Automatic Nervous System

12/8/13 10:13 PM
Central control system: BRAINcoordinate & anticipate actions (movement & anticipation of movement); get
ready for digestion; energy simulation
Parasympathetic ! calms down
Sympathetic ! fight/flight
Parasympathetic NS ! love ! getting nutrients into the body
Assimilation of energy
feed or bread & rest and digest
discrete enervations ! specific
neurotransmitter associated = acetylcholine
Sympathetic NS ! hate ! using energy
dissipation of energy
fight or flight
network enervation (stimulate one part, everywhere else is stimulated)
neurotransmitter ! norepinephrine (aka noradrenaline)
eye:
pupil
o sympatheticopens (when you are scared, your eyes get big)
o parasympathetic closes
vision
o sympatheticdistance (think about when you are scared, you can see things far away)
o parasympathetic close
tears
o sympatheticinhibit (when scared, save energy from crying to other things more important)
o parasympatheticstimulates
salivary glands:
sympathetic: inhibit (when youre scared, your mouth is dry)
parasympathetic: stimulate
bronchial system:
breathing rate:
o sympatheticincrease
o parasympatheticdecreases
bronchial tube
o sympatheticdilates ! opens up
o parasympathetic constricts
bronchial circulation
o sympatheticincrease
o parasympathetic decrease
heart rate & velocity

 sympathetic increases
parasympatheticdecreases
blood flow:
heart, large muscles, brain:
o sympathetic: increases
o parasympathetic: decreases
digits & GI tract:
o sympathetic: decreases
o parasympathetic: increases
stomach: ! in parasympathetic, breakdown of fat ! getting energy (LOVING YOUR BODY " )
gastric tone:
o sympathetic: tightens
o parasympathetic: relaxes
mucous secretion
o sympathetic: decreases
o parasympathetic: increase
gastric acid:
o sympathetic: decrease
o parasympathetic: increase
pancreas:
insulin (released when blood glucose is above set point to take up blood glucose/uptake of nutrients):
o sympathetic: inhibit
o parasympathetic: releases (get sugar into the body ! love)
glucagon (released when blood glucose is below set point; release of nutrients)
o sympathetic: releases
o parasympathetic: inhibits
Liver: glucose metabolism:
Sympathetic:
o Gluconeogenesis
o Glycogenolysis
Parasympathetic:
o Glycogenesis
o Lipogenesis
Adipose cells (fat storage cells)
Sympathetic: stimulates enzyme to release fat from cells
Parasympathetic: stimulates enzyme to promote fat synthesis
Intestines
Motility:
o Sympathetic: inhibit
o Parasympathetic: facilitates
Anal sphincter:
o Sympathetic: relaxes

o Parasympathetic: controls (tightens)

Bladder:

Bladder sphincter:
o sympathetic: relaxes (you pee in your pants when youre scared)
o parasympathetic: constricts (tightens)
sex organs:
pre-orgasm
o male:
# parasympathetic: allows erection
# sympathetic: inhibits erection
o female:
# parasympathetic: allows vaginal opening, mucous secretion
# sympathetic: vaginal constricts, no mucous secretion
orgasm ! TOTALLY SYMPATHETIC

Entering the Holy Sanctuary: The Mouth

12/8/13 10:13 PM

our body is like a donut

begins with semlling food ! sends signal to the brain ! starts parasympathetic nervous system
cephalic phase: the process of anticipating food (starts the digestion process) ! activate the parasympathetic
NS
Parasympathetic effect of food stimuli:
Stimulates salivary secretion
Tightens the esophageal sphincter (Valve located at the bottom of the esophagus before the stomach
! prevents food in the stomach from getting out)
Stimulates gastric mucous secretion
Stimulates gastric secretion such as digestive enzyme
Sensitize insulin to be released from pancreas
Directs thought to eating
Salivary glands function to:
Lubricate (so food can slide down esophagus smoothly)
antibacterial
o Nursing bottle syndrome: (Decay in childrens teeth)
# Teeth of 25 month old baby bottle fed ! decay due to the glucose on the teeth
# Sleep suppresses rate of salivatory flow (unless you are dreaming about food)
# Tooth truths:
$ Tooth decay was uncommon prior to 1886 (the year coke began mass
marketing campaign)
People only consumed a little amount of sugar during meals (back
then, tooth decay signified wealth)
Back then, most people lost their teeth due to gum disease ! poor
hygiene
tooth decay didnt decline until fluoridation of water began
$ tooth decay is caused by acids produced by bacteria in mouth
sugar would stick together and form plaque
o allows further metabolism of sugar by bacteria
# the teeth would be bathed in acid solution. As a result
had to release bicarbonate to neutralize and calcium
released at the same time ! soft teeth
o allows anaerobic bacteria to grow ! cause bad breath
$ drugs can increase tooth decay & other dental problems
antihistamines, antidepressants, BP medication, decongistations,
cancer treatment drugs ! stop salivary glands response from being
secreted ! dry mouth

chewing tobacco ! high acidity

tetracycline ! children-growth staining
illicit drugs cause tooth decay
heroin, Percodan, oxycodone, vicodin, and codeine
o bruxing ! tooth grinding
metamphetamines, cocaine, crack (mimick the sympathetic NS)
o meth mouth (inhibit antibacterial production because salivary
gland is inhibited
o sympathominetics
relationship between teeth & heart disease watch lecture
prevalence of disease is relative to teeth risk ratio

Mastication: the process where you break down food into smaller pierces. By increasing the surface area of the
food, you are maximizing the effects of enzyme
Plants cover nutrients with cellulose and the body cannot digest cellulose
Elderly have a lot of teeth problems ! cannot eat and breakdown food !
Salivary glands: (cont.)
Begins digestion
o Lipase: breaks triglycerides into fatty acids ! glycerol
o Amylase: breaks starches into simple sugars (initially has no taste and it breaks it down into
something sweet)

The stomach

12/8/13 10:13 PM

Taste: the response to taste is hard wired

Sugar : born with the affinity
o Sweetness is a surrogate for calories (energy)
# When tired/hungry, we want to eat something sweet
Sour
Bitter! something potentially dangerous (ex. Chemicals and alcohol)
Newborns cannot detect salt ! dangerous because parents always add salt to food for flavor ! too
much salt is bad for health
Tricking mother nature?
Carbohydrates can be bad (Ex: if you are diabetics)
Obesity (related to amount sweet food/drink we have)
Nice we can get sweet taste w/o calories & carbohydrates ! artificial sweeters
o Artificial sweetners (works for reducing sugar, works for diabetes)
# Saccharin cancer promoter (eat a carcinogen and saccharin will potentiate effect at
very high dose)
# Aspartame(nutrasweet, amino sweet)
$ Phenylalanine + aspartic acid
Phenylalanine (amino acid that can lead to severe mental retardation)
(high level of phenylalanine)
To prevent mental retardation ! diets with low phenylalanine
$ Methane (break down product of aspartame)
Dangerous alcohol! can get you high;
Body actually breaks it down all the time (people just exaggerate the
effects of them)
# Acesulfame (sunett, sweet one) ! safe
# Sucralose (splenda)
# Xylitol (sugar alcohol)
$ 2.2 kcal/g
$ actually reduces tooth decay
# sorbital: natural teeth decay fighting
Daves Dietary Delusion: chewing gum ! lose weight (statistical significant) but not clinical significance
Would have to chew gum continuously
Swallowing:
Bolus ! epiglottis (closes when we eat so food does not go down trachea) ! esophagus !
passageway to lungs
Chew food into a bolus and your tongue will throw the food back. Neural innovation ! elicit
swallowing effect and epiglottis (top flat of skin that comes down over the trachea) goes down
Peristaltic contraction:

o When going down esophagus, contraction in one part of the muscle and relaxation on the
other end
Heimlich maneuver ! someone choking (but someone cant talk when they choke)

Stomach part 2

12/8/13 10:13 PM

2 Major valves:
esophageal sphincter: (between esophagus and stomach)
pyloric sphincter (between stomach and intestines)
Esophageal sphincter:
Degree to which it tightens is regulated by SNS & PNS
o Parasympathetic: tightens it up
o Sympathetic: loosen it up
Vagus nerve: parasympathetic nerve that controls the opening/closing of sphincter (caused by the
relaxation and contraction of esophagus ! opens)
o Can be voluntarily controlled (PNS allows you to discretely enervate one organ! specific)
o Loosen it up !
# Belchers (happens because we also swallow air when we eat, let the air leave intestine
by belching)
# Beer pourers (direct control of esophageal sphincter)
# Sword swallowers
# Purgers ! gag reflex
$ When eating something bad, we have a protective mechanism to rid the body
of food.
$ Gastric cells send signal to Tumor Necrosis Factor (TNF) in the brain to
inhibit the vagus nerve (open the esophageal sphincter) & return stomach back
to original shape ! vomiting
$ Purging is a lethal behavior
$ Consequences:
Esophageal lesions: acid from stomach ! lesions
Tooth decay from acidic medium that will draw calcium away
Cardiac irregularities: stomach gets liquid from blood to create an
aqueous environment so enzymes can break down the food. However,
in that liquid there is also critical ions. When you purge, you throw up
those ions and those ions are necessary for cardiac function.
Effect of incomplete closure of esophageal sphincter ! heart burn
o Results from stress (because it stimulates SNS and that loosens it up)
o Heart burn: aka gastroesophageal reflux disease (GERD)
# Common symptom of older people
# Nothing to do with heart
# Sympathetically mediated stress
# Cause of GERD: stress ! acid coming up & agitating the esophagus acid reflux
# Treatment
$ Reduce acidity with acid buffers (problem is not acid, but stress ! acid
buffers do not solve problem just prevent the pain)
Bicarbonate ! neutralize acidity but does not fix problem

$
$

o Alka-seltzers
Acid blockers !
o Pepto-bismo (bismuth)prevents cells from secreting acid
o H2 blockers (blocks histamine cells & no acid is made)
# But there will be nothing killing bacteria in stomach?
o
Proton pump inhibitor (PPI): pump gets taken apart and acid cannot be
created
o ex: Prilosec, peracid
o problem when you stop, production of acid increase. Only
effective when you are taking it
avoid foods and drugs that release gastrin (secretagogue that stimulates acid
production)
sleeping vertically (helps prevent acid from coming up)

Stomach events:
Cephalic stage: mucous secretion
Gastrin (acid producing cells)
o First: Anticipated release by PNS
o Released by stretching wall by food bolus
Gastrin then causes the release of
o HCl
# Bactericides (kill germs, denature viruses, etc.)
# Activates pepsinogen (safer form of pepsin since pepsin will eat membrane )
$ Pepsin (breaks down proteins)
$ Powerful proteases (enzymes that break down proteins)
Gastrin also released by secretogogues:
o Aspirin, ibuprofen, smoking, alcohol, coffee, hot spices
Gastric Ulcers: what happens if mucous does not line the stomach
Causes of gastric ulcers:
o Bacteria
# Helicobacter pylori (acid resistant and can act on tissues to stop mucous secretion)
o Rapid eating and stress
# Stress stimulates SNS ! inhibit mucous coating
o First treatment for ulcers is an antibiotic
Daves Dietary Delusions: on supplemental digestive enzymes
Enzymes are proteins
Proteins are destroyed by proteases
o One exception is lactade (which is protected)
Stomach secretions
Gastrin ! acid

Pepsinogen ! pepsin
Gastric lipase (triglycerides ! fatty acids + glycerol)
Ghrelin: ! (hormone that makes you want to eat)
o released when hungry or when stomach is emptying
o eating; once full, ghrelin levels decrease
o Secretion inhibited by full stomach
# Unfortunately, release is not related to stomach contents but to blood glucose levels
o Determinants of gastric emptying: (based on the pylorus sphincter)
# Volume of food ate:
$ Increase volume ! mechanically pushes the food out of stomach
$ However, not all food might have been digested
# Osmotic pressure:
$ Osmotic pressure in stomach = osmotic pressure in blood ! when pylorus
opens
# Acidity
$ Very high acid content (due to the dumping of acid in it) ! opening of pyloric
$ Elderly: have a problem because they do not produce as much acid so food
stays in the stomach and they dont eat
# Viscosity: reach a degree of thinness (from the h2o)
$ Only open when the content is not too thick
# ! FIBER! !!!!

