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Diet Analysis Using the US FDA SuperTracker Website OBJECTIVES To connect essential nutrients to their specific functions To recognize the relationship between good or poor nutrition and health To collect and analyze your own nutritional data and compare it to target values for your age, gender and height to see if you are deficient in essential nutrients, calories and food group items To learn a number of approaches to determining healthy weight To allow you to determine your own nutritional status and make good nutritional choices in the future INTRODUCTION Diet and nutrition have recently become very hot topics. In the past thirty years the incidence of diabetes and obesity has dramatically increased. The NIH Heart, Lung and Blood Institute blames this on an energy imbalance: we consume more energy in the form of calories in than we burn through activity and metabolic processes. The diet industry has tried to capitalize on people’s natural desire for a quick fix for excess weight. They say if you eliminate certain foods and eat others, you will lose weight ignoring this energy balance. For example, naturally occurring, saturated fats (butter) and oils (palm and coconut) were vilified as dangerous sources of cholesterol and created paranoia around fat. This fostered a whole new industry of light and fat-free foods. An interesting quote from an article in Science (2001) titled The Soft Science of Dietary Fat had a quote that sums up our perception of dietary fat. “In America we no longer fear God or the communists, but we fear fat.” Industry reacted to the fear of saturated fats by switching to partially hydrogenated vegetable oils (PHOs) lower in saturated fats in the manufacturing of processed foods. However, the hydrogenation process resulted in the formation of “trans-fats” which we have now discovered are much worse than saturated fats for raising levels of bad cholesterol (low density lipoproteins) leading to heart disease (atherosclerosis and hypertension). The US FDA now states that they no longer recognize PHOs as safe and are moving to change laws so that companies would have to get their approval to include PHOs in the manufacturing of food items (Nov. 2013). Unfortunately, dietary decisions are being made with almost no hard science to back them up. The controversy over the correct percentage of carbohydrate, fat and protein in our diets rages on and the diet industry has become a billion dollar industry. Popular diets, such as the Atkins Diet, South Beach Diet, Hollywood Diet and the High Protein Diet, all severely restrict carbohydrate intake with an increased protein intake. This forces the body to use fat as the main source of energy causing ketosis, a metabolic imbalance due to increased fat digestion. Ketosis can produce side effects such as fatigue, nausea, dizziness, metabolic dehydration causing headaches , and in some cases gout and acute kidney stress. The Zone Diet proposes a more moderate dietary intake of approximately 30% protein, 30% fat and 40% low glycemic carbohydrate. The lack of Julie Dais, Okanagan College, Kelowna, BC Page 1 hard science on any of the low carbohydrate diets prevents us from objectively evaluating their value. Lately there has been a movement away from grains, especially wheat as described in the diet book Wheat Belly, by William Davis. Gluten-free products are on the rise due to fears of allergies to wheat leading to gastrointestinal problems and celiac disease. In addition, carbohydrates in general (good or bad) are being blamed for causing weight gain. While the controversy over how much fat, protein, and carbohydrate (macronutrients) we should consume rages on, the more important factor that all of these diets seem to overlook is what effect they have on the intake of vitamins, minerals, and fiber. These are essential nutrients, ones we cannot make for ourselves (there are essential amino acids and lipids too) and are necessary for proper long term metabolic health and body function. We can assume for the time being that the US FDA Dietary Reference Intakes (DRIs) daily minimum requirements for vitamins and minerals are correct. You will analyze your diet to see if these nutrients are within the acceptable range. The problem of obesity plagues a very large proportion of adult Americans. The initial analysis of the data shows that overeating alone does not account for the problem. Those who are overweight may not eat many more calories than those who are of “normal” weight. There are a number of theories to try and explain this. Recognize that many of the studies on nutrition and obesity involve mice and rats. We can’t always assume that the findings from these studies will also apply to humans. Obesity Theories (NIH): 1. Sedentary lifestyle Calorie intake and physical activity need to be considered. To maintain a constant weight, the calories expended by metabolism and physical activity should equal the calories consumed. Over the past few decades Americans have generally reduced their levels of physical activity in response to changes in the workplace and advances in “time saving” technology. In addition, many adults and children spend much more time in front of “screens” than participating in physical activity. We also tend to walk less and use our cars for even short trips. The impact of such changes on metabolism and the consequences for health are indeed complex and remain only partially understood. Since the level of physical activity, as well as the amounts and types of food consumed are matters of personal choice, obesity can sometimes be reversed. 