Author’s Contribution:

1. Dt. Gautam Jani:

Mr. Gautam is a civil engineer. By passion he is a dietitian and had
started practicing it in the year 2016. He is the founder of
fitnesswithgomzi firm established in 2018. He has achieved many
certificate from ACSM, ISSA and VLCC.

2. Dt. Foram Desai:

Ms. Foram is a sport dietitian and Taekwondo 4 Dan Black Belt
holder. She is the founder of Fitnesswithgomzi established in 2018.
She is an International coach and National referee. She has an
experience of 10 years coaching Taekwondo at S.D. Jain School. She
has achieved certificates from ACSM, ISSA and VLCC. She is the best
dietitian in Surat.

3. Dt. Nitin Patel:

Mr. Nitin Patel is a photographer expert. He started personal training
and gym since 2018. He is also an owner of gym and a franchisee
owner of fitnesswithgomzi. He has given diet and exercise plan to
many of his clients and all are very happy with their achieved results.
Diploma in Ditetics FGIIT,

SERVICES

FGIIT provide the highest quality of education in the field of a nutritionist,

personal trainer, yoga instructor, and functional trainer.

Our certification which will be provided after the completion of your course will
be valid in 192 countries and we have also mentioned a few of the key features of
your screen

The course will provide you an opportunity to be successful, make a highly

qualified, and experienced professional.

FGIIT use different teaching strategies: online & offline lectures, seminars,
workshop and diet therapy practicals, case study-based learning. We expected
you will also be to undertake a significant amount of independent study

Course Info

Diploma in a nutritionist course diverse course where we are teaching our

nutritionist students that how to make a diet for clinically ill patients for fat loss
and muscle building or first aid kit. in this course, we are also teaching a diverse
subject which is given below in syllabus segments.

We take care that meanwhile pursuing your course with us you know how to
consult with the clients, how to make a diet for clients, customize a diet, and how
to get success in your field. so from basic to advance we are covering all the
subjects and your soft skills which help you to archive great success in your
career.

So, let's dig in right away.

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Diploma in Ditetics FGIIT,

Other than this FGIIT Provides you a vast knowledge on courses like
• Diploma in Personal Trainer
• Diploma in Nutrition Course
• Anabolic and androgenic Steroids Master Class
• Tabata, TRX, & Functional Training Master Class
• Nutri-Trainer (Blend of both personal training and nutritionist to make you
all-rounder)
• Injury Reheblitation Master Class
• Digital Freedom that allows you to become independent on the basis to
grow your business online
FGIIT serves you a variety of courses that helps you grow

Accreditation

FGIIT is recognized by International Accreditation Certificate (IAO) for the

achievement of the highest standards of organizational management, academic
management, and Institutional performance through a commitment to quality
and continuous improvement. You'll get a certificate once you have complete the
course which is valid in 192 countries

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Diploma in Ditetics FGIIT,

SR NO. TOPIC PAGE NUMBER

1 CARBOHYDRATES 7
2 PROTIENS 25
3 LIPIDS 55
4 WATER – MOST FORGOTTEN NUTRIENT 63
5 ENERGY METABOLISM 73
6 VITAMIN 92
7 MINERALS 118
8 INTRODUCTION TO LIVING BEINGS: PHYSIOLOGY 135
9 ANATOMY OF OUR HUMAN BODY 140
10 FUNDAMENTALS OF MEAL PLANNING 147
11 FOOD GROUPS 149
12 FOOD EXCHANGE LIST 153
13 METHODS OF IMPROVING NUTRITIONAL QUALITY OF FOODS. 159
14 NUTRITION IN THE LIFE CYCLE 164
15 NUTRITION IN OLD AGE 200
16 THERAPEUTIC ADAPTATIONS OF NORMAL DIET 204
• Fluid Diet
• Total parenteral nutrition
• Tube feeding

17 GASTRO INTESTINAL DISORDERS 216

• Hernia
• Diarrhoea
• Constipation
• Peptic Ulcer
• Ulcertive Colitis
• Crohns diseases
• Dumping Syndrome
• Dysphagia
18 METABOLIC DISORDERS 244
• Diabetes

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Diploma in Ditetics FGIIT,

• Gout
• Hypothyroidism
• Hperthyroidism
• Menopause
• PCOS
• PMS
19 CARDIOVASCULAR DISORDERS 262
• Hypertension
• Atherosclerosis
• Myocardial infaction
20 LIVER DISORDERS 275
• Jaundice
• Hepatitis
• Diseases of gallbladder
21 FEBLIFE DISORDERS 285
• Typhoids
• Tuberculosis
22 MUSCULOSKELETAL DISORDERS 289
• Osteoarthritis
• Osteoporosis
23 DIET FOR HEALTHY SKIN, HAIR & NAILS 294
24 NUTRITION FOR NIGHT SHIFT WORKERS 299
25 FOOD ALLERGIES & FOOD INTOLEARANCE 302
26 WEIGHT MANAGEMENT & OBESITY 307
27 COUNCELLING SKILLS 315
28 SPORTS NUTRITION 322
29 SUPPLEMENTS 329
30 HOW TO MAKE DIET PLAN 344
31 JOB PLACMENT 358

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Components of food
There are major two components of food

1. MACRO Nutrient
2. MICRO Nutrient

1. MACRO Nutrient :

These are the nutrients which are generally found in large quantity in
food. It has three sub-component.

• Carbohydrates
• Proteins
• Fats
• Water

2. MICRO Nutrient :

This is generally found in small quantities in the food.

•
• Vitamins
• Minerals

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Energy:

Energy is needed in human body to function properly and lead to active lives.

Sources of this energy are variety of food we consume. Our body burns food for
energy. Even individual is at rest. Our body also needs energy to run different
organs like lungs, heart, liver, intestine.

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CARBOHYDRATES
What are Carbs?
Carbs, or carbohydrates, are molecules that have carbon, hydrogen, and oxygen
atoms.

In nutrition, the word “carbs” refers to one of the three macronutrients. The
other two are protein and fat.

Dietary carbohydrates have three main

categories:

Sugars:These are sweet, short-chain

carbohydrates found in foods. Examples are
glucose, fructose, galactose, and sucrose.

Starches: These are long chains of glucose

molecules, which eventually get broken down into glucose in the digestive
system.

Fiber: Humans cannot digest fiber, but the bacteria in the digestive system can
make use of some types. Plus, eating fiber is vital to your overall health.

One of the primary purposes of carbohydrates in our diet is to provide fuel for our
bodies.

Most carbs get broken down or transformed into glucose, which can be used as
energy. Carbs can also be turned into fat (stored energy) for later use.

Fiber is an exception. It doesn’t provide energy directly, but it does feed the
friendly bacteria in the digestive system. These bacteria can use the fiber to
produce fatty acids that some of our cells can use as energy.Sugar alcohols are
also classified as carbohydrates. They taste sweet but usually don’t provide many
calories. They don’t tend to be nutritive

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Carbohydrate are necessary and major part of a healthy diet, supplying the body
nutrients it can convert to glucose, a currency of energy.

These are chemical compounds made up of carbon, hydrogen and oxygen. They
are the most abundant source of energy in different populations.

Different type of Carbohydrates

S. Class Examples Sources Glycaemic No. Of Units sugar
No. Index
1. Monosaccharide Glucose Fruits, High one
Fructose honey, High one
Galactose Milk and its Moderate one
products
2 Disaccharide Maltose Glucose High Two
Lactose syrup, Moderate Two
Milk and its
Sucrose products, High Two
sugarcane,
sugar
3. Trisaccharide Raffinose Chick peas, Low More than two
legumes
4 Polysaccharide Raffinose Plant based Low Three to six

Glycemic index:
It’s an indication of blood glucose levels whether it increases or decreases with
certain carbohydrate foods. On the basis of that, we divided carbohydrates in three
categories. Food we provide consume contain various substance called nutrient
which provide nutrition to our body.

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Diploma in Ditetics FGIIT,

1. High glycemic index food 80 > H. G. C. > 100

2. Moderate glycemic index food 60 > M. G. C. > 80

3. Low glycemic index food. < 60

Whole’ vs. ‘refined’ carbs

Though there is a lot of information floating around about carbs, keep in mind
that not all carbs are created equal.

There are many different types of carbohydrate-containing foods, and they can
vary in their health effects.Carbs are sometimes referred to as “simple” versus
“complex” or “whole” versus “refined.”

Whole carbs are minimally processed and contain the fiber found naturally in the
food, while refined carbs have been processed more and have had the natural
fiber removed or changed.

Examples of whole carbs include:

• Vegetables
• Quinoa
• Barley
• Legumes
• Potatoes
• Whole Grains
• Oats
• Beans

On the other hand, refined carbs include:

• Sugar-sweetened beverages
• White bread

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Diploma in Ditetics FGIIT,

• Pastries
• Other items made with white flour

Numerous studies show that refined carbohydrate consumption is associated

with health conditions like obesity and type 2 diabetes.

Refined carbohydrates tend to cause spikes in blood sugar levels, which can lead
to a subsequent crash that can trigger hunger and lead to food cravings.

They’re usually also lacking in many essential nutrients. In other words, they’re
“empty” calories.There are also added sugars, which should be limited as diets
high in added sugars are linked to an increased risk of many different chronic
diseases .

While it is important to limit refined carbs and added sugars, whole carbs should
be a part of a balanced diet.Whole food sources of carbohydrates are loaded with
nutrients and fiber and don’t cause the same spikes and dips in blood sugar levels.

Numerous studies on high fiber carbohydrates, including vegetables, fruits,

legumes, and whole grains, show that eating them is linked to improved
metabolic health and a lower risk of disease.

How to make the right choices

As a general rule, carbohydrates in their natural, fiber-rich form are healthy, while
those stripped of their fiber are not.

If it’s a whole, single-ingredient food, then it’s probably a healthy food for most
people, no matter what the carbohydrate content is.Instead of thinking of carbs
as either “good” or “bad,” focus on increasing whole and complex options over
those that are heavily processed. It is better to focus on what you are gaining
instead of what it feels like you may be giving up.

Things are rarely ever black and white in nutrition. But the following foods are a
better source of carbs.Vegetables. All of them. It’s best to eat a variety of
vegetables every day.

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Diploma in Ditetics FGIIT,

• Whole fruits: Apples, bananas, strawberries, etc.

• Legumes: Lentils, kidney beans, peas, etc.
• Nuts:Almonds, walnuts, hazelnuts, macadamia nuts, peanuts, etc.
• Seeds: Chia seeds and pumpkin seeds.
• Whole grains: Choose grains that are truly whole, as in pure oats, quinoa,
brown rice, etc.
• Tubers:Potatoes, sweet potatoes, etc.

These foods may be acceptable in moderation for some people, but many will do
best by limiting them as much as possible.

• Sugary drinks. These are sodas, fruit juices with added sugar, and beverages
sweetened with high fructose corn syrup.
• White bread. These are refined carbohydrates that are low in essential
nutrients and have a negative effect on metabolic health. This applies to
most commercially available breads.

Pastries, cookies and cakes. These foods tend to be very high in sugar and refined
wheat.Ice cream. Most types of ice cream are very high in sugar, although there
are exceptions.Candies and chocolates. If you’re going to eat chocolate, choose
quality dark chocolate.French fries and potato chips. Whole potatoes are healthy.
However, french fries and potato chips don’t provide the nutritional benefits that
whole potatoes do.

Low carb is great for some, but others function best with plenty of carbs.There is
no one-size-fits-all solution in nutrition.The “optimal” carbohydrate intake
depends on numerous factors, such as:

• Age
• Gender
• Metabolic Health
• Physical Activity
• Food Culture
• Personal Preference

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Diploma in Ditetics FGIIT,

If you’re overweight or have medical conditions such as metabolic syndrome

and/or type 2 diabetes, you may be carbohydrate sensitive.

In this case, reducing carbohydrate intake is likely beneficial. On the other hand, if
you’re just trying to stay healthy, there’s probably no reason for you to avoid
“carbs.” However, it’s still important to eat whole, single-ingredient foods as
much as possible.

If your body type is naturally lean and/or you’re highly physically active, you may
even function much better with plenty of carbs in your diet. For more information
about the amount of carbs that’s right for you, talk with your doctor.

Simple Carbohydrates vs. Complex Carbohydrates

Carbohydrates are an important nutrient found in numerous types of foods. Most

of us equate carbs with bread and pasta, but you can also find them in:

• Dairy Products
• Fruits
• Vegetables
• Grains
• Nuts
• Legumes
• Seeds
• Sugary Foods And Sweets
• Carbohydrates are made up of three components: fiber, starch, and sugar.

Fiber and starch are complex carbs, while sugar is a simple carb. Depending on
how much of each of these is found in a food determines its nutrient quality.

Simple carbs equal simplistic nutrition

Simple carbs are sugars. While some of these occur naturally in milk, most of the
simple carbs in the American diet are added to foods.

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Common simple carbs added to foods include:

• Raw Sugar
• Brown Sugar
• Corn Syrup And High-Fructose Corn Syrup
• Glucose, Fructose, And Sucrose
• Fruit Juice Concentrate

Simple carb foods to avoid

Try to avoid some of the most common refined sources of simple carbs and look
for alternatives to satisfy those sweet cravings:

1. Soda: Sugary soda is bad for your health in several ways. You can try water
flavored with lemon instead.

2. Baked treats: Satisfy your sweet tooth with fruit, rather than baked goods full
of simple carbs and added sugars.

3. Packaged cookies: Bake your own goods using substitutes like applesauce or
sweeteners, or look for other mixes that contain more complex carbs.

4. Fruit juice concentrate: An easy way to avoid fruit concentrate is to look closely
at nutrition labels. Always choose 100 percent fruit juice or make your own at
home.

5. Breakfast cereal: Breakfast cereals tend to be loaded with simple

carbohydrates. If you just can’t kick the habit, check out our rundown of breakfast
cereals, from the best to the worst for your health.

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The more complex the carb, the better

Complex carbs pack in more nutrients than simple carbs. They’re higher in fiber
and digest more slowly. This also makes them more filling, which means they’re a
good option for weight control.

They’re also ideal for people with type 2 diabetes because they help manage
blood sugar spikes after meals.Fiber and starch are the two types of complex
carbohydrates. Fiber is especially important because it promotes bowel regularity
and helps to control cholesterol.

The main sources of dietary fiber include:

• Fruits
• Vegetables
• Nuts
• Beans
• Whole Grains

Starch is also found in some of the same foods as fiber. The difference is certain
foods are considered more starchy than fibrous, such as potatoes.

Other high-starch foods are:

• Whole Wheat Bread

• Cereal
• Corn
• Oats
• Peas
• Rice

Complex carbohydrates are key to long-term health.They make it easier to

maintain a healthy weight and can even help guard against type 2 diabetes and
cardiovascular problems in the future.

Complex carbs you should eat more of:- Be sure to include the following complex
carbohydrates as a regular part of your diet:

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Diploma in Ditetics FGIIT,

1. Whole grains: Whole grains are good sources of fiber, as well as potassium,
magnesium, and selenium. Choose less processed whole grains such as quinoa,
buckwheat, and whole-wheat pasta.

2. Fiber-rich fruits: Some of these are apples, berries, and bananas. Avoid canned
fruit since it usually contains added syrup.

3. Fiber-rich vegetables: Eat more of all your veggies, including broccoli, leafy
greens, and carrots.

4. Beans: Aside from fiber, these are good sources of folate, iron, and potassium.

Choosing the right carbs can take time and practice. With a little bit of research
and a keen eye for nutrition labels, you can start making healthier choices to
energize your body and protect it from long-term complications.

12 High Carb Foods That Are Incredibly Healthy

1. Quinoa: Quinoa is highly nutritious and may help improve blood sugar
management and support heart health. Quinoa is also high in protein and
fiber, so it may be useful for weight loss, as both of these nutrients can help
keep you feeling full for longer.
2. Oats: Oats contain many beneficial nutrients, including fiber and protein.
Studies have also shown that eating oats lowers blood sugar and
cholesterol levels.
3. Buckwheat: Buckwheat is highly nutritious and contains more antioxidants
and minerals than many grains. Buckwheat isn’t related to wheat and
doesn’t contain gluten. Eating it may benefit your heart health and blood
sugar regulation.
4. Bananas: Bananas are high in potassium, a mineral that plays a key role in
regulating blood pressure. Less ripe bananas also contain resistant starch
and pectin, both of which can improve digestive health.
5. Sweet potatoes: Sweet potatoes are an excellent source of vitamin A, along
with several other vitamins, minerals, and antioxidants.

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Diploma in Ditetics FGIIT,

6. Beets: Beets are loaded with vitamins, minerals, and plant compounds.
They also contain high amounts of inorganic nitrates, which can improve
heart health and boost physical performance.

7. Oranges: Oranges are a good source of fiber. They also contain high
amounts of vitamin C and other healthy plant compounds. Eating oranges
may benefit heart health and increase iron absorption to help prevent
anemia.

8. Blueberries: Blueberries are very healthy. They contain many vitamins,

minerals, and antioxidants, and they can help protect against oxidative
damage.

9. Grapefruit: Grapefruit contains many beneficial vitamins, minerals, and

antioxidants. It may provide numerous health benefits.

10. Apples: Apples contain a decent amount of vitamin C, antioxidants, and

plant compounds. Eating apples may improve blood sugar management, as
well as reduce the risk of heart disease and potentially even certain types of
cancer.

11. Kidney beans: Kidney beans contain many vitamins, minerals, and
antioxidants. Cooked kidney beans are also a good source of protein and
have been linked to several health benefits.

12. Chickpeas: Chickpeas are an excellent source of plant-based protein and

contain many vitamins and minerals. Eating chickpeas has been linked to
benefits for heart and digestive health, as well as potential cancer
prevention.

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Diploma in Ditetics FGIIT,

Why Refined Carbs Are Bad For You

Many whole foods that are high in carbs are incredibly healthy and nutritious.On
the other hand, refined or simple carbs have had most of the nutrients and fiber
removed.

Eating refined carbs is linked to drastically increased risk of many diseases,

including obesity, heart disease and type 2 diabetes.Almost every nutrition expert
agrees that refined carbs should be limited.

However, they are still the main source of dietary carbs in many countries.This
article explains what refined carbs are, and why they are bad for your health.

What Are Refined Carbs?

Refined carbs are also known as simple carbs or processed carbs.

There are two main types:

Sugars: Refined and processed sugars, such as sucrose (table sugar), high fructose
corn syrup and agave syrup.

Refined grains: These are grains that have had the fibrous and nutritious parts
removed. The biggest source is white flour made from refined wheat.

Refined carbs have been stripped of almost all fiber, vitamins and minerals. For
this reason, they can be considered as “empty” calories.They are also digested
quickly, and have a high glycemic index. This means that they lead to rapid spikes
in blood sugar and insulin levels after meals.

Eating foods high on the glycemic index has been linked to overeating and
increased risk of many diseases (1Trusted Source, 2Trusted Source).Sadly, sugars
and refined grains are a very large part of the total carbohydrate intake in many
countries (3Trusted Source, 4Trusted Source, 5Trusted Source).

The main dietary sources of refined carbs are white flour, white bread, white rice,
pastries, sodas, snacks, pasta, sweets, breakfast cereals and added sugars.

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Diploma in Ditetics FGIIT,

They are also added to all sorts of processed foods.

Refined Grains Are Much Lower in Fiber and Micronutrients

Whole grains are very high in dietary fiber.

They consist of three main parts :

Bran: The hard outer layer, containing fiber, minerals and antioxidants.

Germ: The nutrient-rich core, containing carbs, fat, protein, vitamins, minerals,
antioxidants and plant compounds.

Endosperm: The middle layer,

containing mostly carbs and small
amounts of protein.

The bran and germ are the most

nutritious parts of whole grains.

They contain high amounts of

many nutrients, such as fiber, B
vitamins, iron, magnesium, phosphorus, manganese and selenium.During the
refining process, the bran and germ are removed, along with all the nutrients they
contain.This leaves almost no fiber, vitamins or minerals in the refined grains. The
only thing left is rapidly digested starch with small amounts of protein.That being
said, some producers enrich their products with synthetic vitamins to make up for
some of the loss in nutrients.

Whether or not synthetic vitamins are as good as natural vitamins has long been
debated. However, most people will agree that getting your nutrients from whole
foods is always the best choice (10Trusted Source).

Diets high in refined carbs also tend to be low in fiber. Low-fiber diets have been
linked with an increased risk of diseases like heart disease, obesity, type 2
diabetes, colon cancer and various digestive problems.

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Refined Carbs Can Drive Overeating and Increase the Risk of Obesity

A large portion of the population is overweight or obese. Eating too many refined
carbs may be one of the main culprits.Because they are low in fiber and digested
quickly, eating refined carbs can cause major swings in blood sugar levels. This
can contribute to overeating .

This is because foods high on the glycemic index promote short-term fullness,
lasting about one hour. On the other hand, foods that are low on the glycemic
index promote a sustained feeling of fullness, which lasts about two to three
hours.Blood sugar levels drop about an hour or two after eating a meal high in
refined carbs. This promotes hunger and stimulates parts of the brain associated
with reward and craving.

These signals make you crave more food, and are known to cause
overeating.Long-term studies have also shown that eating refined carbs is linked
with increased belly fat over the course of five years.

Furthermore, refined carbs may cause inflammation in the body. Several experts
have speculated that this may be one of the primary dietary causes of leptin
resistance and obesity.

Refined Carbs May Increase the Risk of Heart Disease and Type 2 Diabetes

Heart disease is incredibly common, and currently the world’s biggest killer.Type
2 diabetes is another very common disease, affecting about 300 million people
worldwide.People with type 2 diabetes have a high risk of developing heart
disease.Studies show that a high consumption of refined carbs is linked with
insulin resistance and high blood sugar levels. These are some of the main
symptoms of type 2 diabetes.

Refined carbs also increase blood triglyceride levels. This is a risk factor for both
heart disease and type 2 diabetes.One study in Chinese adults showed that over
85% of the total carbohydrate intake came from refined carbs, mainly white rice
and refined wheat products.The study also showed that people who ate the most

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Diploma in Ditetics FGIIT,

refined carbs were two to three times more likely to get heart disease, compared
to those who ate the least.

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METABOLISM OF CARBOHYDRATES

Carbohydrate
Intake

Energy Glucose in Energy

output blood stream output

Liver
Extra calorie Muscle
glycogen
Glycogen glycogen

Stored
Fat

When you consume carbohydrates your body turns it into glucose which
provides sufficient energy in everyday task. If you eat too much
carbohydrates which result into excess glucose in your blood stream, which
afterwards convert into liver and muscle glycogen, to be used when body
needs extra burst of energy. Any leftover glycogen will be converted into
fat.

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Various Functions of Carbohydrates:

I. Energy Source :
1 gram of carbohydrates provides 4 kcal. Carbohydrates are vital for
functioning the organs like brain and heart. Lower glycogen levels which
resulted because of lower carbohydrate diets can damage your heart
immensely.

In many different populations’ carbohydrates has been the major source of

fuels since the beginning.

II. Anti-ketogenic effect:

Presence of carbohydrate is necessary for fat metabolism in absence of
carbohydrates. Larger amount of fats used as a fuel which is not the ideal
scenario.
This results into accumulation of ketone bodies. This may lead to acidosis,
sodium imbalance and dehydration which is not ideal state for our body.

III. Excretion of toxins :

Metabolism of glucose combined with chemical and bacterial toxins and
some normal metabolise in the liver and thereby help in excretion.

1 gm. Of carbohydate contains 4 kcal.

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Sources of Carbohydrates:
Sr. Vegetarian Sources Animal Sources Artificial sweeteners
No.

1. Rice, wheat, corn, bajra, Milk, curd, lassi, Energy drinks

ragi, millet etc. paneer,

2. Roots, tubers, seeds. Meat, poultry and Corn syrup

fish (small amount).

3. Legumes, beans, peas, Honey products

yams.

4. Fruits Stebia like sugars

5. Sweets

Major Hormones Which has certain reaction from carbohydrate:

1) Insulin:

Only one hormone is known to lower the blood sugar. Whenever you eat
carbohydrates it increases the concentration of blood glucose to stimulate that
body releases insulin. Insulin does three major works

1. Synthesis of glycogen into liver,

2. Transport glucose across the cells,

3. Conversion of glucose to fatty acids.

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2) Glucagon:

Glucagon is produced to maintain glucose levels in the bloodstream when fasting

and to raise very low glucose levels.

1. It stimulates the conversion of stored glycogen (stored in the liver) to

glucose, which can be released into the bloodstream. This process is called
glycogenolysis.

2. It promotes the production of glucose from amino acid molecules. This

process is called gluconeogenesis.

3. It reduces glucose consumption by the liver so that as much glucose as

possible can be secreted into the bloodstream to maintain blood glucose
levels.

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PROTEINS
➢ What is protein, and why is it important?

Proteins are the main building blocks of your body. They’re used to make muscles,
tendons, organs, and skin, as well as enzymes, hormones, neurotransmitters, and
various molecules that serve many important functions.

Proteins consist of smaller molecules

called amino acids, which link together
like beads on a string. These linked
amino acids form long protein chains,
which then fold into complex
shapes.Your body produces some of
these amino acids, but you must obtain
others known as essential amino acids
via your diet.Protein is not only about
quantity but also quality.

Generally, animal protein provides all essential amino acids in the right ratio for
you to make full use of them. This makes sense, as animal tissues are similar to
your own tissues.If you’re eating animal products like meat, fish, eggs, or dairy
every day, you’re likely getting enough protein.

However, if you don’t eat animal foods, getting all the protein and essential
amino acids your body needs can be more challenging. If you’re following a plant-
based diet, you may be interested in this article on the 17 best protein sources for
vegans.Few people need to supplement with protein, but doing so can be useful
for athletes and bodybuilders.

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Proteins are classified into two major categories:

1. Essential Amino acids which cannot synthesis (produce) in our body.

• Methionine
• Tryptophan
• Valine
• Isoleucine
• Leucine
• Phenylalanine
• Lysine
• Threonine
• Arginine
• Histidine (only for infants)

2. Non Essential Amino acids which can be synthesised (produce) in our

body.
• Glutamic acid
• Proline
• Glycine
• Alanine
• Hydroxyproline

Proteins which are lacking amino acids they do not meet the protein
requirements of our body because they are not good quality proteins. The higher
the amino acid profile the higher the nutritive value of protein. Based on amino
acid profile we can subclassified proteins into three categories:

1. Complete proteins – for eg: eggs. This proteins promote growth and
provided all essential amino acids .
2. Partially complete proteins – for eg: wheat protein. These promote
moderate growth and partially lack one or more essential amino acid.

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Diploma in Ditetics FGIIT,

3. Incomplete proteins – for eg: Gelatin. They do not promote good growth.

Function of Protein:
Each of various proteins serves the major function as maintenance of
life. Any loss in body protein means loss in cellular function. When
human beings take insufficient supply of protein the dietary deficiency
create loss of tissue functionality.
➢ Can aid weight loss and prevent weight gain.
A protein intake at around 30% of calories seems to be optimal for weight
loss. It boosts your metabolic rate and causes a spontaneous reduction in
calorie intake.
➢ Can help you gain muscle and
strength.
Muscles are largely made of
protein.
As with most body tissues,
muscles are dynamic and
constantly being broken down and rebuilt.
To gain muscle, your body must synthesize more muscle protein than it
breaks down.In other words, there needs to be a net positive protein
balance in your body — often called nitrogen balance, as protein is high in
nitrogen.

As such, people who want to build muscle often eat more protein, as well
as exercise. A higher protein intake can help build muscle and strength.
Meanwhile, those who want to maintain the muscle they’ve built may need
to increase their protein intake when losing body fat, as a high protein
intake can help prevent the muscle loss that usually occurs when dieting.
When it comes to muscle mass, studies usually don’t look at the percentage
of calories coming from protein but rather the daily grams of protein per
kilograms or pounds of body weight.A common recommendation for

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gaining muscle is 1 gram of protein per pound (2.2 grams per kg) of body
weight.

Other scientists have estimated protein needs to be a minimum of 0.7

grams per pound (1.6 grams per kg) of body weight.Numerous studies have
tried to determine the optimal amount of protein for muscle gain, but
many have reached varying conclusions.
Some studies show that consuming more than 0.8 grams per pound (1.8
grams per kg) has no benefit, while others indicate that intakes slightly
higher than 1 gram of protein per pound (2.2 grams per kg) are best.
Though it’s hard to give exact figures due to conflicting study results, about
0.7–1 gram per pound (1.6–2.2 grams per kg) of body weight seems to be a
reasonable estimate.If you’re carrying a lot of body fat, using either your
lean mass or goal weight — instead of your total body weight — is a good
idea, as it’s mostly your lean mass that determines the amount of protein
you need.
➢ Protein in pregnancy
During pregnancy, the body needs more protein for tissue development
and growth. Protein benefits both the mother and baby.
The authors of one study suggest that people consume 0.55–0.69 grams
per pound (1.2–1.52 grams per kg)
of protein daily during pregnancy.

Elsewhere, experts recommend

consuming an extra 0.55 grams per
pound (1.1 grams per kg) of protein
per day during pregnancy (17).

The recommended daily allowance for protein during breastfeeding is 0.59

grams per pound (1.3 grams per kg) per day, plus 25 additional grams (18).

Dietary sources are the ideal way to obtain any nutrient. Good sources
include:

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• Beans, Peas, And Lentils

• Eggs
• Lean Meat
• Dairy Products
• Nuts And Seeds
• Tofu
➢ Other circumstances that can increase protein needs
Regardless of muscle mass and physique goals, those who are physically
active need more protein than those who are sedentary.If your job is
physically demanding or you walk a lot, run, swim, or do any sort of
exercise, you need to eat more protein.

Endurance athletes also need significant amounts of protein — about 0.5–

0.65 grams per pound (1.2–1.4 grams per kg) of body.Older adults have
significantly increased protein needs as well — up to 50% higher than the
DRI, or about 0.45–0.6 grams per pound (1–1.3 grams per kg) of body
weight.This can help prevent osteoporosis and sarcopenia, both of which
are significant problems among older adults.
People recovering from injuries may likewise need more protein.
Fish and seafood are also good sources. During pregnancy and lactation,
choose fish that are low in mercury and high in omega-3 fatty acids, such as
salmon, sardines, and anchovies.
However, take care to avoid those that may be high in mercury, such as
shark, swordfish, tilefish, and king mackerel.

Ideally, you should get all your protein from food sources. In some cases,
your healthcare provider may recommend supplements. However, there
are no guidelines for supplementing with protein during pregnancy.

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• Protein as carriers: There are several compound in our body which need
transportation where amino acid plays vital role which help
certain compound to transport and make the process safe
from reactions.

• Protein as regulater of water: The protein hormone particularly Antidiuretic

Hormone (ADH) plays a role in controlling water balance. The
oedema of protein deficiency may also be the results of the
body’s inability to regulate ADH. The effect of protein deficiency
is on the distribution of water amongst the various body
compartments than on the total body water.

• Protein as enzymes: Protein have the ability to accept or donate hydrogen

ions, hence serving as enzymes.

• Protein as lubricants: surrounds the joints. It is also present as mucous in the

respiratory tract, oral cavity, vaginal tract and the rectal cavity thereby
reducing the irritation which might be caused by materials moving through
these passages.

• Protein as structural units: Liver cell membren contains 50-60% protein,

muscle contains 20%. Keratin is a protein which is in form of nails and hairs.
Melanin is the derivative which provides which provides characteristic colour
to the skin.

➢ Does protein have any negative health effects?

Protein has been unfairly blamed for a number of health problems.Some
people believe that a high protein diet can cause kidney damage and
osteoporosis, but science does not support these claims.

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Though protein restriction is helpful for people with preexisting kidney

problems, there’s no evidence that protein can cause kidney damage in
healthy people.

In fact, a higher protein intake may lower blood pressure and help fight
diabetes, which are two of the main risk factors for kidney disease.

Any assumed detrimental effects of protein on kidney function are

outweighed by its positive effects on these risk factors.

Some people have claimed that too much protein can lead to osteoporosis,
but research shows that it can prevent this condition.Overall, there’s no
evidence that a reasonably high protein intake has any adverse effects in
healthy people trying to optimize their health.

➢ How to get enough protein in your diet.

The best sources of
protein are meats, fish,
eggs, and dairy products,
as they have all the
essential amino acids that
your body needs.

Some plants are fairly

high in protein as well, such as quinoa, legumes, and nuts.However, most
people generally don’t need to track their protein intake.

If you’re healthy and trying to stay that way, simply eating quality protein
sources with most of your meals, along with nutritious plant foods, should
bring your intake to an optimal range.

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Dietary Allowances Protein

The necesassary amount to meet the need of physological needs and maintain
the healthy health all individual should folllow the daily recommended allowances
of protein approved by WHO.

As per different requirement of protein in different age, gender, locality, weather

groups daily allowance changes.

