Nutrition by the Numbers Simple Ways to Improve your Diet · Nutrition by the Numbers Simple Ways...
Transcript of Nutrition by the Numbers Simple Ways to Improve your Diet · Nutrition by the Numbers Simple Ways...
Nutrition by the Numbers Simple Ways to Improve your Diet
Dr. Wendy L. Stuhldreher, RD, LDN
Department of Public Health & Social Work
Slippery Rock University of Pennsylvania
Topics covered 1. The Power of Protein
A “25-30 g dose” at every meal
2. Calcium – milk = 300 mg More than just for bones
3. Vitamin D – take a grand -1000 IU More than just for bones
4. Omega-3 fatty acids -1-1½ g Time for an “oil” change!
5. High five – fiber that is Does whole grain mean high fiber?
6. The power of 10,000 steps!
What is Sarcopenia? Involuntary, progressive loss of muscle mass 3-8% reduction in lean muscle mass per decade
after age 30! Consequences
in muscle strength mobility ↑ risk of falls ↑ morbidity
Prevalence 60 yr olds ~ 30%
Source: Paddon-Jones D. et al. Am J Clin Nutr 2008; 87: 1562-65. Paddon-Jones, Rasmussen. Dietary protein recommendations and the
prevention of sarcopenia: Protein, amino acid metabolism and therapy. Curr Opin Clin Nutr Metab Care. 2009; 12: 86-90.
What controls synthesis of muscle?
During the Growth years
Physical activity
Eating food particularly carbohydrate which stimulates insulin
Insulin is an anabolic (Growth promoting) hormone
After age 30 yrs
Anabolic drive is lost especially with carb-containing mixed nutrient meal
Sedentary Lifestyle ↓ efficiency of use
mTOR signaling pathway regulated by leucine
(mTOR is mammalian target of rapamycin)
Reference: Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs. Nutrition & Metabolism. www.nutritionandmetabolism.com/content/6/1/12
What is the difference between the RDA and these new recommendations?
RDA
Based on nitrogen balance
Preventing deficiency
Minimal daily average intake level that meets nutritional requirements of nearly all health individuals
Higher levels (1.2 g/kg)
Cell signaling via leucine
Satiety
Thermogenesis
Glycemic control
Reference: Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs. Nutrition & Metabolism. www.nutritionandmetabolism.com/content/6/1/12
Proposed Protein Dose for Adults
Response determined by leucine – signal for triggering initiation of muscle protein synthesis
Importance
Protection of lean tissues during wt loss and to prevent age-related sarcopenia and osteoporosis
25-30 g high quality protein at every meal stimulates skeletal muscle protein synthesis
Reference: Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs.
Nutrition & Metabolism. www.nutritionandmetabolism.com/content/6/1/12
Can elderly respond to exercise training?
Yes!
25% increase in mean muscle fiber in elderly males after
12 wk resistance training program
Supplement of 10 g protein + 7 g CHO immediately after resistance training
Reference: Esmarch B, Andersen JL, Olsen S et al. Timing of postexercise protein intake is important for muscle hypertrophy with resistance training in elderly humans. J Physiol. 2001; 535:301-311
Focus on total calories consumed and protein intake of elderly
http://www.fotosearch.com/IMP185/1525r-81932/
Best Medicine – Primary Prevention We need a new message!
Rather than treat sarcopenia – prevent its development!
Identify the minimal exercise regimen to achieve desired results
Maximize the interactive effect between nutrition intake and exercise in muscle protein synthesis
Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006; 84: 475-482.
Tips to help you make wise choices from the protein foods group
Go lean with protein http://www.choosemyplate.gov/foodgroups/proteinfoods.html
Summary of Research on Dietary Cholesterol
Challenge studies (by Dr. Fernandez) – children, adults, people on wt loss regimen, people with metabolic syndrome
Up to 3 eggs per day increased LDL and HDL size which is NEGATIVELY related to CVD risk
Changed the ratio of LDL to HDL in a favorable way
Source: The State of Cholesterol Science, SCAN Webinar by Dr. Maria Luz Fernandez
How Many Eggs Yolks?
