(1) Trends

Monday, May 18, 2015 12:47 PM

The Harvard School of Public Health is anti-milk. They think that

teenage boys that drink milk are larger than boys who don't drink milk.
They say that is bad. They say: "people who drink more milk when
they are young get more fractures when they get old".

So much bad information out there about nutrition:

• Nutrition really helps with health: who pays the bill when you
get older? The federal government.
○ We are looking for the active components that help in
food. It’s the "functional" foods.
○ Human milk: some active component in there makes it
better than formula milk.
○ Space-flight nutrition: bone and muscle: can have
optimal nutrition but if you don't use it you lose it!
When the astronauts came out of the space shuttle they
had major loss of muscle functionality.

How do you define "organic"? Everything has carbon so how

do you define "organic"?
• Quality of the TOTAL DIET. This is the big idea! Eat
various types of foods in moderation to get a balanced
diet to get everything you need nutrition wise.
• Lack of beta-carotene is the major cause of blindness in
the world BELOW the age of 25. so this should be
added to food (fortified) to prevent blindness.
• Old people: what's different about them? Things don't
work the same. Need to make sure they get their proper
nutrition since they are more susceptible.

Lectures Page 1
 • Despite what you read, supplementation for the most
part is HARMFUL. Can even increase the morbidity
of patients. More calls for regulating supplements.
Kellogg is the cereal brand that had to change their
terminology because the word "natural" is misleading.

• Dr. Oz is an example of someone who gives information

that is not always accurate. Your role as a clinician is to
understand what is wrong so when a patient asks you
about something you can tell them it's not correct.

• Your job as a clinician includes helping people

understand nutrition properly and prevent the
prevalence of disease.

Lectures Page 2
 • Notice here that healthcare clinicians are NOT included in this survey at all!
There was an Australian survey that appears similar to the American results.
In the Australian report it was internet, then friends = magazines = family.

This is information from a registered nurse. They say that in

most medical schools there is no nutrition classes. As dentists we
do have nutrition classes and therefore we may be more
equipped to deal with nutrition issues.

In France, they have a high fat diet and drink lots of red wine and have
low cardiovascular disease. However, they have LOW portion size.
Not like us Americans that consume huge portions of food. The SIRT1
is simply going to be stimulated by resveratrol to increase the
mitochondria regions.

Lectures Page 3
 • Lots of people in this long term study: people who took beta
carotene supplements had an increase in cancer. These were
people who smoked a pack a day. We kill cancer cells with
oxidizing agents.

Lectures Page 4
 • 18,000 people: at the end of 4 years of supplementation:
it caused an increase in lung cancer. You don't see this
on the internet because it's not good for corporate
businesses.

• Don't worry about supplements: eat a balanced diet. Don't

emphasize single foods or one nutrient supplement. Need
to have a balanced diet.

Lectures Page 5
 RDA is NOT recommended daily allowance. Over a period
of days you should average this much. The "d" is always
dietary not daily! So the vitamin per day pill is misleading.

RDA = Recommended DIETARY allowance

RDI = Reference DIETARY Intake.
DRV = Daily Reference Value.

Don't memorize this list. Just know they are standardized reference
values. You may actually need more or less than 2,000 calories daily.
And children below the age of 4 are NOT included in this.

Lectures Page 6
 Ignore this: he totally ignored it.

So daily values are used to compare foods not to

tell you how much you should eat.

Under the "new rules" you can compare a pretzel to a potato chip. Pretzels are
baked and chips are fried in fat. However, if the chips have more fat and the
pretzels less, then a pretzel company can advertise the pretzel as "less fat".

From May to Must:

• Any component of the "may list" must be listed if the food is enriched or
fortified with it, or if a health claim is made concerning the component. So
you must list how much of that is in the product. Let's say you say
"glycopene" will make you wonderous. You must list how much of this
glycopene you have in the product.

Lectures Page 7
 Calories: main energy source.

Example: 12 oz can of coke was labeled as "two" servings because it

used to be that we had 6 oz bottles. But we actually drink a 12 oz can
so this is the actual serving we drink. We need MORE potassium then
sodium. Also need to specifically list the added sugars.

Lectures Page 8
 Advertising terms:
• Free (for most nutrients)
○ Less than 0.5 grams per serving
• Reduced/less (usually calories, sugar, or
fat)
○ Compared to a reference food.

Sugar free
Fat free
Saturated fat free

Reduced sugar
Reduced or less fat
Reduced or less saturated fat

Lectures Page 9
 It's not about what you eat, it's about how OFTEN and how MUCH
you eat. So there is nothing called junk food, it's more of a junky
eating habit.

Lectures Page 10
(2) Proteins
Wednesday, May 20, 2015 3:16 PM

Comment about science in the news: Small sample

size, tiny effects, invalid exploratory analysis, and
conflicts of interest can all make studies provide
information that is not accurate.

Floating restorations can occur: well above the tooth surface

because the acid erodes the enamel around the restoration but
the amalgam just stays in place normal. What to take?
Omeprazole = prilosec.

Lectures Page 11
 3 phases: luminal, mucosal (at the mucosal lining where final
digestion occurs, then post-absorptive. Celiac disease is a problem
at the MUCOSAL STAGE. Same thing with lactose intolerance
because no lactase (brush border enzyme).

Many osmotically active components contribute to the edema and

diarrhea that occurs because of increased presence of water. These
substances will absorb water across the luminal wall and cause
malabsorption to be intensified.

Steatorrhea = lipid absorption messed up and you get oily stools.

Systemic results as a result of problems with nutrient absorption.

Lectures Page 12
 We do NOT store proteins or amino acids. You either use
it or lose it.

Can use AA to make tissue protein or use it for energy. Can

be converted to glycogen or fat. Or if we are starving can use
them directly in energy metabolism. This is the last choice.
Carbs and fats are used FIRST, and then we use proteins. Get
rid of the nitrogens and use the carbons to make glucose and
fats. The nitrogen is converted to ammonia, goes to urea, gets
excreted or we can use the nitrogen for other substance
production like neurotransmitters.

Eat too much protein get lots of urea and get fat too.

GLUTAMINE is a neurotransmitter. Its present more

commonly than any other AA in the blood. Then Alanine is the
NEXT HIGHEST. Then Glycine is the third most common. These are
all non-essential amino acids. Why is alanine the second highest in
the blood? Because it is used to make glucose.

In humans, protein is our ONLY source of metabolically active

nitrogen. Can't get if from AIR. Any nitrogen starts as a protein
in the diet. Protein = nitrogen. So with proteins we are talking
about nitrogen balance because it's easier to measure than protein
content in the body.

Lectures Page 13
 in the diet. Protein = nitrogen. So with proteins we are talking
about nitrogen balance because it's easier to measure than protein
content in the body.

Problems can occur: look at protein in food you look at total

nitrogen. In china, melamine was added to milk and caused death
of people. Melamine is the industrial equivalent of protein. Some
executives were like: what do we do with all this extra melamine?
Told dairy farmers to add some melamine to boost the protein
(nitrogen) content which increases the profitability of their milk
product.

We start in the stomach with pepsin and HCl. Start doing much
more in the duodenum with pancreatic secretions like trypsin.
Get lots of di and tri peptides. Usually absorb only free amino
acids. Can't take insulin orally because it would be digested.

Lectures Page 14
 Collagen: can't digest very well. Other proteins can be
digested better than others.

True or false: All animal proteins are capable of supporting

human protein nutrition. Example we just gave above is
collagen. We have collagen but we cannot digest it very
well!

If it's hard to make, we eat something that has it instead.

Arginine is semi-essential depending on the protein content in
the diet. Cysteine and tyrosine are derived from two essential
amino acids. Can then become essential (instead of non-
essential) because we have a lower amount of methionine and
phenylalanine.

Glutamate (non-essential AA) is used to supply the carbon

skeleton for the synthesis of arginine.

Plant proteins have different functions. Therefore

their proteins will look different.

Vegetarians need to eat many different types of

vegetables to be able to get all the nutrients you need.

These 3 things are important for proper

protein nutrition: plant proteins are less
digestible than animal proteins.

Lectures Page 15
 In order of how easy it is to measure
the protein quality. Four ways to
measure protein quality.

Lectures Page 16
So most ANIMAL proteins (exception being connective tissue like collagen since its low digestable and low in essential amino acids)
will rank highly with the protein ranking scores. Can use (1) Chemical Score (2) protein effeciency ratio (3) Biological Valu e (4)
Protein Digestability Corrected Amino Acid Score). Soy protein will rank very highly and is also cholesterol free. What about the plant
proteins? They will ALSO have a LOW ranking because also have low digestability in humans and have low essential amino acids.

Which ones are low in what?

• Lets Go Now So Venezuela Cries
Legumes (soybean) = low in methionine
Grains = low in lysine and threonine
Nuts and Seeds = low in lysine
Vegetables = low in methionine
Corn = low in lysine and tryptophan

Lectures Page 17
 Most common cause of protein deficiency in the world. We have
this problem in the world but not so much in the USA.

Deposed: no longer breast feeding (also means red boy).

Pure protein deficiency problem. The edema you see in these

"fatty" kids is due to protein deficiency. Why would they get
red hair? It's because of a decrease in melanin synthesis. It's
made from tyrosine. Semi-essential amino acid from
phenylalanine (which is essential). Red is the absence of color
in hair.

Lectures Page 18
 Older patients should not eat in their room. Need to go to
the common room to eat more. The kids were getting milk
but it was rice milk. This is just a starchy water type milk
that has no protein in there.

Here we don't have enough proteins and ALSO we have lack of

calories. NOT just protein deficiency like with the kwashiokor
syndrome. We break down muscle protein in this condition to
provide nutrients

Lectures Page 19
 In Kwashiokor, they are NOT hungry. In Marasmus, they
are constantly searching for food. So the issue with
kwashiokor, full of low quality of foods with lots of
starches and fibers so they feel very full.

Lectures Page 20
 Most brain development is finished by age 6. from 6-12 you can ease
them out of the lack of phenylalanine diet. By age 12 BRAIN is fully
developed.

Lectures Page 21
 Soy protein does NOT contain any gluten. May be able to
lower cholesterol and LDL levels. consume up to 50
grams/day (more than most people need for total protein
intake), then we have a 3% decrease in LDL cholesterol. No
dose dependence (25 or 50 grams = same amount of
reduction). Its low in saturated fats and cholesterol. Not
really clinically significant.

