Mindanao State University

COLLEGE OF EDUCATION
Home Economics Department
Marawi City

Foods &
Nutrition

SAHIBA R. MACACUNA
Instructor

Student
 OVERVIEW

Food, nutrition, and physical fitness are the foundation of a healthy lifestyle in today’s society. We eat to

grow and develop, sustain life, and nourish our bodies, as well as to enjoy food and dining, share meals,

and celebrate events. More and more, we equate certain foods and diet patterns with nutritional well-being

and realize the complexities of choosing foods wisely. Beyond the physical and emotional satisfaction of

eating, we often are concerned about how food choices affect our health. At the same time, however, new

information is exploding on the quantity and quality of foods and nutrients needed for optimal health. Our

choice of diet choice of diet strongly influences whether we will get certain diseases, such as heart disease,

cancer, and stroke—No doubt eating right contributes to health and quality of life, and this is reflected in

growing consumer awareness of eating healthy.

The link between good nutrition and healthy weight, reduced chronic disease risk, and overall health is

too important to ignore. By taking steps to eat healthy, you'll be on your way to getting the nutrients your

body needs to stay healthy, active, and strong. Your food choices each day affect your health — how you

feel today, tomorrow, and in the future.

Read, enjoy learning, be active, and eat healthy for healthy living!
 Table of Contents

MODULE I. MSU Vision and Mission, CED Goals, Home Economics 1

Program Objectives and Course Orientation

TOPIC 1: MSU Vision and Mission 1

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TOPIC 2: CED Goals
2
TOPIC 3: Home Economics Program Objectives 2
TOPIC 4: Course Orientation

MODULE II. BASIC NUTRITION CONCEPTS

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TOPIC 1: Food and Nutrition

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TOPIC 2: Macronutrients 7
TOPIC 3: Micronutrients 8
TOPIC 4: Balanced Nutrition 10

MODULE III. HEALTHFUL EATING: THE BASICS 12

TOPIC 1: Your healthy weight 13

TOPIC 2: Nutrition Calculations
14
TOPIC 3: Body Mass Index (BMI)
16
TOPIC 4: Energy (Calorie) Needs 17
TOPIC 5: Obesity 19
TOPIC 6: Malnutrition 20
TOPIC 7: Proteins 21
TOPIC 8: Carbohydrates 22
TOPIC 9: Fats 23
TOPIC 10: Minerals 24
TOPIC 11: Vitamins 25
TOPIC 12: Water 27
TOPIC 13: Infant Nutrition 27
TOPIC 14: Dietary Supplements 28
TOPIC 15: Vegetarian diets 29
TOPIC 16: Safe preparation and storage 30

MODULE IV. Digestion and Detoxification 31

TOPIC 1: Digestion 32
TOPIC 2: Key Points in Maintaining a Healthy Digestive System
34
TOPIC 3: Stress 36
TOPIC 4: Detoxification 37
TOPIC 5: Constipation 39
TOPIC 6: Indigestion 40
TOPIC 7: Heartburn 41
TOPIC 8: Gallstones 43

MODULE V. EATING DISORDERS 48

TOPIC 1: Common eating disorders 49

TOPIC 2: Anorexia 54
TOPIC 3: Bulimia Nervosa 59
TOPIC 4: Binge Eating Disorder 63
TOPIC 5: Geophagy 67
TOPIC 6: Disordered Eating 71
TOPIC 7: Eating according to a set time 73
TOPIC 8: Eating by food types 74

MODULE VI. MEAL PLANNING 80

TOPIC 1: Food groups 80

TOPIC 2: Meal Planning 82
TOPIC 3: Modification of family meals for various age groups 85
TOPIC 4: Need for special diet 93
 MODULE I
MSU VISION AND MISSION, CED GOALS, HOME ECONOMICS PROGRAM
OBJECTIVES AND COURSE ORIENTATION

Learning Objectives
After completing this module the learners will be able to:
1. Share commitment in achieving MSU Mission and Vision, CED Goals, and Program Objectives
2. Write a reflective action plan for better learning of the course

MINDANAO STATE UNIVERSITY

Vision

MSU System aspires to be a Center of Excellence in Instruction, Research and Extension transforming
itself into a premier and globally competitive national peace university.

Source: BOR Resolution No. 250 series of 2019

Mission
MSU System is committed to:

1. Lead in social transformation through peace education and integration of the Muslims and other
cultural minority groups into the mainstream society;
2. Ensure excellence in instruction, research development, innovation, extension and environmental
education and discovery;
3. Advance national and international linkages through collaborations and,
4. Demonstrates greater excellence, relevance, and inclusiveness for Mindanao and the Filipino nation.
Source: BOR Resolution No. 250 series of 2019

GOAL OF COLLEGE OF EDUCATION

To develop highly skilled, competent, and globally competitive teachers, educational leaders and peace
advocates.

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HOME ECONOMICS PROGRAM OBJECTIVES:
Home Economics Department aims to produce future Technical-Vocational teachers who can:
1. Demonstrate the competencies required of the Philippine TVET Trainers-Assessors Qualifications
Framework (PTTQF);

2. Apply broad and coherent, meaningful knowledge and skills with minimal supervision in technical
and vocational education;

3. Demonstrate higher level of literacy, communication, numeracy, and critical thinking skills and
competencies;

4. Show deep and principled understanding of how educational processes relate to a larger historical,
social, cultural, and political context towards attainment of peace and development; and

5. Reflect on the relationships among the pedagogical skills of teachers, the learning processes of the
students, the nature of the content, and other factors affecting educational procedures in order to
constantly improve instruction.

COURSE ORIENTATION
This course aims to introduce the principles of food, nutrition, and meal management as applied to
nutrition and food needs of families and individuals. It also includes the discussion of the importance of
foods, basic tools in nutrition, different nutrients and its function as well as its sources and deficiency
symptoms, current issues and applied and public health nutrition. The preparation of menu for pregnant
and lactating mothers, adolescents, children and aged is also included in this course.
At the end of the course, the learners are expected to:
1. Share commitment in achieving MSU Mission and Vision, CED Goals, and Program Objectives and
write a reflective action plan for better learning of the course.
2. Develop an understanding and appreciation of the relation between food, nutrition and good health
3. Cite the basic tools in nutrition
4. Understand how our body uses each of the nutrients for healthy growth and development
5. Manage healthy weight through proper diet and exercise.
6. Realize the importance of good nutrition thereby producing healthy people for a more productive
nation
7. Plan a set of meals that demonstrate ways to add food variety and nutrients to eating plan.

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Course Requirements
1. Attendance in online classes
2. Recorded demonstrations
3. Reports/Journal
4. Examination
5. Module Compilation/ e-portfolio
6. Attend course related webinars

ONLINE CLASS POLICIES

1. Attendance will be checked anytime of the day. To give considerations to those students who have
poor internet connection, the attendance of the class will not be limited to the time it is scheduled. The
students can still be present if they have appeared on the google classroom/messenger anytime of the
day of the class schedule.

2. No reading/studying, no checking of assessment/activity. To check if the students are really doing

their written tasks such as self-assessments, activities, assignments, and researches, they should leave
study marks through note taking, highlighting of important words, underlining, and the likes. This is to
avoid cheating and relying on others. To submit their proof, they must take a picture of their modules
and send it to the instructor. Additional points will be given to students who provides additional infor-
mation/ side notes in their module.

3. Submission of tasks should be on time. If the students don’t want to be burdened with multiple
tasks at the near end of the semester then they should not procrastinate. They should make sure to do
their tasks on time and submit it on or before its set deadline. Additional points will be given as reward
to those students who have passed their works on time. For the consideration of the students who have
slow internet connection, late submission of task will not be deducted. Follow this file name format in
submitting your output: FAMILY NAME-WK#-COURSE CODE

4. References for online resources are required to be listed at the end of the paper. Students must
not forget to copy the URL of the website they have visited in answering their assignments. This is to
check the reliability of the work they have submitted. Additional points will be given to students who
have complete reference list.

5. Answering of queries and concerns related to the class is only allowed M-F 7:00am-5:00pm.
Beyond the given time will not be entertained and only related to class matters will be responded.
Weekends are rest days thus questions will no longer be entertained (except for Saturday classes). Stu-
dents must only use messenger in sending queries and concerns.

6. Observe formality. Rude and disrespectful behavior will not be tolerated. Students' microphone
must be muted unless permitted by the instructor and their cameras must not be turned off during online
classes. Students must wear appropriate attire during virtual meetings and when video recording as-
signed tasks.

7. Exams will be given online through google classroom using google forms. Failure to take the
exam without valid reasons means no grade for that said exam.
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8. Cheating is not allowed. Students must not rely on others if they want to be independent in the fu-
ture. They may ask their classmates' ideas but they must not copy and submit it to the instructor. Being
responsible is a must for a future educator. Once caught cheating especially during the exams, the stu-
dent will be automatically marked failed or "5.00" in this course.

9. Compilation of the course module is a final requirement. The students will be given a series of
modules weekly and they have to print it for compilation. They must make sure that the compiled mod-
ules are intact. They may sew it with large thread, or bind it with glue but they must not use paper clip,
fastener or sliding folder to avoid separation of the papers. Submission of the compilation will be at the
near end of the semester. They must make sure to have a complete copy of the entire course module
and this must contain study marks as mentioned in the second policy. Ecopy of module will be submit-
ted and proof of binding. PDF format via Camscanner will be sent as final requirement.

10. The instructor reserves all the rights to revise or modify the class policies and course syllabus
as she may see fit.

Self- Assessment

1. Discuss how you understand the MSU Mission and Vision, CED Goals, and Program Objectives
by giving brief elaborations of your commitment on how you will apply it in real life situation.
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2. Write a reflective action plan for this course, showing how you will give your best in committing
in the online class policies and learning the content and skills mentioned in the course objectives.
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 MODULE II
BASIC NUTRITION CONCEPTS

Lesson Objectives:
At the end of the lesson, the learners are expected to:
1. Discuss Food and Nutrition
2. Define the different terms related to food and nutrition terminology
3. Differentiate macronutrients and micronutrients, and give examples of each.

Food & Nutrition

All foods are made up of a combination of macronutrients (protein, fat, carbohydrate) and micronutrients
(vitamins and minerals). Together with water, these nutrients are essential for life. The effective management
of food intake and nutrition are both key to good health. Smart nutrition and food choices can help
prevent disease. Eating the right foods can help your body your body cope more successfully with an
ongoing illness. Understanding good nutrition and paying attention to what you eat can help you
maintain or improve your health.

What Is Good Nutrition?

Food and nutrition are the way that we get fuel, providing energy for our bodies. We need to replace
nutrients in our bodies with a new supply every day. Water is an important component of nutrition. Fats,
proteins, and carbohydrates are all required. Maintaining key vitamins and minerals are also important
to maintaining good health. For pregnant women and adults over 50, vitamins such as ns such as vitamin
D and minerals such as calcium and iron are important to consider when choosing foods to eat, as well
as possible dietary supplements.

A healthy diet includes a lot of natural foods. A sizeable portion of a healthy diet should consist of fruits and
vegetables, especially ones that are red, orange, or dark green. Whole grains, such as whole wheat and brown rice,
should also play a part in your diet. For adults, dairy products should be non-fat or low-fat. Protein can consist of
lean meat and poultry, seafood, eggs, beans, legumes, and soy products such as tofu, as well as unsalted seeds and
nuts.

Good nutrition also involves avoiding certain kinds of foods. Sodium is used heavily in processed foods
and dangerous for people with high blood pressure. The USDA advises adults to consume less than 300
milligrams (mg) per day of cholesterol (found in meat and full-fat dairy products among others). Fried
food, solid fats, and trans fats found in margarine and processed foods can be harmful to heart health.
Refined grains (white flour, white rice) and refined sugar (table sugar, high fructose corn syrup) are also
bad for long-term health, especially in people with diabetes. Alcohol can be dangerous

6
 to health in amounts more than one serving per day for a woman and two per day for a man. There are
many high-quality, free guidelines available for healthy eating plans that give more details on portion
size, total calorie consumption, what to eat more of, and what to eat less of to get healthy and stay that
way.

Nutritional Deficiencies:

Even if you are getting enough to eat, if you are not eating a balanced diet, you may still be at risk for
certain nutritional deficiencies. Also, you may have nutritional deficiencies due to certain health or life
conditions, such as pregnancy, or health or life conditions, or certain medication you may be taking,
such as high blood pressure medications. People who have had intestinal diseases or had sections
of intestines removed due to disease or weight loss surgery also may be at risk for vitamin deficiencies.
Alcoholics are also at high risk of having nutritional deficiencies.

One of the most common nutritional deficiencies is iron deficiency anemia. Your blood cells need iron
in order to supply your body with oxygen, and if you don’t have enough iron, your blood will not will
not function properly. Other nutritional deficiencies nutritional deficiencies that can affect your blood
cells include low levels of vitamin B12, folate, or vitamin C.

Vitamin D deficiency may affect the health of your bones, making it difficult for you to absorb and use
calcium (another mineral that you may not be getting enough of). Although you can get vitamin D by
going out in the sun, many people with concerns about skin cancer may end up with low levels of vitamin
D by not getting enough sun.

MACRONUTRIENTS

Macronutrients consist of carbohydrate, protein and fat. These nutrients form the bulk of the diet and
supply all the energy need and supply all the energy needed by the body.

1. Carbohydrates are made up of carbon, hydrogen and oxygen. They are burned during metabolism to
produce energy. Carbohydrates in the human diet human diet are mainly in the form of starches and
sugars. For many (poorer) people in the developing world, carbohydrate is the main source of energy,
accounting for as much as 80% of the food they eat.

2. Fats are also comprised of carbon, hydrogen and oxygen. The term fat encompasses all fats and oils that
are edible and found in human diets. Fats in the body are divided into two groups: storage fat, which
provides a reserve of fuel for the body; and structural fat, which is part of the essential structure

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 of cells. In developing countries, dietary fat provides a smaller part of total energy (8 to 10%,) than
carbohydrates.

3. Proteins are made up of ‘building blocks’ called amino acids, composed of carbon, hydrogen, oxygen
and nitrogen (amino group). Proteins from different food sources contain different amounts of amino
acids. Proteins from animal origin, such as meat, milk and eggs, contain all essential amino acids in
balanced amounts. Essential amino acids are those that the body cannot make itself and must therefore
be eaten. In contrast, proteins of vegetable origin (e.g., cereals and pulses) contain on their own
insufficient quantities of some of the essential amino acids. By combining different foods, however (e.g.,
cereals with beans), adequate levels of all amino acids can be obtained without requiring protein from
animal sources. Proteins are required to build new tissue, particularly during the rapid growth period of
infancy and early childhood, during pregnancy and nursing, and after infections or injuries. Excess
protein is burned for energy

Energy provided by macronutrients

Energy is needed for the essential body functions (such as breathing), growth (especially during childhood), and
physical activities (working and playing).

Macronutrients provide different amounts of energy, expressed as kilocalories (Kcals). Fat provides
approximately twice as much energy (9 kcals/g) as the same weight of protein or carbohydrate (4 kcal/g). As
stated above, more carbohydrate than fat is usually eaten in developing countries and, therefore, most food energy
in the diet in these countries is derived from carbohydrate sources.

The relative concentration of protein and fat in the diet is important and is expressed by the percentage of energy
in the diet provided by either fat or protein. For example, if a diet provides 2,000 kcal, of which 200 kcal is
provided by fat, that fat is described as providing 10% of total energy.

The total amount of energy and protein needed by different individuals varies a great deal, depending
primarily on the amount of physical activity but also on age, sex, body size and, to some extent, climate.
Extra energy is needed during pregnancy and lactation.

MICRONUTRIENTS

Micronutrients include all vitamins and minerals. Required in only tiny amounts, they are nonetheless
essential for life and needed for a wide range of body functions and processes. Vitamins are either water-
soluble (e.g., those found in fruits and vegetables such as the B complex vitamins and

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vitamin C) and generally not stored by the body for future needs, or fat-soluble (e.g., vitamins A and D),
which can be stored by the body.

Micronutrients are variously distributed in food. Some micronutrients, such as riboflavin, are widely available in
a range of foods and hence deficiencies of these are extremely unusual. Deficiencies are more common when
particular micronutrient, such as Vitamin A, is found in only a limited range of foodstuffs.

An individual’s requirement for different micronutrients depends on age and sex. There are also key periods when
micronutrient requirements increase: pregnancy and lactation, early infant and child growth, and during certain
illnesses. There is a risk of toxicity with excessive intakes of some micronutrients; a high intake of vitamin A, for
example, is especially dangerous for pregnant women as damage to the growing baby can occur.

The ability of the body to absorb and utilize certain micronutrients in food depends on four factors:
 The form of the nutrient in food. For example, iron in meat (haem iron) is much more easily absorbed
than iron contained in plant foods (non-haem iron).
 Other items in the diet, which either enhance or inhibit absorption. For example, the absorption of iron
from plant foods is enhanced by eating foods high in vitamin C like oranges or tomatoes, but inhibited
by compounds such as tannin (present in tea) and phytate (present in cereals).
 Infection. A number of infections adversely affect the body’s ability to absorb nutrients. For example,
persistent diarrhea prohibits absorption of both macro and micronutrients.
 Food preparation methods. Some methods of food preparation can enhance the availability
of micronutrients.

Key Readings

FAO HUMAN NUTRITION in the Developing World. FAO 1997

FAO and WHO. 1995. Trace elements in human nutrition and health. Report of a FAO/WHO consultation.
Geneva: WHO.
WFP and UNHCR. 1997. Joint WFP/UNHCR guidelines for estimating food and nutritional needs in emergencies.
WFP/UNHCR.
WHO. 1974. Handbook of Human Nutritional Requirements. Geneva: WHO.
Paul, A.A. and Southgate, D.A.T. 1978. McCance and Widdowson's the composition of foods, Fourth Ed London:
Elsevier/North-Holland Biomedical Press.

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Balanced Nutrition

What foods should be eaten to provide a good balance of nutrients?

 Nutrition is best balanced by eating the right amounts of a large variety of foods.
 This provides the protein, carbohydrates, fats, minerals, and vitamins needed for a healthy
body.
 The right amounts of water and exercise are also critical to good health.
 A balanced diet is often represented by different symbols
 A wheel, plate, or circle symbol suggests a balance of foods is desirable.
 The rainbow symbol emphasizes variety.
 A pyramid symbol recommends the number of servings from various food groups decreases
from a solid foundation at the bottom (or the base) to the top.
 Different cultures may use different symbols of healthy food intake based on foods available
to them.
 All symbols have in common a variety of food intake from different food groups.
 Grains provide mostly carbohydrates as starches.
 They also provide some protein that needs to be combined with legumes (beans), nuts, seeds,
dairy, or meat to be complete.
 Half of the grain category should be from whole grains for fiber and vitamins.
 Vegetables provide vitamins, minerals, and fiber.
 Certain vegetables such as potatoes also provide carbohydrates and some vegetable protein,
which needs to be eaten with another protein food to be complete.
 Fruits provide different vitamins, minerals, and fiber.
 They also provide sugars for quick energy.
 ½ to ¾ cup or 120 to 180 mL of fruit juice is the same as one serving of fruit. It is not wise
to drink much more than this because the high sugar tends to replace other needed foods.
 Dairy products provide complete proteins and major minerals, particularly calcium.
 They are commonly supplemented with vitamin D and vitamin A.
 If dairy products are not consumed in the recommended amounts, special efforts should be
made to eat other calcium-rich foods or take a calcium supplement. This is particularly
important for women.
 Complete protein can be provided by meat, chicken, eggs, fish, ad soybeans (e.g., tofu).
 Legumes (e.g., beans) can also provide complete protein if nuts/seeds or grains such as
rice or corn are eaten at the same meal to provide limiting amino acids.

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 Vegetable oils can provide a balance of essential fatty acids.
 Use them in food preparation (frying, salad dressings, spreads, etc.).
 Canola and soy oils are preferred.
 Mustard and hemp seed oils are similar but less common.
 Olive oil is high in healthy monounsaturated fat and has a good ratio (although relatively
low amounts) of essential fatty acids.
 Peanut, corn, sesame, sunflower, and safflower oils are relatively low in essential omega-
3 fatty acids.
 Half of servings in the oil category should be one of the vegetable oil providing essential
fatty acids each day. Tropical oils (e.g., coconut and palm) are extremely low in essential
fatty acids.
 Discretionary calories should be limited to avoid excessive weight gain.
 Satisfying appetite with sweets limits eating of vitamin-, mineral-, and protein-rich foods
important to good health and function.
 Low fat dairy products and lean meat should be used or discretionary calories reduced.
 A simple summary of food groups and good nutrition includes:
 Grains for carbohydrates and fiber.
 Brightly colored vegetables and fruits for vitamins, minerals, and fiber.
 Dairy for calcium and protein. Meats, legumes (beans), and nuts for proteins.
 Fats (oils) scattered among the foods for essential fatty acids.
 Iodized salt should be used in all food preparation, even if it costs more, to avoid goiters which
occur in many parts of the world.

