Basics of Nutrition

Basics of
Nutrition for
Patient
Education
Education
Updated November 2020
Natalie Johnson, RDN, CDN
York College Physician Assistant
Program

Nutrition education
necessary for
clinicians for patient
education
So what are the current dietary recommendations?
You’ll find out today
https://pubmed.ncbi.nlm.nih.gov/28973179/

“A healthy diet helps children
grow and develop properly
and reduces their risk
of chronic diseases, including
obesity. Adults who eat a
healthy diet live longer and
have a lower risk of obesity,
heart disease, type 2 diabetes,
and certain cancers”
- Dietary Guidelines for American 2015-2020
U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015.

United States needs help

What is a
“western
diet”?
A Western dietary pattern
typically includes red and
processed meat, sugar-
sweetened foods and
beverages, French fries, and
high-fat dairy products, as
well as refined grains.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520038/
The Western diet has been linked to increased risk of many chronic diseases

Why are
people
confused on
what to eat?
1. Some people want a
quick, fix and gravitate
towards ”fad diets” and
listen to unreliable
resources
Ex. I heard on the Dr. Oz show
that drinking apple cider
vinegar before every meal will
lower my cholesterol
2. Causation vs. association
relationships are harder to
prove in nutrition due to the
many cofounding factors
Ex. This decade’s nutrition
question is it the cholesterol
in food or saturated fat in
food that increases human
cholesterol?
The Truth: Is complicated. Eating a diet high in fiber ( fruits, vegetables and
whole grains) as well as a diet low in saturated fat ( animal foods) will decrease
your LDL cholesterol. However some people have familial hypercholesteremia

Where you
get your
nutrition
information
matters
The nutrition information you
give patients should be from
an an accredited resource that
has been peer reviewed and
has sufficient scientific
evidence
Reliable resources for
nutrition information:
• https://www.nutrition.gov/
• https://www.dietaryguideli
nes.gov/
• https://www.choosemyplat
e.gov/
• https://nutrition.cochrane.
org
• https://jandonline.org/
• https://www.eatright.org/
Unreliable resources for nutrition
information
• .com websites
• Blog posts
• Social media (FB, Instagram, reddit,
twitter)
• Any publications without creditable
and up to date resources
• Look for studies who are funded by
cereal brands or by Cola-cola

This is a good
website for getting
free resources and
up to date handouts
on nutrition
https://www.nutrition.gov/

Nutrition can be
made simple,
these
recommendations
have stood the test
of time
1. Increase fruit and
vegetables intake
2. Decrease saturated fat
intake
3. Increase whole grain vs
processed grain
4. Decrease processed meat
intake
5. Increase physical activity
6. Decrease salt intake
7. Decrease added sugar
8. Eat lean mean vs red meat
( chicken, eggs, seafood)

Why Increase fruit and vegetables
intake?
1. They densely contain necessary nutrients for function
Nutrients in fruits/vegetable such as vitamin A, vitamin C, folate, fiber and potassium
Folate helps the body form red blood cells. It is especially important for women of childbearing age to
consume folate-rich foods such as bell peppers, tomatoes and spinach to prevent neural-tube defects in
babies.
Vitamin A-rich foods such as sweet potatoes, carrots and butternut squash help keep your skin and
eyes healthy and protect against infections.
Vitamin C in foods like citrus and strawberries helps with wound healing and keeps gums and teeth
healthy.
2. They reduce risk of cardiovascular disease, stroke and type 2 diabetes and
protect against various forms of cancer
USDA states that fruits and vegetables high in fiber can reduce chances of developing
coronary heart disease.
Eating potassium-rich foods such as bananas and potatoes can help reduce blood
pressure, decrease bone loss and prevent development of kidney stones.
Fruits and vegetables also contains different phytochemicals and antioxidants, natural
chemical compounds in plants, which maintain proper cell health and can reduce risk of
cancer.

What is the significance of
saturated fat?
Eating foods that contain saturated fats raises the level of cholesterol in
your blood. High levels of LDL cholesterol in your blood increase your risk
of heart disease and stroke
AHA Recommendation: The American Heart Association recommends
aiming for a dietary pattern that achieves 5% to 6% of calories from
saturated fat.
• For example, if you need about 2,000 calories a day, no more than 120
of them should come from saturated fat
That’s about 13 grams of saturated fat per day.
https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats

The recommendation to
reduce refined grain intake
based on results from
studies linking a Western
dietary pattern to numerous
adverse health outcomes is
contrary to a substantial
body of published scientific
evidence.
Refined Grains—Grains and grain products
with the bran and germ removed; any grain
product that is not a whole-grain product.
Many refined grains are low in fiber but
enriched with thiamin, riboflavin, niacin, and
iron, and fortified with folic acid.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520038/
What is a refined grain?

