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CARBOHYDRATES (CHO) –
4 CAL/GRAM
 Simple Carbohydrates
 Monosaccharides
 Disaccharides
 Complex Carbohydrates
 Oligosaccharides
 Polysaccharides
SIMPLE CARBOHYDRATES
Monosaccharides
• Glucose
• Predominate form in nature; basic building block of other carbs
• Fructose
• Sweetest; found in fruit
• Galactose
• Often bound with glucose to form lactose (in milk)
• Bound by glycosidic bonds to form more complex molecules
• Body uses glucose; so convert fructose and galactose
DISACCHA
RIDES
Lactose
• Glucose + Galactose
• Dairy (milk, yogurt, ice cream)
Sucrose
• Glucose + Fructose
• Table sugar
Maltose
• Glucose + Glucose
• Malt sugar
Honey is a natural form of sucrose
that is made from plant nectar
and harvested by honeybees,
which secrete an enzyme that
hydrolyzes sucrose to form glucose
and fructose.
Oligosaccharides
• Chain of 3 – 10 simple sugars
• Fructooligosaccharides
• Found in fruits/veggies
• Commercially produced as low-cal sweetener
• Mostly indigestible
• Help relieve constipation, improve TG levels,
decrease foul-smelling stool
Oligosaccharides and
Polysaccharides
Polysaccharides
• Hundreds of monosaccharides bound together
• Starch
• Produced by grains and veggies
• Amylose
• Small linear molecule of tightly packed
glucose molecules
• Mostly resistant to digestion
• Amylopectin
• Larger, highly branched chain of glucose
molecules that is easily digested
• Cellulose
• Low viscosity starch made of long chains of
glucose; structural component of the cell wall
in plants that is indigestible to humans
• Fiber
• Largely indigestible 2/2 lack of enzymes to disrupt
glycosidic bonds
• Some fiber Is fermented in large intestine for
energy to flora
• 1.5 – 2.5 cal/gm
• Glycogen
• Polysaccharide that is a highly branched chain of
glucose molecules
• Chief carb storage material in animals formed and
stored in liver and muscle
COMPLEX
CARBOHYDRATES
CARBOHYDRATE
DIGESTION
CARBOHYDRATE
METABOLISM
 Glucose C02 a+ H20 +
ATP
 Liver: 90 gm glycogen
 Muscle: 150+ gm
glycogen
 Excess carbs adipose
tissue
HORMONE REGULATION
Insulin
 Postprandial rise in BG
 Aids in cellular glucose uptake
 Promotes conversion of carbs into fat for LT storage
 When sugar is abundant and glycogen stores maximized
Glucagon
 Low BG levels
 Increase BG levels
 As glycogen levels decrease, glucagon metabolizes fat from storage for fuel
to help conserve glycogen and maintain BG levels
GENERAL
CARBOHYDRATE
RECOMMENDATIONS
 Acceptable Macronutrient Distribution Ranges (AMDR)
 Range assoc. with reduced risk for chronic dz while still providing
adequate intake of nutrients (ie vit/min)
 For carbs: 45% to 65% of total cal intake
 Recommended Dietary Allowances (RDA)
 Amount of nutrient known to be adequate to meet the
nutritional needs of nearly all healthy persons
 For carbs: 130 gm/day
 Min based on brain needs (so need more for body reqs)
 Academy of Nutrition and Dietetics/ACSM
 Carb needs for athletes: 6-10 g/kg (2.7 to 4.5 g/lb) of body wt daily
 Depends of total daily energy expenditure, types of exercises
performed, gender, environmental conditions to maintain BG
levels during exercise and to replace muscle glycogen
GLYCEMIC
INDEX
• Ranks carbs based on their BG response; based on reference amt (50 gm)
• High GI
• Enter bloodstream rapidly  large BG spike  insulin spike  muscle
glucose uptake and fat deposition in adipose tissue
• From 2 – 4 hrs postprandial, residual effects of insulin spike can lead to
hypoglycemia
• Low GI
• Digested slowly  small BG increase  small insulin boost
GLYCEMIC
LOAD
 Accounts for portion size
 Glycemic Load (GL) = GI x grams of carbs ÷ 100
 A food can have high GI but a low GL
 i.e. carrots have high GI, but 50 gm carrots = 4 cups,
but since serving size is
½ cup, then GL is low
 Carb foods that are also mod to high in fat or protein,
fiber, and other nutrients and that are min processed
may have a high GI and low GL
 Benefits of Low GI foods
 Weight control
 Decreased risk of diabetes and CVD
 Usu more nutrient dense
 i.e. 16 oz soda has same amt of carbs as 2
med-size apples
Functional Fiber Dietary Fiber
• Nondigestible carbs
isolated from food or
added to food products,
with potentially beneficial
health effects
• Improved GI sxs, wt loss, dec
cholesterol, colon ca prevention
• Food labels:
• Isolated nondigestible plant
carbs
• Resistant starch, pectin,
gum
• Animal carbs
• Chitin, chitosan
• Commercially produced carbs
• Resistant starch,
polydextrose, inulin,
indigestible dextrin
• Nondigestible carbs and
lignins that are obtained
naturally from plant foods
• High viscosity (soluble) fiber
• A type of fiber that forms gel in water;
may help prevent CVD and stroke by
binding bile and cholesterol, diabetes
by slowing glucose absorption, and
constipation by holding moisture in
stools; includes gums, pectin, psyllium
seeds
• Low viscosity (insoluble) fiber:
• Fiber that does not bind with water
and adds bulk to the diet (includes
cellulose, hemicellulose, and lignins
found in wheat bran, veggies, and
whole grain breads and cereals);
important for proper bowel bowel
function and reducing sxs of
constipation
FIBER = FUNCTIONAL FIBER + DIETARY
FIBER
Large biological molecules, or
macromolecules, consisting of
one or more long chains of
amino acid residues. Proteins
perform a vast array of
functions within living
organisms, including catalyzing
metabolic reactions, replicating
DNA, responding to stimuli,
and transporting molecules
from one location to another.
Proteins differ from one
another primarily in their
sequence of amino acids,
which is dictated by the
nucleotide sequence of their
genes, and which usually
results in folding of the protein
into a specific three-
dimensional structure that
determines its activity.
