Download Chapter 1 – Title of Chapter

Chapter 18 – Diet and Health
Learning Objectives
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Describe the immune system and the cells that compose it.
Identify nutrients that are known to enhance immunity.
Discuss the role of nutrition and lifestyle in the development of chronic disease.
Describe cardiovascular diseases and risk factors in the development of each.
Discuss the role of nutrition in the prevention and treatment of the cardiovascular disease.
Describe risk factors in the development of hypertension and the role of nutrition in the prevention and treatment of the
disease.
7. Discuss diabetes, including types of diabetes and the role of nutrition in prevention and treatment.
8. Describe cancer development and dietary factors that may initiate or impede the process.
9. List the nutrition and lifestyle factors that may reduce specific types of cancer.
10. Identify recommendations for the prevention of chronic disease in individuals and groups.
11. Describe alternative/complementary medicine and nutrition-related alternative therapies.
12. Identify herbal remedies and the risks and benefits of each.
Lecture Presentation Outline
I.
Nutrition and Infectious Diseases
Personal strategies to prevent infectious disease are important. Nutrition intervention can help prevent malnutrition and
minimize the wasting that accompanies AIDS.
A. The Immune System
1. Organs of the immune system fight antigens
a. Spleen.
b. Lymph nodes.
c. Thymus.
2. Phagocytes
a. Engulf and digest invaders; a process is called phagocytosis.
b. Secrete special proteins called cytokines that activate a metabolic and immune response.
3. Lymphocytes: B-cells
a. Produce antibodies that react selectively, part of a class of proteins called immunoglobulins.
b. Retain memory to react faster with the same foreign organism.
c. Resistance to infection.
4. Lymphocytes: T-cells
a. Release powerful chemicals to destroy foreign particles.
b. Highly specific, attacking only one antigen.
c. Defend against fungi, viruses, parasites, some bacteria, and cancer cells.
d. Participate in the rejection of transplanted tissue.
B. Nutrition and Immunity
1. Malnutrition compromises immunity.
2. Immunity and infectious disease increase nutrient needs and lower food intake.
3. The synergistic downward cycle of disease and malnutrition must be broken for recovery to occur.
4. Opportunistic infections develop when the immune system is suppressed.
C. HIV and AIDS
1. HIV (human immunodeficiency virus) is the infection that attacks the immune system and disables the body’s
defenses.
2. AIDS (acquired immune deficiency syndrome) is the infectious disease that destroys health and life.
3. Epidemic
4. Early detection and early intervention are critical.
D. Inflammation and Chronic Disease
1. Inflammation occurs in response to infection or injury.
2. Acute inflammation is beneficial because it fights off infection or injury, removes damaged tissue, heals wounds,
and promotes recovery.
3. Chronic inflammation results in tissue damage.
II. Nutrition and Chronic Diseases
Four of the top ten causes of death are related to diet. There are also genetic and lifestyle risk factors that are important
and related to chronic disease. Many of the nutritional factors in the treatment of chronic disease are interrelated.
III. Cardiovascular Disease (CVD)
Atherosclerotic plaques can raise blood pressure, cause abnormal blood clotting, and cause heart attacks and strokes.
There are many recommendations for prevention and treatment including dietary interventions, quitting smoking, and
engaging in regular physical activity. The most common form of CVD is coronary heart disease (CHD), which develops
due to atherosclerosis in the coronary arteries.
A. How Atherosclerosis Develops
1. Atheromatous plaque builds on artery walls and leads to inflammation.
2. Inflammation
a. Cells lining the blood vessels incur damage.
b. Inflammatory response using macrophages that become the cells of plaque.
c. Blood clots form and minerals harden the plaque.
d. Fibrous connective tissue.
e. C-reactive protein (CRP) is a sign of inflammation of the artery walls.
f. Lipoprotein-associated phospholipase is an inflammatory marker that appears to be specific for plaque
inflammation.
3. Plaques – Fibrous coating can be torn away with a surge in blood pressure.
4. Blood Clots
a. Platelets cover the damaged area and form a clot.
b. Thrombosis is a blood clot that sticks to an artery and grows large enough to restrict or close off a blood
vessel.
c. Embolism is when a blood clot breaks free, travels, and lodges in a small artery and shuts off blood flow to
tissues.
d. Platelets are under the control of eicosanoids, made from omega-3 and omega-6 fatty acids.
