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Adele Hite, MAT Ph. D candidate, Nutrition Epidemiology MPH/RD candidate, Nutrition Gillings School of Adele Hite, MAT Ph. D candidate, Nutrition Epidemiology MPH/RD candidate, Nutrition Gillings School of Global Public Health University of North Carolina at Chapel Hill Healthy Nation Coalition, Policy Chair

USDA Diet Untested & Unproven “The [USDA] food patterns were developed to meet nutrient USDA Diet Untested & Unproven “The [USDA] food patterns were developed to meet nutrient needs, . . . while not exceeding calorie requirements. Though they have not been specifically tested for health benefits, they are similar to the DASH research diet and consistent with most of the measures of adherence to Mediterranean-type eating patterns. ” --from the 2010 Dietary Guidelines

Source: CDC 2010 Source: CDC 2010

Food Availability Data, USDA 700 600 Calories 500 400 1970 1990 300 2008 200 Food Availability Data, USDA 700 600 Calories 500 400 1970 1990 300 2008 200 100 0 Flour & cereal Added fats & products oils Calories available from: Flour & cereal products Added fats & oils Other fats - dairy Meat, eggs, nuts Fruit Vegetables Dairy Caloric sweeteners Other fats dairy 1970 432 403 6 463 71 125 Meat, eggs, nuts 1990 573 446 15 453 85 126 Fruit Vegetables 2008 625 616 25 482 87 122 +193 +213 +19 +16 -3

Dr. Janet King Chairwoman of the 2005 Dietary Guidelines Advisory Committee “[E]vidence has begun Dr. Janet King Chairwoman of the 2005 Dietary Guidelines Advisory Committee “[E]vidence has begun to accumulate suggesting that a lower intake of carbohydrate may be better for cardiovascular health. ” Institute of Food and Medicine 2005 Macronutrient Report “. . . [L]ow fat, high carbohydrate diets may modify the metabolic profile in ways that are considered to be unfavorable with respect to chronic diseases such as coronary heart disease and diabetes” BUT, the USDA 2010 Dietary Advisory Committee Report says: “Healthy diets are high in carbohydrates. ”

 • low-fat highly processed grain & cereal products • blood sugar goes up • low-fat highly processed grain & cereal products • blood sugar goes up • insulin goes up to remove sugar Dietary Sugars & Starches • Eat less? • Move more? Elevated Insulin Hunger & fatigue No available fuels • blood sugar goes down • fat is stored • fat use is stopped

“The low-fat– high-carbohydrate diet, promulgated vigorously. . . by the U. S. Department of “The low-fat– high-carbohydrate diet, promulgated vigorously. . . by the U. S. Department of Agriculture food pyramid, may well have played an unintended role in the current epidemics of obesity, lipid abnormalities, type II diabetes, and metabolic syndromes. “ Dr. Sylvan Lee Weinberg Director of Medical Education at the Dayton Heart Hospital Clinical Professor Medicine at the Wright State University School of Medicine past President of the American College of Cardiology

2010 Dietary Guidelines Advisory Committee Report “Adequate intake of high-quality protein is essential for 2010 Dietary Guidelines Advisory Committee Report “Adequate intake of high-quality protein is essential for health. ” Institute of Medicine 2005 Macronutrient Report “The lower limit of dietary carbohydrate compatible with life is apparently zero. ”

Calories Protein (g) Sugar (g) Price/ serving Number of ingredients Sausage (1 1. 5 Calories Protein (g) Sugar (g) Price/ serving Number of ingredients Sausage (1 1. 5 oz patty) 170 12 0 0. 50 5 2 whole eggs Cheese (1/4 cup) 140 100 12 6 0 0 0. 22 0. 21 1 4 Total: 410 30 g 0 $0. 93 10 Calories Protein (g) Sugar (g) Price/ serving Number of ingredients Instant oatmeal (1 package, ½ cup) 160 4 7 0. 37 17 Fruit & veggie blend drink (8 oz) 100 0 23 0. 93 11+ Soy yogurt (6 oz) 150 410 4 8 21 41 1. 00 $2. 20 15 43+ Total:

“Eat less, move more” The real message: “Eat less, BUY more” “Eat less, move more” The real message: “Eat less, BUY more”

Peter Farnham Director of Government Relations Nutrition and Metabolism Society Peter Farnham Director of Government Relations Nutrition and Metabolism Society

Energy intake during the obesity epidemic. Data from CDC. Energy intake during the obesity epidemic. Data from CDC.

