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NUTRISI DAN NUTRASETIKA Suwaldi Martodihardjo, Prof. Dr., MSc., Apt Fakultas Farmasi UGM, Yogyakarta DAFTAR PUSTAKA 1. Lockwood, B., 2007, Nutraceuticals, 2nd Ed., Pharmaceutical Press, London. 2. Anonim, 2005, PDR Nutritional Supplements Guide. 3. Watson, R.R. and Preedy, V.R., 2004, Nutrition and Heart Disease Causation and Prevention, CRC Press, Boca raton. 4. Truswell, A.S., 2003, ABC of Nutrition, 4th Edition, BMJ Publishing, London. 5. Zempleni, J. and Daniel, H., 2003, Molecular Nutrition, CABI Publishing, Oxon. 6. Frost, G., Dornhorst, A., and Moses, R., 2003, Nutritional Management of Diabetes Mellitus, John Wiley & Sons, Chichester. 7. Talbott, S.M, 2003, A Guide to Understanding Dietary Supplements, The Haworth Press, New York. 8. Anonim, 2000, Integrative Medicine Professional Access, Integrative Medicine Communications. 9. Wiki Contributors, 2007, Human Physiology, diunduh dari http://en.wikibooks.org/wiki/Human_Physiology. 10. Etc. Deskripsi singkat kuliah Nutrisi dan Nutrasetika Secara keseluruhan mata kuliah Nutrisi dan Nutrasetika berisi materi tentang: Arti penting nutrisi dan nutrasetika; Kebutuhan nutrisi manusia; Kebutuhan nutrisi spesifik; Kebutuhan nutrisi pada pasien dengan penyakit tertentu; Penyakit mendeplesi nutrisi dan perlunya nutrisi tambahan; Obat dapat mendeplesi nutrisi dan perlunya nutrisi ditambahkan dalam terapi obat; Nutrisi-nutrisi yang berguna dalam terapi dan dalam menjaga kesehatan. Nutrisi untuk meningkatkan sistem imun, mencegah penyakit kardiovaskuler, mencegah penuaan dini, menurunkan kholesterol, memperbaiki fungsi ginjal dan liver, memperbaiki mood dan perilaku; mengurangi gejala asma, dan pengatasan diabetes mellitus. Arti penting Nutrisi dan Nutrasetika Nutrisi: “Nutrients are chemical substances found in food that are needed for life” Enam kelas utama dan paling sedikit terdiri dari 45 jenis diperlukan oleh tubuh untuk pertumbuhan, reproduksi, dan memelihara jaringan dan regulasi tubuh Enam kelas utama dan satu tambahan berupa oksigen karbohidrat lemak protein vitamin mineral air Nutrisi Utama Nutrisi Esensial Karbohidrat Glukosa Lemak Asam lemak: asam linoleat Protein Asam amino: leusin, isoleusin, lisin, metionin, treonin, triptofan, valin, fenilalanin, histidin Vitamin Vitamin larut lemak: vitamin A, D, E, dan K Vitamin larut air: tiamin, niasin, riboflavin, biotin, folasin, vitamin B6, vitamin B12, asam pantotenat, dan vitamin C Mineral Mineral makro: Ca, P, Na, K, S, dan Mg Mineral mikro: Fe, Mn, Zn, Co, Mo, I, Cr, V, Sn, Ni, Si, dan F Air Air Sumber energi: karbohidrat, lemak, dan protein Pertumbuhan dan menjaga normalnya jaringan: protein, lemak, vitamin, mineral, dan air Mengatur proses-proses dalam tubuh: vitamin, mineral, dan air. KESEHATAN Kesehatan adalah keadaan sejahtera badan, jiwa, dan sosial yang memungkinkan setiap orang hidup produktif secara sosial dan ekonomi (UUKesehatan no. 23 tahun 1992). KECUKUPAN NUTRISI Nutrisi yang dibutuhkan oleh individu secara ratarata dalam sehari untuk mencapai derajat kesehatan yang optimal. Recommended Dietary Allowance (RDA): Standar nutrisi yang dianjurkan untuk dimakan agar dapat menjamin kesehatan sebaik-baiknya; RDA suatu kecukupan rata-rata nutrisi setiap hari bagi hampir semua orang (97,5%) menurut golongan umur, jenis kelamin, ukuran tubuh, dan aktivitas untuk mencapai derajat kesehatan yang optimal. RDA Angka Kecukupan Gizi (AKG) Hal-hal yang mempengaruhi kebutuhan nutrisi individu: 1. Tahap Perkembangan a. Sebelum dan setelah lahir memerlukan nutrisi esensial lebih tinggi dibanding masa lainnya. Usia 6 bulan, bayi sehat bobot badannya 2x bobot sewaktu lahir. b. Pertumbuhan masa kanak-kanak (growth spurt I, umur 1-9 tahun) memerlukan nutrisi protein, Ca, dan P. c. Masa Remaja (growth spurt II, 10-19 tahun) memerlukan banyak nutrisi guna pertambahan tinggi dan bobot; pertumbuhan seksual terjadi pada masa ini. d. Masa Dewasa (20-60 tahun) masa kerja fisik tinggi Masa Dewasa madya (40-60 tahun) aktivitas mulai menurun dan BMR (basal metabolism rate) relatif rendah. Nutrisi diperlukan untuk pemeliharaan. e. Masa Usia Lanjut (> 60 tahun) penurunan kegiatan fisik dan rentan terhadap penyakit. Nutrisi digunakan untuk mengganti/ memperbaiki jaringan yang rusak. Di sini, kebutuhan energi menurun tetapi protein meningkat. 2. Fisiologi Tubuh a. Kehamilan, nutrisi diperlukan untuk pertumbuhan organ reproduksi ibu dan pertumbuhan janin. Jika wanita hamil pada bulan ke 4 s.d. ke 7 tidak bertambah bobot badannya, kemungkinan akan melahirkan sebelum waktunya atau melahirkan bayi dengan bobot rendah (< 2,5 kg). b. Menyusui, memerlukan lebih banyak nutrisi untuk menghasilkan ASI 3. Keadaan sakit dan dalam penyembuhan Penderita demam akan memerlukan lebih banyak protein karena terjadinya perombakan protein yang tinggi. 4. Aktivitas fisik, semakin tinggi aktivitas fisik maka semakin tinggi pula keperluan nutrisinya. 5. Ukuran tubuh, individu yang besar memerlukan energi lebih banyak daripada individu yang lebih kecil. Angka Kebutuhan Gizi/Nutrisi rata-rata yang dianjurkan ( Umur 0-6 bl 7-12b 1-3 th 4-6 th 7-9 th PRIA 10-12 13-15 16-19 20-45 46-59 ≥ 60 Wanita 10-12 13-15 16-19 20-45 46-59 ≥ 60 Hamil BB TB Energi Protein Vit (Kg) (Cm) (kkal) (g) A (µg RE) 5,5 60 560 12 350 8,5 71 800 15 350 12 90 1250 23 350 18 110 1750 32 460 24 120 1900 37 460 Vit Vit E Vit K Tiamin Ribo- Niasin D (µg) (µg) (mg) .flavin (mg) (RE) (mg) B12 (µg) 7,7 10 10 10 10 3 4 6 7 7 5 10 15 20 30 0,3 0,4 0,5 0,8 1,0 0,3 0,5 0,6 1,0 1,0 2,5 3,8 5,4 8 9 0,1 0,1 0,5 0,7 0,9 30 45 56 62 62 62 135 150 160 165 165 165 2000 2400 2500 2800 2500 2200 45 64 66 55 55 55 500 600 700 700 700 600 10 10 10 5 5 5 10 10 10 10 10 10 45 65 70 80 80 80 1,0 1,0 1,0 1,2 1,2 1,0 1,0 1,2 1,3 1,5 1,5 1,2 9 10 11 12 12 10 1,0 1,0 1,0 1,0 1,0 1,0 35 46 50 54 54 54 140 153 154 156 156 156 1900 2100 2000 2200 2100 1850 +285 54 62 51 48 48 48 +12 500 500 500 500 500 500 +200 10 10 10 5 5 5 10 8 8 8 8 8 8 10 45 55 60 65 65 65 65 1,0 1,0 1,0 1,0 1,0 1,0 +0,2 1,0 1,2 1,0 1,2 1,2 1,0 +0,2 8 10 10 9 9 8 +0,1 1,0 1,0 1,0 1,0 1,0 1,0 +0,3 Menyusui 0-6 bl 7-12 bl +700 +500 +16 +12 +350 10 +300 10 12 10 65 65 +0,3 +0,3 .* Sumber: Widya Karya Pangan dan Gizi (1998) PENENTUAN KEBUTUHAN KECUKUPAN ENERGI Perhitungan kecukupan nutrisi yang dianjurkan berdasarkan rata-rata berat badan untuk masingmasing kelompok umur dan jenis kelamin. Penyesuaian perbedaan berat badan ideal dalam AKG dengan berat badan actual: badan standar) X AKG (Berat badan actual) / (berat Contoh: Seorang pia dengan usia 35 tahun mempunyai berat badan 58 kg. Hitung: Kebutuhan energy dan proteinnya. Jawab: Dari Tabel diketahui BB pria usia 35 tahun adalah 62 kg. +0,4 +0,3 +0,3 +0,3 +0,3 +0,3 AKG Energi 2800 kkal dan protein 55 g Kebutuhan nutrisi pria tersebut: Energi = (58/62) x 2800 kkal = 2619,35 dibulatkan 2619 kkal Protein = (58/62) x 55 g = 51,5 g Vitamin A = (58/62) x 700 RE = 654,8 RE Cara lain 1. Teori RBW (relative body weight) RBW = {(BB (kg) / (TB (cm) - 100)} X 100% Ketentuan: Kurus jika RBW < 90% kebutuhan energy perhari = BB x 40-60 kal Normal = 90 – 100% = BB x 30 kal Gemuk > 110% atau < 120% = BB x 20 kal Obesitas ringan = 120 – 130% = BB x 10 – 15 kal Obesitas sedang = 130 – 140% Obesitas berat > 140% 2. Energi BMR (Basal Metabolism Rate) Energi BMR adalah energy minimal untuk menjalankan proses kerja atau proses faal dalam tubuh pada kondisi berbaring istirahat di tempat tidur. Rumus untuk menghitung energy BMR (energy basal selama 24 jam): Untuk pria BMR = (BB) / {0,1015 x A. 0,1333} ; A = umur dalam tahun; BB = berat badan dalam gram Untuk wanita BMR = (BB) / {0,1227 x A. 0,1333} INDEKS MASSA TUBUH (IMT) Body Mass Index (BMI) IMT digunakan untuk mengetahui status Nutrisi/Gizi orang dewasa IMT (BMI) = (BB dlm kg) / {Tinggi Badan (TB dalam m2)} Kategori IMT IMT (BMI) Kategori <17,00 Kurus sekali 17,0 – 18,4 Kurus 18,5 – 25,0 Normal 25,1 – 27,0 Gemuk >27,0 Gemuk sekali NUTRACEUTICS (NUTRACEUTICALS) The term of nutraceutical was first used by Stephen DeFelice in 1991. Definition of Nutraceuticals: Any substance that may be considered a food or a part of a food and provides medical or health benefits, including the prevention and treatment of disease According to Mueller and Nestle (1995), “NUTRACEUTICALS” include: Conventional Foods (labeling regulated under NLEA, Nutrition Labeling & Education Act, of 1990) Conventional foods Functional foods Phytochemicals Foods for Special Dietary Uses (FSDU) (labeling regulated under NLEA, Nutrition Labeling & Education Act, of 1990) Hypoallergenic foods Weight reduction foods Diabetics’ foods Reduced sodium foods Infant formulas Dietary Supplements (Labeling Regulated Under DSHEA, Dietary Supplement Health and Education Act of 1994) Essential nutrients Vitamins Minerals Amino acids Herbal preparations Glandular extracts Medical Foods (Exempt from most NLEA and DSHEA Labeling Requirements) Fall under narrower scope than FSDU Primarily includes products for those with inborn errors of metabolism Supplements: Supplements could be considered additives because they become part of the diet even when they are not in a food product. A food additive is any substance that becomes part of a food product. Broad purposes of food additives include: 1. maintaining or improving nutritional value such as the addition of vitamins and minerals to a food products (addition of calcium to juices and other foods) 2. to maintain freshness in the food (addition of antioxidants to foods processed with fat and of preservatives help to prevent spoilage) 3. to help in the processing and preparation of foods such as emulsifiers are added to peanut butter and mayonnaise to keep the product smooth 4. to make food more appealing (addition of coloring agents, synthetic flavors, and sweeteners) Dietary Supplements: Dietary Supplement Health and Education Act (DSHEA), 1994 ‘Any product (other than tobacco) intended to supplement the diet that contains one or more of the following ingredients: a vitamin, mineral, herb or other botanical, an amino acid; a concentrate, metabolite, constituent, extract or combination of any of these ingredients’ ‘A supplement must be in “dosage forms such as capsules, tablets, liquids, powders, or soft gels and may not be represented as a conventional food or as a sole item of a meal or of the diet” In addition, dietary supplements must be labeled as supplements. Dietary supplements are permitted to carry disease claims for the following: Folic acid and decreased risk of neural defects Calcium and a lower risk of osteoporosis Psyllium seed husk and heart disease Soy protein and heart disease Omega-3 fatty acids and heart disease B vitamins (folic acid, B6, and B12) and heart disease The antioxidants, vitamin A, C, and E, are among the most commonly known nutrients which, in general, may be useful in the prevention of cancer and cerebrovascular disease. The combination of vitamin E, C, and beta-carotene has been useful in reducing LDL oxidation and subsequent atherosclerosis. Jialal and Fuller (1995, Effect of Vitamin E, Vitamin C and beta-carotene on LDL oxidation and atherosclerosis, Can. J. Cardiol., 11, 97G-103G) speculated that these substances work synergistically to prevent oxidation of LDL in the following manner: 1. Vitamin C scavenges aqueous radicals and regenerates alpha-tocopherol from the tocopheroxyl radical species; 2. Vitamin E, in the form of alpha-tocopherol protects polyunsaturated fatty acids within the LDL particle, reduces platelet adhesion and inhibits smooth muscle cell proliferation and protein kinase C activity; and 3. Beta-carotene provides reserve antioxidant activity, especially in the arterial wall where low partial pressures of oxygen are found. Supplementation with vitamin C may be beneficial in the management of asthma patients, and high dietary intake of vitamin E may prevent Parkinson’s disease Functional Foods Definition of functional foods established by the University of Illinois Functional Foods for Health Program is: “refers to foods that, by virtue of physiologically active components, provide benefits beyond basic nutrition and may prevent disease or promote health” Foods for Special Dietary Uses (FSDU) and Medical Foods FSDU and medical foods are broadly defined as enteral products designed to meet the specific dietary needs of certain subsets of population. Common Nutrients and Their Associated Health Benefits Nutrient Fat-Soluble Vitamins Vitamin A Vitamin D (calciferol) Vitamin E (tocopherol) Vitamin K Health Benefit Antioxidant, essential for growth and development; maintains healthy vision, skin, and mucous membranes; may aid in the prevention and treatment of certain cancers and in the treatment of certain skin disorders (note: the body converts beta carotene into vitamin A) Essential for formation of bones and teeth; helps the body absorb and use calcium Antioxidant; helps form blood cells, muscles, and lung and nerve tissue; boosts the immune system Essential for blood clotting Water-Soluble Vitamins Ascorbic acid (vitamin Antioxidant; necessary for C) Thiamine (vitamin B1) Riboflavin (vitamin B2) healthy bones, teeth, and skin; helps in wound healing; may prevent common cold and attenuate its symptoms should a cold occur Helps convert food into energy; essential in neurologic function Pyridoxine (vitamin B6) Helps in energy production and other chemical processes in the body; helps maintain healthy eyes, skin, and nerve function Cyanocobalamin (vitamin B12) Helps convert food into energy; helps maintain proper brain function Niacin (vitamin B3) Helps produce essentials proteins; helps convert protein into energy Folic acid (pteroylglutamic acid, folacin) Panthothenic acid Helps produce the genetic material of cells; helps with formation of red blood cells and maintenance of central nervous system; helps make amino acids; involved in metabolism of fat, protein, and carbohydrates Necessary to produce the genetic materials of cells; essential in first 3 months of pregnancy for preventing birth defects; helps in red blood cell formation; protects against heart disease Aids in synthesis of cholesterol, steroids, and fatty acids; crucial for intraneuronal synthesis of acetylcholine Minerals Calcium Iron Magnesium Essential for building bones and teeth and maintaining bone strength; important in muscle function Helps in energy production; helps to carry oxygen in the bloodstream and to transfer oxygen to muscles Phosphorus Essential for healthy nerve and muscle function and bone formation; may help prevent premenstrual syndrome (PMS) Essential for building strong bones and teeth; helps in formation of genetic material; helps in energy production and storage Trace Elements Chromium Works with insulin to convert carbohydrates and fat into energy Cobalt Copper Fluorine Iodine Manganese Molybdenum Nickel Essential component of vitamin B12, but ingested cobalt is metabolized in vivo to form the B12 coenzymes Essential for making hemoglobin and collagen; essential for healthy functioning of the heart; helps in energy production; helps in absorption of iron from digestive tract Presumably makes enamel resistant to erosive action of acids produced by bacteria in the oral cavity Selenium Essential for proper functioning of the thyroid Silicone Required for glucose utilization, synthesis of the mucopolysaccharides of cartilage, biosynthesis of steroids Tin Vanadium May function as an enzyme cofactor Zinc Involved in specific metalloenzymes Antioxidant; essential for healthy functioning of the heart muscle Functions in the development and maintenance of connective tissue May be involved in growth and reproductive functions May be involved in functions related to growth and reproduction Essential for cell reproduction, normal growth and development in children, wound healing, and production of sperm and the male hormone testosterone Vitamin-like Compounds Biotin (vitamin H) Member of B-complex group vitamins; required for various metabolic functions L-Carnitine Choline Oxidation of fatty acids, promotion of certain organic acid excretions, and enhancement of the rate of oxidative phosphorylation Essential fatty acids (vitamin F) Inositol Laetrile (amygdalin, vitamin B17) Pangamic acid (vitamin B15) Taurine (aminoethanesulfonate) Lipotropic agents; they have been used to treat fatty liver and disturbed fat metabolism Involved in proper development of various membranes and the synthesis of prostaglandins, leukotrienes, and various hydroxyl fatty acids Necessary for amino acid transport and movement of potassium and sodium; Lipotropic