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This lecture was presented as part of Lunch and Learn series at the Mountain Park Health System by Dr. Siri Chand Khalsa. Content includes Culturally Relevant Tools for Improving Health through......

This lecture was presented as part of Lunch and Learn series at the Mountain Park Health System by Dr. Siri Chand Khalsa. Content includes Culturally Relevant Tools for Improving Health through Nutrition.

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  • 1. Food as Medicine Culturally Relevant Tools for Improving Health Through Nutrition Siri Chand Kaur Khalsa MD, MS 1
  • 2. Integrative Nutrition “Let food be your medicine and medicine be your food” Hippocrates 460 BC – 370 BC 2
  • 3. Food as Medicine Lecture Overview ✦ Introduction ✦ Overview Nutrition ✦ Resources 3
  • 4. Vegetarian Eating Types ✦ Ovo-lacto vegetarianism includes animal products such as eggs, milk, and honey ✦ Lacto vegetarianism includes milk but not eggs ✦ Ovo vegetarianism includes eggs but not milk ✦ Veganism excludes all animal flesh and animal products, including milk, honey, eggs ✦ Raw veganism includes only fresh and uncooked fruit, nuts, seeds, and vegetables ✦ Macrobiotic diets consist mostly of whole grains and beans 4
  • 5. Vegetarian Eating Rationale ✦ Ethical ✦ Health ✦ Environmental ✦ Religious ✦ Political ✦ Cultural ✦ Aesthetic ✦ Economic 5
  • 6. Vegetarian Eating Motivation ✦ Religious ✦ Hindu ✦ Jain ✦ Buddhist ✦ Sikh ✦ 30% of India's 1.2 billion population practices lacto- vegetarianism 6
  • 7. Vegetarian Eating Environmental ✦ To produce 1 pound of feedlot beef requires about 2,400 gallons of water and 7 pounds of grain ✦ Average American consumes ✦ 97 pounds of beef ✦ 273 pounds of meat ✦ Modest reductions in meat consumption in such a culture would substantially reduce the burden on our natural resources." 7
  • 8. Vegetarian Eating Environmental ✦ Production of meat versus plant protein ✦ 4:1 meat protein/energy invested ✦ 54:1 Plant protein/energy invested ✦ Animal-based food is less efficient than the direct harvesting of grains, vegetables, legumes, seeds and fruits for human consumption. A person existing chiefly on animal protein requires 10 times more land to provide adequate food than someone living on vegetable sources of protein. ✦ Methane released into air from livestock contributing to between 18-51% of greenhouse gases and global warming 8 http://www.news.cornell.edu/releases/Aug97/livestock.hrs.html
  • 9. Vegetarian Eating Environmental ✦ Production of meat versus plant protein ✦ 4:1 meat protein/energy invested ✦ 54:1 Plant protein/energy invested ✦ Animal-based food is less efficient than the direct harvesting of grains, vegetables, legumes, seeds and fruits for human consumption. A person existing chiefly on animal protein requires 10 times more land to provide adequate food than someone living on vegetable sources of protein. ✦ Methane released into air from livestock contributing to between 18-51% of greenhouse gases and global warming 9 http://www.news.cornell.edu/releases/Aug97/livestock.hrs.html
  • 10. Vegetarian Eating Health ✦ American Journal of Clinical Nutrition, Vol. 78, No. 3 ✦ Review of 6 studies ✦ Very low meat intake ✦ Associated with a significant decrease in risk of death in 4 studies, nonsignificant decrease in risk of death in the fifth study, and virtually no association in the sixth study; ✦ 2 of the studies with low meat intake significantly decreased mortality risk ✦ Longer duration ( 2 decades) of adherence to this diet contributed to a significant decrease in mortality risk and a significant 3.6-y (95% CI: 1.4, 5.8 y) increase in life expectancy 10 Does low meat consumption increase life expectancy in humans? Singh et al.American Journal of Clinical Nutrition, Vol. 78, No. 3, 526S-532S, September 2003
  • 11. Obesity Epidemic ✦ Obesity is an epidemic of growing proportion ✦ Obesity and genes ✦ About 85% of obesity is hereditary risk ✦ Last 25 years growing trend is profound weight gain ✦ Factors are varied including cultural acceptance, decreased activity, increased stress and changes in food supply Obesity is an epidemic of growing proportion 11