2. Genetics and Epigenetics There appears to be a genetic component to obesity as revealed by twin studies (higher incidence with identical twins versus non-identical twins), but there also seems to be an epigenetic component. Consumption of high fat foods and chemical exposure during pregnancy can alter the epigenome (methylation on chromosomes) of the fetus to modify gene expression leading to more efficient energy storage in adipose cells. This is a new area of research that may lead to promising obesity treatment and prevention. Julie Dais, Okanagan College, Kelowna, BC Page 2 3. Environment We are bombarded with advertisements for easily accessible fast food which is high in salt and calories on a daily basis. Sometimes it is hard to find fresh fruit and vegetables and the only option is fast food. Cooking healthy meals takes time and many of us have long work days and long commutes. Sometimes external cues make a person want to eat even if they are not hungry such as someone might eat a meal at a certain time whether or not they are hungry. Other people may eat when under stress or when they are depressed. 4. Sleep-wake cycles and hormones Studies are also demonstrating that people who don’t get enough sleep at night are more likely to be overweight. A number of hormones seem to be out of balance in these individuals. Leptin, a hormone produced by adipose cells after a meal functions to decrease appetite. Its levels seem to be lower in people who do not get enough sleep. Ghrelin, which is produced when you haven’t eaten in a while, is elevated in people who do not get enough sleep. Therefore, it makes one feel hungrier than they should if they had had enough sleep. It is important to note that insulin levels are also affected by insufficient sleep and this is related to an increased risk of diabetes mellitus. . The overall concept though is that to maintain a steady weight, energy consumed must equal energy expended (i.e. Calories in = Calories out). If you wish to gain weight, you eat more calories than you burn and if you wish to lose weight you eat fewer calories than you burn. You shouldn’t reduce the calorie intake too much or your body may go into conservation mode. It is best to increase activity level and not lose more than 1 – 2 pounds per week. We use the word calories, but we really mean kilocalories (kcal). Essential Nutrients of Importance Iron is required for hemoglobin production and deficiencies can result in anemia. This can affect vegetarians and females who are athletic, and/or pregnant. Iron can be obtained in your diet by consuming meat such as beef, liver, poultry, clams, and oysters). There is some iron in other foods such as processed foods made with enriched flour, legumes (beans and lentils) and dark green vegetables, but this form of iron is not as readily absorbable. Cooking foods in cast iron pans also increases iron content. Calcium is a mineral found in dairy products, bones of fish, legumes, and dark green vegetables. Calcium is stored in our bones and is important for bone strength, but calcium homeostasis in blood is vital for other functions such as muscle contractions (including the heart), nerve transmission, and blood clotting. Bone density is sacrificed if dietary calcium is low. Calcium deficient diets can result in osteoporosis or brittle bones that can lead to hip and vertebral fractures. Water soluble vitamins are lost daily and must be obtained in your diet. These are Vitamin C (ascorbic acid) and the B Vitamins. Niacin (B3), Riboflavin (B2), Thiamin (B1) and folate (folic acid) are 4 important ones. They are important for many different metabolic processes and deficiencies can lead to neurological problems (such as numbness and weakness) and anemia among many disorders. Low maternal folate intake during pregnancy has been linked to a spinal cord condition called spina bifida in the newborn. Fat-soluble vitamins (A, D, K, and E) are stored in adipose cells and it isn’t Julie Dais, Okanagan College, Kelowna, BC Page 3 as important to meet requirements on a daily basis, but a 3-day average should meet the recommended dietary intake. Vitamin D, which aids in the uptake of calcium, is not sufficiently synthesized by the body in the winter months and thus supplements are required to help prevent osteoporosis. Additionally, vitamin D production can be hampered by sunscreen use. Sources