1 DNT 200 NUTRITION FOR HEALTH SCIENCES METABOLISM AND ENERGY BALANCE

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DNT 200NUTRITION FOR HEALTH

SCIENCES

METABOLISM AND ENERGY BALANCE

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Life is largely a matter of chemistry

William J. Mayo, MD

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DEFINITIONSMetabolism -- the sum total of all the chemical

reactions that go on in living cells

Anabolism -- reactions in which small molecules are put together to build larger ones; anabolic reactions consume energy

Catabolism -- reactions in which large molecules are broken down into smaller ones; catabolic reactions usually release energy

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EXAMPLESAnabolism

– Making of glycogen

– Making of triglycerides

– Making of protein

Catabolism– Breakdown of glycogen

– Breakdown of triglycerides

– Breakdown of protein

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METABOLISM AND ENERGY BALANCEBREAKING DOWN NUTRIENTS FOR

ENERGY• If the body needs energy, it may break

apart any or all of the basic units (glucose, fatty acids, glycerol, and amino acids) into smaller fragments

• Glucose– Glucose to Pyruvate

• Glycolysis is the metabolic breakdown of glucose to pyruvate

• Pyruvate (pyruvic acid [C3H4O3]) is a three carbon compound that, in metabolism, can be derived from glucose, certain amino acids, or glycerol

• Is a reversible process• Is anaerobic (does not require

oxygen) but cannot be sustained for long

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METABOLISM AND ENERGY BALANCEBREAKING DOWN NUTRIENTS

FOR ENERGY• Glucose

– Pyruvate to Acetyl CoA• If the cell needs energy and

oxygen is available, pyruvate can then be broken down into a smaller compound called acetyl CoA

• CoA is the coenzyme derived from the B-vitamin pantothenic acid -- is central to the energy metabolism of nutrients

• Acetyl CoA is a two carbon compound (acetate or acetic acid) to which a molecule of CoA is attached

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– Pyruvate to Acetyl CoA (con’t)• Is aerobic (requires oxygen)• Is an irreversible step

– Can be used as a building block for fatty acids

– If energy is not needed, acetyl CoA will not enter the TCA cycle, but will be used to make fatty acids instead -- this is how carbohydrate eaten in excess of the body’s needs can lead to fat deposition

– Cannot be used to remake glucose

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BREAKING DOWN NUTRIENTS FOR ENERGY

• Glucose– Pyruvate to Acetyl CoA (con’t)

• When less oxygen is available, pyruvate is converted to lactic acid

• Lactic acid accumulates in the muscles causing a burning pain and fatigue

• To relieve this pain, relax the muscles frequently so the circulating blood can carry the lactic acid back to the liver to be converted back to glucose

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– Acetyl CoA to Carbon dioxide

• In a series of metabolic reactions called the tricarboxylic acid (TCA) cycle, acetyl CoA splits, carbon dioxide is released, and its energy is

– Stored

– Does the body’s work

– Produces heat

• Is aerobic (requires oxygen)

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METABOLISM AND ENERGY BALANCEBREAKING DOWN NUTRIENTS FOR ENERGY

Glucose Summary

Glucose Pyruvate Acetyl CoA

Energy

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METABOLISM AND ENERGY BALANCE BREAKING DOWN NUTRIENTS FOR ENERGY

Glucose Summary

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METABOLISM AND ENERGY BALANCEBREAKING DOWN NUTRIENTS FOR ENERGY– Glycerol

• Is broken down like glucose– Is first broken down into pyruvate – Is then broken down into acetyl CoA

• If the cell does not need energy, the acetyl CoA molecules combine with each other to make body fat

GLYCEROL SUMMARY Glycerol

Glucose Pyruvate Acetyl CoA Energy

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BREAKING DOWN NUTRIENTS FOR ENERGY– Fatty Acids

• Converted directly into Acetyl CoA (no pyruvate step)

• Cannot be used to make glucose – Because no pyruvate step

– Fats cannot normally therefore provide energy for the brain and nervous system that require glucose

FATTY ACID SUMMARY

Fatty Acids Acetyl CoA Energy

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THE FATS TO ENERGY PATHWAY

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– Amino Acids• Will ideally be used to replace needed body proteins and will not

be used for energy• If they are needed/used for energy, they are

– Stripped of their nitrogen (deamination) -- which is used to make other compounds or excreted as urea through the kidneys

– Most of the amino acids can then be converted to pyruvate and therefore provide glucose (glucogeneic). Some are both glucogenic and ketogenic. Leucine is ketogenic only.

– Other amino acids are

» Converted into Acetyl CoA (ketogenic) or

» Enter the TCA cycle at a later point

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AMINO ACID SUMMARY

Glucogenic Ketogenic

Amino Acids Amino Acids

Glucose Pyruvate Acetyl CoA Energy

Other amino acids enter the TCA chain directly

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BREAKING DOWN NUTRIENTS FOR ENERGYOVERALL SUMMARY

PROTEIN STARCH OR FAT

EATEN SUGARS EATEN EATEN

AMINO FATTY

ACIDS GLUCOSE GLYCEROL ACIDS

BODY GLYCOGEN

PROTEIN STORES

FATSTORES

GLUCOSE

AMINO PYRUVATE

ACIDS*

N

ACETYL TCA WATER N N COA CYCLE CO2, ENERGY

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ECONOMICS OF FEASTING• When you consume more energy

than you expend, much of the excess is stored as body fat

• Fat can be made from an excess of any energy yielding nutrient you eat.

