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526 Cards in this Set

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Nutrition is ...
the study of foods, nutrients, other chemical constituents, and the effects of foods on health & disease
Nutrients are required for...
growth, maintenance, reproduction
Energy is measured in...
Calories (nutritionists always mean kilocalories)
Nutrients are characterized by 6 main categories, what are they?
– Carbohydrates
– Lipids
– Proteins
– Minerals
– Vitamins
– Water

All of these are "macro-nutrients" except for water, which is a "micro nutrient"
How are essential nutrients characterized?
Life-sustaining
Must be provided by the diet
The body cannot synthesize these nutrients in adequate quantities
Examples of some essential nutrients...
Carbs, fats, proteins and water
Examples of some essential vitamins...
Vitamins A, B (6 & 12), C, D, E, K
Examples of some essential minerals...
calcium, iron, zinc...
3 Types of Carbs...
Simple- glucose (blood), sucrose (common), lactose (milk)
Complex - starches (long chains)
Fiber - plant carbs (indigestible)
Sources of Protien...
Animals and plants
Amino acids
Types of Lipids/Fats...
Saturated fats- mostly animal (carbon molecules are saturated in their bonds with hydrogen)

Unsaturated - mostly plant

Essential fatty acids - linolenic and linoleic acids

Others: trans fat, cholesterol
How many kilocalories in carbs (CHO)?
4 kcal/gram
How many kilocalories in fat?
9 kcal/gram
How many kilocalories in protein?
4 kcal/gram
How many kilocalories in alcohol? (not a nututrient)
7 kcal/gram
Our requirements for nutrients vary as a function of...
Age, Sex, Growth Status, Body Size, Genetic traits, Pregnancy, Breast Feeding, Illness, Drug use, Environment
Excess energy from which nutrients will be stored as fat?
Carbs
Protein
Fat
How many vitamins in total?
13
Characteristics of vitamins...
Organic micronutrients
Contain C, H, and O; other elements
Do not provide energy
Essential
Vulnerable to destruction by heat, light, and chemicals
How many minerals in total?
16 essential minerals
Alcohol is turned directly into...
Adipose tissue (fat)
Vitamin D can be is a special essential nutrient because...
It can be synthesized by the sun, but only on a case by case basis so it is still essential
Characteristics of water...
Inorganic
Contains only H and O
Does not provide energy
Participates in many metabolic reactions
Provides a medium for transport of vital materials to cells and wastes away from cells
Of all 6 nutrient classes, most foods contain water in highest amounts
The nutrient consumed in greatest quantity
Phytochemicals are..
plant chemicals
sudo-nutrient
non essential and don't usually synthesize
Rich in veg & fruits known to be protective against heart disease, cancers (sulfur)
beneficial but some can be detrimental (alliin)
Examples of phytochemicals...
Lycopen - beneficial in supplement form

Antioxidants - prevent/repair damage to cells by oxidizing pollutants (smoke, ozone, oxygen)
Malnutrition can occur from...
inadequate or excessive intake

Increased need due to:
Disease
Genetic susceptibility
Growth
How have animals adapted to nutrient availability?
Fasting vs. excessive intake
Altered expenditure
Storage of fuels
Absorption
Increases when stores are low
Decreases when stores are high
Excretion
Increased filtration and loss through urine
Examples of malnutrition influencing disease development...
Lack of calcium- osteoporosis

High sugar diet – tooth decay

low fiber, high fat, low vegetable diet- CVD
Groups at risk for malnutrition...
Pregnant & breastfeeding women
Infants
Children
Frail elderly
Ill
Poor/Inadequate health care
Key to a healthy diet...
Variety, moderation, adequacy and balance

There are no good or bad foods only good or bad diets.
Major causes of death in Americans are...
slow-developing lifestyle-related chronic diseases. Such as:

Obesity
Coronary Heart Disease
Cancer
Diabetes Mellitus
Osteoporosis
Liver and Renal Disease
Stroke
Etc.
ALL DIRECTLY RELATED TO NUTRITIONAL STATUS
% of U.S.A that is overweight or obese
72.9%
% of U.S.A that is obese
33%
Leading Lifestyle- Related Chronic Deaths...
Tobacco use, currently the leading cause of preventable death in the U.S., killed 400,000+ people
Obesity – No. 7 leading cause of deaths in the United States in 2005 -- about 25,814 people.
Obesity may surpass Tobacco Use as the #1 leading cause of death in the U.S. in future years - CDC
What is DRI?
Dietary Reference Intakes (umbrella term)...

Decreasing level of goodness:

1. Recommended Dietary Allowance (RDA) (old term, still used, rarely able to achieve, only for 97-98% of people)

2. Estimated Average Requirement (EAR) (only able to determine for 1/2 of population b/c people over-consume)

3. Adequate Intake (IA) (new term, more of an estimate, used when RDA can't be determined)

4. Tolerable upper levels of intake (UL) (new term, almost never reached by food alone)
The RDA is...
Not designed for individuals
A guide for food intake of groups
Generous by design, except for energy
How is nutrition assessed for individuals?
Historical information
Anthropometric data
Physical examinations
Laboratory tests
How is nutrition assessed for populations?
National Nutrition Surveys
Food consumption surveys
Nutrition status surveys
National Health Goals
What is on the food label?
Serving Size
based on an average amount people actually eat, may not be the amount you eat!

Servings per Container

Amount Per Serving; listed in cups and grams

Ingredient List
if more than one ingredient
in descending order by weight
"Fat Free" is measured how?
By weight not by calories
Food Label: Nutrition Facts for a single serving.
Calories (kcal) and Calories from fat
Macronutrients:
Fat
saturated fat
polyunsaturated fat
monounsaturated fat

Carbohydrates (CHO)
dietary fiber
sugars

Protein

Cholesterol
Sodium
Vitamins and Minerals
Vitamins: A and C
Minerals: Calcium and Iron
Food Label: Percent Daily Value (% DV)
shows how nutrients fit into the overall daily diet

based on a 2000 or 2500 calorie diet
What are daily reference values?
based on 2000 and 2500 calorie diets

gives example of good diet structure

adjustable depending on individuals kcal needs
What does it mean when foods are enriched?
Replacement of vitamin and mineral loss to refined grains and bran
Ex. Thiamin, iron, riboflavin, niacin
What does it mean when foods are fortified?
Addition of one or more vitamin/mineral to a food product
Ex. Folate, vitamin D, iron, etc.
Health claims must:
be validated by scientific research
describe an association between
a disease or health condition
&
a nutrient or food substance

Examples:
Calcium and Osteoporosis
Folic Acid and Neural Tube Defects
Sodium and Hypertension
Dietary saturated fat and cholesterol
and Cardiovascular Disease
Dietary Supplements...
Do not have to undergo vigorous FDA approval
Cannot claim the products treat, cure, or prevent disease.
Must have supplement facts
What is irradiation?
Exposure of foods to gamma rays
Fragment DNA
Destroys insects, bacteria, mold, microorganisms
Enhances shelf life
Reduces risk of food born illness
Common practice
Dried herbs, poultry, beef, lamb, grains, etc.
Still controversial
What is a healthful diet?
Adequate diets
Wide variety of foods – providing sufficient calories and essential nutrients
Balanced diets
Provide calories, nutrients, and other components in the right proportion
Example of fortification...
Folate - all cereals are required to be fortified with this
History of Nutritional Recommendations...
1916 – Dept of Agriculture Nutritional Guidelines

1956 – 4 Basic Food Groups

1980 – Introduction of Dietary Guidelines
Address issues of:
dietary balance
Adherence to the food guide pyramid
Updated as new information is available
Low saturated fat, trans fat, cholesterol.
Moderate overall total fat - not to exceed 30% of total calories for a day
1992, the U. S. Department of Agriculture issued a Food Guide Pyramid
2005 - Dietary Guidelines for Americans (next issued in 2010) updated every 5 years by the Departments of Agriculture
2 Parts of Circulatory System
Vascular System
Lymphatic System
What regulates digestion and absorption?
Hormones and Nerve Pathways
System at Its Best
Overview of body functions...
DIGESTION GI Tract


ABSORPTION Walls of GI tract
primarily small intestine

TRANSPORT Blood and
Lymphatic System

METABOLISM Cells within target
tissues

EXCRETION Large intestine (via anus),
kidney, skin, hair and nails
1st step in body food processing:
Ingestion

Regulated by internal & external cues:

Hunger

Appetite

Satiety
Hunger is...
physiological drive (internal cues)

metabolically motivated

hunger signals can be overridden
Appetite is...
a learned response (non-physiological; external cues)

Includes:
site or aroma of food
social or environmental cues
time association
Satiety is...
the cessation of food intake; meal termination

doesn't require being full

Both physiological (internal cues) and a learned response (external cues)
Satiation is...
feeling leading up to satiety, signals causing sequences of satiety
Digestion is...
Process by which foods are broken down into simple absorbable units
Digestive system:
mechanical and chemical breakdown of food.

all the organs and glands associated with the ingestion and digestion of food.
Alimentary Canal:
from mouth to anus.
What is digestion and absorption?
Processes that make nutrients available for body to use
Nutrients transported via lymphatic and circulatory system
(out of GI into cells)

Eventually all nutrients go into circulatory system

Large intestine: water, Na
What happens during mastication?
chewing

mechanical breakdown of food

salivary amylase is excreted - breaks down simple starches and carbs
What nutrients can be directly absorbed through the mouth?
glucose and water
The esophagus is...
A muscular tube about 10" long

connector between mouth and stomach
Peristalsis is
chain of rhythmic contractions that propels food to stomach

food transported through the diaphragm
Lower esophageal sphincter is also known as...
cardiac sphincter (lies below the heart)

closes so food stays in stomach

GERD - heartburn (gastro esophageal reflux disorder)
Stomach is...
Muscular organ that grinds and churns swallowed food mixing with enzymes and acid

On the left side of the body
Chyme is...
semi-liquid mass of partly digested food (vomit)
Gastrin is triggered by...
chyme in the stomach

it stimulates release of hydrochloric acid (HCl)
When HCl is released in the stomach it results in...
drop in pH to ~2.0 and release of:

– protease: protein digestion
Pepsin – Protein Digesting Enzyme (central is protein digestion)
– lipase: lipid digestion (no absorption in stomach of nutrients)
– mucus: protective coating
How is chyme released to the small intestines?
through the pyloric sphincter

this is what makes the gurgling sounds after eating
What connects the stomach to the small intestine?
the pyloric sphincter (only flaps out, but if it goes inward, bile can come out of vomit)
Stomach is made up of...
crisscrossed muscle layers (creates churning and mixing motions)

has mucus layer that protects stomach tissue (ulcers form if there's not enough mucus)
What are the 3 sections of the small intestine (IN ORDER) and their length?
1) Duodenum (10 in)
2) Jejunum (8ft)
3) Ileum (12ft)
Chyme stimulates what?
release of pancreatic juice

pancreatic duct ==> intestine
Pancreas secretes what?
enzymes to digest CHO, fats and proteins and bicarbonate (a base) to increase pH to 5.5-6.5 (make it more neutral)
Liver secretes what?
bile which solubilizes or emulsifies water-insoluble fats
What is emulsification?
mixture of two immiscible (unblendable) liquids.


example: soap is an emulsifier, fat and water combine through emulsification
What does the gallbladder do?
It stores and concentrates bile between meals; contracts to release concentrated bile during meals

you can have it removed, just have to stay away from high fatty foods
What is bile made up of and what is its purpose?
made up of cholesterol

purpose - to emulsify fats ( holds small particles of fat in suspension with water)
What is absorption?
Process by which simple nutrient components move from lumen of the GI tract into the cells of the GI tract
Where does the bulk of the absorption occur?
Small intestine:
duodenum
jejunum
ileum
What are inside the intestinal folds and by how much do they increase the surface area?
Villi -- 15 times more surface area
Microvilli -- 300 times more

both found only in small intestine
What is intestinal lumon?
The area within the intestine
What happens to villi during absorption?
As food goes through GI tract the top of the cells get broken off.