Absorption (small intestines)

12/8/13 10:13 PM

stomach secretions:
gastrin ! acid
pepsinogen ! pepsin
gastric lipases ! lipids into simple sugars
ghrelin
intrinsic factor! reabsorption of vitamin B12
o cannot absorb b12 vitamin (mainly from meat and meat products) without b12
o people who dont eat meat no deficiency because of microbes?)
o intrinsic factors bind to b12 to protects it against acids and proteases in the stomach
Determinants of Gastric emptying:
FIBER
Dietary Fiber:
Soluble fiber
o Soluble fiber + h2o ! thickens (impediment of dumping content by making it more viscous)
o Is helpful in treating (from delayed gastric emptying)
# Dumping syndrome
$ Happens when pylorus opens too early and allows the undigested food to go
to digestive system ! damage to small intestines
$ Since delay gastric emptying, food can be properly digested before going into
intestines
# Duodenal ulcers
$ Slow down dumping and will allow ulcers to heal
# Diabetes (type 1&2)
$ Slows down rate of food dumping ! slow down rise in glucose level
# Appetite suppressant ? ! very small
o Binds to bile
# Lower blood cholesterol
$ Cholesterol is recirculated in the body, but if bile binds to cholesterol then it
cannot be reabsorbed
# Reduces colon cancer (high bile production = increase chance of colon cancer)
o Sources of soluble fiver:
# Fruits (pectins) (ex: apple, pear, peach)
$ Prunes (help poop)! contain pectin but also lubricates w/ peptin ! contain
something that helps with movement in colon
# Legumes/beans
# Whole grains
# Nuts
# Gums ! make things thicker (carrageenan in cheap ice cream)
# Chitosan? Fat absorber ! but no evidence that it is effective

Into the Intestine:

Stretching of the intestine
o Releases secretin (hormone that operates on the pancreas)
# Pancreas has two jobs:
$ Exocrine: dump bicarbonate & water to neutralize acidity from the stomach
$ Endocrine: creates hormone (ex. Insulin)
o Releases cholecystokinin (CCK)
# Released by stretching of S.I, but release of FFA (fatty acids) is more a more
powerful stimulus; FFA released from lipase in salivary glands & stomach)
# Functions of CCK:
$ Constricts the pyloric sphincter (regulating release of gastrointestinal
contents)
$ Causes pancreas (exocrine) to release digestive enzymes
Proteases: proteins (some in stomach, most are released in intestines)
Lipase: triglycerides
Amylase: starch
$ Gall bladder to release bile
CCK stimulates release of bile from gall bladder to break down fats
$ Primes pancreas to release insulin (insulin already sensitized through PNS in
cephalic phase)
$ Inhibit appetite?
o Release of Gastric Inhibiting Protein (GIP)
# Functions of GIP:
$ Inhibits gastric secretions ! shut things down
$ Has insulin-like effects (like CCK) ! operate all over the body ! increase
blood glucose uptake
Increase glucose uptake
Increases fat synthesis & storage
Decreases glucose production by liver
o good for diabetes
small intestine
o 6-8 meters long (20-25 feet)
o SA = size of tennis court = 2355 sq ft (maximize absorption of nutrients)
o Function! digestion & absorption
# Villa increase SA
# Around villa are epithelial cells
$ Divide inner from outside barriers
$ very sensitive
$ high turnover rate
$ contain enzymes
o Celiac Disease
# Occurs when the villas reduce absorption because of less SA

#
#

Caused by gluten ( a protein that people with celiac are very sensitive to)
$ Found in: wheat, barley, rye, & possibly oats
Symptoms:
$ Abdominal pain, bloating, gas, or indigestion
$ Constipation/ diarrhea
$ Decreased appetite
$ Lactose intolerance ! inability to digest lactose
$ Nausea & vomiting
$ Stools that float (air in intestine made by bacteria), are foul smelling, bloody,
or fatty
$ Unexplained weight loss (although people can be overweight or normal
weight)
$ Fatigue (not absorbing nutrients), difficulty concentrating and short term
memory
Treatment:
$ Gluten-free foods
Stay away from: barley (malt, malt flavoring & maltivin); rye, wheat
Eat beans, seeds, nut in natural unprocessed form, fresh eggs and fresh
meats, fish & poultry (not breaded, batter-cooked or marinated); fruits
and vegetables, most dairy products
$ Gluten-sensitivity

The Colon

12/8/13 10:13 PM

small intestine:
doesnt get tangled up because of the mesentery (tissue that holds intestine in place)
o mesentery has high blood supply
dangerous to be fat in the abdominal area (more dangerous than being fat all over) because
mesentery tissues are expanding
macronutrients involved:
o carbohydrates
# monosaccharide
$ glucose (most abundant sugar, 6 carbon)
$ galactose (rare in nature, milk sugar)
$ fructose (fruit sugar, sweetest of all sugar, 5 carbon)
# disaccharide
$ sucrose = glucose + fructose
$ lactose = glucose + galactose
$ maltose = glucose + glucose
# saccharides: (epithelial cells contain enzymes to break these down) ! ENZYMES
$ maltase = maltose + glucose
$ sucrase = sucrose + fructose
$ lactase= lactose + galactose + glucose
people who are lactose intolerant cant break this down
o symptoms:
# abdominal pain
# abdominal bloading
# gas
# diarrhea
# nausea
o lactose tolerance decrease with age (everyone born with it) &
Americans + northeastern Europeans remain pretty normal;
everyone else is usually lactose tolerant
o coping with lactose intolerant
# put lactase enzyme in protein so when we consume
lactose, it will get broken down
# drink small amount of milk with food
# polysaccharides
$ starch ! rice, potato
starch starts getting broken down by amylase that is released in the
saliva which stimulates CCK release
cck released from IG stretching ! pancreatic amylase
break down into mono/dissacchardies ! use enzymes ! glucose
salivary amylase starts breakdown of starch in mouth, but pancreatic
amylase finishes it

$
$

fiber
will not get broken down (we absorb some though)
glycogen
storage form of glucose can make this into polysaccharide and store it

o proteins
# enzymes that digest proteins:
$ gastric pepsin ! produced from pepsinogen (found in stomach)
$ pancreatic proteases released from CCK % stretching & fatty acids & lipase
The Colon (large intestine)
Entrance near the appendix
o Function of appendix:
# Contains cells related to immune function
# May signal production of good bacteria
# We can live without the appendix, but it is painful
Function of the colon
o Reabsorption of water and ions
o Bacteria
# may synthesize B12 and vitamin K
# functional?
# may produce carcinogens (colon is the site of most gastric cancer)
$ bile products ! cannot keep contact with intestinal cells for a long time
o discard food residuals
o ! COLONIC CLEANSING
constipation
one of the most common gastrointestinal complaints in the United States, resulting in about 2 million
annual visits to the doctor
causes of constipation
o lack of fiber
# soluble fiber (binds with water to thicken it) ! spend more time in stomach and gets
breaken down more and spends less time in the colon
# insoluble fiber (binds with water and makes gel like substance) ! push against the
wall and generates peristalsis
# lack of fiber ! minimize fluid in the lumen (harder to poop)
o lack of exercise
# exercise stimulates the sympathetic NS ! after exercising your PNS will turn on and
stimulate GI track movement
# elderlycannot chew well ! overcook food ! break down the fiber & do not
exercise a lot ! max. constipation
o medication
# causes increase in reabsorption of water in colon ! constipation
# irritable bowel syndrome:
# ignoring the urge

# lack of water?? ! not a major determinant

treatment of constipation
o consumption of fiber (25-30 g/day)
o exercise
o laxatives
# bulk forming laxatives
$ absorb water in the intestine and make the stool softer
$ Metamucil, Citrucel, konsyl, serutan
# Stimulants cause rhythmic muscle contraction in the intestines
$ Corectol, dulcolax, purge, feen-amint, senokot (prunes)
# Stool softeners provide moisture to the stool and prevent dehydration
$ Colace, dialose, and surfak
# Lubricants greast the stool enabiling it to move through the intestine more easily
$ Mineral oil
# Saline laxatives act like a sponge to draw water into the colon
Insoluble Fiber:
Good for constipation
Mixes with water and swells (pushes against the intestine walls ! stimulates peristalsis
Causes movement
Ingestion correlated inversely with cancer of colon
o More fiber, the faster bolus will move through the colon and decrease the chance of
carcinogen causing cancer
Sources:
o Whole grains
o Green leafy veggies
o Root veggies

Diarrhea & Glucose

12/8/13 10:13 PM

Diarrhea:(one(of(the(major(causes(of(death(of(children(worldwide((
Causes:((water(is(not(reabsorbed)((
o Bacterial(infections:(Campylobter,(salmonella,(etc.((
# Infect(colon(and(blocks(reabsorbing(action)(
o Viral(infections:(rotavirus,(herpes(simplex(virus,(etc.((
o Food(tolerances:(lactose,(gluten((
o Parasites(
o Reaction(to(medicine(:((
# Antibiotics((they(also(kill(good(bacteria),(BP(medication,(antacid,(etc.((
o Intestinal(diseases(
# Inflammatory(bowel(disease,(celiac(disease,(cronhs(disease((stress)((
o Functional(bowel(disordersirritable(bowel(syndrome((
Treatments:((
o Replenish(water(and(electrolytes((the(salts:(potassium(and(sodium)((
# You(lose(a(lot(of(ions/electrolytes(that(you(need(!(disaster(in(heart(&(
neuromuscular(functioning((
o To(maintain(electrolyte(levels,(consume(
# Broth(or(soups,(which(contain(sodium((
# Fruit(juices,(soft(fruits,(veggies(!(contain(potassium((
o for(children,(rehydration(supplements((
frequent(intestinal(disease((
diverticula:(little(pouches(that(form(in(the(colon((
o pouch(is(formed(and(likely(to(open(up((exposing(inner(sanctum)(!(infection((
# chronic(constipation(causes(pressure(on(the(pouch(!(open(it(up((
o caused(by(age(&(low(fiber(diet((
o prevention:((
# increasing(fiber(diet((both(soluble(&(insoluble)((
# exercise(!(sympathetic(activity(!(parasympathetic(!(GI(track(stimulated(!(
cleans(and(speeds(things(up((
polyps:(posh(tissues(into(intestinal(lumen((
o dangerous(because(can(become(cancer(cells((
o polypectomy1!(way(to(remove(it((
o causes:(unknown((might(be(related(to(fiber(content)((
hemorrhoids:(overexpansion(of(veins(in(intestine(
o causes:((
# lack(of(dietary(fiber((fiber(softens(things(and(things(move(more(freely(
# pressure(on(the(veins((MAJOR(CAUSE)((
# common(among(people(who(sit(all(day((
$ truck(drivers(&(writers((
# pregnancy(!(developing(fetus(that(cuts(off(blood(flow((
# obesity(!(mesentery(getting(fat((

