Welcome to:FCSN 245-Basic Nutrition

Summer 2006

Virginia Bennett, PhD, RDDavid L. Gee, PhD

Course web page: www.cwu.edu/~bennettv

Keys to SuccessFCSN 245 - Basic Nutrition

Organize into study groups– improves test scores– group extra credit points

Review copies of old exams on course web page– use as study guide before exam– read before lectures for important points

Keys to SuccessFCSN 245 - Basic Nutrition

Use PowerPoint notes on course web page– print to reduce lecture note taking– These notes do not replace note taking or

attending classRead the assigned readings in the

textbook– clarification of lectures

Keys to SuccessFCSN 245 - Basic Nutrition

Review/rewrite your notes ASAP!– Clarify note taking– Review for Clicker Points

Keys to SuccessFCSN 245 - Basic Nutrition

Maximize your discussion group points– attend all discussion group session– do all assigned work

Attend lectures– Clicker points – lecture revisions– learning: listening + reading + doing

Dietary Guidelines, Dietary Standards, & Nutrition

Education:

A Changing Science

Causes of Death in the US1900

#1 Pneumonia and influenza (12%) #2 Tuberculosis (11%) #3 Diarrhea and enteritis (8%) #4 Heart disease (8%) #5 Stroke (6%) #6 Nephritis (5%) #7 Accidents (4%) #8 Cancer (4%)

Causes of Morbidity and Mortality in the US

First half of the 20th CenturyInfectious DiseasesNutritional Deficiency DiseasesCurrent CausesChronic Non-infectious Diseases

– http://www.cdc.gov/nccdphp/factsheets/death_causes2000.htm

Nutritional Concerns

First half of the 20th Century

–Adequacy Avoiding Deficiency

Current

–Imbalance Avoiding Excesses and Deficiency

Nutrition Teaching Tools

First half of the 20th

Century – Four Food

GroupsCurrent

– Food Guide Pyramid

1999 Food Supply Servings Compared w ith Food Guide Pyramid Serving Recommendations

0

2

4

6

8

10

12

Gr ains Vegetables Fr ui t Dair y Meat, etc(oz)

1999 Servings

PyramidRecommendations

010

20304050

6070

Added fats (g) Added sugars(tsp)

1999 intake

PyramidRecommendations

Government Nutritional Advice First half of the 20th Century

– Dietary Standards Emphasis on specific nutrients Recommended Dietary Allowances (RDA’s)

– Calories, protein, vitamins, minerals

Current

– Dietary Guidelines Emphasis on whole foods and macronutrients

– Dietary Reference Intakes (DRI’s) Updated version of the RDA’s

Issued every 5 years– Jan 12, 2005

Issued by: – Dept of

Health and Human Services (DHHS)

– US Dept. of Agriculture (USDA)

Dietary Guidelines for Americans – 2005

Feel better today. Stay healthy for tomorrow.– Make smart choices from every food

group– Find your balance between food and

physical activity– Get the most nutrition out of your

calories

Dietary Guidelines for Americans - 2005

Nutrition: To know the facts…use the label

Play it safe with foodAbout alcohol, if you choose

to drink, do so in moderation.

Government Nutritional Advice First half of the 20th Century

– Dietary Standards Emphasis on specific nutrients Recommended Dietary Allowances (RDA’s)

– Calories, protein, vitamins, minerals

Current

– Dietary Guidelines Emphasis on whole foods, macronutrients,

and balance

Nutrition Food Labels

First half of the 20th century– Voluntary w/o nutritional claim– Old label format

Current– Mandatory– Nutrition Facts Label

Nutrition Facts Label

1992 - NLEA – Nutrition Labeling Education Act

Mandatory on package of almost all foods– except fresh meats & produce

Focused on imbalances in US diet

Nutrition Facts LabelServing SizeIngredient List

–Listed in descending amounts

Labels: Daily ValueBased on dietary guidelines

(1990)How much of your allowance

of a particular nutrient one serving of that food provided

Labels: Daily Value

Based on a 2000 Calorie Diet< 30% Calories from fat<10% Calories from saturated fat<300 mg cholesterol60% Calories from carbohydrate>12.5 g dietary fiber/1000 Calories

Labels: % of what?% = parts per 100

– per 100 what?

% of Daily Value– per 100% of DV for that nutrient

% of Calories– per 100 calories

% by weight– per 100 grams

Labels: % of what?

“Contains 7% Fat”

% Fat by weight = (8g Fat/112g total wt)x100– % Fat by weight = 7.1%

– Low Fat?

Labels: % of what?% Calories from Fat

% Cal from Fat = (70 Fat Cal/160 Cal) x 100– % Cal from Fat = 44% – Low Fat?

Labels: % of what?% Daily Value for Fat

% Daily Value = (8g fat/65g fat per day) x 100– % DV = 12.3%– Low Fat?

Should Nutrition Facts Be Required on All Foods?

