NMT 100 Nutrition Lecture 1 (Week 11) PDF

NMT 100 COURSE Clin Nut Lecture I Introduction, History food guides and RDI Dr Ehab Mohammed ND LEARNING OBJECTIVES Examine the historical and cultural context of naturopathic therapeutics Compare and contrast different dietary guidelines Explain daily recommended intakes (RDIs) with consideratio...

NMT 100 COURSE Clin Nut Lecture I Introduction, History food guides and RDI Dr Ehab Mohammed ND LEARNING OBJECTIVES Examine the historical and cultural context of naturopathic therapeutics Compare and contrast different dietary guidelines Explain daily recommended intakes (RDIs) with consideration on the impact of patient care HISTORY AND CULTURE Global Nutritional crisis - Poor diet (meaning either deficiency or excess) - Food and diet disparities with inaccessibility of foods for poorer nations and an extra food availability in wealthy countries HISTORY AND CULTURE - Health care cost - Progressive rise of chronic illnesses ( such as DM, HTN and Cancer0 in the last few years. - Climate changes with loss of foods and many crops. HISTORY AND CULTURE National security : linked to the Progressive rise of chronic illnesses and so this would affect the country’s social stability for those who don’t have access to their daily nutrient needs HISTORY AND CULTURE - Nutritional science has developed tremendously over the last few decades. - What is needed now is the integration of the nutritional science and the policies so to apply the updated nutritional recommendations to everyone’s daily life. MODERN NUTRITIONAL SCIENCE - Early in the past century (sixties and seventies) All nutritional approaches were very reductionist (focusing only on single or a few items of food not everything) - For example: weight reduction was based on : Calculation of the energy in and energy out and trying to balance them MODERN NUTRITIONAL SCIENCE The major trigger for world’s interest in nutrition in the 20th century was WW II as this led to a significant need for nutritional support after war Crimes) MEANS TO IMPROVE NUTRITION PRACTICE 1- More Research 2- More Data and knowledge 3- Implementing a policy V I TA M I N C Initially discovered in 1932 Highly significant as it helps build collagen, connective tissues and bones NUTRITION FOCUS IN THE 1980S AND 1990S It was about the impact of nutrition on chronic diseases such as DM and hypertension The focus during that time was to limit the energy foods (carbohydrates rich (foods) and increase the protein rich foods Results: No much success in managing these chronic diseases and even it opened the door for more nutrients bases businesses to sell more protein and vitmain rich products especially to the 3rd world countries. FOOD INDUSTRY AND A C C O U N TA B I L I T Y Advertising Low nutritious foods can be a negative factor of your health N OT A L L DAIRIES ARE THE SAME Not all fats are the same Definition of double burden 1- Low nutrition problems 2- Over nutrition problems Fibres, minerals, vitamins, healthy fats, good protein C O N C LU S I O N Best foods to eat with high nutritional value are fish, nuts fruits vegetables plant oils and whole grains Foods to limit as they are least beneficial such as refined grains, sugars and processed meats. FUTURE DEVELOPMENTS Nutrient’s interactions. How do different nutrients (or supplements) interact & affect eachother Diet and microbiome: Most important Effects of diet composition rather than calories in weight gain. Influence of social status on nutrition and diet. Nutritional value of the calories you are taking in Diet Quality not quantity. Processing and additives including how the animal proteins come from (e.g grass fed versus grain fed beef/chicken). BEHAVIOR CHANGE IN NUTRITION Not only individual’s behavior (asking persons to pick the healthiest dietary options) but also from the food industry and regulators to support the healthier foods more then the less healthy ones. Avenues for behavioral changes / improvements are Research & innovation , Healthcare reform, economic incentives (e.g add more taxes to sugars and Salty foods etc), Schools (School meals standards), Worksite wellness, and Standards of food labelling. ie adding less taxes to healthy foods to get more people to buy it EXAMPLES OF THE HISTORIES AND DISCOVERIES IN NUTRITION FOLIC ACID: FIRST KNOWN TO PREVENT ANEMIA IN MONKEYS