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What are the three types of lipids in the body?
Sterols (cholesterol)
Phospholipids (emulsifiers)
Fats (triglycerides)
What is the most prevalent lipid in both dietary intake of fat and in body fat storage?
Triglycerides
What are the 3 important functions of cholesterol in the body?
Bile
Steroid hormones
Vitamin D
Do we need to consume cholesterol?
No, body can make cholesterol
What is the role of dietary cholesterol on blood lipids?
The relationship between dietary cholesterol and blood cholesterol has been inconsistent
Health benefit of monounsaturated fats
Help lower LDL cholesterol and may have help to raise HDL cholesterol
Food sources of monounsaturated fats
olive, peanut, canola oils; and high-oleic safflower and sunflower oils, nuts and avocados
What are the two essential fatty acids (polyunsaturated)?
Linoleic acid (omega 6)
Alpha-linoleic acid (omega 3)
Why is the intake of essential fatty acids necessary for health?
They are used to build cell membranes and the covering of nerves
Sources of linoleic (omega 6) fatty acids?
walnuts, seeds, safflower, soybean, sunflower, walnut, and corn oils
What are the 3 types of Alpha-linoleic (omega-3) fatty acids?
ALA- Alpha-linoleic (plant)
EPA- eicosapentaenoic acid (animal)
DHA- docosahexaenoic acid (animal)
Sources of ALA
plant oils, nuts and seeds
Sources of EPA
fish/seafood
Sources of DHA
fish/seafood, grass fed meat, dairy, omega-3 enriched eggs
What is the challenge if the only source of omega-3 is plant bases?
Must be converted to EPA and DHA before it is biologically active and can be utilized for something other than energy (1-10% is converted)
What is the potential concern with the current American diet that tends to be a high ratio of omega-6 to omega-3 fatty acids?
It is believed that omega-6 is pro-inflammatory while omega-3 is anti-inflammatory
What does the research say regarding linoleic acid and its impact on health?
a higher ratio of omega-6:omega-3 may support chronic inflammation
What does some of the current research say related to whole dairy food products as discussed in class?
Several foods rich in saturated fatty acids are not associated with increased CVD or diabetes risk
There is no evidence that current population wide arbitrary upper limits on saturated fatty acid consumption in the U.S. will prevent CVD or reduce mortality
Differentiate between the nutrient content of egg whites versus egg yolks
Egg white: 3.6 grams of protein and 25 kcal
Egg yolk: 2.4 grams of protein and 50 kcal and ALL OF THE OTHER NUTRIENTS TO INCLUDE OMEGA-3
Are plant-based beef substitutes healthier than unprocessed beef?
No necessarily, calories, fat, saturated fat, and sodium is higher
Hypertension sodium intake
2300mg/1500mg
Elevated lipid profile
may benefit from replacing less healthy fats with more healthy fats, generally be prescribed statins
Narrowed/blocked arteries
all be on statins
Public recommendation of sodium intake
3-4 grams/day
What percentage of salt consists of sodium?
NaCl is 40% sodium
1 teaspoon of salt= how many mg of sodium?
2300 mg
What are the levels of sodium restrictions most recommended for individuals with hypertension?
reducing sodium intake is generally agreed to reduce blood pressure, at least people with hypertension- some observational studies suggest a U-shaped curve
What is the estimated intake of daily sodium in the U.S.?
3600 mg/day
What is the breakdown for the percentage of sodium in the diet that comes from processed and restaurant foods?
75%
What is the breakdown for the percentage of sodium in the diet that comes from cooking or eating?
10%
What is the breakdown for the percentage of sodium in the diet that occurs naturally in foods?
15%
What is the potassium recommendation for adults?
4700 mg/day
Why do we not recommend Potassium supplements without physician supervision?
Supplements not recommended because potassium levels too high or too low can cause a heart attack
Mediterranean diet
Appears to be a healthy option for lowering risk or managing heart disease, T2D and other risk factors- also help in lowing weight (plant focused diet)
DASH diet
designed to lower blood pressure, encourages daily intake, encourages meat more often (less than 6 servings a day)
High in calcium, potassium and magnesium which have all been to show lower BP
What was the origin of the idea for promoting alcohol consumption (red wine) for health?