5. Blood Pressure and Atherosclerosis
a. Arteries are narrowed due to plaque, clots, or both.
b. The heart must generate more pressure to deliver blood to the tissues.
c. Higher blood pressure results in further damages.
6. The Result: Heart Attacks and Strokes
a. Angina – pain or pressure feeling around the area of the heart.
b. Heart attack – restricted blood flow to the heart.
c. Transient ischemic attack or stroke – restricted blood flow to the brain.
B. Risk Factors for Coronary Heart Disease
1. Diet and physical activity are modifiable risk factors.
2. Age, Gender, and Family History
a. Cannot change these factors.
b. Men higher risk than women.
c. Men older than 45 years of age.
d. Women older than 55 years of age.
e. Immediate family history of premature heart disease.
3. High LDL and Low HDL Cholesterol
a. LDL
1. Excess LDL (low-density lipoproteins) become available for oxidation, high risk.
2. Risk factors for LDL cholesterol
a. Desirable: 100 mg/dL.
b. Above optimum level: 100-129 mg/dL.
c. Borderline: 130-159 mg/dL.
d. High: 160-189 mg/dL.
e. Very High: 190 mg/dL.
b. HDL
1. HDL (high-density lipoproteins) represent cholesterol being carried back to the liver, reduced risk.
2. Risk factors for HDL cholesterol
a. Desirable: 60 mg/dL.
b. Borderline: 59-40 mg/dL.
c. High: 40 mg/dL.
c. Total cholesterol
1. Desirable levels at  200 mg/dL.
2. Borderline levels at 200-239 mg/dL.
3. High levels at  240 mg/dL.
4. High Blood Pressure (Hypertension)
a. Injures artery walls and accelerates plaque formation, which in turn increases blood pressure.
b. Blood pressure (systolic and/or diastolic pressure)
1. Desirable: 120/80.
2. Borderline: 120-139/80-89 (prehypertension).
3. High: 140/90 – stage one hypertension.
4. Stage two hypertension: 160/100.
5. Diabetes
a. Risk similar to people with established CHD.
b. CHD risk equivalents.
6. Obesity and Physical Inactivity
a. Obesity, especially abdominal obesity, and physical inactivity increase risk.
b. Body mass index
1. Desirable: 18.5-24.9.
2. Borderline: 25-29.9.
3. High: 30.
c. Weight loss and regular physical activity are protective.
7. Cigarette Smoking
a. Powerful factor for increased risk.
b. Increases blood pressure and the workload of the heart.
8. Atherogenic Diet
a. A diet high in saturated fats, trans fats, and cholesterol and low in fruits and vegetables elevates LDL
cholesterol.
b. Antioxidants and omega-3 fatty acids lower the risk of CHD.
9. Other Risk Factors
a. Emerging risk factors and predictions.
b. Elevated triglycerides are a marker for other risk factors and being studied in relation to CHD.
1. Desirable levels of fasting triglycerides: 150 mg/dL.
2. Borderline levels of fasting triglycerides: 150-199 mg/dL.
3. High levels of fasting triglycerides: 200-499 mg/dL.
4. Very high levels of fasting triglycerides:  500 mg/dL.
c. Diabetes and overweight.
10. Metabolic Syndrome – also called Syndrome X or insulin resistance syndrome.
a. Insulin resistance is a risk factor.
b. Any three of the following factors
1. Abdominal obesity
a. Men: Waist circumference 40 inches.
b. Women: Waist circumference 35 inches.
2. Triglycerides: 150 mg/dL.
3. HDL: 40 mg/dL in men, 50 mg/dL in women.
4. Blood pressure: 130/85 mm Hg.
5. Fasting glucose: 100 mg/dL.
C. Recommendations for Reducing Coronary Heart Disease Risk
1. Cholesterol Screening – at least two times at least one week apart.
2. Lifestyle Changes
a. Balance energy intake with energy needs.
b. Include lean meats, vegetables, and low-fat milk products.
c. Limit foods with high concentrations of saturated fatty acids (< 7% of total kcalories) and trans-fatty acids
( 1% of total kcalories).
d. Limit foods with a high content of cholesterol ( 300 mg/day).
e. Choose foods high in soluble fiber: vegetables, fruits, and whole grains.
f.
g.
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Choose high-potassium, low-sodium foods.
Limit sodium to 2,300 mg/day.
Limit intake of added sugar.
Consume fatty fish at least twice a week for omega-3 fatty acids.
Consume foods with plant sterols or stanols added.
Use soy products in place of animal foods that are high in saturated fat and cholesterol.