Fresh meats– servings per container

Fresh produce– cost of packaging

– consumer selection

Restaurants– no packaging

Fast Food Restaurants

– 50% of meals today are prepared by others

Nutrient Claims&

Health Claims

Nutrient Claims: Definition of Fat Terms

Fat Free: < 0.5 g/servingLow Fat: < 3 g/servingReduced Fat: 25% less

fat than regular

Nutrient Claims - Definition of Saturated Fat Terms

Saturated Fat Free:– less than 0.5 g per serving

Low Saturated Fat:– less than 1 g per serving

Reduced or Less Saturated Fat:– 25% less than reference food

Nutrient Claims - Definition of Terms

High – > 20% of Daily Value

Good– 10-19% of Daily Value

Nutrition Facts Label: Allowable Health Claims

Food and Drug Administration (FDA)

Substantial evidence linking nutrient and disease prevention

Currently 14 approved health claims

Nutrient Claims&

Health Claims

Allowable Health Claims

Calcium and Osteoporosis–food “high” in calcium

Sodium and Hypertension–food “low” in sodium

Fat and Cancer–food “low” in fat

Allowable Health ClaimsSaturated fat, cholesterol, and

Heart Disease– food “low” in saturated fat, cholesterol,

and total fat

Fiber and Cancer– food “good source” of fiber, low fat, not added

fiber

Allowable Health Claims

Fruits, Vegetables, and Grains containing fiber, particularly soluble fiber and reduction in risk of heart disease.

Fruit & vegetables and Cancer– low fat, good fiber, carotenoids, & vitamin C

Allowable Health ClaimsFolic Acid and Birth Defects

–“good” source of folic acid

Allowable Health Claims

Soluble fiber such as oat fiber & psyllium seed husk and Heart Disease

Sugar alcohols & Dental Caries

Allowable Health Claims

Soy protein and prevention of coronary heart disease– October 1999– “Diets low in saturated fat and cholesterol that

include 25 grams of soy protein a day may reduce the risk of heart disease. One serving of (name of food) provides >6.25 grams of soy protein.”

Allowable Health Claims

Whole grains and reduced risk of heart disease and certain cancers– Whole grains must be more than 50% of food’s

ingredients

– Also low fat, etc…

Potassium and reduced risk of hypertension and stroke– Good source of potassium

– Low sodium, low fat, etc…

Allowable Health ClaimsPlant sterols and stanols and

prevention of heart disease– Sept 2000

– Benecol & Take Control margarine spreads

– Functional Foods

Functional Foods:a $10 Billion/yr market

Foods with added health promoting ingredients

“FDA to Encourage Science-based Labeling and Competition for Healthier Dietary Choices”

July 10, 2003

New review process for qualified health claims on food labels.– New ranking system

A: unqualified claim B: good evidence, not entirely conclusive C: limited evidence, inconclusive D: little scientific evidence

New health claims to be investigated:– Benefits of

5-9 servings of fruits and vegetables Replacing solid fats with vegetable oils Several servings of fish per week Substituting nuts for proteins high in

saturated fats

Qualified Health Claims

First FDA-approved qualified health claim (July 2003)– ‘Scientific evidence suggests but does not prove

that eating 1.5 ounces of most nuts, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease’

– March 2004 – FDA approves claim for walnuts– http://www.cfsan.fda.gov/~dms/qhc-sum.html

Regulation of Dietary Supplements

Dietary Supplement Health Education Act - 1994

Product derived from food (in pill, liquid, non-food form) designed to supplement diet

Cannot claim to diagnose, prevent, treat, or cure a specific disease other than those allowed by NLEA

Dietary Supplement Health Education Act - 1994

Can make “Structure/function” claims The FDA does not review dietary

supplements for safety or effectiveness prior to marketing.

The FDA can prohibit sale of a dietary supplement if it “presents a significant or unreasonable risk”.

How big is the dietary supplement industry?

Nutrition Business Journal 2003 Report– http://www.nutritionbusiness.com/

US market: $18.8 billion World market $150 billion

Dietary Supplements Case Study:GHB

Gamma Hydroxy Butyrate– trace amounts of GHB found in beef

Claims: AnabolicStore.com (1/02)– “a powerful anabolic steroid used to build

muscle– “stimulate growth hormone release which aids

in fat reduction and muscle building”– “pleasant alcohol like, hangover free ‘high’

with potent pro-sexual effects”

Dietary Supplements:GHB

Recent Headlines: Yahoo News (1/02)– “Risky sex, drugs: circuit party norm?”– “Date rape drug attacks on the rise”– “5 arrested in Western PA Club-drug ring”

Other names:– Liquid Ecstasy, Soap, Easy Lay, and Georgia Home Boy

GHB effects:– coma and seizures– w/ alcohol: nausea and breathing difficulties– withdrawal effects: insomnia, anxiety, tremors

Dietary Supplements:GHB

GHB considered to be an illegal dietary supplement by the FDA– Prescription drug (schedule III) for treatment of cataplexy

(weakness, paralysis) in patients with narcolepsy Emergency Room cases

– 55 in 1994– 2973 in 1999– 4969 in 2000– 3340 in 2001

US Drug Enforcement Agency reports 72 deaths related to GHB use

Dietary Supplements Case Study:

