Nutrition by the Numbers Simple Ways to Improve your Diet · Nutrition by the Numbers Simple Ways...

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Nutrition by the Numbers Simple Ways to Improve your Diet Dr. Wendy L. Stuhldreher, RD, LDN Department of Public Health & Social Work Slippery Rock University of Pennsylvania

Transcript of Nutrition by the Numbers Simple Ways to Improve your Diet · Nutrition by the Numbers Simple Ways...

Nutrition by the Numbers Simple Ways to Improve your Diet

Dr. Wendy L. Stuhldreher, RD, LDN

Department of Public Health & Social Work

Slippery Rock University of Pennsylvania

Topics covered 1. The Power of Protein

A “25-30 g dose” at every meal

2. Calcium – milk = 300 mg More than just for bones

3. Vitamin D – take a grand -1000 IU More than just for bones

4. Omega-3 fatty acids -1-1½ g Time for an “oil” change!

5. High five – fiber that is Does whole grain mean high fiber?

6. The power of 10,000 steps!

What is Sarcopenia? Involuntary, progressive loss of muscle mass 3-8% reduction in lean muscle mass per decade

after age 30! Consequences

in muscle strength mobility ↑ risk of falls ↑ morbidity

Prevalence 60 yr olds ~ 30%

Source: Paddon-Jones D. et al. Am J Clin Nutr 2008; 87: 1562-65. Paddon-Jones, Rasmussen. Dietary protein recommendations and the

prevention of sarcopenia: Protein, amino acid metabolism and therapy. Curr Opin Clin Nutr Metab Care. 2009; 12: 86-90.

What controls synthesis of muscle?

During the Growth years

Physical activity

Eating food particularly carbohydrate which stimulates insulin

Insulin is an anabolic (Growth promoting) hormone

After age 30 yrs

Anabolic drive is lost especially with carb-containing mixed nutrient meal

Sedentary Lifestyle ↓ efficiency of use

mTOR signaling pathway regulated by leucine

(mTOR is mammalian target of rapamycin)

Reference: Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs. Nutrition & Metabolism. www.nutritionandmetabolism.com/content/6/1/12

What is the difference between the RDA and these new recommendations?

RDA

Based on nitrogen balance

Preventing deficiency

Minimal daily average intake level that meets nutritional requirements of nearly all health individuals

Higher levels (1.2 g/kg)

Cell signaling via leucine

Satiety

Thermogenesis

Glycemic control

Reference: Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs. Nutrition & Metabolism. www.nutritionandmetabolism.com/content/6/1/12

Proposed Protein Dose for Adults

Response determined by leucine – signal for triggering initiation of muscle protein synthesis

Importance

Protection of lean tissues during wt loss and to prevent age-related sarcopenia and osteoporosis

25-30 g high quality protein at every meal stimulates skeletal muscle protein synthesis

Reference: Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs.

Nutrition & Metabolism. www.nutritionandmetabolism.com/content/6/1/12

Can elderly respond to exercise training?

Yes!

25% increase in mean muscle fiber in elderly males after

12 wk resistance training program

Supplement of 10 g protein + 7 g CHO immediately after resistance training

Reference: Esmarch B, Andersen JL, Olsen S et al. Timing of postexercise protein intake is important for muscle hypertrophy with resistance training in elderly humans. J Physiol. 2001; 535:301-311

Focus on total calories consumed and protein intake of elderly

http://www.fotosearch.com/IMP185/1525r-81932/

Best Medicine – Primary Prevention We need a new message!

Rather than treat sarcopenia – prevent its development!

Identify the minimal exercise regimen to achieve desired results

Maximize the interactive effect between nutrition intake and exercise in muscle protein synthesis

Wolfe RR. The underappreciated role of muscle in health and disease. Am J Clin Nutr. 2006; 84: 475-482.

Tips to help you make wise choices from the protein foods group

Go lean with protein http://www.choosemyplate.gov/foodgroups/proteinfoods.html

Summary of Research on Dietary Cholesterol

Challenge studies (by Dr. Fernandez) – children, adults, people on wt loss regimen, people with metabolic syndrome

Up to 3 eggs per day increased LDL and HDL size which is NEGATIVELY related to CVD risk

Changed the ratio of LDL to HDL in a favorable way

Source: The State of Cholesterol Science, SCAN Webinar by Dr. Maria Luz Fernandez

How Many Eggs Yolks?

