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Chapter 9 Impact of Fluids and Beverages on Nutritional Health Ask Yourself True or False? 1. “Soft” water is healthier than hard water. 2. Bottled water sold in the U.S. is always cleaner and safer than most tap water. 3. Caffeine can cross the placenta and enter the fetus. 4. Even moderate caffeine users can suffer from withdrawal symptoms if they stop using caffeine cold turkey. 5. Soft drinks sweetened with sugar contribute to empty calorie intake. Ask Yourself 6. Energy drinks are regulated and therefore always safe to consume. 7. Enhanced waters provide an important source of nutrients. 8. A 12-ounce beer, a 5-ounce glass of wine, and a 1-ounce shot of tequila all contain the same amount of alcohol. 9. Reflexes are not impaired if your blood alcohol concentration is below the legal limits of intoxication. 10. Drinking alcohol may be associated with an increased risk of breast cancer. Water • Adults consume and excrete about 1 ½ to 3 quarts of water a day. • Most of the water we consume comes from juice, milk, soft drinks, and other beverages including tap water. • Foods add considerable water to the diet. • Adults are advised to consume 1-1.5 mL of water from all sources for each calorie expended. Water input (Total = 1,450–2,800 mL)a Water created by metabolism (200–300 mL) Foods (700–1,000 mL) Water output (Total = 1,450–2,800 mL)b Feces (150 mL) Liquids (550–1,500 mL) Lungs (350 mL) Skin (450–900 mL) Kidneys (500–1,400 mL) Water • The makeup of water differs based on: Where it comes from. How it is processed. • Variations can have significant health implications : One of the most basic distinctions, hard versus soft water, is based on the concentrations of three minerals: 1. Calcium 2. Magnesium 3. Sodium Water • Hard water: Water with a high concentration of minerals such as calcium and magnesium. From a health standpoint, hard water seems to be the better alternative. • Soft water: Water containing a high sodium concentration. The excess sodium adds more of the mineral to our already sodium-laden diets. It dissolves potentially toxic substances such as lead from pipes. Water Keeping Water Safe • Water taken from the earth contains different levels of bacteria, microorganisms, and heavy metals such as lead. • Environmental Protection Agency (EPA): arm of the government responsible for monitoring municipal water supplies. • Some potential health threats are: A parasite called Cryptosporidium. The level of lead that comes out of your faucet (EPA has little control over this). Lead-containing plumbing was banned in 1986. Water Bottled Water • Not necessarily any purer or more healthful than tap water. • About 25%-40% of bottled water comes from the same municipal water supplies. • Bottled water may not contain adequate amounts of fluoride. • Increased the use of nonrenewable resources. • Cost may be 250-10,000 times higher than tap water. Juices Best Choices for Juice • Select a 100% fruit/vegetable juice. • Read labels; not all juices are uniformly beneficial. • Avoid “juice drink,” “fruitflavored drink,” or “juice blend” because these contain little real juice and have added sugars. • Select juices that have the most color. Juices Juices with Benefits • Cranberry juice protects against urinary tract infections and may protect against heart disease and cancer. • Citrus juices are rich in flavonoids that help protect against cancer. • Tomato juice and tomato products are rich in lycopene which may protect against prostate cancer and cardiovascular disease. MILK • Also applies to non animal beverages such as soy milk • Nutritional content varies per animal species • Nutrient dense • Intake has been associated with weight control • Milk consumption has declined Caffeinated Beverages • Caffeine is one of a group of chemicals called xanthines. • In the U.S. most caffeine is consumed in coffee but teas, carbonated soft drinks, and energy drinks also contribute. • Reports have linked caffeine to more than 100 diseases but scientists have never confirmed the evidence with the exception of jitteriness. Caffeinated Beverages • Daily caffeine consumption can be habit forming. • Caffeine dependence syndrome includes three out of these four symptoms upon withdrawal: headache and fatigue; caffeine consumption despite knowledge that it may be causing harm; repeated unsuccessful attempts to cut back; and tolerance to caffeine. • People with some medical conditions should consume caffeine in moderation or avoid it. Pregnant women advised to limit to <150 mg/day. Caffeinated Beverages • For a healthy person, drinking 1-2 cups of coffee, tea, or cola a day does not pose any hazard. • People who are sensitive to caffeine and experience headaches, nervousness, and insomnia should avoid it or cut back. • If you decide to quit, do it gradually. Caffeinated Beverages Coffee • Contains antioxidants which have been found to reduce inflammation. • Potential health benefits for coffee drinkers include: Lower risk of type 2 diabetes. Reduced risk of cardiovascular disease and stroke. Reduced