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Alcohol In Depth: Alcohol Alcohols are chemical compounds characterized by a hydroxyl group In common usage, beverages containing ethanol made from fermented fruits, vegetables, or grains What Does One Drink Look Like? In Depth: Alcohol What is moderate alcohol intake? • A drink is defined as the amount of a beverage that provides ½ fluid ounce of pure alcohol • Proof is a measurement of alcohol content • Moderate alcohol intake is defined as the consumption of up to one drink per day for women, and up to two drinks per day for men In Depth: Alcohol Possible Benefits of moderate consumption include • Stress and anxiety reduction • Appetite improvement • Lower rates of heart disease • Possible lower risks for diseases such as diabetes, heart disease, and liver disease In Depth: Alcohol Concerns about moderate alcohol intake include • Women appear to be at higher risk for breast cancer • Increased risk for hypertension • Higher rates of bleeding in the brain • Increased risk of liver damage • Increased risk of Malnutrition • Relatively high Calorie content • Potential risk for adverse drug interactions Metabolism of Alcohol Myths About Alcohol Metabolism In Depth: Alcohol Types of alcohol abuse: • Alcohol abuse is excessive intake of alcohol • Binge drinking is consumption of five or more drinks per occasion • Alcoholism is a disease characterized by chronic dependence on alcohol In Depth: Alcohol Effects of alcohol abuse: • A hangover is a consequence of drinking too much alcohol; symptoms include headache, fatigue, dizziness, muscle aches, and nausea- dehydration is key factor in symptoms of a hangover • NO CURE FOR A HANGOVER • Even at low intakes, alcohol impairs reasoning and judgment • Alcohol poisoning is a potentially fatal metabolic state involving cardiac or respiratory failure • Alcohol abuse can lead to traumatic injury from falls, drownings, assaults, and traffic accidents Effects of Alcohol on Mortality Risk Effects of Alcohol on Brain Activity In Depth: Alcohol Effects of alcohol abuse: • When the rate of alcohol intake exceeds the ability of the liver to break alcohol down, liver cells are damaged or destroyed • Fatty liver is an early but reversible sign of liver damage • Alcohol hepatitis results in loss of appetite, nausea and vomiting, abdominal pain, and jaundice • Cirrhosis of the liver involves permanent scarring after years of alcohol abuse Cirrhosis of the Liver In Depth: Alcohol Effects of alcohol abuse: • Chronically high intake increases risk for • Impaired bone health • Liver damage • Malnutrition • Pancreatic injury and diabetes • Cancer • Abdominal obesity • Malnutrition Alcohol-Related Malnutrition In Depth: Alcohol Fetal and infant health problems include • Fetal alcohol syndrome (FAS), a set of serious, irreversible birth defects, including physical, emotional, behavioral, and developmental problems • Fetal alcohol effects (FAE), subtler consequences that may be exhibited later, including hyperactivity, attention deficit disorder, and impaired learning abilities Fetal Alcohol Syndrome (FAS) In Depth: Alcohol You should be concerned about your alcohol intake if you engage in binge drinking or drink at inappropriate times Speak with a trusted friend, coach, teacher, counselor, or healthcare provider Take this seriously! VIDEO - SLOPPY SPRING BREAK

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Designing a Healthful Diet, In Depth What Is a Healthful Diet? A healthful diet is • Adequate • Moderate • Balanced • Varied A Healthful Diet Is Adequate An adequate diet provides enough energy, nutrients, and fiber to support a person's health A diet adequate in one area can still be inadequate in another A diet adequate for one person may not be adequate for another A Healthful Diet Is Moderate Another key to a healthful diet is moderation A healthful diet contains the right amounts of foods for maintaining proper weight and nutrition A Healthful Diet Is Balanced A balanced diet contains the right combinations of foods to provide the proper proportions of nutrients A Healthful Diet Is Varied Variety: eating many different foods from the different food groups on a regular basis A healthful diet is not based on only one or a few types of foods Food Labels Nutrition Facts Panel Calorie Check: How Many Servings Are You Eating? Nutrient Claims on Food Labels The FDA has approved several claims related to health and disease If current scientific evidence about a health claim is not convincing, the label may have to include a disclaimer Structure-function claims such as "Builds stronger bones" can be made with no proof and therefore no actual benefits may be seen Dietary Guidelines for Americans • A set of principles developed by • U.S. Department of Health and Human Services • U.S. Department of Agriculture • Revised every 5 years (most recently in 2010) • Designed to • Promote health • Reduce the risk for chronic diseases • Reduce the prevalence of overweight and obesity Dietary Guidelines for Americans Key DGA recommendations: • Balance Calories to maintain a healthy weight • Reduce consumption of foods and food components of concern, such as: • Sodium • Fat (especially saturated) • Sugars • Alcohol • Increase consumption of healthful foods and nutrients • Follow healthy and safe eating patterns Comparing Nutrient Density The USDA Food Patterns: MyPlate MyPlate is intended to help Americans • Eat in moderation to balance Calories • Eat a variety of foods • Consume correct proportions of the recommended food groups • Personalize their eating plan • Increase their physical activity • Set goals for gradual improvement in their food choices and lifestyle MyPlate Graphic Spanish Language Version of MyPlate Mediterranean-Style MyPlate Mediterranean Diet Could Help Reduce Heart Disease Food Groups of the USDA Food Patterns The Concept of Empty Calories Empty Calories is a concept introduced in the USDA Food Patterns • Calories from solid fats and/or added sugars that provide few or no nutrients • GOAL IS TO LIMIT EMPTY CALORIES and Eat foods with COLOR Serving Size Examples Serving Size Examples Food Portions Have Increased Other Eating Plans The DASH diet • Dietary Approaches to Stop Hypertension • More details to come on DASH when we address Hypertension Eating Out as Part of a Healthful Diet Eating in restaurants often involves • High-fat foods • Large portion sizes A restaurant meal can be equivalent to the recommended fat or Calorie intake for an entire day! Nutritional Value of Fast Foods Eating Out as Part of a Healthful Diet Tips for restaurant meals • Avoid all-you-can-eat buffets, breaded and fried foods, and cream and cheesy sauces • Substitute an appetizer or children's portion for a large meal, or share an entrée with a friend • Order broth-based soups; salads with dressing on the side; lean cuts of meat, vegetarian dishes, and chicken or fish burgers; steamed vegetables instead of potatoes or rice; and beverages with few or no Calories • Don't feel you must eat everything you're served • Skip dessert or have fruit Menu Calorie Counts: How Accurate Are They? Crackdown on Food Labels: Many Not as "Healthy" as Claimed? Miscounting Calories: Surprising New Diet Food Report Blue Zones - Sardinian Diet Calorie Count: Eat by the Numbers

carb = 4 calorie fat= 9 calori protein= 4 calorie

