Nutrition Guide for Physicians (eBook)

Dr. Ted Wilson, PhD is an associate professor of Biology at Winona State University in Winona, Minnesota. He teaches courses in Nutrition, Physiology, Cardiovascular Physiology, Cell Signal Transduction and Cell Biology. His research examines how diet affects human nutritional physiology and whether food/dietary supplement health claims can be supported by measurable physiological changes. He has studied many foods, dietary supplements and disease conditions including low-carbohydrate diets, cranberries and cranberry juice, pomegranate juice, apple juice, grape juice, wine, resveratrol, creatine phosphate, soy phytoestrogens, tomatoes, eggplants, coffee, tea, energy drinks, heart failure prognosis, diabetes and obesity. Diet induced changes have includes physiological evaluations of plasma lipid profile, antioxidants, vasodilation, nitric oxide, platelet aggregation, glycemic and insulinemic responses using in vivo and in vitro models. With Dr N. Temple he has edited Beverages in Nutrition and Health (Humana Press, 2004) and Nutritional Health: Strategies for Disease Prevention (Humana Press, 2001 1st and 2006 2nd edition).

Dedication 6
Series Editor Introduction 7
Preface 12
Contents 15
Contributors 18
1 Fat: The Good, the Bad, and the Ugly 21
1 Introduction 21
2 Types of Dietary Fat and Their Food Sources 22
2.1 Saturated Fats 22
2.2 Monounsaturated Fatty Acids (MUFA) 23
2.3 Polyunsaturated Fatty Acids (PUFA) 23
2.4 Essential Fatty Acids and the n--6 and n--3 Families 23
2.5 Trans Fats 24
2.6 Sterols 24
3 Dietary Fat Effects on Health 24
3.1 Obesity 24
3.1.1 Role of Total Dietary Fat 24
3.1.2 Role of Specific Fatty Acids 25
3.2 Heart Disease 26
3.3 Type 2 Diabetes and Insulin Resistance 26
3.3.1 Role of Total Dietary Fat 26
3.3.2 Role of Specific Fatty Acids 27
3.4 Cancer 28
3.5 Inflammation 28
4 Conclusions 29
Suggested Further Reading 30
2 Dietary Fiber: All Fibers Are Not Alike 32
1 Introduction 32
2 Definition and Sources of Dietary Fiber 35
3 Benefits of Adequate Fiber Intake 35
3.1 Cardiovascular Disease 35
3.2 Weight Control 36
3.3 Type 2 Diabetes 37
3.4 Cancer 37
3.4.1 Large Bowel Cancer 37
3.4.2 Breast Cancer 38
3.5 Bowel Function 38
3.6 Colon Disease 39
3.6.1 Diverticulosis 39
3.6.2 Irritable Bowel Syndrome 40
4 Potential Negative Effects of Dietary Fiber 40
5 Conclusions 41
Suggested Further Reading 41
3 Sugar and Artificial Sweeteners: Seeking the Sweet Truth 44
1 Defining Sweeteners Caloric And Noncaloric 45
2 Consumption Patterns Of Sweeteners 46
2.1 Methods for Obtaining Sweetener Data 46
2.2 Global Trends in Availability 47
2.3 United States per Capita Trends in Total Caloric Sweeteners 47
2.4 Caloric Sweeteners in Beverages 49
2.5 Caloric Sweeteners in Foods 50
2.6 United States per Consumer Trends 50
3 Health Effects Of Added Caloric Sweeteners 51
4 Discussion 55
Suggested Further Reading 56
4 The Vitamins and Minerals: A Functional Approach 58
1 Introduction 58
2 The Antioxidant Nutrients 60
