Final Exam Study Guide PDF

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Final exam study guide for Dr. Almstedt...

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Marcella Marcella is training for a marathon coming up in three months. She has read a lot about sports nutrition, and especially about the importance of eating a high-carbohydrate diet while training. She has also been struggling to eat enough to fuel exercise yet keep her weight in a range that she feels contributes to better speed and endurance. Consequently, she is trying to eat as little fat as possible. Unfortunately, over the past month her workouts on the weekends have not met her expectations and she has developed some pain in her right foot. Marcella is scared that she has arthritis in the joint of her big toe (metatarsophalangeal joint). She runs 5 days per week and her weekly long run begins on Saturday morning at 7:00 am. Marcella finds it hard to eat breakfast early in the morning and avoids consuming fluids during her run because it may slow her down. On Tuesday, her breakfast was a large white bagel and orange juice, followed up with coffee. For lunch, she had a small salad with fat-free dressing, a large plate of pasta with tomato marinara sauce, some French bread, and a diet soda. For dinner, she had a small, broiled chicken breast, a cup of rice, some carrots, and green tea. Later, she snacked on fat-free pretzels. Everyone around her at work is sick, so to avoid getting a cold Marcella drinks 1 liter of orange juice a day. Marcella is 20 years old, 5’6”, and weighs 110 pounds. ●

MyPlate ○ Needs 45-65% CHO - maybe even more considering her daily running ■ Fuel source during int exercise ■ Fuel source for CNS, red & white blood cells ○ Needs 20-35% fat ■ Fuel sources @ rest ■ Component of cell membrane ■ Protects organs ○ Needs 10-35% PRO ■ Growth & repair ■ Energy if needed ○ Obvious need for more well rounded diet ■ F/V ■ Grains ■ Dairy

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Immune Health ○ Vit C ■ Neutralizes reactive O2 species ■ Needed to make neutrophils ■ Sources ● All F/V, red peppers, GLV, oranges ○ Vit D ■ Mechanisms ● Improve & support physical barriers ● Enhance innate immune system ● Enhance adaptive immunity ● Increases antioxidant proteins ■ Sources ● Fatty fish, fortified foods, mushrooms ○ DHA ■ ALA, EPA & DHA ■ Anti-inflammatory compounds ■ Incorporated into cell membranes & influence cell structure & fx ■ Sources ● Fish 2x/week, krill & cod liver oil, seaweed, algae ○ Zinc ■ Innate & acquired immunity ■ Vaccine efficacy ■ Synthesis of antibodies ■ Lozenge @ onset of sym can reduce cold duration ■ Sources ● Oyster, beef, poultry, nut, beans, mushrooms, coca, GLV

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Probiotics & Immune Health ○ Mechanisms ■ Interference w/ pathogens ■ Improvement of barrier fx ■ Immunomodulation ■ Neurotransmitter production ○ Gleeson et al (2011) - Probiotics & Infection ■ Methods ● 4 months probiotics use on infection/immune fx during winter ■ Results ● 27% fewer people had URTI in PRO group ● 50% fewer URTI in PRO group ● Severity & duration of infection equal ● Training less affected in PRO group ● # days w/ GI sym 33% lower in PRO

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IgA ○ ○

“Couldn’t directly attribute benefits to any specific improvement of immune fx” ■ Analysis of blood not helpful PRO same level thr/ 16 week & winter PLA group fell off

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CHO & Exercise ○ Super Composition - can result in very high glycogen levels ■ Day 1 = glycogen depleting exercise bout ■ Day 2-4 = high protein/fat diet & low carb ■ Day 4 = 2nd bout of exhaustive ex ■ Day 5-7 = high carb diet & low fat/protein ■ Day 8 = competition ● Works best for one event sport - marathon, triathlon ○ Mild Composition ■ Gradual taper ■ Progressive ↑ CHO in 6 days ○ Wee et al (2005) - GI & Exercise ■ High vs low GI on exercise ■ Results ● High GI = greater muscle glycogen storage ● Low GI = greater usage of fat during exercise ○ Greater chance to lose weight ○ Gout - diet of red meat & alc ■ Inflammation, pain in big toe ● Buildup of uric acid in blood = crystals in joints ■ Need to take anti-inflammatory foods ● Omega 3 ● tomatoes

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PRO intake ○ Needs to be 1.2-2.0 g/kg BW for active = 60-100 g PRO ○ Sources ■ Meat, poultry, legumes, beans, lentils ■ Make PRO lean ● Pork loin,tenderloin, less 8% fat, skinless part, no frying

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Problems of Underweight ○ Associated w/ sarcopenia (loss muscles mass) & cachexia (“wasting” disorder) ○ Health risks ■ Amenia, nutrient deficiencies, osteoporosis ■ Heart arrhythmia, blood vessel dz ■ Infection, delayed wound healing

