This lecture was presented as part of Lunch and Learn series at the Mountain Park Health System by Dr. Siri Chand Khalsa. Content includes Culturally Relevant Tools for Improving Health through Nutrition.

1. Food as Medicine
Culturally Relevant Tools for Improving
Health Through Nutrition
Siri Chand Kaur Khalsa MD, MS
1

2. Integrative Nutrition
“Let food be your medicine and medicine be your food”
Hippocrates 460 BC – 370 BC
2

3. Food as Medicine
Lecture Overview
✦ Introduction
✦ Overview Nutrition
✦ Resources
3

4. Vegetarian Eating
Types
✦ Ovo-lacto vegetarianism includes
animal products such as eggs,
milk, and honey
✦ Lacto vegetarianism includes milk
but not eggs
✦ Ovo vegetarianism includes eggs
but not milk
✦ Veganism excludes all animal flesh
and animal products, including
milk, honey, eggs
✦ Raw veganism includes only fresh
and uncooked fruit, nuts, seeds,
and vegetables
✦ Macrobiotic diets consist mostly of
whole grains and beans
4

5. Vegetarian Eating
Rationale
✦ Ethical
✦ Health
✦ Environmental
✦ Religious
✦ Political
✦ Cultural
✦ Aesthetic
✦ Economic
5

6. Vegetarian Eating
Motivation
✦ Religious
✦ Hindu
✦ Jain
✦ Buddhist
✦ Sikh
✦ 30% of India's 1.2 billion
population practices lacto-
vegetarianism
6

7. Vegetarian Eating
Environmental
✦ To produce 1 pound of feedlot
beef requires about 2,400
gallons of water and 7 pounds
of grain
✦ Average American consumes
✦ 97 pounds of beef
✦ 273 pounds of meat
✦ Modest reductions in meat
consumption in such a culture
would substantially reduce the
burden on our natural
resources."
7

8. Vegetarian Eating
Environmental
✦ Production of meat versus
plant protein
✦ 4:1 meat protein/energy invested
✦ 54:1 Plant protein/energy invested
✦ Animal-based food is less efficient
than the direct harvesting of grains,
vegetables, legumes, seeds and fruits
for human consumption. A person
existing chiefly on animal protein
requires 10 times more land to provide
adequate food than someone living on
vegetable sources of protein.
✦ Methane released into air from
livestock contributing to between
18-51% of greenhouse gases and
global warming
8
http://www.news.cornell.edu/releases/Aug97/livestock.hrs.html

9. Vegetarian Eating
Environmental
✦ Production of meat versus
plant protein
✦ 4:1 meat protein/energy invested
✦ 54:1 Plant protein/energy invested
✦ Animal-based food is less efficient
than the direct harvesting of grains,
vegetables, legumes, seeds and fruits
for human consumption. A person
existing chiefly on animal protein
requires 10 times more land to provide
adequate food than someone living on
vegetable sources of protein.
✦ Methane released into air from
livestock contributing to between
18-51% of greenhouse gases and
global warming
9
http://www.news.cornell.edu/releases/Aug97/livestock.hrs.html

10. Vegetarian Eating
Health
✦ American Journal of Clinical Nutrition,
Vol. 78, No. 3
✦ Review of 6 studies
✦ Very low meat intake
✦ Associated with a significant decrease
in risk of death in 4 studies,
nonsignificant decrease in risk of death
in the fifth study, and virtually no
association in the sixth study;
✦ 2 of the studies with low meat intake
significantly decreased mortality risk
✦ Longer duration ( 2 decades) of
adherence to this diet contributed to a
significant decrease in mortality risk
and a significant 3.6-y (95% CI: 1.4,
5.8 y) increase in life expectancy
10
Does low meat consumption increase life expectancy in humans? Singh et al.American Journal of
Clinical Nutrition, Vol. 78, No. 3, 526S-532S, September 2003

11. Obesity
Epidemic
✦ Obesity is an epidemic of growing
proportion
✦ Obesity and genes
✦ About 85% of obesity is hereditary risk
✦ Last 25 years growing trend is profound
weight gain
✦ Factors are varied including cultural
acceptance, decreased activity,
increased stress and changes in food
supply Obesity is an epidemic of growing
proportion 11

12. Obesity
Epidemic
✦ Causes 300,000 premature deaths per year
✦ Cost of 150 billion to health care per year
✦ High Blood Pressure
✦ Diabetes
✦ Joint problems
✦ Sleep Apnea
✦ Cancer
✦ Depression
✦ Social isolation
12

13. Obesity
BMI: Body Mass Index
✦ Calculation
✦ = mass (kg)/Height (m) 2
✦ = mass (lbs)*4.88/Height (ft)2
✦ Normal 18.5 to 24.9
✦ Overweight from 25 to 29.9
✦ Obese Class I from 30 to 34.9
✦ Obese Class II from 35 to 39.9
13

14. Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2009
(*BMI ≥30, or about 30 lbs. overweight for 5’4” person)
1990 1999
2009
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.

