1. Nutrition / Dietary

2. Registered Dietician
Manage food service systems, assess patients’ and residents' nutritional needs, plan menus, teach others proper nutrition and special diets, research nutrition needs and develop recommendations based on the research, purchase food and equipment, enforce sanitary and safety rules, and supervise and/or train other personnel.
Dietetic technicians & dietetic assistants

3. Dietician vs. Nutritionist??
Registered Dietician: A healthcare professional with a degree and supervised training in a clinical setting. Covered by a professional organization.
Nutritionist: A person who has studied nutrition and titled themselves. This is not covered by any governing body.

4. Average Pay

5. IAN: (Page 30) Scope of practice (top)
Middle (Page 30)
Your favorite fast food meal?
-calories, nutritional values
Bottom (Page 30)
How to Calculate BMI and what is your BMI? Are you considered…
- underweight
- normal weight
- overweight
- obese

6. Dietician’s Scope of Practice
 Only a dietitian can be licensed to provide nutrition care including: assessment, goal setting, counseling, or advice. If you have a Masters or above in human nutrition, food and nutrition, dietetics, food systems management, or nutrition education, or a doctorate in nutritional biochemistry you are exempt from the existing law and may provide nutrition services but may not be licensed. If you are licensed to practice dentistry, medicine, osteopathy, chiropractic, nursing, or pharmacy you may provide nutrition services incidental to your primary profession but may not use the title “dietitian”. -

7. Nutrition
All body processes relating to food. Including digestions, absorption, metabolism, circulation, and elimination.
These processes allow the body to use food for energy, maintenance of health, and growth.

8. Definitions
Nutritional status: The state or condition of one’s nutrition.
Wellness: To be in a state of good health with optimal body function.
Essential nutrients: The chemical elements found in food and used by the body to perform many different body functions.

9. 6 Essential Nutrients (Page 31 Ian)
Carbohydrates
Vitamins
Lipids (fats)
Minerals
Water
Proteins

10. Carbohydrates Provide heat and energy
Supply fiber for good digestion and elimination
Commonly called: starches or sugars
Cheap energy source
Made of Carbon, Hydrogen, and Oxygen
Mainly produced by plants
Easily digested

11. Breads Peas Cereals Beans Noodles/ Pastas Grains Crackers Fruits
carbohydrates
Breads
Peas
Cereals
Beans
Noodles/ Pastas
Grains
Crackers
Fruits
Potatoes
Sugar
Corn
Syrup

12. Cellulose Fibrous, indigestible form of plant carbohydrate.
Provides bulk in the digestive tract and causes regular bowel movements.
Best sources: bran, whole-grain cereals, fibrous fruits and vegetables.

13. Lipids (fats) Organic compounds commonly called fats and oils.
3 common forms
Triglycerides (fats and fatty acids)
Phospholipids (lecithin)
Sterols (cholesterol)
Also made of carbon, hydrogen, and oxygen.
However contains more O2 than carbs

14. Lipids
Provide the most concentrated form of energy and are more expensive than carbs.
Fats maintain (1)body temperature (insulation), (2)cushion organs and bones, (3)aid in the absorption of fat soluble vitamins, and (4)provide flavor to meals.
Main source: butter, margarine, oils, cream, fatty meats, cheeses, and egg yolk.

15. Saturated / polunsaturated
Saturated: Usually solid at room temp. Ex: fats in meat, eggs, whole milk, cream, butter, and cheeses.
Polyunsaturated: Usually soft or oily at room temp. Ex: vegetable oils, margarines, and other products made from vegetable oils, fish, and peanuts.

16. Cholesterol A sterol lipid found in body cells and animal products.
Used to produce steroid hormones, vitamin D, and Bile Acid.
Cholesterol is also a component of cell membranes.
Cholesterol is synthesized (manufactured) by the liver.

17. Lipoproteins
Transported in the bloodstream mainly by two carrier molecules called lipoproteins.
HDL- high-density also known as “good” cholesterol because it tends to transport cholesterol back to the liver and prevents plaque from building up on artery walls.
LDL – low-density also known as “bad” cholesterol because it contributes to plaque buildup which leads to atherosclerosis.

18. Proteins Basic components of all body cells.
Essential building and repairing tissue, regulating body functions, and providing energy and heat.
Made of carbon, hydrogen, oxygen, and nitrogen (and some also contain sulfur, phosphorus, iron, and iodine.)