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Healthy Weight Gain ○ Genetics, training intensity, timing of feeding, consistency ○ Extra 500-1000 kcal/day ■ Emphasis on CHO & PRO ○ 6 recommendation for weight gain 1. 3 meals per day a. PRO thr/out day 2. Larger than normal portions 3. Eat extra snack a. Especially before bed 4. Select nutrient/kcal dense food a. Not high in fat but high in energy 5. Drink calories - juice, milk, smoothies 6. Resistance training a. Rest, training, create hormone profile optimal for weight gain

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BMI ○ ○

Formula = kg/m^2 Marcella ■ 110 lbs = 40 kg ■ 5’6 = 1.67 m ● in/39.37 = m ○ 40/1.67^2 ● = 14.34 ○ Underweight

Chris Chris was an athlete in college but over the past few years his weight has been climbing upwards as his life has become more sedentary. He has a hectic schedule and busy family life which leaves little time to think about what he eats and no time for the gym. At 42 years old, he is 5’11” tall and weighs 226 pounds, exercising less than 30 minutes per day. Chris’ doctor is concerned about his blood pressure (142/86 mmHg), total cholesterol (224 mg/dL), LDL (162 mg/dL), and HDL (35 mg/dL). Chris recently finished a night-class course to receive a new certificate in computer science. The computer training enabled him to get a new job closer to home which, without the commute, will now give him more time to work on his lifestyle. This “triggering event” has encouraged Chris to consider making healthy changes. In addition, Chris is a bit of a picky eater and refuses to eat any seafood even though he knows it may be good for him. His favorite foods include barbecued beef, meat-lover’s pizza, and smoked sausage. His favorite pre-bedtime snacks are packaged bakery items with whole milk. ●

MyPlate ○ Needs 45-65% CHO - maybe even more considering her daily running ■ Fuel source during int exercise ■ Fuel source for CNS, red & white blood cells ○ Needs 20-35% fat ■ Fuel sources @ rest ■ Component of cell membrane ■ Protects organs ○ Needs 10-35% PRO ■ Growth & repair ■ Energy if needed ○ Obvious need for more well rounded diet ■ F/V ■ Grains ■ Dairy

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Cholesterol ○ Brand-Miller & Buyken - GI & CVD ■ Low GI diet on CVD ■ Results ● ↓ HbA1c, ↓ LDL & ↑ HDL ● Saturated fat risk ○ ↓ sat fat = ↓ CVD risk ■ But many times just replace sat fat w/ high GI foods ○ Voon et al - FA ■ MCFA (coconut oil) = ↓ Lp(a) = ↓ risk CVD

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Cholesterol Levels

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Chris’ doctor is concerned about his blood pressure (142/86 mmHg), total cholesterol (224 mg/dL), LDL (162 mg/dL), and HDL (35 mg/dL). Total Cholesterol = borderline high @ 224 mg/dl ■ Desirable < 200 ■ Borderline high = 200-239 ■ High > 240 LDL = high @ 162 mg/dl ■ Optimal < 100 ■ near/above ideal = 100-129 ■ Borderline high = 130-159 ■ High > 160 HDL = in the range of 29-72 @ 35 mg/dl ■ Males ● 29-72 ● Undesirable < 40 ● Protective > 60 ■ Females ● 35-80 Cholesterol ratios = 6.4 = 2 times the risk ■ 4.4 = avg risk for 50-70 yr old men ● 4.6 = avg American male ● 4.0 = avg American female ■ < 3.5 = half risk = ideal ■ 6.2 = 2x risk ■ 7.7 = 3x risk ■ 9.5 = 4x risk

Blood Pressure Levels ○ High Systolic BP ○ High Diastolic BP ■ Hypertension Stage 1

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Dash Diet ○ Dietary Approaches to Stop Hypertension ■ Emphasis K, Mg, Ca, P ■ Decrease NA ■ Lots fo F/V per day ● Whole grains ● Fat free milk ● Lots nuts, seeds & legume ■ Does lower BP

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Weight Loss ○ Assuncao et al (2009)- Coconut oil & obesity ■ MCFAs led to small reduction in WC ○ Josse et al (2010) - Milk & resistance exercise ■ Milk ● Greater fat loss ● More lean mass - greater skeletal muscle gains ● Strength gains ● Blood - ↑ 25[OH]D & ↓ PTH

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DHA ○ ○ ○ ○

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Important for immune health Anti inflammatory compounds Sources ■ Flax seed, chia, walnuts Supplement = 2g/day in GRAS ■ USP symbol

GI ○

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Wee et al (2005) - GI & Exercise ■ High vs low GI on exercise ■ Results ● High GI = greater muscle glycogen storage ● Low GI = greater usage of fat during exercise ○ Greater chance to lose weight Low GI ■ Avoid highly refined rice (Jasmine rice) ■ “Whole grain” ■ Fresh fruit over dried fruit ■ Cooking from scratch, rather than just instant ■ Adding lipids, protein & fiber