risk of alcohol-related cirrhosis and liver cancer. • May increase blood pressure. Caffeinated Beverages Tea • Tea leaves are rich in phytochemicals, antioxidants and caffeine. • Health benefits for tea drinkers include: Decreased risk of cardiovascular disease. Decreased risk of cancer. Protects against neurodegenerative diseases. • Health benefits appear to be dose-dependent. Caffeinated Beverages Cocoa • Contains minerals: potassium, magnesium, phosphorus, and calcium. • Contains fats and protein. • Contains antioxidants, phytochemicals, and caffeine. • May positively influence cardiovascular health. Caffeinated Beverages Soft Drinks • Standard serving size (increasing) 1950s = 6.5 oz 1960s = 12 oz 1990s = 20 oz 2000+ = 32 oz & 64 oz Caffeinated Beverages Soft Drinks • Called soda, pop, soda pop, coke, or fizzy drinks, all are carbonated soft drinks. • Includes soft drinks sweetened with highfructose corn syrup. Contributes to empty-calorie intake in the U.S. population and its replacement of nutrient-dense foods. • Includes soft drinks sweetened with artificial sweetener. Caffeinated Beverages Soft Drinks • Nutrition and health issues related to soft drink consumption: Increased energy consumption. Increased weight. Lower consumption of other nutrients. Lower intake of milk, fruit, and fruit juices. Increased risk of medical problems such as: type 2 diabetes, osteoporosis, dental caries, increased blood pressure. • No indisputable positive health benefits have been associated with soft drink consumption. Functional Beverages Energy Drinks • Nonalcoholic beverages enhanced with purported energyenhancing ingredients. • Primary ingredients are sugar and caffeine. • Energy drinks tend not to live up to most of the claims made. Functional Beverages Energy Drinks • Nutrition and health concerns: Not regulated by FDA. Caffeine level unsuitable for children or caffeinesensitive individuals. Mixing energy drinks with alcohol can cause heart arrhythmias. Should not be used before or during exercise. Counter productive for fluid replacement. Combo of stimulant ingredients can be unsafe. Sudden cessation can cause withdrawal • Should be used with caution. Functional Beverages Sports Drinks • Formulated to replace fluids and electrolytes (minerals) lost through sweat and provide energy for muscles. • What should you look for? 6% carbohydrate (glucose, sucrose, and fructose) Sodium No carbonation No caffeine Functional Beverages Enhanced Waters • Most are no healthier than other beverages containing sugar. • The only ingredient in “vitamin waters” that your body might use is sugar. Functional Beverages • Water with fiber? The fiber is maltodextrins and no research shows it works like fiber from fiber-rich foods • Antioxidant supplemented water? No research has ever shown antioxidant supplements prevent disease. • Why is it invigorating or energizing? Same amount of caffeine as a cup of coffee… • Therapeutic substances like herbs added to help…………? Only if in therapeutic doses and that is probably NOT the case Functional Beverages Enhanced Waters • Water-soluble vitamins taken in excess will flush out of the body with water. • Fat-soluble vitamins will not be absorbed without the presence of fat. • Some of the ingredients may not have proven health benefits. • A vitamin/mineral supplement is a better choice. Alcohol • Alcohol is not a nutrient and is best described as an organic chemical. • The most commonly ingested form is Ethanol (EtOH). • Alcohol is a sedative and central nervous system depressant. • Alcohol supplies 7 calories/gram. • Alcohol is not an essential nutrient, nor is it stored in the body. Alcohol Alcohol Absorption and Metabolism • Alcohol absorption involves the stomach and the small intestine. Alcohol absorbed in the small intestine passes through the portal vein to the liver. • Alcohol dehydrogenase: A liver enzyme that facilitates conversion of alcohol into acetaldehyde and water. Acetaldehyde: a substance to which drinking alcohol (ethanol) is metabolized. • Alcohol that has yet to be metabolized flows through the bloodstream and affects the brain and other tissues. Alcohol absorption Mouth Very small amounts of alcohol are absorbed in the mouth and esophagus. Esophagus Stomach Upper small intestine The upper portion of the small intestine is the primary site of alcohol absorption. Some alcohol absorption takes place here. Alcohol Alcohol Absorption and Metabolism • The liver can metabolize a limited amount of alcohol per hour, no matter how much is consumed. • Alcohol metabolism rate is dependent on the amount of alcohol dehydrogenase formed. • Until all alcohol has been metabolized, it circulates through the bloodstream, affecting the brain and other tissues. • It takes about one hour to metabolize a standard drink. Alcohol: Influencing Absorption & Metabolism: • Food Presence of food in the stomach slows absorption. Dietary fat delays emptying time of the stomach. • Gender Men and women absorb and metabolize alcohol differently. Women will absorb 30% more alcohol into the bloodstream. Women are more susceptible