Transcript Bio_246_files/Nutritionx

Nutritional Considerations For The Future Physical
Therapist
By Dr. Peter Smith DPT. ATC
Lecture Overview
1. Scary statistics to why the lecture is
necessary.
1. Contributing factors.
2. Basic human physiology relating to nutrition
3. Components of a healthy diet.
4. Reading food labels
Current Healthcare Statistics
• CDC’s 7 leading causes of death in the United
states.
1. Heart disease 614,348
2. Cancer 591,699
3. Chronic lower respiratory diseases 147,101
4. Accidental ( unintentional injuries) 136,053
5. Stroke (CVA) 133,103
6. Alzheimer’s disease 93,541
7. Diabetes: 76,488
http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm
Current Healthcare Statistics
• How is the CDC’s math?
• The US medical system is the 3rd leading cause of death.
– 106,000 people are killed annually by prescription medication
prescribed correctly.
– 7000 from medical errors
– 20,000 from errors in hospital not related to medications or botched
surgeries
– 80,000 deaths from hospital caused infections
– 2000 deaths from unnecessary surgery
– 0 by physical therapist
– Starfield, Barbara. "Is US health really the best in the world?." Jama 284.4 (2000): 483-485.
• Diabetes cost United states 174 billion dollars in 2007
• “CDC predicts that one in three Americans will be diabetic by
midcentury”
– Boyle, James P., et al
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2009
(*BMI 30, or about 30 lbs. overweight )
1999
1990
2009
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2009
(*BMI 30, or about 30 lbs. overweight )
1999
1990
2009
No Data
<10%
10%–14%
15%–19%
20%–24%
25%–29%
≥30%
A picture is worth a 1000 words
1900’s
Today
Visceral fat
Visceral fat
Visceral fat has a high concentration of cortisol receptors!
Björntorp, Per. "Hormonal control of regional fat distribution." Human Reproduction 12.suppl 1 (1997): 21-25.
Visceral fat
Leads to insulin resistance and releases inflammatory cytokines increasing risk
for cardiovascular disease and DM.
Rimm, Eric B., et al.
How Did We Get Here?
Government Subsidized Foods
• Many key ingredients found in processed foods are
government subsidized. The major players are corn, soy
beans and wheat .
– Examples include fructose(HFCS), xantham gum, maltodextrin,
sucrose,, citrus cloud emulsion, gluten, hydrolyzed soybean
extract, soy lecithin, flours and many more!
• Corn, soybeans and wheat are all genetically modified
unless labeled organic.
– Corn is feed to chicken, cows and even fish now.
• Concentrated Animal Feeding Operation(CAFO)
– Corn feed cows developed resistant bacterial strains E-cole
0157:H7
• Long food labels are a marker for highly processed food!
Before We Figure Out What Went
Wrong We Need to Understand the
Basics.
Systems Synergy
• Digestive system provides
the raw materials for the
body to both function
and repair itself.
• All systems are
influenced by the
digestive system.
• 70% of the body's
immune system is
located within the
digestive system.
• 90% of the body’s
serotonin is produced
in the gut.
Digestive System Overview
• Enteric Nervous System : Is a
complex system that has as
many neurons as the spinal
cord.
•
Often referred to as the second
brain.
• Parasympathetic nervous
system has many neural
connections to the ENS.
•It stimulates digestive
activities via the Vagus nerve.
•Encourages blood flow to
the gut and activates
associated digestive organs.
•Which state of mind is best
for digestion?
Digestion is a very energy intensive process. Under stress blood is shunted away
from the digestive organs resulting in a reduced ability to create ATP.
Less nutrition can be absorbed under stress.
Nutrients
• Ingested chemicals used for growth, repair or
maintenance.
• Macronutrients consumed in large amounts
– proteins, fats and carbohydrates
• Micronutrients needed in small amounts
– Vitamins, minerals, phytonutrients, etc.
• Essential nutrients can not be synthesized
– minerals, vitamins, 8 amino acids and fatty acids must
be consumed in the diet every day.
Vitamins
• Body synthesizes some vitamins from precursors
– niacin, vitamin A and D
– vitamin K, pantothenic acid, biotin, folic acid, small chain
fatty acids
• produced by intestinal bacteria and yeast
• Water-soluble vitamins (C, B)
– absorbed with water in small intestine; not stored
• Fat-soluble vitamins (A, D, E, K)
– absorbed with dietary lipids; stored
– Refer to Nutrition Reference Guide
Carbohydrates
• Carbohydrates found in 3 places in body
– 450 grams total
• Muscle (325 grams)
• Liver glycogen (90-100 grams)
• blood glucose?
• Carbohydrate serves as fuel exclusively
– neurons and RBCs depend on glucose
• Blood glucose carefully regulated by insulin and glucagon
• Not all carbohydrates are created equal!!!
– Highly processed refined sugars and flours
• Deplete the body of many micronutrients
Dietary Fiber
• Fibrous carbohydrates that are indigestible because we don’t produce the
specific enzyme.
• Fiber (RDA is 25-45 g/day) Paleolithic ancestors (~100 g/day)
• Water- soluble fiber
– Found in fruits, potatoes, oatmeal, beans
– Bind bile salts which  blood cholesterol, BGLs and LDL levels
– Act as prebiotics :feed the probiotics.(good bacteria and yeast)
• Water-insoluble fiber
– Found in wheat, bran, and pears.
– absorbs water in intestines, softens stool, gives it bulk, speeds transit
time
Protein
• 12-15% of body mass
– mostly in skeletal muscles
• Functions
– muscle contraction, cell membranes , collagen, bones, keratin,
antibodies, myoglobin, enzymes, neurotransmitters, plasma
proteins needed for blood osmolarity and viscosity.
