Systems Synergy

• Digestive system provides the raw materials for the body to both function and repair itself.

• All systems are influenced by the digestive system. • 90% of the bodies

serotonin is produced in the gut.

• 70% of the body's immune system

Digestive System Overview

• Enteric Nervous System : Is a complex system that has as many neurons as the spinal cord. • Often referred to as the second

brain. • Parasympathetic nervous

system has many neural connections to the ENS.• It stimulates digestive

activities via the vagus nerve.•Encourages blood flow to the gut and activates associated digestive organs.•What state of mind is best for digestion?

Microscopic Anatomy of the Small Intestine

Digestion is a very energy intensive process. Under stress blood is shunted away from the digestive organs resulting in a reduced ability to create ATP. Less nutrition can be absorbed under stress.

Nutrients• Ingested chemicals used for growth, repair or

maintenance.• Macronutrients consumed in large amounts

– proteins, fats and carbohydrates• Micronutrients needed in small amounts

– Vitamins, minerals, phytonutrients, etc.

• Essential nutrients can not be synthesized– minerals, vitamins, 8 amino acids and fatty acids must

be consumed in the diet every day.

Vitamins• Body synthesizes some vitamins from precursors

– niacin, vitamin A and D– vitamin K, pantothenic acid, biotin, folic acid

• produced by intestinal bacteria

• Water-soluble vitamins (C, B) – absorbed with water in small intestine; not stored

• Fat-soluble vitamins (A, D, E, K)– absorbed with dietary lipids; stored

Functions of Minerals• Calcium and phosphorus

– bones and teeth

• Phosphorus– phospholipids, ATP, CP, buffers, nucleic acids

• Calcium, iron, magnesium and manganese – cofactors for enzymes

• Iron - essential for hemoglobin and myoglobin

• Chlorine - component of stomach acid (HCl)

• Mineral salts – electrolytes; govern function of nerve and muscle cells;

regulate distribution of body water

Protein• 12-15% of body mass

– mostly in skeletal muscles• Functions

– muscle contraction, cell membranes , collagen, bones, keratin, antibodies, myoglobin, enzymes, neurotransmitters, plasma proteins needed for blood osmolarity and viscosity.

• Protein requirements vary.– ADA:(.8g /kg)– ACSM: Power athletes: 1.6-1.7g /kg Endurance athletes: 1.2-1.4g /kg– On average the body can only utilize between 20- 30 grams per meal.

Protein Sources• Nutritional value depends on proportions of amino acids

– 8 essential amino acids can not be synthesized• Complete proteins (dietary)

– supply all amino acids in right amount needed to synthesize protein

• Animal proteins (meat, eggs and dairy) – Closely match human proteins in amino acid composition– Protein with every meal will reduce the glycemic load of

the meal which will stabilize blood insulin levels.

Carbohydrates• Carbohydrates found in 3 places in body

– 450 grams total • Muscle (325 grams)• Liver glycogen (90-100 grams)• Blood glucose(4-5 grams)

• Carbohydrate serves as fuel exclusively – neurons and RBCs depend on glucose

• Blood glucose carefully regulated by insulin and glucagon• Not all carbohydrates are created equal!!!

– Highly processed refined sugars and flours• Deplete the body of many micronutrients

– Dietary fiber are nutrient rich and provide many health benefits.

Dietary Fiber• Fibrous carbohydrates that are indigestible because we don’t produce the

specific enzyme.• Fiber is important to diet (RDA is 25-45 g/day)• Water- soluble fiber

– Found in fruits, potatoes, oatmeal, beans– Bind bile salts which blood cholesterol, BGLs and LDL levels– Act as prebiotics :feed the probiotics.(good bacteria and yeast)

– Role in immune system activation and modulate inflammation. – Dysbiosis : to many of the bad bacteria. Associated with obesity and disease

• Water-insoluble fiber – Found in wheat, bran, and pears. – absorbs water in intestines, softens stool, gives it bulk, speeds transit

time

Why Water• Thermoregulation• Its needed for enzymatic

reactions within the body.• Both anabolism and

catabolism• Needed to maintain proper

electrolyte balance• Neuronal function and

maintaining blood pressure

• Needed to maintain proper connective tissue

• Tensile vs compressive forces

Structural Elements of Connective Tissue

Nutritional Exercise Recommendations• Carbohydrates Requirements

• Daily requirements: 6-10g CHO/kg BW depending on intensity of work out.

• Pre-work out snack: • Post exercise :1.5 g CHO/kg of CHO within 2 hours (maximize

glycogen storage)– 4:1 CHO to PRO

• Water requirements – Pre workout: 500 ml (about 17 ounces) of fluid 2 hours before

exercise.• ACSM/ADA rec: 16-24 oz per pound weight loss

– Intense exercise lasting longer than 1 hour, it is recommended that electrolytes and carbohydrates be added to prevent dehydration, hyponatremia and delay fatigue.

– Carbohydrates and electrolytes will improve rehydration!