Low-Fat Message Backfired Low-Fat Message Backfired "The country's big low-fat message backfired. The overemphasis on reducing fat caused the consumption of carbohydrates and sugar in our diets to soar. That shift may be linked to the biggest health problems in America today. " Dr. Frank Hu Professor of Nutrition and Epidemiology at the Harvard School of Public Health.

What about the Shortfall Nutrient Choline? Pamela Schoenfeld, RD Director, Healthy Nation Coalition www. What about the Shortfall Nutrient Choline? Pamela Schoenfeld, RD Director, Healthy Nation Coalition www. forahealthynation. org [email protected] com February 14, 2011

Choline is essential Functions include: – Neurotransmitter synthesis (acetylcholine) – Critical component of cell Choline is essential Functions include: – Neurotransmitter synthesis (acetylcholine) – Critical component of cell membranes (phosphatidylcholine) – Lipid transport from the liver (lipoproteins) – Major dietary source of methyl groups that regulate metabolic pathways and detoxify body – Important role in brain development in fetus, influencing lifelong learning and memory. (Zeisel & da Costa 2009; Sanders & Zeisel 2007)

Choline requirements • Choline can be endogenously synthesized but this will not meet human Choline requirements • Choline can be endogenously synthesized but this will not meet human requirements (Zeisel & da Costa 2009). • Only 1 out of 10 American adults are meeting the Adequate Intake guidelines for choline (425 -550 mg/d), including pregnant women. (ENC, Jensen et al 2007). • 10% of adults studied developed fatty liver and/or muscle damage even with AI of choline; resolved on high-choline diet (Zeisel & da Costa 2009). • “Although the choline Adequate Intake level may be an overestimate of dietary requirements, data derived from highly controlled feeding studies involving adult men suggests that this is not the case. ” (Caudill 2010).

Choline deficiency causes illness • An early clinical sign of deficiency is development of Choline deficiency causes illness • An early clinical sign of deficiency is development of fatty liver from lack of phosphatidyl choline to export VLDL (Sanders & Zeisel 2007). • Elevations in muscle enzymes (da Costa 2006). • Associated with increased risk of neural tube defects – 4 times in lowest quintile of maternal intake or < 300 mg/d (Shaw et al 2004). • Maternal levels of choline can become depleted because of increased transport to fetus (Sanders & Zeisel 2007).

The Choline Problem Consider the: • Increase in learning problems among children. • Epidemic The Choline Problem Consider the: • Increase in learning problems among children. • Epidemic of fatty liver disease. Per NIH, 10 -20% Americans are affected. Could there be a connection with low choline intakes?

The DGAC Report re: Choline “[R]equired for cell structure and function, neurotransmission, lipid transport The DGAC Report re: Choline “[R]equired for cell structure and function, neurotransmission, lipid transport from the liver, and as a dietary methyl groups source (Zeisel 2006. )” “Deficiency states that can arise from inadequate choline intake include fatty liver and muscle dysfunction…as well as elevated plasma homocysteine level…” “Americans could meet recommendation for choline by consuming modest amounts of eggs and replacing other meat, poultry, and starchy vegetables with cooked dry beans and peas, within fixed energy intakes. ”

Eggs and choline • 2 large eggs contain 252 mg choline • Plasma choline Eggs and choline • 2 large eggs contain 252 mg choline • Plasma choline level is predicted by egg consumption (Konstantinova 2008). • Eating eggs daily does not increase risk of diabetes (Djousse, 2010) or heart disease (Kritchevsky, 2004). • “Two strategies could make more choline available for brain development: maternal diet could include more foods such as eggs and liver, a supplement… (Zeisel 2009).

