The Silent Suffering
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[Nutrition]
MYTH V. FACT
Sugar Causes Diabetes
The most common nutrition myth is probably that sugar causes diabetes. If you have diabetes, you do need to watch your sugar and carbohydrate intake, with the help of your Registered Dietitian, to properly manage your blood sugar level. However, if you do not have diabetes, sugar intake will not cause you to develop the disease. The main risk factors for Type 2 diabetes are a diet high in calories, being overweight, and an inactive lifestyle. (Health Castle)
All Fats are bad
It's a long-held nutrition myth that all fats are bad. But the fact is, we all need fat. Fats aid nutrient absorption and nerve transmission, and they help to maintain cell membrane integrity - to name just a few of their useful purposes. However, when consumed in excessive amounts, fats contribute to weight gain, heart disease and certain types of cancers.
Not all fats are created equal. Some fats can actually help promote good health, while others increase the risk for heart disease. The key is to replace bad fats (saturated fats and trans fats) with good fats (monounsaturated fats and polyunsaturated fats. (Health Castle)
Brown Sugar is better than White Sugar
The brown sugar sold at grocery stores is actually white granulated sugar with added molasses. Yes, brown sugar contains minute amounts of minerals. But unless you eat a gigantic portion of brown sugar every day, the mineral content difference between brown sugar and white sugar is absolutely insignificant. The idea that brown and white sugar have big differences is another common nutrition myth. (Health Castle)
Eating for two is necessary during pregnancy
Energy requirements vary among individuals. Unfortunately, the idea that pregnancy is an ice cream free-for-all is a nutrition myth. It is generally recommended that pregnant women increase their daily intake by 100 kcal in the first trimester and 300 kcal in the second and third trimesters. An extra snack before bedtime consisting of a fruit, a serving of milk or yogurt, and a few biscuits is often enough.
A daily prenatal multivitamin supplement is often recommended during pregnancy, but not a daily bowl of ice cream! (Health Castle)
Skipping meals can help lose weight
Many people think that by skipping a meal, they will be eating less food and therefore lose weight. As we now know, this is a nutrition myth. People who think skipping meals means weight loss do not understand how our bodies work.
If you skip a meal, your body will think that you are in starvation mode and therefore slow down the metabolism to compensate. You then tend to overeat at the next meal. Often, skipping a meal and then eating too much at the next one means that you have a higher total caloric intake than if you just ate more frequently throughout the day. A better approach is to eat smaller frequent healthy meals and snacks to keep your blood sugar balanced. (Health Castle)
Red meat is bad for health
I often hear people saying that they do not eat red meat. When I ask why they don't, or even what they consider to be red meat, the answers vary dramatically.
It is true that some studies have linked red meat with increased risk of heart disease, partly due to the saturated fat content. In fact, even chicken can contain as much saturated fat as lean cuts of beef or pork. For instance, a serving of sirloin beef or pork tenderloin has less saturated fats than the same serving size of chicken thigh with skin. It is true that poultry like chicken and turkey is naturally lower in saturated fats. But it is only true IF you do not eat the skin.
It is a nutrition myth, however, that red meat is altogether bad for your health. Instead of excluding red meats, choose leaner cuts of beef and pork. For beef, choose eye of round, top round roast, top sirloin and flank; for pork, choose tenderloin and loin chops. (Health Castle)
Vitamin supplements are necessary for everyone.
If you eat a variety of fruits, vegetables, and whole grains, along with moderate amounts of a variety of low-fat dairy and protein and the right quantity of calories, you don't need to supplement. Most Americans do not, so a multi-vitamin might be good. Special vitamin supplements are also recommended for people who are pregnant or have nutritional disorders. (Newsday)
Sources
Tsang, Gloria. "Top 10 Diet & Nutrition Myths Debunked." Healthcastle.com. Nov. 2005. Web. 24 Oct. 2009.
"Dispelling the Top 10 Nutrition Myths." Newsday.com. Newsday, Mar.-Apr. 2007. Web. 24 Oct. 2009.
Under Construction
Proteins
Functions
Requirements
______________________________________________
Carbohydrates
Function
Simple v. Complex Carbohydrates
Fat
Saturated v. Unsaturated
Healthy "low-fat" diets contain about 20 -30 % of calories from fat. Diets lower in fat than this are not healthy.
UNDER CONSTRUCTION
Herrin, Marcia. Nutrition Counseling in the Treatment of Eating Disorders. New York: Brunner-Routledge, 2003. Print.
How are they harmful?
Why they don't work.
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UNDER CONSTRUCTION.
Please continue to check back.