Additional resources:
U.S. Department of Agriculture; Food Pyramid
U.S. Department of Agriculture; Dietary Guidelines
American Heart Association; food portion control
American Cancer Society; food portion control

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Food and Nutrition

Healthful Eating:
Module III The Basics

Learning Outcomes
By the end of this module the learners will be able to:

Calculate Body Mass Index (BMI)

Compute nutrition in food
Apply safe food preparation and storage

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 Your Healthy Weight

We often take it for granted, but good health is one of the most precious gifts of life. A
healthy weight—maintained throughout life—helps you achieve good health in many ways:
look your best, feel your best, and reduce your risk for many serious and ongoing
diseases.

What is a healthy weight?

It’s the weight that’s best for you—not necessarily the lowest weight you think you can be.
A healthy weight actually is a range that’s statistically related to good health. Being above
or below that range increases the risk of health problems, or decreases the likelihood of
good health.

The smart approach to your best weight is really no secret—only common sense. A
healthful lifestyle, with regular physical activity and an eating pattern chosen for variety,
balance, and moderation, makes all the difference. Maintaining a healthy weight throughout
life is best for health. Do you need to be “everyday perfect”? No. Just try to manage your
weight by eating smart and living actively most of the time.

Body Basics: What’s Your Healthy Weight?

The answer isn’t as simple as stepping onto a bathroom scale, then comparing your weight
to a chart. Your own healthy weight is one that’s right for you. It may be quite different from
someone else’s weight, even if you are the same height, gender, and age.

What makes the difference?

 Your genetic makeup plays a role because it determines your height and the size and
shape of your body frame. A genetic link to body fat also may exist. Of course, genetics
isn’t the only reason why weight differs from person to person.
 Your metabolic rate, the rate at which your body burns energy, makes a difference. So
does your body composition. Muscle burns more calories than body fat does. Your level
of physical activity and what you eat both play an important role, too.

So what’s your healthy weight?

That depends. Determining your right weight takes several things into account:
(1) your body mass index, or your weight in relation to your height;
(2) the location and amount of body fat you have; and
(3) your overall health and risks for weight-related problems such as diabetes or high blood
pressure.

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 Nutrition Calculations

What is the Body Mass Index (BMI) and how is it calculated? Nutrition Calculations
The body mass index is calculated using weight and height in the calculator on Instantly personalize these by
the right. changing the information below.
A higher number means more fat and a lower means less fat. Measurement units:
The range for good health is between 18.5 and 25; up to 28 is acceptable if over kg-cm lb-inch
age 50. Weight: 60.0
Obesity is from 30 to 40 and morbid obesity is over 40.
Severe malnutrition is 17.5 and lower. Height: 160.0
What impacts daily calorie needs and how are they estimated? Body Mass Index (BMI)
In addition to weight and height, the calories needed to maintain that weight 23.4
depend upon gender, age, and activity.
Activity is estimated from the number of minutes spent exercising each day, Gender:
including walking. male female
The estimator on the right applies only to persons age 3 and Minutes of daily exercise:
older.
Sedentary < 30 min.
You can also use the estimator as a guide to lose or gain weight.
Use your target weight to estimate your target calories needed. 30-60 min. > 60 min.
To lose weight, choose a level below or equal to your target calories but no Age in years: 20.0
less than 1000 calories per day unless otherwise directed by your physician.
To gain weight, choose a level above or equal to your target calories. Estimated Calorie Expenditure
2,290
How is the number of servings in each food group determined for a balanced diet
at a particular calorie intake?
A balanced diet includes servings from each food group during each day. Daily calorie goal: 2,250
Use the calculator on the right or the table below to convert any calorie goal
Calories in Servings Shown
between 1000 and 9800 into the number of servings needed from each food
group each day. 2,200
The number of calories entered will be rounded to the nearest 200 to generate
the list of servings. Daily Servings
Whole grains should make up half of the servings of grains. Grains: 7.0
A variety of fruits and vegetables of different bright colors will provide needed 6.0
vitamins and minerals. Vegetables:
Oil should include vegetable oils containing essential fatty acids to be used in Fruits: 4.0
food dressings and cooking. Dairy: 3.0
If meat is not lean and/or dairy is not reduced fat, then the servings of extra 2.0
calories should be reduced. Meat & beans:
The size of each serving is critical in determining the total number of Oil: 2.0
calories consumed each day. See the following table that shows the relatively 2.5
Extra calories:
modest size of the servings compared to what may be customary.

Category Serving Sizes Examples

Grains 1 oz or 30 g 1 slice bread, ½ cup or 125 mL cooked rice
Vegetables ½ cup or 120 mL tennis ball-sized serving
tennis ball-sized serving or medium-sized piece of
Fruits ½ cup or 120 mL
fruit (apple, orange, peach) or ½ cup of juice
Dairy 1 cup or 240 mL 1 cup low-fat milk or yogurt
(milk group) 2 oz or 60 g 2 dominoes-sized pieces of cheese
card deck-sized piece of lean meat, ½ cup beans,
Meat & beans 3 oz or 90 g
checkbook-sized piece of fish
Vegetable oil 1 tablespoon or 15 mL in cooking, gravies, or dressings
small piece of cake, ½ candy bar,
Extra calories 120 calories
2 golf ball-sized scoops of ice cream

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 SUGGESTED SERVINGS FOR DIFFERENT TOTAL DAILY CALORIES

To estimate servings for higher intakes, multiply 3200 calorie column numbers by chosen calorie factor
(e.g., 3500/3200)

TOTAL
CALORIES 1000 1200 1400 1600 1800 2000 2200 2400 2600 2800 3000 3200
Grains 3 4 5 5 6 6 7 8 9 10 10 10

Vegetables 2 3 3 4 5 5 6 6 7 7 8 8
Fruits 2 2 3 3 3 4 4 4 4 5 5 5

Dairy 2 2 2 3 3 3 3 3 3 3 3 3
Meat & beans 1 1 1.5 1.5 2 2 2 2 2.5 2.5 2.5 2.5

Vegetable Oil 1 1 1 1.5 1.5 2 2 2 2 2 3 3

Extra Calories 1 1 1 1 1.5 2 2.5 3 3.5 4 4.5 5

Additional resources:
U.S. Department of Agriculture; Food Pyramid
U.S. Department of Agriculture; Dietary Guidelines
California State University; Composition of common foods
U.S. Department of Agriculture; Comprehensive source of food composition
American Heart Association; food portion control
American Cancer Society; food portion control

15
 Body Mass Index (BMI)

The BMI has been used as a measure of

the appropriateness of a person’s weight
for a given height. It is calculated as…
Weight
BMI = ,
Height 2
with weight in kg and
height in meters.

OR

703 x Weight
BMI = ,
Height 2
with weight in lbs and
height in inches.
The normal BMI is between 18.5 and 25,
although for persons over 50 years, up to
28 is acceptable. If this number is less
than 17.5, then the person is severely
underweight and there is a good chance
he or she has protein-energy
malnutrition.

COMPUTATION CHART
1. Find weight in pounds on leftmost
scale or weight in kg on scale next to it.
2. Find height in inches on bottom scale
or height in cm on scale just above it.

3. Locate the intersection of these two

coordinates on the black square grid.

4. Read BMI (kg/cm2) on the curved

green lines with values on right and
above ranging from 10 to 40.

For example, 70 kg (155 lbs) intersects

with 175 cm (69 in) at the green BMI
curve labeled 23 kg/cm2 on the right.

16
 ENERGY (CALORIE) NEEDS

The first step in defining a balanced diet is to determine the estimated daily calorie requirement for an
individual. Important factors to consider are gender, weight (pounds or kilograms), height (inches or
meters), level of activity, and age (years). If a change in weight is desired, consider using the desired
weight instead of actual weight. The factor for the level of activity should be determined from the table
below considering the number of minutes spent walking or exercising each day.
In the appropriate gender column in the estimation table, fill in the weight (pounds in top chart or
kilograms in bottom chart) on line 2, height (inches in top chart or meters in bottom chart) on line 5,
activity factor on line 8, and age (years) on line 13. Then fill in the lines of that column from top to bottom
according to the instructions in the first column.

ACTIVITY FACTOR (PA)

Activity Level Boys (3-18) Girls (3-18) Men (>19) Women (>19)
Sedentary 1.0 1.0 1.0 1.0
< 30 minutes 1.13 1.16 1.11 1.12
30-60 minutes 1.26 1.31 1.25 1.27
> 60 minutes 1.42 1.56 1.48 1.45

Adapted from Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids
(Macronutrients), 2005, National Academy of Sciences, Institute of Medicine, Food and Nutrition Board, pp. 159 (in Chapter 5) and
1200 (in Appendix I).
http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=4&tax_subject=256&topic_id=1342&level3_id=5141&level4_
id=10588

17
 ESTIMATED ENERGY REQUIREMENT – LBS./INCHES ESTIMATED ENERGY REQUIREMENT – LBS./INCHES
(Make entries on lines 2, 5, 8, and 13 then fill in others) (Make entries on lines 2, 5, 8, and 13 then fill in others)
INSTRUCTIONS MEN WOMEN INSTRUCTIONS BOYS GIRLS
1 7.22 4.25 1 12.12 4.54
Enter target weight in 2 Enter target weight in 2
pounds on line 2 pounds on line 2
Multiply line 1 by line 2 and 3 Multiply line 1 by line 2 and 3
enter product on line 3 enter product on line 3
4 13.71 18.44 4 22.94 23.72
Enter height in inches on 5 Enter height in inches on 5
line 5 line 5
Multiply line 4 by line 5 and 6 Multiply line 4 by line 5 and 6
enter product on line 6 enter product on line 6
Add line 3 to line 6 and enter 7 Add line 3 to line 6 and enter 7
sum on line 7 sum on line 7
Enter activity factor from 8 Enter activity factor from 8
table above on line 8 table above on line 8
Multiply line 7 by line 8 and 9 Multiply line 7 by line 8 and 9
enter product on line 9 enter product on line 9
10 662 354 10 88.5 135.3
Add line 9 to line 10 and 11 Add line 9 to line 10 and 11
enter sum on line 11 enter sum on line 11
12 9.53 6.91 12 61.9 30.8
Enter age in years on line 13 Enter age in years on line 13
13 13
Multiply line 12 by line 13 and 14 Multiply line 12 by line 13 and 14
enter product on line 14 enter product on line 14
Subtract line 14 from line 11 Subtract line 14 from line 11
and enter difference on 15 and enter difference on 15
line 15 = Estimated Daily line 15 = Estimated Daily
Maintenance Calories Maintenance Calories

ESTIMATED ENERGY REQUIREMENT – KG./METERS ESTIMATED ENERGY REQUIREMENT – KG./METERS

(Make entries on lines 2, 5, 8, and 13 then fill in others) (Make entries on lines 2, 5, 8, and 13 then fill in others)
INSTRUCTIONS MEN WOMEN INSTRUCTIONS BOYS GIRLS
1 15.91 9.36 1 26.7 10.0
Enter target weight in 2 Enter target weight in 2
kilograms on line 2 kilograms on line 2
Multiply line 1 by line 2 and 3 Multiply line 1 by line 2 and 3
enter product on line 3 enter product on line 3
4 540 726 4 903 934
Enter height in meters on 5 Enter height in meters on 5
line 5 line 5
Multiply line 4 by line 5 and 6 Multiply line 4 by line 5 and 6
enter product on line 6 enter product on line 6
Add line 3 to line 6 and enter 7 Add line 3 to line 6 and enter 7
sum on line 7 sum on line 7
Enter activity factor from 8 Enter activity factor from 8
table above on line 8 table above on line 8
Multiply line 7 by line 8 and 9 Multiply line 7 by line 8 and 9
enter product on line 9 enter product on line 9
10 662 354 10 88.5 135.3
Add line 9 to line 10 and 11 Add line 9 to line 10 and 11
enter sum on line 11 enter sum on line 11
12 9.53 6.91 12 61.9 30.8
Enter age in years on line 13 Enter age in years on line 13
13 13
Multiply line 12 by line 13 and 14 Multiply line 12 by line 13 and 14
enter product on line 14 enter product on line 14
Subtract line 14 from line 11 Subtract line 14 from line 11
and enter difference on 15 and enter difference on 15
line 15 = Estimated Daily line 15 = Estimated Daily
Maintenance Calories Maintenance Calories

18
 Obesity

Why is it not good to be overweight? How can weight be managed?

Excess weight interferes with health, well-being, At least 30 minutes of daily exercise for six days
and the ability to perform normal daily activities. each week is normally recommended.
― Some immediate problems of excess weight ― An additional 30 minutes of daily activity would
include decreased mobility, fatigue, tiredness, be wise.
shortness of breath with exercise, increased ― A good goal is to walk or run five miles a day.
sweating, back pain, and lower limb problems A carefully selected diet is important to
with feet, ankles, knees, and/or hips. successfully manage excessive weight.
― Longer-term excess weight includes increased ― A diet low in animal fat will help.
susceptibility to type 2 diabetes mellitus, ― The diet should be modified to maintain
hypertension, and cardiovascular disease. appropriate nutrition while decreasing calorie
― The normal body mass index (BMI) is between intake.
18.5 and 25, although up to 28 is acceptable ― A daily multiple vitamin and mineral
for persons over age 50. See Nutrition supplement is recommended.
Calculations, BMI to calculate your body mass Design a weight-reduction diet such as the
index. following:
― Waist size measured at the navel line has also ― Determine the estimated number of calories
been shown to be an indicator of health risks estimated to be needed to maintain weight
due to obesity, regardless of actual weight. based on gender, age, height, weight, and
Risks are increased in adult women with a activity level. See Nutrition Calculations,
waist size greater than 35 inches (89 cm) and Estimate Daily Calories.
in adult men with a waist size greater than 40
inches (102 cm). ― Choose an intake of 500-1000 calories LESS
― It is best to begin early to control a tendency to than the one estimated to maintain your
be overweight. current weight (but not less than a total of
1000 calories per day).
― Use your chosen daily calorie intake to
Obesity determine the servings in each food group.
― Body mass index is between 30 and 40.
― Normal body function is compromised because See Nutrition Calculations, balanced diet
of excess weight. servings.
― Obesity should be treated vigorously when ― Distribute these servings over 5 to 6 meals
evident. throughout waking hours.
Use low-calorie snacks to stave off hunger, such
Morbid obesity as yogurt (80-100 calories) plus a glass of
― Body mass index is 40 or more.
― Both body functions and health are impaired. water.
Strictly maintain the size and number of servings
― Aggressive action may be required to correct each day.
it. Consider and treat edema and hormonal
― Weight loss surgery may be necessary if life is imbalances, if present. These are uncommon
in jeopardy. and most persons with excess weight can
benefit from calorie management.
What causes obesity?
Most commonly, obesity is due to eating more Additional resources:
calories (energy) than used for activity and National Institutes of Health (NIH), Medline; weight control
maintenance. National Institute of Diabetes and Digestive and Kidney
Occasionally, hormonal imbalances such as Diseases, NIH; weight-control information network
National Heart, Lung, and Blood Institute, NIH; Body mass index
hypothyroidism or excessive hydrocortisone Body mass index, formulas and interpretation
can help cause obesity. National Heart, Lung, and Blood Institute, NIH: Aim for a healthy
weight and waist size

19
 Malnutrition

What’s wrong with being underweight? • Marasmus and kwashiorkor are the two
forms of protein-energy malnutrition. Both
Moderate nutritional deficiency appears as conditions may be distinguished by their
general weight loss; muscle loss; muscle own particular clinical characteristics.
weakness; sensation of coldness; thin, boney
appearance; listlessness; fatigue; apathy; The main distinguishing characteristics of
anxiety; decreased social responsiveness; and kwashiorkor is oedema, or fluid accumulation
frequent infections. in the body as a result of severe nutritional
Severe nutritional deficiency results in fatty
liver; edema (swollen limbs and face, which can deficiencies. Oedema may be detected by
mask weight loss); thin, easily broken fissured pressing the thumb body as a result of severe
nails; poor wound healing; “flaky paint” rash; nutritional deficiencies. Oedema may be
skin ulcerations; brittle, depigmented hair; and detected by pressing the thumb just above the
wrinkled, baggy skin (loss of subcutaneous fat). ankle for three seconds; this will leave a
It can become a life-threatening condition if not
resolved promptly. definite pit. Loss of appetite is
Malnutrition is a risk when body mass index is another common feature. Mental changes are
less than 18 and clearly present when less than also common, resulting in a child who is
17. See Nutrition Calculations, BMI. apathetic and irritable.
What causes malnutrition?
Malnutrition is the result of an inadequate intake
and retention of nutrients.
This condition can be caused by lack of food,
lack of a particular food group, failure to
consume enough food or a particular food
group, vomiting, diarrhea, parasitic infection, or
chronic mental or physical disease.

How is malnutrition managed?

It is critical that underlying infections and
physical and emotional diseases be treated
while attempting to restore a normal body
weight.
Feeding a malnourished person is best done
under the direction of a competent health care Malnourished Children
professional to avoid severe reactions to the
wrong foods being fed too rapidly. Note the oedema on the childs hands and
Protein-Energy Malnutrition (PEM) is the most feet, this is the key sign of kwashiokor a
common form of malnutrition occurring among very serious form of malnutrition.
infants and young children. Mild PEM manifests
itself mainly as poor physical growth, whereas
individuals with severe PEM have high case fatality
rates.

Additional resources:
Facts on carbohydrates, proteins, fats and fiber and amounts in common foods
USDA. Food sources of protein beginning with the highest concentration
USDA. Food sources of calories beginning with the highest concentration
USDA. Food sources of protein listed alphabetically
USDA. Food sources of calories listed alphabetically

20
 Proteins
“The biological essence of life”

What are proteins and where do they come from? How can babies receive an adequate amount of
protein?
Proteins are the “building blocks of life” and
necessary for good health. Proteins are made of Breast milk is an ideal source of protein for the
chains of up to 20 different amino acids. During first 12 to 24 months of life, because it:
digestion, proteins are broken down into amino
acids for the body to use. Has a perfect balance of amino acids.
Amino acids are generated by the body or Does not cause allergy.
obtained through food. There are eight Provides all needed nutrients for normal-term
“essential” amino acids that cannot be made by infants.
adult bodies and must be eaten. ― Additional minerals, vitamins, and other
“Complete” proteins contain all the essential nutrients are needed after the first 6 months.
amino acids in adequate amounts. Foods with ― Low-birth-weight infants may also need
complete proteins include meats and animal additional nutrients for rapid growth.
products such as milk, yogurt, cheese, and eggs.
Soybean proteins, as in tofu or “soy milk,” are
also complete proteins.
“Partially complete” proteins contain all the
essential amino acids, but the amount of one or
more of those essential amino acids is
inadequate. Most proteins in a plant group are
only “partially complete” but can be made Additional resources:
“complete” if combined with another protein
source: NIH Medline Encyclopedia, protein
― legumes (beans) + grains = “complete” Harvard Hospital nutrition source, protein
protein (e.g., peanut butter sandwich)
― grains + dairy = “complete” protein (e.g.,
cereal and milk)
― grains + nuts or seeds = “complete” protein
(e.g., granola)

Why are proteins important?

Provide needed components for gene and cell
reproduction.
Carry out the instructions of the genes in the
cells.
Form a major part of muscle, including the heart.
Make up tendons and most connective tissues.
Help make up collagen and cartilage, which
determines the shape of the skeleton.
Direct and control the chemical reactions of life
as enzymes.
Direct and balance body functions as hormones.
Repair body damage by forming scar tissue.
Defend against infection as antibodies.