  • 12. Obesity Epidemic ✦ Causes 300,000 premature deaths per year ✦ Cost of 150 billion to health care per year ✦ High Blood Pressure ✦ Diabetes ✦ Joint problems ✦ Sleep Apnea ✦ Cancer ✦ Depression ✦ Social isolation 12
  • 13. Obesity BMI: Body Mass Index ✦ Calculation ✦ = mass (kg)/Height (m) 2 ✦ = mass (lbs)*4.88/Height (ft)2 ✦ Normal 18.5 to 24.9 ✦ Overweight from 25 to 29.9 ✦ Obese Class I from 30 to 34.9 ✦ Obese Class II from 35 to 39.9 13
  • 14. Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2009 (*BMI ≥30, or about 30 lbs. overweight for 5’4” person) 1990 1999 2009 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 15. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 16. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 17. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 18. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 19. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 20. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 21. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 22. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 23. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 24. Obesity Trends* Among U.S. Adults BRFSS, 1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 25. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 26. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 27. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 28. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 29. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 30. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 31. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 32. Obesity Trends* Among U.S. Adults BRFSS, 2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 33. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 34. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 35. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 36. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 37. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 38. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 39. Obesity Trends* Among U.S. Adults BRFSS, 2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Behavioral Risk Factor Surveillance System, CDC.
  • 40. Obesity Vegetarian Diet ✦ Probably provides benefit when used long term ✦ Maybe associated with other positive lifestyle changes ✦ At the least reduction in animal fats 40
  • 41. Food as Medicine Lecture Overview ✦ Introduction ✦ Overview Nutrition ✦ Resources 41
  • 42. Basic Nutritional Concepts Macronutrients ✦ Carbohydrates ✦ Lipids ✦ Proteins Micronutrients ✦ Vitamins ✦ Minerals ✦ Phytonutrients 42
  • 43. Carbohydrates Monosaccharides ✦ Glucose ✦ Galactose ✦ Fructose Disaccharides ✦ Maltose: Glucose + Glucose ✦ Sucrose: Glucose + Fructose (table sugar) ✦ Lactose: Glucose + Galactose ✦ Lactose intolerance: missing the enzyme to breakdown Lactose 43
  • 44. Carbohydrates Polysaccharides ✦ Amylose ✦ i.e Basmati rice ✦ Amylopectin ✦ i.e. Sushi rice ✦Branching gives a larger surface area to digest the molecule ✦Simplestarch: more amylopectin ✦Resistant starch: more amylose 44
  • 45. Carbohydrates Glycemic Index Calculation ✦ An amount of food containing 50 grams of carbohydrate is given ✦ 200 g of spaghetti = 50 grams of carbs ✦ Blood samples every 15 minutes for first hour then every 30 minutes thereafter and graphed ✦ Response is compared to reference values found with 50 g of pure glucose (GI of 100) ✦ Retested 3 occasions and averaged with 8-10 other volunteers 45
  • 46. Carbohydrates High Glycemic Index Diets ✦ Relevance is that High GI foods invoke strong insulin response ✦ Insulin has been shown to encourages the body to store calories as fat ✦ Promote atherosclerosis ✦ Accelerate tumor growth ✦ i.e. Breast cancer 46 Borugian MJ, Sheps SB, Kim-Sing C, Van Patten C, Potter JD, Dunn B, Gallagher RP, Hislop TG.Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer?Cancer Epidemiol Biomarkers Prev. 2004 Jul;13(7):1163-72.