Fats in FOOD and Lipids in BODY Dietary Fat different forms and sources Importance in cooking Taste 9 kcal/gam Lipids in the Body: different forms and storage for different body functions Importance health and wellness Essential fat soluble vitamins Excess storage in adipose tissue (impact on body composition) Why Do We Need Fats? Fat-soluble vitamins Vitamins A, D, E, and K are soluble in fat; fat is required for their transport Fat is essential to many body functions Cell membrane structure Nerve cell transmissions Protection of internal organs Insulation to retain body heat Why Do We Need Fats? Fat provides flavor and texture to foods Fat contributes to making us feel satiated Fats are more energy dense than carbohydrates or protein Fats take longer to digest Types of Dietary Fats Chemically there are different structures of fats in food - differ by degree of "saturation" Regardless of the saturation, the calorie value is the same, all dietary fats yield 9 calories/gram So---- Consider 2 concepts regarding dietary fats: • The total amount of fat (all dietary fat sources) in the diet • The sources of fat or types of fat in the diet Separately we will address: • dietary cholesterol, blood lipids and cholesterol • Omega-3 fatty acids vs. omega-6 fatty acids- importance in health Triglyceride (Triacylglyceride) Structure or form of fat in food structure or form of fat we store as "body fat" in adipose tissue (can be mobilized for fuel) TG is the form of fat we store in muscle for fuel EACH strand of the TG is a fatty acid: The fatty acid chain can be short or long, saturated or unsaturated Triglycerides- Form of fat we eat! Form of fat we store in body! Saturated vs. unsaturated Fatty acids -combinations of all types Major Sources of Dietary Fat Dietary fats in foods- plant and animal sources Saturated Fats Animal fats, solid fats Butter, stick margarine, lard, cream/whole milk fat, cheese Beef, pork, poultry Vegetable sources: coconut oil, palm kernel oil, and palm oil Unsaturated Fats Vegetable/plant fats, liquids, oils Monounsaturated Fats avocado, olive, nuts Coconut- HOT food trend Saturated, but....it's primarily medium chain fatty acids (MCTs) Populations with high coconut consumption- do not have the same high rates of atherosclerosis or lipid profiles Healthy when part of a diet high in antioxidants and omega-3 fatty acids Saturated Fatty acids (SFA) Within the body there are physiological and structural functions of saturated fats HOWEVER, the body has the ability to synthesize these, therefore there is NO ESSENTIAL need for these fats in the diet Strong evidence indicates higher intake of dietary saturated fatty acid is associated with higher levels of blood cholesterol and LDL cholesterol- both increase CVD risk. Recommendations: • <10% of total calories from SFA, replace with mono- and/or poly-unsaturated • <7% of total calories from SFA reduces risk of CVD further It's all very complicated, not all saturated fats are the same, and a goal is to help reduce the fear of eating fat. We do need to eat dietary fat! Major sources of SFA in American diet Regular/Full fat cheese Pizza Desserts- grain based and dairy based Chicken and chicken-mixed dishes Sausage, hotdogs, bacon, ribs Recommendations: Lower use of solid fats in cooking and food preparation- use oils in place of butter, stick margarine, lard Choose lower fat milk and dairy products Trimming fat from meats Choose Leaner cuts of meat Reduce consumption of fried foods Reduce amount/portion/frequency of higher SFA foods, ie: can still enjoy pizza but can reduce number of slices or reduce frequency per week/month and not eat pizza same day as burgers and fries! Not all Saturated Fats are the Same The chain length matters in effect on LDL and sub-fractions Butter and Dairy Fats most strongly INCREASE LDL Beef Fats increase LDL, but not as high as butter/dairy Cocoa Butter- slight increase in LDL Coconut Fat- (medium chain length) - atherogenic in animals based on total serum cholesterol, BUT seem to increase HDL, and not consistent evidence in humans with cholesterogenic effect MORE research in this area is needed (hard to separate the types of saturated fats from whole when looking at real food and meals) Cis and Trans Polyunsaturated Fatty Acids: Not all UNsaturated fats are healthy Trans Fat and CHD Fats and CHD: Application An article discussed that contrary to fad diets in the '80s and '90s, it is not beneficial to decrease overall fat consumption by increasing intake of carbohydrates because levels of both LDL and HDL decrease. (In the Nurse's Health Prospective Study) :Saturated fat was only weakly and non-significantly associated with risk of CHD, which is consistent with its lack of effect on the total cholesterol:HDL ratio" (ONE study, lot of controversy) If this is the case, why is it still important to discuss the need to decrease saturated fat intake but to maintain intake of unsaturated fats? Why is it crucial to discuss the relationship between saturated fat intake and CHD? How to make a healthy heart Dietary Fats and CHD: Simple case A friend with family history of CHD risk claims he read online the body makes fats naturally. This has lead him to think he doesn't have reduce his fat intake because "his body is used to fats." How would you explain the flaw in your friend's reasoning? Fats and CHD: More application An article explains that modest reductions in CHD can occur if one reduces the amount saturated fats he/she consumes. What would you advise to reduce amount of saturated fat intake? Your audience is not convinced that altering their diet can decrease their risk of CHF. How might you explain the link between fatty foods and CHF? Dietary Fat and Health We know strong evidence for dietary fats associated with cardiovascular diseases - heart, stroke Saturated fats and processed meats are also associated with risk for colorectal cancer, prostate cancer, and breast cancer- evidence ins mixed, but meats are often the most commonly associated with risk. often these foods replace healthier options, such as high fiber foods and plant sources, that would be protective Higher body fat contributes to vascular and metabolic diseases- especially when fat accumulates in the liver and around the visceral organs (internal fat) Dietary Fat and Nonalcoholic Fatty Liver Disease Nonalcoholic Fatty Liver Disease In the U.S. NAFLD is the most common form of chronic liver disease. ~ 80-100 million people. Liver inflammation- may progress to scarring and irreversible damage (similar to cirrhosis or damage from excessive alcohol use) Every age group is at risk: 40-50 y.o. who also are at higher risk for CVD, T2DM, and obesity are a group of concern. NAFLD is associated with metabolic syndrome Cluster of problems that arise from abdominal fat, impaired insulin function, hypertension, high TG levels Dietary Fat and Alzheimer Disease Saturated and trans-fatty acids positively associated with risk for Alzheimer Disease Intake of omega-3, omega-3, and other mono-unsaturated fats inversely associated with risk Upper intake level of saturated fat resulted in 2.2 times increases incidence of AD Fats and CHD: Application replacing saturated fats with monounsaturated and polyunsaturated fats has shown great benefits on improved health. Substitution of MUFAs for saturated fats reduces LDL but does not change HDL levels • What are some common foods that contain monounsaturated fats? • What are some easy, realistic ways to incorporate monounsaturated fats into your diet to replace saturated fats and trans fats? • The presence of an allergy to 1 or several type of nut(s) is fairly common, what are some ways that a person with this