15. Obesity Trends* Among U.S. Adults
BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.

16. Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.

17. Obesity Trends* Among U.S. Adults
BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.

18. Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.

19. Obesity Trends* Among U.S. Adults
BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.

20. Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%
Source: Behavioral Risk Factor Surveillance System, CDC.

21. Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.

22. Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.

23. Obesity Trends* Among U.S. Adults
BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.

24. Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.

25. Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.

26. Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
Source: Behavioral Risk Factor Surveillance System, CDC.

27. Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.

28. Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.

29. Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.

30. Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%
Source: Behavioral Risk Factor Surveillance System, CDC.

31. Obesity Trends* Among U.S. Adults
BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.

32. Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.

33. Obesity Trends* Among U.S. Adults
BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.

34. Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC.

35. Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.

36. Obesity Trends* Among U.S. Adults
BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.

37. Obesity Trends* Among U.S. Adults
BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.

38. Obesity Trends* Among U.S. Adults
BRFSS, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.

39. Obesity Trends* Among U.S. Adults
BRFSS, 2009
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Source: Behavioral Risk Factor Surveillance System, CDC.

40. Obesity
Vegetarian Diet
✦ Probably provides benefit when used long
term
✦ Maybe associated with other positive
lifestyle changes
✦ At the least reduction in animal fats
40

41. Food as Medicine
Lecture Overview
✦ Introduction
✦ Overview Nutrition
✦ Resources
41

42. Basic Nutritional Concepts
Macronutrients
✦ Carbohydrates
✦ Lipids
✦ Proteins
Micronutrients
✦ Vitamins
✦ Minerals
✦ Phytonutrients
42

43. Carbohydrates
Monosaccharides
✦ Glucose
✦ Galactose
✦ Fructose
Disaccharides
✦ Maltose: Glucose + Glucose
✦ Sucrose: Glucose + Fructose (table sugar)
✦ Lactose: Glucose + Galactose
✦ Lactose intolerance: missing the enzyme to
breakdown Lactose 43

44. Carbohydrates
Polysaccharides
✦ Amylose
✦ i.e Basmati rice
✦ Amylopectin
✦ i.e. Sushi rice
✦Branching gives a larger
surface area to digest the
molecule
✦Simplestarch: more
amylopectin
✦Resistant starch: more
amylose
44

45. Carbohydrates
Glycemic Index Calculation
✦ An amount of food containing 50 grams of
carbohydrate is given
✦ 200 g of spaghetti = 50 grams of carbs
✦ Blood samples every 15 minutes for first
hour then every 30 minutes thereafter and
graphed
✦ Response is compared to reference values
found with 50 g of pure glucose (GI of 100)
✦ Retested 3 occasions and averaged with
8-10 other volunteers
45

46. Carbohydrates
High Glycemic Index Diets
✦ Relevance is that High GI foods invoke strong
insulin response
✦ Insulin has been shown to encourages the
body to store calories as fat
✦ Promote atherosclerosis
✦ Accelerate tumor growth
✦ i.e. Breast cancer
46
Borugian MJ, Sheps SB, Kim-Sing C, Van Patten C, Potter JD, Dunn B, Gallagher RP, Hislop TG.Insulin, macronutrient intake, and physical activity: are potential
indicators of insulin resistance associated with mortality from breast cancer?Cancer Epidemiol Biomarkers Prev. 2004 Jul;13(7):1163-72.