21
 Carbohydrates

What are carbohydrates? • Glycogen lasts less than a day if not replenished
from the diet and can be depleted within a few
 Most carbohydrates (“hydrated carbon”) contain hours with intense activity.
atoms from one water molecule (H2O) for each • If carbohydrates are not replenished regularly,
atom of carbon (C). the body uses protein to make glucose for tissues
 A monosaccharide is the basic dietary which require it for energy.
carbohydrate and has six carbons. Examples are
glucose, fructose, and galactose. Glucose is
the sugar in blood. Fructose is twice as sweet as Can eating or drinking certain carbohydrates cause
glucose and found in fruits. Galactose is less diabetes mellitus to appear early if one is at risk (e.g.,
sweet than glucose and present in milk. has a family history of diabetes, obesity, or sedentary
lifestyle)?
 Disaccharides form when two monosaccharides
join together.
• High-glycemic-index foods increase risk. They
DIETARY DISACCHARIDES include sugary beverages, cornflakes, many
glucose + glucose maltose from starch bakery items (bread, crackers, cookies, pastries,
glucose + fructose sucrose table sugar etc.), rice, and potatoes.
― They are easily digested and increase blood
glucose + galactose lactose milk sugar sugar quickly.
• Low-glycemic-index foods increase risk less.
 Starches in vegetables and grains are long
chains or polymers of glucose. Cornstarch is They include pasta, high-fiber foods, legumes,
oatmeal, milk, yogurt, nuts, peanut butter, and
broken into short chains of glucose to make corn whole fruits.
syrup; using special enzymes makes high- ― They are digested more slowly and influence
fructose corn syrup, a popular sweetener. blood sugar less.
 Cellulose is also a long chain or polymer of
glucose. It is one of several indigestible Why are some people lactose intolerant?
carbohydrates called fiber. • Lactose cannot be used until it is broken down
into its two parts by the enzyme lactase.
Why are carbohydrates important? • Virtually all infants have enough lactase to digest
• Provide energy for brain, muscle, and other body the lactose in milk.
functions. • Lactase levels diminish with age in most
• Combine with proteins or fats to form important populations causing lactose intolerance.
parts of cartilage, connective tissue, the nervous ― Undigested lactose passes through the
system, and the immune system. intestine and into the large bowel.
• Contribute to stool softness and normal bowel ― Bacteria in the large bowel ferment the
function as fiber. Large amounts of some fibers in lactose into gas and acids.
the bowel can ferment to produce gas (flatus). ― Fermentation produces flatus (gas), cramps,
and diarrhea.
How are carbohydrates digested and controlled? ― Butter, cheese, yogurt, and even small
amounts of milk (2-4 oz or 60-120 ml,
• Disaccharides and starches are digested into especially with food) can generally be
monosaccharides in the intestine. tolerated by these persons.
• The monosaccharides are absorbed and carried • However, certain populations of North European
to the liver. ancestry and a few in Africa have genes causing
• The liver uses the glucose or converts other lactase to remain with no symptoms of lactose
monosaccharides to glucose for circulation or intolerance.
storage (glycogen).
• Circulating glucose fuels nerves, brain, eyes, and Additional resources:
other tissues without requiring insulin. NIH Medline Encyclopedia, carbohydrate
• When blood glucose is high, insulin moves it into Harvard Hospital nutrition source, carbohydrates
muscle and fat cells. Harvard Hospital nutrition source, fiber
• When blood glucose lowers between meals, liver National Institute of Diabetes and Digestive and Kidney
glycogen is broken down to maintain it. diseases (NIDDK), NIH, lactose intolerance
22
 Fats

What are fats?

Fats are mostly made of carbon and hydrogen Trans fatty acids are formed when hydrogen is
and do not mix well with water. added to unsaturated fats to make them solid.
Most dietary fats, called triglycerides, are made Cholesterol is another type of fat found in all cell
with three fatty acids. membranes in small amounts.
Fatty acids can be saturated (full of hydrogen),
monounsaturated, or polyunsaturated, Why are fats important?
depending on how much hydrogen can be added Cell membranes are layers of fat which form cell
to them. walls and chambers.
Saturated fats provide concentrated energy, tend ― They keep fluids separate for chemical
to be solid (e.g., in butter and lard), and promote
high blood cholesterol. reactions characteristic of life and require
essential fatty acids to function normally.
Monounsaturated fats are a healthy form of Fat is important insulation.
concentrated energy (e.g., in olive, canola, and ― Fat just below skin insulates the body from
peanut oils) and are less likely to spoil than extreme temperatures.
polyunsaturated fats. ― Layers of fat around important organs
Certain polyunsaturated fatty acids (PUFA) in the insulate them from physical shock or injury.
diet are essential to good health and cannot be ― A special fat forms the layer around nerve
made by humans. cells that “electrically” insulates them from
― The omega-3 fatty acid (ω-3) family includes each other. Multiple sclerosis is an example
ALA (α-linolenic acid), EPA
(eicosapentaenoic acid), and DHA of a condition where this layer is damaged.
Fat is an efficient way to store energy.
(docosahexaenoic acid). ― A pound of fat contains about 3500 calories.
• Rich vegetable oil sources are flax and ― Fats contain 9 calories in each gram
canola. Fish oil (e.g., salmon) is rich in
EPA and DHA. compared to 4 for proteins and
• Omega-3 refers to the last opening for carbohydrates.
― If energy were stored as carbohydrates
hydrogen being 3 positions from the end instead of fats, then body weight could be
of the fat molecule. 30% greater.
― The omega-6 fatty acid (ω-6) family includes
LA (linoleic acid) and AA (ARA or Cholesterol performs several functions.
arachidonic acid). ― It stabilizes cell membranes.
• Rich sources include corn, peanut, ― It is the basis for some hormones (e.g.,
sesame, sunflower, and safflower oils. hydrocortisone, estrogen, and testosterone)
• Omega-6 refers to the last opening for and for the production of vitamin D by
hydrogen being 6 positions from the end sunlight on skin.
of the fat molecule ― It is the basis for bile salts which help
― The best ratios of the two essential fatty acid digestion of fat.
families are in soy oil and canola oil. However, excess cholesterol, saturated fats, and
• There is also a good ratio in the less trans fats in the diet can increase bad cholesterol
common hemp seed, mustard, and rice in blood and worsen atherosclerosis (clogging of
bran oils. the arteries) and associated diseases.
• Olive oil has a good ratio, but levels of Decreasing these fats or replacing them with
the essential fatty acids are low. monounsaturated fats can help reduce these
― Tropical oils (e.g., coconut oil and palm oil) effects.
are low in essential fatty acids.
• Their fatty acids are saturated with Additional resources:
hydrogen but remain fluid at room Harvard Hospital nutrition source, fats
temperature. NIH Medline Encyclopedia, fats

23
 Minerals

Macrominerals – minerals required in large as kidney failure, however, can result in

amounts in the diet. excessive loss of phosphorus, creating a
deficiency in the body.
Over 200 mg of each macromineral is in a normal NIH Medline Encyclopedia, phosphorus
daily diet.
Electrolytes include sodium, potassium, and Magnesium
chloride. About half of the body’s magnesium is found in
Generally, they are adequate in the diet. the bones, half within cells, and about 1% in the
They can become unbalanced if dehydration blood and tissue fluids.
occurs It is important for normal muscle and nerve
functions, keeps heart rhythm steady, supports a
Fruits, vegetables, and meats are good sources healthy immune system, and keeps bones strong.
of electrolytes. Magnesium also helps regulate blood-sugar
levels and promotes normal blood pressure.
Calcium – The most abundant mineral in the body. Muscle cramping may be an early symptom of a
99% of the body’s calcium is combined with deficiency.
phosphorus in the skeleton to make bones The best sources are leafy green vegetables,
strong. nuts, and seafood, although other good sources
1% of the body’s calcium is in various body and include whole grains, meats, and dairy products.
tissue fluids Office of Dietary Supplements, NIH, magnesium
 This calcium is important for muscle tone,
muscle contraction, and nervous system Trace elements or microminerals – minerals
functions. required in very small amounts in the diet.
 Muscle cramping may be an early symptom of Less than 20 mg of each micromineral is in a
low blood calcium. normal daily diet, but each is essential to life and
Excellent diet sources include milk, yogurt, health.
cheese, sardines, tofu, soy milk, and canned Microminerals are important helpers in various
salmon (with bones). reactions throughout the body
 If foods like these are not eaten, then a calcium Some important microminerals are iron, iodine,
supplement should be considered with meals zinc, copper, selenium, fluorine, and chromium.
and green leafy vegetables included in the diet,
particularly for women. Iron
Inadequate intake of calcium leads to early Iron makes up a central part of hemoglobin in red
osteoporosis and complicating fractures. blood cells.
Most bone calcium content accumulates by the It carries life-giving oxygen throughout the body.
end of adolescence and completes by about age Insufficient iron or copper are two causes of
30. After that, skeletal calcium tends to anemia (low red blood cell count), which results
decrease, especially in women after menopause. in paleness, fatigue, tiredness, and loss of
It is particularly critical for young women to energy. Menstruating women lose blood
maximize their bone mineral content before regularly and easily develop iron deficiency.
childbearing begins and to pay serious attention Iron deficiency in the cells, even in the absence
to calcium and vitamin D intake throughout their of anemia, also leads to tiredness, fatigue, and
lives. decreased energy.
Office of Dietary Supplements, NIH, calcium Good sources of iron include meat, fortified
Harvard University nutrition source, calcium cereals, beans, green leafy vegetables, and
Phosphorus whole grains.
Phosphorus combines with calcium to strengthen  Human milk contains little iron.
the skeleton. o However, it is generally sufficient for the first
It participates in numerous chemical reactions in 6 months of life
the body. o After that, the infant diet should include
It also forms part of the nucleic acid strands that additional sources of iron.
make up genes.  If iron deficiency occurs, then a supplement is
Most normal diets have enough phosphorus, so needed.
diet deficiency is very rare. Certain diseases such Office of Dietary Supplements, NIH, iron
24
 Iodine Zinc
Iodine is part of thyroid hormones Zinc helps in many chemical reactions in the
It is critical to human health and function. body.
Deficiency leads to Deficiency leads to
 Goiters (swelling of the thyroid gland).  Skin rashes, dermatitis, hair loss, diarrhea,
 Loss of energy, tiredness, and constipation. poor wound healing, and decreased immune
 Mental function slowing down. function.
 Cretinism and permanent mental retardation in  Diminished eyesight, taste, smell, and memory.
the child when severe deficiency occurs during  Delayed puberty.
pregnancy and infancy. 25% of the people in the world are at risk for zinc
Sources of dietary iodine are quite variable, deficiency, especially populations consuming
depending on the soil in which the food is plant-based diets low in available zinc or with
produced. Seafood is often an excellent source diseases such as chronic diarrhea, which
but is also variable. Dairy products are good increase zinc losses or interferes with zinc
sources if the cows producing them eat grass and absorption.
hay with good iodine content or are Meats are a primary source of zinc but other
supplemented. sources include dairy products, beans, nuts, and
The most reliable dietary source is iodized salt. It fortified cereals. Absorption is best in diets that
is suggested that iodized salt always be used include animal proteins.
even if it costs more than non-iodized salt. Office of Dietary Supplements, NIH, zinc
University of Michigan, iodine deficiency

Vitamins

Vitamins are organic compounds essential to life Water-soluble vitamins (B vitamins, vitamin C,
and health though present in very small amounts. and choline):
Fat-soluble vitamins (vitamin A, vitamin D, Can easily be excreted in the urine if
vitamin E, and vitamin K): consumed in large amounts.
Can be stored in the body. Do not generally reach toxic levels.
Can be toxic if consumed in large amounts. Must be replaced frequently, preferably daily.

VITAMIN TABLE
Vitamin Name Sources Deficiency effects
FAT-SOLUBLE VITAMINS
Preformed vitamin A is found only in
Impaired vision, night blindness, dry eyes, destruction of
animals or supplemented foods. It is
Vitamin retinol, retinal, the cornea, and total blindness. Other effects include
generally made by converting
A retinoic acid impaired immunity, anemia, thickened cells in breathing
compounds in yellow and green
passages and urinary bladder, and damaged teeth.
vegetables.

A deficiency in childhood leads to the bone deformities of

Fish, fish oils, and fortified foods. Most
Vitamin cholecalciferol, rickets. In adulthood, thinning of the bones with muscle
is made by converting a compound in
D ergocalciferol weakness is known as osteomalacia. Reduced bone
the skin when exposed to sunlight.
mineral density and fragile bones is called osteoporosis.

Vitamin tocopherols, Almonds, sunflower seeds, sunflower Deficiency is rare. It usually appears as nerve problems in
E tocotrienols oil, peanuts, hazel nuts, and corn oil. hands and feet but also as anemia in premature infants.

Bacteria in the gut, cabbage,

Vitamin phylloquinone, cauliflower, spinach, other green leafy
Impaired blood clotting, poor mineralization of bone.
K menaquinone vegetables, cereals, soybeans, and
other vegetables.
25
WATER-SOLUBLE VITAMINS
Fortified breads, cereals, and pasta; Beriberi: weight loss, emotional disturbances, impaired
whole grains, lean meats, fish, dried senses, weakness and pain in arms and legs, irregular
Vitamin thiamin beans, peas, and soybeans. Lesser heartbeat, and swelling of bodily tissues. Heart failure and
B1 amounts are found in fruits, vegetables, death can occur in advanced cases. Chronic deficiency can
and dairy products. There is none in also cause permanent psychosis with memory loss and
unfortified polished rice. confusion.
Cracks in lips (especially mouth corners), high sensitivity to
Lean meats, eggs, legumes, nuts, green
Vitamin riboflavin sunlight, inflammation of the tongue, dermatitis (particularly
leafy vegetables, dairy products, and
B2 the genitals and mouth), and sore throat and mouth.
fortified breads and cereals.
Growth failure also occurs in children.

Cereal grains, legumes, vegetables

Vitamin pyridoxine Anemia, depression, dermatitis, high blood pressure, and
(carrots, spinach, peas), potatoes, milk,
B6 water retention.
cheese, eggs, fish, liver, meat, and flour.
Anemia, neuropathy of hands and feet, and mental deficits.
Vitamin cobalamin Eggs, meat, poultry, shellfish, milk, and Decreased absorption occurs with gastritis and pernicious
B12 milk products. anemia. It can also cause symptoms of mania and psychosis.
Rarely, paralysis can result.
Dairy products, poultry, fish, lean meats,
Pellagra: aggression, dermatitis, insomnia, weakness, mental
* niacin nuts, and eggs. Legumes and enriched
confusion, diarrhea, and eventually dementia and death.
breads and cereals also.
Eggs, fish, milk and milk products, whole-
pantothenic grain cereals, legumes, yeast, broccoli
* Uncommon but can result in acne, numbness, and tingling.
acid and other vegetables in the cabbage
family, potatoes, and lean beef.
Eggs, fish, milk and milk products, whole-
grain cereals, legumes, yeast, broccoli
* biotin Impaired growth and neurological disorders in infants.
and other vegetables in the cabbage
family, potatoes, and lean beef.
Beans and legumes, citrus fruits, whole
* folic acid grains, dark green leafy vegetables, Anemia and birth defects.
poultry, pork, shellfish, and liver.
All fruits and vegetables contain some.
Highest: green peppers, citrus fruits,
strawberries, tomatoes, broccoli, turnip Scurvy: loss of appetite, diarrhea, shortness of breath,
greens and other leafy greens, potatoes, weakness, fatigue, irritability, depression, leg pain, bleeding
Vitamin ascorbic acid
and cantaloupe. Other excellent sources: gums, small hemorrhages from capillaries under the skin,
C
papaya, mango, watermelon, brussel pallor, anemia, poor wound healing, corkscrew body hair,
sprouts, cauliflower, cabbage, winter and an impaired immune response.
squash, red peppers, raspberries,
blueberries, cranberries, and pineapple.
Abundant in egg yolk; added during
** choline Fatty liver and liver damage.
processing in many foods; lecithin.
*Vitamin B numbering is controversial for these vitamins **Recently recognized essential nutrient
Additional resources:
NIH Medline Drug Information, pyridoxine, vitamin B6
Office of Dietary Supplements, NIH, vitamin A
NIH Medline Encyclopedia, cobalamin, vitamin B12
Office of Dietary Supplements, NIH, vitamin D
NIH Medline Encyclopedia, niacin
Office of Dietary Supplements, NIH, vitamin E
NIH Medline Encyclopedia, pantothenic acid and biotin
NIH Medline Encyclopedia, vitamin K
NIH Medline Encyclopedia, folic acid
NIH Medline Encyclopedia, thiamin
NIH Medline Encyclopedia, vitamin C, Ascorbic acid
NIH Medline Encyclopedia, riboflavin
Journal of Nutrition, choline

26
 Water

How much water does the human body need? What happens if a person does not get enough
About 60% of the body is water. Virtually all water?
body functions depend on it. Dehydration (weight reduction due to net water
An average of 2–2.5 liters (or quarts) is lost loss) can cause significant problems.
on a normal, quiet day at sea level. Reduced physical and mental function can
 Water in food replaces about 20% of begin to occur after only 1%-2% water loss.
the water lost. Other symptoms include headache, dry
 Plain water and other beverages eyes, irritability, and sleepiness.
replace 80% of the water lost. Muscle cramps and salt loss often occur.
The average adult drinks 2.2–3.0 liters (9– Impairment worsens as dehydration
12 cups) of fluids each day. increases.
 This amount in deciliters should equal Thirst can indicate dehydration but water
about one-third the body weight in loss is already significant by the time
kilograms. someone becomes thirsty.
 This amount in fluid ounces should It is best to drink enough fluids to avoid
equal about one half the body weight in these problems.
pounds.
Daily fluid needs can more than double due to
higher elevation, higher temperature, lower
humidity, more exercise, and wrong clothing. Additional resources:
Water losses are still significant even while Institute of Medicine, National Academies, Dietary
just sitting in air-conditioned comfort. Reference Intakes for Water, …; Free Resources:
Caffeine or guarana found in many “power PDF Executive Summary
drinks” may cause extra water loss in urine Institute of Medicine, National Academies, Dietary
and increase fluid needs. Reference Intakes for Water, …; Google Books Result
The best beverage choice is safe water or, in
specific cases when salt losses are high such
as with heavy sweating, a high-quality sports
beverage.

Infant Nutrition
Why is mother’s milk the best food for infants born How should infants be fed?
near term gestation? Mother’s milk should be exclusively fed to an
The protein from mother’s milk: infant for the first 4 to 6 months and should be the
Is an ideal blend of essential and nonessential foundation of a child’s diet for at least 12 months.
amino acids. By 4 to 6 months of age, infants tend to “outgrow”
Generally does not cause allergies. their body supply of iron, and other nutrients are
Includes antibodies which may provide some needed in addition to mother’s milk.
protection against germs found in the New foods are often introduced one at a time
environment of the mother and infant. for a week or more to determine that the infant
The carbohydrates (lactose) from mother’s milk: tolerates it.
Are readily digestible by virtually all newborn Iron-fortified baby cereal (rice or oatmeal)
infants. mixed with a little breast milk is generally a
Provide a natural laxative function. good first solid food.
The fat provides infants with: This can be followed by pureed fruits,
Essential fatty acids. vegetables, and meats.
Energy to meet rapid growth needs.  Vegetables should be cooked and thoroughly
Minerals and vitamins are readily digestible and mashed.
generally sufficient with modest exposure to  Ripe fruits can be sanitized, peeled, and
sunlight to produce some vitamin D. pureed as well.
 Cooked meats should be chopped and
minced to a fine paste.
27
 If baby cereal is not available, then gruel (made In an emergency, when neither mother’s milk nor
of rice or oatmeal) can be prepared. commercial formula is available, a temporary
Baby foods should be prepared using purified substitute can be prepared by mixing 19 fl. oz.
water and containers which have been (600 mL) whole cow milk, 13 fl. oz. (400 mL)
sanitized. water, and 3 tablespoons (45 mL) granulated
sugar [or alternatively 10 fl. oz. (300 mL)
How do you feed an infant if the mother’s milk is not evaporated milk, 22 fl. oz. (700 mL) water, and 3
available, for example, when the mother is missing tablespoons (45 mL) granulated sugar]. Bring just
or very ill? to a boil and let it cool to room temperature in a
A milk substitute may occasionally be used but sterile container protected from dust and flies.
will not have the advantages of mother’s milk and Caution: Condensed milk, honey, molasses, and
risks of infection may increase. The preferred corn syrup sweetener should not be used, and
substitute is an iron-fortified commercial infant goat milk requires a folic acid supplement.
formula prepared exactly as instructed on the
label. Caution: Do not dilute with extra water. Additional resource:
American Academy of Pediatrics; infant nutrition

Dietary Supplements

Supplements to a well-balanced diet are If sufficient amounts are not eaten, then
generally not necessary. supplements containing them would be
Excess amounts of some supplements may prudent.
create an unhealthy balance of nutrients. Folic acid
However, modest specialized supplements Birth defects increase if folic acid is low.
are desirable in special circumstances. A folic acid supplement is advisable before
and during pregnancy.
Vitamin D production by exposure of the skin to
the sun is usually adequate. If not available, a special effort to eat a diet
rich in folic acid would be wise (e.g.,
Skin synthesis of vitamin D may not be fortified foods such as grains and cereals,
adequate:
 With decreased sun exposure beyond liver, cowpeas, great northern beans,
baked beans, spinach, broccoli, asparagus,
40° latitude.
 When the skin is covered with and green peas).
sunscreen or clothing or as skin Vitamin C
pigmentation increases. Fresh fruits and vegetables may be hard to
 In the elderly, who often do not produce find in very cold climates for months at a
enough 7-dehydrocholesterol, which is time.
necessary for vitamin D production. In such cases, a vitamin C supplement
Since human milk levels of vitamin D are would be helpful.
very low, if nursing infants are not exposed
to sunlight, they may be at risk for Since absorption of B vitamins decreases with
developing crooked bones and fractures age, the elderly may benefit from a supplement.
(rickets). However, too much sun exposure Vitamin B12 is not present in plants. Those
increases the risk of dehydration, sunburn, eating a strict vegetarian diet may need to
and eventually skin cancer in later life. receive a supplement.
In all such circumstances, a vitamin D
supplement may be helpful. Supplements are also useful for treating
specifically identified deficiencies.
Women are particularly susceptible to For example, iron deficiency anemia may
developing osteoporosis and bone fractures be treated with an iron supplement.
later in life On the other hand, if large doses of zinc,
They should consume adequate calcium, copper, or other nutrients are taken without
vitamin D, and vitamin K to: there being a deficiency, they may interfere
 Maximize bone mineral deposits during with the absorption and utilization of critical
the growth and childbearing years. nutrients such as iron.
 Maintain bone mineral content
thereafter. Additional resource:
Office of Dietary Supplements, NIH; fact sheets on
different supplements

28
 Vegetarian diets

Vegetarian diets can be quite varied. Intake of several vitamins may be limited.
They can contain low amounts of or no animal B vitamins
products.  Vitamin B12 is not present in foods from
They are personally chosen, culturally plants.
determined, or mandated by scarcity.  Riboflavin may be deficient if little milk is
Vegans consumed.
 They are strict vegetarians.  Vegetarians can obtain these vitamins from
 They consume no animal sources of food. enriched cereals, fortified soy products, or
 They are at the highest risk for nutritional dietary supplements.
problems. Adequate intake of vitamin D may be a
Lacto-vegetarians, ovo-vegetarians, or lacto- challenge.
ovo-vegetarians will consume milk, eggs, or  Food sources include fortified milk (if
milk and eggs, respectively. consumed), enriched cereals, fortified juice,
Some vegetarians will not eat meat or poultry or supplements.
but will eat fish.  Unblocked sun exposure between the 40-
Other variations of vegetarian diets occur. degree latitude parallels provides vitamin D.
o This exposure is enough year-round for
young to middle-aged persons.
Macronutrients o This exposure may not be enough in
Carbohydrates and fats (oils) are plentiful. older people due to decreased synthesis
Complete proteins may require using: in the sun. They must rely on
 Soy protein (e.g., soy milk and tofu). supplements.
 Simultaneous consumption of combinations
of legumes/lentils, nuts/seeds, grains, and/or
selected vegetables such as potatoes.
Note: The following link is not an official Church
publication but is provided as additional resource
Intake of several minerals may be limited. material.
Vegetarians not eating dairy products should: NIH Medline, vegetarian diets
 Eat enough vegetables containing significant
calcium, e.g., spinach, turnip and collard
greens, kale, and broccoli.
 Eat calcium fortified foods such as tofu, soy
milk, and fortified fruit juices.
Iron and zinc
 High phytate content of whole grains and
legumes may decrease absorption.