AND CHICKEN ESSENTIAL FOR BACTERIAL GROWTH. SPINA BIFIDA Nervous system development Extra folic acid to pregnant women! E X A M P L E S O F T H E H I S TO R I E S A N D D I S C OV E R I E S I N NUTRITION Vitamin B12: Findings of an intrinsic and extrinsic factors essential for its absorption. First discovered in the liver extracts Liver is the main storage site of B12 in the body. Cobalt gives the pink color of B12 Only animals can produce B12 We usually need a very small amounts of B12 daily (2.4 ug) E X A M P L E S O F T H E H I S TO R I E S A N D D I S C OV E R I E S I N NUTRITION B12 and folate together W/o the cobalamin from B12, the folate cannot donate the methyl group to the tissues needed They work in harmony (Cobalamin is a cofactor in the demethylation of MTHF molecule ) So B12 deficiency > functional Folate deficiency In Folate deficient patients you need to supplement them as well with B12 E X A M P L E S O F T H E H I S TO R I E S A N D D I S C OV E R I E S I N NUTRITION Niacin is in almost every type of food we eat, so not common to have B3 deficiency Niacin (B3) Its deficiency causes ( 4 Ds) Dermatitis (inflamed, dry skin), diarrhea, dementia, death Was thought that it is caused by diet deficient in Niacin Truth is that alkalinization of corn > releases Niacin otherwise not> Pellagra If you treat the corn so it is not alkaline, it will not release niacin Tryptophan converts to B1=3 (only 3% needed) EXAMPLES OF THE HISTORIES AND DISCOVERIES IN NUTRITION SELENIUM: THOUGHT IN THE PAST TO BE TOXIC AND CARCINOGEN ESSENTIAL FOR ACTIVATION OF VITAMIN E (400 TIMES AFTER BINDING TO SEL)> LIVER DETOX ESSENTIAL FOR THYROID FUNCTION Called a micro mineral/micronutrient because we only need a little bit of it EXAMPLES OF THE HISTORIES AND DISCOVERIES IN NUTRITION CHROMIUM: ESSENTIAL FOR GLUCOSE METABOLISM ACTS AS A COFACTOR FOR INSULIN GLUCOSE METABOLISM CAN HELP PATIENTS / ANIMALS WITH DM Diabetes! E X A M P L E S O F T H E H I S TO R I E S A N D D I S C OV E R I E S I N NUTRITION Zinc It is so difficult to have zinc deficiency as it is very abundant in nearly all food types Plant based foods rich in calcium or bone metals > impair zinc absorption Reflection: For vegetarians/Vegans, supplement them with more zinc Soy foods are high in phytates (as well most Legumes) > interfere with zinc absorption Zinc deficiency> Skin hypertrophy and scaling , infertility E X A M P L E S O F T H E H I S TO R I E S A N D D I S C OV E R I E S I N NUTRITION Concept of Bioavailability For the microminerals (e.g. Zin Selenium etc) It is not only the daily requirements to be given most important Its Bioavailability Need to know other foods that support/ interfere with their absorption same With other minerals E X A M P L E S O F T H E H I S TO R I E S A N D D I S C OV E R I E S I N NUTRITION Proteins: There is a great variation between the different proteins -> Grain fed animals are proRegarding their aa structure and configuration inflammatory vs grass fed which are not Hence the difficulty in knowing which animal/plant proteins are ideal for human needs D Fish are higher quality meat Combinations of aa cannot replace the whole protein for than red meat human needs. ↳ Need links between the AA - w/o can be considered incomplete protein EXAMPLES OF THE HISTORIES AND DISCOVERIES IN NUTRITION Children’s requirements of proteins can be low as compared to adults Clinical info indicate that the growth of children in general can be achieved with very low proteins During active infections (such as Flu, pneumonia etc) we need more protein than in other healthy states. Because need protein to make the antibodies and other important immune cells to fight off the infection LO W P R OT E I N D I E T I N D E V E LO P I N G COUNTRIES Giving developing countries milk and milk concentrates fortified with minerals and vitamins : FPC (Fish Protein Concentrates). SCP (Single Cell Protein) from Fungi, and Bacteria , problem high nucleic aids > difficult digestion by humans not animals. - Incorporating more carbohydrates and energy foods can improve the outcome - - If give only proteins, the metabolism of the proteins will be incomplete w/o carbs E X A M P L E S O F T H E H I S TO R I E S A N D D I S C OV E R I E S I N NUTRITION Essential fatty acids: Unsaturated fatty acids (e.g.) Linoleic acid are essential for skin health and