Lobster:
• Has high cholesterol (200 mg)
Salmon
• Only 1/2 the cholesterol of Lobster at 100 mg
• But 3 grams of saturated fats per serving
Roasted beef
• Has higher saturated fats than salmon at 5.5 grams
• But less cholesterol than salmon (20% less) so like 80 mg

So the elderly women are at increased risk of protein deficinecy because:

• They don't eat that much which means less food = less protein more likely

Lectures Page 22
 So the elderly women are at increased risk of protein deficinecy because:
• They don't eat that much which means less food = less protein more likely
Have less muscle mass than the other people: less protein to • Don't have much muscle: less source of protein to be broken down
feed from. Main reason: they just don't eat that much.

Lectures Page 23
 If you weigh 190 lbs (86 kg) then how many grams of protein do you need (if you are an
endurance training athlete) above the normal adult who does not do all that endurance
exercise? Its 35 grams.

Question: I thought that nitrogen balance was the same

as protein balance? So if it had a bunch of nitrogen
compouds shouln't that be considerd as Protein
conent? Why did they get sued?

And why was the answer 35 grams in the clicker

question, and not 68 grams per day? The calculation is
shown here.

Lectures Page 24
(3) Lipids
Thursday, May 28, 2015 6:34 AM

FATS: most energy dense food. Protein was 4. carbohydrates is also 4 kcal/gm.
Twice as much energy at 9 kcal/gram. What is the primary determinant of the
melting temperature of dietary lipids? It is the degree of saturation / unsaturation.

Short, medium, and long chain FA.

Not so much the diet, produced by intestine in response to non-digestible starches and
fibers. Come into the diet. Short chain ones (acetic acid, proprionic acid, butyric acid). Can
affect immune function and energy metabolism.

Lectures Page 25
 Omega 3 oils are in:
• Cold water Fish oil
○ DHA and EPA
• Canola oil
• Olive oil
• Soybeans
• English walnuts
○ As alpha-linolenic acid.
▪ EPA and DHA can be made from this.

So the typical NA diet only contains 100-200 mg of omega-3 FA from the

diet. So we need to have an avg of 500 mg/day. So the average american
is LOW in DHA and EPA intake.

Vegetable oil has the omega 6. omega 6 can then be used to make Arachidonic acid.
Fish oil has the omega 3.

BOTH of these omega 3 and omega 6 can be metabolized to form EICOSANOIDS.

Arachidonic Acid: used to make all those eicosinoids such as

prostaglandins and leukotrienes.

Lectures Page 26
 In studies looking at this, most of them are NOT
good studies anyway. Lots of heterogeneity in the
statistics. Omega-3 may actually increase the risk
for prostate cancer (used frozen blood samples).

Looking at ADHD in boys because they have it more often than

girls. Could be to do with omega-3 FA? Study had negative
results. Then throw out different groups of boys and narrowed it
down and threw out 75% of the data. Then they made a positive
correlation. So the omega-3 (NOT the omega 6) is implicated in
ADHD when its LOW.

Basically saying these studies suck so far.

Lectures Page 27
Lectures Page 28
 Who can't use fats for energy? The brain since it can only use glucose. The
heart could use fats but it prefers carbohydrates. Satiety means feeling fullness.
Lipids increase the feeling of fullness quickly. Aromatic cmpds are carried in the
lipids in food.

ONLY animals make cholesterol. Precursor to bile acids. Forms

important hormones. Clicker question: most of the cholesterol in
our body comes from: is it liver or diet? It is definitely the LIVER.
Need to limit your cholesterol to 300 mg/day. Make 1 g/day from
the liver.

HDL: picks up the cholesterol and transfers it to LDL.

• So if we don't have enough HDL then we get too
much cholesterol in the blood.

Lectures Page 29
 HDL: picks up the cholesterol and transfers it to LDL.
• So if we don't have enough HDL then we get too
much cholesterol in the blood.

In the hydrogenation process, you re-arrange and reduce some double bonds.
You get cis conformation but when you CHEMICALLY do this process, you
get some TRANS. Hydrogenated vegetable products commercially have
higher levels of trans fatty acids.

Stearic acid = oleic acid in carbons (both 18 carbons).

To break down fatty acids, we must put in a trans double bond. Also during synthesis. So we
CAN break down the trans bonds. Nothing wrong with trans fats, we can metabolize them just
fine. Difference is when they are inserted into the membrane.

Trans: you got a LONG straight section that can interact with the membrane, this interacts more
successfully than the cis bond. Because of this interaction in membranes, will raise the LDL
levels, lower the HDL, and those two markers will increase the risk for heart disease.

Lectures Page 30
 Relative to the effect on lipoprotein profile which is the worst?
1. Butter: has lots of saturated fats but LOW trans fats.
2. Stick margarine: uses the hydrogenation process and has
much more TRANS fatty acids.
3. Tub / soft spread margarine
4. Squeezable margarine

Must have LESS than 0.5 g trans / fat to claim that you
are trans fat free. So don't eat many foods that are close
to the cut-off range. Hydrogenated vegetable oil
products have a much higher chance of trans FA.

Stick margarine has MORE trans fatty acids than the

butter. This has a worse effect for lipo-protein profile.

Lectures Page 31
 Denmark has BANNED the addition of trans fatty acids to their foods. Since 2003
there are not more trans FA. If the food already has it naturally then it's okay. Since
trans has no know benefit, we need to ban this.

Canoli problem occurred in NYC.

Lectures Page 32
 Why even do this whole process of hydrogenation? There were commercial reasons
for doing this. Rancid = unpleasant smell or taste. We can prevent this from
happening when we use trans fatty acids. Also want to increase the shelf life.

Before we had plastic bottles, if you had a glass jar of oil and you drop it you
get oil everywhere. If you have a solid, you can form them into bricks, they
4 ways to prevent rancidity. are not going to spread all over. So more convenient for transportation. Can
ALSO add Vitamin E, our natural anti-oxidant. Can also use BHA and
BHT.

These are reasons why it's hard to get rid of trans fats. KFC: in 2010
announced they were totally trans fat free. It took KFC 8 years and
10's of millions of dollars to find a substitute. The board of directors
must taste the chicken. It was so hard, time intensive, and expensive
to find a good alternative.

There is an RDA for proteins but NOT for fats. For proteins it was 0.8 grams
/kg of body weight per day. With fats, it's like 30% energy per day.

From that 30%, the 7% and 1% numbers will come from.

• 30%: fats
○ Less than 7%: saturated fats
○ Less than 1%: trans fats

In the brain there is lots of fatty usage (NOT energy usage) Kids can't eat
enough to support their energy needs without a fatty diet. So we need FATS
for the proper brain development since the brain is about 60% fat content.

Why does AHA say to limit margarines and spreads made from vegetable
oils?
• Higher trans fat content than butter. They both have the same amount
of fat in there but the type of fats are different.

Lectures Page 33
 We are not the worst country when it comes to fats. We are around 32%.

Be careful of using mon/di glyceride foods.

Lectures Page 34
 Fat substitutes: very low calorie substitutes put into food. See a list
over here. Add some fiber to the diet. Will carry the "feel" but not the
flavor of fats.

Simplesse = protein substitute.

• Can contain some of the aromatic properties of the fats. Has more
taste and "mouth feel" like normal fats.

Salatrim and benefat: these are actually fats but NOT as digestable with fewer calories.
Shorter chains are NOT metabolized as well as the long chains. Not very active with the
lipases but can cause some GI problems.

Lectures Page 35
 Olestra: lowers cholesterol levels. It actually doesn't really work
very well. Now it's called "Olean". Do not get any gas issues,
and has NO calories. It does bind fat soluble vitamins (A, D, E,
K) now we saturate it with fat soluble vitamins to fix the
problem. Overconsumption: may produce anal leakage = runny
stools. He gave a long story about Olestra. Definitely a test
question. It's used in Pringles chips.

Sucrose polyesters
• 1 - 3 FA chains attached normally.
Olestra
6- 8 FA chains attached to the sucrose

So the fat soluble vitamins do NOT really contribute to the loose

stools. Also ask Sam why these do NOT have any nutritional
benefit? We do add them because Olestra binds these Fat
Soluble Vitamins right? YES!!!

• They are dietarily insignificant!!!!!!!!!!!!!!!!!!

Centers for Science and the Public Interest

• Lots of claims about olestra that aren't all true.
• This is the claim that CSPI makes about Proctor Gamble.

Lectures Page 36
 These proctor and gamble researchers were looking at different
chain length fats were affected by lipase activity. 1972: used esters
of sucrose. What is there to know here?

Lectures Page 37
Lectures Page 38
 So we HAVE cut down on our fat calories but we have INCREASED
the caloric intake of our diets. So the % from fat has gone down but
the consumption has gone up!!! Of course all those carbs we eat will
become converted to fats and then you become obese.

They are not always low in fat. It just means 25%

less fat than the reference foods.

NO, because it could be that the

calories are the same. Calories are the
main cause of obesity!!!

Lectures Page 39
 Taste is perceived as smell. Fats are aromatic compounds. When you have a stuffy nose
everything tastes the same. Most of what you taste is actually what you smell .

A calorie is a calorie, does not

matter where it comes from!!!

Lectures Page 40
(4) Carbohydrates
Thursday, May 28, 2015 6:34 AM

Raffinose:gluc, fruc, gal = tri-saccharide

Stachyose: gluc, fruc, 2 gals = tetra-saccharide

Takes galactose off of the sucrose. Now we can have an easier time digesting
these oligo-saccharides like Rafinose and Stachyose in the small intestine.

We want lots of these in our diet. There are soluble and in-soluble.

Salivary amylase only works on BIG carbohydrates. It is NOT the major

protein made by the parotid gland. Proline rich proteins are much more
produced (80%). It is broken down in the stomach. We have NO CHO

Lectures Page 41
 Salivary amylase only works on BIG carbohydrates. It is NOT the major
protein made by the parotid gland. Proline rich proteins are much more
produced (80%). It is broken down in the stomach. We have NO CHO
digestion in the stomach. Resumes in the small intestine.

Pancreas: MAJOR protein synthesizer in the body for digestive enzymes

• Makes the pancreatic amylase which breaks down CHO to disaccharides.
Then we see that intestinal disaccharidases break them down to absorb.

Sucrose is found very much in fruits. So therefore fructose is found in fruits too,
hence the name fructose. Remember Sucrose = Fructose + Glucose.
• Fructose: facilitated diffusion
• Glucose and Galactose: secondary active transport with SODIUM.

Protein sparing because when the liver wants energy it will use the carbohydrates before
it uses the proteins. So it will "spare" the proteins from being broken down for energy
usage.