PROTEIN
Complete protein
•
• A food item that
contains all essential
AAs
• Generally animal
products
Also plant-based soy, quinoa,
chia seeds, buckwheat, hemp,
flax seeds
Incomplete
protein
• A food item that does
not contain all essential
AAs
• Generally plant
PROTEIN QUALITY
WHEY
PROTEIN
PROTEIN DIGESTION AND ABSORPTION
Denaturation- the process of unfolding a protein by destroying its quaternary,
tertiary, and secondary nature
AS WITHIN, SO WITHOUT
PROTEIN
SYNTHESIS
1) Stomach- HCL acidifies
stomach, triggering activation
of pepsin
2) Pancreas- secretes
proteolytic enzymes into
small intestines
3) Small intestines- trypsin
further breaks proteins down
into di- and tripepides 
cleaved into single AAs 
blood  liver
4) Liver- regulates distribution
of AAs throughout body
MUSCLE PROTEIN
CATABOLISM
Glucose-Alanine Cycle
PROTEIN
RECOMMENDATIONS
RDA = 0.8 g/kg/day
Academy of Nutrition and Dietetics, Dietitians of
Canada, ACSM
• Endurance athletes = 1.2 – 1.4 g/kg (0.5 to 0.6 g/lb) daily
• Strength-training = 1.6 – 1.7 g/kg (0.7 to 0.8 g/lb) daily
IOM = “no compelling scientific evidence to
support active individuals increasing their daily
protein intake above the RDA of 0.8 g/kg)
AMDR = 10 – 35% daily caloric intake
PROTEIN
AND
ATHLETICISM
Carb:Protein = 3:1
• Encourages + nitrogen balance à muscle synthesis, hydration,
energy
6 – 20 gm protein and 30 – 40 gm carbs post-
workout (w/in 3 hrs)
• As little as 5 – 10 gm protein immediately post-exercise can
promote optimal muscle repair
BCAAs
• Combats fatigue when consumed during workout
• Leucine 45 mg/kg/day; Isoleucine 22.5 mg/kg/day; Valine 22.5
mg/kg/day (2:1:1)
Vegetarians
• Should consume 10% more grams of protein daily than recs
• Plant proteins not as readily digestible
• Need complimentary protein-rich plant foods
FAT FARM
• 1 gm fat = 9 calories
• Lipids
• Fat or fat-like substance used in body or bloodstream; includes fats, oils,
waxes, sterols, TGs, all of which are insoluble in water
CHOLESTEROL AND
STEROIDS
• Cholesterol- fat-like, waxy substance produced in liver
and found in cell membrane of all animal tissues 
cell structure and integrity
• Adrenals  glucocorticoid (cortisol) and
mineralocorticoids (aldosterone)
• Testes, ovaries  androgens and estrogens
• Liver  bile acids
• Skin  cholesterol becomes cholecalciferol with
sun exposure, then converted to calcitriol (active Vit
D)
Susceptible to oxidation, distributing
cholesterol to inner lining of arteries,
leading to atherosclerosis
FATTY ACIDS AND TRIGLYCERIDES
• Adipose tissue is an endocrine organ!!!
• Leptin- a hormone produced by
adipose tissue that suppresses the
appetite and increases energy
expenditure; levels increase with
increased fat storage
• Resistin- hormone secreted by
adipose tissue that decreases cell
sensitivity to insulin
• TNF-alpha- helps regulate fat
metabolism and contributes to acute
inflammatory rxns
FAT DIGESTION AND ABSORPTION
1. Lingual lipase- enzyme released from mouth that begins breakdown of
short- and medium-chain FAs
2. Gastric lipase – further digestion of fat
3. CCK – triggered by fat in small intestine; stimulates release of GIP (gastric
inhibitory peptide)  decreases gut movement and slows digestion
• Adipose Tissue Growth:
• Hyperplasia- abnl increase in # of
cells
• Hypertrophy- abnl increase in size
of current cells
• Two Types of Fat Cells:
•
store fat and provide
thermal insulation
• Brown Fat- help to generate body
heat; present in newborns; iron-
containing mitochondria
FAT METABOLISM AND
STORAGE
GENERAL FAT
RECOMMENDATIONS
DRIs set AMDR of fat as 20% to 35% of
total calories from fat
AI of linolenic acid (omega-3) is 1.6 and 1.1
gm/day for men and women
AI of linoleic acid (omega-6) is 17 and 12
gm/day for men and women
2010 Dietary Guidelines for Americans:
• Fewer than 10% of calories from saturated fat
• Less than 300 mg/day cholesterol
• Consume more mono/polyunsaturated fats
• Consume less saturated and trans fats
• Avoid solid fats and added sugars
FAT AND
HEALTH
Replace saturated fat with polyunsaturated fat whenever possible, or otherwise with monounsaturated
fat. Polyunsaturated fats lower LDL cholesterol and improve HDL:total cholesterol ratio, often by
increasing the HDL component. Monounsaturated fats have a more neutral effect.
Choose healthful fats over “low fat” foods that contain refined carbs, as these foods decrease HDL
cholesterol, increase TGs, and overall worsen the atherogenic dyslipidemia assoc w/ obesity and insulin
resistance.
Consume omega-3 FAs in the diet at least 2x/week
Avoid trans fats, as they decrease HDL cholesterol and increase total
cholesterol.
Total fat intake and ratio of omega 3:6 FAs are not predictors of heart health.
Exercise regularly to decrease LDL levels and prevent redux in HDL assoc w/ a diet higher than
recommended in total fat and saturated FAs.
FAT- WHAT
TO TELL
CLIENTS
Use liquid vegetable oils whenever possible
When solid fats are necessary, keep trans fats to a min.
Balance calories by limiting refined carbs and not through avoidance of the
healthy polyunsaturated and monounsaturated fats.
Limit saturated fats to less than 10% of total fat intake.
Dietary fats are never purely one type, but a combo.
Promote fruits, veggies, and whole-grain as ideal sources of carbs rather than refined or processed carbs
Dietary patterns are more important than single dietary components. A healthful eating plan includes
fruits, veggies, unprocessed whole grains, fish, lean meat, low0fat dairy, and vegetable oils.
Calorie balance should emphasize quality of food selection.
VITAMINS
Organic substances obtained from plant and animal foods that are essential in small
quantities for normal growth and activity of the body.
Exceptions for the food source rule:
• Vitamin K and biotin produced by normal intestinal flora
• Vitamin D self-produced via sun exposure
• Niacin synthesized from tryptophan
• Vitamin A synthesized from beta-carotene
The reference values
Recommended Dietary Allowances (RDAs)- the daily dietary intake of a nutrient known to
meet the nutritional needs of 97% of healthy persons in age- and gender-specific groups.
The Food and Nutrition Board, an entity of the Institute of Medicine, establishes RDAs.
Estimated average requirement (EAR)- an amount of nutrient known to be adequate to
meet nutritional needs
in 50% of an age- and gender-specific group.
Tolerable upper intake level (UL)- the maximum intake that is unlikely to pose risk of
adverse health effects to almost all individuals in an age- and gender-specific group.
THIAMIN- VITAMIN
B1
• Essential for carb metabolism and plays role in nerve
fxn
RIBOFLAVIN- VITAMIN
B2
NIACIN- VITAMIN B3
• Cofactor for over 200 enzymes involved in carb, AA, and FAmetabolism
• Lean meats, poultry, fish, peanuts, and yeast
• Muscular weakness, anorexia, indigestion, and skin abnormalities are early
sxs of niacin def.  can lead to pellagra (see below)
PYRIDOXINE- VITAMIN B6
Plays improtant role in protein metabolism, RBC production,
glycogenolysis, conversion of tryptophan to niacin, neurotransmitter
formation, and immune system fxn.