o treatment(&(prevention((
# high(fiber(diet(!(soluble(&((insoluble((
# antiWinflammatory((aspirin)(!(CCK(being(released((
Distributing(the(nutrients(
Glucose1
neural(and(muscle(tissue(prefer(it((
o it(easily(transfers(energy((
o can(be(utilized(without(oxygen((
problem:((
o free(glucose(will(destroy(tissue((
the(starch(march((
o starch(!(disaccharides:((
# from(salivary(amylase((
# gastric(amylase((
# pancreatic(amylase((
o disaccharides ! monosaccharide (happens in the small intestines)
# sucrose((
# maltase(
# lactase((
o monosaccharide(travel(in(the(blood(as(glucose(and(goes(to(liver((
Carbs(in(the(liver((
o Liver(decides(fate(of(glucose((
# Use(it(for(energy((ATP)((
# Stores(it(as(glycogen((safe(form(of(glucose)((
# Stores(it(as(fat(!(most(effective(way(of(storing(calories((
# Make(nonWessential(amino(acids((
# Dump(it(into(the(blood((
Pancrease((
o Islets(of(langerhams((3(types(of(cells)(
# 1)(Beta(Cells(
$ when(blood(glucose(level(is(above(that(of(set(point(value(((
release(insulin((
stimulates(more(production(of(insulin((
$ insulin:(monitors(glucose(amount(
released(into(blood(supply(by(beta(cells(when(blood(glucose(rises(
about(80mg/100ml((
also(released(by(amino(acids((
$ role(of(insulin(in(muscle(cells(
insulin(attaches(to(insulin(repectors(!(uptake(of(glucose(by(
muscle(cell((
o allows(atlhetles(to(use(ATP(when(there(is(no(O2(present((
transports(glucose(into(cell((

o also(amino(acids(and(fatty(acids((
stimulates(synthesis(of(glycogen((
stimulate(synthesis(of(fat(from(glucose((
sensitivity(of(muscle(insulin(receptor(is(dependent(upon(
movement(!(more(you(move(the(more(sensitive(they(are((
exercise(increases(glucose(uptake(through(nonWinsulin(mechanism(
!(ATP(production((
role(of(insulin(on(fat((adipose)(cells((
insulin(attaches(to(insulin(receptors(on(fat(cells((
atctivates(the(transport(of(glucose(&(fatty(acids(into(cell((
stimulates(synthesis(of(fat(from(glucose((
stimulates(lipoprotein1lipase((
o hormone(that(breaks(down(lipids(IN(VLDL((outside(of(the(
fat(cell)?(so(that(fat(can(enter(fat(cells((bringing(in(glucose(&(
fat)((
blocks(hormone1sensitive1lipase((
o hormone(sensitive(lipase(break(down(fat((triglycerides(!(
fatty(acids)(so(that(it(can(escape((
o happens(inside(the(cell((
o blocks(this(action(so(fat(cannot(escape((
blocks(sympathetic(receptor((norepinephrine(receptors)((
sensitivity(of(insulin(and(sympathetic(receptors(is(dependent(upon(
the(size(of(the(adipose(cell((
o increase(in(size(!(decrease(in(sensitivity(((cell(will(not(
uptake(glucose)((
o when(you(lose(weight(and(get(skinner,(your(sensitivity(of(
fat(cells(increase((

Diabetes

12/8/13 10:13 PM

Effect of insulin in liver:

liver has no insulin receptors
transport of glucose not insulin dependent (like neural tissues)
o passive mechanism. Increase in glucose = increase in glucose going to liver
stimulates synthesis of glycogen
stimulates triglyceride synthesis (pack glucose into fat)
stops synthesis of glucose (gluconeogenesis)
o liver can make glucose from amino acids, but insulin wants to prevent glucose from being
made because glucose level is above threshold
o in diabetes, this system does not work
Testing Glucose response:
Glucose Tolerance test
o Overnight fasting
o Drink a liter of glucose
o Measure blood glucose level over the next 1-2 hours
# People who are diabetic have a higher morning level and a larger area under curve
Diabetes prevalence has been going up; body weight also increasing
o Increase in body weight = bigger fat cells = cells not sensitive to insulin = increase diabetes
Prevalence of diabetes:
o More common in male > female (small difference)
o Race: Hispanic > black > white
# Asiansmore likely to get it a lower body weight. Found that increase body weight
less likely to get diabetes
Types of Diabetes
Type 1 : Juvenile onset
o Insulin not produced because beta cells dont work
o Insulin dependent
o Begins in childhood
o Rapid onset of symptoms (follows a virus)
o Higher incidence among people who drink formula milk
o Possibly autoimmune disease
Type 2: adult onset
o Insulin produced but is not taken up because insulin receptors not sensitized
o Insulin independent
o Most prevalent (90%)
o Less severe, slower onset
o High insulin levels (both glucose & insulin levels high)
o Usually occurs in larger people
o Strong genetic component
Gestational diabetes (temporary)

o
o
o
o

Affects about 4% of pregnancies

Caused by hormones released by placenta block insulin
Occurs late in pregnancy
Untreated causes high levels of insulin release by mother
# Result = a lot of glucose & amino acid for baby ! macrosomia
$ Large baby
$ Increase babys chance of obesity and diabetes
Pre-diabetes
o Occurs when persons blood glucose are higher than normal but not high enough for
diagnosis of type 2
o Start watching diet/exercise

Effects of Diabetes:
Circulation
o Accelerate atherosclerosis
# Due to process of glycation (glycosylation) reaction of protein due to high levels of
glucose in the body
# Sugars react with protein ! AGE
$ Maillard reaction ! used by chefs to create flavor
# Produces AGE (Advanced Glycation Endproducts)
$ Binds to collage in muscle, connective tissue & arteries
$ Help with uptake of LDL (bad cholesterol) particles into walls
Facilitates with oxidation of LDL particles
$ Facilitates process of arterial plaque
$ Stimulates inflammatory responses
o Decrease circulation ! heart attach, stroke, limb loss, memory loss
The eye:
o Decreased blood supply causes
# Atherosclerosis
# Cataracts clouding of lens
o High levels of glucose in eye result in fructose & sorbitol formation
# They get metabolized slowly
# Increased concentration gradient and draws in more water
# More pressure in the eye ! damage to the retina & blurred vision
Peripheral neurons:
o Certain concentration gradient
o Too much glucose gets broken down into fructose + sorbitol
o Messed up the ionic gradient ! neuron loses sensitivity
# Result: decrease sensitivity to pain (diabetic neuropathies)
# Impaired immune system
Kidney
o No insulin receptor on kidney

o Sorbitol & fructose damages cell

o AGE effects
# Re-absorptive process is damaged
# Kidney stops reabsorbing proteins used as a clinical sign for kidney damage
# Damage is irreversible

Hypoglycemia (low glucose level)

12/8/13 10:13 PM

Symptoms of diabetes:
Glucose in urine
Increased thirst (water not reabsorbed in kidneys)
Increased urination
Weight loss (growth failure) in type 1
o No insulin ! amino acids cannot go into cell for growth (cells uptake glucose with amino
acids)
Weight gain in type 2 (cause)
Blurred vision (fructose & sorbitol ! pressure on cataracts)
Skin infection
Weakness
Dehydration
Acidosis: condition where blood becomes very acidic
o Dangerous because chemical reactions are blocked when blood acidic (enzymes denature)
o Happens because burn ketone (fat) bodies instead
Coma
Death
Treatment for diabetes
Small frequent meals
o Rise in blood glucose is not abrupt
Eat food with low glycemic index
o Glycemic index measures how quickly blood glucose level rises (determined by the rate your
body turns carbohydrates ! glucose)
o Glycemic index determined for individual food
o Mixed food (no one really knows the glycemic index for those)
Eat high soluble fiber diet
o Makes content in stomach more viscous ! slows down the rate of which food is thrown out
! slows down glucose level
Dont eat carbs by itself
o Carbs will be turned into glucose at must faster rate than if eaten with something else
Type 1: receive insulin
Type II: oral hypoglycemic / medication that stimulates sensitivity of fat cells to insulin
Lose weight ! reduces size of fat cell ! increase sensitivity of fat cells to insulin
Exercise assists in activation insulin receptors in muscle cells
Islets of Langerhans: ball of cells in pancreas responsible for regulating glucose level
Beta cells ! insulin (lower blood glucose level)
Alpha cells! glucagon (raises blood glucose level)
o Releases glucagon when blood glucose level falls below (70 mg/100mL)
o Converts glycogen ! glucose to be released

Delta cells ! somatostatin

o Releases somatostatin around same time alpha cells release glucagon
o Somatostatin reduces/suppresses insulin and glucagon receptors in liver so glucose level
do not constantly oscillate between hypo- and hyper-glycemia

Blood Glucose Response

At around 70 mg ! glucagon released
At around 40 mg ! light headed
At around 30 mg ! sympathetic nervous system aroused (sweating, heart pounding, etc. )
At around 20 mg ! fainting
The role of hypothalamus in regulating blood glucose level:
After a while, glycogen level runs out, so hypothalamus plays a role in regulating glucose level
Hypothalamus ! major regulator in the brain that mediates glucostasis (regulation of blood
glucose)
o Hypothalamus senses when there is a drop in glucose level
# Activates SNS
# Activates adrenal gland (located on top of each kidney)
$ Adrenal cortex: outside the kidney
$ Adrenal medulla: inside the kidney
# Adrenal gland stimulates adrenal medulla to produce and release adrenaline
$ Also releases norepinephrine ! targets liver ! activates gluconeogenesis
(amino acid ! glucose)
$ Neural tissues are happy
$ Muscle tissues are also happy because hypothalamus activates adipose cells
Hormone sensitive lipase breaks fats into fatty acids and released for
muscle
$ After 4-5 hours, run out of amino acid. Hypothalamus releases ACTH !
adrenal cortext ! stimulates the releases of glucocorticoids ! affect muscle
tissue and break down protein to get the amino acid ! amino acid used in
gluconeogenesis
Can remain in this state for about 1 month
Hyperglycemia: blood glucose level is low (glucose not being released)
Symptoms:
o Tenseness (sympathetic action because low glucose activates hypothalamus which is SNS)
o Sweating/cold hands and feet/heart pounding/stomach cramps (part of sympathetic NS)
o Hypertension
o Fatigue
o Inability to concentrate
2 types of hypoglycemia:
o 1) fasting hypoglycemia ! stop eating therefore your blood glucose is very low

o 2) reactive hypoglycemia ! hypersensitive insulin system

causes of hypoglycemia:
o pancreatic tumors (the cells are defected)
# beta cells ! hyperactive
$ extremely sensitive so you release more insulin than you need to
$ more insulin ! less glucose
# alpha cells ! hypoactive
$ alpha cells are slow to react and slow to release glucagon
$ body doesnt make up for the low blood glucose level
o pituitary tumors
# cannot release ACTH to break down protein in muscles into amino acids for
gluconeogenesis ! cannot make glucose
o adrenal tumor
# impair the release of glucocorticoids and insulin ! hypoglycemia
# adrenal glands are used in the regulation of blood glucose by hypothalamus
o liver disease
o drugs
# oral hypoglycemic ! the ones type 2 diabetes take to sensitize insulin receptor
# salicylates ! aspirin
# antipsychotic drugs
# alcohol
treatment:
o immediate treatment: eat sugar
o ketogenic diet: low carbs, lots of fats, lots of proteins
# works because it will sensitize mechanisms for glucose regulation ! mechanism will
become more sensitive
# works because stimulates the enzyme needed to keep glucose up
# ketogenic diet !
$ helps for hypoglycemia by inducing enzymes that keep glucose up
$ petit mal epilepsy (usually happens in kids) ! ketone bodies will protect
$ weight reduction reduces intake
$ psychological problems
brain metabolizes ketone bodies instead of glucose ! makes you feel
different

