Handout

Basics
of
Food and Health
FAH101
SPRING 2023
Faculty of Oral and Dental Medicine
‫رؤﯾﺔ ورﺳﺎﻟﺔ اﻟﻜﻠﯿﺔ‬

‫اﻟﺮؤﯾﺔ‬
‫ﺗﺘﻄﻠﻊ اﻟﻜﻠﯿﺔ أن ﺗﻜﻮن ﻓﻲ ﻣﺼﺎف اﻟﻤﺆﺳﺴﺎت اﻟﺘﻌﻠﯿﻤﯿﺔ اﻟﻤﻌﺘﺮف ﺑﮭﺎ إﻗﻠﯿﻤﯿﺎ ً وﻋﺎﻟﻤﯿﺎ ً ﻣﻦ ﺧﻼل ﺑﺮاﻣﺞ ﺗﻌﻠﯿﻤﯿﺔ‬
.‫ﻣﺘﻄﻮرة وأﺑﺤﺎث ﺗﻄﺒﯿﻘﯿﺔ ﻣﺒﺘﻜﺮة وﺗﻨﻤﯿﺔ ﻣﺠﺘﻤﻌﯿﺔ ﻣﺴﺘﺪاﻣﺔ‬
Vision
The Faculty of Oral and Dental Medicine aspires to be a recognized educa onal
ins tu on, regionally and interna onally, by providing advanced educa onal
programs, innova ve applied research, and sustainable community development.
‫اﻟﺮﺳﺎﻟﺔ‬
‫ ذو ﻛﻔﺎءة ﻣﻌﺮﻓﯿﺔ وﺗﻄﺒﯿﻘﯿﺔ ﻣﻦ ﺧﻼل ﺑﺮاﻣﺞ ﺗﻌﻠﯿﻤﯿﺔ‬،‫إﻋﺪاد طﺒﯿﺐ أﺳﻨﺎن ﻣﻠﺘﺰم ﺑﺎﻟﻘﯿﻢ اﻻﻧﺴﺎﻧﯿﺔ واﻷﺧﻼق اﻟﻤﮭﻨﯿﺔ‬
‫ ﻛﻤﺎ ﺗﻠﺘﺰم اﻟﻜﻠﯿﺔ ﺑﺈﻋﺪاد ﺑﺤﻮث ﺗﻄﺒﯿﻘﯿﺔ‬.‫ﻣﺘﻄﻮرة ﺗﺘﻮاﻓﻖ ﻣﻊ اﻻﺣﺘﯿﺎﺟﺎت اﻟﻔﻌﻠﯿﺔ ﻟﺴﻮق اﻟﻌﻤﻞ اﻟﻤﺤﻠﻲ واﻟﻌﺎﻟﻤﻲ‬
.‫ﻣﺘﻮاﻓﻘﺔ ﻣﻊ اﻻﺳﺘﺮاﺗﯿﺠﯿﺎت اﻟﻘﻮﻣﯿﺔ وﻛﺬﻟﻚ ﺗﻘﺪﯾﻢ ﺧﺪﻣﺔ ﻣﺠﺘﻤﻌﯿﺔ ﻣﺴﺘﺪاﻣﺔ وﻓﻘﺎ ً ﻟﻤﻌﺎﯾﯿﺮ اﻟﺠﻮدة اﻟﻌﺎﻟﻤﯿﺔ‬
Mission
The mission of the Faculty of Oral and Dental Medicine is to prepare
knowledgeable and well-trained den sts commi ed to human values and
professional ethics, by developing advanced educa onal programs that correspond
to the actual needs of the local and global labor market. The Faculty is also
commi ed to preparing applied research in line with na onal strategies, as well as
providing sustainable community service following interna onal quality standards.
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Intended learning outcomes of course (ILOs)

a. Knowledge and understanding:
By the end of this course, the student should demonstrate comprehensive
knowledge and clear understanding of the following:
a1. Describe the energy requirements for different cases.
a2. Describe how to measure and analyse body composition
a3. Design a meal plan for different cases.
a4. Recognize the sources and role of macronutrients on energy production
and general health.
a5. Recognize the role of micronutrients in the body and study their sources
and the effect of their de iciency
a6. Recognize the causes and management of malnutrition and obesity
a7. Recognize the different types of diet regimens, their advantages and
drawbacks.
a8. Describe the effects of hydration and electrolytes on body functions
a9. Describe the effect of bacteria on digestion and general health.
a10. Recognize the importance of food safety and how to avoid food poisoning
a11. Recognize the effect of nutrition on the production of caries and how to
combine food in clinical dental application.
b. Intellectual skills:
By the end of this course, the student should be able to:
b1. Acquire the basic skill of recognizing micro and macronutrient de iciency.
b2. Use the skill of prescribing supplements for different de iciencies and
diseases.
b3. Design a meal plan for different cases.
b4. Demonstrate the skills of food combining to avoid development of caries.
c. Professional and practical skills:

c1. Provide the basic skills of diagnosing nutrition-related dental and oral
diseases

d.General and Transferable Skills:
d1. Develop sensitive and effective communication with patients and
colleagues.
Basics of Food and Health (FAH 101)
Introduction.
Chapter 1: Energy requirements & BMI
Chapter 2: Body composition & anthropometry
Chapter 3: Exchange lists and meal planning
Chapter 4: Macronutrients : Carbohydrates, Proteins and

Lipids.
Chapter 5: Micronutrients: importance & deficiency
Chapter 6: Obesity: causes and management
Chapter 7: Malnutrition: causes and management
Chapter 8: FAD diets
Chapter 9: Water & electrolytes
Chapter 10: Pre & probiotics
Chapter 11: Food safety & storage
Chapter 12: Nutrition & dentistry
Introduction
Food is an enjoyable part of our everyday lives. Whether it’s hot soup
on a winter’s day or ice-cold lemonade in July, food tantalizes our taste
buds and satisfies our appetites. But let’s not forget what food is really
all about — survival. Food keeps us alive and well.
Have you ever thought about how the nutrients in food keep us
healthy? How does the body turn a bowl of cereal and glass of juice
into energy for activity? How does a turkey sandwich help us make
blood cells and repair skin? And exactly how does a glass of milk make
our bones stronger? The answers are found in the study of nutrition.
Nutrition is the science of diet and health — everything from how

and why we choose certain foods to how the body digests, absorbs, and
uses food. Indeed, all the pieces that comprise the body come from the
nutrients in the food we eat. The old saying is true — you are what you
eat.
Each day, we make food choices that can either benefit or harm our
bodies in some small way, and, over months and years, the choices we
make can greatly impact our overall health. So, while a lifetime of poor
food choices can contribute to the development of disease, a lifetime of
healthy choices can bring benefits throughout life. Good nutrition plays
a key role in preventing and treating diseases, and while other key
factors influence health such as heredity, environment, lifestyle and
mental attitude, nutrition is one thing people usually have quite a bit of
control over.
This course covers the basic concepts of good nutrition — from the
nutrients in food to current topics such as different diets and weight
management. By understanding these concepts, you’ll become more
informed, plus you’ll have a chance to impact your own health, as well
as the health and well-being of others.
5
Overview
Nourishing our bodies is no small task. In fact, it takes over 40

nutrients to keep our bodies going. Many are essential, meaning we
have to get them from our food supply in order to survive. There are six
major categories of nutrients:
• Carbohydrates are the body’s major source of energy, or calories.

Scientific evidence suggests that at least 55 percent of our daily
calories should come from carbohydrates.
• Fats transport nutrients, plus they’re part of the structure in many

body cells. Fats also contribute calories — lots of them. Experts
say we should limit our intake of fat to less than 30 percent of our
calories, though many go overboard.
• Proteins are made up of amino acids that the body uses to build,
repair, and maintain tissues. Proteins also contribute calories to
the diet.
• Vitamins don’t provide calories, yet they’re extremely important,

helping with all kinds of chemical reactions in the body.
• Minerals are similar to vitamins; they don’t provide calories, and

they play very specific roles in our body’s metabolism.
• Water is often called “the forgotten nutrient” because people don’t

think of it as an essential part of the diet. But consider this: our
bodies can survive for up to six weeks without food, but we can’t
make it past seven days or so without water.
Certain Nutrients Provide Energy
Before reviewing the six groups of nutrients in more detail, it’s

important to talk about energy. How would you feel about eating a food
that was described as high in energy? How about a food high in
calories? The two words really mean the same thing. A calorie is what
we use to measure energy for the body.
Three types of nutrients in our foods provide calories: proteins, fats

and carbohydrates. Vitamins, minerals, and water don’t have calories so
we don’t use them for energy. Protein and carbohydrate each have 4
calories per gram; fat has 9 calories per gram. For example, a teaspoon
of sugar (pure carbohydrate) weighs 4 grams, so it has 16 calories.
A teaspoon of oil (pure fat) weighs 5 grams and provides 45 calories.
There is one other source of calories — alcohol, which provides 7

calories per gram. Alcohol isn’t a nutrient since our bodies don’t need it
to function; however, alcoholic beverages can contribute a significant
number of calories to a person’s diet.
Chapter 1: Basic Energy Needs
Student Learning Outcomes (SLOs)
By the end of this chapter, the student should demonstrate

comprehensive knowledge and clear understanding of the
following:
1. Describe the energy requirements for different cases.

2. Recognize the different sources of energy.
3. Calculate the basic energy needs for different
individuals.
4. Differentiate between different methods of
calculation of energy.
5. Understand the difference between energy pyramids.
6. Recognize the differences between energy balance.
7. Determine the effect of physical activity on energy.
8. Understand the effect of food digestion on energy
balance.
Chapter 1: Basic Energy Needs
• The body needs constant energy for voluntary and involuntary

activity.
• Voluntary work and exercise:
Includes all physical actions related to usual activities and
additional physical exercise
• Involuntary work: includes all activities of the body that are not
consciously performed as:
▪ Circulation, respiration, digestion and other internal
activities.
▪ Requirements include:
• Chemical energy: in many metabolic products
• Electrical energy: in brain and nerve activities
• Mechanical energy: in muscle contraction
• Thermal energy: to keep the body warm
• Fuel is provided in the form of nutrients.

• Three energy nutrients:
▪ Carbohydrate is primary fuel.
▪ Fat assists as storage fuel.
▪ Protein is a back-up fuel source.
• If sufficient carbohydrate is not consumed to meet energy needs,
the body burns fat.
Key Concepts:
• A balance between intake of food energy and output of body
work energy maintains life and health.
• States of being underweight and overweight reflect degrees of
body energy imbalance.
• If energy intake exceeds energy expended, the result is positive
energy balance. The excess energy consumed is stored resulting
in weight gain.
• Positive energy is important in pregnancy, infancy, childhood &
after loss during disease or starvation.
• Negative energy balance results when energy intake is less than
energy expenditure. This will result in weight loss. It is
recommended in overweight & obese adults.
• Aging itself does not cause weight gain but limited physical
activity & slower metabolism are the main reasons for this.
• Caloric density: concentration of energy in a given amount of
food
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▪ Foods high in fat have the highest caloric density.

▪ Nutrient density: concentration of all nutrients in a given
amount of food
Energy Output
• Three demands for energy determine the body’s total energy
requirements
▪ Basal metabolic rate (BMR)
▪ Physical activity
▪ Thermic effect of food
Basal Metabolic Rate (BMR)

• Sum of all internal working activities of the body at rest (heart
beating, lungs breathing, brain & liver functioning etc).
• Accounts for approximately 65% of total caloric needs.
Measurement of Basal Metabolic Rate

General formula:
• Men
1 kcal x kg body weight x 24 hours
• Women
0.9 kcal x kg body weight x 24 hours
Example:
Calculate the REE of a 59kg female patient.
59 × 0.9 × 24= 1274 Kcal/day
Factors Influencing Basal Metabolic Rate

• Lean body mass (muscles and organs)
Greater metabolic activity in lean tissues.
• Growth periods
Growth hormone stimulates cell metabolism and raises BMR.
• Body temperature
Fever increases BMR.
• Hormonal status
Ex. Hypothyroidism = decreased BMR.
• Another method to calculate BMR is by the Harris Benedict

equation:
Male = 66.5 + 13.8(W) + 5(H) – 6.8(A)
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Female = 655 + 9.6(W) +1.8(H) – 4.7(A)

W= weight in kg
H= height in cm
A= age in years
Physical Activity
• Energy expenditure for physical activity goes above and beyond
energy used for resting energy needs by as much as 25-40%.
• Energy output during physical activity varies widely across
individuals according to their level of activity.
Energy Expenditure per Pound per Hour
PAL Factors
• Categorize physical activity level (PAL) according to standard
values (1.2 to 2.4, depending on lifestyle) and then multiplying
by resting metabolic rate.
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• Very light/sedentary = 1.3

• Light = 1.5-1.6
• Heavy = 1.9-2.1
• Exceptional (intense) = 2.2-2.4
Thermic Effect of Food

• After eating, food stimulates metabolism.
• Extra energy for digestion, absorption, and transport is required.
• This stimulating effect is called the thermic effect of food (TEF).
• 5%-10% of the body’s total energy needs for metabolism relates
to the processing of food.
Total Energy Requirement

• Total energy requirement= resting energy expenditure + physical
activity + thermic effect of food
• Step 1 = estimate BMR
• Step 2 = multiply BMR by activity factor.
• Eg step 1= 59 × 0.9 × 24= 1274 Kcal/day
• Step 2 = 1274 × PAL
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Important Tips
• Basal metabolism decreases by about 10-20% (about 150-300
Kcal/day) when calorie intake declines and the body shifts to
conservation mode.
• Basal metabolism drops 1-2% for each decade past the age of 30
years as a result of lean body mass loss that typically occurs with
advancing age. If lean body mass is maintained by physical
activity, BMR is maintained.
Summary:
1) Basic energy requirements mainly involve the involuntary
energy requirements that the body needs per day.
2) Physical activity requires a further increase in the daily
requirements of energy.
3) Equations have been developed to calculate the daily energy
needs including both basic needs and physical activity.
4) There are many key concepts to remember when calculating
individual energy needs.
5) Food pyramids are designed to illustrate the daily needs from
each food group.
Formative Assessment:
Differentiate between different types of energy that the body
needs and define its main sources.
Chapter 2: Body Composition & Anthropometry

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By the end of this course, the student should demonstrate

following:
1) Understand the concept of different body

compartment models.
2) Calculate the BMI.
3) Analyze the general health of an individual
according to BMI levels.
4) Calculate the ideal and adjusted body weights.
5) Distinguish between different methods of body fat
analysis.
Chapter 2: Body Composition & Anthropometry
15
There are several different models of body composition. The most basic
of these is called the 2component (2C) model, which as the name
suggests divides the body into two basic components:
- Fat mass.
- Fat free mass (FFM).
For a more detailed body composition analysis, we should use the

4component model (4C) that breaks the body down to 4 main
parts:
- Body water: broken down into intracellular and extracellular
water.
- Protein: this reflects the protein content in muscles.
- Minerals: is mainly found in the blood stream and bone.
- Fat: is your stored energy.
Other ways to address body components is by:

- Dry lean mass (DLM): which is made up mainly of protein and
bone.
- Lean body mass (LBM): a combination of DLM and water.
- Skeletal muscle mass (SSM).
Body Mass Index (BMI)

• Index of the relationship between height and weight
• BMI = weight (kg)/height squared (m2)
• BMI of 18.5 to 25 kg/m2 indicates healthy weight
▪ Overweight and Obesity
▪ Overweight—BMI of 25 to 29
▪ Obesity—BMI of 30 or more
▪ Morbid Obesity—BMI of 40 or more
▪ Underweight
BMI less than 18.5 is an indication of chronic energy deficiency
as severe dieting, eating disorders as anorexia or bulimia,
chronic disease, cancer cachexia and rarely familial
What does skinny fat mean?
Health risk based on BMI:

▪ Less than 25= Minimal risk
16
▪ 25-27= Low
Minimal and low= healthful eating, moderate deficit diet,
increased physical activity and lifestyle change.
▪ 27-30= Moderate
Moderate= All of above plus low calorie diet.
▪ 30-35= High
▪ 35-40= Very high
High and very high= All of the above plus pharmacotherapy.
▪ More than 40= Extremely high

Extremely high= All of above plus surgical intervention.
Diet Classification according to Caloric Intake:

▪ Moderate deficit diet= all health risk groups
= 1200-1500Kcal/d for women
= 1400- 2000Kcal/d for men
▪ Low calorie diet= moderate to extremely high risk groups =
800-1200Kcal/d
▪ Very low calorie diet= extremely high health risk groups= less
than 800Kcal/d Very Dangerous!!!
Goals of Treatment:
▪ Induce and maintain weight loss.
▪ Reduce obesity related co-morbidities.
▪ Help patients adopt healthy lifestyles.
Ideal body weight:

▪ Simply it is calculated as height-100= weight
Adjusted body weight:

▪ It is calculated when the increase in weight is more than 30%
than the ideal weight. In this case it is very difficult for the
patient to reach ideal weight goal.
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▪ Adjusted weight is where the patient can lose enough weight to

be healthy.
▪ Calculated as: (current weight-ideal)*0.25+ ideal
▪ Weight loss of as little as 5-15% of initial weight improves many

obesity related diseases.
Measuring Body Fat
Underwater (hydrostatic) weighing.