If alcohol is consumed, it should be limited to 1 drink/day for women or 2 drinks/day for men.
Exercise at least 30 minutes most days of the week to expend 2,000 kcalories weekly.
Reduce exposure to tobacco smoke.
IV. Hypertension
Hypertension with accompanying atherosclerosis can cause heart attacks and strokes. Weight control is the most effective
dietary strategy for treating hypertension.
A. How Hypertension Develops
1. Blood flow to the kidneys is reduced so the kidneys expand blood volume and constrict peripheral blood vessels,
resulting in peripheral resistance and thus raising blood pressure.
2. Cardiac output increases, increasing the work of the heart.
B. Risk Factors for Hypertension
1. Age – risk increases with age.
2. Genetics – family history, African-American.
3. Obesity – 60% of those with hypertension are obese.
4. Salt sensitivity.
5. Alcohol may raise blood pressure and is associated with strokes.
C. Treatment of Hypertension
1. Weight control is the one of the most effective treatments.
2. Physical activity will help – moderate aerobic for 30-60 minutes most days.
3. The DASH Diet – Dietary Approaches to Stop Hypertension
a. Grains: 6-8 ounces.
b. Vegetables: 2-2 ½ cups.
c. Fruits: 2-2 ½ cups.
d. Milk (low-fat or fat-free): 2-3 cups.
e. Meat (lean): 6 ounces or less.
f. Nuts, seeds, legumes: 4-5 ounces per week.
g. 2000 kcalories.
4. Salt/Sodium Intake
a. Restricting sodium is important for preventing or reducing hypertension.
b. The greater the sodium restriction, the greater the reduction in blood pressure.
5. Drug Therapy
a. Diuretics and antihypertensive agents.
b. Watch potassium.
V. Diabetes Mellitus
Diabetes is characterized by high blood glucose (hyperglycemia) and either insufficient insulin, ineffective insulin, or
both. Diabetes treatment involves the coordination of diet and/or drugs and physical activity to control blood glucose
fluctuations and control or lose weight.
A. How Diabetes Develops
1. Impaired glucose tolerance or prediabetes.
2. Type 1 Diabetes
a. 5-10% prevalence in diabetic population.
b. Autoimmune disorder.
c. Usually diagnosed in childhood or adolescence.
d. Relatively severe symptoms.
e. Associated with viral infection and heredity.
f. Insulin is required.
3. Type 2 Diabetes
a. 90-95% prevalence in diabetic population.
b. Occurring in children and adults.
c. Relatively moderate symptoms.
d. Cells are resistant to insulin.
e. Associated with obesity, heredity, and aging.
f. Sometimes insulin is required.
B. Complications of Diabetes
1. Diseases of the Large Blood Vessels
a. Atherosclerosis tends to develop early and is more severe.
b. Long-term, intensive intervention targeting multiple factors can reduce risk.
2. Diseases of the Small Blood Vessels
a. Microangiopathies.
b. Affect kidney function and retinal degeneration.
3. Diseases of the Nerves
a. Hands and feet.
b. Careful of injuries and infections.
c. Gangrene may develop and amputation may be required.
C. Recommendations for Diabetes
1. Total Carbohydrate Intake
a. Consistent intake helps to regulate blood sugar.
b. Too little carbohydrate consumption can lead to hypoglycemia.
2. Carbohydrate Sources
a. Glycemic effect of a food needs to be considered.
b. Avoid foods and beverages with added sugar.
3. Dietary Fat
a. Saturate fat: <7% of total kcalories.
b. Cholesterol: <200 mg/day.
4. Protein
a. No need to modify intake as long as there is normal kidney function.
b. 15-20% of total kcalories.
5. Alcohol
a. Alcohol should be used in moderation.
b. One drink/day for women; two drinks/day for men.
6. Recommendations for Type 1 Diabetes
a. Adjust insulin doses.
b. Optimal nutrition status.
1. Control blood glucose with consistent carbohydrate intake at meals and snacks.
2. Achieve desirable blood lipids.
3. Control blood pressure.
4. Prevent and treat complications.
c. Physical activity
1. Be careful of hypoglycemia.
2. Monitor blood glucose.
7. Recommendations for Type 2 Diabetes
a. Moderate weight loss is helpful (10-20 pounds).
b. Regular, long-term physical activity.