Vitamin A [Retinol]
RDA
Men [age 19 and up] 900 micrograms
Women [age 19 and up] 700 micrograms
liver, sweet potato, carrot, broccoli, kale, butter, spinach, leafy vegetables
Function/Importance
Vision, Gene Transcription, Immune Function, Embryonic Development and reproduction, Hematopoiesis, Skin Health, Reducing risk of heart disease, antioxidant activity
Deficiency
Impaired vision, night blindness. Persistent deficiency gives rise to a series of changes, the most devastating of which occur in the eyes. Other changes include impaired immunity, hypokeratosis (white lumps at hair follicles), keratosis pilaris and squamous metaplasia of the epithelium lining the upper respiratory passages and urinary bladder to a keratinized epithelium. With relations to dentistry, a deficiency in Vitamin A leads to enamel hypoplasia. [Source]
Toxicity
nausea, jaundice, irritability, anorexia (a medical symptom meaning loss of appetite, not the eating disorder), vomiting, blurry vision, headaches, hair loss, muscle and abdominal pain and weakness, drowsiness and altered mental status.
Chronic toxicity - hair loss, dry skin, drying of the mucous membranes, fever, insomnia, fatigue, weight loss, bone fractures, anemia, and diarrhea can all be evident on top of the symptoms associated with less serious toxicity. [Source]
Beta Carotene
[see vitamin A]
Carrots, Squash, Broccoli, Green Leafy Vegetables
Antioxidant. Converted to Vitamin A in the body. May assist in reducing the risk of certain forms of cancer [not effectively proven]
Vitamin D
5 mcg. (10-15 mcg in the elderly)
Sunlight. Is rare in food, but may be found in some fatty fish (salmon, sardines...), fish liver oils, and some eggs from hens fed Vitamin D
Calcium balance, immune function, insulin secretion, blood pressure regulation
decreased calcium absorption, rickets, osteomalacia, muscle weakness and pain, osteoporosis
Hypercalcemia
Vitamin E
15 mg
vegetable oils, nuts, whole grains, green leafy vegetables
Acts as an antioxidant
Mainly neurological symptoms (impaired balance and coordination, injury to sensory nerves, muscle weakness, damage to retina of eye). These may be evident immediately in children, but may not manifest in adults with Vitamin E deficiency for many years.
Impaired blood clotting
Vitamin K
120 mcg (men); 90 mcg (women)
Green leafy vegetables, some vegetable oils
Coagulant, bone mineralization
Impaired blood clotting (may manifest as easy bruising, nose bleeds, bleeding gums, blood in urine or stool, heavy menstruation)
Vitamin B1 [Thiamin]
1.2 mg (men); 1.1 mg (women)
Whole grain cereals, legumes, nuts, lean pork, yeast
Required coenzyme function
Beriberi
anaphylactic reactions in high IV doses
Vitamin B2 [Riboflavin]
1.3 (men), 1.1 (women)
enriched wheat flour and bread, most animal and plant derived foods
redox reactions, antioxidant
Ariboflavinosis - which usually occurs in conjunction with other water soluble vitamin deficiencies (symptoms are sore throat, cracks and sores on mouth/lips, inflammation of tongue, skin inflammation, decreased red count), preeclampsia,
unknown
Vitamin B3 [Niacin]
16 mg (men); 14 mg (women)
Yeast, Meat, Poultry, Red Fish, Cereals, legumes, seeds
redox reactions
Pellagra (Symptoms are the "four D's" - Dermatitis, Diarrhea, Dementia, Death)
Vitamin B5 [Pantothenic Acid]
5 mg
liver and kidney, yeast, egg yolk, broccoli
A component of Coenzyme A
Deficiency is rare. May manifest as tingling, burning feet
Diarrhea
Vitamin B6
1.3 mg (1.5 men and 1.7 women after age 50)
Fortified cereals, bananas, salmon
Proper nervous system function, Red blood cell formation, hormone function
Seizures, abnormal EEG patterns, irritability, depression, confusion
Vitamin B12
2.4 mcg
Clams, Mussels, Crabs, Salmon, Beef, Chicken Turkey, Egg
Megaloblastic anemia, neurologic symptoms (numbness and tingling of the arms and, more commonly, the legs, difficulty walking, memory loss, disorientation, and dementia with or without mood change). Tongue soreness, appetite loss, and constipation have also been associated with vitamin B12 deficiency.