sort of allergy can incorporate monounsaturated fats into his/her diet? Essential Fatty Acids What about Protective Fats? Essential Fatty Acids Essential fatty acids cannot be synthesized in the body and must be obtained in the diet Omega-6 and omega-3 fatty acids They are precursors to biological compounds called eicosanoids, which regulate cellular function Have a MAJOR role in inflammation and blood pressure Essential Fatty Acids Linoleic acid is found in vegetable and nut oils Alpha-linolenic acid (ALA) is derived from dark-green leafy vegetables, flaxseeds and flaxseed oil, soybeans and soybean oil, walnuts and walnut oil, and canola oil Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have important health benefits and are found in fish, shellfish, and fish oils Omega-3 Fatty Acids and Oxidative Stress N-3 FA has role in preventing oxidative stress- which is key to CVD (HTN and dyslipidemia), DM, Alzheimer's Disease, MS, mood disorders, arthritis related inflammation, etc etc. Fact or Fiction Omega 3 Edition Fact or Fiction? Our body can produce Omega 3's on its own, we don't need to consume them. Fiction The truth: Our bodies can't produce Omega-3's. Omega-3 is an essential fatty acid and essential fatty acids your body needs in order to function properly, but your body cannot effectively make these from other substances. Fact or Fiction? Omega 3's can help to reduce inflammation in the body and can help to reduce pain. Fact Research shows that omega-3 fatty acids reduce inflammation and may help lower risk of chronic diseases such as heart disease, cancer, and arthritis. Omega-3 fatty acids are highly concentrated in the brain and appear to be important for cognitive (brain memory and performance) and behavioral function. Fact or Fiction? All Omega 3's are the same Fiction The Truth: Not all Omega 3's are equal. There are 3 main types of Omega-3's: DHA, EPA, and ALA. DHA supports optimal brain and eye development and function and supports heart health. EPA also supports heart health. ALA is used (primarily) as a source of energy. Fact or Fiction? Eating fish is the best way to get healthy Omega 3's. Fiction The Truth: Fish and marine-based supplements are the only ways to get EPA and DHA, two important omega-3 fatty acids. However, walnuts, flaxseed, canola oil, soybeans and some other plant foods offer ALA, a third omega-3 fatty acid. All three types of omega-3 fats can be good sources. Fact or Fiction? Omega 3's or fatty acids cause weight gain. Fiction The Truth: All fats are fats - some are less healthy (saturated and trans fats), some are "protective" (Omega-3s). Regardless of the source, if you eat more calories than you need, you will gain weight. Some foods containing Omega-3 fatty acids (oils and nuts) can be high in calories. Moderation is still key and over-consumption does not equal improved health. Fact or Fiction? People with Rheumatoid Arthritis may have to take fewer NSAIDS to control joint pain and inflammation if they consume a diet with higher Omega 3's Fact An analysis of 17 randomized, controlled clinical trials looked at the pain relieving effects of omega-3 fatty acid supplements in people with RA or joint pain. The results suggest that omega-3 fatty acids, along with conventional therapies such as NSAIDs, may help relieve joint pain associated with these conditions. Pathways of fatty acids Dietary Polyunsaturated Fatty Acids N-3 Anti-Inflammatory Alpha-linolenic acid (ALA) EPA, DHA CVD and sudden death risk thru multiple mechanisms Major pathway in lowering BP Alters platelet function, inflammation endothelial cell function, arterial compliance, and arrhythmia Multiple other health benefits Nervous system development, mood disorders, inflammatory disorders, reduced oxidative stress pathways, and many other disease processes CVD risk, neurological function, inflammatory pathways, and immune diseases N-6 Inflammatory Decreases LDL and total cholesterol Precursor for eicosanoids (prostaglandins, thromboxanes, leukotrienes) RESEARCH: Omega-3 Fatty Acids Omega-3's are antiarrhythmic, antithrombotic, and anti-inflammatory. They can be used to treat hyperlipedimia, hypertension, and rheumatoid arthritis. In contrast, omega-6 fatty acids which are present in most seeds, vegetable oils, and meats, are pro-thrombotic and pro-inflammatory. Omega-3 and omega-6 fatty acids are essential because they are not synthesized by the body and must be obtained through diet or supplementation. Higher concentrations of omega-3 fatty acids are required to reduce elevated triglyceride levels (2-4 g per day) and to reduce morning stiffness and the number of tender joints in pateints with rheumatoid arthritis (at least 3 g per day). Reducing dietary intake of omega-6 fatty acids while increasing consumption of omega-3 fatty acids reduces the inflammatory mediators of RA and consequently allows some patients to reduce of discontinue the use of nonsteroidal anti-inflammatory drugs. Research: Omega 3 Fatty Acids in Inflammation an Autoimmune Diseases. There are at least 13 randomized controlled clinical trials that show benefit from fish oil supplements in patients with rheumatoid arthritis. A common feature of the studies has been a reduction in symptoms and in the number of tender joints. There was also a reduction in the does of analgesic anti-inflammatory drugs. In subsequent meta-analysis, morning stiffness was decreased as well as the number of tender joints Omega-3 and Exercise Omega-3 Fatty Acid in Foods Foods high in Omega 3's (Mix of ALA, DHA, EPA) Anchovies Cabbage Canola Oil Cauliflower Cloves Flax seeds & Flaxseed Oil Halibut Herring (Both Atlantic and Pacific) Mustard Seeds Oregano Oysters (Especially from the Pacific) Pumpkin Seeds Salmon (Especially Farm Raised) Scallops Soybeans & Soybean Oil Tofu Trout (Especially Lake Trout) Walnuts & Walnut Oil Brussels Sprouts Clams Cod Collard Greens Crab Green Beans Haddock Kale Lobster Pollock Romaine Shrimp Snapper Sole Spinach Strawberries Turnip Greens Winter Squash Omega-3 Polyunsaturated Fatty Acids Low CHD in Japan and Greenland thought to be related to high fish consumption Study: 250 mg/d EPA +DHA (1-2 svgs PER WEEK of oily fish) vs. no n-3 intake associated with 36% lower risk of CHD death Little benefit gained from higher intakes Supplements of ALA or plant based n-3 fatty acids do not show reduced incidence of CHD (what do people in non-fish access areas do?) Tough to study differences b/w supplements and fish consumption in populations when hard to quantify actual consumption and what best threshold is for reducing CHD (and other related chronic illnesses that benefit from n-3) Omega-6 Fatty Acids: Discussion Common food sources of linoleic acid in a typical American diet includes: chicken and chicken mixed dishes, grain-based deserts, salad dressing, chips (potato and corn), pizza, yeast breads, fried white potatoes, pasta, Mexican dishes, mayo, quick-breads, eggs, popcorn, sausage, franks, bacon and ribs. • Where is the Omega-6 coming from in these foods? Based on this information alone, do you think that linoleic acid would be of high nutritional value? N-3 and Triglyceride Reduction- Important for CVD Well documented relationship b/w fish oil consumption and lowering TG by both dose and baseline TG level <90 mg/dL TG- negligible effect from n-3, unless very high dose consumed >200 mg/dL TG treated with 4 g/d fish oil = 30% lower TG >500 mg/dL TG (risk for pancreatitis)- use of n-3 are adjunctive to nicotinic acid (niacin) and fibrates (chol