• Fat cells enlarge as they fill with fat

• Body’s fat-storing capacity seems to be able to expand indefinitely

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ECONOMICS OF FEASTING

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ECONOMICS OF FASTING

• Even when asleep and totally relaxed, the cells of many organs are consuming energy -- represents 2/3 of the total energy expenditure per day

• Body’s top priority is to meet energy needs for this ongoing activity

• When food is not available, body must find other fuel sources in its own tissues

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ECONOMICS OF FASTING (continued)

• Activities in starving/fasting

– Glucose from the liver’s stored glycogen and fatty acids from the body’s stored fat supply energy to cells

– After several hours, glycogen stores are exhausted and low blood glucose concentrations signal to further promote fat breakdown

– Most of the body’s cells can use fatty acids as their fuel• Nervous system and brain cells need glucose -- cannot use fatty

acids

• Body protein tissues (liver and muscles) break down to supply 90% of the needed glucose

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ECONOMICS OF FASTING (continued)• Activities in starving/fasting

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METABOLISM AND ENERGY BALANCEECONOMICS OF FASTING (continued)

• Activities in starving/fasting– As the fast continues, brain finds a way to use fat as fuel

• Condenses acetyl CoA fragments (called ketone bodies) derived from fatty acids

• Meets about half of the nervous system’s needs

• Many of the areas of the brain still rely exclusively on glucose -- body protein continues to be sacrificed

– As the fast continues, metabolism slows

• Body reduces its energy output

• Conserves both fat and lean tissue

• Fat loss falls to a minimum

• Therefore, although weight loss during fasting may be dramatic, fat loss may actually be less than when at least some food is supplied

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METABOLISM AND ENERGY BALANCEECONOMICS OF FASTING (continued)

• Activities in starving/fasting

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ECONOMICS OF FASTING (continued)

• Activities in starving/fasting– Other body adaptations

• Wasting of lean tissues• Impairment of disease resistance• Lowering of body temperature• Disturbances of the body’s salt and water balance• Minimal effect on

– Mental alertness– Physical energy

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THE LOW CARBOHYDRATE DIET• Presents the body with the same problems as a fast• Once available glucose stores are spent, the only

available significant glucose source is protein• Most low carbohydrate diets provide some protein

from food, some is still taken from body tissue• Initial weight loss is, at best, 1-2 pounds of fat and

5-6 pounds of lean tissue, water, and minerals -- once off the diet, these are replaced and weight reverts to a few pounds of the starting point

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THE PROTEIN SPARING FAST• Theory

– Eat only protein, which will spare lean tissue and provide needed glucose

– Fat breakdown will be at a maximal rate to meet other energy needs

• Has met with mixed results• Has not been shown to be more effective than a diet

containing a mixture of protein and carbohydrate• Most people regain the lost weight

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MODERATE WEIGHT LOSS• There is a limit to the rate at which body fat will

break down -- the maximum rate, except in a very large, very active person is 1-2 pounds per week

• The most effective diet supplies all three energy nutrients in reasonable amounts

• Energy expenditure should include a reasonable level of physical activity

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ENERGY BALANCE

• If weight is within acceptable range for height, the person has a balanced energy budget

• A negative change in fat stores results from more “energy out” than “energy in”

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ENERGY BALANCE

• A pound of body fat stores approximately 3,500 kcalories– To loose a pound, a person must spend 3,500

kcalories more than is taken in– To gain a pound, a person must take in 3,500

kcalories more than is spent– On average, a deficit or excess of 500 kcalories per

day brings about weight loss or gain of 1 pound per week

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ENERGY IN: THE kCALORIES OF FOODEstimating Food Energy

• Amount of energy received from foods depends on– The food’s composition– How much the person eats

• Methods of estimating food energy– Direct measurement -- measuring the heat given off– Indirect measurement -- measuring the amount of

oxygen consumed in burning

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ENERGY IN: THE kCALORIES OF

FOODEstimating Food

Energy– Bomb Calorimeter

is an instrument that measures the heat energy released when foods are burned

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METABOLISM AND ENERGY BALANCEENERGY IN: THE kCALORIES OF FOOD

Estimating Food Energy– Tables of food values -- reflect mathematically corrected

calorimetry measurements– Calculate from amounts of carbohydrate, protein, fat, and

alcohol in the food• Carbohydrate has 4 kcalories per gram

• Protein has 4 kcalories per gram

• Fat has 9 kcalories per gram

• Alcohol has 7 kcalories per gram

– Exchange system -- sorts foods of similar origin and nutrient content into groups

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METABOLISM AND ENERGY BALANCEENERGY IN: THE kCALORIES FOODS PROVIDE

Determinants of Food Intake• Hunger -- The physiological drive for food that initiates food-

seeking behavior. Influenced by:– Empty stomach– Gastric contractions– Absence of nutrients in the small intestine– GI hormones– Brain peptides– Thought, sight, smell, taste of food– Presence of others; special occasions– Perception of hunger; awareness of fullness– Favorite, ethnic, or religious foods– Time of day– Abundance of food or free food– Appetite