▪ Hydrostatic weighing (also known as underwater weighing)
involves submersing yourself in a pool and being weighed on a
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special scale. Once in the pool, you exhale all your air, completely
submerge yourself in the water, and let the scale record your weight.
Your underwater weight is compared with what you weigh on land,
and these numbers, together with the value of the density of the
water in the pool, are put through a series of calculations. These
calculations produce your body fat percentage.
▪ When done properly, hydrostatic weighing is a very precise
method for measuring your body fat percentage, and it is often
regarded as "Gold Standard" for body composition analysis.
However, hydrostatic weighing cannot report anything beyond body
fat, like skeletal muscle mass, body water, and dry lean mass.
▪ To get a hydrostatic weighing test performed, you will need to make
an appointment at a facility such as university or high-end sports
complex that has built a hydrostatic weighing pool and has trained
staff to perform the test.
Skinfolds:
• These are widely used because they are portable and easy
to use. Calipers that work by pinching external body fat in
several places around your body and measure how much
skin can be grasped. These results are taken and used in
19
mathematical calculations, which determine the fat content

in the body.
• Of course, the accuracy of these results may vary.
Dual-energy X-ray absorptiometry (DEXA)

DEXA (also sometimes abbreviated as DXA), is a medical test that
involves lying on a table while a machine sends X-rays through your
body and measures the difference in the amount of energy initially sent
through the body and the amount detected after it exits the body.
Although DEXA was originally designed to measure bone density, it is
now also used to measure body fat and body composition, and it can
give results such as body fat percentage and soft lean mass.
DEXA scans are also regarded as a "Gold Standard" for measuring
body composition analysis. Unlike calipers and underwater weighing,
DEXA scans are able to measure the body segmentally, scanning each
arm and the trunk separately in order to accurately measure body fat
percentage, soft lean mass, and other body composition elements.
In order to get a DEXA scan performed, you will typically need to
make an appointment with a hospital or clinic that has a DEXA device.
You may need to do some research; not all hospitals and clinics will
have DEXA devices.
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Bioelectrical impedance analysis (BIA)
Bioelectric Impedance Analysis (BIA) works by sending a small

electrical current into a person and measuring the opposition of that
current (impedance) as it travels throughout the body’s water. Once
impedance is measured, body composition is ascertained.
BIA devices range widely in quality and accuracy, and you should be
aware that not all BIA devices test the entire body. Some devices,
such as home bathroom scales, use BIA to directly measure leg
impedance only and use estimations to determine results for the upper
21
body. Others are handheld devices that only directly measure arm
impedance and estimate results for the lower half.
By contrast, modern, medical-grade BIA devices are able to measure
the entire body directly, and can be extremely accurate.
Because BIA measures works by measuring body water, a lot of useful
information can be reported. Although nearly all BIA devices will tell
you your body fat percentage, some devices can go much further and
report the body water weight, skeletal muscle mass, lean body mass,
and much more.
Waist Circumference
Summary:
1) Anthropometry is a science designed to measure the
percentage of body fat.
2) BMI is an equation used to estimate the ratio between weight
and height to assess the safe weight range.
3) Several methods of body fat measurements have been
developed some of which are more accurate than others.
4) Increased central body fat means higher risk of disease.
Formative assessment:
1) Differentiate between different methods of body fat
measurement.
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Chapter 3:Food Exchange Lists

following:
1) Understand the different components of the exchange

list.
2) Recognize the differences between each food group.
3) Calculate the required calories and how to formulate
a personalized meal plan.
4) Formulate meal plans according to different food
de iciencies.
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Chapter 3:Food Exchange Lists

The following pages separate foods into these seven
groups:
- Starches
- Fruits and Fruit Juices
- Milk, Yogurt, and Dairy-like foods
- Non-Starchy Vegetables
- Sweets, Desserts, and Other Carbohydrates
- Meats and Meat Substitutes
Compiled from: Choose Your Foods: Exchange Lists for Diabetes American
Dietetic Association and American Diabetes Association.
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Starches
Breads and Flours

Each Serving = 15 g carbohydrate, 3 g protein, 0-1 g
fat, 80 calories
Bagel 1/4 (1 oz)
Biscuit 1 (2 1/2 inches across)
Bread
Reduced-calorie 2 slices (1 1/2 oz)
White, whole-grain, 1 slice (1 oz)

pumpernickel,
Bun (hotdog or
hamburger) 1/2 bun (1 oz)
Chapatti, small 1 (6 inches across)
Cornbread 1 (1 3/4 inch cube or 1 1/2 oz)
English muffin 1/2
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Flour, corn meal,

wheat germ 3 Tbsp dry
Naan Indian Bread 1/4 (8 inches by 2 inches)
Pancake, 1/4 inch 1 (4 inches across)

thick
Pita bread 1/2 pocket (6 inches across)
Roll, plain, small

1 (1 oz)
Stuffing, bread 1/3 cup
Taco shell or tostada 2 crisp shells (5 inches across)

shell
Tortilla
1
Corn or flour, 6 inches
across
1/3
Flour, 10 inches
across
Waffle 1 (4-inch square, or 4 inches
across)
26
Cereals, Grains and Pasta

fat, 80 calories
Barley, cooked 1/3 cup

Bran, dry
1/4 cup
Oat bran
1/2 cup
Wheat bran
Bulgur, cooked 1/2 cup
Cereals
1/2 cup
Bran
1/2 cup
Oats,oatmeal,cooked
1 1/2 cups
Puffed
1/2 cup
Shredded wheat, plain
Sugar-coated cereals 1/2 cup
Unsweetened, ready- 3/4 cup
to-eat cereals
Cereals, Grains and Pasta (continued)

Each Serving = 15 g carbohydrate, 3 g protein, 0-1
g fat, 80 calories
27
Couscous, cooked 1/3 cup

Granola, regular or low-
fat 1/4 cup
Muesli 1/4 cup
Pasta, cooked 1/3 cup

Quinoa, cooked 1/3 cup
Rice, white or brown,
cooked 1/3 cup
Tabbouleh, prepared 1/2 cup
Wheat germ, dry 3 Tbsp
Starchy Vegetables
fat, 80 calories
Cassava 1/3 cup
Corn 1/2 cup
Corn on cob, large 1/2 cob (5 oz)
Parsnips 1/2 cup
Peas, green 1/2 cup
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Potato
1/4 large (3 oz)
Baked with skin
1/2 cup or 1/2 medium (3 oz)
Boiled, all kinds
1/2 cup
Mashed, with milk
1 cup (2 oz)
French fried (oven
baked)
Pumpkin, canned, no
1 cup
sugar added
Squash, winter (acorn,
1 cup
butternut)
Yam, sweet potato 1/2 cup
Snacks
fat, 80 calories
29
Animal crackers 8 crackers
Crackers
2-5 (3/4 oz)
Crispbreads
6
Round-butter type
6
Saltine-type
3
Sandwich-style, with
2-5 (3/4 oz)
filling Whole-wheat
regular
Popcorn, popped 3 cups
Pretzels 3/4 oz
Snack chips
Baked 15-20 (3/4 oz)
Regular 9-13 (3/4 oz)
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Beans, Peas and Lentils (Cooked)

(also found under Meat and Meat Substitutes)
fat, 125 calories
Baked beans 1/3 cup
Beans (black, garbanzo,
kidney, lima, navy, pinto, 1/2 cup
white)
Lentils (brown, green, 1/2 cup
yellow)
Peas (black-eyed, split) 1/2 cup
Refried beans, canned 1/2 cup
Fruit and Fruit Juices

Each Serving = 15 g carbohydrate, 0 g protein, 0 g
fat, 60 calories
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Note: the weights in parenthesis include the peel, skin,

rind, and seeds
Apple, unpeeled, small 1 (4 oz)

Apples, dried 4 rings
Apricots, fresh 4 whole (5 1/2 oz)
Apricot, dried 8 halves
Banana 1/2 large or 1 baby banana (4
oz)
Blackberries 3/4 cup
Cantaloupe 1 cup cubed (11 oz)
Blueberries 3/4 cup
Cherries
Sweet, canned 1/2 cup
Sweet, fresh 12 (3 oz)
Dates 3
Dried fruits 2 Tbsp
Figs 2 medium (3 1/2 oz)
Grapes, small 17 (3 oz)
Fruit cocktail 1/2 cup
Grapefruit
Large 1/2 (11 oz)
Sections, canned 3/4 cup
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Kiwi 1 (3 1/2 oz)

Mandarin oranges, canned 3/4 cup
Mango 1/2 cup or 1/2 small (5 1/2
oz)
Nectarine, small 1 (5 oz)
Orange, small 1 (6 1/2 oz)
Papaya 1 cup cubed (8
oz)
Peach
Canned 1/2 cup
Fresh, medium 1 (6 oz)
Pear
Canned 1/2 cup
Fresh, large 1/2 (4 oz)
Pineapple
Canned 1/2 cup
Fresh 3/4 cup
Prunes 3
Raisins 2 Tbsp
Strawberries 1 ¼ cup
Watermelon 1 ¼ cup
Fruit Juice
(liquid = fast absorption)
33

fat, 60 calories
Apple juice ½ cup
Grape juice 1/3 cup
Grapefruit juice ½ cup
Orange juice ½ cup
Pineapple juice ½ cup
Prune juice 1/3 cup
Milk and Yogurt
Fat-free (skim) and Low-fat (1%) Selections

34
(Best choice)
fat, 100 calories
Fat-free and low-fat buttermilk 1 cup

Fat-free milk 1 cup
Low-fat, 1 % milk 1 cup
Evaporated fat-free milk 1/2 cup
Fat-free dry milk powder 1/3 cup
dry
Yogurt
Fat-free, flavored with artificial sweetener 2/3 cup (6 oz)
Plain, fat-free 2/3 cup (6 oz)
Reduced-Fat Selections
fat, 120 calories
Milk, 2% 1 cup
35
Kefir 1 cup
Yogurt, plain low-fat 2/3 cup (6 oz)
Sweet acidophilus milk 1 cup
Whole Milk Selections

(Limit use - high in saturated fat)
fat, 160 calories
Milk, whole 1 cup
Evaporated whole milk 1/2 cup
Yogurt, plain (made from whole 8 oz
milk)
Goat’s milk 1 cup
Dairy-like Foods
Chocolate milk
Fat-free 1 cup 30 g carb, 8 g protein, 0 g fat
Whole 1 cup 30 g carb, 8 g protein, 8 g fat
Smoothies, flavored 10 oz 45 g carb, 8 g protein, 0-3 g
fat
36
Soy milk
Light 1 cup 15 g carb, 4 g protein, 3 g fat
Regular, plain 1 cup 15 g carb, 8 g protein, 5 g fat
Candy, Spreads, Sweets, Sweeteners,

Syrups, and Toppings
Candy bar,
2 “fun size” bars
chocolate and 22 g carb, 8 g fat
(1 oz)
peanuts
Candy, hard 3 pieces 15 g carb
Chocolate 15 g carb, 5 g fat

5 pieces
“kisses”
Coffee creamer
4 tsp 8 g carb, 3 g fat
Dry, flavored
2 Tbsp 15 g carb
Liquid, flavored
Fruit snacks, 1 roll (3/4 oz)
chewy 15 g carb
Fruit spread,
1 1/2 Tbsp 15 g carb
100% fruit
Honey 1 Tbsp 15 g carb
Jam or jelly, 1 Tbsp 15 g carb
regular
Sugar 1 Tbsp 15 g carb
37
Syrup
2 Tbsp
Chocolate
2 Tbsp 30 g carb 15 g
Light (pancake carb 15 g carb
type) Regular 1 Tbsp
(pancake type)
Condiments and Sauces

Barbeque sauce 3 Tbsp 15 g carb
Cranberry sauce, jellied 1/4 cup 22 g carb
Gravy, canned or bottled 1/2 cup 8 g carb, 3 g
fat
Salad dressing, fat-free 3 Tbsp 15 g carb
Sweet and sour sauce 3 Tbsp 15 g carb

Doughnuts, Muffins, Pastries, and Sweet
Breads
1 medium (1 22 g carb, 10 g
Doughnut Cake, plain
1/2 oz) fat
inches
1/4 muffin (1 15 g carb, 3 g
Muffin
oz) fat
38 g carb, 10 g
Sweet roll or Danish 1 (2 1/2 oz)
fat
38
Frozen Bars, Frozen Desserts, Frozen

Yogurt, and Ice Cream
Fruit juice bars, 15 g carb

1 bar (3 oz)
frozen, 100% juice
Frozen yogurt 15 g carb, 0-5 g

1/3 cup
Fat-free fat
1/2 cup
Regular 15 g carb
Ice cream 22 g carb

1/2 cup
Fat-free 15 g carb, 5 g fat
1/2 cup
Light 15 g carb, 5 g fat
1/2 cup
No sugar added 15 g carb, 10 g
1/2 cup
Regular fat
Granola Bars, Meal Replacement Bars or

Shakes, and Trail Mix
Granola or snack 1 bar (1 oz)
bar 22 g carb, 0-5 g
fat
Meal replacement 1 bar (2 oz)
bar 30 g carb, 5 g fat
Meal replacement
1 can (10-11 22 g carb, 0-5 g
shake, reduced
oz) fat
calorie
39
Trail mix
1 oz 15 g carb, 10 g
Candy and nut- fat
based 1 oz
15 g carb, 5 g fat
Dried fruit-based
Non-Starchy Vegetables
Serving size= 1/2cupcooked 1 cup raw
1/2 cup vegetable juice
Each Serving = 5 g carbohydrate, 2 g protein, 0 g fat,
25 calories
Artichoke and Artichoke hearts
Asparagus
Baby corn
Bamboo shoots
Beans (green, wax, Italian)
40
Bean sprouts
Beets
Bok choy
Borscht
Broccoli
Brussels sprouts
Cabbage - all types
Carrots
Cauliflower
Celery
Coleslaw, no dressing
Cucumber
Eggplant
Greens (collard, kale, mustard, turnip)
Green onions or scallions
Hearts of palm
Leeks
Mixed vegetables (without corn or peas)
Mushrooms
Okra
Onions
Oriental radish
Peppers (all varieties)
Radishes
Soybean sprouts
Spinach
Tomato (fresh or canned)/ Tomato sauce /Tomato juice
Turnips
41
Water chestnuts
Zucchini
Salad greens are Free Foods including: chicory, endive,
escarole, lettuce, romaine, spinach, arugula, radicchio,
and watercress.
Meats and Meat Substitutes
Lean Selections (Good Choice)

fat, 45 calories
Beef (Select or Choice
grades): ground round,
roast (rib, rump), sirloin, 1 oz
steak (flank, T-bone),
tenderloin
Beef jerky 1 oz
42
Cheeses (0-3 g fat per oz) 1 oz
Cottage cheese 1/4 cup
Egg whites 2
Fish: catfish, cod,

flounder, haddock, halibut,
1 oz
orange roughy, salmon,
tilapia, trout, tuna
Fish, smoked: herring or
salmon (lox) 1 oz
Game: buffalo, ostrich,
rabbit, venison 1 oz
Hot dog with 0-3 g fat per 1
oz
Lamb: chop, leg, roast 1 oz
Organ meats: heart,
kidney, liver (high 1 oz
cholesterol)
Oysters, fresh or frozen 6 medium
Pork, lean: ham, pork

tenderloin, Canadian 1 oz
bacon, rib or loin chop
Poultry, skinless: Cornish
hen, chicken, domestic 1 oz
duck or goose (well-
drained of fat, turkey)
43
Processed sandwich
meats with 0-3 g fat per
1 oz
oz: chipped beef, deli thin-
sliced meats, turkey ham,
turkey pastrami
Salmon, canned 1 oz
Sardines, canned 2 medium

Sausage with 0-3 g fat per 1 oz
oz
Shellfish: clams, crab,
1 oz
lobster, scallops
Shrimp and squid (high
1 oz
cholesterol)
Tuna, canned in water or
1 oz
oil, drained
Veal, lean chop, roast 1 oz
Medium Fat Selections

fat, 75 calories
Cheese, reduced-fat
cheeses (4-7 g fat per oz) 1 oz
Ricotta cheese 1/4 cup, 2 oz
Mozzarella 1 oz
44
Feta cheese 1 oz
Beef: corned beef, ground

beef, meatloaf, Prime
1 oz
grades trimmed of fat
(prime rib), short ribs,
tongue
Egg (high cholesterol) 1
Fish, fried 1 oz
Lamb: ground, rib roast 1 oz
Pork: cutlet, shoulder 1 oz

roast
Poultry: chicken with skin,

dove, pheasant, wild 1 oz
duck, wild goose, fried
chicken, ground turkey
Ricotta cheese 1/4 cup. 2 oz
Sausage, 4-7 grams of fat
per oz 1 oz
Veal, cutlet (no breading) 1 oz
45
High Fat Selections (Limit use)

Each Serving = 0 g carbohydrate, 7 g protein, 8 or
more g fat, 100 calories
Bacon 2 slices (1 oz each before

Pork cooking)
Turkey 3 slices (1/2 oz each before

cooking)
Cheese, regular: bleu,
brie, cheddar, Monterey 1 oz
jack, Swiss
Hot dog: beef, pork,
turkey, chicken or 1
combination (10 per
pound sized package)
Pork: ground, sausage,
1 oz
spareribs
Processed meats with 8
or more g fat per oz: 1 oz
bologna, pastrami, hard
salami
Sausage with 8 or more g
of fat or more per oz:
1 oz
bratwurst, chorizo, Italian,
knockwurst, Polish,
smoked, summer
46
Plant- Based Proteins

See right-hand column for composition of each
food item
“Bacon” strips, soy-
3 strips 7 g protein, 4-7 g fat
based
15 g carb, 7 g
Baked beans 1/3 cup protein, 0-3 g fat
Beans, cooked: 15 g carb, 7 g

black, garbanzo, 1/2 cup protein, 0-3 g fat
kidney, lima, navy,
pinto, white
“Chicken” nuggets, 2 nuggets 8 g carb, 7 g protein,

soy-based (1 1/2 oz) 4-7 g fat
47
8 g carb, 7 g protein,
Edamame 1/2 cup 0-3 g fat
Falafel (spiced 3 patties

15 g carb, 7 g
chickpea and wheat (2 inches
protein, 8 g fat
patties) across)
1 (1 1/2
Hot dog, soy-based 8 g carb, 7 g protein,
oz) 0-3 g fat
Hummus 1/3 cup 15 g carb, 7 g

protein, 8 g fat
Lentils, brown,
1/2 cup 15 g carb, 7 g
green, or yellow protein, 0-3 g fat
Meatless burger, 8 g carb, 14 g

3 oz protein, 0-3 g fat
soy-based
Nut spreads:
almond butter, 7 g protein, 8 or more
1 Tbsp
cashew butter, g fat
peanut butter, soy
nut butter
Peas, cooked:
black-eyed and split 1/2 cup 15 g carb, 7 g
peas protein, 0-3 g fat
Refried beans,
1/2 cup 15 g carb, 7 g
canned protein, 0-3 g fat
48
“Sausage” patties, 1 (1 1/2 7 g protein, 4-7 g fat

soy-based oz)
8 g carb, 7 g protein,
Soy nuts, unsalted 3/4 oz
4-7 g fat
Tempeh 1/4 cup 7 g protein, 4-7 g fat

4 oz (1/2
Tofu 7 g protein, 4-7 g fat
cup)
4 oz (1/2
Tofu, light 7 g protein, 0-3 g fat
cup)
Fats
Monounsaturated Fats
fat, 45 calories
Avocado 2 Tbsp (1 oz)
Nut butters (trans fat-free):
1 1/2 tsp
almond butter, cashew butter,
peanut butter
49
Nuts: Almonds 6 nuts

