CHAPTER-1: NUTRITION

NUTRITION & THE ORIGINS OF DISEASE

PALEOLITHIC DIET
NEOLITHIC DIET
 MACRONUTRIENT CHANGES
PALEOLITHIC TO NEOLITHIC

 PROTEIN INTAKE DECLINED: 25%15.4% OF CALORIES

 INTAKE RANGE: 19-35% VS CURRENT 10-20%
 CARBOHYDRATE INTAKE: 22-40% 45-65% TODAY
 INTAKE RANGE: 44-64% IN PALEOLITHIC DIET
 FAT INTAKE: 25-59% OF CALORIES IN PALEO DIET
CLASSICAL GREEK PERIOD:
NUTRITION AS MEDICINE

Empedocle of Agrigentum (490-430 BC)

Hippocrates (460-375BC)
Plato (427-347 BC)
Aristotle (384-322 BC)
SIGNIFICANT IMPACT ON
HUMAN HEALTH
FAMINES
MALNUTRITION
PLAGUES
 IMPACT OF DISEASE ON SOCIETY
 FAMINES FREQUENTLY AFFLICTED SOCIETIES
 China between 100 BC and AD 1910: 1800 famines
 British Isles between AD 10 and 1850: 200 famines
 Europe from 1308 to1332: several famines
 MALNUTRITION FROM THE AGRICULTURAL REVOLUTION—18th CENTURY
 More output to feed greater population  greater prices
 Subsistence farming to commercial farming: single crops
 Famous French/Paris famine of 1709
 Persistent slow starvation for 40% of Europeans—landless &
jobless
 Frequent low grade famines that devastated France in 1789, and
between 1792 and 1795, caused overt physical manifestations of
diseases.
 IMPACT OF DISEASE ON SOCIETY

 MALNUTRITION DURING 19TH CENTURY INDUSTRIAL

REVOLUTION
 People started to migrate in greater numbers
from rural areas to the urban centers in search
of the higher-paying factory jobs.
 The urbanite, unlike the rural dweller,
experienced outbreaks of scurvy.
 They had depleted the reserves of cabbage, leeks, and
onions by early winter, leaving a diet limited to meat
and bread until the spring.
 IMPACT OF DISEASE ON SOCIETY

 MALNUTRITION DURING 19TH CENTURY INDUSTRIAL REVOLUTION

(Cont’d)
 Food production changed dramatically to industrial
production accommodate the large population base,
now conglomerating in the cities.
 The urbanizing process made acquiring and consuming
all manners of food (from meat to milk to apples, flour
and canned goods) an anxiety-provoking process
 1870 to 1930 favored the development of the
canning industry
 IMPACT OF DISEASE ON SOCIETY

 TRANSFORMATION OF THE HOME

 The American household was changing rapidly
at the turn of the 19th century
 Production unit—85% of manufactured goods were generated
from the household in 1800—to a purchasing unit by 1830
 The dramatic decline in household self-sufficiency within a
generation translated into a more commercial dependence on
food.
 The number of commercial bakeries increased 700 percent,
causing homemade bread to drop from 80% to a mere 6% of
all bread produced in the U.S. by 1920
 IMPACT OF DISEASE ON SOCIETY
 MALNUTRITION AND FOOD IMPURITY IN THE 20TH
CENTURY
 USDA food economist, devised a new food guide in
1933, consisting of 12 food groups (liberal
consumption of bread encouraged)
 Malnutrition became prominent in the US during the
1930s because Americans were consuming 50% of
the calories from white bread
 The white flour was so heavily processed around 1911—the
consequence of the roller mills and the bleach treatments—
that no nutrient in the flour could survive.
 Nitrogen Trichloride (Main bleaching agent) Chlorine Dioxide
 Even US Army recruits were malnourished
 Meat Packing industry was deplorably controlled
(The Jungle by Upton Sinclair)
 IMPACT OF DISEASE ON SOCIETY