We have:
• Insoluble fiber: slows INTESTINAL passage to
• increase nutrient absorption.
• Adds fecal BULK to the intestinal shit
• Soluble fiber: slows GASTRIC emptying
• Associated with the "right" bacteria metabolizing it.
• Get nutrients into small intestine but DECREASES
absorptoin
• Slow glucose absorption
• Lower blood cholesterol (decrease its absorption)

FIBER: Daily value should be 25 g/day. NA diet: 13-17 g/day

Clicker Question: Frosted flakes have too much sugar. 1 tsp = 4 grams of
sugar. If you have 11 grams of sugar per serving, it's about 2.5 teaspoons of
sugar per serving.

Lectures Page 42
 If you get fiber in your diet you won't have diverticulosis. This
is an outgrowth of the intestine. Too much fiber is also a problem:
don't get enough nutrient absorption and elimination issues.

Key point: having a low fiber diet will NOT cause diverticulosis but
if you DO have diverticulosis, then eating a high fiber diet can help
with the condition. Should have 25 g/day in the diet for fiber. 13 -17
is the average for NA.

Increased fiber can treat:

• Hemorrhoids
• Diverticulosis
• Constipation

Only the SOLUBLE fibers lower chosterol:

Gums
Mucilages
pectins

Too many SIMPLE sugars in the diet is problematic. Basically the mono and di
saccharides. They are not toxic to us because starch goes into our body and becomes
glucose. They just tend to be LESS nutritious food. So Coke has poor nutrient density. Also
tend to come in high fat foods. So the concern is what do they come in the body with.

He said in class that all of these have the same amount of sugar:
• Unsweetened apple juice
• Bottle orange juice
• Fresh squeezed orange juice
• Coca Cola
We are talking strictly here about SUGAR content, however, these other drinks have more
nutritional value. The fresh orange juice has some fiber.

NA = North American!!! NOT SODIUM.

Lectures Page 43
 Glycemic Index: presence of fiber slows the digestive process. Simple
sugars do not do this and cause a sudden spike in blood glucose levels.
Question: which has the LOWEST glycemic index?
• Baked potato without skin
• Baked potato with cheddar cheese
○ Slows digestion and absorption
○ Still has the SKIN, which slows the digestive process
• White bread
• Diced boiled carrots

The Glycemic Index is NOT very useful

because people don't eat just one food. They
eat mixtures of foods.

So we actually increase the LDL and the TRIG and in the process we also increase the
amount of fat synthesis. The more carbs in your diet, in general, the higher your glucose
levels will be. We do NOT want to use the Glycemic Index with diabetic patients.
Clicker question: Lactose intolerance in adults is a:
• Normal condition
○ Northern Europeans are less likely to be lactose intolerant. Also
some tribes in Africa. Lactase enzyme is NOT shut down in certain
populations of people. In others it's shut off.
○ Despite this, most people can tolerate some level of lactose.
▪ Get bacterial digestion of lactose in intestine
□ Gives you CO2, CH4, and H2 gas
 Gives you flatulence = fart more.
• Immunological problem
• Genetic disease
• Rare "condition"

Lectures Page 44
 Insulin:
• Primary target is on MUSCLE to uptake glucose
Glucagon:
• Primary target is LIVER to release glucose

Hypoglycemia: VERY uncommon in patients above the age of 10.

• Too much insulin given to patients:
○ Get hypoglycemia

Fiber is NOT considered a complex carbohydrate since it does not

dissolve in the body. Fiber = non-digestable polysaccharide that can
either be:
• Soluble: pectin, gums, mucilages
○ Slows gastric emptying
▪ Lowers cholesterol (prevent re-absorption)
▪ Lowers glucose levels (prevent re-absroption)
▪ Will be associated with the "right" bacteria
▪ Will cause better nutrients to get into the
intestine

• Insoluble: cellulose, hemi-cellulose, lignin.

○ Slows down intestinal absorption
▪ Adds fecal bulk
▪ Increases the nutrient absorption.

Lectures Page 45
 Fermentable = Digestible carbohydrates
• Supplied by STARCH MAINLY.
Not all Starch is digestible!!!
• We can have non-digestible starches too!!!
○ Will be used by the bacteria in LARGE intestine.
▪ THREE Categories of NON-DIGESTABLE starch
□ RS1: stays in the seeds and does not get broken up
 Corn on the cob
□ RS2: crystalline type made by plants during varying
stages of development
□ RS3: starches that undergo retrogradation to ONLY
change the PHYSICAL structure and NOT the
CHEMICAL structure.
 Boil pasta and have this white film in the water
◊ Heating and cooling of starches does this
effect on the starch.
 Amylose
 amylopectin

Even though lactose is a simply sugar, we have way more

sweeteners in our diet in NA than lactose. Note here that yes,
lactose is a simple sugar but also a di-saccharide.

Sweeteners:
• Two major ones:
○ Nutritive (only energy providing)
○ Non-nutritive (very LOW energy)
• Nutritive here just refers to energy NOT the nutritional
value.

Sucrose
• Fructose + Glucose

Note:
• Sucrose is more expensive and is derived from cane sugar
○ Government put taxes on this
• Corn syrup is much cheaper and we use this and modify some of the glucoses to
fructose. That's how you get HFCS

Lectures Page 46
 Fructose is SWEETER than regular old glucose. Can use less to get the same sweetness.

Invert sugar: even SWEETER to use less to get the same level of sweetness.
• It's also a Sucrose but a "hydrolyzed sucrose"
• Called inverted because sucrose is Levorotary. When you hydrolyze sucrose, it does
dextrorotary. So we inverted the rotation of plane polarized light.

HSH: don't metabolize quite as readily as glucose, don't get

as much energy out of it. But if you consume too much of it,
you may still get a spike in your glucose levels. since they are
sugar alcohols (not pure sugars), can be labeled as sugar free.

We know that sugars will definitely absorb water. Sugar

alcohols do not have the "aldeyhyde" group which is the
carbonyl group.

Sugar alcohols add:

• Texture to foods
• Retain moisture in foods
• Reduce browning when cooked.

Starch is hydrolyzed to glucose

• Hydrolyze means to break it down.
• Glucose reduced to various sugar alcohols.

High fructose corn syrup is NOT greater than 70% fructose.

Lectures Page 47
 High levels of reactive carbonyl groups were found in carbonated
beverages. These same groups are found in diabetic patients and cause
certain complications: where do these reactive carbonyls that cause all this
damage in diabetics come from?
• All normal monosaccharides like glucose
○ Any aldehyde or ketone will have these reactive carbonyls.
○ So in other words, it really is NOT that dangerous for you
because any monosaccharides you consume will generate
these reactive carbonyls.

It's like the hydrogenated starch hydrolysis. Take starch, hydrolyze it

down to glucose, called corn syrup. Change some of those glucoses to
fructose, so this will be sweeter and be cheaper to manufacture. Also
has less calories. You can control the product sweetness. Usually
around 50% fructose content.
• Sucrose (following digestion)
• Inverted sugar
• HFCS
All THREE of these have the same ratio of glucose to fructose. Fructose
is cheaper in USA than glucose.

Lectures Page 48
Lectures Page 49
Lectures Page 50
 The HFCS is NOT going to make you fat but rather how MUCH you eat. He got
really excited about this concept. Guaranteed question on the test.
• We are comparing the consumption values from back in the early 1900's to
1985. we some very important results:
• Much MORE SIMPLE carbohydrates'
• Less complex sugars in our diet.
▪ Bowl of broccoli: more nutritious than chocolate cake

Lectures Page 51
Lectures Page 52
 Question: If HFCS will not kill us, the aspartame and acesulfame will.
• TRUE or FALSE?
○ FALSE they won't kill us. Those are diet substitutes.

Non nutritive Carbohydrate sweeteners with NO energy = no calories.

Acesulfame potassium
• 200 times sweeter than sucrose
• Used in combination with other non caloric sweeteners
Aspartame
• 200 times sweeter than sucrose
• Equal = NutraSweet = Sugar Twin
Advantame
• 20,000 sweeter than sucrose
○ Advantame is very advanced so it’s the sweetest!!!
• Derivative of aspartame
NeOtame
• Only commerical use
• 10,000 sweeter than sucrose
• Called Newtame
Saccharin
• Sweet and low, sweet twin, necta
• 500 times sweeter than sucrose
• Banned in 2000
○ Saccaru alayhi
Sucralose
• Spelenda
• 600 times sweeter than sucrose

Cyclamate
• 50 times sweeter than sucrose
• Banned in USA but allowed in Canada (called sugar twin)
Stevia
• Called sweet leaf = honey leaf = sugar leaf
• 300 times sweeter than sucrose
• Not FDA approved
• Sold as a supplement combined with FIBER

Stevia: have some nasty properties so not allowed

as a sweetener but rather used as a supplement.

Lectures Page 53
 These things have to have lots of filler material because the
stuff is so sweet.

Diet Coke: has Aspartame in it but half as much

phenylalanine as the Hot Dog. So this is suprising: we have
much more phenylalanine in a Hot Dog than Diet Coke.

The role of carbohydrates in dental caries has been well established for only the last 50 years.
• TRUE

You MUST know all this information for the EXAM and the BOARDS because this is pretty
much the main etiological agent behind the development of CARIES!

• 1889: Dr. Miller

○ First doctor who showed a LINK between bacteria and fermentable carbs
○ Later came back to USA to become the dean of UOM dental schoool but died
before he could assume that position.
• Until the 1930's, it was thought that TOOTH STRUCTURE deformities were
necessary to allow the bacteria to establish themselves. So stuff like grooves, pits, and
fissures.
○ Then the food would decompose there and lead to caries
• 1940's: studies were not very good.

Lectures Page 54
 • Switch from Hunter/Gatherer to farming diet
(more carbohydrates) caries rate increased to near
current levels.

Tristan da Cunha inhabitants:

• FRIST MODERN CLASSIC STUDY in the 1930
○ KNOW THIS YEAR !!!!
• Only 1% caries rate in adults!!! VERY LOW.
• After trading started to occur and they had more of a Western Diet
available: caries rate went up by 15%!
• Something in the modern diet using refined carbs and simple sugars
might result in increased caries risk.
○ However, they wanted to check and see if lifestyle might
have affected the caries rate too. Back then researchers were
more careful before making conclusions.

Invade in on a culture: you change the culture. Didn't say much!

Lectures Page 55
 • Vipeholm Study
○ Institutionized mental patients: these patients had a GOOD diet
for their patients. NOT many sugars allowed in their diet and no
"in between meals" allowd.
○ Broke the patients up into 7 groups
▪ Different diets allowed for different groups
▪ Carbohyrates, especially sugar = sucrose increased the
caries rate. But not just sucrose
□ Frequency and retentiveness to the tooth.
• What was one of the "uncontrolled" for problems in the study?
○ Lack of interexaminar consistency
○ Controlled population not free living
○ Non-compliance by participants
▪ Giving each other sugary products
▪ Trading of sugar sources between participants.
•

Both the Vipeholm Study and the Hopewoos Study

involved patients who were NOT free living peope.