Energy Metabolism

12/8/13 10:13 PM

glycolysis:
breaking down 6C glucose ! 2 x 3 C pyruvate
requires 4ATP but makes 2 ATP
does not need oxygen
krebs cycle:
3c pyruvate ! acetyl CoA (2C) ! binds with oxaloacetate (in mitochondria)
o requires NAD + releases NADH
creates NADH and FADH2
oxidative phosphorylation
NADP and FADH2 used in oxidative phosphorylation
In liver:
Fatty acids -------! acetyl CoA -! krebs cycle/oxidative
Done by carnitive (supplement for building muscle tissue)
In ketogenic diets (decrease carbohydrate)
No glucose ! no pyruvate ! no lactic acid ! no oxaloacetate
So instead the acetyl coA -! forms ketone bondies
o Small molecules that store a lot of energy
o They are BAD because its very acidic ! cause liver and kidney damage
o Cause stinky breath
Levitskys first rule of metabolism:
ATP production sucks
Cannot be pushed only way to make more ATP is to use ATP
Daves Dietary Delusions:
Energy drinks and energy bars dont realy help because the only way to get more energy is to utlize
energy
Caffeine! powerful drug
o Affects neurojunctions (made up of neurotransmitters and the receptors)
# Sensitizes receptors
o Anti-fatigue factors: norepinephrine & dopamine
# Exist in brain
Drugs: amphetamine ; cocaine ; anti-depressant ! release more neurotransmitter

Proteins

12/8/13 10:13 PM

Benefits of low iron:

Reduces many parasitic infections:
o People with low iron (anemic) are protected from malaria
o Low iron minimizes anemia because low iron ! low RBC and since malaria acts on RBC,
the less RBC the fewer problems
o Low levels of iron protects from intestinal disorders
# Low level of iron ! liver produces hepcidin which acts as a bactericide and acts
against infections especially in tropical areas
Reduces bacterial infections
o Ex: mothers milk vs. cow/formula milk
# Mothers milk contains less iron (the iron is bound and is not freely available for
digestion)
$ Low levels of iron in mothers milk protects infants from bacterial infection.
o Cow and formula milk is not bound and is correlated to a higher rate of infection
Correlates with lower prevalence of cardiovascular disease
o High iron ! higher rater of atherosclerosis ! higher rate of CVD
o Thought that iron acts as an oxidizer
# Less amount of iron flowing around ! less amount oxidized
o Scandinavian studies
o Blood donation is good ! people who give blood ! lower rate of CVD
# Giving blood lowers hemoglobin which is beneficial in protecting against CDV
Other Anemias:
Megablastic anemia: the RBCs are large
Happens during red blood cell division:
happens when the cell is unable to divide due to folate
deficiency
o folic acid is necessary for normal division
o all cells require folate to divide and
differentiate differently
o the macrocyte has a very low O2 carrying
capacity = nonfunctional RBC
megablastic anemia is caused by:
o folic acid (b9) deficiency
o b12 deficiency
Folic acid deficiency:
o Neural tube defect = spinal bifida
# The spine is not fully developed when a baby is born
Folic Acid Fortification of Foods?
Helpful for people with low folate

o Is a genetic link ! Ex: give mom higher levels of folic acid during pregnancy (mom who
may be genetically unable to absorb as much)
Problem of high folate: Reduces the effectiveness of an anti-epileptic drug
May hide b12 deficiency ! BAD
Inactive folate ! active folate
# Requires B12 for the conversion
# by taking folate supplements, you dont need to convert inactive to active folate and
you wont know whether or not you have enough b12 vitamin
o B12 deficiency is much severe than folate deficiency
o B12 deficiency ! neural problems that are irreversible
# Brain requires b12 for myelin synthesis
# If b12 affected ! neural transmission affected
# Deficiency causes severe mental disturbance that may be permanent
# (taking surplus of b12 is not bad because excess will be secreted into urine)
Folic Acids in Foods
o found in green vegetables
B12 found in foods
o Omnivores (eggs, milk, oysters, poultry, meat)
o Vegetarians get it from eggs & milk
o Vegans have to eat b12 fortified foods or take b12 supplements
o Organic food ! organic fertilizer contains a lot of b12
# EAT ORGANIC
Major cause of B12 deficiency = gastric surgery
o Gastric surgery removes intrinsic factor and therefore cannot absorb b12

Diet to optimize exercise:

Creatine supplements ! quick initial bursts
Carbohydrates ! long distance
Low Fat diet ! high fat diets impair performance
Iron
Water
Water is essential for optimal muscle movement:
Aqueous environment is essential for enzymatic function
o Optimize water = optimize water in muscle = optimize performance of muscle fiber
Aqueous supply essential for maintaining blood volume
o Effect of training ! increase in blood volume (by maintaining hydration)
Aqueous state essential for cooling body
Maintaining high state of hydrating essential for optimal performance
Drink 8, 8oz. glasses of water a day?
Body contains about 55% to 78% water
o Womens content of h2o varies more than men

Little scientific evidence that we need to drink more

o all recommendation suggest drinking about 3L of water/day
# 580 mL from food
# 1061 mL for plain water
# 1539 mL from beverages
# TOTAL = 3179 mL/day
Other Myths about drinking water
Drinking water prevents constipation
o Does NOT help at all: constipation is caused by excessive removal of water from lumen itself
o Drinking more water will not help because the water will get absorbed before it gets to the
colon
o to help, we should eat more fiber
Thirst occurs too late to prevent dehydration
o Salivary glands contain h2o
o Low h2o means that the salivary glands are drying out
o Dry salivary glands ! early sign of dehydration
Dark urine means dehydration
o Could mean excessive amount of B vitamins ; does not necessarily mean that you are
dehydrated
High fluids intake needed for kidney function
o Not true b/c kidney works well in all conditions (unless kidney disease)
# if you do have kidney disease, might require greater amt of water going through it.
o Drinking more water does not prevent kidney disease
Bottled water is more healthy than tap water.
o Studies have shown that there are NO advantageous ! just using up a lot of plastic and
spending more money

Diet to optimize exercise: (continue)

Sports drink
o 90% fluid ! maximize fluids will produce maximum performance in exercise
o sugar ! burning glucose in cytoplasm
# more sugar ! maintaining glycogen supply = go longer in exercise
o sports drink will help improve performance (especially in long distance running) compared to
consuming a placebo beverage
vitamins
o vitamins are reused ! recirculated in the body
o NO need to consume more since they are recycled
o When exercising, muscle mass will increase but then you will also eat more so you will
consume more vitamins
o Studies have shown that vitamin supplements (with some exceptions) ! shown to be
ineffective
Protein

o Based on the idea that the protein we eat will become the protein in our body (not true)
o Eating protein does NOT stimulate muscle growth
# Muscle growth only through training
o Anabolic hormones (growth hormone & testosterone) does help build muscle
# BUT high dosing of hormones = high risk of atherosclerosis
$ More transfer of lipid from liver
Arginine (amino acid that if consumed in high dosage ! produce & release more
growth hormone)
$ Usually found in certain foods
$ Sold as muscle enhancer BUT increase in growth hormone production =
trivial
Doesnt help
o Protein balance
# In a state of perfect balance ! protein in = protein out
# Positive
$ Growth ! retaining more proteins than losing
Children need 8-9% of calories as protein ! but they eat more of that
Adults need 6% (on average) of calories as proteins
But we are consuming approx. 15-20% of calories as protein
o Most protein we are consuming ! used for glucose (energy)
and not for building protein
$ Pregnancy ! reason to consume a little more (increase by ~1%) protein
$ Exercise ! we lose tissue so we need to replace it with some protein (dont
need to eat much more)
# Negative effects
$ Diet ! hypoglycemic stage that draws on blood glucose
$ Stressed ! produce glucocorticoids
$ Illness
$ Inactivity ! dont use it, dont loose it
Dont use muscle, then it will atrophied.

Malnutrition

12/8/13 10:13 PM

How about eating protein?

Little evidence to support assertion that consuming more protein helps improve performance
Protein
Unique shape allows communication
o Neurotransmitters
o Hormones
o Enzymes
o Antibodies
o Transport carriers
Fragile
o Egg albumen (white part of egg) ! sticky protein used to transport fatty acids
o Raw egg albumen vs. cooked egg albumen
# Heat denatures protein (like how fever denature proteins in body)
o Stiffened egg albumen ! force air into it (used in cooking)
Determinants of shape:
o Kind of amino acid
o Order of amino acid
o Bonds between amino acids
Protein production
Amino acids are precursors of proteins
Protein production must be made within that cell
Signal comes in & signals the cell nucleus to start protein production
RNA is formed
Wait for amino acids flowing around > line them up & release it when complete
Incomplete Proteins
Happens when body is missing a certain type of amino acid
Body wil not make imperfect protein
Itll disassemble & wait until all amino acid is present
Weird proteins are made if something invades the protein ! ex: virus or bacteria
How closely in time do we need to eat all amino acids? (dont need to consume all amino acids everyday)
Pools of amino acids lasts for several days
We eat a lot more protein than we need
Can live days w/o consuming proteins
Dont have to balance at each meal