Healthy individual for sure need 1 gm. Protein per Kg of body weight minimum as
per daily recommended allownces.

1 gm. Of protein contains 4 kcal.

➢ What “grams of protein” really means.
This is a very common area of misunderstanding.In nutrition science,
“grams of protein” refers to the number of grams of the macronutrient
protein, not the number of grams of a protein-containing food like meat or
eggs.

An 8-ounce serving of beef weighs 226 grams but only contains 61 grams of
protein. Similarly, a large egg weighs 46 grams but only packs 6 grams of
protein.
➢ What about the average person?
If you’re at a healthy weight, don’t lift weights, and don’t exercise much,
aiming for 0.36–0.6 grams per pound (0.8–1.3 gram per kg) is a reasonable
estimate.

• This amounts to:

56–91 grams per day for the average male
46–75 grams per day for the average female
Still, given that there’s no evidence of harm and significant evidence of
benefit, it’s likely better for most people to err on the side of consuming
more protein rather than less.

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Biological value:
It is the measurement of protein quality expressing the rate of efficincy with
which protein is used for growth.

On the scale of 100 most efficient this biological table lies.

Food Items Biological Value

Whole egg 93.7
Milk 84.5
Fish 76
Beef 74.3
Soyabean 72.8
Rice polished 64
Wheat, whole 64
Corn 60
Beans, Dry 58

Protein Imbalance Effectes:

We all know anything which is more and less which has certain pros and cons on
our health.

Spcially in protein content where you take excess there are certain effect which
you will notice on your health which are listed below:

1. Damage kidney stones: Once materials are released from the solid bone,
the calcium and other bone substances move through the blood stream to
the kidneys where they are eliminated in the urine. In an effort to remove
overabundance of waste protein, the flow of blood through the kidney
increases and the results: calcium is filtered of the body. Naturally, the
kidneys, attempt to return much of this filtered calcium back to the body;
unfortunately, the acid and sulphur-containing amino acids from the animal
foods ruin the body’s attempts to conserve calcium. Plant proteins (plant
food bases) do not have these calcium and bone losing effects under

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normal living conditions. Once this bone material arrives in the collecting
system of kidney it easily precipitates into solid formations known as kidney
stones.

2. Uric acid imbalance: Uric acid is a chemical created when the body breaks
down substances called purines.
Purines are normally produced in
the body and are also found in some
foods and drinks. Foods with high
content of purines include liver,
anchovies, mackerel, dried beans
and peas, and beer.

Excess protein as much as 250-300 gm. Of

protein causes all these above mentioned
wear and tear at certain point.

Effect of protein deficiency in elderly called as PEM (protein engery malnutrient)

clinically. It can lead to certain diseases like,

1. Bone loss

2. Osteoporosis : worldwide rates of hip fractures (and kidney stones)

increase with increase in animal protein consumption including dairy
products. Osteoporosis is caused by several controllable factors; however,
the most important one is foods we
choose – especially the amount of
animal protein and the foods high in
acid. The high acid foods are meat,
poultry, fish, seafood and hard
cheeses – parmesan cheese is the
most acidic of all foods commonly
consumed. This acid must be

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neutralize by the body. Carbonate, citrate and sodium area alkaline

materials released from the bones to neutralise the acids. Fruits and
vegetables are alkaline and as a result, a diet high in these plant foods will
neutralize acid and preserve bones.

Effect of protein deficiency in children called as PEM (protein engery

malnutrient) clinically. It can lead to certain diseases like,

1. Marasmus: the dry form, Marasmus, results from the near starvation with
deficiency of protein and non protein nutrients.
2. Marasmic: The marasmic child consumes very little food - often because
his mother is unable to breastfeed - and is very thin from loss of muscle
and body fat.
3. Kwashiorkor: the wet form is called kwashiorkor, An African word meaning
“first child – second child.”It refers to the observation that the first child
develops PEM when the second child is born and replaces the first child at
the breast. The weaned child is fed a thin gruel of poor mal nutrition quality
(compared with mothers’ milk) and fails to thrive. The protein deficiency is
usually more marked than the energy deficiency, and edema results.
Children with kwashiorkor tend to be older than those with marasmus and
tend to develop the disease after they are weaned.

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All these diseases has signs and symptoms like

• Curly hair
• Odema on body
• Protuding belly
• Enlargement of liver
• Tissue wasting
• Hunger
• Gross weight loss

This kind of children who has PEM they need spcial care and nourishment. As
their digestive tract and protein absorbstion system is very less active feeding
them with lots of good quality food would be harmful.

One must gradully increase the amount of nutrient in their food and give
sufficient time to devlop matabolic pathways to Handel a better diet.

Sources of Proteins:
Sr. Vegetarian Sources Animal Sources
No.

1. Grains: Rice, wheat, corn, bajra, Dairy: Milk, curd, lassi, paneer
ragi, millet etc.

2. Green Leafy Vegetables Meat: Mutton

Spinach, Broccoli, Methi, Kale etc..

3. Legumes, beans, peas, sprouts Poltry: Chicken, eggs

4. Fruits Sea Food: Prones, Fish, Oyester etc..

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16 Delicious High Protein Foods.

1. Egg

Whole eggs are among the most nutritious foods

available.They’re a good source of protein that’s easy to
absorb, and they’re also an excellent source of vitamins,
minerals, healthy fats, and antioxidants.

For example, whole eggs are packed with selenium and

vitamins B12 and A. They’re also rich in choline, a nutrient
that’s especially important during pregnancy and
breastfeeding because it plays critical roles in growth and
development .Keep in mind that egg whites are almost
pure protein, but whole eggs that include the yolk provide many more nutrients,
including vitamins, minerals, antioxidants, and healthy fats.

If you’re concerned about the cholesterol in egg yolks, it’s important to note that
lots of research has debunked the idea that they’re bad for you.On the contrary,
many studies have shown that whole eggs are incredibly healthy for most people
and may actually help prevent chronic diseases

2. Almonds

Almonds are a nutritious tree nut rich in essential nutrients like fiber, vitamin
E, manganese, and magnesium.They’re
also high in plant-based protein.

Eating almonds may benefit your health in

several ways, including by lowering heart
disease risk factors like high LDL (bad)
cholesterol and high blood pressure.Try
adding some almonds to plant-based
meals, like grain bowls and salads, for a
boost of filling protein and fiber.

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If you’re looking to add more nuts to your diet, also consider pistachios and
cashews. Both of these healthy nuts are also packed with protein.

3. Chicken Breast

Chicken breast is an excellent choice if

you’re trying to bump up your protein
intake. In addition to protein, chicken
provides a variety of B vitamins, plus
minerals like zinc and selenium.

Chicken breast is also very versatile and

easy to cook. It can taste delicious in a
wide range of dishes.Try adding sliced
chicken breast to salads, stir-fries, and soups to make these dishes more filling.

4. Cottage cheese

Cottage cheese is a type of cheese that is low in fat and calories, yet high in
protein.

It’s rich in calcium, phosphorus, selenium,

vitamin B12, riboflavin (vitamin B2), and
various other nutrients.Plus, research
suggests that cottage cheese is just as filling
as eggs, making it an excellent choice for a
satisfying meal or snack.

For example, you can pair it with cut-up fruit for a high protein breakfast on
the go.

5. Greek yogurt

Greek yogurt, also called strained yogurt, is a

very thick type of yogurt that’s high in
protein.It has a creamy texture and is a good

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source of many nutrients like calcium, vitamin B12, vitamin A, selenium, and
zinc.

Its slightly tart flavor pairs well with both sweet and savory dishes, making it a
versatile kitchen ingredient. Try adding Greek yogurt to smoothies, soups,
salad dressings, and baked goods, or just enjoy it with a bit of fruit and a
sprinkle of crushed nuts for crunch.When you’re buying Greek yogurt, opt for
products that have no sugar added.

6. Milk

Dairy milk contains a little of nearly every nutrient that your body needs.It’s a
good source of high quality protein,
and it’s high in vitamins and
minerals, like calcium, phosphorus,
and riboflavin (vitamin B2).

Many people with lactose

intolerance can’t tolerate milk and
other dairy products, and they
avoid many dairy-containing foods.Fortunately, there’s a variety of lactose-
free products now on the market, including lactose-free milk, cheeses, and
yogurts.

Nondairy milk alternatives, like cashew milk and coconut milk, can be a good
substitute for milk in many cases, but they’re usually much lower in protein
and don’t contain the same nutrients.

If you drink dairy milk, including lactose-free milk, it can be a good choice to
increase your protein intake.

7. Lentils

Lentils are among the richest sources of plant-

based protein you can eat, making them an
excellent choice if you’re following a vegetarian
or vegan diet.Plus, they’re loaded with other

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nutrients too, including fiber, folate, magnesium, potassium, iron, copper, and
manganese.

Studies show that people who regularly consume lentils and other legumes
have a lower risk of developing health conditions like heart disease and fatty
liver disease.

8. Lean beef

Lean beef is a rich source of protein. It’s also high in bioavailable iron, zinc,
selenium, and vitamins B12 and B6.Red
meat can be a part of a healthy diet, but
it’s best to moderate your intake.
Consuming high amounts of red meat has
been linked to a higher risk of developing
certain health conditions, including
colorectal cancer.

Try cutting back on red meat and eating plant-based protein, fish, and poultry
more frequently.

9. Fish

Fish is an excellent source of protein and provides a number of important

vitamins and minerals, like iodine,
selenium, and vitamin B12.

People who include a lot of fish in their diet

tend to have a lower risk of health
conditions like heart disease and type 2
diabetes.Plus, fatty fish like salmon and
herring are high in omega-3 fats, which
have powerful benefits for your overall
health, including supporting heart health.

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10. Quinoa

We think of quinoa as a grain, but it’s actually a seed, which is why it’s
categorized as a pseudocereal. Quinoa is very popular in the wellness world.

It’s rich in fiber, folate, copper,

iron, and zinc, and it’s higher in
protein than many grains.Quinoa is
often referred to as a complete
protein because it contains all nine
of the essential amino acids that
your body can’t make on its own.
However, it actually contains
insufficient amounts of certain amino acids, like lysine.

For this reason, experts argue that quinoa should be considered a “nearly
complete” protein.

This may be of interest to you if you’re following a vegetarian or vegan diet

and looking to make sure you’re getting all nine essential amino acids.
Regardless, quinoa is a good source of protein and is delicious in dishes like
grain bowls, soups, and porridges.

11.Protein Powders

When you’re pressed for time

and unable to prepare a meal,
protein powder can come in
handy.

You can easily add protein

powders like whey and pea
protein to shakes, smoothies,
energy balls, yogurt, and more to
increase the protein and fullness
factor.There’s a protein powder for nearly every taste preference and dietary

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restriction.Pea protein and whey protein are both excellent choices for those
looking for a convenient way to increase their protein intake.

12. Ezekiel bread

Ezekiel bread is different from most other breads.

It’s made of organic and sprouted

whole grains and legumes, including
millet, barley, spelt, wheat, soybeans,
and lentils.Compared with other
breads, like white bread, Ezekiel bread
is high in protein, fiber, and various
important nutrients.

Try making a protein-rich sandwich by topping Ezekiel bread with turkey,

lettuce, tomato, and a bit of hummus.

13.Pumpkin Seeds

Pumpkin seeds are incredibly

delicious and highly nutritious.

For example, they’re a great source of

minerals like iron, phosphorus,
magnesium, and zinc. Plus, they’re
loaded with plant-based protein and
fiber.

Try adding pumpkin seeds to salads, baked goods, oatmeal, or yogurt, or mix
them with unsweetened dried fruit and almonds for a convenient snack.

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14.Turkey breast

Turkey breast is similar to chicken breast in many

ways.

It consists mostly of protein, with very little fat

and a low number of calories. It’s also high in a
number of vitamins and minerals, including
selenium, zinc, and vitamins B12 and B6.Turkey breast is delicious on salads
and sandwiches, and you can also add it to soups
and grain dishes to increase the protein content of
your meals.

15.Shelfish

Shellfish, including shrimp, oysters, clams, and

scallops are excellent sources of protein.

Plus, shellfish contain healthy fats and a number of vitamins and minerals,
including selenium, zinc, vitamin B12, and iron.All types of shellfish are high in
protein. You can enjoy them in recipes like
salads, pastas, and stir-fries.

16.Peanuts and peanut butter

Although people commonly think of peanuts

as nuts, they’re actually legumes.

Peanuts and peanut butter are packed with

nutrients, like protein, folate, magnesium,
and vitamin E.

Eating peanuts and peanut butter may help make you feel full due to their high
protein content. In fact, studies show that adding peanut butter to a high carb
meal may help reduce blood sugar spikes after the meal .For example, putting
peanut butter on a slice of bread can help you feel more satisfied and may
help keep your blood sugar more stable after you eat.

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➢ 14 Easy Ways to Increase Your Protein Intake.

1. Eat your protein first

When eating a meal, eat the protein source first, especially before you get
to the starches.Protein increases the production of peptide YY (PYY), a gut
hormone that makes you feel full and satisfied Source.

In addition, a high protein intake decreases levels of ghrelin, the “hunger

hormone,” and increases your metabolic rate after eating and during
sleep.What’s more, eating protein first can help keep your blood sugar and
insulin levels from rising too high after a meal.

In one small study, people with type 2 diabetes were served identical meals
on different days. Blood sugar and insulin rose significantly less when they
consumed protein and vegetables before eating high carb foods, compared
with when the order was reversed.

2. Snack on Cheese

Snacks are a good way to get extra protein into your diet — as long as you
choose healthy ones.

Many common snack foods, such as chips, pretzels, and crackers, are very
low in protein.For example, a 1-cup (30-gram) serving of plain tortilla chips
has 142 calories but only 2 grams of protein.

In contrast, a 1-ounce (28-gram) serving of cheddar cheese contains 7

grams of protein, along with nearly 30 fewer calories and 6 times as much
calcium.

Additionally, cheese doesn’t seem to raise cholesterol levels much, even

among people with high cholesterol. In fact, some research suggests that
cheese may even benefit heart health.Try enjoying a cheese stick between
meals or pair your favorite type of cheese with whole grain crackers,
tomatoes, or sliced apples for a healthy and satisfying snack.

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3.Replace cereals with eggs.

Many breakfast foods are low in protein, including toast, bagels, and
cereals.

Although oatmeal contains more protein than most cereals, it still only
provides about 5 grams in a typical 1-cup (240-gram) serving.On the other
hand, 3 large eggs provide 19 grams of high quality protein, along with
important nutrients like selenium and choline.What’s more, several studies
have shown that eating eggs for breakfast reduces appetite and keeps you
full for several hours, so you end up eating fewer calories later in the
day.According to one older study, eating whole eggs can also modify the
size and shape of your LDL (bad) cholesterol particles in a way that may
even decrease your heart disease risk.

4.Top your food with chooped almonds.

Almonds are incredibly healthy.They’re high in magnesium, fiber, and

heart-healthy monounsaturated fat, yet low in digestible carbs.Almonds
also contain 6 grams of protein in a 1-ounce (28-gram) serving, which
makes them a better source of protein than most nuts.

And although a serving of almonds contains around 170 calories, studies

have shown that your body absorbs only about 133 of those calories
because some of the fat isn’t digested.So sprinkle a few tablespoons of
chopped almonds over yogurt, cottage cheese, salads, or oatmeal to
increase your protein intake and add a bit of flavor and crunch.

5.Choose Greek yogurt

Greek yogurt is a versatile, high protein food.

It’s made by removing whey and other liquids to produce a richer, creamier
yogurt that’s higher in protein.A 7-ounce (240-gram) serving provides 17–

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20 grams of protein, depending on the specific brand. This is about twice

the amount in traditional yogurt.

Research shows Greek yogurt increases the release of the gut hormones
glucagon-like peptide 1 (GLP-1) and PYY, which reduce hunger and make
you feel full.

In addition, it contains conjugated linoleic acid (CLA), which has been

shown to promote fat loss in some studies.Greek yogurt has a tangy flavor
that goes well with berries or chopped fruit. It can also be used as a
substitute for sour cream in dips, sauces, and other recipes.

6.Have a protein shake for breakfast

Many smoothies contain a lot of fruit, vegetables, or juice, but very little
protein.

However, a shake or smoothie

can be a great breakfast option,
especially if you choose
nutritious ingredients.

Protein powders make it easy to

create a healthy, high protein shake. There are several types on the market,
including whey, soy, egg, and pea protein.Whey protein powder has been
studied the most and seems to have an edge over the others when it comes
to helping you feel full.In fact, one scoop (28 grams) of whey powder
provides about 17 grams of protein, on average.

7.Include a high protein in every meal.

When it comes to protein, it’s not just the total amount you take in every
day that matters. Getting enough at each meal is also important.

Several researchers recommend consuming a minimum of 20–30 grams of

protein at each meal.Studies show that this amount promotes fullness and

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preserves muscle mass better than smaller amounts eaten throughout the
day.

Examples of foods high in protein include meat, fish, poultry, eggs,

legumes, and soy products like tofu or tempeh.You can also select foods
from this list of delicious high protein foods to make sure you meet your
needs at every meal.

8. Choose leaner, slightly larger cuts of meat.

Selecting leaner cuts of meat and increasing portion sizes slightly can
significantly boost the protein content of your meal.

9. Add peanut butter to your diet.

Peanut butter is a delicious, high protein food with a creamy texture that
pairs well with a variety of ingredients.

Studies suggest that peanut butter may be associated with several health
benefits and could decrease appetite, increase fat burning, and reduce
blood sugar levels.

Peanut butter can also boost the flavor and nutritional value of firm fruits
like apples and pears, which are rich in fiber and antioxidants yet low in
protein.

In fact, spreading 2 tablespoons (32 grams) of peanut butter on sliced fruit

can boost the total protein content by 7 grams.

Peanut butter also works well with a wide range of other ingredients,
including oatmeal, celery, whole wheat toast, or yogurt.

10.Eat learn jerky

Lean jerkies and snack sticks are good sources of protein. Choose high
quality types that come from grass-fed animals whenever possible.

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11. Indulge in cottage cheese at any time

Cottage cheese is a tasty food that’s also very high in protein. A 1-cup (210-
gram) serving contains 23 grams of protein and 176 calories.

A 2015 study found cottage cheese to be as filling and satisfying as eggs.

What’s more, full fat varieties are a good source of CLA, which may
promote fat loss and lead to improved body composition.

One older study followed women who ate a high protein, high dairy diet
while exercising and reducing calorie intake. They lost more belly fat and
gained more muscle mass than women with moderate intakes of protein
and dairy.

Cottage cheese is delicious on its own. You can also try it with chopped nuts
or seeds, cinnamon, and stevia for a quick and easy breakfast.Additionally,
smaller amounts of cottage cheese make a great snack between meals and
can be added to fruit salads or smoothies to bump up their protein
contents.

12.Munch on Endamame

Edamame is the term for steamed soybeans in

their unripened form.

Soybeans have more protein than other legumes

and are popular among vegetarians and vegans.

One cup (155 grams) of edamame has almost 19

grams of protein and about 188 calories.

Edamame is also high in an antioxidant known as kaempferol. Mouse

studies suggest it may reduce blood sugar and aid weight loss.Edamame
can be purchased fresh or frozen and makes a great snack. It can also be
added to stir-fries, salads, stews, and rice dishes.

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13.Eat canned Fish

Canned fish is a fantastic way to boost your protein intake.

It requires no refrigeration, so it’s wonderful for travel. It can also be

enjoyed as a snack or with a meal.A 3.5-ounce (100-gram) serving of
canned fish contains about 19 grams of protein and just 90 calories.

Fatty fish like salmon, sardines, herring, and mackerel are also excellent
sources of omega-3 fatty acids, which can fight inflammation and improve
heart health.Ideas for serving canned fish include combining it with healthy
mayo, serving it on top of a salad, eating it straight from the can, or adding
it to an omelet, croquette, or pasta dish.

14.Enjoy More Whole grains

Whole grains are highly nutritious and can bump up the protein content of
many dishes when used in place of refined grains.

➢ 10 Science-Backed Reasons to Eat More Protein.

1. Reduces Appetite and Hunger Levels

The three macronutrients — fats, carbs, and protein — affect your body in
different ways.

Studies show that protein is by far the most filling. It helps you feel more
full — with less foodThis is partly because protein reduces your level of the
hunger hormone ghrelin. It also boosts the levels of peptide YY, a hormone
that makes you feel full.

These effects on appetite can be powerful. In one study, increasing protein

intake from 15% to 30% of calories made overweight women eat 441 fewer
calories each day without intentionally restricting anything.

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If you need to lose weight or belly fat, consider replacing some of your
carbs and fats with protein. It can be as simple as making your potato or
rice serving smaller while adding a few extra bites of meat or fish.

2.Increase Muscle Mass & Strength.

Protein is the building block of your muscles.

Therefore, eating adequate amounts of protein helps you maintain your

muscle mass and
promotes muscle growth
when you do strength
training.Numerous studies
show that eating plenty of
protein can help increase
muscle mass and
strength.

If you’re physically active,

lifting weights, or trying to gain muscle, you need to make sure you’re
getting enough protein.

Keeping protein intake high can also help prevent muscle loss during weight
loss.

3.Good for your bones

An ongoing myth perpetuates the idea that protein — mainly animal

protein — is bad for your bones.

This is based on the idea that protein increases acid load in the body,
leading to calcium leaching from your bones in order to neutralize the
acid.However, most long-term studies indicate that protein, including
animal protein, has major benefits for bone health.

People who eat more protein tend to maintain bone mass better as they
age and have a much lower risk of osteoporosis and fractures,This is

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especially important for women, who are at high risk of osteoporosis after
menopause. Eating plenty of protein and staying active is a good way to
help prevent that from happening.

4. Reduces Cravings and Desire for Late-Night Snacking

A food craving is different from normal hunger.

It is not just about your body needing energy or nutrients but your brain
needing a reward.

Yet, cravings can be incredibly hard to control. The best way to overcome
them may be to prevent them from occurring in the first place.

One of the best prevention methods is to increase your protein intake.One

study in overweight men showed that increasing protein to 25% of calories
reduced cravings by 60% and the desire to snack at night by half.

Likewise, a study in overweight adolescent girls found that eating a high-

protein breakfast reduced cravings and late-night snacking.This may be
mediated by an improvement in the function of dopamine, one of the main
brain hormones involved in cravings and addiction.

5. Boosts Metabolism and Increases Fat Burning.

Eating can boost your metabolism for a short while.

That’s because your body uses calories to digest and make use of the nutrients
in foods. This is referred to as the thermic effect of food (TEF).However, not all
foods are the same in this regard. In fact, protein has a much higher thermic
effect than fat or carbs — 20–35% compared to 5–15%.

High protein intake has been shown to significantly boost metabolism and
increase the number of calories you burn. This can amount to 80–100 more
calories burned each day.

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In fact, some research suggests you can burn even more. In one study, a high-
protein group burned 260 more calories per day than a low-protein group.
That’s equivalent to an hour of moderate-intensity exercise per day.

6. Lowers Your Blood Pressure

High blood pressure is a major cause of heart attacks, strokes, and chronic
kidney disease.

Interestingly, higher protein intake has been shown to lower blood pressure.

In a review of 40 controlled trials, increased protein lowered systolic blood

pressure (the top number of a reading) by 1.76 mm Hg on average and
diastolic blood pressure (the bottom number of a reading) by 1.15 mm Hg.

One study found that, in addition to lowering blood pressure, a high-protein

diet also reduced LDL (bad) cholesterol and triglycerides.

7. Helps Maintain Weight Loss

Because a high-protein diet boosts metabolism and leads to an automatic

reduction in calorie intake and cravings, many people who increase their
protein intake tend to lose weight almost instantly.One study found that
overweight women who ate 30% of their calories from protein lost 11 pounds
(5 kg) in 12 weeks — though they didn’t intentionally restrict their diet.

Protein also has benefits for fat loss during intentional calorie restriction.

In a 12-month study in 130 overweight people on a calorie-restricted diet, the

high-protein group lost 53% more body fat than a normal-protein group eating
the same number of calories.

Of course, losing weight is just the beginning. Maintaining weight loss is a

much greater challenge for most people.A modest increase in protein intake
has been shown to help with weight maintenance. In one study, increasing
protein from 15% to 18% of calories reduced weight regain by 50%.If you want

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to keep off excess weight, consider making a permanent increase in your

protein intake.

8. Does Not Harm Healthy Kidneys.

Many people wrongly believe that a high protein intake harms your kidneys.

It is true that restricting protein intake can benefit people with pre-existing
kidney disease. This should not be taken lightly, as kidney problems can be
very serious.

However, while high protein intake may harm individuals with kidney
problems, it has no relevance to people with healthy kidneys.

In fact, numerous studies underscore that high-protein diets have no harmful

effects on people without kidney disease.

9. Helps Your Body Repair Itself After Injury.

Protein can help your body repair after it has been injured.

This makes perfect sense, as it forms the main building blocks of your tissues
and organs.Numerous studies demonstrate that eating more protein after
injury can help speed up recovery.

10. Helps You Stay Fit as You Age.

One of the consequences of aging is that your muscles gradually weaken.

The most severe cases are referred to as age-related sarcopenia, which is one
of the main causes of frailty, bone fractures, and reduced quality of life among
older adults.Eating more protein is one of the best ways to reduce age-related
muscle deterioration and prevent sarcopenia.

Staying physically active is also crucial, and lifting weights or doing some sort
of resistance exercise can work wonders.

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➢ 17 Cheap and Healthy Sources of Protein.

• Natural peanut butters
• Eggs
• Edamame
• Canned Tuna
• Plain Greek yogurt
• Sunflower Seeds
• Black beans
• Sardines
• Cottage cheese
• Whey protein
• Lentils
• Oats
• Amaranath
• Milk
• Pumpkin seeds
• Canned Seeds
• Ground turkey

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LIPIDS
Since we all forced to believe that eating fat will
do the bad effect in our body and any direct fat
will stored as fat we tend to think fat is not
essential for our body.
But that is not true anymore. Fat is the most
essential nutrient for a human body.
Fats are storage from concentrated fuel for
human energy system. They are reserve store of
energy too.

Fats have poor oxygen levels and they are insoluble in water.

Properties of fats are like:

1. Insoluble in water
2. Soluble in organic solvent such as chloroform

Classification of fats
Based on Fatty acids:

1. Simple lipids: Simple lipids are esters of fatty acids with various glycerol and
they are called triglycerides.

2. Compounds lipids: Compound lipids are simple lipids which are combined
with proteins (lipoprotein) carbohydrate (glycolipids), Phosphates
(phospholipids) etc.

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Broader classifications:
Saturated Fat: - is type of fat in which the fatty acid chains have all single bonds. A
fat is made two kinds of smaller molecules: glycerol and fatty acids. Fats are made
of long chains of carbon atoms.

Unsaturated Fat: - is a fat or fatty acid in which there is at least one double bond
within the fatty acid chain. A fatty acid chain is mono un saturated fatty
acids(MUFA) contain one double bond and poly unsaturated fatty acids(PUFA)
contains more than one double bond.

Essential Fatty acids: they are essential because your body cannot produce them
on its own so they must come from your diet. The two primary EFAs are known as
linoleic acid (Omega-6) and alpha linoleic (Omega-3). They are necessary for the
following processes.

1) Formation of health cell membranes.

2) Proper development of functioning of the brain and nervous system.
3) Proper thyroid and adrenal activity.
4) Hormone production.
5) Regulation of blood clotting, omega-6, encourage blood clot formation,
whereas, omega-3 oil reduce clotting. The ideal is to achieve a balance
between omega-6 and omega-3.
6) Support healthy skin and hair.
7) Regulation of blood pressure, liver function, immune and inflammatory
responses.

Trans Fatty acids: Tran’s fatty acids are produced when vegetable oils are
hydrogenated to make margarines, vanaspati etc. Hence, major sources of Tran’s
fatty acids to human diets are commercially baked products, deep fried snacks in
vanaspati and sweets. Metabolically, trans fatty acids and saturated fatty acids
raise blood cholesterol levels.

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Sources of Fats:
Fats and Oils and their Fatty Acids

Saturated Fatty Monounsaturated Polyunsaturated Fatty Acids

Acids Fatty Acids
Linoleic Acid Linoleic Acid
Omega 3 Omega 6
Ghee / Butter Olive Low Mustard
Coconut Canola Red Palm Oil Canola
Palm Kernel Groundnut Palmolein Soybeans
Palm Oil Rice Bran Olive Rice Bran
Vanaspati Sesame Medium
Palmolein Groundnut
Red Palm Oil Rice Bran
High
Safflower
Sunflower
Cottonseed
Soya been
Sesame
Corn

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Functions of fats and oils: -

1. Fats contribute to texture, flavour, and taste and increases palatability
of the diet. They provide and effective medium of heat transfer in deep
frying and transfer of flavours from Indian spices.
2. Fats have highest heat energy density of 9 kcal/g. It is the major storage
form of energy in body requiring least space and minimum water for
hydration. Adipose cells are 80% lipid and only 20% water and protein.
3. Fats are essential for meeting nutritional needs of essential fatty acids.
SFA, MUFA and cholesterol can be synthesized in the body. Excessive
intake of SFA and cholesterol in diets can therefore be harmful.
4. Fats promote absorption of fat soluble vitamins like vitamin A, D, E and
K
5. Fat intake ensures satiety. It imparts feeling of fullness and satisfaction
and thus delays onset of hunger.
6. Fatty tissue provide insulation, adipose tissue helps to insulate your
body. This heat insulation keeps your body warm when you are exposed
to cold temperatures. Protection adipose tissue protects organs, bone
and other tissues from damage.
7. Some dietary fats contains antioxidants which provide stability to the oil
and prevent rancidity

Excessive Fat intake: - Contemporary Indian society shows nutrition transition

and access to fast food and fried snack while eating out has become a fashion.
This leads to an increased intake of saturated fatty acid, milk and milk products,
flesh foods and sugar at the cost of whole cereals, millets and pulses. The total
calories are also high, especially if alcohol consumption is also on a rise. Hence it
is important to draw the upper-limit of fat intake, as excess intake is closely linked
with increased risk of developing obesity, heart diseases and cancer.

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Clinical understanding of lipids: -

The blood is the means of transportation of lipids from one site to another and
the liver and the adipose tissues are the specialised organs that control lipid
metabolism. The synthesis of new lipids (Lip genesis) and the catabolism of lipids
(Lipolysis) are taking place continuously. These reactions are catalysed by specific
enzymes under the control of nervous and hormonal mechanisms.

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- Blood Lipids: the level of cholesterol and triglycerides in blood serum are
frequently determined in the clinical laboratories and provide clues to the
presence or absence of hyperlipidaemia.

- Triglyceride levels vary widely during the day. They are increased when
chylomicrons and very low destiny lipoproteins being transported following
a meal. The level increased with Lipolysis by adipose tissue as during weight
loss. They decrease when fat is being synthesized by the adipose tissue or
liver. The triglyceride levels increase gradually with age, but such an
increase in not necessarily desirable.
- However, cholesterol and triglyceride do not exist the Free State in the
circulation. Since fats are insoluble in water, protein provides the
mechanism for transport in the aqueous medium of the blood. These
protein- lipid complexes are known as Lipoproteins.
- Very low density Lipoproteins (VLDL):
Lipoproteins are made up to cholesterol, triglycerides and proteins. They
move cholesterol, triglycerides and other lipids to around the body. VLDL is
one of the three main types of lipoproteins. VLDL contains the highest
amount of triglycerides and a small amount of proteins.

- Low density Lipoproteins (LDL):

A molecule that is combination of lipids and proteins. LDL are the chief
carriers of cholesterol and are relatively low in triglycerides. When diets are
rich in saturated fatty acids lipids are transported in the blood. LDL
transports cholesterol from the liver to the tissues of the body. LDL
cholesterol is therefore considered the “bad” cholesterol.

- High density Lipoproteins(HDL):-

Have a protective effect i.e. it reduces the risk of coronary heart disease.
Persons who exercise regularly, who do not smoke and are of normal
weight have higher levels than those who are sedentary and obese.

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- Free Fatty acids (FFA): also designated as non-esterified fatty acids (NEFA)
are the principal source of fatty acids that are made available to the cells
for energy. The concentration of FFA in the blood at the given time is quite
low but the rate of turnover is so rapid that several thousand calories are
transported daily in the circulation in this way. The concentration of free
fatty acids is somewhat higher in the circulation during fasting, thus
indicating more rapid release from adipose tissues. It is somewhat lower
when carbohydrate is being absorbed, which indicates that carbohydrate is
being used for energy as well as synthesized to fat.

Liver and fat metabolism:

In fat metabolism the liver cells break down triglycerides and produce energy. If
someone’s blood sugar levels are too low, the livers break down glycogen and
releases sugar into the blood. As well as sugar the liver also store vitamins and
minerals (Iron and Copper) and release them into the blood when needed.