  • 47. Carbohydrates Low Glycemic Index Diets ✦ Lower LDL ✦ Raise HDL ✦ Lower total cholesterol Influenced by ✦ Structure of the molecule ✦ Sucrose(disaccharide) GI is 65 ✦ Composed of Glucose 100 + Fructose 23 ✦ Branched vs unbranched starch ✦ Amylose vs. Amylopectin 47
  • 48. Carbohydrates Glycemic Index ✦ Tools that slow digestion will affect GI ✦ Presence of fiber ✦ Presence of fat ✦ i.e French fries have lower GI than baked potatoes but are laden with saturated fats ✦ Presence of acid ✦ Lemon or lime juice with rice ✦ ie sushi 48
  • 49. Apple ✦ Glycemic Index of 38 ✦ French Fries are 75 ✦ High antioxidant punch from flavanoids and polyphenols ✦ 100 gram apple equivalent to 1500mg of Vitamin C ✦ Skin has pectin which may play role in digestive health 49
  • 50. Carbohydrates Summary ✦ Diet should consist of low GI foods ✦ Whole grains ✦ Vegetables ✦ Apples (temperate fruits) vs. mangoes (tropical) ✦ Al dente pasta vs. overcooked ✦ Basmati rice vs. white sticky rice ✦ Sweet potatoes, beans vs. Idaho fluffy potatoes ✦ Whole grain breads ✦ Avoid all high fructose corn syrup ✦ Avoid all processed white flour 50
  • 51. Basic Nutritional Concepts Macronutrients ✦ Carbohydrates ✦ Lipids ✦ Proteins Micronutrients ✦ Vitamins ✦ Minerals ✦ Phytonutrients Liquid Nutrition 51
  • 52. Lipids Classes ✦ Saturated Fatty Acids (SFAs) ✦ Monounsaturated Fatty Acids(MUFAs) ✦ Trans Fatty Acids ✦ Polyunsaturated Fatty Acids (PUFAs) ✦ Essential Fatty Acids 52
  • 53. Lipids Saturated Fatty Acids ✦ All bonds are occupied ✦ Myristic and palmitic acid ✦ Increase total cholesterol ✦ Medium chain saturated fatty acids ✦ Lauric and capric acids ✦ May play a role in immune function ✦ Primary component of the following: ✦ Animal Fat, Butter Fat, Coconut oil, Palm oil, Kernal Oil ✦ Not healthy to eliminate all SFA’s 53 http://www.mie.utoronto.ca/labs/lcdlab/biopic/fig/3.20.jpg
  • 54. Lipids Diet High in TFA leads to ✦ Diets high in TFA lead to ✦ Increased LDL and lowered HDL ✦ Increased markers of inflammation (CRP) ✦ Decreased Apo B ✦ Increased risk atherosclerosis ✦ Increased risk colon cancer ✦ Increased triglycerides ✦ Food Labeling started January 1, 2006 ✦ Wide variability - check the label ✦ Recommended daily amount -NONE 54 Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC.Related Articles, Trans fatty acids and cardiovascular disease.N Engl J Med. 2006 Apr 13;354(15):1601-13
  • 55. Lipids Trans fat in the diet ✦ Big Mac Profile ✦ Total fat 52 g ✦ Calories from fat 270 ✦ Saturated fat 10g ✦ Trans Fat 1.5 g (?) ✦ McDonald’s Nutrition Center 55
  • 56. Lipids Polyunsaturated Fats (PUFAs) ✦ Found in: ✦ Corn Oil ✦ Cottonseed Oil ✦ Fish Oil ✦ Flaxseed oil ✦ Grapeseed oil ✦ Safflower Oil ✦ Sesame Oil ✦ Soybean Oil ✦ Sunflower Oil 56
  • 57. Lipids Polyunsaturated Fats (PUFAs) 57