DGAC meeting excerpts MS. MOSHFEGH: For choline, which is based now on the 2005 DGAC meeting excerpts MS. MOSHFEGH: For choline, which is based now on the 2005 -2006 data, about 10 percent of all individuals had intakes at or above their AI. SLAVIN: Alanna, can you talk a little bit about choline? Aren't most of the sources animal sources? I mean, where else do you get that from? Because that seemed to be really a problem. DGAC 2 nd meeting, Day 1: 1 -29 -09

DGAC meeting excerpts CHAIR VAN HORN: …the take-home message here is just the stunning DGAC meeting excerpts CHAIR VAN HORN: …the take-home message here is just the stunning number of Americans who still are well below the recommended intakes of calcium, potassium, fiber, and choline, and the vast majority that eat well beyond the recommended amounts of sodium and dietary cholesterol. DGAC 2 nd meeting, Day 1: 1 -29 -09

DGAC – choline is the “tail? ” PEARSON: some of our models may not DGAC – choline is the “tail? ” PEARSON: some of our models may not show adequacy in choline, and it looks like you've had that kind of across the board in many instances. I guess it would certainly be helpful to us…to get an idea of really the significance of the choline recommendation, how definite those are. I had been led to believe that these were perhaps still a little bit sketchy in terms of compared to the nutrient adequacy data we have for many other things, and that would be very helpful for us to know that so that we don't basically have kind of the tail wag the dog here in terms of the – a relatively minor issue, actually starting to control something that -- such as saturated fat or cholesterol content, which obviously are big issues. DGAC 4 th meeting, Day 2: 11 -5 -09

DGAC – ran out of time? NICKOLS-RICHARDSON… The evidence for those concerns is not DGAC – ran out of time? NICKOLS-RICHARDSON… The evidence for those concerns is not at the same level of – I don't think we have the ability to conduct a NEL search at this point. We have done some soft searches, if you will, some exploratory searches, and the evidence that is there is not as robust as what we have been able to do for some of the other questions. So, I -- we don't plan at this point to have a NEL process to go along with that, but it's more a cautionary note for certain subgroups. DGAC 4 th meeting, Day 1: 11 -5 -09

DGAC – it’s the cholesterol, silly SLAVIN: I wanted to follow up on Mim's DGAC – it’s the cholesterol, silly SLAVIN: I wanted to follow up on Mim's just because of the egg, because I think for high quality protein I'm with kids and getting better diets into people with lower calories. I'm just really big on eggs and protein qualities. So making sure we don't let cholesterol make the decision here. PEARSON: But also to remind you that the cholesterol is in the yoke of the egg, and the protein is in the white, and you can actually do something about that. DGAC 4 th meeting, Day 2: 11 -5 -09

Choline sent to the back of the line SLAVIN: [I]t kind of comes back Choline sent to the back of the line SLAVIN: [I]t kind of comes back to the choline recommendations we heard about. We are not meeting that. Nobody is really thinking about how that’s… how we’re going to--NELSON: I think we have to focus on those nutrients, the shortfall nutrients that seem to have fairly profound health implication. I mean I think we have to triage some of those nutrients… But eggs, I mean, are we dealing with eggs anywhere? Is that in fats? CHAIR VAN HORN: Fatty eggs. (Laughter) DGAC 2 nd meeting, Day 2: 1 -30 -09.