47. Carbohydrates
Low Glycemic Index Diets
✦ Lower LDL
✦ Raise HDL
✦ Lower total cholesterol
Influenced by
✦ Structure of the molecule
✦ Sucrose(disaccharide) GI is 65
✦ Composed of Glucose 100 + Fructose 23
✦ Branched vs unbranched starch
✦ Amylose vs. Amylopectin
47

48. Carbohydrates
Glycemic Index
✦ Tools that slow digestion will affect GI
✦ Presence of fiber
✦ Presence of fat
✦ i.e French fries have lower GI than baked
potatoes but are laden with saturated fats
✦ Presence of acid
✦ Lemon or lime juice with rice
✦ ie sushi
48

49. Apple
✦ Glycemic Index of 38
✦ French Fries are 75
✦ High antioxidant punch from
flavanoids and polyphenols
✦ 100 gram apple equivalent to
1500mg of Vitamin C
✦ Skin has pectin which may play
role in digestive health
49

50. Carbohydrates
Summary
✦ Diet should consist of low GI foods
✦ Whole grains
✦ Vegetables
✦ Apples (temperate fruits) vs. mangoes (tropical)
✦ Al dente pasta vs. overcooked
✦ Basmati rice vs. white sticky rice
✦ Sweet potatoes, beans vs. Idaho fluffy potatoes
✦ Whole grain breads
✦ Avoid all high fructose corn syrup
✦ Avoid all processed white flour
50

51. Basic Nutritional Concepts
Macronutrients
✦ Carbohydrates
✦ Lipids
✦ Proteins
Micronutrients
✦ Vitamins
✦ Minerals
✦ Phytonutrients
Liquid Nutrition
51

52. Lipids
Classes
✦ Saturated Fatty Acids (SFAs)
✦ Monounsaturated Fatty Acids(MUFAs)
✦ Trans Fatty Acids
✦ Polyunsaturated Fatty Acids (PUFAs)
✦ Essential Fatty Acids
52

53. Lipids
Saturated Fatty Acids
✦ All bonds are occupied
✦ Myristic and palmitic acid
✦ Increase total cholesterol
✦ Medium chain saturated fatty acids
✦ Lauric and capric acids
✦ May play a role in immune function
✦ Primary component of the following:
✦ Animal Fat, Butter Fat, Coconut oil, Palm oil,
Kernal Oil
✦ Not healthy to eliminate all SFA’s
53
http://www.mie.utoronto.ca/labs/lcdlab/biopic/fig/3.20.jpg

54. Lipids
Diet High in TFA leads to
✦ Diets high in TFA lead to
✦ Increased LDL and lowered HDL
✦ Increased markers of inflammation (CRP)
✦ Decreased Apo B
✦ Increased risk atherosclerosis
✦ Increased risk colon cancer
✦ Increased triglycerides
✦ Food Labeling started January 1, 2006
✦ Wide variability - check the label
✦ Recommended daily amount -NONE
54
Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC.Related Articles, Trans fatty acids and cardiovascular disease.N Engl J Med. 2006 Apr 13;354(15):1601-13

55. Lipids
Trans fat in the diet
✦ Big Mac Profile
✦ Total fat 52 g
✦ Calories from fat 270
✦ Saturated fat 10g
✦ Trans Fat 1.5 g (?)
✦ McDonald’s Nutrition Center
55

56. Lipids
Polyunsaturated Fats (PUFAs)
✦ Found in:
✦ Corn Oil
✦ Cottonseed Oil
✦ Fish Oil
✦ Flaxseed oil
✦ Grapeseed oil
✦ Safflower Oil
✦ Sesame Oil
✦ Soybean Oil
✦ Sunflower Oil
56

57. Lipids
Polyunsaturated Fats (PUFAs)
57

58. Lipids
Essential Fatty Acids
✦ Not made by the body
✦ Linoleic acid C18:2w6 (LA/Omega 6)
✦ Plentiful in nature and diet
✦ Corn oil, peanut oil, sesame oil, poultry
✦ Linolenic acid C18:3w3 (ALA/Omega 3)
✦ Oily Fish: mackerel 2.5g of omega 3 per
100g of food
✦ Flax, hemp, walnuts, pumpkins
✦ Purslane (herb) used in cooking
58

59. Lipids
Essential Fatty Acids
✦ Alpha linolenic acid C18:3w3 (ALA)
✦ Flax, hemp, walnuts, pumpkins
✦ Purslane (herb) used in cooking
✦ ALA conversion to EPA or DHA can be impaired
or inefficient
✦ Delta 6 desaturase requires
✦ B6, Magnesium and zinc
✦ Delta 5 desaturase requires
✦ Vitamin C, niacin, zinc
59

