EDGU Quiz 1 Lectures Week 1-5

trans fats

partial hydrogenation of polyunsaturated fats in food processing - elongates molecules

The "ferrous" wheel: -

pathway of iron usage in the body check study guide graph lecture 2

Classification of Vitamins:

Two types Fat soluble (A, D, E, K) Water soluble (B group (8), vitamin C) Too much Vitamin A - teratogenic (causes early birth, miscarriage)

monounsaturated fats

plant based foods

polyunsaturated fats

plant based foods Two or more double bonds (e.g. linoleic acid - n-6 due to position of double bond) High intake of polyunsaturated → lower risk of CHD, lower total LDL cholesterol, increased HDL)

macronutrients include?

protein carbohydrate fat fibre water -make up bulk of diet -diff macros give body diff amounts of glucose

The five major food groups of 'The Australian Guide to Healthy Eating' are grouped together because:

provide similar amounts of key nutrients

Diagnosis of diabetes and pre-diabetes:

refer to lecture 4 graph of fasting glucose levels and after digestion glucose levels

long term benefits of good nutrition

Type 2 diabetes Heart diseases Cancers High blood pressure Dementia - fish is effective to prevent (Twice a week) Osteoporosis - insufficient calcium Crohn's disease - inflammation of gut Ulcerative colitis Varicose veins Haemorrhoids Diverticulosis Gout

Prevalence of diabetes:

Type 2 much more common than Type 1. Type 2 represents 85-90% of all cases. Mostly adults, however more children being diagnosed. Type 1 represents 10-15% (10% max) of all cases and is one of the most common chronic childhood diseases in developed nations. World-wide increase in prevalence Diabetes prevalence has increased approximately 7.2% per annum since the year 2000. By 2018, Diabetes NSW expects the number of people with diagnosable diabetes to total approximately 2.65 million. Type 1 diabetes prevalence is increasing at about 3% annually. Reasons for high surge of diabetes Aging population - comorbidities (diseases that occur at the same time) Reduced activity Increased consumption of energy-dense foods

Blood pressure conditions:

Type of fat White, waxy, insoluble substance Body synthesis it and derive it from diet It's needed for metabolic processes: Production of hormones Making bile Synthesising vitamin D The body mechanism of making it is very efficient and sufficient. It travels around the body in two forms: LDL (low density lipoproteins - bad) and HDL (high density lipoproteins - good)

Cholesterol:

Type of fat White, waxy, insoluble substance Body synthesis it and derive it from diet It's needed for metabolic processes: Production of hormones Making bile Synthesising vitamin D The body mechanism of making it is very efficient and sufficient. It travels around the body in two forms: LDL (low density lipoproteins - bad) and HDL (high density lipoproteins - good)

fats

richer in kj energy than protein or carbs cushion internal and reproductive organs carrier for fat soluble vitamins and phytochemical

Low Glycaemic Index foods cause the blood sugar levels to:

rise slowly

what does waist measurement predict

risk of stroke, cardiovascular disease, high blood pressure, type 2 diabetes observes type of fat (visceral around midsection)

Stomach -

rugae muscle Secretes Gastric juice HCL Pepsin (protein → amino acids) Mucous, water Mucous protects stomach lining Becomes chyme after bolus leaves stomach

pancreas

secrete digestive enzymes and hormones lipases proteases amylase sodium bicarbonate insulin glucagon

Pancreas:

secretes digestive enzymes and hormone production Located behind the stomach, level with top of the small intestine Secretes digestive enzymes and hormones Secretes the following secretions into the duodenum via a duct: Lipases (fats) Proteases Amylase Sodium bicarbonate Insulin Glucagon

What is one of the main harvested crops of Australia?

sheep lamb cattle

Risk of scurvy:

Unhealthy diet - people who regularly neglect their diet such as alcoholics, illicit drug users, elderly people. Extreme diets - extreme versions of the high-protein, low-carbohydrate diet - cutting out a whole food group Dependency - some elderly people or young children who are not given adequate care Allergy diets - very restrictive in an attempt to manage particular allergies Smoking - smokers require more to cope with the damage from free radicals in smoke - a supplement of 50-500mg is a good idea Fussy eating - refuse to eat any vegetables or fruit or juice

Appendix:

Unknown role in digestion Ancestory origins: required to break down tree bark and tough foods Currently used to fight infection Houses beneficial bacteria - can repopulate gut bacteria Appendicitis can occur when a blockage occurs at the spot where the appendix joins the large intestine

diverticulosis

small pouches form and food chewed/swallowed falls into the pouch, undergoes fermentation, pops, releasing pus → infection (diverticulitis) For people with diverticulosis - small foods (nuts and seeds) must be removed (may fall into the pouch) Ground up small foods into powder/small pieces Count number of times of chewing Diverticulosis leads to diverticular attacks

types of fibre

soluble insoluble

Dependence signs:

spending lots of time thinking about alcohol, buying it, drinking it and recovering from it. It becomes difficult to stop.

WHO definition of health:

state of wellbeing that is free of disease or infirmary Instead holistic health is a better definition of health

Gall bladder:

stores and concentrates bile Located on underside of the liver Muscular little sac Bile = green-yellow, acidic fluid that emulsifies fat Gall bladder stores bile and concentrates it by removing water Gallstones form when cholesterol crystallises into a stone-like material

Rectal cancer:

Usually affects people 50+yo. The rectum is the last 20 cm of the bowel. Men more at risk than women If treated in early stages is very curable.

eat more of

Vegetables Green, orange and red vegetable Leafy vegetables Legumes Fruit Whole grains Milk, yoghurt, cheese Lean meat Drink more water

Carbohydrate (CHO) foods:

Vegetables, legumes, intact fruits (not juice) and wholegrain cereals are preferred sources Rich in dietary fibre Favourable effect on glycaemic control (<55 is low, medium GI, >70) Reduce risk of cardiovascular disease Low glycaemic index preferred Smaller fluctuations in blood glucose levels Added sugars in modest amounts OK (50 g/day)

Obsolete names for vitamins:

Vitamin B5 → panthothenic acid Vitmain F - obsolete name for fatty acids Vitamin H → biotin Vitamin PP or PP Factor → former name for the B vitamin niacin. It was called this due to the vitamin's ability to act as a "pellagra preventative"

Key nutrients in vegetables:

Vitamin C - antioxidant, prevents free radical damage, important for cells Beta-carotene and carotenoids- help with eyesight. found in orange and red vegetables (but can overdose) Folate (B vitamin) - important for developing babies to prevent neural tube defects Fibre - good for gut, lower cholesterol levels, helps maintain regularity, keeps bowel active Potassium and magnesium → muscle contraction

VITAMIN D:

Vitamin D is both a vitamin AND a hormone It was first discovered in the 1920's as a result of the search for a cure for rickets, a disease causing softening of the bones in children. INACTIVE Vitamin D is stored under the skin, it is activated by sunlight and processed by the liver/kidney to the active form

Sunlight in relation to vitamin D:

Vitamin D is made by the body from sunlight (UV rays) in a reaction that takes place in the skin. During summer, being outdoors before 11 am and after 4pm should allow enough sunlight to be absorbed to meet your vitamin D needs. We still need to practice good sun protection (sunscreen, hats and coverage) during the summer months. In winter, longer periods are required, with those people living further SOUTH needing more exposure because of the lower UV levels. 15-20 min with forearm and face exposed

Australian exports:

Vity culture - exporting wine culture (China, Japan, Korea, Taiwan, Thailand) Exports to neighbouring countries (e.g. Taiwan, japan, china) to preserve freshness Health and functional foods to Japan

waist to hip ratio

WHR: waist circumference/ hip circumference least risk: WHR <0.9 for men WHR < 0.8 for women visceral fat/ subcutaneous fat

VITAMINS:

What are they? Only required in very small amounts Required for health, growth and reproduction Discovered when certain foods cured diseases

observed level of intake graph

X axis → intake of vitamin EAR: Estimated average requirement - nutrient intake value estimated to reach the requirements of half of the healthy individuals in a group to prevent being inadequate RDI/RDI: recommended daily intake - Average daily level of intake sufficient to meet nutrient requirements of almost all healthy individuals (97-98%) AI: adequate intake - aim to be in this range, desirable to be in the middle of the bell curve For fluids - can't give a gram amount so AI is used UL: upper limit - risk of exces refer to lecture 3 graph

vitamin D3

a vitamin and a hormone need exposure to sunlight for it to be made lack of it causes weakening in bones if deficient then you won't absorb calcium body absorption through skin> liver (1st hydroxylation)> kidney (2nd hydroxylation)> 1.25 (OH) 2 Vit D3> metabolically active form

vitamin B1

thiamin need for metabolism of carbs and fat release of edgy from food normal appetite and digestion proper function of heart and nervous system peripheral nerve myelination brain function -if not enough all those are slowed as myelin sheath is thinner limited body stores of B1

standard vegetable serving size

about 75g 1 medium tomato 1/2 medium potato, sweet potato, taro, cassava 1/2 cup cooked green or orange veggie (carrot, spinach, broccoli) 1 cup leafy green or raw salad veggie 1/2 cup sweet corn

small intestine

absorbs nutrients (in duodenum)

When pregnant, women should consume _______ carbohydrate foods

additional

Protein is mainly found in:

all living cells fruits and vegetables meats and dairy products

saturated fat

animal based foods (milk, cream, cheese, meat, palm oil, baked goods) No double bonds *saturated - heart disease, atherosclerosis, cardiovascular disease

Saturated fats are mainly found in:

animal-based foods

sources of fat

animal: meat, bacon, sausages, oily fish, fish liver, cod liver oil, milk, butter, cream, cheese plant: nuts, seeds, legumes, palm oil coconut, avocado, olives

Bad fats:

trans fats, saturated fats → link with chronic disease Fat on the meat is the easiest to change (removing fat before cooking is essential)

key principle of good nutrition

variety!

5 food groups

vegetables and legumes fruits milk, yoghurt and cheese lean meat breads, cereals, rice

key nutrients in veggie serving?

vitamin C: decreases free radical damage, antioxidants vitamin A: orange veggies folate fibre: keeps you regular potassium and magnesium: contraction of muscles

Which of the following vitamins helps to stop the bleeding when you cut yourself?

vitamin K

Average intake of sodium

was 2404 mg per day. (1 teaspoon) Included processed foods and naturally occurring and discretionary. 64% of Australian reported adding salt to food Probably underreported This is way higher than recommended

inflammatory bowel disease

body consumes a food that the body considers an allergen, ensuing inflammatory response Crohn's disease Ulcerative colitis Both involve inflammation of the lower digestive tract It can cause pain, diarrhoea, weight loss and fevers

amylase

breaks down carbs

lipases

breaks down fats

proteases

breaks down protein

Fatty liver:

"Steatosis" - It can damage the organ and lead to complications such as cirrhosis. Diet related risk factors, lifestyle and diet changes can halt or even reverse damage. Liver's function: remove toxins and process food nutrients. After nutrients are absorbed from the intestine they pass through the liver and then get sent to areas where they are needed. Common complaint in Western countries. 1/10 people Alcohol abuse can lead to it. NAFLD - non alcoholic fatty liver disease (cases when people who do not consume alcohol still develop fatty liver disease)

RDI for calcium

(1000 mg for men/women 19-64 years)

Large intestine

(other names: colon, large bowel or large intestine) Converts food waste product into faeces Water is reabsorbed and we eliminate undigested food + other body wastes and fibre 1.5 meters Site of diverticulitis

Risk factors for hypercholesterolaemia:

*Hypercholesterolaemia (high cholesterol levels in the blood) Familial hypercholesterolemia → if it is in the family Age Fender Family history Overweight Sedentary → high calories and not enough to burn it off Stress Diet

plant fat high in saturated fat

*coconut/palm oil - high in unsaturated fat

Diabetes mellitus

*use full term in the dietary report Group of conditions characterised by raised blood glucose levels resulting from a problem with insulin Insulin (hormone) that causes liver and muscle cells to take in glucose and store it as glycogen 2 major types - Type 1, Type 2 Type 2

Effect of calcium deficiency:

- osteoporosis Bone loss Bone Ca mobilised to maintain muscle function Reduced bone mass/density Causes mineralisation of bone - eating the bone from inside out → fragile/brittle New bone formation is hindered Reduced growth rate Affects growing children Tetany Muscle neurological disorder (weird muscle contractions - burning sensation)

two types of protein are:

-meat -plant and vegetable -high quality protein vs low quality protein

types of fat

-monosaturated -polysaturated -saturated

Liver cancer:

1 (common amongst population > 65 and male) and 2 Liver function recap: Destroys harmful substance such as alcohol Gets rid of waste products Converts foods containing fats and sugars into energy Produces bile to help digest food Primary liver cancer is more common in people 65+yo and in men. Interestingly, most people with primary liver cancer also have cirrhosis. However only a small proportion of people who have cirrhosis of the liver develop primary liver cancer. Secondary liver cancer is more common. Most of the causes of liver cancer are not related to food or beverages however two do apply; Long term alcohol abuse Diabetes, poorly controlled especially. 2-3x higher risk.