2010 Dietary Guidelines say: “Evidence suggests that one egg (i. e. egg yolk) per 2010 Dietary Guidelines say: “Evidence suggests that one egg (i. e. egg yolk) per day does not result in increased blood cholesterol levels, nor does it increase the risk of [CVD] in healthy people. Consuming less than 300 mg per day of cholesterol can help maintain normal blood cholesterol levels. Consuming less than 200 mg per day can further help individuals at high risk of [CVD]. ” “The fats in meat, poultry, and eggs are considered solid fats. . . ” An egg contains about 200 mg of cholesterol. To stay within the 200 -300 mg per day, we must limit whole eggs to one or fewer per day. Americans eat < ¼ of an egg/day, = 0. 4 oz, same as USDA recommends. Eggs could be an easy way to meet choline shortfall, with 125 mg choline per egg yolk.

No Egg Problem in the UK The Food Standards Agency (UK) sets no restrictions No Egg Problem in the UK The Food Standards Agency (UK) sets no restrictions on number of eggs that can be eaten within an otherwise varied diet. “Eggs are a good source of protein, iodine, and vitamins such as D and B 2. ” “If you are eating a balanced diet, you don't need to cut down on eggs (or kidneys and prawns) unless your GP or dietitian has advised you to do this. ”

More on eggs in 2010 DGA “The major sources of cholesterol in the American More on eggs in 2010 DGA “The major sources of cholesterol in the American diet include eggs and egg mixed dishes (25% of total cholesterol intake)…Cholesterol intake can be reduced by limiting the consumption of the specific foods that are high in cholesterol. Many of these major sources include foods that can be purchased or prepared in ways that limit the intake of cholesterol (e. g. , using egg substitutes). ” “The fats in meat, poultry, and eggs are considered solid fats, while the fats in seafood, nuts, and seeds are considered oils. Meat and poultry should be con-sumed in lean forms to decrease intake of solid fats. “ “They include moderate amounts and a variety of foods high in protein (seafood, beans and peas, nuts, seeds, soy products, meat, poultry, and eggs). ” “A healthy eating pattern focuses on nutrient-dense foods—vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, lean meats and poultry, seafood, eggs, beans and peas, and nuts and seeds that are prepared without added solid fats, sugars, starches, and sodium. ” 2010 Dietary Guideline for Americans Policy Document

Pregnancy – no word on choline “Women capable of becoming pregnant • Choose foods Pregnancy – no word on choline “Women capable of becoming pregnant • Choose foods that supply heme iron, which is more readily absorbed by the body, additional iron sources, and enhancers of iron absorption such as vitamin C-rich foods. • Consume 400 micrograms (mcg) per day of synthetic folic acid (from fortified foods and/or supplements) in addition to food forms of folate from a varied diet. 8 Women who are pregnant or breastfeeding • Consume 8 to 12 ounces of seafood per week from a variety of seafood types. • Due to their high methyl mercury content, limit white (albacore) tuna to 6 ounces per week and do not eat the following four types of fish: tilefish, shark, swordfish, and king mackerel. • If pregnant, take an iron supplement, as recommended by an obstetrician or other health care provider. 2010 Dietary Guideline for Americans Policy Document

Is this what the USDA wants our children to eat for breakfast? ADA Times, Is this what the USDA wants our children to eat for breakfast? ADA Times, Winter 2011

Dr James E. Carlson BS, DO, MBA, JD Physician Port Jefferson Station, New York Dr James E. Carlson BS, DO, MBA, JD Physician Port Jefferson Station, New York

Genocide! How Your Doctor’s Dietary Ignorance Will Kill You !!! By Dr. James E. Genocide! How Your Doctor’s Dietary Ignorance Will Kill You !!! By Dr. James E. Carlson With humor, wit, and a good dose of common sense, this guide shows readers that a diet with daily sources of fat, cholesterol and protein is effective in treating disease.

® THE WESTON A. PRICE FOUNTATION® COLORFUL DIETARY GUIDELINES and RECIPE BOOKLET based on ® THE WESTON A. PRICE FOUNTATION® COLORFUL DIETARY GUIDELINES and RECIPE BOOKLET based on FOUR FOOD GROUPS 40