 NUTRITION DURING THE 1929 DEPRESSION

 During the Depression access to protective foods such as milk, butter,
tomatoes, citrus fruits, leafy, green, and yellow vegetables, and eggs
was rather difficult.
 For a nutritionally “good diet” to be achieved in U.S. the following
changes were needed:
 20% more milk
 15% more butter
 35% jump in eggs
 70% more tomatoes and citrus
 100% increase in vegetables
PLAGUES
PLAGUES
THE 14TH CENTURY PLAGUES WIPED OUT 24 MILLION
EUROPEANS
Bubonic and Pneumonic plagues: 1351 and 1358
Plagues continued to visit Europe up to 1720
THE 19TH CENTURY PLAGUE
Cholera pandemic began to strike the European continent in the early
1830s, creating terror among its population.
 IMPACT OF PLAGUES ON SOCIETY

 CHOLERA PLAGUE DURING 19TH CENTURY

 The cholera scourge that struck both Paris in 1832 and the
London district of Soho in 1854; 14,000 cases of cholera and
618 deaths were reported (Summers, 1989).
 Preventative medicine, at a public health level, had
suddenly become more meaningful and beneficial to the
people because of Sir Edwin Chadwick
 He instituted the national system of public health in England.
 He persuaded Parliament to implement a network of sewers
 Chadwick revolutionized public health in Britain by implementing a
school meals program, a School Medical Service (1907) and the
National Insurance Act (1911)
 THE END OF THE CHOLERA EPIDEMIC

 The cholera epidemic ended both because of dramatic

improvements in public hygiene and because of the
lower class’s greater purchasing power
CHAPTER-1: NUTRITION
THE RISE OF CHRONIC DISEASES
 NUTRITION & CHRONIC DISEASE
IN 20TH AND 21ST CENTURIES

 U.S.’s national health expenditure grew between 1980 and 2017

from $256 billion to $3.5 trillion, a jump that is so extraordinarily
large that it defies the imagination (CDC, 2018).
 In 2010 reveals that slightly more than 50% of total health care
expenditure originated from hospital care and physician/clinical
services (Martin, 2010)
 The CDC now estimates that as much as 75% of the total health
care costs are tied to chronic diseases (CMMS, 2012).
 NUTRITION & CHRONIC DISEASE
IN 21ST CENTURY
 OBESITY IS AT THE CENTER OF MANY CHRONIC DISEASES
 Since the 1980s, the most significant
contributor to the epidemic of chronic
diseases now observed in American society
has been the surprising surge in obesity.
 Many secondary diseases are derived from
obesity:
 Hypertension, atherosclerosis, gallbladder disease,
sleep apnea, type II diabetes, various cancers and
depression
 PARADOX: yet physicians will rarely
address it.
 NEOLITHIC REVOLUTION (6000–2000 BC).

 The Paleolithic diet is prized by some as healthiest

 Neolithic diet: diversity of cereals, fish, domesticated
animals, fruits, and vegetables
 Archaeologists claim population health began to
decline when nomadic groups transitioned to
sedentism, and began planting crops and
domesticating animals to feed the growing population
(Richards, 2002).
 Deficiency diseases were infrequent until the 18th & 19th
centuries
 NUTRITION & CHRONIC DISEASE
IN THE 20 & 21ST CENTURIES

 SINCE THE 1970s DIET HAS BEEN A PROBLEM

 Saturated fat,
 Cholesterol,
 Total fat,
 Sodium
 NUTRITION & CHRONIC DISEASE
IN 20 & 21ST CENTURIES

 Senate Select Committee on Nutrition and Human Needs (1977)

 Carbohydrates to between 55% and 60% of calories
 Maintaining total fat at <30% of calories
 Saturated fat low
 Cholesterol at <300 mg per day
 Sugar at <15% of calories
 Salt at <3 g per day
 Recommendations were also made to lower salt, sugar, and
meat intake specifically, in order to decrease fat and
saturated fat.
 NUTRITION & CHRONIC DISEASE
IN THE 20 & 21ST CENTURIES

