Nutrition and Pain Risa Bernasconi, MSN, FNP Basics Calories are the unit by which to measure the energy provided by food (1 gm fat = 9 calories; 1 gm carbohydrates = 4 calories; 1 gm protein = 4 calories; 1 gm alcohol (not considered a nutrient) = 7 calories) Carbohydrates meet most energy needs of the body. Carbohydrates are compounds composed of single or multiple sugars. Simple carbohydrates are composed of one molecule (saccharides) or two molecules (disaccharides). Complex carbohydrates are long chains of sugar molecules arranged to form starch or fiber when foods are ingested, they are converted to sugar (glucose) for energy or to be deposited as fat. Protein is needed for growth and repair of every cell. Muscles and connective tissue are primarily made up of protein. Skin, hair, nails, antibodies, many hormones, and enzymes are primarily comprised of protein. Amino acids are the building blocks of protein. Protein occurs in complex and diverse structures built from chains of amino acids linked together. There are thousands of different proteins, but all are formed around a carbon core, with hydrogen, oxygen, and nitrogen attached to the carbon core. The varied protein structures built from amino acids range from the protein in muscle which is able to contract and hold water, the protein in hair, skin, and nails which is hard and insoluble, and the protein in blood vessels which is elastic. Dietary protein cannot be used directly in the body. Instead, the body breaks down dietary protein into amino acids, and then uses these amino acids to build the proteins needed by the body. Twenty different amino acids are needed to build the various proteins used in the body. Of these, some can be made by the body itself, while eight (called essential amino acids) must come from the diet. The essential amino acids are: isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. Two other amino acids - arginine and histidine - are considered essential for children. The non-essential amino acids are alanine, asparagine, aspartic acid, cysteine, glutamine, glutamic acid, glycine, proline, serine, tyrosine, and citrulline. Fats (and oils) are made up of chains of carbon molecules with hydrogen and oxygen molecules attached around the edges: -
saturated fat = carbon chain is completely full of hydrogen -
monounsaturated fat = carbon chain missing two hydrogen molecules -
polyunsaturated fat = carbon chain missing four or more hydrogen molecules (corn oil, fish oil) Two kinds of polyunsaturated fatty acids can not be created by the body and must be provided by the diet in the right ratio for optimal health. These are "essential fatty acids" (omega-6 fatty acids (derived from linoleic acid) and omega-3 fatty acids (derived from alpha linolenic acid)). They can lower blood pressure and decrease the chance of blood clots, as well as the risk of colon, breast and prostate cancers. These polyunsaturated fatty acids block the production of arachidonic acid and also target leukotrienes (provoked by free radicals) Omega-3 fatty acids are found in the oils from flax, hemp, borage, pumpkin seeds, walnuts, and cold-water, fatty fish. Omega-6 fatty acids are found in many vegetable oils, including walnut, wheat germ, soybean, safflower, borage, evening primrose, flax, black currant, sunflower, and corn oils. Fats -
cannot be utilized for energy unless essential fatty acids are present, in which case they can be burned as fuel -
can be stored as body fat -
can be incorporated into the cell membrane - good fats have a stabilizing effect on the cell and will prevent breakdown from inflammatory chemicals Water is essential to all bodily functions and processes. The amount of water you need depends on your body size, body fat percentage, activity level, climate and more. Fiber is an essential part of diet. It is an indigestible component of many natural-state carbohydrate foods, such as grains. Fiber helps to move food through the digestive system as well as keeping you regular and helping you feel full after eating. Fiber also slows the absorption of carbohydrates eaten at the same time (lowering the rate of conversion to glucose). Inflammation is the way the body repairs cells and tissues damaged by stress, injury, poor nutrition. Also, it is the body's main