growth in infants Cholesterol and IHD . Ischemic heart disease When people from Naples Italy were compared to US it was found that cholesterol levels and IHD and highCholesterol are linked to the types / amounts or both fats in diet? Found that high cholesterol and IHD were linked to the amount of types of fat in the diet - US ppl had higher cholesterol and IHD than Europeans - due to the saturated fats of the US vs ie from Italy more unsaturated like olive oil, coconut oil, and omega from fish EXAMPLES OF THE HISTORIES AND DISCOVERIES IN NUTRITION FATS AND ATHEROSCLEROSIS: RACIAL FACTORS DON’T INFLUENCE THE INCIDENCE OF HIGH CHOLESTEROL AND IHD IT IS THE EATING PATTERNS L I P O P R OT E I N S Low density = protein part is low Low density LP Versus HDLP HDLP are the good LP not the LDL density = protein parts are high ** DA High WE WANT THIS!! ↳ More water soluble - will not get stuck in the blood vessels S 34 Fats are insoluble in water - to make them soluble you have to combine with proteins EXAMPLES OF THE HISTORIES AND DISCOVERIES IN NUTRITION FAT CONSUMPTION AND CANCER THERE IS A CORRELATION A Saturated fats correlated with breast and colon cancer - risk factor BREAST AND COON CANCER EXAMPLES OF THE HISTORIES AND DISCOVERIES IN NUTRITION Polyunsaturated FA (PUFA) Plant origin versus Fish The amount of PUFA in plant foods are much more than fish It is recommended to do a fish-based ones and not a plant based PUFA to prevent heart disease and cholesterol Fish unsat fats have more omega 3 which are anti-inflammatory EXAMPLES OF THE HISTORIES AND DISCOVERIES IN NUTRITION FIBERS H I G H F I B E R I N TA K E C A N P R O T E C T P E O P L E FROM COLON CANCER(EXAMPLES AFRICAN COUNTRIES PEOPLE CONSUME THERE UP T O 1 0 0 G M O F F I B E R S A D AY ) Needed to form the bulk of the stool Examples of the histories and discoveries in nutrition Fibers: A: Two mechanisms: 1- Reduces the intestinal emptying times ( as compared to low residue diet) so the carcinogens From pathogenic bacteria do not have long contact with the colon Short chain fatty acids 2- Fermentation of the fibers > increase in SCFA in the colon> exerts an anti cancer effects 35-45 g are good for daily amount of fibre E X A M P L E S O F T H E H I S TO R I E S A N D D I S C OV E R I E S I N NUTRITION Effect of nutrition change on chronic diseases: Sine the 1980s marked improvements in the control of DM were made but Still obesity is a problem More work is needed to solve the obesity issue not only from The reductionist view of Caloric intake/ expenditure but also but the role of Micronutrients and food pollution. E AT I N G PA R A D I G M S Canada Food Guide Principles: Daily foods are vegetables, fruits whole grains and proteins Proteins come from legumes, soy, nuts, seeds, fish, lean red meat including game meat, Low fat milk and Yogurt, Unsaturated fats should replace saturated fats Nutritious foods to consume regularly can be fresh, frozen, canned, or dried. Water is the beverage of choice CFG (Cont.) Try to have these proportions in your meals ½ fruits and vegetables (F&V) ¼ Protein ¼ whole grains Water is your main drink CONT CANADA FOOD GUIDE Eating with others can bring enjoyment to healthy eating and can foster connections between generations and cultures. Traditional food improves diet quality among Indigenous Peoples. Main Health Goals of CFG To protect from cardiovascular health problems Almost 50% of cardiovascular related mortalities were related to the dietary patterns (2017 statistics), dietary fiber, associated with a lower risk of cardiovascular disease (including well-established risk factors such as LDL-cholesterol), colon cancer, and type 2 diabetes Lowering the intake of foods that contain mostly saturated fat by replacing with foods that contain mostly unsaturated fat decreases total and LDLcholesterol CFG (CONT) Health Canada recommends water as the beverage of choice to support health and promote hydration without adding calories to the diet Reason: Part of the enjoyment of eating is choosing nutritious foods that reflect the cultures and traditions we come from. The cultural makeup of Canada is rich, with over 250 different ethnic origins identified on the Canadian Census Water is so important!!! CFG (CONT) Energy needs are individual and depend on several factors, including levels of physical activity For optimal