Examples of a standard serving of fruit include;

1 cup diced, cooked or canned fruit (no added sugar) one medium piece (banana apple, etc) two small pieces (apricots, plums, kiwi fruit)

Standard Serve Grain foods

1 slice (40g) bread ½ medium (40g) roll or flat bread ½ cup (75-120g) cooked rice, pasta, noodles, barley, buckwheat, polenta, bulgur or quinoa ½ cup (120g) cooked porridge 2/3 cup (30g) wheat flakes ¼ cup (30g) muesli 3-4 crispbreads 1 crumpet

Nutrition/Health campaigns:

1. Measure up campaign (2008-2013) - aimed at visceral fat (waist circumference) Visceral fat - Coronary heart disease, heart attack, stroke Subcutaneous fat - not as harmful for health Did not work as people did not have equipment to measure waistline 2. Swap it, don't stop it Unrelatable make better nutrition choices instead of stopping a disorder later 3. Go for 2 (fruit) and 5 (veggies) Memorable, worked well 4. Make healthy normal - 2015 Newest health campaign from NSW Government http://www.makehealthynormal.nsw.gov.au/ By NSW Health In response to "obesity crisis" Did not work Used fear to inforce change (like cigarette packages) → not inclusive of all types

Australian food intake recommendations

10-15% protein 45-60g F 65-80g M 30% fat 70g daily less than 10% saturated fat under 25g daily 40-60% carbohydrates Fibre intake 25g F 30g M

Food affects health:

14 million Australians are overweight or obese. More than 5 million Australians are obese (BMI ≥ 30 kg/m2). Obesity has overtaken smoking as the leading cause of premature death and illness. ATSI/Indigenous Australians are 1.9 times as likely as non-indigenous Australians to be obese.' Access to food, health care systems, genetic makeup It's not about the weight on the scales, the BMI isn't a golden standard for health. More about cardiovascular and cardiopulmonary fitness rather than weight/BMI Deposits of fat, placement on the body are more important than 'being fat'.

Adaptation of the Australian palate

1950's post war immigration - multiculturalism and diversity in the population and palate Pre 1950s was British style National dish pre 1950's: kangaroo tail soup Innovation and creation of contemporary, modern Australian cuisine

evolution of 5 food groups in australia

1960 Fruit and vegetables Grains Meat Dairy Fats and oils today Vegetables and legumes Fruit Grains (cereal foods) Meat/fish/poultry/eggs + legumes/nuts/tofu Milk, yoghurt, cheese + allowance for fats/oils

classification of vitamins

2 types: soluble - A, D, K, E not soluble - B group and C

Folate is added to foods like wheat flour and breads. There are recommendations within Australia for the limits of fortification. Which of the following represents the accurate window of fortification of folic acid in micrograms to be added to wheat flour used for baking breads in Australia?

2,000-3,000 micrograms

how long does food take to break down?

2-72 hours (nutrient digestion is slowest)

Solid foods contribute to how much of our total water intake?

20%

Blood Pressure (hypertension)

3% of the adult populations developed high BP annually Risk of developing it increased with age. Risk increased if pre-diabetic, diabetic, overweight or obese ("individual of a higher weight") Smokers at higher risk. 50% greater risk if male than female

Food and Australian Economy:

31 billion on export 11.3 billion on imports 2% of fresh produce are not from local suppliers Australia is one of the key players in the global food supply Benefits of this include the economy, food supply and jobs Australia's reputation is for high-quality, safe and nutritious food

Small intestine -

4.5-10.5 m (duodenum, jejum, ileum) Main function is to absorb nutrients Food is squirted into the duodenum where nutrient absorption occurs Bile - released from gallbladder into small intestine (fat digestion) Appendix - function is to house gut bacteria Protein takes the longest to break down

Current Average Australian diet:

45% - carbohydrates 25% - protein 30% - fats Abundance of meat Processed meats and food Fried foods, high in salt Alcohol

average needed serving of 5 food groups

5 servs vegetables 2 serves fruit 4-6 serves whole grain 2-3 serves lean meat 2.5-4 dairy mixed extra servs 0-3

WATER:

60% of body composition brain and other organs contain 75% water Reasons we need water Clear waste (kidney) Moisten food (to form bolus) For digestion (to form chyme) Homeostasis of body temperature (perspiration)

B GROUP VITAMINS

8 B vitamins that help to release energy from carbohydrates, proteins and fats that we eat Thiamin (B1), Riboflavin (B2), Niacin (B3), Pantothenic Acid (B5), Pyridoxine (B6), Biotin (B7), Folate (B8), Cobalamin, Choline

RDI of water:

8 glasses or 2L/day Solid foods (fruits, veg) contributes 20% of total water from solid foods Free fluid - water is preferable (not coffee, tea - dehydrating) - 80% from fluids

What do gut microbes do?

>400 bacterial species are found in the bowel. Higher number of bacteria that do not need oxygen to survive than those who do. Reflects the nature of the environment. Jobs include aiding digestion, making gas, circulating nutrients Enteropathic circulation. → help liver to circulate metabolites Vitamin synthesis Drug synthesis Make enzymes

Management of diabetes in life: Alcohol

A lcohol can be tricky, especially with type 1 diabetics → can cause hypoglycaemic attacks. Advice is to limit very sweet drinks including regular softdrink mixers, sweet liquers and pre-mixes. If drinking, choose wines, low alcohol beers or spirits mixed with diet mixers. However.....low carb beers often tend to be higher in alcohol which can cause issues for diabetes management. Less likely to recognise a hypo, people often mistake for being drunk so don't help, the hypo may be harder to treat. Don't drink alcohol on empty stomach. Make sure you include carbohydrate foods in meals you eat before drinking alcohol eg: potato, rice, pasta or bread. Always eat some form of carbohydrate while drinking alcohol. If there are no carbohydrate foods available, use a standard soft drink or fruit juice when mixing drinks. Otherwise use a low joule (diet) soft drink as a mixer. When drinking alcohol, particularly in the evening, always eat a carbohydrate snack before you and eat breakfast as soon as you wake up in the morning. Test your blood glucose level before bed. Avoid drinking excessive amounts of alcohol. The more you drink, the greater your risk of hypoglycaemia. Always carry some fast acting carbohydrate such as jellybeans in case of a hypo. Avoid alcohol after vigorous exercise When drinking alcohol, always tell someone that you have diabetes. Always wear some form of diabetes identification.

Nephropathy

A degree of kidney failure Filtering function of the kidneys doesn't work properly and proteins are lost from the body in the urine

In avoiding osteoporosis, which of the following is not considered a modifiable risk factor?

A direct relative who has had an osteoporotic fracture

unsaturated fats

A fat that is liquid at room temperature and found in vegetable oils, nuts, and seeds. better for you make double bonds between molecule

saturated fats

A fat that is solid at room temperature and found in animal fats, lards, and dairy products. single bond hydrogen solid like butter

Which of the following will enhance iron absorption?

A low pre-existing iron status Reducing agents such as vitamin C. Eating iron found in sources of animal protein

Resting heart rate:

A normal heart rate is 60-100 per minute

Standard serve of vegetables:

A standard serve is 75 g or: ½ cup cooked green or orange vegetables (broccoli, spinach, carrots or pumpkin) ½ cup cooked or canned beans, peas or lentils 1 cup green leafy or raw salad vegetables ½ cup sweet corn ½ medium potato, sweet potato, taro or cassava 1 medium tomato

Standard serving sizes of fruits:

A standard serve is about 150g or: 1 medium apple, banana, orange or pear 2 small apricots, kiwi fruits or plums 1 cup diced or canned fruit (no added sugar) Or occasionally: 125 mL (1/2 cup) fruit juice 30 g dried fruit (4 dried apricot halves, 1 ½ tablespoons of sultanas)

what vitamins are fat soluble?

A, D, K, E

Difference between ADG / ADGHE:

ADGHE: food selection guide which visually represents the proportion of the five food groups recommended for consumption each day ADG (Australian dietary guidelines): overall guidelines → policy "how to guide" AGHE (Australian guide to healthy eating): pie chart → poster "quick reference" Require guidelines because chronic disease and diet are linked and are a major cause of death and disability among Australians Adults require the guidelines to maintain good health (or learn how to reach it) to protect against chronic disease and improve quality of life Infants require guidelines → good nutrition is essential for normal growth

How much Vitamin D is enough?

AI of Vit D for adults aged between 19 and 70 is 10μg per day or 400 IU each day (international units). This rises to 15 μg per day over the age of 70. It is hard to get enough Vit D from food alone, only a few foods contain vitamin D. Significant sources are oily fish, butter/margarine, egg yolk, full-fat cheese. - takes months to boost stores of vitamin D Margarine and a few brands of milk (eg. Anlene) are fortified with added vitamin D Most people in Australia and NZ get around 25 per cent of their vitamin D from food. Cod liver oil

Visible fats

Add these to foods, add them to our cooking or find them on our foods before they are cooked Easy to limit intake or remove from diet

Planning a healthy diet:

Adequacy Kilojoules (KJ density or energy control) Nutrients (nutrient density) Balance Variety - spend more energy to break down Learn to compare foods on how many kilojoules they deliver per 100 grams or per serve.

RDI for Vitamin C:

Adults require 45mg of vitamin C each day (19-70+ years) Good food choices that help achieve this: A medium sized orange as a snack = 70mg Fresh squeezed 300mL orange juice = 100mg Greek salad with ½ tomato (45mg), ½ cup capsicum (95mg) and parsley (30mg) = total 170mg ½ cup fresh strawberries with icecream/yoghurt = 50mg Punnet of blueberries = 60mg

Factors that influence the BMI include:

Age (e.g. females have more body fat) Gender Ethnicity Muscularity Genetic makeup

Serves a day dairy:

Aim for 3 serves of dairy a day 1 serve from the dairy groups: 1 cup of milk 200g of yoghurt 40g or 2 slices of cheese How to get this Cereal with milk in the morning Tube of yoghurt for snack Fruit salad with handful of almonds

ALCOHOL

Alcohol is a depressant Affects and slows the CNS Influences BAC (blood alcohol concentration) Made by fermentation (ethanol) Different alcohol, different source e.g. vodka from potatoes and sometimes very specific like Cognac (made only from Ugni Blanc grapes, distilled twice in copper pot stills and aged for 2 years in oak barrels) Different names if produced in different parts of the world (e.g. whisk/ey, scotch)

METABOLIC SYNDROME:

Also known as Syndrome X or insulin resistance syndrome. Single syndrome with multiple conditions that occur simultaneously. Comorbidities Having MetX can increase the risk of developing type 2 diabetes, stroke and heart disease. Good news is that lifestyle and dietary changes can reduce the risk of developing those diseases associated with MetX. Causes are complex, thought to be a genetic link Being overweight or obese can increase risk, as can being physically inactive. As we age, weight gain can naturally occur. Weight stored around the tummy leads to insulin resistance. This makes the action of insulin less efficient especially in muscles and in the liver. >35% of the Australian population is thought to have MetX, thought to be higher in people who have diabetes.

trans fats

An unsaturated fat, formed artificially during hydrogenation of oils, containing one or more trans double bonds. stretched and add more h2

Kidney disease:

Angiotensin hormone is released -> high blood pressure Similar rates to developing diabetes Key risk factors were diabetes and high blood pressure Having signs/symptoms of kidney disease doubled chances of hospital admission or multiple trips to the GP. Cognitive impairment and physical disability common amongst population with it aged 60+. (end stage kidney problems → renal dialysis)

Diabetes:

Annually, 0.7% of adults were diagnosed with diabetes Low SES (social economic status) doubled the risk of developing diabetes Having diabetes doubled the chance of hospitalisations and repeat visits to the GP. When aged >60, having diabetes increased risk of cognitive impairment and physical disability.

kill bacteria

Antibiotics Antibacterial products Alcohol

Diabetes and heart disease:

Around 75% of people with diabetes die from cardiovascular disease, including heart attack and stroke. People with diabetes are six times more likely to suffer from atherosclerosis (heart disease) than people without diabetes People who have pre-diabetes (impaired glucose tolerance or impaired fasting glucose) also have an increased risk of heart disease

Pre-diabetes (Type 2)

As the name suggests, is a diagnosis that means you almost have diabetes. Approximately 2.46 million Australians have pre-diabetes. Occurs when blood sugar levels are higher than normal but not high enough to qualify for a diagnosis of diabetes. It's a warning sign if picked up early enough. With strict diet control, lifestyle changes and a commitment it does not have to lead to a type 2 diabetes diagnosis. However, if left untreated, can develop into type 2 within 5-10 years.