Brazil 2 nuts
Cashews 6 nuts
Hazelnuts 5 nuts
Macadamia 3 nuts
Peanuts 10 nuts
Pecans 4 halves
Pistachios 16 nuts
Oils: olive oil, canola oil, 1 tsp
peanut oil
Olives
Black (ripe) 8 large 10 large
Green, stuffed
Polyunsaturated Fats
fat, 45 calories
Margarine, reduced-fat
(30-50% vegetable oil, trans 1 Tbsp
fat-free)
50
Mayonnaise:
1 Tbsp
Reduced-fat
1 tsp
Regular
Nuts
1 Tbsp
Pignolia (pine nuts)
4 halves
Walnuts
Oils: corn, cottonseed,
flaxseed, grape seed, 1 tsp
safflower, soybean, sunflower
Margarines with plant stanol
esters Light 1 Tbsp
Regular 2 tsp
Polyunsaturated Fats (continued)

fat, 45 calories
Salad dressing
Reduced-fat (check label for 2 Tbsp
carbohydrate count)
1 Tbsp
Regular
51
Se
eds
:
flax 1 Tbsp
see
d,
pu
Tahini, sesame paste 2 tsp
Saturated Fats
(Limit Use)
fat, 45 calories
Bacon, cooked 1 slice
Butter
Reduced-fat 1 Tbsp
Stick 1 tsp
Whipped 2 tsp
Butter blends made with oil

1 Tbsp
Reduced-fat or light
1 1/2 tsp
Regular
Coconut, shredded 2 Tbsp
52
Coconut milk 1/3 cup

Light 1 1/2 Tbsp
Regular
Cream
Half and half 2 Tbsp
Heavy 1 Tbsp
Light 1 1/2 Tbsp
Whipped 2 Tbsp
Lard 1 tsp
Oil: coconut, palm, palm kernel 1 tsp
Shortening, solid 1 tsp
Sour cream
3 Tbsp
Reduced-fat or light
2 Tbsp
Regular
Formative Assessment: Meal Planning
Case 1:
• 90kg male patient for weight loss
• 90× 20=1800kcal
• Carbs 50%= 1800 × 50/100= 900kcal/4= 225gm
• Proteins 30%= 1800 × 30/100= 540kcal/4= 135gm
• Fats 20%= 1800 × 20/100= 360kcal/9= 40gm
53
Carbohydrates Proteins Fats

starch 5×15=75 5×3=15 ……………
legumes 2×15=30 2×7=14 ……………
fruits 3×15=45 …………… ……………..
milk 3×15=45 3×8=24 3×3=9
vegetables 6×5=30 6×2=12 ……………..
meat ………….. 10×7=70 10×2=20
fats ………….. ……………. 2×5=10
Total gm gm
gm
Starch Legum Fruit Vegetabl Milk Meat Fats

5 es s es 3 10 2
2 3 6
Breakfa 2 1 2 1 3
st
Snack 2
Lunch 1 1 3 4 1
Snack 1 1
Dinner 2 1 1 2 1
Case 2:
• 105kg male patient for weight loss
• 105× 20=……………kcal
• Carbs 50%=
• Proteins 30%=
• Fats 20%=
54
Carbohydrates Proteins Fats

starch ……………
legumes ……………
fruits …………… ……………..
milk
vegetables ……………..
meat …………..
fats ………….. …………….
Total gm gm
gm
Starch Legum Fruit Vegetabl Milk Meat Fats

es s es
Breakfa
st
Snack
Lunch
Snack
Dinner
Case 3:
• 80kg female patient, height 153cm and anemic for
nutritional assessment.
Chapter 4: Macronutrients
55
Student learning outcomes of course (SLOs)

By the end of this course, the student should
demonstrate comprehensive knowledge and clear
understanding of the following:
1) Recognize the importance of macronutrients for the

body in terms of energy productions and their
multiple roles in preserving general health.
2) Recall the sources from which these macronutrients
can be obtained.
3) Distinguish between different types of carbohydrates,
proteins and lipids and how this difference affects the
body.
4) Determine the effects of macronutrient de iciency and
it can be managed.
Chapter 4: Macronutrients
56
Carbohydrates
Carbohydrates are biological molecules consisting of carbon,
hydrogen, and oxygen atoms. Like proteins and fats, they are
macronutrients that are part of our daily diet.
What Are the Functions of Carbohydrates in the Body?
The world would be an awful place without carbohydrates. Just think

— we’d have no rice, bread, cereal, pasta, cookies, or many other
popular foods. Worse yet, our bodies wouldn’t have the energy to
function without carbohydrates. That’s because the primary role of
carbohydrates is to provide energy to every cell in the body.
Each gram of carbohydrate in a food provides 4 calories. Also,

carbohydrates serve as fuel for the brain. Glucose, a carbohydrate, is the
primary energy source for the brain and the rest of the central nervous
system.
Fiber isn’t digested, but it offers other unique benefits related to the
intestinal tract. The following pages describe the three types of
carbohydrates.
What Foods and Drinks Have Carbohydrates?
Carbohydrates are found in varying amounts in many foods, including

vegetables, fruits, grains, legumes, beans, milk, milk products, and
foods with added sugar (candy and soda).
How Are Carbohydrates Used in the Body?
Complex carbohydrates in foods are broken down and converted to

57
simple carbohydrates (glucose), before being absorbed in the blood and

used as energy. Metabolism to glucose increases the blood sugar levels,
which triggers the pancreas to release a hormone called insulin. This
hormone facilitates the entry of glucose into the cells, which convert it
to energy or store it as glycogen in muscle and liver, extra glucose is
converted and stored as fat to avoid any waste.
Glucose uptake into muscles and adipose tissue depends on the

presence of insulin-responsive glucose transporters (GLUT) meanwhile
the brain and liver tissue have glucose transporters that don’t require
insulin for the uptake of glucose.
Classification of Carbohydrates
Carbohydrates are also called saccharides, which comes from sakkron, a

Greek word that means sugar.
Carbohydrates are usually classified into three broad categories: sugars,

starches, and fiber.
• Sugars are simple carbohydrates like glucose, fructose and

lactose. They cause a rapid rise in blood glucose levels.
• Starches are complex carbohydrates that are composed of
several molecules of glucose. They cause a less rapid rise in
blood glucose levels. On the other hand, resistant starch and fiber
are not digested or broken down in the small intestine, but these
have many positive health effects.
• Fiber is a non-digestible complex carbohydrate. Our gut does

not possess the enzymes needed to break apart the links between
sugar units. Undigested fiber travels through our gut and while
doing so, provides health benefits.
Chemical Classification of Carbohydrates

• Monosaccharides: one sugar unit (glucose, fructose, galactose)
58

• Disaccharides: 2 linked sugar units (maltose, lactose, sucrose)

• Polysaccharides: ≥10 sugar units (starch, glycogen, cellulose)
• Polysaccharides:
Starch: Starch comes from plant based food: rice,
potato, beans, pasta etc. It’s made of sugar but doesn’t have a
sweet taste because of their high molecular weight so they
can’t fit into receptors of taste buds. When salivary amylase
(digestive enzyme in saliva) breakdown starch into sugar →
then you can feel the sweetness, that’s why one must chew
food well.
Glycogen: Glycogen comes from animal source.
It’s the storage form of carbohydrates in animals and humans
It’s an important source of energy during sports.
Fibers: They can’t be digested or broken down to
simple sugar They can’t be used as a source of energy. There
are 2 types of fibers:
Soluble form: dissolve in water (pectin, gums, β-glucan)
Insoluble form: known as roughage (leafy greens)
• Health Benefits of Fiber
• Constipation: Fiber holds water which increases bulk of stool,

producing softer stools, and reducing constipation.
• Hemorrhoids: Larger, softer stools reduce straining during

bowel movements
• Obesity: Increased feeling of fullness from high-fiber food,

resulting in less food eaten.
• Heart disease: Eating certain kinds of fiber reduces heart-disease

risk.
• Colorectal cancer: Large, soft stools may dilute carcinogens;

also faster time through colon reduces contact of carcinogen with
intestinal wall.
59

• Simple Carbohydrates:
Simple carbs are anything made from sugar (glucose) for quick
energy.
Sources of simple carbs:

Healthy choice e.g. fruits contain vitamins, minerals, antioxidants,
fibers and a trace of amino acids. In addition to that, it is cheap and
convenient to eat.
60
Less healthy choices e.g. biscuits, cakes and soft drinks, contain
sugar more than 15g per 100gm, processed, low quality fat, no
vitamins and minerals. Results in insulin spikes.
Glycemic Response
61
Glycemic Index:
The glycemic index, or GI, measures how a carbohydrate-containing

food raises blood glucose. Foods are ranked based on how they
compare to a reference food — either glucose or white bread.
A food with a high GI raises blood glucose more than a food with a
medium or low GI.
If eating a food with a high GI, you can combine it with low GI foods to
help balance the meal.
Meats and fats don’t have a GI because they do not contain

carbohydrate.
Low glycemic index foods (55 or less) e.g. oats, bran, corn, sweet
potato, lentils, most fruits, vegetables and carrots.
Medium glycemic index foods (56-69) e.g. brown rice, basmati rice
and couscous.
High glycemic index foods (70 or more) e.g. white bread, pasta, white
rice and corn flakes.
What Affects the GI of a Food?
Fat and fiber tend to lower the GI of a food. As a general rule, the more
cooked or processed a food, the higher the GI; however, this is not
always true.
Below are a few specific examples of other factors that can affect the
GI of a food:
1) Ripeness and storage time — the riper a fruit or vegetable is, the
higher the GI.
2) GI Processing — juice has a higher GI than whole fruit; mashed

potato has a higher GI than a whole baked potato.
3) Cooking method — how long a food is cooked (al dente pasta has a
62
lower GI than soft-cooked pasta)
4) Variety — converted long-grain white rice has a lower GI than

brown rice but short-grain white rice has a higher GI than brown rice.
• Other types and names of sugars — When you look at ingredients

on a food label, you’ll find all kinds of terms referring to
sugars. A food is likely to be high in sugars if one of these
names appears first or second in the ingredient list, or if
several names are listed:
Brown sugar, Corn syrup, Dextrose, Dextrin, Fructose, Honey, Invert

sugar, Maltose, Malt syrup, Mannitol, Molasses, Sorbitol, Sucrose and
Syrup.
Lactose Intolerance
People with lactose intolerance have difficulty digesting lactose, the

sugar that is naturally present in milk. The problem is that they don’t
make enough lactase, the enzyme the breaks down lactose in the small
intestine. So milk and food that contains milk cause bloating, cramping,
gas, discomfort, and diarrhea.
Babies are born with the enzyme necessary to digest lactose, but
some people lose this ability, as they get older. It’s an inherited
condition, and certain groups have higher rates of lactose intolerance,
including Native Americans, Asians, African Americans, Middle
Easterners, and people of Mediterranean descent.
The severity of the intolerance varies from person to person. Many

people with lactose intolerance can drink a small glass of milk or eat
products like yogurt, pudding, and cheese without any problems. Also,
products that have been treated with lactase are available (such as
®
Lactaid ). Calcium-fortified soymilk is also an option.
PROTEINS
63
Proteins are the building blocks of life. They are vital to our
existence and are found in every organism on Earth.
Proteins are the most common molecules found in cells. In fact,
they constitute more of a cell’s dry matter
than lipids, carbohydrates and all other molecules combined.
Proteins are chemical compounds that contain the same atoms as
carbohydrates and lipids – carbon (C) hydrogen (H) and oxygen (O) but
proteins are different in that they also contain nitrogen (N) atoms.
These nitrogen atoms give the name amine (nitrogen containing) to
the amino acids that form the links in the chains we call protein.
A protein is made from one or more polypeptide chains and each
polypeptide chain is built from smaller molecules called ‘amino acids’.
Proteins are in fact the most structurally complex molecules known to
biology.

BUILDING BLOCKS OF PROTEINS
Amino acids are the building blocks of proteins. In total, there are 20
different amino acids found in nature. Amino acids can link together in
a huge variety of ways to create different proteins.
The chemical structure of amino acids is the key to why proteins have
become the foundation of life. An amino acid consists of a carboxyl
group (chemical structure -COOH), an amine group (-NH₂), and a side
chain made mostly from carbon and hydrogen.
The side chain is often referred to as the R group. Differences in the R
group, is what makes the 20 amino acids different from each other.
64
Structure of amino acids

All 20 amino acids are necessary for good health. If an organism is
low in one of the 20 amino acids, certain proteins will not be able to be
built and the loss of their functions will cause health issues for the
organism.
Some amino acids can be created by the body using other molecules
while other amino acids must be sourced from food. The amino acids
that must be eaten are known as the ‘essential amino acids’ because
they are an essential part of a healthy diet. The amino acids that can be
made by our bodies are known as ‘non-essential amino acids’.
65
Structure of different amino acids

Difference between essential and non-essential amino acids
Essential Amino Acids
These are the nine amino acids that your body cannot create on its own,
and that you must obtain by eating various foods. Adults need to eat
foods that contain the following eight amino acids: methionine, valine,
tryptophan, isoleucine, leucine, lysine, threonine and phenylalanine.
Instead of storing up a supply of the essential acids, the body uses them
to create new proteins on a regular basis. Therefore, the body needs a
continual – ideally daily – supply of these amino acids to stay healthy.
Non-Essential Amino Acids
The other type is the non-essential amino acids, 11 of which exists and
are synthesized by the body. Thus, although they are an important part
of building proteins, they do not need to be included in an everyday
diet.
66
Eight of these non-essential acids are also known as “conditional”

meaning that the body may not be capable of producing enough of them
when presented with substantial stress or illness.
• Nonessential amino acids include: alanine, asparagine, aspartic
acid, and glutamic acid.
• Conditional amino acids include: arginine, cysteine, glutamine,
tyrosine, glycine, ornithine, proline, and serine.
Protein digestion:
67
The liver is the central processing unit for protein synthesis,

continually monitoring protein needs and synthesizing amino acids and
proteins to satisfy a variety of needs.
Roles of proteins:
1. Enzymes:
68
• Enzymes are catalysts that are essential to all life processes

• All enzymes are proteins and when amino acids have to be put
together to make proteins, its enzymes that put them together too
• In other words, these proteins can make other proteins
2. Fluid and electrolyte balance:

• Proteins help maintain the body’s fluid and electrolyte balance
• The body fluids are contained in 3 major body compartments:
1) The spaces inside the blood vessels
2) The spaces within the cells
3) The spaces between the cells (the interstitial spaces outside the
blood vessels)
• Fluids flow back and forth between these compartments, and
the proteins in the fluids together with the minerals, help
maintain the need distribution of these fluids.
• Proteins are able to help determine the distribution of fluids in
living systems for 2 reasons:
1) Proteins cannot pass freely across the membranes that separate
the body compartments
2) They attract water
A cell that wants a certain amount of water in its interior space
cannot move water around directly, but can manufacture
proteins, and these proteins will hold water.
• Thus the cell can use proteins to help regulate the distribution
of water indirectly.
• Similarly, the body makes proteins for the blood and interstitial
(intercellular) spaces, these proteins help maintain the fluid
volume in those spaces.
• Excess fluid accumulation in the interstitial spaces is called
edema.
69
3. Transport proteins:
• Special transport proteins in the membranes of cells
continuously transfer substances into and out of cells to
maintain balance
• The protein hemoglobin, which carries oxygen from the lungs
to the body cells is a prime example
• Also lipoproteins transport lipids around the body, in addition,
special proteins also carry vitamins and minerals
4. Antibodies:
• Are specialized proteins involved in defending the body from
antigens (foreign invaders).
• They can travel through the blood stream and are utilized by
the immune system to identify and defend against foreign
intruders.
5. Hormones:
• Are messenger proteins, which help to coordinate certain
bodily activities.
• Examples include insulin, oxytocin, and somatotropin.
• Remember that some hormones are sterols, members of lipid
family.
6. Structural Proteins:
• Are fibrous and stringy and provide support.
• Examples include keratin, collagen, and elastin. Keratins
strengthen protective coverings such as skin, hair,
feathers, horns, and beaks. Collagens and elastin provide
70
support for connective tissues such as tendons and

ligaments.
7. Contractile Proteins:
• Are responsible for movement. Examples include actin and
myosin that are involved in muscle contraction and
movement.
8. Growth, maintenance and repair:

• After our body breaks dietary proteins down into amino
acids, it uses them to build and repair cells and tissue,
including muscle tissue.
• The entire process of breakdown, recovery and synthesis is
called “protein turnover”.
• People need to eat protein rich food every day to replace
the protein they continuously lose. If the body is growing,
it needs more protein than that needed for maintenance.
• This is one of the main reasons why nutritionists
recommend that bodybuilders eat protein-rich foods such
as meat, fish, legumes and eggs. However, it's important to
remember that protein cannot build muscle by itself; a high
protein intake must also be complemented by vigorous
exercise for effective muscle growth.
9. Providing energy and glucose:

• Even though amino acids are needed to do the work that
only they can perform, build vital proteins, they will be
sacrificed to provide energy and glucose if needed
• If our carbohydrate reserves are depleted, our bodies can
utilize proteins as an energy source by reducing them to
their basic amino acid structures and then oxidizing them
as it would glucose. However, this is a "last resort" way of
71
generating energy; too much protein used in this manner

can cause dysfunction.
• The body doesn’t make a specialized storage form of
protein as it does for carbohydrates and fat and any excess
proteins will be stored as fat.
Protein excess
• Over consumption of protein offers no benefits and may pose
health risks for the heart, weakened kidneys and bones.
• Selecting too many protein-rich foods, such as meat and milk,
adds saturated fat and crowds out fruits, vegetables and whole
grains, a problem that can increase risk for chronic diseases, as
increase risk of atherosclerosis and chronic heart disease.
Adult bone loss

• Research clearly shows that high protein intakes increase urinary
calcium excretion thus, increasing calcium intake may be needed.
• The researchers concluded that in many elderly men and women,
bone health may be improved by increasing protein intake as
long as calcium (and vitamin D) intakes meet recommendations.
Protein and amino acid supplements:

• Protein supplements, including whey protein are popular with
athletes, but well-fed athletes do not need them.
• Whey protein is a by-product of cheese manufacturing and is a
common low cost ingredient in many protein powders.
• When combined with strength training, whey supplements may
increase protein synthesis slightly, but they do not seem to
improve athletic performance
• If supplements create a surplus of protein or certain amino acids,
the excess must be metabolized in the liver placing a burden on it
and also the kidneys will need to excrete excess nitrogen.
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• To build stronger muscles, athletes need to eat food with

adequate energy and protein to support the weight-training work.
Protein recommendations:
• The RDA states that a generous daily protein allowance for a
healthy adult is 0.8 gram per kilogram of healthy body weight.
• The protein RDA is adjusted to cover additional needs for
building new tissue and so is slightly increased for infants,
children, pregnant and lactating women.
• RDA:
- 0.8 g/kg/day
- 10 % - 35 % of energy intake
Nitrogen Balance:
• Underlying the protein recommendation are nitrogen balance
studies, which compare nitrogen lost by excretion with nitrogen
eaten in food.
• If the body maintains the same amount of protein in its tissues
from day to day, it’s in nitrogen equilibrium “zero nitrogen
balance”.
• If the body adds protein, it’s in “Positive nitrogen balance”; if it
loses protein it’s in “Negative nitrogen balance”.
• Normally healthy adults are in nitrogen equilibrium, that is their
nitrogen intakes (from food) equal their nitrogen outputs (in
urine, faeces and sweat).
• Growing children, adolescents and pregnant women are in
positive nitrogen balance because they are adding new blood,
bone and muscle cells to their bodies.
• Meanwhile people who are fasting, starving or suffering from
traumas such as burns are in negative nitrogen balance because
their bodies are forced to use protein energy.
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Protein in food
Protein quality:
• The protein quality of the diet determines, in large part how well
children grow and how well adults maintain their health.
• High quality proteins provide enough of all the essential amino
acids needed to support the body’s work meanwhile low quality
proteins do not.
• Factors influencing protein quality:

1. Digestibility:
- Proteins must be digested before they can provide
amino acids.
- Digestibility depends on:
1. The protein source: animal vs. plant source
Digestibility of most animal proteins is high
(90-99%) plant proteins are less digestible (70-90%
for most, but over 90% for soy).
2. Food eaten with protein.
2. Amino acid composition:
- To make proteins, cells must have all the needed amino
acids available simultaneously.
- The liver can produce non-essential amino acids that
may be in short supply.
- If an essential amino acid is missing, a cell must
dismantle its own proteins to obtain it.
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• Generally, proteins derived from animal foods (meats, fish,

poultry, cheese, eggs, yoghurt and milk) are high quality proteins,
although gelatin is an exception.
• Proteins derived from plant foods (legumes, grains and
vegetables) tend to be limiting in one or more essential amino
acid.
Complementary proteins:
Obtaining enough essential amino acids presents no problem to

people who regularly eat high quality protein from an animal source.
But for vegetarians and vegan diets some plants (Incomplete protein)
are highly deficient in some amino acids. Combining two or more foods
with incomplete proteins, to form complementary proteins, can
provide adequate amounts of all the essential amino acids.
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LIPIDS
Lipids, commonly known as fats, are naturally occurring organic
compounds. They contain hydrocarbons and make up the building
blocks of the structure and function of living cells.
Examples of lipids include oils, waxes, some vitamins, hormones and

most of the non-protein membrane of cells.
Functions of Fat
In foods, fat provides flavor, aroma, and texture. But, besides making
our ice cream creamier and our cheese tastier, fat serves a number of
important functions in the body:
• Fat provides energy. Each gram of fat provides nine calories; so fat
is a very concentrated source of energy compared to protein and
carbohydrate. Also, the body stores extra calories as fat, creating
an energy reserve for times of famine.
• Fat is needed for the absorption, storage, and circulation of

vitamins A, D, E, and K in the body. These four are the fat-
soluble vitamins.
• Fat provides essential fatty acids. Fatty acids are part of the
chemical structure of fats. There are three essential fatty acids
76
that must come from the diet. These are linoleic acid, linolenic
acid, and arachidonic acid. Essential fatty acids are necessary for
proper growth and brain function, especially in infants.
• Fat provides cushioning for internal body parts like the liver. Fat
underneath the skin acts as insulation to help the body maintain a
constant internal temperature.
• Fat also provides the sensation of satiety or the feeling of fullness.
Types of Fat in Foods
Most of the fat found in foods is in the form of triglycerides. Each

triglyceride molecule is made up of two basic parts: glycerol and fatty
acids. Glycerol makes up the “backbone” of the molecule, and three
fatty acids are attached to the glycerol backbone. The glycerol portion is
always the same, while the fatty acids can vary.
Structure of a Triglyceride:
The three types of fatty acids are:
• Saturated,
• Monounsaturated, and
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• Polyunsaturated.
All foods that contain triglycerides contain a mixture of saturated

and unsaturated fatty acids. The type of fatty acid that is most
prevalent determines whether a fat is referred to as saturated,
monounsaturated, or polyunsaturated. For example, most of the fatty
acids in butter are saturated, so butter is known as a saturated fat.
Similarly, corn oil contains mostly polyunsaturated fatty acids, so we
say that it’s polyunsaturated.
Saturated Fats
If there are only single bonds between neighboring carbons in the

hydrocarbon chain, a fatty acid is said to be saturated.
Saturated fats are generally solid at room temperature and are

usually from animal sources like meat, whole milk, cheese, butter,
egg yolk, and cream.
There are some plant sources of saturated fats, including coconut oil,
palm oil, and chocolate. Eating large amounts of saturated fats can
significantly raise blood cholesterol.
Unsaturated Fats
When the hydrocarbon chain has a double bond, the fatty acid is said
to be unsaturated as it has fewer hydrogens. If there is only one free
double bond, it is known as monounsaturated fatty acid. If there are
multiple free double bonds, then it is a polyunsaturated fatty acid.
Unsaturated fats are generally liquid at room temperature and are

usually from plant sources. Both types reduce blood cholesterol
when they replace saturated fats in the diet. The essential fatty acids
— linolenic acid, linoleic acid, and arachidonic acid — are all
polyunsaturated fatty acids.
The double bonds in unsaturated fatty acids, like other types of

double bonds, can exist in either a cis or a trans configuration.
In the cis configuration, the two hydrogens associated with the
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bond are on the same side, while in a trans configuration, they are
on opposite sides.
A cis double bond generates a kink or bend in the fatty acid, a
feature that has important consequences for the behavior of fats.
Saturated fatty acids tails are straight, so fat molecules with fully
saturated tails can pack tightly against one another. This tight packing
results in fats that are solid at room temperature (have a relatively high
melting point). For instance, most of the fat in butter is saturated fat.
In contrast, cis-unsaturated fatty acid tails are bent due to the cis double
bond. This makes it hard for fat molecules with one or more cis-
unsaturated fatty acid tails to pack tightly. So, fats with unsaturated tails
tend to be liquid at room temperature (have a relatively low melting
point) – they are what we commonly call oils. For instance, olive oil is
mostly made up of unsaturated fats
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Trans fats
Trans fats are rare in nature, but are readily produced in an
industrial procedure called partial hydrogenation.
In this process, hydrogen gas is passed through oils (made mostly
of cis-unsaturated fats), converting some – but not all – of the double
bonds to single bonds.
The goal of partial hydrogenation is to give the oils some of the
desirable properties of saturated fats, such as solidity at room
temperature, but an unintended consequence is that some of
the cis double bonds change configuration and become trans double
bonds.
Trans-unsaturated fatty acids can pack more tightly and are more
likely to be solid at room temperature. Some types of shortening, for
example, contain a high fraction of trans fats.
Unfortunately, trans fats have turned out to have very negative
effects on human health. Because of a strong link between trans fats
and coronary heart disease, the U.S. Food and Drug Administration
(FDA) recently issued a ban on trans fats in foods, with a three-year
deadline for companies to remove trans fats from their products.
Dietary Recommendations for Fat
• Eating a diet high in fat, especially too much saturated fat, can
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increase the risk of heart disease. But, remember, the body needs
a certain amount of fat to survive, plus many of our favorite
foods would be extremely bland and boring without fat. So the
key is moderation. According to the Dietary Guidelines, fat
intake must be limited to less than 30 percent of total calories,
and no more than one-third of this amount should come from
saturated fats. That means most fat should come from foods
higher in polyunsaturated and monounsaturated fat.
To keep fat intake at an acceptable level, consumers should:
• Use lean meats.
• Use liquid unsaturated vegetable oils for cooking instead of lard or

shortening.
• Read nutrition labels on food packages to check the kinds and

amounts of fat.
• Bake, broil, steam, and grill more often, rather than frying.
• Eat plenty of fruits, vegetables, and whole grains — foods

naturally low in total fat and high in starch and fiber.
Cholesterol
• Cholesterol is a waxy, fat-like substance found in every cell in
the body. Cholesterol is also found in all foods of animal origin.
• Cholesterol isn’t an essential nutrient because the liver can make
all the cholesterol the body needs, even if a person doesn't eat
any. The body uses cholesterol to make hormones like estrogen
and testosterone, plus it’s needed to make cell walls, bile, and
vitamin D. But, even though cholesterol performs some very
important and necessary functions in the body, it’s also true that
cholesterol deposited in arteries is a risk factor for heart disease.
• When discussing cholesterol, it’s important to clarify whether

you’re referring to dietary cholesterol or blood cholesterol. The
cholesterol that circulates throughout the body is known as blood
cholesterol. The cholesterol that comes from food is called
dietary cholesterol.
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• Dietary cholesterol is found only in foods of animal origin. Plant

products do not contain cholesterol. So, contrary to what some
consumers think, certain high-fat foods such as nuts, peanut
butter, vegetable oil, and avocados don’t contain cholesterol
because they come from plants. Still, they are high in fat, so the
advice is to enjoy them in moderation.
Cholesterol in the Blood
Just like oil and water, cholesterol and blood don’t mix. So, for
cholesterol to travel through your blood, it’s coated with a layer of
protein to make a “lipoprotein.” Two lipoproteins you may have
heard about are low-density lipoprotein (LDL) and high-density
lipoprotein (HDL).
LDL carries most of the cholesterol in the blood. When too much
LDL cholesterol is in the blood, it can lead to cholesterol buildup in
the arteries, thus increasing your risk for heart disease. That’s why
LDL cholesterol is called “bad” cholesterol. HDL cholesterol helps
remove cholesterol from the blood and helps prevent the fatty
buildup. So HDL cholesterol is called the “good” cholesterol.
Lipid Digestion and Absorption
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Summary:
1) Macronutrients are divided into carbohydrates, proteins and
lipids.
2) The body depends on them for its energy.
3) Each type of macronutrient differs in the way the body
handles its metabolism and how the body uses it for its
various functions.
4) Deficiency of macronutrients results in low energy production
and multiple other manifestations that are specific to each
type.
Formative Assessment:
Analyze the difference between the metabolism of each of the
three different macronutrients.
Chapter 5: Micronutrients
Student learning outcomes of course (SLOs)
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following:
1) Recognize the importance of micronutrients for the

body in terms of their multiple roles in preserving
general health.
2) Recall the sources from which these micronutrients

can be obtained.
3) Distinguish between fat-soluble and water-soluble

vitamins and how this affects their actions.
4) Determine the effects of micronutrient deficiency and

it can be managed.
Chapter 5: Micronutrients
Vitamins
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Vitamin Basics
Vitamins partner up with other nutrients to build, maintain, and repair

body tissues and regulate body processes. Vitamins don’t provide
energy themselves, but they help us produce energy from
carbohydrates, fats, and proteins.
Vitamins are widely distributed in food. Some are found mostly in

fruits and vegetables, others in enriched and whole grain breads and
cereals, and others in meats and dairy products. So, needless to say, the
best way to get enough vitamins is to eat a wide variety of foods.
How Much Do We Need of Each Vitamin?
Vitamins are micronutrients, meaning our bodies’ require only small

amounts. But how much is enough? To answer that question, a group of
researchers and nutrition experts known as the Food and Nutrition
Board of the National Academy of Sciences (FNB/NAS) routinely
publishes standard recommendations for daily nutrient intakes.
Until recently, these recommendations have been known as the

Recommended Dietary Allowances (RDAs), daily levels of nutrients
that researchers determined to be adequate for healthy people. The
original goal was to prevent vitamin- deficiency diseases, such as
scurvy and rickets. But the board recently changed its approach; the
emphasis is now on decreasing the risk of chronic diseases such as heart
disease, cancer, and osteoporosis. So the FNB/NAS is now in the
process of developing new standards known as the Daily Reference
Intakes (DRIs), which are levels determined to be optimal for healthy
people.
Fat-Soluble and Water-Soluble Vitamins
There are 13 vitamins that we know humans need. These 13 vitamins

fall into two groups depending on how they exist in food and how
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they’re carried in the body: fat-soluble vitamins and water-soluble

vitamins.
Vitamins A, D, E, and K are fat-soluble vitamins, meaning they

dissolve in fat rather than water or body fluids. Instead of excreting
excess amounts, the body stores them in body fat. If you take dietary
supplements, it’s possible to take in extremely high levels of fat-soluble
vitamins, which can have toxic effects. If, however, you rely on foods
to supply your vitamins, there’s no danger of toxic amounts.
Since our bodies store fat-soluble vitamins, we don’t have to take in

100 percent of the daily values of these vitamins every single day,
though it’s a good goal to have.
In foods, fat-soluble vitamins are fairly stable, meaning they aren’t

really affected by food preparation, storage, or cooking.
Water-soluble vitamins dissolve in water, and the body easily gets rid
of excess amounts in the urine. Water-soluble vitamins include vitamin
C and eight different B-complex vitamins: thiamin, riboflavin, niacin,
vitamin B , vitamin B (also called cobalamin), folic acid,
6 12
pantothenic acid and biotin.
In foods, water-soluble vitamins are not as stable as fat-soluble

vitamins, so heat, air and cooking can easily destroy them. The body
doesn’t store any significant amounts of these vitamins, so it’s
important to get enough each day. And, even though our bodies don’t
accumulate toxic levels of water-soluble vitamins, scientists have
learned that excessive intakes of certain water-soluble vitamins can be
harmful. For example, large doses of vitamin C from supplements can
lead to problems such as kidney stones and diarrhea, and mega doses of
niacin can cause flushing of the skin, nausea, and liver damage.
What About Supplements?
A balanced and varied diet provides all the vitamins most people need.
However, someone experiencing rapid growth, stress to the body, or
86
other conditions may need extra vitamins in the form of supplements.

People who potentially need supplements include pregnant and
breastfeeding women, infants, teenagers, those recovering from illness,
and those on weight-loss diets.
But many consumers who aren’t at risk of a deficiency feel the need
to take vitamin supplements. In fact, according to a survey by the
American Dietetic Association, about half of the adults in the U.S. take
a vitamin/mineral supplement on a daily basis. While some people feel
that supplements provide extra “insurance” for days when they don’t eat
well, others see supplements as cure-alls or preventives for numerous
discomforts and illnesses. Nutrition experts stress that supplements
shouldn’t take the place of a healthy diet. People should try to improve
their eating habits rather than rely on supplements. Also, contrary to
what many people believe, vitamins and minerals don’t supply extra
energy. Remember, energy only comes from carbohydrates, protein, and
fats.
For persons who do want to take a supplement, it’s safe to take one that
provides no more than 100% of the recommended levels, like a daily
multivitamin. Unfortunately, many people routinely take supplements
that supply mega doses, which are levels of nutrients in excess of 10
times the amount the body needs. Taking excessive amounts of
nutrients without medical supervision is dangerous. Depending on the
supplement and the dosage, the effects can include anything from hair
loss, fatigue, or gastrointestinal distress to more serious results such as
kidney stones, nerve damage, birth defects, and even death. Also, be
aware that dietary supplements don’t have to be tested for safety or
approved by the FDA.
Fat Soluble Vitamins
Vitamin A
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The body needs vitamin A to resist infection and keep the eyes, skin,
and internal organs moist. Healthy, moist surfaces inside the mouth, in
air passages and other mucous membranes are more resistant to
infection, thanks to vitamin A. Also, vitamin A helps us see in dim light,
and it’s needed for proper bone growth, tooth development, and
reproduction. The body stores vitamin A in the liver and then transports
it to various tissues when needed.
Sources:
Liver, eggs, cheese, milk, yellow, orange and dark green vegetables
and fruit.
Different Forms of Vitamin A in Foods
In foods, vitamin A exists in two different forms: retinol (in animal

foods) and carotenoids (in plant foods).
• Retinol — Animal products such as eggs, liver, butter, margarine,

fortified milk, and cheese contain retinol. The body is able to absorb
most of the retinol from foods.
• Carotenoids — Carotenoids, such as beta-carotene, exist in the

yellow pigments of plants including carrots, sweet potatoes, pumpkins,
cantaloupes, tomatoes, red peppers, apricots, mango, and papaya. Our
88
bodies only absorb 5 percent to 50 percent of the carotenoids we eat.

Then the body converts them to active forms of vitamin A. But, after
they’re converted, carotenoids are less active than retinol. For example,
it takes about 6 µg of beta-carotene to equal the biological activity of 1
µg of retinol.
What if You Don’t Get Enough Vitamin A?
Vitamin A deficiency may cause eye changes, inability to see in dim

light, and even blindness. Vitamin A deficiency also decreases
resistance to infection, slows growth, affects tooth formation, and
results in dry, scaly skin. In children, failure to grow is one of the first
signs of poor vitamin A status. When these children receive vitamin A
supplements, they gain weight and grow taller. Children who receive
adequate amounts of vitamin A are better able to survive infectious
diseases.
People at risk for inadequate vitamin A intake include groups who

have a tendency not to eat enough vegetables, such as preschoolers and
the elderly. And, since vitamin A is stored in the liver, individuals with
alcoholism or liver disease can have poor vitamin A status. Also, people
with diseases that affect fat absorption can become deficient in vitamin
A.
What if You Get Too Much Vitamin A?
Mega doses of vitamin A from supplements can cause vitamin A

toxicity. This is especially dangerous during pregnancy since too much
vitamin A can cause fetal deformities of the face and head, such as cleft
lip, heart malformations, brain disorders, or even fetal death. Also, a
special oral form of vitamin A that is prescribed for severe acne can
produce serious birth defects. This drug, called Accutane, shouldn’t be
used prior to or during pregnancy. Similarly, Retin-A, the topical form,
should only be used under a doctor’s advice.
On the other hand, getting large amounts of carotene from plant foods
such as carrots, carrot juice, and sweet potatoes doesn’t appear to be
89
dangerous for pregnant women or other persons. One side effect that
can occur is a harmless condition called hypercarotenemia. Basically,
the skin takes on a yellow-orange color as a result of high levels of
carotene in the body.
Tips for Including Vitamin A
One good strategy for including vitamin A in the diet is to snack on

fresh fruits and vegetables throughout the day. Also, everyone should
try to eat at least one vitamin A fruit or vegetable every day. A good tip
to pass along is that dark green and orange choices are the best sources
of vitamin A, so it helps to prepare colorful meals.
Vitamin D
90
Vitamin D is a fat-soluble vitamin that is naturally present in very few

foods and is available as a dietary supplement. It is also produced
endogenously when ultraviolet rays from sunlight strikes the skin and
triggers vitamin D synthesis.
Vitamin D obtained from sun exposure, food, and supplements is
biologically inert and must undergo two hydroxylations in the body for
activation. The first occurs in the liver and converts vitamin D to 25-
hydroxyvitamin D [25(OH)D], also known as calcidiol. The second
occurs primarily in the kidney and forms the physiologically active
1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.
Vitamin D promotes calcium absorption in the gut and maintains
adequate serum calcium and phosphate concentrations to enable normal
mineralization of bone.
Without sufficient vitamin D, bones can become thin, brittle, or
misshapen. Vitamin D sufficiency prevents rickets in children and
osteomalacia in adults.
Vitamin D has other roles in the body, including modulation of cell
growth, neuromuscular and immune function, and reduction of
inflammation.
Serum concentration of 25(OH)D is the best indicator of vitamin D
status.
Sources:
Milk, eggs, liver and exposure of skin to sunlight.
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Vitamin D Deficiency
Nutrient deficiencies are usually the result of dietary inadequacy,
impaired absorption and use, increased requirement, or increased
excretion.
A vitamin D deficiency can occur when usual intake is lower than
recommended levels, exposure to sunlight is limited, the kidneys cannot
convert 25(OH)D to its active form or absorption of vitamin D from the
digestive tract is inadequate. Vitamin D-deficient diets are associated
with milk allergy, lactose intolerance, ovo-vegetarianism, and
veganism.
Here are 7 common risk factors for vitamin D deficiency:
• Having dark skin.
• Being elderly.
• Being overweight or obese.
• Not eating much fish or dairy.
• Living far from the equator where there is little sun year-round.
• Always using sunscreen when going out.
• Staying indoors.
Common signs and symptoms of vitamin D deficiency:

- Frequently getting ill.
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- Fatigue and tiredness.