30% of protein goes to replenish cells in small intestine.
What does the ileocecal valve do?
joins the small and large intestines. Most digestible nutrients are gone at this point.
What happens in the large intestine?
Intestinal bacteria degrade some fiber to simpler compounds
The colon reabsorbs water and salts. (water concentrates feces)
Waste is excreted as feces through the rectum and anus.
Colon =
secum
What is bili reuben?
the black tarry substance that changes feces black/brown

if you can't process it you get jaundice (babies usually get this)
What is dumping syndrome?
diarrhea
What does feces consist of?
dietary fiber
microorganisms
water

Also includes losses from:
kidney
skin
liver
epithelial cells shed by body
hair and nails
lungs
What are the different mechanisms of absorption?

** KNOW
Passive diffusion (not common)
Does not require energy

Facilitated diffusion (not common)
require assistance to move across the membrane – minimal to no energy requirement (like a turn dial)

Active transport (most common)
requires expenditure of energy, lots of ATP use
Factors influencing GI function:
Physical immaturity
Infants spitting up
Aging
Constipation
Illness
Diarrhea
Nutrition
Fiber = Effect GI structure & function
Common digestive disorders:
Constipation and Hemorrhoids
Ulcers and heartburn
Irritable Bowel Syndrome (IBS)
Diarrhea
Flatulence
Stomach Growling
How are nutrients entering the cells of villus transported to the rest of the body?
by either the:

Lymphatic system - fats and fat soluble vitamins A, D, E, K
-or-
Vascular (circulatory) system
-carbs and protein (everything else)

fats do make their way into circulatory system
What happens to carbs and fats inside cells?
They are “metabolized” inside cells to produce energy
(plus water, CO2 and heat)
Why is the net energy yielded less for carbs than for fats?
It takes mor energy to break a circular bond (carb) than a straight bond (fat)
What happens to protein in cells?
It is “metabolized” in cells to produce energy (plus H2O, N, CO2 and heat)
What is a calorie?
the amount of energy needed to raise the temp of one kilogram of water (about 4 cups) from 15 degrees Celsius to 16 degrees Celsius (59 to 61 degrees F)
How can you measure the energy in food?
Calorimeter
Direct measurement of heat produced
Bomb calorimeter - all processed foods must go through this
Calculate
4,9,4 calories / gm : CHO, fat, protein
based on how fast it burns and the heat it produces
Calorie chart or nutrient database
Energy leaves through:
Basal metabolism – at rest – post absorptive state – room temperature environment

“Dietary thermogenesis” (thermic effect of food)

Exercise-induced thermogenesis
what is basal metabolism? how do you estimate it and what is it affected by?
the energy needed to maintain life when a body is at complete digestive, physical and emotional rest

Men estimate: lbs body weight X 11
Women estimate: lbs body weight X 10

affected by
Muscle > Fat Male > Female
Previous nutr. status
Temperature: body and environment
what is the basal metaolic rate (bmr)
Measurement of basal metabolism
2/3 of total energy used by the body
Varies among individuals
The energy required to eat goes to what processes?
chewing food
digesting food
absorbing nutrients
transporting nutrients
storing excess nutrients
excreting waste
10% of energy expenditure happens from what?
the thermic effect of food (diet-induced thermogensis)
What is the energy expenditure required as a % of BMR while being inactive? active?
Inactive, sedentary 30%
Active, physically active, 50%
strenuous exercise 75%
How do you calculate your energy expenditure?
Basal metabolism: weight x 10 or 11

Physical Activity (BM x .3, .5, or .75)

Dietary Thermogenesis: .1 x (BM+PA)

Total needed: BM + PA + DT
How is obesity often treated?
as a “subacute” illness, in which time-limited treatment will lead to a complete cure

it is a chronic disease
What is body weight made up of?
fat + lean tissue + water
What is BMI?
Weight (kg)/height (m2)
Advantages:
Independent of frame size
Independent of gender
Better correlated with body fatness
No tables needed

Conversions: 2.205 lbs = 1kg
2.54 cm = 1 inch
100 cm = 1m
Definition of obesity in ranges:
BMI Status / Obesity Class
<18.5 Underweight
18.5 – 24.9 Normal weight
25.0 – 29.9 Overweight
30.0 – 34.9 Obesity I
35.0 – 39.9 Obesity II
> 40.0 Extreme (Morbid) Obesity III
U.S Obesity Trends:
1990 - 10 states w/ prevalence of obesity less than 10%
no states w/ prevalence equal or greater than 15%

1998: no states w/ less than 10% prevalence, 7 states 20-24%, no state greater than or equal to 25%

2007: only Colorado less than 20%, 30 states equal to or greater than 25%, 3 states equal or greater than 30%
What are the costs related to obesity?
+400,000 deaths per year attributable to obesity
$117 billion/year in economic costs – in 2000
$61 billion in direct medical costs – in 2000
What is the body fat percentages in males and females?
Male 10-25%
Female 18-32%
Storage primarily under skin (subcutaneous) around hips, upper arms, thighs, and abdomen
What is central obesity?
(android obesity)
Fat accumulation around the abdomen (apple)
This “visceral” fat more metabolically active---oxidative stress (under abdominal tissue)
Inflammation-damage to blood vessels and tissues
Associated with increase in disease-type II diabetes, high BP, cancer, etc.
More common in men
What is gynoid obesity?
Lower body fat (gynoid obesity)
Fat accumulation around the hips (pear)—subcutaneous fat
Not associated with increase in disease
More common in women
Less associated with chronic diseases
What are the major flaws of BMI?
Major flaws:
Body composition is not considered
% fat
% lean tissue
Fat distribution
Subcutaneous
Visceral
Other ways to measure body composition?
Anthropometrics
Waist to hip ratio (WHR)
Fatfold measures
Waist to height ratio
Hydrodensitometry (Underwater Weighing)
GOLD STANDARD
Bioelectrical Impedance
Potassium Counters (Whole Body and Segmental)
Dual X-ray Absorptometry (DXA)
What are the health risks associated with being underweight?
Further compromises status during disease
Particular problem in wasting diseases such as cancer, and AIDS

Changes in physiology
Amenorhea - Women cease menstruating when body fat < 12%
What are the health risks associated with being overweight?
Coronary heart disease
Especially with central obesity
Diabetes
Type 2 diabetes risk  3x
Cancer
Obesity is associated with various cancers
Breast, Colon
Hypertension (high blood pressure)
Approx what percentage of Type 2 Diabetes may be prevented by weight loss of as little as 5 or 10%
90%
Lost productivity due to obesity:
$3.9 billion, with $39.2 million in lost workdays
1995: Cost attributable to obesity?
$99.2 billion
3 Factors that cause people to become obese
1. GENETICS

2. METABOLICAL AND PHYSIOLOGICAL

3. ENVIRONMENT
Stages in food consumption.
Hunger
Seek food/start meal
Continue meal
Satiation
End meal
Satiety
The general goals of weight loss and management are:
At a minimum, to prevent further weight gain,
To reduce body weight if prescribed, and
To maintain a lower body weight over the long term.
6 Strategies for weight loss and maintenance
Dietary therapy
Physical activity
Behavior therapy
“Combined” therapy
Pharmacotherapy
Weight loss surgery
Reasonable timeline for weightloss goal
= 6 months of therapy
1 lb of body fat = how many kcal?
3500
What happens in weight loss?
Decrease in:
Water
Fat
Bone density

gradual weight loss minimizes loss of muscle and bone
An example of genetics and environment contributing to obesity...
Pima Indians - genetically predisposed to be obese if their environment permits
What does PAL stand for?
Physical activity level
From what part of the body do obese people expend the most energy? normal sized people?
obese - extremities
- because there is less insulation there
- more likely to have sweaty palms

normal- core
Why do obese people loose more weight quicker?
The larger the mass the greater the amount of energy expended.

They also have more water retention (weight fluctuates 2-5 lbs throughout the day depending on water)
Volumetrics says...
adding water increases volume and reduces the energy density of high fat foods

adding air affects volume, but not energy density

example. raisins vs grapes
grapes have a greater volume (the excess water increases volume)
Summary of dietary intervention...
SMALLER PORTION SIZE
REPLACE HIGH KCAL DENSE FOODS WITH LOW KCAL DENSE FOODS
INCREASE FRUITS AND VEGETABLES
EAT BREAKFAST
SMALLER FREQUENT MEALS
The only two weight loss supplements approved for long-term use...
Sibutraminie (Meridia)
Orlistat (Alli)
What is ketosis?
Lack of carbs

ketons are produces when the body doesn't have enough carbs
- acetone is produced in the body

This would happen with people on the Atkins diet.
What is the problem with high protein diets?
Protein is the most satiating nutrient, but we don't need more than 10-15% in our diet.
What happens in gastric bypass surgery?
Stomach is almost completely removed from the GI nutrient flow.

Still need stomach to secrete enzymes into duodenum and ileum

2% die due to surgery complications
Why is Sibutramine (Meridia) so effective?
It reduces the presence of the transmitters seratonin and norepinephrine (neurotransmitters that aid in weight control)
What is the risk of Xenical (Alli)?
risk of vitamin deficiency (blocks fat soluble vitamins A, D, E, K

binds to lipase so you can't absorb the fat; causes oily stools
Other types of gastrointestinal surgeries:
Vertical Banded gastroplasty - irreversible, more of the GI tract left, band and staples are used to create a small stomach pouch.