 Pressure from the SCIENTIFIC community’s

recommendation to decrease meat ingestion was
changed to “decrease consumption of animal fat, and choose
meats, poultry, and fish which will reduce saturated fat
intake.”
 The true nefarious atherogenicity of the trans-fats
emerged 13 years later, when Willett and his
colleagues from Harvard confirmed in 1993 that trans-
fats did cause LDL cholesterol to increase, HDL
cholesterol (good cholesterol) to drop, and markers of
inflammation to increase.
 FOOD GUIDE PYRAMID 1979

It clearly identified, for the first time, overeating as a significant problem

and pointed the finger at a culprit food group that needed to be consumed
sparingly.
 1979 HEALTHY PEOPLE REPORT

 Concluded that it was indeed possible to lower disease

rates by adopting healthy dietary practices
 1980 Dietary Guidelines for Americans were formulated
based on Healthy People Report
 1985 Dietary Guidelines for Americans
SURGEON GENERAL’S 1988 REPORT
ON NUTRITION AND HEALTH

 The report promoted a dietary pattern that

“emphasized consumption of vegetables, fruits, and
wholegrain products foods rich in complex
carbohydrates and fiber and of fish, poultry without
skin, lean meats, and low-fat dairy products selected to
reduce consumption of total fat, saturated fat, and
cholesterol.”
 1989 NATIONAL RESEARCH COUNCIL’S
FOOD AND NUTRITION BOARD

 Then, in 1989, the National Research Council’s Food

and Nutrition Board reiterated the Council’s Diet and
Health Report
 <30% calories as total fat;
 <10% calories for saturated fat;
 <300 mg for dietary cholesterol.
 Emphasis to consume a minimum of five servings per
day of fruits and vegetables and to increase starches
and other complex carbohydrates consume at least six
servings per day of breads, cereals and legumes.
THE 5-A DAY FRUIT & VEGETABLE CAMPAIGN

 USDA, NCI, ACS, CDC, PRODUCE FOR BETTER

HEALTH FOUNDATION
 1990 DIETARY GUIDELINES FOR
AMERICANS—DHHS & USDA

 TOTAL FAT: ≤ 30% OF DRI CALORIES

 MAINTAIN A HEALTHY WEIGHT

 SATURATED FAT” <10% OF CALORIES

 TOTAL CHOLESTEROL: < 300 mg/day

 MORE FRUITS, VEGETABLES & GRAIN PRODUCTS

 USE SUGAR AND SODIUM IN MODERATION

 1992 FOOD PYRAMID

ALL FATS WERE INFERRED TO BE BAD AND THE SAME

 2005 REVISED FOOD PYRAMID

 BALANCE BETWEEN EXERCISE & FOOD

 DIETARY GUIDELINES FOR AMERICANS
2010
 GENERAL SOCIETAL CONTEXT

 A. 15 percent of American households

have been unable to acquire adequate
food to meet their needs.
 B. Rising concern about the health of
Americans. Poor diet and physical
inactivity are the most important
factors contributing to an epidemic of
overweight and obesity affecting men,
women, and children
 DIETARY GUIDELINES FOR AMERICANS
2015

 MAIN GOALS OF THE GUIDELINES

 A. Maintain calorie balance over time to

achieve and sustain a healthy weight.

 B. Focus on consuming nutrient-dense foods
and beverages.
 DIETARY GUIDELINES FOR AMERICANS
2015
 FOODS TO LIMIT/REDUCE
 1.Reduce daily sodium intake to less than 2,300 milligrams (mg)
 2. Consume less than 10 percent of calories from saturated fatty acids by
replacing them with monounsaturated and polyunsaturated fatty acids
 3.Consume less than 300 mg per day of dietary cholesterol
 4. Keep trans fatty acid consumption as low as possible by limiting foods that
contain synthetic sources of trans fats, such as partially hydrogenated oils, and
by limiting other solid fats.
 5. Reduce the intake of calories from solid fats and added sugars
 6. Limit the consumption of foods that contain refined grains, especially
refined grain foods that contain solid fats, added sugars, and sodium.
 7. If alcohol is consumed, it should be consumed in moderation—up to one drink
per day for women and two drinks per day for men—and only by adults of legal
drinking age.
 DIETARY GUIDELINES FOR
AMERICANS 2015
 FOODS TO INCREASE
 • Increase vegetable and fruit intake, ESPECIALLY dark green
 & red vegetables, legumes & peas

• Consume at least half of all grains as whole grains.