 Good vegetable sources of iron include

cooked legumes (beans, peas, lentils),
enriched cereals, dark leafy green
vegetables, whole grain products, and dried
fruit.
o Eating fruits and vegetables with high
vitamin C content helps use iron.
 Good vegetable sources of zinc include
whole grains, soy products, nuts, and wheat
germ.

29
 Safe Food Preparation and Storage

Eating contaminated food is a common source Prepared food is an excellent place for disease-
of illness. producing bacteria to grow and multiply enough
It may carry disease-causing bacteria or at room temperature to make a person very ill.
parasites. Illness-producing growth does not generally
A relatively safe guide regarding food is: occur in the first two hours.
All prepared food should be eaten or put
COOK IT, PEEL IT, BOIL IT, OR FORGET IT! into a refrigerator (<4°C or <40°F) within
two hours.
Certain fresh fruits and vegetables that are An exception would be carefully prepared
not peeled can be sanitized. sandwiches that are usually safe for five to
Wash free of obvious dirt. six hours.
Soak for at least 30 seconds in sanitizing Bacteria growth and spoilage can occur in
solution. the refrigerator as well but is slowed.
Rinse in purified water. Prepared food should be cleaned out of the
These suggestions may not be enough for refrigerator and discarded at least weekly.
foods formed in heads (lettuce, cauliflower, If frozen, prepared food can be kept for up
cabbage, etc.) or with an irregular surface to a year or more.
such as spinach, broccoli, or most berries.
Typical Bacterial Growth in Food
Due to the agricultural practices in some
countries, leafy vegetables such as lettuce Temperature Time to Double
and spinach may actually integrate 90°F (32°C) ½ hour
parasites in such a way that they cannot be
sanitized without cooking. 70°F (21°C) 1 hour
60°F (16°C) 2 hours
All surfaces (cabinet tops, cutting boards, 50°F (10°C) 3 hours
dishes, plates, utensils, etc.) which come into
contact with food during its preparation and 40°F (4°C) 6 hours
serving should be cleaned with warm, soapy 32°F (0°C) 20 hours
water or sanitizing solution and rinsed with 28°F (-2°C) 60 hours
purified water before and after using.

SANITIZING SOLUTION
2 teaspoons (10 mL) fresh liquid bleach
1 quart (or liter) of water

Surfaces which come into contact with

uncooked meat (especially poultry) should
not be exposed to other foods until cleaned
and sanitized again.

Additional resources:
U.S. Department of Agriculture, Basics for Handling Food
Safely
U.S. Department of Agriculture, Safe Food Handling Fact
Sheets
University of Tennessee, Guide to Safe Food Handling

30
Food and Nutrition

Digestion and
MODULE IV Detoxifica-
tion

Learning Outcomes
By the end of this module the learner will be able to:

 Discuss what Digestion is.

 Outline the key points in maintaining a healthy digestive system.

31
Food and Nutrition

Digestion and Detoxification

What is Digestion?
Digestion is the process of breaking down food so that it is small enough to be absorbed and used by the
body for energy, or processed in other bodily functions. Digestion involves a number of different stages.
The first phase is known as the cephalic (head) phase. It starts before food has even entered into our
mouth. The sight, smell, taste, or even the thought of food, will activate saliva in the mouth, as well as
digestive juices, which contains enzymes to break down food.

In the Mouth

Once food is in our mouth, the taste buds begin determining the chemicals within the food via their
nerve endings, in order to give us the taste sensations of salty, sweet, sour, or bitter. As our teeth chew
and grind down the food, it is mixed with saliva. This comprises many enzymes including salivary
amylase, which begins to break down the long chains of starch found in foods such as bread, cereals,
potatoes and pasta. Saliva also contains mucin, which moistens the food so it can pass easily through the
digestive (gastrointestinal) tract.

The Oesophagus

After the food has been swallowed, it is carried down the oesophagus (a muscular tube) towards the
stomach. The oesophagus can contract and relax in order to propel the food onwards, and each
mouthful of food takes about six seconds to reach the stomach once swallowed.

The Stomach

The stomach is a sack made of muscle and, when it is empty, it has a volume of only 50 ml but this can
expand to hold up to 1.5 litres or more after a meal. The walls of the stomach are made of three
different layers of muscle that allow it to churn food around and make sure it is mixed with the
stomach's acidic digestive juices. The presence of hydrochloric acid in the stomach prevents the action of
salivary amylase and helps to kill bacteria that might be present. The stomach also produces the enzyme
pepsin, which breaks down proteins (mostly found in meat, fish, eggs, and dairy products).

The hormone ghrelin is produced by cells lining the stomach. Ghrelin stimulates hunger and tends to
increase before a meal and decrease after eating. This hormone forms part of the communication
system between the gut and the part of the brain that controls hunger and satiety (how full you feel).

Food can remain in your stomach for a few minutes or several hours in the gastric phase where
numerous acids and enzymes are released, including the hormone gastrin. When the food has been

32
Food and Nutrition

churned into a creamy mixture known as chyme, the pyloric sphincter (an opening controlled by muscle)
opens and chyme passes gradually into the small intestine.

The Small Intestine

About 3 ml of chyme is squirted into the small intestine at short intervals as the pyloric sphincter opens.
This is known as the intestinal phase and causes the secretion of many hormones, which all aid the
digestive process. The sphincter is designed to open partially so that large particles are kept in the
stomach for further mixing and breaking down.

Digestion and absorption of fats, protein, and carbohydrates occurs in the small intestine. Three
important organs are involved:

1. The gall bladder provides bile salts that help make fats easier to absorb.
2. The pancreas provides bicarbonate to neutralise the acidic chyme from the stomach, and also
produces further digestive enzymes.
3. The intestinal wall contains cells that make up the wall of the small intestine. These cells help
neutralise the acid and also, produces enzymes to digest food.

The inner surface of the small intestine is folded into finger-like structures called villi, which greatly
increase the surface area available for absorption - in fact, the surface area of the villi is equivalent to
that of a tennis court! Blood vessels receive the digested food from the villi where it's then transported
through the blood stream to the liver via the hepatic portal vein. Fat can take much longer to be broken
down, with the process of fat digestion and absorption taking between three and five hours. The
unabsorbed residue of this process finally reaches the end of the small intestine and enters the large
intestine.

The Large Intestine

This is one of the most metabolically active organs in the body. It measures about 1.5 metres and
contains over 400 different species of bacteria that break down and utilise the undigested residues of
our food, mostly dietary fibres. As the watery contents move along the large intestine, water is absorbed
and the final product - faeces - is formed, which is stored in the rectum before excreting from the body.

The Importance of Digestion

The food that we eat - whether it is rice, chicken, bread, a piece of fruit, or even, orange juice - cannot be
used by the body in its usual form. Foods and liquids need to be broken down mechanically and
chemically into very small particles/molecules. These nutrient molecules are absorbed through the wall
of the small intestine and transferred around the body via blood, to nourish cells and organs (from the
brain to the immune system and even, into the cells in our feet), and to provide a source of energy.

33
Food and Nutrition

The collection and elimination of waste products also is an important part of digestion. Indigestible parts
of foods (fibre), older cells that line the digestive tract, and some water, are eliminated from the body as
faeces. Thus, maintaining a healthy digestive system is extremely important for our general health and
wellbeing.

Maintaining a Healthy Digestive System

Good (healthy) digestion is a 'silent' process – digestion, in some form, is always taking place, at any
given time - while we rest, eat, sleep, or work. We generally only become aware of digestion when
something goes wrong (e.g. if we eat foods that don't agree with our body or drink too much alcohol or
say, if we become constipated or have gas).

Although the digestive system can withstand a lot of stress (from the foods we eat to emotional
stresses), it can only do so for a limited period. Over time, the negative effects will accumulate and
create health problems in the long-term. We should take some positive steps to maintain the health of
our digestive system.

Key Points in Maintaining a Healthy Digestive System

A healthy digestive system can be maintained by:

1. Eating a healthy diet

2. Eating moderately, slowly, and regularly
3. Exercising regularly
4. Stopping/never beginning smoking
5. Reducing/managing stress levels

Eating a Healthy Diet

Those foods should be eaten which are rich in fibre (vegetables, fruits, and whole grains/cereals). Fibre
encourages passage of material through the digestive system and gives the correct consistency and bulk
to stools. Ideally one should consume at least 30 g of fibre per day. A balanced diet, which is rich in fibre,
may reduce the risk of developing diverticular disease, heart disease, or colorectal cancer. We should
also try to reduce the intake of processed foods - these generally have little nutrition or fibre and often
contain large amounts of saturated fats, salt and preservatives that can be harmful to the body.

Moderate amounts of 'good' fats (such as omega-3 and omega-6) should be eaten and the intake of
saturated fats (e.g. animal fat) should be reduced. A diet high in fat can make the digestive system
sluggish and may cause or aggravate diseases of the digestive system (and heart disease, as well).

Alcohol can inflame the lining of the stomach or oesophagus or cause symptoms of heartburn. Excessive
intake of alcohol can lead to cirrhosis of the liver. Plenty of fluids should be consumed - especially water.

34
Food and Nutrition

Water helps to dissolve some nutrients, encourages passage of waste through the digestive system, and
helps soften stools.

Eating Moderately, Slowly, and Regularly

Eating moderate portions can help maintain a healthy digestive system.

The process of digestion starts in our mouth. One should take time and eat slowly, chewing each
mouthful well. Relaxing while we eat also helps the nerves of the digestive system, and food that is well
chewed is easier to digest than larger pieces. One should eat regularly and should not skip meals - this
will prevent overeating due to hunger and this prepares the digestive system for regular meals.

Exercising Regularly

Regular cardiovascular exercise helps strengthen the muscles of the abdomen and reduces sluggishness
by stimulating the intestinal muscles to push digestive contents through our system.

Stopping/Never Beginning Smoking

Smoking lowers the pressure at the junction between the stomach and oesophagus, promoting backflow
of stomach acid into the oesophagus (reflux) - which can result in heartburn and other complications.
Smoking also aggravates peptic ulcers and certain inflammatory conditions of the bowels and it is linked
with an increased risk of many cancers.

Reducing/Managing Stress Levels

Stress effects the nerves of the digestive system and can upset the intricate balance of digestion. In some
people stress slows the process of digestion, causing bloating, pain, and constipation while others may
need to frequently empty their bowels and the stools may be more loose and watery than usual. Stress
can worsen some conditions, such as, peptic ulcers or irritable bowel syndrome.

Stress and Digestion

What is Stress?

In order to understand what stress might be doing to our digestion we first need to understand what
happens to our body when we are stressed. Like animals, we are programmed to react to danger with a
physical response, which is known as ‘Fight-or-Flight Syndrome’ and this response is how our cave-
dwelling ancestors would have reacted when confronted by a tiger. Without it, we would not have the
energy to survive encounters with dangers.

35
Food and Nutrition

Though the stress really starts in our brain when we become aware of a stressor, the hormones that
begin the stress response come from our adrenal glands. The adrenal glands are the two small triangular
glands that sit on the kidneys. They are endocrine glands, which mean that they secrete the hormones
they make directly into the blood stream. The major stress hormone influence almost everybody
function.

How Stress Makes Us Feel

If we are stressed, we might feel anxious, nauseous, teary, angry, or shaky. Sometimes, stress can cause
our heart beat to beat faster. When we are undergoing stress, the following events can occur:

The heart rate rises: this is to move blood with glucose and oxygen faster to our muscles so that
we will have more energy to fight or run away from the tiger.
The digestive and reproductive organs do not receive the energy they normally need because our
body assumes that when we are fighting a tiger we are not lying under a bush digesting our meal.
Our liver releases stored carbohydrates into our bloodstream as glucose and our body also starts
to make more glucose from our own body proteins because it thinks that we will need extra sugar
for energy for fighting. So when we are under stress our blood sugar levels rise.
Cortisol is a natural anti-inflammatory hormone; therefore, stress causes cortisol levels to rise
because the body thinks that the body is wounded and needs treatment.
The cholesterol levels may also rise because it is a starter material for making cortisol and all the
other adrenal hormones.

The Effects of Prolonged Stress

The body’s response to stress is designed to be of short duration. Let’s continue with the “cave person”
analogy – imagine a cave person encountering a tiger - once the tiger has been killed, the cave person
has successfully escaped, or if the situation, which caused the stress level to rise, is resolved, their
cortisol levels diminish and the cave person is able to get on with their regular day-to-day activities.

The problem with our modern “tigers” – or stressors – is that they aren’t going away. This changes the
picture from one alternating between times of stress and times of relaxation to one where there is
ongoing stress. This results in elevated cortisol levels that are ongoing. If our cortisol levels are too high
over a long period of time, our adrenal glands will become exhausted by the need to produce high levels
of cortisol all the time.

Eventually, they become depleted and then it will be difficult for them to produce high levels of cortisol
even when they receive messages from the brain telling them to do so.

36
Food and Nutrition

Stress and Hormones

The hormones in our body are always striving for balance. They operate in relation to each other. There
is a direct connection between the adrenal stress and the thyroid. If the body is in a constant breakdown
state and is not rebuilding itself, then the thyroid might slow down in order to stop the breakdown of
body tissue. Remember, the thyroid is in the control of the rate of metabolism in the body. If the thyroid
slows down for this reason then it might show up in blood test as low thyroid. The relationship between
stress and the digestive problem may not be a direct one. You don’t necessarily have an argument with
your boss and immediately develop a stomach ache. What we can say is that if someone is leading a
propensity to develop digestive problems, stress can make the problem worse. If the person then learns
to relax and practices relaxation regularly, it can diminish the severity of the symptoms. Stress manifests
itself mostly in the GI tract. Stress does mess with the stomach a little bit, but most of the responses
occur in the intestines.
Food stays in the stomach for about 30 minutes but takes from 48 to 72 hours to pass through the whole
of the digestive tract. Stress hormones slow digestion down, leaving food to fragment or stagnate and
that can result in diarrhoea or constipation. Stress can also upset the balance of the gut flora which
keeps the intestines healthy.

Stress Management Strategies

The digestion is impaired if we are under stress because its energy is diverted to the organs and
the systems, which are involved in fighting our stressors. When working on managing stress
levels, we should take as much work off of the digestive system as possible.
Smokers must consider giving up smoking - which drastically depletes the body of nutrients and
since it is toxic, it is another ‘tiger’ in our physical bodies .
People who do not exercise regularly should begin regular exercise programme.
Poor blood sugar control is the second greatest stressor to the body after mental and emotional
stress. The person should pay attention to managing the blood sugar.
Ongoing stress rapidly uses vitamin C. Foods that are high in this vitamin should be used.
These include citrus fruits, peppers, broccoli, strawberries and tomatoes.
Vitamin B5 directly feeds the adrenal glands. Foods that are high in the B vitamins should be used
to relieve these conditions. A whole food diet will contain all the B vitamins.
Maintaining good potassium to sodium ratio is very beneficial. Vegetables, especially the leafy
greens, have higher potassium to sodium ratio.
Zinc and magnesium are minerals that are vulnerable to depletion during times of stress. Foods
that are high in these minerals should be used. Wholegrain, nuts, seeds, leafy green vegetables,
shellfish, and turkey’s dark meat are all examples of these kinds of foods.

Detoxification
Every day we face toxicity: it comes from the environment, from pathogens, from chemicals we breathe
in or eat, drugs, and even from the by-products of our metabolic processes. No matter how careful we
are we cannot avoid all toxins. We have little control over our exposure to these chemicals. If we add to
this burden the toxicity from lifestyle factors over which we do have some control, such as drugs use; the

37
Food and Nutrition

consumption of foods with pesticides, food additives and colourings; smoking, sugar, alcohol, and
artificial sweeteners, we can begin to imagine the burden we are putting on our bodies’ detoxification
system.

The Liver

The liver is the major detoxification organ in the body and has a tremendous job to do. It performs many
functions including filtering and cleaning our blood, converting thyroid hormones, breaking down old
hormones and creating new ones, making proteins, making bile, storing some nutrients and detoxifying
toxins (symptoms of a toxic, overworked liver include, but are not limited to, migraines, eczema, skin
rashes, and allergies).

The Two Phases of Detoxification

When our liver detoxifies a substance, it does so in two phases, appropriately named Phase I and Phase
II. Phase I involves a lot of enzymes, which turn a toxin into a water-soluble form or into a more
chemically active form. Phase I occurs in the liver but also elsewhere in the body; especially places where
toxins may enter. If the toxin becomes water soluble, then it can be eliminated through the kidneys in
the urine. If the toxin becomes more metabolically active, then it becomes more poisonous than the
original one, but it does this because that is the form the toxin must be in, in order to go through phase
II.

However, in this intermediate stage, the converted toxin has time to do some damage. Therefore it is
important to have good liver health so that both phases are working well. The intermediate stage is the
reason why poisonous mushrooms can kill someone.

After the intermediate stage the converted toxin is sent to Phase II. In this phase, the liver conjugates, or
joins, chemicals to the toxin. This either renders the toxin totally harmless or converts it into a form that
can be excreted through the urine or through the bile that the liver also creates.

Sources of Toxicity

Cigarette smoke, excess alcohol, sugar, drugs, excess caffeine, artificial sweeteners, food additives, and
pesticides found on processed and non organic foods all create toxicity. Often we can choose to avoid
many of these substances. Heavy metal exposure is another source of toxicity. Heavy metals include
mercury, lead and cadmium. One can be exposed to these through the environment, the silver fillings in
the teeth, cigarette smoking, old building paint and other sources. Eating an organic whole food diet that
includes leafy greens and some raw nuts and seeds can help provide the body with nutrients it needs to
help rid it of toxicity.

How Toxins Affect Hormones

There are toxins in the environment that have a direct impact on our hormones. They are hormone like
substances that act in a similar way to human hormones when they enter the body. Xeno-oestrogens are

38
Food and Nutrition

foreign substances that are not real oestrogen but act like it. These are chemicals are found in
substances such as, plastic and pesticides. Oestrogen should be in balance with progesterone. The
balance exists in the ratio between the two hormones, not their levels. If a woman has a higher amount
of oestrogen compared to progesterone she is in oestrogen dominance which can put her at risk of
developing cancers such as breast cancer.