In the 1980s- observed that the French have relatively low rates of heart disease despite their diet of rich, fatty foods (included red wine)
What is the specific component of red wine that is credited with its potential health benefits?
Resveratrol- acts like an antioxidant
What other foods have resveratrol?
skins and seeds of grapes, blueberries, cranberries, cocoa/dark chocolate and peanuts/pistachios
What would we recommend alcohol consumption to someone who doesn’t consume alcohol?
do not recommend that individuals who do not drink alcohol start drinking
Moderate alcohol intake for men/women
2 for men, 1 for women
What do recommendations say related to sleep?
Sleep is associated with coronary heart disease and many of the other seven components to lower risks
What are the 3 health factors that are an important component of CVD health?
high BP, high cholesterol, smoking
Physical activity
any movement that is carries out by the muscles that require energy
Exercise
planned, structured, repetitive and intentional movement- goal is to improve physical fitness
Aerobic activity
activity in which the body’s large muscles move in a rhythmic manner- have 3 components: intensity, frequency, duration
Muscle strengthening
physical activity, including exercise, that increases skeletal muscle strength, power, endurance, and mass- has 3 components: intensity, frequency, sets and repetition
Bone-strengthening
physical activity that produces an impact or tension on the bones that promotes bone growth and strength (weight-bearing or weight-loading)
Talk test during moderate intensity versus vigorous intensity
moderate-intensity can talk, but not sing
vigorous intensity cannot say more than a few words without pausing
What is the recommended range of minutes for physical activity for adults to attain the most benefits? Children 6-17?
150-300 minutes a week for adults
60 min per day for children
Exercise and weight loss
Diet is more important
98% report they modified their food intake
94% increased physical activity
Exercise and weight maintenance
90% reported they exercise about 60 min/day
What level of sedentary activity would some be at high risk versus low risk?
High: sitting 8-11 hours per day
Low: less than 4 hours per day
Questions to ask patient to assist them in purchasing best body worn devices
How reliable is it?
Is it affordable?
How much information do you want?
What goals do you want to achieve from this device?
How many miles and minutes of physical activity are represented by 10,000 steps?
10,000 steps equals approximately 5 miles and represents 30 minutes of physical activity
Alpha cells
glucagon (hypoglycemia)
Beta cells
insulin (hyperglycemia)
What are the 2 sources for glucose in the human body?
The food we eat
liver produces glucose as needed
What complication has the greatest risk for pre-diabetes and both T1 and T2?
Dyslipidemia/ heart disease
Normal fasting glucose
<100 mg/dL
Prediabetes fasting glucose
100-125 mg/dL
Diabetes fasting glucose
>126 mg/dL
Why is pre-diabetes taken seriously?
70% of people with prediabetes will eventually progress to T2D
Remission
the individual can stop taking medications required to manage blood glucose levels
What is the goal of the National Diabetes Prevention Program (NDDP)
improve the treatment and outcomes for people at risk of developing T2DM
What criteria must be met to qualify for the NDDP
over the age of 18
BMI > 24
Diagnosis of pre-diabetes OR history of gestational diabetes
What are the weight loss and physical activity goals the NDDP?
7% of body weight lost and at least 150 minutes of physical activity a week
What are the 5 components for the management of T2D?
weight loss/controlling weight
healthy eating pattern
moderate intake of carbohydrates (less than 45% of calories)
physical activity
monitor blood glucose and medications
What percentage of calories come from carbohydrates in the majority of high-protein, low-carbohydrate diets?