Energy and diet breakdown

Average energy intake was 9655 kJ for males, 7402 kJ for females. Of the total kJ consumed, this was the break down (on average); Carbohydrate 45% Fat 31% (saturated <10%) Protein 18% Alcohol 3.4% Dietary fibre 2.2% Minimise alcohol and dietary fibre (only 30 g/day for fibre)

Obesity

Average waist gain was 5.3cm, higher in women than men. Younger people gained more weight and waist circumference than older people (higher metabolism) Obese people were 2x to be depressed → cycle of more obesity coupled with depression Like diabetes, if aged 60+ were more likely to have cognitive impairment and physical disability.

Common Measurements of Health:

BMI Waist to hip ratio Waist circumference DEXA Blood tests for iron, cholesterol, blood sugar BMD Blood pressure

Bring cholesterol down:

Be careful with your diet Take your medicines as prescribed Be smoke-free Be physically active Manage your blood pressure Achieve and maintain a healthy body weight Maintain your social and emotional health

Treatment for kidney cancer is often surgical.

Be familiar with the multiple methods of measuring health and their pros/cons. Be able to link diet to common diseases and understand the place of recommended diets in prevention and treatment of these diseases. Begin a conversation with relatives about nutrition related diseases in the family to build awareness of future health concerns relevant to you

Times when vitamins are needed:

Before contraception - high intake of folate During pregnancy - extra iron, calcium, omega 3 FA's Vegans - may need B12, iron, zinc, calcium, omega 3 FA's Smokers (incl. passive) - double Vit C requirement and need more zinc,folate, beta carotene, antioxidants Heavy drinkers - excessive alcohol depletes B grp vits such as thiaminand folate + zinc, potassium, vit E Athletes - various vits and minerals but generally antioxidants Vit C, E and iron. Coeliac dx and irritable bowel - may need extra calcium, iron, zinc, vitamin C Elderly/housebound - absorption decreases with age (villi become flatter), requirement for Vit D, calcium, B12, B6 increases Elimination diet for allergy/food intolerance - removal of whole food groups eg grains/dairy eliminates vits + minerals Illness/after surgery/burns - More vit C and protein needed for tissue synthesis Restricted weight loss diets - low energy diets <5000KJ need a multivitamin and mineral supplement Anaemics - top up of iron. Also B12 for pernicious anaemia.

Australian crops: - abundance of arable land

Biggest crops: Barley, Cattle, Cotton, Oats, Rice, Rye grain, Sheep, Sugar cane, Wheat, Fruits and vegetables,Dairy

BLOOD PRESSURE

Blood pressure is a measure of the heart's force when pumping blood through the arteries. It is highest when the heart contracts (called the systolic measurement, around 120 millilitres of mercury) and lowest when the heart relaxes (called the diastolic, at around 80 millilitres). Systolic - away Diastole - towards the heart Hence the ideal measurement is 120/80.mmg Hg Measured using a sphygmomanometer.

TYPE 2: Causes:

Body cells are resistant to action of insulin (insulin resistance)

Osteoporosis:

Bone lose minerals such as Ca, bones become thinner and less dense, more brittle Higher risk of fractures most common sites are hip, spine, wrist, ribs, pelvis and upper arm No signs or symptoms usually until a fracture occurs - "silent disease" Some effects include Changes in posture (Dowager's hump) - pronounced upper slump Loss of height Muscle weakness Deformity of the area affected Long-term pain and disability Loss of independence Premature death

Gut microbiome:

Both help the growth of good bacteria in the gut but are not the same thing. 1. Probiotics The healthy bacteria E.g. probiotic capsule to obtain the bacteria Many different types, each behaves differently in the gut. Prebiotics Food for probiotics Non-living food ingredients that make it through the digestive tract relatively undigested and provide 'food' for the bacteria. Common names are fructooligosaccharides and galacto-oligosaccharides (FOS - from fruit and GOS - from galactose). A combination of both is important for immunity, digestion and during times of gastrointestinal upset.

stomach

churns food doesn't absorb nutrients

When the stomach has finished breaking down food, what is the name of the substance it makes that gets squirted into the intestines?

chyme

Micronutrients:

consumed in small amounts but frequently Vitamins Minerals and trace elements

Cancers that are linked with nutrition include:

Bowel cancer Kidney cancer Liver cancer Mouth cancer Rectal cancer Stomach cancer Throat cancer

Journal of Gastroenterology Implications:

Brain chemistry also seemed to be affected. The mice given antibiotics had higher levels of a protein called BDNF in their brain compared to the control group mice. Changes in levels of BDNF have been linked by other researchers to depression and anxiety. The researchers tried gut flora swapping. Behaviour patterns were flipped when flora was exchanged. Unclear if the same thing would happen in humans (hard to ethically test). Potential ramifications for irritable bowel syndrome, depression and anxiety disorders. Altered behaviour may be associated with gut bacteria! Not just for the physical symptoms like diarrhoea, gas and pain.

Which of the following is an example of a discretionary food choice?

cordial

fracture risk higher in which gender

women

best sources of vitamin B1

yeast extracts, wheat germ/ bran, nuts, fortified b1 cereals, liver, kidneys, pork, peas, wholemeal flour/ bread, sesame seeds all flour is fortified with thiamin/ B1

Influences on digestion

Caffeine digestion → body will want to expel caffeine quickly, gastric irritant Coffee, tea, energy drinks, sensitive to chocolate Fat content of the food → ease of expulsion, decreasing food is better Fibre content -> too much fibre - constipation (30 g of fibre for males and females) Hydration level Stress → governs blood supply to the gut, haltering absorption and slowing digestion → less defecation Exercise pattern Artificial sweeteners added Speeds up digestion (laxative effect)

Calcium balance throughout life:

Calcium balance changes throughout lifecycle Growth (in infancy/youth) Pregnancy Lactation Menopausal status for women Older age

Which is not a form of calcium in food?

Calcium complexed with biotin

Which is a form of calcium in food

Calcium complexed with physic acid calcium carbonate calcium phosphate

Calcium balance in the body

Calcium is in constant exchange between skeleton, intestine and kidney PTH (?) hormone via kidneys, intestines need to take more from diet or break down bones (leads to brittle weakening) Low calcium stores → PTH hormone is release → take more from diet OR break down bones Plasma calcium kept within a narrow range Bone calcium is drawn upon if diet does not supply enough to maintain blood levels Absorption is maximised in younger age

Key nutrients milk, yogurt, and cheese (low fat dairy):

Calcium → preventative for osteoporosis Protein Riboflavin B2 → important for energy metabolism (especially for carbohydrate metabolism) - focus and stress Vitamin B12

Importance of the glycaemic index:

Carbohydrate foods must be incorporated into every meal that a diabetic person eats. Need to consider the type and amount of that carb. Amount = how much sugar/starch is in the food. Type = glycaemic index of the food.

Key nutrients Grains:

Carbohydrates Protein - muscle development and growth Iron Fibre Vitamin B1 Folate Iodine

Health risks associated with adiposity:

Cardiovascular: Stroke, coronary heart disease, hypertension Endocrine: Type II diabetes (insulin, glucagon) Gastrointestinal: Gallbladder disease, gastro-oesophageal reflux disease, cancer of the bowel, oesophagus, gall bladder and pancreas Genitourinary: Chronic kidney disease, kidney cancer, kidney stones, stress urinary incontinence (women) Pulmonary: Obstructive sleep apnoea, asthma Musculoskeletal Osteoarthritis, spinal disc disorders, lower back pain, disorders of tendons, fascia and cartilage Reproductive: Miscarriage, infertility, breast cancer (in postmenopausal women), endometrial cancer, ovarian cancer Mental Health: Depression, anxiety disorder, disordered eating.

Guideline 5

Care for your food, prepare and store it safely e.g. Flash defrosting/microwave defrosting is better than leaving out in room temp (this risks contamination by bacteria)

Junk food:

Cheap Widely available/easily accessible Served in large portions Kilojoule-dense but nutrient-poor Easy to over consume - hits our "bliss point" Doesn't fill and satisfy Hard to recognise the extra kilojoules

Inhibitors of iron absorption:

Chelators e.g. phytic acid → molecules that bind tightly to metal ions, hence preventing their absorption Phenolic compounds e.g. polyphenols in tea, coffee, cocoa. Tannins, oxalates, phytates are also found in tea and coffee Black tea inhibits more than green tea and coffee High calcium presence at same meal (take calcium supplements at bedtime) Legumes, wholegrains and chocolate with calcium, polyphenols and phytates can decrease absorption of non-haem iron Caffeine Tea: peppermint, penny royal, cocoa, vervain, lime flower, chamomile and most herbal teas with polyphenols

Risk factors of coronary disease:

Children's sedentary behaviour - decrease in activity levels, energy dense and nutrient empty diets/low nutrient profile/increased consumption of the triad nutrients (sugar, fats, salts) Early diet and lifestyle practices Lack of awareness of the importance of early prevention against chronic disease Recognition of common risks Dietary habits that we've learnt about so far Convenience food High in salt, sugar and bad fats Not enough fibre, fluids Smoking and drinking

BLOOD CHOLESTEROL LEVELS

Cholesterol is a fatty substance produced naturally by your body and found in your blood. Also found in some foods. It is used for many different things in the body, but causes health problems when there is too much in the blood. (e.g. cell structure - rigidity of walls) High cholesterol = fatty build up in blood vessels = restricted blood flow & ↑ risk of heart attack or stroke. Dietary (too high) vs blood cholesterol (from liver - safe) 3.5 million Australians affected, 33% of Australians aged 30-65 diagnosed with high cholesterol.

Burden of worst nutrition disease:

Chronic disease - 85% of the total disease burden in Australia. Definition: More than 3 months at a time, unlikely to cure from them The largest contributors to the total burden were cancer (16%), musculoskeletal disorders (15%), cardiovascular diseases (14%) and mental and behavioural disorders (13%). Of the risk factors considered by the study, dietary risks (accounting for 11 % of the total burden), high body mass index (9%) and smoking (8%) were the leading risk factors. While these risk factors are known to be associated with many diseases, the main conditions affected by these risk factors were cancer, cardiovascular diseases, and diabetes, urogenital, blood and endocrine diseases combined

List of diseases linked to microbiome imbalance (long term)

Colon cancer Liver cancer Diabetes Obesity Inflammatory irritable bowel syndrome Celiac disease Arthritis Potential links to: Mental health problems Parkinson's Alzheimer's disease

Hyperglycaemia:

Common when diabetic does not take medications or take a normal diet Retinopathy Neuropathy Nephropathy

CALCIUM:

Composition in the body Skeleton: 99% Crystals of Ca phosphates (hydroxyapatite) in a complex with collagen Teeth: 0.6% Plasma: 0.03%

PROTEINS

Consists of amino acids Helps body grow and repair tissue Makes enzymes, antibodies and hormones Helps make up proteins in blood such as haemoglobin Required for recovery after sport/illness/burns Needed in growth stages of life and maintenance of body stores is required Protein molecules are foundin muscles, organs, bones and skin 15-20% of calories/kilojoules must be sourced from protein

Macronutrients:

Consumed in large amounts Proteins Carbohydrates High and low GI carbohydrates Fat Monosaturated Polyunsaturated Saturated Fibre Soluble and Insoluble

Which of the following will not enhance iron absorption?

Consuming a meal that has both iron and high calcium in it.