60. Lipids
Essential Fatty Acids
✦ Ratio between LA/omega 6 and ALA/omega 3
affects prostaglandin synthesis
✦ This has a bearing on inflammation and
probably atherosclerosis and cancer
✦ Current diet 20-40:1
✦ Consider a goal diet of a ratio of 6:1
✦ Mediterranean inspired diet
✦ Eating foods high in omega 3
✦ Decreasing foods high in omega 6
60

61. Flax
✦ High in Omega 3 fatty acids
✦ High in fiber
✦ Phytochemical: lignans which
convert in intestine to
substances that may benefit
hormone regulation
✦ High in vitamins and minerals
61

62. Lipids
Recommendations
✦ Increase MUFAs
✦ Make olive oil primary dietary fat
✦ Eat PUFA’s as ratio of 6:1
✦ Omega-6:Omega 3 (average diet sits around
40:1)
✦ Increase Omega 3 foods by increasing oily
fish, fortified eggs, soy products, walnuts,
hemp, flax
✦ Protect oils from light and heat
62

63. Basic Nutritional Concepts
Macronutrients
✦ Carbohydrates
✦ Lipids
✦ Proteins
Micronutrients
✦ Vitamins
✦ Minerals
✦ Phytonutrients
Liquid Nutrition
63

64. Proteins
Essential Building Blocks
✦ Essential amino acids
✦ Phenylalanine
✦ Valine
✦ Threonine
✦ Tryptophan
✦ Isoleucine
✦ Methionine
✦ Leucine
✦ Lysine
64

65. Proteins
Vegetarian
✦ Combinations of grains and beans
✦ Complete protein is seed Quinoa
✦ 1/4 cup uncooked has 5.5 grams protein -
10% daily
✦ Considered Gold of the Incas
✦ High in magnesium- helpful in migraines
✦ 1/4 cup uncooked has 89.25 mg or 22%
RDA
65

66. Proteins
Animal Sources
✦ Cows
✦ Bison
✦ Pigs
✦ Sheep
✦ Wild game
✦ Chicken
✦ Eggs
✦ Milk
✦ Fish
66

67. Proteins
Commercial Animals
✦ Cows
✦ To increase growth, they are given
✦ Estrogen, Growth Hormone
✦ Antibiotics
✦ Residuals may function as
✦ “Endocrine Modulators”
✦ Increased estrogen exposure and related
diseases
✦ Increased risk prostate cancer
✦ Large animals are at the top of the food chain
and may accumulate toxins 67
Whitehead SA, Rice S. Endocrine-disrupting chemicals as modulators of sex steroid synthesis.Best Pract Res Clin Endocrinol Metab. 2006 Mar;20(1):45-61

68. Proteins
Buffalo
✦ Per serving size, less fat, cholesterol and
calories
Species Fat Grams* Calories Cholesterol
Buffalo 2.2 148 61
Beef 6.5 180 72
Pork 4.9 165 71
Chicken 7.4 167 62
USDA Handbook 8-5; 8-10; 8-13; 8-17
* Per 100 grams of meat
68

69. Proteins
Plant Proteins
✦ Soy
✦ Many forms from edamame to tofu
✦ Tempeh - fermented soy product
✦ Can be sold with grains,legumes,seeds
✦ TVP - textured vegetable protein
✦ Process that isolates the proteins from soy
flour
69

70. Proteins
Replacing Animal Proteins
✦ Seeds
✦ Sesame, sunflower, hemp, quinoa
✦ Nuts
✦ Almonds, Walnuts, Hazelnuts
✦ Spirulina
✦ Legumes
✦ Grains
✦ Fruits
✦ Vegetables
70

71. Proteins
Replacing Animal Proteins
✦ Benefits of Soy
✦ Cost less
✦ Contains less saturated fatty acids
✦ Contains more omega 3 fatty acids
✦ Presence of isoflavones (phytonutrient)
✦ Contains more fiber
✦ May have less environmental toxins
71

72. Proteins
Legumes
✦ Garbonzo beans (chickpeas), 1 cup cooked
has 268.96 calories
✦ molybdenum 123.00 mcg 164.0
✦ manganese 1.69 mg 84.5
✦ folate 282.08 mcg 70.5
✦ dietary fiber 12.46 g 49.8
✦ protein 14.53 g 29.1
✦ copper 0.58 mg 29.0
✦ phosphorus 275.52 mg
✦ iron 4.74 mg 26.3
72

73. Proteins
Vegan Diet
✦ Vegetarian Diet without any daily products or
egg products
✦ Cow milk has saturated fat and cows have
been given growth hormone to stimulate
production of milk
✦ Non-dairy cheeses
✦ can have casein a binder and milk protein
✦ Other milk sources
✦ Soy, Rice, Almond, Hemp Milk
73