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METABOLISM AND ENERGY BALANCEENERGY IN: THE kCALORIES FOODS PROVIDE

Determinants of Food Intake• Satiation -- The feeling of satisfaction and

fullness that occurs during a meal and halts eating; satiation determines how much food is consumed during a meal

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ENERGY IN: THE kCALORIES FOODS PROVIDE

Determinants of Food Intake• Satiation

– Food in the stomach triggers stretch receptors and the person begins to feel too uncomfortable to continue to eat

– Nutrients in the small intestine elicit hormones which send messages to the hypothalamus to stop eating (e.g. fat elicits cholecystokinin which slows gastric emptying)

– The hypothalamus is a brain center that controls activities such as appetite as well as the maintenance of water balance and regulation of body temperature

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METABOLISM AND ENERGY BALANCEENERGY OUT: THE kCALORIES THE BODY SPENDS

Components of Energy Expenditure

• Basal Metabolism -- The energy needed to maintain

life when a body is at complete rest after a 12 hour fast

– Examples

• Beating heart

• Maintenance of body temperature

• Lungs breathing

– About 65% of the total energy needs support basal

metabolism

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Components of Energy Expenditure– Influencing factors on the basal metabolic rate (BMR)

INCREASE EE DECREASE EE

•Total Body weight

•Large body surface area

•Hot and cold ambient temperature

•Fever•Hypo-thyroidism

•Stress•Caffeine•Smoking•Increased LBM•Rapid growth

•Pregnancy & lactation

• Genes

• Some meds

•Aging

•Female gender

•Fasting/starvation

•Hypothyroidism

•Sleep

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Components of Energy Expenditure• Voluntary Activities -- Conscious and deliberate

muscular work; physical activity– Examples

• Walking• Lifting• Climbing

– kCalorie expenditure depends on• Larger muscle mass required• Heavier the weight of the body part being moved• Longer the activity takes

– The more intense the activity, the more kcalories spent– Streamlined moves will conserve energy (e.g. swimming)

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Components of Energy Expenditure• Thermic Effect of Food

– Includes digestion, absorption, utilization of nutrients– Peaks 1 hour after eating– Effect disappears 4 hours after eating also known as the

specific dynamic effect of food– Examples

• Muscles that move food through the intestinal tract speed up their rhythmic contractions

• Cells that manufacture and secrete digestive juices begin their tasks

– Represents 6-10% of the total energy taken in

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Components of Energy Expenditure• Adaptive Thermogenesis -- adjustments in energy

expenditure related to changes in environment such as cold and to physiological events such overfeeding, trauma, and changes in hormone status– Changed circumstances may cause the body to do extra work

• Building tissue• Producing enzymes and hormones

– Is quite variable and specific to individuals -- is not included when calculating the energy RDA

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WEIGHT: HOW MUCH IS TOO MUCH?

Component Lean Man Lean Woman

% %

• Water 62% 59%

• Fat 16% 22%

• Protein 16% 14%

• Minerals 5-6% 4-5%

• Carbohydrate <1% <1%

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• Body Mass Index is an index of a person’s weight in relation

to height, determined by dividing the weight in kilograms by

the square of the height (in meters) -- doesn’t consider body

fat

– Can also be expressed as Weight (lbs.) * 705

Height (in)2

• 64% of Americans are overweight by BMI (CDC)

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METABOLISM AND ENERGY BALANCEWEIGHT: HOW MUCH IS TOO MUCH?

BMI OBESITY CLASS

Underweight <18.5

Normal 18.5 - 24.9

Overweight 25.0 - 29.9

Obesity 30.0 - 34.0 I

35.0 - 39.9 II

Extreme Obesity(Morbid Obesity)

>40 III

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• Body Weight/BMI says little about body fat– A person who doesn’t seem to weigh too much may be

too fat– A person who seems to weigh too much may not be too

fat

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• Weight is still the measure that people most commonly use as an index of body composition

• Obesity is a major problem in developed countries• Health hazards associated with obesity include

– Abdominal hernias

– Arthritis (especially in knees, hips, and lower spine)

– Complications after surgery

– High blood cholesterol

– Hypertension

– Respiratory problems

– Varicose veins

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Obesity Trends* Among U.S. AdultsBRFSS, 1985

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

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No Data <10% 10%–14%


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No Data <10% 10%–14% 15%–19%


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No Data <10% 10%–14% 15%–19% ≥20


52Source: Behavioral Risk Factor Surveillance System, CDC

(*BMI 30, or ~ 30 lbs overweight for 5’4” person)

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



53Source, Non-scientific study : Men’s Fitness Magazine, 2005

Obesity Trends Among U.S. AdultsMEN’S FITNESS MAGAZINE, 2005

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• Location of fat on the body may be as critical (or even more critical) than the total amount– Fat around the abdomen may represent a greater risk to health

than fat elsewhere around the body– Abdominal fat (even in the absence of obesity) is associated

with• Heart disease• Diabetes• Hypertension

– Fat around the hips and thighs (most common in females) seems relatively harmless

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METABOLISM AND ENERGY BALANCEWEIGHT: HOW MUCH IS

TOO MUCH?Causes Of Weight Gain

• Most Common: – Energy input > energy output– Too many calories and/or not

enough aerobic exercise• Less Common Causes:

– Medical Disposition• Hypothyroidism

– Genetics – Medications

• Prescribed steroids• Some hormonals

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WEIGHT: HOW MUCH IS TOO MUCH?Fat Cell Development

– The amount of fat on a person’s body reflects both the number and size of the fat cells

– When fat cells reach their maximum size they may also divide

– A gain or loss in weight can take place through an increase or decrease in either the size or number of fat cells

– People with the greatest number of fat cells (hyperplastic obesity) are least likely to loose weight successfully

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WEIGHT: HOW MUCH IS TOO MUCH?Fat Cell Development

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Genetics

– Tendency toward obesity is inherited but the

environment is influential in the sense that it can

prevent or permit the development of obesity when

the potential is there

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Learned Behavior

• Habits learned in childhood tend to persist throughout life– Overeating at mealtimes

– Rapid eating

– Excessive snacking

– Eating to meet needs other than hunger

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Set Point Theory

– The body sends out signals to establish, regulate, and

maintain a set body weight

– Not only do these signals maintain a constant body

weight, they defend that body weight when it is

challenged

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Environmental Factors

– People overeat because they are pushed

to do so by factors in their surroundings

-- foremost among them, the availability

of a multitude of delectable foods

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METABOLISM AND ENERGY BALANCEWEIGHT: HOW MUCH IS

TOO MUCH?

Deep Emotional Needs

– Primitive fear of

starvation

– Infants association of food

with motherly love

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Treatments For Obesity• Drugs

– Diuretics• Temporary water retention may add several pounds

to a person’s weight

• Water does not cause obesity

• Obesity does not cause water retention

• When people take diuretics they loose water, not fat

• Weight loss is temporary and may result in dehydration and mineral imbalances

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Treatments For Obesity• Drugs (con’t)

– Amphetamines• Speeds up metabolism• No longer approved by the FDA for weight

loss• Are highly addictive• Side effects include dizziness, irritability,

blurred vision, nausea, vomiting, and diarrhea• Have not been proven effective in treating

obesity

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– Other Drugs• Mechanisms include appetite suppression and

reduced nutrient digestion and absorption• Significant side effects include

– Increased blood pressure

– Intestinal gas, cramping, and diarrhea

– Tremors

– Cardiac events

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– Prescription Drugs• Safe and effective prescription drug therapy has

proven elusive

• Sibutramine (Meridia®)– Inhibits serotonin reuptake (may produce enhanced

satiety) and inhibits norepinephrine reuptake (raises metabolic rate)

– Doesn’t work that well

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– Prescription Drugs • Orlistat (Xenical ®)

– A gastrointestinal lipase inhibitor– Decreases the absorption of fat– May reduce absorption of fat soluble vitamins and beta carotene– Still need to follow a low Calorie diet

• Venlafaxine (Effexor ®)– A combined serotonin and norepinephrine reuptake inhibitor– Decreases weight in 43% of patients– Side effects include dry mouth, sexual dysfunction, insomnia,

nausea

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– Over-The-Counter Drugs• Phenylpropanolamine

– Suppresses appetite– Enhances weight loss when used in conjunction with a low kcalorie

diet– Side effects include dry mouth, rapid pulse, nervousness,

sleeplessness, hypertension, irregular heartbeats, kidney failure, seizures, and strokes

• Benzocaine– Comes in a candy or gum form– Anesthetizes the tongue reducing taste sensations

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– Herbal Products• St. John’s Wort

– Contains substances that enhance seratonin (a neurotransmitter important in appetite control) and thus suppresses appetite

• Ephedrine– Often St John’s Wort is prepared in combination with the

herbal stimulant ephedrine

– Some ephedrine-containing supplements have been implicated in heart attacks and seizures and have been linked to a number of deaths

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– Herbal Products• Herbal Laxatives

– Commonly sold as “dieter’s tea”– Commonly cause nausea, vomiting, diarrhea, cramping, and

fainting– Laxatives act on the lower large intestine -- nutrient absorption

occurs primarily in the upper small intestine; therefore kcalories are not “saved”

– Other ‘treatments’• Hot baths -- may dehydrate individuals resulting in lost

water weight• Brushes, Sponges, Wraps, Creams, Massages -- are

ineffective

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Treatments For Obesity• Very Low kCalorie Diets (VLCD)

– Provide 800 kcalories, at least 1 gram high quality protein per kilogram of body weight, little or no fat, and a minimum of 50 grams carbohydrate

– Vitamin and mineral supplements given– Meals consist of a limited number of foods each day and/or a

powdered formula available by prescription– Body reacts as to prepare for starvation– VLCD’s appropriate for short-term use only and under medical

supervision– Many side effects to include a decline in cardiac output,

irregular heartbeats, formation of gallstones and kidney stones, nausea, vomiting, diarrhea, abdominal discomfort, diminished immune response, headaches, and sleeplessness

– Weight loss can be dramatic but weight regains are almost certain

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Treatments For Obesity• Surgery

– Gastric Partitioning• Limit food intake by reducing the size

of the stomach• Size of outlet is also reduced, delaying

the passage of food from the stomach into the intestine

• Complications include vitamin and mineral deficiencies as well as psychological problems

