Gut Health

• Characteristics of an enzyme

• Function of major/accessory organs of the digestive system

• Digestion and absorption of macronutrients

• Diet and lifestyle modifications for GI complications

  • GERD

    • Decrease spicy, acidic foods

    • Sit upright

    • Eat smaller meals, rather than large meals

    • Avoid caffeine

  • Ulcers

    • Eat more probiotics

    • No smoking or drinking

    • Increase vitamins and minerals

  • Gallstones

    • Increase fiber

      • Fiber can lower total cholesterol levels

    • Decrease alcohol

    • Avoid excess calories and excess fats

  • Diarrhea

    • Increase fluids, electrolytes

    • BRAT diet

  • Constipation

    • Increase fiber

    • Increase fluids

    • Physical activity

Diabetes and Obesity

• Health risks associated with excess body fat

  • Visceral fat is located deep within the central abdomen

    • Raises the risks of:

      • Hypertension

      • Heart Disease

      • Stroke

      • Diabetes

  • Subcutaneous fat is located on the surface on the skin; more on the lower body, such as hips, thighs, butts

• BMI uses weight and height to measure how healthy you are

  • However, it doesn’t take into account muscle mass and genetic blueprint

  • BMI is not accurate for athletes or bodybuilders

• Hormonal regulation of hunger/satiety

  • Leptin is hormone produced by fat, adipose tissue

    • Increases energy expenditure

    • Tells us that we’re full

    • Suppress hunger

  • Ghrelin is hormone produced in the stomach

    • Stimulates hunger

    • Reduces energy expenditure

• Treatments of Obesity

  • Roux-en-Y Gastric Bypass

    • Cuts and bypass the midsection of the small intestine

    • Reattach to the new, small stomach pouch

    • Stomach size is reduced to large egg

    • Restriction of large amounts of food:

      • Reduce the actual size from about 400 mL to a mere 15-20 mL

    • Malabsorption of nutrients:

      • Malabsorption of fats and carbohydrates which further adds to the efficacy of the procedure

  • Vertical Sleeve Gastrectomy

    • The left side of the stomach is surgically removed

      • Sort of like the shape of a banana

      • Can’t drink or eat a lot at a given time

      • Decrease ghrelin secretion (since ghrelin is produced in the stomach)

    • No “rerouting” or reconnecting the intestines. Simpler operation than the gastric bypass

      • So, no interference in absorption or digestion

    • Only causes restriction of food, no malabsorption

    • Has been shown to resolve diabetes within days after surgery without weight loss

  • Adjustable Gastric Banding

    • Purely a restrictive procedure

    • Requires implant of band but no surgical resectioning of the stomach or intestines

    • The band is an inflatable balloon connected to a port that is implanted under the skin

    • Complications: erosion and slippage

• Hormonal regulation of blood glucose

  • Insulin

    • Produced in pancreas

    • Comes from beta cells

    • Produced when blood sugar is high

    • Signal body to receive glucose

    • Considered growth hormone because it promotes glycogen storage (stored glucose), protein, and fat synthesis

  • Glucagon

    • Produced in pancreas

    • Comes from alpha cells

    • Produced when blood sugar drops

    • Tell body to break down glycogen storage (glycogenolysis)

    • Stimulate lipolysis (lip - fat, olysis - break down)

  • Epinephrine

    • When blood sugar is low

    • When we need the instant energy

• Type 1 vs Type 2 Diabetes Mellitus

  • Type 1

    • Born with type 1

    • Forever

    • No insulin is produced

  • Type 2

    • Diagnosed with because of obesity, aging, and inherited factors

    • Forever, but therapeutic ways and lifestyle approaches we can implement

    • Ineffective insulin, insulin resistance, insulin deficiency

• Diet and lifestyle modifications for diabetes

  • Total Carbohydrate Intake

    • Consistent CHO Diet

  • Carbohydrate Sources

    • Glycemic effect of a good needs to be considered

    • Avoid foods and beverages with added sugar

  • Dietary fat

    • Saturated fat: <7% of total kcals

    • Cholesterol: <200 mg/day

  • Protein

    • Consider normal kidney function

    • 15-20% of total kcals

  • Alcohol Use in Diabetes

    • Moderation or none at all

Energy Balance and Weight Management

• Positive vs Negative energy balance

  • Negative energy balance: weight loss

    • Calorie intake is lower than calorie output

    • Needs more calories than provided by diet, body breaks down fat stores

  • Positive energy balance: weight gain

    • Calorie intake is greater than calorie output

    • Body stores excess dietary fat in adipose cells

• Energy expenditure

  • Basal Metabolic Rate (50-65%)

