NMT100 Nutrition Lecture 3 (Wk13) PDF

SKILLS IN NUTRITION DR EHAB MOHAMMED ND LEARNING OUTCOMES Identify and develop skills in applying naturopathic therapeutics that can support treatment goals and address health concerns. Explain the metabolism of the macro-nutrients (carbohydrates, lipids and proteins) and the impact on patient hea...

SKILLS IN NUTRITION DR EHAB MOHAMMED ND LEARNING OUTCOMES Identify and develop skills in applying naturopathic therapeutics that can support treatment goals and address health concerns. Explain the metabolism of the macro-nutrients (carbohydrates, lipids and proteins) and the impact on patient health and naturopathic care. LEARNING OUTCOMES Outline the role of essential fatty acids in health and specific pathological conditions with consideration of how and when to prescribe appropriately. Explain the dietary and environmental factors that affect the gut microbiome (including prebiotics, probiotics and fermented foods) demonstrating ability to integrate knowledge into a patient's treatment plan Bottomline • Need a good knowledge and information about nutrition, its role in health and wellness and in different illness 2nd tip Good nutrition is essential for the proper control of chronic illnesses such as atherosclerosis, diabetes and osteoporosis So, working with patients and health professionals to solve these chronic illnesses can help improve their outcomes. RD 3 TIP CREATING AWARENESS AMONG THE PUBLIC ABOUT THE COSTS OF CHRONIC ILLNESSES AND ITS IMPACT ON THE SOCIETY AND ECONOMY AND HOW PROPER NUTRITION AND LIFESTYLE CARE CAN IMPROVE THIS SITUATION . 4 TH TIP - Playing several roles in health and nutrition such as: Educational of other healthcare professionals, schools and patients. Modelling: To be a role model in proper nutrition and lifestyle for the public and other healthcare professionals. Organizing: To organize community health educational programs. Advisory: To advise the best nutritional practices to the healthcare professionals and policy makers . Integrative role: to be involved in the basic and applied science CARBOHYDRATE METABOLISM Glucose (the simplest form of carbohydrates) is essential for energy building of the body. Glucose reassembles to form more complex molecules such as Glycogen (an energy storage in the body), deoxyribose (essential for the genetic and chromosomal material synthesis), and glycolipids (essential components of cell membrane structure and function) C O N S E Q U E N C E S O F G LU C O S E M E TA B O L I S M IMBALANCE - Mainly development of Diabetes Mellitus (either type I or II) with so many health issues if left untreated such as Ischemic heart disease. Hypertension. Renal dysfunction then renal failure. Strokes. Peripheral neuropathy Metabolism of Glucose • Carbohydrates are digested to the simplest forms called Monosaccharides (such as :Glucose, Galactose, and Fructose). • Insulin hormone is integral in Glucose uptake by liver and resting muscle cells. Cont. Carbohydrates Metabolism CONT. CARBOHYDRATES METABOLISM THE ONLY SITUATION WHEN GLUCOSE CAN ENTER YOUR TISSUES WITHOUT THE NEED FOR INSULIN IS PHYSICAL EXERCISE Become insulin dependent if not doing any physical exercise LIPIDS Essential for cell membrane functions Energy metabolism and fuel creation Signal transduction (DNA and RNA function). Delay aging and neurodegenerative diseases. LIPIDS (CONT.) Prostaglandins (derived from Arachidonic acid which is a fatty acid) - Regulate inflammation - Regulate vasoconstriction - Regulate platelet aggregation - Regulate various hormones PROSTAGLANDINS (CONT.) Regulate cell growth Regulate intra-ocular pressure Regulate fever Regulate GFR Sensitize spinal neurons to pain LIPOPROTEINS Basic Lipoprotein structure LIPOPROTEINS Lipoproteins are complex particles with a central core containing cholesterol esters and triglycerides surrounded by free cholesterol, phospholipids, and apolipoproteins, which facilitate lipoprotein formation and function. Helps lipids become more absorbent and increase their functions Bad only if in higher levels in the blood! Less protein than fat Lipoproteins Bad fats Amount of molecules of fat are less and amount of protein is more Lot of protein relative to lipid component Good fats • Plasma lipoproteins can be divided into seven classes based on size, lipid composition, and apolipoproteins (chylomicrons, chylomicron remnants, VLDL, IDL, LDL, HDL, and Lp (Lipoprotein-a) ). LIPOPROTEINS AND HEALTH Chylomicron remnants, VLDL, IDL, LDL, and Lp (a) are all pro-atherogenic while HDL is anti-atherogenic. Apolipoproteins ( Proteins that bind lipids (oil-based soluble substances such as fats, cholesterol and fatsoluble vitamins ) to form lipoproteins), have four major functions including LIPOPROTEINS AND HEALTH 1) serving a structural role, 2) acting as ligands for lipoprotein receptors, 3) guiding the formation of lipoproteins, and 4) serving as activators or inhibitors of enzymes involved in the metabolism of lipoproteins Big fat molecules w/ very thin layer of proteins Lipid metabolism • Sites of storage: • Adipose tissues • Muscle • Lymph vessels (Chylomicrons). • Liver • Blood Transport • Lipids are transported in the blood after being bound to a protein, i water-soluble form (Hydrophilic) called lipoproteins, as they are originally in a state of water insoluble form (Hydrophobic) without being bound to these proteins TRANSPORT Lipoproteins in blood and sites of storage Proteins Growth and development of the body. Major player and cofactor for many bodily chemical and hormonal reactions. Synthesis of hormones (such as insulin, growth hormone, prolactin, Thyroid Hormones etc). Synthesis of enzymes such as lipase, maltase, trypsin etc Building the DNA and RNA structure Provides building blocks for muscles (Myocytes). Proteins Maintains bodily PH Balances bodily fluids and maintain osmolarity Immune system function and structure. Lipid metabolism and transportation (Lipoproteins complexes). Maintain muscle mass and function. Source of energy. Protein Metabolism • After being digested to their simplest form (amino acids) they follow on of 3 routes: • 1- Anabolism: in Latin it means building so it restructured again and build up bigger protein molecules that help in the formation of the bodily essential hormones and digestive enzymes • 2- Catabolism: in Latin it means breakdown: They breakdown to their basic units: carbon for energy yielding and nitrogen a byproduct in the form of Urea. • 3- Excess amino acids are discharged either in urine as ammonia or skin in the sweat OVERVIEW OF MICRONUTRIENTS They are called micronutrients because they are required in small quantities (RDA is small) as compared to the Macronutrients mentioned above whose RDA are much higher What are micronutrients • Either • Vitamins OR • Minerals VITAMINS A vitamin is an organic molecule that is an essential micronutrient that an organism needs in small quantities for the proper functioning of its metabolism VITAMINS CLASSIFICATION - Either Dissolve in water and can be excreted by kidneys Water Soluble Or Water Insoluble vitamins Only soluble in fat & are excreted by stools WATER SOLUBLE VITAMINS All of them dissolve in water Mostly excreted in urine. They are usually safe for human use due to their water solubility The toxic doses are usually extremely high Water Soluble vitamins Vitamin C (Ascorbic Acid) Vitamin Bs B1 (Thiamine) B2 (Riboflavin) B3 (Niacin) B5 (Pantothenic Acid). B6 (Pyridoxine) B7 (Biotin) B9 (Folate) B12 (Cobalamine) FAT SOLUBLE VITAMINS They are all fat soluble So, they are better to be administered with fatty meals for better absorption. Being fat soluble they are mainly metabolized by the liver They tend to be stored for a longer periods in the body as compared to the water-soluble vitamins They can reach a higher /toxic levels in the blood after high dose supplementation, so It is better to monitor their levels closely if prescribed at high doses. FAT SOLUBLE VITAMINS Vitamin A Vitamin D Vitamin E Vitamin K ROLES OF VITAMIN C Essential Nutrient. Cannot be made in body, need to consume it from foods Cofactor for many chemical reactions in the body for example amino acids metabolism. Support Hormonal Functions. V I TA M I N C (ASCORBIC ACID) V I TA M I N C V I TA M I N B S General overview B V I TA M I N S General functions B V I TA M I N S (FUNCTIONS) MINERALS -Macro-minerals: They are named Macro-minerals because they are needed in higher amounts than their counterparts (Microminerals). Examples: Calcium, Magnesium, Phosphorus, Potassium, Sodium, Chorine General functions maintain bone and connective tissues health (Calcium, magnesium and phosphorus), maintain electrolytes balance and muscle and nerve action potential and function (Potassium, Sodium, Chorine). MINERALS Microminerals: They are given this name as they are needed in a very small quantities for their RDA This does not mean that they are not essential for the human health and wellbeing. Examples: Iron, Copper, Zinc, Selenium, Chromium, Iodine, Manganese, Molybdenum, Fluoride, Boron, Silicon, and Vanadium. Microminerals functions/roles • Blood building and Hemoglobin Synthesis (Such as Iron) • Thyroid function (Iodine, and Selenium). Cont. (Microminerals roles) • Glucose metabolism and diabetes Management (Chromium and Vanadium), • Bone and connective tissue building and structure (Boron, and Silicon) ESSENTIAL FATTY ACIDS Definition: - They are essential fatty acids (meaning that your body cannot produce them or produce enough of them) so you need to take them from diet. Mainly 2 acids : Linoleic acid (sometimes called Omega 6 fatty acid) and alpha linoleic acid (called Omega 3 Fatty acid). ESSENTIAL FAT T Y A C I D S Roles/functions EICOSANOIDS They are by products of essential fatty acids (so they are not essential, being produced by the body not gained form outside). They perform various functions in the body that are critical to the human physiology W H AT A R E T H E EICOSANOIDS? 