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My BIO
Registered Dietitian MPH, Nutrition Le Cordon Bleu trained chef Doctorate student Professor: Nutrition, Public Health, and Culinary Arts Chef Instructor/Consultant Public Health Writer: LA Times TheRealBetty@aol.com
Nutritional Assessment
Dietary Assessment
24 hour recall 72 hour recall Eating patterns Meal plans Looking for deficiencies Barriers:
Limited recall due to______ Older patients Women vs. Men
Anthropometric Assessment
BMI:
Limitations Overestimate
body fat in athletes High muscular build
Underestimate
Older persons Significant muscle loss
D-E-T-E-R-M-I-N-E
Checklist to help older adults ID symptoms of Nutritional Problems Table 7.2
1. Disease: confusion, memory loss, depression 2. Eating poorly: too little/much, same pattern, skip meals 3. Tooth loss/mouth pain 4. Economic Hardship 5. Reduced Social Contact: living alone 6. Multiple Medicines: nausea, diarrhea 7. Involuntary Weight Loss/Gain 8. Needs assistance in self-care: eat, cooking, shopping 9. Above 80 years
DOES provide
Screening tool Requires clinical judgment
Interpret information
Table 7.3
Nutrition Counseling
Nutritional Counseling
Healthy Meal Plan Objective
DIET: foods you NORMALLY eat and drink Cho0se whole foods 3 Macronutrient Strategies
Put fiber behind your carbohydrates (CHO) Lean Protein (PRO) Choose Healthy Fat (Lipids)
My Plate Strategies
plate fruits/veg grains whole grains Lean protein
MyPyramid is now
16
MyPlate
17
18
19
21
22
23
Whole 165
calories Calories saved
2% 125
calories
1% 100
calories
Fat-free 85
calories
40
24
65
80
Not Physically Active <30 min most days moderate - vigorous physical activity
Moderately Active ~30 min most days moderate - vigorous physical activity
Physically Active 60+ min most days moderate - vigorous physical activity
Males 19-30
Females 31-50 Males 31-50 Females 51+ Males 51+
2400 Calories
1800 Calories 2200 Calories 1600 Calories 2000 Calories
2600 Calories
2000 Calories 2400 Calories 1800 Calories 2200 Calories
3000 Calories
2200 Calories 3000 Calories 2200 Calories 2800 Calories
Calorie Level
Grains
2,200
2,400
2,600
2,800
3,000
3,200
7 ounces
8 ounces
9 ounces
Vegetables 2 cups
3 cups
3 cups
3.5 cups
3.5 cups
4 cups
4cups
Fruits
2 cups
2 cups
2 cups
2.5 cups
2.5 cups
2.5 cups
Dairy
3 cups
3 cups
3 cups
3 cups
3 cups
3 cups
3 cups
3 cups
3 cups
Protein Foods
7 ounces
7 ounces
COUNTING BY HAND
MACRONUTRIENTS
CARBOHYDRATES (CHO) FAT (LIPIDS) PROTEIN (PRO)
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CARBOHYDRATES
30
AMDR
Acceptable Macronutrient Distribution Range
31
Basically Fiber
Structural form of glucose in plant leaves, stems, and seeds.
Cell wall= 95% fiber
Human digestive enzymes cannot break the chemical bonds holding the sugar units together, i.e. indigestible in human beings.
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Basically Fiber
Polysaccharide
Many sugar units
Types of Fiber
Dietary Fiber:
Nondigestible intact plant components Two type:
Soluble Fiber Insoluble Fiber
Functional Fiber:
Nondigestible CHO that have been extracted or manufactured from plants
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Insoluble Fiber
Doesnt dissolve in Called roughage water Example = cellulose Insoluble fiber passes Strings of celery through the GI almost Kernels of corn intact Bran layer of Adds bulk to stool whole wheat Acts as a sponge to kernel absorb water
Aids in digestion & elimination Reduces constipation
Soluble Fiber
Dissolves in water Attracts water & forms gel in GI (viscous) Slows digestion Slows gastric emptying (stomach) Promotes fullness Slows blood glucose absorption Gives a gummy or gel-like characteristic to food Binds to cholesterol for elimination (lowers LDL)
36 Sources: oats, soy, legumes, nuts, bananas, apples, oranges celery, cucumbers
Functional Fiber
Added to food Extracted, isolated or manufactured from plants Contain both soluble & insoluble fiber Takes on same physiological benefits as soluble insoluble Passes through GI, nondigestable
http://www.aaccnet.org/ news/pdfs/DFreport.pdf
Sources: available throughout the food supply and included in the list of ingredients and fiber 37
38
NLEA
National Labeling & Education Act 1990
Calorie values generally reflect industry practices of calculating calories from 4-4-9 kcal/g for protein, carbohydrate, and fat, respectively or from 4-4-9 kcal/g for protein, carbohydrate minus fiber, and fat. The latter method is frequently used for high-fiber foods. Notice that this presents an opportunity for inconsistency in labeling among different food products and companies. Some food items may include the dietary fiber in the calculation of total calories; others may not."