Dietary Guidelines for Americans 2010

“independent of other dietary factors, evidence

suggests that one egg (i.e., egg yolk) per day does not result in increased blood cholesterol levels, nor does it increase the risk of cardiovascular disease in healthy people”

Page 27

Comparing Protein Values in all foods

Meat, poultry and fish 7 g per ounce

Beans, dried peas, lentils 7 g per 1/2 c cooked

One large egg 7 grams

Milk 8 grams per cup

Bread 2 grams per slice

Cereal 2 grams per 1/2 cup

Vegetables (non-starchy) 2 grams per 1/2 c

Plant Protein Examples of protein content

1 cup quinoa………………………………………….21g 1 cup lentils…………………………………………..18 g 1 veggie hot dog (Yves Veggie Dogs)……… 16 g 1 cup kidney beans………………………………...15 g ½ cup tofu………………………………………….…14 g 1 veggie burger (Boca burger)….................13 g 2 T peanut butter………………………………….…9 g 1 cup cooked brown rice…………………………..9 g 1 cup soymilk (Silk)……………………………..…..6 g 1 cup oatmeal…………………………………….……6 g ¼ cup walnuts……………………………..............4 g 1 slice whole wheat bread………………… ……..3 g

New Research Osteoporosis and Protein

Indicates more than calcium is needed

Calcium and protein are interrelated

Calcium supplements are ineffective for remodeling bone if protein is limited!

Positive effects of calcium appear to require 1.2 g/kg protein

Reference: Layman DK. Dietary Guidelines should reflect new understandings about adult protein needs. Nutrition & Metabolism. www.nutritionandmetabolism.com/content/6/1/12

Have you heard that you should have lunch for breakfast if you want to lose weight?

Protein greater satiety than other E-yielding nutrients

Reduces daily calories by ~ 200 kcal Source: Schoeller DA, Buchholz AC. Energetics of obesity and weight control: does diet composition matter? J Am

Diet Assoc 2005; 105: S24-28

Requires > 30 g protein at a meal

Breakfast has greatest impact on protein intake Source: Rolls BJ, Hetherington M, Burley V. j: The specificity of satiety: The influence of foods of different

macronutrient content on the development of satiety. Physiol Beh 1988; 43: 145-53

Higher protein diets protect muscle and bone during weight loss

Protein Content of “breakfast” Foods

Food Item Serving size Grams of Protein

Greek Yogurt 1 cup 23

Greek yogurt 1 container (6 oz or 170 g)

12

Skim milk 1 cup 8

Whole egg 1 large 7

Cottage Cheese ¼ cup 7

Regular Yogurt (6 oz or 170 g) 5

Calcium Requirements Adequate Intake

Life Stage Group Recommended Dietary Allowance (mg)

4-8 800

9-18 1,300

19-50 1,000

51-70 1,200 F 1,000 M

>70 1,200

How is Osteoporosis Diagnosed?

T-score – measure of bone mineral density (BMD) compares one to a 30 yr old healthy adult

Measured at

Hip

Spine

Wrist

Finger

Shin bone

Heel

Milk and Dairy Group

What does this food group contribute to a balanced diet?

Calcium, Vitamin D and Protein

1 cup of milk ~ 300 mg calcium

http://www.choosemyplate.gov/food-groups/dairy.html

Get your calcium-rich foods.

See DairyGroup

Bioavailability

the rate and extent to which a nutrient is absorbed

Copyright 2005 Wadsworth Group, a division of Thomson Learning

~ 300 mg

~10 - 50 mg

~ 20-80 mg

~ 50-175 mg

Calcium Supplements

Calcium, whether from the diet or supplements, is absorbed best by the body when it is taken several times a

day in amounts <500 mg But taking it all at once is better than not taking it at all!

(National Osteoporosis Foundation- www.nof.org)

Calcium Carbonate

Calcium Citrate

Calcium supplements

Calcium Carbonate (40% calcium) Take supplements with a meal because

food slows intestinal transit time and allows more calcium to be absorbed from the gut

Stomach acidity enhances absorption

Reference: Whitney & Rolfes Understanding Nutrition: Highlight #12 2005

Calcium supplements

Calcium citrate (21% calcium) Can be taken anytime

To test calcium supplements– drop in 6-oz cup of vinegar, should dissolve within 30 minutes

Reference: Whitney & Rolfes Understanding Nutrition: Highlight #12 2005

What is new about Vitamin D?

Goes beyond bone heatlh!