VI. Cancer
Cancer is the growth of malignant tissue. Dietary factors that initiate cancer development include alcohol and heavily
smoked foods. Dietary factors that promote cancer once it has started include saturated fat and trans fat. Dietary factors
that serve as antipromoters—that is, protect against the development of cancer—include fiber, antioxidant nutrients, and
phytochemicals. Eating a variety of healthful foods and adapting a physically active lifestyle is the best advice to lower
cancer risk.
A. How Cancer Develops
1. Carcinogenesis is the development of cancer from mutated cells and can result in the formation of an abnormal
mass, or tumor.
2. Classifications of cancers
a. Adenomas – glandular tissues.
b. Carcinomas – epithelial tissues.
c. Gliomas – glial cells of the central nervous system.
d. Leukemias – white blood cells.
e. Lymphomas – lymph system.
f. Melanomas – pigmented skin cells.
g. Sarcomas – muscle, bone, or connective tissues.
3. Tumors can metastasize, or spread to other areas of the body.
4. Carcinogens are substances an individual is exposed to that can lead to cancer.
5. Environmental Factors
a. Exposure to radiation and sun, water and air pollution, and smoking are known to cause cancer.
b. Physical activity may protect against certain types of cancer.
c. Obesity increases risk for cancer.
6. Dietary Factors—Cancer Initiators
a. Additives and pesticides.
b. Minimize carcinogens when cooking – use foil on grill, do not burn foods, and marinate meat beforehand.
c. Alcohol and smoking.
d. High red meat intake and colon cancer.
e. Acrylamide is produced when starches are cooked at high temperatures – french fries and potato chips.
7. Dietary Factors—Cancer Promoters
a. High-fat diets correlate with high cancer rates in animals.
b. Omega-3 fatty acids may be protective.
8. Dietary Factors—Antipromoters
a. Fruits and vegetables and low incidence of cancer.
b. Fiber-rich diets might protect against colon cancer.
c. Phytochemicals found in cruciferous vegetables activate enzymes that destroy carcinogens.
d. Antioxidant nutrients are effective – vitamin C, vitamin E, and beta-carotene.
B. Recommendations for reducing cancer risk
1. Maintain a healthy body weight.
2. Be physically active.
3. Limit consumption of energy-dense foods.
4. Consume five or more cups of fruits and vegetables per day.
5. Limit the consumption of red meat.
6. Limit consumption of alcoholic beverages.
7. Limit consumption of salt.
8. Try to meet nutritional needs through the diet rather than supplements.
VII. Recommendations for Chronic Diseases
A. Recommendations for the Population – making dietary changes to forestall or prevent disease is the preventive or
population approach.
B. Recommendations for Individuals – urging dietary changes for people who need them is the medical or individual
approach.
C. Recommendations for Each Individual – Genomics may allow for individual nutritional recommendations.
VIII. Highlight: Complementary and Alternative Medicine
Alternative therapies come in many different practices and products. Benefits and risks may be great, small, or
nonexistent. Wise consumers and health care professionals accept the beneficial effects that have been confirmed by
research to be safe and effective. They reject those practices that cause harm. Making healthful choices requires
understanding and seeking out reliable sources of information.
A. Defining Complementary and Alternative Medicine
1. Complementary and alternative medicine: diverse medical and health care systems, practices, and products
that are not currently considered part of conventional medicine.
a. Acupuncture – uses long, thin needles to relieve pain or illness.
b. Aroma therapy – uses plant or flower oil extracts to enhance health.
c. Ayurveda – uses herbs, diet, meditation, message, and yoga to prevent and treat disease.
d. Bioelectromagnetic medical applications – uses electrical or magnetic energy to increase healing.
e. Biofeedback – allows individuals to learn how to control body functions.
f. Biofield therapeutics – uses a healing force.
B.
C.
D.
E.
g. Cartilage therapy – uses connective tissue to increase health.
h. Chelation therapy – removes toxic substances from the body.
i. Chiropractic – manipulation of the spine.
j. Faith healing – use of divine intervention in healing.
k. Herbal medicine – uses plants to treat disease.
l. Homeopathy – belief that substances can help relieve symptoms.
m. Hydrotherapy – use of water to heal and relax.
n. Hypnotherapy – uses power of suggestion.
o. Imagery – guided visual relaxation.
p. Iridology – study of the eye and how it is related to disease.
q. Macrobiotic diets – a restricted diet of grains and vegetables.
r. Massage therapy – manipulation of the muscles to promote healing.
s. Meditation – calming and relaxation of the mind.
t. Naturopathic medicine – includes several natural healing practices.
u. Orthomolecular medicine – use of large doses of vitamins to treat disease.
v. Ozone therapy – use of ozone gas to boost the immune system.
w. Qi gong – uses movement, meditation, and breathing to change energy flow in the body.