Digestive Conditions

Some of the conditions associated with the digestive and detoxification system include:

Constipation

Constipation is usually caused by a disorder of the bowel’s functions rather than a structural problem.
Common causes of constipation include:

Inadequate water intake

Inadequate fibre in the diet
A disruption of regular diet or routine, travelling
Inadequate activity, exercise, or immobility
Eating large amounts of dairy products
Stress
Resisting the urge to have a bowel movement, which is sometimes the result of pain from
hemorrhoids
The overuse of laxatives (stool softeners) which, over time, weaken the bowel muscles
Hypothyroidism
Neurological conditions, such as Parkinson's disease or Multiple Sclerosis
Antacid medicines, which contains calcium or aluminium
Medicines (especially strong pain medicines, such as narcotics, antidepressants, or iron pills)
Depression
Eating disorders
Irritable Bowel Syndrome
Pregnancy
Colon cancer

In some cases, lack of good nerve and muscle function in the bowel may also be a cause of constipation.

Symptoms of Constipation

Symptoms of constipation can include:

Infrequent bowel movements and/or difficulty having bowel movements
Swollen abdomen or abdominal pain
Pain
Vomiting

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How Is Constipation Diagnosed?

Most people do not need extensive testing to diagnose constipation. Only a small number of patients
with constipation have a more serious medical problem, which is contributing to their constipation. If
constipation is caused by colon cancer, early detection and treatment is very important.
How can Constipation be Prevented?

There are several things which can be done to prevent constipation. Among them:

Eating a well-balanced diet with plenty of fibre. Good sources of fibre are fruits, vegetables,
legumes, and whole-grain bread and cereal (especially bran). Fibre and water help the colon pass
stool.
Drinking 1 1/2 to 2 quarts of water and other fluids a day (unless fluid restricted for another
medical condition). Liquids that contain caffeine, such as coffee and soft drinks, seem to have a
dehydrating effect and may need to be avoided until the bowel habits return to normal. Some
people may need to avoid milk, as dairy products may be constipating for them.
Exercising regularly.

Indigestion

Indigestion is often a sign of an underlying problem, such as gastroesophageal reflux disease (GERD),
ulcers, or gallbladder disease, rather than a condition of its own. Also called dyspepsia, it is defined as a
persistent or recurrent pain or discomfort in the upper abdomen.

Symptoms of Indigestion

The symptoms of indigestion include:

Burning in the stomach or upper abdomen
Abdominal pain
Bloating (full feeling)
Belching and gas
Nausea and vomiting
Acidic taste
Growling stomach

These symptoms may increase in times of stress. People often have heartburn (a burning sensation deep
in the chest) along with indigestion. But heartburn itself is a different symptom that may indicate
another problem.

Who Is at Risk for Indigestion?

People of all ages and of both sexes are affected by indigestion. It is extremely common. An individual's
risk increases with excess alcohol consumption, use of drugs that may irritate the stomach (such as

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NSAIDS, aspirin, etc.); other conditions where there is an abnormality in the digestive tract such as an
ulcer, and emotional problems such as anxiety or depression.

What Causes Indigestion?

Indigestion has many causes, including:

Ulcers
G.E.R.D.
Stomach cancer (rare)
Gastro paresis (a condition where the stomach doesn't empty properly; this often occurs in
diabetics)
Stomach infections
Irritable Bowel Syndrome
Chronic pancreatitis
Thyroid disease
Pregnancy

Lifestyle:

Eating too much, eating too fast, eating high-fat foods, or eating during stressful situations
Drinking too much alcohol
Cigarette smoking
Stress and fatigue

How can Indigestion be Prevented?

The best way to prevent indigestion is to avoid the foods and situations that seem to cause it. It can be
avoided by:

Eating small meals

Eating slowly
Avoiding foods that contain high amounts of acids, such as, citrus fruits and tomatoes
Reducing or avoiding foods and beverages that contain caffeine
Smokers should consider quitting smoking, or at least, they should avoid smoking right before or
after eating, since smoking can irritate the stomach lining
Avoiding exercising with a full stomach
Waiting at least three hours after eating before going to bed
Sleeping with your head elevated (at least 6 inches) above the feet
Heartburn

Despite its name, heartburn has nothing to do with the heart (although some of the symptoms are
similar to a heart attack). Heartburn is an irritation of the oesophagus caused by acid that refluxes

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(comes up) from the stomach. Heartburn is also a symptom of more serious gastroesophageal reflux
disease or G.E.R.D.

When swallowing, food passes down the throat and through the oesophagus to the stomach. Normally,
a muscular valve, which is called the Lower Oesophageal Sphincter (LES), opens to allow food into the
stomach (or to permit belching); then, it closes again. Then the stomach releases strong acids to help
break down the food. But if the lower oesophageal sphincter opens too often or does not close tight
enough, stomach acid can reflux or seep back into the oesophagus, damaging it, and causing the burning
sensation, which we know as heartburn.
Heartburn Symptoms

Heartburn has several symptoms, including:

A burning feeling in the chest just behind the breastbone that occurs after eating and lasts a few
minutes to several hours.
Chest pain, especially after bending over, lying down, or eating.
Burning in the throat - or a hot, sour, acidic, or salty-tasting fluid at the back of the throat.
Difficulty swallowing.
Feeling food "sticking" in the middle of the chest or throat.

Heartburn Causes

Various lifestyle and dietary factors can contribute to heartburn by relaxing the lower oesophageal
sphincter and allowing it to open, increasing the amount of acid in the stomach, increasing stomach
pressure or making the oesophagus more sensitive to harsh acids.
These factors include:

Dietary Habits
Eating large portions
Eating certain foods, including onions, chocolate, peppermint, high-fat or spicy foods, citrus
fruits, garlic, and tomatoes or other tomato-based products
Drinking certain beverages, including citrus juices, alcohol, caffeinated drinks, and carbonated
drinks
Eating before bedtime

Lifestyle Habits
Being overweight
Smoking
Wearing tight-fitting clothing or belts
Lying down or bending over, especially after eating
Stress

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Ways to Alleviate Heartburn Symptoms

Raising your head on your bed by about 6 inches can allow the stomach's contents to settle
down.
Eating meals at least three to four hours before lying down and avoiding bedtime snacks.
Eating smaller meals.
Maintaining a healthy weight to eliminate unnecessary intra-abdominal pressure caused by extra
pounds.
Limiting consumption of fatty foods, chocolate, peppermint, coffee, tea, fizzy drinks, and alcohol -
all of which can relax the Lower Oesophageal Sphincter - and tomatoes and citrus fruits or juices,
which contribute additional acid, can irritate the oesophagus.
Giving up smoking, which also relaxes the Lower Oesophageal Sphincter.
Wearing loose belts and clothing.

Heartburn can be treated with medicine. Medicines used to treat heartburn can range from over -the -
counter remedies to medicine requiring a doctor's prescription.

Gallstones

Gallstones form in the gallbladder, which is a small organ located under the liver. The gallbladder aids in
the digestive process by storing bile and secreting it into the small intestine when food enters. Bile is a
fluid produced by the liver and is made up of several substances, including cholesterol, bilirubin, and bile
salts.

What Are Gallstones?

Gallstones are pieces of solid material that form in the gallbladder. These stones develop because
cholesterol and pigments in bile sometimes form hard particles.
The two main types of gallstones are:

Cholesterol stones (which makes up approximately 80% of gallstone cases): these are usually
yellow-green in colour.
Pigment stones: these stones are smaller and darker and are made up of bilirubin.

What Causes Gallstones?

Several factors may come together to create gallstones, including:

genetics (i.e., if others in your family have had gallstones)
body weight
decreased motility (movement) of the gallbladder
diet

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Gallstones can form when there is an imbalance in the substances that make up bile. For instance,
cholesterol stones may develop as a result of too much cholesterol in the bile. Another cause may be the
inability of the gallbladder to empty properly.

Pigment stones are more common in people with certain medical conditions, such as cirrhosis (a liver
disease in which scar tissue replaces healthy liver tissue) or blood diseases such as sickle cell anaemia.

What Are the Risk Factors for Gallstones?

Risk factors for getting gallstones include:

Obesity - this is one of the biggest risk factors. Obesity can cause a rise in cholesterol levels and can also
keep the gallbladder from emptying completely.

Oestrogen - women who are pregnant, take birth control pills, or hormone replacement therapy have
higher levels of oestrogen. This can cause a rise in cholesterol, as well as, a reduction in gallbladder
motility.

Ethnic Background - certain ethnic groups, including Native Americans and Mexican-Americans, are
more likely to develop gallstones.

Gender and Age - gallstones are more common among women and older people.

Cholesterol Drugs - some cholesterol-lowering drugs increase the amount of cholesterol in bile, which
may increase the chances of developing cholesterol stones.

Diabetes - people with diabetes tend to have higher levels of triglycerides (which is a type of blood fat),
which is a risk factor for gallstones.

Rapid Weight Loss - if a person loses weight too quickly, his or her liver secretes extra cholesterol,
which may lead to gallstones. Also, fasting may cause the gallbladder to contract less.

Symptoms of Gallstones

Gallstones often don't cause symptoms. Those that don't are called "silent stones". A person usually
learns he or she has gallstones while being examined for another illness.

When symptoms do appear, they include the following:

Pain in the upper abdomen and upper back. The pain may last a long time (several hours)
Nausea
Vomiting
Other gastrointestinal problems, including bloating, indigestion, and gas

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Enhancing the Process of Digestion

Organic food is good for health. Sulphur-rich food, such as, garlic, onions, and eggs should be
increased in the diet. These assist the liver detoxification pathways. Other foods that assist the
liver include leafy greens and other vegetables: broccoli, cauliflower, brussels sprouts, cabbage,
and avocado.
Chewing the food properly also helps the digestive system work properly. Soups and pureed food
should be increased in the diet.
Sugar upsets the balance of healthy intestinal floras it also feeds pathogenic bacteria. The use of
sugar should be minimised in the diet.
Refined foods should be avoided as they have little nutritional value.
All grains and beans should be soaked overnight or for at least eight hours before cooking.
Fragmented foods, such as, live yogurt should be added to the diet. This will encourage the
growth of good bacteria in the intestines.
There are many herbs that can be extremely useful in digestion and detoxification. Silymarin or
milk thistle helps protect the liver.

Further Reading:

 Healthy Healing's Detoxification: Programs to Cleanse, Purify & Renew, (2008), By

Linda Page
 Physiological Aspects of Digestion and Metabolism in Ruminants: Proceedings,
(1991), edited by T. Tsuda, Y. Sasaki, R. Kawashima
 User's Guide to Detoxification: Discover How Vitamins, Herbs, and Other, (2005),
By Shari Lieberman, James J. Gormley, Jack Challem

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Eating Disorders
Module V

Learning Outcomes
By the end of this module the learner will be able to:

 Explore different eating disorders.

 Identify common eating disorders and ways to prevent these disorders.

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Eating Disorders
What are Eating Disorders?

"Eating disorder” is a phrase that describes conditions in which individuals engage in disordered eating.
Eating disorders are not simply poor eating habits but are recognised mental health disorders in which
emotional issues manifest in harmful eating habits. Eating problems in childhood and adolescence are
very common. Eating disorders affect seven girls in every 1,000, and one boy in every 1,000.

It usually starts to be a problem in teenage years, but can occur at any given time. The most common
types of eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder. Types of
eating disorders include anorexia, bulimia, and binge eating disorder, as well as, other patterns of
disordered eating.

Overeating, under eating, purging, over exercising, or a combination of these behaviours are frequent
occurrences in everyday life for someone with an eating disorder, so much so that their health can suffer
severely from poor nutrition and their normal daily routine becomes difficult.

The main types of eating disorders include:

Anorexia Nervosa
Bulimia Nervosa
Binge Eating Disorder

It is possible for these conditions to co-exist alongside one another.

Common Eating Disorders

Anorexia is an eating disorder in which the sufferer is terrified of gaining weight and decreases the
amount of food that they will eat in an attempt to limit weight and body fat.
Bulimia is an eating disorder marked by the consumption of a great amount of food in one sitting and
then, the purging of this food by inducing vomiting or taking laxatives and/or diuretics.
Binge eating disorder is also characterised by the consumption of large amounts of food at one sitting
but does not include the purging of this food afterwards. Though eating disorders are often associated
with different signs and symptoms, they are often connected to low self esteem, poor body image,
environments obsessed with thinness, a lack of support systems, trauma, bullying, and abuse, and
sometimes, genetics.

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There is no single cause of an eating disorder such as anorexia, bulimia, and binge eating disorder, but
rather it is accepted that a combination of personal, family, interpersonal, biological, and socio-cultural
factors influence the development of an eating disorder.

It is not known for certain what causes them, but many factors could play a part:

Social pressure, particularly caused by the media idealising being thin.

Losing weight can make us feel good and in control.
Puberty - anorexia reverses some of the physical changes of becoming an adult.
Family problems - saying “no” to food may be the only way for expressing the feelings.
Trauma, bullying, and abuse.
Depression and low self-esteem - binges may start off as a way of coping with unhappiness.
Genes - it can run in families.

Though each of these disorders result in different eating behaviours, each occurs when sufferers cannot
separate their emotions from their eating habits, and this affects the way they eat and the amount they
eat.

Eating disorders can strike young or old, male or female, any race, and any income level. However, eating
disorders are, by some estimates, eight times more likely to affect women than men and are also more
frequently found among younger women.

Signs of Eating Disorders

Signs of eating disorders vary, but here are some of the signs and symptoms to look out for that may
suggest someone has, or is on the verge of developing, an eating disorder:

Only eating certain types of food.

Using the bathroom immediately after eating.
Making excuses not to eat at meal times.
Obsession with body weight/being overweight.
Picking at food.
Rapid fluctuations in weight (weight loss or weight gain).
Mood swings.
Excessive use of exercise.

If eating disorder symptoms are recognised in the early stages of the disease, help can be sought more
quickly making a successful recovery more likely.

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Factors that Cause Eating Disorders

1) Stress

There are a variety of external factors that can cause the development of an eating disorder and
most of them represent some sort of crisis or disappointment to the individual. The loss of a
loved one or life changes, such as moving homes or transferring jobs, are seen as precipitating
factors of eating disorders as they throw an individual’s life off balance, as well as causing
significant stress when the individual’s normal support system has vanished.
Divorce and the loss of a job are also precipitating factors of eating disorders as not only do they
bring major life changes, but often a financial insecurity, as well.

In all of these cases, the resulting stress can be enough for an individual’s poor coping strategies
to fail and for them to turn to an eating disorder instead – whether knowingly or unknowingly.
Unsuccessful attempts at dieting are precipitating factors of eating disorders as well, in that when
“regular” diets fail, some individuals more quickly to fall into eating disorders as a means to an
end. Again, this may be consciously known or unknown to the individual.

2) Lack of Communication

People who are unable to communicate clearly and effectively often prefer to hold in their
emotions, sometimes described as “swallowing” their emotions. This is particularly true of
negative emotions such as anger, sadness, or disappointment.
Rather than confronting another individual with these emotions, many individuals choose to
remain silent but express their feelings and frustrations in other ways, including through
abnormal eating disorders.

Some people also keep quiet but end up convincing themselves that they were the cause of the
problem in the first place. This can lead to negative self-talk such as telling themselves that they
are stupid or always cause problems. Either way, when emotions are not expressed but instead
are projected onto food and eating behaviours, an eating disorder can begin.

Disturbed Relationships

Whether troubled personal relationships result from poor communication or poor

communication results from troubled personal relationships, is immaterial; the fact of the matter
remains that the two often develop hand-in-hand with an eating disorder.
More than simply inhibiting communication, however, troubled relationships also often serve to
convince an individual that they are unlovable, deeply flawed, and unworthy of positive
attention.

To cope with this, frustrations may be projected onto food and eating behaviours, particularly if
an individual falls into the trap of thinking that if they could just lose a little more weight than

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they would be able to find, or be worthy of having, a loving relationship. Unfortunately, those
with eating disorders may not simply engage in trouble with personal relationships of the
romantic kind, but friendships and family relationships as well.

3) Ineffective Coping Strategies

When people are frustrated, angry, discouraged, or sad, they use a variety of coping strategies to
get them through the tough times. For many, this means engaging in a favourite activity,
spending time with friends and family, or enjoying solitary time in which they can pull themselves
together.

However, a lot of people with eating disorders do not have other coping strategies, so, they turn
to their eating disorder to help them cope. Without any other behaviours to fall back on to get
them through a rough patch, they will indulge in their eating disorders, in hopes of keeping them
in control. Sadly, and without even realising it, many of these individuals actually end up harming
their health and the quality of their lives through what they believe are effective coping
strategies.

Interpersonal factors, such as poor communication skills, troubled personal relationships, and
ineffective coping skills have all been linked to eating disorders. Though these factors are not
formal causes of eating disorders, they have been seen to influence the development of them
and inhibit recovery from them.

Coping with Stress

Developing efficient coping skills may help people avert the development of an eating disorder.
Many of these coping skills are simple and can be used daily in order to keep stress from building
in the first place.
Commonly taught coping skills, which can be used in any part of life, include:

Accepting that life brings disappointments and there will be hardly a perfect situation in
life.
Avoiding stressful situations. If reading fashion magazines makes people feel bad about
themselves, then, they should stop looking at them and focus on another activity instead.
Scheduling time for hobbies. Regardless of which specific activities are enjoyable and
relaxing, people should make time for them.
Building a support system. People should cultivate a support system of friends and family
who support their hopes and dreams, and accept them for who they are.
Breathing. When all else fails, individuals should remember to breathe deeply, take time
to think to reflect, and move forward only when they have formulated plans with which they
are comfortable.

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A person, with healthy coping skills and support systems will learn to accept their flaws and be happy
within themselves.

How to Avoid or Prevent an Eating Disorder

Eating disorders, such as, anorexia, bulimia, and binge eating are most prevalent in countries and
cultures which place a high degree of importance upon being thin and presenting an appealing image.
Most people with an eating disorder feel that they are not as thin, and therefore not as successful, as
they would like to be and they use their eating behaviours to either attempt to rectify this (by restricting
calories and losing further weight) or find relief from this (such as by binging and/or purging).
Unfortunately, there are no cures for eating disorders, but there is a lot that can be done to prevent an
eating disorder by developing a healthy balance and outlook on life, these are the two key means of
preventing an eating disorder.

A healthy balance in life means that an individual is able to balance work/school and personal life, a
healthy diet with occasional treats, and exercising for fun with an appropriate amount of rest and
relaxation. A healthy outlook is such that an individual can recognise the “big picture”, that weight and
appearance are just one facet of a person. What is more, maintaining a healthy outlook allows an
individual to remember that they have both strengths and weaknesses, but does not allow them to get
caught up in flaws.

Individuals who routinely express dissatisfaction with their work, their personality, or their appearance
should consider getting expert advice before these thoughts take root.

Family and friends can help individuals stay strong and prevent an eating disorder by:

Praising an individual’s talents and strengths.

Listening to and discussing an individual’s thoughts, feelings, and fears.
Supporting an individual’s hopes and dreams.
Reminding an individual that a healthy body, not necessarily a slim body, is most important.
Encouraging an individual to explore hobbies in which they show an interest.
Helping individual make new friends who are also supportive.
Barring unrealistic and unhealthy diets and excessive exercise regimes.

Treatment for Eating Disorders

The type of eating disorder treatment that is most appropriate will depend on the severity and type of
eating disorder and the length of time it has continued, as well as, the patient's individual preferences
about the type of treatment they would like. If a person's physical health is in immediate danger because
they are underweight or undernourished, hospitalisation may be necessary to restore it to an acceptable

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level. However, this is the exception, rather than the rule, when deciding treatment for an eating
disorder.

Various therapies are available, including behavioural therapy, psychotherapy, family counselling, group
therapy, and self-help groups, in which patients can explore their issues with food and learn to develop
healthy eating habits. Although lapses and relapses may occur once eating disorder treatment has
begun, there is a far greater chance of recovering successfully if treatment is sought early on.

Anorexia
Anorexia nervosa is an eating disorder in which an individual becomes so afraid of gaining weight and/or
having body fat that they severely limits the amount of food that they eat. Often, anorexics will also
exercise excessively in an attempt to burn off the calories that they do eat so that they will not gain any
extra weight. Even when they are physically wasting away, and others perceive them as almost
sickeningly thin, anorexics will still feel that their bodies are too heavy and continue to eat as little as
possible. Unfortunately, without enough nutrients to nourish them, an anorexic’s internal organs may
fail and death can result.

A Fear of Gaining Weight

Perhaps the best known of the eating disorders, anorexia nervosa is a debilitating, dangerous, often life-
threatening psychiatric illness. It is typically characterised by a person's thinness due to their fear of
gaining weight (although this is not always the case) and their subsequent refusal to eat. A person with
anorexia nervosa often has a very extreme fear of weight gain. They will refuse food and embark on
prolonged periods of self-starvation in order to lose weight, and will continue to do so even when their
weight has fallen below what is acceptable for their height and age. They are considered to be anorexic
(or an anorectic).