Synthesis of fat: - Triglycerides are synthesized by the epithelial cells of the

intestine mucosa, by the adipose tissue and by the liver.

Oxidation of fatty acids: -- all cells of the body except those of the central
nervous system and red blood cells can oxidize fatty acids to yield energy.
Although glucose is normally the only source of energy for the central nervous
system, the brain cells after a period of total starvation can adapt to the
utilization of ketone bodies derived from fat and amino acids.

Ketogensis: -
Ketogenesis is the biochemical process through which organisms produce. Ketone
bodies through breakdown of fatty acids and ketogenic amino acids. Ketosis is a
metabolic state in which fat provide most of the fuel for the body. It occurs when
there is limited access to glucose (Blood sugar). Which is the preferred fuel source
for many cells in the body. Ketosis is most often associated with ketogenic and
very lowcarbs diets.

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Cholesterol metabolism: - The liver and the intestine are the chief sites of
cholesterol synthesis but all cells are able to produce some cholesterol. The
endogenous production of cholesterol has been variously estimated at 800 to
1500 mg daily and is apparently independent of the dietary supply. Acetyl
coenzyme A is the direct precursor of cholesterol and thus any donor of acetyl
coenzyme A – fatty acids, glucose and some amino acids – is a potential source of
cholesterol.

Cholesterol is transported in the blood in the various classes of lipoproteins. The

body is unable to break down the cholesterol nucleus but the liver converts it by
enzyme action to bile acids. This is apparently rate limited, and therefore any
excess supply poses problems of disposal. Cholesterol as such and bile acids are
constituents of bile and excretion occurs from the intestine.

Morden myth buster:

1. Eating fat will make you fat.
2. Moderate to high cholesterol levels will hurt your heart conditions.
3. One should follow low fat diet for long time.
4. One should follow keto diet as lifestyle.

1 gm. Of fat contains 9 kcal.

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WATER – MOST FORGOTTEN NUTRIENT

Water is most forgotten nutrient but most essential substance.

Total water in our body is around 50-60%

of total body weight.

In male the ratio vary up to 65-70% of

water because they have higher
proportion of lean tissue and low amount
of fats. In female it varies up to 50-55%
because they have slightly higher amount
of fat.

Functions:
1. Water is a universal solvent:-
The more water we expand, the more water we need. It is the medium of
all cell fluids including digestive juices, lymph, blood, urine, and
perspiration. It carries nutrients to the cells and removes the waste
products to the lungs, kidney, gut and skin.
2. Water helps into many essential reactions like: hydrolysis that occurs in
digestion. It is providing yielding nutrients.
3. Water based fluids acts as lubricant in various parts of the body especially
within the joints. This makes movement easier and minimizes the wear and
tear in cartilage and bone.
4. Temperature regulator: Water plays an important role in the distribution of
heat throughout the body and the regulation of body temperature. Heat is
produced in the body due to hard work, exposure to heat, fever or by the
evaporation of perspiration from the surface of the skin.
5. Source of dietary Minerals: Water is composed of only oxygen and
hydrogen, however the water we drink or use in food preparation can
contain significant amounts of minerals such as calcium, magnesium, zinc,
copper and fluoride depending on the source of water and any water

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treatment e.g. hard water contains magnesium and calcium whereas soft
water contains sodium.
Water being an effective solvent, may carry significant amounts of toxic
compounds like lead, cadmium, pesticides and other industrial waste
products. Regular monitoring of water supply to check for contamination
and the filtering of water at the household level becomes and an
imperative action to safeguard our health.

➢ 7 Science-Based Health Benefits of Drinking Enough Water.

1. Helps maximize physical performance

If you don’t stay hydrated, your physical performance can suffer.

This is particularly important during intense exercise or high

heat.Dehydration can have a noticeable effect if you lose as little as 2% of
your body’s water content. However, it isn’t uncommon for athletes to lose
as much as 6–10% of their water
weight via sweat.

This can lead to altered body

temperature control, reduced
motivation, and increased fatigue. It
can also make exercise feel much
more difficult, both physically and
mentally

Optimal hydration has been shown to prevent this from happening, and it
may even reduce the oxidative stress that occurs during high intensity
exercise. This isn’t surprising when you consider that muscle is about 80%
water. If you exercise intensely and tend to sweat, staying hydrated can
help you perform at your absolute best.

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2. Significantly affects energy levels and brain function

Your brain is strongly influenced by your hydration status.Studies show that

even mild dehydration, such as the loss of 1–3% of body weight, can impair
many aspects of brain function.

In a study in young women, researchers found that fluid loss of 1.4% after
exercise impaired both mood and concentration. It also increased the
frequency of headaches .

Many members of this same research team conducted a similar study in

young men. They found that fluid loss of 1.6% was detrimental to working
memory and increased feelings of
anxiety.

A fluid loss of 1–3% equals about

1.5–4.5 pounds (0.5–2 kg) of body
weight loss for a person weighing
150 pounds (68 kg). This can
easily occur through normal daily
activities, let alone during
exercise or high heat.Many other
studies, with subjects ranging
from children to older adults,
have shown that mild dehydration
can impair mood, memory, and brain performance.

3. May help prevent and treat headaches

Dehydration can trigger headaches and migraine in some individuals.

Research has shown that a headache is one of the most common symptoms
of dehydration.

What’s more, some studies have shown that drinking water can help relieve
headaches in those who experience frequent headaches.

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A study in 102 men found that drinking an additional 50.7 ounces (1.5
liters) of water per day resulted in significant improvements on the
Migraine-Specific Quality of Life scale, a scoring system for migraine
symptoms.

Plus, 47% of the men who drank more water reported headache
improvement, while only 25% of the men in the control group reported this
effect.However, not all studies agree, and researchers have concluded that
because of the lack of high quality studies, more research is needed to
confirm how increasing hydration may help improve headache symptoms
and decrease headache frequency.

4. May help relieve constipation

Constipation is a common problem that’s characterized by infrequent

bowel movements and difficulty passing stool.Increasing fluid intake is
often recommended as a part of the treatment protocol, and there’s some
evidence to back this up.

Low water consumption appears to be a risk factor for constipation in both

younger and older individuals.

Increasing hydration may help decrease constipation.Mineral water may be

a particularly beneficial beverage for those with constipation.Studies have
shown that mineral water that’s rich in magnesium and sodium improves
bowel movement frequency and consistency in people with constipation.

5. May help treat kidney stones

Urinary stones are painful clumps of mineral crystal that form in the urinary
system.

The most common form is kidney stones, which form in the kidneys.There’s
limited evidence that water intake can help prevent recurrence in people
who have previously gotten kidney stones (22, 23).

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Higher fluid intake increases the volume of urine passing through the
kidneys. This dilutes the concentration of minerals, so they’re less likely to
crystallize and form clumps.Water may also help prevent the initial
formation of stones, but studies are required to confirm this.

6. Helps prevent hangovers

A hangover refers to the unpleasant symptoms experienced after drinking

alcohol.Alcohol is a diuretic, so it makes you lose more water than you take
in. This can lead to dehydration .

Although dehydration isn’t the main cause of hangovers, it can cause

symptoms like thirst, fatigue, headache, and dry mouth.Good ways to
reduce hangovers are to drink a glass of water between drinks and have at
least one big glass of water before going to bed.

7. Can aid weight loss

Drinking plenty of water can help
you lose weight.

This is because water can

increase satiety and boost your
metabolic rate.

Some evidence suggests that

increasing water intake can promote weight loss by slightly increasing your
metabolism, which can increase the number of calories you burn on a daily
basis. A 2013 study in 50 young women with overweight demonstrated that
drinking an additional 16.9 ounces (500 mL) of water 3 times per day before
meals for 8 weeks led to significant reductions in body weight and body fat
compared with their pre-study measurements.

The timing is important too. Drinking water half an hour before meals is the
most effective. It can make you feel more full so that you eat fewer
calories.In one study, dieters who drank 16.9 ounces (0.5 liters) of water

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before meals lost 44% more weight over a period of 12 weeks than dieters
who didn’t drink water before meals.

➢ What Are the Benefits of Drinking Hot Water?

1. May relieve nasal congestion
A cup of hot water creates steam. Holding a cup of hot water and taking a
deep inhale of this gentle vapor may help loosen clogged sinuses and even
relieve a sinus headache.

Since you have mucous membranes throughout your sinuses and throat,
drinking hot water may help warm that area and soothe a sore throat caused
by mucus buildup.According to an older 2008 studyTrusted Source, a hot drink,
such as tea, provided quick, lasting relief from a runny nose, coughing, sore
throat, and tiredness. The hot drink was more effective than the same drink at
room temperature.

2. May aid digestion

Drinking water helps to keep the digestive system moving. As the water moves
through your stomach and intestines, the body is better able to eliminate
waste.Some believe that drinking hot water is especially effective for
activating the digestive system.

The theory is that hot water can also dissolve and dissipate the food you’ve
eaten that your body might have had trouble digesting.

More research is needed to prove this benefit, though a 2016 studyTrusted

Source showed that warm water may have favorable effects on intestinal
movements and gas expulsion after surgery.In the meantime, if you feel like
drinking hot water helps aid your digestion, there is no harm in using this as a
remedy.

3. May improve central nervous system function

Not getting enough water, hot or cold, can have negative effects on your
nervous system functioning, ultimately affecting mood and brain function.

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Research from 2019Trusted Source has shown that drinking water can improve
central nervous system activity, as well as mood.This research showed that
drinking water boosted participants’ brain activity during demanding activities
and also reduced their self-reported anxiety.

4.May help relieve constipation

Dehydration is a common cause of constipation. In many cases, drinking water

is an effective way to relieve and prevent constipation. Staying hydrated helps
soften stool and makes it easier to pass.

Drinking hot water regularly may help keep your bowel movements regular.

5.Keeps you hydrated

Although some evidenceTrusted

Source shows that cool water is
best for rehydration, drinking
water at any temperature will
help keep you hydrated

The Institute of Medicine

recommendsTrusted Source that
women get 78 ounces (2.3 liters)
of water each day and that men get 112 ounces (3.3 liters) daily. Those figures
include water from food like fruits, veggies, and anything that melts.

You also need much more water if you’re pregnant or breastfeeding, engaging
in strenuous activity, or working in a hot environment.Try starting the day with
a serving of hot water and ending it with another. Your body needs water to
perform basically every essential function, so the value of that can’t be
overstated.

6. Reduces shivering in the cold

A 2017 studyTrusted Source found that while the body’s natural response in
cold conditions is to shiver, drinking warm fluids can help reduce shivering.

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Subjects wore suits circulated with water that was a bit above freezing, then
drank water at a variety of temperatures, including up to 126°F
(52°C).Researchers found that drinking the hot water quickly helped the
subjects put less work into maintaining their body temperature. That could be
handy, the study notes, for people working or exercising in cold conditions.

7. Improves circulation

Healthy blood flow affects everything from your blood pressure to your risk of
cardiovascular disease.

Taking a warm bath helps your circulatory organs — your arteries and veins —
expand and carry blood more effectively throughout your body.Drinking hot
water may have a similar effect. However, there’s little research that this is
effective.

As a bonus, warmth from drinking hot water or bathing at nighttime may help
relax you and prepare you for restful sleep.

8. May decrease stress levels

Since drinking hot water helps improve central nervous system functions,
you might end up feeling less anxious if you drink it.

According to a 2014 studyTrusted Source, drinking less water resulted in

reduced feelings of calmness, satisfaction, and positive emotions.Staying
hydrated may therefore improve your mood and relaxation levels.

9. May help the body’s detoxification systems

While there’s no definitive evidence hot water has a specific benefit in this
regard, a 2020 studyTrusted Source found drinking more water can help
protect the kidneys while diluting waste materials in the blood.

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And according to the Arthritis Foundation, drinking water is important for

flushing out your body. It can also help fight inflammation, keep the joints
well lubricated, and prevent gout.

10.May help relieve symptoms of achalasia

Achalasia is a condition during which your esophagus has trouble moving

food down into your stomach.

People with achalasia have trouble swallowing. They may feel as though
foods get stuck in their esophagus instead of moving to the stomach. This is
called dysphagia.Researchers aren’t sure why, but an older 2012
studyTrusted Source found drinking warm water may help people with
achalasia digest more comfortably.

Requirement of water:
The body has no provision for water storage, therefore the amount of water lost
every 24 hrs. must be replaced to maintain health and body efficiency. The
requirements in relation to body weight varies in a general way with age; the
younger the individual, the greater his/her requirements for water per unit body
weight.

• In Adults - 35ml/kg
• Children - 50 to 60 ml/kg
• Infants - 150ml/kg

Exercise, high temperature, low humidity, high altitude and a high fibre diet
increase fluid needs. Alcoholic beverages and those containing caffeine such as
coffee, tea and sodas, however are not good substitutes of water: both the
alcohol and caffeine acts as a diuretics, causing the body to lose fluids.

Daily loss of water:

Water is lost from the body by four routes: kidneys, skin, lungs and intestine.

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Renal Loss: normal adult kidneys excrete about 1 - 2 litres of urine daily. The
water is this total volume is made up of two proteins – Obligatory and facultative.

Obligatory water excretion – the kidney is obligated to excrete some water to rid
the body of its daily load of urinary solutes. The average adult obligatory water
excretion is about 900 ml.

Facultative water excretion – an additional 500 ml, more or less water is excreted
for maintaining water balance.

Skin: the water loss from the skin is through perspiration, which could be
insensible and/or visible.

- Insensible Perspiration: are relatively constant amount of water loss that is

proportionate to the surface area of the body. The name signifies that the water is
not noticeable as the evaporation takes place from the skin immediately.

- Visible Perspiration: are highly variable water losses. Whenever a great deal of
water is lost by perspiration, body water is conserved by the elimination of more
concentrated urine.

- Intestine: A small quantity of water lost in phases but this exceeds in diarrhoeal
episodes.

Lungs: - The air expired from the lungs also contains water. Conditions that would
increase the rate of respiration, such as fever increase the water loss by this
route. An individual involved in strenuous activity will lose more water by this
route compared to a sedentary person.

Oedema: In some pathological conditions the body is in positive water balance;

that is the intake of fluids is greater than the excretion, oedema results when the
body water is increased to the levels of 10% or more above normal.

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ENERGY METABOLISM
Energy: Energy in simple terms may be defined as the ability, or power, to do
work. Energy is released by the metabolism of food and the potential energy
value of foods is expressed in terms of the kilocalorie (Kcal). A kilocalorie is
defined as the amount of heat required to raise the temperature of 1 kg of water
through 1 degree Celsius. Internationally, the unit of energy measurement
commonly used is the Joule (J). It expresses the amount of energy expended
when 1 kg of a substance is moved 1 meter by a force of 1 newton. The
conversion factor for changing kilocalorie to kilojoules is 1 kilocalorie = 4.184
kilojoules.

The amount of heat energy per gram that can be made available to the body by
each of the energy yielding macronutrients as follows:

1 g of carbohydrates yields 4 Kcal

1 g of fat yields 9 Kcal

I g of protein yields 4 Kcal

Definition and components of energy: Basal Metabolic Rate is defined as that

fraction of total energy expenditure that is needed to maintain the vital
involuntary process of the body like heartbeat, kidney function etc. In other
words, Basal Metabolic Rate is the minimal calorie requirement needed to sustain
life in a resting individual. It is expressed as Kilocalories per 24 hours.

A closely related term used now is Resting Metabolic Rate (RMR). RMR is
measured with the subject in a supine or sitting position in a comfortable
environment several hours after a meal and without any significant activity. RMR
is slightly higher than BMR but the difference is small.

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Additional energy required in following conditions:

Growth: the energy cost of growth has two components comprising of the energy
needed to synthesize growing tissues and the energy deposited in this tissues. The
energy cost of growth declines with age.

Pregnancy: to meet the requirements of the growing child and the changes in the
maternal metabolism, extra energy is needed by the expectant mother.

Lactation: Well-nourished lactating women derive part of the additional

requirement for feeding the child from body fat stores accumulated during
pregnancy.

➢ What Is Basal Metabolic Rate?

Even when resting, your body burns calories by performing basic functions
to sustain life, such as:

• Breathing
• Circulation
• Nutrient processing
• Cell production
• Basal metabolic rate is the number of calories your body needs to
accomplish its most basic (basal) life-sustaining functions.

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➢ Basal metabolic rate vs. resting metabolic rate

Basal metabolic rate (BMR) is often used interchangeably with resting
metabolic rate (RMR). While BMR is a minimum number of calories
required for basic functions at rest

RMR — also called resting energy expenditure (REE) — is the number of

calories that your body burns while it’s at rest.

Although BMR and RMR slightly differ from each other, your RMR should be
an accurate estimate of your BMR.

FACTORS AFFECTING BMR

BMR is the largest component of the daily energy demand representing 45 to 70
percent of the daily total energy expenditure. The factors affecting BMR are:

Body Size: the BMR is closely related to the body surface area as basal heat
production is directly proportional to surface area.

Age: The BMR is highest during the first 2 years of life. It declines gradually during
childhood and increases slightly during adolescence. It gradually declines in
adulthood with a greater decline in later years.

Sex: Women have a 6 -10 % lower BMR than men.

Body Composition: BMR is directly related to the lean body People with well-
developed muscle like athletes have a higher BMR than obese people whose body
has a higher percentage of adipose tissue.

Sleep: The BMR in sleep is about 5% less than in the Basal Metabolic Rate.

Fever: The BMR is raised in fever conditions. For every 1 degree Fahrenheit rise in
body temperature, BMR is increased by about 7%.

Fear, Anxiety, Nervous Tension: Such emotions tend to elevate BMR.

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Under nutrition and Starvation: Prolonged under nutrition or Starvation causes a

reduction of about 10-20% in BMR.

Hormonal imbalance: Conditions like Hypothyroidism decreases BMR while

Hyperthyroidism increases the
BMR. Increase in adrenaline
secretion, associated with highly
emotional states, temporarily
increase the BMR.

Calculation of BMR:
BMR: Weight in Kg * 2.2 * 11

For example someone weighing 80 Kg probably have a BMR of

80*2.2*11 = 1936 kcal.

Do it by yourself.

1) 98 Kg
2) 105 Kg
3) 45 Kg
4) 75 Kg
5) 140 Kg

More analysis like BMI, BF, SMM, SYS, DYS, and PUL will be necessary and we will
understand that in consulting training in further course.

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➢ Why you might want to know your BMR.

Your BMR can be used to help you gain, lose, or maintain your weight. By knowing
how many calories you burn, you can know how many to consume. To put it
simply:

• Is your goal to maintain your weight? Consume the same number of

calories that you burn.
• Is your goal to gain weight? Consume more calories than you burn.
• Is your goal to lose weight? Consume fewer calories than you burn.

➢ Is 'Starvation Mode' Real or Imaginary? A Critical Look

Weight loss is associated with numerous physical and mental health
benefits and generally seen as a positive thing.
However, your brain, which is more worried about keeping you from
starving, doesn’t necessarily see it that way.When you lose a lot of weight,
your body starts trying to conserve energy by reducing the number of
calories it burns .

It also makes you feel hungrier, lazier, and increases food cravings.
These effects can cause you to stop losing weight and may make you feel so
miserable that you abandon your weight loss efforts and regain the weight.
This phenomenon, which is your brain’s natural mechanism to protect you
from starvation, is often called “starvation mode.”This article investigates
the concept of starvation mode, including what you can do to prevent it
from happening.

➢ What does ‘starvation mode’ imply?

What people generally refer to as “starvation mode” (and sometimes
“metabolic damage”) is your body’s natural response to long-term calorie
restriction.

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It involves the body responding to reduced calorie intake by reducing

calorie expenditure to maintain energy balance and prevent starvation.
This is a natural physiological response, and the technical term for it is
“adaptive thermogenesis”.

The term starvation mode is a misnomer, as true starvation is something

that is almost completely irrelevant to most weight loss discussions.
Starvation mode is a useful physiological response, although it does more
harm than good in the modern food environment where obesity runs
rampant.
➢ Calories in, calories out

Obesity is a disorder of excess energy accumulation.

The body puts energy (calories) into its fat tissues, storing it for later use.If more
calories enter your fat tissue than leave it, you gain fat. Conversely, if more
calories leave your fat tissue than enter it, you lose fat.

All weight loss diets cause a reduction in calorie intake. Some do so by controlling
calorie intake directly (counting calories, weighing portions, etc.), while others do
so by reducing appetite so that you eat fewer calories automatically.

When this happens, the number of calories leaving your fat tissue (calories out)
becomes greater than the number of calories entering it (calories in). Thus, you
lose fat, which your body views as the beginning of starvation.a result, your body
fights back, doing everything it can to make you stop losing.

The body and brain can respond by making you hungrier (so you eat more,
increasing calories in), but they can also affect the number of calories you burn
(calories out).

Starvation mode implies that your body reduces calories out to restore energy
balance and stop you from losing any more weight, even in the face of continued
calorie restriction.This phenomenon is very real, but whether it’s so powerful that
it can prevent you from losing weight or even cause you to gain weight despite
continued calorie restriction is not as clear.

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➢ The number of calories you burn can change.

The number of calories you burn in a day can be split into four components.

Basal metabolic rate (BMR). BMR is the number of calories your body uses
to maintain vital functions, such as breathing, heart rate, and brain
function.
Thermic effect of food (TEF). This is the number of calories burned while
digesting a meal, which is usually about 10% of calorie intake.
Thermic effect of exercise (TEE). TEE is the number of calories burned
during physical activity, such as exercise.

Non-exercise activity thermogenesis (NEAT). NEAT refers to the number of

calories burned fidgeting, changing posture, etc. This is usually
subconscious.Levels of these
four measurements can
decrease when you cut
calories and lose weight. This
is due to a reduction in
movement (both conscious
and subconscious) and major
changes in the function of the nervous system and various hormones .The
most important hormones are leptin, thyroid hormone, and
norepinephrine. Levels of all of these hormones can decrease with calorie
restriction.

➢ Studies show that calorie restriction can reduce your metabolism.

Studies show that weight loss reduces the number of calories you
burn.According to one large review, this amounts to 5.8 calories per day for
each pound lost, or 12.8 calories per kilogram. However, this largely
depends on how fast you lose weight. Slow and gradual weight loss due to
mild calorie restriction does not reduce the number of calories you burn to
the same extent.

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For example, if you were to lose 50 pounds (22.7 kg) quickly, your body
would end up burning 290.5 fewer calories per day.What’s more, the
reduction in calorie expenditure can be much greater than what is
predicted by changes in weight.

In fact, some studies show that losing and maintaining 10% of body weight
can reduce calories burned by 15–25% .

This is one reason why weight loss tends to slow over time, as well as why
it’s so difficult to maintain a reduced weight. You may need to eat fewer
calories indefinitely.

Keep in mind that this metabolic “slowdown” my be even greater in some

groups that have a hard time losing weight, such as postmenopausal
women.

➢ Muscle mass tends to decrease

Another side effect of losing weight is that muscle mass tends to

decrease.Muscle is metabolically active
and burns calories around the clock.

However, the reduction in calorie

expenditure is greater than what can be
explained by a reduction in muscle mass
alone.The body becomes more efficient at
doing work, so less energy than before is
required to do the same amount of
work.Therefore, calorie restriction makes you expend fewer calories to
perform physical activity

➢ How to avoid the metabolic slowdown

A reduced metabolic rate is simply a natural response to reduced calorie
intake.

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Although some reduction in calorie burning may be inevitable, there are a

number of things you can do to mitigate the effect.The single most
effective thing you can do is resistance exercise.

The obvious choice would be to lift weights, but bodyweight exercises can
work just as well.Studies have shown that resistance exercise, as in exerting
your muscles against resistance, can have major benefits when you’re on a
diet.

In one study, three groups of women were placed on a diet providing 800
calories daily.One group was instructed not to exercise, one to perform
aerobic exercise (cardio), while the third group did resistance
exercise.Those in the groups that either didn’t exercise or did aerobic
exercise lost muscle mass and experienced significant reductions in
metabolic rate.However, the women who did resistance exercise
maintained their metabolic rate, muscle mass, and strength levels.
This has been confirmed in many studies. Weight loss reduces muscle mass
and metabolic rate, and resistance exercise can (at least partly) prevent it
from happening.

➢ Keep protein high.

Protein is the king of macronutrients when it comes to losing weight.

Having a high protein intake can

both reduce appetite (calories
in) and boost metabolism
(calories out) by 80–100 calories
per day.It can also reduce
cravings, late-night snacking,
and calorie intake.Keep in mind
that you can reap the benefits of
protein by simply adding it to your diet, without consciously restricting
anything.

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That said, adequate protein intake is also important for preventing the
adverse effects of long-term weight loss.

When your protein intake is high, your body will be less inclined to break
down your muscles for energy or protein.This can help preserve muscle
mass, which should (at least partly) prevent the metabolic slowdown that
comes with weight loss.

➢ Taking a break from your diet might help | Taking breaks

Some people like to routinely include refeeds, which involve taking a break
from their diet for a few days.

On these days, they may eat slightly above maintenance, then continue
with their diet a few days later.There is some evidence that this can
temporarily boost the levels of some of the hormones that decrease with
weight loss, such as leptin and thyroid hormone.

It may also be useful to take a longer break, as in a few weeks.

Just make sure to be conscious of what you’re eating during the break. Eat
at maintenance, or slightly over, but not so much that you start gaining fat
again.Intermittent fasting might likewise help, although studies have
provided conflicting results. Compared with continuous calorie restriction,
some studies report that intermittent fasting decreases adaptive
thermogenesis, while others show an increase, or a similar effect.

➢ A weight loss plateau can be caused by many things.

When you first attempt to lose weight, you may experience rapid results.

In the beginning weeks and months, weight loss can occur quickly and
without much effort.However, things may slow after that. In some cases,
weight loss slows so much that many weeks can go by without any
noticeable movement on the scale.However, a weight loss plateau can have

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many different causes (and solutions), and it doesn’t mean that you aren’t
losing weight.

For example, water retention can often give the impression of a weight loss
plateau.

➢ Why Your Metabolism Slows Down With Age.

People Tend to Be Less Active With Age,
Research
• shows that people become less active with age. Being less active can
significantly
• slow down your metabolism, as it is responsible for 10–30% of your
daily calories burned.
➢ How Can You Prevent Your Metabolism Slowing Down With Age?
Although the metabolism typically slows down with age, there are many
things you can do fight this. Here are six ways you can combat the effects of
aging on your metabolism.

1. Try Resistance Training

Resistance training, or weight lifting, is great for preventing a slowing
metabolism.It offers the benefits of exercise while preserving muscle
mass — two factors that affect the speed of your metabolism.One study
with 13 healthy men aged 50–65 found that 16 weeks of resistance
training three times weekly increased their RMR by 7.7%.

Another study with 15 people aged 61–77 found that half a year of
resistance training three times weekly increased RMR by 6.8%.

2. Try High-Intensity Interval Training

High-intensity interval training (HIIT) can help prevent a slowing
metabolism. It is a training technique that alternates between intense
anaerobic exercise with short periods of rest.

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HIIT also continues to burn calories long after you finish exercising. This
is called the “afterburn effect.” It occurs because your muscles need to
use more energy to recover after exercise.

In fact, research has shown that HIIT can burn up to 190 calories over 14
hours after exercising.Research also shows that HIIT can help your body
build and preserve muscle mass with age.

3. Get Plenty of Sleep

Research shows a lack of sleep can slow down your metabolism.
Fortunately, a good night’s rest can reverse this effect.

One study found that 4 hours of sleep reduced metabolism by 2.6%

compared to 10 hours of sleep.
Fortunately, a night of long
sleep (12 hours) helped restore
metabolism.

It also seems that poor sleep

may increase muscle loss. Since
muscle influences your RMR,
losing muscle can slow down your metabolism.

If you struggle to fall asleep, try unplugging from technology at least one
hour before bed. Alternatively, try a sleep supplement.

4. Eat More Protein-Rich Foods

Eating more protein-rich foods can help fight a slowing
metabolism.That’s because your body burns more calories while
consuming, digesting and absorbing protein-rich foods. This is known as
the thermic effect of food (TEF). Protein-rich foods have a higher TEF
than carb- and fat-rich foods.

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In fact, studies have shown that consuming 25–30% of your calories

from protein can boost your metabolism by up to 80–100 calories per
day, compared to lower protein diets.

Protein is also essential to fight sarcopenia. Thus, a protein-rich diet can

fight an aging metabolism by preserving muscle.A simple way to eat
more protein daily is to have a source of protein at every meal.

5. Make Sure You Eat Enough Food

A low-calorie diet can slow down your metabolism by switching your

body into “starvation mode.While dieting has its benefits when you’re younger,
maintaining muscle mass is more important with age.

Older adults also tend to have a lower appetite, which may decrease calorie
intake and slow metabolism.If you struggle to eat enough calories, try eating
smaller portions more frequently. It is also great to have high-calorie snacks like
cheese and nuts handy.

6. Drink Green Tea

Green tea can increase your metabolism by 4–5%. This is because green tea
contains caffeine and plant compounds, which have been shown to increase your
resting metabolism.A study in 10 healthy men found that drinking green tea three
times daily increased their metabolism by 4% over 24 hours.

➢ The 12 Best Foods to Boost Your Metabolism

1. Protein-rich foods
rotein-rich foods — such as meat, fish, eggs, dairy, legumes, nuts, and
seeds — could help increase your metabolism for a few hours.

This is because they require your body to use more energy to digest
them. This is known as the thermic effect of food (TEF).The TEF refers to
the number of calories your body needs to digest, absorb, and process
the nutrients in your meals.Research shows that protein-rich foods

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increase TEF the most. For example, they increase your metabolic rate
by 15–30%, compared with 5–10% for carbs and 0–3% for fat.

Protein-rich diets also reduce the drop in metabolism often seen during
weight loss by helping your body hold on to its muscle mass.

What’s more, protein may also help keep you fuller for longer, which
can prevent overeating

2. Mineral-rich foods
The minerals iron and selenium each play different but equally
important roles in the proper functioning of your body.

However, they do have one thing in common. They’re both required for
the proper functioning of your thyroid gland, which regulates your
metabolism.

Research shows that a diet too low in iron or selenium may reduce your
thyroid’s ability to produce sufficient amounts of hormones, which could
slow down your metabolism.To help your thyroid function to the best of
its ability, include selenium- and iron-rich foods like meat, seafood,
legumes, nuts, and seeds in your daily menu.

3. Chili peppers
Capsaicin, a chemical found in chili peppers, may boost your metabolism
by slightly increasing the rate at which your body burns calories.

In fact, a review of 20 research studies notes that capsaicin — from

supplements or the peppers themselves — may help your body burn
around 50 extra calories per day (7).Some studies report similar benefits
with doses as low as 9–10 mg per day. This is equivalent to one jalapeño
pepper.Moreover, capsaicin may have appetite-reducing
properties.According to a review of studies in nearly 200 people,

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consuming at least 2 mg of capsaicin directly before each meal appears

to reduce calorie consumption, especially from carbs.

Similarly, adding cayenne pepper to your meal may increase the amount
of fat your body burns for energy, especially following a high
fat meal. However, this fat-burning effect may only apply to people
unaccustomed to consuming spicy foods .That said, findings are mixed
on capsaicin’s metabolism-boosting abilities.

4. Coffee
The caffeine found in coffee may help increase metabolic rate.

Several studies have noted that people who consume at least 270 mg of
caffeine daily, or the equivalent of about 3 cups of coffee, burn up to an
extra 100 calories per day.Furthermore, caffeine may help your body
burn fat for energy, and it seems especially effective at boosting your
workout performance.
However, its effects vary from person to person, based on individual
characteristics such as body weight and age.

5. Tea
Tea contains health-boosting compounds called catechins that may work
in tandem with caffeine to boost metabolic rate.In particular, both
oolong and matcha green tea may increase fat oxidation and may help
you burn extra calories when part of an exercise plan.

In addition, oolong and green teas may help your body use stored fat for
energy more effectively, increasing your fat-burning ability by up to
17%.Nevertheless, as is the case with coffee, effects may vary from
person to person.

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6. Beans and legumes

Legumes and beans — such as lentils, peas, chickpeas, black beans, and
peanuts — are particularly high in protein compared to other plant
foods.

Studies suggest that their high protein

content requires your body to burn
more calories to digest them, compared
to lower-protein foods. This is due to
their TEF.

Legumes also contain dietary fiber,

including resistant starch and soluble
fiber, which your body can use as a prebiotic to feed the good bacteria
living in your large intestine .
In turn, these friendly bacteria produce short-chain fatty acids, which
may help your body more effectively use stored fat as energy and
maintain normal blood sugar levels.

7. Ginger
Ginger and related spices are thought to have particularly beneficial
metabolism-boosting properties.For instance, research shows that
dissolving 2 grams of ginger powder in hot water and drinking it with a
meal may help you burn up to 43 more calories than drinking hot water
alone.This hot ginger drink also may decrease levels of hunger and
enhance feelings of satiety (fullness).