lowering meds) Lovaza only recommended for pts with TG >500 mg/dL (see notes below) Omega-3 Fatty Acids and Cancer High fish intakes associated with reduced risk of breast and colorectal cancer EPA and DHA shown to reduce expression genes involved in colorectal cancer A large review across several countries evaluating various types of cancer- no associations between plant and marine-derived n-3 fatty acids and incidence of cancer Omega-3 fatty acids and Nervous System DHA critical for nervous system development, esp. retina of eye Low n-3 in diet and plasma/RBC levels of DHA associated with several neurological and visual problems Higher intake of DHA or EPA showed lower risk of cognitive decline or verbal fluency- higher levels DHA assoc with reduced risk of all-cause dementia Recommendations for consumption do not differ from those based on CVD- currently DHA critical for neural development and function Dietary intake during pregnancy and lactation transfers from placenta and breast milk, respectively large longitudinal study reported verbal intelligence quotients were higher among children 6 mo- 8 yrs of mothers who consumed more than 349 g seafood per week during pregnancy than mothers who reported no seafood consumption Long term benefits of early exposure on later child development is uncertain Not recommended to supplement during pregnancy, lactation or infancy (other than use of infant formula) Recommendations 2 servings FISH per week (fatty fish) intake equivalent to 1 g/day of EPA and DHA for secondary prevention of CAD Supplements of EPA and DHA possible alternatives to fish consumption for secondary prevention Food Sources= 1 gm EPA and DHA in meal Omega-3 and Depression (Mood Disorders) Very cool area of research! Generally involves supplemental doses, beyond what can be achieved from food alone: therefore, medicinal/pharmacological Studies using EPA vs. placebo show: Adults with unipolar depression- highly significant improvement after 3 weeks of tx Children 6-12 y.o. with depression- highly significant effects on each rating scale measured (n-3 used as monotherapy) Adults with bipolar after 1 month- 8 of 10 subjects had 50% reduction on Hamilton Depression scores Bottom Line for Omega-3's All Good- SO many health improvements associated with omega-3 fatty acids Eat more! Transition: Lipids in the body 3 classes of lipids • Triglycerides (tri-acyl glyceride= tag) • Phospholipids • Sterols Generally "fat" refers to triglycerides (tags) There are several critical functions/roles of lipids in the body. Phospholipids Sterols Sterols: lipids containing multiple rings of carbon atoms Essential components of cell membranes and many hormones Manufactured in our bodies (NOT ESSENTIAL) Cholesterol is the major sterol found in the body Cholesterol: The Good • High concentration of cholesterol in the brain (because it's part of cell membranes and myelin sheath around nerve cells) • Cholesterol in the membrane helps maintain cell "integrity" (cell is not fluid or mushy) • Helps cell signalling • Cholesterol is part of mitochondria and endoplasmic reticulum inside cells (energy production and protein synthesis, respectively) Cholesterol: The Good Brain cells can synthesize cholesterol (which is controversial because of alzheimer's) Cholesterol may be good for learning and memory- especially with connection to sleep. During sleep, cholesterol is needed to make myelin The brain contains 25% of the body's cholesterol (abundant) MYELIN- covers nerve cells to help conduction- synapses- which is critical for all other responses- movement, thinking, learning, etc. A large amount of cholesterol is part of myelin Cholesterol: The Good Precursor for: Vitamin D Other hormones progesterone, testosterone, estrogen Steroid hormones Bile (aids in fat digestion as you all know!) REMEMBER: Cholesterol is SYNTHESIZED in your body- YOU MAKE cholesterol to do good! Why Do We Need Fats? Energy Fat is very energy dense, providing 9 kcal/gram Much of the energy used during rest comes from fat Fat is used for energy during exercise, especially after glycogen is depleted Fat is also used for energy storage Fat Is Used for Energy During Exercise Diagram of an Adipose Cell How Much Fat Should We Eat? The Acceptable Macronutrient Distribution Range (AMDR) for fat 20%-35% of calories should be from fat Athletes and highly active people may need more energy from carbohydrates and can reduce their fat intake to 20-25% of total calories Some endurance athletes have "higher fat" days to boost calories and store intramuscular triacylglyceride for fuel Recognize the Fat in Foods Visible fats are those we can see in foods or can easily see have been added to foods, such as dressing or chicken skin Hidden fats are those added to processed or prepared foods to improve texture or taste, which we may not be aware of, or that occur naturally Read the Nutrition Facts Panel on foods carefully Lower-fat versions of foods may not always be lower in Calories, may have more sugar and more sodium What less dietary fat looks like in food In Depth: Cardiovascular Disease Cardiovascular disease (CVD) Dysfunction of the heart or blood vessels The most common forms: Coronary heart disease, or coronary artery disease Stroke Hypertension, or high blood pressure Peripheral vascular disease In Depth: Cardiovascular Disease Atherosclerosis is a disease in which artery walls build up lipid deposits and scar tissue, impairing blood flow The stiffness that results is commonly called "hardening of the arteries" The result is that the heart must work harder to push blood through the vessels In Depth: Cardiovascular Disease The Chemical Components of Lipoproteins Structure of a Lipoprotein Cholesterol: The Bad Cholesterol: The Bad Hyperlipidemia- both high blood cholesterol and high fat in the blood LDL- damages endothelial cells (along inside of artery) Macrophages attack the LDL- FOAMY (foam cells) LDL cells link together to form large fat deposit- fatty streaks Becomes fibrous (like a scab) Smaller diameter within blood vessel and wall is stiff (calcified) Ten-Year Risk for Cardiovascular Disease In Depth: Cardiovascular Disease Modifiable risk factors for cardiovascular disease include Diet Being overweight Physical inactivity Smoking Type 2 diabetes mellitus Inflammation in the body Abnormal blood lipids Maintaining blood pressure In Depth: Cardiovascular Disease Hypertension= High Blood Pressure is a major chronic disease in the United States HUGE warning sign for risk of stroke and cardiovascular disease For many people, hypertension is hereditary; for others, it can be induced through poor nutrition and exercise habits or a combination of poor habits and heredity The DASH Diet Plan: see link below in notes On Call: Tips to Raise Good Cholesterol