Deficiency leads to decrease dneurological and dermatological fxn
weakend immunity
FOLATE
• DNA production
• Red and white blood cell formation
• Neurotransmitter formation
• AA metabolism
• Deficiency leads to megaloblastic anemia,
skin lesions, poor growth
• Excess folate can mask Vitamin B12
deficiency
COBALAMIN- VITAMIN
B12
Rich sources: clams, oysters, milk, eggs, cheese, muscle meats, fish, liver,
kidney
Deficiency- megaloblastic anemia and neuro dysfxn- demyelination 
parasthesias, burning feet, stiffness and generalized LE weakness
BIOTIN- VITAMIN
B7
• The ultimate “helper vitamin”
• Typically bound to protein, carries and carboxyl group (-COOH)
• Plays important role in fxns of pantothenic acid, folic acid, vit B12
• Deficiency uncommon
PANTOTHENIC ACID- VITAMIN
B5
Present in all plant and animal tissues
Forms integral component of coenzyme A and acyl-carrier protein
essential for metabolism of fatty acids, amino acids, and carbs, and as
well as for normal protein fxn
essential for synthesis of acetylcholine
Involved in the production of steroid hormones, Vit D, Vit A, and cholesterol
VITAMIN C
• Plays a role as an antioxidant
• Necessary to make collagen
• Deficiency leads to scurvy
• Causes dark purplish skin lesions and spongy/bleeding gums
• Improves iron absorption, promotes resistance to infection, and helps with steroid,
neurotransmitter, and hormone production
• Sxs of deficiency: impaired wound healing, swelling, bleeding, and weakness in bones,
cartilage, teeth, and connective tissues
VITAMIN A
• Vision, growth, development
• Development and maintenance of epithelial tissue (including bones/teeth)
• Immune fxn
• Reproduction
VITAMIN D
Vitamin D3
(cholecalciferol) from sun,
animals, supps
Vitamin D2 (ergocalciferol)
from plants and supps
CALCITRIO
L
Responsible for vitamin D’s
biological effects
VITAMIN E
 Protects against
conditions related to
oxidative stress: aging, air
pollution, arthritis, cancer,
CVD, cataracts, diabetes,
infection
VITAMIN K
MINERALS!!!
MORE
MINERALS!!!
MACROMINERALS
Major Elements
• Body requires 100+ mg daily
• Calcium
• Phosphorous
• Magnesium
• Sulfur
• Sodium
• Chloride
• Potassium
MICROMINERALS
Trace Elements
• Body requires <20 mg daily
• Iron
• Iodine
• Selenium
• Zinc
• Copper
• Chromium
• Other minerals w/o established DRI
CALCIUM
Calcium is the most abundant mineral in the body and serves various functions, including mineralization of
the bones and teeth, muscle contraction, blood clotting, blood-pressure control, immunity, and possibly
colon-cancer prevention.
CALCIUM
SUPPLEMENTATIO
N
• No more than 500 mg of calcium should be taken at a time because this is
the maximum amount the body can absorb at once. Calcium carbonate
should be taken with food to help with absorption; calcium citrate can be
taken with or without food
• High calcium intake can interfere with absorption of iron, zinc, manganese
and can lead to constipation and nephrolithiasis
PHOSPHORUS
Along with calcium, phosphorus plays a key role in mineralization of bones and
teeth. Phosphorus helps filter out waste in the kidneys and contributes to
energy production in the body by participating in the breakdown of carbs,
proteins, and fats. Phosphorus is needed for the growth, maintenance, and
repair of all tissues and cells, and for the production of DNA and RNA.
Phosphorus is also needed to balance and metabolize other vitamins and
minerals including vitamin D, calcium, iodine, magnesium, and zinc. Too much
phosphorus intake interferes with calcium absorption and may lead to
decreased bone mass and density.
MAGNESIUM
• Important for bone mineralization, protein production, muscle contraction,
nerve conduction, enzyme function, healthy teeth
• Food sources: nuts, legumes, whole grains, dark leafy green veggies, milk
• High intakes of calcium, protein, vitamin D, and EtOH increase body’s
magnesium requirements
• Depletion can occur as a result of aging, IDDM, hypermagnesuric diuretics
• Can contribute to many chronic illnesses and is assoc w/ heart arrythmias
and MI
• Magnesium toxicity (very rare) may prevent bone calcification
SULFU
R
• Important component of many important body
compounds
• Cysteine and methionine
• Thiamin, biotin, panothenic acid
• Heparin
• Food sources: meat, poultry, fish, eggs, dried beans,
broccoli, cauliflower
IR
O
N
• Regulates cell growth and differentiation
• Production of hemoglobin and myoglobin
• Fe stored in the body as ferritin for future use
• Liver, spleen, bone marrow
• Fe released from breakdown of RBCs transferred to
working cells via transferrin
IRON HOMEOSTASIS
• Heme iron: from animal sources; 10 -
35% bioavailability
• Nonheme elemental iron: from plant
sources; 2 - 10% bioavailability
• Increase Fe absorption via vitamin C
• Decrease Fe absorption via coffee/tea;
excess Zn, Mg, Ca; high phytic acid
(fiber)
SPORTS ANEMIA
(PSEUDOANEMIA)
• Athletes experience small amounts of exercise-induced blood loss
• Urine, GI bleeding, high sweat rates, mechanical trauma
• Leads to increased RBC destruction and loss of Fe
• Hg low; Fe normal
• 2/2 increased plasma volume in response to physical training
• Total Hg unchanged
• Hg concentration decreased
• Total Hg divided by total volume
IODINE
• Stored in thyroid gland
• Essential for normal growth
• Food sources: seafood and iodized salt
SELENIUM
• Antioxidant
• Deficiency: heart dz, hypothyroidism, weakened immune system
• Excess: (selonosis) GI distress, alopecia, white blotchy nails, garlic
breath, fatigue, irritability, nerve damage
ZINC
• Found in almost every cell; 2nd most abundant trace element after iron
• Stimulates activity of enzymes, supports a healthy immune system, assists in
wound healing, strengthens the senses (esp taste and smell), supports normal
growth and development, and helps with DNA synthesis
• Food sources: meat, fish, poultry, dairy, seafood
• Deficiency: delayed wound healing, immune dysfunction
• Toxicity: decreased HDL, impaired copper absorption, altered Fe function
CHROMIUM
• Trace mineral that helps to increase the effectiveness of insulin and aids in
glucose metabolism
• Food sources: corn oil, clams, whole-grain cereals, brewer’s yeast
• Deficiency and toxicity are very rare
COPPER
 Helps make RBCs
 Keeps nerve cells and immune system
healthy
 Helps in formation of collagen and
cellular energy production
 Acts as an antioxidant by eliminating
free radicals
 Helps in the absorption of Fe
 Food sources: oysters, liver, organ
meats, dried legumes
 Deficiency rare: anemia, low body temp,
bone fractures, osteoporosis
ELECTROLYTES
Four Essential Roles
1. Water balance and distribution
2. Osmotic equilibrium
3. Acid-base balance
4. Intracellular/extracellular differentials
Sodium
Potassium
Chloride
MICRONUTRIENT DIGESTION, ABSORPTION,
DISTRIBUTION
ATHLETES RISK LOSING…
• B vitamins
• Vitamin C
• Vitamin E
• Beta-carotene
• Calcium
• Vitamin D
• Selenium
• Iron
• Zinc
• Magnesium
VITAMINS
AND
EXERCISE
• Supporting energy
production
• Thiamin
• Riboflavin
• Niacin
• Pyridoxine (B6)
• Pantothenic acid
• Biotin
• Supporting formation of
RBCs
• Folate
• Cobalamin (B12)
Two essential roles:
DRINK MORE H2O
DIETARY
GUIDELINES
• Published q5yrs by USDA and Department of Health and Human Services
• Includes 23 recs for gen pop and 6 addl recs for special groups
• 4 categories
1. Balance calories to achieve and maintain a healthy weight
2. Foods and food components to reduce
3. Foods and nutrients to increase
4. Building healthy eating patterns.
DASH (DIETARY APPROACHES TO STOP
HYPERTENSION)
MEDITERRANE
AN DIET
MYPLATE
1. Balance calorie intake with calories expended through physical activity.
2. Enjoy food, but make sure proportions are appropriate; eat slowly; minimize
distractions (i.e. television; smartphones)
3. Avoid oversized portions; utilize smaller plates, smaller serving sizes, mindful
eating
4. Eat more vegetables, whole grains, fat-free or low-fat dairy products (or dairy-free
alternatives) for adequate potassium, calcium, vitamin D, and fiber
5. Make half of your plate fruits and veggies; most Americans need 9 servings of
fruits and veggies daily (2013 average adult in U.S. eats fruit 1.1x/day and veggies
1.6x/day)
6. Switch to fat-free or low-fat (1%) milk or dairy alternative like almond/coconut milk
7. Make at least half of grains whole grains; ensures adequate fiber intake and
decreased intake of processed foods
8. Eat fewer foods high in solid (saturated/trans) fats, added sugars, and salt
9. Compare sodium in foods and choose lower sodium version
10. Drink water instead of sugary drinks to cut sugar and unnecessary calories
DIETARY
REFERENCE
INTAKES
 RDA is the sufficient average intake for most
healthy individuals. RDA values may vary
based on age and gender.
 Estimated average requirement (EAR) is an
adequate intake (AI) in 50% of an
age- and gender-specific group
 Tolerable upper intake level (UL), the
maximum intake of a nutrient that is
unlikely to pose risk of adverse health
effects to almost all individuals in an age-
and gender-specific group.
 AI is used when a RDA cannot be
determined. AI is a recommended nutrient
intake level that is based on research and is
sufficient for healthy individuals
FOOD
LABELS
Clients should minimize intake
of the first three nutrients:
• Fat (esp sat and trans): clients on a
2,000 cal/day diet should aim for a
total per day of < 65 g total fat or <
20g saturated fat
• Cholesterol: goal of < 300 mg
• Sodium: goal of <2,300 mg
REDUCE EXPOSURE TO
FOODBORNE ILLNESS
• Check produce for bruises and punctures, either may allow for contamination.
• Look for sell-by date for breads and baked goods, a use-by date on packaged
foods, an expiration date on yeast and baking powder, and a pack date on
canned and some packaged foods.
• Make sure packaged goods are not torn, and cans are not dented, cracked or
bulging to prevent contamination or botulism.
• Separate fish and poultry from other purchases by wrapping them separately
in plastic bags. Once home, prevent leakage and cross-contamination.
• When shopping, choose refrigerated and frozen foods last. Try to make sure
all perishable foods are refrigerated within one hour of purchase.
FOOD
SAFETY
• Wash hands often with warm water and soap for at least 20 seconds
• Clean hands, food contact surfaces, and fruits and veggies; to prevent cross-
contamination, meat and poultry should not be washed or rinsed.
• Separate raw, cooked, and ready-to-eat foods while shopping, preparing, and
storing foods
• Cook foods to safe temp to kill microorganisms; pregnant women and ppl over
age 65 should eat deli meats only if reheated to steaming hot to reduce risk of
infxn
• Refrigerate perishable food within 1-2 hrs and defrost foods properly; eat
refrigerated leftovers within 3-4 days; “When in doubt, throw it out”
• Avoid raw (unpasteurized) milk (products), raw or partially cooked eggs,
raw/undercooked meat/poultry, raw fish, unpasteurized juice, and raw sprouts
• Esp infants, young children, pregnant women, older adults,
immunocompromised individuals
JAMA NUTRITION
POLICY
• Taxation: imposing higher taxes on calorie-dense and
nutrient-poor foods might lower consumption of
unhealthy foods and generate revenue to subsidize
healthful foods.
 Food prohibitions: removing harmful ingredients from
the food supply eliminates their health risks
 Regulation of food marketing to children and
adolescents: restricting food advertising during
children’s programs, counter-advertising to promote
good nutrition and physical activity, limiting use of
cartoon characters, and other regulations may help
protect children who are otherwise unable to critically
evaluate advertisements
Policy strategies to help increase nutrition and PA habits on a population level, to hopefully reduce obesity rates and improve health
•
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THE POTENTIAL
FOR ACTI(O)N
ATP AND MUSCLE CONTRACTION
GLYCOGENOLYSIS AND
GLYCOLYSIS
OXYGEN AND NUTRIENT DELIVERY
• Oxygen-carrying capacity: the body’s ability to obtain oxygen from the air
inhaled into the lungs and transported to the bloodstream; affected by 2 main
factors:
1. The ability to adequately ventilate the alveoli in the lungs
2. Hemoglobin concentration in the blood
• Oxygen delivery: the ability of the body to transport oxygen from the lungs to
the mitochondria of the working cells; the amount delivered is a function of
cardiac output
VO2 MAX
a measure of maximal oxygen uptake; liters of O2 consumed per kilogram of
bodyweight per minute; generally considered the best indicator of a person’s
cardiovascular fitness and aerobic endurance (the more O2 used during intense
performance, the more ATP is produced)
AEROBIC GLYCOLYSIS- TCA
2 ATP
8 NADH
2 FADH
6 CO2
AEROBIC GLYCOLYSIS- OXIDATIVE
PHOSPHORYLATION
2 ATP
8
NADH
2
FADH
6 CO2
LYPOLYSIS AND FATTY
ACID OXIDATION
ENERGY
DEAMINATION AND
PROTEIN AS ENERGY
FOOD
TO FUEL
LIPOGENESIS
OXYGEN CONSUMPTION AND EXERCISE
GLYCOGE
NESIS
GLUCOSE- FOOD TO FUEL
• 1-4 hrs for carbs to be
digested, absorbed, and
stored as glycogen in
liver or muscle
• Carbs can be ingested at 3
gm/min before causing GI
upset
• Portal circulation is rate-
limiting step in carb food to
fuel time
• Max rate of carb absorption
is 1.2 – 1.7 gm/min
• Glucose released from liver
at max 1 gm/min
• Glucose uptake by muscle
at max 1 g/min
• Glucose  ATP at ~ 1 g/min
CARBOHYDRATE DIVERSITY
• Consumption of carbs with 2-3 diff saccharides (ie glucose, fructose, and
sucrose) may increase carb absorption bc diff transport mechanisms from
small intestine to bloodstream are used
• Less competition for transporters
• Enhanced athletic performance
• Decrease GI upset during exercise
CARBOHYDRATE
LOADING
Eating pattern that consists of increasing the amount of carbohydrates
consumed in the days leading up to an athletic endurance event to
maximize muscle and liver glycogen stores. Typically, activity levels are
decreased during this time as well
• Increased muscle and liver glycogen storage
• Improvement in athletic performance
• 7-day, 6-day, and 1-day protocols in two stages:
1. Glycogen depletion stage: moderate-to-high intensity exercise to deplete
glycogen stores, coupled with low-to-moderate carbohydrate intakes
(<55% of total kcal)
2. Glycogen loading stage: tapered exercise (low-intensity, short-duration),
coupled with high carbohydrate intakes (>70% of total kcal)
• Two methods: classical and modified

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Nutrition in sports physical therapy.pptx

  • 1.