agent No vitamin activity; no nutritional or therapeutic value; no approved medical use No nutritional or therapeutic value Aids in retinal photoreceptor activity, bile acid conjugation, white blood cell antioxidant activity, CNS neuromodulation, platelet aggregation, cardiac contractility, sperm motility, growth, and insulin activity Makanan yang banyak mengandung vitamin dan mineral Vitamin dan mineral Vitamin A (Retinol) Vitamin B1 (Thiamin) Vitamin B2 (Riboflavin) Vitamin B3 (Niasin) Vitamin B5 Makanan dengan kandungan vitamin dan mineral Apel, pir, pisang, bit, berry, brokoli, kubis, wortel, kacang mete, pepaya, paprika/cabai, bayam, biji bunga matahari, tomat, dan selada air. Bubur gandum, kacang tanah, kedelai, roti gandum. Almond, brokoli, keju, dan susu. Jamur, ikan berminyak, kacang Vitamin B6 (Piridoksin) Vitamin B12 o Vitamin C (Asam askorbat) tanah, kedelai, dan roti gandum utuh. Brokoli Pisang, bit, hazelnut, dan kedelai. Keju, telur, dan ektrak ragi. o Apel, pir, pisang, bit, berry, brokoli, kubis, wortel, kelapa, bawang putih, madu, sayur hijau, mangga, papaya, cabai, bayam, tomat, dan selada air. Vitamin dan mineral Makanan dengan kandungan vitamin dan mineral Vitamin D Keju, kuning telur, susu, ikan berminyak, dan biji bunga matahari. Vitamin E Berry, kubis, mangga, kacang-kacangan, minyak zaitun, pepeya, Vitamin K Asam folat Kalsium Besi (Ferum) Mangan Magnesium Potasium Fosfor Selenium Silikon Seng cabai, biji wijen, biji bunga matahari, bayam, tomat, dan selada air. Bayam dan biji bunga matahari. Apel, pir, buncis, lentil, bit, brokoli, kelapa, biji wijen, bayam, dan selada air. Kacang almond, apel, pir, buncis, lentil, bit, berry, kubis, wortel, kacang mete, gandum, labu, biji wijen, rumput laut/ tumbuhan laut, kedelai/tahu, bayam, biji bunga matahari, selada air, dan yogurt. Buncis, lentil, bit, berry, brokoli, mangga, pepaya, labu, biji wijen, rumput laut/tumbuhan laut, kedelai, biji bunga matahari, dan selada air. Buncis, lentil, bit, dan bayam. Tembaga Yodium Apel, pir, buncis, lentil, bit, berry, kubis, cabai, labu, biji wijen, rumput laut, kedelai, dan bayam. Apel, pir, buncis, lentil, bit, berry, kedelai, bayam, dan pisang. Apel, pir, bit, gandum, kedelai,dan tahu. Buncis, lentil, ikan berminyak, biji wijen, kedelai, dan walnut. Rumput laut dan tumbuhan laut. Kacang almond, berry, brokoli, mangga, papaya, labu, biji wijen, rumput laut, biji bunga matahari, kedelai/tahu, tomat, dan selada air. Rumput laut dan tumbuhan laut. Pir, rumput laut, tumbuhan laut, ikan laut dan selada air. Makanan Untuk Kesehatan Jika menderita penyakit atau mengalami keluhan dan kondisi yang disebut di bawah ini, dianjurkan untuk memakan lebih banyak makanan seperti yang disebutkan pula. Keluhan Makanan yang dianjurkan Kecemasan dan depresi Pisang, brokoli, dan gandum Kanker (membantu Pisang, buncis, lentil, melindungi dari brokoli, kubis, resiko kanker) gandum, ikan berminyak, minyak zaitun, pepaya, Kolesterol (mengurangi mangga, kolesterol) paprika/cabai, bijibijian, kedelai/tahu, bayam, ubi, tomat, Kekurangan sel dan selada air. darah merah (masalah Apel, pisang, buncis, peredaran darah) lentil, bawang putih, kacang-kacangan, gandum, ikan berminyak, Detoksifikasi minyak zaitun, (membentu mencegah kedelai/tahu, selada air, timbunan racun) dan yogurt. Masalah pencernakan Bit, blackberry, blackcurrant, blueberry, redcurrant, kubis, wortel, bawang Kekurangan energi Penglihatan Menurunkan resiko penyakit jantung dan membantu menurunkan tekanan darah Penurunan sistem kekebalan tubuh Ginjal, hati, kandung kencing, dan infeksi saluran kencing Masalah saat menstruasi (PMS) putih, madu, kacangkacangan, gandum, pepaya, mangga, bayam, ubi, tomat, dan selada air. Apel, pir, buncis, lentil, brokoli, wortel, bayam, ubi, dan selada air. Apel, pir, pisang, buncis, lentil, brokoli, kubis, wortel, bawang putih, madu, gandum, minyak zaitun, pepaya, raspberry, bijibijian, kedelai/tahu, bayam, ubi, tomat, selada air, dan yogurt. Apel, pir, pisang, blackberry, brokoli, madu, kacangkacangan, pepaya, mangga, paprika/cabai, bayam, ubi, singkong, dan selada air. Wortel, bayam, dan biji bunga matahari. Pisang, brokoli, wortel, bawang putih, kacangkacangan, ikan berminyak, minyak zaitun, paprika/cabai, rumput laut, tumbuhan laut, biji-bijian, kedelai/tahu, bayam, ubi, tomat, dan selada air. Apel, pir, bit, brokoli, kubis, wortel, bawang putih, madu, ikan berminyak, pepaya, mangga, paprika/cabai, rumput laut/tumbuhan laut, biji-bijian, bayam, ubi, tomat, dan selada air. Buncis, lentil, bit, brokoli, kubis, wortel, kacang panjang, bawang putih, madu, ubi, tomat, selada air, yogurt. Pisang, buncis, lentil, bit, wortel, kedelai/tahu, singkong, kacangkacangan, gandum, dan ikan berminyak. Keluhan Makanan yang dianjurkan Sistem syaraf Pisang, brokoli, kubis, kacang-kacangan, gandum, rumput laut/tumbuhan laut, biji-bijian, bayam, ubi, dan selada air. Masalah pada prostat Masalah saluran nafas atau batuk & pilek Biji labu dan tomat. Apel, brokoli, kubis, wortel, bawang putih, madu, dan minyak Encok & rematik Kondisi pada kulit Masalah tidur zaitun. Apel, buncis, lentil, madu, kacang-kacangan, ikan berminyak, biji-bijian, dan stroberi. Apel, pir, brokoli, kubis, wortel, kacangkacangan, ikan berminya, minyak zaitun, pepaya, mangga, stroberi, ubi, dan selada air. Gigi, tulang, dan jaringan ikat yang kuat (membantu membuat gigi dan tulang yang Pisang kuat) Wortel, gandum, ikan Masalah tiroid berminyak, pepaya, mangga, kedelai/tahu, bayam, ubi, dan selada air. Kubis, gandum, pir, rumput laut/tumbuhan laut, dan selada air. PISANG Manfaat: 1. sumber energi 2. sumber serat yang baik (memperlancar BAB) 3. ada efek penenang 4. meningkatkan daya tahan tubuh Kandungan kalori pisang adalah setiap 100 g pisang mengandung kalori sekitar 79 kalori. Kandungan ini sebanding dengan 46 buah apel atau 41 buah pir. Pisang mempunyai kandungan serat yang tinggisehingga pisang dapat digunakan untuk memperlancar buang air besar (BAB). Pisang juga mengandung asam amino tryptophan, yaitu asam amino yang mempunyai efek penenang sehingga pisang sangat baik dikonsumsi oleh orang yang mengalami kesulitan tidur. Tryptophan juga dapat memperbaiki suasana hati dan mengurangi gejala depresi, kecemasan, dan sindrom pramenstruasi (PMS = premenstruation syndrome). Pisang mengandung pula mineral, seperti kalium. Kalium ini dalam tubuh dapat membantu pertumbuhan sel, mengendalikan tekanan darah, memperlancar fungsi sistem syaraf, dan memperlancar pengaturan cairan tubuh dan keseimbangan asam – alkali. Kandungan antioksidan dari pisang juga tinggi, khususnya beta-karoten. Beta-karoten dalam tubuh akan berubah menjadi vitamin A. Vitamin C juga terkandung dalam pisang. Vitamin A dan C dapat meningkatkan sistem kekebalan tubuh dan melawan penyebab kanker (radikal bebas). Selain itu, pisang juga mengandung vitamin B6. Vitamin B6 sering pula disebut sebagai vitamin antistres. Vitamin B6 ini dapat melindungi tubuh dari penyakit jantung, mengatur syaraf, dan membantu mengurangi masalah haid dan menopause. Pisang sebagai makanan yang lembut Pisang sebagai makanan yang bermanfaat dan mudah dicerna sehingga pisang menjadi makanan pertama yang ideal bagi bayi. Meskipun demikian, seyogyanya tidak memberikan pisang pada bayi di bawah usia 6 bulan karena dapat terjadi kondisi tidak toleran terhadap makanan. Karena rasanya yang manis, pisang dapat menjadi alternatif yang sehat untuk menggantikan permen, kue, atau biskuit, dan membuat hampir semua makanan menjadi manis. Memilih dan menyimpan pisang Pilihlah pisang yang tidak lembek dengan warna kuning dengan sedikit bintik cokelat. Pisang dapat dikombinasikan dengan hampir semua buah. Pisang dapat menjadi camilan yang bermanfaat baik selama bepergian maupun sewaktu di rumah. Pisang dapat dimasak menjadi berbagai puding buah dan kue. Untuk dimasak, semakin matang pisang, semakin baik. Simpanlah pisang ditempat yang sejuk dan jauhkan dari sinar matahari, tetapi jangan di masukkan dalam almari es. MANGGA DAN PEPAYA Manfaat: Merupakan antioksidan kuat Meningkatkan fungsi kekebalan tubuh Merupakan antikanker Memperbaiki kondisi kulit dan kuku Memperlancar system pencernaan Meningkatkan energy Mangga dan papaya banyak mengandung beta-karoten; senyawa ini banyak pula dikandung dalam semua jenis jeruk dan buah