39s
Benefits of Fiber
Reduces Calorie consumption
Think nutrient dense Displaces Calorie-dense fats & sweets
Promotes a feeling of fullness Slows movement of food from the stomach to the small intestine
Reduce blood glucose
Postprandial (after eating)
Contributes no Calories
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42
FANTASTIC STOOL:
If LOVING you is WRONG, I dont want to be RIGHT!
8 glasses water daily PATIENT READY Happy Colon = Healthy Colon Yes, these are GI cookies
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44
Keeps GI muscles healthy & toned Prevents Diverticulosis Once diagnosed, high fiber diet paramount to ensure the smooth passage of fecal material Abnormal pockets in the colon wall Caused by weakening of muscles surrounding the colon Prevent bouts of Diverticulitis Inflammation of diverticulum
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Fiber Recommendations
DRI: Dietary Reference Intake Men 19-50: 38 g/day Women 19-50: 25 g/day Fiber intake should be increased gradually because it may cause bloating or gas These side effects disappear within 2-3 weeks Fiber intake recommended from FOOD Adequate fluid intake with high fiber diet: 8-8oz glasses water/day
Recall DV on label is used as a reference. Label based on 25g/d
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Dehydration Malnutrition
Can reduce energy intake
Bowel impactions
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50
Fats
Break DOWN
Saturated Fats
The Bad Fats
Maximum number of hydrogen atoms No point of saturation (double bonds between carbon) Triglycerides that contain 3 saturated fatty acids More stable at high temperature
Saturated Fats
The Bad Fats Founds in Animal Products such as: Butter Cheese Whole Milk Ice Cream Fatty Meats Coconut, Palm & Kernel Oil
Saturated Fats
The Bad Fats
Why are they bad?
Saturated Fats
Diets High in Saturated Fats
Saturated Fats
Adequate Amounts of SFA
Cardiovascular Benefits Bone Health Optimal Liver Function Strong Lungs Healthy Brain Nerve Communication Immune System Function
The Bad Fats Trans fat is another name for an unsaturated fat Carries a trans isomer in the fatty acid chain. It has a double carbon bond They are sometimes monounsaturated and polyunsaturated but never saturated. They are known for raising your LDL levels lowering your HDL levels causing coronary heart disease
Trans Fats
Fad Diets
Low Fat & Nonfat
Low Fat and nonfat diets may not be the healthiest for your body Taking the fat out of your diet often removes the flavors of the food you consume Some foods remove fat and add sugar for flavor
Good Fats
Good fats help fight the very diseases that consuming excess fat was said to cause. good fats are beneficial to cholesterol. Monounsaturated fat helps to lower cholesterol. they are a good source of omega-3 fatty acids (cold water fish, nuts, oils, seeds, dark leafy greens).
http://www.med.umich.edu/umim/food-pyramid/fats.htm
Good Fats
Omega-3 fatty acids is an essential fatty acid which is NOT manufactured by our bodies, so eating those foods is the only way to get them. Omega -3 fatty acids are also thought to lower blood pressure, combat LDL (bad) cholesterol, fight inflammation and protect the brain and the nervous system.
http://www.med.umich.edu/umim/food-pyramid/fats.htm
Good Fats
Eating monosaturated fats improves blood cholesterol levels which can decrease your risk of heart disease. Research shows also shows that MUFAS may benefit insulin levels and blood sugar control which is helpful to people who have type two diabetes. Omega-3 fatty acids found in some types of fatty fish, appear to decrease risk of coronary artery disease.