1999

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1999, 2009

(*BMI 30, or about 30 lbs. overweight )

2009

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

A picture is worth a 1000 words1900’s 2014

Contributors of Recent Obesity Epidemic • Sedentary life style

– Technology, scary world, comfortable couches! • Increased stress levels :

– Increased cortisol leads to increased insulin resistance

– increase deposition of visceral fat.• Increased consumption of both total caloric

intake and nutrient depleted processed foods. • Super Size me please!

CHEESECAKE 25 Years Ago Today

260 calories3 ounces

640 calories7 ounces

Calorie Difference: 380 calories

What Role Does Governmental Policies Play

Government Subsidized Foods• Many key ingredients found in processed foods are

government subsidized. The major players are corn, soy beans, cotton and wheat .– Examples include HFCS, xantham gum, maltodextrin,

Sucrose, Fructose, citrus cloud emulsion, gluten, hydrolyzed soybean extract, soy lecithin, flours many more!

– Corn, soybeans and wheat are all genetically modified unless labeled organic.

– Corn is feed to chicken, cows and even fish now.– Concentrated Animal Feeding Operation(CAFO)

– Corn feed cows developed resistant bacterial strains E-cole 0157:H7

– Long food labels are a marker for highly processed food!

What Not To Eat!• Avoid trans fats!!!

– Toxic to the coronary cardiovascular system.

• Processed meats such as hot dogs, sandwich meats and pepperoni.

– Grain fed animals given with hormones, antibiotics and pesticides.

– Sodium nitrate which provides the bright red color is a known carcinogen.

• Sugar correlates with hypertension, diabetes, CAD, obesity, renal disease and fatty liver disease.

• Soda is a concentrated form of sugar particularly high fructose corn syrup.

– Associated with an increase in osteoporosis, tooth decay and obesity.

Carbs Rules!

• Limit products with added sugar/fructose (HFCS).• Limit flour of any type.• Limit breads unless they are 100% whole wheat.• Limit fruit juice. (eat your calories) • Unrefined Carbs naturally have fiber. Eat whole grains,

fruit and vegetables) • At least 4 grams per serving• No added sugar!

CLASSIC FOOD PYRAMID

Standard American Food Pyramid

• Omnivores' Dilemma by Michael Pollen• Watch Food Inc.

Let Food Be Thy Medicine Hippocrates

• Phytonutrients : Polyphenols: a class of phytonutrients that has anti-inflammatory, antibacterial, anti-mutagenic, antioxidant effects, inhibit platelet aggregation, strengthen vessel walls and influence gene expression.– Coffee, Dark Chocolate, blueberries, extra virgin olive oil,

citrus fruits and walnuts• Bioflavonoids: colored pigmented citrus fruits , nuts,

legumes, seeds and vegetables.• Sulforaphanes and indoles are phytonutrients found in

cruciferous vegetables and sulfur compounds such as garlic. These provide protection from a variety of cancers such as breast and bladder cancer.

Carotenoids• Pigments produced by the plants that are responsible for

the red, orange and yellow colors. • There are over 600 types including beta-carotene, beta-

crytoxanthin, lutein, zeaxanthin ,astaxanthin and lycopene.– Peppers, carrots, sweet potatoes, tomatoes, oranges ,

spinach and salmon. – Protection from diseases of the skin ,eyes, prostate,

cervix, lung and digestive tract.– Best absorbed with a little fat such as olive oil – Bioavailability increased with cooking.

Plants Defense is Our Best Defense!

• Many of the bright colors, textures, tastes and shapes are part of the plants immune system.

• Plants have a cell wall which don’t produce cholesterol.

• Much of their benefits are found in their skin.• Phytonutrients and antioxidants are produced by

plants in response to stress from their environment. – These include sunlight, being eaten by bugs and

even the cutting of their leaves.

The Science of Fresh

•6H2O + 6CO2 + 36 ATP C6H12O6 + 6O2 + 36 ADP +36 P •Once a plant is harvested it continues to respire using its glucose maintaining cellular functions including phytonutrient and antioxidant production. •Once glucose reserves become exhausted plant cellular functions cease. •The cold water lowers their temperature, which slows the aging process. It also increases the internal moisture of the greens, which keeps them crisp longer.•Storing methods vary

– micro perforated plastic bags vs. countertop.

Conventional vs. Organic• Studies examining nutritional profiles are conflicting.• Stanford University Study: showed no nutritional difference?

– 30% increase in pesticide residue, conventionally raised chicken and corn were treated with more hormone, antibiotics and harbor more resistant bacteria.

– Long-term environmental concerns were not even taken into consideration.

• Conventionally grown food may have lower levels of the protective antioxidants.– Plants that are sprayed with pesticides, fungicides and

antibiotics don’t need to produce as much of their own inherent protective defenses.

• Produce might look better cosmetically.