Quality of Dietary Protein

The more similar to AA pattern to human muscle, the higher the quality
o Closer quality to human muscle ! higher the quality
o Meat is not the perfect protein
Measured in terms of biological value

o Animal protein is the highest

Meat has one of the highest biological value for humans
Essential Amino acids: acids that we have to consume because our body cannot make them
Non-essential amino acids: we do not need to consume them because our body can make them
Protein Quality:
Complete protein:
o Has all amino acids in right proportions
o Ex: meat and meat products
Incomplete protein:
o Has 1 or more limiting amino acids
o Ex: plants
o Improving the protein quality of plants:
# Complementing protein : both foods are incomplete proteins but are missing
different amino acids. The food together will be a complete source of protein
# Usually legumes + grains
$ ex: beans (legumes)+rice(grain) = meat
$ peanut butter (legume) + bread (grain)
$ tabouli (grain) + bean (legume) salad
# supplementing protein: one food is incomplete and the other is complete so together
itll be complete source of protein
$ ex: macaroni (grain) + cheese (complete protein)
$ cereal + milk
$ chicken/meat stir-fry
Prion: a type of protein that flows around in our environment that causes a lot
mad cow disease
o animals develop a spongy cortex because protein ! misshaped brain ! holes in vacuoles
that interfere with cell function
# ex: if found in motor neurons ! affect movements
in animals = scrapie (bovine spongiform encephalopathy)
in humans = creutzfeldt-Jakob Disease (CJD)
o usually found in humans that are in contact with animals
o irreversible disease
prions proteins (PRP) are found in all neurons
o they are thought to stabilize membrane (but not entirely show)
when a different kind of PRP from environment (PRPsc) get into body and into neural cells, they
oxidize prions in body to the ones that are similar to the ones outside
o influences other PRPc to get oxidized too
creates amyloids (central characteristic of central nervous system disease)
o happens in spongiform encaphalopathies
# generation of amyloids !
$ alzheimers disease ! amyloids in brain
$ parkinsons disease

$ huntingons disease
lack of dietary protein (not infrequent situation
Kwashiorkor (happens in children)
o consumption of low-protein diet with sufficient calories (no protein is available so caregiver
gives it sugar water when baby is crying)
o can slowly recover if give baby enough protein
o characterized by
# retarded growth (look younger b/c missing protein & differentiation)
# high rate of infection
$ immune system needs protein
# edema (fluid accumulation in legs & belly)
$ result of low blood protein in
# pot belly ! edema & intestine has a lot of worms ! pushing out belly
# very low serum protein
$ low protein concentration in blood
$ when the heart beats, the pressure generate pushes water out of the tissue and
the only mechanism to get the water back is through osmotic gradient (the
higher concentration of protein inside the blood vessels will carry water back
in)
$ low protein ! water not being carried back into blood and stays into tissue !
edema
$ normal: blood pressure = osmotic effect
$ edema: blood pressure > osmotic effect
# fatty liver
$ reduced VLDL (protein) ! cannot remove fat from liver
$ reduced blood albumin (protein )
albumin (the white egg) is used as a carrier of fatty acids in blood
# retarded motor and cognitive development

Malnutrition & Cancer

12/8/13 10:13 PM

Lack of dietary protein = kwashiorkor

Effect= Mental Retardation?
Long-term reduction in brain size
Malnourished children = retarded psychomotor and mental development
Human data confounded
o Difficult to ascribe mental retardation to malnutrition when there are so many factors that
case retardation in cognition
But Malnourished children can learn (no impairment in learning)
o Smaller brain =/= less intelligence
o Connections between neurons are not affected; but
o Impaired mental developmental through functional isolationism (instead of being curious,
they focus on their survival)
# Mammals require environmental info to optimally surivive
$ Poor nutrition removes animal from environment that is necessary to optimize
cognitive ability
# Receive that information by being curious early in life
# Also programed to survive
$ Behaviors necessary for survival =/= behaviors necessary to grow
intellectually
$ Only curious abut where to get food ! survival
# When nutrition is scarce (protein or calories) ! behaviors involved in survival
inhibits the curiosity to learn
# Consequences = for optimal development children need not only food, but an
environmentally stimulating environment cognitive stiimlation ! intellectual
deficit
o Must be rehabilitated medically and nutrionally
# Cystic fibrosis studies (cannot absorb things in GI track)
$ they grow up malrnourished
$ they are not retarded at all
psychological consequences:
o stunting (short ideas) is a measure of early malnutrition
o stunted child displays
# cognitive deficits
# more aggressive behavior
# attentional deficits
# poor social relationships
# more symptoms of depression and anxiety
# low self-esteem! increase chance of high risk crime/behavior
o when tested as late adolescents, psychosocial stimulation ameliorated most cognitive effects
except for hyperactivity
# nutritional supplementation alone did not

lack of calories = marasmus (most prevalent cause of malnutrition in the world)

NOT due to a lack of food in the world
But because of a poor distribution of food
o War ! cut supplies line (political problem)
# Use of food as a political weapon (ex: in ww2, Germans)
o Competition in the world market
# Hurts developing countries
# Produce food for exports at the expense of feeding their own
$ Vs. food needed to feed population
Infants Formula & Malnutrition:
Less severe but still potent case
When formula were introduced, it was thought to:
o Help liberate women ! help poor women be able to go to work
Bottle/formula feeding suppresses breast feeding
Benefits of breast feeding:
o Breast milk contains:
# Sanitary nutrients = nutrients kids need
$ Vs. formula !need sanitary nutrients since babys GI track is not well
developed and is vulnerable to infection & parasite
$ Increase in bottle feeding ! increase in infectious rates b/c lack of sanitary
nutrients
# Growth promoters
$ Stimulates lactobacilli (Which helps digest milk)
If babies drink formula milk ! does not develop bacteria that enables
growth factors to be expressed
# Bactericides:
$ Helpful in poor areas because it decreases the effects of unsanitary conditions
# Mothers antibodies
$ They get transmitted to the baby
$ Lower chance of child getting disease that mother developed antibodies to
# Anti-inflammatory factors:
$ Ex: ibuprofen (comes in mothers milk )
$ Which is important b/c infants GI track does nto develop enzymes & lipases
# May stimulate jaw growth (lower jar) through sucking
$ Resistance/pressure stimulates bone growth
$ When using a bottle, do not need to suck as hard as they would when sucking
a mothers breast
# Problem: HIV transmission?
$ Aids transmission vs. Infection
$ There is a higher chance of transmitting it, but economic pressure pushes you
to bottle feed
# Protects against obesity?

$
$

Children who are bottle fed are bigger than those who are breast fed
Push breast feeding as a way of minimizing obesity
When bottle fed, easier for parents to force kids to drink more milk
Small difference in BMI

What effect does poor nutrition have in more developed nations?

Early studies of the effect of eating breakfast
o Smarter students eat breakfast BUT does not mean that breakfast ! smarter; just parents are
encouraging kids to eat bfast are more concerned about their kids
o % of children who eat breakfast decrease through the year
o only study to clearly demonstrate negative effect of not eating breakfast:
# Test of word fluency ! shows that previous periods of malnourishments have long
term effects
School breakfast program:
o No academic achievement increase, but psychological achievement
o There is a lower school absentee rate
o School breakfast improves school attendance
o School attendance is correlated with adult behavior
# poor attendance in school ! greater crime rate and greater divorce rate
# greater attendance in school ! greater adult income
o effect of Head start program (geared for poor students)
# did not affect grades
# affected how long students stay in school
! OBESITY?
Role of protein in physical performance
for adults, 5% of calories needed, 10% max for atlhetes
lack of protein in children ! Kwashiokor
lack of protein & calories ! marasmus
eating more protein than required = no advantage

Protein & Cancer (vitamin A)

12/8/13 10:13 PM

Can Protein be bad? ! CANCER

2nd cause of death after CVD is CANCER
prostate & breast ! related to diet
colon & rectum cancer ! most closely linked to diet
Causes of preventable cancer
Smoking ! bad CDV & lung disease
Food ! affect breast cancer / colon & rectum cancer
Cancers related to dietary fat ! colon, prostate, breast
Correlation between fat consumption and animal protein intake
Decrease animal protein consumption = decrease fat/caloric consumption
Formation of cancer cells:
Two mechanisms in body:
o Proto-oncogenes: genes that make normal cell into cancerous cells (aka uncontrollable
growth)
o Tumor suppressor genes: suppress the formation of abrnomal cells
Our body lives in a balance of these two (we have both present)
Colon is most vulnerable to cancer
In cancer, proto-oncogenes ! oncogenes
o Oncogenes suppress the tumor suppressor genes

Is there any hope? YES

Calories & cancer

o Clive McKay, Cornell University did a study
# Rats who halved their diets ! doubled lifespan
# problem: rats lived in a sterile environment
# found that as little as 10% diet reduction can reduce chances of cancer by natural
means
o incidence of cancer in formally hospitalized anorectics
# ! considerably lower cancer rates
# suggest that caloric restrictions may be good for people too
o monkey experiment ! caloric restriction helped slow down aging process

Reservatrol! found in red grapes & red wine

Reservatrol mimics many functions that caloric reduction does
The French paradox! high fat in cooking but have long life
o They do drink a lot of red wine (however, amount of reservatrol in wine is very small)
Minimizing the risk of cancer:
Dont smoke
Minimize caloric intake
Maximize intake of fruits & vegetables
o Vegetarians show a lower rate of cancer compared to non-vegeterains
o Fruits & vegetables contain anti-oxidants (remember carcinogen must be oxidized)
o BUT increase in vitamin E consumption did not show reduce in rate of cancer
# Vitamin E are anti-oxidants
Other types of antioxidant! VITAMIN A (retinol)
Sources of vitamin A:
o Animal: retinol + retinyl esters (preformed vitamin A)
o Plants: carotinoids (provitaminA)
o Goes to intestine where everything converted to retinol
o Stored in liver
Role of Vitamin A:
o Eye (dark absorption)
# Go from light ! dark area
# Retinal + opsin &! rhodopsin
$ Low in retinal makes it hard for you to adapt to dark light
$ Rhodopsin is terribly sensitive to photo ! stimulates neurons in retina
o Growth:
# Cell differentiation
# Reproduction
# Bone growth
# Epithelial cell formation

# Immunity
Deficiencies
o ! night blindness
# foamy line of bitot spot ! history of night blindness
# bitots spot (localized xerosis) ! night blindness
# preventable but irreversible