Dietary Guidelines for Americans 2010
“independent of other dietary factors, evidence
suggests that one egg (i.e., egg yolk) per day does not result in increased blood cholesterol levels, nor does it increase the risk of cardiovascular disease in healthy people”
Page 27
Comparing Protein Values in all foods
Meat, poultry and fish 7 g per ounce
Beans, dried peas, lentils 7 g per 1/2 c cooked
One large egg 7 grams
Milk 8 grams per cup
Bread 2 grams per slice
Cereal 2 grams per 1/2 cup
Vegetables (non-starchy) 2 grams per 1/2 c
Plant Protein Examples of protein content
1 cup quinoa………………………………………….21g 1 cup lentils…………………………………………..18 g 1 veggie hot dog (Yves Veggie Dogs)……… 16 g 1 cup kidney beans………………………………...15 g ½ cup tofu………………………………………….…14 g 1 veggie burger (Boca burger)….................13 g 2 T peanut butter………………………………….…9 g 1 cup cooked brown rice…………………………..9 g 1 cup soymilk (Silk)……………………………..…..6 g 1 cup oatmeal…………………………………….……6 g ¼ cup walnuts……………………………..............4 g 1 slice whole wheat bread………………… ……..3 g
New Research Osteoporosis and Protein
Indicates more than calcium is needed
Calcium and protein are interrelated
Calcium supplements are ineffective for remodeling bone if protein is limited!
Positive effects of calcium appear to require 1.2 g/kg protein
Reference: Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs. Nutrition & Metabolism. www.nutritionandmetabolism.com/content/6/1/12
Have you heard that you should have lunch for breakfast if you want to lose weight?
Protein greater satiety than other E-yielding nutrients
Reduces daily calories by ~ 200 kcal Source: Schoeller DA, Buchholz AC. Energetics of obesity and weight control: does diet composition matter? J Am
Diet Assoc 2005; 105: S24-28
Requires > 30 g protein at a meal
Breakfast has greatest impact on protein intake Source: Rolls BJ, Hetherington M, Burley V. j: The specificity of satiety: The influence of foods of different
macronutrient content on the development of satiety. Physiol Beh 1988; 43: 145-53
Higher protein diets protect muscle and bone during weight loss
Protein Content of “breakfast” Foods
Food Item Serving size Grams of Protein
Greek Yogurt 1 cup 23
Greek yogurt 1 container (6 oz or 170 g)
12
Skim milk 1 cup 8
Whole egg 1 large 7
Cottage Cheese ¼ cup 7
Regular Yogurt (6 oz or 170 g) 5
Calcium Requirements Adequate Intake
Life Stage Group Recommended Dietary Allowance (mg)
4-8 800
9-18 1,300
19-50 1,000
51-70 1,200 F 1,000 M
>70 1,200
How is Osteoporosis Diagnosed?
T-score – measure of bone mineral density (BMD) compares one to a 30 yr old healthy adult
Measured at
Hip
Spine
Wrist
Finger
Shin bone
Heel
Milk and Dairy Group
What does this food group contribute to a balanced diet?
Calcium, Vitamin D and Protein
1 cup of milk ~ 300 mg calcium
http://www.choosemyplate.gov/food-groups/dairy.html
Get your calcium-rich foods.
See DairyGroup
Copyright 2005 Wadsworth Group, a division of Thomson Learning
~ 300 mg
~10 - 50 mg
~ 20-80 mg
~ 50-175 mg
Calcium Supplements
Calcium, whether from the diet or supplements, is absorbed best by the body when it is taken several times a
day in amounts <500 mg But taking it all at once is better than not taking it at all!
(National Osteoporosis Foundation- www.nof.org)
Calcium Carbonate
Calcium Citrate
Calcium supplements
Calcium Carbonate (40% calcium) Take supplements with a meal because
food slows intestinal transit time and allows more calcium to be absorbed from the gut
Stomach acidity enhances absorption
Reference: Whitney & Rolfes Understanding Nutrition: Highlight #12 2005
Calcium supplements
Calcium citrate (21% calcium) Can be taken anytime
To test calcium supplements– drop in 6-oz cup of vinegar, should dissolve within 30 minutes
Reference: Whitney & Rolfes Understanding Nutrition: Highlight #12 2005
Vitamin D Functions Endocrine Functions
Raising serum 25(OH)D from 50 to 80nmol/L
Improves calcium absorption
Raises Bone Mineral Density
Decreases the risk of falling ( 33%) and osteoporosis fracture risk
Improves neuromuscular function
Update from a Presentation: Dr. Robert Heaney. Creighton University Osteoporosis Research Center.