Ephedra“Botanical” (plant) productHerbs from the genus Ephedra (Ma

Huang)– Ephedra: collection of compounds from Ma Huang– Ephedrine: synthetic compound, active chemical of

ephedra, regulated as a drugClaims related to weight loss, increased

energy, body building

Dietary Supplements:Ephedra

Chemically - ephedrine alkaloids are amphetamine-like compounds

Ephedrines are cardiovascular and nervous system stimulants

Since 1994, the FDA has received and investigated > 1000 reports of adverse effects

Dietary Supplements:Ephedrine- A case study

High blood pressure, irregularities in heart rate, insomnia, nervousness, tremors and headaches, seizures, heart attacks, strokes and death

FDA proposes to limit amount and require warnings (6/97)

Dietary Supplements:Ephedrine- A case study

Objections to proposed regulation– led by supplement industry

– evidence is not convincingFDA withdraws proposal (Apr 2000)Major study in NEJM 2000 reports

“convincing evidence linking ephedra and adverse effects”

Dietary Supplements:Ephedrine- A case study

2002 Minnesota Viking lineman dies of heat stroke, used ephedra supplements. NFL bans ephedra use

2003 Baltimore Oriole pitcher dies of heat stroke, used ephedra supplements.

2003 Rand report for FDA– Modest benefit of ephedra/caffeine on short-term weight

loss– Very limited evidence on benefits to athletic performance– Very few clinical trials on safety: 2-3X risk for nausea,

vomiting, anxiety, palpitations– Case studies: 5 deaths, 5MI, 11 CVA, 3 seizures, etc.

Dietary Supplements:Ephedrine- A case study

2003 FDA re-introduces proposed warning label:– Possible serious adverse effects: heart attack, seizures,

strokes, death

– Risk increases with dosage, exercise, caffeine

– Never to be used during pregnancy and lactation

Feb. 2004: FDA – sales of supplements containing ephedra and ephedrine alkaloids are prohibited

Support of current Dietary Supplement Regulations

Freedom to use supplements Number of adverse effect cases small relative to use FDA approved foods with adverse effects

– NutraSweet– Olean

Testing for safety and effectiveness would greatly increase the cost of dietary supplements

Dietary supplements are derived from foods and should be regulated as foods

Concerns on current dietary supplement regulations

DSHEA: Dietary supplements are ‘assumed’ to be safe and effective– No proof of safety– No proof of effectiveness– New drugs are assumed to be unsafe and

ineffective Drug companies must prove safety and

effectiveness of drugs.

Concerns on current dietary supplement regulations

Dietary supplement industry is poorly regulated– Many studies showing supplements contain less

than or none of the active ingredient Ginseng - 60% failed test SAMe - 50% failed test glucosamine - 33% failed test

–Studies showing presence of illegal ingredients in dietary supplements

Internet Marketing of Herbal Supplements

Morris & Avorn, JAMA 290:1505-1509 (2003)

Authors noted that 80% of US adults use internet to find health information

Analyzed 443 web sites– 8 common herbs (ginko, St. John’s Wort, etc)– 5 most popular search engines

81% of .com sites made health claims 55% claimed to treat, diagnose, or cure specific diseases 52% omitted standard federal disclaimer 32% of Kava retail sites did not mention FDA advisory

linking herb to liver toxicity

USDA National Organic Standards

October 2002

What is “Organic”? Food grown and processed without:

– Conventional pesticides– Synthetic fertilizers or sewage sludge– Biotechnology – genetically modified

organisms (GMO)– irradiation

Organic Label Guidelines

100% Organic– All product ingredients are organic

USDA Organic Seal can be displayed

“Organic”– >95% of products are organic

USDA Organic Seal can be displayed

“Made with Organic Ingredients”– >70% of ingredients are organic

Organic Foods Are organic foods safer?

– Maybe… Credible evidence lacking USDA makes no claim of increase safety

Are organic foods pesticide free?– Depends….

Organic farmers can use ‘natural’ pesticides– Plant derived pesticides -Rotenone– Microbial pesticides - Bacillus thuringiensis– Synthetic pesticides - Insecticidal soaps, horticultural oils– Minerals - Sulfer, copper, copper-zinc

Very limited safety testing of ‘natural’ pesticides

Organic Foods:Are organic foods pesticide free?

Pesticide residues in conventional, IPM-grown and organic foods: Insights from three U.S. data sets.– B.Baker, C.Benbrook, E. Groth, and K. Benbrook. Food Additives and

Contaminants, 19 (5): 427-446 (2002).

Using USDA data from 20 fruit and vegetable crops:– 73% of conventionally grown were positive of pesticide residues

23% of organically grown were positive

– 46% of conventionally grown were positive with multiple residues 7% of organically grown were positive with multiple residues

Questions:– Why do organically grown food have pesticide residues at all?– Are the levels of pesticides residues found unsafe?

Organic Foods

Are organic foods more nutritious?– Very little credible evidence of this

Are organic foods more expensive?– Probably

Consumer Reports (Jan 1998) found organic produce to be on average 57% more expensive than non-organic

Are organic foods more friendly to the environment?– Probably

No pesticide runoff to pollute environment Use ‘sustainable’ agricultural techniques

– Reduced tilling, efficient use of water, etc…