  • 2.
  • 3. CARBOHYDRATES (CHO) – 4 CAL/GRAM  Simple Carbohydrates  Monosaccharides  Disaccharides  Complex Carbohydrates  Oligosaccharides  Polysaccharides
  • 4. SIMPLE CARBOHYDRATES Monosaccharides • Glucose • Predominate form in nature; basic building block of other carbs • Fructose • Sweetest; found in fruit • Galactose • Often bound with glucose to form lactose (in milk) • Bound by glycosidic bonds to form more complex molecules • Body uses glucose; so convert fructose and galactose
  • 5. DISACCHA RIDES Lactose • Glucose + Galactose • Dairy (milk, yogurt, ice cream) Sucrose • Glucose + Fructose • Table sugar Maltose • Glucose + Glucose • Malt sugar Honey is a natural form of sucrose that is made from plant nectar and harvested by honeybees, which secrete an enzyme that hydrolyzes sucrose to form glucose and fructose.
  • 6. Oligosaccharides • Chain of 3 – 10 simple sugars • Fructooligosaccharides • Found in fruits/veggies • Commercially produced as low-cal sweetener • Mostly indigestible • Help relieve constipation, improve TG levels, decrease foul-smelling stool Oligosaccharides and Polysaccharides Polysaccharides • Hundreds of monosaccharides bound together • Starch • Produced by grains and veggies • Amylose • Small linear molecule of tightly packed glucose molecules • Mostly resistant to digestion • Amylopectin • Larger, highly branched chain of glucose molecules that is easily digested • Cellulose • Low viscosity starch made of long chains of glucose; structural component of the cell wall in plants that is indigestible to humans • Fiber • Largely indigestible 2/2 lack of enzymes to disrupt glycosidic bonds • Some fiber Is fermented in large intestine for energy to flora • 1.5 – 2.5 cal/gm • Glycogen • Polysaccharide that is a highly branched chain of glucose molecules • Chief carb storage material in animals formed and stored in liver and muscle COMPLEX CARBOHYDRATES
  • 8.
  • 9. CARBOHYDRATE METABOLISM  Glucose C02 a+ H20 + ATP  Liver: 90 gm glycogen  Muscle: 150+ gm glycogen  Excess carbs adipose tissue
  • 10. HORMONE REGULATION Insulin  Postprandial rise in BG  Aids in cellular glucose uptake  Promotes conversion of carbs into fat for LT storage  When sugar is abundant and glycogen stores maximized Glucagon  Low BG levels  Increase BG levels  As glycogen levels decrease, glucagon metabolizes fat from storage for fuel to help conserve glycogen and maintain BG levels
  • 11. GENERAL CARBOHYDRATE RECOMMENDATIONS  Acceptable Macronutrient Distribution Ranges (AMDR)  Range assoc. with reduced risk for chronic dz while still providing adequate intake of nutrients (ie vit/min)  For carbs: 45% to 65% of total cal intake  Recommended Dietary Allowances (RDA)  Amount of nutrient known to be adequate to meet the nutritional needs of nearly all healthy persons  For carbs: 130 gm/day  Min based on brain needs (so need more for body reqs)  Academy of Nutrition and Dietetics/ACSM  Carb needs for athletes: 6-10 g/kg (2.7 to 4.5 g/lb) of body wt daily  Depends of total daily energy expenditure, types of exercises performed, gender, environmental conditions to maintain BG levels during exercise and to replace muscle glycogen
  • 12.
  • 13. GLYCEMIC INDEX • Ranks carbs based on their BG response; based on reference amt (50 gm) • High GI • Enter bloodstream rapidly  large BG spike  insulin spike  muscle glucose uptake and fat deposition in adipose tissue • From 2 – 4 hrs postprandial, residual effects of insulin spike can lead to hypoglycemia • Low GI • Digested slowly  small BG increase  small insulin boost
  • 14. GLYCEMIC LOAD  Accounts for portion size  Glycemic Load (GL) = GI x grams of carbs ÷ 100  A food can have high GI but a low GL  i.e. carrots have high GI, but 50 gm carrots = 4 cups, but since serving size is ½ cup, then GL is low  Carb foods that are also mod to high in fat or protein, fiber, and other nutrients and that are min processed may have a high GI and low GL  Benefits of Low GI foods  Weight control  Decreased risk of diabetes and CVD  Usu more nutrient dense  i.e. 16 oz soda has same amt of carbs as 2 med-size apples
  • 15. Functional Fiber Dietary Fiber • Nondigestible carbs isolated from food or added to food products, with potentially beneficial health effects • Improved GI sxs, wt loss, dec cholesterol, colon ca prevention • Food labels: • Isolated nondigestible plant carbs • Resistant starch, pectin, gum • Animal carbs • Chitin, chitosan • Commercially produced carbs • Resistant starch, polydextrose, inulin, indigestible dextrin • Nondigestible carbs and lignins that are obtained naturally from plant foods • High viscosity (soluble) fiber • A type of fiber that forms gel in water; may help prevent CVD and stroke by binding bile and cholesterol, diabetes by slowing glucose absorption, and constipation by holding moisture in stools; includes gums, pectin, psyllium seeds • Low viscosity (insoluble) fiber: • Fiber that does not bind with water and adds bulk to the diet (includes cellulose, hemicellulose, and lignins found in wheat bran, veggies, and whole grain breads and cereals); important for proper bowel bowel function and reducing sxs of constipation FIBER = FUNCTIONAL FIBER + DIETARY FIBER
  • 16. Large biological molecules, or macromolecules, consisting of one or more long chains of amino acid residues. Proteins perform a vast array of functions within living organisms, including catalyzing metabolic reactions, replicating DNA, responding to stimuli, and transporting molecules from one location to another. Proteins differ from one another primarily in their sequence of amino acids, which is dictated by the nucleotide sequence of their genes, and which usually results in folding of the protein into a specific three- dimensional structure that determines its activity. PROTEIN
  • 17. Complete protein • • A food item that contains all essential AAs • Generally animal products Also plant-based soy, quinoa, chia seeds, buckwheat, hemp, flax seeds Incomplete protein • A food item that does not contain all essential AAs • Generally plant PROTEIN QUALITY
  • 19. PROTEIN DIGESTION AND ABSORPTION Denaturation- the process of unfolding a protein by destroying its quaternary, tertiary, and secondary nature
  • 20. AS WITHIN, SO WITHOUT
  • 22.
