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Nutrition Lecture Week 7

MIDTERM EXAM REVIEW--questions we missed
and then a lecture on DIETARY APPROACHES TO STOP HYPERTENSION

FOR DIET EVAL ASSIGNMENT
he says use Kraus' older editions of book, good index
don't use programs in library, they're too complicated
assignment due week 9, 2 weeks from today


CAUSES OF MALABSORPTION
hypothyroid-->hypochlorhydria-->poor assimiliation
parasites
proton pump inhibitors
celiac

HEMOCHROMATOSIS
over 30% of Africans have gene for hemochromatosis??? this is what Marz says but I suspect that their iron burden may be without the gene that is found in Northern Europeans.
13% in Scandinavians is what I've heard before

http://www.biomedexperts.com/Abstract.bme/8178799/Serum_transferrin_receptor_in_hereditary_hemochromatosis_and_African_siderosis
The present investigation evaluated the serum transferrin receptor concentration in subjects with nontransfusional iron overload who were identified in two separate studies on the basis of a serum ferritin level above 400 micrograms/L. Subjects with preclinical hereditary hemochromatosis were evaluated in the first study and those with the African form of iron overload in the second. In the first study, hereditary hemochromatosis was identified in 14 white men on the basis of a persistent elevation in transferrin saturation above 55%. The serum receptor concentration was elevated above the upper cut-off of 8.5 mg/L in two of the subjects, but the mean receptor of 6.1 +/- 1.4 mg/L (mean +/- 2 SE) did not differ significantly from the normal mean for this assay of 5.6 +/- 0.3 mg/L. In the same study, 60 control subjects with secondary iron overload were identified on the basis of a serum ferritin persistently above 400 micrograms/L, with a normal serum C-reactive protein concentration but with a transferrin saturation < 55%. Three of these subjects had an elevated serum receptor concentration but the mean value of 5.5 +/- 0.4 mg/L did not differ from normals nor from subjects with hemochromatosis. In the second study, 49 black Africans with iron overload were divided into those with or without an elevated transferrin saturation. The mean serum receptor concentration of 5.0 +/- 0.8 mg/L and 4.5 +/- 0.4 mg/L, respectively, did not differ statistically. It was concluded that there is no evidence of generalized dysregulation of the transferrin receptor in hemochromatosis or African siderosis.

HIGH MAGNESIUM FOODS
almonds
soybeans
potato skins
buckwheat (not a grass)
figs
whole grains, raisin bran, brown rice
rye
black eyed peas
chard
sea vegetables, kelp
filberts, brazil nuts, pecans, peanuts, walnuts
halibut
chocolate, banana
*intake in last 100 years has decreased steadily from 1/2 gram to below 200mg

*Calcium antagonizes lead absorption
Ca supps mb contaminated with lead, esp the less processed ones
however if you take Ca and Pb together, Pb doesn't stay in body

*iodine to protect thyroid from taking up radioactive materials

**paleolithic potassium consumption: 9grams/day (this factoid will be on final exam too)

GLUTEN FREE FOODS
buckwheat
quinoa
amaranth
teff

HIGH POTASSIUM FOODS
avocados
tomato
apricot
potato
cantaloupe
papaya
prune juice
figs
lima beans
parsnips
pumpkin, cooked
watermelon
raisins
kiwi
sardines
flounder
OJ
soy beans
squash, winter
broccoli
tomato
pinto beans
banana
milk, skim
pomegranate
eggplant
sweet potato
salmon
beans, breath northern
potato chips
cod

folate not related to HTN
is related to high turnover tissues: GI epithelial cells, def in UC, cx dysplasia

LECTURE BEGINS HERE

DASH DIET
dietary approaches to stop hypertension
HTN causes much death & dz
stats in his lecture are old, now well over 67 million in US have HTN
70 million have pre-HTN

SODIUM
1/3 of sodium in diet comes inherent in food, 1/3 is added, 1/3 is from processing
ideal intake of Na below 1.5 grams, true needs more like 200mg/day, he often says 500mg
crazy to take salt tablets, more need K and Mg
**reducing Na to 1,500 mg/day has greatest effect on BP of all dietary changes investigated
read labels carefully
lots in lox, anchovy, soy sauce, chs, baking soda, processed meats, chips, feta