Adjustable gastric band procedure - less effective 50%, reversible
Why is liposuction not very effective?
No more than 8 lbs. of fat permitted to be vacuumed per procedure in U.S. (though people bend the rule constantly)

Fat is active tissue—vascularization, hormonal release
Re-distribution of body fat stores post-op
Symptoms & Risks of Anorexia Nervosa
Self-starvation; < 85% Healthy wt
Often 300-700 calories per day
Distorted food beliefs-overwhelming fear of weight gain
Body dysmorphia
Amenorrhea
early osteoporosis, lack of estrogen regulation
Hypothermia
Death

33% incident of relapse

1% of adolescent women, 0.1% men in Western World
To be classified as having bulimia nervosa...
need to have recurrent binge purge syndrome at least 2 times a week for 3 months

loss of control and feeling of guilt during and after the binge
1-3% of women, 0.5% men
Treatment for bulimia...
Break the cycle
Organize the eating pattern
Psychological counseling and anti-depressants
Like anorexia, high degree of relapse (33%)
Interestingly, pregnancy improves condition in almost 70% of cases
(Seratonin increases in pregnancy and play key role in combating depression)
What is binge eating?
Excessive intake without purge
Compulsive behavior
Secretive
Disgust after binge
30-90% of obese exhibit BE
What is Pica?
consumption of non-food substances
Types of Pica...
Geophagia – clay, dirt (most common)
Pagophagia- ice
Amylophagia- laundry starch
Plumbism- lead

Coprophagy – Eating of Feces (required in some animals; absorb nutrients the 2nd or 3rd pass)
How many carbs in:
1 cup Milk?
1/2 cup veggies?
1 fruit?
1 tsp sugar?
1 slice bread?
1 small dessert?
Milk: 12 g
1/2 cup veggies & tsp sugar: 5 g
fruit, slice bread, dessert: 15 g
Sources of carbs...
Starch from grain products & veggies
Sugars from fruits & refined sweets
Milk sugars from dairy
NOT from eggs, meats or oils
55-60% of calories should come from carbs
Chemical makeup of Carbohydrate
C6H12O6
Simple Carbs...
require little digestion

Monosaccharide
”One Sugar” (no digestion required)

Disaccharide
“Two Sugars”
3 Types of Monosaccharides:

(in order of prevalence)
1. Glucose
2. Fructose
3. Galactose
Glucose is...
Also known as dextrose (energy currency of body)
- Essential energy source
- One part of every disaccharide
Fructose is...
Also known as levulose
- Fruit sugar
- Sweetest of sugars
Galactose is...
Rare as lone monosaccharide
- Part of primary sugar in milk
With glucose (as a disaccharide)
3 Types of Disaccharides
Sucrose - table sugar (also honey) (glucose and fructose)
Lactose - milk sugar (glucose and galactose)
Maltose - breakdown product of starch (glucose and glucose)
What is glycogen?
complex carb
Storage form of glucose in animals
branched molecule (every ~8 glc)
glucose polymer
What is the function of glycogen?
Maintain blood glucose between meals
Provide muscle with energy during anaerobic exercise
How is glucose stored in the body?
Liver glycogen can supply body with glucose for energy needs (limited)
- Stores only enough for a few hours

Muscle glycogen supplies glucose only for muscle energy (limited)
Excess stored in fat (unlimited)
What is starch?
storage form of glucose in plants
How much of our caloric need do we have stored in our body?
Only 1/2 of our caloric need per day.
Starches are...
Amyloplasts
Amylose (30%)- Linear glucose polymer
Amylopectin (70%) - Branched glucose polymer-less extensive branching than glycogen
What is the function of starch?
Provide an energy source for the developing plant
What are the word endings for sugars? enzymes?
-ose = sugar
-ase= enzyme
Salivary amylase digests...
starch (amylose)
HCL acid deactivates what once it reaches the stomach?
salivary amylase (no starch breakdown)
The more branched the chemical...
the more can be stored in smaller places
Enzymes in the small intestine:
Pancreatic amylase (from pancreas)
- digests amylose and dextrins
Disaccharidases from small intestine:
Sucrase (glucose and fructose)
- Lactase (glucose and galactose)
- Maltase (glucose and glucose)
Carb absorption mainly happens in...
small intestine

- Active transport mostly
- Absorbed into portal vein
=> Directly to liver
What organ converts galactose and fructose to glucose?
the liver
they travel there via the portal vein (general circulation)
What are the end products of carb digestion and how do they enter the intestinal villi?
monosaccharides and through the capillaries
What is found in the large intestine?
Indigestible CHO (fiber) found here
- Some breakdown occurs due to bacteria (microflora)
- Very little energy derived from fiber

little starch enters the Large Intestine
What happens when someone is lactose intolerant?
Undigested lactose is fermented by GI bacteria - results in the production of gas & acids

not enough lactase

Symptoms: Bloating, pain, diarrhea

Lactaid supplements/milk-- treatment
Causes of lactose intolerance...
Ethnicity
Groups with incidence:
Asian, Native North American, African American

Damage to villi
Illness, medications, malnutrition

Deficiency from birth

Age
Remedies for lactose intolerance...
Replace missing lactase enzyme
Milk with lactase
Lactase tablets taken with food

Aged cheese < cottage cheese
Fermented milk < regular milk
- yeast has begun to break down lactose
How are starch and fiber similar? different?
similar:
Both are polymers of glucose
- Different bonds connecting the glucose molecules together (alpha vs. beta)

different:
We can digest starch (amylopectin)
Enzymes that break the bonds between the glucose molecules
- Energy source
We can not digest fiber
Our enzymes do not break the bonds between the glucose molecules
- Not an energy source
4 Types of Indegestible dietary fibers
Cellulose - vegetables, fruits and legumes
Pectins - vegetables and fruits
Gums
Lignin
Types of water soluble fiber and their metabolic effects...
gums, pectins
- bind with fatty acids
- prolong stomach emptying time so that sugar is released and absorbed more slowly
Oat bran
Barley
Legumes
Fruits


Metabolic effects:
Lowers blood cholesterol
Delays stomach emptying
Types of water insoluble fiber and their metabolic effects...
cellulose, lignin
Vegetables
Wheat
Grains


Metabolic effects:
Increase fecal bulk
Decreases intestinal transit time
Normal concentration of blood glucose?
Between 80-120 mg/dl
Excess glucose from meal stored as
- Glycogen in liver and muscles - limited

- Fat reserves - unlimited
What are the two primary hormones are released from the pancreas to regulate blood glucose?
Insulin - transports glucose into cells

Glucagon - releases glucose from storage
If you get too little glucose from meal...
Gluconeogenesis
Protein converted to glucose
Fat converted to ketone bodies
Energy for muscles
Not for brain and nerve cells
Results in ketosis
Glucose homeostasis: maintaining blood glucose concentration is vital. What are the extremes?
Too low = weakness, coma and death

Too high = vasculature damage, peripheral nerve damage, wasting syndrome
3 Types of Diabetes:
Type 1: Insulin-dependent diabetes mellitus (IDDM); lack of insulin; destruction of pancreas
Type 2: Non insulin-dependent diabetes mellitus (NIDDM); insufficient use of insulin; insulin resistant; Western diets and physical inactivity are conducive
Gestational diabetes: 3-6% pregnant women; disappears after delivery
What are the recommended Carb and Fiber daily intakes?
CHO: 55-60% of energy (kcal)

Fiber: 25 gm/day
or
11.5gm/1000 kcal
What happens if you have too much fiber?
Can displace kcal and nutrients
Intestinal discomfort
Interfere with mineral and nutrient absorption
Types of artificial sweeteners (zero calorie)...
Saccharin
Aspartame
Sucralose
Acesulfame potassium
Alcohol Benefits (moderate drink,1-2 drinks)
Increases HDL-cholesterol (clears cholesterol)
Protects against heart disease
Alcohol Adverse effects (excessive drink, > 5 drinks)
Hypertension, stroke, liver cirrhosis, cancers, nerve system disorders
Associated with:
Death from homicide, drowning, traffic accidents, suicide
Proteins are made of...
many Amino acids (AA) connected together
What is the basic structure of an Amino Acid?
Central carbon (C)
Hydrogen (H)
Acid (COOH)
Amino Group (NH2)
Exception: side group or side chain “R”
How many different AA's? How many essential & non essential?
20 in all:
9 essential from food
11 non essential
AA’s are connected to each other through a...
peptide bond (condensation reaction)
The enzyme that will break apart a peptide bond is called...
a peptidase
What is the name of the chemical breakdown that occurs in the stomach?
Hydrolysis
What is denaturation?
When protein looses its 3-D structure due to the acidic environment (HCl) of the stomach
What is pepsin and how is it formed?
It is the stomach's peptidase (enzyme that breaks the peptide bonds of amino acids)

The HCl in the stomach converts inactive enzyme pepsinogen to active form pepsin.
What is the order of the GI tract?
Mouth
Esophagus
Stomach
Small intestine:
- Duodenum
- Jejunum
- Ileum
Large intestine:
- Cecum
- Colon
Rectum
Anus
What is present in the small intestine to aid in digestion?
Pancreatic and intestinal proteases (enzymes specific for certain peptide bonds)
What do you call 2 AA's linked together? 3? 2-20?
2 - Dipeptide
3 - Tripeptide
2-20 - Oligopeptide
Given that insulin is a protein what would its fate be if it were taken orally?
The stomach would denature it. That is why diabetics need to inject insulin so that it can bypass the GI tract.
What do intestinal cells do?
They absorb single amino acids, di- and tri-peptides
How do AA's get absorbed?
AA's must pass through the cell membrane, through the cell and then through the cell membrane again where transporters are located.

Absorption occurs through transporters specific for certain AA’s
What is phenylalanine?
it is an essential AA that is converted into tryptophan in the body which increases mellatonin (neurotransmitter than makes you sleepy)
What are conditionally essential AA's? An example?
AA’s that are normally made providing the precursors are available.

People that have PKU can't metabolize phenylalanine or they will die (caused by inbreeding; prominent in Pennsylvania & Utah) Therefore typtophan becomes conditionally essential.