health, children and youth should achieve high levels of physical activity. That means at least 60 minutes of moderate to vigorous physical activity each day and low levels of sedentary behavior, as well as sufficient sleep For adults and older adults, at least 150 minutes of moderate- to vigorousintensity aerobic physical activity per week, in bouts of 10 minutes or more, is recommended to achieve health benefits.40,41 CFG (CONT.) GUIDELINE 2 Processed or prepared foods and beverages that contribute to excess sodium, free sugars, or saturated fat undermine healthy eating and should not be consumed regularly. What is your opinion about sugar and sugar’s substitute’s consumption? The guidelines recommend only least intake Only small amounts of sweeteners should be consumed - in extreme amounts can result in certain types of cancers & CVD Sodium Rich Foods CFG (Cont.) - Trans fats - Risks: CVD disorders and High Cholesterol Not natural fats - changed by the manufacturer to make fats more tasty - add more hydrogen to the oils, making it harder in consistency - harder on the body C F G ( C O N T. ) Sweeteners Moderate use only Excess use: CVD, DM, Cancer C F G ( C O N T. ) There are health risks associated with alcohol consumption. DM, HTN, CVD, Cancer Hypertension C F G ( C O N T. ) Nutrition facts CFG (Cont.) Healthy eating recommendations Mindful eating Taking time to eat Enjoy your food Most of dairies come from grainfed cows which makes them inflammatory MEDITERRANEAN DIET MEDITERRANEAN DIET Goals Prevention of Heart disease Certain cancers Cognitive decline Mediterranean Diet Based mainly on seasonal grown and fresh vegetables fruits beans nuts and seafood Mediterranean Diet Based mainly on the diet most people around the Mediterranean sea eat People eating this diet have the least incidences of Heart Diseases and need the least medical services Mediterranean Diet - Physical activities in Mediterranean Diet is an essential part Mediterranean Diet • Cost can be a factor • Especially with the animal sources of protein Mediterranean Diet • Advantages • Prevention of heart disease and strokes • Keeping your fitness • Reducing Alzheimer’s disease incidence (better BV health) • Reducing Parkinsonism (Rich in Anti Oxidants) • Protection against Type II DM Mediterranean Diet • you can consume 1 glass of wine a day (beneficial item of Mediterranean Diet ) if you consume more (2-3 glasses a day) this can be more harmful than useful. Mediterranean Diet Mediterranean Diet is only about the food MEDITERRANEAN DIET Tips to start Start with more fresh vegetables/ fruits Always eat breakfast with high fiber foods and whole grains Seafood twice weekly Low dairy portions Replace the sweets with fresh fruits as your deserts Eat healthy fats (Avocado oil, Nuts, and Olive oil) Mediterranea n Diet • Fish and Mercury poisoning, how to minimize/avoid this? • Small fishes have less mercury (anchovies , sardines, herring and mackerel). • Eat 2 servings a week • Listen to local seafoods advisories • Pregnant women and children <12 YO to eat one serving a week. Vegetarian Diet • Main ingredients : V&F Milk and dairy some nuts but no meat or fishes • So Mainly Vegetables, Fruits, Eggs and Dairy ( some people eat only V&F &eggs so called Ovo vegetarians and others eat only V&F& Dairy and called Lactovegetarians). Vegetarian Diet • Tips • Eat variety of V&F everyday (do not stick to a single or a few items) VEGETARIAN DIET The recommendation is to eat at least 5 servings a day each serving is 80 GMs (total 450 GM (almost 1 LB) Lots of V&F are a good source of fibers that is essential for proper digestion, colon health and blood sugar and lipids normal levels. They are rich in an anti oxidants that help prevent cancer and inflammatory diseases Vegetarian Diet Milk and Dairy Products support your protein, calcium vitamin A, and B12 Vegetarian Diet Eggs they are good sources of animal proteins and vitamin B12 Vegetarian Diet • Other healthy sources in Vegetarian Diet: • Pulses, peas and lentils as a good sources of plant-based proteins, vitamins minerals and fibers. Vegetarian Diet • Fats: Should be unsaturated (such as Olive oil, Sunflower oil, Avocado oil) avoid Saturated fats (such as Butter, Lard and Ghee) MINERALS AND VITAMINS LACKING IN THE VEGETARIAN DIET Due to the lack of meats and fishes vegetarians are liable to