19. Proteins (22 amino acids)
9 amino acids are essential to life
The proteins that contain these 9 are considered complete proteins.
Sources: meats, fish, milk, cheeses, and eggs.
Incomplete proteins: contain any combination of the 22 AAs but not those 9.
Sources: cereals, soybeans, dry beans, peas, corn, nuts
Vegetarians need to understand how to combine

20. Vitamins Organic compounds that are essential to life.
Important for: metabolism, tissue building, regulating body processes.
They allow the body to use the energy provide by carbohydrates, fats, and proteins.
Most can be consumed in a well balanced diet.
Deficiencies and excessive amounts can cause poor health.

21. ANtioxidants
Organic molecules that help protect the body from harmful chemicals called Free Radicals.
Free radicals can damage tissues, cells, and even genes in the same way that oxygen causes metals to rust or apples to become brown.
Main antioxidants: Vitamin A, C, and E

22. Water soluble
Water Soluble: dissolve in water, not normally stored in the body, and are easily destroyed by cooking, air, and light.
Examples
B1 – thiamine
B2 - riboflavin
Niacin B6
B12
Vitamin C
Folic Acid

23. Fat Soluble
Fat Soluble: Dissolve fat, can be stored in the body, and are not easily destroyed by cooking, air, and light.
Examples:
Vitamin A
Vitamin D
Vitamin E
Vitamin K

24. Minerals Inorganic (nonliving)
Regulates: body fluids, assist in various body functions, contribute to growth , and aid in building tissues.
Examples: Calcium, Phosphorus, Magnesium, Sodium, Potassium, Chlorine, Sulfur, Iron, Iodine, Copper, Fluoride, Zinc, Selenium
Selenium, Zinc, Copper, and Manganese are antioxidants.

25. Water
Found in all body tissues
Essential for the digestion of food

26. BMI (Body Mass Index)
BMI is a calculation that measures weight in relation to height and correlates this with body fat.
Ideal Range:
BMI < 18.5 indicates an individual is underweight.
BMI > 25 is indicative of excess weight and more health risks.

29. Definitions
Digestion: Process by which the body breaks down food into smaller parts, changes the food chemically, and moves the food through the digestive system.
Peristalsis: A rhythmic, wavelike motion of the muscles.
Absorption: the process in which blood or lymph capillaries pickup the digested nutrients.

30. Metabolism: The process in which nutrients are used by the cells for building tissue, providing energy, and regulating various body functions.
Basal Metabolic Rate (BMR): The rate at which the body uses energy just for maintain in its own tissue. (page 33 IAN w/ food diary)

31. Therapeutic Diets (page 32 IAN)
Modifications of the normal diet and are used to improve specific health conditions.
Usually prescribed by a Doctor or dietician.
May change nutrients, caloric content, and/ or texture of the normal diet.

32. Regular Diet
A balanced diet usually used for the patient with no dietary restrictions. At times, it has a slightly reduced calorie content.
Desserts, cream sauces, salad dressings, and fried foods may be decreased or omitted.

33. Liquid Diet Clear and full liquids Liquid foods at body temperature
Clear: carbohydrates and water
Full: clear liquids plus other liquids
Uses such as the following: surgery, digestive problems, to replace lost fluids, and in preparation for X-rays of the digestive tract

34. Soft DIet Similar to a regular diet, but foods are easy to digest
Avoid meat, shellfish, coarse cereals, spicy foods, rich desserts, fried foods, raw vegetables, fruits, and nuts
Uses: after surgery, patients with infections, digestive disorders, and chewing problems

35. Diabetic Diet
Used for patients with diabetes mellitus who often take insulin
Exchange lists are used to choose foods
Avoid sugar-heavy foods

36. Calorie – controlled diets
Low-calorie—used for patients who are overweight; avoid or limit high-calorie foods
High-calorie—used for patients who are underweight, have anorexia nervosa, hyperthyroidism, or cancer

37. Low-Cholesterol diet Restricts foods containing cholesterol
Used for patients with atherosclerosis and heart disease
Limit foods high in saturated fats

38. fat-restricted diets Also called low-fat diet
Used for patients with gallbladder and liver disease, obesity, and certain heart diseases
Avoid foods high in fat

39. Sodium-restricted diets
Otherwise known as low-sodium or low-salt diets
Used for cardiovascular diseases, kidney disease, and fluid retention
Avoid or limit addition of salt; avoid salt-rich foods

40. Protein Diets
Protein-rich foods such as meats, fish, milk, cheese, and eggs
High-protein for children and adolescents for additional growth, pregnant or lactating women, surgery, burns, fevers, infections
Low-protein for certain kidney or renal diseases and allergic conditions

41. Bland Diet
Easily digested foods that do not irritate the digestive tract
Used for patients with ulcers, colitis, and other digestive diseases

42. Low-residue diet Eliminate or limit foods high in bulk and fiber
For patients with digestive or rectal diseases such as colitis or diarrhea