For burn victims all AA's become condit. essential
Which body processes do protein regulate?
Water (fluid) balance--prevent edema

Acid-Base (pH) balance--buffers Immune system - antibodies
What happens in protein synthesis?
Transcription: DNA ==> RNA
- Taking the information from DNA and transcribing it into RNA

Translation: RNA ==>Protein
- Taking the information from RNA and translating it into an amino acid
What does DNA stand for? RNA?
DNA=deoxyribonucleic acid
RNA=ribonucleic acid
What is an example of error in protein synthesis?
Sickle cell anemia
- One AA is wrong causing the structure of hemoglobin structure to change resulting in a dysfunctional protein
In protein synthesis what is the role of DNA?
DNA code controls : Which AA needed and what order AA go on new chain
What are the requirements for protein synthesis?
Requires: Calories Essential AA from AA pool Non-essential AA from synthesis or diet
Proteins are the building materials in what?
Growth and maintenance
- Muscle tissue
- Bone tissue
- Blood
- Skin
- Intestinal cells
Repair
- Clotting factors
Replacement
- Red blood cells (have no nucleus so they can't reproduce by themselves)
- production within bone marrow
Life span of ~120 days

- Protein turnover
Continuous breakdown and synthesis
What are hormones?
Compounds made in one cell or organ that elicit effects upon other organs
Examples: Insulin and glucagon
-Insulin: Half-life of 6-10 minutes (ceases to function, constantly needs to synthesize protein to release insulin)
What is osmosis?
Water will move from an area of low solute concentration into an area of higher solute concentration. Solutes can be proteins, salt, etc.
What is happening in the body when a person develops edema?
If the concentration of proteins in the blood decreases, perhaps due to malnutrition, the effective solute concentration in the interstitial space has increased. Water will leave the blood vessels and enter into the interstitial space resulting in edema (swelling).
What happens in the protein role of transporter and receptor?
- In blood proteins transport:
Glucose
Water insoluble compounds
Fat, steroids, hormones, vitamins
- Hormone receptor
Insulin, glucagon, estrogen
What are the 3 type of nitrogen balance in amino acids?
Nitrogen balance
a. Balance: intake = output
- Normal losses include: urine, feces, sweat, skin, hair
b. Negative balance: intake < output
- Nitrogen consumed is less than that lost
-  loss due to stress or injury
c. Positive balance: intake > output
- Nitrogen consumed is more than that lost
How do you use amino acids to make glucose for energy?
1. Deamination
a. Removal of the amino group (N)

2. Carbon skeleton then used to make glucose (gluconeogenesis)
b. used for energy
c. excess used to make fat (lipogenesis)
What happens during the catabolism (breakdown) of protein?
AA converted to fat when excess AA are ingested
N from AA is reused for AA synthesis; excess is excreted in urine
May cause loss of Ca in urine
Kidney disease problem
What is a complete protein? example?
Contains all essential amino acids in amounts we require
support growth
maintain adult’s protein

Example:
- Animal proteins
- Egg protein is reference protein (egg whites have all 9 essential AA's; standard again which all proteins are evaluated)
What are incomplete proteins? example?
Lack “limiting” amino acid
- One essential amino acid that is not present in sufficient amounts
Examples:
- Cereals => lysine
- Legumes => methionine
Must be supplied by another food “complementary protein”
What are the protein requirements for the population?
.8 gm/kg body weight
Protein RDA
~46 gm for women
~58 gm for men
10-35% kcal from protein
Actual US Intake
>90 gm
>130 gm
~15% kcal from protein
What are the protein requirements for athletes?
Athlete needs 1.26 gm / Kg (~90 gm)
Food protein sources:
Meat
Fish
Poultry
Eggs

Beef & pork rich in iron but high in fat

Dairy products select low fat (butter not good protein source)
Legumes
Cereal grains
Seeds
Nuts
Plant sources of protein are low in fat
What is the only AA supplement that became credible in 2002?
Typtophan - for people with sleep disorders
What is the most widespread form of malnutrition? What are the causes?
Protein-Energy Malnutrition (PEM) and Protein-Calorie Malnutrition (PCM)

Primary: inadequate food intake
Secondary: disease states that lead to 1) low food ingestion, 2) inadequate nutrient absorption or use, 3) increased nutrient requirements, and/or 4) nutrient losses
What are the forms of PEM/PCM?
Decreased Protein  Kwashiorkor
Decreased Energy  Marasumus
Decreased Protein & Energy  Marasmic

1. Marasmus (severe-chronic PEM)
- severe deprivation or malabsorption of protein and calories
Chronic food deprivation
Children 6-18 mo.
Impairs brain development & learning
Muscle wasting, including heart
Severe weight loss


2. Kwashiorkor (acute PEM)
- inadequate protein intake or infections
Primary  decreased food intake
Secondary  due to a concurrent disease
A disease primarily occurring in young children when sufficient kcalories, but insufficient protein is consumed; child suffers from edema, poor growth, weakness, and an increased susceptibility to infections
What is the difference btw starch and fiber?
their molecular structures:
fiber - beta bonds
starch - alpha bonds
What are the two critical dietary fibers?
cellulose and pectins (in fruit and veggies
How does the body control blood glucose levels?
1) Rush of glucose into body - Beta cells of pancreas secrete insulin - promotes glycogen storage in liver and muscles and glucose uptake in cells

2)When glucose levels drop - alpha cells of pancreas secrete glucagon - promotes for gluconeogenesis (stimulates liver cells to break down glycogen)
When the body is deprived of glucose what happens?
All other organs will cease to use glucose to maintain the brain, liver, lungs, heart and kidney.
What does diabetes mellitus mean?
Sweet urine (eww)
What did type 1 diabetes used to be known as?
Childhood onset diabetes
Aspartame is...
an artificial sweetener.

the most widely studied supplement in the world. 99 countries have adopted it as safe.
Artificial sweeteners are...
man made
zero calorie

sucralose and aspartame are both derived from nutrients
What are the FDA requirements for weight loss supplements?
no side effects for vast majority of population

min of 5% weight loss in 6 months
What is the primary site of digestion and absorption for carbs? What form do they need to be in at this stage?
Monosaccharides - in order to be absorbed

glucose and lactose - need active transport

sucrose - need facilitated transport

SI = primary site
What is the primary site of digestion and absorption for protein? What form do they need to be in at this stage?
Di, Tri or single AA

need active transport

SI = primary site
What is the primary site of digestion and absorption for alcohol?
Stomach and SI
What is the primary site of digestion and absorption for fat?
SI
Y or N: All all fats lipids?
Yes
Y or N: All all lipids fats?
No
What are the classes of lipids and their characteristics?
1) Fats (triglycerides)
-solid, triglycerides/saturated fat, caloric
2) Oils
-liquid, unsaturated fats, caloric, also exists as triglycerides
3) Cholesterol
-used to make Bile (fat digestion), sex hormes, and Vitamin D (w/o cholesterol you can't make them)
- non caloric
4) Phospholipids
-makes up cell membrane bilayer, the surrounding barrier of animals cells
What is a triglyceride?
glycerol with 3 fatty acid chains (interchangeable btw saturated and unsaturated)
In what form does fat...form?
In droplets
The longer the fatty acid chain, what happens to the food?
It becomes more solid
How much of dietary fat is made up of triglycerides?
98% (also a vast majority of body fat stores are also triglycerides)
What is the length range for fatty acids? What is the most common length?
4 to 24 carbons long (always even numbers).

18 is most common
What are some characteristics of unsaturated fatty acids?
Unsaturated fatty acids may have one or more “point of saturation”

May be “monounsaturated” (MUFA) or “polyunsaturated” (PUFA)
Name 2 polyunsaturated fats and the location of their first point of unsaturation.
Omega-3 fatty acids
First point of unsaturation next to 3rd carbon in chain
Linolenic Acid : 18 carbon chain omega-3

Omega-6 fatty acids
First point of unsaturation next to 6th carbon in chain
Linoleic Acid : 18 carbon chain omega-6
Name the parts of a fatty acid.
Carbon chain (C,H,O elements)
Omega end (CH3)
Carboxyl “acid” end (COOH)
Chemistry of opposite ends allows FA to group together
What is the point of saturation?
where the double bonds are introduced.
how is a fatty acid different from sugar and protein?
in its formation. it is circular
What are the 2 chemical properties that lipids exhibit?
LIPIDS ARE BOTH :

HYDROPHOBIC - (water-resisting, fat attract)
HYDROPHILIC - (water-attracting, fat resist)

Allows fats to attract each other, and group together, forming spheres
Which end of a fat molecule is very reactive?
carboxyl end
what is saturation?
molecule is saturated in its bond with hydrogen
How many bonds can each of the following make?:
Carbon
Hydrogen
Oxygen
Carbon: 4 bonds
Hydrogen: 1 bond
Oxygen: 2 bonds
What do carbon carbon double bonds do?
= alter the orientation of the molecule
- which leads to different biological functions and health implications
Difference between saturated and unsaturated
Saturated: no double Carbon to Carbon bonds in chain
C-C-C-C *all possible hydrogens are bonded, solid at room temp (almost always)


Unsaturated: one or more double bonds between carbons
C=C-C-C=C *double bonds can be broken to add hydrogens
What do double bonds do?
They make molecules more fluid. Unsaturated fats have more double bonds.
What are food foods with saturated fatty acids?
Animal fats
Meat
Dairy products
Butter

Tropical oils (heat degrades many things. the weather you find them in made them develop into more saturated FA to protect cells)
Palm and coconut oil
Characteristics of a Monounsaturated FA (MUFA)
One double bond (C=C)
liquid at room Temp
Characteristics of a Polyunsaturated FA (PUFA)
Greater than 2 double bonds (C=C)
Highly unsaturated
liquid at room temp
All Omega-3 and Omega-6s are PUFAs
Example of Nonessential FA (the body can make it)
Oleic Acid from stearic acid by Desaturation
What happens in desaturation?
Insert carbon double bond,
removes hydrogens
Examples of essential FA
LINOLENIC Primary Omega-3 Family Member
also, EPA (eicosapentaenoic acid) (20:5)
DHA (docosahexaenoic acid) (20:6)

LINOLEIC ACID – Primary Omega-6 Family Member
-also, arachidonic acid (20:4)
How do you identify a fatty acid's family?
THE LOCATION OF THE DOUBLE BOND CLOSEST TO THE OMEGA (METHYL) END OF THE FA IDENTIFIES A FATTY ACID’S FAMILY
Examples of Omega 3,6 & 9 unsaturated fatty acids and the location of their double bonds
OLEIC ACID:OMEGA 9 (DOUBLE BOND AT C 9)
LINOLEIC:OMEGA 6 (DOUBLE BOND AT C 6 AND C9)
ALPHA LINOLENIC: OMEGA 3 (double bond…)
If there is a picture of a molecule and it says the following on the bottom, what does this mean?:
ALA, C18:3, omega-3
Alpha Linoleic Acid
From methyl end,
where is first carbon double bond? C3 or C6?
C3

How many total carbons? 18

How many carbon-carbon double bonds? 3
What are the sources of omega fatty acids?
OMEGA 6
LINOLEIC ACID: VEGETABLE OILS, POULTRY FAT

ARACHIDONIC ACID: MEATS OR FROM LINOLEIC

OMEGA-3
LINOLENIC ACID: cod and salmon, flax seeds, walnuts

EPA AND DHA: HUMAN MILK, SHELFISH AND FISH
What is the important ratio of Omega 6 to Omega 3 that we should intake?
4 to 1
What is the recommended % of Omega 6 to intake daily?
5-10%
What is the recommended % of Omega 3 to intake daily?
0.6-1.2%
Are there any foods with more omega 3 than omega 6?
no
Fatty acids combine to form what?
tryglerides
What does hydrogenation do?
Improves texture, taste & cooking properties
Adds H at double bond
Becomes solid at room temp
Decreases health benefits
What are the advantages and disadvantages of hydrogenation?
AVANTAGES OF HYDROGENATION

1. PROTECTS AGAINST OXIDATION (SHELF LIFE)

2. ALTERS TEXTURE (HYDROGENATED OIL BECOMES SPREADABLE)

DISADVANTAGES:

1. POLYUNS FATS BECOME MORE SATURATED
2. UNSATURATED MOLECULES AFTER HYDROGENATION CAN CHANGE SHAPE:
- FROM CIS (H’s on same side, naturally occurs)
- TO TRANS (H’s on alternate sides, synthetic)
When does hydrogren contribute to disease?
when it is incomplete
what is CIS confirmation?
both H are moved from the same side
what are TRANS FATTY ACIDS?
Hydrogens surrounding double bond on opposite side of the carbon chain
- causes the bent carbon chain to straighten, solidifying the chain
-acts like a saturated FA
What are the Eicosanoids?
EICOSANOIDS are derived from omega acids.