defense mechanism against any hostile environment (i.e. viruses, bacteria or allergenic substances). Chronic inflammation does not protect the body but breaks it down, causing fatigue, illness and pain. This can occur in the joints, muscles, nerves, and other tissues. Foods can be anti-inflammatory or pro-inflammatory. Pro-inflammatory foods cause free-radical formation. Free radicals ("pro-oxidants") are highly reactive molecules found in air pollution, cigarette smoke, ultraviolet radiation, foods, and metabolic wastes created when breathing, transforming food into energy, or fighting infection. A free radical molecule is missing an oxygen molecule and is very unstable. Free radicals affect the phospholipid bilayer surrounding cells, releasing toxic inflammatory chemicals which leak into the interior of the cell (arachidonic acid - broken down into prostaglandins and leukotrienes and oxidized fats which can convert to aldehydes) - these interfere with the production of energy in the cell and actually cause the production of more free radicals (cytokines, collagenase). Trans-fats produced by chemically adding hydrogen molecules (done to stabilize food products/ extend shelf life). Trans-fats prevent the conversion of LDL to HDL and decrease insulin sensitivity by making the cell membrane stiff and inflexible Sugars/any food with a high glycemic index (converted quickly into glucose after being ingested). -
Sugar can react with minerals (iron and copper) to create free radicals -
Sugar causes surge of insulin - this leads to more storage of fat (insulin "locks" fat in storage rather than allowing it to be used for energy). Also, repeated over time will wear out the pancreas (leading to diabetes) -
High sugar levels can oxidize LDL leading to plaque deposits in the arteries -
High sugar levels for extended periods of time cause glucose molecules to build up on red blood cells (RBCs) so they can no longer carry oxygen -
Sugar molecules can attach to collagen fibers where they trigger a series of spontaneous chemical reactions (can lead to loss of skin elasticity) A free radical molecule is missing one of its electrons. To restore its structure, it steals an electron from any nearby molecule in the body, such as fats, proteins, or even DNA (genetic material). As the original free radical passes off its unpaired electron or steals an electron from another molecule, that molecule becomes unbalanced. This newly formed free radical then interacts with yet another molecule in pursuit of stability, and so on. Over time, free radical damage to the body leads to dozens of diseases and premature aging. For instance, free radical changes to LDL-cholesterol are an early step in atherosclerosis (hardening of the arteries), DNA damaged by these reactive compounds can contribute to cancerous mutations, and proteins in the skin mangled by free radicals can appear as wrinkles. Essentially, antioxidants provide missing electrons to halt the game of free radical hot potato that, if left unchecked, can destroy the body. Antioxidants have the unique ability to donate the much sought-after electron without becoming a free radical themselves. Antioxidants, therefore, stop the deadly chain of free radical reactions. Anti-inflammatory foods contain nutrients that function as antioxidants in the body. The cell's defenses depend on "anti-oxidants". Olive oil is very stable in storage (vs. polyunsaturated oils) -
contains oleic acid (a member of the omega-9 family) which can be incorporated in the cell plasma membrane to help maintain fluidity and decreases the oxidation of LDLs -
lowers LDL and raises HDL -
contains polyphenols and beta-carotene (powerful antioxidants) Alpha lipoic acid (ALA) is a powerful antioxidant available as a supplement (100 mg in two doses at breakfast and lunch) -
inhibits glycosylation -
protects and elevates glutathione -
acts as a powerful anti-inflammatory agent -
accelerates the removal of glucose from the bloodstream -
improves insulin function -