2. Conventional medicine: diagnosis and treatment of diseases as practiced by medical doctors, doctors of
osteopathy, and allied health professionals.
3. Integrative medicine is an approach that combines conventional and complementary therapies.
Sound Research, Loud Controversy
1. Little research – folklore, tradition, and testimonials.
2. Placebo effect can bring about a healing effect in people who believe they are receiving treatment.
3. Risks versus Benefits
a. There are herbal remedies that are safe and reasonably effective.
b. Some therapies are not hazardous or costly but help mood and reduce stress.
c. Some are dangerous, posing great risks.
d. Some are dangerous but have some benefits.
Nutrition-Related Alternative Therapies
1. Foods
a. Potential health benefits of soy in relation to heart disease are documented.
b. More research is needed on phytoestrogens of soy to manage symptoms of menopause.
2. Vitamin and Mineral Supplements
a. Research on some vitamins and minerals might be appropriate in preventive care.
b. Safety and effectiveness issues.
3. Herbal Remedies
a. Used throughout history.
b. Benefits.
c. Synthesized medicines contain exact doses.
d. Herbal preparations can vary from batch to batch.
4. Herbal Precautions
a. “Natural” does not mean beneficial or safe.
b. Herbs are not drugs; they are dietary supplements.
c. Lack of information and discrepancies.
1. True identification of herbs.
2. Purity of herbal preparations.
3. Appropriate uses and contraindications of herbs.
4. Effectiveness of herbs.
5. Variability of herbs.
6. Accuracy of labels.
7. Safe dosages of herbs.
8. Interactions of herbs with medicines and other herbs.
9. Adverse reactions and toxicity levels of herbs.
Internet Precautions
1. Advertising and marketing of their own products.
2. Quotations from researchers and physicians may be taken out of context.
3. Increased access to products.
The Consumer’s Perspective
1.
2.
3.
4.
Seek alternative medicine because it is more in line with their beliefs about health and life.
Use alternate therapies in addition to conventional therapies.
Selecting reliable practitioners means checking out training, qualifications, and licenses.
Keep physicians informed.
Case Study
Ellen is a 53-year-old married woman with multiple medical problems, including chronic back pain. She takes medication for
high blood pressure and hypercholesterolemia, both of which are currently under control. She also takes pain medications
every day and has difficulty walking, although she occasionally attends a water exercise class at the local sports center. She is
5 feet 6 inches tall and weighs 236 pounds. She states she has been overweight most of her life and confesses that food,
especially sweet foods, are a comfort to her when she has physical or emotional pain. Her diet history reveals an intake of 2 or
3 cans of ginger ale or root beer each day. Her usual meals with her husband include meat or chicken (she does not like fish)
and vegetables such as corn or potatoes. She snacks on several types of frozen desserts between meals. She enjoys milk on
occasion but admits it is not a part of her regular diet. A recent visit to her doctor reveals a weight gain of 15 pounds over the
past 6 months and an increase in her fasting blood glucose level into the “pre-diabetes” range. She has no family history of
diabetes. Her doctor has recommended she lose weight and make lifestyle changes to prevent her from developing diabetes.
1.
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4.
5.
6.
Using the information in Table 18-3, list the risk factors that are evident from Ellen’s history and the chronic diseases that
impact her life.
What advice would you give Ellen regarding her intake of sweetened beverages as it relates to her obesity and blood
glucose levels?
Using strategies suggested in Table 18-6 and the “How To” on page 617, suggest 2 or 3 dietary changes that would help
Ellen reduce her risk for heart disease.
What dietary plan would help Ellen control her blood pressure as well as her blood cholesterol levels? What are the main
features of this diet?
Prepare a sample one-day menu with 3 meals and 1 or 2 snacks for Ellen that includes the minimum servings of each food
group for the DASH Eating Plan as outlined in Table 18-8.
According to Table 18-12, what are the four dietary guidelines that are recommended to decrease the risks associated with
all the major chronic diseases?
Answer Key:
1. Diet high in added sugars: obesity. Diet low in fruits, vegetables, and other foods rich in fiber and phytochemicals:
diabetes, atherosclerosis, obesity. Diet low in vitamins and minerals: hypertension, atherosclerosis. Increasing age:
hypertension, diabetes, atherosclerosis. Sedentary lifestyle: hypertension, diabetes, obesity. Stress: hypertension,
atherosclerosis.