- Prostaglandins – inflammatory responses, clot formation or clot prevention, hormone regulation, etc.
- Thromboxanes – clot formation
What are the physiological effects if eicosanoids are derived from omega 6 FA? omega 3?
OMEGA-6 LINOLEIC ACID (18:2)
CONSTRICTING BLOOD VESSELS
PROMOTING BLOOD CLOTTING
PROMOTING INFLAMATION

OMEGA-3 ALPHA-LINOLENIC (18:3)
DILATING BLOOD VESSELS
DISCOURAGING BLOOD CLOTTING
REDUCING INFLAMMATION
About phospholipids:
- Contain Fatty acids
- Cell membranes formation
- Lipid transport (lipoproteins/cholesterol)

They have:
hydrophilic heads and hydrophobic tails
about cholesterol:
(only from animal source)-Cell component, 2/3 made in liver
Bile Acid precursor
Contain no Fatty Acids
Plant Sterol or phytosterols – can reduce cholesterol absorption
what do Plant Sterol or phytosterols do?
can reduce cholesterol absorption
how is bile made? where is it stored?
synthesized from cholesterol in liver, stored in gall bladder
what does bile do?
Acts as an emulsifier : holds small particles of fat in suspension with water so enzymes can break down triglycerides
what does bile help with?
fat digestion
what is the role of sterols?
Sex hormone production
a. Estrogen
b. Testosterone
c. Adrenal hormones
- Corticosteroids
Vitamin D formation
what does fiber do?
Sequestering Cholesterol from Bile and excreting it in the feces
A high fiber diet does what?
helps reduce the risk of CHD, by lowering blood cholesterol
What happens in the stomach?
Minimum digestion – mixing to expose fat molecule-attack by gastric lipase
What happens in the small intestine during digestion
Fat entering the small Intestine stimulates release of cholecystokinin (CCK) causing the gallbladder to release bile into the small intestine
What happens in fat digestion?
Fats and watery juices tend to stay separate
Bile released in watery portion attacks fat, surrounds droplets and pulls into water layer
Enzymes (lipases) can now break down fat
how much of the bile do our bodies reabsorb?
Approximately 95% of the bile acids delivered to the duodenum are absorbed back into blood within the ileum.
What accounts for the majority of cholesterol breakdown in the body?
Hepatic synthesis of bile acids
how much cholesterol converted to bile acids and eliminated in bile every day?
500mg
What are the small molecules that get absorbed during digestion?
Glycerol, Short- and Medium-chain Fatty Acids
- Diffuse directly into intestinal cells and absorbed into blood
what are the larger molecules that get absorbed in the body?
- Monoglycerides, Long-chain fatty acids
what are micelle and how are they formed?
emulsified fat droplets surrounded by bile
- Bile assists in micelle formation which are transported into intestinal cells
What molecules re-form to triglycerides in intestinal cells? What is then formed?
Glycerides and fatty acids

Chylomicrons are then formed from triglycerides, protein and cholesterol
how is digested fat transported?
via the lymphatic system
what are lipoproteins
emulsified fats for transport in blood
what are lipoproteins and the different types?
Lipoproteins: emulsified fats for transport in blood

Chylomicron -- food fat from gut to body
VLDL (very low density) -- carries fats to adipose
LDL (low density) -- carries cholesterol to body
HDL (high density) -- removes cholesterol from body
the HIGHER the triglyceride level...
the LOWER the density.
fat, in the form of what, is much less dense than both cholesterol and water?
Fat as triglyceride
why can't a chylomicron go directly from the intestinal cell to blood?
b/c blood capillaries and intestinal wall is too small
about the chylomicron:
A water soluble transport vehicle for dietary fatty acids
Synthesized in the intestinal cell
Transports fat to cells
Leaves intestinal cell through lymphatic system, then travels to thoracic duct where it can enter bloodstream b/c it is big enough to allow it to enter
where does the chylomicron remnant go for destruction?
the liver
what is the order of the chylomicron lipoprotein pathway?
intestine=> chylomicros=>triglycerides=>fat & muscles

once the chylomicros are devoid of triglycerides (phospholipid shell and cholesterol) it goes to the liver and gets destroyed.
what are chylomicrons essential for?
absorption of large triglycerides and other associated fat soluble compounds
how are the chylomicros able to enter the lymphatic system
via the lacteals located near to and associated with the small intestinal cells
About VLDLs
Lipoprotein made by liver
Consists mostly of triglycerides
- also of protein and cholesterol
Transports lipids to various tissues in the body
About LDLs
Derived from VLDL
Meaning, after an LDL downs off triglycerides to body it BECOMES an LDL
Consists mostly of cholesterol
Transports contents to all cells

‘bad’ cholesterol
-Associated with high risk of heart attack
Healthy levels of HDL vs LDL
Ideally, HDL >60 mg/dl in blood, less than 40 is considered significant health risk

Ideally, LDL <100 mg/dl in blood, above 130 is considered significant health risk

Total cholesterol (HDL + LDL) should be less than 200 mg/dl
About HDL
High density lipoprotein (HDL)
made by Liver
Transports cholesterol away from cells to liver
Removes cholesterol from arteries
Made by liver

‘good’ cholesterol
Health effects of lipids:
coronary heart disease ( how does it relate to each
Positive association with saturated fat
- Some saturated fats raise LDL
Positive association with  LDL
Negative association with MUFA
- Monounsaturated fats raise HDL
Negative association with PUFA
- Omega-3 fatty acids (fish oils)
decrease cholesterol
reduce blood clotting
reduce blood pressure?
Positive association with trans-fatty acids
Formed in the hydrogenation of vegetable oils (margarine)
what is the recommended fat intake?
10% or < of total kcals from saturated
200 mg or < of cholesterol
how are carbs stored?
glycogen in muscles
fat
about the adipose cell:
loaded with triglycerides
nucleus is being pushed out because there is so much fat
what happens when you loose fat?
fat cells diminish in size not quantity so they just shrink
what do lipase inhibitors do?
blocks breakdown of triglyceride in intestinal lumen, inhibiting absorption
how can you reduce cholesterol?
reduce fat consumption
at what mg level does the benefits of omega 3 max out?
800mg
what is CHD?
Any disorder that results from inadequate blood circulation to the heart, impairing heart function.
what is CVD?
Any disorder that results from inadequate blood circulation in heart, brain, neck, and extremities
--often due to plaque build-up and atherosclerosis
how are CHD and CVD related?
CHD is a kind of CVD
what is angina?
– chest pain resulting from arteries that are narrowed by 50% or more, reducing blood supply to the heart
how does plaque start in the arteries?
elevated total plasma cholesterol
what is atherosclerosis?
the hardening of the arteries
what is the cause of atherosclerosis?
Elevated blood levels of cholesterol
- Focus on HDL (under 200) vs. LDL (>60)
- Role in plaque formation and progression
what are the primary and secondary risk factors for atherosclerosis?
Primary risk factors
Smoking (1 or more packs a day)
-- veins constricted
-- carcinogens promote free radicals that cause micro tears in blood vessels
Blood Pressure (diastolic > 90 mm Hg; systolic > 150 mm Hg)
Elevated plasma cholesterol (>240-250 mg/dl (can be hereditary)

Secondary risk factors
Elevated plasma triglycerides
Obesity
Diabetes
Chronic stress
Arteriosclerosis –
degeneration of the arteries, resulting in thickening and hardening of the arterial wall
Atherosclerosis –
specific form of arteriosclerosis  accumulation of lipids in lesions of intima of large - & medium-sized arteries
Aneurysm –
dilation or ballooning of an artery
Ischemia –
deficient blood supply (angina)
Infarct –
area of coagulation necrosis due to deficient blood supply
- In myocardial infarction (heart attack), part of the heart dies due to inadequate blood flow
Embolus –
a plug, composed of a detached clot, mass of bacteria, or other foreign body, occluding a blood vessel.
Thrombus –
a blood clot which more or less occludes an artery or cavity in the cardiovascular system
-heart attack can occur from both thrombus or embolus
Infarct in extremities –
gangrene
Stenosis –
the narrowing of a vessel
Cerebral infarction –
stroke
what are the layers of a blood vessel?
endothelial cells - line the inside wall
intima - innermost layer
media- all muscle
adventitia - needed to make muscle cell in media
what are the good cholesterol levels and risk factors?
Cholesterol;Desirable ;Borderline ;High

Total <200 ;200-239; >240

LDL <100 ;130-159 ;>160

HDL >60 <40 ---

Triglyceride <150; 150-200 ;>200
what is the link between Chronic Inflammation and Heart Disease?
LDL breakage of endothelial layer can trigger inflammatory response.

Inflammation release a number of factors, among them, free radicals, which are reactive oxygen atoms that lack an electron.

These free radicals oxidize LDL. An oxidized LDL more plaque forming than normal LDL since steal electrons from a nearby atom or molecule (oxidation).
Antioxidants –
substance that prevent or repair damage to cell cause by exposure to free radicals
examples of antioxidants
Beta-carotene
Vit E
Vit C
Selenium
about PUFA in our cell membranes
double bonds susceptible to oxidation
free radical + FA oxidized FA(reactive)
anti oxidants get oxidized instead
what can happen if atherosclerotic plaque builds up?
pieces of plaque can break free, travel to the brain and block blood vessels that supply blood to the brain
TWO main types of Drugs used to combat elevated Cholesterol
HMG-CoA reductase Inhibitor - best molecular target of cholesterol in liver
-- target key enzyme in cholesterol synthesis
Bile Acid Sequestrants
what does Hepatic synthesis of bile acids do?
accounts for the majority of cholesterol breakdown in the body.
In humans, how much cholesterol is converted to bile acids and eliminated in bile every day.
500mg
Approximately how much bile acid delivered to the duodenum are absorbed back into blood within the ileum.
95%
what do sequestrants do?
interfere with the reabsorption of bile acids by the intestine
Enhance conversion of cholesterol into bile acids in the liver
Reduce hepatic cholesterol content
Enhance the activity of LDL receptors
Shifts system toward excretion rather than reabsoption
Not as effective as statins
what are the 2 key events that happen for atheroscleratic plaque to form?
Endothelial injury
Foam Cell Formation
other risk factors for CVD
High Blood pressure
High blood homocysteine
degrades and inhibits the formation of the three main structural protein components of the artery, collagen, elastin and the proteoglycans
HOMOCYSTEINE –
an “intermediate byproduct” of normal metabolism
High levels of homocysteine result from what?
1) genetic defects, and/or 2) nutritional deficiencies.
Men and women with high levels of homocysteine have increased risk not only for:
1)     stroke and
2)     heart attack but also
3)     osteoporosis,
4)     depression,
5)     certain types of cancer, and
6)     dementia (memory loss and loss of higher brain functions, such as seen with Alzheimer’s disease)
what are foods with little caloric sources can be rich sources of phytochemicals
Celery, tea, garlic
how do phytochemicals work?
Hormone-inhibiting substances – prevent cancer initiation

