Nutrition and Diet Theraphy

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INTRODUCTION TO NUTRITION
Nutrition is a vital component to overall wellness and health. Diet affects energy,
well being and many disease states. There is a connection between lifetime nutritional
habits and the risks of many chronic diseases such as cardio vascular diseases,
diabetes, cancer. A well balanced diet can prevent such conditions and improve energy
levels and over all health and wellness. The basis of nutrition is FOOD
Definition of terms:
1) Nutrition – is the study of food in relation to health.
2) Food – is any substance when ingested or eaten nourishes the body.
3) Nutrient – is a chemical component needed by the body to provide energy, to
build and repair tissues and to regulate life process.
4) Digestion – it is a mechanical and chemical breakdown of food into smaller
components.
5) Absorption – it is a process where the nutrients from foods are absorb by the body
into the bloodstreams.
6) Metabolism – is a chemical process of transforming foods into other substance to
sustain life.
7) Enzymes – an organic catalyst that are protein in nature and are produced by living
cells.
A catalyst speeds up or slows down chemical reactions without itself
undergoing change.
8) Nutritional Status – is the condition of the body resulting from the utilization of
essential nutrients.
9) Calorie – fuel potential in a food. One calorie represents the amount of heat required
to raise one liter of water one degree Celsius.
10) Malnutrition – It is the condition of the body resulting from a lack of one or more
essential nutrients or due to excessive nutrient supply.

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The Digestive System
• Mouth: The digestive process begins in the mouth. Food is partly broken down
by the process of chewing and by the chemical action of salivary amylase (these
enzymes are produced by the salivary glands and break down starches into
smaller molecules).
On the way to the stomach:
• Esophagus – After being chewed and swallowed, the food enters the
esophagus. The esophagus is a long tube that runs from the mouth to the
stomach. It uses rhythmic, wave-like muscle movements (called peristalsis) to
force food from the throat into the stomach. This muscle movement gives us the
ability to eat or drink even when we’re upside-down.
• Stomach – The stomach is a large, sack-like organ that churns the food and
bathes it in a very strong acid (gastric acid). Food in the stomach that is partly
digested and mixed with stomach acids is called chyme.
• Small intestine – absorption happens in the small intestine. Bile (produced in
the liver and stored in the gall bladder), pancreatic enzymes, and other digestive
enzymes produced by the inner wall of the small intestine help in the breakdown
of food.
• Large intestine – Undigested food passes in the large intestine. In the large
intestine, some of the water and electrolytes (chemicals like sodium) are
removed from the food.

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• The end of the process – Solid waste is then stored in the rectum until it is
excreted via the anus.
ENZYMES – an organic catalyst that are protein in nature and are produced by living
cells.
3 Groups of Digestive Enzymes:
1. Amylase – carbohydrate splitters
2. Lipase – fat splitters
3. Proteases – protein splitters
PART SECRETION ENZYME SUBSTRATE PRODUCT
Mouth Saliva Ptyalin (salivary
amylase)
Cooked
Carbohydrate
Dextrin and
Maltose
Esophagus
Stomach Gastric juice
(acidic)
Pepsin
Rennin
Lipase
Protein and
polypeptides
Milk Casein
Fats
Branched chain
amino acids
Calcium
Caseinate
Long chain
fatty acids,
glycerol
Small Intestine Pancreatic Pancreatic Branched chain polypeptide

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Juice
(alkaline)
Bile (alkaline)
Intestinal juice
(succus
entericus)
Trypsin
Pancreatic
Lipase
Pancreatic
Amylase
Aminopeptidase
Intestinal lipase
amino acid
Long chain fatty
acids, glycerol,
cholesterol
Dextrin and
Maltose
polypeptide
amino acids
long chain fatty
acids,
glycerides,
cholesterol
amino acids
long chain fatty
acids,
glycerides,
cholesterol
Dextrin,
lactose,
sucrose,
maltose
Facilitates fat
and Vit. A, D,
E, K absorption
Single chain
amino acid
Fatty acids

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Isomaltase
Lactase
Sucrase
maltose
lactose
sucrose
Glucose
Glucose,
galactose
Glucose,
fructose
Large Intestine
Digestibility of an average person
CHO – 90%
Protein – 92%
Fats – 95%
Factors that affect digestion and absorption:
1. Crude fibers – skin and seed of fruit
2. Preparation and cooking
3. Disease – intestinal cancer, diarrhea
4. Surgery – gastrectomy
5. Parasitism
6. Presence of interfering substance

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PHYSIOLOGIC VALUE OF FOOD
Food is good to eat when it fulfills the ff. qualities:
1) It is nourishing or nutritious
2) It has satiety value
3) It is prepared under sanitary conditions
4) Its palatability factors (color, aroma, flavor, texture)
5) Within the budget and suitable to the occasion.
Nutrition Classification
1) According to function
2) According to chemical nature
3) According to essentiality
4) According concentration
Classification of Nutrients
1) According to function:
- Function as energy giving, body building, body regulating.
2) According to chemical properties:
a) Organic – protein, lipids, carbohydrates and vitamins
b) Inorganic – water & minerals
3) According to concentration
a) Macro nutrients – Carbohydrates, Protein, Fats
b) Micro nutrients – Vitamins, Minerals & water
BASIC TOOLS IN NUTRITION
Food Groups –group of foods that have similar nutritional properties and
is part of the hierarchy of the food pyramid, such as cereal group, milk
group, meat and protein group, fruit and vegetable group, fats and sweets
group .

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The 3 Main Food Groups:
1.Body-building foods - foods that supply good quality proteins, some vitamins
and minerals.
2. Energy foods - mostly of rice and other cereals, starches, sugars and fats
contribute
the bulk of Calories.
3. Regulating foods - composed of fruits and vegetables that provide vitamins
and minerals, particularly ascorbic acid and pro vitamin A.
Dietary Guidelines strategies to promote appropriate diets and related
health practices to achieve the goal of improving the nutritional condition.
10 Nutritional Guidelines For Filipinos
1. Eat a variety of foods everyday.
2. Breast-feed infants exclusively from birth to 4-6 months and then, give
appropriate foods while continuing breast-feeding.
3. Maintain children’s normal growth through proper diet and monitor their
growth regularly.
4. Consume fish, lean meat, poultry or dried beans.
5. Eat more vegetables, fruits and root crops.
6. Eat foods cooked in edible/cooking oil daily.
7. Consume milk, milk products and other calcium-rich foods such as small
Fish and dark green leafy vegetables everyday.
8. Use iodized salt, but avoid excessive intake of salty foods.
9. Eat clean and safe food.
10. For a healthy lifestyle and good nutrition, exercise regularly, do not smoke
and
avoid drinking alcoholic beverages.
FOOD GUIDE PYRAMID -
FNRI (Foods & Nutrition Research Institute)

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FOOD GUIDE PYRAMID
(USDA) United States Dept. of Agriculture

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MyPyramid contains eight divisions. From left to right on the pyramid are six food
groups:
• Grains, recommending that at least half of grains consumed be as whole grains
• Vegetables, emphasizing dark green vegetables, orange vegetables, and dry
beans and peas
• Fruits, emphasizing variety and deemphasizing fruit juices
• Oils, recommending fish, nut, and vegetables sources
• Milk,, a category that includes fluid milk and many other milk-based products
• Meat and beans, emphasizing low-fat and lean meats such as fish as well as
more beans, peas, nuts, and seeds
RDA & RENI
Recommended Dietary Allowance (RDA) - is the information of nutrient allowance
for the maintenance of good health. A tool for assessing a dietary intake of the
population group. This emphasize the amount of foods or diet.
RENI – Recommended Energy Nutrient Intake
- A new standard replacing RDA, emphasizing on recommending on the nutrients
rather than food or diet.
- This tool serve as a guide for designing nutrition and health intervention towards
an improvement of the health of the Filipinos.
Food Exchange List
- A classification or grouping of common foods in terms of equivalent amounts
of Carbohydrates, Protein, Fat and Calories
- The word exchange refers to the fact that each item on a particular list in the
portion listed may be interchanged with any other food item on the same list. An
exchange can be explained as a substitution, choice, or serving.

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Nutritional Labeling
Nutrient density is a measure of the nutrients a food provides compared
to the calories it provides. Foods low in calories and high in nutrients are
nutrient dense, while foods high in calories and low in nutrients are
nutrient poor.
References:
http://www.fnri.dost.gov.ph/index.php?option=content&task=view&id=1126
http://www.hc-sc.gc.ca/fn-an/label-etiquet/index-eng.php
MACRO NUTRIENTS
Macro nutrients - constitute the bulk of the food we eat, they provide energy and
chemical building-blocks for tissues.
3 Macro Nutrients:
1. Carbohydrates
2. Protein
- Primary means of communication between the
producer or manufacturer and the consumer.
2 Components of Nutritional Labeling:
1. Nutrient Declaration – a standardized statement
or listing of the nutrient content of food.
2. Nutrition Claim – representation which
states or implies that a food has some
particular nutritional proponents.

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3. Fats
CARBOHYDRATES
Classification of Carbohydrates
Simple Carbohydrates
1) Monosaccharide – “simple sugar”, is the simplest form of sugar.
a) Glucose – “blood sugar”
b) Fructose – sweetest of simple sugar. Found in honey, fruits and vegetables.
c) Galactose – not found in free foods. Galactose is a result when the lactose
breakdown.
** Simple sugar are water soluble, and quickly absorb in the bloodstream ***
2) Disaccharide – “double sugar”. Made up of 2 monosaccharide.
a) Sucrose – ordinary table sugar (glucose & fructose)
b) Lactose – “milk sugar” (glucose & galactose)
c) Maltose –(malt sugar) is produced during the malting of cereals such as
barley.
- Major source of energy
for the body.
- Consist of 60-100%of calories.
- 1 gram of carbohydrates
contains 4 calories.
- carbohydrates are made of carbon,
hydrogen and oxygen with the general
formula of Cm(H2O)n.

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3) Polysaccharide – “ complex sugar”
Composed of many molecules of simple sugar
a) Starch – most important in human. They supply energy for longer period of time.
Examples: rice, wheat, corn, carrots and potatoes.
Starches are not water-soluble and require digestive enzymes called amylases to
break them apart.
b) Dextrins – formed by the breakdown of starch. obtained from starch by the
application of heat or acids and used mainly as adhesives and thickening agents.
c) Cellulose – Non-digestible by humans. They lower the blood glucose level of
people with diabetes. that is composed of glucose units, forms the main constituent of
the cell wall in most plants, and is important in the manufacture of numerous products,
such as paper, textiles, pharmaceuticals
d) Pectin – Sources from fruits and are often used as a base for jellies.
e) Glycogen – “animal starch”
f) Hemicellulose – also indigestible, found in agar, pectin, woody fibers, leaves, stems.
g) Inulin – Important medicine and nursing as it provides test of renal function.
Functions of Carbohydrates:
1) Main source of energy for the body.
2) Protein sparing action
3) Necessary for normal fat metabolism
4) Cellulose stimulate peristaltic movement of the gastrointestinal tract. Absorb
water to give bulk to the intestines.
5) Lactose encourage the growth of beneficial bacteria, resulting in a laxative
action.
6) Glucose is the sole source of energy in the brain. Proper functioning of the
tissues
Sources of Carbohydrates
1) Whole grains
2) Sweet potatoes & white potatoes. Bananas, dried fruits.