http://www.med.umich.edu/umim/food-pyramid/fats.htm
FLAX MEAL
NUTRITION INFORMATION
The Good Fat
1 Tablespoon of flax meal: 3 grams fiber 2 grams omega-3 (good fat) Recipe: 1-2 Tablespoon/cup flour
http://www.youtube.com/watch?v=_1EbDdAeq7A
CHIA SEEDS
NUTRITION INFORMATION
The Good Fat
1 Tablespoon of CHIA SEED: 4 grams fiber 2.4 grams omega-3 (good fat) Recipe: Gel: 1 cup water: 2T 2t chia seeds, mix, store in refrigerator up to a week
http://www.youtube.com/watch?v=_L4wJ1vadUg
Polyunsaturated
The Good Fat
Corn Oil Soybean Oil Safflower Sunflower, Sesame, pumpkin seeds and flaxseed
Walnuts Soymilk Tofu Fatty fish (salmon, tuna, mackerel, herring, trout, sardines)
Cholesterol
blood level indicates increased risk of atherosclerosis Reduce your total blood cholesterol by: 1. Consuming less saturated and trans fat 2. Consuming more fiber 3. Exercising
GOOD/BAD EICOSINOIDS
Physiological Event GOOD EICOSANOIDS n-3 DRIVEN
Open Decrease Prevent Decreased
Pain
Inflammation Smooth Muscle Immune Function Menstrual Cramps Tumor Cells Gestation (Pregnancy)
Decreased
Decreased Relaxation Increase Decreased Kill Prevent preterm birth
Increased
Increased Contraction Decreased Increased Promote Promote preterm birth
PREFERRED:
Fish (whole food) NOT fish oil
EXCEPTION:
People who cannot get enough EPA/DHA from their diet
MANUFACTURING
Made from skins & liver more likely to contain contaminants Newer processing reduces risk
CAUTION
Interfere with blood clotting: EPA supplements 200 mg/d DHA Fish Oil 300 mg/d Vitamin Toxicity Fish liver oil naturally contains high levels A & D
AMDR
Acceptable Macronutrient Distribution Range
PROTEIN
Importance of PROTEIN
AA must be continuously available to build PRO of new tissues for GROWTH & MAINTENANCE
Embryo, athletic muscles, growing child, new blood cells lost in menstruation, scar tissue to heal wounds, new hair & nails Protein Turnover Constantly make & break down PRO Recycling AA Daily: 25% AA are irretrievably diverted to other tissues to be used for fuel
MUSCLES contain 40% body PRO Muscles can release EMERGENCY AA for energy Building Compounds: enzymes & hormones ENZYMES: 1000s reside in every cell Recall: enzyme=catalyst to speed up reactions HORMONES: messenger molecules made from AA Recall: Insulin & Glucagon for glucose regulation
Wasting AA Summary
WASTING: When AA not used to build PRO or make other Nitrogen-containing compounds When wasting occurs
1. 2. 3. 4. Body lacks energy from CHO/Lipids Diet supplies MORE PRO than needed Body has TOO much of any single AA (supplements) Diet supplies PRO of LOW quality (too few essential AA)
Recall NLEA
National Labeling & Education Act 1990 PRO Labeling Must Include: PRO grams in bold print Incomplete PRO: When food is for adults/children over 1 year of age : label should state "0%" in % DV column or state "Not a significant source of protein. Voluntary Labeling: %DV Protein % Daily Value is not required when the food is for adults or children over 4 years of age unless a protein claim is made
http://www.fda.gov/ICECI/Inspections/InspectionGuides/ucm074948.htm
RECALL: AMDR
Acceptable Macronutrient Distribution Range
AMDR Recommendations*: CHO: 45-65% lipids: 20-35% n-6: 5-10% n-3: .6-1.2%
% of Total Calories *Authored by the DRI Committee 19-50 Years Old
QUALITY AA
1. LIMITING AA
An essential AA that is present in dietary PRO in INUSUFFICIENT amount, thereby limiting the bodys ability to build protein Acute shortage: inconsequential as cells resume normal protein activities when limiting AA is provided in next meal (~24 hours) Chronic shortage: lack variety of plant based foods Protein synthesis slows Cells begin to break down protein-making machinery Wasted AA: Amine groups excreted, C,H,O used elsewhere Severe cases: break down organs for AA
QUALITY AA
2 COMPLIMENTARY PRO
Plant-based diet 2 or more PRO whose AA assortments compliment each other in such a a way that the essential AA missing form one are supplied by another AA low in some foods are supplied by other Goal: to consume essential AA in sufficient amount to support health MUTUAL SUPPLEMENTATION: strategy of combing 2 incomplete PRO sources so that the AA in one food make up for those lacking in the other food Example: Beans & Rice
QUALITY AA
3 PRO Digestibility
Method to evaluate: Protein Digestibility Corrected Amino Acid Score (PDCAAS)
Reference AA = egg white (high biological value) Animal based diets have highest digestibility Milk (100%), Beef (92%) Plant based diets have less Soy protein (100%) Legumes (90-70%), Fruits (75%), vegetables (73%), cereals (59%), peanuts (52%), Grains (90-70%0 Cooking with moist heat improves digestibility
http://jn.nutrition.org/content/130/7/1865S.f ull
Remember
A variety of foods, in moderation, can fit into a healthy eating pattern if nutrient needs have been met without exceeding calorie limits. Regular physical activity helps maintain calorie balance.
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Thank you