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Plant-Derived Energy Nutrients In Depth: Diabetes What Are Carbohydrates? Carbohydrates MACROnutrient Carbon, hydrogen, oxygen An important energy source, especially for nerve cells, muscles, brain What Are Carbohydrates? Glucose The most abundant carbohydrate Produced by plants through photosynthesis The preferred source of energy for the brain An important source of energy for all cells Photosynthesis: Why plant sources are carbohydrates What Are Carbohydrates? Simple carbohydrates contain one or two molecules Monosaccharides contain only one molecule Glucose, fructose, galactose, ribose Disaccharides contain two molecules Lactose, maltose, sucrose -OSE on the end of the word indicates chemically a SUGAR/CARBOHYDRATE Monosaccharides: Little Chemistry Disaccharides: little more chemistry Nutrient Content of Sugars Complex Carbohydrates: more chemistry Moving from SIMPLE to COMPLEX Complex Carbohydrates: In FOOD we call these STARCH Plants store glucose as polysaccharides in the form of starch Our cells cannot use complex starch molecules exactly as they occur in plants We digest (break down) starch into glucose Grains, legumes, and tubers are good sources of dietary starch Complex Carbohydrates: In our BODY we call these GLYCOGEN Animals store glucose as glycogen Stored in our bodies in the liver and muscles Not found in food and therefore not a dietary source of carbohydrate WE MAKE GLYCOGEN, WE DON'T EAT GLYCOGEN Complex Carbohydrates: another food source is FIBER Dietary fiber: the nondigestible part of plants Functional fiber: nondigestible form of carbohydrate with known health benefits, which is extracted from plants and added to foods Cellulose, guar gum, pectin, psyllium = You can see these regularly on ingredient list Total fiber = dietary + functional fiber 2 Classes of Fiber: Soluble and Insoluble Soluble fiber Dissolves in water Viscous and fermentable Easily digested by bacteria in the colon Found in citrus fruits, berries, oats, and beans Reduces risk for cardiovascular disease and type 2 diabetes by lowering blood cholesterol and glucose levels Insoluble fibers Generally do not dissolve in water Found in whole grains (e.g., wheat, rye, brown rice) and many vegetables Promote regular bowel movements, alleviate constipation, and reduce risk for diverticulosis We want to eat BOTH soluble and insoluble fiber to boost health! START PART 2 WHY Do We Need Carbohydrates? Energy! Fuel daily activity Fuel exercise Help preserve protein for other uses When diet does not provide enough carbohydrate, the process of gluconeogenesis converts proteins in blood and tissue into glucose- YOU NEED GLUCOSE! Carbohydrate Use by Exercise Intensity MORE ABOUT CHO ENERGY Each gram of carbohydrate = 4 kcal Red blood cells rely only on glucose for their energy supply Glucose is PREFERRED fuel source for brain and CNS Both carbohydrates and fats supply energy for daily activities Glucose is especially important for energy during exercise- especially high intensity and long duration type exercise More on CHO Energy Sufficient energy intake from carbohydrates prevents production of ketones as an alternate energy source Excessive ketones can result in high blood acidity and ketoacidosis High blood acidity damages body tissues KETONES are not a "normal" or healthy state for the body- these are "emergency" back up sources only when the body is in need and it is not the preferred fuel source for the body. Why Do We Fiber? May reduce the risk of colon cancer Promotes bowel health by helping to prevent hemorrhoids and constipation May reduce the risk of heart disease May enhance weight loss May lower the risk for type 2 diabetes Reduces risk for diverticulosis Provides feeling of fullness (satiety) Diverticulosis Fiber May Help Decrease Blood Cholesterol Digestion of Carbohydrates Most chemical digestion of carbohydrates occurs in the small intestine Recall: carbohydrate digestion begins in the mouth (saliva= salivary amylase) Pancreatic amylase Enzyme produced in the pancreas and secreted into the small intestine Enzymatically digests starch to maltose BREAKING DOWN COMPLEX TO SIMPLE CHO Digestion of Carbohydrates Additional enzymes secreted by cells that line the small intestine (mucosal cells) digest disaccharides to monosaccharides (simple CHO) These enzymes include maltase, sucrase, and lactase Monosaccharides are absorbed into the cells lining the small intestine and then enter the bloodstream= GLUCOSE Digestion of Carbohydrates Digestion of Carbohydrates Most monosaccharides are converted to glucose by the liver Glucose is released into the bloodstream to provide immediate energy Excess glucose is converted to glycogen and stored in the liver and muscles- more exercise builds more storage capacity Both liver and muscle have limited storage Excess above what the liver and muscle have capacity to store- can be converted and stored as fat in adipose cells (This is why some refer to carbohydrates as "fattening") The Process of Glycogenesis Regulation of Blood Glucose: Insulin A hormone secreted by the pancreas Transported in our blood throughout the body Helps transport glucose from the blood into cells Stimulates the liver and muscles to take up glucose and convert it to glycogen MANY other regulatory and signalling pathways by insulin (above is the basic overview) Regulation of Blood Glucose: Insulin Regulation of Blood Glucose: Glucagon Another hormone secreted by the pancreas Stimulates the breakdown of glycogen to glucose to make glucose available to cells of the body Stimulates gluconeogenesis—the production of "new" glucose from amino acids We don't want to make glucose from amino acids (proteins)= we want dietary and body protein to be used for tissue growth, maintenance, and repair. We want dietary and body carbohydrates to provide glucose. Regulation of Blood Glucose: Glucagon Glycemic Index: What is it and Why is it important? Glycemic index: a measure of a food's ability to raise blood glucose levels Foods with a low glycemic index cause low to moderate fluctuations in blood glucose Glycemic load: amount of carbohydrate in a food multiplied by its glycemic index Glycemic Index is ONLY a measure used in connection to blood glucose (it doesn't tell you anything else about the food, nutrient density, or "healthfulness) Example of Foods using Glycemic Index What does the Glycemic Index tell us? Foods and meals with a lower glycemic load Are generally helpful for people with diabetes Are generally higher in fiber (but not all higher fiber foods are low GI foods) May reduce the risk for heart disease and colon cancer Epidemiologically associated with a reduced risk for prostate cancer- SEE NOTES below Start Part 3 How Much Carbohydrate Should We Eat? 130 g per day is the MINIMUM NEEDED to supply the brain with glucose THE RECOMMENDATION IS: 45-65% of daily calorie intake should be in the form of carbohydrates Focus on foods high in fiber (25-38 gm/d) and low in added sugars (<25% of calories from added sugar) IMPORTANT DISTINCTION: The recommendation is NOT suggesting that 130 gm per day is adequate or sufficient. THIS IS THE MINIMUM YOUR BODY NEEDS for the brain, NOT The most appropriate amount overall How Much Carbohydrate Should We Eat? Most Americans eat too much added sugar Sugars are added to foods during processing or preparation Most common source is soft drinks Typical sources are cookies, candy, fruit drinks Unexpected sources include peanut butter, flavored rice mixes, salad dressing Added sugars are not chemically different from naturally occurring sugars, but have fewer vitamins Sugar- tastes nice, but not so nice to our body Sugars are blamed for many health problems Can cause dental problems and tooth decay No proven association with childhood hyperactivity; long-term effects not known Associated with increased "bad cholesterol" and decreased "good cholesterol" (linked to insulin resistance) Associated with a higher risk for diabetes Associated with obesity Metabolic Syndrome and Non-Alcoholic Fatty Liver Disease (high fructose, excess sugar, high fat) We need MORE fiber! Most Americans eat too little fiber-rich carbohydrates (avg ~ 15 gm/day) The Adequate Intake (AI) of fiber is 14 grams per 1,000 