• Lifelong medical supervision necessary

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Treatments For ObesityGastric Surgery is on the Rise

JADA 9/04

63,000

103,000

150,000

0

20,000

40,000

60,000

80,000

100,000

120,000

140,000

160,000

# Surgeries (*2004 projected)

2002

2003

2004*

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Treatments For Obesity• Surgery

– Liposuction• Does not treat obesity but removes the evidence• Has little effect on body weight but can alter the

body shape slightly in specific areas

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Treatments For Obesity• Eating Plans

– Should be realistic– Emphasize nutrient-dense foods that you like– Make tasty vegetables and fruits central– Encourage complex carbohydrate-rich foods

high in bulk– Use fats cautiously– Drink plenty of water– Anticipate a plateau– Learn, practice and eat right for the rest of

your life

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Treatments For Obesity• Exercise

– Helps to speed weight loss– To loose fat, exercise intensely and expend

as much energy as your time allows– Activity speeds up the basal metabolism

• Remains elevated as long as the person keeps exercising regularly

• Over long term, daily vigorous activity gradually changes body composition toward more lean tissue

– Metabolic rate rises accordingly– Supports continued weight loss or maintenance

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Treatments For Obesity• Exercise (con’t)

– Activity helps to control appetite• Immediately after an intense workout,

most people do not feel like eating– Body has released fuels from storage to

support exercise– Glucose and fatty acids are abundant in the

blood– Digestive functions are suppressed

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METABOLISM AND ENERGY BALANCEWEIGHT: HOW MUCH IS TOO

MUCH?Treatments For Obesity

• Exercise (con’t)– Activity helps to reduce stress

• Stress can cue eating• Fit person looks and feels healthy,

increasing self esteem– Types of activities

• Sustained physical activity of moderate intensity (aerobic activities) are more effective in weight control than short bursts of vigorous exercise

• Do what you enjoy doing and do it often

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Treatments For Obesity• Exercise (con’t)

– Spot reducing• Muscles do not “own” the fat around them• Fat cells all over the body release fat in response to

the demand of physical activity for use by whatever muscles are active

• No exercise can remove the fat from any one particular area

• Strength training can help to improve the tone of muscles in a “trouble” area

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Treatments For Obesity• Behavior and Attitude

– Become aware of behaviors• Keep a record of eating and exercise

behaviors• Establish a baseline against which to

measure future progress– Change behaviors

• Eliminate inappropriate eating cues– Buy foods that are low in fat– Shop when you are not hungry

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Treatments For Obesity– Change behaviors (con’t)

• Suppress the cues you cannot eliminate– Eat only in one place (at a table) and in one

room– Make small portions of food look large by

spreading food out and serving on small plates• Strengthen cues to appropriate eating and

exercise– Keep your appropriate foods in the front of the

refrigerator– Learn appropriate portion sizes and prepare one

portion at a time

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Treatments For Obesity– Change behaviors (con’t)

• Engage in desired eating or exercise behaviors– Eat only at planned times; plan not to eat after a

specified time– Slow down (pause several times during a meal, put

down utensils between mouthfuls, chew thoroughly before swallowing, swallow before reloading the fork, always use utensils)

• Arrange or emphasize negative consequences of inappropriate eating

– Eat your meals with other people– Ask that others respond neutrally when you deviate

from your plan (make no comment). This is a negative consequence because it withholds attention

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WEIGHT: HOW MUCH IS TOO MUCH?Treatments For Obesity

– Change behaviors (con’t)

• Arrange or emphasize positive consequences of appropriate behaviors

– Update records of food intake, exercise, and weight change regularly

– Arrange for rewards for each unit of behavior change or weight loss

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• Behavior and Attitude– Personal Attitude

• Those who fully understand their personal relationships with food are best prepared to make healthful changes in eating and exercise behavior

– Support Groups• Is important when making life changes• Some find groups such as Take Off Pounds Sensibly, Weight

Watchers, and Overeaters Anonymous helpful in providing support in efforts to loose weight

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• National Weight Control Registry– A research study developed by Rena Wing and

James Hill in 1993– Identified nearly 3,000 individuals who have lost

significant amounts of weight and kept it off for long periods of time

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Treatments For Obesity• National Weight Control Registry

– Characteristics of successful weight losers• Rarely ate at fast food restaurants• Used a variety of weight loss efforts• Consumed a low fat diet• Ate all foods but limited the quantity• On average, ate five times per day (smaller but more frequent meals• 80% ate breakfast• Exercised• Weighed themselves regularly• Have an improved quality of life

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WEIGHT CONTROL

Diet Planning Using Exchange Lists• Food Groups sort foods by protein, vitamin, and

mineral content• Exchange Lists sort foods by energy, carbohydrate,

protein, fat, and portion size• Exchange Lists are diet planning tools that organize

foods by their proportions of carbohydrate, protein, and fat.– Foods on any single list can be used interchangeably– Were originally developed for diabetic diets but were so

useful they are now in general use for diet planning

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WEIGHT CONTROL

Diet Planning Using Exchange Lists

LISTPORTION

SIZE CHO, g PRO, g FAT, gENERGY,

KcalCarbohydrate Group Starch varies 15 3 1 or less 80 Fruit varies 15 --- --- 60 Milk Skim 1 cup 12 8 0-3 90 Low-fat 1 cup 12 8 5 90 Whole 1 cup 12 8 8 150 Other Carbohydrates varies 15 varies varies varies Vegetables 1/2 cup 5 2 --- 25Meat & Sub Group Meats, Very Lean 1 oz --- 7 0-1 35 Meats, Lean 1 oz --- 7 3 55 Meats, Med Fat 1 oz --- 7 5 75 Meats, High 1 oz --- 7 8 100Fats 1 tsp --- --- 5 45