Grains of paradise, another spice in the ginger family, may have similar
effects.A study in 19 healthy males reported that participants given a 40
mg extract of grains of paradise burned 43 more calories in the following
2 hours than those given a placebo.That said, researchers also noted
that some of the participants were non-responders, so the effects may
vary from one person to another.

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8. Cacao
Cacao and cocoa are tasty treats that may also benefit your metabolism.
For instance, studies in mice have noted that cocoa and cocoa extracts
may promote the expression of genes that stimulate fat burning. This
appears to especially true in mice fed high fat or high calorie diets.
Interestingly, one study suggests that cocoa may prevent the action of
enzymes necessary to break down fat and carbs during digestion, which
could prevent the body from absorbing them and the calories they
provide.
However, human studies examining the effects of cocoa, cacao, or cacao
products like dark chocolate are rare. More studies are needed before
strong conclusions can be drawn.If you’d like to give cacao a try, opt for
raw versions. Processing tends to reduce the amounts of beneficial
compounds and add extra sugar and calories.

9. Apple cider vinegar

Apple cider vinegar may increase your metabolism.

Animal studies have shown vinegar to be

particularly helpful in increasing the amount
of fat burned for energy.

Likewise, apple cider vinegar is often

claimed to boost metabolism in humans, but
few studies have investigated this directly.
It may help you lose weight by slowing stomach emptying and
enhancing feelings of fullness .If you decide to take it, make sure to limit
yourself to 1–2 tablespoons per day and dilute it in at least 1 cup of
water per tablespoon of vinegar to limit the risk of tooth erosion,
damage to the lining of your digestive tract, or other potential side
effects.

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10.Medium chain triglyceride (MCT) oil

MCT oil is a unique type of fat that may offer some metabolic benefits.
Most fats found in foods are long-chain triglycerides, but MCT oil is
comprised of medium-chain triglycerides.

Some studies have shown that MCT oil consumption can increase
metabolic rate in humans. Additionally, unlike long-chain fats, once
MCTs are absorbed, they go directly to the liver to be turned into
energy. This makes them less likely to be stored as body fat.

MCT oil is typically taken as a supplement, although it can be added to

foods like soups or smoothies. It’s not suitable for cooking, though.

11.Water
Drinking enough water is a great way to stay hydrated. Additionally,
some studies show that drinking water may also briefly boost
metabolism by 24–30%.

Researchers note that about 40% of that increase is explained by the

additional calories needed to heat the water to body temperature —
known as water induced thermogenesis.

However, the effects only appear to last for 40–90 minutes after
drinking water, and the strength of the effect may vary from person to
person.

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12.Seaweed
Seaweed is rich in iodine, a mineral required for the production of
thyroid hormones and proper functioning of your thyroid gland.

Thyroid hormones have various

functions, one of which is to regulate
your metabolic rate.

Regularly consuming seaweed can help

you meet your iodine needs and
maintain your metabolic health.

What’s more, fucoxanthin is another

seaweed-based compound — primarily found in brown seaweeds —
that may increase your metabolic rate.

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VITAMIN
Definition: A substance can be classified as vitamin as it satisfies 2 criteria.

• It must be a vital, organic dietary substance, which is neither a

carbohydrate, fat, protein nor mineral and is necessary in only very small
amount to perform a specific metabolic function.
• It cannot be manufactured by the body and therefore must be supplied by
the diet.

Fat soluble vitamins dissolve in fat before they are absorbed in blood stream to
carry out their functions.

• Vitamins participate in many metabolic reactions in the body which take

place as food is being utilized. The fat soluble vitamins act as a regulator of
specific metabolic activity and the water soluble vitamins function as
coenzymes. Coenzymes combine with a protein to form enzymes which
promote, release and utilization of energy. The energy comes from mainly
carbohydrate, fat, and protein respectively but not from the vitamins.
• The Recommended Dietary Allowances (RDA) provides scientific and
accurate information on Vitamins are easily lost from the food sources.
Some vitamin loss occurs when the food is harvested. Modern method of
harvesting, storage, transportation, processing and preparation minimizes
these losses. Vitamin loss occurs by oxidation, by light, by heat, by exposure
to acids and alkali and by leaching onto water.

Food preparation methods to prevent vitamin loss are: -----

• Peel vegetables and fruits thinly or cook some vegetables with the skin if
palatable like small potatoes, bitter gourd etc.
• Cut vegetables into large pieces.
• Use minimum amount of water for cooking.
• Cook the vegetables with the lid on
• Serve food immediately
• Cook until just tender but not mush

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Classification of vitamins:-
1) water Soluble vitamins
➢ Vitamin B1
➢ Vitamin B2
➢ Vitamin B3
➢ Vitamin B6
➢ Vitamin B7
➢ Vitamin B12
➢ Vitamin C

2) Fat soluble vitamins

➢ Vitamin A
➢ Vitamin D
➢ Vitamin E
➢ Vitamin K

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VITAMIN A
Carotenoids are yellow – orange pigments found only in foods of plant origin. The
primary and most effective carotenoid is the beta carotene.

Functions of vitamin A:
1) Protects your eyes from night
blindness and age related decline: -
eating adequate amounts of vitamins
A prevents the development of night
blindness and may help slow the age
related decline of your eyesight.
2) May lower your risk of certain
cancers: - adequate vitamin A intake
from whole plant foods may reduce
your risk of certain cancers as well as cervical, lung and bladder cancer.
However, the relationship between vitamin A and cancer is not fully
understood.
3) Supports a healthy immune system: - having enough vitamin A in your diet
helps keep your immune system healthy and function at its best.
4) Reduce your risk of Acne: - acne is a chronic inflammatory skin disorder.
People with this condition develop painful sports and blackheads, most
commonly on the face, back and chest. The exact role of vitamin A in the
prevention and treatment of acne is unclear. Yet, vitamin A based
medications are often used to treat severe acne.
5) Supports bone health: - eating the recommended amount of vitamin A
may help protect your bones and reduce your risk of fractures.
6) Promotes healthy growth and reproduction: - adequate amounts of
Vitamin A in the diet are essential for reproductive health and the healthy
development of babies during pregnancy.

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Food sources of vitamin A:

➢ Palm fruit dark green leafy vegetables

➢ mango, papaya, apricots

➢ Yellow/ orange vegetables like carrot, pumpkin and sweet potato are rich in
beta carotene.

➢ animal origin such as milk, cheese, cream, butter, ghee, egg, fish, kidney
and liver oils of fish such as halibut, cod and shark.

1 IU Vitamin A activity = 0.3 mg retinol

= 3.6 mg carotene

Retention of vitamin A:
Vitamin A can be lost from foods during preparation, cooking, or storage. To
retain vitamin A:

• Serve fruits and vegetables raw whenever possible.

• Keep vegetables and fruits covered and refrigerated during storage.
• Steam vegetables and braise, bake, or boil meats instead of frying. Some
vitamin A is lost in the fat during frying.
• Low fat and skim milk are often fortified with vitamin A content the same
as butter.

Who’s goal is the worldwide elimination of Vitamin A Deficiency (VAD) and its
tragic consequences, including blindness, disease and premature death. To
successfully combat VAD, short – term interventions and proper feeding in
infancy must be backed up by long-term sustainable solutions like combination
of breastfeeding and vitamin A supplementation, coupled with enduring
solutions, such as the promotion of vitamin A supplementation, coupled with
enduring solutions, such as the promotion of vitamin A-rich diets and food
fortification.

pg. 95
Diploma in Ditetics FGIIT,

Deficiency of Vitamin A:
• nyctalopia (night blindness)
• xerophthalmia (dryness of eye)
• conjunctiva and cornea of the eye
• Changes in skin (follicular hyperkeratosis)
• salivary gland atrophy
• dry, increase risk of infection
• itchy and inflamed eyeballs
• susceptibility to colds

• flu, abnormal skeletal development in children

• bacterial and viral infections,

• respiratory and urinary tract

• Acne; rough, dry, scaly, prematurely aged skin, sensitivity to light and
reproductive difficulties.

Toxicity:
• Liver damage, bone abnormalities and joint pain, alopecia, headaches,
vomiting and skin desquamation.
• Symptoms that occur due to intakes in excess of those recommended over
a prolonged period are referred to as symptoms of hypervitaminosis.
• Very high single doses can cause transient acute toxic symptoms that may
include bulging fontanels in infants, headaches in older children and adults
and vomiting, diarrhea, loss of appetite and irritability in all age groups.

Requirement and Recommended daily allowance (RDA) for vitamin A:

• Amount of vitamin A need depends on individual but normally 700-900 mcg
per day is ideal.

pg. 96
Diploma in Ditetics FGIIT,

VITAMIN D
Vitamin D either be made from cholesterol like precursor in exposure of sunlight.

Function:
1. Vitamin D is required to maintain
normal blood levels of calcium and
phosphate which is needed for the
structuring of bone.
2. Mineralisation and formation of new
bones in growth and development.
3. Vitamin D is essential for formation of
the enzyme which transport calcium
for collagen formation in bones.
4. Participation in muscle formation and metabolism.
5. Vitamin D is called natural steroid hormone.
6. Regulation of blood pressure.

Sources of Vitamin D:
➢ Vitamin D is easily manufactured in the exposure of sun.
➢ Small amount present in milk, cheese, butter, egg yolk and fish.

Deficiency of Vitamin D:
➢ ultra violet rays and poor quality of food
➢ Rickets or osteomalacia.

Symptoms of rickets:-
➢ Membranous gap between the cranial bones, softening and reduced
mineralisation of the skull (craniotabes)
➢ Rachitic Rosary, pigeon chest and spinal curvature.
➢ Enlargement of wrist, knee (knock knees) and ankle joints.

pg. 97
Diploma in Ditetics FGIIT,

➢ Poorly developed muscles, lack of muscle tone, pot belly being the result of
weakness of abdominal muscles, weakness with delayed walking.
➢ Restlessness and nervous irritability.
➢ Low inorganic blood phosphorus, normal or low serum calcium.
➢ Tetanic characterised by low serum calcium, muscle twitching, cramps and
convulsions.
➢ Delayed definition and malformation of the teeth, permanent teeth more
subject to decay.

Symptoms of ‘adult rickets’ i.e. osteomalacia:

➢ Bones leading to deformities of legs, spine, thorax and pelvis.
➢ Rheumatic pain in bones of the legs and back.
➢ General weakness with difficulty in walking.
➢ Spontaneous multiple fractures.
➢ Normal child birth is difficult to sacrum and rib deformities.

Toxicity:
Excessive amounts of vitamin D are not normally available from dietary sources,
hence cases of vitamin D intoxication are rare.

Requirement and Recommended dietary Allowance (RDA) for Vitamin

D:
➢ Indian council of Medical Research (ICMR) for Indians is 200 – 400 IU.
➢ A vitamin D supplement providing 400 to 800 IUs may be essential for the
elderly.

pg. 98
Diploma in Ditetics FGIIT,

VITAMIN E
Introduction:
Vitamin E is a powerful antioxidant that protect our body from free radicals. Free
radicals are generally developed due to cigarette smoke and ultraviolet light. They
cause damage to our cell membrane.

Functions:
1. Protection of poly unsaturated
fatty acids (PUFA).
2. Protection of erythrocytes.
3. Protection against poisoning
4. Protection of vitamin A and
carotene
5. Protection of Mitochondria
6. Reduction of free radical
generation.
7. Regulation of enzyme activity.

Sources:
➢ Corn, nuts, seeds, olives, spinach and all green leafy vegetables.

Deficiency of vitamin E:-

There is no retention of vitamin D in our body.

There is no deficiency of vitamin E in our body because it is generally present in

our all food.

➢ Vitamin E almost nontoxic.

➢ Recommended and dietary allowances of vitamin E varies up to 8 mg to 10
mg.

pg. 99
Diploma in Ditetics FGIIT,

VITAMIN K
Vitamin K is essential fat soluble vitamin.

Vitamin k is found generally in forms of

vitamin K2 and vitamin K3.

Functions:
➢ Blood Coagulation
➢ Vitamin K dependent proteins
➢ Prevents bone loss

Sources:

➢ Green leafy vegetables

➢ Except that vegetable oil, peanut oil, corn oil, sunflower oil.
➢ egg yolk, milk, organ meat like liver

Vitamin k deficiency:

➢ Vitamin k deficiency leads to lower Prothrombin level and increase clotting

time.
➢ Vitamin K does not produce any toxicity in our body.
➢ Recommended Daily allowances are 80 mcg for males and 65 mcg for
females.

pg. 100
 Diploma in Ditetics FGIIT,

VITAMIN B1 (THIAMINE)

This is one of the earliest recognised

vitamin also called as anuran. Major
functions of thiamine are as below:

1. Thiamine plays role as a

regulator in enzyme activity.
Especially in carbohydrate
metabolism.
2. Coenzyme of thiamine are vital
for nerves and cardiac tissues.
When thiamine is insufficient
overall decrease in carbohydrate metabolism and its interconnection with
amino acid metabolism have severe consequences which result into less
neural function.
3. Role in conversion of carbohydrate to fats: Thiamine helps in the
conversion of carbohydrate to fats for storage of potential energy.

Food sources:
• Rice products, yeast products, whole cereals, whole wheat, millets,
soybean, pulses and nuts.
• Low amount of Thiamine also present in vegetables and fruits.

Retention of thiamine:

➢ Thiamine is lost in cooking and depleted by the use of coffee, tannin,

nicotine and alcohol. Hence, thiamine intake should be in optimal range.
➢ Sometimes when rice is washed before cooking and when it is cooked in a
large quantity and later drained off, loss of thiamine is very obvious.

pg. 101
Diploma in Ditetics FGIIT,

Deficiency of thiamine
Deficiency of thiamine causes the disease Beriberi in human beings and it
classified into three forms.

➢ Wet Beriberi
➢ Dry Beriberi
➢ Infantile Beriberi.

Symptoms of Beriberi
➢ Frequent indigestion associated with heaviness and weakness of legs.
➢ Patient frequently complaints for “Pins and needles” type of pain in legs.
➢ Patient feels low and easily exhausted while working.
➢ If not treated properly, patient developed polyneuritis Beriberi in which
inflammation happens in nerves.
➢ Thiamine deficiency also is observed in people with chronic alcoholism,
hyper metabolic, renal dialysis patient.

Treatment
➢ Thiamine has no toxicity over a human body.
➢ Recommended dietary allowances are 0.9 mg per day up to 1.2 mg per day.

pg. 102
Diploma in Ditetics FGIIT,

RIBOFLAVIN (VITAMIN B2)

Riboflavin, a water soluble vitamin was

discovered in milk as a pigment possessing
yellow green fluorescence.

Fun fact is “Riboflavin” is a name given to

this vitamin due to its structure similarity of
sugar ribose and because of its relation to
general group of flaming compounds.

Functions
➢ Precursor of co-enzymes
➢ It catalyse various reactions involved in drug and lipid metabolism.
➢ Protective Role
➢ Regulatory function

Sources
➢ Rich sources : Liver, dried yeast, egg powder, milk powder
➢ Good Sources: Whole Cereals, millets, pulses, green leafy vegetables,
oilseeds and nuts, meat, fish, eggs and milk.
➢ Fair Sources: Milled cereals and cereal products, roots and tubers, other
vegetables and fruits.

Retention of Vitamin B2:

➢ Riboflavin is sensitive to light. It is not stored in the body and a major
part is excreted in urine and the rest is broken down in the tissues.

Deficiency of Vitamin B2
➢ Riboflavin deficiency results in the condition of hypo-or ariboflavinosis
with sore throat, hyperaemia.

pg. 103
Diploma in Ditetics FGIIT,

Toxicity
➢ Riboflavin toxicity is not a problem because of the limited intestinal
absorption of vitamin

Recommended Dietary Allowances:

➢ Riboflavin Recommend dietary allowances is between 1.1 mg – 1.4 mg
per day.

pg. 104
Diploma in Ditetics FGIIT,

NIACIN (VITAMIN B3 / NICOTINAMIDE / NICOTINIC ACID)

Introduction: Nicotine acid was first isolated from rice polishing and shown to be
component of coenzyme I and coenzyme II and several transporting enzymes in
the tissues.

Functions:
1) Lowers LDL cholesterol.
2) Increases HDL cholesterol.
3) Lowers triglycerides.
4) May help prevent hearts disease.
5) May help trial type-1 diabetes.
6) Boosts brain function.
7) Improves skin function.
8) May reduce symptoms of arthritis.
9) Treats pellagra.

Sources:
➢ Niacin is widely distributed in plant and animal foods.
➢ Rich sources: Dried yeast, rice polishing, and peanuts, liver.
➢ Good Sources: whole cereals, legumes, meat and fish.
➢ Fair sources: Milled cereals, maize, roots and tubers, other vegetables, milk
and eggs.

Retention of Vitamin B3:

Whole cereals are good sources of niacin but the removal of the bran in the
milling of wheat reduces the niacin content of white wheat flour to a low
level. Niacin is readily soluble in water, but it is resistant to heat, oxidation of
alkalis. It is one of the most stable vitamins.

pg. 105
Diploma in Ditetics FGIIT,

Deficiency of Vitamin B3:

➢ Digestive System
➢ Skin
➢ Nervous System

Toxicity:
Administration of chronic high oral doses of nicotinic acid can lead to
hepatotoxicity as well as dermatologic manifestations.

Recommended Dietary Allowance:

➢ ICMR recommended RDI for individual intake of niacin as niacin equivalents
for adult is 6.6 mg/1000 kcal i.e. for a sedentary male and sedentary
female; it is 16 and 12 mg/day respectively.
➢ With pregnancy and lactation, the RDA increases to about 14-16mg/day.

pg. 106
Diploma in Ditetics FGIIT,

VITAMIN B6 (PYRIDOXINE)
Introduction:
Vitamin B6 is also called as pyridoxine.
Vitamin B6 composes of a triad of closely
related compounds that in free form are
called pyridoxine, pyridoxal and
pyridoxamine.

Functions:
1) May improve mood and reduce symptoms of depression: - low levels of
vitamin B6 in older, adults have even linked to depression but research
has not shown that B6 is an effective treatment for mood disorders.
2) May promote brain health and reduce Alzheimer risk:- vitamin B6 may
prevent a decline in brain function by decreasing homocysteine levels that
have been associated with Alzheimer’s disease and money impairments
3) May prevent and treat anaemia by aiding hemoglobin production: - due
to its role in hemoglobin production, vitamin B6 may be helpful in
preventing and treating anaemia caused by deficiency.
4) May help treat nausea during pregnancy: - vitamin B6 supplements in
doses of 30-75 mg a day have been used as an effective treatment for
nausea and vomiting during pregnancy.
5) May prevent clogged arteries and reduce heart disease risk: - vitamin B6
may help reduce high homocysteine levels that lead to narrowing of
arteries. This may minimize heart disease risk.
6) May help prevent cancer: - getting enough vitamin B6 may lower your risk
of developing certain types of cancer.
7) May treat inflammation associated with rheumatoid arthritis: -
inflammation associated with rheumatoid arthritis may lower blood levels
of vitamin B6. Supplementing with high doses of B6 may help correct
deficiencies and reduce inflammation.

pg. 107
Diploma in Ditetics FGIIT,

Sources:
➢ Raw food contains more of this vitamin than cooked foods.
➢ Rich Sources: Rice polishing, wheat bran, wheat germ, and dried yeast,
liver.
➢ Good Sources: whole cereals, legumes, nuts and seeds, milk powder,
meat, egg, leafy vegetables.
➢ Fair Sources: Milled cereals, vegetables and fruits.

Retention of Vitamin B6:

Long storage, canning, roasting or stewing of meat, food processing
techniques, use of alcohol are destructive to this vitamin.

Deficiency of Vitamin B6:

➢ Decrease level of plasma and urinary.

➢ Hypovitaminosis B6 may often occur with riboflavin deficiency as

riboflavin is needed for the formation of Vitamin B6 compounds.

Toxicity:
➢ Though toxicity related to pyridoxine intake are rare but use of high
doses of pyridoxine for the treatment of pre-menstrual syndrome,
carpal tunnel syndrome (compression of a nerve of the wrist resulting in
numbness, tingling, weakness in the hand and fingers) and some
neurologic diseases has resulted in neurotoxicity.

Recommended Dietary Allowance (RDA):

➢ The ICMR recommendations for individual intake of pyridoxine for adult
males and females are the same – 2.0mg/day.

pg. 108
Diploma in Ditetics FGIIT,

FOLATE (FOLIC ACID)

Introduction:
Folate is a generic term which includes naturally occurring food folate and folic
acid in supplements and fortified foods.

Functions:
Folate is essential for good health.

➢ Important for reactions

➢ Reduces risk of certain diseases
➢ Important for nerve cells
➢ Importance during pregnancy

Sources:
➢ Rich Sources: Liver, dried yeast, leafy vegetables, wheat germ and rice
polishing.
➢ Good Sources: whole cereals, dried legumes (pulses have twice as much
folic acid as cereals), nuts, fresh oranges, green leafy vegetables.
➢ Fair sources: Milled cereals, other vegetables, milk and fruits.
➢ Natural folates found in foods are in a conjugated form, which reduces
their bioavailability by as much as 50%. Also, natural folates are much less
stable.

Retention of Folate:
Deficiency of folate:

➢ Effect on metabolism
➢ Effect of pregnancy
➢ Congenital abnormalities
➢ Cancer of the colon

pg. 109
Diploma in Ditetics FGIIT,

Toxicity
The possibility of consuming excess dietary intake of natural folate and hence
posing a risk of toxicity has not been proven. This however does not apply to
folic acid given in supplements or fortified foods.

Recommended dietary allowance

➢ ICMR are 100 mcg/day which increases in condition of pregnancy and
lactation to 400 and 150 respectively.

pg. 110
Diploma in Ditetics FGIIT,

VITAMIN B12 (CYANOCOBALMIN)

Introduction
Vitamin B12 is a unique vitamin in human
nutrition, since its malabsorption leads to the
fatal syndrome of pernicious and megaloblastic
anaemia’s. Vitamin B12 is the largest of the B
complex vitamins. It contains cobalt at the centre
of its structure in the form of a ring. Vitamin B 12
is the only B vitamin our body can store. The
average adult body contains 2 to 5 mg of vitamin
B12 with 80 percent of this stored in liver.

Functions:-
1) Helps with red blood cell formation and anaemia prevention: - vitamin
B12 is involved in red blood cell formation. When vitamin B12 levels are too
low, the production of red blood cells is altered. Causing megaloblasm
anaemia.
2) May prevent major birth defects: - appropriate vitamin B12 levels are key
to a healthy pregnancy. They are important for the prevention of brain and
spinal cord birth defects.
3) May support bone healthy and prevent osteoporosis: - vitamin B12 may
play a vital role in your bone healthy. Low blood levels of this vitamin have
been associated with an increased risk of osteoporosis.
4) May improve mood and symptoms of depression: - vitamin B12 is needed
for for the production of serotonin, a chemical responsible for regulating
mood. Vitamin B12 supplements may help improve mood in people with an
existing deficiency.
5) Benefits your brain by preventing the loss of neurons: - vitamin B12 may
help prevent brain atrophy and memory loss. More research is needed to
conclude if supplementing with this vitamin can improve memory in those
without a deficiency.

pg. 111
 Diploma in Ditetics FGIIT,

6) Give you an energy boost: - vitamin B12 is involved in energy production in

your body. Taking a supplement may improve your energy level but only if
you’re deficient in this vitamin.

Sources
➢ Rich sources: Liver (goat, sheep, ox, pig)
➢ Good sources: Meat, fish, egg, kidney, brain.
➢ Fair sources: Fresh milk, milk powder and cheese.

Retention of Vitamin B12

➢ Factory that destroy this vitamin are sunlight, alcohol and oestrogen –
the female hormone.

➢ Calcium and protein rich foods greatly help the absorption of this vitamin
in the intestine,

Deficiency of Vitamin B12

1) Blood
2) Bone marrow
3) Stomach
4) Nervous system

Vitamin B12 deficiency in Vegetarian

➢ Because plants do not synthesize Vitamin B12, individuals who consumes
diet completely free of animal products (vegan diets) are at risk of Vitamin
B12 deficiency. This is not true of lacto-ova vegetarians, who consume the
vitamin through eggs, milk and other dairy products.
➢ Persons living exclusively on vegetarian diets (vegans) have low serum
levels of Vitamin B12 and develop specific symptoms such as sore tongue,
paraesthesia and signs of degeneration of the long tracts of the spinal cord
as a result of low intakes of Vitamin B12.

pg. 112
Diploma in Ditetics FGIIT,

Toxicity
Intake of 1000 mcg Vitamin B12 has never been reported to have any side
effects.

Recommended Dietary Allowance

➢ Vitamin B12 deficiency is common in true Vegans who can be treated with
small doses since the daily requirement is only 1.0 mcg/day. The
requirements increase in lactation by 0.5 mcg/day.

pg. 113
Diploma in Ditetics FGIIT,

BIOTIN
Function:
➢ Biotin, a water-soluble B vitamin, acts as a coenzyme during the
metabolism of protein, fats and carbohydrates.

Sources:
➢ Organ meats, oatmeal, egg yolk, soy, mushrooms, bananas, peanuts, and
brewer’s yeast.
➢ Bacteria in the intestine produce significant amounts of biotin, which is
probably available for absorption and use by the body.

Deficiency of Biotin:
Certain rare inborn diseases a leave people
with depletion of biotin due to the inability to
metabolize the vitamin normally. A dietary
deficiency of biotin, however, is quite
uncommon, even in those consuming a diet
low in this B vitamin. Nonetheless, if someone
eats large quantities of raw egg whites, a biotin
deficiency can develop, because a protein in
raw egg white inhibits the absorption of biotin.
Cooked eggs do not present this problem. Long-term antibiotic use can interfere
with biotin production in the intestine and increase the risk of deficiency
symptoms, such as dermatitis, depression, hair loss, anaemia, and nausea. Long-
term use of anti-seizing medication may lead to biotin deficiency. Alcoholics,
people with inflammatory bowel disease, and those with disease of the stomach
have been reported to show evidence of poor biotin status.

Toxicity:
Excess intake of biotin is excreted in the urine; no toxicity symptoms have been
reported.

pg. 114
Diploma in Ditetics FGIIT,

VITAMIN C
Introduction:
➢ Vitamin C is also known as an ascorbic acid. Humans are unable to
synthesize Vitamin C. Hence, when there is insufficient vitamin c in the diet,
Humans suffer from the potentially deadly deficiency disease - Survey.

Functions:
1) Reduce your risk of chronic
disease: - vitamin C is a
strong antioxidant that can
boost your blood antioxidant
levels. This may help reduce
the risk of chronic disease like
heart disease.
2) Manage high blood pressure:
- vitamin C supplements have
been found to lower blood pressure in both healthy adults and those with
high blood pressure.
3) Lower your risk of heart disease: - vitamin C supplements have been linked
to reduced risk of heart disease. These supplements may lower heart
disease risk factors including high blood levels of LDL cholesterol and
triglycerides.
4) May reduce blood uric acid levels and help prevent gout attacks: - vitamin
C rich foods and supplements have been linked to reduced blood uric acid
levels and lower risk of gout.
5) Helps prevent iron deficiency: - vitamin C can improve the absorption of
iron that poorly absorbed. Such as iron from meal free sources. It may also
reduce the risk of iron deficiency.
6) Boosts immunity: - vitamin C may boost immunity by helping white blood
cells functions more effectively, strengthening your skin’s defence system
and helping wounds heal faster.

pg. 115
Diploma in Ditetics FGIIT,

7) Protects your memory and thinking as you age: - low vitamin C levels have
been linked to an increased risk of memory and thinking disorders like
Demetrio while a high intake of vitamin C from foods and supplements has
been shown to have a protective effect.

Sources:
➢ Food sources of vitamin C are:
➢ Rich Sources: Amla and guava
➢ Good Sources: Drumstick Leaves, other Leafy Vegetables and fruits such as
berries, pine apple and tomatoes.
➢ Fair Sources: Apples, banana and grapes
➢ cherries, kiwi fruits, mangoes, papaya, strawberries, tomatoes and water
melon
➢ cabbage, broccoli, Brussels sprouts, cauliflower, mustard greens, red and
green peppers, peas and potatoes

Retention of Vitamin C:
➢ The Vitamin C content of food is strongly influenced by season, transport to
market, length of time on the shelf and in storage, cooking practices and
the chlorination of water used in cooking. Heating and exposure to copper
to copper or iron or to mildly alkaline conditions destroys the Vitamin and
too much water can leach it from the tissues during cooking. Blanching and
lowering the pH (making it acidic) helps to retain Vitamin C whereas cutting
or bruising the produce leads to loss of Vitamin C.

Deficiency of Vitamin C:
➢ Gingival changes, pain in the extremities and haemorrhagic manifestations
precede oedema, ulcerations and ultimately death. The disease occurs in
adults and infants.
➢ In infantile scurvy, the changes are mainly at sites of most active bone
growth.

pg. 116
Diploma in Ditetics FGIIT,

Toxicity:
➢ Intake of 2-3 g/day of Vitamin C produce unpleasant diarrhea due to the
unabsorbed Vitamin in the intestinal lumen in most people.
➢ Future Oxalate is an end product of Vitamin C catabolism and plays an
important role in kidney stone formation.

Recommended Dietary Allowance (RDA) for Vitamin C:

➢ The ICMR recommendation is 40 mg/day for both adult males and females.
The requirements increase by another 40 mg in case of lactation.
➢ FAO/WHO 2004 consultation agreed that 1 g of Vitamin C appears to be the
advisable upper limit of dietary intake per day.

pg. 117
Diploma in Ditetics FGIIT,

MINERALS
Introduction:
Humans require several mineral element for optional functioning. These minerals
elements are broadly divided into two classes i.e. macro & micro minerals. macro
minerals also referred to as major minerals are distinguished from micro minerals
by their occurrence in the body .thus macro minerals constitute at least 0.01% of
the total body weight or occur in minimum quantity of 5 g in a 60 kg body .they
are required in amount greater then 100mg per day on the other hand,
requirement of micro minerals varies from a few milligrams to micrograms per
day.

Functions:
1) Do not provide energy but involved in generation of energy through their
metabolic function.
2) Maintaining body fluid balance.
3) Regulation of acid base balance.
4) For structural units(bones and teeth)
5) Haemoglobin and thyroxin formation.
6) Some are cofactors in the enzymation reactions.

Macro minerals largely perform structural functions e.g. 99% of body calcium
85% of phosphorus

And 50-60 % of magnesium is in the bone & is calcified tissue.

And 50-60 % of magnesium is in the bone & is calcified tissue. Besides this
phosphorus is an important component of phospholipids & phosphoproteins that
from important structure component of cell membranes. Some micro minerals in
addition to the structural role, are involved in catalytic function e.g. magnesium
exerts catalytic & regulatory role in number of biochemical reactions. Calcium
function as a messenger in signal transduction in never & muscle cells.
Phosphorus is involved in the regulation of enzymes.

pg. 118
Diploma in Ditetics FGIIT,

Although macro minerals are mainly involved in structural role while micro
elements are involved in catalytic role, there seems to be some overlap, for some
minerals.

Classification of minerals:-
There are two types of minerals:

Major Minerals Trace Minerals

Calcium Iodine

Phosphorus Sulfur

Magnesium Zinc

Sodium Copper
Chloride Fluoride

Pottasium Selenium

Iron Chromium

Molybdenum

Manganese

pg. 119
Diploma in Ditetics FGIIT,

CALCIUM
Introduction:
Among minerals, calcium (CA) is the
most abundantly present in humans,
representing 52% of the body’s
minerals content and amounting to
1.2% of the body weight.

In the elementary composition of the

human body, calcium ranks fifth after
oxygen, carbon, hydrogen and
nitrogen, and it makes up 1.9% of the
body by weight. Nearly all (99%) of
total body calcium is located in the skeleton .The remaining 1% is equally
distributed between the teeth and soft tissues, with only 0.1% in the extra cellular
fluid (ECF)

Functions:
➢ Important for healthy bones and teeth; helps muscles relax and contract;
important in nerve functioning, blood clotting, blood pressure regulation,
immune system health.

Food Sources:
➢ Milk and milk products; caned fish with bones (salmon, sardines); fortified
tofu and fortified soy milk; greens (broccoli, mustard greens); legumes

Calcium Supplements:
➢ When taken with a meal, the absorption is greatest when calcium is taken
in doses of 500 mg or less.

pg. 120
 Diploma in Ditetics FGIIT,

Deficiency:
Dietary calcium intake above or below the requirements can result in the
irruption of several signs of deficiencies and excess.

➢ Increased bone desorption.

➢ reduce the rate of growth of the skeleton
➢ Rickets in children.
➢ Calcium and Osteoporosiestimated at 3% per year in the first five years
after menopause
➢ Loss in postmenopausal women.
➢ Women with calcium intakes below 400 mg per day may benefit by
increasing their dietary intakes or by taking supplements of calcium.