  • 23. 1) Stomach- HCL acidifies stomach, triggering activation of pepsin 2) Pancreas- secretes proteolytic enzymes into small intestines 3) Small intestines- trypsin further breaks proteins down into di- and tripepides  cleaved into single AAs  blood  liver 4) Liver- regulates distribution of AAs throughout body
  • 25. PROTEIN RECOMMENDATIONS RDA = 0.8 g/kg/day Academy of Nutrition and Dietetics, Dietitians of Canada, ACSM • Endurance athletes = 1.2 – 1.4 g/kg (0.5 to 0.6 g/lb) daily • Strength-training = 1.6 – 1.7 g/kg (0.7 to 0.8 g/lb) daily IOM = “no compelling scientific evidence to support active individuals increasing their daily protein intake above the RDA of 0.8 g/kg) AMDR = 10 – 35% daily caloric intake
  • 26. PROTEIN AND ATHLETICISM Carb:Protein = 3:1 • Encourages + nitrogen balance à muscle synthesis, hydration, energy 6 – 20 gm protein and 30 – 40 gm carbs post- workout (w/in 3 hrs) • As little as 5 – 10 gm protein immediately post-exercise can promote optimal muscle repair BCAAs • Combats fatigue when consumed during workout • Leucine 45 mg/kg/day; Isoleucine 22.5 mg/kg/day; Valine 22.5 mg/kg/day (2:1:1) Vegetarians • Should consume 10% more grams of protein daily than recs • Plant proteins not as readily digestible • Need complimentary protein-rich plant foods
  • 27. FAT FARM • 1 gm fat = 9 calories • Lipids • Fat or fat-like substance used in body or bloodstream; includes fats, oils, waxes, sterols, TGs, all of which are insoluble in water
  • 28. CHOLESTEROL AND STEROIDS • Cholesterol- fat-like, waxy substance produced in liver and found in cell membrane of all animal tissues  cell structure and integrity • Adrenals  glucocorticoid (cortisol) and mineralocorticoids (aldosterone) • Testes, ovaries  androgens and estrogens • Liver  bile acids • Skin  cholesterol becomes cholecalciferol with sun exposure, then converted to calcitriol (active Vit D) Susceptible to oxidation, distributing cholesterol to inner lining of arteries, leading to atherosclerosis
  • 29. FATTY ACIDS AND TRIGLYCERIDES • Adipose tissue is an endocrine organ!!! • Leptin- a hormone produced by adipose tissue that suppresses the appetite and increases energy expenditure; levels increase with increased fat storage • Resistin- hormone secreted by adipose tissue that decreases cell sensitivity to insulin • TNF-alpha- helps regulate fat metabolism and contributes to acute inflammatory rxns
  • 30. FAT DIGESTION AND ABSORPTION 1. Lingual lipase- enzyme released from mouth that begins breakdown of short- and medium-chain FAs 2. Gastric lipase – further digestion of fat 3. CCK – triggered by fat in small intestine; stimulates release of GIP (gastric inhibitory peptide)  decreases gut movement and slows digestion
  • 31. • Adipose Tissue Growth: • Hyperplasia- abnl increase in # of cells • Hypertrophy- abnl increase in size of current cells • Two Types of Fat Cells: • store fat and provide thermal insulation • Brown Fat- help to generate body heat; present in newborns; iron- containing mitochondria FAT METABOLISM AND STORAGE
  • 32. GENERAL FAT RECOMMENDATIONS DRIs set AMDR of fat as 20% to 35% of total calories from fat AI of linolenic acid (omega-3) is 1.6 and 1.1 gm/day for men and women AI of linoleic acid (omega-6) is 17 and 12 gm/day for men and women 2010 Dietary Guidelines for Americans: • Fewer than 10% of calories from saturated fat • Less than 300 mg/day cholesterol • Consume more mono/polyunsaturated fats • Consume less saturated and trans fats • Avoid solid fats and added sugars
  • 33. FAT AND HEALTH Replace saturated fat with polyunsaturated fat whenever possible, or otherwise with monounsaturated fat. Polyunsaturated fats lower LDL cholesterol and improve HDL:total cholesterol ratio, often by increasing the HDL component. Monounsaturated fats have a more neutral effect. Choose healthful fats over “low fat” foods that contain refined carbs, as these foods decrease HDL cholesterol, increase TGs, and overall worsen the atherogenic dyslipidemia assoc w/ obesity and insulin resistance. Consume omega-3 FAs in the diet at least 2x/week Avoid trans fats, as they decrease HDL cholesterol and increase total cholesterol. Total fat intake and ratio of omega 3:6 FAs are not predictors of heart health. Exercise regularly to decrease LDL levels and prevent redux in HDL assoc w/ a diet higher than recommended in total fat and saturated FAs.
  • 34. FAT- WHAT TO TELL CLIENTS Use liquid vegetable oils whenever possible When solid fats are necessary, keep trans fats to a min. Balance calories by limiting refined carbs and not through avoidance of the healthy polyunsaturated and monounsaturated fats. Limit saturated fats to less than 10% of total fat intake. Dietary fats are never purely one type, but a combo. Promote fruits, veggies, and whole-grain as ideal sources of carbs rather than refined or processed carbs Dietary patterns are more important than single dietary components. A healthful eating plan includes fruits, veggies, unprocessed whole grains, fish, lean meat, low0fat dairy, and vegetable oils. Calorie balance should emphasize quality of food selection.
  • 35.
  • 36. VITAMINS Organic substances obtained from plant and animal foods that are essential in small quantities for normal growth and activity of the body. Exceptions for the food source rule: • Vitamin K and biotin produced by normal intestinal flora • Vitamin D self-produced via sun exposure • Niacin synthesized from tryptophan • Vitamin A synthesized from beta-carotene The reference values Recommended Dietary Allowances (RDAs)- the daily dietary intake of a nutrient known to meet the nutritional needs of 97% of healthy persons in age- and gender-specific groups. The Food and Nutrition Board, an entity of the Institute of Medicine, establishes RDAs. Estimated average requirement (EAR)- an amount of nutrient known to be adequate to meet nutritional needs in 50% of an age- and gender-specific group. Tolerable upper intake level (UL)- the maximum intake that is unlikely to pose risk of adverse health effects to almost all individuals in an age- and gender-specific group.
  • 37.
  • 38.