Invisible fats

Contained within a pre-packaged or pre-prepared food, we eat it without thinking about it Difficult to reduce intake without avoiding the food or eating very small portions Hence home cooking is important (limit invisible fats)

economic factors

Cost Personal budgets, eating for one vs feeding for family, Fresh vs frozen, home made vs store bought Availability Metropolitan vs rural, Seasonal variations, Foods grown according to climate Time 40 hour working week minimum, eating at desk vs taking time out

Out of bread, dairy, cooked spinach and almonds which is the best source of bioavailable calcium?

dairy

sources of calcium in food

dairy bread, whole grain meat almonds tahini legumes spinach, cooked *don't absorb much calcium due to phytates and oxalates (known calcium inhibitors) Other sources of calcium: Dried Herbs - celery seeds, thyme, dill, marjoram, rosemary, sage, sisybrium, oregano, spearmint, parsley, poppy seed, chevril, basil. Cheeses - parmesan, romano, gruyere, mozarella, swiss, cheddar, hard goats cheese, provolone. Sesame seeds Tofu, especially that prepared with calcium sulfate Almonds, turnip, mustard, dandelion greens, collards, kale. Flax seeds (but not refined flaxseed oil), brazil nuts, herring

Retinopathy

damage to capillaries that nourish the retina High ocular pressure → strain on eye sight may result in poor vision or even blindness Common when diabetic does not take medications or take a normal diet

DXA Scan

duel-energy x-ray absorptiometry gold standard- precise method of measuring the proportion of fat in person's body - total body muscle mass - total body fat mass - total body fat percentage

what factors affect food selection?

economic physiological lifestyle psychological

tryptophan

essential amino acid, meaning body cannot make it on its own and it must be ingested

energy dense vs nutrient dense

ex vegetable soup 220 kJ per 100g 80% water Fibre Nutrient dense and fewer kilojoules per gram ex chocolate 160 kJ per 100g 57% sugar 30% fat Nutrient poor and more kilojoules per gram

how to determine energy?

ex. protein gives 37 kilojoules and I had 30g of protein so 37x30= 510kj

Dietary: aim change fat profile

Cut back on saturated & trans fats Eat unsaturated fats Add plant sterols (mimic fibre, remove excess cholesterol, occur in fruit and vegetables) No limit on dietary cholesterol eg from eggs and prawns Avocado debate & egg yolk rages on (not actually detrimental to cholesterol levels)

What is the name of the smaller molecules that fats are broken down into when digested?

fatty acids

what are fats broken down into?

fatty acids

During the digestion process, what dietary component of food lingers in the stomach and delays gastric emptying making us feel satiated and full?

fibre

Energy:

food and nutrients supply our bodies with energy Energy = kilojoules = calories Energy dense, nutrient poor foods are not the best choices but are predominant in convenience and processed foods Fats the most nutrient dense, then alcohol, then protein, then carbs

Of the five food groups, which one is not likely to provide lots of zinc in the diet?

fruit

what hormone makes you feel hungry?

ghrelin

The Australian Dietary Guidelines (ADG)

give advice on eating for health and wellbeing. Refer to your usual diet, considering eating at special occasions is less likely to impact your current and future health than what you eat every day. Based on the latest scientific evidence and describe the best way to eat so that you live a long and healthy life. Designed for use by health professionals, policy makers, educators, food manufacturers, food retailers and researchers, so they can find ways to help Australians eat healthy diets. Applicable to all healthy Australians, as well as those with common health conditions such as being overweight. Do not apply to people who need special dietary advice for a medical condition, or to the frail elderly.

What is not one of the main harvested crops of Australia?

goat

types of carbohydrate

high and low glycemic index

Neuropathy

Damage to nerves of the limbs, especially feet: Common symptoms of peripheral neuropathy: Numbness or insensitivity to pain or temperature Tingling, burning, or prickling Due to loss of sensation, injuries may go unnoticed and become infected.If ulcers or foot injuries not treated in time, the infection may involve the bone and require amputation

Dietary factors affecting urinary calcium excretion:

Decrease excretion of calcium Intake of soy foods (contain phytoestrogens) Increase excretion of calcium Sodium High salt intake promotes Ca excretion 60 mg Ca excreted for every 2000 mg Na in diet Protein 150 mg Ca is excreted for every 50 g of dietary protein Caffeine Caffeine blocks uptake of Ca Take these foods which inhibit calcium uptake separately from calcium rich foods

Hypertension =

high blood pressure. (diagnosed over 140/90 mmg Hg) The heart pumps blood around the body through the blood vessels. Blood pressure is the amount of force exerted on the artery walls by the pumping blood. High blood pressure (hypertension) means that your blood is pumping with more force than normal through your arteries. Can lead to heart attacks, kidney failure or stroke. Stress on the arteries speeds up clogging with fatty plaques. This is atherosclerosis. It usually presents no symptoms 1/7 Australian adults has it, older people tend to develop it more. Get it checked annually.

Factors increasing the risk of serious problems if one has a

higher cholesterol Smoking High blood pressure Overweight Diabetes Family history

insulin

hormone that clears glucose

sodium bicarbonate

hormone that neutralizes food break down

glucagon

hormone that releases glucose

FATS

i.e. lipids Increased branching → more energy (hence fats are energy rich) During digestion, broken down into fatty acids Rich in energy, 2x as many kJ as carbs or proteins Cushions internal and reproductive organs Carrier for fat soluble vitamins and phytochemicals Fat soluble vitamins: A, D, E, K → absorbed with dietary fat Types of fats include: Monounsaturated Polyunsaturated Saturated trans fat

"Steatosis" -

if >10% of the weight of the liver is fat Build up of excess fat in liver cells.

RDI for iron

infants 0-6 >>>> 0.2mg kids 1-3 >>>> 11mg kids 4-8 >>>> 9 mg kids 9-13 >>>> 10 mg boys 14-18 >>>> 11mg girls 14-18 >>>> 15mg women 19-50 >>> 18mg pregnant women >>>> 27 mg lactating women >>>> 9mg women 51+ >>>> 8 mg men 19+ >>>> 8mg

Iron absorption:

Depends on the form of iron in foods Haem Fe (associated with haemoglobin/myglobin) In meat, poultry, fish 20% absorbed Non-haem Fe (other Fe sources) In plant foods 0-8% absorbed

BMD: BONE MINERAL DENSITY

Determines how rich your bones are in minerals such as calcium and phosphorus. Helps determines your risk of osteoporosis (useless for people with family history of osteoporosis) Individuals at risk: Corticosteroid treatment long term or Cushing syndrome Absence of menstrual periods for over 6 months Testosterone deficiency (if you are male) Long-term liver or kidney disease or rheumatoid arthritis Overactive thyroid A condition that stops you absorbing the nutrients from food (such as coeliac disease). Other measures of BMD: Ultrasound "heel test" Note heels have lower bone mineral density so is not reflective of true BMD Do not look at the areas most at risk of fracture and are not considered as accurate as DEXA tests

Limitations of BMI:

Developed for populations, not individuals Doesn't take account muscle mass - just overall weight. Does not take into account endocrine organs (e.g. muscle is an endocrine organ - very muscular individuals can have high BMI which is not truly reflective of their overall health) Doesn't reflect body fat distribution or describe the same degree of fatness in different population groups. Designed to apply to adults (both women and men) 18 and over. Is not suitable for children - use Growth Charts for them until they reach 18. Does not take into account ethnicity or location of fat on the body

Complications of diabetes: Diabetes and heart disease/stroke:

Diabetes is also often associated with high blood pressure and high blood fats It causes an increased risk of heart attack and stroke. Close to 80% of people with diabetes will die from a heart attack or stroke (high blood pressure due to high renin -produced by kidneys)

Complications of diabetes: Diabetes and kidney disease:

Diabetes is the fastest-growing cause of kidney failure. It is the leading cause of end stage renal disease (ESRD), before kidney failure Toxins may travel to other parts of the body About 30% of people with diabetes will develop kidney disease.

Statistics - diabetes:

Diabetes is the sixth-highest cause of death by disease in Australia. People with diabetes are twice as likely to be have high blood pressure and also are more likely to have elevated blood fats e.g. cholesterol, triglycerides. They are two times more likely to have cardiovascular disease, e.g. heart disease and stroke. One in four Australian adults has either diabetes or impaired glucose metabolism.

HYPERTENSION

Diagnosed when blood pressure is >140/90 mmHg. 120/80 is normal Affected by genetics, lifestyle or kidney/cardiovascular disease. High blood pressure increases risk of developing cardiovascular disease, stroke and kidney disease. Ideal BP is <130/80 mmHg and lower if no other diseases are present. Reduce risk and improve health by: Regular physical activity (200min/wk) No smoking Reduce salt in diet Reducing stress Limit alcohol

Diagnosis of MetX:

Diagnosis is positive when someone has three or more of the following symptoms: Central obesity Hypertension High blood TGs Low HDL cholesterol levels Impaired fasting glucose or diabetes. A diagnosis is completed using a combination of: Blood tests Waist circumference Blood pressure readings Family history taken Chats with the person to determine if they have noticed any changes in their body or moods etc.

NNPAS 2011-12 - survey

Did not use the food groups of the ADG → not useful in gauging major food groups consumed National Nutrition and Physical Activity Survey 2011-12 first national survey on nutrition since the 1995 survey. Data collected by a 24 hour recall Australian population aged >2 years surveyed. Average of 3.1 kg of food consumed daily. From the main food groups with variety.

Eat to beat liver disease:

Diet rich in fresh fruits and vegetables Smart carbohydrates Lots of foods rich in fibre Less processed foods Low fat, lean meats, low fat dairy Less creamy dishes and fried foods Improve cardiovascular and cardiopulmonary fitness, get fit Exercise Be smart with alcohol - stop drinking or reduce If have diabetes, control it properly If losing weight, do so slowly.

Sources of protein:

Difference between proteins Animal source High bioavailability e.g. steak → high protein reaping Plant/vegetable source Low bioavailability Compensate by increasing consumption H quality proteins vs low quality proteins → old terms (do not use) Different bioavailability's (how much of a nutrient one derives from a food) Essential vs non-essential amino acids (cannot be synthesised by the body - derived from diet)

Digestion:

Digestion is complex (starts in mouth, finishes in lower bowels) Involves enzymes specific to each nutrient Breakdown of food takes 2-72 hours to complete Evolution has prepared humans to be able to eat most things (progression from roots/seeds + berries/nuts to meat) Maximizing surface area of food and digestive system Breaking down food to digestible sizes (via enzymes, acids) Mastication in the mouth Maximize SA in small intestine Salivary amylase in the mouth starts carbohydrate digestion Bolus - travels via peristalsis

Quick and fasting eating:

Dinner in 10mins 'Deskfast' Dashboard dining One-handed cuisine Drive-through Grab & go 'Portafuel'

What is alcohol

Directly absorbed into blood stream through the walls of the stomach and small intestine then rapidly distributed to all parts of the body including the brain Takes affect within 5 mins of being consumed, BAC peak 30 to 45 min after 1 std drink Liver = main organ responsible for removing alcohol from your body Travels around body as acetaldehyde (i.e. ethanol - easy to absorb) Takes one hour to break down the alcohol in one standard drink 1 standard drink = 10 g of alcohol

Nomenclature vitamins:

Discovered around the early 20th century Originally named alphabetically eg B1, B2, B3, B4, B5, B6, B12, B17 Now known by their chemical names

IRON:

Distribution and function: Total body iron: 4 g 2.5 g → haemoglobin 0.3 g→ myoglobin Used in transport and release of oxygen 1.0 g → transferrin and ferritin 0.2 g → enzymes (e.g. ferrodoxins) Important for oxygen transport Iron intake and iron status (Hb) closely related to competition performance in athletes and to VO2 max

Which of the following can lead to chronic mild dehydration?