Calcium Toxicity:

➢ High blood calcium may be asymptomatic or can cause constipation,

nausea and vomiting, increased urination, thirst, muscle weakness, kidney
failure, irritability, confusion, psychosis and coma.
➢ Since the efficiency of absorption from large doses is poor, no adverse
effects have been found with calcium supplements providing up to
2400mg/day.
➢ However, in practice, an upper limit on calcium intake of 3 g is
recommended by the FAO/WHO 2004.

Dietary Calcium Requirements:

➢ The RDA for Indian adult male is based on replacing the losses of calcium in
urine, stools, bile and sweat which is estimated to be 700 mg calcium per
day.
➢ The fractional absorption in adults is taken to be 20-30% in the presence of
adequate vitamin D.

pg. 121
Diploma in Ditetics FGIIT,

PHOSPHORUS
Introduction:
Phosphorus is the second most abundant
element in the human body, comprising
30% of the total mineral content. An adult
human body contains approximately 600g
of phosphorus. Most phosphorus like CA is
stored in the bone and teeth. The
remaining 15% is distributed in soft tissues.

Functions:
➢ Important for healthy bones and teeth; found in every cell; part of the system
that maintains acid base balance.

Sources:
➢ meat, fish, poultry, eggs, milk, processed foods

Deficiency:
➢ loss of appetite
➢ anaemia
➢ muscle weakness
➢ bone pain
➢ rickets (in children)
➢ osteomalacia (in adult)
➢ increased susceptibility to infection
➢ numbness and tingling of the extremities
➢ difficulty in walking

pg. 122
Diploma in Ditetics FGIIT,

Toxicity:
➢ Such calcium phosphate deposition can lead to organ damage, especially
kidney damage.
➢ When kidney function is only 20% of normal, even typical levels of dietary
phosphorus may lead to hyperphosphatemia.

Dietary requirements:
➢ Phosphate requirements are fully met usually when diets provide adequate
calcium as these two minerals generally occur together in foods.
➢ However, situations may develop when the phosphate levels in blood and
other tissues many increase or decrease beyond normal levels.
➢ Such disturbances in the phosphorus levels may develop with or without
any effect in the calcium metabolism.

pg. 123
Diploma in Ditetics FGIIT,

MAGNESIUM
Introduction:
Magnesium (Mg) ranks fourth in overall
abundance in body. It is also the least
abundant among macro minerals, the
total amount in the body being 25g. CA
and p, this mineral is also present in the
bones. Only 55-60% of the total
magnesium is located in the skeleton.
Another 20-25% is found in muscles with remaining in other soft tissues. Only 1%
of the total body magnesium is extra cellular. Magnesium is closely associated
with cells and is the 2nd most abundant mineral in cells after potassium.

Functions:
➢ Found in bones, needed for making protein, muscle contraction, never
transmission, immune system health

Sources:
➢ Knutson seeds, legumes, leafy green vegetables, seafood , chocolate,
artichokes, hard drinking water

Deficiency:
➢ Deficiency of magnesium is rare for two reasons: firstly, the mineral is
widely distributed in the food; secondly, kindly is able to adjust re-
absorption of filtered magnesium to body needs. However, mg depletion
occurs in various conditions, which either impair its intestinal absorption or
increase its urinary excretion.

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Toxicity:
➢ Excessive intake of mg is not likely to cause toxicity except in people with
impaired renal function. Excessive intake of mg salts of mg salts can lead to
diarrhoea.

Dietary requirements:
➢ FAO/WHO recommends 220 and 260 mg magnesium per day for adult
females and males and males, respectively.

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IRON
Introduction:
Total body Iron – In humans, total
quantity of iron in the body varies with
haemoglobin concentration, body
weight, gender and amount of iron
stored in various tissues.

The amount of storage iron shall

depend upon the dietary iron
consumed and its bioavailability.

Function:
➢ Part of haemoglobin found in red blood cells that carries oxygen in the
body, needed for energy metabolism

Sources:
➢ Organ meats, red meats, fish, poultry, shellfish, egg, yolk, legumes, dried
fruits, dark leafy greens, iron-enriched breads and cereals, and fortified
cereals

Deficiency:

➢ Iron deficiency is defined as a hemoglobin concentration below the

optimum value in an individual.
➢ 1) reduced serum ferritin
➢ 2) Increased most prevalent nutritional deficiencies in the world today.
➢ The functional effects of iron deficiency anaemia results from both
reduction in circulating hemoglobin and a reduction in iron containing
enzymes and myoglobin.

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Prevention of Iron Deficiency:

➢ Iron (100mg elemental iron) and folic acid (0.5 mg) in the form of tables are
provided to all pregnant women for 100 days during a pregnancy.

Toxicity:
➢ cirrhosis hepatocellular cancer,
➢ Congestive heart failure and eventual death.

Dietary requirement:
➢ The recommend intakes are based on iron absorption by 3% in adult men,
adolescent boys and children; 5% in adult woman, adolescent girls,
lactating woman and 8% in pregnant woman.

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IODINE
Introduction:
Iodine derives he nutritional importance as
a constituent of hormones. The thyroid
hormones are indispensable for normal
growth and development in humans.
Synthesis of the iodine containing thyroid
hormones occurs exclusively in the thyroid
gland.

About 15-20 mg iodine is found in human body, of which 70-80 % is present in the
thyroid gland. The thyroid gland weighs 15-25 grams and has a remarkable ability
to concentrate iodine. In the iodine deficient individual, enlarged thyroid gland
may contain only 1 mg iodine.

Functions:
➢ Found in thyroid hormone which helps regulate growth, development and
metabolism

Sources:
➢ Seafood, foods grown in iodine rich soil, iodized salt, bread dairy products

Deficiency:
➢ The most severe form is endemic cretinism, which is characterized by
congenital, severe irreversible mental and growth retardation.
➢ Hypothyroidism, which is accompanied by low BMR, apathy slow reflex and
relaxation time with slow movements, cold intolerance and myxoedema
skin and subcutaneous tissues and thickened because of accumulation of
cumin and become dry and swollen.

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ZINC
Introduction:
➢ Zinc is present in all body tissues and fluids.
The total body zinc content has estimated
to be 2g. Skeletal muscle account for
approximately 60% of the body content
and bone mass, with a zinc concentration
of approximately30%.

Function:
➢ Zinc of many enzymes, needed for making protein and genetic material, has
a function in taste perception, wound healing, normal foetal development,
production of sperm, normal growth and sexual maturation, immune
system health

Sources:
➢ Lean red meat, whole grain cereals, pulses and legumes
➢ polishes rice and chicken, pork or meat
➢ Fish, roots and tubers, green leafy vegetable and fruits
➢ Among the foods of plant origin, legumes, whole grain cereals and
vegetables (leafy vegetables and roots) are the good sources

Deficiency:
➢ Growth retardation, delayed sexual and bone maturation, skin lesions,
diarrhoea, alopecia (loss of hair baldness), impaired appetite, increased
susceptibility to infection mediated via defects in the immune system, and
the appearance of behavioural changes.

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COPPER
Introdution:
Copper is a constituent of several
enzymes and proteins, most of which
catalyse oxidation reduction reactions.

The body of healthy adult contains a

little over 0.1 g of copper with
concentration being high in liver, brain,
heart, bone, hair and nails. About 25%
of body copper is present in muscle,
and 42% in the skeleton.

Funtions:
➢ Part of many enzymes; needed for iron metabolism

Sources:

➢ Legumes, nuts and seeds, whole grains, organ meats, drinking water

Deficiency:

➢ The most frequent symptoms are anaemia, neutropenia (abnormally high

levels of a type of WBC’s in blood) and bone fracture.
➢ Other less frequent symptoms include hypo-pigmentation, impaired
growth and an increased incidence of infections and abnormalities of
glucose and cholesterol metabolism.
➢ Sub-optimal copper intakes over long periods may be involved in the
precipitation of chronic diseases such as cardiovascular disease and
osteoporosis.

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Toxicity:
➢ Symptoms include vomiting, diarrhoea, haemolytic, anaemia, renal and
liver damage.
➢ Clinical symptoms of chronic toxicity appear when the capacity for
protective copper binding in the liver is exceeded which include jaundice,
hepatitis and liver cirrhosis.

Dietary requirement:
➢ Safe and adequate range of copper intake is 1.5-3 mg/day.

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SODIUM, POTASSIUM AND CHLORIDE

Introduction:
The total body water (TBW) in a 70 kg man is 60% of the body weight i.e. about 40
litres. Two thirds of this resides inside the cells, i.e. the intracellular fluid (ICF),
while one third is in the extracellular compartment (ECF) that bathes the cells. A
minor portion about 1 litter is present in the intestines and anterior chambers of
the eyes. The most important electrolytes in the ECF are sodium and chloride. The
concentration of potassium in the ECF is very low. However, potassium is the
predominant action (k+) in the ICF whereas sodium and chloride in the ICF are
negligible.

Muscle cells have much higher water content than the others and therefore ICF
and TBW are closely related to lean body mass.

The three macro minerals, Na, k and cl are related to each other. Na and K are
captions (ions that carry a positive charge) while CL is an anion (ions that carry a
net negative charge) All three are known as electrolytes as their ions are used for
generating electric differences across the plasma membrane of most cells.

Na constitutes 2%, K5% and CL3% of the total mineral content of the body. These
mineral exist as ions in the body fluids and are principal electrolytes in the body. K
is a major intracellular electrolyte while Na and CL are present in the extracellular
fluids.

Function:
➢ Needed for proper fluid balance, nerve transmission, and muscle
contraction
➢ Needed for proper fluid balance, stomach acid
➢ Needed for proper fluid balance, nerve transmission, and muscle
contraction

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Sources:
➢ Meats, milk, fresh fruits and vegetables, whole grains, legumes
➢ Table salt, soy sauce, large amounts in processed foods, small amounts in
milk, meats, breads and vegetables
➢ Table salt, soy sauce, large amounts in processed foods, small amounts in
milk, breads, vegetables, and unprocessed meats

Deficiency and excess of electrolytes:

➢ Hypernatremia and Hypernatremia: Serum concentration of Sodium is
normally regulated within the range of 135 to 145 mill mole per litre
(Mm/l).
➢ Hypernatremia is defined as a Na level under 130 MM/L.
➢ When plasma Na level falls below 120 Mm/L symptoms such as headache,
confusion, seizures and coma can occur.

Hypokalaemia and Hyperkalaemia:

Normal serum K range from 3.5-5Mn/L. Hypokalaemia or low plasma K levels
can occur with net shift or K from the plasma to the cells. The shift can occur in
alkalosis. Overall depletion of body’s K which occurs in vomiting, prolonged
fasting can also results in this shift. Mild hypokalaemia results in weakness and
muscles cramps and cause arrhythmias in patients with heart diseases. Serves
hyperaemia (<2.5Mm/L of K) can results in paralysis.

Hyperkalaemia occurs when serum K levels are greater than 5Mm/L. High
plasma K result in cardiac arrhythmias, cardiac arrest and death. It can also
occur in severe kidney diseases where ability to excrete K is impaired
especially if K consumption is not restricted and patient is experiencing tissue
or RBC breakdown.

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PHYTOCHEMICAS
Introduction:
The wisdom of familiar advice, “eat more vegetables” stands on firmer scientific
ground today then- ever before. The stimulating colours and flavours in fruits and
vegetables result from thousands of phytochemicals found in edible plants foods.
THE WORD “PHYTO” derives from the Greek word meaning plants.

These are non-nutrient compounds are found in plants. They act as antioxidants,
mimicking hormones and suppressing the development of diseases, thus
rendering tremendous health benefits. People who consume lots of vegetable,
fruits and whole grain products may be less likely to develop heart disease,
cancer, type 2 diabetes, premature ageing.

Role as an antioxidant:
Phytochemicals act as antioxidants to prevent unstable molecules or free radicals
from damaging the cells

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INTRODUCTION TO LIVING BEINGS: PHYSIOLOGY

Biology is the science of living things. The word biology is derived from a Greek
word which means knowledge of life.

Living and non-living:

The study to biology, which is a science of life processes, being with the
differentiation between the living and non-living.

All living organism begin life as a single cell. Cell are immensely complex entities
engaged in constant physical and biochemical activity. Each cell represents the
simple structural and function unit from which an organism can be composed.

Cell group together to from tissues and different tissue group to from organs and
organ systems. The sum of these is the organism.

CHARACTERISTICS OF LIVING AND NON-LIVING: Some of the characteristic

different between living and non-living.

Cellular Structure:
All living organisms are made up
of one or more cells. A cell is a
unit of life consisting of a tiny
mass of semi fluid substance
called protoplasm and bounded
by a cell membrane. If the
protoplasm is removed the cell
dies.

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Metabolism:

The various life

processes taking place
within the body of an
organism is called
metabolism.
Metabolism can be
divided in to two;

1) ANABOLISM:

It is a biological process that involves building up of complex substances from

simpler substances and result in formation of protoplasm.

E.G.: Photosynthesis in plants

2) CATABOLISM:

It is a biological process that consists of biochemical reaction that breaks down

complex chemical substances resulting in release of energy.

E.G.: Digestion, Respiration

Non-living things do not exhibit metabolism.

GROWTH, REPAIR AND DEATH: Both anabolism and catabolism occur
simultaneously inside an organism. Anabolism in excess of catabolism causes the
organism to gain weight and grow. When catabolism exceeds anabolism
unchecked, i.e. when the destruction of protoplasm exceeds the rate at which it is
being produced, the ultimate result is death.

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Nutrition:-
The process by which a living
organism assimilates food and
uses it for growth and
replacement of tissues is
known assimilation. Nutrition is
completely lacking in non-living
things.

Excretion:-
During metabolism a number of waste
products are formed. Some of them such
as carbon dioxide, urea, uric acid, etc. are
toxic which if allowed to accumulate
within the body of the organism, would
lead to its death. Excretion is the property
of living things to get rid of unwanted
matter.

Irritability:-
The property of protoplasm to react to changes in its environment in a
particular manner usually in the form of some movement it called
irritability.

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Reproductive and evolvability:-

Each living organism has the ability
to duplicate itself or produce new
individuals resembling it in all
essential features. During
reproduction, the organism uses its
own body material.

Life span and death:-

The period during which an organism completes its life cycle is called its life span.

Non-living things do not have a physiological life span.

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Digestive system:

Importance of digestion: When we eat such

things as bread, meat, and vegetables, they are
not in a form that the body can use as
nourishment. Our food and drink must be
changes into smaller molecules of nutrients
before they can be absorbed into the blood and
carried to cells throughout the body. Digestion is
the process by which food and drink are broken
down into their smallest parts so that the body
can use them to build and nourish cells and to
provide energy.

Digestion and absorption are two distinct body

functions. Digestion is the breakdown of foods
into nutrition components that the body can
use. An example of this is the breakdown of the
cheese in your pizza into amino acids.
Absorption is the transport of digested food (nutritional components, such as
amino acids, and monosaccharide) to where it is needed in the body.

Digestive system:
• Pharynx (throat)
• Oesophagus
• Liver
• Stomach
• Gall bladder
• Large intestine (colon)
• Rectum

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ANATOMY OF OUR HUMAN BODY

What is Anatomy?
Anatomy is a Greek term;

"It refers to Ana = sepa rate, tomy= to cut open."

"Anatomy is the study of structures of the bodies of human or animal."

"To better understand the anatomy of human body, certain position is been"

Derived through which entire body structures can be easily studied or visualized.

We will going to study,

1) Bones

2) Muscles

3) Cell

4) Soft Tissue

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Skeletal Bones:

Musculoskeletal system consists of muscles and bone

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Joints: A joint is formed where the two body part meet.

Tendon: a flexible but inelastic cord of strong fibrous collagen tissue attaching a
muscle to a bone.

Ligaments: a short band of tough, flexible fibrous connective tissue which

connects two bones or cartilages or holds together a joint.

Cartilage: A strong calcified tissue which is work as a coverage of a bone and

protect them against the wear and tear of daily life.

Bones: Bone is the substance that forms the skeleton of the body. It is composed
chiefly of calcium phosphate and calcium carbonate.

Spine: a series of vertebrae extending from the skull to the small of the back,
enclosing the spinal cord and providing support for the thorax and abdomen; the
backbone.

1. Skull: - it is a bone structure of the head. It supports and protects the face and
the brain. The adult skull has a total of 22 individual bones. They don’t move
and united into a single unit.
2. Mandible: - lower jaw or jawbone is the largest, strongest and lowest bone in
the human face. It forms the lower jaw and holds the lower teeth in place.
3. Cervical vertebras: - the cervical vertebras of the spine consist of seven bony
rings that reside in the neck between the base of the skull and thoracic
vertebras in the trunk. Among the vertebrae of the spinal column, the cervical
vertebrae are the thinnest and most delicate bones.
4. Thoracic vertebrae: - the thoracic vertebrae are a group of twelve small bones
that form the vertebrae spine in the upper trunk its support ribs.
5. Lumbar vertebrae: - the lumbar vertebrae are bones that make up the spinal
column or back bone. Specifically within the lower back. These bones are
below the cervical and thoracic vertebrae but above the sacrum or pelvis.
6. Pelvis: - in human anatomy bones that connects the trunk and the legs.
Supports and balance the trunk and contains and supports the in testing the
urinary bladders and the internal sex organs.

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7. Sacrum: - the sacrum is a shield shaped bony structure that is located at the
base of the lumber vertebrae and that is connected to the pelvis. The sacrum
strengthens and stabilized the pelvis.
8. Coccyx: - the coccyx also known as the tailbone is a small, triangular bone
resembling a shortened tail located at the bottom of the spine.
9. Clavicle: - the clavicle or collarbone is a long bone that comes between the
shoulder blade and the breast bone. There are two clavicle one on the left and
one on the right. The clavicle is the only long bone in the body that lies
horizontal.
10.Scapula: - in anatomy the scapula also known as the shoulder bone. This bone
connects the upper arm bone with the clavicle (collar bone)
11.Sternum: - the long flat bone in the middle of your chest that the seven top
pairs of curved bones (ribs) are connected to.
12.Ribs: - the ribs are a set of twelve bones which form the protective cage of the
thorax. As a part of the bony thorax, the ribs protect the internal thoracic
organs.
13.Humerus: - the humerus is a long bone in the arm that runs from the shoulder
to the elbow. It connects the scapula and two bones of the lower arm.
14.Ulna: - the ulna is located on the opposite side of the fore arm from the
thumb. It joins the humerus on its larger and to make the elbow joint and joins
with the carpal bones of the hand at its smaller end.
15.Carpals: - the carpal bone are the eight small bones that make up the wrist
that connects the hand to the forearm.
16.Metacarpals:- in human anatomy , the metacarpal bones form the
intermediate part of the skeletal hand located between the phalanges of the
fingers and the carpal bones of the wrist which forms the connection to the
forearm.
17.Phalanges: - the phalange are the bones that makes up the fingers of the hand
and the toe of the foot. There are 56 phalanges in the human body with
fourteen on each hand and foot.
18.Femur: - the femur is the only bone located within human thigh. It is the
longest and the strongest bone in the human body, extending from the hip to
the knee.
19.Patella: - the patella also known as the knee cap, is a flat, circular-triangular
bone. Which protects the surface of the knee joint.

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20.Fibula: - the fibula or calf bone is a leg bone on the lateral side of the tibia, to
which it is connected above and below.
21.Calcaneus: - the calcaneus also called the heel bone is a large bone that forms
the foundation of the rear part of the foot.
22.Tarsals: - in the human ankle there are seven tarsal bones.
23. Metatarsals: - the metatarsals bones, are a group of five long bones in the foot
located between the tarsal bone and the phalanges of the toes.

Types of bones:
1) FIXED: Joints which are fixed and cannot move freely e.g. parietal temporal
(eye suture)
2) MOVABLE: Joints which are easily movable e.g. hinge joint (elbows, knees);
Ball & socket (shoulder & hips)

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Muscles:

A band or bundle of fibrous tissue in a human or animal body that has the ability
to contract, producing movement in or maintaining the position of parts of the
body.

It classified into three groups.

1) Skeletal muscles: Skeletal muscle is one of three major muscle types, the
others being cardio muscle and smooth muscle. Most skeletal muscles are
attached to bone by bundle of collagen fibres known as tendons.

2) Smooth muscles: Smooth muscle or “involuntary muscle” is found within the

walls of organs and structures such as the oesophagus, stomach, intestines,
bronchi, uterus, urethra, bladder, and blood vessels, and unlike skeletal muscle,
smooth muscle is not under conscious control.

3) cardiac muscle: Cardiac muscle is also an “involuntary muscle” but is a

specialized kind of muscle found within the heart.

Cell Structure:-

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Soft Tissues:

Ligament:-
A ligament is the fibrous connective tissue that
connects bones to other bones. It is also known as
articular ligament, articular larua,
fibrous ligament, or true ligament.
Other ligaments in the body include the:
Peritoneal ligament: a fold of peritoneum or other
membranes.

Cartilage:-
Cartilage is a resilient and smooth elastic tissue, a
rubber-like padding that covers and protects the
ends of long bones at the joints, and is a structural
component of the rib cage, the ear, the nose, the
bronchial tubes, the intervertebral discs, and many
other body components.

Tendon:-
A tendon or sinew is a tough band of fibrous
connective tissue that connects muscle to
bone and is capable of withstanding
tension. Tendons are similar to ligaments;
both are made of collagen. Ligaments connect
one bone to another, while tendons connect
muscle to bone.

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FUNDAMENTALS OF MEAL PLANNING

Essentials of meal planning:

Nutritional Adequacy: The first pre requisite of a good meal plan in its ability to
meet the nutritional needs of the entire family. You have succeeded in appeasing
every taste bud but the health issues too need a thought. Since no single food will
meet the entire nutrient requirement, decide on the type of meals to be enjoyed
for the entire week.

Planning the meal

• Plan a perfect and simple menu with alternatives for the week, which is
less time consuming.
• Make use of convenience gadgets (labour saving devices) since valuable
time can be saved.

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• Make the best use of all the ingredients so that you do not land up wasting
food. For example, if you need just chicken flesh for a particular recipe,
then you can use as much flesh you want and then use the bones to
prepare chicken stock which can be used for used be for soups. Some dry
chicken dishes can be made with the remaining chicken pieces.
• To add variety to the menu use different methods of cooking such as
broiling, grilling, baking. A chicken stew would be as desirable as roasted
chicken.
• Keep a not on the ingredients that are used. The will help in writing the
grocery list as well as budget.
• Try and use ingredients, which can be used on a regular basis and cooked
in a different style for e.g. dal goes well with rice or chapattis and can be
prepared very often but if prepared in a different way, your menu will look
appetizing with each passing day.
• Keep in mind that you do not waste even a single item from your grocery
list, as it is a budgeted one, for e.g. If you have had bread for breakfast on
Monday and there is some remaining the next day you use it by either
making a bread upma or bread toast topped with butter.
• Make use of leftovers from previous day’s meals and turn them in to dish
by itself for the next day. Ingenious presentation can help make even a
simple dish look great and be a sure winner at the dining table.

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FOOD GROUPS
Cereals: Cereals from the staple diet in India e.g. rice, wheat, maize. Cereals,
except rise, generally lack lysine. Lysine is an amino acid, which needs to be
supplied in the diet. Ragi, a millet, is a rich source of calcium and known as poor
man’s milk. Cereals do not contain Vitamin A and Vitamin C except yellow maize,
which contains carotene.

1 Cereal serving = 1 Katori of cooked

rice 2 phulkas or 2 slices of bread.

1 Cereal serving will supply about 70

calories and 2-3 g protein.

Legumes & Pulses: Pulses are rich sources of protein (up to 22-25%). Vegetarians
can meet their protein requirement by including different pulses in their diet. But
they lack Vitamin A and Vitamin C.
However, germination of pulses
increases the Vitamin C levels. Soaking
and cooking of legumes destroy their
anti-nutritional factors like tannin and
trypsin inhibitors and make it easier to
digest. Cereal-pulse combination in a
proportion of 4:1 or 3:1 provides a good
biological value protein by
supplementing lysine.

1 serving = 1 Katori of cooked dal, 1 serving of legumes will supply = 100 calories
and 6-7 g protein.

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Vegetables: Green leafy vegetables are very rich sources of Vitamin B, carotene,
iron, calcium, Vitamin B complex and vitamin C. At least fifty grams of green leafy
vegetable should be consumed daily.
Yellow-orange vegetables are goods
source of vitamin B, carotene, and
lycopene’s.

Roots and tubers are rich in

carbohydrate and contain some
vitamins and mineral. Three to five
servings of vegetable per day is a must
and one of them should be a green
leafy vegetable.

Fruits: They are rich in

carbohydrates and contain and
fibre. Green, yellow and orange
fruits like mango, papaya contain
beta-carotene. Amla, citrus fruit and
guava are rich sources of vitamin C.
Dried fruits like dates supply iron.
Banana and jackfruit are good
sources of energy.

Two to three servings of fruits per day are recommended.

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Milk and milk products: Milk is a good

source of protein, calcium and vitamins.
It is deficient in iron and vitamin C.
Whole milk has high percentage of fat
(8-12%) whereas low fat or toned milk
has about three percent fat. Skimmed
milk has little or no fat. Recommended
servings per day is two to three serving
where one serving =1 cup (225-240 ml).

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Food Pyramid:

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FOOD EXCHANGE LIST

Foodstuff Amount Protein Carbohydrate Fat Energy
gm.|ml. gm. gm. gm. Kcal.
Milk, Cow 100 3.4 5 2
Milk, Buffalo 100 4.5 5 8
Skim milk, liquid 100 8 12 1
Whole milk 100 3.4 5 2
powder
Skim milk powder 100 8 12 1
Butter milk 100 3.3 4.8 0.9
Curd 100 11 3.4 4.3
Paneer, Cow’s 100 20 2 21
milk
Paneer, buffalo’s 100 25 5 30
milk
Cheese 100 21 3 29

Foodstuff Amount Protein Carbohydrate Fat Energy

gm. gm. gm. gm. kcal.
Egg 1 Piece 6 Nil 6 60
Fowl
Goat meat 100 25 Nil 21
Goat liver 100 20 Nil 20
Sheep liver 100 18 Nil 22
Mutton muscle 100 25 Nil 21
Pork 100 17 Nil 21
Crab, small 100 11 Nil 18
Hilsa 100 20 Nil 17
Katla 100 20 Nil 17
Pomfret 100 20 Nil 17
Prawn 100 20 Nil 17
Sardines 100 20 Nil 17
Rohu 100 20 Nil 17
Singhara 100 20 Nil 17

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Foodstuff Amount Protein Carbohydrate Fat Energy

gm. gm. gm. gm. kcal.
Bengal 100 11 30 1
gram(roasted)
Bengal gram 100 13 25 0.5
(whole)
Bengal gram dal 100 12 30 0.4
Black gram dal 100 10 27 0.3
Cow pea (lobia) 100 12 29 1
Green gram 100 11 28 0.2
Green gram dal 100 12 24 0.1
Lentil 100 10 26 0.6
Peas, dry 100 13 25 1
Rajmah 100 12 29 1
Red gram dal 100 14 30 0.9
Soybean 100 11 27 0.6
Moth beans 100 10 25 1

Foodstuff Amount Carbohydrate Protein Fat Energy

gm. gm. gm. gm. kcal.

Bajra 100 67 12 5
Barley 100 73 12 2.3
Bread, white 100 49 9 3.2
Bread, brown 100 54 11 3.3
Biscuit, salty 100 55 7 23.4
Biscuit, sweet 100 67 6 20
Jowar 100 70 10 4
Maize 100 60 8 10
oatmeal 100 60 12 5
Ragi 100 70 15 5
Rice, raw 100 28 2.7 0.3
milled
Rice flakes 100 29 2 0.5

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Foodstuff Amount Carbohydrate Protein Fat Energy

gm. gm. gm. gm. kcal
Rice, puffed 100 28 2.7 0.3
Semolina 100 73 13 1.1
Bulgar wheat 100 76 12 1.3
Wheat flour, 100 72 13.2 2.5
whole
Wheat flour, 100 67 9 1
refined
Vermicelli 100 82 0.1 0.1
Potato 100 17 0.2 0.1
Potato, sweet 100 20 1.6 0.1
Yam, Ratalu 100 28 1.5 0.2

FOOD STUFF Carbohydrate

gm.
Bathua leaves 2.9
Bottele gourd 2.5
Cucumber 2.5
Lettuce 2.5
Mustard leaves 3.2
Parwal 2.2
Radish leaves 2.4
Radish, white 3.4
Ridge gourd 3.5
Snake gourd 3.3
Spinach 2.9
Tinda 3.4

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Foodstuff Amount Carbohydrate Protein Energy

gm. gm. gm. Kcal
Amaranth 100 65 g 2.5 371

Beetroot 100 4.8 g 1.6 43

Bitter gourd 100 6g 2.5 20
Bringal 100 8.7g. 2.5 35
Broad beans 100 33 g 13 187
Cabbage 100 5.5 1.3 25
Capsicum 100 2.6 2.5 26
Carrot 100 9.6 1 41
Cauliflower 100 4.1 3.5 45
Colocasia leaves 100 4 4.0 35
Coriander leaves 100 5.8 3.4 36
Drum stick 100 5.0 4.0 37
Fenugreek leaves 100 6 4.0 49
French beans 100 7.9 1.9 7.9
Jack fruit 100 24.0 1.47 94
Knoll khol 100 7 4 43
Lady’s finger 100 7.0 2.0 54
Mint leaves 100 4.8 1.2 24
Onion 100 5.1 1.4 130
Plantain, green 100 7 4.5 120
Peas 100 11 4 81
Pumpkin 100 5.9 0.7 49
Tomato, ripe 100 6 0.9 18
Turnip 100 8.36 1.17 36.4
Mushroom 100 3.28 3.9 22

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Foodstuff Amount Carbohydrate Energy

gm. gm. Kcal
Amla 100 10 48
Apricot 100 11 48
Apple 100 11.6 51
Banana 100 22.8 89
Cherries 100 22 87
Dates, fresh 100 31 110
Dates, dry 100 31 110
Grape fruit 100 25.13 95
Grapes 100 27.33 104
Lemon(sweet) 100 9.3 29
Litchi 100 16.5 66
Lime, sweet (malta) 100 8 36
Lime sweet(musambi) 100 9.3 25
Loquat 100 12.14 47
Mango 100 15 99
Orange 100 14.8 66
Papaya 100 7 62
Pear 100 27 101
Peaches 100 10 39
Pineapple 100 22 82
Plums 100 11 46
Pomegranate 100 12 83
Raspberry 100 14.7 64
Raisins 100 79.18 299
Sapota 100 48 83
Watermelon 100 7.6 30
muskmelon 100 8.36 35

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Foodstuff Weight Fat Protein Carbohydrate Energy

gm. gm. gm. gm. Kcal.
Butter 100 81 0.9 0.1
Ghee 100 78 0.2 Nil
Hydrogenated oil 100 100 0.1 Nil
Cooking oil 100 100 0.1 Nil
Cream 100 36 2.8 2.7
Almonds 100 54 10 12
Cashew nuts 100 60 9 15
Coconut, dry 100 27 3 10
Coconut, fresh 100 27 3 10
Gingelly seeds 100 49 30 11
Groundnuts, roasted 100 50 12 10
Walnuts 100 55 9 15

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Diploma in Ditetics FGIIT,

METHODS OF IMPROVING NUTRITIONAL QUALITY OF FOODS.

Introduction:

The nutritive value of most foods can be improved by careful consideration

and acceptance of

slight variations in the taste, appearance

and texture of the food product. Methods of
improving

nutritional quality of foods are:

1.Germination

2.Fermentation

3.Fortification

4.Supplementation

Germination / Sprouting

Whole grams are soaked overnight, water should be drained away and the
seeds should be tied in

a loose cotton cloth and hung. Water should be sprinkled twice or thrice a day.
In a day or two,

germination takes place. Moisture and warmth are essential for germination.
Green gram, Bengal

gram, dry beans, dry peas all can be germinated.

Advantages:

1. Sprouting improves the digestibility and availability of nutrients. Starches

and proteins are

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converted to simpler substances as germination proceeds, the ratio of

essential to non-

essential amino acids changes providing more of essential amino acids.

Minerals like calcium,

zinc and iron are released from bound form. Phytic acid amount is reduced so
the availability

of proteins and minerals are increased. Riboflavin, niacin, folic acid, choline
and biotin content

are increased. Vitamin C is synthesized during germination hence germinated

pulses can be

substituted for fruits. The increase in vitamin C is around 7 - 20 mg per 100gm

of pulses.

Vitamin C content is maximum after about 30 hours of germination.

2. Sprouting decreases cooking time. The thick outer coat opens the grain and
the grain becomes

soft making it easier for the cooking water to penetrate the grain.