2.1 Vitamin C 60
2.2 Vitamin E 60
2.3 The Vitamin A Precursor: ß-Carotene 63
2.4 Selenium 64
3 Nutrients for Healthy Blood 64
3.1 Folate 64
3.2 Vitamin B 12 64
3.3 Vitamin B 6 68
3.4 Vitamin K 68
3.5 Iron 69
3.6 Zinc 69
3.7 Copper 70
4 Nutrients for Healthy Bones 70
4.1 Vitamin D 70
4.2 Vitamin K 74
4.3 Calcium 74
4.4 Phosphorus 74
4.5 Magnesium 75
4.6 Fluoride 75
5 Vitamins, Minerals, and Energy Metabolism 75
5.1 Thiamin 76
5.2 Riboflavin 76
5.3 Niacin 76
5.4 Iodine 80
5.5 Chromium 80
6 Minerals and Fluid Balance 80
Suggested Further Reading 82
5 Dietary Reference Intakes: Cutting Through the Confusion 84
1 Introduction 84
2 The Dietary Reference Intakes 85
2.1 Estimated Average Requirement 85
2.2 Recommended Dietary Allowance 85
2.3 Adequate Intake 86
2.4 Tolerable Upper Intake Level 86
2.5 Estimated Energy Requirement 86
2.6 Acceptable Macronutrient Distribution Ranges 86
3 Limits And Uses Of The Dri 86
3.1 Limits 86
3.2 Statistical Analysis 87
3.3 General Guidelines for Diet Assessment of Individuals 87
4 Dri And The Consumer 88
5 Summary 88
Suggested Further Reading 89
6 Food Labels and Sources of Nutrients: Sorting the Wheat from the Chaff 90
1 The Nutrition Facts Label 90
2 Using The Nutrition Facts Label 93
3 Major Nutrient Contributions Of The Food Groups And Of Various Foods 95
4 Food Sources Of Select Nutrients 95
4.1 Lipids 95
4.2 Dietary Fiber 95
4.3 Vitamins 96
4.4 Minerals 96
5 Health Claims 96
Suggested Further Reading 98
7 Vegetarian and Vegan Diets: Weighing the Claims 99
1 Introduction 99
2 Health Benefits of Vegetarian Diets 100
2.1 Vegetarian Diets and Cardiovascular Disease (CVD) 101
2.1.1 Vegetarian Diet and Serum Lipids 101
2.1.2 Vegetarian Diets and Blood Pressure 102
2.2 Vegetarian Diets and Obesity 102
2.3 Cancer 102
2.4 Type 2 Diabetes 103
2.5 Bone Health 103
3 Nutrient Deficiencies In Vegetarian Diets 103
3.1 Energy 104
3.2 Protein 104
3.3 Calcium 105
3.4 Iron 105
3.5 Zinc 107
3.6 Vitamin B 12 (Cobalamin) 108
3.7 Vitamin D 108
3.8 n--3 Fatty Acids 109
4 Summary 109
Suggested Further Reading 110
8 Dietary Recommendations for Non-alcoholic Beverages 112
1 We are (mainly) what we Drink 112
2 Coffee Consumption Poses No Health Risk for Most Persons 113
3 Tea Consumption is Protective and Should Be Encouraged 113
4 Milk is Good for You 115
5 Health Benefits Of Fruit Juices 115
5.1 Health Benefits of Citrus Juice Consumption 116
5.2 Health Effects of Other Types of Fruit Juice 117
5.3 And Don't Forget Vegetable Juices 118
6 Health Effects of Soft Drink Consumption 118
7 Weight Loss and Weight Management Beverages 119
8 Sports Beverages 119
9 Energy Drinks Remain Controversial Beverages 120
10 What'S the Buzz Regarding Caffeine? 121
11 Conclusions 122
Suggested Further Reading 122
9 Should Moderate Alcohol Consumption Be Promoted? 124
1 Introduction 124
2 Phytochemicals In Alcholic Beverages 125
3 Harmful Effects Of Alcohol 125
4 Health Benefits Associated With Alcohol Consumption 127
5 Effect Of Alcohol On Total Mortality 129
