Vanquished
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hope the new edition will stimulate natural curiosity in each reader to embark on their own path of nutritional inquiry.
CHAPTER FEATURES
Something new to this textbook is that each chapter was vetted for scientific accuracy by Tonia Reinhard, Registered Dietitian, author and professor of Nutrition and Food Science. With her contribution the reader can have confidence that all content is current and research supported.
This third edition presents consistent chapter organization. Each chapter begins with a related quote, learning objectives, and key terms that set the stage for learning. Every chapter has an introduction that is written to serve as a segue into more detailed content. At the end of each chapter is a Relate to Patient section that compiles and lists information for the reader, so they can incorporate lessons learned during patient education and nutritional counseling. The next section, Practice for Patients, offers an opportunity to critically think through a patient case, while applying information from the chapter. Finally, the Relate to You section includes challenges to the reader to self-apply the information, drawing from personal eating practices.
Nutritional content has been researched and referenced and is current for the moment. Even as you read this statement, new ideas are being discussed in the world of nutrition. As stated earlier, nutrition is not a static science, so it is very possible new trends are emerging.
NEW RESOURCES
New to this edition and available online is Chapter 18, Nutritive Value of Complimentary Therapies for Oral Care. This chapter complements information in Chapter 8, Dietary and Herbal Supplements. An introduction and history of holistic or complimentary therapies is explained. Content, including nutritional value, for progressive or nontraditional practices includes miswak, oil pulling, essential oils, aromatherapy, and teas. Step-bystep instructions for making a breathing inhaler, frozen oil bites, safety guidelines for using aromatherapy, and brewing tea for the best flavor and benefit are presented.
Five Nutritional Counseling Videos are posted for both students and instructors online. Chapter 16 teaches that Nutritional Counseling sessions are individualized according to patient need, allowing that each one is different. These videos are meant to serve as exercises for students to pick out good learning features and those that can be improved upon. A rubric is posted to assist instructors in guiding students to pick out important points. Examples of personalized nutritional counseling PowerPoint presentations are provided that illustrate the variety of ways that information can be packaged for patients.
Faculty Calibration PowerPoint can be placed on the dental department’s electronic learning platform, so instructors can access and view prior to grading students in clinic. This ensures consistent grading practices in clinic. Many instructors appreciate a refresher on nutrition as it relates to the oral cavity, especially if it has been many years since they completed their nutrition course.
Flash Cards serve as a learning aid to assist students with studying and learning. They prove to be very helpful when studying for National Boards as they include all the major key terms.
24-hour food recall and caries risk matrix is included in Chapter 16 and are also posted online for both students and instructors. These practical forms also relate to one of the new videos as their use is demonstrated while waiting for the doctor to check the patient.
New questions added to the test bank are in a format most likely to be seen on the National Board Exam. Questions from the previous edition remain allowing for different levels of assessing.
You will notice that color photos now adorn the chapters for enhanced learning. Tissue changes are discernable providing better examples than the previous black and white.
New and additional full-color graphics have been created for many chapters. New and previous illustrations assist students with understanding of more complex concepts.
Many chapters have suggestions for further content exploration through videos, Web sites, and books. Suggestions can be used to flip the classroom or used as part of online drop-box assignments and discussion threads.
Chapter Critical Thinking Challenges encourage students to process content and apply knowledge to a higher thinking order. These assignments can also
be used to flip the classroom or be used for online assignments. Basic new PowerPoint slides have been created to include new content. They are easy to customize to include or delete information or enhance with illustrations of your choosing. Special effects like progression/transition can be added to conform to instructor style.
