The Use of a Balanced Diet to Manage Chronic Conditions

Macronutrients: Proteins, Fats, and Carbohydrates Case Study # 2
Mr and Mrs Mine (M) are both in their late twenties. Married for only two years, they plan on continuing their work careers and have decided to put off having children for the next four or five years. Because they work hard, neither Mr nor Mrs M are very careful about what they eat. Monday through Saturday they usually skip breakfast or if there's time, they'll fry some food left over from the day before. At lunch Mrs M eats a simple meal, usually a bowl of rice with some meat (usually beef or pork) and a sweet dessert, cake, cookies or ice cream. Mr M's lunch is usually a hamburger or fried chicken or fried fish.
Since Mr M works late, Mrs M eats her dinner alone, and very often her dinner is a combination of snack food and sandwiches -­‐-­‐ she especially likes cheese or eggs and butter or margarine on her bread. - point out saturated/unsaturated fats!!!! 
When Mr M comes home late at night, both Mr and Mrs M share fast food that Mr M picks up on his way from the office -­‐-­‐ pizza, yakitori or Chinese noodles with eggs, pork and chicken.
Mr and Mrs M have asked for your advice about their unbalanced diets. Further, there are early signs that Mr and Mrs M are not in perfect health. Mr M has high blood pressure and occasionally experiences angina chest pains. He tells you he has no opportunity to do regular exercise, and you observe that he is a heavy smoker, as well. Mr M has low levels of HDL but his LDL level is 170.
Mrs M, on the other hand, has both high HDL and LDL levels; her LDL is 165. Mrs M is more concerned about her appearance than her health. She cannot understand, for example, why she is 20 pounds overweight, since she eats only two meals a day. But even if she continues with her dietary pattern and her lack of exercise, she does not think she will gain more weight. (She tells you that most women in her family are thin, but, more important, you also learn that several aunts and her mother have developed complications with various cancers, including cancer of the breast.)
With regard to their daily eating habits, both Mr and Mrs M need good information about what and how to change and they need to be educated about why these changes are important. Several issues are common problems for both these patients, but there are also specific risks for Mr M and other risks for Mrs M. Please help them to better understand what they must do to improve their prospects for a healthier future. Include in your analysis:
QUESTIONS:
1. What food categories are missing from their normal diet? Why it is important to have all food categories.
2. Since there are several food categories missing from their daily food intake, you need to explain what kinds of fats they need and why.
3. How could Mr. and Mrs. M improve the cholesterol and high blood pressure problems if they are unwilling to exercise.
4. How could you address Mrs. M’s weight issue? Include dietary recommendations for her to help lose and maintain her weight.
Please do not use personal opinions but rather include objective information from evidence-­‐based peer-­‐reviewed literature – YOU MUST PROVIDE REFERENCES and cite properly. Please limit your case study to 3 pages double-­‐spaced, 12pt font. Please be concise.
please go into Omega 3 and 6 fats!!!! lipids
Inflammation
• Part of a healthy immune system response
• Low-level, chronic inflammation is an excessive, inappropriate inflammatory response
• Linked to heart disease, cancer, diabetes, osteoporosis, Alzheimer’s disease and even depression and mood disorders
Relationship Between Atherogenic
Lipoproteins and Inflammation
• A high plasma LDL-C level is a major risk factor and causes the development of atherosclerosis. Beyond LDL, other lipids are pro-inflammatory including elevated triglycerides, VLDL remnants, small particle size LDL.1
• Inflammation plays a role in all stages of atherogenesis.2,3
• Increased circulating levels of inflammatory markers may indicate the presence of atherosclerotic disease.3
– May provide independent predictive risk beyond established lipid risk factors.
Foods that promote inflammatory
disease
• Foods with high saturated fat content, such as animal products and dairy products
• Foods with high omega-6 fatty acid content and low omega-3 fatty acids such as partially hydrogenated oils, margarine, oils from corn, cottonseed, safflower, sesame and sunflower
• Foods with high glycemic load, such as bagels, instant rice, white pasta
Foods that promote inflammatory
disease
• Food with high allergy potential, such as dairy products, wheat and eggs
• These inflammatory foods can increase production of inflammatory mediators
• Foods with high allergy potential may also increase intestinal permeability, triggering immune response and potential increase in inflammatory disease
Anti-Inflammatory Foods
• Foods with high omega-3 fatty acids, such as cold water fish, flaxseeds, walnuts
• Foods with high levels of antioxidants, such as vegetables, citrus fruits, cherries, garlic, onion and tea
• Spices, in particular, ginger, garlic, rosemary, turmeric, oregano, cayenne, clove and nutmeg
Anti-Inflammatory Foods
• Low glycemic index/load foods
• Mediterranean diet foods rich in omega-3 fatty acids, fruits/vegetables,
nuts
Polyunsaturated fatty acids in
inflammation
• Coronary heart disease, major depression, aging and cancer are characterized by an increased level of interleukin 1 (IL-1), a pro-inflammatory cytokine.
• Arthritis, Crohn’s disease, ulcerative colitis and lupus erythematosis are autoimmune diseases characterized by a high level of IL-1 and the pro-inflammatory leukotriene LTB(4) produced by omega-6 fatty acids.
Omega-3 fatty acids in inflammation
• Among the fats, omega-3 PUFA from fish oil – eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) – has some of the most potent anti-inflammatory properties
• Clinical trials assessing benefits of fish oils in inflammatory and autoimmune diseases including rheumatoid arthritis, Crohn’s disease, ulcerative
colitis, psoriasis, lupus, multiple sclerosis and migraine headaches reveal significant benefit, including decreased disease activity and a lowered use of anti-inflammatory drugs
Omega 3s and Plant Sterols
• Dietary intervention with omega-3 PUFA (1.4 g/d) plus plant sterols (2g/d) reduced several markers of systemic inflammation in hyperlipidemic individuals
• C-Reactive protein was reduced by 39%
• Tumor necrosis factor-alpha reduced by 10%
• Interleukin-6 reduced by 10.7%
• Overall cardiovascular disease risk by 22.6%