The Hopewood House study:

• Very strict "lactovegetarian" diet. Their caries rate was much lower
than the free living Australian populatoin of the same age group.
When these orphans left the Hopewood House, and followed them:
their caries rate increased rapidly up to the general population
because their diet (and lifestyle?) changed.
○ This is despite the fact that these patients had rotten oral
hygiene. Not much brushing and flossing.

Lectures Page 56
FIRST FREE LIVING
STUDY!!!!!!!!!!!!!!!!!!!!
= Seventh Day Adventists

• Kids are FREE LIVING which corrects for the institutionized idea: they
are also restricted in what they eat. Had much LOWER caries rate as
opposed to Amish people with similar relegion who had a much higher
caries rate. There is a big Amish community in the Cleaveland, Ohio area.

Which genetic disease played a key role in linking sucrose consumption to

significantly DECREASED risk of caries development?
• Glucose 6 phosphate deficiency
• Lactose intolerance
• Hereditary frucosose intolerance
○ How is this different than fructosuria? Fructosuria the cells don't
take it up because no transporter. In intolerance, the fructose gets
into the cell but aldolase B ( fructose to fructose phosphate) is not
working. Frustoce builds up in the cell.
○ Since they can't tolerate fructose, they just don't eat as much
therefore they end up with LOWER caries rates.
• Fructosuria

This study was in 1971:

Lectures Page 57
 Sucrose: GREAT subsrate for the process of Acid production.
• Bacteria convet sucrose to:
○ Dextrans = glucose polymers
○ Levans = fructose polymers

Lectures Page 58
 Came up with the plaque friendly index.

Lectures Page 59
(5) Diabetes
Tuesday, June 09, 2015 9:05 AM

Lectures Page 60
 Most of the glucose coming in from the diet is going to the MUSCLE because they
are the insulin sensitive tissue. So that's why we want to increase the muscle mass
of our tissue. For older people, they say "check with your physician to see if the
exercise regime is healthy for you".

Lectures Page 61
Lectures Page 62
(6) Vitamins (fat soluble)
Tuesday, June 09, 2015 9:07 AM

Even though they don't need it. They also take more than they need since they
think if a little is good, why not take some more.

Beri-beri is thiamin deficiency that has two forms: wet

and dry forms. So the origin of the word "vitamin"
comes from the discovery of thiamin and the fact that it
cured "beriberi".

Lectures Page 63
 Transthyretin is prealbumin. Prevents the retinol-RBP complex from
being excreted in the kidney. Transthyretin in additoin to its role in the
transport of retinol and thyroid hormones, is used clinically to:
A. Indicate Vitamin A status
B. Monitor anticoagulant levels
C. Indicate protein nutritional status
D. Measure liver function.

Carotenoids can be converted to retinal, which is a form of Vitamin A.

Here we see the different forms: aldehyde, alcohol, and acid. Must be a
prrimary alcohol.

We have rod cells and cone cells. Rod cells are for night vision. Lack of
retinal can cause night blindness Rhodopsin is in the family of which
receptors? The G protein coupled receptors.

Epithelial cells need Retinoic Acid to have proper "growth and cell
maturation". Lead to zeropthalmia = major source of blindness in the world
below the age of 25. so if he asks a question on this, then it must be just
Vitamin A in general since all the forms of Vitamin A are interchangeable.

Can also cause Keratomalacia.

Keratomalacia is an eye disorder that results from vitamin A deficiency.
Vitamin A is required to maintain specialized epithelia (such as in the
cornea and conjunctiva).

Hyperkeratosis: due to lack of Vitamin A.

Lectures Page 64
 Smokers have many issues with oxidation and reduction. We know
that giving them Vitamin A will INCREASE the risk for lung cancer.
Reserachers didn't give them food with Vitamin A but rather give them
pills that contain the vitamin. It is more advivsed to get your Vitamin
A from foods.

Beta carotene (Vitamin A in plants, retinal is in humans). As you get older

your vision goes: beta-carotene with zinc/copper supplement might help.
Actually they found out later beta-carotene had no effect.

Some acne drugs have Vitamin A and they can induce toxicity symptoms.

Lectures Page 65
 RDA will meet the needs of 97% of the population. RDA = Recommended Daily Allowance.
So most people already have enough Vitamin A in their diet.

Carrots are orange but still in the class of yellow vegetables. In

animals we don't store carotenoids very much. Highest
concentratin of pre-formed retinols in the liver. Liver can contain
huge quantities of Vitamin A.

Xerophtalmia = dry eye. MAJOR source of blindness in the world below the
age of 25. it is due to vitamin A deficiency.

Developing coutry = okay.

Developing country = MAJOR problem.

The name beta-carotene comes from the Greek beta and Latin carota (carrot).
It is the yellow/orange pigment that gives vegetables and fruits their rich
colors.

The human body converts beta-carotene into Vitamin A (retinol) - beta-

carotene is a precursor of vitamin A. We need vitamin A for healthy skin and
mucus membranes, our immune system, and good eye health and vision.

Beta-carotene in itself is not an essential nutrient, but vitamin A is.

Golden Rice: genetically engineered rice that will actually produce pro-
Vitamin A (beta-carotene) to reduce blindness in the world. Greenpeace is
STUPID and made up some reasons against it just because it's genetically
modified.

Lectures Page 66
 Golden Rice: genetically engineered rice that will actually produce pro-
Vitamin A (beta-carotene) to reduce blindness in the world. Greenpeace is
STUPID and made up some reasons against it just because it's genetically
modified.

There are too many compounding factors to say Vitamin A is

responsible for these effects mentioned here.

3 times the RDA is close to being toxic. Most of the fat soluble vitamins, if you're 5 times the RDA
you start running into toxicity because they are stored excessivly in the liver. . The water soluble
vitamins are NOT going to be stored in the body.

Polar bear liver has the HIGHEST concentration of Vitamin A

in the world. An Inuit Eskimo died from eating too much of it.

Too much Vitamin A can actually INCREASE osteoporosis. They also

have less Vitamin D intake which means they get less calcium influx into
the body. So the role is not 100% clear about this because patients
who are deficient in Vitamin A are probably also deficient in Vitamin
D.

Lectures Page 67
 You cannot overdose on beta carotenes unlike retinoic acid (a metabolite of retinol
= in animals). It can get stored in the subcutaenous fat which will then make
someone turn yellow. That's why we said this is found in the "yellow vegetables".
This may be mistaken for jaundice which is due to excess bilirubin in the body.
Jaundice = Icterus.

Vitamin D is a prohormone that is derived from cholesterol. Its synthesis

requires sun exposure. Then it's activated by enzymes in the Liver and the
Kidney. Of course a deficiency will cause a disease like osteoporosis. It is a
vitamin because if we don't get enough sun, we have problems making it.

Lectures Page 68
 Older people don't go outside as much. They need more Vitamin D to make up for the
fact that they don't go out in the sun as much. Light skinned people can make Vitamin
D much faster than dark skinned people. Just casual exposure for white people should
be enough. Infants: need 9 months to be born and have enough Vitamin D stored for 9
months too. Classic disease of Vitamin D deficiency in childrens is Rickets Disease. In
adults, they do NOT get Rickets, they get osteomalacia which is NOT the same as
osteoporosis. Difference in cause but look the same so different ways to treat them.

Clicker question: the use of sun screen has been linked to decreased Vitamin D levels.
Is this True or False? The answer was TRUE.

Showed a picture of Rickets's Disease child that was dark skinned and had plenty
of sun exposure. However, he is dark so it's like a super sun screen so the rays of
light do not penetrate his skin. Also his diet is really poor.

Calcitriol is a form of vitamin D that is used to treat and

prevent low levels of calcium in the blood of patients whose
kidneys or parathyroid glands (glands in the neck that release
natural substances to control the amount of calcium in the blood)
are not working normally. Low blood levels of calcium may cause
bone disease. Calcitriol is in a class of medications called
vitamins. It works by helping the body to use more of the
calcium found in foods or supplements.

Lectures Page 69
Lectures Page 70
 A condition in which skin cells build up
and form scales and itchy, dry patches.
Pediatric disease with geriatric consequences. Supplementation studies with Vitamin D
and calcium have shown a SMALL effect on:
• Bone mass density
• Falls and fractures
• Kidney stones increase as well.
So the best way to get sun is getting Vitamin D production from sun exposure. Better
then getting supplementation. In fact supplementation with Vitamin D has as of yet
NOT been shown to provide any clinical benefit to resovling osteoporosis.

Poly-unsaturated fats: natural source of Vitamin E.

• Only alpha-tocopherol is the one that works in humans.
Fetal resportion:
• In Humans, does NOT affect it
• In Rats, it will affect its resorption.
○ These are called tocoperols (not alpha-tocopherol).

Vitamin E: used for cancer prevention because it will donate the electrons to oxidizing agents.
• Activate WBC: to kill foreign cells they produce reactive oxidizing agents. Vitamin E is
crucial to ensuring we have a healthy supply of WBC to fight infections.
• Most Vitamin E is in the lungs.
○ If you smoke, you need more Vitamin E supplementation.

Lectures Page 71
 So the enzyme "glutathione peroxidase" will help Vitamin E in its job of attacking and
removing free radicals. Glutathione peroxidase (has selenium) will break down fatty
acids that are peroxidized (free radical forms of fatty acids). Also see some other
enzymes like superoxide dismutase and catalase. So we see that the following four are
crucial for the removal of free radicals in the body:

• Vitamin E (alpha-tocopherol)
• Glutathione peroxidase
• Superoxide dismutase
• Catalase

Decreased platelet function = increased tendency to bleed.

So list of other functions of Vitamin E:

• Platelet function decreased (less binding to blood vessel = endothelial cells)
due to increased prostacyclin production
• Iron metabolism
• Nervous tissue maintenance
• Immune function via production of reactive oxidizing agents
○ Vitamin E donates an electron to oxidizing agents to power them up

Lectures Page 72
 With Vitamin A, we said there were MIXED results when it came
to its effect on increasing the risk for PROSTATE CANCER but
did increase the risk of lung cancer.