Antioxidants

Block harmful enzymes

Modify cholesterol absorption, synthesis, and utilization

Decrease blood clot formation
what is resveratrol and where can you find it?
a phytochemical

skin of red grapes, constituent of red wine
what is a hazardous phytochemicals?
ackee fruit
Found in Jamaica, Africa
Fleshy part around seed edible
Skin, and unripe fruit contain agents that drop blood pressure and blood glucose
Can result in immediate death
do vitamins have calories?
no, don't break them down for energy
what do vitamins do?
Function as regulators--allow metabolic reactions to occur
Serve as part of a “co-enzyme”
non-protein chemical compound that is bound (either tightly or loosely) to a protein (enzyme) and is required for the protein's biological activity.
what is the active site?
where compounds will bind to the enzyme in order for them to function
what is bioavailability?
Availability of vitamin in food depends on quantity in food and amount absorbed.
How is bioavailability determined?
Efficiency of digestion and time of transit through GI tract
Previous nutrient intake and status
Other foods in meal
Method of preparation (raw, cooked, processed)
Source of nutrient (synthetic, fortified, naturally occurring)
how can vitamins be damages?
Prolonged heating – (thiamin loss)
Can refrigerate most foods

UV light – (riboflavin loss)
Translucent storage containers

Oxygen – (vitamin C)
Store cut fruits in airtight wrappers, then refrigerate
when measuring vitamin intake what must be taken into account?
both vitamin and provitamin intake must be taken into account.
what causes vitamin deficiency?
Little variety in diet--insufficient intake
Poor intake of vitamin
Increased requirement for vitamin
illness
competing drugs
growth, etc.
Severe vitamin deficiency is not a big US problem
what nutrients are enriched grains still deficient in?
B-6, magnesium and zinc
what was the point of the enrichment act of 1941 and 1998?
increase vitamin b content in foods
what are the 9 water soluble vitamins
B-complex vitamins: B1, B2, B3, B6, B12, folate, biotin, pantothenic acid
Vitamin C
what are the 4 fat soluble vitamins
A, D, E & K
about water soluble vitamins
Absorption: Directly into the blood
Transport: Travel freely
Storage: Freely circulate in watery area
Excretion: Excess removed via urine
Toxicity: Possible with supplements
Requirements: Frequent doses every 1-3 days
what are the names of b1, b2, and b3
Thiamin, Riboflavin & Niacin
what do the b vitamins do?
Function: as coenzymes for energy absorption and utilization
Energy metabolism, nerve cell function

must be added to enriched flour by law
what are the deficiencies associated with b1, b2, and b3
B1-beriberi; B2-ariboflavinosis; B3-pellagra

lots of effect on nervous system
what are the 3 types of beri beri?
Dry BB
- Nervous System

Wet BB
- Heart & Circulation

Wernicke’s
– brain/nerves. Often seen in alcoholics, at risk group for thiamin deficiency
- excessive alcohol consumption blocks thiamin absorption
what are the main thiamin sources?
pork, meat products, fortified grains
what happens in riboflavin deficiency?
No one disease associated with deficiency

General inflammation of the mouth, skin, GI tract
what is a great riboflavin food source?
liver
what happens in niacin deficiency? how can it be prevented?
Pellagra
Diarrhea, Dermatitis, Dementia, (Death)
Occurs in 50-60 days
Decrease appetite & weight

Prevented with an adequate protein diet

Only dietary deficiency disease to reach epidemic proportions in the U.S. in the 20s and 30s
- prompted acts of congress in '41 to enrich foods
what is the name of b6 and what is it's function?
Pyridoxine

Function:
protein and amino acid metabolism
neural function
conversion of tryptophan to niacin
conversion of tryptophan to serotonin
what happens in b6 deficiency?
Deficiency: anemia, muscle weakness, depression, confusion
what happens in b6 toxicity?
Toxicity: first reported 1983: 2 grams/day supplement for 2-3 months.—nerve degeneration
what does folic acicd do? what is the current recommendation?
Functions:
production of red blood cells; protein synthesis
Synthesis of nucleotides to make DNA
Prevents neural tube birth defects; maintains normal homocysteine level

Current recommendation: Women should take folic acid supplements when they want to become pregnant, as well as during pregnancy
what happens in folate deficiency?
Heart Disease & hyperhomocysteinemia
Megaloblastic Anemia
Neural Tube Defects

Similar signs and symptoms of vitamin B-12 deficiency
what happens in megaloblastic anemia?
due to folate or vitamin b12 deficiency red blood cells are unable to divide. so they stay in an early stage of development, keep their nuclei and are slightly larger than normal red blood cells.
what are the causes of folate deficiency?
Poor diets
poor & elderly
Pregnant women – increased requirements
Alcoholics
Anticancer/ RA drug methotrexate
what is the neural tube?
the embryo's precursor to the central nervous system, which comprises the brain and spinal cord
what happens in spina bifida?
th eneural tube has failed to close near the base of the spine
what is anencephaly?
the brain is absent or very poorly developed
what is encephalocele?
the brain is protruding through an opening in the skull.
what are the food sources of folate?
Liver
Fortified breakfast cereals
Grains, legumes
Foliage vegetables
Susceptible to heat, oxidation, ultraviolet light
what is the name is vitamin b12 and what is its function, deficiency and sources?
Cobalamin
Function: red blood cell, Nerve tissue production

Deficiency: Megaloblastic Anemia
similar to folate, it is also characterized by large immature cells
neurological disorders – including neurodegeneration

Source: animal products and fortified grains
Absorption can be problem in elderly--take B12 shots
what are the 2 ways to have deficiency of b12?
Dietary Deficiency
Megaloblastic Anemia, similar to folate, it is also characterized by large immature cells
Atrophic Gastritis
Condition common in older people, cells of stomach damaged
Normally, stomach cells release Intrinsic Factor (IF) with HCL which binds VitB12 and releases it from proteins in foods undergoing digestion
VitB12 not easily absorbed into blood without being bound to IF
If stomach cells damaged due to Gastritis, too little IF released.
Resulting Megalobastic Anemia due to B12 deficiency in patients with Gastritis termed to have Pernicious Anemia
how can you differentiate vit b12 and folate deficiency?
Vitamin B-12 deficiency is usually accompanied by elevated concentrations of blood homocysteine and methylmalonic acid.

Folate deficiency results in only elevated homocysteine.

Also test for Intrinsic Factor in blood
what is the name of vitamin c, can we synthesize it and what conditions are related with its deficiency?
Ascorbic Acid/ Anti-Scorbutic Vitamin


Synthesized by most animals
not by humans

Deficiency- Scurvy, dermatitis
what are the functions of vit c?
Collagen synthesis (main protein of connective tissue) - if not then you bruise easily
Reducing agent (antioxidant)
Enhances Iron absorption
Synthesis of neurochemicals, steroids, cholesterol to bile acids (the enzyme that does this requires vit c)
Immune functions
Cancer prevention?
what happens in vit c toxicity?
Possible with Supplements (greater than 10x the upper limit)
Tendency toward Gout
Kidney stones
Pro-oxidant
Cramps, nausea, diarrhea
about fat soluble vitamins
Absorption: Lymph then blood
Transport: Many need protein carriers
Storage: In fat cells
Excretion: Tend to remain stored
Toxicity: Likely with excessive intake/supplements
Requirements: Periodic doses (Weeks- months)
what prefic denotes vit a? what are the different forms of vit a?
retin-

retinol (alcohol)
retinal (aldehyde)
retinoic (acid)
what is rhodopsin?
- (Opsin + Retinal)
- Responsible for black and white vision
- Located in the rods
- Night vision
what is iodopsin?
- Contains Retinal
- Responsible for color vision
- Located in the cones
- Day and color vision
what are the rods and cones responsible for in the eye?
rods - night
cones-day/color
what are more functions of vit a?
Maintains mucus-forming cells throughout the body
- Produce mucopolysaccharides
- Act a lubricants and protects against infections
- Found in eyes, lungs, GI tract, etc.
Maintains epithelial cells (skin...)
Growth (retinoic acid)
- normal bone growth
- tissue growth
Immune function
Cancer prevention ? - cancer involving epithelial cells - beta-carotene acts as antioxidant to trap free oxygen radicals
what happens in vit a deficiency?
Night blindness
Permits early deficiency diagnosis
The eyes slow to recover in response to flash of bright light
Blindness (xerophthalmia)
Caused by severe Vit-A deficiency
Cornea becomes dry and hard, then soft (irreversible)
Keratinization
Epithelial cell secretes Keratin (found in hair and nails)
Skin becomes hard, rough, and scaly
Infectious Disease
Measles, Malaria susceptibility enhanced with Vit A deficiency
Widespread initiatives, supplement infrequent mega Vit-A doses
what happens in vit a toxicity?
Birth defects; liver damage; hair loss
Toxic only by supplementation, not food

Vit A is toxic but not beta-carotene
Carotene from food stored in fat tissue. May turn skin orange, but this is cosmetic, and not harmful.
From supplement, may act as Pro-Oxidant in very high levels
what is the name of vit d and how is it synthesized?
calciferol

Synthesized in skin when exposed to sunlight
From U.V. irradiation of skin
Possible for adult to synthesize requirement,
different from all other nutrients

Acts like a hormone
Controls cellular functions
what is the function of vitamin d?
Function in Calcium balance:  blood Calcium
 absorption in small intestine
 calcium deposition in bone for mineralization and strengthening
 urinary calcium re-absorption by kidney
what happens in vit d deficiency and toxicity? what are food sources?
Deficiency:
Rickets in children
Loss of Calcium in bone leads to osteoporosis in adults

Toxicity in excess – supplements can alter calcium concentrations in blood and bone

Few food sources
Fortified milk, butter/margarine, Liver
Sunlight activates precursor in skin
what is the name of vit e and what is the function and food sources?
tocopherol

Function as antioxidant
Foods: protects against rancidity(oxidation of food)
Body: protects from “free radical damage” to cells and tissues; prevents artery plaque formation
Food sources
Nuts, seeds, wheat germ, whole grain
Veg oil, marg, mayo & salad dressing
what is the function and food sources vit k?
Function: blood “K”oagulation
Synthesized by colonic bacteria in GI tract
Food sources--leafy green veg
what happens in vit k deficiency and toxicity?
Deficiency: abnormal blood clot; bruise easily
Long term use of antibiotics
Hemorrhage common in infants b/c little synthesis (sterile GI tract at birth)
Toxic only with excess synthetic supplements
what is an antioxidant? examples?
substance that prevent or repair damage

Beta-carotene
Vit E
Vit C
Selenium
what is the most abundant mineral in the body? where is it found?
calcium