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3) Milk (lactose)
4) Sugar , sweets, honey, maple sugar
“Empty Calories” - foods which do not contain any other nutrients except
carbohydrates
Common Diseases:
1. Overweight
2. Diabetes
3. Tooth Decay
4. Depressed appetite
5. Fermentation causing gas formation
6. Cancer
Deficiency
1)Ketosis – disease caused by lack of carbohydrates, in which the acid level of the body
is raised
2)Protein _ Energy Malnutrition
a) Kwashiorkor – Protein Def.
b) Marasmus – Calorie Def.
3) Low Blood Sugar Level
FATS or Lipids
- Fats, oils, and waxes belong to the group of
naturally occurring organic materials called
- lipids.
- Lipids are those constituents of plants or
animals which are insoluble in water but
soluble in other organic solvents.

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- Most concentrated form of energy
- Contains 9 calories per gram fat
- It is recommended 15-25% fat in the diet
- The basic unit of fat is called “triglyceride”, which consist of molecule of glycerol
attached to the 3 fatty acids
3 Forms Fatty Acids
1) Saturated Fats – Shown to raise blood cholesterol.
• Considered the most “dangerous” type of fat that lead to raise blood
cholesterol may lead to coronary heart disease
• Difficult to metabolize causing weight gain
Sources: butter, lard, meat, cheese, eggs, coconut oil, chocolate, cakes, cookies
2) Monounsaturated fats – lower level of “bad” cholesterol.
Sources: Vegetable oil, peanut, soybean, corn, olive oil, canola oil
3) Polyunsaturated Fats – Lower levels of total cholesterol.
Classes:
1) Omega 3 - have a positive effect on reducing mortality from cardiovascular
disease.
 Reduced blood clotting tendency and reduced blood pressure.
2) Omega 6 – “Linoleic acid” polyunsaturated fatty acid.
 lowers cholesterol levels in the blood and helps in the prevention of heart
disease.
 Sources of Polyunsaturated fats : unrefined safflower, corn, sesame, soybean,
sunflower oil, seeds, nuts, dark green vegetables.

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Fatty Acid Composition of Common Food Fats
OIL POLYUNSAT.
F.A
MONOUNSAT.
F.
TOTAL
UNSAT. F.A
SATURATED
F.A
Safflower Oil 75% 12% 86% 9%
Sunflower Oil 66% 20% 86% 10%
Corn Oil 59% 24% 83% 13%
Soybean Oil 58% 23% 81% 14%
Cotton seed Oil 52% 18% 17% 26%
Canola Oil 33% 55% 88% 7%
Olive Oil 8% 74% 82% 13%
Peanut Oil 32% 46% 78% 17%
Margarine Oil 18% 59% 77% 19%
Palm Oil 9% 37% 46% 49%
Coconut Oil 2% 6% 8% 86%
Shortening 14% 51% 65% 31%
ANIMAL FAT
Tuna fat 37% 26% 63% 27%
Chicken fat 21% 45% 66% 30%
Beef fat 4% 42% 46% 50%
Butter fat 4% 29% 33% 62%
Lard 11% 45% 56% 40%
Functions:
1) Important source of calories to provide a continuous supply if energy.
2) Protein sparing
3) Maintain the constant blood temperature
4) Cushions vital organs such as kidney against injury
5) Facilitates the absorption of fat soluble vitamins (ADEK)
6) Provides satiety and delays onset on hunger.

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7) Contributes flavor and palatability to the diet.
Cholesterol
Cholesterol is a major component of all cell membranes. It is required for synthesis of
sex hormones, bile acids, and vitamin D. It is also a precursor of the steroid hormones.
 Cholesterol is also made in the body and is taken also thru foods
 But Cholesterol is a major factor in the development of heart diseases
 Daily intake should not exceed 300 mg./day
Source of Dietary Cholesterol
• Richest: egg yolk, fish roes, mayonnaise and shell fish.
• Moderate : Fat on meat, duck, goose, cold cuts, whole milks, cream, ice cream,
cheese, butter and most commercially made cakes, biscuits and pastries.
• Poor : All fish and fish canned in vegetable oil, very lean meats, poultry without
skin, skimmed milk , low fat yoghurt and cottage cheese.
• Cholesterol free : All vegetables, and vegetable oils, fruit (including avocados
and olives), nuts, rice, egg white and sugar.
Vocabularies:
Lipid – Any of a group of organic compounds, including the fats, oils, waxes, sterols,
and triglycerides, that are insoluble in water but soluble in nonpolar organic solvents,
are oily to the touch.
Fat - Any of various soft, solid, or semisolid organic compounds constituting the esters
of glycerol and fatty acids and their associated organic groups.
Oil – is liquid at room temperature soluble in various organic solvents such as ether but
not in water
Cholesterol – is a form of fat in animal origin that is a factor in the development of heart
disease.

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Transfats - fatty acids that are produced when polyunsaturated oil are hydrogenated to
make them more solid. Thus raise the level of blood cholesterol.
Hydrogenated fats – unsaturated oil undergone hydrogenation to make them more
solid and less resistant to heat.
Low Density Lipoprotein (LDL) - A complex of lipids and proteins, with greater
amounts of lipid than protein, that transports cholesterol in the blood. High levels are
associated with an increased risk of atherosclerosis and coronary heart disease.
High Density Lipoprotein (HDL) - A complex of lipids and proteins in approximately
equal amounts that functions as a transporter of cholesterol in the blood. High levels are
associated with a decreased risk of atherosclerosis and coronary heart disease.
10 Foods High Transfats
1. Spreads – mayonnaise, margarine, butter
2. Package foods – cake mixes, biscuits
3. Soups – noodle soups
4. Fast foods – Mcdonalds, Kentucky Fried Chicken
5. Frozen foods – frozen pies, pizza, breaded fish sticks, breaded chicken
6. Baked goods – cupcakes
7. Cookies & cakes
8. Donuts
9. Cream Filled cookies
10.Chips & Crackers
Sources of Fat
1) Animal Fats – fat from meat, fish, poultry, milk, milk products and eggs.
2) Vegetable Fats – margarine, seed and vegetable oil, nuts
3) Visible Fats – butter, cream, margarine, lard, fish liver oils, pork fat
4) Invisible Fats – cheeses, olives, cakes, nuts, pastries
Diseases:
1) Heart Disease
2) Cancer

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3) Obesity
PROTEIN
AMINO ACIDS
Amino acids are known as the building blocks of protein.
They perform many important functions such as: building cells, protecting the body
from viruses or bacteria, repairing damaged tissue and carrying oxygen throughout the
body
There are 20 different amino acids. Amino acids are linked together to form
peptides, which are small chains of amino acids. The peptides are then linked together
to form larger proteins.
There are thousands of different proteins that carry out a large number of jobs in the
human body. Even though so many different proteins are at work in your body, you don't
have to worry about consuming each individual protein from the foods you eat. Your
body will make those proteins. All you need to do is to make sure your body has a
healthy supply of all 20 of the different amino acid "building blocks." Having enough of
those amino acids is easy because your body can make 11 of them from other
compounds already in your body. That leaves eight amino acids that you must get from
your diet.
• Known as the building blocks of the body
• It contains the elements of carbon,
hydrogen, oxygen and nitrogen.
• Protein is made up of amino acids which is
the basic component of protein

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Types of Amino Acids
1) Essential Amino Acids –are those that are necessary for good health but cannot be
produced by the body and so must be supplied in the diet.
Ex. Leucine, Isoleucine
Lysine, Valine
Typtophan, Phenylalanine,
Methionine Serine
2) Non-Essential Amino Acids –are those that are produced by the body so not as
necessary in the diet
Ex. Aspartic Acid Tyrosine Glycine
Cysteine Arginine
Glutamic Acid Histidine
Glutamine Alanine
Asparagine Proline
Complete and Incomplete Protein
• Complete – contain all essential amino acid in sufficient quantities to supply the
body’s need
Sources: proteins from animals
• Incomplete – those deficient in one or more essential amino acids.
Sources : Plant ( grains, legumes, seeds and nuts
Functions of Proteins
1) Used in repairing worn out body tissue
2) Source of heat and energy
3) Contribute to numerous essential body secretions (mucus, milk, sperm cells)
4) Keeping fluids and pH balanced in the body
5) Play a large role in the resistance of the body to diseases
6) Contributing to enzyme activity that promotes chemical reactions in the body
7) Signaling cells what to do and when to do it

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8) Transporting substances around the body
9) Serving as building blocks for hormone production
10) Helping blood clot
11) Serving as structural components that give our body parts their shapes
Sources:
Complete Protein
1. Meat – beef, pork, lamb
2. Poultry – chicken, turkey, duck
3. Fish
4. Dairy Products – milk, yogurt, cheese
Incomplete Protein
Grains – beans, corn, oats, pasta, whole grain breads
Legumes, seeds & nuts – sesame seed, sunflower seed, peas, rice, peanuts,
cashew
Vegetables – Brocolli
Common Diseases
1) Heart Disease
2) Cancer (prostate, pancreas, kidney, breast and colon)
3) Osteoporosis
4) Weight control
5) Kidney Diseases
6) Ketosis
Protein – Energy Malnutrition

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MICRO NUTRIENTS
VITAMINS & MINERALS
Vitamins Terminologies
• Precursor or Provitamins – these are compounds that can be changed to the
active vitamins
Ex. Carotene are precursors to Vit. A
• Preformed Vitamins – naturally occurring vitamins that are inactive form and
ready for its biological use.
Ex. Animal sources
• Avitaminosis – severe lack of vitamins
Ex. Avitaminosis A leads to night blindness
• Hypervitaminosis – “vitamin toxicity”
excessive accumulation of vitamins in the body
• Vitamin Malnutrition – “too much or too little”
NOMENCLATURE OF VITAMINS
VITAMIN NOMENCLATURE
VITAMINS
• Complex organic compound to regulate body
processes and maintain body tissue
• “Vitamin” comes from the Latin word “vita”
meaning life, “amine” means nitrogen
compound.
• Vitamins do not give the body energy.
• Therefore, we cannot increase our physical
capacity by taking extra vitamins
• Vitamins do not have calorie value.