35 P R O S TA G L A N D I N S Glomelular filtration rate THROMBOXANES Rise of BP is good sometimes - within limits Ie when in an acute stress situation allows better focus L E U KO T R I E N E S Over production over time is no good - can cause asthma Protective mechanism OT H E R FUNCTIONS E S S E N T I A L FA DEFICIENCY SOURCES OF EFA Ethyl ester forms of omega-3 fatty acid supplements are becoming more prevalent than the TG (Triglycerides)forms in the market because of the cost: they are cheaper to produce than triglyceride forms. .. . They have a much higher boiling point and are easier to work with when processing for supplement distribution. No known difference in absorption or bioavailability. Krill oil contains EPA and DHA, the same omega-3 fatty acids in fish oil , although usually in smaller amounts. The effects of krill oil have not been researched as thoroughly as those of fish oil, But a few preliminary studies suggest that krill oil could be superior in some ways. Krill oil might be better absorbed in the body than fish oil. SOURCES OF E FA EFS SOURCES : SUPPLEMENTS WISE Algae extracts • Algae extracts have balanced amounts of Omega 3 and 6 however • Drinking algae-affected water or consuming food (such as fish or shellfish) may contain some toxins that can lead to gastroenteritis, • Presents as vomiting, diarrhea, fevers and headaches. These toxins may also affect the liver or nervous system Gut Microbiome What is gut microbiome? What is microbiome? • They are normal bacteria in our body that live in different locations such as • Mouth • Pharynx • Respiratory system. • Urogenital tract • Stomach • Small and Large intestine. Bowel physiology and function. General roles /functions in the body Carcinogenesis (Cancer initiation) prevention. Weight gain or loss Immune function. Metabolism regulators. Types of gut microbiota Only 6 known so far for example, Bacteroides Actinobacteria Firmicutes (Main type) Number • Number 10-100 Trillion organism's total • (more than your body cells !!!) • They should be in balance with other (Non friendly) bacteria to help normal Body functions Maintaining the balance • The Gut Microbiota secrets chemicals to signal the epithelia cells of the gut that connect to the immune cells under the gut lining to create the balance between the 3 cell groups Role of diet and nutrition in the microbiome • Whatever you eat will be reflected on the growth/suppression of growth of microbiome. • For example, if you eat CHO rich foods the microbiome that feed on them will grow, similarly with proteins/fats etc. • The determination of the type of nutrients needed by each microbiota is well determined in their GENES, the essential nutrients that your microbiota need to function and survive Short chain fatty acids (such as Butyrate, acetate and propionate) Peptides Polysaccharides Linoleic acid (Omega 6) Outcome of microbiome work • Either an anti-inflammatory state • Or a Proinflammatory state • What determines which state the microbiome produce at the end? The outcome of the microbiome is determined by • YOUR DIET • So, eating high refined foods such as sugary drinks, jams, candies and chocolates, potato chips and pretzels, bakery products such as donuts and cakes You are inviting an inflammatory outcome from your microbiome. Anti inflammatory outcomes • On the other hand, if you ear food rich in fibers, prebiotics, dark green leafy vegetables you will get an anti-inflammatory microbiome Other factors that impact your microbiota are: Exercise, Not only diet Lifestyle ( smoking and drinking lead to a pro-inflammatory biota), Genetics Environmental factors Dysbiosis means dysregulation of the gut microbiome, so the Proinflammatory Bactria start to dominate On the expanse of the useful bacteria Dysbiosis and gut microbiome This happens with one of 2 mechanisms 1- Either dysregulation of the microbiome so a few bacteria overgrow and dominate with others are downregulated (Called less diversity) Or 2- the useful bacteria do not find their essential nutrients to function and thrive (e.g. Short chain fatty acids) What happens with dysbiosis? Not only a proinflammatory outcome results but The ability to produce useful nutrients by normal bacteria is impaired (e.g., SCFA), so a vicious circle starts with dysfunction of the normal bacteria, its inability to produce useful nutrients for them and the body then they are more negatively impacted and so on. Other Factors that influence microbiome Antibiotics : Negative impact Probiotics: Provide direct support for the normal microbiota. Prebiotics: Provide the nutrients essential to feed the normal microbiota. Diet: impacts the pro versus anti-inflammatory outcomes Fecal transplant: Change the whole ecosystem. REFERENCES Ceriello et al: Clinical implications of oxidative stress and potential role of natural antioxidants in diabetic vascular complications, Nutrition, Metabolism & Cardiovascular Diseases (2016) 26, 285-292. REFERENCES Health-Care Professionals: Strategies and Actions for Implementation - Improving America's Diet and Health - NCBI Bookshelf Institute of Medicine (US) Committee on Dietary Guidelines Implementation; Thomas PR, editor. Washington (DC): National Academies Press (US); 1991 Mutlu et al : Lipid metabolism and lipid signals in aging and longevity, Dev Cell. 2021 May 17; 56(10): 1394– 1407 Thank you for your attendance • If you have any questions, please let me know