  • 58. Lipids Essential Fatty Acids ✦ Not made by the body ✦ Linoleic acid C18:2w6 (LA/Omega 6) ✦ Plentiful in nature and diet ✦ Corn oil, peanut oil, sesame oil, poultry ✦ Linolenic acid C18:3w3 (ALA/Omega 3) ✦ Oily Fish: mackerel 2.5g of omega 3 per 100g of food ✦ Flax, hemp, walnuts, pumpkins ✦ Purslane (herb) used in cooking 58
  • 59. Lipids Essential Fatty Acids ✦ Alpha linolenic acid C18:3w3 (ALA) ✦ Flax, hemp, walnuts, pumpkins ✦ Purslane (herb) used in cooking ✦ ALA conversion to EPA or DHA can be impaired or inefficient ✦ Delta 6 desaturase requires ✦ B6, Magnesium and zinc ✦ Delta 5 desaturase requires ✦ Vitamin C, niacin, zinc 59
  • 60. Lipids Essential Fatty Acids ✦ Ratio between LA/omega 6 and ALA/omega 3 affects prostaglandin synthesis ✦ This has a bearing on inflammation and probably atherosclerosis and cancer ✦ Current diet 20-40:1 ✦ Consider a goal diet of a ratio of 6:1 ✦ Mediterranean inspired diet ✦ Eating foods high in omega 3 ✦ Decreasing foods high in omega 6 60
  • 61. Flax ✦ High in Omega 3 fatty acids ✦ High in fiber ✦ Phytochemical: lignans which convert in intestine to substances that may benefit hormone regulation ✦ High in vitamins and minerals 61
  • 62. Lipids Recommendations ✦ Increase MUFAs ✦ Make olive oil primary dietary fat ✦ Eat PUFA’s as ratio of 6:1 ✦ Omega-6:Omega 3 (average diet sits around 40:1) ✦ Increase Omega 3 foods by increasing oily fish, fortified eggs, soy products, walnuts, hemp, flax ✦ Protect oils from light and heat 62
  • 63. Basic Nutritional Concepts Macronutrients ✦ Carbohydrates ✦ Lipids ✦ Proteins Micronutrients ✦ Vitamins ✦ Minerals ✦ Phytonutrients Liquid Nutrition 63
  • 64. Proteins Essential Building Blocks ✦ Essential amino acids ✦ Phenylalanine ✦ Valine ✦ Threonine ✦ Tryptophan ✦ Isoleucine ✦ Methionine ✦ Leucine ✦ Lysine 64
  • 65. Proteins Vegetarian ✦ Combinations of grains and beans ✦ Complete protein is seed Quinoa ✦ 1/4 cup uncooked has 5.5 grams protein - 10% daily ✦ Considered Gold of the Incas ✦ High in magnesium- helpful in migraines ✦ 1/4 cup uncooked has 89.25 mg or 22% RDA 65
  • 66. Proteins Animal Sources ✦ Cows ✦ Bison ✦ Pigs ✦ Sheep ✦ Wild game ✦ Chicken ✦ Eggs ✦ Milk ✦ Fish 66
  • 67. Proteins Commercial Animals ✦ Cows ✦ To increase growth, they are given ✦ Estrogen, Growth Hormone ✦ Antibiotics ✦ Residuals may function as ✦ “Endocrine Modulators” ✦ Increased estrogen exposure and related diseases ✦ Increased risk prostate cancer ✦ Large animals are at the top of the food chain and may accumulate toxins 67 Whitehead SA, Rice S. Endocrine-disrupting chemicals as modulators of sex steroid synthesis.Best Pract Res Clin Endocrinol Metab. 2006 Mar;20(1):45-61
  • 68. Proteins Buffalo ✦ Per serving size, less fat, cholesterol and calories Species Fat Grams* Calories Cholesterol Buffalo 2.2 148 61 Beef 6.5 180 72 Pork 4.9 165 71 Chicken 7.4 167 62 USDA Handbook 8-5; 8-10; 8-13; 8-17 * Per 100 grams of meat 68
  • 69. Proteins Plant Proteins ✦ Soy ✦ Many forms from edamame to tofu ✦ Tempeh - fermented soy product ✦ Can be sold with grains,legumes,seeds ✦ TVP - textured vegetable protein ✦ Process that isolates the proteins from soy flour 69