10-30%
Net carbs/ how it is determined
active or impact carbs- subtract the grams of fiber and sugar alcohols from the total carbs
Ketosis
not a dangerous state- achieved by eating a low carb diet and leaves ketones in the blood stream
Ketoacidosis
very high levels of ketones in the blood, can cause death. Occurs in diabetes or people who are starving/sick
How does a state of ketosis assist with weight loss (3)?
more fat burn, reduced hunger, stabilized blood sugar
How do individuals determine if they are in a state of ketosis?
urine strips or breath meter
Difference between Atkins and ketogenic diet
While both are high fat and low carb diets, atkins emphasizes more protein than a ketogenic diet
Paleo diet
whole foods, no processed foods, lean protein, vegetables, nuts and seeds
HCG diet
begin to take supplements and consume high fat, high calorie foods for 2 days
restrict caloric intake to 500 calories/day for 2-6 weeks (still taking supplements)
stop taking supplements and gradually increase caloric intake but avoid sugar and starch for 3 weeks
3 basic types of intermittent fasting
alternate day fasting (1-2 days/week of complete fasting)
whole day fasting (5-2 method)(5 days with no restrictions and 2 days with 500-600 kcal)
Time restricted fasting (16-8 method)(most common- 16 hours of fasting and 8 hours of eating)
Difference between GOLO and other weight loss programs?
GOLO is a supplement that is taken 3 times a day with meals
Noom weight loss program
App-based weight loss program rooted in psychology
guides behavior changes/personalized
dedicated health coach and virtual support group
includes pedometer and health log
Weight maintenance
refers to a weight change less than 3%
What is the definition of size acceptance?
Refers to the fact that as human beings we come in all types of shapes and sized and out acceptance of that can reduce weight stigma and ur obsession with weight
What are the 5 basic components of Health At Every Size®?
weight inclusivity
health enhancement
eating for well-being
respectful care
life-enhancing movement
What is the relationship between Health At Every Size® and healthy weight?
Healthy weight is weight appropriate for body type, something that could also be managed long term
What is the definition of obesity based on the Canadian Adult Obesity Clinical guidelines?
a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long term medical complications and reduce lifespan
What is the Hamwi formula for men and women
100# for the first 5 ft + 5 pounds for each additional inch
106 for first 5ft + 6 pounds for each additional inch
Realistic weight goal
health can be improved by just a 5-10% weight loss
Permanent lifestyle changes
develop a new pattern of eating-food choices and eating habits that support new weight- need to build skills to eat and live more healthfully
Positive psychological mindset
keep focusing on the “why” of wanting to lose weight
Ability to handle lapse/relapse
focus on returning to healthful habits and impact on weight will generally be minimal
Development of will power
ability to delay gratification and resist short-term temptations to meet long-term goals
What % of Americans have a diagnosis of Prediabetes? What % have a diagnosis of diabetes?
38%, 11.3%
What % of Americans say they are trying to limit or avoid sugars? Reason?
73%, avoiding weight gain
ADI
the maximum amount of a substance that can be consumed each day over a lifetime without causing
health risks
What does the 2023 American Diabetes Association Standard of Cre say about the impact of LNCS on glycemic management?
Nonnutritive sweeteners do not appear to have a significant effect on glycemic management- they can reduce overall caloric and carbohydrate intake as along as individuals are not compensating with additional calories from other food sources
What does the American Heart Association 2018 Scientific Statement say about LNCS and risk of coronary heart disease or impact on related heart biomarkers?
Consumption of LNCS beverages was not associated with risk of coronary heart disease or related biomarkers
Sugar-sweetened beverages have been associated with increased risk of coronary heart disease
What does Dr. Skolnik present related to research findings of the effect of LNCS on appetite? The effect of LNCS on the gut microbiome?
The current literature is limited —> Limited studies have shown changes in microbiome, though most studies short term (5-14 days)
Dr. Skolnik discusses the slide related to “Observation Evidence-The Pitfall of Reverse Causation Bias”. How does he explain this concept as it relates to LNCS and weight gain in adults?
He first started off by saying logic does not always fit the evidence, the he said observational trials are plagued with the issue of confounding, leading to reverse causation bias
What conclusions does Dr. Skolnik present from prospective randomized control trials related to weight gain in children and adults?
20 studies, prospective, randomized studies- it said that there was very real weight loss as shown in prospective trials
What is the position of the Academy of Nutrition and Dietetics related to the use of LNCS?
a. NNS works as a strategy for diet/health concerns including the limiting of carbohydrate and energy intake as well as blood glucose and/or weight management
b. Favorable for use in adults with T1D and T2D
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