of vitamin D include sunlight, cod liver oil, fortified dairy products, and fortified dairy alternatives such as soy milk. Salt (NaCl) or sodium is an important nutrient in our bodies as both sodium and chloride play roles in fluid balance. Additionally, sodium is important for the resting membrane potential of muscles and neurons, so you need to have some sodium in your diet. Too much sodium may cause high blood pressure in some individuals. Dietary fiber, derived from structural carbohydrates of plants, is not digestible by humans and is found in vegetables, fruits, legumes, and unrefined cereals (whole grain bread and bran). Dietary fiber has the property of providing bulk to fecal matter, absorbing water and keeping feces soft (making us “regular”). The benefits of fiber in the diet are a topic of debate. Past studies indicated that dietary fiber prevented colon cancer. However, recent studies have dispelled this idea, although dietary fiber is very important in preventing heart disease and regulating blood glucose levels. The amount and type of fiber that is considered beneficial is still controversial (and very hard to achieve in the diet), but for a young adult, 25-30 grams per day is recommended. Essential fatty acids such as omega-3s found in leafy greens, seeds and nuts, oils from flaxseed, canola, soy, and fish are important for reducing inflammation which helps maintain cardiovascular health and joint function. It is also important that people obtain the essential amino acids as well. If animal products are consumed, this isn’t an issue. However, vegans need to ensure that they eat vegetable, seed, legume, and whole grain combinations that supply all 20 amino acids. Mutual supplementation (consuming at least two of these food groups with each meal) is a method of ensuring this balance or protein energy malnutrition could result. The Glycemic Index (GI) rates foods according to their effect on blood sugar/glucose levels after consumption and thus in turn the effect on insulin levels. It is supported by hard science. The Glycemic Index has shown that not all sugars are created equal. For example, the GI of glucose = 100, the GI of Sucrose = 59, and the GI of Fructose = 20 (>55 high GI, <55 low GI). Table sugar (sucrose) is actually 50% glucose and 50% sucrose so it isn’t nearly as bad on blood glucose levels as starchy foods like processed cereals and rice cakes. Starchy foods are composed of only glucose molecules joined together. When broken down in the digestive tract, they are absorbed as straight glucose which results in a high GI or glycemic response by the body. Whole grains are digested more slowly so they don’t raise blood glucose levels as quickly. Combining starchy foods with proteins and fats (which have no effect on blood glucose levels) will also slow down starch digestion and glucose absorption. Julie Dais, Okanagan College, Kelowna, BC Page 4 Macronutrients that provide energy include carbohydrates (4 kcal/g), proteins (4 kcal/g), and fats/oils (9 kcal/g). Vitamins, minerals, and fiber do not provide energy. Notice that fats and oils store more than twice as much energy per gram as carbohydrates and proteins. Target percentages for these 3 macronutrients vary depending on gender, age, and fitness regime so a target range is given. Fat 20-35% Carbohydrates 45-65% Protein 10-25% DIET ANALYSIS PROCEDURE: Part 1: Record What You Eat on the Food Record Form Record all of the items that you eat and drink on the Food Record Form for any two days. Use one form per day. Estimate the portion size as accurately as possible. For example, if you ate 1 Big Mac that’s easy, just write that down. However, if you ate a stir fry you need to record the estimated amount of each ingredient that you ate (1/2 chicken breast, 1/4 red pepper, 10 snow peas, 1 carrot, 1 cup white rice). Note that it is important to include % fat with dairy products. (Note: 1 cup = 250 ml or 8 oz.; 1 oz. = 30 g) Include any alcoholic drinks in your form too. Note that they may not have any other nutrient value other than 7kcal/g. If you have mixed drink such as a rum and cola, then you need to record the quantity of rum and the quantity of cola separately. Also record any vitamins and mineral supplements you consume and keep the bottle handy (or photograph it with your smartphone) so that you can include this in your calculations later. Part 2: Calculate Your Nutrient Intake and Food Group Servings Go to the SuperTracker (US Department of Agriculture) website https://www.supertracker.usda.gov/default.aspx You will first need to create your profile to use this site (its free), but the benefit is that the website will retain your information and you can track your diet over time. Follow these steps: (input each day separately): 1. Choose Food Tracker. If you consume the same item regularly you could start with the My Favorite Foods List tab and input commonly consumed items to make future input go more quickly. 