Why are whole grains better than refined grains?
Whole grains offer a “complete package” of health benefits, unlike refined
grains, which are stripped of valuable nutrients in the refining process
What gets refined out?
B vitamins, iron, copper, zinc, Vitamin E, healthy fats magnesium, antioxidants, and
phytochemicals
(Phytochemicals are natural chemical compounds in plants that have been researched for their role in disease
prevention)
Other positives:
• The fiber slow the breakdown of starch into glucose—thus maintaining a
steady blood sugar rather than causing sharp spikes.
• Fiber helps lower cholesterol as well as move waste through the digestive tract.
• Fiber may also help prevent the formation of small blood clots that can trigger
heart attacks or strokes.
• Phytochemicals and essential minerals such as magnesium, selenium and copper
found in whole grains may protect against some cancers.
https://www.hsph.harvard.edu/nutritionsource/what-should-you-eat/whole-grains/

Processed
meat and
Cancer link
In 2017, the World Health
Organization’s International
Agency for Research on
Cancer (IARC) named
processed meat as a
carcinogen.
Processed meat (and high
amounts of red meat)
increase risk for stomach
and colorectal cancer
Processed Meat & Processed
Poultry—All meat or poultry
products preserved by smoking,
curing, salting, and/or the
addition of chemical
preservatives. Processed meats
and poultry include all types of
meat or poultry sausages
(bologna, frankfurters, luncheon
meats and loaves, sandwich
spreads, viennas, chorizos,
kielbasa, pepperoni, salami, and
summer sausages), bacon,
smoked or cured ham or pork
shoulder, corned beef, pastrami,
pig’s feet, beef jerky, marinated
chicken breasts, and smoked
turkey products.
https://www.aicr.org/news/diet-cancer-experts-welcome-who-report-on-meat-and-cancer/
Why decrease processed meat intake?

Why increase
physical
activity?
Benefits of Physical Activity
1.Immediate Benefits.
2.Weight Management.
3.Reduce Your Health Risk.
4.Strengthen Your Bones and
Muscles.
5.Improve Your Ability to do
daily Activities and Prevent Falls.
6.Increase Your Chances of Living
Longer.https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm

Why decrease salt intake?
The American Heart
Association recommends no
more than 2,300 milligrams
(mgs) a day and an ideal limit
of less than 1,500 mg per
day for most adults,
especially for those with high
blood pressure.
https://www.heart.org/-/media/data-import/downloadables/8/2/0/pe-abh-why-should-i-limit-sodium-ucm_300625.pdf

What is
added
sugar?
Added Sugars—Syrups and
other caloric sweeteners
used as a sweetener in
other food products.
Naturally occurring sugars
such as those in fruit or milk
are not added sugars.
Specific examples of added
sugars that can be listed as
an ingredient include brown
sugar, corn sweetener, corn
syrup, dextrose, fructose,
glucose, high-fructose corn
syrup, honey, invert sugar,
lactose, malt syrup,
maltose, molasses, raw
sugar, sucrose, trehalose,
and turbinado sugar. (See
Carbohydrates, Sugars.)

Why does decreasing added sugar matter?
Americans are eating and drinking too
much added sugars which can lead to
health problems such as weight gain and
obesity, type 2 diabetes, and heart
disease
Americans should keep their intake of
added sugars to less than 10% of their
total daily calories as part of a healthy
diet.2 For example, in a 2,000 daily
calorie diet no more than 200 calories
should come from added sugars.
https://www.cdc.gov/nutrition/data-statistics/know-your-limit-for-added-sugars.html

What are the
benefits of
lean meat
over red
meat?
Benefits of lean meat:
Meat, poultry, fish, dry beans
and peas, eggs, nuts, and
seeds supply many nutrients.
These include protein, B
vitamins (niacin, thiamin,
riboflavin, and B6), vitamin E,
iron, zinc, and magnesium
Seafood contains a range of
nutrients, notably the omega-3
fatty acids, EPA and DHA.
Eating about 8 ounces per
week of a variety of seafood
contributes to the prevention
of heart disease. Smaller
amounts of seafood are
recommended for young
children.
Again, negative of fatty,
processed meat:
Diets that are high in saturated fats
raise “bad” cholesterol levels in the
blood.
The “bad” cholesterol is called LDL
(low-density lipoprotein) cholesterol.
High LDL cholesterol, in turn,
increases the risk for coronary heart
disease.
Some food choices in this group are
high in saturated fat.
These include fatty cuts of beef, pork,
and lamb; regular (75% to 85% lean)
ground beef; regular sausages, hot
dogs, and bacon; some luncheon
meats such as regular bologna and
salami; and some poultry such as
duck.
To help keep blood cholesterol levels
healthy, limit the amount of these
foods you eat.
https://www.choosemyplate.gov/eathealthy/protein-foods/protein-foods-nutrients-health
Why are lean protein and seafood promoted over
processed red meat?