  • 70. Proteins Replacing Animal Proteins ✦ Seeds ✦ Sesame, sunflower, hemp, quinoa ✦ Nuts ✦ Almonds, Walnuts, Hazelnuts ✦ Spirulina ✦ Legumes ✦ Grains ✦ Fruits ✦ Vegetables 70
  • 71. Proteins Replacing Animal Proteins ✦ Benefits of Soy ✦ Cost less ✦ Contains less saturated fatty acids ✦ Contains more omega 3 fatty acids ✦ Presence of isoflavones (phytonutrient) ✦ Contains more fiber ✦ May have less environmental toxins 71
  • 72. Proteins Legumes ✦ Garbonzo beans (chickpeas), 1 cup cooked has 268.96 calories ✦ molybdenum 123.00 mcg 164.0 ✦ manganese 1.69 mg 84.5 ✦ folate 282.08 mcg 70.5 ✦ dietary fiber 12.46 g 49.8 ✦ protein 14.53 g 29.1 ✦ copper 0.58 mg 29.0 ✦ phosphorus 275.52 mg ✦ iron 4.74 mg 26.3 72
  • 73. Proteins Vegan Diet ✦ Vegetarian Diet without any daily products or egg products ✦ Cow milk has saturated fat and cows have been given growth hormone to stimulate production of milk ✦ Non-dairy cheeses ✦ can have casein a binder and milk protein ✦ Other milk sources ✦ Soy, Rice, Almond, Hemp Milk 73
  • 74. Proteins Vegan Diet ✦ Benefits ✦ Lowers LDL and TG ✦ Lowers BMI ✦ Socially responsible ✦ Potentially harmful?? ✦ Lowers serum HDL cholesterol ✦ Increases homocysteine concentrations due to vitamin B-12 deficiency ✦ This may have implication for cardiovascular disease 74
  • 75. Proteins Recommendations ✦ Substitute plant for animal proteins ✦ Decrease red meat/ change to Bison ✦ Get free range animals ✦ Never eat brain ✦ Eat fish with high omega 3’s content ✦ Salmon, Mackerel, Sardines ✦ Avoid Swordfish, Marlin, Shark as accumulation of toxins 75
  • 76. Proteins Vegetarians ✦ Dairy can have a lot of saturated fat ✦ Nondairy cheeses ✦ May have casein, a milk protein ✦ Soy products should have less than 30 % saturated fat ✦ Read labels ✦ Eat nuts in moderation ✦ Eat whole grains, beans frequently ✦ Supplemental B12 76
  • 77. Basic Nutritional Concepts Macronutrients ✦ Carbohydrates ✦ Lipids ✦ Proteins Micronutrients ✦ Vitamins ✦ Minerals ✦ Phytonutrients Liquid Nutrition 77
  • 78. Vitamins Intake ✦ Estimated Average Requirement (EAR) ✦ Estimate of daily needs of 50% of population ✦ Recommended Daily Allowance (RDA) ✦ Average requirement for 90% population to prevent a deficiency ✦ Adequate Intake (AI) ✦ Recommendations based on experimental data for things not established yet in the RDA ✦ Tolerable Upper Intake Level (UL) ✦ Highest level under which no harm came to 98% of the population 78
  • 79. Vitamins Water Soluble ✦ Vitamin B1 (thiamin) ✦ Vitamin B2 (riboflavin) ✦ Vitamin B3 (niacin) ✦ Vitamin B5 (panthothenic acid) ✦ Vitamin B6 (pyridoxine) ✦ Vitamin B12 (cobalamin) ✦ Folic Acid ✦ Biotin ✦ Vitamin C 79
  • 80. Vitamins Fat Soluble ✦ Vitamin A (retinal) ✦ Vitamin D (calcitriol) ✦ Vitamin E (tocopherol) ✦ Vitamin K (phylloquinone) 80