- Bone and back pain.
- Depression.
- Impaired wound healing.
- Hair loss.
- Muscle pain.
Lab. Diagnosis:
• Blood test to measure 25-hydroxy vitamin D
• More than 32ng/ml= Normal
• 20-31ng/ml= Insufficient
• 10-19ng/ml= Deficient
• Less than 10ng/ml= Severely deficient
Vitamin E
Sources:
Margarine, vegetable oils, wheat germ, whole grains, legumes and
green leafy vegetables.
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Main functions:
• Strong antioxidant. May help prevent oxidation of unsaturated
fatty acids and vitamin A in GIT and body tissues.
• It is the most important lipid soluble antioxidant in the cell.
Vitamin K
• Sources:
Green, leafy vegetables, potatoes, liver and intestinal bacteria.
• Main functions: Aids in blood clotting.
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Water-soluble vitamins
Vitamin B Complex
95
Vitamin Sources Functions Deficienc Toxicity

y symptoms
symptom
T h i a m i n M e a t s a s P a r t o f a n B e r isb e r i : N o
(B1) liver, wheat enzyme that confusion, evidence of
g e r m , breaks down l o s s o f symptoms
l e g u m e s , carbohydrates a p p e t i t e , to date.
p e a n u t s , for energy m u s c l e
fresh green wasting,
vegetables h e a r t
failure.
Riboflavin Milk, organ Helps break Cracks in N o
(B2) meat, meat, down fat for the corner evidence of
fish, eggs, energy. of t h e symptoms
legumes, mouth, red to date.
green leafy swollen
vegetables tongue,
teary eyes,
scaly skin
around the
nose.
Niacin (B3) L i v e r , -Helps break Pellagra: Flushing;
meat, fish, d o w n nausea;
p o u l t r y , carbohydrates Weakness; l i v e r
p e a n u t s , , fats, and l o s s o f damage
w h o l e - protein. a p p e t i t e ;
grain & diarrhea;
e n r i c h e d - H e l p s t h e skin rash in
breads & body make a r e a s
cereals s o m e exposed to
hormones the sun;
and fat. s o r e
tongue;
dementia.
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Pyridoxine Meat, fish, -Helps make A b n o r m a l Neurologica

B6 p o u l t r y , body protein. b r a i n l problems.
milk, eggs, function;
g r e e n -Helps break s k i n
vegetables, d o w n changes.
avocado, proteins for
prunes, energy
b e a n s ,
bananas,
whole-
g r a i n
cereals,
potatoes.
Pantotheni O r g a n Assists in the Deficiency N o

c Acid m e a t s , breakdown & is unlikely, evidence of
salmon, production of unless it’s s y m p t o m s
e g g s , protein, p a r t o f a to date.
broccoli, hormones, deficiency
mushrooms cholesterol, of all B
, pork, a n d vitamins.
w h o l e hemoglobin. Nausea;
grains, diarrhea;
legumes. cramps.
Widespread
in foods &
produced
b y
intestinal
bacteria.
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Biotin Widespread Assists in the Hair loss, N o

in foods, breakdown of lack of evidence of
esp. organ carbohydrate, appetite; symptoms
m e a t s , protein and depression; to date.
eggs, milk, fat for energy. dry skin;
whole- numb feet
g r a i n and hands
cereals,
s o m e
vegetables.
98
Pellagra.
99
Vitamin B12= Cobalamin

Sources:
Meat, fish, poultry, eggs, milk and cheese.
Main functions:
• Maintains healthy nervous system and RBCs.
• Immune functions: increased need in elderly, plus folic acid
needed for proper production of lymphocytes
Deficiency:
• Megaloblastic anemia, fatigue, weakness, constipation, loss of
appetite and weight loss.
• Neurological problems like numbness and tingling in hands and
feet.
• Depression, confusion, dementia, poor memory and soreness of
the mouth and tongue.
Folate= Folic acid= Vitamin B9

Sources:
Green, leafy vegetables and legumes.
Main functions:
Helps in the formation of RBCs, protein and support the immune
system. Needs are increased during pregnancy.
Deficiency:
• Anemia
• Apathy
• Loss of appetite
• Neural tube defects= Spina bifida
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Vitamin C= ascorbic acid
Sources:
Citrus fruits, green vegetables, melons, potatoes and tomatoes.
Main functions:
• Helps in bone, teeth and skin formation.
• Resistance to infection.
• Iron uptake.
• Immune functions: Superimmune vitamin.
• Needed for cell division, which leads to production of T and B
cells.
• Strong anti-viral.
• Depleted by antibodies, aspirin, pain relievers, coffee, cortisone,
smoking, stress, burns and high fever.
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Deficiency= Scurvy
• Fatigue
• Malaise
• Inflammation of gums
• Loosening of teeth
• Joint pain
• Poor wound healing
Minerals
102
Minerals are similar to vitamins in a number of ways. First, they’re

micronutrients, so we only need small amounts. Also, minerals are
involved in numerous chemical reactions, plus they don’t contribute
calories to the diet. But, unlike vitamins, minerals aren’t destroyed by
heat. That means cooking doesn’t affect the mineral content of a food.
In fact, if you burn a food completely leaving nothing but ash, the ash is
the food’s mineral content.
Minerals are part of many cells in the body’s structure, including:

• Red blood cells
• Bones, teeth, and nails
• Muscle tissue
Minerals regulate many chemical reactions in the body, such as:

• Helping maintain the right amount of water inside and outside the
body’s cells
• Keeping the heart beating normally
• Helping nerves respond normally
• Making the blood clot in wounds
• Regulating the release of energy from food.
Types of Minerals We divide minerals into two categories, based on

how much the body needs: major minerals and trace minerals. Our
bodies need major minerals in greater amounts as compared to trace
minerals. The major minerals include calcium, phosphorus, potassium,
sodium, chlorine, magnesium, and sulfur.
Trace minerals make up less than 1 percent of the total minerals in the
body. Still, they’re essential for good health. The trace minerals include
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iron, iodine, fluoride, zinc, manganese, chromium, cobalt,

molybdenum, copper, and selenium. In addition to these, scientists have
identified other trace minerals, but they’re still learning about their
functions and how much our bodies need.
Can You Get All the Minerals You Need from Foods?
As with other nutrients, most people who eat a balanced and varied diet
can get all the minerals they need. However, some people need
additional amounts of certain minerals; more than what they can get
from their diet. For example, people who have had chronic blood loss
or multiple pregnancies typically need extra iron. Also, physicians often
prescribe extra calcium for women at risk of osteoporosis.
Can You Get Too Much of Any Mineral?
Yes, excessive intakes of minerals can be dangerous. However, this is

usually a result of taking too many supplements rather than ingesting
high levels from foods. One dangerous example is accidental iron
poisoning in young children who consume excessive quantities of iron
supplements. An overdose of supplemental iron can kill a young child.
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Calcium
Forming and maintaining bones is calcium’s main job, and, in fact,
the human skeleton contains 99 percent of the body’s calcium. But
calcium’s role goes beyond the skeleton. The bones are in a continuous
state of change — they constantly take up calcium and then release it
back into the blood. This action helps maintain a steady calcium supply
in the bloodstream for functions such as:
• Forming teeth
• Clotting blood
• Stimulating nerves
• Maintaining normal blood pressure
• Helping muscles contract
• Maintaining the heartbeat.
As your body uses calcium, you need to replace it by eating more
calcium-rich foods. If you don’t eat enough, your bones end up
releasing more calcium than they take up. This leaves space in the
bones where calcium should be, so they become porous and fragile. But
if you eat a healthy diet with plenty of calcium-rich foods you’ll have
stronger bones.
Calcium During Childhood and Adolescence
Have you noticed how children and young teenagers seem to suddenly
grow, as if overnight? Rapid growth means the bones are getting longer
and thicker, so those are times when the body needs even more calcium.
Nearly half of the body’s bone mass is formed between ages 11 and 15
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in girls and ages 12 and 17 in boys. Calcium recommendations are

higher for adolescents, plus their bones are programmed to take up
calcium more easily. It’s crucial that kids in this age group get enough
calcium in their diets. Those who don’t put themselves at risk because
they start their adult lives with a calcium deficit.
Calcium During Adulthood
After age 19 or so, our bones quit growing, but we still keep building
more bone mass throughout our twenties. Then, after about age 30 or
35, the bones start to lose more calcium than they gain, a natural part of
the aging process. This slow bone loss that occurs in adulthood
gradually weakens the skeleton. For women in their childbearing years,
the hormone estrogen helps protect bones but, after menopause, bone
loss seems to speed up due to hormonal changes.
Osteoporosis
In later adulthood, if there’s a long history of poor calcium intake and/

or other risk factors, osteoporosis can develop. This condition is also
called porous bones or brittle-bone disease. A person with osteoporosis
may have a humped back because the bones of the spine have shrunk.
Also, sufferers have a high risk of breaking bones, even with a slight
knock or fall. Osteoporosis is a painful disease with no cure. Risk
increases with:
• Being a woman
• Early menopause
• A family history of osteoporosis
• Being of Caucasian or Asian race
• Being underweight
• Smoking cigarettes
• Alcohol abuse
• A sedentary lifestyle
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• A very low intake of dietary calcium

The best way to try to avoid osteoporosis is to make sure you reach
adulthood with a strong skeleton and to try to reduce calcium loss as
you age.
Many adults wonder if they can make up for their teen years when
they didn’t eat enough high-calcium foods. Unfortunately, after we
reach about 30 to 35 years old, we don’t add extra calcium to the bone
matrix, so our bones are as dense as they’ll ever be. Still, it’s never too
late to start consuming more calcium. Adults can slow down the natural
process of bone loss by eating more calcium-rich foods and by making
healthy lifestyle choices.
Sources:
• Highest in dairy products, one glass of skimmed milk =300mg
Ca= 1/3 of adult RDA; fish as sardines and canned salmon; dark
green leafy vegetables; tofu; legumes; nuts.
For Ca to work:
• It must be first metabolized by vitamin D.
• Excess Na can increase Ca excretion.
• For every 500mg increase in urinary Na = 10mg of Ca loss.
• Increased protein intake = increased Ca excretion = 1mg Ca/gm.
• Intense exercise = increase Ca loss.
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• Increase intake of coffee and alcohol may increase Ca loss.
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Sodium
Sodium is one of the major minerals in the fluid that surrounds body
cells. Our bodies need sodium to:
• Transmit nerve impulses
• Help balance fluids in the cells
• Help muscles relax
• Regulate blood pressure
While sodium is essential for body functions, the flip side is that too
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much dietary sodium is associated with high blood pressure. High blood
pressure causes the heart to work harder and, if it goes undetected, it
can eventually damage the heart, brain, kidney, and arteries.
Another health concern regarding excess sodium is that it can increase

the amount of calcium excreted in the urine. So, eating less salt may cut
down on calcium lost from bone, which in turn could lower the risk of
osteoporosis and fractures.
Sources:
Table salt, processed food & soy sauce.
Reducing Sodium Intake

Obviously, there are some good reasons to limit dietary sodium,
although, for many people, that’s easier said than done. People eat all
kinds of processed foods loaded with sodium: canned and instant soups;
canned meat and fish; crackers, chips and pretzels, cheese, frozen meals
and condiments such as soy sauce, ketchup and pickles. In fact, most
people get six to 12 times the amount of sodium their bodies actually
need! Still, with a little effort, most people can lower their salt intake.
Here are some tips:
• Rather than ordinary canned vegetables, choose fresh, frozen, or low-

sodium canned vegetables.
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• Choose fresh or frozen meat, poultry, and seafood rather than canned,
cured, or smoked products.
• Read the label to check the sodium content of processed foods,

especially frozen dinners, packaged mixes, soups, salad dressings, and
sauces.
• Look for labels that say “low-sodium.”
• Rather than salt, learn to use spices and herbs to enhance the flavor of
food.
• Leave the saltshaker in the cupboard.
Iron
Our bodies only need small amounts of iron, yet getting enough in the
diet can be a challenge. Iron needs are highest during rapid periods of
growth, so infants, children, and pregnant women are at higher risk for
becoming deficient.
Iron is a trace mineral that our bodies need for normal growth, to
prevent infections, and to promote learning. But iron’s main job is to
help form hemoglobin, a protein in red blood cells. Specifically, iron
carries oxygen within the hemoglobin molecule. Then hemoglobin
travels to all of the body’s cells, taking oxygen to the tissues for energy
production.
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If you don’t get enough iron in your diet, or if your body’s iron stores
get too low, your red blood cells can’t carry as much oxygen. That
means there’s less oxygen going to the body’s cells, so they can’t
produce as much energy. The end result? You feel tired, weak, and
irritable — symptoms of iron- deficiency anemia.
Iron-deficiency Anemia
If you don’t get enough iron to meet your needs, over time you’ll
develop an iron deficiency, which then leads to anemia. A person who is
anemic may have enough energy for most activities of daily living, but
any physical effort becomes very difficult. Running, climbing stairs, or
even rapid walking is hard, because the muscle cells do not have the
oxygen they need to produce energy.
Causes of Iron-deficiency Anemia
Iron-deficiency anemia is a widespread health problem, especially

among infants, growing children, and women in their childbearing
years. The main causes are poor dietary intake, rapid growth, major
blood loss, or a combination of these factors.
Symptoms of Iron-deficiency Anemia
• Difficulty learning
• Slow growth
• Shorter attention span
• Poor appetite
• Problems breathing, especially during exercise
• Less resistance to infection
• Pale skin and nails
• Reduced ability to exercise
• Less ability to regulate temperature
• Changes in behavior
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Poor Iron Intake — Poor iron intake is a common cause of anemia.

Many foods are relatively low in iron, so it takes a well balanced diet
with plenty of iron-rich foods to meet recommended levels. And it’s a
well-known fact that many people don’t eat a well balanced diet.
• Children and teenagers often eat a lot of iron-poor foods, such

as soft drinks, snack crackers, chips, cookies, and candies, and
these replace iron-rich foods in the diet.
• Many women and teenage girls put themselves on calorie-

restricted diets to lose weight, making it difficult for them to eat
adequate amounts of iron-rich foods.
• For many infants, there’s a sudden drop in dietary iron at 1 year

of age when they switch from either iron-fortified formula or
breast milk to cow’s milk, since cow’s milk is a poor source of
iron.
• Some children drink more milk than they need, and, as a result,
don’t eat enough iron-rich foods. This combination of a low
intake of solid foods and excessive milk intake can contribute to
iron-deficiency anemia.
Blood Loss — 60 percent to 70 percent of all the iron in the body is

contained in the blood; so losing large amounts of blood can lead to
anemia.
• Menstruation: Women lose iron with blood during menstruation.

Women with heavy menstrual periods may need iron supplements to
prevent anemia.
• Childbirth: Blood lost during delivery can cause women to have less
iron in reserve. Women who have pregnancies close together without
iron supplementation may not be able to build up their iron stores
between pregnancies. Mild anemia has little effect on the quantity of
iron in breast milk, but the mother may be at greater risk of developing
infections.
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• Intestinal bleeding: This can occur in very young infants fed cow’s
milk. Also, untreated ulcers and excessive, long- term use of aspirin can
cause intestinal bleeding.
• Parasites: Worms that attach to the intestine can cause a small but
daily loss of blood, which often leads to anemia.
• Blood donation: Donating blood too often can cause anemia. Blood
banks test for anemia before allowing people to donate blood.
Rapid Growth — Growth requires more iron to make extra blood and
muscle. Rapid growth occurs during pregnancy, infancy, early
childhood and adolescence.
• Pregnancy doubles a woman’s iron needs because of increased blood

volume. Pregnant women have at least 3 more pints of blood
compared to their pre-pregnancy state. During the last three
months of pregnancy, the fetus stores iron in its body, even if the
mother is anemic. So mild anemia in a pregnant woman won’t
harm the fetus, but the mother may experience fatigue and an
increased heart rate. The mother is also at greater risk of
developing infections.
• In infants, children, and adolescents, rapid growth combined with

poor intake often leads to anemia. Adolescent boys who are
growing rapidly and building larger muscles need additional iron
for their muscles and their larger blood volume. Young girls need
extra iron at puberty for increased growth and because they start
losing blood with menstruation.
• Premature infants and twins often don’t have the opportunity to

build up their iron stores the last few months before birth. Full-
term infants, on the other hand, are usually born with enough iron
to last through the first four to six months of age.
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Sources:
• Red meats, sea foods, legumes, green leafy vegetables, fortified
cereals, dried fruits.
Types:
Heme iron: hemoglobin, myoglobin,
• Found in meat, poultry and fish.
• 20-23% absorbed.
Non-Heme iron:
• Found in vegetables, fruits, nuts, breads and cereals.
• Only about 3% absorbed.
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Iron Absorption
It’s possible either to help or to hinder the amount of iron your body
absorbs. For example, eating vitamin C–rich foods along with foods
containing iron increases iron absorption. On the other hand, tea, coffee,
spinach, chocolate, soy protein, wheat bran, calcium supplements, and
fiber all interfere with iron absorption. So, to increase the amount of
iron that you absorb, here are some tips:
• Include vitamin C–rich foods when you plan meals. For

example, serve green and red peppers along with chicken or beef,
or orange juice along with iron- fortified cereal.
• Avoid drinking tea and coffee with meals, including

decaffeinated coffee and tea (it’s not the caffeine that decreases
iron absorption, but substances called polyphenols).
• Cook foods in iron pots. When highly acid foods such as

tomatoes in spaghetti sauce or chili are cooked in iron pots, a
small amount of the iron is absorbed into the food, increasing its
iron content.
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• Include meat in your diet. The iron in meat is well absorbed,