With Vitamin E Supplementation, there is a DEFINITE

INCREASED RISK of PROSTATE CANCER!!!
• Vitamin E is MORE prevalent in the lungs
○ Smokers need more Vitamin E

Lectures Page 73
 1 mg Vitamin E
• 1.5 IU from food source (get more from the food)
• 1.0 IU from synthetic source

Vitamin K functions:
• Coagulation process
• Calcium binding (necessary for coagulation).
• Osteocalcin formation

Lectures Page 74
 Anticoagulants remove Vitamin K. things like warfarin will prevent Vitamin K from
participating in the formation of thrombin so it will thin the blood. Need to monitor
vegetable intake since they have lots of Vitamin K.

Some antibiotics can actually destroy intestinal bacteria (can lead to pseudomembraneous
colitis) but also inhibit Vitamin K absorption (and synthesis). This will lead to excessive
bleeding. So we make most of our Vitamin K in the intestine

More than half of our necessary Vitamin K comes from intestinal baceteria making it
for us. The rest comes from the diet. Deficiency in Vitamin K is rare. Only two
populations that may be affected are:

• Newborn infants (intestinal flora not well developed?)

○ Can't make enough Vitamin K
• People who take antibiotics long-term.
○ Kill of those benefical microbes we need to make Vitamin K

Lectures Page 75
Lectures Page 76
(7) Vitamins (water soluble)
Tuesday, June 16, 2015 9:02 AM

As long as you're eating a normal diet, you can't get deficient in fat soluble vitamins since they
can get stored for the most part. The exception is Vitamin D since it requires sun exposure. Also
another exception is cobalamin = Vit B12 which is water soluble and can get stored for the most
part. Here we see a flow chart for the progression of disease for water soluble vitamins.

Vitamin C as a supplement is not really that helpful in treating the vast

majority of diseases that people claim they are important for.

Prolyl hydroxylation is necessary for:

• Stability of the left handed helix. Collagen initially forms as a left hand helix. That's when
prolyl hydroxylation takes place. Bacteria also form collagen and then go on to form the
whole R handed triple helix unless above 30 C. above that temperature, without prolyl
hydroxylation, the whole collagen unit will stabilize.

Scurvy: hemorrhage is very striking! All this bleeding that happens.

They smile and then their gingiva bleeds, that's how friable it is. Can
also bleed into joint spaces to cause joint pain. Very severe disease. In
children can also see skeletal changes because you need collagen to
build good bone. In fact the minerlazation with calcium start on the
collagen framework. Get defective osteoid production.

Not all patients who bruise easily will necessarily have scurvy.

Lectures Page 77
 What's different than Vitamin C rickets and Vitamin D deficeincy rickets?
The scorbutic rosary: only found in scurvy of the kids. So Vitamin C
deficeincy in kids = rickets of the kids = scorbutic rickets.

Can get "corkscrew hairs" on the arms and legs of these scurvy
patients. Also will see many petichiea .

Compare and contast the functions of Vitamin E and Vitamin C:

functions of Vitamin E:
• Platelet function decreased (less binding to blood vessel = endothelial cells) due
to increased prostacyclin production
• Iron metabolism
• Nervous tissue maintenance
• Immune function via production of reactive oxidizing agents
○ Vitamin E donates an electron to oxidizing agents to power them up

Now let's look at what Vitamin C = Ascorbic Acid is used for:

• Collagen synthesis
○ Hydroxylation of prolyl and lyslyl residues to form mature cross links of
collagen.
○ Antioxidant (like Vitamin E)
▪ maintain iron and copper in reduced state
▪ Protect from lipid peroxidation
○ Iron Absorption (not metabolism)
▪ Absorb non-heme iron in the reduced state (ferrous)
○ Immune Cell Activation (similar to Vitamin E)
○ Hydroxylation reactions.

Lectures Page 78
 Below 150 mg you absorb most of the Vitamin C. above that, only
absorb 10-20% of that extra every day. You absorb the 1st 150 and then
maybe only 10 mg of the second hundred (if you ingest 250 mg). What is
the minimum dietary intake of Vitamin C to prevent scorbutic gingivitis?
Only 10 mg per day so very low intake necessary to prevent scurvy.

Smokers: only need about 1/3 more that the RDA for the extra 35 mg per day.
Will provide more protecion from free radicals. We said that Vitamin C plays a
role in anti-oxidant formation by keeping iron and copper in their reduced states
AND protecting from lipid peroxidation.

So smokers need more Vitamin C and Vitamin A.

Lectures Page 79
 Vitamin C is an acid called Ascorbic Acid. If levels are too high, It will cause too
much stomach inflammation. Get diarrhea, too much iron absoprtion, and kidney
stones.

Rebound scurvy: don't just stop taking the Vitamin C if you were taking too
much! Kind of like a drug withdrawal syndrome. Don't stop suddenly. The
body is so used to massive quantities of Vitamin C that it will filter the
Vitamin C in higher rates out of the kidney. So even though you are taking
the 150 mg you need, you start having scurvy symptoms because the
body got used to a higher dose so it will keep on excreting what the
body thinks is "extra Vitamin C".

Vitamin B1 = thiamin
• What is the coenzyme thiamin pyrophosphate? It needs Vitamin B1. so
it's used to form the co-enzyme. So this will be used to figure out what
pathway in the body (metabolism) is being affected.
• It's mainly used in de-carboxylation reactions especially in the nervous
system. The brain has an absolute requirement for glucose.

Thiamin is a CO-ENZYME used in TWO reactions in oxidative metabolism of glucose:

1. Oxidative metabolism of glucose
a. Generation of ATP (especially for the BRAIN = very sensitive)
b. Need glutamate dehydrogenase, alpha ketoglutarate decarboxylase, and branched
chain amino acid dehydrogenase
2. Hexose monophosphate shunt
a. Makes those reducing equivalents (NADPH) that will be used to keep oxidizing
agents in their reduced state to remove RBC radicals. Otherwise you can get
hemolytic anemia. This makes sense why a deficieny in Vitmain E can be linked
to hemolytic anemia (since then we loose the antioxidant functionality in which
we donat electrons to oxidizing agents)
b. Need transketolase

Lectures Page 80
 List of thiamine function and facts:
• Invovled in carboxylation and decarboxylation reactions
○ Decarboxylation reactions in the brain
• Two reactions:
○ ATP production via oxidative metbabolism
○ HMP shunt
• Thiamine requirement: depends on carbs & energy in diet
○ High carb diet with low thiamin intake will lead to deficiency
• Metabolism of alcohol
○ Involves microsomal (on the SER) detoxification
○ Deficiency can result in Wernicke korsakoff

To prevent thiamine loss, need to:

• Realize that it is heat sensitive and can be destroyed
• Enrich rice and grains with it.

We don't have that many stores of thiamin. In ONLY

10 days, we can start experiencing the symptoms
shown here due to thiamin deficiency. We have wet
and dry forms of beri beri.

These four enzymes mentioned here are all going to need "thiamine pyrophosphate" for
proper activity. The first two are for the TCA Cycle. The transketolase is for the Pentose
monphosphate shunt pathway. Its used to generate NADPH to prevent anemia due to
oxidation reactions in RBC. So these first three are all related to glucose and energy
metabolism.

So BOTH beri beri and Wernicke Korsakoff Syndrome are attributed to thiamine
deficiency. Alcohols also may have an increased need for thiamine.

Lectures Page 81
 Which enzymes are imporant for thiamine pyrpphosphate?
• Pyruvate decarboxylase
○ Associated with death in Wernicke Korsakoff due to
excess lactic acid production.
• Alpha-keto glutarate dehydrogenase
• Branched chain AA dehydrogenase
• Transketolase (HMP shunt pathway)
○ Genetic defect is commonly seen in alcoholics.

Normally alcohol breaks down to acetic acid and you're okay. In alcoholism, another pathway in
the microsomal system that starts metabolizing alcohol but needs NADPH. Since transketolase is
not working, hexose monophophate shunt won't work as well. Messes up the cytochrome in the
P450 in the alternative pathway which needs NADPH from the HMP shunt.

Riboflavin: important as a HYDROGEN CARRIER in FAD and FMN.

• Important in ox/red reactions because of this
• Also part of flavoproteins.

Lectures Page 82
 Two main groups associated with vitamin deficiency:
1. Alcoholics
2. Elderly

Riboflavin deficiency risk groups:

1. Alcoholics: PRIMARY risk group
2. Newborn infants
a. The ones exposed to bright lights for jaundice rx
3. Strict vegetarian athletes:
a. Increased nutritional needs and non-animal products
i. No meat, no milk, no eggs

Most likely cause of anemia in riboflavin deficeincy would be a

problem with which enzyme:
• Glutathione metabolism
○ Uses NADP or NAD
• Its NOT Hexose Monophosphate shunt b/c that uses NADPH.

So BOTH Niacin and Riboflavin have a role as HYDROGEN carriers?

• Riboflavin: FAD and FMN involvement

• Niacin: every anabolic and catabolic pathway in the cell
○ NAD and NADP

Deficiency in tryptophan can then lead to a niacin deficeincy.

Lectures Page 83
 Statin: lowers cholesterol. How about using niacin with statins?
What happens? Nothing was happening different than just taking
a statin. So no results and they stopped the research studies.

Lectures Page 84
Vitamin B4 does NOT exist!!!!!!!!!!!

• Vitamin B1 (thiamine)
• Vitamin B2 (riboflavin)
• Vitamin B3 (niacin or nicotinic acid)
• Vitamin B5 (pantothenic acid)
• Vitamin B6 (pyridoxine, pyridoxal, pyridoxamine)
• Vitamin B7 (biotin)
• Vitamin B9 (folic acid)
• Vitamin B12 (various cobalamins; commonly
cyanocobalamin or methylcobalamin in vitamin
supplements)

Literally anything has this in the food. Its so ubiquitous. You MUST be deficient in
something else and its part of Co-enzyme A. make sure you know these important
concepts.

Tania & Renata Now Are Physicians Because Father

Cheered
• B1 = T hiamine
• B2 = R iboflavin
• B3 = N iacin
• B5 = A cid Pantothenic
• B6 = P yridoxine
• B7 = B iotin
• B9 = F olic Acid
• B12 = C obalamin = Cyanocobalamin
○ We store significant amouts of this
vitamin. This is the EXCEPTION to the
rule.

Which form is more absorbable, biotin or biocytin?

• They are both equally absorbed
What is biocytin?
• It's a biotin with a "lysine" attached to it.
What does the enzyme biotinidase do?
• It cleaves "thelysine" forming free biotin

Lectures Page 85
 Avidin: avidly binds biotin. This will prevent its absorption and is found
in raw egg whites. The animal model for Vitamin D deficiency is putting
socks on chickens since that's how they got their Vitamin D absorption .
Some alcoholics put a raw egg in their beer. They will get a biotin
deficiency possibly.

