HUN Exam 3

Insulin Pathway

• eat carbs → blood glucose increases

• pancreatic beta cells release insulin

• insulin binds to insulin receptor

• activates the GLUT4 membrane

• glucose enters the cell and stores as glycogen

Glucagon vs. Insulin

• Glucagon

  • alpha cells

  • blood glucose low

  • stimulates liver to release glucose

• Insulin

  • beta ells

  • blood glucose high

Diabetes

• Type 1

  • no production of insulin

• Type 2

  • insulin resistance

  • impaired cellular response

  • 5-7% weight loss

  • 150 minutes of moderate exercise

    • raise HDL, lower LDL, improves insulin resistance, improves glycemic control

Chronic Complications Diabetes

• microvascular disease

  • eyes (retinopathy)

  • kidneys (nephropathy)

  • nerves (neuropathy)

• macro vascular disease

  • coronary artery disease

  • cerebrovascular disease

  • peripheral vascular disease

• amputations

• blindess

Prevention + Treatment Diabetes

• fiber

  • slows glucose absorption

  • improved blood glucose control

  • lower LDL cholesterol

• low fat dairy

• carb counting

• avoid sugar sweetened beverages

Blood glucose levels

• normal: < 100 mg/dL

• pre-diabetes: 100-125 mg/dL

• diabetes: 126 mg/dL or higher

Signs + Symptoms

• glucosoria (glucose in urine)

• polyuria (excess urination)

• polydipsia (excessive thirst)

Hemoglobin A1C

• measures concentration of glucose attached to hemoglobin

• higher blood glucose the higher the HbA1C

Triglyceride

• three fatty acids and one glycerol group

Phospholipid

• glycerol, two fatty acids, and phosphate group

• responsible for making up the membranes

Saturated Fatty Acid

• straight chains of carbons and hydrogens

• methyl group and carboxyl groups

• animals fats, tropical oils, butter

• raises LDL

Polyunsaturated Fatty Acids

• greater than one carbon double bond to carbon

• omega 3 fatty acids

  • three carbons from the methyl end (CH3)

  • walnuts, salmon, soybean, flaxseed

  • lowers triglycerides

• omega 6 fatty acids

  • six carbons from the methyl end (CH3)

  • corn, soybeans

  • lowers LDL

• vegetable oils

Monounsaturated Fatty Acid

• one carbon double bonded to carbon

• nuts, olives, avocados, vegetable oils

• lowers LDL

Chylomicrons

• transport triglycerides from small intestine to other tissues

• 80% triglycerides

VLDL

• transport triglycerides produced by the liver

• 55-65% triglyceride

LDL

• deliver cholesterol to body cells

• 45% cholesterol

HDL

• return cholesterol to liver for disposal

• takes up unhealthy cholesterol

• 45-50% protein

Fat Reccomendations

• total: 20-35%

• saturated: <10%

• monounsaturated: 15-20%

• polyunsaturated: 10%

Triglyceride Levels

• Normal: <150

• borderline high: 150-199

• high: 200-499

• very high: >500

Pregnancy and Fats

• fish oil and polyunsaturated fats lower the risk of blood clots and increases mental functions of newborns

• recommended to consume vegetable oils, 2 servings of low mercury food, and supplements (algae based)

Fish Oils

• no real evidence that fish oils can help prevent heart disease or stroke

• in some cases fish oils can cause more internal bleeding

• EPA and DHA

Functions of Lipids

• cell structures

• eicosanoid synthesis

• hormone synthesis

• energy

• insulation

Emulsification

• helps water and oil mix because of hydrophobic and hydrophilic nature of phospholipids

Cholesterol

• can form cortisol, progesterone, testosterone, and estrogen

Blood Clot Formation

• plaque with fibrous cap forms

• cap ruptures

• blood clot forms around the rupture, blocking the artery

Southern Diet

• high in saturated fats, sweetened drinks, processes meats, sweets

• 56% higher risk of heart disease

• 35% higher rish of stroke

Prevention of Cardiovascular Disease

• diet

  • vegetables. fruits, nuts, legumes, fish, whole grains

  • replace saturated fat with monounsaturated and polyunsaturated fatty acids

  • reduce sodium

  • minimize processed meats and sweetened beverages

  • reduce trans fats

• maintain healthy blood pressure

DASH Diet

• prevents hypertension

• grains

• vegetables

• fruits

• low fat milk products

• lean meats, poultry, fish

• nuts, seeds, legumes

Lifestyle Factors of Cardiovascular Disease

• soy

  • soy protein

• antioxidants

  • fruits and vegetables

• processed meats

• plant sterols and stanols

  • works similar to soluble fiber

• exercise

• folate

  • lowers homocysteine

Omega 3 Fatty Acid Role in CVD

• EPA and DHA are used to make eicosanoids in the body

• these can lower the risk of blood clots, inflammation, and blood pressure

• also, polyunsaturated fatty acids create fluidity in the membrane which allows LDL receptors to fit in the membrane and remove LDL from the blood and into the liver for it to be broken down