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Meat ○

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IARC (2015) concluded ■ processed meat = carcinogenic to humans (1a carcinogen) ■ Red meat = probably carcinogenic to humans (2a carcinogen) Red Meat ■ Good source - iron, zinc, vitamin B12, Mg, B6, high quality protein Johnston et al (2019) - Red/Processed Meat ■ Consensus = people can/should continue eating red/processed meat ■ risk/benefit ratio ● Are people willing to change their diet? ■ Very low risk bet/ meat & cancer ● “Adults should continue current red & processed meat consumption” ■ Potential lowered risk for cancer does not outweigh the joy of eating meat

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PRO Intake ○ As exercise ↑ so does use of PRO as energy source ○ After exercise there is ↑ Muscle Protein Synthesis ○ More PRO may be needed @ beginning of exercise program ■ Or @ time of change

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Fiber ○

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Dietary fiber vs functional ■ Dietary fiber - plant/grain = grilled broccoli, oatmeal, beans, ■ Functional - isolated from plant & added as ingredient = strawberry gum or Fiber 1 bar CVD - Soluble = lower LDL & cholesterol Colorectal cancer ■ Fiber binds to bile acid = lower risk for cancer ■ Fiber ↑ fecal bulk = ↓ toxins that could cause cancers ■ Prebiotics in fiber allow for fermentation = creation of SCFAs = healthy environment ● SCFAs = lower pH & hard for cancer cells to grow ■ Fermentation of prebiotics = releases calcium & helpful to colorectal cells

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Weight Science ○ Intuitive Eating ○ HAES ○ Obesity related to ■ HD, stroke, type 2, certain cancer ● Some of leading causes of preventable death ○ Internal Cues & Intrinsic Motivation

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Fit vs Fat ○ Meta Analysis - BMI > 30 ■ Unfit - 2.46 x ● 246% increase for mortality ■ Fit - 1.21 x ● Confidence interval range from 0.95-1.5 means no greater risk ○ Specific Recommendations ■ DASH Diet w/ more F/V & fiber = rapid ↓ in BP ● Independent of weight loss ■ Dietary Approaches to Stop Hypertension ■ Lifestyle changes can be more beneficial than prescription ■ Use health related goal not weight related goals ■ Mediterranean diet ● Lots F/V & fiber ○ Similar to DASH ○ Liposuction doesn’t improve health

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National Weight Control Registry ○ Ate 4-4.5 times per day ○ Ate fast food less than 1 per week ○ 2-3 restaurant meals per week ○ 78% ate breakfast every day ○ Ate ■ 25% fat, 55% CHO & 20% PRO ■ Only 11% followed low CHO diet ○ Plan ahead ○ Drink water ■ No kcals in beverage ○ Exercise of 400 kcal per day ■ Most walking ■ 1 hour day of exercise ○ 60% had increased cholesterol, risk of CVD Fiber ○

AI female = 25 g/d for women bet/ 19-50

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BMI ○ ○

■ So jeny falls about 50% short Dietary fiber vs functional ■ Dietary fiber - plant/grain = grilled broccoli, oatmeal, beans, ■ Functional - isolated from plant & added as ingredient = strawberry gum or Fiber 1 bar Fiber & disease prevention ■ Diabetes - Insoluble = decrease inflammation & protect beta cells ■ CVD - Soluble = lower LDL & cholesterol ■ GI disorders = diverticulosis, gallstones, IBS, constipation & hemorrhoids ■ Colorectal cancer ● Fiber binds to bile acid = lower risk for cancer ● Fiber ↑ fecal bulk = ↓ toxins that could cause cancers ● Prebiotics in fiber allow for fermentation = creation of SCFAs = healthy environment ○ SCFAs = lower pH & hard for cancer cells to grow ● Fermentation of prebiotics = releases calcium & helpful to colorectal cells

Formula = kg/m^2 Marcella ■ 160 lbs = 72.72 kg ■ 5’5 = 1.65 m ● in/39.37 = m ○ 72.72/1.65^2 ● = 26.7 ○ Overweight