plus it helps the body absorb iron from plant sources.
Fluoride
During early childhood, fluoride helps to strengthen developing
tooth enamel and protect teeth from decay. When fluoride is lacking,
tooth decay is common. In one study that followed individuals from
birth to adolescence from 1946 through 1979, water fluoridation
resulted in a 40 to 60 percent reduction in caries of permanent teeth
compared to an area where there was no fluoride in the water.
Some people oppose water fluoridation, claiming that it can lead to

cancer and other chronic health problems. However, the American
Dental Association has collected extensive research to show that such
claims are unfounded. Water fluoridation is one of the most carefully
studied public health measures, and data show that fluoridation does not
increase the incidence of cancer, heart disease, Down Syndrome, liver
disease, kidney disease, or any other chronic illness.
Sources of Fluoride
The main source of dietary fluoride is water. Fluoride may be naturally

present in water or added to the community water supply, although
fluoride levels will vary from one area to another. The ideal level in is
0.8 ppm (eight-tenths part fluoride per million parts water).
Topical fluoride treatments, as well as toothpastes and rinses with

fluoride, offer additional protection against dental caries, although
fluoridated water is a much more reliable source. Also, some foods
contribute fluoride, including tea, fish with edible bones, and some
commercially prepared foods.
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Other important minerals:
Best Functions Deficiency Toxicity

sources symptoms symptoms
Potassium Orange -Maintains Tiredness,
juice, t h e h e a r t weakness in
bananas, beat limbs, rapid
dried heartbeat,
fruits, - H e l p s heart failure,
potatoes m u s c l e s kidney
are rich contract damage.
sources.
-Stimulates
Also found
nerves.
in meats,
fish,
poultry,
whole
grains,
fruits and
vegetables.
M a g n e s i u Green • Forms Tremors, Heart

m leafy bones; convulsions. changes,
vegetables, • Helps coma.
nuts, muscles
whole function.
grains,
meats,
milk,
seafood,
chocolate.
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Iodine Iodized Part of Goiter Thyroid

salt, thyroid (enlarged disturbances.
seafood, hormones thyroid
and food that control gland).
grown near energy During
the ocean. production pregnancy,
in the body. deficiency
causes
cretinism, a
form of
mental
retardation,
in the baby.
Zinc Meat, -Helps form Poor wound Nausea,

liver, enzymes healing; vomiting,
oysters, and insulin; decreased diarrhea.
herring, sense of Difficult to
fish, milk, -Helps taste; produce
whole produce retarded from food
grains, body growth and alone.
nuts, proteins; sexual
legumes. development.
-Helps the
body use
vitamin A;
-Provides
normal
taste
sensations.
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Summary:
1) Micronutrients are elements that are essential for normal body
functions but they do not produce energy. They can only assist
in the energy production process.
2) Each micronutrient has a specific function in the body and
when a deficiency occurs, that function is hindered and is
portrayed in the form of specific clinical signs and symptoms.
3) The source of each micronutrient is a part of a normal, healthy
diet, which is enough to provide the daily requirements for the
majority of the population.
4) Deficiencies occur when these requirements are not met.
5) Micronutrient supplementation might be needed in certain
cases.
Determine the major vitamins and minerals that affect immunity.
Chapter 6: Obesity
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following:
1. Define obesity and malnutrition and how to

measure them.
2. Understand their detrimental effects on the body.
3. Recognize the different methods by which they can

be avoided.
4. Determine the management of each case.
Chapter 6: Obesity
• Obesity means having excess body fat.
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• Obesity is not just a cosmetic consideration. It is a chronic

medical disease that can lead to multiple concomitant diseases.
• Obesity is difficult to treat and has a high relapse rate. Most
people who lose weight regain the weight within five years.
• Even though medications and diets can help, the treatment of
obesity cannot be a short-term "fix" but has to be a lifelong
commitment to proper diet habits, increased physical activity, and
regular exercise.
• The goal of treatment should be to achieve and maintain a
"healthier weight," not necessarily an ideal weight.
• Even a modest weight loss of 5%-10% of initial weight and the
long-term maintenance of that weight loss can bring significant
health benefits.
• The chances of long-term successful weight loss are enhanced if
the doctor works with a team of professionals, including
dietitians, psychologists, and exercise professionals.
What are the health risks associated with obesity?
Obesity is not just a cosmetic consideration; it is harmful to one's
health as it is a risk factor for many conditions. In the United States,
roughly 112,000 deaths per year are directly related to obesity, and
most of these deaths are in patients with a BMI over 30. Patients
with a BMI over 40 have a reduced life expectancy. Obesity also
increases the risk of developing a number of chronic diseases,
including the following:
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What causes obesity?

The most common causes of obesity are overeating and physical
inactivity.
However, other factors are now known to contribute to obesity
including;
• Genetics. A person is more likely to develop obesity if one or
both parents are obese. Genetics also affect hormones involved in
fat regulation. For example, one genetic cause of obesity is leptin
deficiency. The role of leptin replacement as a treatment for
obesity is under exploration.
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• Frequency of eating. The relationship between frequency of

eating and weight is somewhat controversial. There are many
reports of overweight people eating less often than people with
normal weight. Scientists have observed that people who eat
small meals four or five times daily, have lower cholesterol and
lower and/or more stable blood sugar levels than people who eat
less frequently (two or three large meals daily). One possible
explanation is that small frequent meals produce stable insulin
levels, whereas large meals cause large spikes of insulin after
meals.
• Medications. Medications associated with weight gain include
certain antidepressants, anticonvulsants some diabetes
medications and most corticosteroids.
• Psychological factors. For some people, emotions influence
eating habits. Many people eat excessively in response to
emotions such as boredom, sadness, stress or anger. While most
overweight people have no more psychological disturbances than
normal weight people, about 30% of the people who seek
treatment for serious weight problems have difficulties with
binge eating.
• Diseases such as hypothyroidism are also contributors to obesity.
• Social issues: There is a link between social issues and obesity.
Lack of money to purchase healthy foods or lack of safe places to
walk or exercise can increase the risk of obesity.
• Ethnicity. Ethnicity factors may influence the age of onset and
the rapidity of weight gain. African-American women and
Hispanic women tend to experience weight gain earlier in life
than Caucasians and Asians.
• Childhood weight. A person's weight during childhood, the
teenage years, and early adulthood may also influence the
development of adult obesity.
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• Hormones. Women tend to gain weight especially during certain

events such as pregnancy, menopause and in some cases, with the
use of oral contraceptives.
• Environmental Factors
• Bombarded with advertising
• Changes in working families
• Bottle-feeding in infants
• Increase in sedentary lifestyle
• Misleading food labels
• Increased opportunities for eating
o Endocrine In uence: The Hungry Hormones
• Hunger—an inborn physiological response to nutri onal
needs.
• Appe te—a learned response to food that is ed to an
emo onal or psychological craving.
• Sa ety—to feel sa s ed, or full, when one has sa s ed
their nutri onal needs and the stomach signals “no more”.
Does it matter where body fat is located? (Is it worse to be an
"apple" or a "pear"?)
Concern is directed not only at how much fat a person has but also
where that fat is located on the body. The pattern of body fat
distribution tends to differ in men and women.
In general, women collect fat in their hips and buttocks, giving their
figures a "pear" shape. Men, on the other hand, usually collect fat
around the belly, giving them more of an "apple" shape. (This is not a
hard and fast rule; some men are pear-shaped and some women become
apple-shaped, particularly after menopause.)
What can be done about obesity?
All too often, obesity prompts a strenuous diet in the hopes of
reaching the "ideal body weight." Some amount of weight loss may be
accomplished, but the lost weight usually quickly returns. Most people
who lose weight regain the weight within five years. It is clear that a
more effective, long-lasting treatment for obesity must be found.
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Keeping Weight Control in Perspective

▪ Each person is different.
▪ Weight loss is not simple.
▪ Depression, stress, culture, and available foods can affect a
person’s ability to lose weight.
▪ Set realistic goals.
▪ Work out a maintainable lifestyle change.
Improving Your Eating Habits

▪ Evaluate what triggers your eating.
▪ Seek assistance from the MyPyramid plan.
▪ Set goals.
▪ Keep a detailed daily log of eating triggers.
▪ Reward yourself when you lose pounds.
▪ Avoid weight loss programs that promise quick, “miracle”
results.
Characteristics of an Ideal Diet:
▪ Supplies all macro and micronutrients.
▪ Supplies enough calories to avoid fatigue.
▪ Tailored to each patient.
▪ Weight loss of 0.5-1kg /week
▪ Flexible diet to avoid boredom.
▪ Diet composition should consider co-morbid disease.
▪ Achieve 10% weight loss within 6 months.
What is the role of physical activity and exercise in obesity?
Physical activity and exercise help burn calories. The amount of
calories burned depends on the type, duration, and intensity of the
activity. But exercise as a treatment for obesity is most effective when
combined with a diet and weight-loss program.
Exercise alone without dietary changes will have a limited effect on
weight. Another advantage of regular exercise as part of a weight-loss
program is a greater loss of body fat versus lean muscle compared to
those who diet alone.
Other benefits of exercise include
• Improved blood sugar control and decreased insulin resistance.
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• Reduced triglyceride levels and increased "good" HDL

cholesterol levels.
• Lowered blood pressure.
• A reduction in abdominal fat.
• Reduced risk of heart disease.
• Release of endorphins that make people feel good.
Role of exercise in obesity management
▪ Carbohydrates are a major fuel provider during exercise.
▪ Energy pathways:
1- ATP= 2-3 seconds = short burst of energy
2- ATP-CP= 8-10 seconds
= anaerobic, no lactic acid production
= quick, powerful movements
= e.g. 100m race
3- Anaerobic energy= 2-3 minutes (lactic acid with muscle fatigue and
cramps)
= recovery period requires oxygen
= uses muscle and liver glycogen
= higher rate of ATP production
4- Aerobic energy= 3+ minutes
= highest rate of ATP production
= fat is main source of energy (preserve glucose)
= mainly endurance exercise with lower intensity.
▪ Fat oxidation= beta oxidation
= lowest rate of ATP production
= highest total energy production
= mainly in lower intensity endurance, more than 30
minutes.
General exercise recommendations:

• Perform 20-30 minutes of moderate exercise five to seven days a
week, preferably daily. Exercise can be broken up into smaller
10-minute sessions.
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• Start slowly and progress gradually to avoid injury, excessive

soreness, or fatigue. Over time, build up to 30-60 minutes of
moderate to vigorous exercise every day.
• People are never too old to start exercising. Even frail, elderly
individuals (70-90 years of age) can improve their strength and
balance.
What to eat before and after exercise?
Summary:
1) Obesity is not a cosme c issue; in fact, it needs to be treated
as a disease that requires management.
2) Obesity is the primary cause of many secondary diseases.
3) The causes of obesity are mul factorial including diet issues,
psychological issues and behavioral issues.
4) A t least a 5% reduc on of body weight can produce
signi cant health improvements.
5) Management of obesity has many elements including diet,
physical ac vity and psychological management.
Forma ve assessment:
1) Underline the secondary diseases that develop due to
obesity.
Chapter 7: Malnutrition

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following:
1. Define malnutrition and how to measure it.
2. Understand its detrimental effects on the body.
3. Recognize the different methods by which it can be

avoided.
4. Determine the management of clinical cases

suffering from malnutrition.
Chapter 7: Malnutrition
- Derived from malus (bad) and nutrire (to nourish).
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- Includes both: undernutrition with a deficiency of one or more

essential nutrient and overnutrition due to an excess of a
nutrient or nutrients.
Undernutrition occurs when an individual does not consume enough

food. It may exist if the person has a poor diet that gives them the
wrong balance of basic food groups.
Obese people, who consume more calories than they need, may suffer
from the undernutrition aspect of malnutrition if their diet lacks the
nutrients their body needs for good health.
The World Health Organization (WHO) says that malnutrition is by

far the largest contributor to child mortality globally, currently present
in 45 percent of all cases.
Underweight births and inter-uterine growth restrictions are
responsible for about 2.2 million child deaths annually in the world.
Deficiencies in vitamin A or zinc cause 1 million deaths each year.
WHO adds that malnutrition during childhood usually results in worse
health and lower educational achievements during adulthood.
Malnourished children tend to become adults who have smaller babies.
Globally, as well as in developed, industrialized countries, the
following groups of people are at highest risk of malnutrition:
▪ Elderly people, especially those who are hospitalized or in long-term
institutional care.
▪ Individuals who are socially isolated.
▪ People on low incomes (poor people).
▪ People with chronic eating disorders, as bulimia and anorexia
nervosa.
▪ People convalescing after a serious illness or condition.
Signs and symptoms of malnutrition include:

▪ Loss of fat (adipose tissue).
▪ Breathing difficulties, a higher risk of respiratory failure.
▪ Depression.
▪ Higher risk of complications after surgery.
▪ Higher risk of hypothermia.
▪ The total number of some types of white blood cells falls;
consequently, the immune system is weakened, increasing the risk of
infections.
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▪ Longer healing times for wounds.

▪ Longer recover times from infections.
▪ Longer recovery from illnesses.
▪ Problems with fertility.
▪ Reduced muscle mass.
▪ Fatigue and apathy.
▪ Irritability.
In more severe cases:

▪ Skin may become thin, dry, inelastic, pale, and cold.
▪ Eventually, as fat in the face is lost, the cheeks look hollow and the
eyes sunken.
▪ Hair becomes dry and sparse, falling out easily.
▪ Sometimes, severe malnutrition may lead to unresponsiveness
(stupor).
▪ If calorie deficiency continues for long enough, there may be heart,
liver and respiratory failure.
▪ Total starvation is said to be fatal within 8 to 12 weeks (no calorie
consumption at all).
Children
Children who are severely malnourished typically experience slow
behavioral and intellectual development, which may lead to intellectual
disabilities. Even when treated, undernutrition may have long-term
effects in children, with impairments in mental function and digestive
problems persisting - in some cases for the rest of their lives.
Adults whose severe undernourishment started during adulthood
usually make a full recovery when treated.
In more wealthy industrialized nations malnutrition is usually

caused by:
1) Poor diet
If a person does not eat enough food, or if what they eat does not
provide them with the nutrients they require for good health, they suffer
from malnutrition. Poor diet may be caused by one of several different
factors. If the patient develops swallowing difficulties because of an
illness, or when recovering from an illness, they may not be able to
consume enough of the right nutrients.
2) Mental health problems
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Some patients with depression may develop eating habits, which lead to
malnutrition. Patients with anorexia nervosa or bulimia may develop
malnutrition because they are ingesting too little food.
3) Mobility problems
People with mobility problems may suffer from malnutrition simply
because they either cannot get out enough to buy foods, or find
preparing them too arduous.
4) Digestive disorders and stomach conditions
Some people may eat properly, but their bodies cannot absorb the
nutrients they need for good health. Examples include patients
with Crohn’s disease or ulcerative colitis. Such patients may need to
have part of the small intestine removed (ileostomy).
Individuals who suffer from Celiac disease have a genetic disorder that
makes them intolerant to gluten. Patients with Celiac disease have a
higher risk of damage to the lining of their intestines, resulting in poorer
food absorption.
Patients who experience serious bouts of diarrhea and/or vomiting may
lose vital nutrients and are at higher risk of suffering from malnutrition.
5) Alcoholism
Alcoholism is a chronic (long-term) disease. Individuals who suffer
from alcoholism can develop gastritis, or pancreas damage. These
problems also seriously undermine the body's ability to digest food,
absorb certain vitamins, and produce hormones that regulate
metabolism. Alcohol contains calories, reducing the patient's feeling of
hunger, so he/she consequently may not eat enough proper food to
supply the body with essential nutrients.
In the poorer nations malnutrition is commonly caused by:

1) Food shortages
In the poorer developing nations food shortages are mainly caused by a
lack of technology needed for higher yields found in modern
agriculture, such as nitrogen fertilizers, pesticides and irrigation. Food
shortages are a significant cause of malnutrition in many parts of the
world.
2) Food prices and food distribution
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It is ironic that approximately 80% of malnourished children live in

developing nations that actually produce food surpluses (Food and
Agriculture Organization). Some leading economists say that famine is
closely linked to high food prices and problems with food distribution.
3) Lack of breastfeeding
Experts say that lack of breastfeeding, especially in the developing
world, leads to malnutrition in infants and children. In some parts of the
world mothers still believe that bottle-feeding is better for the child.
The care plan

Aims for treatment will be set out, which should include the treatment
for any underlying conditions/illnesses which are contributory factors to
the malnutrition.
Typically, treatment will include a feeding program with a specially
planned diet, and possibly some additional nutritional supplements.
Severely malnourished patients, or individuals who cannot get
sufficient nutrition by eating or drinking may need and should receive
artificial nutritional support.
The patient will be closely monitored for progress. Their treatment will
be regularly reviewed to make sure their nutritional needs are being
met.
Diet
A good healthcare professional will discuss eating and drinking with the
patient and provide advice regarding healthy food choices. The aim is to
make sure the patient is receiving a healthy, nutritious diet.
The doctor or dietitian will work with the patient to make sure enough
calories are being consumed from carbohydrates, proteins, fats and
diary, as well as vitamins and minerals. If the patient cannot get their
nutritional requirements from the food they eat, oral supplements may
be needed. An additional 250kcal to 600kcal may be advised.
Artificial nutritional support

There are two main types of artificial nutritional support, mainly for
patients with severe malnutrition:
▪ Enteral nutrition (tube feeding) - a tube is placed in the nose, the
stomach or small intestine. If it goes through the nose it is called a
nasogastric tube or nasoenteral tube. If the tube goes through the
skin into the stomach it is called a gastrostomy or percutaneous
endoscopic gastrostomy (PEG) tube. One that goes into the small
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intestine is called a jejunostomy or percutaneous endoscopic

jejunostomy (PEJ) tube.
▪ Parenteral feeding - a sterile liquid is fed directly into the
bloodstream (intravenously). Some patients may not be able to take
nourishment directly into their stomach or small intestine.
Monitoring progress
The patient will be regularly monitored to check that he/she is receiving
the right amount of calories and nutritional needs. This may be adjusted
as the patient's requirements change. Patients receiving artificial
nutritional support will be switched over to normal eating as soon as
they are able to.
Summary:
1) Malnutri on means both under nutri on and poor nutri on.
2) Many factors result in malnutri on.
3) Mul ple macronutrient and micronutrient de ciencies are seen.
4) Management of malnutri on depends mainly on the cause and
the severity of the condi on.
Describe the main methods by which malnutri on can be managed.
Chapter 8: FAD Diets
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By the end of this course, the student should

demonstrate comprehensive knowledge and clear
understanding of the following:
1) Understand the concept of a FAD diet.
2) Recognize the difference between a normal, healthy diet

and a FAD diet.
3) Differentiate between different types of FAD diets.
4) Criticize FAD diets and their effects on the body.
Chapter 8: FAD Diets
What is a fad?
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■ Webster’s dictionary defines a fad as “a short-lived fashion or

craze”.
■ So fad diets are short-lived, crazy diets!
Elimination Diets
■ Demonize one or more foods or food groups.
■ “Sugarbusters!” – calls for elimination of sugar in the diet.
■ This includes carrots and beets since they are naturally
high in sugar.
■ Very low in calories/ high in fat – people do see temporary
weight loss.
Single Food Diets –