  • 81. Vitamins Vitamin D ✦ Daily Requirements ✦ Birth to 50 years, 5 µg (200 IU) ✦ 51–70 years, 10 µg (400 IU) ✦ 71+ years, 15 µg (600 IU) ✦ Vitamin D2 (ergocalciferol) ✦ Vitamin D3 (cholecalciferol) skin by UV light ✦ Calcitriol (kidneys, macrophages) ✦ Regulating calcium and phosphate ✦ promoting the healthy mineralization, growth and remodeling of bone ✦ neuromuscular function, reduces inflammation ✦ Influences the action of many genes that regulate the proliferation, differentiation and apoptosis of cells. 81
  • 82. Shitake Mushrooms ✦ 100g provides: ✦ 14 IU (0.14 IU/g) ✦ Dried in the sun: 500 IU (5 IU/g ✦ Lentinan ✦ Strengthening its ability to fight infection and disease ✦ L-ergothioneine ✦ Powerful antioxidant 82
  • 83. Basic Nutritional Concepts Macronutrients ✦ Carbohydrates ✦ Lipids ✦ Proteins Micronutrients ✦ Vitamins ✦ Minerals ✦ Phytonutrients Liquid Nutrition 83
  • 84. Minerals Essential ✦ Calcium ✦ Chloride ✦ Magnesium ✦ Phosphorus ✦ Potassium ✦ Sodium 84
  • 85. Minerals Trace Minerals ✦ Arsenic ✦ Manganese ✦ Boron ✦ Molybdenum ✦ Chromium ✦ Nickel ✦ Cobalt ✦ Selenium ✦ Fluoride ✦ Silicon ✦ Iodine ✦ Sulfur ✦ Iron ✦ Tin ✦ Vanadium ✦ Zinc 85
  • 86. Micronutrients Minerals: Zinc ✦ RDA 15 mg per day ✦ Important for ✦ Smell, immunity, protein synthesis, enzymes cofactor, DNA ✦ Deficiency ✦ Diarrhea, impotence, hair loss, eye and skin lesions, impaired appetite, and depressed immunity ✦ People at risk ✦ Vegetarians, alcholics, sickle cell disease, malabsorbtion diseases, pregnant woman 86
  • 87. Tahini (100g) ✦ 100 gram is 595 cal ✦ 17 grams protein ✦ Calcium 426 mg 43% ✦ Iron 8.95mg 50% ✦ Magnesium 95mg 24% ✦ Phosphorus 732mg 73% ✦ Sodium 115mg 5% ✦ Potassium 414mg 12% ✦ Zinc 4.62mg 31% ✦ Copper 1.62mg 81% ✦ Manganese 1.46mg 73% ✦ Selenium 1.7μg 2% 87
  • 88. Basic Nutritional Concepts Macronutrients ✦ Carbohydrates ✦ Lipids ✦ Proteins Micronutrients ✦ Vitamins ✦ Minerals ✦ Phytonutrients 88
  • 89. Phytonutrients Nutrients in plants ✦ Chemical compound ✦ Occur naturally ✦ May affect health and many scientific studies ongoing ✦ Health benefits may be combo of these elements and minerals ✦ Example of modern drug is taxol which was derived from Pacific Yew Tree 89
  • 90. Phytonutrients Major Classes ✦ Carotenoids ✦ Polyisoprenoids - over 600 compounds ✦ Carrots, pumpkins, peaches ✦ Flavonoids ✦ Isoflavones ✦ Anthocyanins, Proanthocyanidins ✦ Flavanols ✦ Betalanins ✦ Organosulfides 90
  • 91. Carotenoids Alpha Carotene Beta Carotene Lycopene Lutein Zeaxanthin 91
  • 92. Phytonutrients Carotenoids ✦ High carotenoid intake has been linked to ✦ 20% decrease in postmenopausal breast cancer ✦ 50% decrease in the incidence of cancers of the bladder, cervix, prostate, colon, larynx, and esophagus. 92
  • 93. Flavinoids Anthocyanidins Flavanols Flavanones Flavonols Isoflavones 93