serta sayuran berwarna oranye. Semakin intens warna suatu buah, semakin tinggi kandungan beta-karotennya. Mangga dan papaya mengandung banyak vitamin C Mangga mengandung pula vitamin E Mangga dan papaya mengandung zat besi dan seng Banyaknya antioksidan dalam buah mangga dan papaya maka kedua buah itu dapat meningkatkan daya tahan tubuh sehingga melindungi tubuh dari berbagai penyakit dari infeksi sampai kanker Mangga dan papaya mempunyai efek detoksifikasi yang ditunjukkan secara nyata dengan membaiknya tekstur kulit, berkurangnya kerutan, dan meningkatkan kecerahan kulit serta dapat memperkuat kuku Mangga dan papaya dapat memberi energy Mangga dan papaya membantu memperlancar pencernaan. Pepaya mempunyai enzim papain yang dapat mencerna protein KEDELAI DAN MAKANAN OLAHANNYA MANFAAT: Menurunkan tekanan darah tinggi Menurunkan kadar kolesterol Mengurangi gejala PMS dan menopause Melindungi tubuh dari resiko kanker yang berkaitan dengan hormone Sumber protein nabati Menurunkan resiko penyakit jantung (kardiovaskuler) Mengatur kadar gula darah Mencegah sembelit Kedelai merupakan jenis kacang yang paling bergizi karena mengandung asam lemak esensial Omega-3 (dari lesitin), asam amino, isoflavon (phytoestrogen), protein, mineral, dan vitamin. Kedelai dapat digunakan dalam masakan atau makanan yang berupa susu, tepung, tempe, tahu, dll. FLAVONOIDS At one time a mixture of flavonoids was shown to decrease capillary permeability and fragility in human beings and was named vitamin P, but later, 1950, when it was found that they are not dietary essentials, the name was dropped. More recently there has been epidemiological evidence from observations in population groups with a high intake of fruits and vegetables that flavonoids may have a role in protection against some forms of cancer. Some are antioxidants and may help to prevent atherosclerosis; others have weak estrogen activity (phytoestrogens) and have been associated with lower incidence of breast, uterus and prostate cancer. Soya (soy) A bean (Glycine max) is important as a source of both oil and protein. The protein is of higher biological value than many other vegetable proteins, and is of great value for animal and human food. When raw it contains a trypsin inhibitor, which is destroyed by heat. Native of China, where it has been cultivated for 5000 years; grows 60–100 cm high with 2–3 beans per pod. Composition/100 g: (edible portion 53%) water 67.5 g, 615 kJ (147 kcal), protein 12.9 g, fat 6.8 g (of which 15% saturated, 25% mono-unsaturated, 60% polyunsaturated), carbohydrate 11.1 g, fibre 4.2g, ash 1.7g, Ca 197mg, Fe 3.5mg, Mg 65mg, P 194mg, K 620mg, Na 15mg, Zn 1mg, Cu 0.1mg, Mn 0.5mg, Se 1.5μg, vitamin B1 0.44mg, B2 0.17mg, niacin 1.6mg, B6 0.06mg, folate 165μg, pantothenate 0.1mg, C 29mg. Soybean oil is 15% saturated, 24% mono-unsaturated, 61% polyunsaturated, contains 9.2mg vitamin E, 198mg vitamin K/100g. Soya flour Dehulled, ground soya bean. The unheated material is a rich source of amylase and proteinase and is useful as a baking aid. Composition/100 g: Water 7.3 g, 1381kJ (330kcal), protein 47 g, fat 1.2 g (of which 13% saturated, 25% mono-unsaturated, 63% polyunsaturated), carbohydrate 38.4 g (20 g sugars), fibre 17.5 g, ash 6.2 g, Ca 241mg, Fe 9.2mg, Mg 290mg, P 674mg, K 2384mg, Na 20mg, Zn 2.5mg, Cu 4.1mg, Mn 3mg, Se 1.7μg, vitamin A 2μg RE (24μg carotenoids), E 0.2mg, K 4.1mg, B10.7mg, B2 0.25mg, niacin 2.6mg, B6 0.57mg, folate 305μg, pantothenate 2mg. Soy sauce A condiment prepared from fermented soya bean, commonly used in China and Japan. Traditionally the bean, often mixed with wheat, is fermented with Aspergillus oryzae over a period of 1–3 years. The modern process is carried out at a high temperature or in an autoclave for a short time. Tofu Originally Japanese; soybean curd precipitated from the aqueous extract of the soya bean. Composition/100 g: Water 85 g, 293 kJ (70 kcal), protein 8.2 g, fat 4.2 g (of which 23% saturated, 31% mono-unsaturated, 46% polyunsaturated), carbohydrate 1.7 g (0.6 g sugars), fibre 0.9 g, ash 1 g, Ca 201mg, Fe 1.6mg, Mg 37mg, P 121mg, K 148mg, Na 12mg, Zn 0.8mg, Cu 0.2mg, Mn 0.6mg, Se 9.9μg, vitamin B1 0.06mg, B2 0.06mg, niacin 0.1mg, B6 0.07mg, folate 19μg, pantothenate 0.1mg. An 80 g serving is a source of Cu, P, a good source of Ca, Mn. Foods that have been shown to have low glycaemic indices (55 or less) compared to glucose (100): Soya beans (18) Pearl barley (28) Bananas (53) Lentils (29) All pastas (40-45) Apples (36) Dried peas (31) Rolled oats (55) Apple juice (36) Canned baked beans (40) Oat bran (50) Grapefruit (25) Frozen peas (boiled) (48) All Bran (40) Oranges (43) Other dried legumes, (around 30) Pumpernickel (rye) bread (41) Orange juice (57) Plums (24) Peaches (28) Milk (full cream or low fat) and yoghurt (25-35) The glycaemic index of glucose is 100, of fructose 20, of sucrose (half way between) 60, of lactose 45. High fat foods may also give a low glycaemic index, because of delayed gastric emptying, but are not recommended. Lecithin - An Amazing Youth Element Lecithin is the most abundant of the phospholipids. It is a fatty food substance, which serves as a structural material for every cell in the body. It is an essential constituent of the human brain and nervous system. It forms 30 per cent of the dry weight of the brain and 17 per cent of the nervous system. Lecithin is also an important component of the endocrine glands and the muscles of the heart and kidneys. It makes up 73 per cent of the total liver fat. Nervous, mental or glandular over-activity can consume lecithin faster than its replacement. This may render a person irritable and exhausted. It is, therefore, of utmost importance to add lecithin to the diet, if the body’s own supply decreases as in old age or working under stress. Rich Sources Lecithin is derived from the Greek Word, likithos, meaning egg yolk. Egg yolk is a rich source of lecithin, and also a rich source of cholesterol. This combination makes it possible for the lecithin to emulsify the cholesterol. Vegetable oils, whole grain cereals, soybeans, liver and milk are other rich sources of lecithin. The cells of the body are also capable of synthesizing it as needed, if several of the B vitamins are present. Since these B vitamins are generally removed when grains are refined, people who eat exclusively white flour products are lacking them. Benefits The action of lecithin on the heart is the most important of all its proved benefits. It achieved its popularity initially in this area. Cholesterol is a fatty substance that tends to collect in the walls of the arteries and veins, thus narrowing them. This may eventually lead to a fatal blood clot. Scientific studies have shown that lecithin has the ability to break up cholesterol into small particles which can be easily handled by the system. With sufficient intake of lecithin, cholesterol cannot build up against the walls of the arteries and veins. Like cholesterol, lecithin is continuously produced in the liver, passes into the intestine with bile and is absorbed in the blood. It helps in the transportation of fats. It also helps the cells to remove fats and cholesterol from the blood and to utilise them. It increases the production of bile acids made from cholesterol, thereby reducing the amount in the blood. It will thus be seen that cholesterol can cause trouble only if lecithin is lacking in the system. All atherosclerosis or changes in the arterial walls are characterized by an increased of the blood cholesterol and a decrease in lecithin. It has been shown that experimental heart disease, produced by feeding cholesterol, could be prevented merely by giving a small quantity of lecithin. Atherosclerosis has been produced in various species of animals by increasing the blood cholesterol or decreasing the lecithin. In normal health, when a diet high in fat is taken, there is tremendous increase in the production of lecithin. This helps in changing the fat in the blood from large particles to smaller and smaller ones. In case of atherosclerosis, however, the lecithin in the blood remains very low regardless of the quantity of fat entering the blood. The result is that, the fat particles remain too large to be able to pass through the arterial walls. A more serious situation can