    • Energy burned at rest

    • Energy that is used to keep our organs healthy

    • Circulate blood

    • Exchange oxygen and carbon dioxide

    • Things we don’t control or feel but require a lot of calories

  • Non Exercise Activity Thermogenesis (NEAT)

    • Technically physical activity but not really

    • Physical activity they don’t know that they’re doing, but still burning calories

    • Standing

  • TEF (5-10%)

    • Calories used to absorb, digest, and metabolize nutrients

  • Physical activity (25-50%)

• Body Mass Index

  • (Weight (lbs) / height (in) ) * 703

  • Underweight

    • BMI < 18.5

  • Healthy weight

    • BMI 18.5 - 24.9

  • Overweight

    • BMI 25 - 29.9

  • Obesity

    • BMI 30 - 39.9

  • Extreme obesity

    • BMI >= 40

• Diet and lifestyle modifications for weight loss and weight gain

  • Weight loss

    • Calorie reduction (3500 kcal)

    • High-volume, low energy dense foods

    • Don’t forget lean protein and fats

    • Increase PA

    • Behavior modification

      • ABC’s

        • A: Antecedent

        • B: Behavior

        • C: Consequence

  • Weight gain

    • Additional 500 kcals/day

    • Increase consumption of energy-dense foods

    • Nutritious beverages

    • Snacks throughout the day

    • May need to be less active

• Health implications of fad diets

  • Low Carb (Atkins, South Beach, Paleo)

    • High in saturated fat, ketosis, strain on kidneys, nutrient deficiencies

  • Low Fat (Macrobiotic, Pritikin, Ornish)

    • High carb, need some fat for absorption of A,D,E,K

  • What about gluten?

    • Higher in fat, lack vitamins/minerals/fiber, restricting variety

• Disordered eating

  • Abnormal or potentially harmful eating patterns

    • Restrictive eating

    • Following fad diets

    • Compulsive or binge eating

    • Irregular eating patterns

    • Ignore hunger cues and satiety

• Eating disorders

  • Psychological illness involving specific abnormal eating; diagnosed by criteria

  • Anorexia Nervosa: self-imposed starvation resulting in malnutrition and low body weight

    • BMI 17.5 or less

    • Effects: amenorrhea, accelerated bone loss, constipation, white hairs on skin, shrunken breasts/buttocks

  • Bulimia Nervosa: cyclic overeating and caloric restriction; binging and purging

    • Difficult to identify by appearance

    • Effects: scrapes/bite marks on knuckles, enamel erosion

  • Binge-Eating Disorder

    • Isolation

    • Feels depressed, ashamed, guilty, disgusted after episode

  • Night Eating Syndrome

    • 50% or more of calories consumed

    • Sleep disturbances

Cardiovascular Disease

• Atherosclerosis

  • Plaque build-up in artery walls

  • Fatty streaks, cholesterol, calcium deposits

  • Blood flow is restricted

  • Rough buildup increases likelihood of clots - thrombus

• Role of lipoproteins

  • High-density Lipoprotein

    • “Good” cholesterol

    • Transports lipids to liver for disposal

      • Scavenge body for fat and take it to liver for disposal

  • Low-density Lipoprotein

    • “Bad” cholesterol

    • Transports lipids out to tissues; contributes to plaque in arteries

  • Very-low-density Lipoprotein

    • Transports mostly triglycerides out to body cells for use

• Classifications of blood lipid levels

  • Saturated Fat

    • Solid at room temperature

    • Animal foods (fatty meats, whole fat dairy, lard) and oils (coconut, palm)

    • Increases LDL cholesterol

  • Unsaturated Fat

    • Liquid at room temperature

    • Plant and animal foods (avocadoes, fish, nuts, seeds)

    • Decreases LDL cholesterol

  • Trans Fat

    • hydrogenated/partially hydrogenated oils

    • Processed and convenience foods

    • Increases LDL cholesterol

    • Decreases HDL cholesterol

    • Avoid trans fat

• Diet and lifestyle practices that influence risk of cardiovascular disease

  • Increase risk of CVD

    • Saturated fat

    • Trans fat

    • High sodium

    • Excess sugar

    • Excess kcals

    • Excess alcohol

  • Decrease risk of CVD

    • Polyunsaturated fat

    • Monounsaturated fat

    • Fiber

    • B vitamins

    • Antioxidants

    • Moderate alcohol

• Hypertension

  • Silent killer because there might be no symptoms

  • Persistent elevated blood pressure

    • Normal = <120/<80

    • Prehypertension = 120-139 (systolic) or 80-90 (diastolic)

    • Hypertension = >=140 (systolic) or >=90 (diastolic)

  • Risk factors

    • Family Hx

    • Age

    • Race/ethnicity

    • Obesity

    • Lack of PA

    • High sodium diet

    • Cigarette smoking

    • Excessive alcohol consumption

    • T2DM