Vitamins A & C

12/8/13 10:13 PM
High intake of Vit. A ! lower rate of cancer (because vit. A has antioxidant properties)
HOWEVER, taking excess vitamin A ! harmful
Vitamin A intake regulation:
Excess intake:
o Redness of skin (not dangerous, but indicator that consuming too much vitamin A)
o Fetal malformation (pregnancy vulnerable to high level of Vita A) (vitamin A plays a role in
reproduction)
o Dermatitis (skin infection, irritability because skin has high rate of turn over)
o Hemorrhages (bruise & bleed early); liver toxicity (vitamin A storage)
o Death
Normal Range : 500-3,000 microg
Deficiency:
o Night-blindness ! most preventable
# Usually first signs (cant quickly go from light ! dark)
o Xerophthalmia ! spots in eyes
o Keratinzation of mucous forming cell ! scarring in eyes (irreversible)
o infection
o death
Role of Vitamin A in epithelia function
Skin consists of epithelia cell
o Acne! caused by sebacias gland (located near hair roots) ! carries dead skin cell/oil
# 85% of population from 12-25 suffer from acne
$ due to overproduction of sebum
$ sebum carries skin cells and oil to surface
$ excess sebum plugs duct causing a comedo
due to hormones [puberty]
$ under skin it appears white ! whitehead
$ if plugs goes to surface ! turns black blackhead
they get oxidized ! exposure of oil to air
# not caused by diet (eating junk food -/-> acne)
# caused by androgens stimulating sebaceous secretions
# picking pimples ! causes scaring
# Accutane ! retinoid
$ most prescribed drug to treat acne
$ reduces sebum production
$ taken orally
$ problem:
toxic in high doses (similar to taking high levels of vitamin A)
may cause birth defects

o Wrinkles:
# retin-A
$ used to tighten skin
as we get old, collagen (which keeps skin intack) > loosen up
$ high concentrations may cause birth defects (acts like vitamin A)
$ effect of retin-a is temporary (works until body removes the vitamin A)
same as Botox (the more expensive form)
How much vitamin A do we need?
There is an upper limit (do not need to worry; only worry if we take supplements because normal
food does not contain that much vitamin A)
Infants need a higher level of vitamin A than children b/c growing faster
Male generally need more vitamin A
Need a little bit more during pregnancy
Need much more during lactation
Different forms of Vitamin A:
Retinol vitamin A
Retinal
Beta-carotene
o Precursor to retinal
o Sold to increase vitamin A
Problem: they are absorbed differently
o Vitamin A is fat-soluble, but absorbed into the micelle differently depending on the form)
International units (IU)= 0.3 of retinol
o 0.6 of beta-carotene
o 1.2 of other provitamin A carotenoids
in 2001! institute of medicine recommended the retinal activity equivalent (RAE) = 1 ug of retinal
o comprehensive inactivity & absorptive capacity
Where do we obtain vitamin A?
Liver (since liver stores it)
Dandelion leaves
Leaves of broccoli
Yellow veggies (sweet potato, yams, carrots)
Other Carotenoids (what are carotenoids? )
People who eat foods containing
o Lycopene have lower risk of prostate cancer
# Tomatoes and other red fruits and vegetables
o Beta-carotine (precursor to carotenoids) have lower risk of oral cancer
# Apricots, broccoli, carrots, melon, palm oil, papaya, pumpkin, spinach, tomatoes

o Cryptoxanthin have lower risk of cervical cancer

# Orange rind, papaya, egg yolk, butter, apples
Do vitamin A supplements help ! NOPE (no effect)
Vitamin C: also acts as an antioxidant
Good antioxidant
Good evidence that it acts as anti-cancer agent in lab
o In vitro studies, cancer cells stop dividing with high levels of vitamin C
Good evidence that people who eat food rich in vitamin C have lower risk of cancer (colon, prostate,
breast)
NO evidence that vitamin C supplements reduces the risk of cancer
Does vitamin C counter Stress?
When stressed, we lose a lot of vitamin C
Vitamin C is stored in adrenal medulla (gland)
Released during sympathetic stimulation
Facilitates the conversion of tyrosine to NE and E (epinephrine)
Stress reduces vitamin C content of adrenal
No evidence that improves performance under stress
Can cause runners diarrhea
o Not absorbed and when it gets to the colon, water is absorvd
Major Function of Vitamin C
Important for formation and integrity of collagen
o Collagen= abundant protein in body
o Makes up connective tissue
o Development of bones, tissues, neurons, etc.
o Uses collage for structural (ex: found in hair products)
o Collagen important to maintain capillaries
Deficiencies causes scurvy aka sailors disease
o In children causes poor growth
o In adults, causes
# Easy bruising ! capillaries are easily broken and blood can break out
# Bleeding gums ! gums hold teeth through protein where collagen plays a role
# Tender joints ! joints are made up of collagen
# Scurvy nails ! capillary damage under nail
$ The white parts under the nail leukonychia ! caused by injury; not related
to ca deficiency
The common cold
o Colds are caused by viruses
o Viruses transmitted by hand to mouth
o More colds in winter because were indoors ! less air circulation
# Virus changes between seasons

o Chicken soup
# Provides moisture
# Penicillin? (found in chicken soup)
$ Penicillin not helpful towards the cold virus,
$ But after cold ! mucous which contains bacteria
$ Penicillin works there
o People who have the cold + take vitamin C supplements
# Miss fewer days of work because of a cold
# Spend less time in because of cold
# Suffer less discomfort
# Less fatigue
o However, vitamin C supplement have no effect on:
# Mucous thickness
# Fever
# Nasal opening
# Airway resistance
o CONCLUSION ! believing in vitamin C influences your perception of symptoms

Foods & Cancer

12/8/13 10:13 PM

Minimizing Risk of Cancer:

dont smoke

minimize caloric intake

decrease fat

decrease protein

increase fruits & vegetables consumption

o

eat more food that contain vitamin A&C (antioxidants); lycopene, beta-carotene

increase fiber intake

studies shown that supplements do not help

(cruciferous vegetables & citrus fruits)

increase coffee intake

Foods that protect against cancer:

cruciferous vegetables: cabbage, broccoli, Brussels sprouts

o

correlational studies show that people who intake large amt of cruciferous vegetables ! lower risk of cancer

but not sure what is in that veg that helps

citrus fruits: lemons, grapefruit, oranges

o

they contain vitamin C

coffee bean: increase coffee consumption ! lower risk of gastrointestinal cancer

o

before, decaffeinated coffee! increase rate of cancer (but not anymore)

Food practices that increase risk of cancer:

Smoking

Drinking more than 2oz./day of alcohol

o

Increases oral/gastric cancer

Grain storageaflatoxin (ex: peanut, peanut butter)

o

Natural fungus infection

Carcinogen aflatoxin (cannot eliminate it, but government monitors a max. amount of it in grain storage)

Smoking foods ! food that is smoked

Charcoal grilling ! applies to meat/ not vegetables

More frequently consume it ! increase risk of cancer

2 potent carcinogen:
#

Polycylic aromatic hydrocarbons (PAHs)

Heterocyclic amines (HCAs)

Deep frying (also contains PAHs and HCAs)

o

Heat concentrated on fat! amines

Using already used oil ! increase risk of cancer

Salt-pickling
o

Leads to gastric cancer

Ex: pickles!

Salt concentrated with throat

Increase salt intake ! increase prevalence of helicobacterpylori ! gastric ulcers/cancers

Sun-exposure

Exercise & cancer

Exercise reduces the risk of:

o

Colon, breast, prostate (mianly diet though)

Endometrium

Esophagus

Kidney

Lung

! CDC recommends that adults engage in moderate-intensity physical activity for at least 30 minutes on 5+day/week
or vigorous intensity for at least 20 minutes 3+days week

cancer incidence decrease w/ increasing physical activity levels

exercise decreases the side effects of anticancer therapy

aids in the recovery and rehabilitation following chemo, radiation, surgery

all cause mortality in cancer survivors decrease with increasing amount of exercise

! maintain a positive attitude

meat, calcium, & osteoporosis

12/8/13 10:13 PM

Perils of proteins:

Does not increase athletic performance

Associated with increased risk of cancer

Associated with osteoporosis

Calcium paradox:

US consumes the highest amt of calcium, yet have highest rate of osteoporosis

Africa consumes lowest amt of calcium, yet have lowest rate of osteoporosis

! because more protein you eat, the more calcium you lose
o

eating protein ! increase in blood amino acid

increase in amino acids ! blood more acidic

bicarbonate needed to buffer the blood

bicarbonate released from bones, but calcium released with it

calcium also necessary for removing amino groups from kidney

Bone:

Tissue is constantly rehealing itself

2 factors operate in the bone ! together they do remodeling

o

osteoblast: fortifies bone with calcium

osteoclast: takes calcium away from bones

#

can increase due to inactivity

from birth to 25 ! calcium concentration in body goes up

from then on, calcium concentration decreases as the matrix in bones start to break ! osteoporosis

after reaching menopause, women Ca concentration decreases a lot faster ! more bones broken at an earlier age

in older people ! spinal cord is bent due to loss of Ca

long term consequence of losing CA from bone ! osteoporosis

Blood calcium is regulated

CRITICAL for neural and muscle function

Low blood calcium:

o

Neural and muscle super excitable

#

Muscle spasms

Tetany: hyper excitable/almost epileptic reoccurrence of muscle movement

High blood calcium:

o

Depressed neural and muscular function

Cardiac arrhythmias
#

Leg cramps ! suffering from low Ca

Heart is a muscle that requires a good amt of calcium

When there is LOW LEVEL of calcium:

o

Parathyroid gland detected

Parathyroid hormone is released

#

Stimulates CA loss from bone

Increases CA absorption

Activates vitamin D ! affects intestinal & increase Ca absorption

When there is HIGH LEVEL of calcium

o

Thyroid gland stimulated

Releases CALCITONIN
#

Inhibits bone loss from bone

Increases CA loss from kidney

Ways to maintain bone calcium

Exercise
o

Weight bearing exercise ! movement that compresses bone

#

Estrogen replacement helps reduce loss of Ca

o

Compression of bone = absorption of CA

Estrogen patches ! help retain Ca in tissues

Increases Ca consumption/exercise as kids, have more Ca for the rest of the life

Resolution of calcium paradox

Africans consume less protein

Africans are more physically active

Some risk factors for osteoporosis:

Early menopause (before age 45) ! low estrogen

Eating disorders as teen/preteen

o

Ex: female athletes and dancers

Caucasian/Asian ethnicity

Small body frame

o

Putting less pressure when you are smaller

Obese people are safer from osteoporosis

Family history of osteoporosis (there is genetics related)

Early malnutrition

Low vitamin D ! important for absorbing CA from intestine

Certain medicine ! prednisone (for example) forces kidney to lose too much Ca

Intestinal pathology
o

Celiac disease, inflammatory bowel disease

Space flight

Daves Dietary Delusions ! calcium supplements

Ca + estrogen ! effective

Ca + weight bearing exercise ! effective

Ca + vitamin D ! effective

Bottom line: CA ALONE IS LEAST EFFECTIVE

Food rich in Calcium

Milk ! skim milk has just as much calcium as whole milk

Cheese

Broccoli

Almonds

Sardines

Vitamin D & Hypertension

12/8/13 10:13 PM

Vitamin D:

Important for:
o

Regulating uptake of Ca

Cell differentiation ! fetal malformation, etc.