Vitamin D: Health, Promotion, Disease Prevention & Treatment. View from the Clinic. Food and Nutrition Conference and Expo.
American Dietetic Association. Philadelphia, PA October 1, 2007
Vitamin D Functions Autocrine Functions
Immune Response
Evidence that Vit D reduces influenza and TB
Antipromotion of Cancer
decreases risk of prostate cancer
decreases risk of colorectal cancer ( 50%)
decreases risk of breast cancer (animal model)
Maintains insulin sensitivity
Decreased risk of auto-immune disease (RA)
Decreased HTN
Update from a Presentation: Dr. Robert Heaney. Creighton University Osteoporosis Research Center.
Vitamin D: Health, Promotion, Disease Prevention & Treatment. View from the Clinic. Food and Nutrition Conference and Expo.
American Dietetic Association. Philadelphia, PA October 1, 2007
Examples of Vitamin D Sources 1 mcg = 40 IU
Food Serving IUs mcg
Cod liver oil 1 TBS 1,360 34
Salmon 3.5 oz. 360 9
Sardines, canned in oil, drained 1.75 oz. 250 6.25
Tuna 3 oz 200 5
Vitamin D fortified orange juice 1 c. 100 2.5
Milk, nonfat fortified 1 c. ~100 2.5
Egg (found in yolk) 1 yolk 20 .5
Recommendations 51-70 400 10
70+ 600 15
Vegetarian Diets – Nutrients of Concern
Vitamin D
“Milk” substitutes – soy, rice, almond milk – most are fortified with Vit D now
Fortified fruit juices
Vitamin D-2 produced from uv irradiation
Vit D-2 (plant form) seems to be as effective as Vit D-3 (animal form) in recent studies
Source: Position of the American Dietetic Association: Vegetarian Diets. J Am Diet Assoc. 2009; 109: 1266-82
Omega-3 FA
What is an omega-3 fatty acid? Type of oil (fatty acid) named by the location
of the double bond (a good thing!)
Where do you get it? Soybean, canola oil, flaxseed , walnuts
EPA & DHA found in fish oil and seafoods, (cold-water fish and crustaceans)
How much do you need? Women need 1.1 g (remember ~ 1 gram)
Men need 1.6 g (remember ~ 1.5 gram)
Health Benefits of Omega-3 fatty acids
Anti-inflammatory Improves rheumatoid arthritis, psoriasis, asthma
Reduces severity of symptoms of colitis and Crohn’s
Improves Cardiovascular Health Antithrombotic - reduces clotting
Antiarrhythmic
Vasodiloatory properties Improves blood circulation, improves vascular function, lowers
blood pressure
Hypolipedmic - triglycerides HDL-cholesterol
Health Benefits of Omega-3 fatty acids
Type 2 Diabetes Mellitus Reduces hyperinsulimemia and insulin resistance
Renal disease Preserves renal function in IgA nephropathy
Mental function Reduces severity of mental conditions –
Alzheimer’s disease, depression and bipolar disorder
Improves ADHD in children
American Heart Association Summary of Recommendations for Omega-3 Fatty Acid Intake
Population Recommendation
Patients without documented coronary heart disease (CHD)
Eat a variety of (preferably fatty) fish at least twice a week.
Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts).
Patients with documented CHD Consume about 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA in capsule form could be considered in consultation with the physician.
Patients who need to lower triglycerides
2 to 4 grams of EPA+DHA per day provided as capsules under a physician’s care.
Patients taking more than 3 grams of omega-3 fatty acids from capsules should do so only under a physician’s care. High intakes could cause excessive bleeding in some people. http://www.americanheart.org/presenter.jhtml?identifier=4632
Omega-3 Fatty Acids in Fish [per 100 grams (3.5 ounces) of raw fish]
Fish (in mg) EPA DHA Chol Total Omega-3
Mackerel, Atlantic 900 1600 80 2500
Herring, Atlantic 700 900 60 1600
Bluefish 400 800 59 1200
Salmon, Atlantic 300 900 74 1200
Tuna 100 400 47 500
Cod, Atlantic 100 200 43 600
Shrimp 200 100 142 300
Flounder 100 100 46 200
Haddock 100 100 63 200
Swordfish 100 100 39 200
Recommendation Males 1.6 g (1600 mg)
Females 1.1 g (1100 mg)
What is better Wild or Farm-Raised Salmon?