• Increase intake of fat-free or low-fat milk and milk products, such as milk, yogurt,
 cheese, or fortified soy beverages.

• Choose a variety of protein foods: seafood, lean meat and poultry, eggs, beans
 and peas, soy products, and unsalted nuts and seeds.

 • Replace protein foods that are higher in solid fats with choices that are lower in
 solid fats and calories and/or are sources of oils.

 • Use oils to replace solid fats where possible.


• Choose foods that provide more potassium, dietary fiber, calcium, and vitamin D:
 These foods include vegetables, fruits, whole grains, and milk and milk products.
 HEALTHY PEOPLE 2020

 Goal of Nutrition & Weight Status

 Promote health and reduce chronic disease risk through the
consumption of healthful diets and achievement and maintenance of
healthy body weights.
 Americans with a healthful diet:
 Consume a variety of nutrient-dense foods within and across the food
groups, especially whole grains, fruits, vegetables, low-fat or fat-free
milk or milk products, and lean meats and other protein sources.
 Limit the intake of saturated and trans fats, cholesterol, added sugars,
sodium (salt), and alcohol.
 Limit caloric intake to meet caloric needs.
 All Americans should avoid unhealthy weight gain, and those whose
weight is too high may also need to lose weight
CHAPTER-1: NUTRITION
WHAT IS A HEALTHY DIET?
WHAT MAKES A DIET UNHEALTHY?
THE 7 ERRORS OF THE NEOLITHIC DIET

 HIGHER GLYCEMIC INDEX

 DEVIANCE IN THE FATTY ACIDS CONSUMED
 ALTERED MACRONUTRIENT COMPOSITION
 DECREASE IN MICRONUTRIENT DENSITY
 DISRUPTION IN THE ACID-BASE BALANCE
 DISTURBED SODIUM: POTASSIUM RATIO
 LOWER FIBER INTAKE
 HIGHER GLYCEMIC INDEX

 MEASURES THE CAPACITY OF ONE SERVING OF

CARBOHYDRATE –BASED FOOD TO INCREASE BLOOD
SUGAR WITHIN A DEFINED PERIOD OF TIME IN
COMPARISON TO PURE GLUCOSE
 GLYCEMIC LOAD -1

 G.I. X gram of carbohydrates in one serving) / 100g

 Food has G.I.=74
 Label indicates 20g of carbohydrates in one 30g serving
 GLYCEMIC LOAD= (74 x 20g) / 100g = 14.8 ~15
 GLYCEMIC LOAD-2

 G.I x grams of carbohydrate/serving) / weight of 1

serving
 Food has G.I.=74
 Label indicates 20g of carbohydrates in one 30g serving
 GLYCEMIC LOAD= (74 x 20g) / 30g = 49.33 ~ 49
DEVIANCE IN FATTY ACID MAKEUP

 TOTAL FAT CURRENT ~40% OF CALORIES VS 21%

 HIGHER PREVALENCE OF OMEGA-6 FATTY ACIDS
 LARGER OMEGA-6 : OMEGA-3 RATIO
 MACRONUTRIENT CHANGES
PALEOLITHIC TO NEOLITHIC

 PROTEIN INTAKE DECLINED: 25%15.4% OF CALORIES

 INTAKE RANGE: 19-35% VS CURRENT 10-20%
 CARBOHYDRATE INTAKE: 22-40% 45-65% TODAY
 INTAKE RANGE: 44-64% IN PALEOLITHIC DIET
 FAT INTAKE: 25-59% OF CALORIES IN PALEO DIET
 MICRONUTRIENT DENSITY