6 What Advice Should A Physician Give? 129
Suggested Further Reading 130
10 Issues of Food Safety: Are ``Organic'' Apples Better? 131
1 Introduction 131
1.1 Conventional and Organic Food Production Systems 132
2 What Makes A Food Safe? 133
3 Nutritional Value of Organic Versus Conventional Fruit and Vegetables 133
3.1 Comparison of Organically Grown and Conventionally Grown Products 135
3.1.1 Grapes and Wine 135
3.1.2 Oranges 136
3.1.3 Apples 136
3.1.4 Peach and Pears 136
3.1.5 Tomatoes 136
3.2 Other Causes of Differences Between Organic and Conventional Foods 137
3.2.1 Pesticides 137
3.2.2 Food Poisoning 137
3.2.3 GMOs 138
3.2.4 Antibiotics 138
3.2.5 Food Additives 138
3.2.6 Food Palatability 138
4 Conclusion 139
11 What Is a Healthy Diet? From Nutritional Science to Food Guides 141
1 Defining A Healthy Diet 141
1.1 Controlling Fat Intake and BMI 141
1.2 All Fats Are Not Alike 142
1.3 Carbohydrates Good and Bad
1.4 Whole Fruits and Vegetables Are Better 143
1.5 Coffee, Tea, and Alcohol 144
1.6 The Problem with Salt 144
1.7 Supplements: There Is No Shortcut to a Balanced Diet 145
1.8 How Safe Is Our Food? 145
2 Food Guides 146
2.1 MyPyramid 147
2.2 Harvard's Healthy Eating Pyramid 147
2.3 DASH Eating Plan 148
2.4 Canada's Food Guide 149
2.5 Traffic Lights Food Guide 149
Suggested Further Reading 151
12 Achieving Dietary Change: The Role of the Physician 152
1 Introduction 152
2 Efficacy Of Nutrition Counseling By Physicians 153
3 Medical Office System Support 153
4 Client-Centered Therapy 155
5 The 5 A's Counseling Model 155
6 Models for Inducing Change 156
6.1 Transtheoretical Model and Stages of Change 156
6.2 Motivational Interviewing 156
6.3 Cognitive-Behavioral Theory 157
6.4 Incorporation of Behavioral Theory Tenets to the 5A Model 158
7 Summary 158
Suggested Further Reading 161
13 Dietary Supplements: Navigating a Minefield 163
1 Introduction 163
2 Common Supplements 164
2.1 Supplements with Strong Supporting Evidence 164
2.2 Antioxidants 165
2.3 Detoxification 165
2.4 Boosting the Immune System 166
2.5 Herbs and Herbal Cocktails 166
2.6 Exotic Fruit Juices 166
2.7 Weight loss Products 166
2.8 A Repeating Story 167
2.9 Potential Hazards from Supplements 167
3 How Dietary Supplements Are Marketed 168
3.1 Direct Contact with Consumers 168
3.2 Multilevel Marketing 168
3.3 Sources of the Supplemental Message 169
3.4 The Object of the Exercise 169
4 Regulations On The Marketing Of Supplements 169
4.1 United States 169
4.2 Canada 170
5 Helping Patients Make Informed Choices About Dietary Supplements 170
Suggested Further Reading 171
14 Taste Sensation: Influences on Human Ingestive Behavior 173
1 Introduction 173
2 Anatomy and Physiology of the Taste System 174
3 Innate vs. Acquired Tastes for Specific Macronutrients and Salt 174
3.1 Carbohydrate 175
3.2 Protein 175
3.3 Fat 176
3.4 Sodium Chloride 177
4 Genetic Variations in Taste 177
5 Physiological Responses to Taste Perception 177
6 Taste Sensation Abnormalities and Effects on Nutritional Status 178
