiling, steaming, stewing (moisture and lower heat)

127
Q

What specific groups of cell are particularly vulnerable to damage by AGEs?

A

Nerve and brain cells, collagen proteins in kidneys, blood vessels and eye cells
(increased AGEs linked to: DM, Atherosclerosis, CKD, slow wound healing)

128
Q

To help avoid / reduce consumption of AGEs what general rules may be followed?

A

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
129
Q

What general nutritional principles should be followed to treat / prevent hyperlipidaemia?

(portfolio diet for hypercholesterolaemia)

Avoid: 3

Increase: 4

A
  • 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)
130
Q

What general nutritional principles should be followed to treat / prevent hypertension?

A

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
131
Q

What general nutritional principles should be followed to treat / prevent Type 2 diabetes?

A

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

132
Q

What are the main aims of a diet to reduced risk of cancer?

A
  • 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

133
Q

Anti-oxidant supplements appear to reduce cancer risk

True or False?

A

False

Anti-oxidants from whole foods do

134
Q

What two things have been demonstrated to increase risk of Breast Ca?

A

1) BMI >30

2) Increased meat intake

135
Q

What foods have been demonstrated to decrease risk of Breast Ca?

A

soy
fruit
veg

136
Q

What two antioxidants have been demonstrated to reduce risk of Prostate Ca?

A

Lycopene (tomatoes, watermelon, guava, pink grapefruit)

Selenium (brazil nuts, sunflower seeds, fish, mushrooms)

137
Q

What two foods have been most associated with increased risk of Colon and Gastric Ca?

A 
Processed meat
Red meat (more assoc with colon)
138
Q

What foods are thought to reduce colon Ca risk?

A

High fibre
Calcium
Folate

139
Q

What foods are thought to reduce Gastric Ca risk?

A

Fruit and Veg

140
Q

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

A

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)

141
Q

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

a) Whole food plant-based diet
b) Exercise
c) Stress management
d) Group support sessions

142
Q

What type of diet has been shown to reduce growth and increase apoptosis of breast cancer cells?

A

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)

143
Q

The major study “Diabetes Prevention Program trial” concluded that lifestyle interventions were how much more effective than medications?

A

Almost twice as effective

144
Q

What did the “Diabetes Prevention Program trial” show the diabetes prevalence to be among Vegans and Non-vegetarians?

A 
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!)

145
Q

The most plant-based diets have been shown to have the lowest risk for which common ophthalmic condition?

A

Cataracts

146
Q

Increasing consumption of what two major food types have been proven to improve COPD mortality rates and lung function?

A

Fruit; Fruit and Veg respectively

147
Q

What are the 3 major dietary risk factors for kidney function decline?

A
  • animal protein
  • animal fat
  • cholesterol
148
Q

Arachidonic acid found in poultry and eggs has been linked to what mental health complaint?

A

Low mood (secondary to neuro-inflammation)

149
Q

What two major food groups have been linked to increased immune response WITHOUT overstimulating the immune system?

A

Fruit and Veg

150
Q

A semi-vegetarian diet has produced 80% remission rates in what GI condition?

A

Crohn’s Disease

151
Q

Restriction of what specific dietary macronutrient halted disease progression in MS sufferers 34yrs after diagnosis?

A

Saturated Fat

152
Q

Average total cholesterol Uganda, Rural China, US?

A

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

153
Q

Name the only DIRECT risk factor for atherosclerosis

A

Hypercholesterolaemia

154
Q

List the INDIRECT risk factors for atherosclerotic plaques (5)

A 
Smoking
Diabetes
HTN
Inactivity
Obesity
155
Q

What is the optimal LDL level?

A

1.2-1.8mmol/L

Evidence suggests atherosclerosis does not progress when LDL <1.8 mmol/L

156
Q

What % of our diet does the American Heart Association recommend saturated fats comprise?