No toxic or adverse effects have been associated with large intakes of vitamin B12 from food or supplements in healthy people. Doses as high as 1 mg (1000 mcg) daily by mouth or 1 mg monthly by intramuscular (IM) injection have been used to treat pernicious anemia without significant side effects
Biotin
30 mcg
Egg yolk, Liver, Yeast
Signs of overt biotin deficiency include hair loss and a scaly red rash around the eyes, nose, mouth, and genital area. Neurologic symptoms in adults have included depression, lethargy, hallucination, and numbness and tingling of the extremities. The characteristic facial rash, together with unusual facial fat distribution, has been termed the "biotin deficient facies" by some investigators
Biotin is not known to be toxic.
Folic Acid
400 mcg
The only function of folate coenzymes in the body appears to be in mediating the transfer of one-carbon units. Folate coenzymes act as acceptors and donors of one-carbon units in a variety of reactions critical to the metabolism of nucleic acids and amino acids.
Megaloblastic Anemia
Vitamin C
90 mg (male); 75 mg (female)
Orange Juice, Grapefruit Juice, Oranges, Grapefruit, Strawberries
Vitamin C is required for the synthesis of collagen, an important structural component of blood vessels, tendons, ligaments, and bone. Vitamin C also plays an important role in the synthesis of the neurotransmitter, norepinephrine.
Scurvy
A number of possible problems with very large doses of vitamin C have been suggested, mainly based on in vitro experiments or isolated case reports, including genetic mutations, birth defects, cancer, atherosclerosis, kidney stones, "rebound scurvy", increased oxidative stress, excess iron absorption, vitamin B-12 deficiency, and erosion of dental enamel.
Calcium
1200 mg
Calcium is a major structural element in bones and teeth.
Phosphorus
Magnesium
Hypocalcemia, neurological and muscular symptoms (tremors, spasms, tetany), retention of sodium, loss of appetite, nausea, vomiting, personality changes.
Potassium
4700 mg
Fruits & Vegetables
Hypokalemia. Symptoms include fatigue, muscle weakness and cramps, intestinal paralysis. Severe hypokalemia can lead to muscle paralysis and abnormal heart rhythms that can be fatal.
Hyperkalemia. Symptoms include tingling hands and feet, muscular weakness, temporary paralysis. Development of abnormal heart rhythm can also occur, which can lead to cardiac arrest.
Iron
8 mg (men); 18 mg (women 19-50)
Beef, chicken, oysters, shrimp
Oxygen transport and storage
There are 3 levels of iron deficiency-
1) Storage Iron Depletion
2) Early Functional Iron Deficiency
3) Iron Deficiency Anemia
Symptoms: fatigue, rapid heart rate, palpitations, and rapid breathing on exertion
Iron toxicity can be life threatening. Symptoms range from nausea, vomiting, & rapid pulse to vital organ damage.
Zinc
11 mg (men); 8 mg (women)
Shellfish, Beef, Red meats
Important for cellular metabolism, growth and development, immune response, neurological function, and reproduction.
Symptoms: slowing or cessation of growth and development, delayed sexual maturation, characteristic skin rashes, chronic and severe diarrhea, immune system deficiencies, impaired wound healing, diminished appetite, impaired taste sensation, night blindness, swelling and clouding of the corneas, and behavioral disturbances.
Abdominal pain, diarrhea, nausea, vomiting
Selenium
55 mcg (adults)
Organ meats, seafood
According to the Linus Pauling Institute, "Insufficient selenium intake results in decreased activity of the glutathione peroxidases as well as some other thioredoxin reductase and thyroid deiodinases. Even when severe, isolated selenium deficiency does not usually result in obvious clinical illness. However, selenium-deficient individuals appear to be more susceptible to additional physiological stresses"
Copper
900 mcg (adults)
Organ meats, shellfish, nuts, seeds
Energy production, Connective tissue formation, Iron metabolism, normal function of the brain and nervous system, melanin formation
Anemia (unresponsive to Iron supplementation but responsive to copper), losss of pigmentation, osteoporosis in young children, neurological symptoms, impaired growth, neutropenia
Abdominal pain, nausea, vomiting, diarrhea. More serious toxicities could cause coma or death.
Manganese
2.3 mg (adult Males); 1.8 mg (adult Females)
Whole grains, nuts, leafy vegetables, teas
Antioxidant, Metabolism of Carbohydrates, Amino Acids and Cholesterol, Bone Development, Wound healing.
neurologic complications
Molybdenum
45 mcg/day
Legumes, Grains
Molybdenum is an essential trace element for virtually all life forms. It functions as a cofactor for a number of enzymes that catalyze important chemical transformations in the global carbon, nitrogen, and sulfur cycles (1). Thus, molybdenum-dependent enzymes are not only required for human health, but also for the health of our ecosystem. It is essential to human and plant life in metabolizing nucleic acids (RNA, DNA).