Rebecca Sroda
Contributors and Reviewers
CONTRIBUTORS
Jill Gehrig, RDH, MA
Dean Emeritus
Division of Allied Health & Public Service Education
Asheville-Buncombe Technical Community College
Asheville, North Carolina
Deb Milliken, DMD
Professor and Faculty Chair
Department of Dental Education
South Florida State College
Avon Park, Florida
Dawn Pisarski, RN, MS, ANP-BC
Professor
Department of Nursing
South Florida State College
Avon Park, Florida
REVIEWERS
Judy Danielson, MDH
Clinical Assistant Professor
University of Minnesota School of Dentistry
Golden Valley, Minnesota
Heather Doucette, MEd
Assistant Professor
Dalhousie University
Halifax, Nova Scotia, Canada
Pam Kawasaki, RDH, MBA
Associate Professor
Pacific University
Hillsboro, Oregon
Connie Kracher, PhD
Associate Professor of Dental Education
Indiana University Purdue University
Fort Wayne, Indiana
Shawna Rohner, MS
Professor
Pacific University
Hillsboro, Oregon
Claire Tucker, MEd
Assistant Professor
University of Arkansas for Medical Sciences
Little Rock, Arkansas
Cynthia P. Wampler, MS
Professor of Dental Hygiene
Florida State College at Jacksonville
Jacksonville, Florida
Dedication
Preface
Contributors and
Chapter
17
Nutritional Considerations for Special Population Groups
Rebecca Sroda and Dawn Pisarski
Chapter 18 Nutritive Value of Complimentary Therapies for Oral Care (Available ONLINE through our Navigate 2 Advantage Access site)
Dawn Pisarski
Appendix Nutrients at a Glance
Glossary Index
PART I Introduction
Eating 101
In our fast-forward culture, we have lost the art of eating well. Food is often little more than fuel to pour down the hatch while doing other stuff surfing the Web, driving, walking along the street. Dining al desko is now the norm in many workplaces. All of this speed takes a toll. Obesity, eating disorders and poor nutrition are rife.
Carl Honore author of the book In Praise of Slow
Learning Objectives
Discuss the evolution of modern food industry
Create a patient flyer on choosing wisely when eating out
Describe the difference between a food habit and food craving
Explain the relationship between portion distortion and obesity
Outline the journey of food as it makes its way through the body
Conclude how our bodies receive needed nutrients for optimal functioning
Key Terms
Chyme
Comfort Food Consumption Norm
Enzyme
Food Craving
Food Habit
Gastrointestinal Tract
Jejunum
Nutrients
Nutrition
Peristalsis
Portion Distortion
Villi
INTRODUCTION
You are among the majority if you don’t cook like your mother you subscribe to a new generation’s feeding patterns. How you nourish yourself and family is not the same experience as it was for your parents. Meal planning, preparation, and eating are very different in the 21st century, which makes your eating routines unique compared with that of previous generations. The 20th century mutated the concept of family mealtime with the help of food processing plants, a prolific fast-food industry, and targeted mass-marketing concepts.1,2 Prepackaged meals and aisles of frozen meals predominate shopping carts and home pantries and freezers. Mom no longer spends hours in the kitchen preparing meals, and dinner is not always on the table when the bread winner returns home after a long, hard day at work.
(For better understanding of the major corporations that produce our food, watch the videos: Food, Inc. and Fed Up)
EATING IN THE 21ST CENTURY
Families find themselves without a chief cook in the kitchen and consuming one of every five meals (20%) in their cars.3 You probably swing through a drive-thru for breakfast on your way to school or work, grab a quick bite for lunch, and stop for fast food in the evening before going to the next engagement scheduled in your weekly planner. Thanks to the food industry’s 20th century influence, you can drink breakfast from a bottle, eat lunch out of a box, and dinner from a carton. With fast-food restaurants on every corner, you have the convenience your busy schedule demands, but beware….this new way of eating contributes to disease, and especially obesity.4–6 Figure 11: Do you have a street in your city/town that looks like this? FAST FOOD ROW
Here are some not-so-fun facts on current eating habits:
Consumption of soft drinks in the United States has more than doubled in the last 40 years. They are now the single most consumed food in the American diet.7
Average person in the United States consumes about 126 g of sugar/day, which is over two times the 50 g/day recommended by the World Health Organization. Compare that to India’s 5 g/day; Russia’s 20 g/day; Singapore’s 32 g/day; Canada’s 89 g/day; United Kingdom’s 93 g/day (www.euromonitor.com).
The average American eats fast food 159 times a year. The average meal contains 1,200 calories, which is 190,000 calories a year. To burn that many calories you would need to run 1,700 miles equivalent from New York City to Denver, CO.