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Vitamin A Retinol
D Calciferol
E Tocopherol
K Phylloquinone
Vitamin B1 Thiamine
B2 Riboflavin
B3 Niacin
B4 Panthotenic Acid
B6 Pyridoxine
B8 Biotin
B12 Cyanocobalamin
Vit. C Ascorbic Acid
FAT SOLUBLE VITAMINS (Vit. A D E K )
• FAT Soluble Vitamins – can be absorbed in the presence of fat & stored in the
body.
• Fat Soluble vitamins generally have pre cursors or pro vitamins
• They can be stored in the body, deficiencies are slow to develop.
• Not absolutely needed daily from food sources
• Stable especially in daily cooking
Vit. A (Retinol)
FUNCTIONS
1) Vision Cycle – necessary component of visual purple (rhodopsia), a pigment to
make adjustments to light and dark.
2) Necessary material for maintenance of epithelial tissues.
3) Growth & Bone Development –
4) Reproduction – necessary for normal reproduction and lactation.
5) Antioxidant
Food Sources

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1) Animal Sources – liver, yolk, milk, butter, cheese, fish, clams, tahong
2) Plant sources – deep green and yellow vegetables and fruits
DAILY DOSAGE:
Male – 1000 microgram
Female – 800 microgram
Deficiency & Toxicity
Vitamin A (Retinol)
Deficiency
• Night blindness
• Eye lesions
• Retarded growth
• Lower resistance to infections
• Faulty skeletal & dental development
Skin Lesions
Toxicity
• Liver damage
• Mild dermatitis
• Thickening of the skin and peeling off
• Course sparse hair
• Hyper carotenimia
(harmless orange appearance
VIT. D (Calciferol)
Functions
1) Absorption of Calcium & Phosphorus
2) Essential for normal growth development.
Food Sources
1) Synthesis with sunlight (10 mins/day)

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2) cod liver fish, halibut [type of flatfish], salmon, sardine, egg yolk
3) Fortified Vit. A products
Deficiency
• Tetany ( abnormal muscle twitching and cramps
• Rickets (defective bones, retarded growth)
• Osteomalasia
• ( softening of the bones)
Toxicity
• Stone formation on kidney
• Demineralisation of the bone
• Polyuria
• Weight Loss
• Hypercalcemia
Vit. E (Tocopherol)
Functions
1. Maintenance of cellular membrane
2. Anti oxidant
Food Sources
Whole grain nuts, seeds, green and leafy vegetables, polyunsaturated fats
• No toxicity , this nutrient cannot be stored to a large extend in the body
Vit. K ( Phylloquinone)
Functions
Aids in blood clotting and bone mineralization
Food Sources
Green leafy vegetables, soy beans
• Deficiency

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Hemmorhagic diseases
Toxicity
• Vomitting
• Albuminuria
• Hemolysis
FYI
• Anti oxidant - Any substance that reduces oxidative damage (damage due to
oxygen) such as that caused by free radicals.
• Free Radicals - are highly reactive chemicals that attack molecules by capturing
electrons and thus modifying chemical structures
• PHYTOCHEMICAL - natural bioactive compound found in plant foods that works
with nutrients and dietary fiber to protect against disease
WATER SOLUBLE VITAMINS
• Water soluble vitamins are B-complex group and Vit. C
• Dissolve in water and are not stored, they are eliminated in urine, so we need
continuous supply of this vitamins in the diet everyday.
• Water-soluble vitamins are easily destroyed or washed out during food storage or
preparation.
• To reduce vitamin loss, refrigerate fresh produce, keep milk and grains away
from strong light, and use the cooking water from vegetables to prepare soups.
Vitamin C (Ascorbic Acid)
Functions:
1. Maintenance of bones, teeth, connective tissue,cartilages
2. Absorption of Calcium, Iron and Folacin
3. Production of brain hormones, immune factors

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4. Antioxidant
Deficiency:
1. Bleeding gums, scurvy, anemia
2. joint pain, increase resistance to infections,
3. rough skin, hair loss, loose teeth
Toxicity
Diarrhea, bloating, cramps, formation of kidney stones
FOOD SOURCES
Citrus fruits, Brocolli, strawberries, potatoes, mangoes, papaya, red and green
bell pepper,
Dark green vegetables
Vitamin B1 (Thiamine)
Functions
1. Helps release energy from foods,
2. Promotes normal appetite
3. Important in function of nervous system
Deficiency
1. Mental confusion; muscle weakness
2. wasting; edema; impaired growth; beriberi.
Toxicity (none)
None
Food Sources
pork, liver, whole grains, lean meats
Vit. B2 (Riboflavin)
Functions

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1. Helps release energy from foods;
2. Promotes good vision, healthy skin
Deficiency
1. Cracks at corners of mouth;
2. Dermatitis around nose and lips;
3. Eyes sensitive to light.
Toxicity (none)
Food Sources
1. Liver, milk, dark green vegetables, whole and
2. enriched grain products, eggs
Vit. B3 (Niacin)
Functions
1. Energy production from foods;
2. Aids digestion, promotes normal appetite;
3. Promotes healthy skin, nerves
Deficiency
1. Skin disorders; diarrhea; weakness
2. mental confusion; irritability.
3. Pellagra
Toxicity
1. Abnormal liver function;
2. Nausea; irritability
Food Sources
1. Liver, fish, poultry, meat, peanuts,
2. whole and enriched grain products.
Vit. B5 (Panthotenic Acid)
Functions
1. Involved in energy production

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2. aids in formation of hormones
Deficiency
Uncommon due to availability in most foods;
fatigue; nausea, abdominal cramps; difficulty sleeping.
Toxicity (none)
Food Sources
Liver, kidney, meats, egg yolk, whole grains, legumes
Vit. B6 (Pyridoxine)
Functions
Aids in protein metabolism, absorption;
Aids in red blood cell formation;
Helps body use fats.
Deficiency
Skin disorders, dermatitis
Cracks at corners of mouth;
Irritability; anemia; kidney stones;
Nausea; smooth tongue.
B8 (Biotin)
Functions
Helps release energy from carbohydrates
Aids in fat synthesis.
Deficiency
Fatigue; loss of appetite, nausea, vomiting;
Depression; muscle pains; anemia.
Toxicity – none
Food Sources
Liver, kidney, egg yolk, milk,
Fresh vegetables

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Vit. B12 – Phylloquinone
Function: Synthesis of red blood cells
Deficiency - Anemia, fatigue, sore tongue
Food Sources – all animal products
Minerals
What is a mineral?
Minerals are elements that are not organic needed by the body in relatively small
amounts to help regulate body process and maintain tissue structure
• Minerals do not broken down during digestion nor destroyed by heat or light.
Trace and Major Minerals
• Trace Minerals – minerals that are required in our diet at amounts less than 100
mg/day.
• Major Minerals - minerals that are required in our diet at amounts greater than
100 mg/day.
Primary Roles:
• Metabolic health
• Anti oxidant
• Blood health
• Bone health
• Electrolyte balance
Major Minerals:
1) Calcium
2) Phosphorus
3) Magnesium
4) Potassium

30
5) Sodium
6) Chloride
Trace Minerals:
1) Iron
2) Iodine
3) Zinc
4) Flouride
5) Selenium
6) Manganese
7) Chromium
Major Minerals
Mineral Symbol Function Deficiency Food Sources
Calcium Ca Maintenance of bones and
teeth
Osteoporosis,
convulsion,
muscle spasm
Dairy products,
green leafy
veg, fish with
bones
Phosphorus Ph Bone growth Milk,cereal, all
foods
Magnesium Mg Muscle contraction,
Bone & tooth structure
Green veg,,sea
foods, legumes
Sodium Na Body fluid & acid-base
balance
Hypertension,
edema
Salt, processed
foods
Potassium K Body fluid balance All whole foods
Chloride Cl Body Fluid Balance Salt, processed
food

31
Trace Minerals
Mineral Symbol Function Deficiency Food Sources
Iron Fe Red Blood Cell structure Iron def.
anemia
Dark green
leafy
vegetables,
liver, legumes
Iodine I Thyroid hormone
development
Energy metabolism
Goiter Sea foods,
iodized sale
Zinc Zn Fetal development, wound
healing
Whole grain,
meat, egg
Fluoride Fl Teeth maintenance Dental carries Fortified water,
tea, fish bones
Goiter Angular stomatitis Rickets
Iodine deficiency Vit. C deficiency Vit. D deficiency

32
WATER
• Recommended to drink at least 8 glasses a day
• If trying to loose weight 12-15 glasses a day is recommended
• A high intake of water aids in fat loss
• Caffeine & alcohol are both diuretics. Large intake of water is recommended
• Hangover are generally cause by the dehydration action by alcohol
• Match a bottle of beer with a glass of water to lessen the intensity of hangover
• Vital Element, second only to oxygen
• Vital every day
• Things that dehydrate
– Aging process
– Sweat from exercise
– Medications
– Caffeine
• Good general rule: for each glass of beverage with caffeine that you consume,
drink one extra glass of water.
• Other Benefits
– Helps utilize stored fat for energy
• Most important nutritional
constituent is water
• The major component of the body
is water
• 60 – 70% water
• Water has no nutritional values
and no calories
• Water is necessary to transport
nutrients
• regulate body temperature
• Remove waste materials
• Participate in chemical reaction &
energy production

33
– Helps body recover quicker after exercise
– Aids healing process when you have been ill
–
Reference:
Dietary Guidelines. http://healthyeating.sfgate.com/recommended-amount-percent-carbohydrates-per-
day-7287.html
http://www.livestrong.com/article/512044-normal-carbohydrate-intake-per-day/
http://www.mckinley.illinois.edu/handouts/macronutrients.htm:
http://allnutriments.blogspot.com/2013/03/carbohydrate-deficiency-diseases.html
http://www.med-health.net/Protein-Deficiency-Diseases.html
http://www.sciencemag.org/content/296/5575/1991.abstract
Reference: http://www.nutrition.org.uk/healthyliving/healthyeating/fatsugar.html
Basic Nutrition & Diet Theraphy by Maria Lourdes C. Caudal, RND.
Ideal Weight, Total Energy Requirement,Body Mass
Index
Basal Metabolism –the amount of energy required by an individual in the resting state,
for such functions as breathing and circulation of the blood.
Basal Metabolic Rate – the minimum caloric requirement needed to sustain life in a
resting individual. It can be looked at as being the amount of energy (measured in
calories) expended by the body to remain in bed asleep all day.
Factors that affect BMR
1.Genetics. Some people are born with faster metabolisms; some with slower
metabolisms.
2. Gender. Men have a greater muscle mass and a lower body fat percentage. This
means they have a higher basal metabolic rate.
3. Age. BMR reduces with age. After 20 years, it drops about 2 per cent, per decade.