• Protein requirements vary.
• ADA: (Academy of Nutrition and Dietetics) (.8g /kg)
• Growing children may have slightly higher protein requirements.
• Refer to nutrition reference guide.
• ACSM: Power athletes: 1.6-1.7g /kg Endurance athletes: 1.2-1.4g /kg
– ~1.5 to 2.0 grams/kg for burn victims
– On average the body can only utilize between 20- 30 grams per meal.
Protein Sources
• Nutritional value depends on proportions of amino acids
– 8 essential amino acids can not be synthesized
• Complete proteins (dietary)
– supply all amino acids in right amount needed to
synthesize protein
• Animal proteins (meat, eggs and dairy)
– closely match human proteins in amino acid composition.
• Plant sources must be combined in the right proportions
– Beans and legumes have less of the amino acid
methionine. Grains such as rice have less lysine.
– Protein and fat will reduce the glycemic load of the meal
which will stabilize blood insulin levels.
Why Water
• Thermoregulation
• Enzymatic reactions within
the body.
• Both anabolism and
catabolism
• Needed to maintain proper
electrolyte balance
• Neuronal function and
maintaining blood
pressure
• Intelligence?
• Needed to maintain proper
connective tissue
• Tensile vs compressive
forces
Lipids
• Diverse functions
– structural
• phospholipids and cholesterol are components of plasma membranes and
myelin
– chemical precursors
• cholesterol - a precursor of steroids, bile salts and vitamin D
• fatty acids - precursors of prostaglandins and other eicosanoids:
• 2X energy/g, compact storage
– fat-soluble vitamins (A,D,E,K) absorbed with dietary fat
• ingest less than 20 g/day risks deficiency
• AMA recommends limiting fat to less than 30% of daily calorie intake
– typical American gets 40-50%
• Saturated fats ( no double bonds)
– AMA less than 10% total calories
– animal origin -- meat, egg yolks and dairy products
• Unsaturated fats ( contain double bonds)
– found in nuts, seeds and most vegetable oils
Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
O
C
CH2
(CH2)15
CH3
HO
Saturated fatty acid
(Stearic acid)
O
C
CH2
(CH2)5
CH2
CH
CH
HO
CH2
Double bonds deform
the linear chain and give
the fatty acid a kinked 3dimensional structure.
Unsaturated fatty acid
(Linoleic acid)
CH
CH
CH2
(CH2)15
CH3
Cardiovascular
Diseases
Environmental Working Group’s Dirty Dozen
http://www.foodnews.org/executive.php
12 most contaminated
•
•
•
•
•
•
•
•
•
•
•
•
Peaches
Apples
Sweet Bell Peppers
Celery
Nectarines
Strawberries
Cherries
Pears
Grapes (Imported)
Spinach
Lettuce
Potatoes
(consider frozen)
15 Least contaminated with pesticides
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Onions
Avocado
Sweet Corn (Frozen)
Pineapples
Mango
Asparagus
Sweet Peas (Frozen)
Kiwi Fruit
Bananas
Cabbage
Broccoli
Papaya
grapefruit
Sweet potato
Honeydew
Let Food Be Thy Medicine Hippocrates
•
Phytonutrients :Polyphenols: a class of phytonutrients that
has:
• anti-inflammatory
• antibacterial
• anti-mutagenic
• antioxidant effects
• inhibit platelet aggregation
• strengthen vessel walls and influence gene expression.
– Different color reflect different classes of phytonutrients.
Coffee, Dark Chocolate, blueberries, extra virgin olive oil,
citrus fruits and walnuts.
CLASSIC FOOD PYRAMID
Food Labels
• Organic means 95% organic products
– Look for the USDA Organic food label
• Made with organic must be 70%
• Free range: in a chicken coop that the door must stay
open 5 minutes a day.
• Whole Grain= only has to be a little more then ½ to
say it on the label.
– Made with whole grain may almost have none.
• Look for 100%
• Pastured means cage is on the grass.
•
Know your farmer!
Food Labels
• Is it really low fat?
– 1% milk = 18% and 2% =36%fat calories
• Whole milk is more than 50 % fat calories
– Meat 75% lean has 225 calories which 14 grams come from fat
which equals 126 total fat calories = 57% fat by calories
– 93% ground lean = 45% fat calories
• because labeled by weight not % calories
The diet and conditions your meal lived in is important!
• The food industry can make up the serving size.
– 5 calories or less = non caloric.
– ½ gram of fat or less = non fat. Watch the portions size!
– Lite means ½ the amount of fat as the original.
• Usually sugar is substituted.
•
Michael Pollan Food Rules
Eat food, not to much, mostly plants (especially
leaves)!
• G-BOMBS: (Furhman, J)
–Greens
–Beans
– Onions
– Berries
–Seeds
Don’t eat anything your grandmother would not recognize as
food.
Don’t eat food that makes health claims!
Don’t eat anything that has more than 5 ingredients
Don’t eat food that has unpronounceable ingredients.
Final Thoughts
• Drink filtered water (minimize consumption of bottled water)
– Great Pacific Garbage Patch!
• Consider organic when possible if buying the most
contaminated food.(Referred to EWG Dirty Dozen)
• Carbon Footprint and biodiversity
• Consider the whole person. Don’t forget other factors that are
important for health.
• Sleep, social connections, social status, physical activity levels
– Ornish D, et al. Intensive lifestyle changes for reversal of coronary
heart disease.
– McGonigal, Kelly. "How to make stress your friend." TED talk,
September (2013).