  • 94. Phytonutrients Flavonoids ✦ Isoflavones in soy ✦ Lignans in flax ✦ Anthocyanins, Proanthocyanidins ✦ Berries, cherries, red grapes, plums, beets ✦ Flavonols ✦ Onions, kale, apples, berries, tea, broccoli ✦ Flavanones ✦ Citrus juices and fruits ✦ Flavones ✦ Parsley, thyme, celery, hot peppers 94
  • 95. Kale ✦ Glucosinolates and cysteine sulfoxides ✦ May activate detoxifying enzymes in the liver that help neutralize potentially carcinogenic substances ✦ Vitamin A (vision) ✦ One cup of kale contains 192.4% of the daily value for vitamin A ✦ Calcium ✦ One cup of kale supplies 93.6 mg (9 %) of calcium for only 36.4 calories. ✦ Cup of 2% cow's milk provides 296.7 mg of calcium 95
  • 96. Phytonutrients Produce high in pesticides ✦ Environmental Working Group www.ewg.org ✦ Strawberries ✦ Tomatoes ✦ Wheat ✦ Cucumber ✦ Pears ✦ Apples ✦ Broccoli ✦ Grapes from Chile ✦ Cauliflower ✦ Mexican Cantaloupes ✦ Cabbage ✦ Onions ✦ Peaches ✦ Celery 96
  • 97. Food As Medicine Lecture Overview ✦ Introduction ✦ Overview ✦ Resources 97
  • 98. Farmer’s Markets Phoenix ✦Locations around Phoenix ✦Wednesday 9:30 to 1:30 ✦Baseline Health Center ✦Accept WIC coupons 98
  • 99. Fresh Carrots 99
  • 100. Melons 100
  • 101. Red Peppers 101
  • 102. Vouchers 102
  • 103. Community Gardens Phoenix ✦Garden of Tomorrow ✦Tiger Mountain Foundation 103
  • 104. Resources Phoenix ✦ Farmers Markets ✦ Community Gardens ✦ Web 104
  • 105. US FNIC http://fnic.nal.usda.gov/ Complete Database can be found online 105
  • 106. Linus Pauling Institute ✦ http://lpi.oregonstate.edu/ ✦ Dr. Pauling concluded that vitamins and other micronutrients play a significant role in enhancing human health and preventing chronic diseases, not just deficiency diseases. 106
  • 107. Bibliography Books, Websites, Magazine and Scientific Journals 107
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  • 114. Booth SL, Centurelli MA.Vitamin K: a practical guide to the dietary management of patients on warfarin.Nutr Rev. 1999 Sep;57(9 Pt 1):288-96. Review. Booth SL, Madabushi HT, Davidson KW, Sadowski JA.Tea and coffee brews are not dietary sources of vitamin K-1 (phylloquinone).J Am Diet Assoc. 1995 Jan;95(1):82-3 Booth SL, Sadowski JA, Weihrauch JL, Ferland G. Vitamin K1 (phylloquinone) content of foods: a provisional table. J Food Comp Anal. 1993;6:109-120. Booth SL, Sadowski JA, Pennington JAT. Phylloquinone (Vitamin K1) content of foods in the U.S. Food and Drug Administration's total Diet Study. J Agric Food Chem. 1995;43:1574-1579. Booth SL, Suttie JW.Dietary intake and adequacy of vitamin K.J Nutr. 1998 May;128(5):785-8. Review. Couris RR, Tataronis GR, Booth SL, Dallal GE, Blumberg JB, Dwyer JT. Development of a self-assessment instrument to determine daily intake and variability of dietary vitamin K.J Am Coll Nutr. 2000 Nov-Dec;19(6):801-7. Dismore ML, Haytowitz DB, Gebhardt SE, Peterson JW, Booth SL.Vitamin K content of nuts and fruits in the US diet. J Am Diet Assoc. 2003 Dec;103(12):1650-2 Miller C.The scoop on green tea. Nursing. 2004 Jun;34(6):12 Sconce E, Khan T, Mason J, Noble F, Wynne H, Kamali F. Patients with unstable control have a poorer dietary intake of vitamin K compared to patients with stable control of anticoagulation.Thromb Haemost. 2005 May;93(5):872-5. Taylor JR, Wilt VM. Probable antagonism of warfarin by green tea. Ann Pharmacother. 1999 Apr;33(4):426-8. Vitamin K and Coumadin