Description
FOOD FOR THOUGHT
21ST CENTURY SNAPSHOT
Our days are lived according to planned schedules. Time scheduled for eating is minimal, and we prefer to eat on the run.
Due to medical marvels, there is a vast geriatric population with their own unique set of health concerns. Population is increasing in numbers, and individuals are increasing in size.
Portion norms are four times what they were 50 years ago. Although we are more aware of the benefits of daily exercise, we remain sedentary, spending more time in front of the TV or computer.
Figure 1-1 Fast Food Row. (Photo courtesy of Kevin Brown, Zolfo Springs, FL.)
More hours per day are spent at work, which puts more stress on the body. Most of us have other destinations than home after a busy day at work.
According to the Centers for Disease Control and Prevention, Anthropometric Reference Data: Average American male is 5′9″ tall and weighs 195.5 pounds and the average American woman is 5′3″ and 166.2 pounds.
How does this compare to your height and weight? Read the following article for more information: www.npr.org, July 25, 2014. The Average American Man Is Too Big for His Britches by Serri Graslie.
YOU ARE WHAT YOU EAT
Nutrition is what you choose to eat and put into your body. The food you select contains nutrients, which are chemical substances that provide the body with energy and everything else it needs to function. Ninety-six percent of human body mass is composed of the elements: Oxygen Carbon Hydrogen Nitrogen
These elements also make up the six major nutrients found in food, making the saying “you are what you eat” really ring true. Food provides the body with a steady supply of fuel, which is created during digestion and absorption of six major nutrients: carbohydrates, proteins, lipids, water, vitamins, and minerals. Often, the body, in its own subtle way, will let you know which foods to eat in order to balance nutrients. When you are dehydrated, you feel thirsty and drink water (hydrogen and oxygen); when activity levels increase, you crave protein (carbon, hydrogen, oxygen, and nitrogen); and when you increase mental activity, your brain craves carbohydrates (carbon, hydrogen, and oxygen).
The first thing that usually comes to mind when thinking of a nutrient is one or two specific foods from the predominant food group. For example, something sweet for carbohydrates or meat and eggs for protein. In fact, most foods contain all six of the major nutrients. The proportion of the nutrients to each other in a specific food is what gives the food a label of either carbohydrate rich, protein rich, or high (or low) fat.
The food choices you make each day should be well thought out to keep your bodies healthy and functioning efficiently. Eating too much of any one food choice will usually squeeze out other food choices. For example, daily consumption of fast food decreases the chance of consuming more wholesomely prepared foods, and eating sweets throughout the day leaves less appetite for healthier snacks. This is not to say that you should never eat these foods; just don’t eat them exclusively every day or for weeks on end.
Most of your daily food choices should be nutritious. Occasionally indulge yourself in food that is delicious.
The relationship between food and the disease process happens when the body gets too much or too little of a particular nutrient over a period of time. Diabetes, cardiovascular disease, gross obesity, dental caries, and cancer (colon, esophageal, breast, and reproductive) are major diseases associated with unhealthy eating habits.8–12 Consistently making unwise food choices can lead to major disease and a shorter life span.
PORTION DISTORTION
Studies show that portion sizes served in homes, fast food, and fine dining restaurants have increased over the last 20 years. This increase in portion sizes, coined portion distortion, has a direct cause-and-effect relationship with the obesity epidemic. Consider the following examples at the U.S. Department of Health Web site: http://www.nhlbi.nih.gov/health/educational/wecan/eat-right/portiondistortion.htm
See Figure 1-2 PORTION DISTORTION for examples of changes in food portions.
Figure 1-2 Portion distortion. Description
If exercise efforts increased since the 1990s, the additional calories would
burn off the increase in calories consumed. Instead, the population is much more sedentary.
We sit for hours in front of the television and computer screen. We drive instead of walk and let modern appliances do our grunt work.
People have a tendency to eat what is put in front of them and typically do not consider that it might be too much. Consumers will equate bigger size with bigger value. Consumption norm is the proper food unit to eat. Mistakenly (and unfortunately), most consumers assume consumption norm is what is placed before them.
