MODERN DIETETICS: NUTRITION FOR THE SICK AND HEALTHY
CONTENTS 1 DIET BY DESIGN HEALTHY MEAL PLANNING 1 2 FACE TO FACE NUTRITION SCREENING ASSESSMENT AND COUNSELING TECHNIQUES 33 3 FINDING YOUR WEIGH MASTERING WEIGHT MANAGEMENT 113 4 FROM INFANTS TO ANCIENTS NUTRITION THROUGHOUT THE LIFECYCLE 168 5 MATTERS OF THE HEART NUTRITION AND CARDIOVASCULAR DISEASE 251 6 A NOT SO SWEET METABOLIC DISRUPTION DIABETES MELLITUS 289 7 A PAIN IN THE GUT NUTRITION IN GASTROINTESTINAL DISORDERS 361 8 BLOOD AND BONES NUTRITION IN MUSCULOSKELETAL DISORDERS RHEUMATIC DISEASE AND ANEMIAS 421 9 NUTRITION IN HEPATOBILIARY PANCREATIC AND KIDNEY DISEASE 453 10 SKIN SURGERY AND STRESS NUTRITION IN METABOLIC STRESS CANCER AND HIV AIDS 493 1 DIET BY DESIGN HEALTHY MEAL PLANNING HUMANS HAVE BEEN DEBATING THE BASIS OF A BALANCED DIET SINCE TIME IMMEMORIAL ADAM AND EVE DELIBERATED OVER THE APPLE IN THE GARDEN OF EDEN GREEK AND ROMAN PHILOSOPHERS DISAGREED ABOUT THE HOT AND COLD HEALTH ATTRIBUTES ASCRIBED TO DIFFERENT FOODS AND EVEN TODAY WE CANNOT MAKE UP OUR MINDS ABOUT BUTTER OR MARGARINE WHICH ONE REALLY IS BETTER FOR YOU DESPITE OUR DIFFERENCES WE CAN ALL AGREE ON ONE THING THAT AS SURE AS THE SUN WILL RISE WE WILL AT SOME POINT IN OUR NEAR FUTURE FEEL HUNGRY AND WHEN THAT HUNGER HITS WHAT ARE WE SUPPOSED TO EAT THE NEXT SECTION OF THIS BOOK WILL HELP YOU UNRAVEL SOME OF THE MYSTERIES ABOUT HEALTHY MEAL PLANNING GOVERNMENT GUIDELINES FOR GOOD NUTRITION THIS BOOK IS WRITTEN WITH THE ASSUMPTION THAT YOU THE READER HAVE A GENERALLY GOOD GRASP OF BASIC NUTRITION SCIENCE THE BOOK DOES NOT COVER INTRODUCTORY NUTRITION TOPICS IN GREAT DETAIL BUT RATHER FOCUSES ON THE EVIDENCE BASED GUIDELINES AND PRACTICES THAT ARE RECOMMENDED FOR THE PREVENTION MANAGEMENT AND TREATMENT OF A VARIETY OF DISEASE STATES IN THIS BOOK THE TERMS KILOCALORIE KCAL AND CALORIE CAL HAVE BEEN USED INTERCHANGEABLY CALORIES ARE UNITS OF HEAT ENERGY AND THE TERM ENERGY WILL ALSO BE USED TO MEAN CALORIES IF A PATIENT SUGGESTS HE IS TAKING A B COMPLEX VITAMIN SUPPLEMENT BECAUSE IT GIVES HIM ENERGY UNLESS HE EXPERIENCES A PLACEBO DERIVED INVIGORATING RUSH FROM INGESTING THE CAP SULE HE CLEARLY MISUNDERSTANDS THE CONCEPT OF ENERGY ALTHOUGH VITAMINS DO SERVE AS IMPORTANT PRECURSORS FOR UNLOCKING THE ENERGY CALORIES IN THE FOODS WE EAT THE VITAMINS THEMSELVES DO NOT CONTAIN ENERGY AS THEY DO NOT YIELD CALORIES ONE KILOCALORIE IS EQUAL TO 4 184 KILOJOULES KJ AND A KILOCALORIE IS DE NED AS THE QUANTITY OF HEAT NECESSARY TO RAISE THE TEMPERATURE OF 1 KILOGRAM OF WATER BY 1 DEGREE