99% in bones/teeth
Bone structure- rigid frame to hold body upright, attachment of muscles
Serves as a calcium bank, readily available source to fluids of the body if blood calcium drops
Hydroxyapatite- Calcium and Phosphate crystals (seen in bone deposition)
Mineralization- crystals become denser, strengthening and providing rigidity to maturing bone
Bones constantly gaining and losing minerals continuously …NOT inert like a rock!
Balance of the two
Fluoride stabilizes and hardens teeth, opposing mineral withdrawal (different from bone)
1% in blood and soft tissues
Blood clot formation/blood pressure
Nerve impulse transmission
Muscle contraction
Enzyme regulation
Blood level is maintained at the price of bone calcium
about minerals and their varied roles
Inorganic Elements (do not contain carbon)
Unlike vitamins, which are large molecules, are easily damaged/destroyed, mineral atoms always retain their chemical identity.
No destruction by heat, air, acid, mixing
Carry a charge, meaning they are “ions”
Positive charge- Cation, Negative- Anion
May be easily absorbed or require carriers
Water soluble
Fat soluble
Bioavailability variation, similar to vitamins
Interactions
Excess of one mineral can create inadequacy of another (Na/Ca , Mg/K)
Varied roles
Fluid Balance (sodium, potassium, chloride)
Growth and health (calcium, phosphorus, magnesium)
what happens when blood calcium rises?
thyroid glad is signaled to secrete calcitonin => calcitonin does the following things:
inhibits the activation of vit d;
prevents calcium reabsorption in the kidneys,
limits calcium absorption in the intestines;
inhibits osteoclast cells from breaking down bone, preventing the release of calcium
what happens when blood calcium level falls?
signals the parathyroid glands to secrete parathyroid hormone. This hormone in turn...

stimulates the activation of vit D
vit d and the hormone stimulate calcium reabsorption in the kidneys
vit d enhances calcium absorption in the intestines
vit d and parathyroid hormone stimulate osteoclast cells to break down bone, releasing calcium into the blood
what are osteoblasts?
deposits calcium in bones
when is the peak bones mass?
in the 20s
what happens in calcium deficiency?
osteoporosis - holes in bones
what is the adequate intake of calcium and the toxic amount?
AI: 1000 -1200 mg/day for adults
AI: 1300 mg/day for adolescents (9-18 yrs. old)
Actual intake range from 600-800 mg/day for women and 800-1000 mg/day for men

Many are slightly deficient

toxic: 2.5 g/day – deposits in kidney and liver
about sodium: functions, requirement??
Major cation of extracellular fluid
Movement into cell initiates action
Est. min. requirement = 500 mg/d
Should consume < 2300 mg/d
Functions:
Maintains electrolyte balance
Nerve impulse transmission
Muscle contraction
what happens in sodium deficiency?
Sodium Deficiency
(Hyponatremia)
Symptoms
Muscle cramps
Mental apathy
Loss of appetite
what happens in sodium toxicity?
Sodium Toxicity
(Hypernatremia)
Symptoms
Edema
Acute hypertension

Usually not a problem if H2O is adequate
what is hypertension?
= high blood pressure
medical condition in which the blood pressure is chronically elevated.

Sodium
environmental factor given much attention.
~1/3 hypertensive population is responsive to sodium intake.
increasing salt in a person's bloodstream causes cells to release water (due to osmotic pressure) to equilibrate the concentration gradient between the cells and the bloodstream

This increases pressure within the blood vessel wall
Increases thirst
Increase retention of water by kidneys
about chloride?
Major anion in extracellular fluid
HCl in stomach - Protein digestion
Lose HCl through vomiting
pH = Metabolic alkalosis
Abundant (esp. NaCl), no RDA
about potassium?
Principal cation inside all living cells
Fluid balance
Nerve transmission
Muscle contractions
(same as sodium)
Best source: whole & fresh foods
fruits and vegetables
 K diet   blood pressure
about phosphorus?
85% with Ca in hydroxyapatite crystals (bone & teeth)
Energy Metabolism - ATP, many enzymes and B vitamins are “phosphorylated”
Phospholipids - lipid carrier, cell membranes
DNA, RNA
Buffer system for acid-base balance
w/o phosphorus there no ATP
about magnesium?
Bone Mineralization & teeth (~50% of body MG)
Enzymes
Muscle contraction and nerve conduction
Antagonistic to Ca
Ca stimulates contraction
Mg++ relaxes muscles
Regulates b.p., lung function
Important for heart function
about processed foods?
Processed foods - biggest contributor to Na+ in our diet
Foods that have Na added may not taste salty.
Na+ bicarbonate (baking soda)
Na+ saccharine (artificial sweetener)
As Na+ content  through processing, K+ 
Can impair fluid balance in tissues (Na/K relationship)
what are the two ionic states of iron?
ferrous iron (reduced)
ferric iron (oxidized)
where can most iron be found in the body?
Hemoglobin in RBC carries O2 and CO2 (80% of body iron)
Myoglobin in muscles stores O2
So, in both, Fe helps accept, carry and release oxygen
what is hemoglobin?
Oxygen containing protein of RBCs that transports oxygen from the lungs to body tissues
Myoglobin is oxygen-holding protein in muscle
what is ferritin?
protein that receives Iron from food in intestine, and stores iron in mucosal cells lining SI.
what are transferrins? what are the 2 types?
protein that transports iron

mucosal and blood transferrin
what is heme and non heme iron? where do you get it?
heme: the iron holding structure within the hemoglobin and myoglobin proteins
- only foods derived from animal flesh provide heme, also contain non heme iron

all iron in foods derived from plants is nonheme

heme accounts for 10% of the average daily iron intake (25 absorbed)

non heme is the remaining 90%, but only 17% is absorbed.

w/o heme iron can't bind to red blood cells
what is hemosiderin?
Iron storage protein primarily made in time of iron overload

secondary storage mechanism
if excessive amount of iron then there will be lots of hemosiderin/ alerts to iron toxicity
what are the different types of iron deficiency?
Iron deficiency- initial stages
Ferritin levels decrease (stored iron), transferrin increases (form in transport)
Iron deficiency w/o anemia
‘Tired tissues’
Enzymes don’t perform efficiently
Iron deficiency w/ anemia
Severe depletion of Fe stores
Low hemoglobin concentrations
Microcytic, hypochromic anemia – small / pale red blood cells – lower iron levels – reduced Oxygen carrying capabilities
what is hemochromotosis ?
Common genetic disorder failing to prevent unneeded iron from being absorbed.
1.5 million in U.S.
who needs more iron and when?
WOMEN DURING REPRODUCTION
MENSTRUATION
PREGNANCY
INFANTS
YOUNG CHILDREN
ADOLESCENCE
- MALES-RAPID GROWTH
- FEMALES MENSTRUAL LOSSES
BLOOD LOSSES (ULCER, INFECTIONS)
what are the roles of zinc in the body?
- Important in many enzyme systems
genetic materials digestive enzymes heme synthesis essential fatty acid
- Metabolism CHO metabolism Protein synthesis Metabolism of alcohol Free radical disposal
how much zinc is absorbed and how is it stored?
15-40% absorbed

stored by metallothionein - similar to ferritin for iron
what is zinc's interaction with iron?
easily confused for by the proteins thats bind them

High zinc causes low Fe absorption
Similar metals, both +2 charge
Can bind w/ transferrin --> decreases iron absorption
High Fe intakes cause low Zn absorption
Similar effects with Zn and Copper as well
Copper is +2

if there is excessive zinc intake it will bind to albumin and transferrin so there will be less iron intake or vice versa
what happens in zinc deficiency? toxicity?
Poor growth
Inadequate sexual development
Reduced sense of smell and taste
Acne-like rash
Mental confusion
Lack of appetite

toxcitity
Small doses
Over time can affect the heart (interfere with copper)
Larger doses
diarrhea, vomiting, fever, anemia, exhaustion
Related to overuse of supplements
what is the function of iodide?
Part of thyroid hormones - Thyroid hormones control BMR
what happens in iodide deficiency?
Goiter
low Iodide intake (simple goiter)
high goitrogen intake (toxic goiter)
thyroid antagonist, interferes with I absorption
“Goitrogens” found in
cabbage, cauliflower, broccoli, brussel sprouts (few others)

Can cause:
Sluggishness
Weight gain
Cretinism
Iodine deficiency in-utero
Severe mental retardation
Result of I deficiency, or malfunction of thyroid gland
what is the most common cancer death for women?
lung
what is cancer?
A group of diseases in which abnormal cells grow out of control and can spread throughout the body.

Second leading cause of death behind cardiovascular disease.


“mitosis (cell division) out of whack”
what is apoptosis?
normal destruction of cell by body due to damage, some other abnormality
- if it escapes destruction and continues to divide then that can develop into cancer
what are the diff kinds of cancer?
carcinoma - most common; arise from cells that cover external and internal body surfaces,
ex. lung breast, colon

sarcoma - cells found in supporting tissues such as bone, cartilage, fat, connective tissue, and muscle

lymphoma- arise in lymph nodes and tissues of body's immune system

lukemia - cancer of the immature blood cells that grow in bone marrow and tend to accumulate in large numbers in the bloodstream

melanomas - abnormally dividing skin cells
what are the 3 steps of cancer growth?
Initiation: start of the cancer process, which begins with alteration of DNA within the cells.

Promotion: The period in cancer development when the number of cells with altered DNA increases.