2. When you open up the Food Tracker, it will automatically be set to the present date. You can change the date in the upper left corner for your day 1 Food Record Form. Search each food item by category and item and adjust for quantity. You can input by meal, but that is not necessary. Once you have finish day 1, change the calendar to a different day and input your items from your second food record form. Julie Dais, Okanagan College, Kelowna, BC Page 5 3. Go to the top of the page and find the tab for My Reports and generate a report for each day on Food Groups and Calories. Record your Daily Food Group Targets: DAY 1 Your # of Servings Recommended # of Servings Grains ____________ ____________ Dairy ____________ ____________ Fruits ____________ ____________ Vegetables ____________ ____________ Proteins ____________ ____________ Your # of Servings Recommended # of Servings Grains ____________ ____________ Dairy ____________ ____________ Fruits ____________ ____________ Vegetables ____________ ____________ Proteins ____________ ____________ DAY 2 4. Nutrient Intake Report. Go to My Reports at the top of the webpage and generate a single report that includes both of your dates for Nutrient (Intake) Reports. This report will give you more details regarding your energy, fiber, vitamin and mineral intake. Choose the dates that you want to include in the report and print for future reference. a. From your Nutrient Intake Report average for two days, record the following: Your % Recommended % % kcal carbohydrate __________% __________% % kcal protein __________% __________% % kcal total fat __________% __________% % kcal saturated fat __________% __________% b. Record your Daily Calorie Intakes: Day 1 ______________ kcal Day 2 ______________ kcal c. List the vitamins that did not reach target levels. Julie Dais, Okanagan College, Kelowna, BC Page 6 d. List minerals that did not reach target levels. e. Dietary Fiber average eaten = _____________ g Part 3: Determine Your Daily Energy (kcal) Requirement Use the SuperTracker feature called My Physical Activity Tracker to calculate your daily energy requirement fairly accurately. This is a time consuming process, but again you can store your common activities in the My Favorite Activity List. You can even include activities such as doing laundry or walking up stairs and the tracker will give you an indication of the benefits you are receiving during that activity. Try it out! A simple way to approximate the number of kilocalories you require on an average day is to multiply your weight in kilograms by one of the following factors: X 26 Inactive X 31 Mildly active X 35 Medium active X 40 Active X 44 Very active You do nothing actively You ride to work and sit at work Teacher or mother of small children On the move most of the time Physical worker plus extra exercise (pounds to kg conversion – divide weight in pounds by 0.454 to give weight in kg) http://www.metric-conversions.org/weight/pounds-to-kilograms.htm If you are inactive or mildly active but spend an hour per day playing a sport or working out, you should raise your activity level at least one category. Your calculated energy requirement is: ___________ kcal/day Part 4: Determining Your BMI, Waist Circumference and Percent Body Fat There are a number of ways of determining if you are at a healthy weight. You can access the charts and procedures for determining BMI and waist circumference at The Centers for Disease Control and Prevention site below: http://www.cdc.gov/healthyweight/assessing/ 1. The BMI or Body Mass Index is a ratio of your weight to height. BMI is often used to determine if one is at a healthy weight, underweight, overweight or obese. However, it cannot distinguish between lean muscle and fat, and doesn’t take into account activity level, gender, pregnant or nursing women, or children under the age of 18. Thus a healthy body builder or strength-oriented athlete could have a BMI indicating they are overweight or obese. Julie Dais, Okanagan College, Kelowna, BC Page 7 BMI <18.5 18.5-24.9 25-30 >30 Underweight Average Overweight Obese Obtain your BMI from the website = _____________ Under which category do you fall? _______________________ 2. Waist circumference is a quick way to determine if you are at a healthy weight. It seems to be a more reliable indicator of increased risk of developing health problems than BMI. Measure just above your hip bone after exhaling. Make sure tape is snug but not cutting in. Women – 35 inches or less Men – 40 inches or less What is your waist circumference? __________ 3. Optional: Determination of body composition, fat versus lean muscle mass, is another indicator of a healthy weight. Bioelectrical impedance analysis and skin fold tests are two simple methods of determining the % body fat in an individual. If the equipment is available and time permits, determine your % body fat. ______% Julie Dais, Okanagan College, Kelowna, BC Page 8 DIET ANALYSIS ASSIGNMENT TO HAND IN You will need to hand in: 3 food record forms (initial 2 days tracked plus the healthy diet plan created at the end of the assignment) two Nutrient Intake Reports generated from the SuperTracker 1. includes the two days tracked as previously described 2. plus a redesigned, healthy meal plan created at the end of this assignment Answers to the following questions: 1. Total Calorie Intake Compare your total daily calorie (kcal) intake to what is required by the average person of your gender, weight, and activity level. Are you meeting, exceeding, or under your daily calorie needs to maintain weight? Explain. 