This document emphasizes the importance of nutrition and energy balance in managing health, particularly for those experiencing malnutrition and cancer. It discusses various forms of malnutrition, their causes, and suggests dietary and lifestyle interventions to prevent and treat nutritional deficiencies. The overarching goal is to promote healthy eating and active living to enhance overall wellness and reduce healthcare costs.

1. Energy Balance:Banking Currency in the BodyKaron Rzad RD LDN CDE CPTLic. Stress Management CoachIntegrated Medicine Practitioner

2. Disclaimer: RD/Clinical NutritionistThe Registered Dietitian/Clinical Nutritionist is a trained expert in human nutrition and nutrition science.RD’s utilize health promotion, for disease prevention and treatment strategies that support communities and individuals to make healthy eating and active living choices. These strategies are well recognized as important in reducing the incidence of chronic illness and reducing health care costs. Their primary focus is to prevent and correct nutrient deficiency symptoms. Ref. ADA position paper.

3. ReferencesAmericana Dietetic Association, position papers.Shils, M. E. et al, “Modern Nutrition in Health & Disease” 3rd ed., ISBN: 0 7817 4133 5; 2006 Lippincott Wms & Walker.Quillin, P., PhD, RD CNS, Beating Cancer with Nutrition, Nutrition Times Press, Inc., 2002. pgs. 71,Hirsch, Julie B., Ph.D., Wellgen, Inc., Communication Structure-function: Why not call ‘antioxidants’ ‘anti inflammatories’ if that is what they do?Nutr. In Complementary Care, winter, 2007, Vol. 9. Issue 3, page 37.World Cancer Research Fund/American Institute of Cancer Research, Food, Nutrition, Physical Activity, and the Prevention of Cancer: A Global Perspective, Washington, DC: AIRC, 2007.Silva, O., MD-Onc, spec. BrCa-UM/SCCC, Conversations in CA-:What’s Next”. 10/08.Rzad, K. M., RD LDN CDE LSMC CAM, “Know Your Numbers”, 2002 – 2003, Florida Keys.Silver. J Am Geriatr Soc. 1988.Kotler, Ann Intern Med. 2000. Tisdale, Langenbecks Arch Surg. 2004Acharya et al. J Clin Invest. 2004 Inui, CA Cancer J Clin. 2002.Ref. :MEGACE ES625mg/5ml (Strativa Pharm. Formerly PAR)Heber, D., L. O. Byerley & N. S. Tchekmedyian, “Hormonal & Metabolic Abnormalities in the Malnourished Cancer Patient: Effects on Host-Tumor Interaction”, JPEN J Parenter Enteral Nutr 1992 16:60S, DOI: 10:1177/014860719201600605.Dempsey, DT, et al, “Energy expenditure in malnourished gastrointestinal CA patients.” Cancer 53:1265-1273, 1984www.aicr.org , Foods That fight Cancer. www.herbal-supplements-guide.com, Herbs for Cancerwww.cancer.gov, Cancer Prevention.www.medterms.comhttp://www.answers.com/topic/green-marketing#ixzz1JDTzsSb4

4. ObjectivesParticipants will: Verbalize the energy balance equationDefine the difference faces of malnutritionDefine Energy BalanceIdentify Foods to useIdentify Activities that enhance the wellness experience

5. DefinitionsUnder nutrition: Over nutrition:Malnutrition:CachexiaSarcopenia or unexplained weight loss,WastingFunctional Foods:Going Green

6. Presence of Obesity65% of Americans are overweight to obese, & of that, >65% of Females are overweight to obeseRef. “Know Your Numbers” campaign., 2003 Florida Keys.

7. Nutrition and Disease

8. The Presence of Malnutrition Ref. Quillin, P., PhD, RD CNS, Beating Cancer with Nutrition, ; Heber, et. al.,JPEN J Parenter Enteral Nutr 1992>40% CA patients die from malnutrition NOT Cancer;“The overall incidence ranges between 30% and 87%” data from different populations studied.

9. Malnutrition - What is it?It is a state of starvation – a physical conditionCaused from inadequate “CAR” : Consumption, Absorption & RetentionProtein for building & repairingCarbs & Fats for energy & metabolism Or both called PCM = Protein Calorie Malnutrition.Ref. Shils, M.E. et. Al., “Modern Nutrition in Health & Disease”, 10th Ed., ISBN: 0 7817-4133-5, 2006. ppgs. 730-747.

10. Some Nutrient Deficiencies Happen Over Time.Go unnoticed until it is too late!Weight loss or poor diet is not recognized as a problem.Macronutrients imbalance: Protein, Carbohydrates, FatMicronutrients: Minerals, Vitamins Phytochemicals, Antioxidants.