kcal in the diet daily (or 25 g for women; 38 g for men) Whole-grain foods (grains, vegetables, fruits, nuts, legumes) are much more healthful sources than foods with added sugar or fiber Whole grains are kernels that retain the bran, endosperm, and germ READ chpt for more details on "Whole" grains and how these differ from refined grains Fiber Content of Common Foods Alternative Sweeteners Nutritive sweeteners Contain 4 kcal energy per gram Sucrose, fructose, honey, brown sugar Sugar alcohols Contain 2-3 kcal energy per gram Have the benefit of a decreased glycemic response and decreased risk of dental caries Often cause diarrhea (esp when over-consumed) Non-nutritive (alternative) sweeteners Provide little or no energy Developed to sweeten foods without the usual risks Alternative Sweeteners No Acceptable Daily Intake (ADI) has been set for saccharin (e.g., "Sweet'N Low"), but it has been removed from the list of cancer-causing agents ADIs have been established for Acesulfame-k (e.g., "Sweet One," "Sunette") Aspartame (e.g., "Equal") Sucralose (e.g., "Splenda") Alternative Sweeteners In Depth: Diabetes Inability to regulate blood glucose levels Hyperglycemia—in which glucose levels are higher than normal—becomes chronic Different types Type 1 diabetes Type 2 diabetes Type 1 1/2 Gestational diabetes Impaired Glucose Tolerance Uncontrolled diabetes can cause infections, nerve damage, kidney damage, blindness, seizures, stroke, and cardiovascular disease, and can be fatal Type 1 vs Type 2 DM Symptoms of Diabetes Type 1 Diabetes Accounts for about 5% of all cases Pancreas does not produce insulin Characterized by high blood glucose levels One key warning sign is frequent urination Can lead to ketoacidosis, coma, death autoimmune disease with strong genetic link (tracks in families and with other autoimmune diseases) Frequently diagnosed in children and adolescents, but can very easily occur in young adults and adults Type 2 Diabetes Accounts for 90-95% of cases Develops progressively over time Body cells become insensitive or unresponsive to insulin (pancreas may be over producing insulin) Obesity and/or metabolic syndrome is common trigger; increasing incidence in younger age/kids Can occur in non-obese; older age Variations include insulin resistance, impaired fasting glucose, (and "prediabetes" - not a good term) Eventually the pancreas may become unable to produce any insulin Diabetes: who is at risk? Obesity, genetics, physical inactivity, and poor diet increase overall risk (not cause) Metabolic syndrome (high waist circumference, high blood pressure, high blood lipids and glucose= all associated with high blood insulin levels) increases risk for type 2 diabetes Increased age increases risk, but younger people and even children are now commonly diagnosed Diabetes: prevention and management Eat a healthful diet Daily physical activity healthful body weight Eating slightly fewer carbohydrates and slightly more protein and monounsaturated fats may help regulate blood glucose levels SHOULD get individualized diabetes and nutrition education from team of clinicians with expertise in diabetes education Diabetes: prevention and management Avoid alcoholic beverages, which can cause hypoglycemia (with medications/insulin)- excess empty calories, and unawareness Healthful lifestyle choices can prevent or delay onset of type 2 diabetes Oral medications and/or insulin injections may be required once diabetes has been diagnosed VERY glossed over simplified information here! Young Adults and Diabetes High Fiber Diet Grain Labels Do Not Reflect the "Whole" Truth Ditching Sugar How Much Sugar? Cutting Excess From Your Diet Jump Start Your Diet: Put More Fiber on Your Plate

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• Part 2 a) Review What are nutrients? b) Nutrient recommendations c) Overview of Nutrition Research • Six Groups of Essential Nutrients • Determining Nutrient Needs Dietary Reference Intakes (DRIs) identify the • Amount of a nutrient needed to prevent deficiency disease in healthy people • Amount of a nutrient that may reduce the risk of chronic disease • Upper level of safety for nutrient intake • The emphasis is to avoid UNDER and/or OVER consumption • The values are established to meet the needs of 97-98% of the population • Determining Nutrient Needs DRIs consist of four values • Estimated Average Requirement (EAR) • Recommended Dietary Allowance (RDA) • Adequate Intake (AI) • Tolerable Upper Intake Level (UL) • Determining Nutrient Needs • Determining Nutrient Needs: EAR Estimated Average Requirement (EAR) • The average daily intake level of a nutrient that will meet the needs of half of the healthy people in a particular life stage and gender group • Used to determine the Recommended Dietary Allowance (RDA) of a nutrient • Determining Nutrient Needs: RDA Recommended Dietary Allowance (RDA) • The average daily intake level required to meet the needs of 97-98% of healthy people in a particular life stage and gender group • Determining Nutrient Needs: AI Adequate Intake (AI) • Recommended average daily intake level for a nutrient • Based on observations and estimates from experiments • Used when the RDA is not yet established: calcium, vitamin D, vitamin K, fluoride • Determining Nutrient Needs: UL Tolerable Upper Intake Level (UL) • Highest average daily intake level that is not likely to have adverse effects on the health of most people (TOXICITY) • Consumption of a nutrient at levels above the UL is not considered safe • Determining Nutrient Needs: EER Estimated Energy Requirement (EER) • Average dietary energy (kcal/calorie) intake to maintain energy balance • Based on age, gender, weight (kg), height (cm), and level of physical activity (activity factor) • Determining Nutrient Needs: AMDR Acceptable Macronutrient Distribution Range (AMDR) • The range of energy intake from carbohydrate, fat, and protein associated with reduced risk of chronic disease • The range that provides adequate levels of essential nutrients • Interpreting Nutrition Research Part 3 • The Scientific Method • Types of Research Studies • Animal versus human studies • Drawbacks: ethical concerns, and results may not apply to humans • Observational studies • Can only indicate relationships between factors • Case control studies • Clinical trials • Clinical Trials In clinical trials, an intervention's effect on a certain disease or health condition is tested using two groups: the experimental group and the control group • Randomized trials • Single- and double-blind experiments • Placebo: an imitation treatment that has no effect, given to the control group in placebo-controlled double-blind randomized clinical trials • Evaluating Nutrition-Related Claims Ask these questions to determine scientific validity: • Who is reporting the information? • Who conducted the research? • who paid for the research (funding)? • Was the researcher paid to do the experiment/study? • Evaluating Nutrition-Related Claims • Is the report based on reputable research studies? Are the data available and published? • Was there a control and an experimental group? • Was the sample size large enough to rule out chance variation? • Was a placebo effectively administered? • Was it a double-blind study? • Is the report based on testimonials? • Are the claims too good to be true? • Determining a Website's Reliability Look at: • The website sponsors' credentials • Whether the date of the website is recent • The internet address: ".gov", ".edu", and ".org" are generally considered reliable • Whom Can You Trust? Trustworthy experts are educated and credentialed • Registered dietitian (RD) • Licensed dietitian • Nutritionist with credentials and experience • Professional with advanced degree(s) in nutrition • Physician with appropriate expertise in nutrition • Whom Can You Trust? Government agencies are usually trustworthy • The Centers for Disease Control and Prevention (CDC) supports two large national surveys • National Health and Nutrition Examination Survey • Behavioral Risk Factor Surveillance System survey • Numerous institutes within the National Institutes of Health (NIH) focus on specific areas of research, including cancer; heart, lung, and blood diseases; diabetes; and alternative medicine • Whom Can You Trust? Professional organizations publish cutting-edge nutrition research and information Examples include: • Academy of Nutrition and Dietetics • American Society for Nutrition (ASN) • American College of Sports Medicine (ACSM) • North American Association for the Study of Obesity (NAASO) • World Anti-Doping Agency (WADA)- supplements and sports related performance