74. Proteins
Vegan Diet
✦ Benefits
✦ Lowers LDL and TG
✦ Lowers BMI
✦ Socially responsible
✦ Potentially harmful??
✦ Lowers serum HDL cholesterol
✦ Increases homocysteine concentrations
due to vitamin B-12 deficiency
✦ This may have implication for
cardiovascular disease
74

75. Proteins
Recommendations
✦ Substitute plant for animal proteins
✦ Decrease red meat/ change to Bison
✦ Get free range animals
✦ Never eat brain
✦ Eat fish with high omega 3’s content
✦ Salmon, Mackerel, Sardines
✦ Avoid Swordfish, Marlin, Shark as accumulation
of toxins
75

76. Proteins
Vegetarians
✦ Dairy can have a lot of saturated fat
✦ Nondairy cheeses
✦ May have casein, a milk protein
✦ Soy products should have less than 30 %
saturated fat
✦ Read labels
✦ Eat nuts in moderation
✦ Eat whole grains, beans frequently
✦ Supplemental B12
76

77. Basic Nutritional Concepts
Macronutrients
✦ Carbohydrates
✦ Lipids
✦ Proteins
Micronutrients
✦ Vitamins
✦ Minerals
✦ Phytonutrients
Liquid Nutrition
77

78. Vitamins
Intake
✦ Estimated Average Requirement (EAR)
✦ Estimate of daily needs of 50% of population
✦ Recommended Daily Allowance (RDA)
✦ Average requirement for 90% population to
prevent a deficiency
✦ Adequate Intake (AI)
✦ Recommendations based on experimental
data for things not established yet in the RDA
✦ Tolerable Upper Intake Level (UL)
✦ Highest level under which no harm came to
98% of the population
78

79. Vitamins
Water Soluble
✦ Vitamin B1 (thiamin)
✦ Vitamin B2 (riboflavin)
✦ Vitamin B3 (niacin)
✦ Vitamin B5 (panthothenic acid)
✦ Vitamin B6 (pyridoxine)
✦ Vitamin B12 (cobalamin)
✦ Folic Acid
✦ Biotin
✦ Vitamin C
79

80. Vitamins
Fat Soluble
✦ Vitamin A (retinal)
✦ Vitamin D (calcitriol)
✦ Vitamin E (tocopherol)
✦ Vitamin K (phylloquinone)
80

81. Vitamins
Vitamin D
✦ Daily Requirements
✦ Birth to 50 years, 5 µg (200 IU)
✦ 51–70 years, 10 µg (400 IU)
✦ 71+ years, 15 µg (600 IU)
✦ Vitamin D2 (ergocalciferol)
✦ Vitamin D3 (cholecalciferol) skin by UV light
✦ Calcitriol (kidneys, macrophages)
✦ Regulating calcium and phosphate
✦ promoting the healthy mineralization, growth and
remodeling of bone
✦ neuromuscular function, reduces inflammation
✦ Influences the action of many genes that regulate the
proliferation, differentiation and apoptosis of cells. 81

82. Shitake Mushrooms
✦ 100g provides:
✦ 14 IU (0.14 IU/g)
✦ Dried in the sun: 500 IU
(5 IU/g
✦ Lentinan
✦ Strengthening its ability
to fight infection and
disease
✦ L-ergothioneine
✦ Powerful antioxidant
82

83. Basic Nutritional Concepts
Macronutrients
✦ Carbohydrates
✦ Lipids
✦ Proteins
Micronutrients
✦ Vitamins
✦ Minerals
✦ Phytonutrients
Liquid Nutrition
83

84. Minerals
Essential
✦ Calcium
✦ Chloride
✦ Magnesium
✦ Phosphorus
✦ Potassium
✦ Sodium
84

85. Minerals
Trace Minerals
✦ Arsenic ✦ Manganese
✦ Boron ✦ Molybdenum
✦ Chromium ✦ Nickel
✦ Cobalt ✦ Selenium
✦ Fluoride ✦ Silicon
✦ Iodine ✦ Sulfur
✦ Iron ✦ Tin
✦ Vanadium
✦ Zinc
85