Consumption norm = what you should eat
Assumption norm = what is put before you to eat
FOOD FOR THOUGHT
One meal at a fast-food restaurant can add anywhere from 657 to more than 1,000 calories than a similar meal 20 years ago
Today’s fast-food cheese burger is 590 calories versus 333 calories 20 years ago. That means one would have to lift weights for 1.5 hours to burn off the additional 257 calories. Hardee’s, Burger King, and Wendy’s have 1,000+-calorie sandwiches. That is half or more of suggested caloric intake for a day.
Twenty years ago, a 2.4 oz serving of French fries had 210 calories, and now an average serving of French fries is 6.9 oz for 610 calories.
Parents who condition children to eat everything on their plate need to think about what and how much to serve on the dish. With the gradual increase in portion distortion, we mindlessly consume the contents of a meal not until full, but rather until gone. Most diners are not conscious of calories consumed and get more satisfaction from a feeling of getting their money’s worth.
Opt for NO WAIST! Do not be a victim of portion distortion. When eating out:
Opt for the small—forget jumbo, king size, or even medium or large.
Forget the sweet sodas and make water or unsweetened tea your beverage of choice.
Ask for a to-go box when ordering your meal. Remove half of what is served on the plate and put it in the box for a later meal.
At home, serve food on smaller plates and beverages in smaller glasses.
Repackage foods bought at the big box store. The bigger package you pour from, the more you will eat.
Eat slower, savor every bite, and occasionally put the fork down, look around, and see what could happen if you do not become a conscious consumer.
For more reading on this topic—Mindless Eating—Why We Eat More Than We Think by Brian Wansink, PhD.
CHOOSE MYPLATE
The U.S. Department of Agriculture’s (USDA) MyPlate, shown in Figure 13, is designed to serve as a guide to healthy eating and assist you in making healthy food choices. Visit www.choosemyplate.gov to set up a personal account. (See Chapter 11 for more information on MyPlate.) Serving suggestions for five food groups have been made to ensure a daily supply of important nutrients.
FRUITS VEGETABLES GRAINS PRIOTEIN DAIRY
MyPlate guidelines are suggestions and can be modified to accommodate specific diet requirements: vegetarians, lactose intolerant, specific cultural and religious practices. Following MyPlate guidelines configured specifically for you should include the following:
Figure 1-3 MyPlate: a guide to daily food choices.
Description
Broad variety of foods from each category
Three rich sources of calcium
Three high-protein foods
At least five servings of vegetables and fruits
Whole grains for fiber
Vegetable fats and omega-3 fatty acids
Also include plenty of water and daily moderate exercise
FOOD HABITS/FOOD CRAVINGS
You may be choosing the food you eat out of habit, which is no more than mindless, routine eating. Habits are repetitive, and thought is not given to what you choose or why you choose a certain food. However, on a subconscious level, there is an association between eating the food and a comforting feeling or event. Some food habits are borne out of family traditions like turkey for Thanksgiving, cake on birthdays, and cookies for Christmas. Other food habits are created out of social expectations like holding Starbucks coffee as you shop or beautifully displayed finger foods at a party to nibble on as you network and commiserate.
It has been said that: The human body has an innate wisdom. It lets us know when it needs a specific nutrient. When it talks to us like that, we experience craving.
Food cravings can be either emotional or physiological. Not everybody gets them, but for those who do, they are very real. Unlike a food habit, food cravings are a conscious longing for something specific. If your craving is on an emotional level, it remains steady as long as the emotional need remains. Foods high in fat and carbohydrates tend to be chosen as comfort foods like chocolate candy, ice cream, or chocolate chip cookies. Once you fulfill the need, the craving disappears.13,14
If your craving is on a physiological level, it means hormones are in fluctuation.15,16 You may go through phases, like eating peanut butter and crackers every day around 4:00 PM for 2 weeks and then smoked almonds at the same time for the next 2 weeks. This is neither accidental nor coincidental. If what you crave is based on a physiologic need, then your body will communicate when adequate levels are restored by eliminating the desire. If the craving is sustained, like having ice cream every night after dinner: it may start out as physiologic need and then turn in to habit. Table 11 gives examples of physiologic cravings.