to alcoholic liver disease, heart muscle damage, and brain damage. • Ethnicity Native Americans have higher rates of liver damage due to alcohol consumption. Alcohol • Women have a lower capacity to metabolize alcohol because of: Body composition – have less water in their bodies. Enzymes – lower activity of alcohol dehydrogenase in the stomach. Causes a larger proportion of ingested alcohol to reach the blood. Alcohol Alcohol and Its Effects • Alcohol is distributed through the body and affects the central nervous system even in small concentrations. Even small amounts can slow reactions. Higher blood alcohol content (BAC) leads to increased loss of mental and physical control. Large amounts of alcohol over a short period of time can lead to loss of consciousness or even death. Alcohol Alcohol and Its Effects • Alcohol and Medications: Use of prescription or over-the-counter medications can increase the effects of alcohol. Chronic, heavy drinking appears to activate an enzyme that may be responsible for changing the over-the-counter pain reliever acetaminophen and many others into chemicals that can produce liver damage, even when taken in recommended doses. • Alcohol and Sex Hormones: Alcohol alters the sex hormones in men and women. Alcohol Alcohol and Its Effects • Alcohol and Urine Output: Alcohol blocks antidiuretic hormone (ADH), leading to water loss and eventual dehydration. • Alcohol and Hangovers: A group of ailments including headache, nausea, vomiting, sensitivity to light and sound, dry mouth, and irritability. • Alcohol and Blood Alcohol Level (BAL): BAL indicates the amount of alcohol in the bloodstream. BAL is affected by amount and speed at which alcohol is consumed. Alcohol Alcohol and Driving • Never drink and drive. Even one drink can impair your response time. In most states, the legal limit for driving is 0.08 and for those under 21 there is zero tolerance. If this limit is exceeded, the driver could receive a DUI (driving under the influence) or DWI (driving while intoxicated), which is a felony in some states. Alcohol Alcohol and Tolerance • Continued exposure to alcohol causes increased tolerance. Tolerance Decrease of effectiveness of drug after a period of prolonged or heavy use. Metabolic tolerance Increased efficiency of removing high levels of alcohol from the blood due to long-term exposure, leading to more drinking and possible addiction. Functional tolerance: Actual change in sensitivity to a drug resulting in hallucinations and convulsions when alcohol is removed. Alcohol Alcohol and Tolerance • Alcohol abuse (problem drinker) A person who experiences psychological, social, family, employment, or school problems because of alcohol. Problem drinkers often binge drink and turn to alcohol when facing problems or making decisions. • Alcohol dependency (alcoholism): A dependency on alcohol marked by compulsive, uncontrollable drinking with negative effects on physical health, family relationships, and social health. Alcohol Impact of Alcohol on Nutrition • If you are in good health and otherwise well nourished, the occasional consumption of alcohol will probably have little effect on your nutritional status. Alcohol and mixers can contribute additional calories which can cause unwanted weight gain. Impact of Alcohol on Nutrition • Excessive intake of alcohol on a regular basis will compromise your nutritional status. Protein deficiency can develop: Depression of protein synthesis in the cells. Substituting alcohol for food, resulting in poor diet. Stomach cells become inflamed and vulnerable to ulcer formation. Intestinal cells fail to absorb vitamins. Liver cells lose efficiency in activating vitamin D, and the production and excretion of bile are altered. Lowered red blood cell formation due to acetaldehyde interfering with metabolism. Alcohol Health Benefits of Alcohol • Drinking moderate amounts appears to be healthy for people who do not have problems with alcohol abuse or dependency. • People who consume one to two drinks daily have lower mortality rates than nondrinkers. • Like any other drug, there is a beneficial dose and a level (dose) that will cause harm. • Most research indicates wine consumption to be most beneficial; it appears that the benefits are from the alcohol itself. The protective effect is the result of increased levels of high-density lipoprotein (HDL) cholesterol. It also inhibits blood from forming clots, reducing risk of death from heart attack. Alcohol Health Risks of Alcohol • Moderate consumption is not risk free: Deaths reduced by moderate alcohol consumption generally occur in people 45 years of age and older. Most deaths due to alcohol consumption occur in people younger than 45 years of age. Among young adults, the risks far outweigh the benefits. Alcohol Health Risks of Alcohol • Alcohol affects judgment & slows reflexes, which leads to: • Increased accidents: falls, motor vehicle accidents. • Increase in homicide and suicide. • Drug Interactions: Drugs, like alcohol, are metabolized in the liver. • Drugs: substances that can modify one or more of the body’s