Examples: the grapefruit diet, the rice diet, the cabbage soup
diet
■ Variety of foods not being eaten so nutrients are missing from the
diet.
■ Usually low in calories.
Blood Type Diets

■ Eat foods based on your blood type.
■ Thinking is that by eating certain foods, the body will process
them more efficiently because they are for your blood type.
■ Processing food more or less efficiently does not result in weight
loss.
■ Again, it eliminates foods, therefore; one would be missing
important nutrients.
Liquid Diets
■ Simply drink just liquids.
■ It is possible to consume just as many calories through liquid as
through food.
■ May be easier to consume more because food contains more fiber
that can help you feel full.
■ Some may replace one or two meals with liquids, such as “Slim
Fast” or “Optifast”.
■ Most provide few calories per day.
■ Claim to provide everything in a drink but they are missing
nutrients and phytochemicals that can only be found in food.
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Skipping Meals
■ It is a myth that skipping meals will result in weight loss.
■ Going several hours without eating will more than likely cause
one to overeat when they have their next meal.
■ It is healthier for the body and appetite to eat regular meals when
hunger strikes instead of skipping.
Fasting or Near Fasting

■ Also called “crash dieting”.
■ Lacking in nutrients required for normal functioning of the body.
■ Weight loss is a result of water and muscle loss.
■ Side effects include: extreme fatigue, constipation, nausea,
diarrhea, and even gallstone formation.
The Atkins Diet:

Mainly protein intake. Here you also eliminate most carbs and don't
count calories. The major objection to this is its failure to distinguish
between good and bad fats. Similarly, there isn't enough emphasis on
fiber, vitamins and minerals, all of which are important in disease
prevention. If you're on Atkins, you miss out on health-protective
phytochemicals found in fruits and many vegetables and don't learn to
differentiate between healthy low glycemic-load carbs and less healthy
high-glycemic load ones. Some studies have shown that short-term use
of the Atkins diet is safe and effective for healthy weight loss. Many
physicians are concerned about long-term health risks.
The South Beach Diet:

Devised by a noted cardiologist, this diet requires you to eliminate
carbohydrates for two weeks and then add back specific, low glycemic-
load carbs. Its weaknesses are that you don't count calories or control
portion size and exercise isn't addressed.
The underlying assumption is that if you're overweight, you must be
insulin resistant, which isn't true for everyone.
The Ornish Diet:
Mainly a very low-fat, vegetarian plan. This diet, in combination with
group support, stress reduction, and moderate exercise, was devised to
stop (even reverse) coronary heart disease. The emphasis on very low-
fat intake is obsolete.
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Most people not facing invasive cardiac procedures will not have the
motivation to stick with this restrictive diet.
The Keto Diet:

The ketogenic diet is a high fat, adequate protein, low carbohydrate
diet, that in medicine is used primarily to treat difficult-to-control
(refractory) epilepsy in children. The diet forces the body to burn fats
rather than carbohydrates. This reduction in carbs puts your body into a
metabolic state called ketosis. Ketogenic diets can cause massive
reductions in blood sugar and insulin levels.
A ketogenic diet is an effective way to lose weight and lower risk
factors for disease
In fact, research shows that the ketogenic diet is far superior to the often
recommended low fat diet.
What's more, the diet is so filling that you can lose weight without
counting calories or tracking your food intake.
One study found that people on a ketogenic diet lost 2.2 times more
weight than those on a calorie-restricted low-fat diet. Triglyceride and
HDL cholesterol levels also improved.
Another study found that people on the ketogenic diet lost 3 times more
weight than those on the diet recommended by Diabetes UK journal.
However, there are some side effects, that are well known and that any
aspiring keto dieter can get ready for.
Get ready for the keto flu
Most people already know about the keto flu, which can happen when
you start the diet. It’s a result of the body adapting to the low-carb state.
Lowering carb intake forces the body to burn ketones for energy instead
of glucose. Once the body is in ketosis, the keto diet is working. But
you may not feel so great at first, hence the term keto flu.
Symptoms of the keto flu can include everything from headache,
weakness, and irritability, to constipation, nausea, and vomiting.
In the process of breaking down fat, the body produces ketones, which
are then removed by the body through frequent and increased urination.
This may lead to dehydration and flu-like symptoms, such as fatigue,
dizziness, irritability, nausea, and muscle soreness.
With this frequent urination, there is also the inevitable loss of
electrolytes, which can exacerbate these symptoms. In addition, as
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carbohydrates are a source of energy and stimulation, removal of this

source of energy will result in increased sugar cravings, brain fog and
difficulty concentrating, much like most other withdrawal symptoms.
For most people, the keto flu only lasts about a week.
Kidney and heart damage
Because the body can be low on electrolytes and fluid on top of the
increased urination, that can lead to a loss of electrolytes such as
sodium, magnesium, and potassium. This can make people prone to
acute kidney injury.
This may put the dieter at risk of a cardiac arrhythmia, as electrolytes
are necessary for the normal beating of the heart.
Yo-yo dieting patterns
The keto diet can also lead to yo-yo dieting, because people have
difficulty staying on the restrictive diet permanently.
There are few long-term studies on the keto diet, which may be because
it’s difficult to follow, so people aren’t staying on it for a long time.
Other impacts
Other side effects can include bad breath, fatigue, constipation;
irregular menstrual cycles, decreased bone density, and sleep issues.
Then there are other effects that are not well studied, mostly because
it’s hard to track dieters on a long-term basis to find out the lasting
effects of the eating plan.
Nutritional concerns
There is a fear among health experts that such high intakes of
unhealthful fats would have a long-term negative effect. Weight loss
can often confuse the data in the short term. This is because when
overweight people lose weight, regardless of how they do it, they often
end up with better blood lipids and blood glucose levels.
The keto diet is also extremely low in certain fruits, vegetables, grains,
and legumes that are generally thought of as healthy. Without these
foods, people on the diet can miss out on fiber, certain vitamins,
minerals, and phytochemicals that only come in these foods. That has
significant human health impacts over the long term such as bone loss
and increased risk of chronic diseases.
Hundreds of studies suggest that diets rich in whole plant foods are
linked with significantly lower levels of diseases like osteoporosis,
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Alzheimer’s disease, heart disease, cancer, and type 2 diabetes. So, do

people want to risk their long-term health just to lose weight more
quickly?
Is the keto diet for everyone?
Not all patients are appropriate candidates for the keto diet, especially
those with chronic conditions such as high blood pressure, diabetes, or
other conditions that may be the result of a previous diet.
This diet can result in such a big change for many people’s metabolic
and other bodily systems, that adhering to the diet may even change the
effectiveness of a person’s medication.
Patients need to be evaluated and monitored by a physician when they
start a keto diet due to the level of dietary restriction. They may need to
begin electrolyte supplementation or change any daily medication
dosages they take.
The keto diet can be used for short-term fat loss so long as the patient is
medically supervised. But it’s not a permanent weight loss or
maintenance solution.
Laxatives
■ Induces bowel movements.
■ Myth that taking laxatives promotes weight loss.
■ Laxative-induced diarrhea does not significantly reduce the
number of calories absorbed from the food you have eaten.
■ Laxatives do not work on the small intestine – where calories are
absorbed, but on the colon.
■ Use can promote cramping, nausea, diarrhea, vomiting,
constipation, dehydration, fainting, irregular heartbeat and
electrolyte imbalances.
Teas
■ Several teas on the market: dieter’s tea, slim teas, fat-burning
teas.
■ Likely contain a form of a laxative but it may not be listed on
the label.
■ If the tea contains: senna, aloe or castor oil – it contains a
laxative.
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■ Use can promote cramping, nausea, diarrhea, vomiting,

constipation, dehydration, fainting, irregular heartbeat and
electrolyte imbalances.
Herbs, Hormones, Minerals

■ Ma Huang, DHEA (dehydroepiandrosterone), and individual
minerals like chromium are all marketed as weight loss aids.
■ None have been proven to promote weight loss, build muscle or
anything beneficial.
■ Ma Huang and DHEA have been found dangerous and deaths
have been linked to Ma Huang.
Other Gimmicks
■ Cellulite creams, fat-burning sweat suits, vacuum pants (claim to
suck the fat out of your body while you are hooked up to a
vacuum cleaner.
■ Slimmer shorts claim to melt unwanted fat away from hips,
stomach, buttocks, and thighs.
Identify a Fad Diet or Product

■ Promise quick weight loss
■ Flaunt famous names
■ Limit foods to eat
■ Use testimony instead of science
■ No sweat
■ Sell something – like food or pills
■ Have “secret Ingredients”
■ Short-term
■ Disbelieve doctors
Potential Health Problems

■Loss of energy – almost all fad diets call for less calories to promote
quick weight loss.
When this happens, body tries to conserve energy by burning fewer
calories, making you feel tired.
■Dehydration- electrolytes sodium and potassium are dissolved in
body water.
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■Loss of muscle – when the body does not have adequate CHO
intake it is forced to perform glucogenesis (glucose formation) for
energy.
■Source of this glucose is mostly protein, or muscle tissue.
■More muscle you have – the higher your metabolic rate.
■By losing muscle- metabolic rate is slowed.
■Muscle holds water so weight loss will actually be occurring.
■However, person is not losing fat and weight gain will occur when
old habits return.
■Vitamin & Mineral Deficiencies –
Majority of teens do not meet recommended calcium intake and
deficiency can lead to sub-optimal bone formation and osteoporosis
later in life.
■False Hope – fad diets make promises they can’t keep by offering
“magic bullets”.
■Feeling of failure – when the diet doesn’t work or the dieter eats a
forbidden food, he/she may feel failure or guilt.
■Loss of Money- many products are expensive.
■Avoiding Real Change – by trying fad diets, person who really
wants or needs to lose weight is avoiding making the changes that
will promote real weight loss for good.
Summary:
1) FAD diets are short-lived, unhealthy diets that promise quick
weight loss.
2) New FAD diets are being introduced every day with li le
scien c evidence to support their e ec veness.
3) Mul ple health risks are associated with FAD diets.
What are the major di erences between a normal, healthy diet and a
FAD diet?
Chapter 9: Water and Electrolytes for Health
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following:
1) Understand the importance of water and electrolytes for

the body.
2) Determine the amount of water needed to maintain

health.
3) Recognize and manage dehydration.
4) Differentiate between different types of drinks that affect

health.
5) Understand the importance of major electrolytes on body

function.
6) Recognize signs of electrolyte disturbance and how to

manage them.
Chapter 9: Water and Electrolytes for Health
Your body depends on water to survive. Every cell, ssue, and organ
in your body needs water to work properly. For example, your body
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uses water to maintain its temperature, remove waste, and lubricate

your joints.
Water is needed for overall good health. It makes up a large propor on
of the body, an average of 60% of body weight. It is lost in urine, sweat,
breath and by evapora ng through the skin.
The amount of uid needs depends on many factors including the

weather, physical ac vity and age. You should drink water every day.
Most people have been told they should drink 6 to 8 glasses of water
each day. That is a reasonable goal. However, di erent people need
di erent amounts of water to stay hydrated. Most healthy people can
stay well hydrated by drinking water and other uids whenever they
feel thirsty. For some people, fewer than 8 glasses may be enough.
Other people may need more than 8 glasses each day. If you are
concerned that you are not drinking enough water, check your urine. If
your urine is usually colorless or light yellow, you are well hydrated. If
your urine is a dark yellow or amber color, you may be dehydrated.
Water is best for staying hydrated. Other drinks and foods can help
you stay hydrated. However, some may add extra calories from sugar to
your diet. Fruit and vegetable juices, milk, and herbal teas add to the
amount of water you get each day. Even ca einated drinks (for
example, co ee, tea, and soda) can contribute to your daily water
intake. A moderate amount of ca eine (200 to 300 milligrams) is not
harmful for most people. This is about the amount in 2 to 4 cups of
co ee. However, it’s best to limit ca einated drinks. Ca eine may
cause some people to urinate more frequently and predispose to
dehydra on.
Water can also be found in the food you eat as fruits and vegetables
(for example, watermelon, tomatoes, and le uce), and in soup broths.
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It is es mated that an average of 20% of our uid intake comes from
food.
Sports drinks can be helpful if you are planning on exercising at

higher than normal levels for more than an hour. It contains
carbohydrates and electrolytes that can increase your energy. It helps
your body absorb water. However, some sports drinks are high in
calories from added sugar. They also may contain high levels of sodium
(salt). Check the serving size on the label. One bo le usually contains
more than one serving. Some sports drinks contain ca eine, too.
Remember that a safe amount of ca eine to consume each day is
between 200 and 300 mg (milligrams).
Energy drinks are not the same as sports drinks. Energy drinks
usually contain large amounts of ca eine. Also, they contain
ingredients that over-s mulate you (guarana, ginseng, or taurine).
These are things your body doesn’t need. Most of these drinks are also
high in added sugar. According to doctors, children and teens should
not have energy drinks.
If staying hydrated is di cult for you, here are some ps that can
help:
• Keep a bo le of water with you during the day.

• If you don’t like the taste of plain water, try adding a slice of lemon
or lime to your drink.
• Drink water before, during, and a er a workout.
• When you’re feeling hungry, drink water. Thirst is o en confused
with hunger. True hunger will not be sa s ed by drinking water.
Drinking water may also contribute to a healthy weight-loss plan.
Some research suggests that drinking water can help you feel full.
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• If you have trouble remembering to drink water, drink on a

schedule. For example, drink water when you wake up, at
breakfast, lunch, and dinner, and when you go to bed. Or, drink a
small glass of water at the beginning of each hour.
If a person does not consume enough water, over me he will

become dehydrated, studies have shown that at about 1% dehydra on,
nega ve e ects on the mental and physical func ons begin to appear.
Symptoms of mild dehydra on include a dry mouth, headache and
poor concentra on. When the body detects that more water is
needed, the rst thing that happens is that the kidneys reduce the
amount of water lost in urine resul ng in dark, concentrated urine.
The color of urine is a very good predictor of dehydra on where a well-
hydrated person has pale yellow urine. If it’s darker then more uid is
needed.
Once mild dehydra on occurs a person will start to feel thirsty and if
ignored, severe dehydra on will follow.
Recognizing signs of severe dehydra on is important. They include:
• Li le or no urine.
• Sleepiness or fa gue.
• Extreme thirst.
• Severe headache.
• Confusion.
• Dizziness or lightheadedness.
• No tears when crying.
Some people are at higher risk of dehydra on, including people who
exercise at a high intensity (or in hot weather) for too long, have
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certain medical condi ons (kidney stones, bladder infec on), are sick
(fever, vomi ng, diarrhea), are pregnant or breas eeding, are trying to
lose weight, or are not able to get enough uids during the day. Older
adults are also at higher risk. As you get older, your brain may not be
able to sense dehydra on. It doesn’t send signals for thirst.
Can you drink too much?

It is possible, although very rare to drink so much water that the body
cannot get rid of. This could result in sodium levels becoming
dangerously low with many serious health consequences as arrhythmia
and cardiac arrest. In fact, it has happened with individuals performing
extreme detox programs.
Electrolytes
Electrolytes are minerals in the body that have an electric charge.

They are found in blood, urine, ssues and other body uids.
They are important because they help:
- Balance the amount of water in the body
- Balance the acid/base balance or the pH of the body
- Move nutrients into the cells
- Move waste products out of the cells
- Ensure adequate func on of major organs as the heart, brain,
kidneys and muscles.
- Maintain bone strength
Sodium, potassium, calcium, magnesium, chlorine and

phosphates are electrolytes obtained from food and drinks.
The levels of electrolytes can become too high or too low when
there is a water imbalance or malnutri on. Some medicines as
diure cs and laxa ves, vomi ng, diarrhea, kidney or liver
diseases a ect the amount of electrolytes in the body.
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The most important electrolytes outside the cells are sodium,

calcium and bicarbonates. Inside the cells, potassium,
magnesium and phosphates are of importance.
Sodium:
- This is the major posi ve ion (ca on) in uids outside the cells.
- When combined with chloride it becomes table salt, the excess
of which is excreted in urine.
- It regulates the total amount of water in the body and the
transmission of sodium in and out of cells plays a cri cal role in
cellular func ons.
- Many processes in the body especially in the brain, nervous
system, muscles and heart require the presence of sodium in
adequate levels.
- Normal sodium level is 135-145mEq/Lin plasma.
- Hypernatremia (increased sodium levels rela ve to water) may
be due to excess dietary intake, dehydra on, vomi ng and
diarrhea. This could result in hypertension and heart failure.
- Hyponatremia (decreased sodium levels rela ve to water) can
occur in liver and kidney diseases, burn vic ms and some
medica ons. This could result in seizures and coma.
- The Ins tute of Medicine in the USA has recommended a total
daily allowance of 1.2-1.5gm of sodium/day (5gm of NaCl).
Calcium:
- Most people realize that 99% of calcium is found in the
skeleton and teeth, but many do not know the importance of
the remaining 1% that is found as ionized calcium (ca on) and is
known as the “second messenger” that regulates many cell
func ons especially heart beat and blood clo ng.
- The RDA of calcium is 1000-1300mg/d, which can be supplied
by dairy products, nuts and nned sh with bones.
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Potassium:
- This is the most important ca on inside the cells.
- Together with sodium it is responsible for maintaining the acid/
base balance and the water balance of the body.
- Together with calcium it regulates nerve and muscle ac vity.
- The normal level of potassium in the body is 3.5-5.5 mEq/L.
Both hypokalemia and hyperkalemia can have severe and fatal
e ect on the func on of the heart.
- No speci c RDA has been speci ed but a range of 4700mg/d
has been suggested in several studies.
- It if found in most food as fruits, vegetables, meat and dairy
products.
Summary:
1) Water and electrolytes are essen al for maintaining hydra on
and blood pressure within normal levels.
2) Water is involved in many metabolic processes making it
essen al for maintaining healthy metabolism.
3) The average daily intake of water is around 8 glasses of water.
4) Dehydra on is detrimental to health; therefore maintaining
good hydra on is essen al.
5) Major electrolytes in the body are sodium, potassium and
calcium and have major func ons in regula ng the func ons of
the heart.
6) De ciency of any of the major electrolytes has many reasons and
will result in various side e ects.
Describe the e ects of dehydra on on the body.
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Chapter 10: Pre & Probiotics