3. Dehusking is easier when the grains are sprouted and dried.

4. Germination decreases the mucus inducing property of legumes.

5. Thickening power of starch is reduced due to conversion of starch to sugars.

6. Germination metabolizes oligosaccharides and hence do not produce gas or

flatulence.

7. Germination improves taste and texture and without much cooking also
sprouts can be

consumed.

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8.Germinated pulses add variety to the diet.

Fermentation

The term Fermentation refers to break down of carbohydrates and

carbohydrate like materials

under either aerobic or anaerobic conditions. It is the process in which the

naturally present

microorganisms are allowed to bring about desirable physical and chemical

changes in the nutrients

by converting them into simpler and better forms with increased availability,

Examples -

a. Conversion of milk to curd

b. Rice & dal to idli

C. Refined flour with yeast or

milk or curd to make bread,
naan, bhatura

D. Channa dal to make dhokla

As the fermentation proceeds the

mixture becomes more porous, bubbly and sour. Fermentation

should be controlled up to the desirable state. The production of carbon

dioxide makes the mixture

spongy and light. Fermented foods are easy to digest and add variety in
texture and flavour.

Advantages:

1. It increases the digestibility, palatability and nutritive value

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2. It improves the flavour and texture of the product.

3. Nutrients are increased like vitamins B & C.

4. Fermented products are easily digestible!

5. It decreases the pH and inhibits the harmful microorganisms,

6. Certain harmful substances like trypsin inhibitors and phytins are

decreased during fermentation.

7. Variety in the diet is increased.

Fortification

Adding a nutrient or nutrients to

a food in amounts larger than
that contained in any natural
food is

to fortify that food. Examples are

the addition of vitamin D to milk,
fortified margarines, fortified
fruit juices, cornflakes, wheat
flour etc.

Enriched bread may be made

from enriched flour or by the addition of the required substance to the baker's
formula or by the use of special high vitamin yeast and iron.

Enriched flour is white flour enhanced in thiamine, riboflavin, niacin and iron
contents by changing

the milling process to return these constituents or by the addition of

chemicals to white flour.

Certain levels of vitamin D and calcium are permitted as optional ingredients.

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Supplementation

It is the process of combining different foods so that they compliment and

improve the nutrient

content.

Combining foods is done for

• Economy
• Better nutritive value
• Variety
• Healthful living and desirable change in food habits.
Cereal - Pulse combination improves amino acid content

Milk - Fruit combination improves carbohydrates and protein content

Cereal - Milk combination improves protein and calcium content

Iron and vitamin A content can be improved by combining greens, organ meat
and carrots.

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Diploma in Ditetics FGIIT,

NUTRITION IN THE LIFE CYCLE

The maintenance of healthy body tissues depends on the nutrients in the food.
The importance of nutrition throughout life cannot be refuted. After all we must
eat live. Various factor which affect our body needs for different nutrients include
age, sex, physical activity, body weight, height, composition etc. Apart from these
climatic conditions, body growth, physiological and pathological stress also
influences the body’s need for various nutrients. Moreover, the significance of
nutrition at specific times of growth, development and aging is becoming
increasingly appreciated. The Indian Council of Medical Research (ICMR) from
time to time has been giving the nutrients needs and he recommended dietary
allowances for different nutrients for various ages.

Diet for different age groups, stress periods and work can be classified in to
groups. The life cycle of each person goes through 5 basic stages. These are as
follows.

Pregnancy: in which human life begins and develops to birth

Infancy: is the rapid first year of growth

Childhood: is the period in which the child goes through a lot of dietary changes
from the age of two onwards. He also begins attending elementary school.

Adolescence: is the teenage of rapid growth and sexual maturing

Adulthood: is the period during which growth levels off and gradually plateau is
reached.

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Normal diet:
The term “balanced” simply means that a diet
adequately meets your nutritional needs
while not providing any nutrients in excess.
To achieve a balanced diet, you must
consume a variety of foods from each of the
food groups.

A well-planned diet provides all the specific

nutrients to the body and helps to achieve
nutritional homeostasis (a state of equilibrium) in normal healthy individual.

Therapeutic diet:
The modification of the diet according to the
changes in the body which may occur due to
any disease or other metabolic conditions,
injury and other disorders are known as
therapeutic modification of the diet.

A sick person like a healthy person should

maintain a nutritional homeostasis. In

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diseased conditions the body tissues either do not receive proper nutrients in
sufficient amounts or cannot utilize the available nutrients owing to faulty
digestion, absorption or transportation of food elements.

Dietary Management (Objectives):

• To maintain a good nutritional status.
• To correct nutrients deficiencies they may have occurred due to the
diseases.
• To afford rest to the whole body or to specific organs affected by the
diseases.
• To adjust the food intake to the body’s ability to metabolize the nutrients
during the disease.

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Diploma in Ditetics FGIIT,

NUTRITION DURING ADULTHOOD

Our body requires different nutrients in varying proportion so as to maintain
proper body functions. By the time one reaches adulthood, body growth,
particularly in terms of
height and body
stature, stop to a
certain extent. Despite
the fact that there is
not much of apparent
growth, the
breakdown and repair
of body tissues goes on
continuously even
among adults.
Therefore, adequate amounts of all the essential nutrients need to be provided to
adults through their diets for maintaining both physical and mental health.
Nutrient needs and recommended dietary allowances.

ENERGY

Age, sex, body weight and physical activity largely determine nutrient
requirement of an individual. Since, recommended allowances for various
nutrients cannot be given, for any individual person, ICMR has based the
recommendation for adult in terms of “Reference Indian man and Reference
Indian woman”

Reference Indian Man has been defined as “an adult man between 20-39 years of
age, weighing 60kg. He is free from disease and is physically fit for active work.
‘On each working day, he is employed for 8 hours in occupation that usually
involves moderate activity. While not at work, he spend 8 hours in bed, 4-6 hours
in sitting and moving about and 2 hours in walking, active recreation or household
duties,” For such a reference man, ICMR has taken a height of 163cms.

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Reference India Women has been defined as “an adult woman between 20-39
years of age, weighing 50kg. She may be engaged for “8 hours in general
household work, in light industry, or in any other moderately active work. Apart
from 8 hours in bed, she spends 4-6 hours in sitting and moving about and 2
hours in walking, active recreation or household duties,” For such a reference
woman, ICMR has taken a height of 151ms.

ICMR has recommended energy requirement for reference Indian man and
women based on different activity levels, these are:

Daily Energy requirements (Kcal/d)

Activity Adult man Adult women

Sedentary 2400 1800

Moderate 2800 2400
Higher 3500 2800

The energy requirement of an individual has been defined as “the level of

energy intake from food that will balance energy expenditure when the individual
has a body size and composition and level of physical activity, consistent with long
term good health, and that will allow maintenance of economically necessary and
socially desirable activity”.

In case of adults, the body needs energy for:

Basal Metabolic Rate (BMR):-

The BMR refer to the amount of energy your body needs to maintain
homeostasis. An average man has a BMR of around 7100kg per day. (IT 2000
kcal), while an average women has a BMR of around 5900 kg per day (1500 kcal).
Energy expenditure is continuous, but the rate varies through the day.

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ACTIVITY ENERGY REQUIREMENTS

(Kcal/kg Ideal body weight/day)
Obese Normal Underweight
Sedentary 20-25 30 35
Moderate 30 35 40
Heavy 35 40 45-50

Protein

During adulthood, though the body’s physical growth more or less ceases, the
process of repair of the old and worn out tissues continues. Therefore, protein is
still important for this group to compensate for the normal wear and tear. On a
mixed diet, ICMR has recommended 1 g /kg ideal body weight both for males and
females. Since protein needs are not influenced by activity, ICMR has
recommended a level of 60g of protein per day and 50 g of protein per day for
reference adult man and woman respectively.

Fats and Essential fatty acids

While a certain amount of fat has to be present in the diet to meet the minimum
requirements of the two essential fatty acids – linoleic and linoleic acids, at the
same time an excess of fat in the diet is also considered harmful.

MINERALS

Calcium and phosphorus,

The requirements of these two minerals are considered together as their

functions are closely related. The long term balance studies in men have shown
that calcium balance can be achieved at intake of 300-500 mg /day. In view of
these observations, ICMR has recommended as intake of 400mg/day both for
adult men and women. Along with this, it was also suggested that elemental
calcium: phosphorus of 1:1 may be maintained for both adult and women.

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Iron

Iron requirements have been derived by adding up the requirements for different
psychological functions. In case of adult men and women, basal losses of iron
through the GI tract, urine and sweat have been completed to be 14µg/kg body
weight, employing the body weights of reference man and reference woman. In
case of women during reproductive ages, besides the basal losses, menstrual loss
of iron through blood is also accounted for. Thus the recommended dietary
intake of iron for adult man in 28mg/day and that for woman is 30mg/day.

Vitamins

The requirement for vitamin A is given as 600µg of retinol /day for both adult man
and women. In terms of beta-carotene, this works out 2400µg/day.

No recommendation has been made for vitamin D by ICMR.

Requirement of Vitamin E is linked to the essential fatty acid needs and thus an
amount of 0.8mg of vitamin E/gm. of essential fatty acid has been suggested.

The requirements of B vitamins are based on calorie requirements (0.5 mg of

thiamine, 0.6mg of riboflavin and 6.6 mg of niacin/1000 calorie).

Pyridoxine acts as a co-enzyme for several enzymes connected with the

metabolism of amino acids. ICMR recommends a daily allowance of 2.0 mg of
pyridoxine both for adult men and women.

Folic acid also acts as a co-enzyme in the synthesis of various metabolites, nucleic
acids. ICMR recommends a dietary allowance of 100µg of free folate /day for both
for adult men and women.

Cynocobalamin along with folic acid plays an important role in the synthesis of
nucleic acids. ICMR recommends a dietary allowance of 1.0µg vitamin /day both
for adult men and women.

Ascorbic acid plays an important role in the synthesis of collagen, wound healing,
amino acid and carbohydrate metabolism, synthesis of some hormones and in the
absorption and metabolism of iron. An intake of 20mg of vitamin C may be

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sufficient to maintain ascorbic acid levels in the adults. Taking into account that
50% of vitamin C is lost in cooking, ICMR has recommended a dietary allowance of
40 mg of ascorbic acid /day both for adult men and women.

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NUTRITION DURING PREGNANCY

Your body goes through numerous physical and hormonal changes during
pregnancy. The way you nourish your
body during this time will affect your
health and your body’s you must eat a
healthful balanced diet to help ensure
anonymous stay healthy throughout
your pregnancy. The food you eat is
your baby’s main sources of
nourishment are rich in nutrients
proper nutrition can help promote your baby’s growth and development.

Dietary Requirements:

Dietary pregnancy it is advisable to consume a balanced diet composed of all the

five food groups to derive the best combination of nutrients. There is no special
diet during pregnancy just a right mix and balance of foods chosen to provide the
body with adequate nutrition to support the needs of the women as well as
growing foetus.

Energy:

Pregnancy poses increased energy demands on the body. The extra energy
needed is not merely the mathematical sun of the energy needs of the mother
and growing foetus but is a complex sum of the processes going on in the body.

The ICMR 2010 recommendation for pregnant women are as follows:-

1. Sedentary worker 1900 + 350 kcal/day

2. Moderate worker 2230 + 350 kcal/day
3. Heavy worker 2850 +350 kcal/day

Later part of pregnancy is when the energy needs are at the highest. This is the
time when the increased energy is needed for growing foetus, placenta maternal

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tissue and the increase in BMR. The BMR is increased as a consequence of

additional load of the growing foetus and the expanding maternal body size.

Carbohydrate:-

Complex carbohydrate should form the bulk of carbohydrate consumed. Simple

carbohydrate not only contribute to weight gain but also could cause
constipation. This could be due to the food that they would replace complex
carbohydrate in the diet there by causing deficit of fibres. Whole grains, forfeited
cereals, green leafy vegetables and fruits are good option. It is better to avoid
refined flours, processed food made from refined flours, excess sugars fruit juices
and confectionary items.

Proteins:-

An extremely vital nutrient during pregnancy like other stages, due to the many
important functions it performs for the pregnant women as well as the growing
foetus. Special care needs to be taken to supply the adequate amounts of protein
during the second and third trimester when the,

1. Needs of the growing foetus are the highest.

2. The mammary glands, uterus and placenta are enlarging to accommodate
the needs of growing body.

Protein is crucial during pregnancy due to the following needs:-

1. Supply the much needed amino acids which are the building blocks of the
cells of the body both for mother and feeling.
2. Protein in food help to provide the feeling of fullness and satiety for longer
duration, discouraging overeating or eating empty calories which might
contribute to hormone weight gain.
3. Eating a diet rich in protein helps to stabilize blood sugar levels.
4. Protein also play a huge roll in hair and fingernail growth along with the
regulation of hormone secretion and digestion.

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A diet insufficient in protein poses some problems during pregnancy like

1. Increased rich of pregnancy related complication.

2. Increased risk of contracting infections
3. Weight loss
4. Less than optimal growth of foetus.
5. Oedema
6. Higher risk of neonatal death and birth defects.

The RDA for protein as per the 2010 ICMR guidelines are 82.2g/day. Due to a
numbers of issues related to adequate consumption of food like nausea and
vomiting and hypersensitivity to small during pregnancy it might not be possible
to ingest large quantities of one time.

Fats and essential fatty acids: ICMR suggests an intake of 30gms of visible fat
every day to meet the EFA requirements. This level of fat also provides
necessary energy density to the diets. Also bear in mind that when the supple
of calories is inadequate the fat may be used up to provide the high energy
needs of the rapidly growing foetus. This results in an increase in the ketones
in the urine during the 1st trimester of pregnancy.

Vitamins: maintenance of health during the course of pregnancy requires an

adequate supply of vitamins and minerals, some of which have particular
significance. In some instances, this is accomplished by increasing dietary intake;
in other, vitamin-mineral supplementation is initiated.

Folic Acid: this is the most important of the B vitamins to take before and during
pregnancy. Folic acid can help to reduce the risk for developing birth defects,
including spine bifida and other neural tube defects. The neural tube develops
during the first 28 days of pregnancy. Folic acid is also essential for the production
of red blood cells.

Nutritional deficiency anaemia is also caused in folic acid deficiency and may put
extra burden on pregnant women.

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Sources of folic acid include oranges, green leafy vegetables like, spinach, broccoli
and asparagus.

During pregnancy 500 UGu/day.

Vitamin B6: The RDA for vitamin B6 during pregnancy is 1.9 mg per day.

Ascorbic acid: An extra 10 mg/day of vitamin C is recommended for pregnant

women. The total recommendation of 70 mg/day is easily met by a well-planned
diet. Vitamin C, besides its normal functions is also involved in the development
of connective tissue and vascular system as well as in the absorption of iron.

Vitamin A: the vitamin A requirement for pregnant women is calculated on the

basis of the vitamin A content of liver of new born. According to this the RDA for
pregnant women is 6400 ug/day of B carotene and 800 ug/day of retain.

This is an increase as compared to that of normal adult women which is 4800

ug/day and 600 ug/day.

Vitamin D: it is needed to maintain proper levels of calcium and phosphorus

which help build the bones and teeth of the body. A vitamin D deficiency during
pregnancy can cause growth retardation and skeletaldeformaties, increased risk
for rickets, abnormal bone growth and delayed physical development. Most
potential vitamins have around 400 IU of vitamin D.

Vitamin E: Vitamin E needs are believed to be increased somewhat during

pregnancy, but vitamin E deficiency in humans is rare and has not been linked
with their damage to offspring or reduced fertility.

Vitamin K: The recommendation of 65 mg for adult women, aged 25 to 50 applies

to pregnant women as well. This vitamin is essential for synthesis of Prothrombin
that is necessary for normal blood coagulation. However, no RDA for vitamin K
during pregnancy has been established because information is lacking.

Minerals:

Calcium: A developing baby needs calcium to build strong bones and teeth,
Calcium also helps the baby grow a healthy heart nerves and muscle as well as a

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normal heart rhythm and blood clotting abilities. It is also reduces the risk of
hypertension. The new RDA for calcium during pregnancy is 1300 mg/day for
women younger than 19 years of age and 1000mg/day for adult women.

A prenatal supplement usually provider at least 150mg of calcium. In case the diet
is deficient of calcium rich foods an exclusive calcium supplement can be given.
The baby can only absolve up to 500mg of calcium at a time, so the supplemental
calcium in smaller doses should be taken several time a day. Vitamin D is crucial
for absorption of calcium in the baby so care needs to be taken to provide
optimum exposure to sunlight include vitamin D rich food in the diet and take
vitamin D supplements.

Phosphorus: The RDA for phosphorus is the same for pregnant women as for non-
pregnant women.

Iron: Iron is a vital minerals sceptically for women. As they lose a part of it every
month during menstruation till menopause sets in the body needs iron for several
reasons.

1. It helps to maintain a healthy immune system

2. It is essential for making haemoglobin the component of RBC hat carries
oxygen to other cells.
3. It is important component of myoglobin collagen and many enzymes.

The demands are increased manifold during pregnancy due to the following
reasons.

4. To maintain infect iron stores: - infants are born with iron stress in the liver
which are sufficient for first 6 month of life.
5. The amount of blood in the body increase during pregnancy until about
50% more than usual. This cells for extra iron to produce haemoglobin. This
requires about 400 mg iron.
6. To compensate about 170 mg iron last through skin and sweat.
7. It is needed for the growing baby and placenta, especially in the second and
third trimester.

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8. It has usually been seen that women of reproductive age have insufficient
iron reserve and therefore they need extra iron to provide for themselves
as well as the growing foetus.
9. Iron deficiency anaemia during pregnancy is associated with preterm
delivery low birth weight and infant mortality.

During pregnancy 35mg/day.

In order to maximize the intake and absorption of iron from the diet following
points can be kept in mind.

1. Using an iron pan, skillet or tava for cooking purposes.

2. Restricting or avoiding coffee and tea with meals.
3. Including of vitamin C rich foods in the diet along with meals to help in the
absorption of iron studies have shown that vitamin C can increase iron
absorption up to six times.

Zinc: zinc plays a vital role in protein synthesis, cellular division and nucleic acid
metabolism. It is needed for all division and tissue growth, supporting normal
development of the growing foetus. According to WHO, it is estimated that over
80% of pregnant women worldwide have inadequate zinc intake.

During pregnancy 12mg/day.

Sodium: it regulates the fluid levels temperature and PH levels of the body. In
absence of enough sodium, the muscle, nerves and organ would not function
property during pregnancy when the velum of blood and other fluids increase
sodium helps to maintain the water electrolyte balance.

Regular excessive sodium consumption causes the body to retain too much water.
This causes an increase in the pressure of blood pumping through the veins and
arteries. In order to effectively pump blood the body is forced to work harder,
leading to high blood pressure, which can lead to stroke. Heart failure kidney
failure. Stomach cancer, osteoporosis and more. ICMR recommendation (2010)
for sodium are 2500mg/day which is 5gm/day of salt.

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Magnesium: The new RDA of 360-440 mg of magnesium in pregnancy includes an

increase of 40-90 mg to meet the needs of fatal and maternal tissue growth.

Fluoride: The Adequate intake (AI) for fluoride in pregnancy is 3 mg/day.

Iodine: iodine plays an important role in regulating the thyroid gland and the
metabolism. Goitre is caused due to iodine deficiency. In pregnancy iodine also
helps in proper development of the brain and nervous system of the baby. A lack
of iodine during pregnancy has also been linked with an increased risk of
miscarriage, preterm delivery and stillbirth: - the best intervention to provide
iodine in the diet is through iodised salt.

An enlarged thyroid gland, fatigue. Weakness, depression, intolerance to cold and

weight gain can all result from a lack of iodine.

Fluids: - water is an essential as other nutrients drinking at least 10-12 glasses of

water each day is recommended. Consuming a wide range of healthy beverages
during pregnancy is crude to avoid dehydration and relive constipation. It is also
has the added advantages of supplying variance nutrients in one drink as in milk.
Smoothies mixed fruits juice, herbal drinks etc. caffeinated drinks, carbonated
drinks high sugar drinks, alcoholic drinks should be avoided. Drinking water keeps
the urine diluted and helps prevent UTIS care has to take when there is marked
oedema during pregnancy.

Fibre: - in order to avoid GIT problems like constipation and haemorrhoids it is

beneficial to include fibres in the diet. They also help control blood sugar spikes,
blood pressure and keep glucose metabolism under check. Including fibres in the
first trimester have been shown to decrease pregnancy related risks care has to
be taken to avoid excision and very rough fibres in the diet. Whole grains lentils,
green leafy vegetables, are good sources of fibres. A dietary fibre intake of 25-
30gm/day.

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Complications during pregnancy

Nausea and Vomiting: This is commonly called ‘morning sickness’. This is usually a
mild complaint limited to early pregnancy. It occurs more often than rising than
during the day; hence
the term morning
sickness. The reasons
are physiological and
also psychological due
to tensions and
anxieties regarding
pregnancy itself. The
following dietary
suggestion may
provide relief:

• Consuming plain, high-carbohydrate foods (e.g. dry toast, crackers or

cereal) before rising in the morning.
• Drinking fluids between meals rather than with meals.
• Eating small, frequent meals
• Avoiding high-fat or spicy food or foods with strong flavours or odours.
• However, if vomiting becomes severe for a short period of time a clear
liquid diet may be used to provide calories and fluids. Prolonged severe
vomiting will require medical intervention.

Heartburn: Heartburn may occur

more frequently in latter part of
pregnancy. It is a result of the
growing uterus, which exerts
pressure on the stomach, thus
slightly pushing it upwards causing
reflux of the chyme (mixture of
stomach acid and partially digested

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food) into the esophagus leading to hyperacidity and heartburn. Following dietary
recommendation will provide relief.

• Eating small frequent meals

• Avoiding highly seasoned, rich and fried foods
• Taking a walk after meals to encourage the chyme to go down, not up
• Avoiding lying down immediately after meals

Constipation: Generally this is a minor complaint of pregnancy. The pressure of

the enlarging uterus on the lower portion of the intestine causes some difficulty
during elimination. The condition
may be exacerbated by the use of
iron supplements. Dietary
recommendations for the prevention
and treatment of constipation
include:

• Including roughage in the diet

such as that obtained from
eating fruits with their skin,
whole wheat chapatti’s and
green leafy vegetables.
• Increasing fluid intake to 6-8 glasses (8-oz) per day.
• Exercising daily for up to 30-45 minutes; walking is a very good exercise
during pregnancy.

Toxaemia: It is a general term given to an acute hypertensive disorder appearing

after about the 20th week of pregnancy or following delivery and accompanied by
increased oedema, albuminuria and in severe cases, convulsions and coma. The
precise cause is unknown; however it is believed to be the result of malnutrition,
particularly related to deficient amounts of proteins, calories, calcium and salt.
Sodium, however should not be completely avoided, about 2-3 gm. of sodium per
day is suggested. Water and fluids however should not be restricted.

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Gestational Diabetes: - Gestational diabetes is pregnancy include diabetes. It is

when the baby cannot effectively process sugar and carbohydrate leading to
high sugar levels in the blood
stream. It occurs when pregnancy
hormones causes less insulin
sensitivity and is not readily
available for energy. Gestational
diabetes requires a specific diet
where carbohydrates are closely
monitored and regular physical
activity. Medicine is sometimes
required. Some women also need insulin to keep blood sugar levels under
control.

A mother with GDM has greater risks of:

• Hypertension
• Pre-eclampsia
• Urinary tract infection
• Ceaseran section
• Future diabetes

General guidelines during pregnancy:

• Optimal weight gain

• Avoid constipation
• Reduce salt intake
• Reduce intake of caffeine
• Periodic health check-up
• Adequate physical exercise
• Drugs only in consultation with the doctor
• Avoid smoking, alcohol, tobacco
• Discourage wrong belief and taboos

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Myths: there are certain wrong beliefs among women especially elderly women
that certain food-stuffs are harmful if consumed during pregnancy. The most
common food which are taboo are as given below. Pregnant women and their
family members should not be counselled that no food-stuff by itself can cause
any harm to the pregnant woman or to the foetus, unless the child mother is
proven to be allergic to a particular food.

• Papaya
• Cow’s colostrum’s
• Nuts & dry fruits curds
• Banana
• Milk
• Eggs

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NUTRITION DURING LACTATION

Exclusive breast-feeding is the preferred method of infant feeding for the first
4-6 months of life. Anything less than
exclusive breast feeding for the first
four months of a child’s life greatly
increases the chance of infection and
death, even among the children of the
well to do. When the mother is nursing
her baby, it makes greater demand on
her body. The nutritional requirements
of pregnancy continue in lactation
except that they are increased during the latter.

Advantages of breast feeding

• Breast milk is nutritionally superior to other alternatives

• It is bacteriologically safe and always fresh
• It contains a variety of immune cells and anti-infectious factors
• It is the least allergenic of any infant food
• Breast fed babies are least likely to be over fed
• Breast feeding promotes good jaw and tooth development
• Breast feeding generally costs less than the commercial infant formulas
currently available.
• Breast feeding automatically promotes close mother child contact
• Once the process is established, breast feeding is generally more
convenient.
• It helps the uterus regain its normal size after pregnancy

Composition of breast milk: Breast milk has all the nutrients that the baby needs
for the first 4-6 months of life and it is superior to the commercial formulas which
are available for the infant.

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• It contains the most suitable proteins and fats for the baby in the right
quantities
• It contains more lactose than milk from any other source which is what a
human baby needs.
• It contains water-soluble Vitamin D, besides the fat-soluble fraction which
protects against rickets. It also contains more Vitamin A, C and E than cow’s
milk. Thus breast-feed babies don’t require fruit juices or any other vitamin
supplements.
• It contains iron in the form of lactoferrin at acidic pH which makes
absorption easier as compared to iron in cow’s milk.
• It contains enough water for the baby even in hot climates so that there is
no need for any extra water. It contains correct amounts of salt, CA and
Phosphate.
• It is quickly digested because of a special enzyme called lipase which
digests fasts.
• It contains immunoglobulins, lysosomes and “bifid we factor” which helps
fight infections.

Thus, breast-fed babies as opposed to artificially fed infants have fewer incidents
of diarrhoea and respiratory tract infections.

Comparison of breast milk and cow’s milk

S. Nutrients Human milk Cow’s milk

No.
1. Proteins – Whey 60% 40% 20% 80%
Casein
2. Digestibility Soft, Flocculent, curd
Tough, Hard
Curds
3. Linoleic acid 4% energy 1 % energy
4. Zinc High Bioavailability Low availability
5. Anti-infective Present*lag*Enhances Absent
factors & growth of
Antibodies Lactobacillus
Bacterium

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Lactating mother’s nutritional requirements should meet

1. Her own daily needs

2. Provide enough nutrients for the growing infant
3. Furnish energy for mechanics of milk production

Diet of a lactating mother and her nutritional status during pregnancy affects, to
a certain extent, the quality and quantity of breast milk.

Energy: production of 100ml of milk (about 67 kcal) requires 85-kcal expenditure.

Average milk production in the first 6 months is 750ml/day, with a range of 550
to more than 1200ml/day. The RDA for energy needs during lactation provides
for an extra 500 kcal/day above the level for non-pregnant women. However this
factor may vary for obese or underweight women.

Protein: The RDA calls for an additional 15 g of protein during the first 6 months
of lactation and 12 g during the second 6 months, when less milk is produced.
Remember that about 70% of the dietary protein is converted to milk protein.

Lipids: The fat in breast milk directly reflects both the amount and saturation
pattern of fat in the maternal diet. Severe restriction of energy intake results in
mobilization of body fat, with the result that the milk produced has a fatty acid
composition resembling that of the mother’s diet. ICMR suggests 45 gems/day of
visible fat for lactating women so that EF A requirements can also be met.

Vitamins and minerals: Some minerals and vitamin concentrations in the breast
milk are sensitive to maternal intake. For e.g. zinc supplementation in mothers
result in increased zinc concentrations in their milk. The vitamin D status is
related to the maternal vitamin D intake and the exposure to sunlight. The
requirement of calcium during lactation is about 1200 mg and it should be
provided in the diet to prevent the depletion of maternal calcium stores.

Fluids: It is seen that suboptimal quantity of milk production may also result from
inadequate fluid intake by the mother. Breast feeding mothers should be
encouraged to consume 10-15 glasses (8-oz) of fluids.

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Colostrum’s: Milk may be expected to flow within 48-90 hours after delivery.
Before this time, a thin yellow fluid called ‘colostrum’ appears. It may sometimes
appear shortly before birth also. Higher in protein, lower in fat than mature milk,
colostrum provides approximately 15 kcal per oz. It is also a rich source of serum
WBC’s and antibodies.

Complications related to breast feeding

The inexperienced nursing mother may encounter some problems in adjusting to

the ‘breast feeding’ experience.

Engorgement: This is uncommon among mothers who feed their nannies

exclusively from the breast soon after birth and who feed their babies frequently
both day and night. Engorgement may have the following after-effects:

a) The baby finds it difficult to suck properly which in turn reduces the milk
supply.
b) The mother may feed the child less because the sucking hurts her.
c) The breast may become infected leading to mastitis or even breast abscess.

Due to this the mother experiences pain and a hot swelling which fluctuates. It is
important to start management of engorgement as soon it develops. This will
prevent the mother from a great deal of trouble and the child from insufficient
intake.

Sore and cracked nipples: Sore nipple found at the beginning of breast feeding is
usually caused by incorrect positioning of the baby and can be easily treated. It
can be prevented by making sure the child has enough areola in his mouth and
also by avoiding frequent washing of the nipples with soap. Sore nipples if not
treated may result in the damage of the nipple skin causing a fissure or a crack.

Due to painful nipples, mother tends to feed the baby less often and for a shorter
time thus decreasing the infant’s milk supply.

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Galactagogues: these are substances which promote milk production. Examples

of few galactagogues are:

• Garden cress seed barfi / laddoo

• Gond (edible gum) ka laddoo
• Gud jeera
• Ragi porridge
• Wheat flour sheera with nuts
• Rava laddoo
• Rice flour & toddy idlis

Myths: As seen during pregnancy, certain foods such as those given below are
restricted by the lactating mothers themselves or by their family members.
However, there is no scientific evidence the food-stuffs can cause damage to the
lactating mother or to the breast-fed child. These women must be made to
understand that the period of lactation is one where they should consume a
balanced diet including all food- groups in order to ensure adequate milk-
production and also to regain their normal health.

Foods to avoid during lactation

• Leafy Vegetables
• Seedy vegetables
• Potatoes
• Curds
• Cold food
• Whole pulses (except moong)

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NUTRITION DURING INFANCY

An infant or baby is very young offspring
of human beings. The word is derived from
the Latin word infants meaning unable to
speak or speechless.

Salient feature of infancy:-

Infancy is the fastest and most rapid

growth phase in the life of a human.

1. Weight: - new-borns normally lose 5% to 8% of their birth weight during the

first few days of life. They regain this weight by the end of the first 2 weeks. An
infant will double the birth weight by 6 months and triple the birth weight by 1
year. The approximate weight gain is about 0.5 to 1 kg per month.

2. Height: - doctors measure length in children too young to stand. They measure
height once the child can stand. In general length in normal term infants increases
about 30% by age 5 months and more than 50% by age 12 months.

3. Head size: - an infant’s head will grow about ½ inch every month for the first 6
months. Thereafter it will grow ¼ inch per month between 6 months and 1 year of
age. The head should measure close to 17 inch by the time to infant is 6 months
old and 20 inches by 1 year.

4. An infant at birth has a composition of 75% water and 12% to 15% fat. This
composition is alerted to 60% water and 24% fat by the end of the first year.

5. A full term infants has good digestive capacities as regards to protein

emulsified fats and simple carbohydrates. It will take another 4-6 months for the
digestive system to be able to withstand solid food, as salivary secretions and
gastric activity are low in infants below 4 months.

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Nutritional Requirements

During infancy a period of rapid growth, nutrient requirement per kilogram of

body weight are proportionally higher than at any other time in the life cycle. Due
to this precise reason the composition of human milk is ideal for an infant’s
nutritional needs for the first six months of life. There after supplementary
feeding can be started.

Energy:

0-6 month’s 92kcal/kg/day.

7-12 months 80kcal/kg/day.

As started above, during infancy, a period of rapid growth, nutrient requirement

per kilogram of body weight are proportionally higher than at any other time in
the life cycle. Therefore their basal and total energy needs are comparatively
higher at 92 kcal/kg body weight of when compared with 40 kcal/kg body weight
at adults. An infant’s energy or caloric requirement depends on many factors,
including body size and composition, metabolic rate, physical activity, size at
birth, age, sex, genetic factors, energy intake, medical conditions and growth rate.
Infants are capable of regulating their intake of food to consume the amount of
kilocalories they need. Therefore, if an infant refuses to eat, they should not be
force fed.