Distorted Body Image

Even when they are dangerously thin, an anorexic person may still perceive themselves to be overweight
because they have a distorted view of their body image. They are likely to be in denial of the fact that
they are underweight. The absence of eating is often coupled with a compulsion to exercise, and
participation in physical exercise will probably be far greater than is acceptable, placing additional stress
on the body. Purging behaviours, such as self-induced vomiting, the misuse of diet pills, diuretics, or
laxatives may also be employed.

Health Risks of Anorexia

If weight becomes dangerously low, there is the risk of vital organs, such as the heart and kidneys,
shutting down. Of all the eating disorders and all of psychological illnesses, anorexia nervosa has the
highest death rate. Long-term health risks of anorexia include osteoporosis, an impaired immune system,

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fertility problems, damage to bodily organs and mental health problems. Two types of anorexia nervosa
are recognised: the restricting type and the binge eating type or purging type.

Restricting Type

During the current period of anorexia nervosa there is no regular occurrence of bingeing or purging
behaviour.

Binge Eating Type or Purging Type

During the current period of anorexia nervosa, there is a regular occurrence of binge eating or purging
behaviour.

Signs of Anorexia Nervosa

Signs of anorexia nervosa can be physical, psychological, and behavioural. Here are some of the most
common signs and symptoms.
Note: The presence of one or more of these symptoms does not necessarily indicate anorexia nervosa or
any other eating disorder. Conversely, not all of these symptoms will necessarily be present in someone
with anorexia nervosa.

Physical Symptoms of Anorexia Nervosa:

Weight loss.
Weight of less than 85% of what is considered acceptable for height and age.
Thin and emaciated appearance.
Slow heart rate and low blood pressure.
Cold hands and feet and lower body temperature.
Poor circulation.
Digestive problems, such as, constipation and bloating.
Absence of menstrual cycle in women.
Lanugo, a layer of fine hairs, covering the body to act as insulation.
Brittle hair and nails, dry skin, and hair loss from scalp.
Hollow-looking eyes and pasty skin tone.
Weakness and tiredness, dizziness, palpitations, chest pain, and shortness of breath.
Malnutrition and dehydration.
Stunted growth if anorexia occurs before or during adolescence.
Impaired immune system.
Anaemia.
Swollen joints.
Osteoporosis.
Fertility problems.

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Psychological Symptoms of Anorexia Nervosa:

Mood swings.
Depression and irritability.
Difficulty concentrating and memory loss.
Ignoring feelings of hunger.
Obsessive concern about being overweight.
Distorted body image.
Preoccupation with food and calorie intake.
Constantly striving for perfection.
Denial of being underweight.
Low self-esteem.
Fear of weight gain and being too fat.
Preoccupation with tidiness.
Obsessing about exercising.
Anxiety when eating in front of other people.
Feeling that happiness is undeserved.
Strong urge to be in control.

Behavioural Symptoms of Anorexia Nervosa:

Wearing baggy clothing to disguise a thin frame.

Not eating , or only eating certain types of foods and counting calories.
Frequently looking in the mirror and monitoring weight.
Excessive exercising to burn off more calories.
Binge eating.
Purging, including self-induced vomiting, and/or the misuse of laxatives, diuretics, diet pills, or
appetite suppressants.
Fainting and dizzy spells.
Preparing meals for others while refusing to eat meals with them.
Eating or exercising in secret.
Withdrawal from friends, family, and social situations.
Inflicting self-harm.
Displaying controlling behavior.

Causes of Anorexia Nervosa

The causes of anorexia nervosa include a number of interrelated physiological, psychological and social
factors, which can increase the chances of somebody developing the disorder.

Some suggested causes of anorexia nervosa include:

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Physiological/Biological Causes of Anorexia

A genetic predisposition to developing anorexia may be partially responsible. If another

family member has suffered with anorexia nervosa, the likelihood of developing it may be
increased.

Psychological/Emotional Causes of Anorexia

Anorexia nervosa is associated with certain personality traits such as, perfectionism, obsessive-
behaviours, and withdrawal, as well as, other psychological disorders such as anxiety, depression, and
Obsessive- Compulsive Disorder.

Of particular significance to anorexia is low self-esteem along with a negative, distorted body image.
Focusing on food and weight loss provides a diversion away from underlying psychological problems that
may be too difficult to address or control.

Social/Behavioural Causes of Anorexia

The messages people get from society about how they should look give particular cause for concern.
Western culture (particularly, the media) promotes extreme thinness as the epitome of body perfection,
success and happiness. This leads people to become dissatisfied with their own bodies, their self-esteem
suffers and they turn to dieting as they feel the pressure to be thin. Anorexia nervosa can develop from
the desperation to live up to unrealistic cultural expectations.

Difficult, strained relationships within the family, which makes a person view themselves in a negative
way, may lead them down the path to anorexia, as other pressures arising from school or in the work
place may cause this, as well.

Diagnosing Anorexia Nervosa

An anorexia nervosa diagnosis will involve an analysis of the individual's physical signs and symptoms,
along with their behaviours and beliefs about themselves.

A medical doctor will refer to a list of symptoms (or diagnostic criteria) to help them with making a
diagnosis for anorexia nervosa.

Diagnostic Criteria for Anorexia Nervosa

a) Body weight is consistently 15% less (or lower) than that expected for height and age, or body
mass index is 17.5 or less. This can be due to either weight loss or failure to gain weight during
growth.

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b) Weight loss is caused by the avoidance of foods perceived to be fattening, along with one or
more of the following behaviours: self-induced vomiting, purging, excessive exercise, use of
appetite suppressants and/or diuretics.
c) Distorted body image perception driven by an intense, irrational fear of becoming fat, leads to
the desire to remain at a low body weight.
d) Amenorrhea (abnormal absence of a minimum of three successive menstrual cycles) in women,
and loss of libido in men. There may be changes in growth hormone, cortisol, thyroid hormone
and insulin.
e) Puberty in girls and boys may be delayed, if the onset of anorexia nervosa is prepubertal, but
once recovery from the illness is made, development will often progress normally.

Main Treatments for Anorexia Nervosa:

Physical Health

Individual's physical health should be assessed first, in particular to make sure they are not dangerously
underweight and undernourished. Any medical complications, which have arisen due to the eating
disorder, need to be taken care of, as soon as possible.

Therapy

The type of therapy that is most appropriate will depend on the patient's individual preferences and
their particular eating disorder.

Psychotherapy - There are different types of psychotherapy which can be useful in addressing the
underlying psychological causes of an eating disorder. Psychotherapy encourages positive thought
patterns, changes behaviours and improves interpersonal relationships. In particular psychotherapy can
help an anorexia sufferer change their perceptions of their body image and improve their self-esteem, as
well as encourage them to develop a sensible attitude towards food and healthy eating habits.

Family Therapy - Family therapy can be useful if the patient is living at home; the whole family can
attend therapy sessions together. It can help to identify the trigger for the patient's anorexia, such as
troubled relationships and problems within the family that may have led them to have a negative self
image.

An example would be a parent inadvertently putting too much pressure on their child to do well at
school, which would result in the child feeling as though they can never quite live up to their
expectation. Family therapy will help the child and parents to deal with the problem together and help
recovery from anorexia.

Group Therapy - Group therapy sessions may or may not be run by qualified health professionals, and
are attended by individuals with varying degrees of anorexia. Some people find great comfort and
support from attending therapy sessions with other anorexics and are encouraged to beat the disorder.

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Medications

Antidepressants can sometimes be helpful in treating anorexia. However, these will not help change an
individual's attitudes and beliefs about food, or deal with any body image distortion and low self esteem
issues.

Bulimia Nervosa
Bulimia nervosa, which is more commonly known as bulimia, is an eating disorder marked by binges and
then purges. During a binge a bulimic will eat a great amount of food in one sitting, then purge by either
inducing vomiting or taking a laxative or diuretic to expel the food. For bulimics, bingeing and purging
becomes a cycle but they may never lose or gain enough weight to make it obvious that they have an
eating disorder.

Damage to the digestive tract, mouth, teeth, and salivary glands is common among bulimics and the
constant bingeing and purging mean that bulimics rarely keep in enough vitamins and minerals to remain
healthy. These factors can have serious and long-lasting health effects.

Health Risks of Bulimia Nervosa

Long-term health risks include changes in body chemistry, erosion of tooth enamel due to vomiting and,
in extreme cases, stomach rupture and death. A person with bulimia will not necessarily be thin; they
may even be overweight which poses health risks of its own. People suffering with bulimia are often of a
normal weight so it may go undetected for many years, with those close to them often having no idea
they have the disease or that their health is suffering.

There are Two Types of Bulimia Nervosa, Purging and Non-Purging Types:

Purging Type

During bulimia nervosa there has been a regular occurrence of self-induced vomiting, the misuse of
laxatives, diuretics, or enemas.

Non-Purging Type

Usually, this form of bulimia does not include self-induced vomiting, the misuse of laxatives, diuretics, or
enemas, but the person may have partaken in other compensatory behaviours, such as excessive
exercising or self-induced starvation.

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Causes of Bulimia Nervosa

Causes of bulimia nervosa include a number of interrelated physiological, psychological, and social
factors, which can increase the chances of somebody developing the disorder.

Some suggested causes of bulimia nervosa include:

Physiological/Biological causes of bulimia nervosa

Some people may have a genetic predisposition to developing bulimia and therefore, the risk of
developing the disease is increased.
Abnormal levels of serotonin in the brain (a chemical, or neurotransmitter, used by nerve cells to
communicate which controls appetite and mood) are sometimes found in people with bulimia nervosa.

Psychological/Emotional Causes of Bulimia Nervosa

Bulimia nervosa can occur as a result of underlying emotional problems that are difficult to express or
deal with. Bulimia provides the individual with an outlet for their emotional difficulties and helps them to
feel in control, although in reality, they are not in control at all.

Dissatisfaction with weight and body shape can lead to dieting, which can escalate into bulimia. Body
image distortion, low self-esteem, feelings of helplessness, perfectionism, depression, anxiety, and
obsessive-compulsive disorder are all personality traits associated with bulimia.

Social/Behavioural Causes of Bulimia Nervosa

Western culture promotes thinness as the image of success and happiness. This pressure to be thin can
encourage people to start dieting, as they believe it will give them the results they need to make them
happy and successful. If dietary habits get out of control in pursuit of the perfect body, bulimia nervosa
can ensue. Disturbed relationships within the person’s family or a marriage/partnership can be a trigger
for bulimia nervosa, as can stressful life events, such as bullying or traumatic events. Individuals who
have been abused as a child will sometimes go on to develop the disorder.

Signs of Bulimia Nervosa

Signs of bulimia nervosa can be physical, psychological, and behavioural. Here are some of the most
common signs and symptoms.
Note: The presence of one or more of these symptoms does not necessarily indicate bulimia nervosa or
any other eating disorder. Conversely, not all of these symptoms will necessarily be present in someone
with bulimia nervosa.

Physical Symptoms of Bulimia Nervosa:

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Irregular heartbeat.
Irregular/Abnormal menstrual cycle.
Fluctuations in weight.
Fertility problems.
Blisters on the back of the hand and fingers, caused by teeth rubbing during vomiting.
Dental cavities, erosion of tooth enamel, and bleeding gums.
Swollen glands in the face and neck.
Digestive problems, such as indigestion, constipation, and diarrhoea.
Sore throat.
Weakness, tiredness, and fatigue.
Bloodshot eyes.
Stomach pains.
Fluid retention.
Dehydration.
Erosion of tooth enamel from coming into contact with stomach acid when vomiting.
Changes in the body’s chemistry.
Mineral and electrolyte imbalances.
Stomach ulcers.
Malnutrition.
Epileptic fits.
Damage to the kidneys.
In severe cases, the stomach can rupture or a heart attack, which may lead to sudden death.

Psychological Symptoms of Bulimia Nervosa:

Mood swings and irritability.

Low self-esteem.
Depression.
Anxiety.
Feeling a loss of control.
Overly conscious about physical appearance and body weight.
Obsession with food, dieting, and exercise.
Feelings of withdrawal.
Perfectionism.

Behavioural Symptoms of Bulimia Nervosa:

Refusing to eat with other people.

Leaving the table straight after a meal to vomit.
Running water while in the bathroom, in an attempt to disguise the sound of vomiting.
Binge eating, sometimes at strange times, such as in the middle of the night.
Misuse of laxatives, diuretics, enemas, or diet pills.

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Fasting.
Excessive exercising.
Frequently spending time alone and wanting privacy.
Obsessing about body weight.
Withdrawal from social activities.

Diagnosing Bulimia Nervosa

The diagnosis of bulimia nervosa focuses on an analysis of the individual's bingeing and purging
behaviours along with their beliefs and attitudes. Unlike anorexia nervosa, substantial weight loss is not
usually a symptom of bulimia nervosa.
A medical doctor will refer to a list of symptoms (or diagnostic criteria) to help them with making a
diagnosis for bulimia nervosa.

Diagnostic Criteria for Bulimia Nervosa

a) The constant obsession with eating and the overwhelming desire for food leads to episodes of
eating large amounts of food in short time periods.
b) There are efforts made to reduce the effect of eating foods perceived as fattening in the form of
self-induced vomiting and other purging techniques, alternating episodes of calorie restriction,
using appetite suppressants, thyroid preparations, or diuretics. People with diabetes may refrain
from using their insulin treatment.
c) There is an intense fear of becoming fat, which leads to the desire to reach a specific body
weight much lower than is considered normal or healthy for the person’s specific height and age.
In many cases, bulimia follows an episode of anorexia nervosa, although the period of time
between the two disorders may vary considerably.

Treating Bulimia Nervosa

Treatment for bulimia nervosa includes therapy and medication, but in extreme cases if the patient's
health is at risk, hospitalisation may be necessary.

Main Treatments for Bulimia Nervosa:

Cognitive Behaviour Therapy - Cognitive Behavioural Therapy is a type of psychotherapy, in which a

bulimia sufferer has regular discussions about their problem behaviours with a therapist. The discussions
will address the negative thoughts the person has about their weight and body shape, along with other
reasons for bingeing and purging. They will be able to learn how to recognise, understand, and manage
the situations that trigger these behaviours, and develop more positive ways of thinking. Cognitive

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Behavioural Therapy will help an individual to get back to a normal lifestyle by breaking the cycle of
bingeing and purging and encouraging healthier eating patterns.

Interpersonal Therapy - Rather than focus on the bulimic behaviours themselves, Interpersonal Therapy
deals with a person's relationships with other people in order to identify and change interpersonal
problems that are associated with the bulimia. The aim is to help build relationships that are supportive
instead of turning to bingeing and purging for emotional comfort.

Self- Help Programme - A self-help programme uses the same techniques therapists use in Cognitive
Behavioural Therapy, but is self-taught by the individual in their own time. Additional support and
guidance should be offered as they work through the programme. As with Cognitive Behavioural
Therapy, the aim of the programme is to change negative thoughts into more positive ones with the
effect of changing problem behaviours.

Family Therapy - The individual attends therapy sessions with their family. The support of the family can
help the person have confidence in themselves and help aid recovery from their eating disorder.

Group Therapy - Group Therapy Sessions are usually run by a therapist and attended by individuals with
bulimia. Some people find great comfort and support from attending therapy sessions with other
bulimics and are encouraged to beat their eating disorder. It is important that group therapy sessions
encourage recovery rather than the bulimic behaviours themselves.

Medications - Antidepressants can sometimes be helpful in the short-term as a treatment for bulimia.
However, these will not address the underlying causes of bulimic behaviours and probably should not be
considered as a long-term treatment for bulimia. Antidepressants can also have side effects and take
several weeks before they start to work. Lapses and relapses may occur during the recovery process, but
there is a good chance sufferers of bulimia will eventually will be able to lead a normal life.

Binge Eating Disorder

Binge eating disorder is a common eating disorder in which an individual regularly consumes a large
amount of food in one sitting, or “grazes” constantly even when they are not hungry or become
physically uncomfortable from consuming so much food. Unlike bulimics, binge eaters do not purge after
over-eating, nor do they routinely exercise excessively in an attempt to burn off the calories. Binge
eating disorder can occur in individuals of any gender, race, age or socio-economic status, and because
binge eaters often become overweight or clinically obese, they put themselves at risk for a wide variety
of health conditions and diseases. Unfortunately, there is no recognised cure for binge eating disorder
but there are a variety of treatment options that can be explored when binge eating disorder is
diagnosed.

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Health Risks of Binge Eating Disorder

Binge eating disorder is likely to result in the sufferer becoming overweight or obese, although this is not
always the case. Health problems that may arise include those that are associated with being
overweight, such as high blood pressure, diabetes, heart disease, gallbladder disease, kidney disease,
fertility problems, high cholesterol, and some types of cancer. Compared with anorexia and bulimia,
binge eating disorder has been accepted only recently as a serious eating disorder.

Causes of Binge Eating Disorder

Causes of Binge Eating Disorder include a number of interrelated physiological, psychological, and
social factors, which can increase the chances of somebody developing the disorder.

Some suggested causes of binge eating disorder include:

Physiological/Biological Causes of Binge Eating Disorder
It is possible that sufferers of binge eating disorder have a genetic predisposition to developing it, as it
has been found to run in families.
Researchers are also investigating the role of chemical imbalances in the brain (possibly hereditary) and
irregular functioning of metabolic rate as possible causes.

Psychological/Emotional Causes of Binge Eating Disorder

A history of depression is found in up to half of sufferers with binge eating disorder. A difficulty dealing
with emotional states such as stress, boredom, anger, anxiety, low self-esteem, and general unhappiness
are thought to trigger the use of food as a coping mechanism.

Social/Behavioural Causes of Binge Eating Disorder

It is thought that dieting behaviours may sometimes contribute to binge eating disorder, as some people
have binge eating episodes after restricting their food intake for a period of time. Binge eating disorder
has also sometimes been found to be associated with a history of substance or alcohol abuse.

Signs of Binge Eating Disorder

Signs of Binge Eating Disorders can be physical, psychological, and behavioural. Here are some of the
most common signs and symptoms.
Note: The presence of one or more of these symptoms does not necessarily indicate binge eating
disorder or any other eating disorder. Conversely, not all of these symptoms will necessarily be present
in someone with binge eating disorder.

Physical Symptoms of Binge Eating Disorder:

Being overweight or clinically obese (defined by a Body Mass Index of 25 >).

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Fluctuations in weight.
High blood pressure.
Breathlessness.
Heart disease.
Type 2 diabetes.
Digestive problems.
Joint and muscular aches and pains.
Chest pains.
Headaches.
Malnutrition due to eating junk food with little or no nutritional value.
Stroke.
High cholesterol.
Gall bladder disease.
Certain types of cancer.
Respiratory problems.
Kidney disease.
Arthritis.

Here are some of the Psychological Symptoms of Binge Eating Disorder:

Finding comfort in food.

Feeling a loss of control.
Depression and low self-esteem, generally feeling miserable.
Difficulty dealing with emotions such as anger and stress.
Feelings of guilt, disgust, and shame after a binge-eating episode.
Embarrassment about eating large amounts of food.
Suicidal thoughts.
Negative feelings towards food.

Here are some of the Behavioural Symptoms of Binge Eating Disorder:

Hiding food and empty containers of food.

Eating more quickly than usual.
Eating when not even hungry.
Binge eating (eating massive amounts of food) in secret and at odd times.
Feeling uncomfortably full after a binge-eating episode.
Yo-yo dieting.
Cycles of bingeing and dieting.
Avoidance of social situations, work, or school.
Obsessing about and criticising physical appearance.

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Eating alone, even when eating normally.

Difficulty sleeping.
Alcohol abuse.

Diagnosing Binge Eating Disorder

Diagnosis for binge eating disorder takes into account the frequency and duration of binge eating
episodes and the individual's feelings and attitudes towards their behaviour.
A medical doctor will refer to a list of symptoms (or diagnostic criteria) to help them decide if someone
has binge eating disorder.

Suggested Diagnostic Criteria for Binge Eating Disorder

A. Recurring episodes of binge eating. The two characteristics of a binge eating episode are:

 Eating a much larger amount of food than most people would consider normal under similar
circumstances and within the same time frame (eating may continue for several hours).
 While eating, there is a feeling of loss of control over the amount of food or type of food being
consumed.

B. Binge eating episodes are related to at least three of the following:

 eating until feeling uncomfortably full.

 eating very fast, much faster than normal.
 eating large quantities of food even when not hungry.
 eating alone due to the embarrassment of over eating.
 feelings of disgust, depression, or guilt after a binge.

C. There is obvious distress concerning binge eating behaviour.

D. On average, binge eating takes place twice weekly, and has done so for 6 months.
E. There are no recurring efforts to compensate for binge eating, such as purging or excessive exercise.
The disorder occurs at times other than during episodes of anorexia nervosa or bulimia nervosa.

Binge eating disorder treatment can take several approaches.