develop if there is lack of lecithin in cells also. Besides reducing the cholesterol level in the blood, there is mounting scientific evidence to suggest several other benefits from lecithin. It has been suggested that its intake in sufficient amounts can help rebuild those cells and organs which need it. Lecithin helps to maintain their health once they are repaired. It may mean that a deficiency of lecithin in the diet may be one of the causes of ageing and that its use may be beneficial in retarding the ageing process. Edward R. Hewith in his book, The Years Between 75 and 90 says, "with older people the fats remain high in the blood for from five to seven hours and in some cases as long as 20 hours, thus giving the fats more time to become located in the tissues. If lecithin is given to older people before a fatty meal, it has been found that the fats in the blood return to normal in a short time, in the same way they do in younger people.” In some cases, the cosmetic effect of lecithin does as much for the mental outlook of persons as it does for their physical well-being. It has been found to eliminate the yellow or yellow- brown plaques on the skin or around the eyes caused by fatty deposits. It is a natural tranquillizer which is beneficial in nervous exhaustion. It can produce great alertness in elderly people. Some studies have indicated that lecithin increases the gamma globulin in the blood. This helps fight infection. It provides an increased immunity against pneumonia. It has also been found to lower blood pressure in some people. In combination with vitamin E, it has proved helpful in lowering the requirements of insulin in diabetics. It has also proved valuable in the treatment of certain skin ailments, including acne, eczema and psoriasis. Lecithin has been suggested as a sexual aid. It was used in Germany 30 years ago as a restorative of sexual powers, for glandular exhaustion and nervous and mental disorders. Seminal fluid is rich in lecithin. Because of its loss from the body, its need for men is regarded especially great. Its use is also considered valuable in minimizing pre-menstrual and menopausal tension. Dr. N.A. Ferri, an eminent physician remarks - "Lecithin has a versatile function in life. It is an extremely important factor in the digestion and oxidation of fats, thus creating more muscle and glandular activity, resulting in greater body exertion and less fat accumulations. Lecithin is essential not only for tissue integrity of the nervous and glandular system in all living cells, but has been regarded as also the most effective generator and regenerator of great physical, mental and glandular activity. Shattered nerves, depleted brain power, waning activity of vital glands, find in lecithin, especially in the cellular structure of the nervous system and endocrine glands a source of dynamic energy." The best way to increase lecithin is to eat the same amount of fat as usual, but reduce animal fat except that from fish. Oil may be used for cooking, seasoning and salad dressing. All hydrogenated fats such as margarines, cooking fats, hydrogenated peanut butter and processed cheese should be avoided as also foods prepared with them. HERBAL PRODUCTS Common Herbal and Phytochemical P Compound Digestive System Disorders Chamomile (Matricaria recutita L.) Ginger (Zingiber officinale Rosc.) Licorice (Glycyrrhiza glabra L., Glycyrrhiza uralensis Fisch.) Milk thistle (Silybum marianum L.) Peppermint (Mentha piperita L.) Plantago seed, Psyllium seed (Plantago arenaria Waldst., Plantago arenaria Kit., Plantago ovate) Senna (Cassia acutifolia Del., Cassia angustifolia Vahl., Senna alexandrina Mill.) Kidney, Urinary Tract, and Prostate Disorders Beaberry (Arctostaphylos uva-ursi L., Spreng (Ericacaeae) Cranberry (Vaccinium macrocarpon Ait.) Goldenrod (Solidago virgaurea L., Solidago serotina Ait., Solidago Canadensis L.) Saw palmento (Serenoa repens Reported Activity/U Oral: anti-inflammatory, spas Topical: wound-healing, an@ Carminative, antiemetic, cho treatment of dizziness Expectorant, secretolytic; tre Prophylaxis and treatment of Leaf: carminative and choler Oil: reduces symptoms of irr Cathartic Cathartic Antibacterial for UTI, diuretic Bacteriostatic for treatment o Prophylaxis and treatment of stones Antiandronergic, anti-inflamm [Batr.]) Performance and endurance enhancers Echinacea (Echinacea purpurea L. Moench., Echinacea angustifolia DC, Echinacea pallida Nutt. Nutt.) Eleuthero (Eleutherococcus senticosus Rupr. & Maxim. ) Ginseng (Panax ginseng C.A.Meyer, Panax quinquefolius L.) Nervous system Disorders Feverfew (Tanacetum parthenium L.) St. John’s wort (Hypericum perforatum L.) Valerian (Valeriana officinalis L.) Willow bark (Salix alba L., Salix fragilis L., Salix daphnoides Villars, Salix pentandra L.) Metabolic and Endocrine Disorders Black cohosh (Cimicifuga racemosa L. Nutt.) Black currant seed oil (Ribes nigrum L.) Borage seed oil (Borago officinalis L.) Chaste tree berry (Vitex agnuscastus L.) Evening primrose oil (Oenothera benign prostatic hyperplasia Oral: immunostimulant; treat symptoms Topical: treatment of hard-to burns, psoriasis, herpes sim Adaptogen (an agent facilitat kinds of stress) Adaptogen Treatment of headaches, fev prophylactic to reduce frequ of migraine headaches Anxiolytic, anti-inflammatory Spasmolytic, mild sedative, s Anti-inflammatory, analgesic treatment of rheumatic and a headache, and gout Emmenagogue (an agent tha treatment of premenstrual di Dietary supplementation of li atopic eczema Dietary supplementation of li atopic eczema Treatment of menstrual disor Dietary supplementation of li atopic eczema biennis L.) Respiratory tract Disorders Ephedra Horehound Slippery elm Cardiovascular system Disorders Garlic (Allium sativum L.) Ginkgo (Ginkgo biloba L.) Grape seed (Vitis vinifera L.) Hawthorn (Crataegus laevigtata [Poir] DC.) Pine bark (Pinus maritime Lam.), pignogenol Disorders of the skin, mucous membranes, and gingival Aloe vera gel (Aloe vera L. N.L. Burm.) Goldenseal (Hydrastis Canadensis L.) Mellisa (Melissa officinalis L.), lemon balm Tea tree oil (Melaleuca alternifolia [Maiden & Betchej Cheel) Bronchodilator, vasoconstric edema, appetite suppressant ephedra-containing products Expectorant, antitussive, cho ineffective as a nonprescript expectorant) Mucilaginous demulcent, em to sooth irritated mucous me the digestive tract (FDA has soothing demulcent for sore Witch hazel (Hamamelis virginiana L., Hamamelis vernalis Sarg.) DRUGS & THE EFFECT ON NUTRITION ANTACIDS Antacids can cause nutritional deficiencies because people misuse these drugs. Antacids are frequently taken in excess to curb problems produced by the misuse of other dietary substances, such as alcohol or coffee, or by excessive eating. Antacids bind to dietary phosphates in the intestines and increase their excretion. This upset the delicate ratio of calcium to phosphorous that is necessary for normal calcium absorption and deposition into bone. Bone disorders might result. This risk for bone disorders is further increased in the elderly who cannot absorb calcium well and who often consume inadequate amounts of calciumrich foods in the diet. Antacids neutralize excess acid in the GIT and they might interfere with the absorption of iron and the B vitamins – folic acid and B12. The functions of folic acid and vitamin B12 are related. A deficiency of either vitamin results in anemia, which is a reduction in red blood cells, and a reduced ability to build and repair tissues. Cimetidine (Tagamet), a drug that inhibits the secretion of stomach acid and is used in the treatment of ulcers, also reduces vitamin B12 absorption. The therapeutic effects of antacids depend on when they are taken. Aluminum hydroxide: to reduce gastric acidity, it should be taken 2 hrs before or after a meal. to rid the body of excess phosphates, it is taken with a meal. This case, the antacid binds to dietary phosphorous and does not allow it to be absorbed. The nutritional effects of antacids Type of antacid Nutritional consequences Aluminum hydroxide Aluminum toxicity Phosphate depletion Sodium bicarbonate Folic acid malabsorption Sodium overload Magnesium hydroxide Magnesium overload Phosphate depletion ANTIBIOTICS Some essential nutrients are produced by bacteria in the small and large intestines and are absorbed through the intestinal wall. Antibiotics disturb this normal bacterial growth and destroy the nutrientproducing bacteria. A deficiency of vitamin K can result. Tetracycline is an antibiotic that can inactivate the intestinal bacteria that manufacture vitamin K and reduces vitamin C stores in the body. Absorption of calcium and iron is reduced. Neomycin reduces the absorption of nutrients in several ways. 1.It changes the lining of the GIT so that it is less efficient at absorbing nutrients and binds bile and fat-soluble vitamins and inhibits their absorption. 