Vitamin D Functions Endocrine Functions

Raising serum 25(OH)D from 50 to 80nmol/L

Improves calcium absorption

Raises Bone Mineral Density

Decreases the risk of falling ( 33%) and osteoporosis fracture risk

Improves neuromuscular function

Update from a Presentation: Dr. Robert Heaney. Creighton University Osteoporosis Research Center.

Vitamin D: Health, Promotion, Disease Prevention & Treatment. View from the Clinic. Food and Nutrition Conference and Expo.

American Dietetic Association. Philadelphia, PA October 1, 2007

Vitamin D Functions Autocrine Functions

Immune Response

Evidence that Vit D reduces influenza and TB

Antipromotion of Cancer

decreases risk of prostate cancer

decreases risk of colorectal cancer ( 50%)

decreases risk of breast cancer (animal model)

Maintains insulin sensitivity

Decreased risk of auto-immune disease (RA)

Decreased HTN

Update from a Presentation: Dr. Robert Heaney. Creighton University Osteoporosis Research Center.

Vitamin D: Health, Promotion, Disease Prevention & Treatment. View from the Clinic. Food and Nutrition Conference and Expo.

American Dietetic Association. Philadelphia, PA October 1, 2007

Examples of Vitamin D Sources 1 mcg = 40 IU

Food Serving IUs mcg

Cod liver oil 1 TBS 1,360 34

Salmon 3.5 oz. 360 9

Sardines, canned in oil, drained 1.75 oz. 250 6.25

Tuna 3 oz 200 5

Vitamin D fortified orange juice 1 c. 100 2.5

Milk, nonfat fortified 1 c. ~100 2.5

Egg (found in yolk) 1 yolk 20 .5

Recommendations 51-70 400 10

70+ 600 15

Vegetarian Diets – Nutrients of Concern

Vitamin D

“Milk” substitutes – soy, rice, almond milk – most are fortified with Vit D now

Fortified fruit juices

Vitamin D-2 produced from uv irradiation

Vit D-2 (plant form) seems to be as effective as Vit D-3 (animal form) in recent studies

Source: Position of the American Dietetic Association: Vegetarian Diets. J Am Diet Assoc. 2009; 109: 1266-82

Omega-3 FA

What is an omega-3 fatty acid? Type of oil (fatty acid) named by the location

of the double bond (a good thing!)

Where do you get it? Soybean, canola oil, flaxseed , walnuts

EPA & DHA found in fish oil and seafoods, (cold-water fish and crustaceans)

How much do you need? Women need 1.1 g (remember ~ 1 gram)

Men need 1.6 g (remember ~ 1.5 gram)

Health Benefits of Omega-3 fatty acids

Anti-inflammatory Improves rheumatoid arthritis, psoriasis, asthma

Reduces severity of symptoms of colitis and Crohn’s

Improves Cardiovascular Health Antithrombotic - reduces clotting

Antiarrhythmic

Vasodiloatory properties Improves blood circulation, improves vascular function, lowers

blood pressure

Hypolipedmic - triglycerides HDL-cholesterol

Health Benefits of Omega-3 fatty acids

Type 2 Diabetes Mellitus Reduces hyperinsulimemia and insulin resistance

Renal disease Preserves renal function in IgA nephropathy

Mental function Reduces severity of mental conditions –

Alzheimer’s disease, depression and bipolar disorder

Improves ADHD in children

American Heart Association Summary of Recommendations for Omega-3 Fatty Acid Intake

Population Recommendation

Patients without documented coronary heart disease (CHD)

Eat a variety of (preferably fatty) fish at least twice a week.

Include oils and foods rich in alpha-linolenic acid (flaxseed, canola and soybean oils; flaxseed and walnuts).

Patients with documented CHD Consume about 1 g of EPA+DHA per day, preferably from fatty fish. EPA+DHA in capsule form could be considered in consultation with the physician.

Patients who need to lower triglycerides

2 to 4 grams of EPA+DHA per day provided as capsules under a physician’s care.

Patients taking more than 3 grams of omega-3 fatty acids from capsules should do so only under a physician’s care. High intakes could cause excessive bleeding in some people. http://www.americanheart.org/presenter.jhtml?identifier=4632

Omega-3 Fatty Acids in Fish [per 100 grams (3.5 ounces) of raw fish]

Fish (in mg) EPA DHA Chol Total Omega-3

Mackerel, Atlantic 900 1600 80 2500

Herring, Atlantic 700 900 60 1600

Bluefish 400 800 59 1200

Salmon, Atlantic 300 900 74 1200

Tuna 100 400 47 500

Cod, Atlantic 100 200 43 600

Shrimp 200 100 142 300

Flounder 100 100 46 200

Haddock 100 100 63 200

Swordfish 100 100 39 200

Recommendation Males 1.6 g (1600 mg)

Females 1.1 g (1100 mg)

What is better Wild or Farm-Raised Salmon?