What other disease did we see involved a deciency in a Vitamin due

to lack of intestinal flora due to chronic antiotic usage?
• It was with Vitamin K deficiency (only known cause of
Vitamin K deficiency)

So what we are saying is this:

BOTH Biotin and Vitamin K deficiency can be associated with a

reduction or lack of the intestinal flora, commonly attributed to
chronic antibiotic usage. The intestinal bacteria allow the
production and absoprtion of these vitamins.

Lectures Page 86
 Started out with PKU, since then 62 other genetic diseases for enzymes have been added to the
list checked with every newborn. Here we see two enzymes: holocarboxylase and biotinidase.
Attached biotin to the enzymes we are going to use is by biotinidase. Both deficiencies will give
same symtoms. Biotinidase deficient patients: respont to giving biotin itself as a supplement. The
holo enzyme not so much with supplementation because even if they have biotin they can't use it.

So just know that biotin deficeincy can be associated with:

• Biotinidase deficency: supplementation will help
○ Used to remove lysyl residues from biotin to allow its absorption
○ Late onset or juvenile MCD
• Holocarboxylase: supplementation will NOT help
○ Adds biotin to the enzyme required for its activity in the body
▪ Results in Multiple carboxylase deficiency (MCD)

Pyridoxal phosphate used for:

1. Protein metabolism:
a. Add or remove amino groups
2. Metabolism of neurotransmiters made from amino acid
a. GABA is an important example.

Lectures Page 87
 • Pantothenic acid (B5)
• Pyrioxidine (B6)
• Biotin (B7)

PMS = pre-menstrual syndrome which is the conditoin between ovulation and her period.
• Peripheral nerve damage is irreversible and can happen with pyridoxine excess.
• Do NOT use a high dose of pyridozine to fix PMS.
• If you can't feel anything, than people thought Carpal Tunnel Syndrome went away.
Actually you end up with peripheral nerve damage. You killed the nerve so you don't
feel anymore pain.

Lectures Page 88
 So we do NOT want to use pyridoxal phosphate for Carpel Tunnel but
rather for sideroblastic anemia. That's associated with:
• Lead poisoning
• Vitamin B6 = pyridoxal phosphate (don't give too much!!!)

Folate is attached to glutamic acid. That's why you find folate

in food that has glutamic acid. Important for:
• Co-enzyme in TFA
• Transfer of methyl carbons
• Synthesis of purine and pyrimidine

Lectures Page 89
 Folate deficiency:
• Hemolytic anemia
• Megaloblastic anemia
○ Also with B12 deficiency

So folate will NOT have any effect on gingivitis.

Pernicious anemia is when you have low B12 levels. excess folate will
mask the symptoms of pernicious anemia. B12 is necessary to remove
homocysteine from the body.

Lectures Page 90
 The largest population that is going to be subjected to this
disease is the Elderly. NOT the alcoholics. Problmes with
metabolism and diet. Also strict vegetarin diet has no B12 in
it. B12 is an animal product.

Lectures Page 91
Lectures Page 92
d(8) Water & Minerals
Tuesday, June 23, 2015 8:35 AM

Very muscular people will have lots of glycogen in their muscle. For
every molecule of glycogen, you store 4 or more molecules of water. So
these people store more water then "telly tubby type" of people who
have more adipose tissue.

Functions of water:
• Temperature regulation: we lose lots of it via evaporation.
○ 600 kcal / liter of water evaporated
• Removal of waste: in the urine 1-2 L per day
• Lubricate: saliva and amniotic fluid in joint spaces, etc

You actually just need 8 cups of total water and fluid combined
per day. So neeed a total of 12 cups /day of which 8 cups is just
drinking water. Also keep in mind that this number has to do with
having a NORMAL activity level not like if you run marathons or
do some other really strenous activity. Also fluid is not the same
as water. Alcohol does NOT count as being a fluid.

Lectures Page 93
 When you have the thought that you are thirsty, you have already lost
2% of your necessary volume. Thirst is an unreliable indicator of the need to
drink fluids. Things can actually reduce the signaling for thirst so you don't
get the conscious need to drink:
• Old age
• Illness
• Vigourous exercise

• Most water is actually safe unless you get to some rural

communities. But in the USA, any major city will have really
good water in their pipes. Need to add some things to kill the
nasty microbes:
○ Chlorine
○ Ammonia
• Which is the most common waterborne disease in USA?
○ Cryptosporidium
• Bottled water is safter than most city tap water.
○ FALSE

Lectures Page 94
 National Toxicology Program:
• Looked at bromodicholoromethane to see if it had
any bad side effects in drinking water.
○ Fed it to animals at milligrams per Liter levels
which is WAY higher than the levels found in
drinking water.
○ Kept the rats on this diet for 2 years and also
did it on mice. Did not see any bad side effects
but in fact the mice that got lots of this chemical
actually had LESS liver cancer.

Lots of sport drinks have caffeine: people think it will increase

urinary output and some people said that these drinks don't count
towards fluid intake. After many experiments, we can cay that
caffeine is not having an effect when it comes to hydration.

• Classic Dr. Gleason trap: the popular notion of caffeine

causing dehydration has now officially been debunked!!!

So if you take in a MODERATE dose of caffeine per day which is:

• 5 espresso coffee cups
• 7 cups of tea
Will NOT alter the TBW (total body water) and fluid distribution in
healthy men.

Lectures Page 95
Vitamins are ORGANIC essential compounds

Minerals are INORGANIC essential compounds.

Don't confuse Minerals with Vitamins. Also we have Major and Minor Mineral Groups. Major minerals
is anything you need over 100 mg/day but with Minor = Trace Mineral you need less than 100 mg/day.
Iron is less than 20 mg/day so it's a trace Mineral and far away from the 100 level. Magnesium and
Sulfur are actually also MAJOR minerals.

Too much zinc zupplement

• Zinc along with Vitamin C will inhibit copper
absorption
• Iron will increase copper absorption.
You actualy need arsenic and chromium and silicone!!! Of course they must be
in very minute (trace) quantities. Like with most things: too little or too much
you get sick. Applies to all the minerals and everything in nutrition.

Some Minerals don't get digested and never get to the blood. Different than the
definition of "bioavailability" in pharm where it's about what drugs get broken
down and de-activated in the liver before getting into the blood. We need to use
binders and diatary fiber to help in the absorption process. Some vitamins
enhance the absorption (classic is the Calcium with Vitamin D combination and
Iron with Vitamin C combination)

Calcium and Iron are the Big "biggies" and zinc also.
All three are major risk factors for deficiency.

Mostly with the TRACE minerals since things like arsenic and chromium are definitely very
toxic at high enough levels. be careful to use mineral supplements because that's how you
can get too much and get an overdose. This is especially true for the trace metals that should
only be in LOW doses.

Lectures Page 96
 We actually need Na ion not NaCl. Need to have the Cl- to give the charge
balance so you can get a solid solution. So NaCl about 40% of that is Na ions.
If you have kidney problems you might get Na toxicity.

If you take in too much water, you get extreme hyponatremia. Can even kill you like that
Boston marathon runner who drank too much water back in 2002. said that back in the 1970's if
the job candidate tasted their food before salting it, then that was a sign that they would be
impulsive and just start eating their food. Need to taste it first to see if it has enough salt.

We only need 100 mg/day to survive kind of like you need 10 mg of Vitamin C to
prevent scurvy. So you actually need 500 mg/day to be able to not have any pathologies
occur. The Daily Value is way higher at 2400 mg/day. Also even if you consume 4
grams of sodium per day you will still NOT get hypertension because most people
in the world are NOT salt sensitive.

Showed a research study that made the following point:

• The research started at 250 mg/day which is half what we need
• Then the values started going up for how much salt they gave the animals and
then the hypertension became much more pronounced. But the issue is that the
sodium levels that they simulted do not represent the sodium intake of human
beings. We don't ingest 20 or 30 grams of Na day!!!

Lectures Page 97
 Compare morbidity and mortality: most people are between 2600 and
3800 mg/day in Na consumption. If you go above that or below that are
there any changes? They found out that the morbidity and mortality rates
went up on both sides of the range . So in other words if you go below
2600 or above 3800 then you are increasing your risk for disease on
both ends of the spectrum.

There ARE people who suffer from salt sensitive hypertension. It's
10-15% of the population but mostly in African American where over
25% of them are salt sensitive.

What about Potassium? Most of it is intracellular. We know it's

important for nerve conduction. We do NOT add K into food like we
do with Na to preserve food and give it taste. You need more
potassium per day than sodium . Who is at risk for having
Hypokalemia:
• Poor diet and certain diets (don't take K supplements)
• Diuretics
• vigorous exercise

Lectures Page 98
 Lactose increases the absorption of calcium. In growing infants and
mammals, the major source of nutrients is milk which has lactose. So it
makes sense that the combinaiton of lactose and calcium would
stimulate its absorption.

• Achlorhydria: decrease in stomach acids.

○ Ph affects calcium: when its ionized it will actualy
absorb better. Hydrofluouric acid will actually be better
absorbed in this form (non-ionized).

Stress on the bone helps maintain bone. It will tend to be better remodeled.
That's why in space they must to many exercise things to maintain the bone
mass to prevent it from dissolving. By the time we reach 30, we start going
down in terms of bone mass. This is the normal process of things. You can
delay the drop with lifestyle and diet. So you can decrease the rate of decline.

• How to build higher bone mass:

○ Pump those weights
○ Eat good food: have a good diet
▪ MODERATE intake of:
□ Protein
□ Phosphorous
□ Sodium
□ Caffeine
□ Alcohol
○ Do NOT smoke
○ Normal menses
▪ Your exercise and diet can have an effect on how the cycle will
work.
□ If you are fat or exercise too much, you can actually loose
your menses.

Lectures Page 99
 Osteoporosis is significant risk to men, as well as women.
• TRUE
○ Don't hear much about it because men in general have a higher bone
mass to begin with. They are more athletic and active. Men also lose
that bone mass more slowly. We also die younger. They pretty much
died before they got osteoporosis. Now we see men in their 80's and
90's so yes they do start having these issues.

Yogurts have LESS lactose because the bacteria have already

metabolized most of the lactose for you. Plant sources have fiber
and Calcium in them. We have solube and insoluble fiber. Also know
that Calcium and Vitamin D is a good combination to encourage the
absoprtion of these.

Too much Calcium. Need a balance between calcium and

phosphours to have levels close to saturation so bones don't
disolve but if you get too much phosphate you will have super-
saturation and get calcium salts precipitating in ectopic
locations. That leads to hypocalcemia (because it binds the Ca)
with tetany and convulsions due to low calcium levels.