following:
1) Understand the importance of the microbiome for

general health.
2) Recognize the source of microbiome from diet.
3) Understand the difference between pre and probiotics.
4) Determine the effect of incorporating pre and probiotics

in the diet on health.
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Chapter 10: Pre & Probiotics
You are what you eat, or more accurately, you are what you feed the
trillions of li le organisms that live in your gut.
The lining of your gut, like every surface of your body, is covered in
microscopic creatures, mostly bacteria. These organisms create a
micro-ecosystem called the microbiome. And though we don't really
no ce it's there, it plays an oversized role in your health and can even
a ect your mood and behavior.
Not surprisingly, what you feed your microbiome may have the
biggest impact on its health. And the healthier it is, the healthier you
are.
The key to a healthy microbiome is nourishing a balance among the
nearly 1,000 di erent species of bacteria in your gut.
There are two ways to maintain this balance — helping the microbes
already there to grow by giving them the foods they like (prebio c)
and adding living microbes directly to your system (probio c).
Prebio cs
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Prebio cs are specialized plant bers mainly in the form of
oligosaccharides e.g. fructo-oligosaccharide and galacto-
oligosaccharide. They act like fer lizers that s mulate the growth of
healthy bacteria in the gut.
Prebio cs are found in many fruits and vegetables, especially those
that contain complex carbohydrates, such as ber and resistant starch.
These carbs aren't diges ble by your body, so they pass through the
diges ve system to become food for the bacteria and other microbes.
The list of prebio c foods is long, e.g. onions, garlic, ar chokes, beans,
peas, asparagus and sweet potatoes.
Nowadays, the list of prebio c supplements might be even longer,
but they usually contain a complex carbohydrate such as ber.
Supplement companies market products to speci c condi ons, such as
bone health and weight management, claiming that their ingredients
enhance the growth of speci c kinds of bacteria.
Probio cs
Probio cs are di erent in that they contain live organisms, usually
speci c strains of bacteria that directly add to the popula on of
healthy microbes in your gut. They survive diges on in the upper gut
and reach the large intes ne to bring about e ects similar to normal
gut ora.
They act by adhering to gut epithelial cells and prevent binding of
food allergens as well as pathogenic and toxic strains of E. Coli and
salmonella.
Importance of gut ora includes:
- they induce non-speci c immunity
- they reduce synthesis of TGs and VLDL in the liver
- they increase absorp on of calcium and magnesium
- they improve lactose intolerance
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- They have poten al an -cancerous e ect since they degrade

carcinogens as N-nitrosoamines and s mulate phagocytes to
destroy growing tumor cells.
Like prebio cs, you can take probio cs through both food and
supplements. Probably the most common probio c food is yogurt.
Yogurt is made by fermen ng milk with di erent bacteria, which are
le in the nal product. Other bacteria-fermented foods, such as
kombucha and kimchi, are also good sources of probio cs.
Probio c supplements also contain live organisms. A single dose may
include a par cular strain of microbe or blend of microbes. Like with
prebio c supplements, probio c supplement companies market
products to speci c condi ons, such as irritable bowel syndrome.
Synbio c
Combined pre and probio c to improve the survival of the probio c

organism.
e.g. bi dobacteria + fructose oligosaccharides
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Summary:
1) Probio cs are a form of living organism (bacteria or yeast) that
helps regulate GIT ora and diges on.
2) Prebio cs are a form of ber that serve as food for probio cs.
3) Both of them help maintain and develop gut ora, which is
essen al for health.
4) Natural sources for pre and probio cs are available, in addi on
to supplementa on.
Compare between pre and probio cs, their sources and their e ects
on the body.
Chapter 11: Food Safety

following:
1) Recognize the importance of avoiding food borne illness.
2) Understand how food can be contaminated.
3) Determine the various methods by which food can be

kept safe from contamination.
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Chapter 11: Food Safety
Foodborne Illness
Upset stomach Fever
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Vomiting Diarrhea
Dehydration (sometimes severe)

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Paralysis
Don't count on the sight, smell or taste of food to

ensure its safety!!!
People at high risk of foodborne illness include:

- Infants
- Elderly
- Pregnancy
- Immunocompromised patients
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Therefore, the USDA dietary guidelines

developed ive “Key Recommendations” for food
safety.
Recommendation 1: CLEAN
- Clean hands,
food-contact surfaces, fruits
and vegetables.
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Hand washing is the most effective way to stop
spreading of infection.
- Clean during food preparation

Wash cutting boards, knives, utensils and counter tops
in hot soapy water after preparing each food and
before going on to the next.
- Avoid spreading bacteria

- Use paper towels or clean cloths to wipe
up kitchen surfaces
or spills.
- Wash cloths often in the hot cycle of your
washing machine and dry in a hot dryer.
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- Dirty dishcloths spread bacteria

- Wet or damp dishcloths are ideal environments
for bacterial growth.
- Have a good supply of dishcloths to avoid reusing
them before laundry day.
Recommendation 2: SEPARATE
Separate raw, cooked, and

ready-to-eat foods while shopping, preparing or
storing foods.
- Use different cutting boards
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Use one cutting board for fresh produce and a
separate one for raw meat, poultry and seafood.
Replace cutting boards

if they become excessively worn or develop
hard-to-clean grooves.
Recommendation 3: COOK
Cook foods to a safe temperature to kill

microorganisms.
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The ONLY way to know food has been cooked to a

safe internal temperature is to use a food
thermometer!
Placing a food thermometer

1. Place in the thickest part of food.
2. Do NOT touch bone, fat, or gristle.
3. Begin checking temperature toward the end of
cooking, but before the food is expected to be
"done."
4. For irregularly shaped food – such as with a beef
roast – check the temperature in several places.
5. Clean thermometer with hot soapy water before
and after each use!
Recommendation 4: CHILL
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Chill (refrigerate) perishable foods promptly and

defrost foods properly.
The TWO-hour rule

Refrigerate perishable foods so TOTAL time at
room temperature is less than TWO hours or
only ONE hour when temperature
is above 90 degrees F.
Perishable foods include:
• Meat, poultry, ish, eggs, tofu
• Dairy products
• Pasta, rice, cooked vegetables
• Fresh, peeled/cut fruits and vegetables
DANGER ZONE
Bacteria multiply rapidly between 5 and 60

degrees C.
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Bacteria numbers can double in 20 minutes!
How many bacteria will grow from 1 BACTERIA

left at room temperature 7 hours?
Answer: 2,097,152!
The THAW LAW
• Plan ahead to defrost foods.

• The best way to thaw perishable foods is in the
refrigerator.
• Refrigerated leftovers may become unsafe within
3 to 4 days.
• If in doubt, toss it out!
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Recommendation 5: AVOID...
• Raw (unpasteurized) milk or milk products

• Raw or partially cooked eggs and foods containing
raw eggs
• Raw and undercooked meat and poultry
• Unpasteurized juices
• Raw sprouts
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Food safety recommendations

for food groups
Cleaning fruits & vegetables:
1. Remove and discard outer leaves.

2. Rinse under clean, running water just before
preparing or eating.
3. Rub briskly – scrubbing with a clean brush or
hands – to remove dirt and surface
microorganisms.
4. Don’t use soap or detergent.
5. After washing, dry with a clean cloth or paper
towel.
6. Moisture left on produce may promote survival
and growth of microorganisms. Drying is critical if
food won’t be eaten or cooked right away.
7. Cut away bruised and
damaged areas.
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Dairy products:
• Avoid raw (unpasteurized) milk or milk products
such as some soft cheeses.
• Refrigerate dairy foods promptly. Discard dairy
foods left at room temperature for more than two
hours – even if they look and smell good.
Do NOT drink milk directly from the carton.
Meat & beans:

Avoid washing raw meat & poultry!!
- Do NOT wash raw meat and poultry. Washing is not
necessary.
Washing increases the danger of cross-contamination,
spreading bacteria present on the surface of meat and
167
poultry to ready-to-eat foods, kitchen utensils, and counter

surfaces.
- Store raw meat, poultry and seafood on the bottom
shelf of the refrigerator so juices don’t drip onto
other foods.
- Avoid raw or partially cooked eggs or foods
containing raw eggs and raw/undercooked meat
and poultry.
Chemicals should not be forgo en?

Microorganisms are not the only cause of foodborne illness. People
also get sick from poisonous chemicals, which include:
Natural toxins;
Metals and environmental pollutants
Chemicals used for trea ng animals
Improperly used pes cides
Chemicals used for cleaning
Improperly used food addi ves.
Summary:
1) There are 5 major recommendations for food safety.
2) Each rule addresses a speci ic element that could affect safety
of food.
3) Each food group has its speci ic recommendations to
maintain its cleanliness.
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4) Chemicals from many sources can affect food resulting in food
borne toxicity.
What are the ive “Key Recommendations” for food safety?
Chapter 12: Nutrition for Oral and Dental Health

following:
1) Understand the effect of diet on the development of teeth

in children.
2) Recognize the different types of food that increase the

incidence of caries.
3) Determine the methods by which caries can be avoided.
4) Determine the methods by which food combining can

reduce the incidence of caries.
169
Chapter 12: Nutrition for Oral and Dental Health
Diet and nutrition play key roles in tooth development, integrity of the
gingiva and mucosa, bone strength and the prevention and management
of diseases of the oral cavity. Diet has a local effect on tooth integrity,
the type, form, frequency of food and beverages consumed have a direct
effect on the oral pH and microbial activity, which may promote dental
decay.
Nutrition and diet affect the oral cavity, but the reverse is also true
where the status of the oral cavity may affect one’s ability to consume
an adequate diet and achieve nutritional balance. Indeed, there is a
lifelong synergy between nutrition and the integrity of the oral cavity in
health and disease related to the role of nutrients in growth,
development and maintenance of the oral cavity, bones and tissues.
1) Primary tooth development begins at 2-3 months gestation while

mineralization begins at 4 months gestation and continues
throughout the teen years. Therefore, maternal nutrition must
supply the pre-eruptive teeth with appropriate building materials.
2) Dental caries: this is an oral infection caused by (1) a susceptible

tooth surface (2) microorganisms as Streptococci or
Lactobacillus in the oral cavity (3) fermentable carbohydrates in
the diet which serve as substrates for the bacteria and (4) time in
the mouth for the bacteria to metabolize the carbohydrates to
produce acids and cause the salivary pH to drop less than 5.5.
Once this occurs, demineralization process of the tooth with
caries production starts to occur.
170
Cariogenic food: these include fermentable carbohydrates as

sugar, honey, molasses, crackers, chips, pretzels and breads.
The form and consistency of a food have a significant effect o its
cariogenic potential. Liquids are rapidly cleared form the mouth
and have low retentiveness capabilities, whereas solid foods such
as crackers, dry cereals and cookies can stick between the teeth
(interproximal spaces) and have high retention capability.
Cariostatic foods: do not contribute to decay, are not

metabolized by microorganisms and do not cause a drop of
salivary pH e.g. eggs, fish, meat, poultry, vegetables, fats and
sugarless gums.
Anticariogenic foods: these are food when eaten before an

acidogenic food prevents plaque from recognizing the
acidogenic food e.g. aged cheddar, calcium and phosphate in
cheese, xylitol in gum
Sequence and frequency of eating:

Eating sequence and combination of food also affect the caries
potential e.g. bananas are cariogenic because of their fermentable
carbohydrate content and retention ability, have less potential to
produce caries when eaten with milk as a snack since milk reduces the
retention ability of fruits.
The frequency of eating cariogenic food or beverage determines
the number of opportunities for acid production. A decline of pH drops
within 5 to 15 min causing caries. Frequent snacking of cariogenic food
increases the incidence of caries production.
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In November 2015, the Food and Drug Administration recommended

people over the age of 3 eat no more than 12.5 teaspoons (50 grams) of
added sugar a day (about the same amount that is found in a can of
Coke.) Sugar, the FDA says, should make up no more than 10 percent
of your daily calories.
The bacteria in your mouth use carbohydrates for food, so when you cut
back on sugar, and other sources of simple carbohydrates that are easily
fermentable, you reduce your cavity risk. Limit added sugars in your
diet by reading food labels to determine the amount of added sugar in a
food. Since ingredients are listed on the label in order of weight, from
most to least, if one of the following terms is listed as one of the first
few ingredients, it’s a good bet that food is high in sugar
Here are some common added sugars:

• sugar • glucose
• brown sugar • dextrin
• cane sugar • evaporated cane juice
• confectioners' or powdered • fruit juice concentrate
sugar • honey
• turbinado sugar • high fructose corn
• raw sugar syrup
• corn sweeteners • invert sugar syrup
• corn syrup • malt syrup
• crystallized cane sugar • maple syrup
• maltose • molasses
• fructose •
• sucrose
Top Sources of Added Sugar in the Diet and Percentages

• soft drinks, energy drinks, sports drinks, 35.7%
• grain-based desserts (cakes, pies) 12.9%
• fruit drinks 10.5%
• dairy-based desserts (ice cream) 6.5%
• candy 6.1%
• ready-to-eat cereals 3.8%
• sugars and honey 3.5%
• tea (sweetened) 3.5%
• yeast breads 2.1%
• all other foods 15.4%
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• Sugar substitutes may look and taste like sugar but they don’t
promote decay-causing acids in your mouth that can harm teeth.
There are many types of sugar substitutes, including aspartame,
erythritol, saccharin, sucralose, isomalt, sorbitol, acesulfame
potassium and mannitol. You might recognize some of these names
from ingredient lists on food packages, or know some of them by
their brand names (Splenda, Equal and Sunett).
Caries prevention guidelines:

- Brush teeth twice daily, preferably after meals.
- Rinse mouth after meals and snacks.
- Chew sugarless gum for 15-20min after meals and snacks.
- Floss twice daily.
- Use fluorinated toothpaste.
- Pair cariogenic food with cariostatic food.
- Snack on cariostatic and anticariogenic food such as cheese, nuts,
popcorn and vegetables.
- Limit between meal eating and drinking of fermentable
carbohydrates.
3) Saliva: saliva is supersaturated with calcium and phosphorus to

buffer acidic pH to allow remineralization. If fluoride is present
in the saliva, the minerals are deposited in the form of
flouroapatite, which is resistant to erosion.
Any disease or drug that reduces saliva and causes dryness of the
mouth e.g. diabetes, antihypertensive drugs, will increase the
incidence of caries.
4) Fluoride: the effect of fluoride on caries prevention is available

by fluorinated water, toothpaste and oral rinses.
Most food, unless prepared by fluorinated water, contain
minimal amounts of fluoride. In communities without
fluorinated water, supplements will be required.
No child younger than 6 months or older than 16 years should be
supplemented to avoid fluorosis, which results in dark spots on
the teeth.
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5) Tooth loss and dentures: have a significant effect on dietary

habits, masticatory function and nutritional adequacy where the
intake of fruits, vegetables and whole grains may be affected.
6) Periodontal disease: is basically an inflammation of the gums

caused by oral bacteria, which could result in tooth loss in severe
cases. Deficiencies of vitamin C, folate and zinc increase the
incidence of periodontal disease.
The roles of calcium and vitamin D relate to the link between
periodontal disease and osteoporosis in which bone loss is a
common denominator.
Summary:
1) Caries a ects teeth when bacteria accumulate and the pH drops
in the oral cavity.
2) Food can be divided in cariogenic, cariosta c and ant-cariogenic.
3) Food combina ons and the ea ng mings a ects the cariogenic
poten al of food.
4) Poor oral health will a ect ea ng habits and vice versa.
Analyze the reasons why certain food combina ons are detrimental for
oral health.
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References:

** Lippincott William’s & Wilkin’s
Manual of Nutritional Therapeutics, 6th
edition, 2015.
ISBN-13:978-1451191875.
175

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Basics

Faculty of Oral and Dental Medicine

‫رؤﯾﺔ ورﺳﺎﻟﺔ اﻟﻜﻠﯿﺔ‬

Intended learning outcomes of course (ILOs)

c. Professional and practical skills:

Basics of Food and Health (FAH 101)

Chapter 1: Energy requirements & BMI

Chapter 2: Body composition & anthropometry

Chapter 3: Exchange lists and meal planning

Chapter 4: Macronutrients : Carbohydrates, Proteins and

Chapter 5: Micronutrients: importance & deficiency

Chapter 6: Obesity: causes and management

Chapter 7: Malnutrition: causes and management

Chapter 8: FAD diets

Chapter 9: Water & electrolytes

Chapter 10: Pre & probiotics

Chapter 11: Food safety & storage

Chapter 12: Nutrition & dentistry

Nutrition is the science of diet and health — everything from how

Nourishing our bodies is no small task. In fact, it takes over 40

• Carbohydrates are the body’s major source of energy, or calories.

• Fats transport nutrients, plus they’re part of the structure in many

• Vitamins don’t provide calories, yet they’re extremely important,

• Minerals are similar to vitamins; they don’t provide calories, and

• Water is often called “the forgotten nutrient” because people don’t

Certain Nutrients Provide Energy

Before reviewing the six groups of nutrients in more detail, it’s

we use to measure energy for the body.

Three types of nutrients in our foods provide calories: proteins, fats

A teaspoon of oil (pure fat) weighs 5 grams and provides 45 calories.

There is one other source of calories — alcohol, which provides 7

Chapter 1: Basic Energy Needs

Student Learning Outcomes (SLOs)

By the end of this chapter, the student should demonstrate

1. Describe the energy requirements for different cases.

Chapter 1: Basic Energy Needs

• The body needs constant energy for voluntary and involuntary

• Fuel is provided in the form of nutrients.

▪ Foods high in fat have the highest caloric density.

Basal Metabolic Rate (BMR)

Measurement of Basal Metabolic Rate

Factors Influencing Basal Metabolic Rate

• Another method to calculate BMR is by the Harris Benedict

Female = 655 + 9.6(W) +1.8(H) – 4.7(A)

Energy Expenditure per Pound per Hour

• Very light/sedentary = 1.3

Thermic Effect of Food

Total Energy Requirement

Chapter 2: Body Composition & Anthropometry

Student Learning Outcomes (SLOs)

By the end of this course, the student should demonstrate

1) Understand the concept of different body

Chapter 2: Body Composition & Anthropometry

For a more detailed body composition analysis, we should use the

Other ways to address body components is by:

Body Mass Index (BMI)

What does skinny fat mean?

Health risk based on BMI:

▪ More than 40= Extremely high

Diet Classification according to Caloric Intake:

Ideal body weight:

Adjusted body weight:

▪ Adjusted weight is where the patient can lose enough weight to

▪ Weight loss of as little as 5-15% of initial weight improves many