7 Nutritional Implications of Taste in Selected Populations 179
7.1 Age 179
7.2 Obesity 179
7.3 Hypertension 180
7.4 Diabetes 180
8 Summary 180
Suggested Further Reading 181
15 Pregnancy: Preparation for the Next Generation 183
1 Introduction 183
2 Nutrition In The Preconception Period 184
3 Nutrition During Pregnancy 185
3.1 Weight Gain in Pregnancy 185
3.2 Energy and Macronutrient Needs During Pregnancy 186
3.3 Vitamin and Mineral Needs During Pregnancy 186
3.4 Substances to Limit or Avoid in Pregnancy 189
3.5 Food Safety During Pregnancy 190
3.6 Translating Nutrition Guidelines into Practical Advice About Food 190
4 Special Concerns During Pregnancy 190
4.1 Common Complaints 191
4.2 High-Risk Pregnancies 191
5 Nutrition For Lactation 192
6 Nutrition For The Postpartum Period 193
7 Referals For Services 193
8 Summary 194
Suggested Further Reading 194
16 Infants: Transition from Breast to Bottle to Solids 196
1 What Is The Best Milk For An Infant? 196
2 Nutrient Content Of Breast Milk And Infant Formula 197
3 Bioactivity Of Human Milk And Formulas 200
4 Health Benefits Of Human Milk 201
5 Transition To Solid Foods 202
6 Summary 204
Suggested Further Reading 204
17 Young Children: Preparing for the Future 207
1 Introduction 207
2 Monitoring Growth 208
3 Nutrition Guidance 208
3.1 Energy and Nutrient Needs 208
3.2 Dietary Guidance 210
4 Healthy Eating Behaviors 210
5 Nutrition Concerns During Childhood 212
5.1 Childhood Obesity 212
5.2 Food Insecurity 213
5.3 Food Allergies and Sensitivities 213
5.4 Iron Deficiency Anemia 214
5.5 Vitamin and Mineral Supplementation 214
Suggested Further Reading 214
18 Adolescents and Young Adults: Facing the Challenges 216
1 Introduction 216
2 Growth 217
3 Energy and Nutrient Requirement 217
3.1 Energy 218
3.2 Macronutrients 218
3.3 Micronutrients 218
3.4 Nutrition Assessment 220
4 Special Adolescent Nutritional Considerations 220
4.1 Overweight and Obesity 220
4.2 Eating Disorders 220
4.2.1 Anorexia Nervosa 221
4.2.2 Bulimia Nervosa 221
4.2.3 Binge-Eating Disorder 221
5 Promoting Healthy Food Habits 222
6 Summary 222
Suggested Further Reading 223
19 Healthy Aging: Nutrition Concepts for Older Adults 225
1 Introduction 225
2 Physiologic Aging and Nutrition 226
2.1 Body Composition 226
2.2 Gastrointestinal Secretions 226
2.3 Renal System 227
3 Nutrient Requirements of the Older Adult 227
3.1 Energy Requirements 227
3.2 Protein 228
3.3 Micronutrients 228
3.3.1 Fat-Soluble Vitamins (A, E, D, and K) 228
3.3.2 Water-Soluble Vitamins 229
3.4 Minerals 230
3.5 Fluid Homeostasis 231
3.6 Special Benefits of Plant Foods 231
3.7 Dietary Supplements 231
4 Body Weight in the Older Adult 232
4.1 Low Body Weight 232
4.2 Overweight/Obesity 232
4.3 Factors Influencing Food Intake in Older Adults 233
4.3.1 Socioeconomic Factors 233
4.3.2 Health Factors 234
4.3.3 Evaluating Nutritional Risk 234
5 Health Promotion For The Older Adult 235
Suggested Further Reading 235
20 Nutritional Status: An Overview of Methods for Assessment 237
1 Introduction 237