Lectures Page 100

Lectures Page 101
 Steatorrhea: the excretion of
abnormal quantities of fat
with the feces owing to
reduced absorption of fat by
the intestine.

Lectures Page 102

We absorb 25% of heme iron and only 2% of ferrous iron. Yes we need to have iron in the ferrous
form to be absorbed but only 2% of it will be absorbed. Red meat has lots of heme iron so it gets
absorbed really well. If you eat plant sources, .it has lots of ferric iron plus lots of fiber.

Lectures Page 103

 Zn and Iron (along with copper) have a special absorption pattern. High doeses
of iron can interfere with Zn absorption and you can become Zinc deficient.

Why is Zinc better absorbed from animal sources? Because it does not have fibers
that complex metals. If the fiber complexes the metals, then you can't absorb it.
Clicker question: Zn supplements will NOT help reduce the development of the flu.

Functions of zinc:
• Cofactor for many enzymes (don't know the details)
• Component of superoxide dismutase
• Component of Carbonic Anyhydrase
○ Raise the PH by getting rid of carbonic acid.
• Component of alcohol dehydrogenase

If you eat a good diet, then you will get your necessary Zinc absorbed in your diet. Men tend to have
higher amounts because they eat more animal products (mainly meat) then women.

Lectures Page 104

 Only for ionic forms, NOT the heme iron. The ionic form of iron
will not be absorbed well with too much Zn. Zn can actually help
in a few conditions such as:
• Healing gastric ulcers
• Treat sickle cell anemia.

Upper limit: 50% of patients will not develop symptoms below this level of 40 mg/day. Zn can
actually lower the HDL, increase LDL levels like the effect of too much testosterone in the body.

Copper absorption can be decreased with high Vitamin C levels. also iron
absorption will be increased with copper. However zinc will inhibit
copper absorption.
• Zinc inhibits copper absorption
• Vitamin C inhibits copper absorption
• Copper increases Iron absorption.

Lectures Page 105

 Menkes syndrome:
• Error in ATP7A protein copper transporter
• Menkes syndrome is effectively treated by:
○ None are effective in treatment. The transporter is not
working so no matter how you get copper in the body
it won't get into the cell.
• Too much copper in:
○ Intestine and kidney
• Too little copper in the:
○ BRAIN because we can't get it transproter there with
the lack of the ATP7A protein.

M&M's have both cocoa and peanuts:will

give you your copper needs!

Preterm infants: have not developed the copper transporter yet.

Dialysis patients: all things wiped out.
Burn patients: need to rebuild tissue. Requires lysyl oxidase which requires copper.
Too much zinc zupplement
• Zinc along with Vitamin C will inhibit copper absorption
• Iron will increase copper absorption.

Lectures Page 106

 So a deficiency in copper = Menkes Syndrome
So a toxicity in copper = too much copper = Wilson's Disease

Here you have those "Keiser Fleisher" Rings due to the toxicity of too much Copper deposition.
Wilson disease is due to accumulation of copper due to inability to excrete copper. The primary
route of copper excretion is: liver via bile. Lack of transport of copper into bile. Different than
Menkes Syndrome which is the ATP7A protein.

Selenocysteine: in oxidation/reduction reactions.

• Protects from oxidative damage and works with other antioxidants. It
does not really help in preventing cancer because you are breaking
down the process of ROS production. Then the body's defense
mechanism against cancer via ROS is being neutralized.
• Keshan disease is prevented
○ It's a heart disease.
• If you don't have selenuium, then you get Keshan disease.

Keshan disese is an irreversible cardiac disease due to a deficiency in

selenium that involves the accumulation of fatty acid peroxidases in the
heart which increases the risk of blood clots. So why does this happen?
Because selenium is an integral part of glutathione peroxidase which
prevents these fatty acid peroxidases from forming in the heart tissue.

Lectures Page 107

 Summary: Vitamin E supplementation increased prostate
cancer. The prostate cancer was not affected by selenium at
all. So don't supplement with selenium it will not help.

You keep making thyroglobulin via Iodine. Then it gets into the follicular
space and there is no iodine so we don't get any thyroid hormone
production. Get that goiter formation due to iodine deficiency.
• Cretinism: during pregnancy the mother does not have enough
iodine intake
○ Will cause huge goiter formation before puberty.
• Goitrogens:
○ Interefere with absorption of iodine; so it’s going to be
found in some foods. With no absorption of iodine it will
be the same as LOW intake of Iodine clinically. This
involves RAW turnips and other vegetables.
○ Called a "goitrogen" because it will cause a goiter to form

Lectures Page 108

(9) Alcohol
Thursday, June 25, 2015 9:03 AM

Acetaldehyde: reacts with amines. Messes up with the

proteins. We try to get rid of acetaldehyde. Makes lots of
NADH in the formation of acetate. Too much NADH will
affect metabolism.

Which compounnd would likely react with acetaldehyde

produced during alcohol metabolism?
• Proteins because it has the amine group. Its
MAINLY proteins (not so much fat tissue).
• Also Fatty acids: altered NADH/NAD ratio
○ Leads to fatty liver development.

Women absorb a bit more then men in the stomach so alcohol affect hits them
faster. Also estrogen (more in women) increases rate of absorption. If the alcohol
is taken with soda (has carbonation) or with coffee can increase the rate of
absorption

Lectures Page 109

 CYP2 E1: also metabolizes acetominophin.
• Its metabolism is affected by alcohol consumption.

Disulfiram = Antabuse = Used as part of a treatment

plan for problem drinking. Creates an unpleasant
reaction when drinking alcohol, which reduces the
desire to drink.

Lectures Page 110

Lectures Page 111
Lectures Page 112
 Overall alcohol consumption has gone done
quite a bit.

Lectures Page 113

 These people are being asked to admit something
illegal in the past 30 days. These age groups are all
not allowed to drink any alcohol at all. Overall
trends are ALL going down which is a positive
sign. Depends on the people being surveyed.

Ages 12-14:

Ages 15-17:

Ages 18-20:

Lectures Page 114

Lectures Page 115
 If you MUST drink then do NOT drink right before you breast feed your
child. Codeine can also be transferred from the mother to the baby via
breast milk. No suprisingly alcohol can affect milk production negatively.

Lectures Page 116

Lectures Page 117
Lectures Page 118
Lectures Page 119
(10) Weight Control
Thursday, July 09, 2015 9:00 AM

Lectures Page 120

TEI = Total Energy Intake
• Mostly should be carbohydrates
• Then fat
• Remainder from protein

How you use the energy:

• Mostly basal metabolism (breathing, sleeping, sittting)
• Then biggest one next is "physical activity"
• Then the thermic effect of food
• Then NEAT (nonexercise activity thermogenesis)

Fatty acids go directly to adipose tissue and bypass the liver to get stored long
trem. We have an unlimited ability to store fat. First you get really big as a
cell, then you start dividing and making MORE fat cells.

We do NOT have the ability to store that much glycogen. For every glycogen,
we store 4 water molecules. CHO = choice for energy production. Too much
CHO = converted to fat to be stored for energy.

Protein: only replace lost AA. We do NOT store any proteins. Can also be
converted to fat just like the carbohydrates.

• Fat remains as fat until needed for energy production

○ That's why we need to exercise to get rid of excess fat
reserves in the body. Will increase basal metabolic rate,
encourage the buring of fat, and increase the energy
requrirements of the body.

Lectures Page 121

 • Just sitting and minimally thinking: this is what basal metabolism is.
○ Kind of like being in class
○ Just being "awake and alive"
○ Varies between indivdiauls due to:
▪ Muscle mass
▪ Muscle tone
Both of these are modified by exercise. What is muscle
tone? Constant contracting and relaxing of muscles.

Greater or lesser surface area.

Males have more muscle then females
Body temperature (wide variation)
• Range is wide from 91.8 to 100.8 Fahrenheit
• Calories (raise 1 gm of water 1 degree Celsius)
Thyroid hormones (controls metabolic rate)
• Hypothyroidism: lower basal metabolic rate
Age affects basal metabolic rate (loose muscle mass and muscle tone)
How much do you take in? body will try to minimize the gain of weight by slightly
incresaing the BMR when you eat too much.
Caffeine and tobacco have an effect on minimizing appetite.

Less has to be done to fat to consume it and make it into adipose tissue.

Lectures Page 122

Fidgeting is good! If you conusme too much you start to jitter. This is a sympathetic NS function. Does NOT
consume much calories, it's the least amount of calories being consumed. It will help to resist weight gain.

2 methods to meausre the energy needs of the body:

• Direct calorimetry
• Indirect calorimetry

Don't memorize the formula. Way of estimating what the

BMR should be. Men have greater BMR than female since
they have a higher resting energy consumption.

Lectures Page 123

 These numbers are with you just minimally breathing and doing
no physical activity at all.

Hunger is Internal = physiological. Once we have full satiety

signals, we should actually stop being hungry. Others things can
affect hunger:

• Peripheral body system

• CNS
• Emotional factors
• Disease states
• Environmental factors
○ Like temperature

Lectures Page 124

 These are somewhat overlapping with hunger but some are a
bit different:

• Medication influences like cigarretes and sedatives

• Social
○ Religion and culture.
• Pleausrable
○ Deserts are very pleasurable
○ Fat tastes good.
• Specific appetite
○ Sweet, salty
• Learned preferences and aversion to certain foods.
○ Alcohol and insects
○ Cats, dogs, frogs

Hunger and appetite overlap:

• Disease influences
○ Tumor products
• Environmental factors.

Clicker question: eating dessert at the end of the meal is mostly

what? APPETITE (not hunger). You're not hungry anymore
but your appetite is being motivated to eat that.

Lectures Page 125

Lectures Page 126
 A good way of determining if someone is really overweight is
the underwater weighing method. But also we can use:

○ Bioelectrical impedence:
▪ The more resistance to the flow, the higher your
fat content is.
○ Xray photon absorptiometry
▪ Can be used to determine FAT density but
mostly used for BONE density
▪ Not done often because you are exposing your
body to X-rays.
○ Infrared light
▪ Only used in the ARM muscle
▪ Fat is less vascular then muscle tissue so under
infrared light you get more heat transfer in fat
then in muscle.
▪ Interaction of fat and protein together

Not all fat is created equal. Two different ways fat can be distributed:
1. Upper body fat = Apple shape = Abdominal fat = ANDROID obsesity.
a. Associated with:
i. HTN
ii. DM II
iii. Heart disease
b. Abdominal fat goes into the liver
i. Livers ability to clear insulin and lipoprotein is fucked up
ii. Testosterone and too much alcohol will encourage this process of
fat affecting the liver's ability to clear insulin and lipo-protein
c. Waist to hip ratio is going to increase: you have more weight deposited in
your waist area and less in the hip area.
2. MORE fat in the HIPS
a. Called gynecoid because that's how women look like naturally with more
fat in the hip area
i. Encouraged by estrogen and progesterone which is more pronouced
in women
ii. After menopause women loose that and start to develop the android
obesity
iii. With the gynecoid obseity there is LESS health risk then the android
obesity because it's a more natural form for women to be in.