Thomas Thomas is an 18-year-old collegiate football player who spent the first season of college football as a red-shirt freshman. It is now the spring term of his freshman year and he wants to be a starter next year. His position coach has recommended he increase his muscle mass to

improve performance and possibly become a first-string player. Thomas is excited about the possibility of playing and will do anything to help gain weight and is especially interested to know what types of dietary changes could help with his goals. He is 6’2”, weighs 153 pounds, and has 10% body fat. Since this is the off-season, he is not playing football every day, but he lifts weights 5 days per week. He has one-on-one skills training with his coach, 3 hours per week, and does aerobic exercise on his own another 3 hours per week. The strength and conditioning coach ensures that his lifting program will help him gain weight if he is eating properly, does not get sick, or miss any workouts. His coach insists Thomas eats at least one cup of yogurt each day. Yesterday, Thomas got up late and had to skip breakfast before going to class (this happens often). Then at noon, he was starving, so he filled up on a steak sandwich and French fries and washed it down with a protein shake. After his 4 pm lifting session at the gym, Thomas attended office hours to get help with his math homework, then two hours later he ate dinner at about 8 pm. For dinner, he ate three pieces of pepperoni pizza and two cokes, then choked down a yogurt, just to make his coach happy. Without the football scholarship, Thomas is strapped for cash and cannot often afford to eat the “fancy” meals he might need to gain weight. ●

MyPlate ○ Needs 45-65% CHO ■ Fuel source during int exercise ■ Fuel source for CNS, red & white blood cells ○ Needs 20-35% fat ■ Fuel sources @ rest ■ Component of cell membrane ■ Protects organs ○ Needs 10-35% PRO ■ Growth & repair ■ Energy if needed ○ Obvious need for more well rounded diet ■ F/V ■ Grains ■ Dairy

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PRO ○ ○ ○ ○

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CHO ○

As exercise ↑ so does use of PRO as energy source After exercise there is ↑ Muscle Protein Synthesis More PRO may be needed @ beginning of exercise program ■ Or @ time of change Challenges of PRO Intake ■ Encourage AI of PRO w/out undesirable ● Make PRO lean = pork loin, tenderloin ○ Lean = 92% lean or 8% less fat ■ Skinless part - anything instead of frying Mamerow et al (2010)- PRO distribution ■ EVEN PRO distribution = 25% more muscle synthesis ● Specifically w/ 30 g PRO Plant Protein

Wee et al (2005) - GI & Exercise ■ High vs low GI on exercise ■ Results ● High GI = greater muscle glycogen storage ● Low GI = greater usage of fat during exercise ○ Greater chance to lose weight

Immune Health ○ Vit C ■ Neutralizes reactive O2 species ■ Needed to make neutrophils ■ Sources ● All F/V, red peppers, GLV, oranges ○ Vit D ■ Mechanisms ● Improve & support physical barriers ● Enhance innate immune system ● Enhance adaptive immunity ● Increases antioxidant proteins ■ Sources ● Fatty fish, fortified foods, mushrooms

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DHA ■ ■ ■ ■ Zinc ■ ■ ■ ■ ■

ALA, EPA & DHA Anti-inflammatory compounds Incorporated into cell membranes & influence cell structure & fx Sources ● Fish 2x/week, krill & cod liver oil, seaweed, algae Innate & acquired immunity Vaccine efficacy Synthesis of antibodies Lozenge @ onset of sym can reduce cold duration Sources ● Oyster, beef, poultry, nut, beans, mushrooms, coca, GLV

Probiotics & Immune Health ○ Mechanisms ■ Interference w/ pathogens ■ Improvement of barrier fx ■ Immunomodulation ■ Neurotransmitter production ○ Gleeson et al (2011) - Probiotics & Infection ■ Methods ● 4 months probiotics use on infection/immune fx during winter ■ Results ● 27% fewer people had URTI in PRO group ● 50% fewer URTI in PRO group ● Severity & duration of infection equal ● Training less affected in PRO group ● # days w/ GI sym 33% lower in PRO ○ “Couldn’t directly attribute benefits to any specific improvement of immune fx” ■ Analysis of blood not helpful ● IgA ○ PRO same level thr/ 16 week & winter ○ PLA group fell off

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Healthy Weight Gain ○ Genetics, training intensity, timing of feeding, consistency ○ Extra 500-1000 kcal/day ■ Emphasis on CHO & PRO ○ 6 recommendation for weight gain 1. 3 meals per day a. PRO thr/out day 2. Larger than normal portions 3. Eat extra snack a. Especially before bed 4. Select nutrient/kcal dense food a. Not high in fat but high in energy 5. Drink calories - juice, milk, smoothies 6. Resistance training a. Rest, training, create hormone profile optimal for weight gain ○ Josse et al (2010) - Milk & resistance exercise ■ Milk ● Greater fat loss ● More lean mass - greater skeletal muscle gains ● Strength gains ● Blood - ↑ 25[OH]D & ↓ PTH DHA - Omega 3 ○ Anti inflammatory compounds ○ Fish Oil ■ EPA & DHA SDOH ○ Granola & milk, PB&J ○ Oatmeal, beans, soybeans, lentils BMI ○ Formula = kg/m^2 ○ Marcella ■ 153 lbs = 69.54 kg ■ 6’2 = 1.87 m ● in/39.37 = m ○ 69.54/1.87^2 ● = 19.88 ○ Normal Weight...