Carbohydrates:

Carbohydrates serve as primary sources of energy to fuel bodily activities while

protein and fat are needed for other essential functions in the body. Such as
building and repairing tissues. The vital importance of carbohydrates in an infant’s
diet can be underscored by the vital functions it performs like:

1. Supply food energy for growth body functions and activity.

An infant 0-6 months needs about 60gm/day of carbohydrate where as an infant’s

7-12 months requires 95gm/day of carbohydrate.

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Proteins:

0-6 months 1.16g/day/kg.

7-12 months 1.69g/day/kg.

Infants requires high quality protein from the diet in order to perform vital
functions in the body.

1. Build, maintain and repair new tissues including tissues of the skin, eyes,
muscles, heart, lungs, brain and other organs.

2. Manufacture important enzymes, hormones, antibodies and other

components.

3. Perform very specialized functions in regulating body processes.

4. Protein also serve as a potential source of energy if the diet does not furnish
sufficient kilocalories from carbohydrates or fat. Breast milk and infant formulas
provide sufficient protein to meet a young infants needs if consumed in amounts
necessary to meet energy needs. Infant formula provides higher amount of
protein than breast milk, but the protein is not used as efficiently to breast milk
and infant formula protein is derived from legumes, pulses, cereals other grains
products, meat, poultry, fish, egg, yolks, cheese and yogurt.

Fat:

Visible fat in diet of 7-12 months 19g/day. This means 35-54% of the calories
should come from fats of which linoleic acid, which is essential for growth should
provide 3% of the total calories. Both cow’s milk and mother’s milk satisfy the EFA
needs of infants.

Calcium (CA): the infant should be provided 400-800 mg of CA/day. Such high CA
intake is very important for proper growth and development of bones. The
human milk in breast-fed infants generally meets CA requirements of the child.

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Iron (Fe):

Another name of iron is “heave” implying its association with blood. It is a vital
component of haemoglobin the part of red blood cells that carries oxygen
throughout the body. Myoglobin the part of muscle cells that stores oxygen and
many enzymes in the body.

Iron is essential for the,

1. Prepare growth and formation of healthy blood cells.

2. Prevention of iron deficiency anaemia.

Most full stream infants are born with adequate iron stores which last until about
4 to 6 months of age as compared to preterm infants and twins who possess
lower iron stores at birth. Given their rapid growth rate the iron stores are
depleted by 2 to 3 months of age.

Vitamins: The human milk generally meets all the vitamin requirement of the
infant. However, Vitamin D deficiency is sometimes seen in infants due to lack to
exposure of sunlight.

Water: Human milk provides sufficient water to the infant. However the renal
concentrating capacity of young infants is lesser than adults. They are vulnerable
to water imbalance. During very hot climates, the water requirement increases. In
case of diarrhoea, vomiting etc. fluid-electrolyte imbalance can occur.

Weaning: It is a process of gradually introducing foods other than breast milk in

the child’s feeding schedule. This process starts when any food besides mother’s
milk is introduced in the child’s diet and is completed only when the child has
been entirely put off the breast. The introduction of supplementary foods not
only ensures the fulfilment or nutritional requirements but also introduces the
child gradually to the normal family eating pattern. However, there is not set of
pattern for adding solid foods to basic milk diet of the infant. Also the individual
needs and responses of the infants vary. The supplementary foods which can be
given to the child from time to time are listed below:

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Few supplementary foods

Foods When to introduce Form which given Quality

Starting with 1-2

teaspoons, increase to
Fruits juices
Juice mixed with little 30-50ml, Starting with
Green leafy 4-5 months
sugar, Soups in milk 1-2 teaspoons,
vegetables
increase to about
50ml.

Cook about 2 teaspoons

of cereals in a cup of
Cereals 5-6 months Cooked in water or milk
milk/ water e.g. suji
kheer.

Starting from ½
Egg yolk, ½ boiled egg yolk, Boiled
teaspoon increased to
Starchy and mashed potato with
6-7 months one yolk, Start with
vegetables buttermilk/ mashed
small amount and
and fruits banana with milk.
increase to 40-50 gms

Starting with small

Vegetables Well cooked vegetables,
7-8 months amounts, increase the
and pulses thin khichdi
quality gradually.

Whole egg Soft boiled / scrambled

1 egg, Starting with small
meats, egg custard,
10-12 months amounts, increase the
vegetable Well-cooked raw or
quality gradually.
fruits cooked (chopped)

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Important considerations
• Introduce only one food at a time. This facilitates to observe the child’s
response to food. It also helps in finding out if the child is allergic to any
particular food item. If symptoms of allergy i.e. rashes, swelling, fever,
diarrhoea etc. are seen, then that food should be immediately discontinued
‘ and the response to the same food should be rested after about 7-10
days. If the symptoms reappear, then the food should be completely
avoided. Allow infant to get familiar with one food before introducing
another
• Give very small amounts of any new food -1 tsp. or less in the beginning
and the amount should be gradually increased as the child develops a liking
for the food.
• Initially give solid foods of very thin consistency. This is because the child
does not develop sufficient muscular coordination involving the tongue and
the swallowing reflex to be able to eat solid food initially.
• Food should be only slightly seasoned. The child’s food should not ne spicy,
fried foods should also be avoided.
• The person who is feeding the child should himself never show dislike to
any particular food. This makes the child learn to eat all types of food.
• Variety in choice of food is important for an infant also. As the child grows
older, colour, flavour, texture and shape of the food should be given special
consideration to avoid monotony.

It is important that utmost cleanliness is exercised in preparing the feed and while
handling and feeding the baby. This includes the cleanliness of the utensils and
sterilization of bottles and nipples. The traditional method of using a katori and a
spoon is more hygienic and hence safer for the child. Care should be taken to use
thoroughly boiled water for dilution of any food.

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NUTRITION DURING CHILDHOOD

The most common characteristic of
diet during the childhood years is
variability. Children’s appetites and
nutritional needs vary considerably
based on age, size, activity level
and rate of growth. Healthy pre-
schoolers should consume a wide
variety of foods with different
tastes, textures and colours. They
should be encouraged to try most foods eaten by the rest of the family, but in
smaller portions of about one-third to one-fourth the size of an adult portion.
Foods should be cut into bite-sized pieces and self-feeding should be encouraged.

Food and feeding are especially important during this phase of the lifecycle, not
only to support physiologic growth and maturity, but as the basis of life-long, food
related habits and attitudes. It is important for parents to be patient in dealing
with the mixed reactions they like to receive from their children. The physiological
and the psychological changes that occurred in childhood are as follows:

Increase in body size:

During the second year the increase in height is about 10 cms and weight gain
about 2 to 2.5 kg. Though growth is slackened during this period, important
muscle development is taking place.

During the preschool age (3-6years), growth continues in spurts. The child spends
quite a bit energy in play. Annual gain in height and weight is only about 6-7 cms
and 1.5 to 2 kg, respectively. However, there’ is a wide variance in the physical
development of children.

The school age (6-12years) period has been called the latent time of growth slows
and body changes occur gradually. Reserves however are being laid down during

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this period for the rapid growth during the period for the rapid growth during
adolescence ahead.

It is important to monitor the growth of the child particularly upto 6 years of age,
as this is the most crucial period when nutritional deficiency occur easily. A
healthy normal growing child should gain weight and height regularly.

Changes in body composition

As growth proceeds during childhood, there are changes in the proportion of
water, muscle tissue, fat deposits and the skeletal structure, the body water
gradually decreases and there is addition of adipose tissue’ ‘ and that of minerals
to the bones. Usually, girls have a higher deposition of body fat as compared to
boys of the same age but have a lesser percentage of muscle tissue. During
childhood, boys are taller and heavier at each age than girl’s except-at the age of
11 and 12 years when girls are usually heavier and taller.

Psycho-social Changes
During infancy, the child identifies himself all along with his mother. As he steps
into the second year of life, he starts developing a sense of individuality which is
distinct from her and this is even reflected in his food behaviour. With advancing
age and increase in physical mobility, there is an increase sense of independence,
initiative, imagination and curiosity. There is a change from dependence to
parental standards towards those set by the peer group in preparation for the
coming maturity adolescence.

Nutritional Requirements: Food and feeding are especially important during this
phase of the lifecycle, not only to support physiologic growth and maturation, but
as the basis of life-long. Food related habits and attitudes. It is important for
parents to be patient in dealing with the mixed reactions they are likely to receive
from their children.

Energy: Dietary energy must be sufficient to ensure growth and spare proteins
from being used for energy, without being so excessive that obesity results. The

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table given below gives the recommended energy and protein allowance for
children of various age groups as computed by ICMR in 1990.

Protein: protein requirement for children includes not only the basal losses, but in
addition an allowance is also made for growth.

Recommended allowances for energy and proteins for children and adolescents:

GROUP AGE(Years) ENERGY(kcal/day) PROTEINS(gms/day)

Children 1-3 1240 22
4-6 1690 30
7-9 1950 41
Boys 10-12 2190 54
Girls 10-12 1970 57

FAT: A higher fat intake has been recommended for children in view of the high
energy density and thus reduced bulk of the diet. In case of young children, the
linoleic acid requirement has been placed at 3% of energy, which can be satisfied
even by an intake of 109 of visible fat per day. It is however, suggested that an
amount of 25g of visible fat per day must be taken by them to provide sufficient
energy density and palatability of the diet. Since their energy requirements are
almost equal to that of adults, the minimum amount of visible fat intake
suggested for them is 12g/day. However ICMR (1990) has suggested a desirable
level of visible fat intake of 20g/day for older children and adolescents as for
adults.

Minerals and vitamins: Minerals and vitamins are necessary for normal growth
and development. Insufficient intake can cause impaired growth and result in
deficiency diseases. Children between 1 and 3 years of age are at high risk for iron
deficiency anaemia. The rapid growth period of infancy is marked by an increase in
both haemoglobin and total iron mass.

Calcium For this age group, calcium is needed for adequate mineralization and
maintenance of growing bone. The average intake recommendations for increased

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levels of calcium for older school-age children is 1300 mg of calcium/day for

children 9 to 18 years of age, reflecting the need to support optimal bone
mineralization. The average intake recommendation for 1 to 3 years old is 500
mg/day and average intake of 800 mg/day has been recommended for 4 to 8 years
of age.

Zinc is essential for growth; a deficiency results in growth failure, poor appetite,
decreased taste acuity, and poor wound healing. An allowance of 10-mg/day zinc
is recommended.

Iron requirements during childhood need to cover the basal loss of iron, the
amount required for growth and that for increase in the haemoglobin (Hb)
concentration by about 1g/dl. Based on this, during the second to twelfth year, iron
requirement for growth and expansion of Hb mass would be about 15 µg/kg/day
which needs to be added to the basal losses of 14 µg/kg/day as in the case of adults.
Thus the children would require a total of 29µg/kg/day. Taking into account the
body weights and further, an absorption figure of 3%, the daily dietary iron
requirements can be computed. Vitamin A requirements of children have been
from the requirement figures for infants (50 µg/kg) and adults (9.3µg/kg) taking
into account growth rates at different ages. On this basis, vitamin A requirement
for children will be 300-400µg retinol day. It has been observed that the incidence
of vitamin A deficiency is high and serum vitamin A levels are generally low among
Indian children whose dietary intake is less than 100 µg/day.

Other fat Soluble Vitamins ICMR has not given recommendations for vitamin D and
K while the requirements for vitamin E are related to essential fatty acid intake.
Common health problems in childhood:

Underweight/Malnutrition

Many of the Indian school children consume inadequate diet and so they are
malnourished. Malnutrition could also be due to poverty or ignorance on part of
the parents to know the requirements of the child, quantitatively or qualitatively.
When the child is in a hurry to go to school he may miss breakfast or may not carry
proper lunch to school or may because too tired after school activities and sleep of

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without taking night meals and thus skip one or meals in a day. Other factors which
may lead to poor eating include emotional disturbances due to poor academic
performances, child’s likes and dislikes and the environment at home. All this
factors must be kept in mind by the mother while planning the menu of the family.

Constipation

Children may not relish the vegetables and fruits particularly green leafy
vegetables. Parents should make an effort to motivate the child to eat by serving
in different forms. Consumption of less quantity of food can lead to constipation.
Early morning hurry to go to school and lack of sleep and activity can also lead to
constipation.

Dental caries

Consumption of sticky sweets can result in dental carries. Brushing the teeth before
going to bed and after a meal should become a habit in children. Children should
be encouraged to eat hard raw crisp foods.

Packed lunches have become a necessity for school going children as schools are
either away or the lunch period is too short for the children to go home and have
food.

While planning packed lunches, take care that

• The pack lunch meets one-third daily requirements of calories and protein
of the child.
• Preferably the packed lunch consists of all five food groups, though the
number of dishes may be less.
• It includes one serving of green leafy vegetables, milk and milk products, so
that one third requirements of many vitamins and minerals and good quality
proteins respectively are fulfilled.
• Monotony is avoided and there is variety.

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Suggested pack lunches

a) Veg. Pulao, boiled egg, tomato raita and orange fruit.
b) Methi paratha, thick dal and buttermilk
c) Dal paratha, palak sabzi
d) Cheese/Paneer sandwich, Guava
e) Idli and sambhar
f) Khichdi, buttermilk and coriander chutney

Healthy snacking Snacks are food item consumed in between two meals.
Forming a habit of munching on healthy snacks should be made a practice right
from childhood. Though, commercially available fried, spicy snacks are an easy
alternative of working mothers, they should realise the harmful, long-term
consequences of these snacks on the child’s health. A few examples of healthy
snacks are:

1. Groundnut / Til chikki

2. Puffed rice / rice flakes chivda with groundnuts
3. Besan ladoo
4. Coconut barfi
5. Thalipith
6. Shakarpara
7. Khakhra
8. Bread with jam/cheese/paneeer/egg
9. Toast with milk.

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NUTRITION IN OLD AGE

Aging is a normal process that

begins at conception and ends at
death. During periods of
growth,anabolic processes
exceed catabolic changes. Once
the body reaches physiologic
maturity, the rate of catabolic or
degenerative change becomes
greater than the rate of catabolic
cell regeneration.The resultant
loss of cells leads to varying
degrees of decreased efficiency
and impaired organ function.
Aging is marked by a progressive loss of lean body mass, as well as changes in
most body systems.

Nutritional Requirements

A myriad of physiological, psychosocial and environmental factors can

dramatically affect the ability of an elderly patient to meet daily nutritional
needs.

Energy: Dietary Allowances (RDAs) call for a reduction in average daily

energy allowances for those 51 years of age or older, amounting to 600 kcal/
day for men and 300kcal/ day for women, Meting the nutritional needs of the
elderly is challenging because, although their requirements for protein,
vitamins, and minerals either do not diminish or actually increase. Thus, there
is need for nutrient dense foods to meet the daily nutrient needs. Average
caloric intake for persons 51 years and older is 2300kcal/ day for men and
1900 kcal for women. Health problems arise when totalintake is less than 1
500 kcal per day,

Carbohydrate: Current dietary guidelines recommend that 55% to 65 % of

the total daily calories should come from carbohydrates. Emphasis should be

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placed on increasing the intake of complex carbohydrates, including dietary

fibers, and controlling the intake of simple sugars.

Protein: As people age and experience

a decrease in skeletal tissue mass, the
store of protein provided by skeletal-
muscle may be adequate to meet the
needs for protein synthesis, making
dietary protein intake more important
to yet essential needs ug. Kg IBW for
males and 0.9g/ Kg IBW for females is
recommended.

Lipids: There is no established DA for

lipids. Current dietary guidelines
recommend that no more than 30% of
the total daily caloric intake should
come from lipids. Emphasis should be
placed on reducing the intake of
saturated fat and choosing
monounsaturated or polyunsaturated
fat sources. Conversely, over restriction
of dietary fat to less than 20% of the caloric intake may affect the overall
quality of the diet.

Zinc: Older people who avoid flesh foods

may be at increased risk of poor zinc status
owing to the reduced bioavailability of zinc
from other food sources, Zinc deficiency is
associated with impaired immune function,
anorexia, dysgeusia, delayed wound healing,
and ulcer development.

Sodium: Another important mineral is sodium and it is considered prudent to

limit dietary sodium intake to approximately 2 to 4 g per day,

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Calcium: Calcium needs during adulthood increases especially for women.

Women over 50 years of age who are not receiving Hormone Replacement
Therapy (HRT) require more Ca as there is increased loss resulting in
demineralization of bone and osteoporosis. 1500 mgs daily is recommended.

Vitamins: The antioxidant vitamins, such as vitamin E, carotenoids, and

vitamin C, have been promoted as agents that enhance the health of the
elderly. The role of high antioxidant serum levels in reducing the risk for age
related macular degeneration, the leading cause of irreversible blindness, has
been studied. The usual causes of vitamin Bl2 deficiency are atrophic gastritis
and bacterial overgrowth, which" decrease absorption and can lead to
pernicious anemia. Recent research has shown that increased serum levels of
vitamin B6, B12, and folate confer protection against elevated serum
homocysteine, an independent risk factor for cardiovascular diseases,
depression, and certain neurological deficits.

Water: Water accounts for approximately 50% of an older person's weight.

This represents a decline of 10% from young
adulthood, and is associated with a
corresponding decline in lean body mass.
Daily fluid replacement is essential,
particularly in those who exercise regularly,
consume large amounts of protein, use
laxatives or diuretics, or live in areas with
high temperatures.

Factors affecting food intake in elderly patients

Many elderly patients have difficulty consuming enough food to meet even
diminished calorie requirements and therefore are at risk for a number of
nutritional problems. The major physiological, psycho social and
environmental factor that can affect eating behavior are as follows:

Physiological/physical factors

• Decreased taste acuity

• Decreased sense of smell

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Diploma in Ditetics FGIIT,

• Dental problems or poor fitting dentures

• Arthritic changes or other handicapping conditions
• Decreased vision
• Medications that may interfere with nutrient absorption
Psycho social factors

• Long term food habits and preferences that are not easily altered
• Depression and loneliness
• Reduced income and dependence
• Availability of / participation in congregate meals
Environmental factors

• Distance from food store

• Availability of transportation
• Cooking facilities
• Neighborhood safety
The presence or absence of each of the above-mentioned factors will of course
vary widely with each individual. Nutritional plans formulated without regard
to the significant intervening factors such as those listed above hold very little
chances for fulfillment.

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THERAPEUTIC ADAPTATIONS OF NORMAL DIET

• Consistency – in disease like diarrhea, fever, etc., the digestive system gets
affected and a liquid or a soft diet is recommended. Therefore it is
important to modify the consistency of the diet according to the changes in
the metabolic conditions.
• Energy intake-increase in energy is required in the conditions like fever and
injury whereas in conditions like diabetes and other metabolic diseases, if
the patient is on complete bed rest and therefore not consuming calories,
the energy intake decreases.
• Content/quantity- the amount of food intake varies with the types of
diseases as well as factors like age and sex. The content of the specific
nutrient (mineral, vitamin, carbohydrates, and proteins) increases with the
requirement in specific conditions. If a patient is suffers from PEM, there is
a need of more protein in the diet/ in case of anaemia, iron needs to be
monitored. In some other cases restriction of the various minerals and
vitamins are also recommended.
• Bland diet- if the patient is not able to ingest normal diet and has difficulty
in swallowing/suffering from diseases like stomach ulcer/ cancer, bland
diets are recommended. Diet restricted in chemical irritants (spices) is
recommended in many such cases.
• Allergic foods- some people are allergic to some specific foods like milk,
egg, fish, etc. therefore such foods are restricted in the modified diet.
• Frequency of diets- as per the requirements with the change of the
metabolic conditions the timings of feed change. Sometimes small frequent
meals are recommended.
• Mode of feeding – there are various modes of feeding. If the patient is not
able to ingest the food through the normal oral route, methods like
enteral/parenteral, intravenous/ tube feeding is recommended.

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In case of any diseases, normal diet needs to be modified to meet the required
needs of the body.

Foods Recommended
• Milk and milk based beverages and products.
• All cereals and pulses
• All vegetables either cooked or in form of soups, gruels etc.
• Fresh seasonal fruits
• Eggs, fish, poultry etc.
• Butter, cream, ghee.
• Sugar, jam, honey, etc.

Foods Avoided
• Fatty foods like rich cakes, pastries, halwas, sweets, etc.
• Fried foods like puries, paranthas, pakoras, etc.
• Strongly flavoured vegetables like turnip, capsicum, radish, etc.
• Too many spices, relishes or pickles.

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Diet and Feeding pattern

• Small and frequent meal pattern should be monitored to meet the
increased requirements and for better tolerance to food.
• Food should be well cooked. Raw food might lead to digestive problems.
• Seasonal food should be preferred
• Foods should be hygienic and vegetables and fruit should be washed
properly before cooking

Nutrition Pearls/Prescription
• Diet should be well-balanced including foods from all the food groups in
adequate amounts and keep in consideration the appearance, texture and
flavour.
• Energy and nutrient dense foods should be given as they help to meet the
increased energy needs without increasing the dietary bulk.
• All meals should have the combination of cereal and pulse with some amount
of animal protein to improve the protein quality of the diet eg. Khichdi with
curd, sweet Dalia with milk, paucity roti and curd etc.
• More of fats especially fatty foods may result in gastric troubles or diarrhea.
• Ample amount of seasonal vegetables and fruits should be consumed to
improve the vitamin and minerals status.
• Easily digestible, simple and bland (soft) foods are better tolerated by the
patient.
• Force-feeding the patient to gain excess weight is known to be harmful.
• Meals should be well prepared and tempting with good presentation to
encourage the patient to increase appetite.

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Diploma in Ditetics FGIIT,

Fluid diets:
Diet in the form of fluid is recommended when the patients are not able to chew
and digest the normal diet. In conditions like acute stomach disorders, the fluid
diet is recommended.

Types of diets:

• Clear fluid
• Full fluid diet

Clear fluid diets:

Such type of diets are clear strained liquids and recommended in the patients
suffering from diseases like diarrhea, vomiting, anorexia, etc. it mainly includes
water, carbohydrates and electrolytes, therefore provides only 400-500 kcals,
very less fats and proteins.

Types of foods:
• Weak tea and coffee without milk
• Strained fruit juices
• Cereal and pulse waters.
• Carbonated beverages.

Full fluid diets:-

These diets include the liquid foods which are free from complex foods like
cellulose and spices. The patients that are not able to swallow or chew the food
properly are recommended this type of diet. The nutritional composition of the
diet is 1500-2000kcal. With time and the improvement in the condition of the
patient the diet can be slowly modified into normal diet.

Supplements of proteins, vitamins and minerals can be added to the diet as per
the requirements.

Examples: Bournvita, proteinex, horlicks, skimmed milk powder, etc.

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Types of foods:
• Clear broth, strained cream soups.
• Refined and strained cereal and pulse gruel.
• Strained fruit and vegetable juices and purees.
• Milk and milk based beverages like eggnog, malted milk etc
• Plain gelatine deserts, plain ice cream, soft custards and corn starch
puddings.
• Tea, coffee and carbonated beverages.
• Sugar, butter cream, oil, cocoa and salt.

Soft diet
Soft diet is given to the patients who are not suffering from metabolic and
stomach disorders and have difficulty in digestion. Soft diet includes foods which
are soft and mashed and do not require much chewing. The diet is made from all
kinds of food groups to make it a balanced diet and include all the desired
nutrients to fulfil the needs of the patients.

Foods recommended
• Refined cereals like rice and its products, breads, semolina, pastas, etc.
• Washed pulses as such or in the forms of soups and in combinations with
cereals and vegetables.
• Milk and milk products such as curd, cottage cheese and mildly flavoured
processed cheese.
• Eggs and lean meats like fish and chicken
• Starchy low fibre vegetables, like potato, spinach, bottle gourd etc.,
• Soft fruits like, papaya, banana, mango, etc., after removing the skin and
seeds.
• Fruits and vegetables in forms of juices and soups.
• Fats like butter, cream, vegetable oils etc.
• Salt and sugar in moderation.

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Foods not to be included/ avoided:

• Raw vegetables and fruits excepting soft fruits
• High fibre vegetables like tomatoes, beans, peas etc.
• Whole grain cereals and their products like cracked wheat, atta etc.
• Whole pulses and split pulses with husk
• Dry fruits and nuts.
• Fried foods, fatty and tough meats.
• Rich cakes, pastries, halwas etc.

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TOTAL PARENTERAL NUTRITION

Parenteral nutrition or intravenous feeding is a method of getting nutrition into
your body through your veins depending on which vein is used this procedure is
often referred to as either total parenteral nutrition (TPN) or peripheral
parenteral nutrition (PPN).

This form of nutrition is used to help

people who can’t or shouldn’t get their
core nutrients from food. It’s often
used for people with

1. Crohn’s disease

2. Cancer

3. Short bowel syndrome

4. Ischemic bowel disease

It is also can help people with

conditions that results from low blood flow to their bowels.

Parenteral nutrition delivers nutrients such as sugar, carbohydrates, proteins,

lipids, electrolytes and trace elements to the body. These nutrients are vital in
maintaining high energy, hydration, and strength levels. Some people only need
to get certain types of nutrients intravenously.

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What are the side effects of parenteral nutrition?

The most common side effects of parenteral nutrition are mouth sores, poor
night vision and skin changes. You should speak with your doctor if these
conditions don’t go away.

Other less common side effects include:-

1. Changes in heart beat
2. Confusion
3. Conrulsions or seizures
4. Difficulty breathing
5. Fast weight gain or weight loss
6. Fatigue
7. Fever or chills
8. Increased urination
9. Jumpy reflexes
10.Memory –loss
11.Muscle twitching, weakness or cramps
12.Stomach pain
13.Swelling of your hands, feet or legs
14.Thirst
15.Tingling in your hands or feet
16.Vomiting

What are the risks of parenteral nutrition?

The most common risk of using parenteral nutrition is developing catheter
infection.

Other risks include:

1. Blood clots

2. Liver disease

3. Bone disease

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Diploma in Ditetics FGIIT,

It’s essential to maintain clean tubing needless access ports, catheters and other
equipment to minimize these risks.

What is the outlook after parenteral nutrition?

Many people experience some improvement in their condition after parenteral
nutrition. You may not be rid of your symptoms, but your body may be able to
heal more quickly. You will likely feel stronger and more energized. This can help
you do more in spite of the effects of your condition. The results of parenteral
nutrition are maintained health and energy levels in your body. You may need this
treatment only temporarily or you may need to use it for the rest of your life.
Your nutritional needs may change with time.

General usage:
• TPN is normally used following surgery, when feeding by mouth or using
the gut is not possible.
• When a person’s digestive system cannot absorb nutrients due to chronic
disease.
• If a person’s nutrient requirement cannot be met by enteral feeding (tube
feeding) and supplementation.

Sources of calorie available for Intra Venous (IV) infusion

• Hypertonic glucose – 50%, 25%, and 8% are used for providing calories.
• Isotonic fat solution- provides more calories with low osmolarity as calories
are provided in concentrated form.
• Dose of amino acids-2-3g/kg/day should be given.
• Vitamin – standard multivitamin preparations are available.
• Trace elements – oral preparations called Aquamin, which contains all the
major trace elements, can be given (1-3tsp/day).

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Requirement for various age groups in children:

Age Water ml/kg Dextrose/kg Amino acids g/kg Lipids g/lg

Neonate 80-150 7-15 2-5 1-3
Infant 120-200 12-30 2.5-4 1-3
Older child 80-150 7-15 1.5-3 1-3

Table 1.1

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TUBE FEEDING
Feeding tube:

A ‘feeding tube’ is a medical device used

to provide nutrition to patients who
cannot or refuse to (q.v. hunger strike)
obtain nutrition by swallowing. The
state of being fed by a feeding tube
through the large central vein is called
enteral feeding or tube feeding.

Placement may be temporary for the

treatment of acute conditions or lifelong in the case of chronic disabilities. Many
patients treated using a feeding tube lack the ability to survive on their own
without such technology.

Feeding tubes may be inserted through the nasal passageway for short-term use,
but for those patients who require longer use of the tube, it is customary to place
the tube directly into the stomach through the abdominal wall.

Care of the tube and the patient: Greater care is required during the first week
the tube is in place, as the surgery has just been performed. The area around the
wound must be kept thoroughly clean and covered with clean, gauze. During the
period of time the tube may occasionally pull away from the abdominal wall,
resulting in leakage around the insertion site. In some cases it might cause
swelling and infection. When feeding the patient, it is imperative that the
caregiver thoroughly washes their hands with soap and water before preparing
formula. The tube should be checked for patency, and the formula administered
at room temperature. The patient should be upright, no less than thirty degrees,
to minimize the risk of regurgitation and aspiration, and they should be kept
upright for thirty to sixty minutes after feeding. To prevent complications
(abdominal cramping, nausea and vomiting, gastric, distension, diarrhoea,
aspiration), food should be infused slowly, it make take more than an hour to

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administer one feeding session, as the drip mechanism is kept at a very low
settings.

Composition:

Tube feeding formula is a simple blenderized liquid formula with a liquid based
mixed with the other nutrients. Some of the commercial foods and full fluid diets
are given in tube feeding formulas. Dextrose, amino acid, vitamins, minerals and
fatty acids can be administered.

Complications: Tubes are prone to clogging, particularly with some medications

and if not flushed as directed. It sometimes can cause damage to colon can cause
complications of stomach like peritonitis, gastric outlet obstruction, abdominal
facial dehiscence and gastro cutaneous fistula.

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GASTRO – INTESTINAL DISORDERS

Gastritis is inflammation of the gastric mucosa. The word comes from the Greek
gastro-meaning of the stomach and-it is meaning inflammation. Depending on the
cause, it may persist acutely or chronically and may coincide with more serious
conditions such as atrophy of the stomach

Symptoms:
• Abdominal cramping and pain
• Nausea
• Vomiting
• Diarrhea
• Fever
• Loss of appetite
• Belching or gas
• Weakness

Causes:
• Bacterial, fungal (most often in people with immunodeficiency) viral or
parasitic infection.
• Bile reflux
• NSAIDS
• Cigarette smoke
• Autoimmune disorders
• Excessive alcohol consumption
• Excessive caffeine consumption
• Certain allergens
• Certain types of radiation
• Stomach injury
• Stress
• Eat regularly and moderately
• Avoid smoking

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• Limit or avoid alcohol and caffeine

• If possible avoid drugs that re irritating to your stomach
• Avoid foods that you don’t digest easily
• For minor discomfort use antacids; don’t use aspirin
• Don’t eat solid foods on the first day of the attack, give your stomach arrest
and drink liquids only , milk or water are preferred
• Add bland foods to your diet slowly and as tolerated (cooked cereals,
bananas, rice, potatoes, toast) and avoid greasy, spice foods.
• More severe cases may require hospitalization, especially if you have blood
in your bowels

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HERNIA
A hernia occurs when an organ pushes through an
opening in the muscle or tissue that holds it in
place. For example the intestines may break
through a weak-end area in the abdominal wall.
Many hernia occur in the abdomen between your
chest and hips but they can also appear in the
upper thigh and groin areas.

Mast hernia aren’t immediately life-threatening

but they don’t go away on their own. Sometimes
they can requires surgery to prevent dangerous
complication.

Symptoms:
• Most small hiatal hernias cause no
problems. But larger hernias may cause
heartburn, belching or chest pain when
stomach acids back up in to your food pipe (esophagus). These sing and
symptoms tend to become worse when you lean forward, strain, lift heavy
objects or lie down, and they can also worse during pregnancy.
• In rare cases, the part of your stomach that protrudes into your chest cavity
may became twisted (strangulated) or have its blood supply cut off.
• Severe chest pain
• Difficulty swallowing (dysphagia)
• Obstruction of your esophagus

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Diploma in Ditetics FGIIT,

Causes:
Hernia are caused by a combination of muscle weakness and strain. Depending
on its cause, a hernia can develop quickly or over a long period of time.

Some common causes of muscle weakness or strain that can lead to a hernia
include.

1. A congenial condition that occurs during development in the womb and is

present from birth.
2. Aging
3. Damage from an injury or surgery
4. Chronic coughing or chronic obstry pulmonary disorder.
5. Strenuous exercise or lifting heavy weights
6. Pregnancy, especially having multiple pregnancies.
7. Constipation which causes you to strain when having a bowel movement
8. Being overweight or obese
9. Fluid in the abdomen or ascites.