Diuretics such as caffeine environmental conditions Dissatisfaction with the taste of water

Japanese eating guidelines:

Does not gender split, accommodates culturally specific food items

Which part of the digestive tract is the location where faeces are formed and water is reabsorbed?

large intestine

Iron containing foods:

Dried herbs (e.g. thyme, parsley, spearmint, black pepper, coriander, marjoram, cumin seed, oregano, rosemary, basil, anise, turmeric, fenugreek seed, tarragon, chervil) Cocoa powder and chocolate Liver meat - foie gras of duck liver Clams, oysters, mussels Roasted pumpkin and squash seeds Sesame seeds Caviar Sun dried tomatoes Sunflower seeds, dried apricots

Taiwanese guidelines

Drink lots of water Eat 5 different vegetables each day Minimize sugary drinks Don't eat sweets before bed Don't eat 3 hours before going to bed

A lack of dietary polyunsaturated fatty acids is characterised by:

Dry skin and dermatitis

what hormone makes you feel full?

leptin

Live to eat vs eat to live

Eat to Live - nutrition is for nutrients Live to Eat - food is for enjoyment Attitude to food can aid nutrition practices and dietary choices Influenced by many factors Family upbringing Media Health conditions Relationships with food Importance of sports and physical activity e.g. athletes

Factors affecting food selection

Economic Psychological Physiological Lifestyle influences

psychological factors

Emotions (triad nutrient foods - salt, sugar, fat - lift emotions) Sadness, depression Elation, joy Nerves, to gain acceptance Self-concept Term used in psychology Categorical self, including self-image, self-esteem, ideal self Habits - variety needed Out of routine Values Mum's cooking Fair trade coffee/chocolate Ethically harvested tuna/fish Non-battery farm chicken and eggs Non-sow stall pork

ADG Guideline 4

Encourage, support and promote breastfeeding Mainly due to nutritional benefit to child and mother, avoid imposing social stigma

short term benefits of good nutrition

Energy Digestion Sport recovery Focus, brainpower - note: 120 g/glucose/day to fuel the brain, the brain is reliant on glucose Weight maintenance/loss Helps sleep patterns, mood, blood flow - impaired heart pumping to extremities → disease or hypertension Clear skin, glossy hair, strong nails

ADG Guideline 2:

Enjoy a wide variety of nutritious foods from these five groups every day: Plenty of vegetables, including different types and colours, and legumes/beans Fruit Grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties, such as breads, cereals, rice, pasta, noodles, polenta, couscous, oats, quinoa and barley Lean meats and poultry, fish, eggs, tofu, nuts and seeds, and legumes/beans Milk, yoghurt, cheese and/or their alternatives, mostly reduced fat (reduced fat milks are not suitable for children under the age of 2 years) Drink plenty of water. (2L - 8 glasses)

Microflora and nutrition:

Enzymes produced by intestinal bacteria are important in the metabolism of several vitamins. Vitamin K Biotin Vitamin B12 Folic acid Thiamine The intestinal flora is capable of fermenting indigestible carbohydrates (dietary fibre) to short-chain fatty acids such as acetate, propionate, and butyrate. People who are lactose intolerant struggle so much with digestion of milks because they don't have lactase enzyme and the bacteria in the gut ferment the sugar vigorously.

TYPE 1 diabetes Causes:

Exact cause not known Destruction of insulin-producing cells in pancreas (islet Beta cells) Glucose stored as glycogen Glucose is not cleared from the blood from insulin Therefore, reliant on injected insulin Usually results from an autoimmune process Possibly triggered by early introduction of cow's milk? Exclusive breastfeeding until 6 months of age recommended. Prevalence in Australia: 3.61 million Australians have diabetes. Prevalence worldwide:366 million people worldwide have diabetes.

Nutrition related risk factors include:

Excess adiposity Pre-existing inflammatory bowel disease, e.g. ulcerative colitis High fat, low fibre, low calcium diet

Nutrition and eyesight:

Eyesight Macular degeneration, Glaucoma, Cataracts Lack of lutein (in egg yolk) and zeaxanthin (in green leafy vegetables) After pubescence - must include these nutrients

what vitamins are fat soluble and which are water soluble

Fat Soluble (A, D, E, K) Water Soluble (B group, C)

Effects of iron deficiency:

Fatigue Reduction in haemoglobin + iron containing enzymes Reduced ability to mobilise oxygen Reduced physical working capacity Reducing training and competition performance in athletes Decline in cognitive function Several structures in brain have high iron content Adults → reduced ability to concentrate Children → potential intellectual impairment Increased susceptibility to infections Impaired immune function

Symptoms: type 2 diabetes

Feeling tired Passing urine frequently Feeling constantly thirsty Blurred vision Itching of the skin or genital area Slow healing infections Numbness and tingling in hands or feet Sometimes no symptoms at all

non-modifiable risk factors

Female Caucasian or Asian → increased risk Small body build Delayed puberty or early onset of menopause (40 y.o) Previous osteoporotic fracture Direct relative who has had an osteoporotic fracture (likely to have another fracture) Over 60 years of age Long-term drug treatment with corticosteroids Dark skin (non-modifiable)

Eat to beat cholesterol:

Fibre (soluble and insoluble) Fresh fruits and vegetables Antioxidant rich foods, legumes Saturated, animal fats to a minimum Cut off fat before cooking Want to increase HDL and lower LDL Oats have insoluble fibre and beta glucan (lower cholesterol levels)

Key nutrients in fruit

Fibre - reduce cholesterol, keeps bowel active Vitamin C Carbohydrates - for blood sugar Folate Potassium Beta-carotene

How to interpret the guidelines:

Focuses on dietary patterns that promote health and wellbeing rather than recommending that you eat/completely avoid specific foods Provide advice on how many serves of these food groups you need to consume everyday depending on age/gender/body size/physical activity levels. Many of the health problems due to poor diet in Australia stem from excessive intake of foods that are high in energy, saturated fats, added sugars and/or salt but relatively low in nutrients. Many diet-related health problems in Australia are also associated with inadequate intake of nutrient-dense foods, including vegetables legumes/beans, fruits and wholegrain cereals. A wide variety of these nutritious foods should be consumed every day to promote health and wellbeing and help protect against chronic disease.

Factors affecting calcium absorption

Food source Poor bioavailability: inorganic salts and complexes with phytates and oxalates High bioavailability: lactose and complexes with casein On average: 30-40% of calcium is absorbed Pregnancy increases absorption Ageing reduces absorption and increases excretion

Food culture:

Food vans Fine dining, fresh vs takeaway Lunchbreaks Budget of dining out, quality time

Serve:

Foods within each grouping are recommended to be eaten in standard serve sizes. A "serve" is not the same as a "portion" - it is more concerned with the nutrients not the portion size Portion size is the amount you actually eat, depending on how hungry you are and what type of meal or snack you eat

Guidelines for alcohol consumption

For both men and women, - spaced out 2 standard drinks a day 4 standard drinks per single occasion of drinking abstaining from alcohol before 18 (particularly before 15 y.o), delaying the initiation of drinking (15-17 y.o) Maternal health: safest not to drink in pregnancy

Which digestive organ is responsible for making bile?

liver

Cancer and food;

Fresh fruits and vegetables Lots of soluble and insoluble fibre Wholegrain cereals, pasta, noodles and low GI rices Less processed foods including deli meats Less salty foods and not adding salt to cooking BBQ meats - chargrilling Healthy fats not bad fats Less takeaway foods Fried foods a no no Lean meats Not too much red meat Vegetarian options 2-3/wk During treatments: clear soups and broths, simple sugars, bland foods to combat nausea such as crackers and toast.

Where do gut microbes come from?

From the mouth and travel down the gut with each meal. As we go down the digestive tract, the type of bacteria changes as we progress. Also, the types of bacteria are different according to the surface of the gut as well. Different types are found on the mucosal lining, on the epithelial cells and in the lumen. This also helps to stop the bad bacteria penetrating the gut walls when they get into the system. E.g. Almost like a security fence against a rowdy crowd of teens in a mosh pit.

Food sources of Vitamin C:

Fruits such as citrus (oranges, lemons, limes, grapefruits), blackcurrants, mango, kiwifruit, berries, guava, pineapple, pawpaw Vegetables, particularly green vegetables such as cabbage, spinach and broccoli, capsicum, even parsley and other fresh herbs. Kidney and liver → risk of ingesting toxins Over 90% of vitamin C in the diet comes vegetables and fruit. Cooking reduces their vitamin C by 30-40% Prolonged heating destroys a lot of the vitamin C in fresh produce so it pays to cook your veggies lightly (steam or microwave is the kindest - then place under cold water to retain vitamins OR drink the cooking water/vitamin water leeching) and eat plenty of fresh fruit and raw salads.

VITAMIN B1 (THIAMIN)

Function Needed for: Metabolism of carbohydrates and fats Release of energy from food Normal appetite and digestion - homeostasis of appetite levels Proper function of heart and nervous system Peripheral nerve myelination - ensures myelin sheath of neurons are functional Brain function We have limited body stores of B1 (it is water soluble) - excess is excreted as urine waste Best food sources include: Yeast extract, wheat germ/bran, nuts, fortified bf cereals, liver, kidney, pork, peas, wholemeal flour/bread, sesame seeds. All flour for bread is fortified with thiamin. Added to breakfast cereals (riboflavin, niacin, folate, iron) Added to flour for bread RDI 1.1 mg (women) per day 1.2 mg (men) per day Safe UL 50-100 milligrams per day Deficiency is rare and occurs mainly in alcoholics. (ethanol in alcohol leaches thiamin) Severe deficiency results in beri-beri.

VITAMIN C:

Function: Keeps gums, teeth and bones healthy Wound healing, resistance to infection Collagen formation - using vit c and calcium - hypoxoyolate (??) calcium helps bind to to make hydroxyapatite Iron absorption → reducing agent Antioxidation May reduce risk of many cancers High intake helps to reduce risk of cataracts

FOLATE/FOLIC ACID: (B8)

Functions: Needed for: Formation of enzymes and red blood cells Metabolism of DNA- helps prevent malformation of DNA Prevention of neural tube defects e.g. spina bifida Reducing homocysteine - a risk factor for heart disease Deficiency results in a type of anaemia. Sources: green leafy vegetables (kale, spinach, asparagus, broccoli) Recommended daily intake 400 Increased uptake for pregnant females Safe upper limit 1000

Individual dietary requirements vary depending on:

Genetics Lifestyle Activity level Family history

Food choice has ability to influence:

Genetics, Weight, Mental health, Digestion, Mood (e.g. 3pm slump - due to high carbohydrates diet) Sleep patterns, Immunity, Concentration, Interaction with other people Holistic health and nutrition → dietary analysis Sleep (REM sleep cycle) Relationships, spirituality Mental health (mood) Nutrition Physical activity (minimum of 30 min/day) Stress management (cortisol - negative stress hormone, obesogenic)

Gestational diabetes (GDM)

Gestational diabetes mellitus (GDM) is a form of diabetes that occurs during pregnancy and usually disappears after the birth but may reoccur in the next pregnancy. GDM occurs when the hormones made by the placenta during pregnancy stop the body's own insulin from working properly, causing blood glucose levels to rise. This type of diabetes affects up to eight per cent of Australian women during pregnancy. Diagnosed with a glucose tolerance test → (24-28th week of pregnancy) Increases chances of developing diabetes themselves

DXA SCANS

Gives body muscle mass, body fat and fat percentage Gives the muscle and fat mass of the trunk and each of your arms and legs plus a central abdominal fat measurement. It can determine exactly where fat is located, especially around the abdominal area. "Duel-Energy X-ray Absorptiometry" - elite athletes Gold standard - A precise method for measuring the proportion of fat in a person's body. Total body muscle mass (kg) Total body fat mass (kg) Total body fat percentage However, very expensive to run

Carbohydrates and the Glycaemic Index

Glycaemic indsex of a food is a number assigned to it between 1 and 100 GI of a food tells us how easily our body is able to digest components of the food Low GI < 55 Medium GI 56-69 High GI >70 - increase blood sugar levels Proteins and fats do not change the GI dramatically if at all White area is homeostasis - baseline of glucose in blood High GI diet shift in mood/slump hypoglycaemia diabetes Aim for low GI products

Sources of carbohydrates:

Grains and cereals Starchy vegetables (e.g. potato) Legumes → Fruit (staple fruits - medium GI, seasonal fruits (tasty) - high fructose, GI) Dairy foods

Alcohol and pregnancy:

Guidelines are not to drink alcohol while pregnant from both the NHMRC and WHO Overconsumption of alcohol can lead to foetal alcohol spectrum disorders Foetal alcohol syndrome (FAS) - low birth weight, small eye openings, smooth philtrum, heart defects, ADHD, thin upper lip Partial FAS (pFAS)

When comparing the effect of carbohydrates on blood glucose levels not long after eating them, what is the difference between a low and high GI carb?