2.It increases the excretion of nitrogen, sodium, potassium, and calcium. 3.It reduces the absorption of folic acid, iron, vitamin B12, and vitamin K. 4.It reduces the absorption of the sugars, sucrose, and lactose. ANTICONVULSANTS Anticonvulsant drugs are used to control epileptic seizures and to prevent or treat seizures that result from neurosurgical procedures or head injuries. Long-term anticonvulsant therapy with phenytoin, phenobarbital, primidone, or carbamazepine might cause rickets and osteomalacia. Anticonvulsants inhibit the manufacture of vitamin D. A vitamin D deficiency will cause bone degeneration, even with adequate calcium intake. It is recommended that patients who take anticonvulsant drugs also take a vitamin D supplement that contains 400 to 800 IU of vitamin D. The anticonvulsant drugs are associated with anemia. This anemia is caused by a deficiency of folic acid and vitamin K and is characterized by frequent hemorrhage. However, if large doses of folic acid are given to counteract low blood levels, a possible underlying deficiency of vitamin B12 might go unnoticed. To avoid these deficiencies, a daily supplement of vitamin K, folic acid, and vitamin B12 might be necessary. Since folic acid in high doses can interfere with the action of some anticonvulsants (phenytoin), supplement should be taken with caution. ANTIDEPRESSANTS Antidepressant drugs and tranquilizers might alter nutrient status because they affect food intake or nutrient excretion. The anti-anxiety drugs such as meprobamate, lorazepam, oxazepam, alprazolam, chlordiazepoxide, and diazepam can cause nausea, vomiting, dry-mouth, loss of appetite, diarrhea, reduced salivation, and stomach disorders. The tricyclic compounds such as amitriptyline: 1. Alter appetite and can cause weight gain or loss. 2. Increase urinary excretion and might increase losses of B vitamin and vitamin C. Diazepam and diazepoxide might alter magnesium status and increase urinary loss of calcium. The side effects of MAOIs include: . Constipation, . Nausea, . Diarrhea, . Abdominal pain These conditions might reduce nutrient intake and excretion. DRUGS FOR ARTHRITIS TREATMENT D-Penicillamine is used: 1. In the treatment of rheumatoid arthritis. 2. In the treatment of heavy metal poisoning and Wilson’s disease (copper toxicity). D-Penicillamine binds other minerals that are not toxic and can contribute to mineral deficiencies. One of the side effects of D-penicillamine is loss of appetite (anorexia). The loss of appetite might be caused by a drug-induced deficiency of zinc. The symptoms of a zinc deficiency are diminished taste sensitivity and a reduced appetite. ASPIRIN AND NSAIDs Aspirin is used in the control and alleviation of pain, headache, and the symptoms of arthritis. Excessive use of aspirin can cause several nutritional side effects. Aspirin-induced GI bleeding is associated with: 1. Increased losses of iron and iron deficiency anemia. 2. Deficiencies of folic acid, potassium, and vitamin C. 3. Reduced absorption of vitamin B12. ORAL CONTRACEPTIVES Oral contraceptives affect food intake and nutritional status in several ways. They have been associated with: 1. increasing appetite and encouraging weight gain, 2. impairing glucose tolerance, 3. increasing blood levels of cholesterol and triglycerides, 4. reducing absorption of folic acid, and 5. Promoting water retention (edema). Oral contraceptives are associated with several nutrient deficiencies. Some women who take oral contraceptives exhibit: 1. High blood levels of vitamin A and copper. 2. Low blood levels of vitamin E; Vitamin C; vitamin B1, B2, B6, B12; folic acid; zinc; and iron. Vitamin B6 is of particular interest because of its role in mood and behavior. When daily intake is increased from 2 mg to 20 to 40 mg daily, the depression associated with oral contraceptive drugs might be alleviated. DRUGS TO LOWER CHOLESTEROL Elevated blood cholesterol levels are associated with an increased risk for heart disease. Some drugs bind to cholesterol and bile acids in the intestines and prevent their re-absorption and thus reducing the circulating blood levels of cholesterol. Some of these drugs are cholestyramine, clofibrate, cholestipol, and neomycin. The drugs to lower cholesterol bind other fatsoluble substances and might cause vitamin K deficiency, vitamin D deficiency, and related bone disorders. Other symptoms of fat-soluble vitamin deficiencies include: 1. night blindness, 2. the destruction of red blood cells (anemia), and 3. Hemorrhage. Cholestyramine This drug can cause: 1. steatorrhea (fatty stools); 2. mal-absorption of the fat-soluble vitamins A, D, E, and K; 3. deficiencies of iron, carotene, calcium, vitamin B12, and folic acid and might result in bone disorders and anemia; 4. increased urinary excretion of calcium; 5. increased blood levels of triglycerides; 6. Reduced body stores of iron when taken over a long period of time or at high doses. Clofibrate This drug: 1. binds cholesterol and bile acids so that reduces their reabsorption; 2. increases excretion of the fat-soluble vitamins; 3. Changes the taste sensation, which might reduce a person’s desire to eat. Colestipol This drug may cause deficiencies of the fat-soluble vitamins A, D, E and folic acid. Vitamin K supplementation is required only in the presence of poor blood clotting and prolonged bleeding times. The effectiveness of cholestipol is increased when it is combined with the B vitamin nicotinic acid (niacin). DRUGS FOR HYPERACTIVITY TREATMENT Dextroamphetamine and a similar compound methylphenidate are used to control behavioral problems in hyperactive children. These stimulants calm, rather than excite, hyperactive patients. Growth retardation has been noted in hyperactive children who are on long-term drug therapy. This side effect might be a result of reduced food intake associated with drug-induced suppression of appetite. DRUGS FOR HYPERTENSION THERAPY The diuretic drugs used in treatment of hypertension and CHF include the thiazides, furosemide, and ethacrynic acid. These drugs increase the urinary loss of potassium and other minerals, as well as water. If potassium deficiency were allowed to progress, a person might experience: 1. bone fragility, 2. paralysis, 3. sterility, 4. muscle weakness, 5. nerve disorders, 6. irregular heart beat (arrhythmias), and 7. Kidney damage. Some diuretics, such as spironolactone, are not associated with a deficiency of mineral. Other drugs that deplete the body of potassium include: . L-Dopa . Senna . Gentamicin . Amphotericin B . Bisacodyl . Salicylates . Phenolphthalein . Corticosteroids Magnesium Magnesium is another mineral that can be depleted with the use of thiazides. Magnesium functions in: 1. energy production, 2. the manufacture of fat and protein, 3. the removal of toxic compounds such as urea and ammonia, 4. muscle relaxation, 5. nerve transmission, 6. the prevention of tooth decay, 7. the transportation of nutrients into the cells, and 8. Bone formation and maintenance. A deficiency of magnesium affects: 1. the heart, 2. the nerves, and 3. The kidneys. Low magnesium in the body may cause: 1. arrhythmias (irregular heart beat), 2. heart failure, 3. atherosclerosis, 4. destruction of the heart muscle, and 5. convulsions Drugs that affect magnesium status Alcohol Amphotericin B Capreomycin Carbenicillin Cisplatin Cycloserine Digitalis glycosides Ethacrynic acid Furosemide Gentamicin Lithium Phenobarbital Phenytoin Tetracyclines Thiazides Tobramycin Viomycin Mercurial diuretics: . chlormerodrin . meralluride . mercaptomerin . mercurophylline . mersalyl The use of furosemide and ethacrynic acid may cause the deficiency of: 1. Calcium, 