43. Other Diets
Other diets may be ordered that restrict or increase certain nutrients
Check prescribed diet and ask questions if foods seem incorrect
Include patient’s likes if allowed
If patient refuses foods on diet, this will not contribute to good nutrition

44. Effects of good nutrition
Healthy appearance
Good attitude
Proper sleep and bowel habits
High energy level
Enthusiasm and freedom from anxiety
Diseases or conditions prevented or delayed through good nutrition
Hypertension
Atherosclerosis
Osteoporosis
Malnutrition

45. Hypertension:
high blood pressure; may be caused by an excess amount of fat or salt in the diet; can lead to diseases of the heart, blood vessels, and kidneys

46. Atherosclerosis:
condition in which arteries are narrowed by the accumulation of fatty substances on their inner surfaces; though to be caused by a diet high in saturated fats and cholesterol; can lead to heart attack or stroke

47. Osteoporosis:
condition in which bones become porous (full of tiny openings) and break easily; one cause is long-term deficiencies of calcium, magnesium, and vitamin D

48. Malnutrition:
the state of poor nutrition; may be caused by poor diet or illness. Symptoms include fatigue, depression, poor posture, being overweight or underweight, poor complexion, lifeless hair, and irritability. It can cause deficiency diseases, poor muscular and skeletal development, reduced mental abilities, and even death.
Malnutrition is most likely to affect individuals living in extreme poverty, patients undergoing drug therapy such as treatment for cancer, infants, young children, adolescents, and the elderly. Obesity is also a form of malnutrition, caused by excess food consumption.

49. BERIBERI
Beriberi is a disease whose symptoms include weight loss, body weakness and pain, brain damage, irregular heart rate, heart failure, and death if left untreated. It was endemic in Asia for a long time. Strangely, Beriberi occurred almost exclusively amongst the richer members of society, and was unknown in the poor. Although recognized to be a nutritional deficiency, doctors were baffled as to why wealthy people with plentiful and clean food would fall victim to beriberi whereas the poor with limited food did not. As it turned out, beriberi is a deficiency of vitamin B1 (thiamine) which is found in cereal grain husks. The rich had been washing their rice so well that they removed the husk with its vitamin B1, whereas the poor did not wash their food as well and consumed enough vitamin B1. White bread can also potentially cause beriberi, so today developed countries add extra vitamin B1 to it. Beriberi is now found mostly in alcoholics whose bodies become poor at absorbing vitamin B1.

50. Pellagra
After the discovery and exploration of the Americas, corn was grown by settlers and all around the world. The natives who had originally grown it would treat it with lime, but the taste was unpleasant to the Europeans and they omitted this part of the preparation. As corn was increasingly farmed, the disease pellagra began to spread. Symptoms included diarrhea, dermatitis, dementia, and finally death. Many people believed that corn was in some way toxic, but could not explain the lack of pellagra among native New Worlders. After thousands of deaths, it was discovered that corn, although high in carbohydrates, lacked vitamin B3 (niacin). Farmers would sometimes eat little other than corn and succumb to the deficiency. The Native Americans had actually been using lime as a way of adding vitamin B3. Today it is well known that by eating a variety of foods vitamin B3 is freely obtained and pellagra is easily treated.

51. Biotin Deficiency
Biotin deficiency is caused by a lack of vitamin B7 (biotin). It causes rashes, hair loss, anemia, and mental conditions including hallucinations, drowsiness, and depression. Vitamin B7 itself is found in meat, liver, milk, peanuts, and some vegetables. Its deficiency is quite rare; however, there was a brief spike in the number of cases when it became popular for bodybuilders to consume raw eggs. One of the proteins found in raw egg white binds vitamin B7 and makes it difficult for the body to use, leading to a deficiency. Cooking egg whites makes this protein inactive. Mild biotin deficiency is also found is about half of all pregnant women due to a higher use of vitamin B7 in their bodies, and supplements are recommended for such women by the World Health Organization.

52. Scurvy
Scurvy was first noted among people who spent a long time at sea. Boats would only carry non-perishable foods such as salted meats and dried grain, so sailors ate few if any fruits or vegetables. Scurvy causes lethargy, skin spots, bleeding gums, loss of teeth, fever, and death. Ancient sea-faring civilizations would cure it with various herbs. In more recent times, these ancient cures were not used consistently and their value was not realized. In the 18th century horse meat and citrus fruits were found to cure scurvy, and British sailors consumed limes to the extent that they were nicknamed ‘limeys’. It is now known that these foods contain vitamin C, and in modern times scurvy is rarely fatal as it once consistently was. Today, there are groups who advocate vitamin C megadoses of hundreds of times the recommended daily requirement; although any positive effects have not been firmly demonstrated and harmful overdoses can occur.