11. DefinitionsAnorexia: Side effect of therapies resulting in poor oral intake of foods (PEG, PEJ,)Cachexia: Pure Malnutrition = 25% to 67% of all CA patientsProtein-Calorie Malnutrition = 80% have reduced levels of serum albumin.Sarcopenia: Age related wasting: poor nutrient intake and utilization

12. The Many Faces of Malnutrition

13. Potential Causes of MalnutritionInattentive caregivers AlcoholismInappropriate tablemate Anorexia nervosaPoor lighting Dementia Unpleasant odors DepressionExcessive noise Late-life paranoiaInsufficient time to eat Pacing & wandering Cancer Decline in usual activitiesDiabetes Embarrassment diarrhea, Renal Failure vomiting…..Difficulty Breathing LonelinessDigestive Issues Temperature of food + -Tires easilySilver. J Am Geriatr Soc. 1988.EnvironmentPsychologicalMedicalSocialA Life Change

14. Activity: Energy BalanceIssues of Aging and DiseaseInactivity, No exercising or moving!

15. Cachexia Population Statistics Ref. :MEGACE ES625mg/5ml (Strativa Pharm. Formerly PAR)

16. Consequences of MalnutritionBody composition changesMetabolic process changesImpaired immunityDecreased wellness & Quality of Life Nutrient deficiencies:Macronutrient: protein, carbohydrates, fatMicronutrient: minerals, vitamins, phytochemicals (antioxidants)Ref. Shils, M.E. et. Al., “Modern Nutrition in Health & Disease”, 10th Ed., ISBN: 0 7817-4133-5, 2006. ppgs. 730-747.

17. Taking a Look at MalnutritionLoss of appetite, Anorexia;Cachexia = involuntary weight loss;There are ↑cytokines;Metabolism is accelerated;Muscle & fat mass become quickly depleted;Blood sugars may be ↑ and/or go Out-of-Control.Ref: 1. Kotler, Ann Intern Med. 2000. 3. Tisdale, Langenbecks Arch Surg. 2004 2. Acharya et al. J Clin Invest. 2004 4. Inui, CA Cancer J Clin. 2002.

18. “Eat Whatever You Want To..”Beware: A clinical statement made to someone with no clinical knowledge.

19. Dirty Dozen & Clean Fifteen

20. Functional Foods“Are "those foods that encompass potentially healthful products including any modified food or ingredient that may provide a health benefit beyond the traditional nutrients it contains," as defined by the Institute of Medicine.

21. Can include foods like cereals, breads and beverages which are fortified with vitamins, herbs and Nutraceutical.

22. The healing power of foods focuses on how "super foods" can have health protecting properties.

23. These Medicinal foods or "nutritionally high powered foods" have been part of the natural products industry for a long time. Through emerging scientific research and growing public interest, they have reached the mainstream.” www.medterms.comFunctional Foods

24. Natural Foods Work BestOrganicLess ProcessedEating Like a Cave Man!It is not just twigs, bark, and twine!It is colors!

25. The Super Foods

26. Super Foods 2

27. NutraceuticalA Nutraceutical may be a food or part of a food with a nutrient-rich or medicinally active component such as garlic or soybeans, or it may be a specific component of a food, such as the omega-3 fish oil that can be derived from salmon and other cold-water fish.www.medterms.com

28. Going Green with FoodA Marketing Idea: These are products and services based on environmental factors or awareness. Companies involved in green marketing make decisions relating to the entire process of the company’s products, such as methods of processing, packaging and distribution.http://www.answers.com/topic/green-marketing#ixzz1JDTzsSb4

29. Feeding to Fight CancerBeans-Legumes Flaxseed Green TeaBerries Garlic SoyCruciferous Grapes/Jc TomatoesDark Leafy Herbs Whole GrainGreenRef. www.aicr.org

30. The Warrior Foods & Herbswww.herbal-supplements-guide.com, Herbs for Cancer

31. Pleasure for the Palate Herbs MintBasilMintGarlicRosemaryTumeric

32. Size DOES MatterNo One Size Fits All Here!During starvation: A decrease in glucose production, protein synthesis and protein catabolism.Fat derived fuels, ketone bodies, are used for energy.Of the 54,000 kcal of protein stored in the body cell mass only 50% is available for energy production. Metabolically active muscle is preserved.Ref.Heber, et.al., JPEN, 1992.

33. How Can You Eat and Lose Weight?Some truth about food: 4 small meals are better than 1 - 2 large meals!Nibbling just means calories are out-of-control!Drinking juices is not low calories!Eat your carbs before sundown!Exercising on an empty stomach can ↑ appetite.Foods eaten while standing or on the run Count as Kcals!Keep active AFTER eating.

34. Solutions: Energy Balance as a Lifestyle

35. What is the Difference?Lean Body Mass vs. Fat Mass?Hypothesis: The malnourished cancer patient may be hypermetabolic relative to the amount of lean body mass.Conclusion: This difference was due to both a decrease in body cell mass and Increased REE before the onset of the weight loss.Ref.Heber, et.al., JPEN, 1992.

36. What About Exercise?What is it?Walk after each mealConduct an orchestra using upper body movementRock in a rocking chair “toes to nose” techniqueIf bedridden: Move by rolling from side to side every 2-4 hoursRoll to one side; sit up slowly; swing legs to the side; slowly standNo scooting or sliding to get out of bed

37. Non-CA, Normal: Talk & WalkExercise: 60 to 90 Minutes Daily↓Obesity ↓Insulin Resistance ↑Oxygenation to cells & WellnessWalking continuously gives the greatest benefit.Ref. Silva

38. Why Walking?Walk: 5 hours/week ↓BrCa by 50%