  • 115. Anderson CF, Nelson RA, Margie JD, Johnson WJ, Hunt JC. Nutritional therapy for adults with renal disease.JAMA. 1973 Jan 1;223(1):68-72. Aparicio M, Chauveau P, Combe C. Low protein diets and outcome of renal patients.J Nephrol. 2001 Nov-Dec;14(6):433-9. Review. Bergesio F, Monzani G, Guasparini A, Ciuti R, Gallucci M, Cristofano C, Castrignano E, Cupisti A, Barsotti G, Marcucci R, Abbate R, Bandini S, Gallo M, Tosi PL, Salvadori M. Cardiovascular risk factors in severe chronic renal failure: the role of dietary treatment.Clin Nephrol. 2005 Aug; 64(2):103-12. Kent PS. Integrating clinical nutrition practice guidelines in chronic kidney disease.Nutr Clin Pract. 2005 Apr;20(2):213-7. Review. Mitch WE. Beneficial responses to modified diets in treating patients with chronic kidney disease.Kidney Int Suppl. 2005 Apr;(94):S133-5. Review. Rosolowska-Huszcz D, Kozlowska L, Rydzewski A. Influence of low protein diet on nonthyroidal illness syndrome in chronic renal failure.Endocrine. 2005 Aug;27(3):283-8. Savica V, Santoro D, Ciolino F, Mallamace A, Calvani M, Savica R, Bellinghieri G.Related Articles, Nutritional therapy in chronic kidney disease.Nutr Clin Care. 2005 Apr-Jun;8(2):70-6. Liver and Kidney Disease
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  • 118. Chand N, Mihas AA. Celiac disease: current concepts in diagnosis and treatment.J Clin Gastroenterol. 2006 Jan;40(1):3-14. Dolinsek J, Urlep D, Karell K, Partanen J, Micetic-Turk D. The prevalence of celiac disease among family members of celiac disease patients.Wien Klin Wochenschr. 2004;116 Suppl 2:8-12. Fasano A, Berti I, Gerarduzzi T, Not T, Colletti RB, Drago S, Elitsur Y, Green PH, Guandalini S, Hill ID, Pietzak M, Ventura A, Thorpe M, Kryszak D, Fornaroli F, Wasserman SS, Murray JA, Horvath K. Prevalence of celiac disease in at-risk and not-at-risk groups in the United States: a large multicenter study.Arch Intern Med. 2003 Feb 10;163(3):286-92. Lee SK, Green PH. Celiac sprue (the great modern-day imposter).Curr Opin Rheumatol. 2006 Jan;18(1):101-7. Review Rampertab SD, Pooran N, Brar P, Singh P, Green PH. Trends in the presentation of celiac disease.Am J Med. 2006 Apr;119(4):355.e9-14. Thompson T, Dennis M, Higgins LA, Lee AR, Sharrett MK. Gluten-free diet survey: are Americans with celiac disease consuming recommended amounts of fiber, iron, calcium and grain foods?J Hum Nutr Diet. 2005 Jun;18(3):163-9. Westerberg DP, Gill JM, Dave B, DiPrinzio MJ, Quisel A, Foy A. New strategies for diagnosis and management of celiac disease.J Am Osteopath Assoc. 2006 Mar;106(3):145-51. Celiac Disease