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METABOLISM AND ENERGY BALANCE WEIGHT CONTROL

Diet Planning Using Exchange ListsCarbohydrate GroupStarch List (Examples)

• Bread, 1 slice

• Ready-to-eat Cereal, 3/4 cup

• Cooked Pasta, 1/2 cup

• Cooked Rice, 1/3 cup

• Cooked Beans, 1/2 cup

• Corn, 1/2 cup

• Potato, 1 small (3 oz)

• Bagel or English Muffin, 1/2

• Tortilla, 1

• Cooked Cereal, 1/2 cup

• Peas, Green, 1/2 cup

• Animal Crackers, 8 ea

• Graham Crackers, 3 ea

• Popcorn (no fat added), 3 cups

• Lima Beans, 2/3 cup

• Hot Dog or Hamburger Bun, 1 ea

• Sugar Frosted Cereal, 1/2 cup

• Saltine Crackers, 6 ea

• French Fried Potatoes, 16-25 ea (omit one fat)

• Waffle, 4-1/2” Square, 1 ea (omit one fat)

• Pancake, 4”, (omit one fat)

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Diet Planning Using Exchange ListsCarbohydrate Group

Fruit List (Examples)

• Apple, 1 small

• Applesauce, Unsweetened, 1/2 cup

• Banana, 1small (4 oz)

• Peach, 1 small

• Orange, 1 small

• Pear, 1 small

• Grapefruit, 1/2 ea

• Orange Juice, 1/2 cup

• Grapefruit Juice, 1/2 cup

• Grapes, 15 small (3/4 cup)

• Cantaloupe, 1/3 (3/4 cup)

• Canned Pineapple, 1/2 cup• Apple Juice, 1/2 cup• Grape Juice, 1/3 cup• Prune Juice, 1/3 cup• Raisins, 2 Tablespoons• Dried Prunes, 3 ea• Unsweetened Fruit Cocktail, 1/2 cup• Fresh Cherries, 12 ea (3 oz)• Unsweetened Canned Pears 1/2 cup• Unsweetened Canned Peaches, 1/2

cup• Strawberries, 1-1/4 cup whole berries

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Milk List (Examples)

Non-Fat

• Non-Fat Milk, 1 cup

• Plain Non-Fat Yogurt, 1 cup

• Non Fat or Low Fat Buttermilk, 1 cup

• Evaporated Non Fat Milk, 1/2 cup

• Non-Fat Dry Milk, 1/3 cup

Low Fat

• 2% Milk, 1 cup

• Plain Low Fat Yogurt, 1 cup

Whole

• Whole Milk, 1 cup

• Evaporated Whole Milk, 1 cup

• Whole Yogurt, Plain, 1 cup

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Other Carbohydrates (Examples)• Angel Food Cake, 1/12 (2

carbohydrates)

• Frosted Cake, 2” Square (2 carbohydrates and 1 fat)

• Glazed Donut, 3-3/4” across (2 carbohydrate and 2 fat)

• Regular Gelatin, 1/2 cup (1 carbohydrate)

• Ice Cream, 1/2 cup (1 carbohydrate and 2 fats)

• Regular Jam or Jelly, 1 Tbsp (1 carbohydrate)

• Fruit Pie (2 crusts), 1/6 pie (3 carbohydrates and 2 fats)

• Potato Chips, 12-18 (1 oz) (1 carbohydrate and 2 fats)

• Canned Spaghetti or Pasta Sauce, 1/2 cup (1 carbohydrate and 1 fat)

• Sweet Roll or Danish , 2-1/2 oz, 2-1/2 carbohydrates and 2 fats)

• Pancake Syrup, 1 Tbsp (1 carbohydrate)• Low Fat Frozen Yogurt, 1/3 cup (1

carbohydrate and 1 fat)• Vanilla Wafers, 5 ea (1 carbohydrate

and 1 fat)

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Vegetable List (Examples)

• Cooked Carrots, 1/2 cup

• Cooked Greens, 1/2 cup

• Cooked Brussels Sprouts, 1/2 cup

• Cooked Beets, 1/2 cup

• Cooked Asparagus, 1/2 cup

• Cooked Broccoli, 1/2 cup

• Cooked Zucchini, 1/2 cup

• Cooked Mixed Vegetables (no corn, peas, or pasta), 1/2 cup

• Cooked Cabbage, 1/2 cup

• Sauerkraut, 1/2 cup

• Raw Tomatoes, 1 cup

• Raw Peppers, 1 cup

• Raw Carrots, 1 cup

• Raw Onions, 1 cup

• Raw Celery, 1 cup

• Raw Cucumber, 1 cup

• Salad Greens, 1 cup

• Canned Tomatoes, 1/2 cup

• Tomato Sauce, 1/2 cup

• Tomato Juice, 1/2 cup

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Diet Planning Using Exchange ListsMeat and Meat Substitute Group