Environmental Working Group’s Dirty Dozen http://www.foodnews.org/executive.php

12 most contaminated

• Peaches• Apples• Sweet Bell Peppers• Celery• Nectarines• Strawberries• Cherries• Pears• Grapes (Imported)• Spinach• Lettuce• Potatoes

(consider frozen)

15 Least contaminated with pesticides• Onions• Avocado• Sweet Corn (Frozen)• Pineapples• Mango• Asparagus• Sweet Peas (Frozen)• Kiwi Fruit• Bananas• Cabbage• Broccoli• Papaya• grapefruit• Sweet potato• Honeydew

Food Labels• Is it really low fat?

– 1% milk = 18% and 2% =36%fat calories• Whole milk is more then 50 % fat calories

– Meat 75% lean has 225 calories which 14 grams come from fat which equals 126 total fat calories = 57% fat by calories

– 93% ground lean = 45% fat calories• because labeled by weight not % calories

The diet and conditions your meal lived in is important!• The food industry can make up the serving size.

– 5 calories or less = non caloric.– ½ gram of fat or less = none fat. Watch the potions size! – Lite means ½ the amount of fat as the original.

• Usually sugar is substituted.

Food Labels

• Organic means 95% organic products – Look for the USDA Organic food label

• Made with organic must be 70%• Free range: in a chicken coup that the door must

stay open 5 minutes a day.• Pastured means cage is on the grass.

• Know your farmer!

• Whole Grain= only has to be a little more then ½ to say it on the label.– Made with whole grain may almost have none.• Look for 100%

• Serving size 2 pieces• Total calories 71• Fat 3.5 grams• Carbohydrates 6 grams

– Sugar 2 – Fiber 2

• Protein2 grams• 70 % dark chocolate,

organic (almonds, cashews, blueberries), organic granola, organic cocoa nibs, cinnamon, and lots of love ;)

Chocolate health benefits include:• Anti-inflammatory- polyphenolic compounds.•Polyphenol making it bitter reduce oxidative damage of arteries and inhibit platelet aggregation.•Choose raw dark chocolate 70% or higher

•

Hidden Food Dangers• Acrylamides: Linked to neurological problems and cancer form between sugars

and aminos in high heating. browning/ roasted or toasting of carbohydrates. ie french fries and breakfast cereal.

• (BPA ) Bisphenol A : Chemical that makes up bottles and lining in cans.• Linked to obesity, heart disease, neurological development, cancers of the

breast and prostate.• Mimics estrogen. Acidic foods in cans can leach more out.

• BVO: Brominated vegetable oil: flame retardant used as emulsifier in many drinks. • Linked to neurological problems such as memory loss. Possible endocrine disrupter

especially the thyroid! • Nitrites: added as a preservative can increase stomach, colon and bladder cancer

through to production of nitrosamines. • Polycyclic aromatic hydrocarbons: Form in many processed smoked meats during

the curing process.• Heterocyclic amines (HCAs) form when meats are charred at high temperatures.• Don’t smoke healthy oil! Know your smoke point!

Treat The Whole Person• Sugar in moderation if coupled with fiber.

– Natural whole fruit and vegetables all provide you with many other protective phytonutrients.

– Don’t eat carbohydrates alone.

• Eat healthy proteins and fats • Control Insulin! • Stress will naturally make you crave sugar!

– Stress hormones (catecholamines and cortisol) all increase BGL’s resulting in greater visceral fat production.

• Exercise : Builds muscle which improves metabolic status– Prevents disease and improves longevity.– Lowers glycogen levels: less of it being converted to fat. – Stimulates SNS which increases metabolism, mitochondrial

function and sense of well being.

Final Thoughts• Michael Pollan Food Rules

– Eat food, not to much, mostly plants (especially leaves)! – Don’t need anything your grandmother would not recognize as

food.– Don’t eat food that make health claims.– Don’t eat anything that has more than 5 ingredients.– Don’t eat food that has ingredients that are unpronounceable.

• Don’t know what’s wrong consider an elimination diet.• Drink filtered water (minimize consumption of bottled water)

– Great Pacific Garbage Patch!• Buy organic when possible especially foods that are most

contaminated.(Referred to EWG Dirty Dozen) • Carbon Footprint and biodiversity

Questions?

New York State Views on Nutritional Patient Education.

• Nutritional guidance is included in the curricula of accredited physical therapy programs. Because many conditions are affected by diet and nutrition, the PT should be aware of the association, and may provide guidance in conjunction with treatment. It is appropriate, for instance, to talk to diabetic patients about the consumption of sugar and the connection that diet may have on recovery.

As with any task, modality or treatment, it is understood that the PT has been properly educated, has had experience and is competent to provide this advice.

PTs may not bill for nutritional advice or advertise that nutritional advice is given. Nutritional supplements should not be sold by PT practices, as the promotion of the sale of service, goods, appliances or drugs in such manner as to exploit the patient or client for financial gain is considered unprofessional conduct.

Supplements should not be sold to patients by physical therapists.

State Board for Physical Therapy

89 Washington Avenue, 2W Education BuildingAlbany, NY 12234phone: 518-474-3817 ext. 180fax: 518-402-5944email: ptbd@mail.nysed.govweb: www.op.nysed.gov/pt.htm