34
4. Weight. The heavier your weight, the higher your BMR. Example: the metabolic rate
of obese women is 25 percent higher than the metabolic rate of thin women.
5. Body Surface Area. This is a reflection of your height and weight. The greater your
Body Surface Area factor, the higher your BMR. Tall, thin people have higher BMRs. If
you compare a tall person with a short person of equal weight, then if they both follow a
diet calorie-controlled to maintain the weight of the taller person, the shorter person may
gain up to 15 pounds in a year.
6. Body Fat Percentage. The lower your body fat percentage, the higher your BMR.
The lower body fat percentage in the male body is one reason why men generally have
a 10-15% faster BMR than women.
7. Diet. Starvation or serious abrupt calorie-reduction can dramatically reduce BMR by
up to 30 percent.Restrictive low-calorie weight loss diets may cause your BMR to drop
as much as 20%.
8. Sleep – BMR falls 10-15% below waking levels.
9. Endocrine Glands – male sex hormones increase the BMR 10-15%
10. Fever – increase 7% for each degree rise the body temperature above 98.6 F
COMPUTATION:
1. BMR = Wt. in lbs. X 10.9 (male)
9.8 (female)
Example : 125 lbs. x 9.8 = 1,225 Cal.
2. BMI = Is a measure of body fat based on height and weight
BMI = weight (kg) = 47 kg_____ = 47 kg. = 20.25 = 20kg/m₂
(Normal)
( ht. meters)₂ (1.524)(1.524) 2.32

35
3. DBW
A . (TANHAUSSER’S METHOD) FOR ADULT
DBW = ( Ht. cm – 100 ) – 10%
Ex. 5‘3“ = (63 inches x 2.54) = (160.02 – 100) = (60.02- 6.002 [10%]) = 54 kg.
Note: (+ / -) 10% of the value within the range of DBW
B.Infants: (0-6 months)
a) DBW = birth weight (gms)+(age in mons.x 600)
Note: if the weight is not known, use 3000 gms.
Example: 4 month old infant
DBW = 3000 + (4 x 600)
= 3000 + 2400
= 5400 gms or 5.4 kg.
b) DBW = (age in months ÷ 2) + 3
Ex: DBW = (4÷2) + 3 = 2 + 3
= 5 kg.
DBW (Children) =( No. of yrs. X 2) + 8
Ex. 7 yr. old 1st
grader
DBW= (7x2)+8 = 14+8
= 22 kg.
4. TER = DBW x activity level
Ex. 5’3” student = 54 x 35 = 1,890 Cal.
1) Infants= DBW x 120 Cals./Kg.
Ex. 4 month old infant
TER = 5.4 kg. x 120 Cals/kg = 648 or 650 Cals.

36
2) Children = 1000 + (100 x age in yrs.)
Ex. 7 yr. old child
TER = 1000 + (100 x 7)
= 1000 + 700
= 1700 Cals.
2) Adult = DBW x activity level
Ex. 5’3” student = 54 x 35 = 1,890 Cal.
CONVERSION:
HT. WT.
1 ft. = 12 inches 1 kg. = 2.2 lbs
1 inch = 2.54 cm
100 cm = 1 meter
ACTIVITY LEVEL :
Bed rest = 27.5 (hospital patients)
Sedentary = 30 (secretary, clerk, typist administrator, cashier, bank teller)
Light = 35 ( teacher, nurse, student, Lab.Tech, house wife with maid)
Moderate = 40 ( housewife w/o a maid, vendor, mechanic, jeepney & car
driver)
Heavy = 45 ( farmer, laborer, cargador, laborer, coal miner, fisherman, heavy
eqpt.optr )
BMI LEVEL:
Obese = above 30
Overweight = 27-30
Normal = 18.5 – 27
Under weight = below 18

37
Reference:
According to WHO (2014 retrieved from http://apps.who.int/bmi/index.jsp?introPage=intro_3.html)
According to Caudal, Maria Lourdes C. , RND Basic Nutrition and Diet Therapy Revised Edition page 10-
11
4. DIET PRESCRIPTION:
Step 1 : Get the DBW of the patient
Step 2 : Compute his/her TER (based on his occupation/activity)
Step 3 : Identify his percentage requirement (based on his/her health
condition or dietary
Requirement
Step 4: Distribution of TER on CHO, PRO, FATS
TER x % CHO
TER x % PRO
TER x % FAT
Percentage Distribution
CHO 50-70%
60% (average)
PRO 10% (infant/children)
10-15% (adolescent/adult)
FAT 20-25% (adult)
30-35% (children)
Step 5 : Gram distribution
% CHO / 4 (fuel value) = ____gm.

38
%PRO / 4 (fuel value) = ____ gm.
% FAT / 9 (fuel value) = _____ gm.
Step 5 : Meal Distribution
COMPOSITION OF FOOD EXCHANGE LIST
LIST FOOD MEASURE CHO PRO FAT CAL
IA
IB
Veg A
Veg B
1 c. raw, ½ c
cooked
½ c raw & cooked
-
3
- - 16
II Fruit varies 10 - - 40
III Milk
Full Cream
Low Fat
Skimmed
Varies
4 tablespoon
4 tablespoon
12
12
12
8
8
8
10
5
-
170
125
80
IV Rice Varies 23 2 - 100
V Meat
Low Fat
Medium Fat
High Fat
Varies -
-
-
8
8
8
1
6
19
41
86
122
VI Fat 1 tsp. - - 5 45
VII Sugar 1 teaspoon 5 - - 20
FOOD DISTRIBUTION
Example: 336g 84 g. 63 g. 2,240
LIST FOOD MEASURE CHO PRO FAT CAL
IA Veg A 3 - - - 48

39
IB Veg B 3 9
II Fruit 5 50 - - 200
III Milk 1 12
Sub: 71
(336-
71)=265
265/23 = 11
8 5 125
IV Rice 10 230 20
Sub : 28
(84-
28)=56
(56/8)=
7
1000
V Meat 7 56 42
Sub: 47
(63-
47)=16
(16/5)=3
602
VI Fat 3 15 135
VII Sugar 4 40 80
341 84 62 2,190
MEAL DISTRIBUTION
FOOD BFAST LUNCH DINNER AM SNACK PM SNACK
Veg A
Veg B
1
1
1
1
1
1
FRUIT 1 1 1 1 1
MILK 1
RICE 2 2 2 2 2

40
MEAT 2 1 1 1 1
FAT 1 1 1
SUGAR 1 1 1 1
NUTRITIONAL ASSESSMENT
What is Nutritional Assessment?
is an in-depth evaluation of both objective and subjective data related to an
individual's food and nutrient intake, lifestyle, and medical history.
Aims of Nutritional Assessment
1. To identify certain specific nutritional problem.
2. To map out magnitude and geographical distribution of malnutrition
3. To determine ecological factors responsible for malnutrition.
Methods of Assessment:
Direct Assessment – based on physical sign
a) Diet History – This method evaluates the primary factor of nutritional
inadequacy.
b) Physical Method or Anthropometric– Taking weight & height data
c) Medical History – record of the person’s
past illnesses
d) Clinical Examination – physical signs associated with malnutrition
e) Biochemical Tests – blood plasma, tissue biopsy, urinalysis
B. Indirect Assessment – use of data, statistics and other information. Includes
food consumption, eating practices

41
1) Vital Statistics -
a) age specific mortality – no. of death/age and sex group
ave. population of the same age
b) Infant Mortality Rate – no. of deaths below 1 yr.
over the number of live births
c) Maternal Morality Rate – no. of deaths among women due to pregnancy,
labor / total live birth
d) Morbidity Rate – no. of reported cases of a given disease present at a given
time per 100,000 population
2. Conditioning infections – diarrhea, measles, tb
3. Food Balance Sheet – rough estimate of food supplies
available for consumption
4. Dietary Survey – 24 hr. food recall
5. Cultural and anthropological influences
6. Socio economic factors- population, family, education
7. Food production -
8. Health and educational services
Methods of Assessing Dietary Intake:
1. 24 Hr. Recall – recall of all what he/she had eaten within 24 hrs.
2. Food Frequency Questionnaire
3. Diet History
- It is more complete than the two previous method. It contains the following:
 Economic ( income, amount of money for food)
 Physical Activity (occupation, exercise, sleep)
 Ethnic & Cultural Background (religion, educ)
 Home life & Meal Patterns (no.per household,
person who does the cooking, type of house)

42
 Appetite (good, poor)
 allergies, intolerances, food avoidance
 Dental/Oral health
 Gastrointestinal ( heartburn, diarrhea, constipation)
 Chronic Diseases
 Medication
4. Food Diary - The subject is asked to write down everything that he eats for
a certain time. It could be 3 days, two weeks
5. Observation of food intake – most accurate but most time consuming.
It requires knowing the amount and kind of food presented and the record
of the amount actually eaten.
MALNUTRITION
Malnutrition – It is the condition of the body resulting from a lack of one or more
essential nutrients or due to excessive nutrient supply.
Reference:
2 Conditions of Nutritional Status
1) Optimum or Good Nutrition – body has adequate supply of essential nutrients
for growth & health
2) Malnutrition – A condition of the body resulting from a lack of one or more
nutrients or it may be due to an excessive nutrient supply creating toxic or harmful
effects
Forms of Malnutrition
1. Under nutrition – resulting fro inadequate quantity of food, over an extended
period of time (kwashirkor, marasmus)

43
2. Specific Deficiency – resulting from a relative or absolute lack of an individual
nutrient ( iron deficiency)
3. Over nutrition – resulting from the consumption of an excessive quantity of food,
calorie excess (obesity)
4. Imbalance – resulting from a disproportion among essential nutrients, with or
with out absolute deficiency of any nutrient.
Types of Malnutrition
1. Acute Malnutrition- related to present state nutrition
ex. Loss of weight
2. Chronic Malnutrition – related to the past state of nutrition
3. Primary Malnutrition – caused by lack or unavailability of food (dietary
malnutrition)
4. Secondary Malnutrition – caused by certain conditioning factors other than
food alone
Nutritional Deficiencies
1) Primary Factor- refers to faulty diet
a. Poverty
b. Ignorance
c. Poor food Habits
d. Limited food supply
e. Poor distribution of foods
f. Cultural Taboos
g. Low level of education
h. Urbanization
i. Infectious diseases / parasitism
2. Secondary Factors:
a) Interfere with normal digestion

44
1. Gastrointestinal disorder
2. Lack of appetite
3. Poor teeth
4. Lack of digestive enzymes
b) Factors that interfere with absorption
1. Diarrhea
2. Mal absorption Syndrome
3. Intestinal Surgery
4. Laxative
5. Parasitism
Factors that affect metabolism & utilization in the cells
1) Liver diseases
2) Malignancy
3) Some drugs
4) Alcoholism
5) Toxins
6) Diabetes Mellitus
Pathogenesis of Nutritional Deficiency
Primary (Dietary)
Nutritional inadequacy tissue depletion (loss of weight)
biochemical changes (laboratory)
functional symptoms ( symptoms appear)
anatomical lesions (physical signs )

45
Effects of Malnutrition
1. Increase susceptibility to infections
2. Inhibits mental development
3. Imposes heavy social and economic burdens
Prevention &Treatment of Malnutrition
Prevention:
1) Increase economic stability
2) Educate the people
3) Practice good sanitation and hygiene
4) Increase food production
5) Eat balance diet
6) Exercise
7) Social Awareness ( thin is not “in”)
FOOD & DRUG INTERACTION
Introduction
Medications, both prescription and over-the-counter, are used every day to treat acute
and chronic illness. Research and technology constantly improve the drugs we have
available and introduce new ones. Medications can help people live healthy lives for a
prolonged period. Although medicines are prescribed often, it is important to realize that
they must still be used with caution.
Foods, and the nutrients they contain, can interact with medications we take. This can
cause unwanted effects. A food/drug interaction occurs when a food, or one of its
components, interferes with the way a drug is used in the body. A drug/nutrient
interaction occurs when a drug affects the use of a nutrient in the body.