High GI will spike blood sugar levels

Risk factors for developing CKD (chronic kidney disease) are:

High blood pressure Diabetes Have established heart problems (heart failure or past heart attack) or have had a stroke Obesity >60 years of age Family history of kidney failure Smoking Aboriginal or Torres Strait Islander origin People with diabetes are more 20-30% more likely to develop a kidney disorder known as diabetic nephropathy. This is a serious disease and is the main cause of kidney failure.

promote growth of bacteria

High fibre foods (insluble, inulin, FOS) - inulin - synthetic Fermented foods Probiotics Dirt

physiological factors

Hunger/appetite Different foods have differing satiety levels Hunger controlled by the stomach - two hormones (ghrelin (hunger) and leptin (satiety)) Nutrients and for fuel Taste Heredity - culture Diseases Body shape Energy needs Genetics Age and gender Growth and maintenance

Bowel cancer: (i.e. colorectal cancer)

If diagnosed early can be cured. 12,500 Australians are diagnosed with it every year. Mostly occurs in people > 50 year olds Polyps develop inside the colon or rectum and can become cancerous. Development of bowel cancer takes years. If untreated it can spread to the lymph nodes and then liver or lungs. Encourage parents to take bowel cancer test kit

Negative modifications of microflora:

If we modify the gut flora at all, defecation is affected. Also, the level of compounds that end up in our bloodstream rise because they have not been properly broken down in the gut first. Digestion of fibre declines →diarrhea or hard stool Synthesis of vitamins is not as efficient or does not take place. The balance of good and bad bacteria shifts. Ways that the ecosystem can fail is when we take antibiotics or certain medications (e.g. birth control pills) → decimate beneficial and non-beneficial bacteria

Functions of vitamin D:

Improving the absorption of calcium and phosphorus into the body so it helps to ensure strong bones and teeth. Maintain healthy nerve and muscle function. Prevents rickets, a bone disease in children which results in stunted growth and bowed legs. Prevents osteoporosis Contributes to normal cell division, growth and development, DNA Under study for its role in preventing cancers and boosting our immune system, depression, rheumatoid arthritis, diabetes and multiple sclerosis.

Treatment: type 2 diabetes

In many people, healthy eating and regular exercise can control blood glucose levels Oral hypoglycaemic drugs (insulin may also be necessary) Weight reduction Exercise and weight reduction often result in improved insulin sensitivity and may reduce the need for drugs

Potential causes of iron deficiency:

Inadequate intake (dieting) Lower bioavailability Intake of factors that interfere with absorption Avoidance of meat Increased requirement Repeat pregnancies Growth in toddlers, children and adolescents Increased loss Heavy menstrual losses (2-30 mg) Long distance runners and "footstrike" Intestinal blood losses (ulcers, parasites, diverticular disease)

Metabolic syndrome:

Incidence rose with age, peaking at 65 years old - Risk of developing it increases if pre-diabetic or diabetic Cognitive impairment and physical disability common amongst population with it aged 60+

KIDNEY DISEASE

Includes urinary tract infections, kidney stones, chronic pain and a decreased function of the kidneys. Kidneys are filters, x2 of them. They produce renin, controls blood pressure Early detection of kidney disease can help lengthen the life and efficiency of the kidneys. Annually in Australia, >500 000 people go to the GP with UTI's and for kidney dx. 1/3 adults are at ↑ risk of developing chronic Kidney Disease (CKD) and 1/10 show some signs of CKD. In a lifetime, a third of women and 10% of men will get a bladder infection and 1/35 women will get kidney stones.

Role of Vitamin D in calcium metabolism

Increase vitamin D to increase Ca absorption Adequate vitamin D is important Sun exposure Face and forearms (10-15 of sunlight a day is sufficient)

Widening of food selection - native Australian foods

Industry boom - ecologically sound and are resistant to temperature and rainfall Grow naturally in country 5000 native food species are used with special preparation methods Until 1990s the only commercially cultivated Australian native food was the macadamia nut

Gut disorders and nutrition

Inflammatory bowel disease - Diverticulosis:

Minerals:

Inorganic elements essential to the functioning of the human body and are obtained from foods Calcium Iron Magnesium Zinc Iodine Trace elements: chemical elements required in minute quantities by organisms in order to maintain proper physical functioning.

Forms of calcium in food

Inorganic salts (e.g. tablet) E.g. carbonates and phosphates (poorly absorbed) Complexes with acids in plant foods Phytic acids (in cereals and legumes) Oxalic acid ( in spinach, rhubard, beetroot and tea) Poorly absorbed Inhinbit calcium intake Complexes with casein proteins (milk protein) Well absorbed by body

TYPE 2 diabetes Characteristics:

Insulin levels may be elevated as -cells produce more insulin in an attempt to overcome the insulin resistance -cells may become "exhausted" and die Glucose builds up in the blood (hyperglycaemia) Some glucose appears in urine (glycosuria) Symptoms come on gradually (usually after age 50 years) Often no symptoms (diagnosed after a blood glucose test)

Other measures: Iron: - tests:

Iron level test Measures the amount of iron in the blood plasma. Total iron-binding capacity (TIBC) test Measures the amount of iron that the blood would carry if the transferrin were fully saturated Transferrin test The transferrin test is a direct measurement of transferrin levels in the blood Ferritin test The ferritin test measures iron stores Ferritin is a buffer (a protein)

Overdose of Vitamin C:

It is possible to have too much. Nausea, abdominal cramps, diarrhoea Decreases effect of prescription medications like certain blood thinning drugs (Wolfram -Coumadin!) Increases risk of kidney stones in people with kidney disease or a hx of kidney stones → precipitate further formation Safe upper limit - stick to 1000mg

ethnology causes of unhealthy eating

Junk food: Quick and fasting eating: Portion sizes are increasing: Other issues: Loss of trust in food supply Confusion about what to eat Food 'scares' e.g. permeate in milk, eggs having high levels of cholesterol Expert opinion changing Wildly-opposing philosophies e.g. paleo, veganism, no sugar, wholefoods, raw foods New trends: (positive) Shunning mass-production Avoiding additives & 'processed' foods Farmers' markets, buying direct Slow Food movement (slow cooker) Growing your own, kitchen garden Eating locally-grown - "locavore", 100-mile dinners Buying in season

American dietary guidelines:

Key recommendations are the focus and portion control Eat the following foods: Vegetable variety from all subgroups (dark green, red and orange, legumes, starchy and others) Fruits (whole fruits) Grains (whole) Fat-free/low-fat dairy including milk yoghurt cheese/fortified soy beverages Variety of protein foods including seafood, lean meats and poultry, eggs, legumes, nuts, seeds, soy products Oils Have quantitative amounts Break into calorie amount on daily basis Added sugars (< 10%) Saturated fats (< 10%) Sodium (< 2.3g) → this is indicative of American high salt diet. In Australia, the recommendation is much lower Alcohol → in Australia, don't impose a limit for fear of psychological thinking that drinking more is sufficient

Best legumes, vegetables and fruit (low GI)

Kidney Beans, Soy Beans, Chickpeas, Split Peas, Lentils, Baked Beans (dried and canned) Sweet Corn, Taro, Yam, Carisma Potatoes, Nicola Potatoes, Parsnips Apple (fresh and dried), Apricots (fresh, dried, canned), Banana, Grapes, Kiwi Fruit Mango, Nectarine, Orange, Peach, Pear (fresh, dried, canned), Plums, Grapefruit

non haem sources of iron

Kidney beans (2.2mg/100g) Soybeans (5.1mg/100g) Lentils (3.3mg/100g) Tofu, firm (2.7mg/100g) Cooked spinach (3.6mg/100g) Raisins (1.9mg/100g) Wholemeal bread (2.4mg/100g) Molasses (4.7mg/100g) Pinto beans (2.1mg/100g) Navy beans (2.4mg/100g)

Kidney cancer:

Kidneys part of the urinary system. More common in people >55 yo. Affects more men than women. If both kidneys are removed, need to be on dialysis Biggest nutrition related risk for kidney cancer is being obese or overweight. Central obesity, i.e. visceral fat. Treatment for kidney cancer is surgical

Nutritional value of alcohol

Kilojoule dense and nutritionally empty One standard drink = 27kJ per gram = 10 g of alcohol = at least 270 kJ Higher alcohol content - higher kilojoule content

Cholesterol and triglycerides (TGs)

LDL vs HDL LDL can block arteries. Saturated fats: animal products and processed products The liver makes cholesterol naturally but most of it comes from our diet. Triglycerides are also made by the liver and come from the diet. They can increase if alcohol intake is higher than recommended. Insulin resistant people are likely to naturally have high TGs. High TGs go hand in hand with low HDL levels. Increased risk of heart disease with raised TGs and reduced HDL levels, get atherosclerosis.

haem sources of iron

Lean beef chuck roast (2.9mg/100 g) Dark turkey meat (2.3 mg/100 g) Chicken meat (1-1.3 mg/100g) Tuna (Bluefin) [1.3 mg/100g] Halibut (1mg/100g) Pork chops (loin) [0.9mg/100g] White tuna (canned) [1mg/100g]

WAIST TO HIP RATIO

Least risk: WHR <0.9 for men WHR <0.8 for women Different body "types" (fruit analogy - pear or apple) Desirable to be "pear" shaped as it means fat is not concentrated in the visceral regions that are associated to many metabolic diseases.

Sources of probiotics from diet:

Legumes Whole wheat products Chicory root which contains inulin Rye based foods Artichokes Onions Cabbage Garlic Bananas Honey Leeks Fortified foods

Lifestyle changes:

Less refined carbs More fibre Lean protein at each meal Go for good fats Rev up the exercise Quit smoking

Statistics in AUS on nutrition diseases:

Life expectancy in Australia for a boy born in 2012 was 79.9, and for a girl, _84.3 years. Life expectancy in Australia has risen by more than 30 years since the late 1800's. - better health care systems, medicines Indigenous life expectancy is still lower than that of Caucasian population In 2012, babies born in the Australian Capital Territory enjoyed the longest life expectancy of any state or territory in Australia. The Northern Territory had the lowest life expectancy. Over the last 2 decades, Australia has consistently ranked in the top 10 of OECD countries for life expectancy at birth

ADG Guideline 3:

Limit intake of foods containing saturated fats (a), added Salt (b), added sugars (c ) and alcohol (d). → triad foods Limit intake of foods high in saturated fat such as many biscuits, cakes, pastries, pies, processed meats, commercial burgers, pizza, fried foods, potato chips, crisps and other savoury snacks. (contains trans fats - causes CD and CHD) Replace high fat foods which contain predominantly saturated fats such as butter, cream, cooking margarine, coconut and palm oil with foods which contain predominantly polyunsaturated and monounsaturated fats such as oils, spreads, nut butters/pastes and avocado. Low fat diets are not suitable for children under the age of 2 years. Limit intake of foods and drinks containing added salt. Limit discretionary salt Read labels to choose lower sodium options among similar foods. Do not add salt to foods in cooking or at the table. Limit intake of foods and drinks containing added sugars such as confectionary, sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks. If you choose to drink alcohol, limit intake. For women who are pregnant, planning a pregnancy or breastfeeding, not drinking alcohol is the safest option.

Water Soluble (B group, C)

Limited stores Absorbed in water Excess mostly excreted in urine Overdose unlikely Heat-sensitive

Of the following cutoffs, which is the correct set that represents a low, medium and high level of energy in foods?

Low <600 kj medium is 600-1700 kj high is >1700 kJ

Eat to beat metabolic syndrome:

Low GI diet Low fat Lots of fresh fruits and vegetables Try to limit high sugar foods Lots of fibre Less alcohol No smoking Lots of exercise

modifiable risk factors

Low calcium intake Do little or no physical activity Area current cigarette smoker High alcohol intake Low body weight Frequently falling - weaken the structure of bones Vitamin D deficiency Low dietary intake of vitamin D Insufficient exposure to sunlight

Mediterranean diet pyramid:

Low in red meat → lower on saturated fat High in olive oil → monounsaturated fat → alpha linoleic acid Less water recommendation than Australia

Safe levels of cholesterol:

Measured through a blood test. Total cholesterol level, triglyceride levels, HDL and LDL cholesterol levels taken. Different levels are safe according to other risk factors. If no other risk factors, cholesterol level <5.5 mmol/L If other cardiovascular risk factors are present such as smoking, high blood pressure, pre-existing heart disease then LDL cholesterol < 2 mmol/L Approximately half the Australian population has a blood cholesterol level of 5mmol/L or more. This makes it a major health concern for the whole population.

eat less of

Meat pies, sausage rolls, hot chips Potato crisps, corn chips, salty snacks Processed meats (salami, bacon, sausages) Soft drinks, energy drinks, sports drinks Wine, beer, spirits Muffins, sweet biscuits, slices, muesli bars Lollies, chocolate Ice-cream and rich desserts

Which of these well known ways of eating is considered protective for heart health?