2 Principles of Nutritional Assessment 238
2.1 Food Frequency Questionnaires 238
2.2 Diet and Lifestyle History 239
2.3 Assessing Current Dietary Intake 240
2.4 Underreporting of Dietary Intake 240
2.5 Physical Examination 241
2.6 Body Composition Analyses 242
2.7 Laboratory Tests 243
3 Special Concerns by Age 243
3.1 Obesity and Age 243
3.2 Adolescents 244
3.3 Elderly 245
3.4 Food Access and/or Food Security 245
3.5 Other Areas of Concern 246
4 Healthy Eating Index 246
5 Conclusion 247
Suggested Further Reading 247
21 Eating Disorders: Disorders of Under- and Overnutrition 250
1 Introduction 250
2 Anorexia Nervosa 251
3 Bulimia Nervosa 252
4 Eating Disorder not Otherwise Specified 253
4.1 Binge-Eating Disorder 253
4.2 Night Eating Syndrome 254
4.3 Purging Disorder 255
5 Prevalence 255
6 Treatment 256
6.1 Psychotherapy 257
6.2 Psychotropic Medications 258
7 Prevention 259
8 Conclusion 259
Suggested Further Reading 260
22 Obesity: Understanding and Achieving a Healthy Weight 262
1 Introduction 262
2 Definition And Prevalence of Obesity 263
2.1 Body Mass Index 263
2.2 Central Adiposity 263
2.3 Prevalence 264
2.4 Cost of Obesity 264
3 Etiology 264
3.1 Energy Imbalance 264
3.2 Epidemiologic Model 265
3.3 Environmental Agents 265
3.3.1 Intrauterine Factors 265
3.3.2 Drug-Induced Weight Gain 265
3.4 Diet 265
3.4.1 Infant and Child Environment 266
3.4.2 Fat Intake 267
3.4.3 Glycemic Index 267
3.4.4 Calcium Intake 267
3.4.5 Frequency of Eating 268
3.4.6 Restrained Eating 268
3.5 Physical Activity 268
3.6 Smoking 269
3.7 Host Agents 269
3.7.1 Genetic Causes 269
3.7.2 Physiologic Factors 269
4 Pathology of Obesity 270
5 Pathophysiology 270
5.1 The Fat Cell as an Endocrine Cell 270
5.2 Visceral Fat 271
6 Complications of Obesity 271
6.1 Death 272
6.2 Diseases 272
7 Prevention 272
8 Treatment 272
8.1 Realities of Treatment 272
8.2 Diet 274
8.2.1 Diets Low in Fat and Low in Energy Density 274
8.2.2 Low-Carbohydrate Diets 274
8.2.3 Portion-Controlled Diets 274
8.3 Behavior Modification and Lifestyle Interventions 274
8.4 Exercise 278
8.5 Medications 278
8.5.1 Noradrenergic Drugs 278
8.5.2 Sibutramine 278
8.5.3 Orlistat 279
8.5.4 Drugs Not Approved by the FDA for Treating Obesity 280
8.6 Surgery 280
9 Conclusion 281
Suggested Further Reading 281
23 Nutrition Therapy Effectiveness for the Treatment of Type 1 and Type 2 Diabetes: Prioritizing Recommendations Based on Evidence 284
1 Introduction 285
2 Medical Nutrition Therapy for Diabetes 285
3 Prioritizing Nutrition Interventions for Type 1 and Type 2 Diabetes 286
3.1 Type 1 Diabetes Nutrition Interventions 287
3.1.1 Identify a Usual or Convenient Schedule of Food/Meals and Physical Activity 287
3.1.2 Integrate Insulin Therapy into the Patient's Lifestyle 287
3.1.3 Determine Insulin-to-Carbohydrate Ratios 288
3.1.4 Calculate Insulin Correction Factor 288
3.1.5 Review Goals 289
3.2 Type 2 Diabetes Nutrition Interventions 289
3.2.1 Focus on Metabolic Control 289
3.2.2 Implement Nutrition Interventions for Glucose Control 290