46
Risk Factors
Risk for food/drug and drug/nutrient interactions can be affected by many factors such
as:
 age
 gender
 medical history
 body composition
 nutritional status
 number of medications used
How Drugs React in the Body
In order to understand food/drug and drug/nutrient interactions, it's important to
understand how drugs work in the body. There are four stages of drug action for
medicines taken by mouth:
Stage 1. The drug dissolves into a useable form in the stomach.
Stage 2. The drug is absorbed into the blood and transported to its site of action.
Stage 3. The body responds to the drug and the drug performs a function.
Stage 4. The drug is excreted from the body either by the kidney or the liver, or both.
Not all medications are taken by mouth. Still, they are all transported to the site of
action. Effects of drug/nutrient and food/drug interactions vary according to:
 type of medication
 form of drug (pill, liquid, etc.)
 dosage
 site of absorption (mouth, stomach, intestine)
 route of administration (oral, intravenous, etc.).

47
Definitions
Absorption: the passage of substances from the GI tract into the blood.
Excretion: removal of drugs or nutrients from the body.
Intravenous: within the blood.
Nutritional status: nutrition-related health.
Transport: movement of a substance from one site in the body to another.
Food/Drug Interactions
Foods can interfere with the stages of drug action in a number of ways. The most
common effect is for foods to interfere with drug absorption. This can make a drug less
effective because less gets into the blood and to the site of action. Second, nutrients or
other chemicals in foods can affect how a drug is used in the body. Third, excretion of
drugs from the body may be affected by foods, nutrients, or other substances.
With some drugs, it's important to avoid taking food and medication together because
the food can make the drug less effective. For other drugs, it may be good to take the
drug with food to prevent stomach irritation.
Alcohol can affect many medications. Always check with your pharmacist about
possible effects of alcohol on your medication.
Grapefruit Juice and Drugs
Grapefruit juice contains a compound that increases the absorption of some drugs. This
can enhance their effects. This compound is not found in other citrus juices.
It's best to not take medications with grapefruit juice. Drink it at least two hours away
from when you take your medication. If you often drink grapefruit juice, talk with your
pharmacist or doctor before changing your routine.
Drug/Nutrient Interactions

48
It is also possible for drugs to interfere with a person's nutritional status. Some drugs
interfere with the absorption of a nutrient. Other drugs affect the body's use and/or
excretion of nutrients, especially vitamins and minerals. If less of a nutrient is available
to the body because of these effects, this may lead to a nutrient deficiency.
Sometimes drugs affect nutritional status by increasing or decreasing appetite. This
affects the amount of food (and nutrients) consumed. Some specific examples of
drug/nutrient interactions are given in Table 2.
The Different Groups of Medicines
Drugs are grouped into classes based on illnesses for which they are prescribed. They
can also be grouped in other ways, such as their chemical make-up or actions in the
body. Different foods can interact with more than one class of drugs.
Table 3 is a list of 14 drug classes and the uses for each. If you take medication in one
of these classes, be aware of potential food/drug and drug/ nutrient interactions. If you
aren't sure which classes your medicines fall into, ask your doctor or pharmacist.
Analgesic
Analgesics are drugs that relieve pain. Analgesics often cause stomach irritation. It's a
good idea to take analgesics, like aspirin, with food. A full stomach lowers the risk for
stomach irritation.
Antacid, Acid Blocker
Antacids neutralize stomach acid, and acid blockers reduce stomach acid production.
Long term use of these drugs may lead to certain nutrient deficiencies. This is because
stomach acid is important in the digestion and/or absorption of nutrients.
Older people produce less stomach acid, which leads to low absorption of vitamin B 12 .
Regular use of antacids or acid blockers lowers vitamin B 12 absorption even more.
Vitamin B 12 supplements may be needed in this situation.

49
Antibiotic
Antibiotics are used to treat bacterial infections. There are many different types of
antibiotics. Some antibiotics decrease the synthesis of vitamin K by the bacteria
normally found in our intestines. Vitamin K is important for normal blood clotting.
Tetracycline antibiotics bind to calcium found in dairy products. This can decrease the
absorption of the antibiotic.
Other drugs like penicillin and erythromycin are most effective when taken on an
empty stomach. This is because they may be partially destroyed by stomach acid when
taken with food. However, food can reduce the chance of stomach irritation from these
drugs. Ask your pharmacist if you should take your antibiotic with or without food.
Anticoagulant
Anticoagulants slow the process of blood clotting. This can decrease risk of strokes in
patients whose blood tends to clot too easily. These drugs, like warfarin (Coumadin),
work by interfering with the use of vitamin K in blood clotting.
People taking these anticoagulants should be consistent in the amount of vitamin K they
get from foods. It's very important to avoid eating large amounts of foods high in vitamin
K. Rich sources of vitamin K include liver, and green vegetables such as broccoli,
spinach, and other leafy greens.
Anticonvulsant
Anticonvulsant drugs help control seizures. Phenytoin (Dilantin), phenobarbital, and
primidone may cause diarrhea and a decrease in appetite. This can decrease the
availability of many nutrients.
These drugs also increase the use of vitamin D in the body. This means that less
vitamin D is available for important functions such as calcium absorption. Vitamin D
supplements may be needed.

50
Some anticonvulsants also interact with the B vitamin folic acid. When drug therapy is
started, folic acid levels in the body decrease. Because folic acid supplements affect
blood levels of the drug, folate supplementation must be supervised by a doctor.
Antihistamine
Antihistamines are used to treat allergies. Many of these drugs often cause drowsiness.
They may also increase the appetite, which can lead to weight gain. Increased physical
activity can help reduce weight gain. Alcohol can cause an even greater increase in
drowsiness caused by antihistamines like diphenhydramine (Benadryl),
chlorpheniramine (Chlor-Trimeton), and other over-the-counter drugs containing
antihistamines.
Anti-inflammatory
Anti-inflammatory medication is prescribed to patients for a number of problems such as
chronic joint pain, headaches, and arthritis. Long-term use may lead to stomach
irritation and eventually ulcers. These medications should be taken with food.
Blood Pressure Lowering Drugs
Antihypertensives are used to control high blood pressure. This group of medications is
widely used throughout the United States due to the large number of people with high
blood pressure.
These medications can affect body levels of minerals such as potassium, calcium, and
zinc. For patients with diabetes, these drugs can cause problems in controlling blood
sugar. In addition, natural licorice, found in some imported candies, causes salt and
water retention. This can lead to an increase in blood pressure.

51
Cancer Drugs
Antineoplastic agents are used to treat different forms of cancer. These drugs can
irritate the cells lining the mouth, stomach, and intestines. Many cause nausea,
vomiting, and/or diarrhea. All of these can affect nutrient status.
Methotrexate reduces availability of the B vitamin folic acid. Supplementation of folate
may be recommended for people taking this drug, but ask your doctor before starting
folic acid.
Diuretic
Diuretics cause the body to excrete more urine and are often used to treat high blood
pressure. Some diuretics increase urine losses of minerals such as potassium,
magnesium, and calcium. Others limit mineral loss (especially potassium). It is
important to talk with your doctor about whether you need to take or avoid mineral
supplements.
Laxative
Laxatives speed up the movement of materials through the digestive tract. This reduces
the time for nutrient absorption. Excessive use of laxatives can deplete vitamins and
minerals needed for normal body function. Laxatives also increase fluid losses. This
may lead to dehydration.
Lipid Lowering Drugs
Lipid lowering drugs, also called Antihyperlipemic drugs, reduce blood cholesterol
levels. Medications such as cholestyramine (Questran) may decrease the absorption
of the fat soluble vitamins (A, D, E, and K), vitamin B 12 , folic acid, and calcium. For
long-term use, it may be helpful to take a multivitamin and a calcium supplement.

52
Mental Health Drugs
Psychotherapeutic drugs treat depression, anxiety, and other mental health conditions.
Some of these drugs increase appetite while others decrease it. Either effect can impact
weight in a significant way.
Avoid alcohol when using these drugs. Alcohol can intensify the drowsiness caused by
this class of drugs. Some psychotherapeutic drugs are Monoamine Oxidase (MAO)
inhibitors.
MAO Inhibitors
These drugs decrease the body's use of compounds called monoamines. MAO
inhibitors can also react with tyramine (a monoamine) found in foods. This reaction can
cause a dangerous rise in blood pressure. If not treated, this can cause death. Some
aged and fermented foods are high in tyramine. They should be avoided by people
taking MAO inhibitors. A few of these foods are:
 aged cheese
 Brewer's yeast, yeast extracts
 Chianti wine
 pickled herring
 fava beans
If you are not sure if you are taking a MOA inhibitor, ask your doctor or pharmacist.
Things to Keep in Mind
As you probably know, there are a wide variety of medications on the market today.
Almost all medications have the potential to cause side effects. Many people take more
than one medication. This is especially true with older people. When people take
multiple medications, food and drug interactions are more likely to occur. The following
tips can help you avoid problems with your medication.

53
 Always carry a list of all your medications and the dosing instructions.
 When your doctor prescribes a new medication, tell him/her all the other drugs
you already take. This includes over-the-counter drugs and supplements that you
use regularly. Also, remind your doctor about any drug allergies you have.
 Know how and when to take all of your medications. If you have any questions,
ask your doctor or pharmacist.
 If you have any side effects from a medication, contact your doctor or pharmacist
immediately. Do not wait until your next appointment. If you are not sure if symptoms
are related to your medication, be sure to ask.
 It is usually best to take medication with a full glass of water. This may help to
prevent stomach irritation and improve absorption. Don't take medications with soft
drinks or grapefruit juice.
 Get your prescription refilled before you run out so that there are no missed
doses.
 Don't stir your medication into food or drink unless your doctor or pharmacist tells
you to. Certain foods may break down the drug, or limit its absorption.
 Always read the directions and warning labels on your medication bottles and
packages. If you don't understand something, ask your doctor or pharmacist.
Table 1.
Table 1: Examples of Food/Drug Interactions
Drug Class Food that Interacts
Effect of the
Food
What to Do
Analgesic
acetaminophen
(Tylenol)
Alcohol
Increases risk for
liver toxicity
Avoid alcohol
Antibiotic
→tetracyclines
→Dairy products; iron
supplements
→Decreases
drug absorption
→Decreases
→Do not take with
milk. Take 1 hour
before or 2 hours

54
→amoxicillin, penicillin,
zithromax,
erythromycin
→nitrofurantoin
(Macrobid)
→Food
→Food
drug absorption
→Decreases GI
distress, slows
drug absorption
after food/milk.
→Take 1 hour before
or 2 hours after
meals.
→Take with food or
milk.
Anticoagulant
warfarin (Coumadin)
Foods rich in Vitamin
K
Decreases drug
effectiveness
Limit foods high in
Vitamin K: liver,
broccoli, spinach,
kale, cauliflower, and
Brussels sprouts
Anticonvulsant
phenobarbital,
primidone
Alcohol
Causes
increased
drowsiness
Avoid alcohol
Vitamin C
Decrease in drug
effectiveness
Avoid excess vitamin
C
Antifungal
griseofulvin (Fulvicin)
High-fat meal
Increases drug
absorption
Take with high-fat
meal
Antihistamine
diphenhydramine
(Benadryl),
chlorpheniramine
(Chlor-Trimeton)
Alcohol
Increased
drowsiness
Avoid alcohol
Antihyperlipemic
lovastatin (Mevacor)
Food
Enhances drug
absorption
Take with food
Antihypertensive
felodipine (Plendil),
nifedipine
Grapefruit juice
Increases drug
absorption
Consult your
physician or
Pharmacist before