#

Relationship btween ca & cancer is not clear

Immune function (development of antibodies)

Inflammatory response

Low blood vitamin D associated with increases in

o

Cancers of the colon, prostate, and breast

Tuberculosis, influenza (viruses like to eat vitamin D)

Heart diseases

Vitamin D deficiency:

Rickets (occurs usually in children) ! curvature bone in legs lack Ca so its soft ! curvature of bones
o

Reversible when consume enough Vitamin D

Osteomalacia (usually in adults) ! softening of the bone

o

Pain in muscle tissues because they require a certain amount of Ca inside and outside

Low Vitamin D in elderly:

Natural decrease in vitamin D as we get older because intestines are not up to absorptive capacity (liver damage, kidney
damange)
o

Osteoporosis

Muscle weakness

Sources of Vitamin D:

Fortified milk ! contains D2

Sunlight ! contains D3
o

Both are precursors and inactive forms

Vitamin D2 & D3 go to the liver ! converted to Calciferol (still not active)! goes to kidney ! converted to
Calcitriol (active) ! increases Ca absorption

Causes of Vitamin D Deficiency

Lack of vitamin D in food

o

Lack of vitamin D in food + lack of exposure to sunlight

o

By itself, its rare because all cultures have at least dairy products fortified with vitamin D
Lack of exposure due to sunlight ! smog, excessive clothing (cultures)

Disease
o

Liver ! block the release of calciferol

Kidney ! block the release of calcitrol

Intestine ! disturbance in absorption

Low fat diets ? (only unreasonably low fat diets & very unlikely)

Medications ! barbiturates, anti-convulsives, prednisone

Getting old ! dysfunction of liver, intestines, kidney

Food rich in Vitamin D

Dairy products (fortified)

Cod liver oil

Catfish

Shitake mushrooms

Sun as a source of vitamin D

Tanning salons vs. direct sunlight

o

Tanning salons not recommended b/c increases the rate of cancer

American academy of dermatology does not recommend getting vitamin D from sunlight because it is linked to skin
cancer

Vitamin D supplements

Known: elderly have low vitamin D

Low vitamin D associated with falls and breaks

Associated with loss muscle strength and increased pain

Bone fractures decrease with vitamin D + CA supplements but not either alone

low vitamin D predicts cancer

studies have failed to show that supplements protects or retards cancer growth

Calciumblod pressure connection

low consumption of Ca correlates with high BP

o

low Ca ! greater excitability of smooth muscle (arteries)

Ca supplements reducse BP in people with low blood calcium

RELATIONSHIP BETWEEN CA INTAKE AND BLOOD PRESSURE IS STRONGER THAN WITH DIETARY
SOIDUM

Sodium-blood pressure connection

o

Significant increase in salt intake and increase of hypertension ONLY between different counties

No significant correlation in salt intake and increase of hypertension in US

Significant correlation with calcium intake and incidence of hypertension

Low Ca intake ! increase hypertension

Hypovolemic Thirst
#

Kidney detects drop in pressure

Decrease in BP ! kidney releases renin into blood stream

Angiotensin I released

Converted to angiotensin II (potent substance)

$

1) go to the brain and stimulate angiotensin II receptor in brain ! drink water (increase BP
because increasing volume in circulation) however, not that sensitive

2) contracts the walls of the arteries. Stimulates adrenal cortex ! secrete aldosterone thatll
modulate absorptive capacity of kidney

in low BP, NA reabsorption increase ! more water renter blood ! increase BP

DRUGS that prevent increase in BP

$

ACE inhibitor

blocks conversion of Angiotensin I to Angiotensin II

Angiotensin II receptor Blockers

works the same was as ACE inhibitor

both relatively safe

Diuretics (oldest form) ! make you pee so you lower blood volume ! lower BP

Lose Na in urine ! lose water ! lower blood volume

Cause a lot of problems

Natural diuretics !
o

water

caffeine (stops reabsorption of Na)

alcohol

Sodium-Blood Pressure Connection

body requires less than 500 mg of sodium/day

average Americans consume 3300 mg of sodium/day

only about 10% of salt intake is under our control

o

can only reduce 10% of salt we eat

75% of salt comes from processed foods

Low sodium diets reduce blood pressure

Low sodium diets reduce food consumption

Reduced food consumption causes reduced body weight

Reduced body weight causes a reduction in BP

Eating high salt foods will raise BP

o

After consuming food, BP will raise, but itll drop over time after kidney detects it

High salt diets does not cause you to become hypersensitive

Exception: salt-sensitive individuals

#

Mainly African-americans

African americans have a high incidence of hypertension

$

Partly due to salt intake (they are more sensitive)

Partly due to environmental stress factors from poverty

Requirements

12/8/13 10:13 PM

Facts about blood pressure:

Major predictor of
o

Heart attack ! build up of atherosclerosis, increase blood pressure ! blow out arteries

Stroke

Retina failure (blindness)

#

Kidney failurefiltration problems

2 types of blood pressure:

o

Increase pressure ! push fluid out into extracellular spaces and out against retina (like diabetes)

1) essential (primary)
#

no physical cause (its a result of aging)

90-95% of hypertensives

2) secondary
#

adrenal tumors ! effect on aldosterone

kidney disease ! messing up renin system (which is very pressure sensitive)

systolic pressure
o

peak pressure of arteries

120 mm Hg

hypersensitive if BP > 140 mm HG

diastolic pressure
o

pressure bringing back theblood

80 mmHg

hypersensitive if BP > 90 mmHg

In the united states:

o

Incidence of BP increases with increase age

#

In women there is an even greater increase due to greater loss of Ca after menopause

BP related to SES:
#

The poorer you are, the increase in incidence of blood pressure

Health disparities

Factors associated with hypertension:

More than 3oz. of alcohol per day

o

Alcohol destroys kidney and liver

Diet: (diet we dont want to have)

o

High saturated fat (from meat)

#

Study: 57 couples living in new Zealand

$

Had a two week baseline period (control)

6 week intervention based on 3 diets:

diet low in fat (23% of energy) and a high polyunstarted:saturated ration

diet with reduced salt intake

usual diet

4 weeks recovery period (control 2)

diet 1: there was a drop in BP during intervention, but control 2 period went back up

diet 2: no significant change

diet 3: no significant change

low fiver

low vitamin D ! decrease Ca absorption which leads to BP

low dietary calcium, potassium, magnesium

high in lead, cadmium, zinc, mercury (toxic metals)

crowding (greater group ofpeople shows an increase in BP)

o

results:

due to stress? People in cities have higher BP than people in rural areas

abdominal fat

How to minimize the incidence of hypertension?

Weight control ! exercise (blood pressure increases when exercising but decreases when relaxed)

Relaxation ! along with exercise helps control BP

Treatment for hypertension:

Stress reduction (BP exacerbated by SNS)

o

Vacations

Meditations

Relaxational therapy

Increase fruits and vegetables

Increase physical activity

Reduce (&maintain) body weight

Drugs?

Perils of proteins:

Does not increase athletic performance

Associated with increased risk of cancer

Associated with osteoporosis

Hypertension

Environment ! changing agriculture

Takes a lot of feed and water to produce 1 pound of beef

Protein:
o

Meat-eating diets ! 4200 gallons/day

Vegetarian diets ! 300 gallons/day

87% agricultural lands used for meat production

1/3 of all fossil fuels are used to raise animals for food

one acre of trees disappear every 8 seconds to provide land to produce meat (usually tropical forests)

ruminant livestock produces about 80 million metric tons of methane

o

28% of global methane emission

bottom line: use meat as a condiment

Government decides how much of each nutrients we need to eat

History of Dietary recommendations:

World War I
o

Food rationing

Question how much protein and energy do we need?

US Department of Agriculture decided to define how much we need based on dietary surveys (how much people ate)

League of nations (precursor to UN)

Concept of dietary requirement

How much of a nutrient is necessary to prevent a deficiency from occurring

1941food & nutrition board of National Academy of Sciences

o

established RDA (recommended dietary allowance)

Protein consumption:

Based on surveys:
o

Mean = 30 mg of protein = 6%

Standard deviation = 45 mg of protein = 9%

Safety margin = 10 %

Food Labels

12/8/13 10:13 PM

Recommended dietary allowance ! based on balance studies

Mean = 30 mg

With standard deviation = 45 mg

Safety margin = 50mg

! say we need 10% of our calories (50mg) from protein (btu really is almost half of what we need)

All government feeding programs are based on RDA

School lunch & breakfast

o

Government sells stored commodities

#

Buy from farmers (dealers) to keep the price up (maintain price)

Cheaper to give it away than to store it (because government ends up with a lot of stored food)

! school lunch & breakfast programs used to give food away (not to feed children )

women infant and children (WIC)

o

giving women food lowers their chance of having a low birth kid (which will cost the government more money
in the long run)

armed forces
o

meals are dictated by RDA because must stay within guidelines

RDA was good for proteins, vitamins, and minerals. However, it was not helpful for avoiding chronic diseases
National Academy invents:

DRI: daily reference intake

Consists of 4 values
o

Estimated Average Requirements (EAR)

#

Meet the need of 50% of the population

Calculated for various stages of life and gender

Recommended Daily Allowance (RDA) amount needed to prevent a deficiency and minimize disease in 98%
of population.

Adequate intakes (AI)

#

expert estimates of how much is needed to live a healthy lifestyle

used when insufficient data to set EAR

Tolerable Upper Intake Level (UL)

#

Maximum amount that can be taken safely

DRI differs from the RDA:

o

Includes not only protein, vitamins, and minerals, but also

#

Carbohydrates, fats, fiver, phytochemicals

Meant not only to prevent deficiencies but to prevent chronic diseases

o
o

RDA was shifted up ! increase amount of food you consume ! increase caloric consumption ! population
overweight

Food labels:
o

Dairy & meat %s are measured in terms of the weight

#

Add more water, increase over all weight, decrease % of fat

Daily Reference Intake

o

Through calculations ! calculated that

#

33% fat diet (too high)

10% protein (too high)

60% carbohydrate (too low)

Food Groups

Four food groups (1951)

o

Meat, poultry, fish, dry beans and peas, eggs, and nuts (protein)

Dairy products, such as milk, cheese, and yogurt

Grains

Fruits & vegetables

**put up by dairy council, recommend that we eat of food from each of these 4 groups

Food pyramid (1992)

food pramind (2005)

categories: grain, veggies, fruits, fats, milk, and meat& beans

big emphasis on ENERGY EXPENDITURE

my plate (2011)

o
Food that the government subsidizes:

Physicians committee for responsible medicine

Created 4 groups

Fruits, legumes, whole grain, and vegetables

Harvard healthy eating plate

Vegetables, fruits, whole grains, healthy proteins, water (not dairy), healthy oil

Nutraceuticals

12/8/13 10:13 PM

Dietary Guidelines:

Tension between the department of agriculture and the department of health

o

Most effective thing we can do is to consume fewer calories, but that will hurt dep. Of agriculture

Recommendations:
o

Prevent obesity/overweight through improved eating & physical activity

Control total calories intake

Maintain appropriate calorie intake during each stage in life

Foods to reduce:

Reduce sodium intake (only effective for those who are hypersensitive to salt)

Consume less than 10% of calories from unsaturated fat

Consume less than 10$ of calories from cholesterol

Keep trans fat low

Reduce intake of calories from solid fat (sat. fat) + added sugar

Limit consumption of food that are refrained grains

Alcohol should be consumed in moderation

Foods & Nutrients to increase:

Increase fruit & veggie uptake

Eat a variety of food (wont run into nutrient deficiencies)

Consume grains as whole grains

Drink free & low-fat milk instead

Eat a variety of protein food (fish, bean, poultry, etc. )

Eat food with less solid fat; use oil to replace

Eat food with more K, fiver, Ca, and Vitamin D

If capable of being pregnant ! consume more heme iron

If pregnant ! 8-12 oz. of seafood & take fe supplement

50 y.o + ! foods fortified with b12 (aging ! decrease in intrinsic factors)

Neutraceuticals & alternative healing

Using food as medicine

Only good to prevent deficiencies

White Willow Bark (the powder):

Contains salicin
o

Converted to acetyl-salicylic acid in liver

We consume this in aspirin

Major anti-inflammatory effects

Due to block of prostaglandin synthesis

#

Inhibit cox 1 and cox 2

Responsible for fevers

Swelling

#
o

Feeling irritable

Non-steroidal anti-inflammatory drugs (can buy w/o prescription)

#

Aspirin (bayer)

Ibuprofen (motrin, advil, nuprin)