WEIGHT LOSS
weight loss is 1st tx
Marz weight loss theory: 500 calories shy of needs/day-->1lb loss in 1 week

DASH STUDY
nutrients in food used to Tx HTN
DIET IMPOSED is rich in Mg, K, Ca:
low sat fat, chol, tot fat
more fruit, veg (potassium) low fat dairy (calcium)
whole grain, nuts (magnesium), fish, poultry,
23% of calories from fat (4% sat), over 1gm Ca, Mg 500-600mg, K 4,700mg, 34g fiber
reduced sweets incl soda (hyperglycemia-->metabolic syndrome-->HTN)
3 eating plans compared, SAD, SAD plus fruit/veg, and DASH diet (as above)
3 Na levels: 3,300, 2,400, and less compared, less is better

MI RISK RELATED TO HTN
for every 5 points over 80 diastolic, risk of MI goes up by 30%
by every 10 pts above 120 systolic, risk of MI incr by 30%
110/70 is his ideal BP
if 125/82 in young person: too high

CIMT
measures intima and media thickness within 1/1000 of an inch?
wishes we had this tool in the NCNM clinic
less invasive and costly, more effective than ???

MEDITERRAINEAN DIET PYRAMID
most calories from bread, pasta, potatoes
next up fruit, bean, veg
then olive oil, cheese, fish, poutry, eggs, sweets, meat in that order of lessness
wine in moderation
lots of water
DIFFERENCES FROM CONVENTIONAL PYRAMID
de-emphasiz meat, more on fruit, veg, nuts
fish is separate from other meats
grains are whole
oil is olive and monounsat
wine and tea beverages

CONVENTIONAL FOOD PYRAMID
bottom is grains
next fruit and veg
next dairy and meat, eggs, nuts
top fats, oils sweets

WILLET
suggests whole grain foods at most meals
plant oils incl canola, soy, corn are also at base of pyramid (prob GMO)

DIRTY DOZEN FOODS
*avoid if not organic, most toxic first
peaches
apples
strawberries
grapes (impored)
nectarines
cherries
pears
celery
kale
lettuce
carrots
bell peppers

CARB INTAKES
494gm/day at turn of century
lowest in 1958 at 376, then gradual increase
now we're almost back to 500, it's HFCS

COMPARING LOW FAT AND LOW CARB DIETS
POM = Pritikin Ornish MacDougal diets keep fat % at 10 (LOW) carb 70-80%, prot 10-20%
ABZ = Atkins Bernstein Zone diets, fat is 30%, prot 40-65%, carb 5-30% (THE "FATKINS" DIET)
POM DIET CONSIDERATIONS: food allergies (gluten, etc, need to diversify carb intake), binge eating, phytates, oxalates

ATKINS DIET
CONSIDERATIONS: low fiber intake, high animal prot intake-->osteoporosis, CV Dz, Ca, renal stress, bigger carbon footprint/bad for envir, also incr fat-->incr environmental xenobiotic toxin intake, decr anti-oxidant intake (flavonoids, ellagic acid), incr heavy metal intake, decreased trace mineral intake from plant foods (selenium)
THEORY: Severely limit carb intake-->"Benign dietary ketosis"-->incr excretion of calories?? Takes more energy to metabolize protein, must be deaminated then is used like carb. Appetite suppression. Food actions. Very effective for kicking off weight loss program but if you add any carbs back in it's easy to gain weight because of the high fat content of the diet. Increased urinary output-->loss of electrolytes esp magnesium. dehydration-->heart palpitations, headaches, elg cramps, back spasms, other musculoskeletal.
INDUCTION DIET RECOMMENDATIONS: eggs, butter, bacon/ham/sausage for breakfast, smoked fish and cream cheese for lunch, soy pancakes with sour cream
CONTINUING DIET: eggs benedict with diet bread, cheese, 3oz of V8, onion rings fried 1/2 cup, 1 slice fresh orange, decaf cappuccino
NOT ENOUGH POTASSIUM, TOO MANY XENOBIOTICS
10% of calories from carbs, 40-50% from prots and fats each, high sat fat
OBESITY
increased in population with decreased fat in diet

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