Mediterranean diet

Heart health:

Mediterranean diet -linoleic acid (ALA) - e.g. food fats, olive oil Fruits and vegetables Antioxidant action - eliminates free radicals (which form when the body is exposed to negative environmental factors) Prevent oxidative damage Soy foods Isoflavones (contain phyto-estrogen) and proteins Decrease lipids (blood fat levels) Antithrombotic (prevents clot formation) Decrease platelet aggregation Increase vascular activity - elasticity of arteries Not ideal for menopause women Wholegrains Soluble fibre decrease serum cholesterol, LDL cholesterol Low GI foods improve insulin sensitivity, insulin resistance linked to CHD Also helps with risk factors including BSL's, lipids, low HDL cholesterol and hypertension Active components are the phytoestrogens e.g. lignans such as enterodiol, enterolactone. Diphenolic compounds

Biochemistry of energy:

Metabolism of proteins, carbohydrates and fats different All macronutrients get broken down into smaller, most easily used parts Energy is used on a cellular level

New research: Journal of Gastroenterology

Mice studies have shown promising results linking gut flora to mental health. If the gut flora was disturbed in the mice the following changes were observed: They became less timid More adventurous Decreased the stress hormone, cortisol. Healthy mice were given antibiotics to disturb the balance of flora. Control groups were given water instead of antibiotics and showed no change in behaviour. Mice that did not have any gut flora and were given antibiotics showed no change either. Less anxious mice meant that they were less hesitant to step off a created platform and were more eager to explore. When gut flora was restored to normal, their behaviour went back to the way it was too. This has implications to new biotechnology E.g. emerging - fecal transplants

Best dairy (low GI)

Milk, Soy Drink, Yoghurt (low fat and diet), Frûche, Custard, Le Rice, Light Flavoured Milk

Modifiable and non-modifiable risk factors diabetes

Modifiable: Weight Lifestyle changes Health eating (portion control) Exercise Regular health checks Non-modifiable: Age Family history Gestational diabetes PCOS (polycystic ovarian syndrome) Ethnicity

Stomach cancer: (i.e. gastric cancer)

More common in people 65+ yo Falling rates maybe due to improved diets. Twice as many men than women affected. Stomach cancer incidence is high in people whose diet has lots of salty foods in it. Eg Japan. Most people diagnosed in the advanced stage. Treatment can control symptoms and the cancer itself. Diets high in preserved foods and salty foods increases the risk of developing stomach cancer.

Mouth cancer:

Mouth cancer usually starts in the cells lining the mouth. The most common sites are the lips, tongue and/or floor of the mouth. Cancer can also originate in the gums, cheeks, roof of the mouth, hard and soft palate, tonsils and salivary glands. Mouth cancer is easily cured if treated in its earlier stages. Increased risk amongst people >45yo and men are 2x more likely than women. Cigarettes and smoking Mouth cancer can metastasise if in bloodstream or lymphatic system. Tobacco accounts for 80% of risk. Nutrition related risks include Poor diet Regular and heavy alcohol consumption As with other cancers, treatment options often include surgery, radiotherapy, chemotherapy or if at end stage, palliative care.

What controls gut microbe growth?

Natural process. Gastric acid in stomach prevents growth or bad bacteria that may have been swallowed. Not 100% efficient, we still get food poisoning. People with low levels of gastric acid or none at all have high numbers of bacteria and not necessarily in balance. Bile also helps to kill of flora. Bacteria doesn't make its way back towards the stomach or beyond because of the action of peristalsis. The bacteria produce antimicrobial substances such as fatty acids and bacterocins that stabilise the population and helps to prevent pathogens from taking up lodgings.

hat to eat to aid growth: of natural bacteria (every few days)

Naturally occurring bacteria are found in fermented foods such as Yoghurt Buttermilk Aged cheeses Saurkraut Sourdough bread Miso Kimchi Tempeh (tofu) Kefir Kombucha Also can be taken in a supplement form. Not generally required daily, only when the balance is disturbed for example after taking a course of antibiotics or after drinking a lot.

Exercise and diabetes:

Need to be careful to watch for hypo's. Good idea to know the signs well, as the signs often get mixed up with commonalities of exercising such as sweating, feeling faint or feeling weak. Hypo's can go unnoticed until it gets serious. Still aim for at least 30 minutes a day for weight maintenance or 60-90 minutes a day for weight loss. Moderate to high intensity but not stupidly high. For your first few sessions, it is a good idea to test your blood glucose level before, during and after exercise, especially if you are on insulin or certain diabetes tablets that can lower blood glucose levels. Always carry quickly absorbed glucose such as jellybeans or glucose tablets in case your blood glucose level drops too low. Wear good quality, well fitting, closed-in footwear as recommended by your podiatrist. Start slowly, gradually increasing the pace and length of each session. Do not be physically active if you are unwell.

Complications of diabetes: Diabetes and lower limbs:

Neuropathy or peripheral nerve disease and blood vessel damage may lead to leg ulcers and serious foot problems → Lower sensitivity in the lower limbs This then may require amputation of limbs. (gangrene, amputation)

Anti-cancer foods:

New research shows that although genes are the biggest factor in developing cancer along with mutations of cells, luck still plays a part. Every piece of advice is cautionary. "May reduce risk", "will not necessarily prevent development of XYZ cancer". No food has been proven through scientific testing to cause nor cure cancer. SO...this is not a guarantee that you will never get cancer. Is healthy way to live in an attempt to control risk factors. Diet is not only important in aiming to prevent cancer but during treatment and in palliative care situations.

CKD and heart disease:

New research shows that they go hand in hand. Recap on function: they regulate water and salts in the blood and make hormones. Having CKD or KD increases heart disease risk in the following ways: High BP by regulating salt and fluid, producing renin. Regulates BP. Heart strain; excess fluid puts strain on the heart and can cause heart failure. Stiff arteries; the kidneys make a hormone that regulates the use of calcium and when not made, leads to calcified or stiff arteries and heart valves. Hyperlipidaemia; People with CKD have high LDL cholesterol, perhaps from disturbed hormone levels. This is big risk factor for CVD. Blood clots; the blood of CKD sufferers and kidney failure is prone to clotting. Clots block blood supply, can lead to heart attack and stroke. A clot in the kidneys can cause high blood pressure.

Prevalence of osteoporosis:

Non-gender discriminant (in males and females) One in two women, one in three men over age of 60 will have an osteoporotic fracture Women are at a greater risk because of hormonal changes that occur at menopause Oestrogen is important for maintaining healthy bones Oestrogen levels decrease at menopause, bones lose calcium and other minerals at a much faster rate (up to 5% per year)

Nutrients:

macronutrients micronutrients

Beating kidney disease:

Nutrition choices Eat lots of fruits and vegetables Lots of legumes Carbohydrate with low GI Grain based foods like pasta, noodles and rice Lean meat each week. Only small amounts of fatty or salty foods. LOTS OF WATER Minimise sugary drinks and soft drink Limit alcohol intake to no more than 2 drinks/day for males or one drink/day for women. Lifestyle choices Exercise and get/stay fit Five days a week minimum to raise heart rate (****) Medical checks

Diabetes:

Obsolete names: juvenile diabetes, IDDM, NIDDM Myths surrounding what causes it. Pre-diabetes precedes diabetes in diagnosis. Management includes a combination of drugs, injections and careful dietary control. Potential complications of diabetes are large as well as co-morbidities. The burden of diabetes in Australia is quite high Big costs to health care systems, quality of life, aged care burdens

Risk groups for deficiency in vitamin D:

Older people, particularly those who are ill or housebound with limited exposure to sunlight Those with a very dark skin colour, e.g. Maori and Pacific Islanders Those living in Tasmania or the South Island NZ during the winter People who are veiled for religious reasons Babies born to women who are vitamin D deficient themselves. People who are obese— vitamin D is absorbed by fat, so less will reach the bloodstream for the rest of your body

Risk factors for gestational diabetes include:

Older than 30 years of age A family history of type 2 diabetes Being overweight Aboriginal or Torres Strait Islanders cultural background Indian, Vietnamese, Chinese, Middle Eastern or Polynesian cultural background Gestational diabetes during previous pregnancies

Eat more of

Omega-3s Soluble fibre Beta-glucan (oats) - fibre supplements (psyllium husks) Oily fish, fresh and canned Seafood (salmon, herring, mackerel) Flaxseed

Which is one serve of vegetables?

One medium tomato One cup of salad vegetables raw Half a cup of cooked green or orange vegetables

People at risk of developing diabetes:

Over 45 years of age & High BP or high blood fats Overweight Inactive One or more family members has or had diabetes (family hx in type 2 means 2-6x more likely to develop it). Over 55 years of age Have heart disease or had a heart attack Have/had high blood glucose levels during pregnancy (gestational diabetes) Have pre-diabetes: Impaired Fasting Glucose (IFG) or Impaired Glucose Tolerance (IGT) IGT: 2 hours, take blood every 30 minutes Have Polycystic Ovarian Syndrome Over 35 years of age and are an Aboriginal or Torres Strait Islander (Indigenous Australians are 10 times as likely to have diabetes than other Australians . Over 35 years of age and from Pacific Islands, Indian subcontinent or Chinese background

Risk of hypertension:

Overweight Family History Age Smoking Stress Inactivity High alcohol intake High salt intake

Risk factors for liver disease:

Overweight (body mass index of 25-30) Obesity (body mass index above 30) Diabetes Elevated triglyceride levels. Eating excess energy. Alcohol abuse, rapid weight loss, malnutrition Metabolic syndrome, insulin resistance Sometimes even none of these apply...it just happens.

which is not a source of carbohydrates?

meat

Flora and IBS:

Paediatric IBS (irritable bowel syndrome) can be painful and quite tough on growth and quality of life. Study on treatment using a good bacterium, Lactobacillus rhamnosus GG (nicnamed LGG) can reduce how often children get abdominal pain and how bad it can be. The positive effects did not stop for weeks after the treatment had ceased. Suggests that the probiotics have a long-lasting effect. Can prevent complications down the line as the children hit adolescence and young adulthood. The longer the paediatric pain lasts, the more likely they are to have other disorders such as anxiety, depression and being a hypochondriac → Dr Ruggiero Francavilla (researcher), a gastroenterologist from the University of Bari in Italy.

TYPE 1 diabetes Characteristics:

Pancreases fails to produce insulin Glucose cannot be transported into cells and levels build up in the blood (hyperglycaemia) The body's cells cannot use glucose and begin to burn fats for energy Unless treated, dangerous chemical substances from the burning of fat accumulate in the blood (keto-acidosis - producing ketone bodies) As the brain runs solely on glucose, ketones are used instead (dangerous if prolonged) If left untreated: loss of consciousness potentially fatal *Insulin pathway is reliant on external insulin injections

for hypertension Eat more:

Potassium rich foods Choose 'no added salt' or 'salt-reduced' foods 6 weeks for taste buds to be accustomed Herbs, spices, chillies, lemon to flavour foods instead of salt Salt substitutes but not ones with sodium. Plant based foods

Reducing the risk of type 2 diabetes:

Prevent/treat overweight/obesity Be physically active (at least 30 min/day, moderate intensity) Ensure saturated fat intake is low (<10% total energy) Low fat dairy foods Lean cuts of meat Limit coconut products Regularly consume wholegrain cereals, legumes, fruit and vegetables

Cancer and nutrition

Prevention Types of cancer: mouth, tongue, oesophageal, tract, stomach, colon - passages that food travels through Carcinogenic compounds Repeat damage (e.g. GORD, gastric ulcers) Two phases: treatment and recovery Treatment: during cancer treatment (chemotherapy, hospitalisation, surgery) → disappearance of taste Appetite can be poor, Cachexia, Nausea, vomiting, Loss of taste Recovery Recovery of muscle mass (key nutrient of interest - protein) Nutrients to help with energy

Iron supplementation:

Priority is always to maximise dietary iron content and availability and not resort to supplementation Increase consumption of dietary iron sources Enhance absorption of iron from these foods

Liver: bile production

Produces alcohol dehydrogenase Rids the body of toxins, regulates blood sugar levels and produces bile and cholesterol Cells of the liver Hepatocyte (compose the liver) Kupffer cells (immunity cells) Liver is essential for survival - survive for a maximum of 24 hours

Key nutrients in meat, fish, poultry, and eggs:

Protein Iron Zinc Vitamin B12 LC-omega-3

Health and growth resultant of:

Proteins - macro, Fats - macro, Carbs - macro Fibre, Vitamins, Mineral, Water Phyto-chemicals - include the vitamins and antioxidants

Function of calcium:

Provides rigidity to the skeleton Initiates contraction of muscle fibres Involved in nerve function Involved in the activity of some enzymes Co-factor for enzymes in the blood clotting cascade (calcium, vitamin K, fibrinogen)

Withdrawing:

Recommendations if > 8 drinks/day, discuss strategy with a doctor as medical treatment may be needed

Enhancements to iron absorption:

Reducing agents (e.g. Vitamin C: reduces Fe3+ → Fe2+) Presence of animal proteins Pre-existing iron status - if low, will increase absorption

Functions vitamins:

Regulate the body's metabolism Act as enzymes or co-enzymes and as antioxidants (A, C, E) Part of the structure of proteins, hormones and blood Prevent deficiencies from occurring (Scurvy, beri beri, pellagra, rickets)

MACRONUTRIENTS CARBOHYDRATES:

Regulated in the body by insulin (released by pancreas → blood system → stores it as glycogen or as energy) Used in the Krebs cycle Most basic form of energy used by the body Other carbohydrates: fructose (fruits - high GI), glucose, galactose (lactose + lactose - found in milk), sucrose (high GI), maltose, white sugar, caster sugar, muscovado sugar (extra nutrient) High GI carbohydrates - do not overconsume

Complications of diabetes: Diabetes and eye disease:

Retinopathy (decay in eye health) is a major long-term complication of diabetes. It affects about 1 in 4 people with diabetes. The development of retinopathy is strongly related to the length of time diabetes has been present and the degree of blood glucose control. Increased ocular pressure → strain on eyesight Regular eye checks and treatment can help prevent retinopathy-caused blindness.