2. Daily Food Group Targets Did you meet your daily food group targets? Which ones are you low in? What specific foods could you add to your diet to meet each food group targets? 3. Nutrient Intake Averages over Two Days How closely does your diet fit the % targets for carbohydrate, protein, total fat, and saturate fat? Explain. 4. Vitamin and Mineral Intake Analysis Examine your Nutrient Intake Report. Compare your average vitamin and mineral intake to the target values. Which vitamins and minerals are deficient in your diet? (Pay close attention to calcium and iron levels if you are female.) Now look at your vitamin and mineral supplement information and add these values to the report values for the ones you were deficient in. Does this bring your levels up to target levels for each deficient vitamin or mineral? Besides supplements, explain how could you modify your diet to obtain these deficient nutrients? If your diet is already meeting your nutritional needs, then list foods you consume and the important nutrients they provide. 5. Compare your fiber intake to the recommended values given in your nutrient intake report. If your consumption is low, what foods could you add to your diet to increase your daily fiber? If your fiber intake is sufficient, then list the foods you ate that were high in fiber. 6. List the sources of fats and oils you consume. Which would be considered healthy? Explain. Which types of fats and oils are considered unhealthy? Why? 7. Comment on your salt intake (NaCl). If it is high, which food items contributed large amounts of salt? Besides reducing the amount of salt we add to foods with the salt shaker, how else can one reduce their salt intake? Julie Dais, Okanagan College, Kelowna, BC Page 9 8. According to the methods employed are you at healthy weight? Do these methods give you similar reports of your health in relation to your weight? If not, explain. Which method is most accurate? 9. Based on what you have learned in this assignment, design a healthy meal plan for one day using a new food record form and analyze it. Make sure it would supply the nutrients you were deficient in earlier. Also, take into account the daily food group targets for grains, vegetables, fruits, dairy and protein, as well as your energy needs (calories). Now take this healthy meal plan and input it into SuperTracker. Hand in this new food record form and the healthy diet nutrient intake report printout as well. References Heart, Lung and Blood Institute, NIH. Retrieved December 6, 2013. http://www.nhlbi.nih.gov/health/health-topics/topics/obe/causes.html The Soft Science of Dietary Fat. Taubes, Gary. 2001. Science Magazine. http://www.sciencemag.org/content/291/5513/2536 http://www.diabetesbook.com/articles/SoftScience.pdf Thompson, J., Manore, M., Sheeshka, J. (2012). Nutrition: A Functional Approach (Second Canadian Edition). Toronto, ON: Pearson Education Canada. US FDA Dietary Reference Intake Tables http://fnic.nal.usda.gov/dietary-guidance/dietary-reference-intakes/dri-tables What Causes Overweight and Obesity? NIH http://www.nhlbi.nih.gov/health/health-topics/topics/obe/causes.html Julie Dais, Okanagan College, Kelowna, BC Page 10 Students will need 3 copies of this food record form FOOD RECORD FORM: Date: ________________ If you are consuming foods such as home-made stir fries with many individual ingredients, include the quantity consumed of each ingredient. Possible units to use: cups, ounces, tablespoons, teaspoons, estimated size of fruit or vegetable (medium or large), packages (i.e. ketchup at fast-food restaurant). Food Item Julie Dais, Okanagan College, Kelowna, BC Quantity Page 11 FOOD RECORD FORM: Date: ________________ If you are consuming foods such as home-made stir fries with many individual ingredients, include the quantity consumed of each ingredient. Possible units to use: cups, ounces, tablespoons, teaspoons, estimated size of fruit or vegetable (medium or large), packages (i.e. ketchup at fast-food restaurant). Food Item Julie Dais, Okanagan College, Kelowna, BC Quantity Page 12 FOOD RECORD FORM: Date: ________________ If you are consuming foods such as home-made stir fries with many individual ingredients, include the quantity consumed of each ingredient. Possible units to use: cups, ounces, tablespoons, teaspoons, estimated size of fruit or vegetable (medium or large), packages (i.e. ketchup at fast-food restaurant). Food Item Julie Dais, Okanagan College, Kelowna, BC Quantity Page 13