CELSIUS 1 PYRAMIDS PLATES AND PORTIONS THE UNITED STATES DEPARTMENT OF AGRICULTURE USDA HAS HAD A HEAVY HAND IN RECOMMENDING HEALTHY NUTRITION GUIDELINES FOR OVER 100 YEARS THE RST GOVERNMENT DIETARY GUIDE WAS A FARMERS BULLETIN WRITTEN BY THE USDA S INITIAL DIRECTOR OF THE OF CE OF EXPERIMENT STATIONS W O ATWATER PUBLISHED IN 1894 DESPITE THE FACT THAT VITAMINS AND MINERALS HAD YET TO BE DISCOVERED ATWATER S CAUTIONARY WORDS RESONATE EVEN TODAY UNLESS CARE IS EXERCISED IN SELECTING FOOD A DIET MAY RESULT WHICH IS ONE SIDED OR BADLY BALANCED THAT IS ONE IN WHICH EITHER PROTEIN OR FUEL INGREDIENTS CARBOHYDRATE AND FAT ARE PROVIDED IN EXCESS THE EVILS OF OVEREATING MAY NOT BE FELT AT ONCE BUT SOONER OR LATER THEY ARE SURE TO APPEAR PERHAPS IN AN EXCESSIVE AMOUNT OF FATTY TISSUE PERHAPS IN GENERAL DEBILITY PERHAPS IN ACTUAL DISEASE 2 IN 1916 NUTRITIONIST CAROLINE HUNT WROTE THE USDA S RST GUIDE FOOD FOR YOUNG CHILDREN SHE CATEGORIZED FOODS AS BELONGING TO ONE OF VE GROUPS MILK AND MEAT CEREALS VEGETABLES AND FRUITS SUGARS AND SUGARY FOODS AND FATS AND FATTY FOODS 3 IN 1917 HUNT AND W O ATWATER S DAUGHTER HELEN TEAMED UP PUTTING OUT HOW TO SELECT FOODS USING THESE SAME FOOD GROUPS WITH INFORMATION TARGETED TO THE LARGER GENERAL PUBLIC 4 US DIETARY GUIDANCE IN THE 1930S WAS DRIVEN LARGELY BY ECONOMIC LIMITATIONS RELATED TO THE GREAT DEPRESSION THE 1940S SAW THE ADVENT OF THE RECOMMENDED DIETARY ALLOWANCES RDAS A SET OF SPECI C RECOM MENDED INTAKES OF CALORIES AND NINE ESSENTIAL NUTRIENTS PROTEIN IRON CALCIUM VITAMINS A AND D THIAMIN RIBO AVIN NIACIN AND VITAMIN C 5 IN 1943 THE USDA WENT ON TO RELEASE THE BASIC SEVEN FOOD GUIDE WHICH DURING WARTIME HELPED FAMILIES HANDLE RATIONING AND LIMITED SUPPLIES THE USDA PUT FORTH THEIR NEXT ADAPTATION IN 1956 AND THIS VERSION WAS COMMONLY REFERRED TO AS THE BASIC FOUR AS IT GROUPED FOODS INTO ONE OF FOUR FOOD GROUPS MILK MEAT FRUITS AND VEGETABLES AND GRAINS THESE FOUR FOOD GROUPS WITH THEIR FOCUS ON OBTAINING ADE QUATE NUTRIENTS AS OPPOSED TO AVOIDING EXCESS WERE USED EXTENSIVELY AS THE WIDESPREAD BASIS OF NUTRITION EDUCATION FOR THE NEXT 20 YEARS NUTRITION EDUCATION IN THE 1970S UNDERWENT A SEA CHANGE WITH REGARD TO HOW PUBLIC NUTRITION MESSAGES WERE CONVEYED EVIDENCE MOUNTED THAT DIETARY COMPONENTS CONSUMED IN EXCESS CALORIES FAT SATURATED FAT CHOLESTEROL AND SODIUM WERE JEOPARDIZING AMERICANS HEALTH IN 1977 THE SENATE SELECT COMMITTEE ON NUTRITION AND HUMAN NEEDS PUBLISHED THE DIETARY GOALS FOR THE UNITED STATES MARKING A DISCERN IBLE FOOD MESSAGING DEPARTURE WHEREAS