Canadian guidelines:

Rich in protein More carbohydrates Low fat diary

Vitamin D deficiency and toxicity

Rickets - bowing of legs, bone softening Osteoporosis - brittle bonds, risk of fractures Bone softening - rickets Winter months and cold/snowy country Toxicity - possible to over consume from supplementation UL: 80 μg per day or 3200IU (hard to achieve)

For hypertension Eat less:

Salt Processed foods Take-away foods Deli meats Chips Cheese Sauces (esp. Asian) Alcohol Max 2 drinks per day with some free days

Types of fats

Saturated = Monosaturated - Polyunsaturated - Trans fats -

Vitamin C deficiency:

Scurvy Onset of symptoms depends on use of body stores Early symptoms: Generally feeling unwell, fatigue, loss of appetite, nausea, diarrhoea, fever, painful joints and muscles, small pinpoint bleeding around hair follicles Late symptoms: Swollen and purple gums that bleed, loose teeth, bulging eyes, scaly skin, slow healing wounds, very dry hair that curls and breaks off close to the skin, bleeding into the joints and muscles that causes swelling over the bones of legs and arms.

Effect of alcohol - short and long term

Short term: dehydration Brain damage, loss of memory, hallucinations, fits, dementia Poor control of diabetes -> hypoglycaemia (due to high sugar alcohol levels) Loss of muscle Enlarged muscle, high blood pressure, irregular pulse Ulcers, gastritis, vomiting blood Pancreatitis Swollen liver, hepatitis, cirrhosis Impotence in men, infertility

Dehydration

Signs of mild dehydration Headache Felling tired Light headed Skins loses its plumpness and becomes flushed Signs of moderate hydration General weakness Rapid heart rate Inability to think clearly Signs of severe dehydration Muscle cramps Failing kidneys *bright yellow urine: sport supplements, vitamin B

WAIST MEASUREMENT

Simple measurement Differentiates between subcutaneous fat and visceral fat Looks at type of fat (visceral) Takes into account of ethnicity Better predictor of risk of cardiovascular disease, stroke, high blood pressure and type 2 diabetes From the Measure Up campaign.

lifestyle influences factors

Social reasons Cultural Customs and traditions Food trends Diets Seasonal Advertising Convenience

the differences between insoluble and soluble fibre?

Soluble fibre is easily digested by bacteria in the colon whereas insoluble fibre is less readily fermented. Although both types are beneficial for health, only soluble fibre will have a protective effect against heart disease and diabetes. Soluble fibre forms a gel in the gut whereas insoluble does not form a gel.

Dietary problems and disease:

Some diseases linked to diet include: Heart disease High cholesterol High blood pressure Metabolic syndrome Alcohol

MYTH: Eggs and cholesterol:

Some healthy whole foods contain dietary cholesterol which has no adverse effect on blood cholesterol levels and can be eaten as part of a healthy well balanced diet. Eggs contain 11 important vitamins and minerals, is a great source of protein and has only a small amount of saturated fat (1.7g). The Australian Dietary Guidelines maintain that the everyday consumption of eggs is not associated with an increased risk of coronary heart disease3.

Link between Cancer and nutrition:

Somewhat of an under-reported link between the food that we eat and cancer. Food can not only be useful to help someone recover from cancer but is important in prevention as well.

Serves of milk, yoghurt and cheese (low fat dairy)

Standard serve: 1 cup (250ml) fresh, long life, reconstituted powdered milk or buttermilk ½ cup (120ml) evaporated milk 2 slices (40g) or a 40g wedge of hard cheese ½ cup (120g) ricotta cheese ¾ cup (200g) yogurt 1 cup (250ml) soy or rice drink with added calcium

Serving sizes of meat, poultry, fish and eggs:

Standard serve: 65g cooked lean red meats such as beef, lamb, veal, pork, goat or kangaroo (90-100g raw) 80g cooked lean poultry such as chicken or turkey (100g raw) 100g cooked fish fillet (~115g raw) or one small can of fish 2 large (120g) eggs Vegetarian alternatives: 1 cup (150g) cooked or canned legumes/beans such as lentils, chick peas or split peas 170g tofu 30g nuts, seeds, peanut or almond butter or tahini Rule of thumb: eat the size and thickness of the palm

Carbohydrate breakdown

Starch (indigestible fibre) 24%, Sugars 20% Of sugars (natural and added): Fruit (16%), soft drink & flavoured mineral waters (9.7%), dairy milk (8.1%), F&V juices (7.5%), sugar/honey/syrup (6.5%), cakes and sweets (5.8%).

Exercising with diabetes:

Stay well hydrated. Drink enough water to avoid thirst and remember you will need a bit more than usual while being active. Check your feet after exercise or at least once a day looking for signs of redness, blisters, cracks and calluses. If your feet perspire, change your socks after activity. Physical activity can lower your blood glucose level for up to 48 hours afterwards, so check your blood glucose levels often after exercise. You might notice a temporary rise after activity. This rise varies between individuals and is due to the release of hormones during periods of intense muscle activity.

Brain function and flora:

Stephen Collins, of the Farncombe Family Digestive Health Research Institute at McMaster University in Ontario, Canada makes some interesting suggestions: Perhaps the bacteria are producing chemicals that can access and influence the brain itself. If this carries over to humans, there is a role of gut flora in human behaviour. Gut flora therapies that aim to restore normal balance and flora such as probiotics can help stabilise mood swings and change behaviour patterns in people who have gastrointestinal diseases. British study on 45 healthy people, aged 18-45 year olds split into two groups. Prebiotic or placebo given. Measured the processing of emotional information including positive and negatives words. Less focus on -ve, more on +ve words, lower levels of cortisol. Note: study was partially funded by organisation that makes prebiotics.

What is the action of the hormone glucagon, made by the pancreas?

Stimulates the liver to convert glycogen into glucose

Bristol chart

Stool can inform us of gut health Factors: Colour, how easy they pass, consistency Helps to diagnose disease and sates of stress E.g. type 1 - insufficient fluid Type 4 is the most desirable

Fat Soluble (A, D, E, K)

Stored in the body Need to be absorbed with food Excess is stored Overdose can occur Stable during cooking and processing

type 1 diabetes symptoms

Sudden onset (during childhood/adolescence) Markedly raised blood glucose levels Feeling constantly thirsty Passing urine frequently, including bedwetting Excessive hunger Blurred vision Unexplained weakness and fatigue Weight loss (major difference between Type 1 and Type 2) Nausea and vomiting

BLOOD SUGAR TESTS

Test may be either A fasting test (no food or fluid except water overnight) Random test taken anytime during the day or Oral glucose tolerance test HbA1C - protein in blood, tests for diabetes >6.5% → diabetes No symptoms and 2 abnormal BGLs on separate days Symptoms plus fBGL > 7 mmol/L or random BGL > 11.1 mmol/L Fasting blood glucose levels → used in diagnosis of diabetes

Management of GDM includes:

Testing for gestational diabetes usually occurs in the 24th-28th week of pregnancy and is diagnosed using a glucose tolerance test. Looking after gestational diabetes is important to prevent complications during pregnancy and childbirth. A healthy eating plan to meet the nutrition requirements of pregnancy and manage BSLs Regular physical activity to help your body's own insulin work better which can help manage BSLs Frequent blood glucose monitoring to try and keep BSLs in the target range for a healthy pregnancy Some women may also require insulin injections to help manage BSLs.

Other measures of health

Tests that measure cardiopulmonary health and cardiovascular fitness better than the BMI or set of scales.

AusDiab study:

The Australian Diabetes, Obesity and Lifestyle (AusDiab) study Baseline study in 1999-2000, five year follow up in 2005, twelve year follow up in 2012 with results published in 2013.

Nutrition related risk factors:

The following can increase risk of developing bowel cancer: Having ulcerative colitis for more than 8-10 years (inflammation) Diets high in red meat Diets high in processed meats Drinking too much alcohol (> 12.5 units/wk) Excess adiposity especially amongst men [Smoking]

Microbiology of the GI tract:

The large intestine contains many microbes that are important to the function and health of the GI tract. Microbes are found elsewhere in the digestive system but not as proliferative as the large intestine Each person will have a different type of bacteria that is important to their digestion. Technically called the" intestinal microflora". (use official name for dietary report) The environment in the bowel is an ecosystem in its own right. Individual person's microflora is different to another persons

Leading diseases:

The leading underlying cause of death was coronary heart --- diseaseaccounting for 11,733 male deaths and 9,780 female deaths. --- Split by gender: For males the next most common causes of death were lung disease (4,959 deaths) and cerebrovascular diseases (which include stroke). --- For females the next most common causes of death were cerebrovascular diseases, dementia and Alzheimer's disease. → often by a secondary consequence of Alzheimers e.g. infection, flu

Iron deficiency in Australia:

The most common nutritional deficiency n both developed and developing countries In Australia Women (8%) Menstrual losses, pregnancy, dieting Girls 99%) Increased requirements (menstrual losses, growth) Vegetarians (women: 27%, men 5%) Low Fe bioavailability in diet Men and boys (2%) Athletes (?) Dieting, increased losses through haemolysis (foostrike) *Footstrike haemolysis: causes anaemia due to repetitive and forceful striking during running -increased likelihood of haemolysis in blood vessels of the feet

micronutrients include

minerals vitamins -needed in small quantities

Good sources of the fatty acid ________ include fatty fish such as anchovies, mackerel, salmon, and sardines. (Be sure to write your answer as an abbreviation in all capital letters.)

monounsaturated, polyunsaturated

where does digestion start and end?

mouth > bowels

Throat cancer:

Throat cancer can originate in the oesophagus, larynx, thyroid gland or cells lining the pharynx. Risk factors for throat cancer include smoking and heavy alcohol consumption. Smokers who drink heavily are at even greater risk.

List of conditions linked to microbiome imbalance - too many "bad" microbes: (short term)

Tiredness Diarrhoea Headache and immune dysfunction

ADG Guidelines (2013): Guideline 1: (9-16 age)

To achieve and maintain a healthy weight, be physically active and choose amounts of nutritious food and drinks to meet your energy needs Children and adolescents should eat sufficient nutritious foods to grow and develop normally. They should be physically active every day and their growth should be checked regularly. Older people should eat nutritious foods and keep physically active to help maintain muscle strength and a healthy weight.

TYPE 1 diabetes Treatment:

To stay alive Type 1 diabetics, depend on up to four insulin injections every day of their lives Short acting insulin (2hours - regular injections) Long acting insulin (8 hours - sustained release of insulin) Blood glucose levels tested several times daily. Vital to monitor the complex interaction of food and exercise with insulin injections Diabetes "control" means keeping the blood glucose level as close to normal as possible (3-8 mmol/L) Measured using a blood glucose monitor The three elements of "control": 1). Food, 2) Exercise 3) Insulin

CHOLESTEROL AND TGs

Too much cholesterol in the blood causes fatty deposits to gradually build up in blood vessels. This makes it harder for blood to flow through, which can cause a heart attack or stroke. TG < 2.0 mmol/L HDL- cholesterol "good" > 1.0 mmol/L LDL-cholesterol "bad" < 1.8 mmol/L

waist measurement for women

normal: <80 cm increased risk: 80-87.9cm greatly increased risk: >88cm

waist measurement for men

normal: <94 cm increased risk: 94-101.9cm greatly increased risk: >102cm