What’s New
With the
Nutrition
Facts Label?
https://www.fda.gov/food/new-nutrition-facts-label/whats-new-
nutrition-facts-label

Why are
certain
nutrients on
the label and
not others?
• Calcium and iron
• This is because Americans do
not always get the
recommended amounts
• Diets higher in calcium and
iron can reduce the risk of
osteoporosis and anemia,
respectively
• Vitamin D
• This is because Americans do
not always get the
recommended amounts
• Diets higher in vitamin D and
potassium can reduce the risk
of osteoporosis and high blood
pressure, respectively.
Most people do not need to take
vitamin supplements and can
get all the vitamins and minerals
they need by eating a healthy,
balanced diet.
Even though supplements are
popular, there is limited
evidence that they offer any
significant health benefits. In
fact, a study published online
May 28, 2018, by the Journal of
the American College of
Cardiology, found that the four
most commonly used
supplements — multivitamins,
vitamin D, calcium, and vitamin C
— did not protect against
cardiovascular disease.
https://www.health.harvard.edu/staying-healthy/do-you-need-a-daily-supplement

The Dietary
Guidelines for
Americans
What is it? current body of nutrition science, helps health professionals and policymakers guide
Americans to make healthy food and beverage choices, and serves as the science-based foundation
for vital nutrition policies and programs across the United States
What is the most recent one right now? DGA 2015-2020
Who writes it? USDA and HHS
How often is it updated? Every five years
Where can I access it? https://health.gov/our-work/food-nutrition/2015-2020-dietary-
guidelines/guidelines/

General DGA
guidelines when
discussing
calories:

General
recommended
amount of food
group per
calorie group

General
recommended
amount of food
group per calorie
group

Why do calories matter?
Calories (kilocalories) are a measurement of energy
It takes using 3,500 calories to lose 1 pound (0.45 kilogram)
of fat.
So, in general, if you cut about 500 to 1,000 calories a day
from your typical diet, you'd lose about 1 to 2 pounds a week
Math = 500 less calories x 7 days = 3500 calories
So if you need 2000kcal, take in 1500kcal each day for 1 week
to lose 1lb a week
Hall KD, et al. Quantification of the effect of energy imbalance on bodyweight. Lancet. 2011;378:826.

General
recommended
amount of
nutrients per
calorie group

Body Mass Index (BMI)
• Body Mass Index (BMI) is a
person's weight in divided by height
• A high BMI can be an indicator of
high body fatness.
• BMI can be used to screen for
weight categories that may lead to
health problems but it is not
diagnostic of the body fatness or
health of an individual.

Remember to try
and use
motivational
interviewing to
help create
SMART goals!
http://aims.fao.org/activity/blog/fao-commits-un-decade-action-nutrition-towards-smart-actions

Resources
• U.S. Department of Health and Human Services and
U.S. Department of Agriculture. 2015 – 2020 Dietary
Guidelines for Americans. 8th Edition. December
2015
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC652
0038/
• Hall KD, et al. Quantification of the effect of
energy imbalance on bodyweight. Lancet.
2011;378:826
• https://pubmed.ncbi.nlm.nih.gov/28973179/
• https://www.fda.gov/food/new-nutrition-facts-
label/whats-new-nutrition-facts-label
• https://fruitsandveggies.org/
• http://aims.fao.org/activity/blog/fao-commits-un-
decade-action-nutrition-towards-smart-actions
• https://www.cdc.gov/nutrition/data-statistics/know-
your-limit-for-added-sugars
• https://www.nutrition.gov/
• https://www.dietaryguidelines.gov/
• https://www.health.harvard.edu/staying-
healthy/do-you-need-a-daily-supplement
• https://www.choosemyplate.gov/eathealthy/pr
otein-foods/protein-foods-nutrients-health
• https://nutrition.cochrane.org
• https://jandonline.org/
• https://www.eatright.org/
• https://www.cdc.gov/physicalactivity/basics/pa
-health/index.htm
• https://www.heart.org/-/media/data-
import/downloadables/8/2/0/pe-abh-why-
should-i-limit-sodium-ucm_300625.pdf
• https://www.hsph.harvard.edu/nutritionsource
/what-should-you-eat/whole-grains/

Basics of Nutrition

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