  • 39. THIAMIN- VITAMIN B1 • Essential for carb metabolism and plays role in nerve fxn
  • 41. NIACIN- VITAMIN B3 • Cofactor for over 200 enzymes involved in carb, AA, and FAmetabolism • Lean meats, poultry, fish, peanuts, and yeast • Muscular weakness, anorexia, indigestion, and skin abnormalities are early sxs of niacin def.  can lead to pellagra (see below)
  • 42. PYRIDOXINE- VITAMIN B6 Plays improtant role in protein metabolism, RBC production, glycogenolysis, conversion of tryptophan to niacin, neurotransmitter formation, and immune system fxn. Deficiency leads to decrease dneurological and dermatological fxn weakend immunity
  • 43. FOLATE • DNA production • Red and white blood cell formation • Neurotransmitter formation • AA metabolism • Deficiency leads to megaloblastic anemia, skin lesions, poor growth • Excess folate can mask Vitamin B12 deficiency
  • 44. COBALAMIN- VITAMIN B12 Rich sources: clams, oysters, milk, eggs, cheese, muscle meats, fish, liver, kidney Deficiency- megaloblastic anemia and neuro dysfxn- demyelination  parasthesias, burning feet, stiffness and generalized LE weakness
  • 45. BIOTIN- VITAMIN B7 • The ultimate “helper vitamin” • Typically bound to protein, carries and carboxyl group (-COOH) • Plays important role in fxns of pantothenic acid, folic acid, vit B12 • Deficiency uncommon
  • 46. PANTOTHENIC ACID- VITAMIN B5 Present in all plant and animal tissues Forms integral component of coenzyme A and acyl-carrier protein essential for metabolism of fatty acids, amino acids, and carbs, and as well as for normal protein fxn essential for synthesis of acetylcholine Involved in the production of steroid hormones, Vit D, Vit A, and cholesterol
  • 47. VITAMIN C • Plays a role as an antioxidant • Necessary to make collagen • Deficiency leads to scurvy • Causes dark purplish skin lesions and spongy/bleeding gums • Improves iron absorption, promotes resistance to infection, and helps with steroid, neurotransmitter, and hormone production • Sxs of deficiency: impaired wound healing, swelling, bleeding, and weakness in bones, cartilage, teeth, and connective tissues
  • 48. VITAMIN A • Vision, growth, development • Development and maintenance of epithelial tissue (including bones/teeth) • Immune fxn • Reproduction
  • 49. VITAMIN D Vitamin D3 (cholecalciferol) from sun, animals, supps Vitamin D2 (ergocalciferol) from plants and supps CALCITRIO L Responsible for vitamin D’s biological effects
  • 50.
  • 51. VITAMIN E  Protects against conditions related to oxidative stress: aging, air pollution, arthritis, cancer, CVD, cataracts, diabetes, infection
  • 55. MACROMINERALS Major Elements • Body requires 100+ mg daily • Calcium • Phosphorous • Magnesium • Sulfur • Sodium • Chloride • Potassium
  • 56. MICROMINERALS Trace Elements • Body requires <20 mg daily • Iron • Iodine • Selenium • Zinc • Copper • Chromium • Other minerals w/o established DRI
  • 57. CALCIUM Calcium is the most abundant mineral in the body and serves various functions, including mineralization of the bones and teeth, muscle contraction, blood clotting, blood-pressure control, immunity, and possibly colon-cancer prevention.
  • 58. CALCIUM SUPPLEMENTATIO N • No more than 500 mg of calcium should be taken at a time because this is the maximum amount the body can absorb at once. Calcium carbonate should be taken with food to help with absorption; calcium citrate can be taken with or without food • High calcium intake can interfere with absorption of iron, zinc, manganese and can lead to constipation and nephrolithiasis
  • 59. PHOSPHORUS Along with calcium, phosphorus plays a key role in mineralization of bones and teeth. Phosphorus helps filter out waste in the kidneys and contributes to energy production in the body by participating in the breakdown of carbs, proteins, and fats. Phosphorus is needed for the growth, maintenance, and repair of all tissues and cells, and for the production of DNA and RNA. Phosphorus is also needed to balance and metabolize other vitamins and minerals including vitamin D, calcium, iodine, magnesium, and zinc. Too much phosphorus intake interferes with calcium absorption and may lead to decreased bone mass and density.
  • 60. MAGNESIUM • Important for bone mineralization, protein production, muscle contraction, nerve conduction, enzyme function, healthy teeth • Food sources: nuts, legumes, whole grains, dark leafy green veggies, milk • High intakes of calcium, protein, vitamin D, and EtOH increase body’s magnesium requirements • Depletion can occur as a result of aging, IDDM, hypermagnesuric diuretics • Can contribute to many chronic illnesses and is assoc w/ heart arrythmias and MI • Magnesium toxicity (very rare) may prevent bone calcification
  • 61. SULFU R • Important component of many important body compounds • Cysteine and methionine • Thiamin, biotin, panothenic acid • Heparin • Food sources: meat, poultry, fish, eggs, dried beans, broccoli, cauliflower
  • 62. IR O N • Regulates cell growth and differentiation • Production of hemoglobin and myoglobin • Fe stored in the body as ferritin for future use • Liver, spleen, bone marrow • Fe released from breakdown of RBCs transferred to working cells via transferrin
  • 63. IRON HOMEOSTASIS • Heme iron: from animal sources; 10 - 35% bioavailability • Nonheme elemental iron: from plant sources; 2 - 10% bioavailability • Increase Fe absorption via vitamin C • Decrease Fe absorption via coffee/tea; excess Zn, Mg, Ca; high phytic acid (fiber)
  • 64. SPORTS ANEMIA (PSEUDOANEMIA) • Athletes experience small amounts of exercise-induced blood loss • Urine, GI bleeding, high sweat rates, mechanical trauma • Leads to increased RBC destruction and loss of Fe • Hg low; Fe normal • 2/2 increased plasma volume in response to physical training • Total Hg unchanged • Hg concentration decreased • Total Hg divided by total volume
  • 65. IODINE • Stored in thyroid gland • Essential for normal growth • Food sources: seafood and iodized salt
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  • 67. SELENIUM • Antioxidant • Deficiency: heart dz, hypothyroidism, weakened immune system • Excess: (selonosis) GI distress, alopecia, white blotchy nails, garlic breath, fatigue, irritability, nerve damage
  • 68. ZINC • Found in almost every cell; 2nd most abundant trace element after iron • Stimulates activity of enzymes, supports a healthy immune system, assists in wound healing, strengthens the senses (esp taste and smell), supports normal growth and development, and helps with DNA synthesis • Food sources: meat, fish, poultry, dairy, seafood • Deficiency: delayed wound healing, immune dysfunction • Toxicity: decreased HDL, impaired copper absorption, altered Fe function
  • 69. CHROMIUM • Trace mineral that helps to increase the effectiveness of insulin and aids in glucose metabolism • Food sources: corn oil, clams, whole-grain cereals, brewer’s yeast • Deficiency and toxicity are very rare
  • 70. COPPER  Helps make RBCs  Keeps nerve cells and immune system healthy  Helps in formation of collagen and cellular energy production  Acts as an antioxidant by eliminating free radicals  Helps in the absorption of Fe  Food sources: oysters, liver, organ meats, dried legumes  Deficiency rare: anemia, low body temp, bone fractures, osteoporosis
  • 71. ELECTROLYTES Four Essential Roles 1. Water balance and distribution 2. Osmotic equilibrium 3. Acid-base balance 4. Intracellular/extracellular differentials Sodium Potassium Chloride
  • 73. ATHLETES RISK LOSING… • B vitamins • Vitamin C • Vitamin E • Beta-carotene • Calcium • Vitamin D • Selenium • Iron • Zinc • Magnesium
  • 74. VITAMINS AND EXERCISE • Supporting energy production • Thiamin • Riboflavin • Niacin • Pyridoxine (B6) • Pantothenic acid • Biotin • Supporting formation of RBCs • Folate • Cobalamin (B12) Two essential roles:
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  • 77. DIETARY GUIDELINES • Published q5yrs by USDA and Department of Health and Human Services • Includes 23 recs for gen pop and 6 addl recs for special groups • 4 categories 1. Balance calories to achieve and maintain a healthy weight 2. Foods and food components to reduce 3. Foods and nutrients to increase 4. Building healthy eating patterns.