Meats, Very Lean (Examples)Poultry

• Chicken or Turkey (white meat, no skin), 1 oz

• Cornish Hen (no skin), 1 oz

Fish

• Fresh or Frozen Cod, Flounder, Haddock, Halibut, Trout; Tuna, fresh or canned in water, 1 oz

Shellfish

• Clams, Crab, Lobster, Scallops, Shrimp, Imitation Shellfish, 1 oz

Game• Duck or Pheasant (no skin), Venison,

Buffalo, Ostrich, 1 oz

Cheese (with 1 gram or less fat per ounce)• Non-Fat or Low Fat Cottage cheese, 1/4

cup• Fat-Free Cheese, 1 oz

Other• Processed Sandwich Meats (with 1 gram

or less fat per ounce), 1 oz• Egg Whites, 2 ea• Hot Dogs (with 1 gram or less fat per

ounce) 1 oz

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Meats, Lean (Examples)Beef

• USDA Select or Choice Grades of Lean Beef Trimmed of Fat Such As Round, Sirloin, and Flank Steak; Tenderloin; Roast (Rib, Chuck, Rump); Steak (T-Bone-Porterhouse, Cubed) Ground Round, 1 oz

Pork• Lean Pork Such As Fresh Ham;

Canned, Cured, or Boiled Ham; Canadian Bacon; Tenderloin, Center Loin Chop, 1 oz

Lamb• Roast, Chop, Leg, 1 oz

Veal• Lean, Chop, Roast, 1 oz

Poultry• Chicken, Turkey (Dark Meat, No Skin)

Chicken (White Meat With Skin)

Fish• Herring, 1 oz• Salmon (Fresh or Canned), Catfish, 1 oz• Tuna (canned in oil, drained) 1 oz

Cheese• Cheeses with 3 grams or less fat per

ounce, 1 oz

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Meats, Medium Fat (Examples)Beef

• Ground Beef, Meat Loaf, Corned Beef, Short Ribs, Prime Grades of Meat Trimmed Of Fat (Such As Prime Rib), 1 oz

Pork• Top Loin, Chop, Boston Butt,

Cutlet, 1 oz

Lamb• Rib Roast, Ground, 1 oz

Veal• Cutlet (Ground or Cubed,

Unbreaded), 1 oz

Poultry• Chicken (Dark Meat, With Skin) Ground

Turkey or Ground Chicken Fried Chicken (With Skin), 1 oz

Fish• Any Fried Fish Product, 1 oz

Cheese• Cheeses with 5 grams Or Less Fat Per

Ounce, 1 oz

Other• Egg, 1• Sausage (With 5 Grams or Less Fat Per

Ounce), 1 oz

99



Meats, High Fat (Examples)

Pork

• Spareribs, Ground Pork, Pork Sausage, 1 oz

Cheese

• All Regular Cheeses Such As American, Cheddar, Monterey Jack, Swiss, 1 oz

Other• Process Sandwich Meats With 8 Grams

Or Less Fat Per Ounce (Such As Bologna, Pimento Loaf, Salami), 1 oz

• Sausage (Such As Bratwurst, Knockwurst, Polish), 1 oz

• Hot Dog (Turkey Or Chicken), 1 (10/lb.)

• Bacon, 3 slices

Peanut Butter• Peanut Butter, 2 Tbsp

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Diet Planning Using Exchange ListsFats (Examples)

Monounsaturated Fats• Avocado, medium, 1/8 (1 oz)• Oil (Canola, Olive, Peanut), 1 tsp• Black Olives, 8 large• Green Stuffed Olives, 10 large• Almonds, Cashews, 6 ea• Peanuts, 10 ea

Polyunsaturated• Margarine (Stick, Tub, Squeeze), 1 tsp• Regular Mayonnaise, 1 tsp• Reduced Fat Mayonnaise, 1 Tbsp• Regular Salad Dressing, 1 Tbsp• Reduced Fat Salad Dressing, 2 Tbsp

Saturated Fats• Bacon, Cooked, 1 slice• Stick Butter, 1 tsp• Butter, Whipped, 2 tsp• Chitterlings, Boiled, 1 Tbsp• Regular Cream Cheese, 1 Tbsp• Reduced Fat Cream Cheese, 2

Tbsp• Shortening or Lard, 1 tsp• Regular Sour Cream, 2 Tbsp• Reduced Fat Sour cream, 3 Tbsp

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WEIGHT CONTROL

How To Plan A Diet Using Exchange Lists

• Estimate Desirable Body Weight– Males -- Allow 106 pounds for the first 5 feet; then add

6 pounds for every inch over 5 feet

– Females -- Allow 100 pounds for the first 5 feet; then add 5 pounds for every inch over 5 feet

– Add 10% for large frame individuals; subtract 10% for small frame individuals

– For children, refer to growth charts in textbook appendix

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METABOLISM AND ENERGY BALANCEWEIGHT CONTROL

How To Plan A Diet Using Exchange Lists (con’t)

• Determine whether individual needs a weight loss or weight maintenance diet

• Calculate energy needs in kilocalories– Simplified method

• Multiply the desirable body weight by 15 for men and active women

• Multiply the desirable body weight by 13 for most women, sedentary men, and adults over 55