3.2.3 Encourage Physical Activity 291
3.2.4 Monitor Outcomes 292
4 Support and Continuing Education 292
5 Macro- And Micronutrients 292
5.1 Carbohydrate 292
5.1.1 Amount and Type of Carbohydrate 292
5.1.2 Glycemic Index 293
5.1.3 Fiber 293
5.2 Protein 294
5.3 Dietary Fat 294
5.4 Micronutrients 295
5.5 Alcohol 295
6 Summary 296
Suggested Further Reading 296
24 Lifestyle Interventions to Stem the Tide of Type 2 Diabetes 298
1 Introduction 298
2 Diagnosis Of Pre-Diabetes 299
3 Prevention Trials 299
4 Lifestyle Intervention Recommendations 302
4.1 Encourage a Moderate and Maintainable Weight Loss and Provide Participant Support 302
4.2 Recommend a Cardioprotective, Energy-Restricted Diet 302
4.3 Recommend 150 Min/Week of Physical Activity 304
4.4 Other Nutrition-Related Factors 305
4.4.1 Carbohydrate/Fats 305
4.4.2 Whole Grains and Dietary Fiber 305
4.4.3 Glycemic Index/Glycemic Load 305
4.4.4 Alcohol 306
5 Summary 306
Suggested Further Reading 307
25 Coronary Heart Disease: Nutritional Interventions for Prevention and Therapy 310
1 Introduction 310
2 Dietary Fat And Chd 311
2.1 Fat Intake 311
2.2 Saturated Fat and Dietary Cholesterol 311
2.3 Trans Fatty Acids 312
2.4 n--6 PUFA and MUFA 313
2.5 n--3 PUFA 313
3 Plant Sterols And Stanols 313
4 Thcy And B-Vitamins 314
5 Alcohol 314
6 Antioxidants 315
7 Dietary Fiber 315
8 Whole Diet Approaches To Chd Risk Reduction 316
8.1 Fruit, Vegetable, and Whole Grain Cereals 316
8.2 Nuts 316
8.3 The Portfolio Diet 317
9 Obesity 317
10 Physical Activity 317
11 Conclusion 318
Suggested Further Reading 319
26 Diet and Blood Pressure: The High and Low of It 320
1 Introduction 320
2 Definitions of Hypertension 321
3 Blood Pressure and Body Weight 321
4 Diet and Bp 322
4.1 Dietary Sodium 322
4.2 Potassium and BP 323
4.3 Dietary Patterns and BP 324
4.4 Dietary Fat 324
4.5 Dietary Protein 324
4.6 Alcohol Intake 325
5 Summary 325
Suggested Further Reading 325
27 Gastrointestinal Disorders: Does Nutrition Control the Disease? 327
1 Introduction 327
2 Constipation 328
3 Diarrhea 328
4 Irritable Bowel Syndrome 329
5 Food Allergy 329
6 Diverticulosis and Diverticulitis 330
7 Gastroesophageal Reflux Disease 331
8 Peptic Ulcers 331
9 Inflammatory Bowel Diseases 332
10 Colorectal Cancer 334
11 Celiac Disease 334
12 Conclusion 335
Suggested Further Reading 336
28 Nutrition in Patients with Diseases of the Liverand Pancreas 338
1 Patients with Liver Disease 338
2 Liver Disease Associated with Nutritional Support 340
3 Patients with Pancreatic Disease 341
4 Conclusion 343
Suggested Further Reading 344
29 Medical Nutrition Therapy in Chronic Kidney Disease and Other Disorders 346
1 Introduction 346
2 Stages Of Chronic Kidney Disease 347
3 Overview Of Nutritional Management Of Ckd For Stages 1-4 347
4 Diet Prescription In Ckd Stages 1-4 350
5 Medical Nutrition Therapy For Hemodialysis 351
6 Medical Nutrition Therapy In Peritoneal Dialysis 353
7 Acute Renal Failure 354
8 Other Kidney-Related Conditions 355
9 Summary 356
Suggested Further Reading 356