A

= 5-6% of total calories

             (Very difficult on non-veggie diet)

(NB: any intake of trans fats, sat fats or cholesterol may increase LDL)

157
Q

At what level of total cholesterol has progression of atherosclerosis been proven to cease? (1995)

A

3.88mmol/L (average vegetarian total cholesterol)

158
Q

What is considered to be the best way to manage coronary artery disease?

A

Lower LDL and triglycerides

To do so a vegetarian diet works best

159
Q

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?

A

Equally effective

160
Q

Dr Dean Ornish found what combination of Intensive Lifestyle Changes to cause regression of coronary plaque stenosis at 1 and 5 years?

(5 elements)

A

Vegetarian diet, aerobic exercise, stress management training, smoking cessation and group psychosocial support

161
Q

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?

A

74% angina free

162
Q

What is the projected proportion of the US population that will have diabetes by 2050?

A

1/3

Approx 10% currently (2020)

163
Q

In 2016 where did diabetes rank in leading causes of death in the US?

A

6th

164
Q

What was the ACCORD study assessing?

A

Effects on cardiovascular risk in diabetes through aggressively lower blood sugars to tightly controlled levels with medications

165
Q

What did the ACCORD study results demonstrate for high-risk T2DM patients when tightly and aggressively controlling blood sugars with medications?

A

Intensively reducing blood sugars below guidelines with meds produced harm in high-risk patients:
- increased insulin assoc with cancer risk, CVD and weight gain

166
Q

Summarise the pathogenesis of Type 2 Diabetes

A

> 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

167
Q

What determines the rate of fatty liver progression in T2DM?

A

Muscle insulin resistance

168
Q

What are fatty liver progression and the deposit of fatty acids in the pancreas responsible for causing?

A

Hepatic insulin resistance (failure to respond to blood glucose levels) and beta cell dysfunction

169
Q

What is the cornerstone of T2DM control, treatment and reversal? (single best intervention)

A

Diet - can undo almost all medical treatments

170
Q

In what way can exercise be helpful in T2DM?

A 
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
171
Q

In what way can stress management be helpful in T2DM?

A

Stress management can:
- help LOWER BLOOD SUGAR by DECREASING the amount of CORTISOL exposure

(cortisol raises blood sugar levels on secretion)

172
Q

Describe the insulin resistance cascade starting with adipocyte hyperplasia and hypertrophy

A

-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!)

173
Q

How is insulin resistance associated with depression?

A

Adipocyte-related insulin resistance cascade results in (among other things) reduced levels of adiponectin.

ADIPONECTIN is involved in REDUCING DEPRESSION

174
Q

Name 3 proteins / hormones produced by adipocytes

A

1) Leptin
2) Epithelium derived factor
3) Retinol binding protein

175
Q

What is leptin and what two significant negative impacts can it have on the body when in excess?

A

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)

176
Q

What does epithelium derived factor do? (produced by adipocytes)

A

Desensitises cells to insulin

177
Q

What does retinol binding protein do? (produced by adipocytes)

A

Prevents activation of glucose carrying proteins

178
Q

How is the NF-kB pathway initiated?

A

Through inflammation and free radicals (which comes from food, radiation and toxins

179
Q

NF-kB pathway is assoc with worsening inflammation and which (disease) processes?

A

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

180
Q

Diet modifies and regulates NF-kB through which two beneficial non-nutrient groups?

A

Antioxidants and phytonutrients

181
Q

Macrophages are recruited as part of the immune system when what general process takes place?

A

Inflammation

182
Q

List 2 inflammatory pathways which result in macrophage recruitment

A

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

183
Q

Macrophages can cause what if recruited near beta cells?

A

Beta cell death

184
Q

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

A

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)

185
Q

In 2009 research by The USDA what percentage of US food consumption comprised processed food (added fats, oils, sugars and refined grains)?

A

63%

186
Q

In 2009 research by The USDA what percentage of US food consumption comprised unprocessed plant foods?