Hormonal Imbalance
SOURCES
Lpi.oregonstate.edu. Linus Pauling Institute - Oregon State University. Web. 24 Oct. 2009.
Weight Restoration
The following information was taken from the book Nutrition Counseling in the treatment of Eating Disorders by Marcia Herrin:
"Prior to improvements in food intake, patients with anorexia nervosa have metabolic rates that are lower than would be predicted for subjects of similar height, weight, and age. Loss of body weight, reduced muscle mass, and increased caloric efficiency are likely contributors to depression in metabolic rates. These findings help to explain the well known clinical observation that anorexic patients are able to maintain weight with low caloric intakes.
Yet, the calories required to sustain weight gain in anorexic patients are consistently higher than would be predicted by standard energy-requirement calculations. Possible explanations for this phenomenon include the substantial calorie costs of growing lean body tissue and restoring depleted fat stores. Heat dissipation associated with improved nutrition and increases in heart rate are also thought to contribute to the increased calorie needs of the recovering anorexic. A number of studies indicate that weight-restored anorexic patients continue to have elevated calorie needs for some time. [They] speculate that anorexic patients may have constitutionally higher-than-average metabolisms and, as a result, require liberal calorie intake over the long term to maintain weight.
On the contrary, it has been shown that patients who previously maintained a relatively high premorbid weight or have had a history of bulimia will be able to restore body weight with calorie levels that are substantially less than patients who had low or normal premorbid weight.
For most patients, caloric needs continue to increase as weight is gained; caloric needs peak as patients approach normal weight levels. Vigorous exercise and compulsive activity, such as pacing or constant fidgeting, will further increase caloric needs.
Despite below normal calorie intakes, some patients gain modest amounts of weight when calories are first increased. Two explanations are likely: First, if a patients metabolic rate remains depressed, small changes in caloric intake induce weight gain. This is a temporary phenomenon. Increases in metabolic rate with weight restoration occur reliably. Second, sudden increases in weight may indicate rehydration of a formerly dehydrated patient.
Gradual increases in the caloric content of weight-gain diets reduces risk of refeeding edema and congestive heart failure. Very-low-weight patients who are fed via feeding tube or total parenteral nutrition are at most risk.
Another consequence of chronically maintaining a lower-than-normal calorie intake is an increased risk for binge eating. Urges to binge may be especially acute when dietary intake is first augmented, particularly if only minimal improvements are made. When anorexic patients binge, the amounts eaten are generally considerably less than is characteristic of an authentic binge. Patients, nevertheless, will be quite distressed about these episodes, which may be as insignificant as eating one unplanned cookie. They will report feeling out-of-control and guilty for consuming more than they usually do or for eating foods they used to make a point of avoiding. Whether anorexic patients act on their urge to binge or not, the fear of succumbing to these urges reinforces restrictive eating patterns.
Physical Obstacles
Gastric discomfort is typical when underweight patients begin to improve dietary intake. Common complaints include early satiety, bloating, indigestion, constipation, and excessive gas. These usually resolve within four to six weeks as eating patterns become normalized and weight is gained. Moreover, even normal sensations of satiety may be explained as unpleasant by these patients.
When severely malnourished and very underweight patients first begin to improve their food intake, they are at risk for developing refeeding syndrome if refed too quickly. Refeeding syndrome is characterized by sudden and unexplained death, presumably secondary to cardiac arrhythmia. Particularly at risk for refeeding syndrome are those who have not eaten for 7 to 10 days. Patients who weigh less than 70% of ideal body weight and those who are refed by feeing tube or TPN are also at risk.
Refeeding can also cause acute dilation of the stomach, characterized by the sudden onset of abdominal pain, nausea, vomiting, and abdominal distention. Patients so malnourished by their eating disorder that refeeding creates medical risks almost always require hospitalization to adequately monitor medical status. Anorexic patients naturally hesitate to eat too much too soon, so rarely experience these complications as outpatients.
Some patients resort to overconsumption of fluids when faced with the need to restore body weight. Consumption of 6 to 10 liters of water over the course of 24 hours can result in sudden death. Water intoxication has been linked to ataxia, seizure, and coma.
REMINDERS FOR PATIENTS
-Only corrected food intake will correct malnutrition and their gastrointestinal distress.
-During weight restoration, you will probably have episodes of extreme hunger causing you to eat more than you have planned. This hunger, more than likely, is the bodys way of ensuring that there are enough nutrients and calories to begin the backlog of biological repair work that was put on hold during the phases of undereating."
Source