30 Bone Health: Sound Suggestions for Stronger Bones 358
1 Introduction 358
2 Calcium 359
2.1 Dietary Calcium Requirements 359
2.2 Calcium Sources 360
3 Vitamin D 361
3.1 Vitamin D Requirements 361
3.2 Sources of Vitamin D 362
3.2.1 Food 362
3.2.2 Sun 362
3.2.3 Supplements 362
3.2.4 Safety 363
4 Protein 363
5 Phosphorus 363
6 Magnesium 364
Suggested Further Reading 365
31 Inherited Metabolic Disorders and Nutritional Genomics: Choosing the Wrong Parents 367
1 Introduction 367
2 Imd Diagnostic Classifications 368
2.1 Disorders Presenting as Intoxication or Encephalopathy 368
2.2 Disorders of Energy Metabolism 368
2.3 Disorders Involving Complex Molecules 369
3 Nutritional Management Of Inherited Metabolic Disorders The General Approach 369
4 Nutritional Management of Inherited Metabolic Disorders Disease-Specific Approach 369
4.1 Medium-Chain Acyl-CoA Dehydrogenase Deficiency (MCAD Deficiency) 370
4.2 Maple Syrup Urine Disease (MSUD) 370
4.3 Phenylketonuria (PKU) 371
4.4 Homocystinuria 372
4.5 Galactosemia 372
5 Conclusions 373
Suggested Further Reading 373
32 Nutritional Challenges of Girls and Women 375
1 Female Reproduction and Nutrition 375
2 Females, Body Dissatisfaction, and Nutrition 377
3 Weight Management In Females 377
4 The Female Athlete Triad 378
5 Polycystic Ovarian Syndrome 379
6 Menopause and Nutritional Supplements 380
7 Summary 381
Suggested Further Reading 381
33 Diet, Physical Activity, and Cancer Prevention 384
1 Introduction 384
2 Body Fatness 386
3 Physical Activity 387
4 Plant Foods 388
5 Meat Intake 393
6 Alcohol 395
7 Conclusions 395
Suggested Further Reading 396
34 Food Allergy and Intolerance: Diagnoses and Nutritional Management 399
1 Introduction 399
2 Food Allergy 400
2.1 Pathophysiology 400
2.2 Diagnosing Food Allergy 400
2.2.1 Medical History 400
2.2.2 Physical Examination 401
2.2.3 Diagnostic Tests 401
2.2.4 Elimination Diet and Oral Food Challenge 402
2.3 Nutritional Management 402
2.4 Prevention 404
3 Food Intolerance 404
3.1 Pathology 404
3.2 Enzymatic Food Intolerance 405
3.3 Pharmacologic Food Intolerance 405
3.4 Undefined Intolerance 406
3.5 Diagnosing Food Intolerance 406
3.6 Nutritional Management 407
4 SUMMARY 407
Suggested Further Reading 407
35 Drug Interactions with Food and Beverages 410
1 Introduction 410
2 Medications To Be Taken On An Empty Stomach 411
3 Specific Examples Of Food-Drug Interactions 411
3.1 Effects of Vitamin K on Warfarin Anticoagulation 411
3.2 Monoamine Oxidase Inhibitors and Tyramine 411
3.3 Calcium Impairs Certain Antibiotic Absorption 412
4 Specific Examples Of FoodBeverage Interactions 412
4.1 Use of Acidic Beverages to Aid Drug Absorption 412
4.2 Grapefruit Juice Inhibits Drug Metabolism 412
4.3 Effect of Alcohol on Drug Action 415
4.4 Effect of Caffeine on Drug Action 415
5 Conclusion 416
Suggested Further Reading 416
Appendix A: Aids to Calculations 418
Appendix B: Sources of Reliable Information on Nutrition 420
Appendix C: Dietary Reference Intakes (DRI) 422
Subject Index 423