Basal Metabolism

• essential body functions

• 60-70%

Thermic Effect of Exercise

• energy used during physical activity

• 20-30%

Thermic Effect of Food

• energy used to digest food

• 5-10%

Hypothalamus

• controls hunger

Gustatory Cortex

• controls appetite, and taste sensation

Endorphins

• provides pleasure when eating

Dopamine

• motivates you to eat

Factors Increase Basal Metabolism

• muscle mass

• fever

• recent food intake

• surface area

• exercise

• thyroid hormone

• trauma

• epinephrine

• male gender

• nicotine

• caffeine

• growth

• genetics

• medications

Factors that Decrease Basal Metabolism

• age

• genetics

• medication

• nutritional state

Hormones that stimulate satiety

• serotonin

• insulin

• leptin

• peptide YY

• CCK

Hormones that stimulate hunger

• cortisol

• NPY

• ghrelin

Central Signals that Stimulate Hunger

• NPY

• AGRP

• Galanin

• Orexin-A

• Dynorphin

Central Signals that Inhibit Hunger

• serotonin

• alpha-MSH

• GLP-1

• CART

• NE

BMI

• greater than or equal to 30 = obese

• 25 - 29.9 overweight

• calculation

  • weight in lbs / (height in inches)² times 703

  • weight in kg / (height in meters)²

Goal Weight Loss Formula

• current weight x 0.01 = goal weight loss over 6 months

• current weight - goal weight loss over 6 months = goal weight

Benefits of Exercise

• increases mitochondrial activity

  • oxidative capacity

• increases mitochondrial biogenesis

  • increases energy expenditure

• increases insulin sensitivity

  • makes the body respond faster to insulin

• increases expression of GLUT transporter proteins

  • more GLUT4 to remove glucose from bloodstream

Behavioral Strategies for Weight Loss

• self-monitoring

  • systematically observing and recording one’s behavior

• Goal Setting

• Stimulus Control

• Social Support

Nutritional Deficiencies for Bariatric Patients

• protein energy undernutrition

• vitamin B12 deficiency

• iron deficiency

• thiamin deficiency

Bariatric Surgery

• must have a BMI > 40

• must have tried all reasonable non-surgical methods to lose weight and manage obesity

• increases insulin production

• decreases glucagon production

• increases gastric emptying and GI mobility

• decreases food and water intake

Low-Carbohydrate Diet

• significant weight loss fast

• gain weight back very fast, low fiber intake, animal fats will increase LDL and HDL

Ketogenic Diet

• very very low carb diet

• rapid initial weight loss

• very hard to maintain and comes with a lot of nasty side affects

  • headache, bad breath, cramps, constipation

Intermittent Fasting

• limits eating times

  • five days eat three normal meals 2 days eat 1 low calorie meal

• can cause binging, extreme self-restriction, inadequate energy intake, not suitable for everyone

  • under 18, pregnant breast feeding, diabetes

Mediterranean Diet

• best diet ever

• supports cardiovascular health and rich in fiber and unsaturated fats

Best Way to Lose Weight

• combination of a slight calorie restriction, exercise, and behavior modification

• calorie restriction

  • try to increase energy expenditure by 500 calories and decrease energy consumption by 500 calories

• exercise

  • at least 150 minutes of moderate exercise per week

  • for more substantial weight loss 300 minutes of moderate exercise per week

• behavior modification

  • helps people develop sustainable habits to achieve and maintain weight loss

Possible Causes of Obesity

• positive energy balance

• genetics

• hormonal factors

• physical inactivity

• unhealthy dietary patterns

• Obesogenic environment

• Psychological/ social factors

• metabolic factors

Health Risks Associated with Obesity

• type 2 diabetes

• cardiovascular disease

• hypertension

• dyslipidemia

• sleep apnea

• osteoarthritis

• certain cancers

• fatty liver disease

Causes of Endothelial Injury

• high homocysteine

  • folate and B12 can help lower homocysteine

• Inflammation

  • omega 3 fatty acids

• Oxidative stress

  • antioxidant rich fruits and vegetables

• Hypertension

  • DASH diet

• healthier artery lining is less susceptible to developing an injury

Prevent LDL Cholesterol Buildup

• increase soluble fiber and plant sterols

  • help lower blood LDL cholesterol

  • oats, whole grains, oranges, fortified margarines

• Increase MUFAs and PUFAs

  • helps lower LDL cholesterol

  • PUFAs will provide fluidity in the membrane which will allow LDL receptors to to fit in and take LDL out of the blood

  • olive oil, fatty fish, nuts, canola oil

• Decrease Saturated Fat

  • helps prevent increase in LDL cholesterol

  • decrease animal fats, whole milk, tropical oils

Prevent Platelet Aggregation

• omega three fatty acids can be used to make eicosanoids

• eicosanoids will decrease the formation of blood clots

• omega 3 fatty acids come from fatty fish, plant oils, and nuts

Ketogenic Mechanism

• very low carb intake

• reduced glucose availability and glycogen storage

• greater reliance on fat metabolism

• liver produces ketone bodies that can be used for energy

Weight Regain

• after weight loss:

  • ghrelin increases

  • leptin and satiety signals decrease

  • energy expenditure decreases

Lipid Digestion

• bile emulsifies fat

• pancreatic lipase digests triglycerides

• micelles carry digestion products to intestinal cells

• triglycerides are reassembled

• chylomicrons enter lymph, then blood