$

Acetaminophen (tylenol)
$

Anti-inflammatory
Only relieves fever

Problem with aspirin & Tylenol ! reyes syndrome (not recommended for children)

Evidence for prevention?

o

Prevents cardiovascular disease

Prevents stroke

Prevents Alzheimers disease

Prevents Parkinsons disease

Xanthines

Coffee
o

Caffeine ! goes to head and affects the brain (Anti-fatigue factor)

Theophylline ! acts like caffeine, causes bronchial dilation

Tea
Chocolate
o

Theobromine ! will increase BP (caffeine like substance)

Phenylethylamine (love drug, that is why we give chocolate during valentines day)
#

Acts like amphetamine

Actions
o

CNS stimulants
#

Potentiate SNS by sensitizing norepinephrine receptors

Relaxes smooth bronchial muscle ! helps you breathe better

Potentiates ephredine

Ephedra

Also known as Ma Huang

Sold by herbalife ! people were taking it for weight control or people suffering effects from high blood pressure

Ephedrine
o

Sympathomimetic ! antifatigue factor, increases heart rate, increases BP

Effect exaggerated by aspirin

Stimulants suppress appetite (because inhibit sympathetic NS)

Exacerbates hypertension

Saw Palmetto

Berries used to treat prostatic hyperplasia (prostates keep growing and will become a cancerous organ; happens very
very very slowly)

Active because contains phytoserols

Effective!
o

Not more effective than placebo

Cochrane Database: base conclusion on reviews of data assess and summarizes study ! help make health care decision

Underestimate the effect of saw palmetto

Echinacea

Enhances immune system?

o

Nothing can enhance immune system; can only be impaired by being nutrient deficient

Prevents/shortens durations of cold

Effectiveness? Evidence not established

Ginkgo Biloba

Oldest living trees

Increases blood circulation to the brain

Acts as an anti-coagulant

Reduces the risk of atherosclerosis

Helpful in Alzheimers or dementia?

o

Evidence: evidence: clinical significant with people with dementia/cognitive impairment

American Ginseng

Stimulating effect on memory, depression, alertness

evidence: no quantifiable effect on memory

o

scarce & inconclusive

Saint Johns Wort

Antidepressant
o

MAO inhibitor (destroys neural transmitters)

Effective in 40% of cases

Serotonin reuptake inhibitor

#

Similar effects as standard antidepressants & lower side effect than standard antidepressants

Garlic for the common cold

No evidence that it decrease cold for periods of time

Health Value of Soy

Phyto-oestrogens
o

Evidence: effects are subtle and do not show protective effects

#

May actually exacerbate breast cancer

Clucosamine + chondroitin

Taken mostly for people with arthritis

Evidence: does not reduce joint pain

NCAM national center for complimentary & alternative medicine

Medical Myths

12/8/13 10:13 PM

Alternative Medicine:

Osteopathy: spinal cord

o

Thought that every injury eminates from spinal cord

By manipulating bones in spines, we can relieve pressure

Chiropractic (branch of osteopathy)

o

Believe that disease is caused by poor connection between brain & organ

Chiropractors Cant write prescriptions

Expert in spine; manipulation of spine ! helpful

Treatment of back pain is effective

**two were based on the idea that touching is an important process of healing. These branch arose because people were
dissatisfied with typical medicine

Herbal therapy ! does nto really work

Acupuncture
o

Alleviate illnesses

Based on the idea that:

Acupuncture works: points that were identified and stimulated were cell bodies that stop pain
#

Certain nerve areas release opiates ! relieve pain by taking space of receptors of pain

Homeopathy
o

Based on the idea that if we feed you low concentration of poison ! helpful

Same thing as the immunity shock

Aromatherapy
o

Use herbs to create certain odors

Effectiveness waiting to be demonstrated scientifically

Hypnotherapy
o

Developed before anesthesia

Most studied area: people who want to stop smoking

Works, but only for a short term effect

Massage therapy
o

Touching powerful psychosemantic effect

By pushing muscles, you can relax

Spiritual therapy
o

Prayer is an effective healer

Literature ! no scientific effect

Who uses CAM?

Women

Older adults

African-americans (68%) more likely than whites (50%) or Asians (48%)

Excluding prayer, use increases with education

More likely to have public health insurance than private

26% of CAM users were advised by their physicians

28% of CAM users believed conventional therapy wouldnt help

o

thought that the treatment was worse than the disease itself

13% of CAM users felt conventional medicine was too expensive

conditions affected by placebo and blocked by pharmalogical antagonists

pain

Parkinson

Depression

Immune response

Therapies may have an effect because you believe (expectancy) they will

Believing that a treatment is efficacious changes the interpretation of symptoms

Believing in a treatment reduces stress

Believing that one is in control is associated with performing other healthy acts

Problems with inferring causality from clinical observations

Clinical fallacy
o

Freud fallacy: you only see what you want to see

Regression fallacy

Body heals
#

Body healing is a natural progress

Medical Myths:

Sugar causes hyperactivitiy

Organically grown food is healthier than commercially grown food

Plastic cutting boards are more sanitary than wooden boards

Amount of bacteria left is around the same

Wood actually contains some antibacterial factors

Starches are fattening

o

It is actually the calories

Eating after 8pm causes weight gain

Teething causes fever

Sleeping by an open window or going outside with a wet head ! common cold
o

Cold is a virus

Cracking knuckles causes arthritis

o

Just relieving the air from knuckles

You can get sexually transmitted disease from sitting on a public toilet

Sitting in hot water will decrease a males capacity to reproduce

o

Based on idea that testicles sperm production decreases. But the decrease is irrelevant

Black coffee can help you stay sober

Wearing tight briefs can make a man sterile

o

Based on idea that increase temperature in testicles, sperm production decreases)

Drinking lots of water will prevent a hangover

Wearing a copper bracelet will cure arthritis

Spinach is a good source of ion

o

Contains it, but is in bound form (unless you eat it with lemon/acid)

Feed a fever, starve a cold ! actually worsens the symptoms

Putting butter on a burn with ease the pain

o

Cool burn with cold water

Cover burn with sterile pad

Maintain body temperature and take to medical facility

Reading in dim light and being too close to the TV or computer monitor will ruin your eyes

If a women carries her baby high in the uterus and her stomach has a around appearance, she will have a girl. Otherwise
it will be a boy

Shaving hair causes it to grow back faster, draker, and coarser

Newborn babies should stay indoors for the first three weeks

If you handle frogs or toads, you will acquire wart

Sugar causes diabetes

Brown eggs are more nutritious than white eggs

Home pregnancy tests are over 95% accurate

o

Accuracy level: 53-82%

Honey is better for you than white sugar

Dark skinned people dont need sunscreen

We only use 10% of our brain

Fresh food is more nutritious than frozen/canned food

Final Review

12/8/13 10:13 PM

What mechanisms come into play when BP drops?

kidney senses drop in BP and releases renin
renin actives ACE (angiotensin converting enzyme)
ACE converts angiotensin I ! angiotensin II
Angiotensin II causes smooth muscle of the arteries to contract
Angiotensin II stimulates aldosterone released from adrenal cortex
Aldosterone ! increase reabsorption of Na in kidney
Increase in blood sodium ! increase h2o volume ! increase blood volume
What mechanisms come into play when serum Calcium drops? (lecture 33)
Parathyroid detects drop in Ca and releases parathyroid hormone
Parathyroid hormone causes release of Ca from bone
Parathyroid hormone increases reabsorption of Ca from the kidney
Parathyroid hormone activates vitamin D ! increase reabsorption of Ca from intestines
What mechanisms come into play when serum calcium increases? (lecture 33)
Thyroid gland detects increase and releases calcitonin
Calcitonin blocks the release of Ca into blood from the bone
Calcitonin blocks uptake of Ca from kidney ! more ca will be released in urine
May block calcium reabsorption in intestines?
Why are low carbs diet good for the treatment of hypertension?
Increases sodium loss by the kidney (low carbs diet = eat less ; loses sodium = lose water)
Decrease energy intakedecreases body weight (caloric intake)
What would happen if, as a nation, we reduced our meat consumption?
Lower risk of osteoporosis (because increase meat ! increase amino acids ! increase acidity !
increase release of bicarbonate ! Ca released with bicarbonate ! less Ca in bones ! osteoporosis)
Less h2o use
Saves energy
Saves rain forest
Reduced fat intake: reduce weight ! reduce risk of hypertension & diabetes
Reduce risk of cancer
What are the advantages of consuming a little meat?
Increase the absorption of iron
Increases protein quality of plants
Increases available B12 (b12 goes down as you get older)
Which dietary techniques are most likely to decrease cancer?
Drink coffee &**

Take vitamin A,C,E supplement (supplements not very helpful)

Eat fruits & vegetables &**
Reduce total caloric intake & **

At which stage in cancer will nutrition have its greatest effect?

Initiation & ** (stage where altered DNA are created; low protein and low fat diet have its effect)
Latent
Promotion
Metastasis
As you progress into later stages, nutrition has less and less effects
What can you do to minimize your risk of cancer?
Examine yourself
Know family history
Dont smoke
Limit exposure to sun
Eat your fruits and vegetables
Limit consumption of meats
Limit consumption of fats
Limit alcohol consumption
o No more than 3 drinks a day for cancer
o No more than 2 drinks a day to prevent heart diseases
# But more than 1 drink/day
Maintain lowest healthy weight possible
Exercise
Maintain a positive attitude
What food practices increase your risk of cancer?
Smoking cigarettes
Any vitamin or mineral deficiency
Grain storage aflatoxin
Smoking foods
Charcoal grilling
Deep frying
Salt-picking
How does taking vitamin C supplements decrease effects of colds?
Believing changes the perception of symptoms
Why do Africans have a lower rate of osteoporosis than americans?
They consume less protein and they exercise more

What are the effects of low serum calcium?

Neural and muscle ! super excitable (increases sensitivity)
Muscle spasms
Tetany
Hypertension
What are the effects of high serum calcium ?
Depressed neural muscular activity
Cardiac arrhythmias
What is the % of daily value?
Amt of nutrient u need based on a 2000 calorie value
% of a 2000 Kcal diet that is composed of a particular nutrient for an average person
What is the difference between new DRI & RDA?
DRI includes not only proteins, vitamins, and minerals, but also
o Carbs & fats
o Phytochemicals
DRI was meant not only to prevent deficiencies, but prevent chronic disease
What are the processes necessary to produce vitamin D?
Intake of the precursors
o Consumed (D2) & sunlight (D3)
Liver converts precursor ! calciferol
Kidney converts calicferol ! calcitriol (active form of vitamin D)
What is a major cause of vitamin D deficiency?
Not being exposed to sunlight (excessive clothing, fog, etc.)
What are some examples of complimenting proteins?
Beans (legume) + rice (grain)
Peanut butter (legume) + bread (grain)
Tabouli (grain) + bean (legume) salad
None of these by itself is complete
What are some example of supplementing proteins
Mac & cheese
Cereal & milk
Chicken or meat stir-fry
How do low salt diets reduce BP?
Reduce energy intake & body weight because food with no salt = nasty = dont eat

Davids rules for healthy eating

Eat as little as possible
o Weigh yourself regularly
Eat primarily a plant based diet
o Use meat as a condiment
Exercise whenever possible
Enjoy life