55
changing diet.
Anti-inflammatory
naproxen (Naprosyn),
ibuprofen (Motrin)
→Food or milk
→Decreases GI
irritation
→Take with food or
milk
→Alcohol
→Increases risk
for liver
→Damage or
stomach
bleeding
→Avoid alcohol
Diuretic
spironolactone
(Aldactone)
Food
Decreases GI
irritation
Take with food
Psychotherapeutic
MAO inhibitors:
isocarboxazid
(Marplan),
tranylcypromine
(Parnate),
phenelzine (Nardil)
Foods high in
tyramine: aged
cheeses, Chianti wine,
pickled herring,
Brewer's yeast, fava
beans
Risk for
hypertensive
crisis
Avoid foods high in
tyramine

56
Table 2: Examples of Drug/Nutrient Interactions
Drug Class
Food that
Interacts
Effect of the
Food
What to Do
Acid Blocker
ranitidine (Zantac),
cimetidine (Tagamet),
famotidine (Pepcid),
nizatidine (Axid)
Vitamin B12
Decrease vitamin
absorption
Consult your physician
regarding B12 supplementation
Antihyperlipemic
cholestyramine
(Questran),
colestipol (Colestid)
Fat soluble
vitamins
(A, D, E, K)
Decreases
vitamin
absorption
Include rich sources of these
vitamins in the diet
Antineoplastic
methotrexate
Folic acid,
vitamin B12
Decreases
vitamin
absorption
regarding supplementation
Diuretic
furosemide (Lasix),
hydrochlorothiazide
(HCTZ)
Many
minerals
Increases mineral
loss in urine
Include fresh fruits and
vegetables in the diet
Laxative
fibercon, Mitrolan
Vitamins and
minerals
Decreases
nutrient
absorption
regarding supplementation
Table 3: Examples of drug classes and their uses.
Class Used to treat...
Analgesic Pain
Antacid, Acid Blocker Stomach upset, ulcers
Antibiotic Infection
Anticoagulant Blood clots
Anticonvulsant Seizures, epilepsy

57
Antihistamine Allergies
Antihyperlipemic High blood cholesterol
Antihypertensive High blood pressure
Anti-inflammatory Fever, inflammation
Antineoplastic Cancer
Diuretic Water retention
Laxative Constipation
Psychotherapeutic Depression, anxiety
NUTRITION IN THE LIFE CYCLE
PREGNANCY
• Pregnancy – (Gestation) is a
period when the fertilized ovum
implants itself in the uterus.
Human pregnancy last for the
period of 266 – 180 days ( 37-
40 weeks)
BIOLOGICAL CHANGES:
• 1. Implantation Period – 1st
2
weeks
• Period of organ formation- next
6 weeks
• Period of rapid fetal
development – remaining 7
months

58
Nutrition in Pregnancy:
• During the total pregnancy period, the basal metabolic rate increase from 6-
14%
• Calorie intake is increased – 10-20% increase ( if the woman is overweight it is
necessary for her o reduce)
• Protein - Increase in nitrogen content of the fetus and its membranes and added
protection of the mother against complications
• Increase of 9.5 gms./ day
• Calcium / Phosphorus / Vit. D – Increase , to calcify the fetal bones & teeth
(0.5 – 0.9 of the RDA)
• Iron – Increase, 700-1000 mg. of Fe is absorbed during the pregnancy
• Iodine – to help the mother and the child prevent goiter in the future and for brain
development
• Folic Acid - women of childbearing age consume 400 micrograms (0.4 mg) of
folic acid each day. Folic acid, a nutrient found in some green, leafy vegetables,
most berries, nuts, beans, citrus fruits, fortified breakfast cereals, and some
vitamin supplements can help reduce the risk of birth defects of the brain and
spinal cord (called neural tube defects).
Dangerous for pregnant women
• Alcohol, Caffeine & Nicotine –
• Smoking – lowers the birth weight, increase the perinatal mortality, decrease
oxygenation of the fetus
• Alcohol – mental retardation, growth deficiencies, facial deformities.

59
LACTATION
Factors Affecting Milk Secretion
1)Diet – intake of meat & veg. soup (tahong, tulya, malunggay) “galactogue”
• Stimulate milk secretion
• Water should not be drunk beyond the level of natural thirst. It suppress milk
secretion
2. Nutritional State of Mother – Malnutrition and illnesses (cardiac and kidney
diseases, anemia, beri-beri, tuberculosis) can lessen the quanity and quality of
milk
• Emotional & Physical State – relax, pleasant surroundings, lots of rest and good
sleep
• Suckling - suckling right after delivery stimulate milk secretion
• Contraceptives & Drugs – depress milk flow
Advantages of Breast Feeding
COLOSTRUM – thin yellowish fluid secreted during the first 2 days
1. Breast milk produces anti bodies, immunity against diseases
2.Lactose is higher in breast milk, to produce beneficial bacteria in the GI tract.
• Calories – additional 1000 calories –
help to produce milk
• Protein – additional of 20 gms. , to
compensate the protein lost in milk
• Calcium & Phosphorous – Increase of
0.5 mg., to prevent severe depletion
of maternal calcium for milk
production
• Iron – additional intake is
recommended for blood lost
• Vit. A – additional 2000 IU, needed in
the ilk secretion
• Riboflavin, Vit. C – increase
Fluids – 8 glasses or more

60
3.Calcium and Phosphorus level are regulated
4. Prevent dental arch
5.Cow’s milk protein causes allergy
6. Less incidence of lung cancer
7. Fast return of the uterus to its original size
8. Biologically complete
9. Easily digested
10. Convenient and dependable
11. Safe
12. Emotional satisfaction between mother & child
INFANCY
• Growth – increase in size due to increase in the number of cells
• Development – increase in functional ability
• Behavioral Development of a Healthy Baby
0-1 month suckles & smiles
2-3 months vocalize & controls head
4-5 months controls hands & rolls over
6-7 months sits briefly & crawls
8-9 months grasps & pulls up
10-11 months walks with support
12 months stars to walk alone
Methods of Feeding the Infant:
1) Breast Feeding
2) Artificial Feeding – bottle feeding using infant formula
3)Mixed Feeding – combination of breast & bottle
Milk Formula:

61
A) Whole Cows Milk Formula
1. Powdered whole cow’s milk – milk dried under controlled condition
(Nido, Birch Tree, Anchor Mik)
2. Full Cream evaporated Milk – whole milk from which 50-60% of water
content has been removed
3. Recombined milk – skim milk powder reconstituted to normal fat content of
the whole milk by adding butterfat
4.Reconstituted milk – process milk to which water is added to restore its
original water content (Frisian Girl, Alpine)
B) Other type of evaporated milk not recommended for infants
1. Sweetened condensed – High in sugar resulting in very diluted milk formula
2. Evaporated Filled Milk – cow’s milk from which butterfat has been
removed
and replaced with vegetable oil
(94% coconut oil, 6% corn oil)
3. Skim Milk – butter fat has been removed (Enfamil, Olac)
4.Acidified Milk – increase digestibility ( Pelargon, Acidolac)
5.Completely Modified Milk Formula – Protein & mineral content are adjusted
to resemble human milk (SMA, S-26, Similac)
6. Non- cows Milk formula – Soybase for infant’s allergy to cow’s milk ( Sobee,
Mullsoy, Isomil)
Note: goat’s milk has also been found effective as hypo allergenic milk
Baby’s Food During the 1st Year of Life:
1. Cereal Foods – (3-4 months), milk is still continued
2. Fruits – (3-4 months) , mashed
3. Vegetables – (3-4 months) , mashed (carrots, squash, sayote,) green leafy
vegetables may be mashed and sieved and mix with other foods.

62
4. Eggs –( 4- 5 months) , only eggyolk is given
5. ( 9-10 months) , can give the whole egg
6. Munggo – ( 5 months) cooked well and strained
7. Meat, fish or Poultry – ( 5-6 months) , ground and strained
8. Other Foods – custards, puddings, plain ice cream, plain gulaman or jello
HOW TO GIVE SUPPLEMENTARY FOODS
• Introduce one food at a time
• Give small amounts of foods
• Use thin, soft consistency. Gradually, modify the consistency
• Never force an infant to eat more of a food he can takes
• Omit the food if the infant refuse to eat several times
• slightly seasoned with small amt. of salt
• Variety of foods is important
• don’t show any dislikes for the food
Reference:
Basic Nutrition and Diet Theraphy. Textbook for Nursing Students. Pages 154 - 172
Author: Maria Lourdes C. Caudal, RND
NUTRITION FOR PRE-SCHOOL
• This is the most difficult stage in feeding a child since the appetite tapers off
corresponding to the lower rate of growth.
Foods to Give the Pre-School Child:
1) Mildly flavored foods
2) Plain foods is acceptable than mixed foods.
3) Fruits, puddings, custard, ice cream and gelatin may be given

63
Sign of Good Nutrition in Pre-School Child
– Alert, vigorous and happy
– Endurance during activities
– sleeps well
– Normal height and weight for age
– Stands erect, arms and legs straight
– Clear, bright eyes, smooth healthy skin, lustrous hair
– Firm and well developed muscles
– Not irritable and restless
– Good attention
NUTRITION FOR SCHOOL CHILD
Feeding Problems
Limited time for eating
Poor Eating practices
Unbalance program of activities & rest
Recommended Solutions:
allow sufficient time for meals
Encourage child to eat more fruits & vegetables
Provide child with properly selected snacks
Regulate the activities
Guidance in proper food selection
NUTRITION FOR ADOLESCENTS
The best nutrition advise to keep your adolescent healthy includes encouraging
her to:
• Eat a variety of foods
• Balance the food you eat with physical activity
• Choose a diet with plenty of grain products, vegetables and fruits
• Choose a diet low in fat, saturated fat, and cholesterol

64
• Choose a diet moderate in sugars and salt
• Choose a diet that provides enough calcium and iron to meet their growing
body's requirements.
NUTRITION IN THE ELDERLY
Nutritional Requirements:
• Energy (calories) – decreases in calories because of reduced basal metabolic
rate and reduce in physical activities. A decrease of 7.5% intake after 45 yrs. Of
age
• Protein – Protein allowance of 1.12 gms./kg. body weight is maintained
• Necessary for the prevention and tissue wasting and susceptibility to diseases
• Minerals (Calcium) – is maintained to prevent occurrence of osteoporosis
• Iron – Iron allowand for women 50 and above is as low as 7.0 mg/day
• Vitamins – Vit. C is needed for the absorption of calcium and iron. Intake of Vit. E
to retard cellular aging.
• B complex – to maintain good appetite
• Water & Fiber – 6-8 glasses a day. To prevent constipation
FACTORS AFFECTING ADEQUATE FEEDING
• Long standing dietary habits
• Loss of teeth
• Loss of taste and smell
• Loss of neuromuscular coordination
• Physical discomfort
• Economic consideration
• Social Factors
• Psychological factors
Diet Recommendation