2.
Minimizing the intake of foods and beverages with added sugars can prevent excess calories that cause weight gain.
Cutting these extra calories from the diet can help with weight loss efforts. Too much carbohydrate at one time—such as
from sweetened beverages—can raise blood glucose too high and stress insulin-producing cells. Cutting back on sugared
beverages can help prevent this.
3.
Find ways to consume fatty fish such as tuna or salmon at least twice a week. Suggest that she try milder forms of fish
such as canned salmon or tuna. Participate in water exercises at least 3 for 4 days a week for 30 to 60 minutes. Incorporate
fruits and vegetables into meals and snacks instead of highly sugared foods. Include 2 to 3 servings of fat-free or low-fat
milk, yogurt, or cottage cheese into her daily diet. (Students may come up with other answers as well.)
4.
DASH; rich in fruits, vegetables, nuts, and low-fat milk products; low in total and saturated fats.
5.
Breakfast: 1 cup cooked whole-grain oatmeal with 1 ounce walnuts, 1 cup fat-free milk. Snack: peanut butter and apple.
Lunch: sandwich made with whole-grain bread, 2 ounces turkey, lettuce, and tomato. Dinner: 1 cup brown rice, 1 cup
cooked broccoli, 3 oz cooked salmon. Snack: 1 cup yogurt with blueberries.
6.
Maintain a healthy body weight; engage in regular physical activity; select fiber-rich fruits, vegetables, and whole grains;
drink alcohol in moderation.
Critical Thinking Questions
1.
Discuss how altered nutrition status can affect the immune system.
Answer: The immune system is a critical system within our body, protecting the body from daily exposure to harmful
bacteria, viruses, toxins, and fungal invasions. In addition, the immune system constantly surveys the body in search of
foreign cells and rids the body of any invaders through its system of phagocytosis.
Lymphocytes or white blood cells also participate in an immune response by mounting an acquired immune response
through the work of the B-cell lymphocytes and T-cell lymphocytes. B-cell lymphocytes or Bursa cell lymphocytes
produce antibodies to an antigen (the invader). Antibodies are large proteins and retain memory and the ability to attach to
a specific antigen; therefore, the next time that particular body is attacked by that particular invader, the body retains
antibodies to fight the invader.
T-cell lymphocytes or Thymus cell lymphocytes attach the invader, the antigen. T cells are specific for each specific
antigen and it is this system that works to protect the body against cancerous cells that arise in the body naturally.
The overall health status of an individual impacts the health and wellbeing of the immune system right down to the
integrity of the skin. As indicated in Chapter 18, the skin is the first line of defense against any invasion from bacteria, etc.
and skin breakdown from malnutrition or poor nutrition can stress the immune system both by increasing demand upon
the system and by lack of vital nutrients to the system itself.
Stress, whether it be environmental, physical, emotional, or chemical, can impact an individual’s nutritional status and
consequently their immune function. For instance, during long periods of high temperatures, many individuals do not feel
like eating and if they forget to hydrate, this situation can compromise the immune system. Physical stress might be
described as when an individual undergoes surgery. Some individuals may have severe dietary restrictions before and
after surgery. These restrictions, in addition to the compromise of the integrity of the skin, can significantly compromise
the abilities of the immune system.
Therefore, when working with clients/patients, it is important to think long term and to remember the importance of the
integrity of the skin in the overall approach to protecting immune function. A balanced diet is always important; however,
a few specific nutrients should be pointed out.
Healthy protein status is very important to support a healthy immune system. Individuals that are protein-energy
malnourished cannot build the proteins needed by the body for support of their immune functions, not to mention their
tissue repair, enzymes, etc. Though many clients often think of protein as only important for building muscle, dietary
protein has many other roles within our bodies and its role in the work of the immune system is very important.
As noted several times throughout this text, fatty acids are important for healthy cellular membranes, including those
within the immune system. The immune system is a system of blood cells and the health of these cells is dependent on
healthy cellular membranes.