Both contain high concentrations of EPA and DHA

Compare daily dose of EPA and DHA based on consuming 8 oz/week salmon (227 grams) provides daily dose of

Farm-raised Atlantic ~ 700 mg

Wild Coho or Sockeye ~ 350 or ~400 mg

Source: Santerre CR. Wild Versus Farm-Raised Salmon: Health Benefits and Risks. SCAN’s Pulse. Fall 2008, Vol 27, No 4 page 1-5

But I don’t like fish or I am allergic to fish

Flaxseed, canola oil, soybeans, soybean oil and walnuts provide alpha-linolenic acid

Body makes small amount of DHA and EPA

Better than nothing!

Omega-3 eggs (chickens fed fish oil or flaxseed)

No EPA and small amounts of DHA

FLAX Facts

F – fiber 2TBS = 4 g fiber L – lignan antioxidant and

member of phytoestrogen plant estrogens

A – alpha-linolenic acid (omega-3)

X – excellent choice From Bob’s Red Mill Whole Ground Flaxseed

Meal!

Recommendations for Vegans

Include 2 servings of daily fats that supply omega-3-fats

1 tsp flaxseed oil

1 T canola or soybean oil

1 T ground flaxseed

¼ c walnuts

Comparing omega-3 FA

Recommendation Males 1.6 g 1,600 mg

Females 1.1 g

1,100 mg

Food Item/quantity Kilocalories Omega-3 mg

Eggland eggs– must eat yolk 70 100

Barilla Plus Penne 1 cup 370 360

Smart Balance Omega-plus Mayo (1 TBS)

50 500

Canola Oil 1 TBS 120 1600

Smart Balance 50/50 Butter Blend Spread 1 TBS

100 1760

Flaxseed 2 TBS ground 60 2400

Walnuts 1 oz. (14 halves) 185 2600

Detecting The Good Labeling Terms for Fiber

Required language - dietary fiber only

High fiber - 5 g

Make half your grains whole http://www.choosemyplate.gov/foodgroups/

grains.html

What is a Whole Grain?

Has all beneficial elements of the grain intact

Bran Protective outer shell –

mostly fiber

B-vitamins, trace minerals and phytochemicals

Endosperm Starchy inner portion

Low in vitamins and minerals

Complex carbohydrate and protein

Germ Provides nourishment to the seed

Vitamin E, trace minerals, B-vitamins & essential fatty acids

Phytochemicals

Confusing the consumer

Whole Grain isn’t always High Fiber

Whole grain foods contain water (moisture) and other ingredients which affect fiber level

Bread is 40% moisture, so serving of ww bread provides 3-4 g fiber

High fiber doesn’t mean whole grain

Bran cereals do not provide whole grain

Rare to find whole grain food with more than 4 grams of fiber unless added fiber put in product

“Light” or “diet” breads are high in fiber. Is this a good choice over whole grain breads?

Replaced “starch” with processed fiber from peas or other foods

Lower-calorie

Higher-fiber bread

Lacks the unique “package” of vitamins, minerals, and phytochemicals in whole grains

What is Quinoa?

Botanically, quinoa is not a grain, but a seed belonging to the Goosefoot family

¼ cup dry (~1/2 cup cooked)

170 calories

7 g of protein

3 g of fiber

Complete protein similar to soy

Great whole grain! http://impossiblewriter.wordpress.com/2011/05/29/coconut-oil-and-quinoa/

If we had a pill that conferred all the proven health benefits of exercise, physicians would prescribe it to every patient and our healthcare system would find a way to make sure every patient had access to this wonder drug!

Quote from Webinar: Exercise Is Medicine by Dr. Robert Sallis, MD, FACSM

http://www.shapeup.org/10000steps.html

So how much activity is enough for weight management?

There are now some studies suggesting that walking10,000 steps a day is the

right ball park to be in.

Shape-up America 10,000 Steps Program

Get a pedometer – device that counts

number of steps taken. to track your steps

Contact me at:

[email protected]

Thank you!