THE PREVIOUS EMPHASIS HAD BEEN ON OBTAINING ENOUGH NUTRITION THE TIDE WAS NOW TURNING TOWARD CAUTION AGAINST CONSUMING TOO MUCH 6 THE YEAR 1980 SAW THE PUBLICA TION OF THE RST EDITION OF NUTRITION AND YOUR HEALTH DIETARY GUIDE LINES FOR AMERICANS AFTER THE 1980 RELEASE SUBSEQUENT REVISIONS OF THE DIETARY GUIDELINES FOR AMERICANS TRENDED TOWARD SUGGESTING NUMERICAL TARGETS SUCH AS EATING LESS THAN 30 OF CALORIES FROM FAT AND EATING LESS THAN 10 OF CALORIES FROM SATURATED FAT 5 TO THIS DAY THE DIETARY GUIDELINES FOR AMERICANS DGAS ARE REVISED JOINTLY BY THE USDA AND THE UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES DHHS EVERY 5 YEARS A DESIRE TO CREATE A NATIONALLY RECOGNIZABLE AND VISUALLY APPEALING NUTRITION TEACHING TOOL LED TO THE DESIGN AND EVENTUAL RELEASE OF THE 1992 FOOD GUIDE PYRAMID THE 1992 PYRAMID EMPHASIZED VARIETY AMONG FOOD GROUPS THAT WERE SEPARATED INTO DIFFERENT CATEGORIES AND LEVELS OF THE PYRAMID THE PYRAMID INTENDED TO CONVEY PROPORTIONALITY THROUGH MODERN DIETETICS FEEDING THE SICK IN HOSPITAL AND HOME 2 DIFFERENT SIZES OF THE PYRAMID FOOD GROUPS AND IN ACCOMPANYING TEXT THAT STATED THE NUMBER OF DAILY SERVINGS TO BE CONSUMED THE TIP OF THE PYRAMID WAS INTENDED TO INDICATE MODERATION SHOWING THAT SUGARS AND ADDED FAT SHOULD BE USED SPARINGLY FIGURE 1 1 DESPITE ITS UBIQUITOUS PRESENCE ON VIRTUALLY ALL PACKAGED AND PRO CESSED FOODS SOLD IN THE UNITED STATES FOR OVER A DECADE THE 1992 PYRAMID WAS ULTIMATELY CONSIDERED A FAILED EXPERIMENT DURING THE PERIOD FROM THE PYRAMID S 1992 ROLLOUT TO ITS EVENTUAL DEMISE IN 2005 AMERICANS WEIGHT AND WAISTLINES EXPANDED DRAMATICALLY WITH BODY MASS INDEX BMI INCREASING EVERY YEAR DURING THAT PERIOD 7 ALTHOUGH MOST AMERICANS COULD RECOGNIZE TO SOME DEGREE WHAT THE PYRAMID WAS TRYING TO CONVEY VERY FEW PEOPLE WERE ACTUALLY USING IT TO DRIVE HEALTHY FOOD CHOICES 8 THE MUCH MALIGNED PYRAMID WAS CRITICIZED FOR ITS LACK OF PORTION SIZE INFORMATION FAILURE TO DIFFERENTIATE BETWEEN WHOLE GRAINS AND RE NED GRAINS LUMPING OF HIGH FAT ANIMAL PROTEINS IN WITH HEALTHIER OR LEANER PROTEIN SOURCES DISREGARD FOR STATEMENTS ABOUT THE BENE TS OF HEALTHY FATS FAILURE TO MENTION THE BENE TS OF EXERCISE OR IMPACT OF ALCOHOL IN THE DIET AS WELL AS AN OVEREMPHASIS ON DAIRY IN CONJUNCTION WITH THE 2005 REVISION OF THE DIETARY GUIDELINES FOR AMERICANS THE USDA REPLACED THE 1992 FOOD GUIDE PYRAMID WITH ITS UPDATED PYRAMID CALLED MYPYRAMID THE MYPYRAMID TOOL WAS DESIGNED TO BE SIMPLE AND TO DRIVE TRAF C TO THE USDA S MYPYRAMID FIGURE 1 1 1992 FOOD GUIDE PYRAMID DATA