Many vitamins are important in immune function, as noted in your chapter. These include the fat-soluble vitamins A and
E as well as the water-soluble vitamins folate, B6, and C. Minerals like iron, zinc, and selenium are also critical to strong
immune function. Throughout the duration of this course, students have studied the role of vitamins A, E, and C as well as
selenium as antioxidants. Vitamin B6 is important in protein synthesis, highlighting the importance of protein for
immunity again, and folate is important to the synthesis of DNA, highlighting the role of the immune system in
synthesizing components such as antibiotics that become lifelong defenders for the body against harmful invaders. Iron
and zinc both play critical roles as enzymes in immune function. Of course, iron is a powerful mineral that is critical to
our bodies and immune function.
A varied diet full of fruits, vegetables, high-quality proteins, complex carbohydrates, and monounsaturated fatty acids is
important in maintaining a healthy immune system. So too are exercise for the body and stress management. Maintaining
skin integrity and quickly caring for cuts and scrapes will optimize overall immune status.
2.
Discuss poor nutritional habits and relate them to two of the ten leading causes of death in the United States.
Answer: Students can select any of the following chronic diseases plus accidents: Heart disease, cancer, stroke, chronic
lung disease, accidents, diabetes mellitus, Alzheimer’s disease, pneumonia and influenza, kidney diseases, and blood
diseases. While many will pick the major disease states, some will select areas where a family member has suffered,
which can add to the flavor of the learning experience and discussion, if the instructor chooses to provide time for
discussion.
While the role of nutrition in health and wellness as well as recovery from illness is clearly understood, its role still takes
somewhat of a backseat to medicines and medical interventions, many times because the latter appears to be easier than
changing lifelong dietary habits and cultural traditions.
In this exercise, highlighting the correlation between diet, nutrition and each disease state can be a great learning
experience. The following is a brief list of nutritional habits related to each disease state. Students should be expected to
expand upon this list.
Heart Disease: High-fat diet, particularly in saturated/trans fatty acids. A high-protein diet that is especially high in fatty
meats such as steaks that are marbled with fat, making them very tender, can also be associated with heart disease.
Excessive calories leading to obesity; however, not all individuals with heart disease are obese. Some individuals can be
very thin but inherit a genetic component plus eat a high-fat diet and fail to exercise. Often individuals that are at risk for
heart disease eat diets that are low in fruits and vegetables and prefer refined carbohydrate foods. These of course are
generalizations; there are many ranges of individuals and genetics does play a role.
Cancers: Diets that are high in red/processed meats or rich in smoked or charbroiled foods are a factor here. High body fat
(obesity) and low fruit/vegetable intakes are also associated with cancer risk. Genetics and environment do play a factor.
Strokes: Risks here are similar to those of heart disease. Dietary risks for stroke include those that damage the vascular
system, such as the build-up of plaque from a high-fat diet, especially saturated/trans fats, lack of exercise, and diets low
in fiber, fruits, and vegetables.
Chronic Lung Disease: Smoking is the major factor here. However, poor diets that result in poor immune function
compromise healthy lung function. Diets providing significant amounts of dairy products can be problematic to those with
compromised lung function. Individuals that smoke do lose some of their ability to enjoy the robust flavors of a variety of
foods and may select a diet with less variety and of poorer nutritional quality. These factors further compromise the
individual and their health status.
Accidents: While this is not a chronic disease, accidents can be a result of poor nutrition because when individuals do not
eat properly or if they are replacing food with alcohol, accidents can occur. Many accidents do result from alcohol or drug
abuse or from not paying attention to what one is doing. Malnutrition can hinder one’s ability to pay appropriate attention
to the task at hand.
Diabetes Mellitus: As noted in other chapters, the majority of diabetes in the U.S. is type 2 diabetes, which is the result of
the increasing prevalence of obesity. The overnutrition or poor nutrition of obesity can certainly be redirected to a
healthier lifestyle to slow down the progression of this disease in this country.
Alzheimer’s Disease: While this form of dementia has not been directly linked with diet and nutrition, there is some
research to suggest that mineral deficiencies could be a problem in the disease process. Certainly much more research is
required. In the meantime, caring for Alzheimer’s patients requires many types of nutritional interventions.
Pneumonia and Influenza: Both of these significant disease states do involve a compromised immune system. Many
individuals that succumb to either of both of these diseases were generally immune compromised prior to their acquiring
the disease. That being said, their nutritional status was also in a compromised state. A healthy body with a healthy
immune system is less susceptible to infectious disease.
Kidney Disease: There are many types of kidney diseases; however, one co-morbidity of type 2 diabetes is chronic renal
disease. In this regard, obesity may be the link to this chronic disease.