 TOTAL SUGAR INTAKE: 36.2% OF CALORIES

 FROM 1992-1994 ABOUT 50% OF AMERICANS DO NOT

MEET THE RDAs
ACID-BASE BALANCE DISTRUPTED
 ACID YIEDING FOODS:
 DAIRY
 MEATS
 CEREALS LOW GRADE METABOLIC ACIDOSIS
 GRAINS
 SALTS
 BASE-YIELDING FOODS
 FRUITS
 VEGETABLES
 TUBERS
 NUTS
 SODIUM : POTASSIUM RATIO

 THE UPWARD SHIFT IN THIS RATIO CAUSES

 HYPERTENSION
 CARDIOVASCULAR DISEASE
 OSTEROPOROSIS
 INTESTINAL CANCERS
 LOWER INTAKE OF FIBER

 HUNTER-GATHERERS CONSUMED ~42g/day

 MEAN U.S INTAKE OF FIBER: 15g/day

2011 MYPLATE FOOD GUIDE

www.choosemyplate.gov
FOOD GROUP CHOICES
 THE NEW US MYPLATE GUIDE
 CHECK OUT THE USDA WEBSITE: www.choosemyplate.gov
 KNOW IT COLD
MAKE HEALTHY CHOICES
 LET MYPLATE GUIDE YOU…
 CHOOSE RECOMMENDED FRUITS &
VEGETABLES ON A 1600-2400 KCAL/DAY
 1.5-2 cups of fruits / day
 2-3 cups of vegetables / day
 From vegetable group: dark green, orange, starch, legumes,
others

 CONSUME AT LEAST 50% OF ALL GRAINS

AS WHOLE GRAINS
 CHOOSE FOODS OF HIGH NUTRIENT
DENSITY AND CONTROLLED CALORIC
DENSITY
 NUTRIENT DENSITY

 Mg OF NUTRIENT PER KILOCALORIE

 300 mg of calcium in 1 cup of milk (125 kcal)

 NUTRIENT DENSITY: 300mg/125 kcal = 2.4 mg/kcal
 CALORIC DENSITY

 KILOCALORIES PER GRAM OF FOOD

 1 MEDIUM DONUT WEIGHING 42g = 195 KCAL

 CALORIC DENSITY: 195 KCAL/42g = 4.64 KCALS/gram

 1 MEDIUM APPLE WEIGHING 182g = 95 KCALS

 CALORIC DENSITY: 95 KCALS/182g= 0.52 KCALS/g

 BREADS & CEREALS

 1 oz equivalent of breads & cereals

 ½ cup cooked rice
 ½ cup of macaroni, spaghetti other pastas
 1 slice of bread
 1 mini-bagel or ½ of medium bagel
 1 cup of cold cereal (flake); 1 ¼ cup (puffed)
 ½ cup of cooked cereal (oatmeal)
 1 medium or 2 small pancakes
 3 cups of popcorn

AIM FOR HALF OF ALL GRAINS BEING WHOLE GRAINS OR ABOUT 3-oz EQUIVALENT
 VEGETABLES
 1 cup equivalent of vegetables
 1 cup of vegetables (frozen, can, fresh)
 ½ cup of tomato sauce
 2 cups leafy raw vegetable (spinach, lettuce)
 1 cup vegetable juice
 1 cup of cooked legumes (e.g Pinto beans,
black beans, kidney beans)
 1 large corn on the cob
 1 cup of corn
 1 medium boiled or baked potato
 1 cup mashed potato
AIM FOR AT LEAST 2.5 CUPS OF VEGETABLES / DAY FOR A REFERENCE 2000 KCAL/ DAY DIET
 PROTEIN FOODS

 1 oz-equivalent of meat, poultry, fish, eggs, beans:

 1/4 cup cooked legumes (beans)
 1 oz tofu
 ½ oz of nuts & seeds
 1 egg
 1 oz of cooked meat, poultry, fish
 1 Tbsp peanut butter

1 quart= 4 cups ~ 1 Liter 1 oz in weight= 28 g 1 fl oz weighs 30 g

1tbs= 1 table spoon= 15 ml 1 Gallon= 16 cups ~ 4 Liters
1 tsp= 1 teaspoon= 5 ml 1 cup= 8 fl oz or 250 ml
FRUIT GROUP