Progression: Uncontrolled growth and spread (metastasis) of cancer cells.
what is p53
p53: “tumor suppressor” gene

activates DNA repair proteins when DNA has sustained damage.

can initiate apoptosis, the programmed cell death, if the DNA damage proves to be irreparable.
what happens when something goes wrong with p53
Inactivation of the p53 tumor suppressor gene through mutation by environmental factor is a common event in the development of colon cancer

Risk factors for p53 mutation:
Physical inactivity
large body mass index
cigarette smoking
Western-style diet such as high consumption of red meat and simple sugars
what is superoxide dismutase?
Natural enzyme found in cells that prevents free radical damage
Functions as antioxidant
Superoxide
is an anion, lacking one electron
is a free radical
With help of Fe or Cu as coenzymes, SOD “dismutates” superoxide radicals into oxygen and hydrogen peroxide
Increases stability, naturally prevents cancer initiation from propagating
what do cells classify as cancer cells
beginning with the progression stage
what are the mandatory parameters of cancer stages?
Mandatory parameters ('T', 'N', and 'M')

T (0,1-4): size or direct extent of the primary tumor
N (0-3): degree of spread to regional lymph nodes
N0: tumor cells absent from regional lymph nodes
N1: tumor cells spread to closest or small number of regional lymph nodes
N2: tumor cells spread to an extent between N1 and N3.
N3: tumor cells spread to most distant or numerous regional lymph nodes
M (0/1): presence of metastasis
M0: no distant metastasis
M1: metastasis to distant organs (beyond regional lymph nodes)
What are the different stages of cancer?
Stage 0 carcinoma very localized (no potential for metastasis, early cancer that is present only in the layer of cells in which it began)
Stage I cancers are localized to one part of the body.
Stage II cancers are locally advanced.
Stage III cancers are also locally advanced.
Whether a cancer is designated as Stage II or Stage III can depend on the specific type of cancer
The specific criteria for Stages II and III therefore differ according to diagnosis.
Stage IV cancers have often metastasized, or spread to other organs or throughout the body.
about benign tumors?
not cancerous.

can usually be removed 

do not come back in most cases 

do not spread to other parts of the body and the cells do not invade other tissues
Doesn’t mean not dangerous!
about malignant tumors?
cancerous.

can invade and damage nearby tissues and organs

metastasize (cancer cells break away from a malignant tumor and enter the bloodstream or lymphatic system to form secondary tumors in other parts of the body)
what is endometrial cancer?
cancer of the lining of the uterus - related to inherited factors
what does the cancer drug cisplatin do and what cancers is it used for?
inhibits division of rapidly dividing tumor cells

Sarcomas
– cancer of connective tissues
Carcinomas
-- cancer of epithelial cells
-- e.g., lung and ovarian cancers
Lymphomas
- cancer made in the lymph nodes and tissues of the immune system
Leukemias
- cancers of the immature blood cells that grow in the bone marrow and tend to accumulate in large numbers in t he bloodstream
how is diabetes mellitus characterized?
mainly characterized by chronically high blood glucose
what are the normal functions of insulin?
Hormone produced by the Beta cells of Pancreas

regulates the blood glucose level in the body along with Glucagon

converts free glucose to glycogen and stores it in the liver (and other muscle tissue)

Controls food intake and energy balance
what comes from the alpha and beta cells of the pancreas?
Glucagon
from alpha cells increase blood glucose

Insulin
from beta cells decrease blood glucose
what happens when there is low blood glucose?
glucagon released from pancreas and liver releases glucose into blood
what happens when there is high blood glucose?
insulin released by beta cells in pancreas and fat cells take in glucose from blood
what does hyperglycemia lead to?
Increased blood triglycerides

Atherosclerosis

Chronic inflammation
About IDDM (type I)
Insulin Dependent Diabetes Mellitus
No, or very little, insulin produced by beta cell
5-10% of total DM cases

Juvenile Onset
Immune – mediated
Idiopathic (unknown cause)
Viral infection early in life
Genetic destruction of part of pancreas
About NIDDM (type II)
Non-Insulin Dependent Diabetes Mellitus
Insulin resistance
Insulin receptor and post-receptor defects

Onset from childhood up
Common in advance stage of multiple diseases
Obesity most important environmental determinant in manifestation
Risk increased 10 fold
Increased glucose intolerance and hyperinsulinemia
Associated to visceral fat
about type 1 diabetes
Food enters GI tract, CHO converted to monosaccharides (free glucose)

Glucose absorbed, enters bloodstream

Pancreas does not respond to increased glucose – beta cells make little/no insulin

Little or no insulin in bloodstream

Glucose builds up in bloodstream
about type 2 diabetes
Food enters GI tract, CHO converted to monosaccharides (free glucose)

Glucose absorbed, enters bloodstream

Pancreas makes insulin

Insulin enters bloodstream

Insulin signaling at receptor impairing, glucose cannot enter cell, glucose in bloodstream builds up
Insulin Resistance
what are the symptoms of diabetes?
Shows symptoms of diabetes (polyuria, polydipsia, unexplained weight loss) and has a blood glucose concentration (at any time of day, regardless of meal time) ≥200 mg/dL.
Polyuria – excessive urine
Polydipsia – excessive thirst
A glucose concentration after at least 8 hours of fasting ≥126 mg/dL.
Plasma glucose concentration ≥200 mg/dL two hours after an oral intake of 75g glucose dissolved in water.
Oral Glucose Tolerance Test (OGTT)
what are the causes of insulin resistance?
Abnormal ß-cell secretory product (non func)
Abnormal insulin molecule
Incomplete conversion of pro-insulin to insulin

Circulatory Insulin immune response
Anti-insulin antibodies
Anti-insulin receptor antibodies

Target tissue defects - decreased receptors on cell
Insulin receptor defect
Post-receptor defects
What is HA1C?
Hemoglobin- A1C 
A.K.A HbA1c or A1C
measured in people with diabetes to provide an index of average blood glucose for the previous three to four months.
glucose attached to hemoglobin,
HEMOGLOBIN- protein in red blood cells that transports oxygen

A1C is hemoglobin that has been glycosolated. It is sometimes referred to as glycosolated hemoglobin A1c or glycohemoglobin.

The glucose in A1C is irreversibly bound to hemoglobin.
Glucose binds to hemoglobin continuously throughout the lifespan of the red blood cell. (120 DAYS)
what is the normal level of A1C
The normal level of A1C in people without diabetes is approximately 4% to 6%.
1% A1C corresponds to approximately 35 mg/dl blood glucose
why does the level of A1C increase or decrease relatively quickly with large changes in blood glucose?
blood glucose levels in the preceding 30 days contribute substantially more to the level of A1C than do blood glucose levels 90 to 120 days earlier.
how does diabetes cause blindness?
eyes are highly vascularized
- high glucose leads to spontaneous micro aneurysms which lead to large hemorrhages in the eye
dietary recommendations for diabetics
proteins
ADA recom: 10-20% of energy needs
Diabetics: 10 to 15%
Excessive protein – diabetic nephropathy (should not exceed 15% as energy)

fat
Should not exceed 30% of energy
Saturated fats – 10%
Polyunsaturated fats under 10%
Increase monounsaturated (canola, olive oils)
Cholesterol – 200 mg/day
what is the Drug Treatment of Choice for IDDM?
Insulin
Now rare for people to have antibodies to insulin on the market (recombinant DNA)

Hypoglycemic drugs
**Sulfonylureas
Increase sensitivity to glucose in ß-cells
They produce more insulin
30-50% of Type II are managed by these drugs
Advantages: - Oral
- less risk of becoming hypoglycemic
**Thiazolidinediones (TZDs)
Increase sensitivity of insulin receptors to insulin

Pancreatic cell transplantation:
Implant functional beta cells
All human trials have failed after 2.5 years

Exercise
Essential for Type I and Type II
Moderate levels increase Rate of glucose uptake
Has a direct influence on: - CV performance
- glucose clearance
what is the nutrient needed more than others
water - 6th nutrient class
what is hydrostatic equilibrium?
intake=output

body maintains this through water intake
what are the %s of water in diff parts of the body?
Water ~ 60% of normal adult body weight
More in children, less as %age in obese
Muscle tissue - 75% H2O
Fat cells - 10% H2O
Body water content inversely related to body fat
Make sense?
what is the recommended water intake
The AI for total water intake for young men and women (age 19 to 30 years) is 3.7 L and 2.7 L per day, respectively

In NHANES III, fluids (drinking water and beverages) provided 3.0 L (101 fluid ounces; ~13 cups) and 2.2 L (74 fluid ounces; ~9 cups) per day for men and women age 19 to 30, representing approximately 81 percent of total water intake. Water contained in food provided about 19 percent of total water intake.

1.0-1.5 ml/kcal expended (Adults)
1.5 ml/kcal expended (Infants)

liter = 4.2 cups
cup 8 oz.
what does bottled water lack?
fluoridation
What comprises the daily obligatory water loss?
insensible loss (skin evaporation, respiration): 800 mls

minimal sweat loss: 100 mls

fecal loss: 200 mls

minimal urine volume: 500 mls

can vary from ~1450-2800 ml (6-11 cups)
what are the functions of water in the body?
Transports nutrients & waste products
Regulates body temperature
Medium for chemical reactions
Required for energy formation
- gluconeogenesis- requires water
Lubricant, Cushion, etc.
what are the fluid compartments in the cell?
Intracellular - fluid within the cell
Intercellular/interstitial- fluid between the cells
Intravascular- fluid within the blood vessels

blood: plasma - 90%
how is water movement controlled?
tightly controlled by solute to solvent ratio. osmotic pressure - moves water across a membrane when solute concentrations are not equal
what are some electrolytes and what do they do?
sodium, chlorine, potassium, calcium

they attract water

cells move electrolytes in and out
how are sodium and chloride most easily lost
- Vomiting
- Diarrhea
- Sweating
- Bleeding
A 1-liter preparation of ORT solution contains what?
sodium chloride (NaCl) - 2.6g
trisodium citrate dihydrate - 2.9g
potassium chloride (KCl) - 1.5g
anhydrous glucose - 13.5g
what is thirst?
brain perception of dip in blood pressure and volume
how does the body respond to thirst?
sends out antidiuretic hormone
what is the hypothalamus and what does it do?
Region in the brain with major control of food/water intake
Releases ADH - Antidiuretic Hormone
Anti = against
di = through
ure~ = urine
Kidney reabsorbs H2O
what are osmoreceptors?
thirst sensors
how long can you last without water
3 days
what happens in dehydration as your % body weight loss
1-2% = thirst
3-4% =  muscular strength + endurance physical performance
5-6% = heat intolerance + very weak
7-10% = coma & death
what happens when muscles cell size increases?
increased strength
what is the difference between dark muscle and white muscle?
dark - endurance
white - fat moving, less used muscle
what is myostatin?
hormone that limits muscle growth
what is VO2max
maximum oxygen volume utilization

Measure cardiorespiratory fitness
Max. O2 uptake or consumption during max. aerobic metabolism

100% VO2 max not sustainable

Training at 40-60% of max at first,
can improve to 70-85% over time
what is maximal heart rate
Heart rate where highest level of oxygen consumed.
Roughly equal in intensity to VO2 max
Calculate Target exercise heart rate:
(220-AGE) x %MHR=
% MHR = % intensity of exercise in
reference to maximum heart rate
(220-29) x .80 = 153
what is the best nutrient source for low and intermediate intensity sports?
fatty acids
what is the only significant food that provides energy without oxidative metabolism (AA’s and fat both oxidized)
CHO - Carbs
how much glycogen can our muscles store?
0.5-2.0g/100g muscle
what is glycogen loading?
60-70% cal from CHO 3 days prior to event, 20 min/day training 1st and second day, rest on third day
what should be in pre-event meals?
complex CHO, low fat, fruits, veggies, and fluids, low fiber!
what is oxygen debt?
lactate buildup
how do you get maximum glycogen stores?
Eat high CHO diet regularly (70% of kcal)
Eat snacks containing glucose during event.
Eat CHO foods following exercise.
Within 15 min., 300%  in storage efficiency of glycogen storage
Train regularly.
 glycogen storage
 O2 efficiency can use more fat for energy
endurance athletes need to consume how much energy from fat?
20-30%
protein should comprise how much of energy?
10%
how much protein is needed for remodeling and building muscle?
~15 g protein to existing muscle mass / day during building periods
May go as high as 45g of protein to muscle at max
what comprises dark meat?
mitochondria and myoglobin
what is hyponatremia?
diluted blood sodium level