There are also certain things that an increase your risk of developing a hernia.
They include,

1. A personal or family history of hernia

2. Being older
3. Pregnancy
4. Being overweight or obese
5. Chronic constipation
6. Chronic cough (likely due to the repetitive increase in abdominal pressure.)

pg. 219
Diploma in Ditetics FGIIT,

Treatment:
• Most abdominal hernias can be surgically repaired, and recover rarely
requires long-term changes in lifestyle .Uncomplicated hernias are
principally repaired by pushing back, or “reducing”, the herniated tissue,
and then mending the weakness in muscle tissue(an operation called
herniorrhaphy).
• Many patients are managed through surgical day-care centres, and are able
to return to work within a week or two, while heavy activities are
prohibited for a longer period. Surgical complications have been estimated
to be up to 10%, but most of them can be easily addressed. They include
surgical site infections, nerve and blood vessel injuries, injury to nearby
organs, and hernia recurrence.
• Eat small meals. Large meals can distend your stomach, pushing it into your
chest.
• Avoid alcohol, caffeinated drinks, chocolate, onions, spicy foods, spearmint
and peppermint, all of which increase production of stomach acid and relax
the lower oesophageal sphincter.
• Even decaffeinated coffee can be irritating to an inflamed oesophageal
lining. Also try to limit citrus fruits and tomato-based foods. They re- acidic
and can irritate an inflamed oesophageal.
• Limit fatty foods. Fatty foods relax the lower oesophageal sphincter and
slow stomach emptying, which increase the amount of time that acid can
back up into your oesophagus.
• Sit up after you eat. Wait at least three hours before going to bed or taking
a nap. By then, most of the food in your stomach will have emptied in your
intestine, so it can flow back into your oesophagus. Eating a bed time
snacks stimulates acid formation and further aggravates acid reflux.
• Don’t exercise immediately after eating. Try to wait at least two to three
hours before you engage in any strenuous activity. Low-key exercise, such
as walking is fine.

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Diploma in Ditetics FGIIT,

• Lose weight. If you’re overweight, slimming down helps reduce the

pressure on your stomach. This may well be the most important thing you
can do to relieve your symptoms.
• Stop smoking. Smoking increases acid reflux and dries your saliva. Saliva
helps protect your oesophagus from stomach acid.
• Avoid certain medications, if possible like calcium channel blockers, such as
diltiazem; the antibiotic tetracycline; non-steroidal anti-inflammatory
drugs, such as aspirin, ibuprofen and naproxen sodium; theophylline;
sedatives and tranquilizers; and alendronate. If you take any of these
medications and suffer from heartburn, talk to your doctor. You may be
able to take other drugs instead.
• Elevate the head of your bed. If you elevate the head of your bed 6 to 9
inches, gravity will help prevent stomach acid from moving up into your
oesophagus as you sleep. Using a foam wedge to raise your mattress also
may help. Don’t try to use pillows, which tend to increase pressure on your
abdomen.
• Avoid tight fitting clothes. They put pressure on your stomach.
• Take time to relax. When you’re under stress, digestion slows, which makes
GERD (gastroesophageal reflux) symptoms worse. Relaxation techniques
such as deep breathing, meditation or yoga may help reduce acid reflux.

pg. 221
Diploma in Ditetics FGIIT,

DIARRHOEA
• Diarrhoea is a condition in which a person suffers from loose watery stools.
Acute infectious diarrhoea is a common cause of death in many countries
accounting to 5-8 million
deaths annually. Much of
these incidents of these
deaths are due to the lack
of adequate safe water and
lack of sewage treatment
capacity, the separation of
drinking water from
contaminated sewage is
also a major issue.
• Diarrhoea is generally not a disease by itself but a symptom of an
underlying functional or organic disease.
• Functional disturbances – there is no structural alteration. There may be
disturbances in motility, enzyme production, and release and transport
mechanisms.
• Organic disturbances- involve definite pathological changes like ulcers or
cancers.

Diarrhoea may be either acute or chronic in nature.

Acute diarrhoea
Acute diarrhoea is characterized by sudden onset and frequent passage of
watery stools. The patient may even pass several stools in an hour.

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Symptoms:
• Abdominal bloating or cramps.
• Thin or loose stools
• Watery stool
• Sense of urgency to have a bowel movement
• Nausea and vomiting

Causes:
• Bacterial and parasitic infection leading to gastro-intestinal infection
through contaminated water.
• Food allergy or sensitivity towards a specific food and faulty feeding
practices.
• Protein energy malnutrition (PEM) and deficiency of vitamins.
• Food poisoning
• Psychological factors like anxiety, tension, etc.
• Reaction to medicines.

Chronic diarrhoea
Unlike Acute diarrhoea, chronic diarrhoea persists for a longer time, even
several weeks and the patient may pass 4-5 unformed stools in a day. The
rapid passage of food through the intestines does not allow sufficient time for
the absorption of other nutrients and thus nutritional deficiency may occur.

Symptoms:
• Dehydration
• Blood, mucus or undigested food in the stool.
• Weight loss
• Fever

pg. 223
Diploma in Ditetics FGIIT,

Causes:
• Malabsorption syndromes like celiac disease and lactose intolerance.
• Metabolic disease like diabetes mellitus, uraemia.
• Chronic alcoholism
• Cancer of colon
• Liver cirrhosis

Etiology:
Diarrhoea can affect any age and sex. Diarrhoea is most common in infants
and among the population living in unhygienic conditions where the
management of sewage and water is poor. Such conditions lead to infections
and even death.

Treatment of Acute and Chronic Diarrhoea:

• Oral Rehydration Therapy (ORT):- it is a simple and inexpensive
treatment. The patient is administered liquid formula through mouth to
correct dehydration and loss of electrolytes. It is a dried composition of
oral rehydration salts available in packed form.

The composition consists of

Sodium chloride 3.5 g
Sodium bicarbonate 2.5g
Potassium chloride 1.5g
Glucose 20g
Water (dissolved in) one litre

Table 1.2

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Diploma in Ditetics FGIIT,

ORS should be given as soon as the loose stools start. Other fluids like coconut
water, pulse water, buttermilk, carbonated water etc., can be given along with
the ORS.

• As the energy requirement increases due to the losses therefore intake

of carbohydrates should be increased up to 10% but the roughage
should be minimized to avoid any further bowl movement.
• Fats are important to provide good amount of energy but at the same
time they increase the bulk so they are not completely digested.
Emulsified fats like butter, full cream milk can be given as they are easily
digested.
• Protein intake should also be increased as much as 50% to meet the
tissue breakdown.
• Calcium and iron should be taken increased quantities as the absorption
is lowered and vitamin B complex should also be taken to compensate
for the losses.
• Foods should be soft so that it is easily digested.

Recommended foods:
• Porridge (semolina)
• Spinach Khichdi
• Bread butter
• Boiled egg
• Juices
• Gruels

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Diploma in Ditetics FGIIT,

CONSTIPATION
Constipation may be defined as the retention of faces in colon beyond the
normal time of empting time.
People who are constipation
find it painful to have a bowel
movement and often
experience straining, bloating,
and the sensation of a full
bowel. Constipation is a
symptom, not a disease.
Almost everyone experiences
constipation at some point in
their life, and a poor diet
typically is the cause. Most
constipation is temporary and not serious. Understanding its causes,
prevention, and treatment will help most people find relief. There are 2 types
of constipation:

1. Atonic constipation - also called lazy bowel syndrome. There is loss of

muscle tone in the colon or rectum which causes difficulty in the
passage of stools.
2. Spastic constipation – caused by increase in the muscle tone which
narrows the cavity and movement of faeces is retarded.
3. Obstructive constipation – obstructive constipation is due to the
obstruction of the large bowel or malignancy of the colon.

Symptoms:

• General malaise
• Headache
• Coated tongue
• Foul breath
• Luck of appetite

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Diploma in Ditetics FGIIT,

Causes:

• Poor personal hygiene

• Irregular intake of meals
• Inadequate intake of fluids/insufficient bulk
• Emotional disturbance like tension, depression, anxiety or excitement
• Lack of exercise
• Painful fissures or haemorrhoids
• Diseases like colon cancer or obstruction in intestine.

Aetiology:
Atonic Constipation mainly occurs in the elderly people, in pregnant women and
people leading sedentary life. On the other hand spastic constipation can occur in
people suffering from diseases related to colon and intestine.

Treatment/ dietary management:

1. Develop a regular habit of evacuation
2. Consume high fibre diet and ensure adequate intake of fluids.
3. Exercise regularly
4. Fat intake induces a lubricant effect and stimulating action, therefore
adequate amounts should be induced in the diet. Fat containing foods like
butter, cream. Ghee, and oils in reasonable amounts are useful for some
because of the stimulating effect of the fatty acids on the mucous
members.
5. High water content (10 -12) or water with lemon in the morning also helps
in evacuation.
6. Leafy vegetables like cabbage, spinach, carrots, and radish are also good for
regular bowel habit. Fresh fruits are of great value in overcoming this
condition since it contains roughage in the form of cellulose. Bananas, dried
fruits like prunes, figs, raisins, dates, apricots are very use full. B vitamin and
potassium in the form of brewer’s yeast vegetable soup, oral potassium salts
(kala namak) and juices and help to prevent the constipation.

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Diploma in Ditetics FGIIT,

PEPTIC ULCER:
A Peptic ulcer is any localized erosion of the mucosal lining of those portions of the
alimentary tract that come in contact with acidic gastric juice.

Mostly ulcers are found in the stomach,

jejunum (gastric ulcer) and in duodenum
(duodenal ulcers) above the point of entry of
alkaline pancreatic juices.

A peptic ulcer, also known as PUD or peptic

ulcer disease is an ulcer of an area of the
gastrointestinal tract that is usually acidic and
thus extremely painful. 80% of ulcers are
associated with Helicobacter pylori (bacteria).

ETIOLOGY:

Peptic ulcer may occur at any age but middle age people (45-55 years) are prone to
the disease. Men are more prone than the women. Peptic ulcer may occur in
combination with other diseases like rheumatoid arthritis or other stressful illness
or injuries.

Symptoms:

• Abdominal pain, with severity relating to mealtimes, after around 3 hours of

taking a meal (duodenal ulcers are classically relieved by food, while gastric
ulcers are exacerbated by it)
• Bloating and abdominal fullness
• Water brash(rush of saliva after episode of regurgitation to dilute the acid in
oesophagus)
• Nausea, and lots of vomiting
• Loss of appetite and weight loss;
• Hematemesis(vomiting of blood);
• Melena (tarry, foul-smelling faeces due to oxidized iron from hemoglobin)

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Causes:

• People who have a history of ulcer in the family as a genetic trait then they
are likely to suffer from this problem. Duodenal ulcer are most likely to
develop in people having blood group ‘o’
• Irregular food habits and mental stress & strain are some of the underlying
cause for peptic ulcers especially in doctors and high ranking executives.
• Excessive consumption of chemical and thermal irritants like tea, coffee,
spices, alcohol, tobacco & drugs like steroids & analgesics may also cause
peptic ulcer.
• Improper eating habits like improper mastication of food & missing meals
predispose to peptic ulcer
• A bacterium called helicobacter pylori impairs mucosal defence making it
more susceptible to ulceration.

Treatment:

• Drugs: antacids and inhibitors of gastric acid secretion are two main drugs
used to aid the disease. When h. pylori infection is present, the most
effective treatments are combinations of 2 antibiotics (e.g. erythromycin,
ampicillin, amoxicillin, tetracycline, metronidazole l) and 1 proton pump
inhibitor (PPI). Treatment of H. pylori usually leads to clearing of infection,
relief of symptoms and eventual healing of ulcers. Recurrence of infection
can occur and re-treatment may be required, if necessary with other
antibiotics.
• Dietary management: bland diets are recommended for the patients.
Diets should be free from chemical and thermal irritants. The texture
should be soft and semisolid for digestion. Fibrous foods can be avoided
like husks of fruits, whole cereals as they work as mechanical irritants.
• Rest: the patients suffering from peptic ulcer need lot of rest and care.
The bowl movement should be reduced. The patient should be relieved
from any kind of stress and strain as it may cause unnecessary on the
intestinal walls and stomach.

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• Modification in the nutrients: mostly the patients who suffer from this
disease are generally undernourished. They need extra amount of energy
rich foods to compensate for the less. The food rich in energy like fats &
carbohydrates must be given. Protein intake is increased to provide
essential amino acids to promote healing of the tissues. Adequate
amount of vitamin C should be provided to enhance the absorption of
iron. Care should be taken to induce calcium &iron the diet as they are
essential minerals to meet the increased needs.
• Avoid: certain foods like fried and spicy foods should be avoided. Fatty
and tough meat also irritates the bowl movement. Beverage like black
coffee, strong tea & alcohol is not recommended. Strongly flavoured
foods like radish, turnip, cauliflower, garlic &onion should also be
avoided.

Sample diet menu for a patient suffering from duodenal cancer:

Recommended dietary allowances

Energy 2182kcal

Protein 75 to90 grams

Iron 28 mg
Vitamin C 48 mg

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ULCERTIVE COLITIS:

Is an inflammatory bowel disease

(IBD). IBD comprise a group of disease
that effect the gastrointestinal tract.

Ulcerative colitis occurs when the

lining of your large intestine (also
called the colon), rectum or both
becomes inflamed.

This inflammation produces tiny sore

called ulcer on the lining of your colon.
It usually beings in the rectum and
spreads upward. It can involve your entire colon.

The inflammation causes your bowel to more its content rapidly and empty
frequently. As cells on the surface of the lining of your bowel die, ulcers form. The
ulcer may cause bleeding and discharge of mucus.

Ethology:

While this disease affects people of all ages, most people are diagnosed between
the ages of 15 and 35. After age 50, another small increase in diagnosis for this
disease is seen usually in men.

Causes:

• The most popular theory among many is that the body’s immune system
reacts to a virus or a bacterium by causing ongoing inflammation in the
intestinal wall.
• People with ulcerative colitis have abnormalities of immune system, but
doctors do not know whether these abnormalities are a cause or a result of
the disease.

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• Ulcerative colitis is not caused by emotional distress or sensitivity to certain

foods or food products, but these factors may trigger symptoms in some
people.

Symptoms:

• The most common symptoms of ulcerative colitis are abdominal pain and
bloody diarrhea.
• Patients also may experience fatigue
• Weight loss
• Loss of appetite.
• Frequent colitis may also cause problems such as arthritis, inflammation of
the eye, liver disease (hepatitis, cirrhosis), osteoporosis, skin rashes, and
anaemia.

No one knows for sure why problems occur outside the colon. Scientists think these
complications may occur when the immune system triggers inflammation in other
parts of the body. Some of these problem go away when the colitis is treated.

TREATMENT:

• Most people are treated with medication. In severe cases, a patient may
need surgery to remove the diseased colon. Surgery is the only cure for
ulcerative colitis.
• Some people whose symptoms are triggered by certain foods are able to
control the symptoms by avoiding foods that upset their intestines, like
highly seasoned foods, raw fruits and vegetables, or milk sugar (lactose)
• Each person may experience ulcerative colitis differently, so treatment is
adjusted for each individual. Emotional and psychological support is
important. Some people have remissions-periods when the symptoms go
away-that last for months or even years.
• Some people with ulcerative colitis may need medical care for some time,
with regular doctor visits to monitor the condition.
• A person may have severe bleeding or severe diarrhea that causes
dehydration. In such cases the doctor will try to stop diarrhea and loss of

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blood, fluids, and mineral salts. The patient may need a special diet, feeding
through a vein, medications, or sometimes surgery.

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CROHN’S DISEASE:

Crohn’s disease (also known as

regional enteritis) is a chronic,
episodic, inflammatory condition of
the gastrointestinal tract
characterized by Trans mural
inflammation (affecting the entire
wall of the involved bowel) and skip
lesions (area of inflammation with
areas of normal lining between).

Crohn’s disease is a type of

inflammatory bowel (IBD) and can affect any part of the gastrointestinal tract from
mouth to anus. It is disease that cause swelling in the intestines. Because the
symptoms of crohn’s disease are similar to other intestinal disorders, such as
irritable bowel syndrome and ulcerative colitis, it can be difficult to diagnose.
Ulcerative colitis causes inflammation and ulcers in the top layer of the lining of the
large intestine. In crohn’s disease, all layers of the intestine may be involved, and
normal healthy bowel can be found between sections of diseased bowel.

ETIOLOGY:

Crohn’s disease affects male and females equally and seems to run in some
families. About 20 percent of people with crohn’s disease have a blood relative with
some form of IBD, most often a brother or sister and sometimes a parent or child.

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SYMPTOMS:

The symptoms of crohn’s disease often develop gradually certain symptoms may
also become worse over time. Although it’s possible it’s rare for symptoms to
develop suddenly and dramatically. The earliest symptoms of crohn’s disease can
include:-
- Diarrhea
- Abdominal cramps
- Blood in your stool
- Fever
- Fatigue
- Loss & appetite
- Weight loss
- Feeling as if your bawds aren’t empty after a bowel movement
- Feeling a frequent need for bowel movement

The symptoms may become more severe as the disease progresses. More
troublesome symptoms may include:

- A perianal fistula, which causes pain and drainages near your anus.
- Ulcer that may occur anywhere from the mouth to the anus.
- Inflammation of the joints and skin
- Shortness of breath or decreased ability to exercise due to anaemia.

Early detection and diagnosis can help you avoid severe complications and allow
you to begin treatment early.

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Causes:

• The exact causes of crohn’s disease is unknown. However, genetic and

environmental factors have been invoked in the pathogenesis of the disease.
Genetics play a crucial role in the disease, although environmental factors
also are involved. For example, smoking raises one’s risk.
• Many environmental factors have also been hypothesized as causes or risk
factors for crohn’s disease.
• Diet high in sweet, fatty or refined foods many play a role. A retrospective
Japanese study found that those diagnosed with crohn’s disease had higher
intakes of sugar, fat, fish and shellfish than controls prior to diagnosis.
• A similar study in Israel also found higher intakes of fats (especially
chemically modified fats) and sucrose, with lower intakes of fructose and
fruits, water, potassium, magnesium and vitamin C in the diets of crohn’s
disease sufferers before diagnosis, and cites three large European studies in
which sugar intake was significantly increased in people with crohn’s disease
compared with controls.
• Smoking has been shown to increase the risk of the return of active disease.
• Abnormalities in the immune system have often been invoked as being
causes of crohn’s disease.
• A variety of pathogenic bacteria were initially suspected of being causative
agents of crohn’s disease. However, the current consensus is that a variety
of microorganisms are simply taking advantage of their host’s weakened
mucosal layer and inability to clear bacterial from the intestinal walls.

Complications:

• The most common complication is blockage of the intestine. Blockage

occurs because the disease tends to thicken the intestinal wall with
swelling and scar tissue, narrowing the passage.
• Crohn’s disease may also cause sores, or ulcers, that tunnel through the
affected area into surrounding tissues such as the bladder, vagina, or skin.

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• The areas around the anus and rectum are often involved. The tunnels,
called fistulas, are a common complication and often become infected.
Sometimes fistulas can be treated with medicine, but in some cases they
may require surgery.
• Nutritional complications are common in crohn’s disease. Deficiencies of
proteins, calories, and vitamins are well documented in crohn’s disease.
These deficiencies may be caused by inadequate dietary intake, intestinal
loss of protein, or poor absorption (malabsorption).
• Other complications associated with crohn’s disease include arthritis, skin
problems, inflammation in the eyes or mouth, kidney stones, gallstones,
or other disease of the liver and biliary system. Some of these problems
resolve during treatment for disease in the digestive system, but some
must be treated separately.

Treatment:

Treatment for crohn’s disease depends on the location and severity of disease,
complications, and response to previous treatment. The goals of treatment are
to control inflammation, correct nutritional deficiencies, and relieve symptoms
like abdominal pain, diarrhea, and rectal bleeding. Treatment may include
drugs, nutrition supplements, surgery, or a combination of these options. At this
time, treatment can help control the disease, but there is no cure.

Some people have long periods of remission, sometimes years, when they are
free of symptoms. However, the disease usually recurs at various times over a
person’s l lifetime. This changing pattern of the disease means one cannot
always tell when a treatment has helped. Predicting when a mission may occur
or when symptoms will return is not possible. Someone with crohn’s disease
may need medical care for long time, with regular doctor visits to monitor the
condition. People are encouraged to follow a nutritious diet and avoid any foods
that seem to worsen symptoms. But there are no consistent rules.

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DUMPING SYNDROME:

Definition:
Dumping syndromes happens
when food moves too quickly
from your stomach into the
first part of your small intestine
after you eat. This causes
symptoms like cramps and
diarrhea within a few minutes
to a few hours after you have
eaten. You can get dumping
syndrome after you have surgery to remove part or all of your stomach or if you
have stomach bypass surgery for weight loss.

There are two types of dumping syndrome.

The types are based on when your symptoms start:

1. Early dumping syndrome:

This happen 10-30 minutes after you eat. About 75 percent of people with
dumping syndromes have this type.
2. Late dumping syndrome:-
This happen 1-3 hours after you eat. About 25 percent of people with
dumping syndrome have this type. Each types of dumping syndrome has
different symptoms. Some people have bath early and late dumping
syndrome.

Symptoms:

Early symptoms of dumping syndrome include nausea, vomiting, abdominal

cramping and diarrhea. This symptoms usually start 10 to 30 minutes after you eat.

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Other early symptoms include:-

- Bloating or feeling uncomfortably full

- Flushing of the face
- Swelling
- Dizziness
- Fast heart rate

Late symptoms appear one to three hours after you eat. They are caused by low
blood sugar and can include:

- Dizziness
- Weakness
- Swelling
- Hunger
- Fast heart rate
- Fatigue
- Confusion
- Shaking

You might have both early and rate symptoms.

CAUSES:

Typically when you eat; food moves from your stomach into your intestine over
several hours. In the intestine nutrients from food are absorbed and digestive juice
break down the food even more.

With dumping syndrome food moves too quickly from your stomach into your
intestine.

• Early dumping syndrome happens when the sudden influx of food into
your intestine causes a lot fluid to move from your bloodstream into your
intestine as well. This extra fluid causes diarrhea and bloating. Your
intestine also release substance that speed your heart rate and lower

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your blood pressure. This leads to symptoms like a fast heart rate and
dizziness.
• Late dumping syndrome happen of an increase in starch and sugars in
your intestine. At first, the extra sugar causes your blood sugar level to
rise. Your pancreas then releases the hormone insulin to move sugar from
your blood into your cells. This extra rise in insulin causes your blood
sugar to drop too low. Low blood sugar is called hypoglycaemia.
• Surgery that reduce the size of your stomach or that bypasses your
stomach causes dumping syndrome. After surgery, food moves from your
stomach into your small intestine more quickly than usual. Surgery that
affects the way your stomach empties food can also causes this condition.

Types of surgery that can cause dumping syndrome include:-

1. Gastrostomy this surgery removes part or all of your stomach.

2. Gastric bypass (Roux-en-y) this procedure creates a small pouch from
your stomach to present you from eating too much. The pouch is then
connected to your small intestine.
3. Esophagectomy this surgery removes part or all of your esophagus. It’s
done to treat oesophageal cancer or damage to the stomach.

Complications

Dumping syndrome is a complication of stomach by pass or stomach reduction

surgery. Other complication related to this surgery include:

1. Poor nutrient absorption

2. Weekend bone called osteoporosis from poor calcium absorption.
3. Anaemia or a low red blood cell count from poor absorption of vitamins or
iron.

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Treatments and drugs

You may be able to relive symptoms of dumping syndrome by making a few

changer to your diet:-
1. Eat five to six smaller meals throughout the day instead to three big meals.
2. Avoids or limit surgery food like soda, candy and baked goods.
3. Eat more protein from foods like chicken, fish, peanut butter and tofu.
4. Get more fibre in your diet. Switch from simple carbohydrates like white
bread and pasta to whole grains like oatmeal and whole wheat. You can also
take fibre supplements. The extra fibre will help sugar and other
carbohydrates get absorbed more slowly in your intestine.
5. Don’t drink fluids within 30 minutes before or after meals.
6. Chew your food completely before you swallow to make it easier to digest.

For more severe dumping syndrome. You can take drug as an injection under your
skin, an injection into your hip or arm muscle. Some side effects of this drug include
changes in blood sugar levels, nausea, pain where you get the injection and foul
smelling stool.

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NUTRITIONAL MANAGEMENT IN DYSPHAGIA:

Dysphagia can be defined as having difficulty or discomfort in swallowing. Patients

present with choking and coughing on swallowing, with food sticking and causing
pain or discomfort. Because of this,
dysphagia sufferers often have a loss of
appetite or weight loss. Aspiration and
pneumonia is a serious consequence of
food passing in to the pharynx, entering
the airways, acting as a breeding ground
for infection. Malnutrition and
dehydration are very common, resulting
from the reduced oral intake due to the
increased effort it takes to eat and drink
sufficient amount. Poor nutritional status
is associated with serious health risks such as impaired wound healing, higher risk
of infection and impaired mental and physical function.

Nutritional management in dysphagia

The aim of nutritional management is to provide a suitable nutritious diet which

will prevent aspiration and help make eating a pleasant experience. Other than
texture modification, crucial elements in effective nutritional management of
dysphagia are appropriate food choice, food fortification and the use dietary
supplements. If the patient’s nutritional intake is insufficient, alternative feeding
may need to be considred.in fact, in severe cases of dysphagia or aphasia (complete
absence of swallow), the patient may be put nil by mouth but have to be eternally
fed via a nasal- gastric or gastrostomy tube. Parenteral fluids may also be initiated
to ensure adequate hydration.

The patient may require fluids thickened to an appropriate consistency. Fluids are
thickened by commercial thickener powders, which are based on corn starch and
malt dextrin or vegetable gums like pectin or guar gum.

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If patients are not able to swallow normal food safe, they are provided meals with
altered consistency. Depending in the condition, soft or pureed food is given. Food
with mixed textures and irregular lumps are not safe.

To make foods and fluids more nutritious there are a number of easy and practical
tips.

These include:

• Rather than pureeing meals with water, use more milk or cream-for
protein and energy
• Whole milk can be fortified by adding milk powder-4 tablespoons per
pint of milk
• Melt butter or margarine into savouries
• Add sugar to sweet foods
• Add milk to potatoes before pureeing
• For stewed fruits and other desserts; add cream, custard, natural
yoghurt or evaporated milk before pureeing

Often dysphagia is temporary (as in many stroke patients) and a number of patients
do progress to a completely normal texture of diet and fluids, but the time forb this
could range from a few weeks to years. Unfortunately with some neurological
condition progressive.

Summary

Dysphagia is a complex condition, resulting from a number of medical and surgical

conditions, and it has a profound impact on patient`s lives. Treatment of
swallowing problems has dramatically improved over the past few years; now it
aims at improving quality of life, optimising nutrition and minimising risk of
aspiration. The duty of dietician is to provide a meal with smooth texture i.e. safe
for a patient to swallow, prevent malnutrition and encourage the patient to
continue to continue enjoy the pleasures of eating.

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METABOLIC DISORDERS
DIABETES:

Diabetes mellitus commonly

known as diabetes is a
metabolic disease that
causes high blood sugar. The
hormones insulin moves
sugar from the blood into
your cells to be stared or
used for energy with diabetes
your body either doesn’t
make enough insulin or can’t effectively use the insulin it does make.

Untreated high blood sugar from diabetes can damage your nerves, eyes, kidneys
and other organs.

There are few different types of diabetes:

Types of diabetes

Types of diabetes:

1. Insulin-dependent diabetes mellitus (Type 1 Diabetes) - Usually, this type

of diabetes children or adolescent. There is little or no production of insulin
and as a result, such individuals require daily insulin injection. It is rapid in
onset. The symptoms get severe, when insulin injections are discontinued.
The diabetic develops a life-threatening metabolic complication referred to
as ketoacidosis.
2. Non-insulin dependent diabetes mellitus (Type 2 Diabetes) - this usually
affects overweight or obese adults. The insulin production may be normal
or even high. However, the insulin produced in not as effective as normal
insulin. The symptoms of disease are gradual in onset. In subjects with this
type of diabetes, diet, exercise or oral anti-diabetic drugs may be enough to
control the raised blood sugar.

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3. Malnutrition-related diabetes mellitus- Recently, a third type of

malnutrition-related diabetes mellitus (MRDM) has been categorised as a
separate entity. This type of diabetes is mainly seen in tropical countries like
India, and it occurs in young people between 15-30 years of age. Generally,
people with MRDM are lean and undernourished. In this type of diabetes,
the pancreas fails to produce adequate insulin. As a result, these diabetics
require insulin. In contract to type I diabetics, thee patients generally do not
develop ketoacidosis, when insulin injections are discontinued.

Metabolic changes/symptoms:

Diabetes symptoms are caused by rising blood sugar.

General symptoms:-

- Increased hunger
- Increased thirst
- Weight loss
- Frequent urination
- Blurry vision
- Extreme fatigue

Treatment

1. Dietary management- a therapeutic diet plays an important role in the

treatment of diabetes. The diet plan is based on the height, weight, age,
sex, physical activity & the type of diabetes. The energy value of the diet
and its proportionate distribution needs to be calculated for each
diabetic patient individually. The distribution of carbohydrates, fats and
protein in the diet should be such that it maintains the blood glucose and
reduces the risk of cardiovascular diseases.
2. Types of carbohydrates- more of carbohydrates must be given as
complex rather than simple sugars as they breakdown more slowly to
release glucose.
3. Glycaemic index or the blood glucose response of certain foods is
important in deciding whether to include them in diet or not. The food

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which rate higher on the scale of glycaemic index should not be

encouraged in the diet.
4. Insulation therapy- for a normal blood glucose control, insulin therapy
with multiple injections of soluble insulin may be needed.
5. Oral hypoglycaemic drugs – these help in lowering the elevated blood
glucose and so are used in treatment of hyperglycaemias in NIDDM (non-
insulin dependent diabetes mellitus).

Common foods Glycaemic index

Peas 51
Rajmah 29
Lentils 29
Apples 39
Oranges 40
Methi 34
Curd 36
Barley 31
Oats 49
Corn 51

6. Food to be avoided-glucose, sugar, honey, all sweets, chocolates &

candies; potatoes, yam, arbi, sweet potatoes, mangoes, grapes,
bananas, alcoholic beverages, fried foods, paranthas, poories, pakoras,
dalmoth, mathris, deep fried vegetables, dry fruits, salad oils, cakes &
pastries.
7. Foods allowed –green leafy vegetables, tomatoes, cucumber, raddish,
lemon, clear soups, black coffee, tea without sugar, buttermilk, sour
chutneys, pickles without oil.

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Complications:

• Hypoglycaemia/insulin shock – this is a condition of low blood glucose levels

as a result of overdose of insulin, failure to eat food after a dose of insulin,
loss of food through vomiting or diarrhoea or exercise without modifying the
insulin dose. The symptoms are weakness, sweating, palpitation, tremor,
faintness, dizziness, headache and mental confusion. Movements are
uncoordinated and there is an emotional instability. In children, lassitude,
muscular twitching, convulsions and coma may develop.

• Ketoacidosis- this occurs due to the consumption of food for which insulin
may not be sufficient. Any form of stress, particularly an acute infection can
lead to severe ketoacidosis as it lowers the glucose tolerance. The patient
feels ill and weak; there is headache, anorexia, nausea, abdominal pain and
dehydration. The skin and mouth are dry and foul breath, pulse is rapid and
weak and blood pressure is low. Coma may occur in ketoacidosis as well.

• Nephropathy- functional changes occur in the nephrons of the kidney. The

changes in some parts of kidneys lead to proteinuria with increased renal
failure and uraemia if diabetes is uncontrolled.

• Retinopathy- abnormality of retinal veins like dilatation, haemorrhages,

waxy exudates and fibrous proliferations occur. The changes interfere with
the vision and may ultimately lead to blindness. The problem of cataract in
old people is much higher in those who have diabetes.

• Neuropathy- peripheral neuropathy involving motor, sensory or autonomic

nerves is a common complication. There is diminished transmission of nerve
impulse and nerve damage that affect muscle function and sensory
perception in various parts of the body. This causes pain, muscle tenderness
and paraesthesia in the limbs. Secondary infection may also lead to death
and amputation of limbs if not taken care timely.

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• Vascular disease- atherosclerotic vascular disease is the major cause of

illness and death in persons with uncontrolled diabetes. Coronary artery is
four times more in diabetics. Lowered resistance to infection like that of skin,
urinary tract and pulmonary tuberculosis is commonly associated with poorly
controlled diabetes.

• Diabetes affect pregnancy- it may lead to excessive accumulation of

amniotic fluid and the foetus is usually large leading to complication in
labour. Chances of congenital malformation or neonatal morbidity. As the
main organs are formed in the early weeks of uterine life, good metabolic
control should be developed. A planned pregnancy reduces the risk.

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GOUT:

Gout is a general term for a variety

of condition caused by a build-up
of uric acid. This build up usually
affects your feet. If you have gout,
you will probably feel swelling and
pain in the joints of your foot,
particularly your big toe. Sudden
and intense pain or gout attacks
can make it feel like your foot is on
fire.

Etiology:

Gout is caused when there is overproduction of uric acid in the normal purine
metabolism in the body. A number of factors are related to the development of
hyperuricemia and gout.

• Hereditary –genetics may play a role in determining a person’s risk.

• Gender and age are related to the risk of developing gout. It is more common
in men than in woman and also common in adults than in children.
• