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Lesson 8 mediterranean menu vegetarianism cancer osteoporosis

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Lesson 8 mediterranean menu vegetarianism cancer osteoporosis

  1. 1. Dietetics and Nutrition in the Mediterranean<br />By Dr. Alberto Fatticcioni<br />
  2. 2.
  3. 3. Mediterranean diet rules<br />The Mediterranean diet is principally a plant based diet. Everyday the “mediterranean way” consists of: <br /><ul><li> vegetables (at least 300-400 g a day)
  4. 4. fruit (at least 4 pieces or 400 g a day)
  5. 5. legumes and pulses
  6. 6. grains, pasta and/or bread (mostly wholemeal and unrefined)
  7. 7. olive oil and nuts
  8. 8. an abundant use of herbs and spices
  9. 9. water (more than 2 liters per day)
  10. 10. wine during meals ( maximum 2 glasses per day )</li></li></ul><li>Mediterranean diet rules<br />In the Mediterraneandiet the mostimportant source ofanimalfoodisfish. The Mediterraneanis a seawhichisrich in fish, and to do things the “mediterranean way” weneedtoeatseafoodfrequently:<br /><ul><li>seafood (fish, shellfish, mollusc), recommended 4-6 times a week, at leasttwiceweekly</li></li></ul><li>Mediterranean diet rules<br />The intakeofdairy produce is low to moderate and usually in the formofgoat’s and sheep’s cheese or yoghurt. <br /><ul><li> yoghurt, recommended 2 - 4 times per week
  11. 11. cheese, recommended 1 - 4 times per week
  12. 12. milk, recommended 1 - 2 times per week
  13. 13. eggs, recommended 1 - 4 eggs per week (maximum 1 a day)</li></li></ul><li>Mediterranean diet rules<br />The Mediterraneandietconsists in a low intakeofsweets, poultry and redmeat, thesetypesoffoods are a sortof “specialoccasionfood”. <br />Processedfood and junk food are forbidden. <br /><ul><li>poultry, recommended 1 - 2 times per week
  14. 14. redmeat, recommended 0 - 1 time a week
  15. 15. sweets, recommended 0 - 1 time per week
  16. 16. no junk food</li></li></ul><li>Mediterranean Vegetables<br />Vegetables are the most complex food we eat. <br />Roots and tubers (potatoes, carrots and parsnip)<br />Lower stems and bulbs (beets, celery root, turnip, radish, onion, garlic, leeks) <br />Stems and stalks (asparagus, celery, fennel, kohlrabi, cardoons)<br />Leaves (lettuces, chicories, dandelion greens, cabbage, kale, brussels sprouts, rocket, spinach)<br />Flowers (artichokes, broccoli, cauliflowers) <br />Fruits used as vegetables (tomatoes, eggplant, sweet peppers, cucumber, zucchini, pumpkin)<br />
  17. 17. Mediterranean Fruits<br />Cherries<br />Watermelon<br />Fig, fresh and dried<br />Kaki<br />Melon<br />Pomegranate<br />Medlar<br />Kiwi<br />Clementine<br />Peches<br />Grapefruit<br />Blackberry<br />Raspberry<br />Blueberry<br />Redcurrant<br />Lemon<br />Persimmon<br />Plum, fresh and dried<br />Grape<br />Apple<br />Apricot<br />Orange<br />Strawberry<br />Pear<br />
  18. 18. Mediterranean legumes<br /><ul><li>Chickpeas (dried and flour)
  19. 19. Lentils
  20. 20. Fava beans (fresh and dried)
  21. 21. Borlotti beans (fresh and dried)
  22. 22. Cannellini beans (fresh and dried)
  23. 23. Peas
  24. 24. Black Eyed Beans
  25. 25. Grass Pea </li></li></ul><li>Mediterranean Grains<br /><ul><li> Durum wheat (whole pasta or refined, couscous)
  26. 26. Soft wheat (whole bread or refined)
  27. 27. Farro
  28. 28. Rice (whole or refined)
  29. 29. Maize (cornmeal)</li></li></ul><li>Mediterranean Fats<br /><ul><li> Extravirgn olive-oil
  30. 30. Olive
  31. 31. Almond
  32. 32. Hazelnut
  33. 33. Walnut
  34. 34. Pine nuts
  35. 35. Pistachios
  36. 36. Flaxseeds</li></li></ul><li>Mediterranean Seafood<br /><ul><li>Anchovies
  37. 37. Sardines
  38. 38. Tuna
  39. 39. Swordfish
  40. 40. Mekerel
  41. 41. Eel
  42. 42. Trout
  43. 43. Oyster
  44. 44. Mussels
  45. 45. Clam
  46. 46. Octopus
  47. 47. Squid
  48. 48. Ray
  49. 49. Shrimp
  50. 50. Cod
  51. 51. Cuttlefish
  52. 52. John Dory
  53. 53. Ombrine
  54. 54. Dogfish
  55. 55. Pike
  56. 56. Lobster
  57. 57. Sole
  58. 58. Salmon</li></li></ul><li>MediterraneanDietRules<br /><ul><li>vegetables (at least 300-400 g a day)
  59. 59. fruit (at least 4 pieces or 400 g a day)
  60. 60. legumes and pulses
  61. 61. grains, pasta and/or bread (mostlywhole)
  62. 62. olive oil and nuts
  63. 63. water (more than 2 liters per day)
  64. 64. wine duringmeals ( maximum 2 glasses per day)
  65. 65. seafood (fish, shellfish, mollusc), 4-6 times a week
  66. 66. yoghurt, 2 - 4 times per week
  67. 67. cheese, 1 - 4 times per week
  68. 68. milk, 1 - 2 times per week
  69. 69. eggs, 1 - 4 eggs per week (maximun1 per day)
  70. 70. poultry, 1 - 2 times per week
  71. 71. redmeat, 0 - 1 time a week
  72. 72. sweets, 0 - 1 time per week </li></li></ul><li>Vegetariandiets: historicalcontext<br />Forcenturiesvegetariandiets have been used in different parts of the world for various reasons. <br />Phythagoras is considered the founder of the vegetarian movement and advocates included other ancient Greeks, Hebrew writings documented the practice of vegetarian diets even from Old Testament Bible times. Eastern religions, including Buddhism, Zainism, and Hinduism, also promote vegetarian diets and continue to urge preservation of animal life. <br />
  73. 73. Vegetariandiets: historicalcontext<br />In the 18 thcentury, Benjamin Franklin wasperhaps the mostfamousof the scientists, physicians, and philosopherswhosupportedvegetariandiets. <br />The vegetarianmovementexpandedconsiderably in the 19 th and 20 thcentury. <br />A 1994 surveyreportedthat some 12.4 million people in the UnitedStatescallthemselvesvegetarians. The samepolladministered in the year 2000 concludedthat 2.5% of the USA population can beconsideredvegetarian. <br />
  74. 74. Vegetariandiets: historicalcontext<br />The reasonsforadopting a vegetarian lifestyle are varied. Historically, vegetarian diets were associated with certain religious practices. Currently, health appears to be the primary reason for adopting a vegetarian diet. Other reasons encompass ecologic and environmental issues relating to the large differences in resources necessary to support animal and plant based diets. Another common reason relates to ethical concerns about the treatment of animals for clothing or research. In many cases, however, multiple reasons underlie vegetarian dietary practices. <br />
  75. 75. Vegetariandiets: definitions<br />The termvegetarianencompasses a wide rangeofdietarypractices; cerealgrains, fruits, vegetables, legumes, nuts and seedsform the basisofvegetariandiets, withvarying amounts of dairy products and eggs. Vegetarians exclude meat; the type of animal products included frequently are used to identify the kind of vegetarian diet: <br /><ul><li>Lactoovovegetarians (LOVs)
  76. 76. Lactovegetarians
  77. 77. Ovovegetarians
  78. 78. Vegans (exclude all animal products)
  79. 79. Fruitarians (fruits, vegetables fruits, nuts, seeds)</li></li></ul><li>Vegetariandiets: dietaryintake<br />Dietsofvegetarians tend to be lower in total fat, saturated fat and cholesterol, and higher in fiber, than the diets of non-vegetarians. Vegetarians tend to consume more grains, legumes, vegetables, fruit and wine than non-vegetarians. <br />Other studies also reported that, among vegetarians, intakes of soy and nutrients such as folate, vitamin C, beta-carotene, vitamin E, copper, and magnesium are higher than among non-vegetarians, but intakes of vitamin A, vitamin B12, vitamin D, omega-3, calcium, selenium and zinc are lower. <br />
  80. 80. Vegetariandiets and protein<br />Oneof the mostfrequentquestionsregarding the nutritionaladequacyofvegetariandietsrelatestoproteinrequirements. However, the inadequateenergyintake in some vegetariansmay compromise protein status aswell. Moreover, becauseof the lowerdigestibilityofplantproteins, the proteinrequirementofvegansmaybehigherthanthoseofnon-vegetarians. <br />Foodsofplantorigin are oftensaidtolackcertainindispensable amino acids and thustoprovideproteinoflesserqualitythan in foodsofanimalorigin. <br />
  81. 81. RecommendedProteinIntake<br /><ul><li>Infants: 2.2 grams per kg of body weight.
  82. 82. Children: 1.0-1.6 grams per kg of body weight.
  83. 83. Adults: 0.8 grams per kg of body weight.
  84. 84. Adultathletes: 1.5-2.0 grams per kg of body weight.</li></ul>Currentevidencesuggeststhat a lowerintakeofanimalproteinmaybebeneficial and maylowerurinarycalciumexcretion and slow the progressionofrenaldisease and osteoporosis; thisrelathionshipisnotseenwhenplantproteinisconsumed.<br />
  85. 85. Vegetariandiets and protein<br />Two amino acids are ofparticular interest in vegetariandiets; lysine, the limiting amino acid in cerealgrains, and methionine, the limiting amino acid in legumes. <br />
  86. 86. Compositionof Dry Legumes<br />
  87. 87. Vegetarians, Legumes and Protein<br />Legumesare 20 to 25% proteinbyweight, whichisdouble the proteincontentofwheat and threetimesthatofrice. Forthisreason, legumesare called "vegetarian's meat". Whilelegumesare generally high in protein, and the digestibilityofthatproteinisalso high, theyare oftenrelativelypoor in the essential amino acid methionine. Grains (which are themselvesdeficient in lysine) are commonlyconsumedalongwithlegumestoform a complete proteindietforvegetarians.<br />
  88. 88. Legumes and Aminoacids<br />Legumescontainrelatively low quantitiesof the essential amino acid methionine. To compensate, the MediterraneanDietserveslegumesalongwithgrains, which are low in the essential amino acid lysine, whichlegumescontain. Thus a combinationoflegumeswithgrainsforms a well-balanceddietforvegetarians. Common examplesofsuchcombinations are pasta and beans “pasta e fagioli” andemmerwheat and legume soup “zuppa di legumi e farro”.<br />
  89. 89. Complete proteinfoodforvegetarians<br />Complete proteinscontain a balanced set ofessential amino acidsforhumans. Animalsourcessuchasmeat, poultry, eggs, fish, milk, and cheeseprovideallof the essential amino acids. Near-completeproteins are alsofound in some plantsourcessuchasquinoa,buckwheat, and amaranth. Soyaappearsaslower in methionine and cysteine. Itisnotnecessarytoconsumeplantfoodscontaining complete proteinsas long as a reasonablyvarieddietismaintained. Byconsuming a wide varietyofplantfoods, a full set ofessential amino acidswillbesuppliedand the human body can convert the amino acidsintoproteins.<br />
  90. 90. Vegetarians and Iron<br />Non-hemeironfromplant foods is less available than heme iron, and plant foods contain a variety of substances known to reduce iron availability. However, plant foods also contain other substances that enhance iron uptake, and well-planned vegetarian diets often contain more iron than omnivorous diets. <br />Some studies suggest that long-term LOVs, even with a higher fiber intake, maintain iron status no different from that of omnivores. The high levels of iron in well planned vegetarian diets (15-20mg per day) combined with the frequent intake of fruits and vegetables rich in vitamin C appear to protect against iron deficiency. <br />
  91. 91. Top 10 plant foods richest in iron/100 g <br />14,30 mg pure cocoa<br />10,00 mg germ of wheat<br />9,00 mg dried beans<br />8,00 mg lentils<br />7,80 mg green radicchio<br />7,30 mg pistachios<br />6,40 mg chickpeas<br />5,30 mg dried apricots<br />5,20 mg arugula, oats<br />5,00 mg dark chocolate, fava beans<br />4,50 mg peas<br />
  92. 92. Top 10 plant foods richest in iron/100 g <br />4,00 mg buckwheat<br />3,90 mg dried plums<br />3,50 mg peanuts, olives<br />3,30 mg hazelnuts, raisins<br />3,00 mg dried figs, almonds, whole flour, dried dates<br />2,90 mg spinach <br />2,70 mg green beetroots<br /> 2,60 mg walnuts<br /> 2,00 mg chard<br /> 2,00 mg zucchini flowers<br /> 1,70 mg endives<br />
  93. 93. Top 10 foodsforVitamin C content /100g<br />Redcurrants 200 mg <br />Red peppers 151 mg <br />Broccoli and arugula 110 mg <br />Kiwis 85 mg<br />Brusselsprouts and turnip 81 mg <br />Cauliflower 59 mg <br />Strawberries, clementines, spinach 54 mg <br />Oranges and lemons 50 mg <br />Kale 47 mg <br />Tangerines 42 mg <br />
  94. 94. Top 10 fruitsforVitamin C content /100g<br />Redcurrants 200 mg <br />Kiwis 85 mg <br />Strawberries and clementines 54 mg<br />Oranges and lemons 50 mg <br />Tangerines 42 mg <br />Grapefruit 40 mg <br />Melons 32 mg <br />Raspberries 25 mg <br />Persimmons 23 mg <br />Blackberries 19 mg <br />
  95. 95. Vegetarians and Vitamin B12<br />The usualdietarysources of this vitamin are animal products, plants do not synthesize or store vitamin B12; persons who include only plant foods in their diet, such as vegans and others who consume only raw foods, are at increased risk of deficiency. Vitamin B12 deficiency can result in serious and irreversible neurologic and neuropsychiatric abnormalities. Serum vitamin B12 levels in vegans are generally lower than those in omnivores, with intermediate levels found in LOVs. The requirement of vitamin B12 is very low and cases of B12 deficiency are rare. <br />
  96. 96. Foodsrich in VitaminA mcg/100g<br />Carrots 1149<br />Pumpkin 599<br />Spinach 485<br />Pecorino 380<br />Parmigiano 373<br />Apricots 360<br />Cicory 267<br />Chard 263<br />Kaki 237<br />Lettuce 229<br />Broccoli and eggs 225<br />Brusselsprouts 220<br /> Mozzarella 219<br />Endives213<br />Celery 207<br />Melon 189<br />Medlar 170<br />Escarole 167<br />Sweetpeppers139<br /> Ricotta 128<br />
  97. 97. Vegetarians: Calcium and Vitamin D<br />Adequatecalcium and vitamin D intakes are importanttoensureoptimalbone status over lifetime. Evidence suggests that calcium may also be important in regulating blood pressure and preventing colon cancer (milk and dairy products supply 70% of calcium in US diets). <br />Calcium intake among LOVs appears to be similar to that of omnivores, whereas intake in vegans is less; in addition, vegans, consume less vitamin D. The low consumption of vitamin D may be further exacerbated in some cases by limited exposure to light. <br />
  98. 98. Vegetarians: Calcium and Vitamin D<br />Low vitamin D concentrations and secondaryhyperparathyroidismweredocumentedduring the winter in vegans living at northernlatitudes. In some casesbonemineral density tended to be lower in the vegan group compared with lactovegetarians and omnivores. A high intake of sodium increases calcium excretion (the same for animal protein).<br />Vegans may need to give attention to obtaining an appropriate calcium intake especially during periods of growth. <br />
  99. 99. Foodsrichest in Calciumcontent mg/100g <br />Pecorino 1160<br />Parmigiano 1159<br />Arugula 309<br />Ricotta 295<br />Almonds 240<br />Driedfigs 186<br />Oysters 186<br />Green beet 160<br />Mozzarella 160<br />Hazelnuts 152<br />Cicory 150<br />Anchovies 148<br />Octopus 144<br />Squid 143<br />Chickpeas 142<br />Cannellini 132<br />Walnuts 131<br />Agretti 131 <br />Pistachios 130 <br />Yogurt 125<br />Milk 119<br />Radicchio 115<br />Shrimps 110<br />Buckwheat 110<br />Borlotti 102<br />Broccoli 97<br />Cardoons 96<br />Endives 93<br />Fava beans 90<br />Mussels 88<br />Artichokes 86<br />Driedapricots 85<br />Spinach 78<br />Raisins 78<br />Dates 69<br />Chard 67<br />JhonDory 65<br />Hare 64<br />Olives 63<br />Kale 62<br />Cauliflower 60<br />
  100. 100. Foodsrichest in Vitamin D contentmcg/100g<br />Tuna 16.30<br />Anchovies 11<br />Swordfish 11<br />Trout 10.60<br />Pike 10.60<br />Carp 10.60<br />Shark 9.10<br />Salmon 8<br />Eel 4.90<br />Sardines 4.50<br />Butter 4.35<br />Eggs 1.75<br />
  101. 101. Vegetarians and Zinc<br />Meat, fish, and poultryprovide 40 to 45% of the zinc in the US diet; the absorptionforzincisreducedwithvegetariandiets. <br />An Australian study found that vegetarian women had significantly lower zinc intake than omnivores, but their zinc concentration was not different. <br />A lower zinc intake was found among vegetarian children and adolescents, but growth was not affected; the vegetarians in the study were slightly taller than the non-vegetarians. <br />
  102. 102. Foodswithrichestzinccontent mg/100g <br />Beefliver 6<br />Beef 5,70<br />Ham 5,20<br />Octopus 5,10<br />Anchovies 4,20<br />Cuttlefish 4,20<br />Parmigiano 4<br />Rabbit 3,90<br />Bresaola 3,87<br />Horsemeat 3,72<br />Hare 3,65<br />Cannellini 3,6<br /> Pecorino 3,50<br />Chickpeas 3,20<br />Squid 3,10<br />Oats 3,10<br />Walnuts 3<br />Whole pasta 3<br />Artichoke 2,90<br /> Borlotti 2,90<br />Lentils 2,90<br /> Mozzarella 2,60<br />Mushrooms 1,50<br />Spinach 1,43<br />
  103. 103. Vegetarians and omega-3<br />Vegetariandiets are typically low in omega-3 polyunsaturatedfattyacids.<br />Sourcesrich in omega-3 suchasflaxseed, walnuts, canolaoils and soyoilsshouldbeincluded in the vegetariandiet, and the intakeofrich omega-6 fattyacidsshouldbedecreasedtooptimizeconversiontoeicosapentanoic acid and DHA. <br />
  104. 104. Percentageof Omega-3, Omega 6, and Omega-9 FattyAcids In Some SaladCookingOils<br />
  105. 105. OSTEOPOROSIS<br />
  106. 106. Osteoporosis<br />One and halfmillionosteoporotic fractures of the spine, wrist, hip and other sites occur each year, primarily in postmenopausal white women. <br />In the United States, direct medical costs of fractures among the population age 45 an older totaled nearly $14 billion in 1995. Treatment of men accounted for approximately $3 billion, or 20% of the total amount. <br />Physical inactivity and diet are the most important risk factors of this pathology. <br />
  107. 107. Osteoporosis<br />The term osteoporosis refers to a condition in which the skeleton is subject to an increased risk of fractures due to the decreased mass and alteration of bone microarchitecture.Osteoporosis, although generally considered as a disease of the bones, for some is a paraphysiological process; the presence of which predisposes to a greater development of diseases and a consequent reduction in life expectancy, if not properly treated. <br />
  108. 108. Types Osteoporosis is divided into primary (original) or a secondary event related to or achieved (hyperparathyroidism, osteotoxic drugs, etc.). The primary form is the most exclusive form (95% of cases).<br />Primaryosteoporosis<br /> * Idiopathicosteoporosis (the rarestformofall, the cause isunclear    * Type I osteoporosis or postmenopausal (due to a fall in hormone production)<br /> * Type II or senile osteoporosis (due tovariouscauses, includingimmobilization, reduced production ofsomatotropin, testosterone, calcium, magnesium, vitamin D and otherimportantmicronutrients, reducedfunctionof the enzyme 1a-hydroxylase whichproduces the activehormonevitamin D, ie, calcitriol).<br /> Occurs mainly in trabecular bone, this is the shape with a greater number of fractures.<br />Secondaryosteoporosis<br /> The secondaryosteoporosisis a group full ofvariations, buttheyrepresentonly 5% ofosteoporosis. The mainones are classifiedascausedby:    * Hyperparathyroidism    * Osteopenizzantidruguse (steroids, antiepilepticdrugs, heparin, oralanticoagulants, loopdiuretics)    * Low body weight    * Prolongedimmobilization    * Hypersurrenalism    * Hypercalciuria    * COPD (chronicobstructivepulmonarydisease)    * Rheumatoidarthritis    Sarcoidosis *    * Celiacdisease    * Malignancy    * Reducedintestinalabsorptionofnutrients<br />
  109. 109. Etiology<br />The cause is the loss of the balance between osteoblasts and osteoclasts. The first category of cells contributes to bone formation, the latter contributes to bone reabsorption, where osteoclasts working faster than osteoblasts, the bone deteriorates. Menopause (form I) there is an increased production of osteoclasts, due to loss of estrogen that leads to a possible elevation of cytokines, related to the production of osteoclasts. In the second form, with advancing age the activity of osteoblasts decreases.<br />
  110. 110. Symptomatology<br />Osteoporosis is manifested initially by a decrease in tone calcium in bone mass (osteopenia). The bones more easily affected by the decrease in tone lime are the vertebrae back injury, the femur and the wrist.Initially asymptomatic, that is for 2 / 3 of people. The first signs appear with fractures, bone pain and muscle such as is typical of the presence of fractures, but they may also go unnoticed by the individual and can show even the least traumatic. Usually the pain is back, is acute and growing in the presence of load. With the further development of osteopenia vertebral collapse or fracture of femoral neck may occur.The fractures can lead to cervical cyphosis and lordosis.<br />
  111. 111. Riskfactors<br />Uneditable<br /> * Age - is the highest risk factor, as usually happens in old age deterioration of bone mass, very important for women is also the age at which you reach the menopause <br />  * Genetic factors, including whether or not you are completely    * Lack of hormones such as estrogen (for females), somatotropin, testosterone (for both males and females, the only form II);<br />  * Presence of diseases like cirrhosis, rheumatoid arthritis    * Hereditary diseases: osteogenesisimperfecta, homocystinuria, renal tubular acidosis<br />  * Endocrine abnormalities, Cushing's syndrome (excess cortisol)<br />Invariant<br /> * Diet, lackofcalcium, protein, vitamin C. and vitamin D<br />  * Low body weightmustbelessthan 85% ofthatconsideredideal, or otherwisegenerallyaround 55 kg;<br />  * Abuseofalcohol<br />  * Cigarette smoking<br />  * Algodystrophy<br />  * Anorexia nervosa<br /> * Physicalinactivity, whichrangesfrom a sedentarylifestyleuntil the paralysis;<br /> * Hypercalciuria (urine pH low acid)    Hypogonadism<br /> * Useofdrugssuchasheparin, methotrexate, ethanol and glucocorticoids, which alter the metabolism and produce damagetobones<br /> * Neoplasmsbonemarrow<br />
  112. 112. Nutritionaldeterminantsofbone density<br />Manynutritionalfactors have been examined for associations with osteoporosis and bone mass. Calcium, phosphorus, trace minerals, and protein are components of bone tissue. <br />The most important nutritional determinants are: <br /><ul><li> calcium intake
  113. 113. vitamin D, A, K
  114. 114. potassium
  115. 115. protein
  116. 116. Sodium
  117. 117. caffeine
  118. 118. alcohol</li></li></ul><li>Bone density and calcium<br />Bone mass duringchildhoodand adolescence can be increased by increasing calcium intake; adequate intake values of 1300 mg/day for age 9 through 18 years and 1000 mg for ages 19 through 50 years, for both men and women.<br />Increased calcium intake causes about a 10 to 15% reduction in the bone remodeling rate in adult women; 1000-1500 mg/day is correct calcium intake for premenopausal and postmenopausal women. <br />With foods rich in vitamin C it is possible to absorb more calcium. <br />
  119. 119. Foodsrichest in Calciumcontent mg/100g <br />Pecorino 1160<br />Parmigiano 1159<br />Arugula 309<br />Ricotta 295<br />Almonds 240<br />Driedfigs 186<br />Oyster 186<br />Green beet 160<br />Mozzarella 160<br />Hazelnuts 152<br />Cicory 150<br />Anchovies 148<br />Octopus 144<br />Squid 143<br />Chickpeas 142<br />Cannellini 132<br />Walnuts 131<br />Agretti 131 <br />Pistachios 130 <br />Yogurt 125<br />Milk 119<br />Radicchio 115<br />Shrimp 110<br />Buckwheat 110<br />Borlotti 102<br />Broccoli 97<br />Cardoons 96<br />Endive 93<br />Fava beans 90<br />Mussels 88<br />Artichoke 86<br />Driedapricot 85<br />Spinach 78<br />Raisin 78<br />Dates 69<br />Chard 67<br />JhonDory 65<br />Hare 64<br />Olive 63<br />Kale 62<br />Cauliflower 60<br />
  120. 120. Top 10 foodsforVitamin C content/100g<br />Redcurrant 200 mg <br />Red pepper 151 mg <br />Broccoli and arugula 110 mg <br />Kiwi 85 mg<br />Brusselssprouts and turnip 81 mg <br />Cauliflower 59 mg <br />Strawberry, clementines, spinach 54 mg <br />Orange and lemon 50 mg <br />Kale 47 mg <br />Tangerines 42 mg <br />
  121. 121. Top 10 fruitsforVitamin C content /100g<br />Redcurrant 200 mg <br />Kiwi 85 mg <br />Strawberry and clementines 54 mg<br />Orange and lemon 50 mg <br />Tangerines 42 mg <br />Grapefruit 40 mg <br />Melon 32 mg <br />Raspberries 25 mg <br />Persimmon 23 mg <br />Blackberries 19 mg <br />
  122. 122. Bone density and Vitamin D<br />The roleofvitamin D insufficiency in osteoporosis is recognized. Increasing intake of vitamin D can increase intestinal calcium absorption, lower the circulating levels of PTH (parathyroid hormone) and reduce rate of bone loss. <br />There is also evidence that supplementation with vitamin D can lower fractures. <br />
  123. 123. VitaminD richestfoodmcg/100g<br />Tuna 16,30<br />Anchovies 11<br />Swordfish 11<br />Trout 10,60<br />Pike 10,60<br />Carp 10.60<br />Shark 9,10<br />Salmon 8<br />Eel 4,90<br />Sardines 4,50<br />Butter 4,35<br />Eggs 1,75<br />40 to 80 mcgofvitamin D are recommended in osteoporosis<br />
  124. 124. Bone density and potassium<br />An increase in serum potassium concentration arising from high dietary potassium intake, stimulates intestinal calcium absorption; increasing potassium has an opposing effect on calcium lost through the urine. <br />Prolonged dietary potassium deficiency can deplete the serum level and result in enhanced resorption of this mineral from bone. For a portion of the elderly population, potassium deficiency is a concern. <br />
  125. 125. Top 10 fruitsforpotassiumcontent/100g<br />kiwi 400<br />bananas350<br />melon333<br />apricots320<br />pomegranate290<br />watermelon280<br />figs270<br />peches, blackberries260<br />ananas, medlar, 250<br />grapefruit230<br />cherries229<br />raspberries220<br />clementines210<br />oranges200<br />grape192<br />plums, susine 190<br />kaki 170<br />strawberries, blueberries160<br />pear127<br />apple125<br />
  126. 126. Bone density and sodium<br />Sodium causes an increase in renal calcium excretion. At the high levels of sodium intake typical in US, more than 90% of ingested sodium is excreted. <br />Optimal intake to minimize bone loss were estimated at approximately 1000 mg/day of calcium, 4000 mg/day of potassium and no more than 2000 mg of sodium<br />

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