functions. • Liver has limited processing capacity and drugs and alcohol will compete with each other. • Increased risk of medication side effects. Alcohol Other Risks of Alcohol • • • • Night blindness Breast cancer Other cancers Liver damage Alcoholic hepatitis Cirrhosis • High blood pressure and stroke • Pancreatitis • Gastrointestinal symptoms • Brain damage • Decreased sex hormone production • Anemia • Emotional and social problems Alcohol Pros and Cons of Alcohol Consumption • Compare your age/gender to the leading causes of death for those of similar ages/gender. Leading causes of death for men under 40 years of age and women under 50 years of age (premenopausal) are accidents and breast cancer, respectively. • In this case, risks of low to moderate alcohol consumption outweigh the benefits. Leading cause of death for men over 40 years of age and women over 50 years of age is heart disease. • In this case, the benefits of low to moderate alcohol consumption outweigh risks. Alcohol Alcohol Abuse • Alcoholism is a dependency on alcohol characterized by: Craving (a strong need to drink). Loss of control (being unable to stop drinking despite a desire to do so). Physical dependence. Withdrawal symptoms. Tolerance (increased difficulty of becoming drunk). Alcohol Alcohol Abuse • Use: ingestion of alcohol or other drugs without experiencing any negative consequences. • Misuse: a person experiences negative consequences from his/her use of alcohol or other drugs. • Abuse: continued use of alcohol or other drugs in spite of negative consequences. • Dependency/Addiction: compulsive use of alcohol or other drugs regardless of adverse or negative consequences. Needs professional help. Alcohol Alcoholics Anonymous (AA) • Well-known method to deal with alcohol addiction. • Established in 1935. • Through group meetings, selfproclaimed alcoholics come together for counseling, guidance, and support with the primary purpose of staying sober and helping others to achieve sobriety. Alcohol • What is Binge Drinking? At least five drinks at one time for a man. At least four drinks at one time for a woman. • Short-Term Reactions Include: Vomiting, dizziness, impaired mental capabilities, and hangover. • Serious Problems Include: Risky sexual behavior. Alcohol-related injuries or even death. What Is a Drink? What Is a Drink? According to the Dietary Guidelines for Americans, “If you drink alcoholic beverages, do so in moderation.” Moderation is defined as the following: • Men: No more than two drinks per day. • Women: No more than one drink per day. What Is a Drink? Alcohol is alcohol is alcohol. It does not matter if the beverage of choice is beer, wine, wine cooler, a cocktail, or a mixed drink. • 12 oz of regular beer • 5 ounces of wine • 1 ½ ounces of 80-proof distilled spirits • 12 ounces of wine/malt or spirit-based cooler • 3 oz of sherry or port • 9.75 oz of malt liquor It’s really how much that counts. People who should not drink alcoholic beverages: • Children and adolescents. • Individuals of any age who cannot restrict their drinking to moderate levels. • Women who may become pregnant or who are pregnant. A safe alcohol intake has not been established for women at any time during pregnancy, including the first few weeks. • Individuals who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination. Most people retain some alcohol in their blood up to 2 to 3 hours after a single drink. • Individuals taking prescription or over-thecounter medications that can interact with alcohol. Fetal Alcohol Syndrome What is Fetal Alcohol Syndrome (FAS)? A pattern of birth defects found in the children of mothers who drank alcohol during pregnancy. • One of the primary sources of birth defects in the U.S. • Most common source of preventable birth defects. Defined by four criteria: 1. Maternal drinking during pregnancy. 2. Characteristic pattern of facial abnormalities. 3. Growth retardation. 4. Brain damage including intellectual difficulties or behavioral problems. Fetal Alcohol Syndrome How Does Alcohol Get Into the Baby’s Body? •Alcohol passes from the mother to the baby through the placenta. •The unborn baby’s ability to metabolize alcohol is slower than the mother’s. As a result, the baby’s BAC is higher and alcohol remains in the baby’s blood longer than in the mother’s. How Much Alcohol Causes FAS? • No quantity of alcohol use during pregnancy is considered safe. • An average of one drink a day increases risk. • Especially hazardous use includes: Binge drinking. Frequent heavy drinking. Fetal Alcohol Syndrome FAS is completely Preventable if pregnant women do not drink • Typical traits of FAS… Small eyes with drooping upper lids. Short upturned nose, flat cheeks. Undeveloped groove in center of upper lip. Mental retardation, impaired learning … Memory problems, seizures • Irreversible abnormalities of the brain and other organs. Fetal alcohol syndrome is completely preventable if pregnant women do not consume alcohol. Everything a woman eats or drinks affects her baby. No quantity of alcohol use during pregnancy has been established as safe.