Blood Infections: As noted above, a compromised immune system will result from poor nutritional status and can lead to
blood infections. Blood infections are very serious and demonstrate the significance of the breakdown of the individual’s
immune system.
4.
Discuss the comorbidities of type 2 diabetes, and the role of the RD in preventing these health issues.
Answer: The chronic complications or comorbidities of type 2 diabetes are many. Due to the elevated blood glucose
levels in the body of a diabetic, both peripheral neuropathy, poor circulation, and resulting skin infections are not
uncommon. It is very important for individuals with diabetes to pay close attention to the integrity of their skin and see
their physician at the first signs of moderate lacerations or any sign of infection. A wound on a diabetic individual can
easily become infected, with the infection growing to the surrounding areas. Digits such as fingers and toes, given their
microvascular circulation, can be particularly difficult to heal from any infection and diabetics are prone to amputations of
digits of the fingers and toes as well as the lower legs.
Assisting the diabetic client in careful attention to their diet and monitoring of their blood sugar levels. This can help
reduce the damages of circulatory distress caused by elevated blood sugar levels. Exercise, as advised by the physician,
can also help to stimulate the circulation and assist in the client in managing the diet and the stress associated with
managing a chronic medical condition. Water exercises and swimming are a particularly good sport given the sport does
not impact many joints and expose the client to conditions where they might lacerate themselves.
The RD should also stress the importance of cleanliness to the patient and their family. Considering that the skin is the
first line of defense for all individuals, for the diabetic patient, the poor circulation under their skin is less open and
capable to carry the components in blood (immune cells, proteins, and oxygen) to the site of a cut or infection. The skin of
the diabetic becomes thinner and more fragile over time when compared to an individual that retains a robust circulation.
Therefore, the diabetic patient must keep their living area clean and free of extraneous debris that they might trip over and
cut themselves on.
Also a result of the elevated blood sugar levels, damage to the visual cells occurs. Untreated diabetes can result in
blindness. Therefore, it is particularly important not only to treat diabetes with insulin or an oral hypoglycemic but also to
pay close attention to diet in an effort to moderate the blood sugar levels. As above, the more the RD can maintain normal
blood sugar levels with diet and exercise, the more likely the client is to maintain better visual acuity.
Two major chronic diseases that are frequently a consequence of type 2 diabetes are cardiovascular disease and renal
disease. Both result from the vascular compromise that occurs from the high blood sugar levels present in the diabetic
patient. While above we discussed the microcirculation, which would also include the kidneys, the large vessels, such as
the aorta and the major renal vessels, are also compromised by the high sugar levels. Because type 2 diabetes is most
often a result of obesity, these large vessels are usually also compromised with deposits of plaque.
Assisting the client in weight-loss efforts is important to their overall health and their total chronic condition with
diabetes. Many clients can drastically improve their diabetic conditions by losing weight. Some clients who were
previously on insulin may be able to come off the insulin entirely and take only an oral hypoglycemic, while others can
improve to the extent that they need to take no medication at all. This is not always the case but it is achievable in some
individuals. Loss of weight can certainly improve the client’s overall picture for avoiding further cardiovascular and renal
compromise, and when the client is able to keep their blood glucose levels within a normal range, they greatly reduce
further vascular damage and the consequent visual effects and possible amputations from severe infections.
Type 2 diabetes can be a devastating disease but it does not have to be when a client works closely with the nutrition and
medical team to achieve the best outcome for their body and their health status. Some patients have completely minimized
any need for medications by losing weight and maintain close control of their diet and blood glucose levels. In working
with clients or patients in the hospital, the best approach is prevention through the maintenance of a normal weight,
healthy eating habits that provide the body with all the nutrients it needs to perform all its functions, and exercise to allow
the body and its bones and muscles to stay strong, flexible, and happy.
5.
Review your health status and that of your family. Assess your health risk for cancer, given your medical history. Then
review your dietary habits. What changes do you need to make to optimize your health status and help prevent cancer in
your lifetime?
Answer: Again, the student is gaining a lifetime of education in this exercise by learning about themselves and their
family histories. They will also learn that multiple assessments gain more knowledge about a situation. The student will
learn about their family cancer history and learn how to take a cancer family history. In addition, the student will become
more aware of all the tools, approaches, and methods needed to assess and treat a client with cancer. Cancer is a dreaded
word and the students need to understand how to work with clients and be comfortable with them. The first stop is in their
backyard. Students that have had cancer in their families should be encouraged to share their experiences and how it
changed their lives with the class.