In short, there are two issues that need to be addressed in the treatment of binge eating disorder:
obesity, for people who are overweight from consuming too much food, and binge eating episodes
themselves. Treatment experts differ somewhat in their beliefs about which of these should be tackled
first.

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Main Treatments for Binge Eating Disorder:

Therapy
Cognitive Behavioural Therapy - Cognitive Behavioural Therapy is a type of psychotherapy, in which the
individual has regular discussions about their binge eating with a therapist. The discussions will address
the negative thoughts the person has about themselves along with their reasons for binge eating, such
as low self-esteem, poor body image, depression and anxiety. They will learn to recognise and monitor
the situations that trigger binge eating episodes, and discover how to deal with stress and difficult
situations in a way other than by binge eating. Cognitive behavioural therapy aims to eliminate
unhealthy eating habits.

Interpersonal Therapy - Interpersonal therapy helps the person to identify and deal with relationship-
related problems that may be occurring with a partner, family member or friend. The aim is to help the
person build relationships that are supportive rather than destructive, so that they no longer feel the
need to turn to binge eating for emotional comfort.

Medication

In some cases, antidepressants may be prescribed as part of the treatment for binge eating disorder.

Weight Loss Management Programmes

While many people with binge eating disorder have obesity-related health complications and need to
lose weight, it is not usually enough to just 'go on a diet', as this does not usually address the root cause
of the problem.

There are weight loss management programmes, which focus on helping people to lose weight.
However, someone with binge eating disorder should only attend such a programme under medical
supervision, as dieting itself can lead to binge eating, which will make matters worse. The sooner binge
eating disorder treatment is sought, the better, as obesity has negative consequences for long-term
health, such as heart disease, diabetes, high blood pressure, and stroke.

Geophagy
Geophagy is the practice, by which an individual routinely eats soil substances, such as chalk, soil, mud,
and clay. The cause of geophagy is unknown, but in some parts of the world it is practiced as a means of
completing the diet and is therefore considered an adaptive behaviour and not an eating disorder.

In the UK however, geophagy is most often diagnosed as a type of pica, and therefore, it is considered an
eating disorder, and it is most often diagnosed in children and pregnant women. As with the ingestion of
any type of non-food substance, the consumption of soil substances can lead to extreme health concerns
and so should be treated by a medical professional as soon as possible.

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Symptoms of Geophagy

There are only two real signs of geophagy, which are the craving and eating of soil substances including
chalk, soil, sand and mud. These eating behaviours may or may not be conducted in secret, though soil
substances are rarely the main type of substance consumed by an individual. In fact, hardly ever does
geophagy prohibit an individual from consuming an otherwise normal and healthy diet.

Diagnosing Geophagy

Geophagy is usually only discovered when an associated health problem such as an intestinal blockage,
intestinal perforation or tear, dental injury, poisoning or parasitic infection strikes, and an individual is
rushed to a surgery or hospital. During the medical investigations blood tests will usually be carried out
which determine if a mineral deficiency or anaemia could be the cause of geophagy (as has been
documented in many cases). If no such medical emergencies or investigations occur, then geophagy can
remain undetected for some time.

Geophagy is diagnosed in individuals, who have routinely consumed non-food substances, for at least a
month and for whom this behaviour is inappropriate to their developmental stage. However, geophagy
is not diagnosed as an eating disorder if soil substances are consumed by an individual as part of a
recognised cultural or religious practice. If this is the case, then geophagy is recognised as a type of
traditional or adaptive behaviour and not as a type of pica.

Treating Geophagy

There is no recognised cure for geophagy and the type of treatment recommended will depend upon the
type of geophagy that is diagnosed. If geophagy is recognised as a traditional or adaptive behaviour then
there will likely be no treatment plan recommended. However, if geophagy is believed to result from a
nutritional deficiency then vitamin or mineral supplements will likely be prescribed.

But if geophagy is diagnosed as having a psychological basis then a treatment plan appropriate to this
diagnosis will likely include counselling or talk therapy, family counselling, cognitive behaviour therapy,
attendance at support groups, and nutritional education, counselling and planning.

Geophagy is the practice of eating soil substances and may be either a type of pica and therefore an
eating disorder or a traditional or adaptive behaviour as recognised in certain cultural and religious
groups.

Pica

Pica is an eating disorder in which an individual is drawn to eating non-nutritive substances such as chalk,
soil, paper, sand, plaster, paint chips, and more. The cause of pica is unknown, but very often pica is
diagnosed in children, connected to a developmental disorder or emerges during a pregnancy. In

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children younger than two years old eating such substances is usually explorative and is not considered a
disorder, however those older than two years of age who continue to be attracted to, and consume,
non-food items should be examined by a medical professional as eating such items can have a negative
impact on an individual’s over-all physical health.

Signs of Pica

There are only two main signs of pica, which are the craving and eating of non-food substances. In
addition to chalk, soil, paper, sand, plaster, and paint chips, individuals with pica may also be drawn to
and enjoy eating glue, faeces, insects, leaves, gravel, clay, laundry detergent or starch, baking soda,
cigarette ashes or butts, ice, hair, soap and buttons. These eating behaviours may or may not be
secretive, and usually do not prohibit the individual from consuming a relatively normal diet otherwise.
In adults, such as pregnant women, it is often recognised that eating such substances are abnormal, but
very often shame or embarrassment prohibits individuals from seeking a diagnosis and treatment.

Diagnosing Pica

Pica is usually only discovered when a health problem occurs, so, if no major health concerns emerge in a
person’s life, then pica can remain undetected for months, or even years. Very often, pica is detected
when an individual suffers from an intestinal blockage, intestinal perforation or tear, dental injury,
poisoning, and/or parasitic infection associated with eating non-food substances. Blood tests will usually
be carried out during an investigation into pica to determine if a mineral deficiency or anaemia could be
the cause.
Pica is diagnosed in individuals who have routinely consumed non-food substances for at least a month,
for whom this behaviour is inappropriate to their developmental stage (for example, being over two
years of age) and who do not consume these substances as part of a recognised cultural or religious
practice.
Treating Pica

There is no recognised cure for pica, and the type of treatment recommended will depend upon the type
of pica that is diagnosed. For example, if pica is caused by a nutritional deficiency then this will usually be
remedied with supplements. However, if pica is diagnosed as a having a psychological basis, such as with
an obsessive compulsive disorder, then treatment appropriate to this diagnosis will result. Other
common methods of treating pica may also include counselling or talk therapy, family counselling,
cognitive behaviour therapy, attendance at support groups, and nutritional education, counselling, and
planning.
Children and Eating Disorders

Children, who are still growing and developing, need a healthy diet to fuel all of this activity. At times
children go through food phases or become picky eaters, but these phases are distinct from eating
disorders such as anorexia, bulimia, and binge eating disorder.

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Unfortunately, eating disorders are on the increase among older children and teens, most develop these
disorders between 11 and 13 years of age. The good news is that there is a lot that can be done to
prevent eating disorders from developing and many signs that can alert family and friends to the need
for professional help.
Preventing Eating Disorders in Children

Very few young children develop eating disorders, but by the end of primary school, children begin to
become interested in the opposite sex, aware of fashion, trends, and personal appearance, and are
drifting into puberty, where they find their bodies changing very rapidly and without their consent. At
this time, many girls begin to become curvy and develop breasts, as well as retain a little more weight,
which can be a dangerous period in their life if they are determined that they must remain at a certain
weight or size of clothing. Family and friends can help prevent eating disorders at these ages by doing
the following:
Insisting upon a varied, healthy diet for everyone.
Encouraging appropriate amounts of exercise for health and fun.
Barring dieting for children.
Engaging in regular discussions about school, life, and dreams, etc. with their children.
Listening to children’s thoughts on weight and body image.
Helping children retain realistic expectations about healthy weight and image.
Praising children’s talents and skills.
Reminding children regularly that they are loved and valued, no matter what size they wear.

Common Signs of Eating Disorders in Children

Many children are able to hide the signs and symptoms of eating disorders for months or even years,
which can put their health at great risk.

There is much behaviour that can signal an eating disorder however, such as:

Significant weight loss or gain.

Continuous dieting or discussions of dieting.
Fear of gaining weight.
Persistent preoccupation with food/eating/weight.
Persistent preoccupation with fashion, clothes sizes, and/or personal appearance.
Eating while alone or in secret.
Hidden food or laxatives/diuretics.
“Grazing” or eating all day or for as long as food is available.
Vomiting – or regularly retiring to the toilet – after meals or snacks.
Frequently running the taps while in the toilet (to cover evidence of vomiting).
Swollen cheeks and/or bad breath (from vomiting).
Excessive exercising to burn calories.

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Disordered Eating
“Disordered Eating” is a term used to describe eating habits or patterns that are irregular. Many
different types of disordered eating habits exist but, for the most part, these habits do not add up to a
diagnosis of an eating disorder.

Types of Disordered Eating Habits

Disordered Eating Habits can Include:

Excluding whole food groups (for example, all fats or all carbohydrates).
Eating only at particular times of the day.
Eating only specific foods or eating only foods of a specific colour.
Eating only foods of a specific texture.
Not eating certain foods together in a sitting.
Not eating specific foods from the same plate can all be types of disordered eating.

Sometimes, these habits were formed in childhood, when someone was simply labelled a picky eater,
but such patterns can also develop in a quest to lose weight or as coping mechanisms against emotional
stress.

Disordered Eating and Eating Disorders

Disordered eating habits are not necessarily eating disorders. In fact, these habits do not generally result
in a diagnosis of an eating disorder such as anorexia or bulimia. But they may be diagnosed as eating
disorders not otherwise specified, sometimes referred to as EDNOS. This diagnosis is usually based upon
the fact that a person’s eating is disordered such that they meet some criteria for a diagnosis of an
eating disorder but not all of the required criteria. For example, a girl who fits all of the criteria for
anorexia, but remains within a normal weight range or continues to have menstrual periods, may be
diagnosed with an EDNOS.

Someone who binge eats and purges, but not at a frequency rate regular enough to be diagnosed as
bulimic, may also be diagnosed with an EDNOS. Like recognised eating disorders, eating disorders, which
are not otherwise specified, are diagnosed by mental health professionals.

Dealing with Disordered Eating

Disordered eating may result from childhood habits, a desire to lose weight or as a means of coping with
emotional stress. Depending upon why an individual chooses to engage in disordered eating habits
reveals more about how to help these individuals.

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For example, those who have developed disordered eating in a quest to lose weight can often benefit
from the help of a professional nutritionist who can guide them towards more healthy eating choices
and methods of shedding unwanted weight. But someone who has turned to disordered eating to cope
with their emotions may be helped more by visiting a mental health professional such as a therapist or
counsellor who guides him or her towards more healthy means of coping with their stress.

The term “disordered eating” literally describes eating patterns that are irregular or disordered. There
are many types of disordered eating, and while most do not add up to an eating disorder, some may be
diagnosed as an eating disorder not otherwise specified (EDNOS). Discovering why an individual has
turned to disordered eating habits should help in guiding him or her back towards more healthful eating
habits.

Coloured-Coded Eating

Colour-coded eating results when a person makes his or her food choices based on the colour of a food.
This is a type of disordered eating that can be detrimental to health if an individual cannot obtain all
needed nutrients from the foods that they will eat. Overcoming eating by colour may require
professional help if a disordered eater’s habits are strict enough to prohibit overcoming such eating
patterns by his or herself.

Eating By Colour

Eating by colour literally means that an individual will only eat foods of a certain colour, or will reject
foods based solely on their colour. For example, a disordered eater may decide that they will eat yellow
foods, so yellow peppers are acceptable, but that they may not eat orange foods, orange peppers are
not allowed. Similarly, a disordered eater may eat green foods, so broccoli and peas are acceptable, but
not red foods, so red peppers and strawberries are not. Some disordered eaters may even eat all foods
except for one colour. The defining characteristic of this eating habit, however, is to accept or reject
foods based on colour rather than taste, texture, nutrition or any other variable.

Eating the Rainbow

“Eating the rainbow” is a relatively new term that urges people to eat food of a variety of colours. This
phrase became popular when it became known that foods of different colours contain different
nutrients, so in order to have the most balanced diets foods of a variety of colours are needed.
Unfortunately, individuals whose disordered eating is manifested in colour coded eating cannot eat a
rainbow of different foods. This means that such disordered eaters will automatically keep themselves
from getting the most balanced diet as possible. While taking vitamins or supplements may help to make
up for missed nutrients, these items should not be taken without medical approval.

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Overcoming Eating by Colour

Overcoming eating by colour may seem as easy as including more colourful foods in an individual’s diets,
but if it were this easy to overcome many disordered eaters would not have fallen into their patterns in
the first place. Instead, disordered eaters must recognise why they began to colour code their foods. Are
there connotations with foods or colours? Did colour coding once serve a purpose? Did it begin as a
method of dieting? Is there a measure of stress relief in this type of eating? By answering these
questions and getting to the root of the colour coding, disordered eaters will be more likely to
understand their habits and thus how to overcome them. However, some disordered eaters may find
that they cannot overcome eating by colour on their own. In this case, the help of a dieticians,
nutritionists, counsellors, and therapists may be invaluable to those trying to overcome colour-coded
eating.

Colour-coded eating is a type of disordered eating in which foods are accepted or rejected based on their
colour. Overcoming this type of disordered eating will require an individual to investigate what purpose
eating by colour serves and why they turned to this habit in the first place.

Eating According to a Set Time

Eating according to what time it is a type of disordered eating in which an individual will only eat food at
specific times of the day, or only eat for a set amount of time when they do choose to eat food. This type
of disordered eating may be undertaken as a means of dieting to lose weight, or it may be undertaken as
a coping mechanism in order to deal with emotional stress. Overcoming this type of disordered eating
will depend upon why the individual chose to undertake such eating habits in the first place.

Eating According to a Set Time

Some disordered eaters choose to eat only at particular times of day. For example, some people may feel
that they cannot eat food after a particular time of night out of fear that the calories will not be burned
off and they will then gain weight. Similarly, some people may feel that they can only eat "heavy food",
such as carbohydrates in the morning so that they can be sure to burn them off during the day. Still
other people may assign types of food to particular times of day; for example, carbohydrates in the
mornings, proteins at mid-day and fruits and vegetables in the evening. Any food rules that are
dependent upon the time of day can be a type of disordered eating.

Eating with a Time Limit

Some disordered eaters also set time limits as a part of their eating habits. These people often allow
themselves to eat whenever they choose, but only for a set amount of time. This can be a behaviour
similar to binge eating in which a disordered eater allows him or herself to eat whatever they want, so
long as they adhere to the time limit, or it may be that during these blocked eating sessions the

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Food and Nutrition

individual follows other eating patterns as well. These patterns may also include eating particular foods
depending on the time of day, eating food by texture or eating food by colour.

Overcoming Eating According to Time

Like most disordered eating patterns, the best way to overcome eating according to time is to investigate
why the disordered eater has developed this habit in the first place. Very often disordered eating begins
as a way to lose weight or as a means of coping with emotional stress, but these are not the only reasons
that someone may fall into the habit of eating at specific times or for specific amounts of time.

Some people may have food allergies that they are not aware of and it may be that they are better able
to cope with their reactions at particular times of day. Others may have been "grazers" and would eat
small amounts quite often, and setting a limit was a way to try to consolidate their eating into one main
meal.

Eating by Food Types

Eating according to the food type is another disordered eating habit, which often starts as a desire to
lose weight, such as in an effort to cut out all foods containing fat, sugar, or carbohydrates. However,
individuals who no longer eat whole “categories” of food are not able to eat a well balanced diet. In
order to have the best health possible, disordered eaters must be taught to include a wide variety of
foods in their diets.

Eating By Food Type

Eating by food type can often come about as means of dieting. For example, popular diets that advocate
cutting out whole categories of food (for example, all carbohydrates) can spur an individual into thinking
of that food category as unacceptable. It may also be that an individual develops food type aversions by
him or herself.

For example, a disordered eater may decide that all baked items are “bad”, while all steamed items are
“good”, or that rice is “bad” while turkey is “good”. When an individual loses perspective about how
food affects the body and why the body needs a wide variety of nutrient-rich food, including fat, sugar
and carbohydrates, disordered eating is more likely to creep into his or her daily habits.

Disordered Eating and Dieting

Eating by food type may be thought of simply as a method of dieting, rather than as disordered eating.
This may start when an individual begins to divide foods and food groups into “yes” or “no” foods. “Yes
foods”, even if the individual does not think of them as such, are foods that the individual is allowed to
eat because they are acceptable in his or her diet. “No foods” are foods that the individual feels are
inherently unacceptable and will sabotage his or her ability to lose weight. However, such blanket bans
on these foods tends to indicate that an individual has lost the ability to understand which foods and

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Food and Nutrition

types of foods affect their health in certain ways. When an individual fails to understand that food itself
has no inherent good or bad value, they are very likely to begin categorising it and cutting out those that
they feel will adversely affect dieting as opposed to health.

Eating a Well-Balanced Diet

Those who eat by food type must learn what a well-balanced diet means and how all food types fit into a
well-balanced diet.

Eating by Texture

People who engage in eating by texture, make their food choices based on how food feels in their
mouths, rather than by its nutritional value or even by its taste. However, eating by texture may also
indicate other conditions, so those who notice loved ones rejecting or accepting food based on texture
should investigate why this is so.

Eating By Texture and Disordered Eating

Eating by texture is a common type of disordered eating. When it is not indicative of another condition,
eating by texture means that an individual has decided to sort his or her food choices by the way that
foods feels, rather than by how it tastes or if it is required for a balanced diet. For example, some
disordered eaters may choose only foods that require chewing with the thought that this action may
burn extra calories.

Other disordered eaters may choose only foods that “squish” in their mouths because they prefer that
feeling to foods that “crunch”. While there is nothing inherently wrong with enjoying some textures over
others, if this preference leads to eliminating foods required for healthy eating then it will adversely
impact the body and overall health.

Eating By Texture and Other Conditions

Eating by texture is another condition of disordered eating and may also represent other diseases. For
example, some individuals with Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder
(ADHD) report a hypersensitivity to the texture of food that makes certain foods intolerable to them.
Sensory Integration Disorder can also leave individuals unable to tolerate certain textures of food.
Individuals with Rett Syndrome may also have a low texture tolerance as related to their food. Because
there are obviously reasons other than simple disordered eating that may be related to eating by
texture, further investigations should be carried out when eating by texture is noticed.

Overcoming Eating By Texture

It may seem that eating by texture can be overcome by simply learning to appreciate different food
textures, but this is not so easy when a food texture can make an individual choke, gag or even vomit.

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Food and Nutrition

Some individuals may be able to consciously begin to add more foods and textures into their diet, but
others may need professional help to explore why they react so violently to certain foods. Still others
may find that changing the texture of a food, such as by making smoothies out of crunchy fruits and
vegetables, can help them add nutrients to their diet without having to eat a texture that they do not
enjoy.

However, forcing someone to eat foods with textures that are despised is not a good idea as it will likely
lead to that individual avoiding the food even more. Rather, those who eat by texture must be the ones
to decide that they want more food choices in their diet and to design, or seek help to design, ways to
make this possible.

Further Reading:

 Eating Disorders and Obesity: A Comprehensive Handbook, (2002), edited by

Christopher G. Fairburn, Kelly D. Brownell
 Eating Disorders: A Reference Sourcebook, (1999), edited by Raymond Lemberg,
Leigh Cohn
 Eating Disorders, (2008), By Suzanne Abraham

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 Meal Planning Module VI
MEAL PLANNING

OBJECTIVES

5
At the end of this module, you will be able to:

meals accordingly;

In the previous lesson you have learnt about the meaning of nutrition and health and the inter-
relationship between them. You are also familiar with the various nutrients present in food, their
functions, requirement in the body and the factors influencing these requirements.

In this lesson, you will learn about grouping the foods into different groups according to their
nutrient content. Inclusion of these food groups in our daily meals is important to provide an
adequate diet.

This knowledge is essential to make sure that you are eating the right food in the right quantities. In
this lesson, you will learn how to ensure nutritional adequacy of the food that you eat every day and
how you can plan the same.

FOOD GROUPS

The knowledge of recommended dietary allowances and composition of food is necessary for the
selection of an adequate diet. But if we start doing this, it will be a tedious process. Therefore, it is
necessary to translate the nutritional needs into kinds and amounts of food that we should eat.
Such an information can then be used in everyday meal planning exercise. This is achieved by
dividing/categorizing all food items into various groups called food groups. Now let us see what is
a food group.

A food group, quite simply, consists of a number of food items sharing some common
characteristics.

Let us see the two ways of classifying food into groups

physiological, on the basis of function on the basis of nutrients

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 A. Classification Based on Physiological Functions
These are energy giving, repair and growth, protection and regulation. Commonly known as
GO, GLOW, GROW foods.

B. Classification Based on Nutrients

Now we will study the classification based on the nutrients which they supply.

Five Food Group System

Food Group Main Nutrients

1. Cereals, Grains and Products Energy, protein, fat,

Rice, wheat, ragi vitamin B1, vitamin B2,
bajra, maize, jowar folic acid, iron, fibre
barley, riceflakes,
wheat flour etc.