Both contain high concentrations of EPA and DHA
Compare daily dose of EPA and DHA based on consuming 8 oz/week salmon (227 grams) provides daily dose of
Farm-raised Atlantic ~ 700 mg
Wild Coho or Sockeye ~ 350 or ~400 mg
Source: Santerre CR. Wild Versus Farm-Raised Salmon: Health Benefits and Risks. SCAN’s Pulse. Fall 2008, Vol 27, No 4 page 1-5
But I don’t like fish or I am allergic to fish
Flaxseed, canola oil, soybeans, soybean oil and walnuts provide alpha-linolenic acid
Body makes small amount of DHA and EPA
Better than nothing!
Omega-3 eggs (chickens fed fish oil or flaxseed)
No EPA and small amounts of DHA
FLAX Facts
F – fiber 2TBS = 4 g fiber L – lignan antioxidant and
member of phytoestrogen plant estrogens
A – alpha-linolenic acid (omega-3)
X – excellent choice From Bob’s Red Mill Whole Ground Flaxseed
Meal!
Recommendations for Vegans
Include 2 servings of daily fats that supply omega-3-fats
1 tsp flaxseed oil
1 T canola or soybean oil
1 T ground flaxseed
¼ c walnuts
Comparing omega-3 FA
Recommendation Males 1.6 g 1,600 mg
Females 1.1 g
1,100 mg
Food Item/quantity Kilocalories Omega-3 mg
Eggland eggs– must eat yolk 70 100
Barilla Plus Penne 1 cup 370 360
Smart Balance Omega-plus Mayo (1 TBS)
50 500
Canola Oil 1 TBS 120 1600
Smart Balance 50/50 Butter Blend Spread 1 TBS
100 1760
Flaxseed 2 TBS ground 60 2400
Walnuts 1 oz. (14 halves) 185 2600
What is a Whole Grain?
Has all beneficial elements of the grain intact
Bran Protective outer shell –
mostly fiber
B-vitamins, trace minerals and phytochemicals
Endosperm Starchy inner portion
Low in vitamins and minerals
Complex carbohydrate and protein
Germ Provides nourishment to the seed
Vitamin E, trace minerals, B-vitamins & essential fatty acids
Phytochemicals
Confusing the consumer
Whole Grain isn’t always High Fiber
Whole grain foods contain water (moisture) and other ingredients which affect fiber level
Bread is 40% moisture, so serving of ww bread provides 3-4 g fiber
High fiber doesn’t mean whole grain
Bran cereals do not provide whole grain
Rare to find whole grain food with more than 4 grams of fiber unless added fiber put in product
“Light” or “diet” breads are high in fiber. Is this a good choice over whole grain breads?
Replaced “starch” with processed fiber from peas or other foods
Lower-calorie
Higher-fiber bread
Lacks the unique “package” of vitamins, minerals, and phytochemicals in whole grains
What is Quinoa?
Botanically, quinoa is not a grain, but a seed belonging to the Goosefoot family
¼ cup dry (~1/2 cup cooked)
170 calories
7 g of protein
3 g of fiber
Complete protein similar to soy
Great whole grain! http://impossiblewriter.wordpress.com/2011/05/29/coconut-oil-and-quinoa/
If we had a pill that conferred all the proven health benefits of exercise, physicians would prescribe it to every patient and our healthcare system would find a way to make sure every patient had access to this wonder drug!
Quote from Webinar: Exercise Is Medicine by Dr. Robert Sallis, MD, FACSM
http://www.shapeup.org/10000steps.html
So how much activity is enough for weight management?
There are now some studies suggesting that walking10,000 steps a day is the
right ball park to be in.
Shape-up America 10,000 Steps Program
Get a pedometer – device that counts
number of steps taken. to track your steps