86. Micronutrients
Minerals: Zinc
✦ RDA 15 mg per day
✦ Important for
✦ Smell, immunity, protein synthesis, enzymes
cofactor, DNA
✦ Deficiency
✦ Diarrhea, impotence, hair loss, eye and skin
lesions, impaired appetite, and depressed
immunity
✦ People at risk
✦ Vegetarians, alcholics, sickle cell disease,
malabsorbtion diseases, pregnant woman
86

87. Tahini (100g)
✦ 100 gram is 595 cal
✦ 17 grams protein
✦ Calcium 426 mg 43%
✦ Iron 8.95mg 50%
✦ Magnesium 95mg 24%
✦ Phosphorus 732mg 73%
✦ Sodium 115mg 5%
✦ Potassium 414mg 12%
✦ Zinc 4.62mg 31%
✦ Copper 1.62mg 81%
✦ Manganese 1.46mg 73%
✦ Selenium 1.7μg 2%
87

88. Basic Nutritional Concepts
Macronutrients
✦ Carbohydrates
✦ Lipids
✦ Proteins
Micronutrients
✦ Vitamins
✦ Minerals
✦ Phytonutrients
88

89. Phytonutrients
Nutrients in plants
✦ Chemical compound
✦ Occur naturally
✦ May affect health and many scientific
studies ongoing
✦ Health benefits may be combo of these
elements and minerals
✦ Example of modern drug is taxol which
was derived from Pacific Yew Tree
89

90. Phytonutrients
Major Classes
✦ Carotenoids
✦ Polyisoprenoids - over 600 compounds
✦ Carrots, pumpkins, peaches
✦ Flavonoids
✦ Isoflavones
✦ Anthocyanins, Proanthocyanidins
✦ Flavanols
✦ Betalanins
✦ Organosulfides
90

91. Carotenoids
Alpha Carotene
Beta Carotene
Lycopene
Lutein
Zeaxanthin
91

92. Phytonutrients
Carotenoids
✦ High carotenoid intake has been linked to
✦ 20% decrease in postmenopausal breast
cancer
✦ 50% decrease in the incidence of cancers of
the bladder, cervix, prostate, colon, larynx,
and esophagus.
92

93. Flavinoids
Anthocyanidins
Flavanols
Flavanones
Flavonols
Isoflavones
93

94. Phytonutrients
Flavonoids
✦ Isoflavones in soy
✦ Lignans in flax
✦ Anthocyanins, Proanthocyanidins
✦ Berries, cherries, red grapes, plums, beets
✦ Flavonols
✦ Onions, kale, apples, berries, tea, broccoli
✦ Flavanones
✦ Citrus juices and fruits
✦ Flavones
✦ Parsley, thyme, celery, hot peppers
94

95. Kale
✦ Glucosinolates and cysteine sulfoxides
✦ May activate detoxifying
enzymes in the liver that help
neutralize potentially
carcinogenic substances
✦ Vitamin A (vision)
✦ One cup of kale contains
192.4% of the daily value for
vitamin A
✦ Calcium
✦ One cup of kale supplies 93.6
mg (9 %) of calcium for only
36.4 calories.
✦ Cup of 2% cow's milk provides
296.7 mg of calcium
95

96. Phytonutrients
Produce high in pesticides
✦ Environmental Working Group www.ewg.org
✦ Strawberries ✦ Tomatoes
✦ Wheat ✦ Cucumber
✦ Pears ✦ Apples
✦ Broccoli ✦ Grapes from Chile
✦ Cauliflower ✦ Mexican Cantaloupes
✦ Cabbage
✦ Onions
✦ Peaches
✦ Celery
96

97. Food As Medicine
Lecture Overview
✦ Introduction
✦ Overview
✦ Resources
97

98. Farmer’s Markets
Phoenix
✦Locations around Phoenix
✦Wednesday 9:30 to 1:30
✦Baseline Health Center
✦Accept WIC coupons
98

99. Fresh Carrots
99

100. Melons
100

101. Red Peppers
101

102. Vouchers
102

103. Community Gardens
Phoenix
✦Garden of Tomorrow
✦Tiger Mountain Foundation
103

104. Resources
Phoenix
✦ Farmers Markets
✦ Community Gardens
✦ Web
104

105. US FNIC
http://fnic.nal.usda.gov/
Complete Database can
be found online
105

106. Linus
Pauling
Institute
✦ http://lpi.oregonstate.edu/
✦ Dr. Pauling concluded
that vitamins and other
micronutrients play a
significant role in
enhancing human health
and preventing chronic
diseases, not just
deficiency diseases.
106

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