FROM US DEPARTMENT OF AGRICULTURE HTTP WWW NAL USDA GOV FNIC FPYR FGPYRAMID TIF ACCESSED JANUARY 2 2013 A GUIDE TO DAILY FOOD CHOICES MEAT POULTRY FISH DRY BEANS EGGS NUTS GROUP 2 3 SERVINGS VEGETABLE GROUP 3 5 SERVINGS MILK YOGURT CHEESE GROUP 2 3 SERVINGS FATS OILS SWEETS USE SPARINGLY BREAD CEREAL RICE PASTA GROUP 6 11 SERVINGS FRUIT GROUP 2 4 SERVINGS THESE SYMBOLS SHOW THAT FAT AND ADDED SUGARS COME MOSTLY FROM FATS OILS AND SWEETS BUT CAN BE PART OF OR ADDED TO FOODS FROM THE OTHER FOOD GROUPS AS WELL KEY FAT NATURALLY OCCURRING AND ADDED SUGARS ADDED MODERN DIETETICS FEEDING THE SICK IN HOSPITAL AND HOME 3 GOV WEBSITE WHERE MORE DETAILED INFORMATION ON CALORIE PATTERNS FOR VARIOUS AGE GROUPS AND LIFE STAGES EG PREGNANCY PRESCHOOLERS AND ADOLESCENTS COULD BE ACCESSED IN THIS VERSION OF THE PYRAMID DIFFERENT COLORED BANDS IN THE PYRAMID REPRESENTED THE VARIOUS FOOD GROUPS THE NARROWING WIDTH OF THE BANDS AS THEY APPROACHED THE TIP OF THE PYRAMID INDICATED MODERATION AND PROPORTIONALITY ACTIVITY WAS REPRESENTED BY THE PERSON CLIMBING THE STAIRS WHILE THE STEPS TO A HEALTHIER YOU TAG LINE STOOD FOR GRADUAL IMPROVEMENT THE MYPYRAMID GOV URL INDICATED PERSONALIZATION FIGURE 1 2 FIVE YEARS LATER FOR THE 2010 EDITION OF THE DIETARY GUIDELINES FOR AMERICANS THE USDA SCRAPPED ITS PYRAMID APPROACH ALTOGETHER THIS TIME IN FAVOR OF A PLATE CALLED MYPLATE THE MYPLATE TOOL CHOOSEMYPLATE GOV WEBSITE AND ACCOMPANYING CONSUMER MESSAGES PROMOTE A SIMPLI ED APPROACH TO MEAL PLANNING MAKE HALF YOUR PLATE FRUITS AND VEGETABLES AND BALANCE THE REMAINDER OF YOUR MEAL WITH WHOLE GRAINS LEAN PROTEIN AND LOW FAT DAIRY FIGURE 1 3 DIETARY GUIDELINES FOR AMERICANS 2010 THE DIETARY GUIDELINES FOR AMERICANS 2010 WERE RELEASED IN JUNE 2011 AND SERVE AS THE FEDERAL GOVERNMENT S EVIDENCE BASED NUTRITIONAL GUID ANCE TO PROMOTE HEALTH REDUCE THE RISK OF CHRONIC DISEASES AND REDUCE THE PREVALENCE OF OVERWEIGHT AND OBESITY THROUGH IMPROVED NUTRITION AND PHYSICAL ACTIVITY 9 THE GUIDELINES INCLUDE 23 KEY RECOMMENDATIONS FOR THE GENERAL POPULATION AND SIX ADDITIONAL RECOMMENDATIONS FOR SPE CI C POPULATION GROUPS SUCH AS PREGNANT WOMEN AND OLDER AMERICANS TABLE 1 1 CONTAINS THE DIETARY GUIDELINES FOR AMERICANS 2010 SELECTED MYPYRAMID GOV STEPS TO A HEALTHIER YOU FIGURE 1 2 MYPYRAMID DATA FROM US DEPARTMENT OF AGRICULTURE MYPYRAMID GOV WEBSITE WASHINGTON DC MYPLATE GRAPHIC RESOURCES WEBSITE HTTP WWW CHOOSEMYPLATE GOV PRINT MATERIALS ORDERING GRAPHIC RESOURCES HTML ACCESSED JANUARY 2 2013 MODERN DIETETICS FEEDING THE SICK IN HOSPITAL AND HOME 4