A

6%

187
Q

With decreased pancreas and liver tricyglycerol levels normalisation of what can occur?

A

Beta cell function

188
Q

Blood sugar and HbA1c levels can reduce with what intentional bodily change?

A

Weight loss

189
Q

Murine tests have shown that fasting can promote regeneration of what?

A

B-cell regeneration

190
Q

Reducing weight can have what effect on inflammation and insulin sensitivity?

A

reduce inflammation

increase insulin sensitivity

191
Q

Gastric bypass surgery, when weight loss achieved, has shown a reduction in what 3 things?

A

1) HbA1c
2) all-cause mortality
3) medication requirement
(29-30% remission rates at 5yrs - STAMPEDE Sweden)

192
Q

A high protein, low carb diet can achieve what in T2DM?

A

Weight loss
reduced insulin
Reduced HbA1c

HOWEVER - health prof follow up study demonstrated 37% increased risk of diabetes in low carb diet!

193
Q

A Mediterranean diet has been shown to achieve what 3 results?

A

1) Reduced HbA1c levels
2) reduced incidence of diabetes
3) improved insulin sensitivity

20-30% reduced risk of developing T2DM

194
Q

What did the Diabetes Prevention Program consist of?

A

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
195
Q

What were the 3 conclusions of the Diabetes Prevention Plan?

A

1) Lifestyle habits can prevent diabetes
2) the DPP offers effective clinical applications
3) Lifestyle preferable for mx diabetes - no side effects

196
Q

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

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

197
Q

A 22-week randomised trial showed what reduction in diabetes meds compared with ADA diet?

A

48% med reduction compared with 23%

HbA1c dropped 1.23% vs 0.38%

198
Q

A low-fat vegan diet in non-insulin dependent diabetics has been associated with reduction in what 2 things?

A

Weight

Fasting glucose

199
Q

91% of T2DM cases in the Nurses’ Health Study contradicted 5 factors shown to be evidenced in 3300 low-risk candidates. What were they?

A

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

200
Q

The Adventist Health Study showed that regular meat consumption increased the risk of diabetes in men and women by what %?

A

Men 97%

Women 93%

201
Q

The Nurses’ Health Study showed what link between egg consumption and CVD risk?

A

> 1 egg / day doubled CVD risk compared to those who ate <1 egg / week

202
Q

The Nurses’ Health Study showed what link between egg consumption and diabetes risk?

A

> 5 eggs / week assoc with increased risk of developing diabetes

203
Q

The NIH study showed what 4 attributes associated with a plant-based diet vs ADA diet?

A

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

204
Q

Vegetarian versus American Diabetes Association diet showed what improvements in the veg group?

A
  • Increased reduction in weight & meds
  • Improved insulin sensitivity
  • Increased adiponectin, Vit C and SOD
  • Decreased leptin
205
Q

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?

A

One serving of nuts, low fat dairy or whole grains

206
Q

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?

A 
Healthy plant-based - 34% lower risk
Less healthy (processed) - 16% INCREASED risk
207
Q

What is epigenetics?

A

Study of non-DNA sequence components of genetic inheritance

208
Q

What do non-DNA sequence components do to genes

A

modify and control gene expression

209
Q

What are the 4 key influencers of epigenetics?

A

Diet (high-fat rat foetuses)
Exercise (GLUT4 receptor / improves glucose uptake)
Sleep deprivation (>700 genes)
Obesity

210
Q

T2DM is associated with what two gene expression altering processes?

A

DNA methylation and histone micro-RNA

assoc with insulin sensitivity

211
Q

Name 4 positive influencers of the epigenome

A

a) polyphenols (present in plant foods)
b) exercise
c) stress reduction
d) maternal / paternal diet

212
Q

Name 4 negative influencers of the epigenome

A

z) Sugar
y) Alcohol
x) Saturated fat
w) Processed food

Lifestyle Medicine (11 decks)

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