 1 CUP Equivalent of Fruit is equal to:

 1 cup of juice
 1 cup of frozen or fresh fruit
 1 large banana or orange
 1 small apple
 ½ cup of dried fruit (figs, dates, raisins, etc)
PRACTICE MORE WITH THE GUIDE
PRACTICE
QUESTIONS
MYPLATE FOOD GUIDE
WHILE TAKING A 24 HOUR RECALL, A PATIENT ADMITS TO EATING THE
FOLLOWING OVER THE DAY: 1 CUP OF BRAN FLAKES, 2 WHOLE WHEAT
TOASTS, 2 CUPS OF RICE FOR LUNCH, AND 3 CUPS OF SPAGHETTI FOR
DINNER. IDENTIFY THE NUMBER OF OZ-EQUIVALENTS OF BREADS AND
CEREAL CONSUMED

A) 4 oz equivalents
B) 8 oz equivalents
C) 10 oz-equivalents
D) 13 oz-equivalents
E) 15 oz-equivalents
IF A PATIENT ADMITS TO EATING OVER A DAY: 1 CUP OF
ORANGE JUICE, 2 CUPS OF FRUIT CUP, 2 SMALL APPLES, AND
1 LARGE BANANA. IDENTIFY THE TOTAL FRUIT CUP
EQUIVALENTS CONSUMED

A) 4 cup equivalents
B) 6 cup equivalents
C) 8 cup equivalents
D) 10 cup equivalents
A PATIENT ADMITS THAT OVER THE LAST 24 HOURS HE CONSUMED: 1
SCRAMBLED EGG, 1/2 CUP OF ROMANO BEANS, 2 TABLESPOONS OF
PEANUT BUTTER, 3 OZ-WT OF SIRLOIN STEAK, AND 2 OZ-WT OF FISH.
DETERMINE THE TOTAL OZ-EQUIVALENT OF PROTEIN FOODS

A) 4 oz-equivalents
B) 7 oz-equivalents
C) 10 oz-equivalents
D) 12 oz-equivalents
IF YOU ASSESSED, DURING A 24-HR RECALL, THAT A PATIENT ATE THE FOLLOWING
FOR BREAKFAST:
2 CUPS OF RASIN-BRAN CEREAL + 1/2 CUP OF RAISINS + 1 LARGE BANANA + 2
WHOLE WHEAT TOASTS, HOW MANY FRUIT AND CEREAL SERVINGS EQUIAVALENTS
DID THEY CONSUME FOR BREAKFAST?

A) 2 cup fruit equivalent + 4 oz-equivalent of

breads & cereals
B) 1 cup fruit equivalent + 4 oz-equivalent
of breads & cereals
C) 2 cup fruit equivalent + 3 oz-equivalent
of breads & cereals
D) 1.5 cup fruit equivalent + 3 oz-equivalent
of breads & cereals
E) 2 cup fruit equivalent + 3.5 oz-equivalent
of breads & cereals
HOW MANY MEAT & ALTERNATE OZ-EQUIVALENTS IN 1
CUP OF BEAN+3OZ MEAT +2 TBSP PEANUT BUTTER

 A- 3 oz equiv
 B- 5 oz equiv
 C- 7 oz equiv
 D-9 oz equiv
 E- 12 oz equiv
A PATIENT ADMITS TO CONSUMING THE FOLLOWING OVER THE LAST 24 HOURS: 2
CUPS OF MIXED VEGETABLES, 1 CUP OF V-8 JUICE, 1 CUP OF CARROTS, 2 CUPS OF
RAW SPINACH, 1 CUP OF COOKED NAVY BEANS AND 2 CUPS OF MASHED SWEET
POTATOES. IDENTIFY THE TOTAL NUMBER OF VEGETABLE CUP EQUIVALENTS

A) 4 cups equivalents
B) 6 cups equivalents
C) 8 cups equivalents
D) 10 cups equivalents