65
1. Eat good breakfast to start the day
2. Eat 4-5 light meals a day
3. Include essential foods (fish, vegetables, fruits)
4. Eat leisurely in pleasant surroundings
5. Eat the heaviest at noon
6. Avoid fatty foods
7. Avoid coffee
8. Drink hot milk before going to bed
Reference:
DIET THERAPY
Purpose of Diet Therapy:
1. To maintain or restore good nutritional status
2. To correct nutritional deficiencies which may occurred
3. To afford rest to a particular organ
4. To adjust the diet to the ability of the body to metabolize the nutrients
5. To bring about the changes in the body weight
Hospital Routine Diet:
1. Full, general or regular diet – designed for patients who require no special dietary
modifications or restrictions.
2. Soft Diet – patients who are unable to chew, swallow or digest foods
3. Liquid Diet – Clear, full, cold, osterized, blenderized or tube feeding

66
REGULAR DIET
 A regular diet is a meal plan that includes a variety of foods from all of the food
groups listed below. A healthy meal plan is low in unhealthy fats, salt, and added
sugar.
 A healthy meal plan may reduce your risk of heart disease, osteoporosis (brittle
bones), and some types of cancer.
Fruits and vegetables
 Half of your plate should contain fruits and vegetables.
Fruits: Choose fresh, canned, or dried fruit instead of fruit juice as often as possible.
 Vegetables: Eat more dark green, red, and orange vegetables. Dark green
vegetables include broccoli, spinach, romaine lettuce, and collard greens.
Examples of orange and red vegetables are carrots, sweet potatoes, winter
squash, oranges, and red peppers.ce as often as possible.
 Grains:Half of the grains you eat each day should be whole grains.
 Dairy Foods: Choose fat-free or low-fat dairy foods.
 1½ ounces of hard cheese (mozzarella, Swiss, cheddar)
 1 cup (8 ounces) of low-fat or fat-free milk or yogurt

67
 1 cup of low-fat frozen yogurt or pudding
 Meat and other protein sources: Choose lean meats and poultry. Bake, broil, and
grill meat instead of frying it. Include a variety of seafood in place of some meat
and poultry each week. Eat a variety of protein foods.
 Fats: Limit saturated fats, trans fats, and cholesterol. These unhealthy fats are
found in shortening, butter, stick margarine, and animal fat. Choose healthy fats
such as polyunsaturated and monounsaturated fats
 What foods should I limit?
 Try to limit the following types of foods in each group whenever possible. They
are high in total fat, unhealthy fats, sugar, and calories.
 Breads and starches:
 Cookies, donuts, croissants, store-bought muffins, or other high-fat breads
 Fruits and vegetables:
 Fruit in pastries, ice cream, or rich desserts
 Fried vegetables such as French fries
 Vegetables made with cream sauces or topped with cheese
 Dairy foods:
 Cream and regular hard cheeses
 Regular and premium ice cream
 Whole milk, half and half, and regular eggnog
 Meat and other protein sources:
 Meats, seafood, or poultry that are fried or that are served with high-fat gravies
and sauces
 High-fat meats such as sausages, bacon, lunch meats, and organ meats
 Fats:
 Butter, stick margarine, lard, and shortening
 Visible fat on any meat, fish, or poultry

68
What other guidelines should I follow?
 Choose and prepare foods and drinks with less salt and added sugars. Use the
nutrition information on food labels to help you make healthy choices. The
percent daily value listed on the food label tells you whether a food is low or high
in certain nutrients. A percent daily value of 5% or less means that the food is low
in a nutrient. A percent daily value of 20% or more means that the food is high in
a nutrient.
 Get 2 hours and 30 minutes or more of physical activity each week, such as brisk
walking. Get 1 hour and 15 minutes of physical activity each week if the activity
requires a higher level of effort, such as running. Spread physical activity
throughout the week. Talk to your caregiver about the best exercise plan for you.
 Limit the amount of alcohol you drink. Alcohol can damage your brain, heart, and
liver. It can increase your risk of a stroke and high blood pressure. Women
should limit alcohol to 1 drink a day. Men should limit alcohol to 2 drinks a day. A
drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.
REGULAR DIET
The regular diet composed of all types of foods, is well balanced and capable of maintaining a state of
good nutrition. It is intended for convalescing patients who do not require a therapeutic diet.
MODIFIED OR THERAPEUTIC DIET
These diets are modifications of the regular diet designed to meet specific patient
needs. These include:
Soft
 Method of preparation (boiling or broiling)
 Consistency (ground or chopped)
 Total calories (high or low calorie diets)
 Nutrients (altering carbohydrate, protein, fat, vitamins, minerals)
 Allowing only specific foods (diabetic diet)

69
Soft
This diet is soft in texture and consists of liquids and semisolid foods. It is
indicated in certain postoperative cases, for convalescents who cannot tolerate a
regular diet, in acute illnesses, and in some gastrointestinal disorders. It is an
intermediate step between the liquid and regular diets. It is low in connective tissue and
indigestible dietary fiber. Little or no condiments are used in its preparation.
Soft diets include all liquids in addition to well-cooked cereals, pastas, white
bread and crackers, eggs, cottage cheese, tender meat, fish, poultry, and vegetables,
including baked, mashed, or scalloped potatoes. Foods not allowed include fried foods,
raw vegetables, and nuts. Desserts permitted are custards, gelatin puddings, soft fruits,
and simple cakes and cookies. Vegetables can be pureed and meats ground for dental
patients.
Liquid
This diet consists of foods that are in a liquid state at body temperature. It is
indicated in some post operative cases, in acute illnesses, and in inflammatory
conditions of the gastrointestinal(GI) tract. It is important that feedings consisting of 6 to
8 ounces or more be given every2 to 3 hours while the patient is awake. These diets are
usually ordered as clear, full, or dental liquid. A clear liquid diet includes clearbroths,
black tea or coffee, plain gelatin, and clear fruit juices (apple, grape, and cranberry),
popsicles, fruit drinks, and soft drinks. This diet is in-adequate in all nutrients. A full
liquid diet includes all the liquids served in a clear liquid diet, with the addition of
strained soups and broths, milk and milk drinks, ice cream, sherbet, puddings, and
custard. The all liquid diet is inadequate in iron, niacin, and possibly Vitamin A and
thiamin. A dental liquid diet includes foods slenderized and strained in liquid form and all
foods allowed on clear and full liquid diets. Vitamin and mineral supplements may be
necessary with the dental liquid diet if the recommended amounts of food are not
tolerated.
HIGH FIBER DIET
Eating a diet that is high in fiber has many potential health benefits, including a
decreased risk of heart disease, stroke, and type 2 diabetes. Because high-fiber foods
may be healthy for reasons other than their fiber content, the research has not always
been able to determine if fiber is the healthful component.

70
A high-fiber diet is a commonly recommended treatment for digestive problems, such as
constipation, diarrhea, and hemorrhoids, although individual results vary widely, and the
scientific evidence supporting these recommendations is weak.
Fiber is normally found in beans, grains, vegetables, and fruits. However, most people
do not eat as much fiber as is commonly recommended. This topic discusses what fiber
is, why it is helpful, and how to increase dietary fiber.
WHAT IS FIBER?
There is no single dietary "fiber." Traditionally, fiber was considered that substance
found in the outer layers of grains or plants and which was not digested in the
intestines. Wheat bran, the outer layer of wheat grain, fit this model. We now know that
"fiber" actually consists of a number of different substances. The term "dietary fiber"
includes all of these substances and is now considered a better term than just "fiber."
Most dietary fiber is not digested or absorbed, so it stays within the intestine where it
modulates digestion of other foods and affects the consistency of stool. There are two
types of fiber, each of which is thought to have its own benefits:
Soluble fiber consists of a group of substances that is made of carbohydrates and
dissolves in water. Examples of foods that contain soluble fiber include fruits, oats,
barley, and legumes (peas and beans).
Insoluble fiber comes from plant cells walls and does not dissolve in water. Examples of
foods that contain insoluble fiber include wheat, rye, and other grains. The traditional
fiber, wheat bran, is a type of insoluble fiber.
Dietary fiber is the sum of all soluble and insoluble fiber.
BENEFITS OF A HIGH-FIBER DIET
The health effects of a high-fiber may depend to some extent on the type of fiber
eaten. However, the difference between the health effects of two types of fiber are not
very clear and may vary between individuals, so many providers encourage adding fiber
in whatever way is easiest for the patient.
There are several potential benefits of eating a diet with high-fiber content:

71
 Insoluble fiber (wheat bran, and some fruits and vegetables) has been
recommended to treat digestive problems such as constipation, hemorrhoids,
chronic diarrhea, and fecal incontinence. Fiber bulks the stool, making it softer
and easier to pass. Fiber helps the stool pass regularly, although it is not a
laxative. Soluble fiber (psyllium, pectin, wheat dextrin, and oat products) can
reduce the risk of coronary artery disease and stroke by 40 to 50 percent
(compared to a low fiber diet)
 Soluble fiber can also reduce the risk of developing type 2 diabetes. In people
who have diabetes (type 1 and 2), soluble fiber can help to control blood glucose
levels.
 It is not clear if a high-fiber diet is beneficial for people with irritable bowel
syndrome or diverticulosis. Fiber may be helpful for some people with these
diagnoses while it may worsen symptoms in others.
HOW MUCH FIBER DO I NEED?
 The recommended amount of dietary fiber is 20 to 35 grams per day. By reading
the nutrition label on packaged foods, it is possible to determine the number of
grams of dietary fiber per serving
FIBER SIDE EFFECTS
 Adding fiber to the diet can have some side effects, such as abdominal bloating
or gas. This can sometimes be minimized by starting with a small amount and
slowly increasing until stools become softer and more frequent.
 However, many people, including those with irritable bowel syndrome, cannot
tolerate fiber supplements and do better by not increasing fiber in their diet.
VEGETARIAN DIET
 The term vegetarian generally means a person who does not consume animal
products; this includes land and sea animals. Most vegetarians generally do
consume eggs and dairy products (milk products).
 Somebody who does not consume any animal protein at all, not even eggs,
dairy, or honey, is a vegan. Some people call themselves vegetarians, but they
consume fish.