• Multiply the desirable body weight by 10 for sedentary women, obese people, and sedentary adults over 55

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WEIGHT CONTROL

How To Plan A Diet Using Exchange Lists (con’t)– Children

• Need about 100 kilocalories daily for the first year of life plus 100 kilocalories per year up to 2000 kilocalories by age 11

• For children 12-15, add 100 kilocalories per year for girls and 200 kilocalories per year for boys

– Harris-Benedict Equation -- Can also be used to determine energy requirements

• Males -- 66+(6.165*pounds)+(12.82*inches)-(6.8*age)

• Females -- 655+(4.32*pounds)+(4.359*inches)-(4.7*age)

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WEIGHT CONTROL

How To Plan A Diet Using Exchange Lists (con’t)• Add factors

– Activity» + 20% for sedentary» + 35% for moderate» + 50% for active

– Stress» + 10-15% for uncomplicated elective surgery» + 20-40% for complicated surgery/fractures» + 50-100% for major burns

– Fever» + 13% for each degree Celsius over normal body

temperature

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WEIGHT CONTROL

How To Plan A Diet Using Exchange Lists (con’t)

– Growth (if necessary)

» + 5% for moderate weight loss

» + 10-15% for moderate to severe weight loss

– For Overweight -- For people who are greater than 125% of their IBW

» Adjusted body weight = (Actual body weight - Ideal body weight)*125

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WEIGHT CONTROLHow To Plan A Diet Using Exchange Lists (con’t)

Case Study• Subject: Female, moderately active, 50 years old, 65

inches tall, 150 pounds• Step 1 -- Calculate BEE

– Harris-Benedict Equation• = 655 + (4.32*pounds) + (4.359*inches) - (4.7*age)• = 655 + 648 + 283 - 235• = 1351

– Add 35% for moderate activity• = 1351 * 1.35 • = 1824 (Round to 1800)

107



Case Study• Step 2 -- Determine Grams of CHO, Fat, and Protein

– 55-60% of kcalories come from CHO• 1800*55% = 900 kcalories• 900 kcalories/4 = 247.5 grams

– 25-30% of kcalories come from Fat• 1800*25% = 450 kcalories• 450 kcalories/9 = 50 grams

– 12-20% of kcalories come from Protein• 1800*20% = 360 kcalories• 360 kcalories/4 = 90 grams

***** 108



Case Study• Step 2 -- Translate The Diet Prescription Into A Meal Plan

– Become familiar with the client’s usual pattern of meals, likes, and dislikes

– Include basic foods to ensure adequate levels of minerals and vitamins

• 2-3 exchanges of milk• 3-5 exchanges of vegetables• 2-4 exchanges of fruit• 6-11 exchanges of starch• 4-6 exchanges of meat

**** 109


How To Plan A Diet Using Exchange Lists (con’t)Case Study

• Step 2a -- Translate The Diet Prescription Into A Meal Plan– List the carbohydrate, protein,

and fat values for the milk, vegetables, and fruit

– Subtotal the carbohydrate

– Subtract this subtotal from the carbohydrate level prescribed, in this case 247.5 grams - 99 grams

– The resultant answer is 148.5 grams

LIST # EXCH CHO, g PRO, g FAT, gMilk, Skim 2 24 16 --Vegetables 3 15 6 --Fruit 4 60 -- --

Subtotal 99Bread

SubtotalMeat, Lean

SubtotalFatTOTAL

*** 110



• Step 2b -- Translate The Diet Prescription Into A Meal Plan– We know each exchange of bread

contains 15 grams of carbohydrate

– The balance of 148.5 grams of carbohydrate allows for 10 bread exchanges (148.5/15)

– Since there is no carbohydrate in Meat or Fat, the total amount of carbohydrate is 249 grams

– Subtotal the protein


Subtotal 99Bread 10 150 30 --

Subtotal 52Meat, Lean

SubtotalFatTOTAL 249

** 111



• Step 2c -- Translate The Diet Prescription Into A Meal Plan– Subtract this subtotal from the

protein level prescribed, in this case 90 grams - 52 grams

– The resultant answer is 38 grams– We know each exchange of meat

contains 7 grams of protein– The balance of 38 grams of

protein allows for 5 meat exchanges (38/7)

– Since there is no protein in Fat, the total amount of protein is 87 grams

– Subtotal the fat



Subtotal 52Meat, Lean 5 -- 35 15

SubtotalFatTOTAL 249 87

* 112



• Step 2d -- Translate The Diet Prescription Into A Meal Plan– Subtract this subtotal from the fat

level prescribed, in this case 50 grams - 15 grams

– The resultant answer is 35 grams

– We know each exchange of fat contains 5 grams of fat

– The balance of 35 grams of fat allows for 7 fat exchanges (35/5)




Subtotal 15Fat 7 -- -- 35TOTAL 249 87 50

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• The resultant pattern of exchanges compares favorably with the prescription of 247.5 grams of carbohydrate, 90 grams of protein, and 50 grams of fat yielding 1794 kcalories




Subtotal 15Fat 7 -- -- 35TOTAL 249 87 50

Documents

1 DNT 200 NUTRITION FOR HEALTH SCIENCES METABOLISM AND ENERGY BALANCE