2. Pulses and Legumes Energy, protein, fat,

Bengal gram, blackgram vitamin B1, vitamin B2,
greengram, redgram, folic acid, calcium,
lentil (whole as well as dhals), iron, fibre
cowpea, peas rajmah,
soybeans, beans etc.
3. Milk and Meat Products
Milk: Protein, fat, vitamin B2 ,
Milk, curd, skimmed milk, calcium, vitamin A
cheese
Meat:
Chicken, liver, fish, Protein, fat, vitamin B2,
egg, meat vitamin A, vitamin B12
4. Fruits and Vegetables
Fruits:
Mango, guava, tomato Carotenoids, vitaminn C,
ripe, papaya, orange, fibre, carbohydrates
sweet lime, water melon
Vegetables (Green Leafy) Fats, carotenoids,
Amaranth, spinach, gogu, vitamin B, folic acid
drumstick leaves, coriander calcium, iron, fibre
leaves, mustard leaves,
fenugreek leaves

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 Other Vegetables: Carrots,
brinjal, ladies finger, capsicum, Carotenoids, folic acid,
Meal Planning
beans, onion, drumstick, calcium, fibre
cauliflower
5. Fats and Sugars
Fats:
Butter, ghee Energy, fat
hydrogenated oils,
cooking oils like ground
nut, mustard, coconut oil
Sugars:
Sugar, jaggery Energy

Note: Carotenoids are a form of vitamin A available from plant sources.

A ready recknoner is provided to give you a comprehensive information on the nutrients, their
food sources and groups to which they belong.
In this system of food grouping, similar food items are placed together. For example, all
cereals are similar in their nutrient content and all pulses are also similar in nutrient content.
Similarly, milk, egg and flesh foods are comparable, all oils, butter, ghee have similar nutrients.
Therefore, if we substitute one food for the other in the same group we will, to a large extent,
get the same nutrients. For example, whether we select wheat flour, rice we would get
approximately the same nutrients.

Substitution of one food item with the other in such a way that the nutrients provided by
them are the same is called Food Exchange.

Food Exchanges make Diet Planning Easy

WHAT IS MEAL PLANNING?

Meal planning is making a plan of meals with adequate nutrition for every member of the
family within the available resources. The term ‘available resources’ means whatever the
family has in terms of time, energy and money.
IMPORTANCE OF MEAL PLANNING
Meal planning is important for meeting the nutritional requirements of the family members. It
helps us to decide what to eat each day and in each meal. We can call it our ‘daily food guide’.

Meal planning helps us to:

(a) fulfill the nutritional requirements of the family members
(b) make the food economical
(c) cater to the food preferences of individual members
(d) save energy, time and money
(e) use left over food
The following section, will help you to understand these points clearly.

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FACTORS AFFECTING MEAL PLANNING

What guidelines do you keep in mind while planning meals? What all do you consider to make
your meal planning effective? Yes, there are many factors such as:

1. Nutritional Adequacy
This is the most important factor, which means that the nutritional requirements of all the
family members are fulfilled. For example, you know a growing child needs more protein,
a pregnant or lactating woman needs calcium, etc.

While planning meals you will include food items from various food groups, that is,
energy giving foods, body building foods and protective and regulating foods.

2. Age

People normally eat according to their age. You must have observed in your family that
the diet of various members of different age groups differs in quantity. A new born baby
drinks only milk, a small child’s meal is also of very small quantity, an adolescent eats still
more in amount and variety of foods. Similarly, you must have seen your grandfather
eating less food and also that they prefer soft and easy to digest foods.
3. Sex
Sex is another factor which determines the dietary intake. Dietary requirement of
adolescent and adult males are more than their female counterparts.

4. Physical Activity
The kind of work a person does affects the kind and amount of food they need to take. Do
you remember that RDA is different for people engaged in different activities? A
labourer not only eats more quantity but needs more energy because he is engaged in hard
work. His body uses up more energy while performing hard work. So, if you have to plan
for such a person you will include more energy giving foods in the diet.

5. Economic Considerations
Money available to the family to be spent on food is another major factor. Foods like milk,
cheese, meat, fruits, nuts etc. are expensive. However, alternative sources like toned milk,
seasonal fruits and vegetables are less costly and at the same time nutritious. You can
therefore plan a balanced diet to suit every budget.

Tips for economy

tive stores, etc.

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6. Time, energy and skill considerations
While planning the meals, you should consider the resources like time, energy and skill
available to the family. Meals can be elaborate with different dishes but you can simplify
them by cooking a simple but nutritious dish.

7. Seasonal availability

Some foods are available in summers while some in winters. The off season foods are
expensive and less nutritious, while those in season are fresh, nutritious, tasty and cheap.
Hence, while planning seasonal foods should be used.

8. Religion, region, cultural patterns, traditions and customs

Regional factors influence meal planning. For example, if you are a Filipino, you will
consume more of rice, while those Americans, will consume more of bread, pasta, etc.

Religious beliefs prevalent in the family also have an influence. For example, if you are a
vegetarian, your diet will not have any meat or meat product, and Muslims do not eat pork
etc.

9. Variety in colour and texture

Examine the following two menus - which one is better?
Recipe - I Recipe- II

The second one, as it has variety in terms of colour, texture, flavour and method of
preparation. These factors help you to make meals more appealing, attractive and hence
more acceptable.
10. Likes and dislikes of individuals
The food you serve should cater to the likes and dislikes of the individual family
members. It is often better to change the form of some particularly nutritious food item,
rather than omitting it completely.
For example, if someone in your family does not like milk, you can give it in the form of
curd, cheese, etc. Similarly, if one does not want to take green leafy vegetables in cooked
form, what alternative would you suggest, so that it can be taken in adequate amount? Yes,
it can be used in a variety of ways.

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11. Satiety Value

While planning meals, take care that you select foods which provide satiety value. Meals
which produce inadequate satiety, will lead to onset of hunger pangs, which in turn will
affect the working capacity and efficiency of a person.

Satiety : Feeling of fullness after eating

SELF ASSESSMENT

Answers the following questions. Write your answer in a short bond paper with proper
margin.
(a) What are the qualities of a well planned meal?
(b) Differentiate between seasonal foods and out of season foods.
(c) List at least two points you will keep in mind in order to prepare
an attractive and appealing meal.
(d) List the different types of work. Which kind of work requires
maximum energy?

MODIFICATION OF FAMILY MEALS FOR VARIOUS AGE GROUPS

Meal planning is an art and science in itself. What is to be cooked is decided by the homemaker
from the available food items. But the meal planning is affected by various factors like nutritional
requirements, budget, season etc. all of which you have studied earlier.

These factors various from family to family. Do you remember what you had for lunch? A typical
Filipino lunch is composed of a food variant (or two for some) and rice, sometimes with soup and
vegetables. Whether grilled, stewed or fried, everything eaten with rice. Since the Philippines is a
tropical country, we usually pair our meals with iced cold water, juices or even soft drinks.

This is generally a balanced meal. Can you tell why?

Yes, because it has food items from all the food groups. This meal provides all the essential
nutrients such as - energy, protein, fats, vitamins and minerals.

The nutritional requirements of all the family members can be met by varying the quantity of
food items and by combination of foods. Include food items from different food groups to get
variety and maximum nutrients.

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Consider a family having members in various age groups, that is, parents, grandparents, a school
going child and an adolescent girl. Now, you know all of them have different requirements. If
you have to cook for them how will you go about it? Will you cook specially for each member
according to individual nutritional needs or cook a common meal and serve according to
the various nutritional needs?

Definitely, the second alternative is a better choice. What are you doing here? You are
modifying the same meal according to the needs of each member. This is what is known as diet
modification. This can be achieved through two methods.

A. Through Modification in the Diet

Diet modification means serving the meal cooked for the family to any member after varying it in
quantity, quality and frequency of eating.

1. Quantitative modification of diet

This refers to the increase or decrease in the number of times a meal is taken and/or the portion
size (Portion size the amount of a particular dish eaten at a meal).

For example, pregnant women, sick people or older persons need to eat smaller meals but at shorter
intervals, that is, they may need 6-8 meals instead of four meals a day. Similarly, adolescent boys
needs larger portions at each meal (may be more rice, more curd) and also more frequent meals
to meet their nutritional needs. Persons who are dieting are advised to reduce the amount of food
eaten at each meal. This will force the body to use stored reserves which will help in reducing boy
weight.

2. Qualitative modification of diet

It refers to the change in nutrients, consistency, flavour, amount of spices and fibre content of the
diet. For example, the increased protein requirement of a pregnant woman can be met by
increasing the quantity of protein rich foods in her diet. You must have seen mothers taking out
some boiled dal in a separate bowl, mashing it and feeding it to babies between the age of 6
months to 1 year. Dal a dried, split pulses does not contain any spices, except salt and turmeric.
Slightly older children are fed well cooked and mashed ‘Khichri’. Older people need a diet
soft in consistency and less spicy. This is a qualitative modification of diet.

3. Modification in terms of frequency

What would you suggest to a person whose requirements are increased but they are not able to
increase the quantity of food in the original meals? Yes, you will suggest an increase in the
number of meals instead. This means the should take something in between the main meals. This
is diet modification in terms of frequency.

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B. Through Food Exchange Method
If you are modifying the same meal for different family members, then how will you decide on
how much of one item is equivalent to another one? If you are not sure about how to go about
exchanging one food item with another in the correct proportion, then you may not be able to fulfill
everyone’s requirements correctly. For example, if you are exchanging milk with egg then you
should know how much of milk is equivalent to one egg or if one does not want to eat egg, in that
case, how much of pulses should be given instead?

Food exchanges help you to modify the diet for an individual according to needs, likes, dislikes
and food habits and help you to make the diet more flexible and interesting. The following food
exchange table gives you a fair idea about the exchanges that can be done among various foods,
so that the nutrients derived by these foods remain the same.

Refer to Food Exchange Lists for Meal Planning material provided by your instructor for more
examples

Protein rich foods

1 glass of milk = 1 egg = 1 medium size katori meat = 1 big katori pulses =1 big katori curd
= 1/4 cup of paneer = 3 cups of butter milk

Cereals

1 Chapati = 1 bread slice = 1 potato = ½ cup rice = ½ cup dalia = 4 salted biscuits = ½ cup
noodles = 1 idli = 1 plain dosa = ½ cup upma/poha

Fats

1 tsp of butter = 1 tsp of oil = 2 tsp mayonnaise = 4-5 pieces of nuts = 10-12 pieces of peanuts = 5
tsp cream.

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A Sample Menu of a Common Meal
While planning meals for different family members, keep in mind the nutrient content of food.
You want that the common menu should be served to everyone. But this does not work out, as
the needs of different individuals vary.

One easy way is to start with a sample menu for a healthy adult man engaged in normal activity.
Plan for one person, decide how much to provide at different meals, according to the
requirements. This becomes the reference menu for different family members according to their
specific requirements.

1. Menu for an Adult Man/Woman

The following example meal plan has been designed for an 'average' male. It's nutritionally
balanced to suit a young adult male who has a sedentary job and weighs 70-75kg, and he should
maintain his weight on this. Obviously this is a hypothetical male, so like all plans, it is merely
an example and needs to be adapted to suit an individual's own lifestyle, daily routine and
nutritional requirements. Use this to give you an idea of what are healthy nutritious foods to
include, but don't forget to vary your food choices and to drink plenty of water through the day.

Read more at: https://www.mealplansite.com/age/male-adult.aspx

Sample menu for an average male engaged in moderate work

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The following example meal plan has been designed for an 'average' female. It's nutritionally
balanced to suit a young adult female who has a sedentary job and weighs 60-65kg, and she
should maintain her weight on this. Obviously this is a hypothetical female, so like all plans, it
is merely an example and needs to be adapted to suit an individual's own lifestyle, daily routine
and nutritional requirements. Use this to give you an idea of what are healthy nutritious foods to
include, but don't forget to vary your food choices and to drink plenty of water through the day.

Read more at: https://www.mealplansite.com/age/female-adult.aspx

Sample menu for an 'average' female engaged in moderate work

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2. Modification for Pregnant Woman
You have already learnt in the previous lesson that during pregnancy, the need of calories,
proteins, calcium, iron, vitamin A and vitamin C are increased for the healthy growth and
development of foetus. Also, you should give her more of water and fibre, as she may suffer
from the problem of constipation. But since she is not able to eat much at a time, you should
give her small frequent meals. Keeping all these points in mind the menu has to be modified.

The calorie requirement of pregnant lady is 13% less than that of an adult man and can be done
by reducing the quantity of cereals in her menu as compared to the reference menu. Her
protein requirement is slightly higher, which can be compensated by giving her more of protein
rich foods. The frequency of meals should be also increased, as compared to the sample
menu.
Sample menu for pregnant women

As with all the meal plans this is merely a guide and a mother is encouraged to eat a variety of
different meats / fish / alternatives, complex carbohydrates, fruit and vegetables every day, and
drink plenty of water. Adapt the plan to suit your own needs and daily routine and vary portions
and food choices from day to day.
Read more at: https://www.mealplansite.com/age/pregnancy.aspx

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3. Modification for Lactating Mother
You are already aware of the fact that the nutrition of lactating mother is very important as the
newborn baby relies completely on the mother for nutritional requirements. Inadequate food
intake reduces the milk secretion.
Her requirement is even greater than that of a pregnant woman. So while modifying her diet, you
will take care that her meals are rich in energy, protein, calcium, vitamin A and C.

She should be given more of foods like milk, curd, pulse, which are rich in protein, calcium, and
vitamin A. Further, to compensate for her requirements, an additional serving of egg and vitamin A
rich food like mangoes are given to her as compared to the sample menu. The frequency of meals
too should be increased to fulfill her extra needs.

4. Modification for an Infant

Mothers milk is sufficient to meet the nutritional requirements of the baby up to 6 months.

Liquid Juice, soups, milk

(6 months)
Whole Ancient Grain Baby Cereal ; Mashed avocado;
Unsweetened applesauce and shredded or cubed cheese;
Soft steamed chunks of broccoli or green beans;
Semi-Solid Read more at:
(6-9 months) https://www.happyfamilyorganics.com/learning-
center/recipes-meal-plans/6-9-months-meal-plan/

Solid
Egg, vegetables and fruits
9-12 months

Weaning pattern for an infant

You know that by 6 months, infants are put on weaning foods to take care of their rapid growth and
development. Weaning is a gradual process of shifting the child from breast milk to a normal
household diet. A good diet during infancy is very important, since the foundation of future health is
laid during this stage. They now need weaning foods rich in proteins, Vitamin A and specially
calcium. The calorie requirements of infants is nearly ¼ and protein is 1/3 of that of adults. But
they need more calcium than adults. So they should be given more of foods like milk, egg, green
leafy vegetables etc. Keeping in mind all these factors, the sample menu can be modified in terms
of quantity, quality and frequency.

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5. Modifications for Children and Adolescents
A well balanced healthy diet is a must for all age groups. The modifications for various age
groups are as follows:
Modifications for children

Pre-schoolers School going Adolescents

Children
- A high calorie high - A high calorie, high - A high calorie, high protein
protein diet, rich in cal- protein diet with diet, rich in calcium and iron.
cium and vitamin A. plenty of vitamins
and minerals. - Quantity of food intake must
- Mildly flavoured and
be increased to meet their
less spicy foods to be - Need energy rich rapidly changing body needs.
given foods for their hec-
- Handy Finger Foods tic activities both at
are preferred. school and home. - Nutritious fast foods and
snacks should be planned.
Example - French - Packed ‘tiffin’ as-
fries, Sandwiches, sumes a lot of im- - Peer group influence affects
vegetable rolls, portance as break- food intake, it must be kept in
Stuffed pranthas etc. fast is usually mind while planning.
skipped. ‘Tiffin’
- Foods should neither should be tasty be- - Starving crash dieting/erratic
be too hot or too cold sides being nutri- eating habits must be
for the child to handle tious. discouraged.

6. Modifications for old People

Many physiological changes occurring during old age affects nutritional requirements. They
need less energy and fats as compared to an adult man but the proteins and other nutrient
requirements remain the same. They need lots of water and fibre to check the problem of
constipation. Also, you know that they may suffer from chewing problems, so give them soft
and well cooked foods.

Now you have learnt how to adapt the same menu for various family members according to
their requirements. It also saves time and effort and makes planning simple.
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NEED FOR SPECIAL DIET

You are all aware that a normal diet satisfies the nutritional needs of a healthy individual. But
when a person falls sick there is a malfunctioning of parts of the body, therefore, the nutritional
needs of a sick person changes.
For example, in diabetes, the pancreas do not produce insulin which is needed to digest sugars.
In such a case, presence of the normal amount of sugar in the food will be harmful to the system.
In jaundice there is malfunctioning of the liver, hence digestion of fats is affected and presence
of normal amounts of fats in the diet will be harmful to health. In case of diarrhea, there is loss
of body fluids and salts with every passage of stool. Also, the digestive system is unable to cope
with the solid food eaten.

Under these circumstances, if one goes on eating normal food the system will be burdened and
damaged. Hence, there is a need to modify the food eaten. Can you suggest some more reasons
for modifying diet during diseases? Here are some reasons:
• To maintain good nutritional status.
• To correct nutritional deficiencies.
• To provide a change in the consistency of diet: liquid or semi-solid
• To bring about change in the body weight, if required.

THERAPEUTIC DIET

What is meant by ‘Therapeutic Diet’?

Therapeutic diet is the special diet given to a person suffering from a disease, to
facilitate recovery. It is a modification of the normal diet.

Does the change in diet help the person to recover from disease?
Yes, certainly. When sugars are withdrawn from food, insulin is not required to digest them.
When fats are taken off the diet, the liver can relax and take time to recover. Drinking fluids
certainly helps to overcome losses of water and minerals.

Some points to remember

While modifying the diet of a patient, keep the following points in mind:
1. Do not plan a completely different diet because:
(i) Diets based on a person's daily diet have better acceptance.
(ii) Such diet do not make a patient feel that he/she is eating something
completely different from the family members.
(iii) It is difficult to prepare.
2. Try to include only those foods which are liked by the patient, otherwise
food may not be eaten at all.
3. Serve the meal in an attractive way to make them feel like eating.

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 DIET IN SPECIFIC DISEASES

Now let us see what kind of food should be given to persons suffering from different diseases. These diseases may be due to
infection - fever, hepatitis, diarrhea or malfunctioning of some part of the body - hypertension, diabetes or constipation.

MODIFICATIONS IN FOOD TO BE
DISEASES Diet consistency Nutrient content Interval and Taken Avoided
frequency of feeding
Diarrhoea Liquid/semi solid Low fibre Frequent meals, Soups, banana, biscuits, Whole cereals,
intervals of 1-2 hrs sago khichdi, potato, chillies, whole pulses,
boiled egg, curd, fried food, guava, fruit
dals, refined with skin, leafy vegetables,
cereals pastries, milk
Fever Semi solid diet High calorie, Frequent meals at Milk, egg, chicken, fish, Whole cereals,
high protein 2-3 hrs interval juices, fruits, soups, chillies, whole pulses,
lassi, dalia, kheer fried food, guava, fruit
with skin, leafy vegetables,
pastries, milk
Diabetes No change Normal diet Meals taken at Vegetables, roti, dal, Sugar, sweet, honey, jam,
with no sugar fixed time, take six milk, curd, fruit, egg. jellies, cakes, pastries,
small meals/day sweetened fruits, cold
drinks, tinned fruit
Hypertension No change Low calorie, No change Roti, dal, vegetables, Food rich in cholesterol
low cholestrol, milk, fruits and salt like cheese, butter
low salt egg yolk, pickles, chutneys,
papads, sauces
Jaundice Start with liquids Low fat Small frequent meals Roti, vegetable, dal, Fried food-puri, pakoda,
slowly go to a at 1-2 hrs intervals skimmed milk, fruit, sugar samosa
normal diet

Constipation No change High fibre, No change Atta with husk, whole Refined foods like suji,
drink lots of pulses, green leafy rice, candies, bread, maida
water vegetables, guava

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WRONG BELIEFS (MYTHS) REGARDING DIET
There are many wrong beliefs prevalent among people regarding diet. We
present here only a few myths and the facts.
1. Myth: Diabetics can not eat rice or potatoes.
Fact: A little amount can be taken daily.

2. Myth: Jaundice patients should not take fats or turmeric in their diet.
Fact: Fats must be excluded for a while but turmeric is not harmful
during jaundice.

3. Myth: Crash dieting or eating very little is good for losing weight fast.
Fact: Starvation diet is harmful to the body. A controlled, high fibre,
low calorie diet is recommended.

4. Myth: In diarrhoea, stop eating

Fact: The body needs food to help recover. Stopping food only aggra-
vates the problem.

5. Myth: In fever do not give hot foods.

Fact: There is nothing like hot and cold food.

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