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• The Human Body: Are We Really What We Eat? • Organization of the Body Atoms: the smallest units of matter • Atoms bond to each other to form molecules Molecules: groups of atoms bonded in specific configurations • Examples • Water is H2O • Carbon dioxide is CO2 • Organization of the Body Carbohydrates, proteins, fats, and vitamins are usually very large molecules The goals of digestion: • Break these large molecules down into smaller molecules • Absorb the smaller molecules into the cells of the body • Organization of the Body • Organization of the Body Molecules are the building blocks of cells Cells are the smallest unit of life • FOOD is composed of large MOLECULES • DIGESTION breaks the large molecules apart into smaller molecules • Our body BUILDS CELLS (body structures) from the smaller molecules • Organization of the Body Cell membrane: outer layer enclosing each cell of the body • Composed of two layers of phospholipids • Long lipid "tails" face each other toward the interior of the membrane • Phosphate "heads" line the interior and exterior surfaces of the membrane • Cholesterol and proteins are embedded in the membrane NOTE: cholesterol is NORMAL part of cell membranes and not always "bad"; TOO MUCH cholesterol in your bloodstream is harmful • Organization of the Body The cell membrane is selectively permeable= controls material moving inside and outside of the cell The cell membrane encloses the • Cytoplasm: the liquid within the cell • Organelles: tiny structures that perform many different cellular functions • Examples • Nucleus • Mitochondria • Representative Enterocyte • Organization of the Body Cells join together to form tissues Tissue: group of cells acting together to perform a common function • Examples • Muscle tissue • Nervous tissue • Organization of the Body Different tissues combine to form organs Organ: a sophisticated organization of tissues that performs a specific function • Examples • Stomach • Heart • Brain Organ systems: groups of organs working together for a particular function • Example • Gastrointestinal system • Why Do We Eat? Appetite is a desire to eat that is stimulated by • Sight • Smell • Thought of food Hunger is a physiologic drive to eat that occurs when our body senses that we need food • Regulation of Eating The hypothalamus region of the brain contains a cluster of nerve cells known as the feeding center and another cluster of cells known as the satiety center • Nerve cells in the stomach and small intestine sense food and send message to hypothalamus • Hormones relay messages to the hypothalamus • Amount and type of food consumed influence satiety • The Hypothalamus Triggers Hunger Physiological Need/Response • Regulation of Eating The signals that prompt us to eat include • Nerve receptors in the stomach-send signals to the hypothalamus if the stomach is full or empty • Blood glucose levels, which trigger the release of hormones called insulin and glucagon • Caution: insulin is critical, but it doesn't mean everyone has low blood glucose or hyperglycemia or can "feel" low blood glucose. (see notes) • Regulation of Eating Hormones: chemicals produced in specialized glands that travel in the bloodstream to target organs in other parts of the body • Some hormones stimulate hunger • Ghrelin • secreted when stomach is empty • When stomach full/stretch- decreased ghrelin release • Acts on hypothalamus to signal hunger and need to eat • Acts on GI tract to prepare for digestion • Some hormones produce a feeling of satiety • Leptin • Made in adipose cells, signals hypothalamus • Regulates energy balance • Works opposite ghrelin • Obesity= decreased sensitivity to leptin • Regulation of Eating Foods have differing effects on our feelings of hunger and satiety • Proteins have the highest satiety value • Carbohydrates have a lower satiety value than fats • Bulky foods provide a sense of satiety • Solid foods are more filling than semisolid foods or liquids • However, drinking water with meals (between bites) is a strategy to help reduce over consumption of food - provides sense of fullness with stomach stretch End of Part 1 • Start Part 2 • What Happens to the Food We Eat? Digestion and Absorption Gastrointestinal (GI) tract: series of organs arranged as a long tube through which the food passes The GI tract includes • Organs: stomach and intestines. Organs that assist: pancreas, gall bladder, liver • Sphincters: muscles that control the passage of material from one organ to the next • Lower Esophageal Sphincter (LES) = Gastroesophageal Sphincter- controls food moving down from esophagus INTO STOMACH. When forced open - stomach contents released UP into esophagus= "heart burn" or gastroesophageal reflux • Digestive System • Digestion: The Pathway After the food leaves the mouth it travels to the Esophagus. The esophagus propels food into the stomach • The epiglottis covers the opening to the trachea during swallowing • Food travels from the mouth to the stomach through the esophagus • Peristalsis is the muscular contractions moving food through the GI tract • The gastroesophageal sphincter (or LES) separates the esophagus from the stomach • Video of Chewing and Swallowing • https://www.youtube.com/watch?v=eYMZ81NUilk • Digestion: Peristalsis • Digestion: Stomach The stomach mixes, digests, and stores food Digestion in the stomach includes • Extensive mechanical digestion to mix food with gastric juice • Chemical digestion of proteins and fats (carbohydrate too, but not initial digestion) • Recall- carbohydrate digestion begins in the mouth • Digestion: Stomach Gastric juice contains • Hydrochloric acid (HCl): to denature proteins and activate pepsin • Intrinsic factor: a protein critical to the absorption of vitamin B12 • Pepsin: an enzyme to digest protein • Gastric lipase: an enzyme to digest fat Chyme: semisolid product of mechanical and chemical digestion in the stomach (this is the bolus of food that ends up in the small intestine) • Hydrochloric Acid on the pH Scale • Digestion: Small Intestine From the stomach, chyme is slowly released through the pyloric sphincter to the small intestine Chemical digestion continues in the small intestine using pancreatic enzymes and bile Bile- Made in Liver; Stored in Gall Bladder Necessary for digestion of fats/lipids Pancreatic Enzymes- needed for break down/digestion of