53. Rickets
Rickets causes muscles and bones to become soft, which can cause permanent deformities in children. It is most common in children and infants who have a poor diet or who are housebound, but is nowadays relatively rare in developed countries. Breast-fed babies are at higher risk if they or their mothers do not take in enough sunlight, and baby formula is now designed to prevent this. Rickets is caused by a lack of vitamin D or of calcium. Vitamin D is required for calcium to be properly absorbed into bones to strengthen them. Adults rarely develop rickets because their bones are not growing and do not need much calcium. Vitamin D itself is obtained from many foods but the body can only use it if it has been converted into its active form via sunlight. In recent years there has been a slight increase in children with rickets possibly due to too many of them staying indoors.

54. Ariboflavinosis
This condition is present mostly in people who suffer from malnutrition and in alcoholics. It causes distinctive bright pink tongues, although other symptoms are cracked lips, throat swelling, bloodshot eyes, and low red blood cell count. Ultimately it can cause comas and death. It is caused by a lack of vitamin B2 (riboflavin), but easily treated by eating foods rich in vitamin B2, including meat, eggs, milk, mushrooms, and leafy green vegetables. Vitamin B2 is also used as artificial orange color in foods. It is absorbed through the liver, so alcoholics might eat enough of it but be unable to use it. True deficiencies are rare, but about 10% of people in developed countries live in a state of slight deficiency, thought to be from a diet of highly processed foods. Constant slight deficiencies can increase the risk of mild health problems.

55. Vitamin K deficiency
This deficiency affects nearly half of all newborn infants worldwide. In severe cases it causes uncontrolled bleeding and underdeveloped faces and bones. Many hospitals give newborns vitamin K injections to avoid the more severe symptoms. Unfortunately babies born outside hospitals are statistically at a much higher risk of serious deficiencies. Vitamin K is found chiefly in leafy green vegetables, although human gut bacteria help produce it in humans. Newborns have not yet developed gut bacteria which is why they are so prone to deficiencies. Other than newborns, vitamin K deficiency is found in alcoholics, bulimics, strict dieters, and people with various severe diseases such as cystic fibrosis. Adults who bruise or bleed easily sometimes have vitamin K deficiency which itself may be indicative of one of these more serious disorders.

56. Hypocobalaminemia
This mouthful of a disease was first noticed as a symptom of an autoimmune disease. It causes gradual deterioration of the spinal cord and very gradual brain deterioration, resulting in sensory or motor deficiencies. Mental disorders from the gradual brain damage begin as fatigue, irritability, depression, or bad memory. As the disease progresses over several years, psychosis and mania can appear. This damage is irreversible and is caused by a deficiency in vitamin B12. Fortunately, this vitamin is easily found in meat, dairy, and eggs. Vitamin B12 is stored in the liver and can last for years before deficiency sets in. Hypocobalaminemia is most common in developing countries amongst people who eat few animal products. The most at-risk groups in developed countries are vegans, as no plant produces enough B12 for a human diet. Children need much more B12 than adults because they are growing, so infants who are only breast-fed can become deficient and suffer permanent brain damage if their mother is only slightly deficient. Supplements are recommended for people of all diet types as an easy way to avoid the devastation of this disease.

57. Paraesthesia
Vitamin B5 is found in nearly every food, and deficiencies are found in people who have been starving, volunteers of particular medical studies, and people on diets restricted to a very small number of foods. A deficiency in vitamin B5 causes chronic paraesthesia. Paraesthesia is most familiar to us as the numbing sensation we feel as ‘pins and needles’ or a limb ‘falling asleep’. This kind of paraesthesia is perfectly normal; however, in vitamin B5 deficiencies it occurs constantly. Malnourished prisoners of war sometimes reported prickling and burning sensations in their hands and feet which is now thought to have been paraesthesia. As this is nearly unseen today, most vitamin supplements do not include B5.

58. Night Blindness
The Ancient Egyptians and Greeks wrote about night blindness, or ‘nyctalopia’. This affliction makes it impossible to see in dim light, and sufferers become completely blind when night falls. The Egyptians found that they could cure sufferers by feeding them liver, which contains high levels of vitamin A, the deficiency of which causes night blindness. Vitamin A deficiency still affects one third of all children on Earth under the age of five, resulting in over half a million deaths each year. Most high dose vitamins obtain their vitamin A from liver, which is dangerous at high levels and can cause various health complications. In the past, starving Antarctic explorers would eat their dogs for food but became sick when they ate too much liver. Vitamin A found in carrots is a slightly different molecule to that found in liver and is not toxic in high doses, although it can cause skin to turn yellow. During the Second World War, the Allies announced that they ate carrots to see well, although carrots only help maintain normal vision and do not improve it beyond this. Actually they were lying to hide their development of radar.