Lectures Page 127

 Clicker question: who has the higher BMI: a really fat dude or a
really muscular person?
• The very muscular person because his BMI is 63.
• The reason is that BMI = weight in kg / (meters)^2
○ So BMI is NOT an accurate estimate of how fat you are
because it does not take the fact that muscle weighs more
than fat into consideration.

Two types of obesity:

1. Juvenile onset obesity
a. Childhood
b. Increase in the NUMBER of adipose tissue
i. This is the difference between this type of obesity and in
adult-onset obesity. The total number of fat cells will
INCREASE rapidly
c. Adipose tissue: have a LONG life span and need to store fat
i. Makes it so difficult to loose the fat!!!
ii. So its very dangerous to gain wight as a child because that
kind of fat is hard to loose as an adult
2. Adult Onset obesity:
a. Adulthood
b. FEWER number of Adipose cells!!!
i. LARGER cells (excess FAT storage)
ii. Eventually with TOO MUCH FAT STORAGE, can then
get an increase in the # of Adipose cells too.

Causes of obesity:

• NATURE = genetic factors

○ Genetics: identical twins raised apart from each other but
have similar weight
• Genetics is 40% of weight difference
○ "Thrifty metabolism gene"
• Allow MORE fat storage to protect against
famine
• NURTURE = environmental factors
○ Environmental factors
○ Learned eating habits
○ Activity factor
○ Poverty
○ Obesity
• Female obesity related to childhood obesity
• Males does not appear until age 30 when they
start slowing down their metabolism

Lectures Page 128

 Set Point theory:
• The body can regulate it's weight
○ Genetically pre-determined by body weight
○ Body resists weight change because fat cells are long lived
• You can shift your set point but it takes time
○ Leptin assists in weight regulation because it makes you feel full.
• If you go on the "loose weight quick" scheme, the weight you loose can
easily come right back because the set point has not changed fast enough
• When you reduce your energy intake like during fasting, the lower
metabolic rate will cause less heat to be burned = conserve your energy =
conserve your fat reserves
• To shift your set point you need to loose weight gradually.

Severely underweight: can actually die very fast like within 1 year

Overweight: will actually not be as hazardous as being severely

underweight.
• Chronic disease takes much more time to manifest itself.

Wow, look at this trend:

• If you loose weight too quickly and gain it back, you will have a
HIGHER % of body fat than before your weight loss
• That means you are now LESS healthier than before dieting
• MUST be motivated and concerned to have a healthy long term
diet and prevent weight re-gain from occurring

Clicker question: "high protein diets (atkins) are better at wight loss then:
• Fat diet
• Carbohydrate diet
Answer: it does NOT matter, what matters is how many calories you take
in. A calorie is a calorie. So not all fat is created equal but ALL calories
are certainly created equal.

Lectures Page 129

 Doesn't matter if you eat carbohydrates, proteins, or fats: what matters is
reducing the caloric intake to be ablet to actually lose some real weight.

Lectures Page 130

Lectures Page 131
(11) Eating Disorders
Thursday, July 09, 2015 9:03 AM

Which psychiatric disorder has the higest mortality rate?

• Anorexia nervosa = NOT the most common but the most
deadly one = severely under-weight.
• Bipolar disorder
• Schizophrenia
• Unipolar disorder

Four categories for eating disorders:

• Anorexia nervosa
• Bullemia nervosa
• Binge eating disorder
• Eating disorder not otherwise specified
▪ Does NOT meet criteria of the first three
mentioned in this list.
▪ This one is the MOST COMMON.

Dental erosion: bullemia is the most commonly associated one with this but all of these disorders
can be associated with dental erosion due to induced vomitting. Maybe we have dry mucous
membranes. If their parotid gland is large, means they are throwing up a lot because "nauseu"
induces the parotid gland. Can have eye hemorrhage = subconjuctival hemmorage and also
sunken eyes. Trousseau sign is associated with pancreatic carncoma and venous
thromboembolism. Easy bruising since they are not eating enough so they have low cloting
factors. Lanugo - fine body hair, seen on arms. Russel's sign = calluses on the knuckles or the
dorsum of the dominant hand. They are trying to vomit. Really mainly associated with Bullemia
nervosa where they do lots of induced vomitting.

• Cardiac changes commonly seen in patients with easing disorders

○ INCREASE the QT interval
▪ QT interval can also be fucked up with drugs and local
anesthetics.
○ Keep in mind that MANY other conditions can lead to
vomiting and weight loss that may appear similar to an eating
disorder.
▪ That's why we don't diagnose an eating disorder but
just recognize signs and symptoms and encourage the
patient to seek professional help from physicians and
dieticians that can handle this.
▪ Patients who complain about weight loss and vomiting
are likely NOT suffering from an eating disorder
▪ Patients that hide the fact that they have major wight
loss and vomiting are MORE likely to be those people
who are actually suffering from an eating disorder.

Lectures Page 132

 So this disorder is MAINLY in rich teenage girls but
its also expressed in males too.

Lectures Page 133

 Amenorrhea = loss of menses. This is NOT used as diagnostic
criterea for anorexia nervosa.

Stuffing yourself at a buffet is NOT considered as binge

eating disorder. This has to be done on a consistent basis to
be called binge eating disorder. Differentiate this from
"overeating".

Also involve huge eating episodes. It is then followed by

vomiting to get rid of food or use laxatives or excessive exercise
or excessive fasting. Must occur atleast once a week to be
considered as bullimia nervosa.

Exam:
• 60 questions
• 90 minutes
• 10 questions from each of these:
○ Proteins = Lecture 2
○ Lipids = Lecture 3
○ Carbohydrates = Lecture 4
○ Fat soluble and water soluble vitamins
▪ Lecture 6 = fat soluble
▪ Lecture 7 = water soluble
• 5 from each of these:
○ Lecture 8 = water and minerals
○ Lecture 9 = alcohol
• 10 multi-topic questoins
○ Lecture 1 = trends
○ Lecture 5 = diabetes
○ Lecture 10 = weight control
○ Lecture 11 = eating disoders
○ Lecture 12 = dietary supplements

Lectures Page 134

(12) Supplements & Pre-biotics
Tuesday, July 14, 2015 4:02 PM

Dietary Supplements: it can contain vitamins, minerals, and other

things that are important for metabolism and growth.

It MUST be labled as a dietary supplement. The FDA cannot regulate

any diatary supplements. It can be an add on to a meal but not a meal.

Drugs cannot be labeled as dietary supplements to get away from

FDA approval.

Lectures Page 135

 • The FDA cannot regulate the vitamin and mineral content of
certain products
○ Called the Proxmire Amendment (1976)
○ Puts the burden of proof that it's harmful on the FDA. So
that means the FDA (federal government) has to do the
research. So supplement companies get a free ride to do
whatever they want.
○ So the supplement companies used Mel Gibson and others
to get the letter writing campaign to start:
▪ Produced the largest single letter writing campaign
to Congress in history
▪ Took away the FDA's power to regulate dietary
supplements

Even Vitamins and Minerals can also be labeled as dietary

supplements so they do NOT require FDA regulation.

Lectures Page 136

 2008: FDA was able to get a law in place that says you MUST
report adverse effects of any dietary supplements. They have 1 week
to file any adverse effects or proove that they are false effects.

Hatch and Harkin: pushed throught the DS and Health Implementation

Act of 2010. they are Pro-supplement companies. They paid them lots of
money to do this.

Lectures Page 137

Lectures Page 138
 The Federal Trade Commission = FTC = regulates the adverstising
claims. They regulate truth in advertising.

The FDA regulates what's on the label only.

Placebo: just a fake pill that is given to patients to make them feel like
they are having a therapeutic effect. Comes from the Latin and means to
please the patient.

Patient takes an antibiotic pill even though it won't help = placebo.

students were informed that the pills you took were all
placebo pills with sugar .

Lectures Page 139

 Placebos:
• Can be active
○ Easiest example is a sham operation where an incision is made then
closed
• No ANY one can have this happen to them
• Can be long term and last for months
• It is NOT the same as doing nothing because the patient feels that you did
something
• No, you may actually have an illness when taking the placebo.
• Classic number of 1/3 can be MUCH higher actually.

If you ligate the mammary artery, increase back pressure into coronary vessel which
dilates. Angina, exercise, and all that would be reduced some. He did some studies and
ligated the mammary artery and many people had less angina and increased exercise
ability.

60% of the people who had the actual operation saw improvement.

Almost 100% of people who had the SHAM operation saw an improvement!!! This was
reported back in 1960.

TMJ disorder treated by mock (sham) eqilibration. Run the burr inside the
mouth, bouce things around, and tell the patient that they had an operation done
to them. Gave them several "treatments" and they saw 64% partial or total
relief from the TMJ pain. This is a STRONG placebo affect.

The placebo effect is responsible for many things that

happen in small trials and other trials that are not very
well designed.

Lectures Page 140

 These are the two PRIMARY reasons why dietary supplements can work:
• The placebo effect
• Regression to the mean

Regression to the mean: applies to chronic conditions like TMJ disorder. Most
chronic diseases are cyclical in nature. You have good days and you have bad
days.

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 Probiotics are LIVE bacteria found in yogurts and milk.
What is their role according to Dr. Gleason? It does NOT
really help with allergies or anything.

However, there HAS been shown to be some benefit of pro-biotics for

travelers diarrhea. There was some improvement by less than 1 day so 6
days instead of 7 days. In infants it's more important. Be careful what
strain is used for the prebiotics. One of the purposes of the stomach has
low pH will kill lots of bacteria. Need to know that ONLY certain
probiotic strains will survive the pH environement of the stomach.

Pre-biotics: carbs that we don't digest. Get to large intestine (has

LOTS of bacteria) and promote growth of benefical microflora:
• Bifodobacterium
• Lactobacillus
Less emphasis on prebiotics and more emphasis on synbiotics =
combination of prebiotics and probiotics. So you mix the prebiotics with
some bacteria and look at the results.

What's a fiunctional food?

• Its normal food that has additional mutritional benefits beyond its normal
benefit
• Effects other than what are classically listed as happening in your body.
○ Most vitamins and minerals
○ Live bacteria
○ Many others

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