72
 Lacto-vegetarians - they consume dairy products, but no eggs. Most do consume
honey.
 Ovo-vegetarians - they consume eggs, but no dairy. Most do consume honey.
 Lacto-ovovegetarians - they consume eggs and dairy. Most do consume honey.
 Vegans - only consume plant-based foods (no dairy, eggs or honey)
Benefits of being a vegetarian?
 Have a lower body weight
 Have better cholesterol levels
 Live longer
 Have a lower risk of developing cancer
 Have a lower risk of developing several diseases
Therapeutic Diets
 Therapeutic Diets refer to diets indicated for the treatment of various medical and
surgical conditions e.g. the gluten-free diet used for the treatment of coeliac
disease.
1. Healthy Eating
 We provide a healthy eating menu which has been specifically modified for
people with diabetes or heart disease. A varied range of main meals and snacks
are available that are lower in total fat and sugar content.
2. Gluten-Free
 This menu provides meals suitable for people with coeliac disease. These dishes
do not contain wheat, rye, barley or oats. Suitable gluten free varieties of bread,
pasta and biscuits are readily available
3. Renal
 This diet is required for people with impaired kidney function. The person with
kidney disease may need to modify their intake of some or all of the following

73
dietary components – protein, salt, potassium and phosphate. The Renal Menu
caters for this diet in general but further individual education will be provided by
your dietitian
4. Modified Consistency
 These diets are generally required for people with difficulty swallowing, for
example, following a stroke. Puree and soft diets are available. Foods are
thickened with food thickener as/if necessary to ensure the correct consistency.
 If you have any other specific dietary requirements, for example, a milk-free diet
our catering department will be happy to provide suitable alternatives to help
meet your dietary needs.
References
http://www.health.com/health/gallery/0,,20553010,00.html
http://www.wisegeekhealth.com/what-is-diet-therapy.htm
http://www.allinahealth.org/mdex/ND7216G.HTM
Therapeutic Diet:
A. Modification in Consistency
Liquid Diet
1. Clear Liquid Diet
Indication : surgery, inflammatory on GI Tract, necessary to minimize
fecal material
Food Selection : clear, fat-free broths, strained juices, tea, black
coffee, gelatin, hard candies, give small amount every 1-2 hrs
2. Full Liquid Diet
Indication : Post operative, acute infection, impaired chewing and
swallowing, mouth
Surgery

74
Food Selection: strained cream soups, pureed fish and juices, plain
gelatin, plain ice cream, custard, milk & mild drinks, 6-8
frequent feeding.
3. Cold Liquid Diet
Indication : Tonsilectomy, dental extraction, throat & mouth operations
Food Selection : Plain ice creams, cold milk, iced tea, iced coffee
Soft Diet
Patients who are unable to chew, swallow or digest foods
1. Minimum Residue Diet
Indication : Dysentery, Diarrhea, Pre and post operation,
colostomy, ileostomy
Food Selection : plain, strained foods, lean, tender meats, chicken
no skin, soft cooked egg, strained vegetables
Avoided: milk, cheese, raw eggs, vegetables, fruits, coarse bread,
fried foods
2. Bland Diet
Indications: Gastric, Doudenal ulcers, gastritis, ulcer, cardiac cases
Food Selections: mild in flavor, no coarse fiber and tough connective
tissue
Avoided: Black pepper, chili powder, strong coffee, alcohol
3. Mechanical Soft
Indications : Poor dentures, lack of teeth, sores & lesions in the mouth
Spastic constipation, diverticulisis, other gastro-intestinal
disturbances
Food Selections : full diet but reduced amount (grinding, chopping,
mincing)

75
REFERENCES:
Jackson, Frank W. MD 2011 retrieved from http://gicare.com/diets/soft-and-mechanical-soft-diet/
http://www.surspc.com/complete%20fiber%20restricted%20diet%20plan%20-%20paoli.pdf
http://www.drugs.com/cg/low-fiber-diet.html
B.Modification in Composition
1. High Calorie Diet
Indications: Underweight, PEM, fevers, infections, hypertyroidism, burns,
growth,
pregnancy, lactation
Food Selections: Normal diet , increase amount of cereals, breads, butter,
cream , fats and sugar
Avoided: Excessive amount in bulky low calorie foods
2. Low Calorie Diet
Indications : Obesity, diabetes, renal failure, gout, gallbladder, preceding
surgery
Food Selections :Emphasize in bulk low in calorie for satisfied feeling
3. High Carbohydrates
Indications : renal & liver disturbances, toxemia of pregnancy, Addisons's
disease
Food Selections -Emphasize on rice and other cereals, root crops,
noodles, sugar, native cakes
4. Low Carbohydrates
Indications : Hyperinsulinism, dumping syndrome, obesity, epilepsy,
celiac disease
Food Selections : Foods high in protein, adequate to high fat foods, in
certain conditions

76
5. High Protein
Indications : Growth, pregnancy, malnutrition, lactation, burns, surgery,
fractures,
anemia, hepatitis, cirrhosis, hyperinsulinism
Food Selections : With emphasis on meat, milk, eggs, cheese, poultry
6. Low Protein
Indications : Acute glomerunephritis, uremia, hepatic coma
Food Selections : Avoided: protein foods in excess amounts, limit the
intake of legumes, nuts
7. Zero Protein
Reference:
https://www.scribd.com/doc/49747521/diet-modified-in-composition
TUBE FEEDING
Enteral & Parenteral Feeding
Parenteral feeding –
(Total Parenteral Nutrition)
describes the intravenous administration of nutrients.
• Designed for individuals who cannot accept nutrients enterally.
• The person receives nutritional formulas containing salts, glucose, amino
acids, lipids and added vitamins.

77
Method of Administering TPN
TPN is administered by:
1) Medical infusion pump
2) A sterile bag of nutrient solution
Performed through a central intravenous catheter, usually through the
subclavian jugular vein with the tip of the catheter at the superior vena cava
without entering the right atrium. Another common practice is to use a PICC
GENERAL USAGE
• Is provided when the
gastrointestinal tract is
nonfunctional.
• When the patient is comatose
• Patient’s digestive system has
shut down
• To treat people suffering the
extended consequences of an
accident, surgery, or digestive
disorder.

78
line, which originates in the arm, and extends to one of the central veins, such
as the subclavian with the tip in the superior vena cava. In infants, sometimes
the umbilical vein is used.
Complications:
1. Bacterial and fungal infections
2. Liver failure due to excess glucose contained
in the solution.
3. acute cholecystitis due to complete unusage of gastrointestinal tract
ENTERAL FEEDING:
Enteral Feeding – delivery of food and nutrients either orally or by tube feeding directly
into GIT.
Reference:
Dr Hayley Willacy (2011). Enteral Feeding. http://www.patient.co.uk/doctor/Enteral-Feeding.htm.
(11/23/2014)

79
Types of Enteral Feeding
Types of Enteral Formulation
1. Ready to Use formulations
2. Tube feedings – prepared from regular foods
Gastric feeding tube
• A gastric feeding tube (or "G-
tube," or "button") is a tube
inserted through a small incision
in the abdomen into the
stomach and is used for long-
term enteral nutrition.
• Nasogastric intubation is a medical
process involving the insertion of a
plastic tube through the nose, past the
throat, and down into the stomach.
• Use to treat anorexia nervousa

80
3. Blenderized Tube feeding – are soft diet which can be blenderized.
4. Standard tube feeding – fiber free, high in cholesterol, fat and sugar. (milk, sugar
and soft cooked eggs)
Complications:
1. Mechanical
a) Nasopharyngeal irritation
b) Luminal obstruction
c) Mucosal erosions
d) Tube displacement
e) Aspiration
2) Gastrointestinal
a) cramping/distention
b) vomiting/diarrhea
c) costipation
3) Metabolic
a) Hypertonic dehydration
b) Glucose intolerance
c) Cardiac failure
d) Renal failure
e) Hepatic ecephalopathy
Reference:
Basic Nutrition & Diet Theraphy by Maria Lourdes C. Caudal, RND, pages 119-121
Feeding administration
 The continuous drip method is most commonly used. Continuous drip is
administered via gravity or a pump and is usually tolerated better than bolus
feedings.

81
 This method is preferable in many patients. The feeding pump (a machine) is set
up and the tubing connected to the PEG tube. The formula is poured slowly; the
patient is placed at a high back rest to prevent risk of aspiration.
 Continuous drip feeding may be delivered without interruption for an unlimited
period of time each day, however, good practice suggests it is best to limit
feeding to 18 hours or less where possible. Feeding around the clock is not
recommended as this limits a child's mobility and in some limited cases may
elevate insulin levels contributing to hypoglycemia.
 Commonly, continuous feeding is used for 8 to 10 hours during the night for
volume-sensitive patients so that smaller bolus feedings or oral feeding may be
used during the day. Continuous drip feeding is usually delivered by infusion
pump.
ADVANTAGES
Advantages of continuous feeding over bolus feeding are that:
 it may be tolerated better by children who are sensitive to volume, are at high risk
for aspiration, or have reflux.
 continuous feeding can be administered at night, so it will not interfere with
daytime activities.
 continuous feeding increases energy efficiency, allowing more calories to be
used for growth. This can be important for severely malnourished children.
 when feedings are delivered continuously, stool output is reduced which may be
a consideration if the child suffers from chronic diarrhoea.
Disadvantages of continuous feeding include:
 the child is "tied" to the feeding equipment during the feed, although
feedings can be scheduled for night time and naptime feedings.
 In some countries continuous feeding is more expensive because of the
cost of the pump and additional feeding supplies which may be necessary.
 a child's medication needs to be considered as continuous feeding may
interfere with serum concentration of some drugs.
Bolus Feedings
Bolus feedings allow for more mobility than continuous drip feedings because there are
breaks in the feedings, allowing the patient to be free from the TF apparatus for
activities such as physical therapy.

82
Bolus feedings are usually delivered four to eight times per day, with each feeding
lasting about 15 to 30 minutes.
ADVANTAGES
The advantages of bolus feedings over continuous drip feeding are that:
 bolus feedings are more similar to a normal feeding pattern,
 more convenient,
 less expensive if a pump is not needed
 bolus feeding allows freedom of movement for the patient, so the child is not
tethered to a feeding bag.
DISADVANTAGES
The disadvantages of bolus feedings are that:
 they are aspirated more easily than continuous drip feedings,
 in some children, they may cause bloating, cramping, nausea, and diarrhoea
 it may not be practical to bolus feed a child when the volume of formula a child
needs is large or requires that the child needs to be fed around the clock.
Combination
A combination of continuous drip (at night) and bolus feedings (during the day) can be
used.

83
What is combination feeding?
"Combination or mixed feeding refers to when a baby is both breastfed and bottle-fed,"
Gray tells us. You'll probably stumble on phrases like complementary feeding or
supplementary feeding in your research. It's all the same thing!
What factors might make me choose combination feeding?
“There are many reasons a mother might choose to use mixed feeds,” Gray answers.
“Separation from baby (such as returning to work), low milk supply (a mother wants to
breastfeed but doesn’t have enough milk for exclusive breastfeeding), higher order
multiples [when you have twins or triplets and can’t produce enough milk for both], and
desire for partner to help with feeding" are all understandable reasons.
What are the risks of combination feeding?
 Here's where we sit you down and give ya some hard truths. "Introducing
anything other than breast milk for the first six months of life can open up the
baby’s immature immune system and gastrointestinal tract to inflammation,
illness, and disease," Gray informs.
 Too much bottle-feeding can also have an effect on a mother's production.
"Introducing formula during the first 6 weeks (when a woman’s body is
establishing its milk supply), or having too many feeds a day away from the
breast can cause a mother’s supply to decrease – sometimes to the point of
weaning."
 Secondly, "if babies are introduced to an artificial teat before breastfeeding is well
established" they might start to prefer the bottle over breast. A bottle releases
formula without stopping until the bottle's empty, whereas "a baby at the breast
must suck-suck-suck to have a let-down which lasts a minute or two and then
there’s a pause before another let-down."
References:
http://site.matthewsfriends.org/index.php?page=continuous-drip-feeds
http://site.matthewsfriends.org/index.php?page=bolus-feeds
http://www.sofeminine.co.uk/baby-first-year/everything-you-need-to-know-about-combination-or-mix-
feeding-your-baby-s439242.html

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