carbohydrates, lipids, and proteins Bicarbondate released into small intestine at same time to neutralize stomach acid contents • Transit Time: food moving through digestion Start Part 3 • Digestion: Accessory Organs Surrounding the GI tract are several accessory organs: • Salivary glands • Liver: produces bile, which emulsifies fats • Pancreas • Produces many digestive enzymes • Produces bicarbonate to neutralize chyme • Gallbladder: stores bile • Absorption Absorption: the process of taking molecules across a cell membrane and into cells of the body A small amount of absorption occurs in the stomach (alcohol is absorbed from stomach) Most absorption of nutrients occurs in the three sections of the small intestine • Duodenum • Jejunum • Ileum • Digestion: Accessory Organs • Absorption The lining of the GI tract has special structures to facilitate absorption • Villi: folds in the lining that are in close contact with nutrient molecules • Brush border: composed of microvilli that greatly increase the surface area • Celiac Disease - autoimmune disease in response to gluten (protein) in small intestine- destroys (flattens) the villi- leads to MALABSORPTION and Malnutrition • Absorption • Absorption Water-soluble nutrients (carbohydrate, protein, minerals, and some vitamins) enter the portal vein • The portal vein transports these nutrients to the liver Fat-soluble nutrients (lipids and some vitamins) enter the lymphatic vessels • Lymphatic vessels transport these nutrients directly to the bloodstream • Transport by Blood and Lymph • Elimination Undigested food components move through a sphincter called the ileocecal valve to the large intestine In the large intestine • Very little digestion takes place • Material is stored 12-24 hours (or longer) prior to elimination • Water and some nutrients are absorbed (vitamin K) • Elimination • The Role of the Neuromuscular System Two components of the neuromuscular system regulate the activities of the GI tract • The muscles of the GI tract mix and move food • Both voluntary and involuntary muscles • Nerves control the contractions and secretions of the GI tract • The enteric nervous system (ENS) • Other branches of the autonomic nervous system • The central nervous system (CNS) Digestion and absorption are HIGHLY COORDINATED processes in the body • GI Tract Disorders- Examples The lining of the stomach is designed to cope with hydrochloric acid, but other regions of the GI tract are not Heartburn is caused by hydrochloric acid in the esophagus Gastroesophageal reflux disease (GERD) is a chronic disease for which painful, persistent heartburn is the most common symptom • Heartburn • GI Tract Disorders Peptic ulcers are regions of the GI tract that have been eroded by HCl and pepsin The bacterium Helicobacter pylori contributes to the production of both gastric and duodenal ulcers (NOT spicy food) - Can lead to stomach cancer - Can cause bleeding ulcers and further infection - Common infection, often occurs in childhood, many people have this without sx - CLEAN water and hygiene are key to preventing H.pylori • Peptic Ulcer • GI Tract Disorders Vomiting often accompanies a gastrointestinal infection such as the norovirus Cyclic vomiting syndrome (CVS) is a chronic condition involving severe nausea and vomiting that can last for hours or days • GI Tract Disorders Diarrhea can be caused by • Food intolerances • Infection of the GI tract • Stress • Bowel disorders • Can lead to severe dehydration • Is more dangerous for children and the elderly Constipation: no stool passed for two or more days • Signs and Symptoms of Dehydration • GI Tract Disorders Irritable bowel syndrome (IBS) is a disorder that interferes with normal colon function Symptoms of IBS include • Abdominal cramps and bloating • Either diarrhea or constipation IBS is more common in women than in men • GI Tract Disorders Cancer can develop in any region of the GI tract The most common forms are • Oral cancer (often linked to HPV) • Pancreatic cancer • Colorectal cancer

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• The Role of Nutrition in Our Health • What Is Nutrition? Nutrition: the study of food, including • How food nourishes our bodies • How food influences our health Nutrition is a relatively new discipline of science Nutrition research focuses on supporting health and preventing and treating chronic diseases • Nutrition Science- an overlapping and inclusive science • Biology • Anatomy • Physiology • Chemistry • Medical Science • Psychology • Sociology • Food Science • Consumer Science • Environmental Science • Math • What Is Nutrition? Nutrition involves study of the following: • Food consumption • Food digestion • Food absorption • Food storage • Factors that influence eating patterns • Recommended amounts of types of food • Food safety • The global food supply • How Does Nutrition Contribute to Health? Nutrition supports health and wellness Wellness: physical, emotional, social, occupational, and spiritual health Critical components of wellness • Nutrition • Physical activity • Wellness • Relationship between Nutrition and Disease • Leading Causes of Death in the U.S. • Increase in Obesity Rates • Healthy People 2020- Emphasis on Public Health Nutrition is a national goal The Healthy People plan, revised every decade, identifies goals and objectives to reach by 2020 • Healthy People 2020- Emphasis on Public Health Goals of Healthy People 2020 • Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death • Achieve health equity, eliminate disparities, and improve the health of all groups • Create social and physical environments that promote good health for all • Promote quality of life, healthy development, and healthy behaviors across all life stages • Six Groups of Essential Nutrients • Energy from Nutrients We measure energy in kilocalories (kcal) Kilocalorie: amount of energy required to raise the temperature of 1 kg of water by 1°C On food labels, "calorie" actually refers to kilocalories We'll use all three words interchangeably in class= Energy=kcal=Calories • Carbohydrates • Fats and Oils= Lipids Fats are composed of lipids, molecules that are insoluble in water • Provide 9 kcal per gram • Source of fat-soluble vitamins and essential fatty acids • Proteins Proteins are chains of amino acids • Can supply 4 kcal of energy per gram, but are not usually a primary energy source • Important source of nitrogen • Proteins Proteins are important for • Building cells and tissues • Maintaining bones • Repairing damage • Regulating metabolism • Fluid balance NOTE: all these vital body functions- Protein NOT intended to be used as energy/fuel source Protein sources include meats, dairy products, seeds, nuts, and legumes • Micronutrients Vitamins and minerals Vitamins: organic molecules that assist in regulating body processes Vitamins are micronutrients that DO NOT supply energy to our bodies • Fat-soluble vitamins • Water-soluble vitamins • Overview of Vitamins • Minerals Minerals: inorganic substances required for body processes Two groups of Minerals: Trace and Major Minerals are micronutrients that DO NOT supply energy to our bodies Minerals have many different functions, such as fluid regulation and energy production; are essential to bones and blood; and help eliminate harmful by-products of metabolism • Overview of Minerals • Water - a vital nutrient Water supports ALL body functions: fluid balance nutrient transport nerve impulses removal of wastes muscle contractions body temperature and many, many more...