Iron deficiency (available in pulses, dries fruits, whole meal bread,(Whole meal bread is made from wholegrains that have been milled to a fine texture, giving a plain brown appearance. and nuts) Vitamins B12 deficiency (available in milk, cheese and eggs) VEGETARIAN DIET Health goals To avoid cardiovascular diseases To prevent certain types of cancers To prevent/ improve type II DM Vegan Diet • Is based ONLY on plants (V&F Grains and Nuts) • No animal foods at all VEGAN DIET How much G&V to eat every day? VEGAN DIET Answer: 5 servings (each serving is around 80 GM) Minimum!! VEGAN DIET Vegan sources of vitamin D and Calcium Dark green leafy vegetables (broccoli and cabbage) NOT SPINACH (rich in calcium that is not absorbable) Fortified soy products . Pulses. = legumes ie lentils, beans Sesame seeds and Tahini. Dried fruits. VEGAN DIET Vegan Sources of Iron Se Whole meal bread and flower. Iron fortified cereals. Nuts dries fruits VEGAN DIET Omega 3 fatty aids Olive oil Flaxseeds oil Avocado oil Wallnuts Shea seeds VEGAN DIET Value of vegan diet Protection of cardiovascular health Prevention of certain types of cancer Management and prevention of type II DM Weight loss 4 DIFFERENT FOOD GUIDES CFG Mediterranean Diet Vegetarian Diet Vegan Diet DIETARY REFERENCE INTAKES (DRIS) Definition: The amounts of vitamins, minerals and other substances like fiber that we need - not only to prevent deficiencies, but also to lower the risk of chronic disease DIETARY REFERENCE INTAKES (DRIS) There are 5 measurements under the DRIs Estimated Average Requirement (EAR) Recommended Dietary Allowance rage (RDA) Adequate Intake (AI) Tolerable Upper Intake Level (UL) Acceptable Macronutrient Distribution Range (AMDR) - I ESTIMATED AVERAGE REQUIREMENT (EAR) I - Not very accurate - THE AMOUNT OF A NUTRIENT THAT IS ESTIMATED TO MEET THE REQUIREMENT OF HALF OF ALL HEALTHY INDIVIDUALS IN A GIVEN AGE AND GENDER GROUP. SO, IT IS CALLED ESTIMATED AS IT IS BASED ON HALF OF ALL HEALTHY INDIVIDUALS RECOMMEN DED DI ETA RY A L LOWA N C E ( RDA ) the average daily dietary intake of a nutrient that is sufficient to meet the requirement of nearly all (97-98%) healthy persons. This is the number to be used as a goal for individuals. It is calculated from the EAR ADEQUATE INTAKE (AI) only established when an EAR (and thus an RDA) cannot be determined because the data are not clear-cut enough; a nutrient has either an RDA or an AI. The AI is based on experimental data or determined by estimating the amount of a nutrient eaten by a group of healthy people and assuming that the amount they consume is adequate to promote health What do you think about the AI? Is it more accurate than the EAR or the RDA ? And why? RDA is most accurate TOLERABLE UPPER INTAKE LEVEL (UL) the highest continuing daily intake of a nutrient that is likely to pose no risks of adverse health effects for almost all individuals. As intake increases above the UL, the risk of adverse effects increases. ACCEPTABLE MACRONUTRIENT DISTRIBUTION RANGE (AMDR - THE PERCENTAGE RANGE OF PROTEIN, FAT, AND CARBOHYDRATE INTAKES THAT IS ASSOCIATED WITH REDUCED RISK OF CHRONIC DISEASE WHILE PROVIDING ADEQUATE INTAKES OF ESSENTIAL NUTRIENTS. WHEN TO USE THE RDI VALUES? 1- For government agencies to set up policies for dietary intakes and food guides 2- To help your patients achieve an adequate and healthy diet that does not only satisfy their health requirements and normal physiology but also to protect them from the chronic illnesses 3- To help people check the different food ingredients and their amount in a packaged food preparations to be able to decide for the best foods that they can eat. REFERENCES Canada food Guide online source: https://foodguide.canada.ca/en/ Help Guide online source: https://www.helpguide.org/articles/diets/the-mediterraneandiet.htm Carpenter K: History of Nutrition, J Nutr., 2003, PP 3331-3342. Online video presentation: https://nutrition.tufts.edu/video/historynutrition-science-implications-current-research-dietary-guidelines-and-food-policy REFERENCES (CONT.) Online video presentation: https://youtu.be/UPsymcEobDk?t=420 Online source: Government of Canada, Dietary Reference Intakes https://www.canada.ca/en/healthcanada/services/food-nutrition/healthy-eating/dietaryreference-intakes.html ANY QUESTIONS ? You can always email me at [email protected] Good luck