2. Iodine, and 3. Zinc. Prolong use of diuretics may place a person at risk for deficiencies of the water-soluble vitamins, such as vitamin C and the B vitamins. The antihypertensive hydrazine interferes with vitamin B6 metabolism and causes deficiency symptoms that include: 1. behavioral disorders, 2. sleep irregularities, and 3. convulsions STEROIDS Steroids are a group of drugs that are used to increase muscle mass in athletes, and include oral contraceptives and estrogen. Estrogen, this drug can cause: 1. abdominal cramping, 2. loss of appetite, 3. diarrhea, and 4. nausea These side effects can reduce food and nutrient intake or increase nutrient losses. Salt and fluid retention and weight gain also are possible. TUBERCULOSIS DRUGS INH is used in the long-term treatment of TB. This drug can cause: 1. dry mouth, 2. loss of appetite, 3. nausea, 4. stomach distress, and 5. vomiting The potential nutritional side effects include a vitamin B6 deficiency. INH binds to the vitamin and the two are excreted in the urine. INH taken with pyrazinamide and cycloserine may cause anemia. The daily supplementation 50 mg of vitamin B6 might protect against a deficiency. WEIGHT CONTROL PILLS Phenylpropanolamine (PPA) is used in weight loss. This drug is ineffective in permanent weight loss; the weight gain exceeds weight loss. More than 10,000 cases of toxic effects attributed to PPA have been reported to FDA’s Poison Control Center and 1000 of these cases were emergency room visits. The side effects of PPA include: 1. increased blood pressure, 2. restlessness, 3. irritability, 4. anxiety, 5. insomnia, and 6. headaches The side effects related to anxiety and pain can reduce a person’s desire for food and interfere with nutrient intake and absorption. LAXATIVES Laxatives impair the absorption of nutrients from intestines. The laxatives, such as phenolphthalein, senna, and bisacodyl, increase the activity of intestines and alter the intestinal lining. As a result, several nutrients are excreted rather than absorbed. These nutrients: 1. calcium, 2. potassium, 3. vitamin D Mineral oil binds: 1. the fat-soluble nutrients, 2. the essential fatty acids, and 3. the fat-soluble vitamin A, D, E, and K As little as 4 teaspoons of mineral oil used daily can produce deficiency symptoms of the fatsoluble vitamins. Symptoms of vitamin A deficiency include: 1. poor vision at night (night blindness); 2. reduced resistance to infection; 3. skin problems such as dermatitis; 4. abnormal bone and tooth development Inadequate intake of vitamin D can result in bone problems such as osteomalacia. A deficiency of vitamin K causes hemorrhage. A vitamin E deficiency can cause skin, blood, and nerve problems. DRUGS FOR CANCER TREATMENT Some drugs used to treat cancer cause nausea, vomiting, sore or dry mouth and throat, bloating, fullness, and other symptoms that cause aversions to food and eating. The 5-fluorouracil alters taste sensations and affects appetite. The results of these conditions are loss of appetite, malnutrition, tissue wastage, and weight loss. Other drugs can damage the lining of GIT or cause diarrhea reduces nutrient absorption and increases the excretion of nutrients. Some drugs interfere with the use of nutrients in cells. Methotrexate is used for the treatment of cancer and psoriasis. The therapeutic effect of methotrexate is altering folic acid metabolism. Methotrexate blocks the enzyme necessary for the conversion of dietary folic acid to its biologically active form and cells cannot divide or grow. A drug-induced folic acid deficiency exerts a greater effect on these diseased cells. Red blood cells do not divide properly and megaloblastic anemia is common in patients taking methotrexate. DRUG-NUTRIENT INTERACTIONS Drug Alcohol Amitriptyline Imipramine Lithium Carbonate Amphotericin B Use Toxic effect on intestinal lining, altered secretion of digestive enzymes . Reduced absorption of vitamin B1, folic acid, and Vitamin B2; . Increased excretion of Antidepressant magnesium and zinc; . Reduced blood levels of vitamin B12. Antifungal Antihistamines Barbiturates Effect on Nutritional Status Nasal congestion . Weight gain; . Altered blood glucose; . Increased blood levels of Biguanides Metformin Phenformin Anticonvulsant magnesium; . Increased excretion of calcium. Diabetes . Increased urinary excretion of potassium and nitrogen; . Reduced blood levels of magnesium and potassium. Increases appetite. . Increased need for folic acid and vitamin D; . Reduced absorption of vitamin B1; . Increased excretion of vitamin C. Reduced absorption of vitamin B12. Drug Use Effect on Nutritional Status Chloramphenicol Antimicrobial Increased need for vitamin B2, Chlorpromazine Tranquilizer B6, and B12. Colchicine Colocynth Corticosteroids AntiIncreased inflammatory appetite and body weight. Cathartic Reduces absorption of carotene, sodium, potassium, lactose, and vitamin B12. Reduces transit time and absorption of nutrients. Coumarin . Reduced Anticoagulant absorption of calcium and phosphorous; . Increased urinary excretion of vitamin C, calcium, potassium, zinc, and nitrogen; . Reduced blood levels of zinc; . Increased blood levels of glucose, triglycerides, and cholesterol; . Increased need for vitamin B6, vitamin C, folic acid, vitamin D. . Impaired bone formation; . Reduced wound healing. Antagonist to vitamin K. Drug Use Effect on Nutritional Cycloserine Antitubercular . Reduced protein sy . Reduced absorption calcium and magnes . Reduced blood leve and B12. Dextroamphetamine Appetite suppressant Weight loss, reduced Indomethacin . Reduced blood leve . Reduced absorption Analgesic amino acids; . Anemia. Insulin Diabetes Increases appetite Glutethimide Sedativehypnotic Increased need for v Griseofulvin Antifungal Alters taste sensitivit Hydralazine Hypotensive Increased excretion o Acne Avoid supplementati Jalap Cathartic Reduces transit time nutrients. K-Tab Potassium Reduces absorption Isotretionin (a synthetic derivative of vitamin A) Drug Use Effect on Nutritional Status Lithium carbonate Tranquilizer Increases appetite and body weight. Methylphenidate Appetite suppressant Para-aminosalicylic acid Weight loss and reduced Antitubercular growth in children. Penicillins Antimicrobial Phenobarbital Phenytoin Primidone Reduced absorption of Anticonvulsant vit. B12, iron, folic acid, and fat. Podophyllin Cathartic Propranolol Sodium nitroprusside Cardiac Hypotensive Reduced blood level of potassium. . Impaired vit D metabolism; . Increased excretion of vit D; . Reduced Sulfasalazine Ulcerative colitis Thiazides blood levels of folic acid, vit B6, B12; . Anemia. Diuretic Viomycin Antimicrobial Reduces transit time and absorption of nutrients. Reduced glucose tolerance. . Increased urinaryexcretion of vitamin B12; . Reduced blood level of vitamin B12. Reduces absorption of folic acid and reduces intestinal transit time. Increased urinary excretion of potassium, magnesium, zinc, and vit B2. Reduced blood levels of potassium and calcium; alkalosis. DRUG-NUTRIENT INTERACTIONS AND DIETARY RECOMMENDATIONS Drug Effects on Nutritional Status Dietary Recommendation s Antacids . Bloating, constipation, & nausea. . Reduces phosphate . Reduces vit A . Loss of appetite . Take between meals; . Increase intake of vitamin A, iron, and folic acid. . Diarrhea, nausea, fluid loss. Cholestyramin . Reduces e absorption of glucose. . Hypokalemi Colchicine a (loss of potassium) . Take on empty stomach with water; . Increase water intake. Bisacodyl . Increase intake of fat-soluble vitamins, carotene, iron, Belching, B12, bloating, and calcium. constipation, . High fiber diet if flatulence, constipated. diarrhea, steatorrhea. . Take with water and food; . Avoid alcohol; . Diarrhea, . Increase fluid nausea, intake; vomiting. . Supplement or . Reduces increase dietary absorption intake of high risk or nutrients. increases excretion of sodium, potassium, fat, carotene, B12, folic acid, calcium. Drug Effects on Nutritional Status Dietary Recommendations Furosemide . Take single dose Constipation, early in morning. diarrhea, nausea or vomiting. . Increased Excretion potassium, calcium, Hydralazine magnesium, sodium and water. . Dry mouth, loss of appetite. . Take with food; . Maintain ideal weight; . Vit B6 supplementation; . Sodium