  • 78. DASH (DIETARY APPROACHES TO STOP HYPERTENSION)
  • 80. MYPLATE 1. Balance calorie intake with calories expended through physical activity. 2. Enjoy food, but make sure proportions are appropriate; eat slowly; minimize distractions (i.e. television; smartphones) 3. Avoid oversized portions; utilize smaller plates, smaller serving sizes, mindful eating 4. Eat more vegetables, whole grains, fat-free or low-fat dairy products (or dairy-free alternatives) for adequate potassium, calcium, vitamin D, and fiber 5. Make half of your plate fruits and veggies; most Americans need 9 servings of fruits and veggies daily (2013 average adult in U.S. eats fruit 1.1x/day and veggies 1.6x/day) 6. Switch to fat-free or low-fat (1%) milk or dairy alternative like almond/coconut milk 7. Make at least half of grains whole grains; ensures adequate fiber intake and decreased intake of processed foods 8. Eat fewer foods high in solid (saturated/trans) fats, added sugars, and salt 9. Compare sodium in foods and choose lower sodium version 10. Drink water instead of sugary drinks to cut sugar and unnecessary calories
  • 81. DIETARY REFERENCE INTAKES  RDA is the sufficient average intake for most healthy individuals. RDA values may vary based on age and gender.  Estimated average requirement (EAR) is an adequate intake (AI) in 50% of an age- and gender-specific group  Tolerable upper intake level (UL), the maximum intake of a nutrient that is unlikely to pose risk of adverse health effects to almost all individuals in an age- and gender-specific group.  AI is used when a RDA cannot be determined. AI is a recommended nutrient intake level that is based on research and is sufficient for healthy individuals
  • 82. FOOD LABELS Clients should minimize intake of the first three nutrients: • Fat (esp sat and trans): clients on a 2,000 cal/day diet should aim for a total per day of < 65 g total fat or < 20g saturated fat • Cholesterol: goal of < 300 mg • Sodium: goal of <2,300 mg
  • 83. REDUCE EXPOSURE TO FOODBORNE ILLNESS • Check produce for bruises and punctures, either may allow for contamination. • Look for sell-by date for breads and baked goods, a use-by date on packaged foods, an expiration date on yeast and baking powder, and a pack date on canned and some packaged foods. • Make sure packaged goods are not torn, and cans are not dented, cracked or bulging to prevent contamination or botulism. • Separate fish and poultry from other purchases by wrapping them separately in plastic bags. Once home, prevent leakage and cross-contamination. • When shopping, choose refrigerated and frozen foods last. Try to make sure all perishable foods are refrigerated within one hour of purchase.
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  • 85. FOOD SAFETY • Wash hands often with warm water and soap for at least 20 seconds • Clean hands, food contact surfaces, and fruits and veggies; to prevent cross- contamination, meat and poultry should not be washed or rinsed. • Separate raw, cooked, and ready-to-eat foods while shopping, preparing, and storing foods • Cook foods to safe temp to kill microorganisms; pregnant women and ppl over age 65 should eat deli meats only if reheated to steaming hot to reduce risk of infxn • Refrigerate perishable food within 1-2 hrs and defrost foods properly; eat refrigerated leftovers within 3-4 days; “When in doubt, throw it out” • Avoid raw (unpasteurized) milk (products), raw or partially cooked eggs, raw/undercooked meat/poultry, raw fish, unpasteurized juice, and raw sprouts • Esp infants, young children, pregnant women, older adults, immunocompromised individuals
  • 86. JAMA NUTRITION POLICY • Taxation: imposing higher taxes on calorie-dense and nutrient-poor foods might lower consumption of unhealthy foods and generate revenue to subsidize healthful foods.  Food prohibitions: removing harmful ingredients from the food supply eliminates their health risks  Regulation of food marketing to children and adolescents: restricting food advertising during children’s programs, counter-advertising to promote good nutrition and physical activity, limiting use of cartoon characters, and other regulations may help protect children who are otherwise unable to critically evaluate advertisements Policy strategies to help increase nutrition and PA habits on a population level, to hopefully reduce obesity rates and improve health • • • • • •
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  • 91. ATP AND MUSCLE CONTRACTION
  • 93. OXYGEN AND NUTRIENT DELIVERY • Oxygen-carrying capacity: the body’s ability to obtain oxygen from the air inhaled into the lungs and transported to the bloodstream; affected by 2 main factors: 1. The ability to adequately ventilate the alveoli in the lungs 2. Hemoglobin concentration in the blood • Oxygen delivery: the ability of the body to transport oxygen from the lungs to the mitochondria of the working cells; the amount delivered is a function of cardiac output
  • 94. VO2 MAX a measure of maximal oxygen uptake; liters of O2 consumed per kilogram of bodyweight per minute; generally considered the best indicator of a person’s cardiovascular fitness and aerobic endurance (the more O2 used during intense performance, the more ATP is produced)
  • 95. AEROBIC GLYCOLYSIS- TCA 2 ATP 8 NADH 2 FADH 6 CO2
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  • 105. GLUCOSE- FOOD TO FUEL • 1-4 hrs for carbs to be digested, absorbed, and stored as glycogen in liver or muscle • Carbs can be ingested at 3 gm/min before causing GI upset • Portal circulation is rate- limiting step in carb food to fuel time • Max rate of carb absorption is 1.2 – 1.7 gm/min • Glucose released from liver at max 1 gm/min • Glucose uptake by muscle at max 1 g/min • Glucose  ATP at ~ 1 g/min
  • 106. CARBOHYDRATE DIVERSITY • Consumption of carbs with 2-3 diff saccharides (ie glucose, fructose, and sucrose) may increase carb absorption bc diff transport mechanisms from small intestine to bloodstream are used • Less competition for transporters • Enhanced athletic performance • Decrease GI upset during exercise
  • 107. CARBOHYDRATE LOADING Eating pattern that consists of increasing the amount of carbohydrates consumed in the days leading up to an athletic endurance event to maximize muscle and liver glycogen stores. Typically, activity levels are decreased during this time as well • Increased muscle and liver glycogen storage • Improvement in athletic performance • 7-day, 6-day, and 1-day protocols in two stages: 1. Glycogen depletion stage: moderate-to-high intensity exercise to deplete glycogen stores, coupled with low-to-moderate carbohydrate intakes (<55% of total kcal) 2. Glycogen loading stage: tapered exercise (low-intensity, short-duration), coupled with high carbohydrate intakes (>70% of total kcal) • Two methods: classical and modified