decreases insulin resistance Antioxidant Nutrients Protect the Body: | Nutrient | Antioxidant Role | | Vitamin C | Neutralizes free radicals in the blood and within cells; protects vitamin E | | Vitamin E | Protects cell membranes from oxidation; scavenges free radicals | | Carotenoids | Quench free radicals in cell membranes; protect DNA from oxidative damage | | Minerals | Components of various antioxidant enzymes (e.g., superoxide dismutase, glutathione peroxidase) that neutralize free radical oxygen molecules | | Coenzyme Q10 | Scavenges free radicals, especially in the blood | | Bioflavonoids | Prevent the formation of free radicals and scavenge existing free radicals; protects vitamin C | | Alpha Lipoic Acid | Water and fat soluble substance that neutralizes free radicals throughout the body; protects vitamins C and E |
Phytonutrients
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Without phytonutrients, plants would not be able to protect themselves from free radicals, parasites, bacteria, viruses, insects, and injuries. Many of these benefits are transferred when people consume the plant or plant extract. -
While scientific evidence on phytonutrients dates back only a few decades, many phytonutrients like garlic have been used as traditional remedies. -
Bioflavonoids and a major class of phytonutrients garnering a significant portion of the spotlight. Bioflavonoids, found in citrus fruits, apples, onions, tea, red wine, and numerous other foods, are powerful antioxidants that help strengthen capillaries. -
Other types of phytonutrients, like sulforaphane from broccoli, stimulate the production of enzymes that help protect healthy cells and tissues; coumarins and lycopene from tomatoes act as antioxidants. -
Soybeans contain isoflavones, such as genistein, that help support the immune system. Garlic is a phytonutrient powerhouse. Allicin, ajoene, saponins, and phenolic compounds (among others in garlic) stimulate the production of enzymes which protect healthy cells and tissues. Examples of Phytonutrients in fruits, vegetables, nuts, berries and other foods: | Phytonutrient | Food Source | | Anthocyanins | Bilberry, grape seed, pine bark, and tea | | Carotenoids | Fruits and vegetables | | Catechins | Green tea | | Coumarins | Vegetables and citrus fruits | | D-Limonene | Citrus fruits | | Ellagic Acid | Fruits, nuts, berries and tea | | Flavonoids | Fruits and vegetables | | Glycrrhizin | Licorice | | Indoles | Cruciferous vegetables | | Isoflavones | Soybeans | | Organo-sulfur compounds | Garlic | | Polyphenols | Red wine, fruits, berries, and olives | | Sulforaphane | Cruciferous vegetables | Dehydration: -
Dehydrated muscles cramp more easily than well-hydrated muscles -
Plenty of water filters kidneys and helps wash away built-up toxic by-products (waste) of metabolism -
Mild dehydration can cause a 3 percent drop in baseline metabolism Reasons for Eating: -
Hunger - best reason -
Emotional (stress, boredom, anger) - can lead to poor food choices and cause further emotional "roller coaster" (i.e. high-sugar foods cause short term "sugar high" and then "crash" -
Sleep Deprivation - insufficient sleep can cause poor impulse control. Also, fatigue can make one feel that a "pick-me-up" is needed. Caffeine (coffee, colas, chocolate, tea) can interrupt sleep cycles Exercise: -
Important to maintain balance between intake and energy use -
Helps maintain glucose at steady level -
Makes metabolism more efficient -
Regulates mood and reduces cravings -
Improves sleep Food Sensitivities/Allergies Foods to Enjoy Asparagus Avocado Beans (black, kidney, lima) Bell peppers Blackberries Blueberries Broccoli Brussels sprouts Cabbage Cantaloupe Capon Cauliflower Celery Chicken Chilean sea bass Clams Cod Coriander Cottage cheese, low-fat Crab meat Cucumbers Dill Egg whites Eggplant Endive Escarole Low-fat milk Fennel Feta cheese Filet of sole Flounder Garlic Ginger (fresh) Grapefruit Halibut Hazelnuts Honeydew melon Kale Kiwi Leafy greens Legumes Lemons | Lentil soup Lettuce Lobster Monkfish Mushrooms Mussels Nectarines Nuts Oatmeal (not instant) Olive oil Olives Onions Parmesan cheese Parsley Peaches Pears Pecans Plums Radishes Raspberries Salmon Sardines Scallions Scallops Shrimp Snow peas Soybeans Spinach Swiss chard Swordfish Tea Tofu Tomatoes/tomato juice (unless sensitivity) Trout Turkey Walnuts Yogurt (no sugar added) Zucchini | | Source: The Perricone Prescription (phyto is the Greek word for plant) are naturally occurring compounds found in plants. Many act as hormones, enzymes, pigments, or growth regulators. |