restriction. . Diarrhea, Isoniazid constipation, nausea; . Reduces B6; . Loss of appetite; Methotrexate . Sodium retention. . Stomach distress, nausea, . Take on empty stomach. . Avoid alcohol. . Vit B6 supplementation. . Increase water intake. vomiting; . Avoid alcohol. . Reduced B6; . Dry mouth; . Loss of appetite. . Diarrhea, GI bleeding, nausea, or vomiting. . Reduces folic acid. . Poor absorption of B12. . Loss of appetite, sore mouth and throat. . Altered taste. Drug Effects on Dietary Mineral Oil Penicillamine Nutritional Status Recommendation s . Flatulence, nausea, vomiting. . Reduces absorption of vitamins A, D, E, and K. . Loss of appetite and weight loss. . Hypokalemia . Take 2 hrs before a meal. . Increase fatsoluble vitamin intake. . Take with water. . Take on empty stomach . Supplementation of B6 and trace mineral. . Diarrhea, nausea, Phenolphthalei vomiting. n . Reduces cooper, zinc, and iron. . Altered taste Phenylbutazon and loss of e appetite. . Take on empty stomach. . Chew well. Steroids Steroids (Anabolic) . Reduced absorption of vit D, calcium, and other minerals. . Take with food. . . Avoid alcohol. Hypokalemia Constipation, diarrhea, heartburn, fluid retention, and weight gain. . Bloating, indigestion, nausea. . Fluid and sodium retention. . Reduced absorption . Take with food or low-sodium snack. . Sodiumrestricted diet. . Increase potassium. of vit D. . Osteomalacia . Nausea, vomiting, fluid retention, edema, and weight gain. FOOD AFFECTS THE ACTION OF DRUGS Food could: 1. increase a drug’s effect, 2. decrease a drug’s effect, 3. prevent s drug usefulness, 4. increase the absorption or excretion of drug, 5. decrease the absorption or excretion of drug, 6. interfere with the drug’s metabolic effects Vitamin A in doses of 50,000 IU in combination with tetracycline can cause intracranial pressure (severe headache). Patient who is taking a MAOI such as isocarboxazid, phenelzine, and tranylcypromine should avoid all aged or fermented foods. These foods include: . pickled herring . fermented sausages (salami and pepperoni) . sharp or aged cheese . yogurt . sour cream . beef and chicken liver . canned figs . bananas . avocados . soy sauce . meat tenderizers . yeast . beer . Chianti wine . sherry . other wines. The drug reacts with these foods and might produce high blood pressure, headaches, and brain hemorrhage. Excessive consumption of vitamin K-rich foods, such as liver and dark green leafy vegetables, can interfere with anticoagulant therapy. THE EFFECTS OF FOOD ON ABSORPTION AND ACTION OF DRUGS Food Drug Action Coffee/tea Neuroleptic agents Theophylline Reduces drug absorption Increases drug side effects Citrus Quinidine Fiber (bran, Digoxin Increases blood levels of drug pectin) Food/meals Chlorothiazide Reduces drug absorption Propranolol Nitrofurantoin Cimetidine Increases drug absorption. Increases drug absorption Aspirin High-fat foods Tetracycline Increase drug effectiveness Griseofulvin Delays drug absorption Highprotein food Levodopa, methyldopa Licorice Antihypertensive drugs Reduces drug absorption Milk Tetracycline Meal with milk Reduces drug absorption Methotrexate Increases drug absorption Reduces drug absorption Salty foods Lithium Vegetables (dark green) Warfarin Induces hypokalemia and sodium retention Reduces drug absorption Reduces drug absorption drug effectiveness drug effectiveness DIETARY SOURCES OF VITAMINS AND MINERALS Nutrient Dietary Source Vitamin A Vitamin D Dark green and orange vegetables and fruits (i.e., carrots, apricots, spinach), liver. Vitamin E Fortified milk, fish oils Vitamin K Vegetable oils, cereals, dark green leafy vegetable Vitamin B1 Dark green leafy vegetables Vitamin B2 Niacin Vitamin B6 Pork, beef, organ meat, cereals, nuts, legumes Milk, cheese, yogurt, mushrooms, broccoli, avocados Folic acid Organ meats, peanut, meat, poultry, fish, legumes, milk Vitamin B12 Meat, organ meats, poultry, fish, soy-beans, dried beans Biotin Panthothenic acid Vitamin C Dark green vegetable, dried beans, orange juice, cantaloupe, green peas, sweet potatoes Meat, poultry, fish, clams, oysters, milk, cheese, fermented soybean products Calcium Chromium Liver, organ meats, molasses, milk Copper Meat, fish, chicken, cheese, cereals, avocados, green peas, dried beans, nuts, dates Iron Fresh fruits and vegetables Milk, yogurt, cheese, dark green leafy vegetables Whole grain breads, Cereals and meats Whole grain breads, Cereals, shell-fish, nuts, organ meats, dried beans & peas, dark green vegetables Meat, liver, dried fruits, legumes, dark green vegetable, prune juice, oysters, strawberries, watermelon, broccoli Magnesium Nuts, legumes, cereals, soybeans, seafood, dark green leafy vegetables Manganese Liver, lettuce, spinach, cereals, dried beans &peas, nuts Potassium Selenium Meat, milk, fruits, potatoes, bananas, orange juices, dried fruits Zinc Meats, poultry, seafood Oysters, milk, meat, cereals and breads SYMPTOMS ASSOCIATED WITH VITAMIN AND MINERAL DEFICIENCIES Nutrient Deficiency Symptom Vitamin A Skin disorders, poor night vision, reduced resistance to infection, poor bone and tooth development Vitamin D Rickets or osteomalacia Vitamin E Vitamin K Anemia, reproductive system damage Vitamin B1 Hemorrhage Fatigue, anorexia, weight loss, Vitamin B2 GI problems, weakness, nausea, numbness & tingling in the hands and feet, memory loss, reduced attention span, irritability, confusion. Vitamin B6 Cracks at the corners of the mouth, inflammation of the mouth, reddening of the eyes, burning and itching of the eyes, dermatitis, depression. Folic acid Dermatitis, diarrhea, irritability, headache, insomnia, memory loss. Niacin Vitamin B12 Vitamin C Weakness, mental confusion, irritability, nervousness, insomnia, poor coordination, anemia, dermatitis. Anemia, irritability, weakness, weight loss, apathy, headache, forgetfulness, GI problems, diarrhea. Anemia, anorexia, GI problems, fatigue, dizziness, numbness and tingling, moodiness. Anemia, joint tenderness & swelling, poor wound healing, weakness, bleeding gums, bruising. Nutrient Deficiency Symptom Calcium Osteoporosis. Chromium Glucose insensitivity resembling diabetes. Copper Iron Magnesium Low white blood cell count, poor collagen formation, bone deterioration, anemia. Anemia, lethargy, poor concentration, paleness, headaches. Lethargy, weakness, confusion, personality Manganese Potassium changes, muscle tremors, anorexia, nausea, lack of coordination, GI problems, heart disease and arrhythmia. Selenium No established deficiency symptoms in humans. Zinc Impaired growth, bone weakness, sterility, muscle weakness, reduced heart rate. Structural damage to the heart. Changes in hair and nails, sterility, skin disorders, lethargy, anemia, poor wound healing, loss of taste and smell. Vitamin B6 and Temperament Drugs might affect mood and personality because of their effect on how vitamin B6 is used in the body. Vitamin B6 is an essential component in the body’s production of several neurotransmitters and hormones. These substances regulate behavior and numerous body processes. For example, serotonin is a principal neurotransmitter found in the brain. It is produced from the amino acid tryptophan in the presence of vitamin B6. Serotonin regulates biological and psychological functions including sleep, emotions, and mood. Low levels of serotonin are associated with depression, insomnia, and seizures. Drugs that raise the level of serotonin can affect behavior. The brain depends on what is eaten to regulate the production of serotonin. The level of serotonin is regulated by the amount of tryptophan and vitamin B6 in the diet; chronically low intake of either or both can result in reduced production of serotonin and might cause mood disorders. Drugs such as steroid hormones, oral contraceptives, and INH interfere with vitamin B6 metabolism and suppress the synthesis of serotonin. The mood swings and depression that often accompany these drugs are reduced or eliminated when vitamin B6 supplements are taken. On the other hand, vitamin B6 can inhibit the effectiveness of other drug such as L-Dopa since vitamin B6 increases the decarboxylation of LDopa in the blood. Vitamin B6 supplementation is recommended when the following drugs are used: Prednisone Methylprednisolone Oral contraceptives Estrogen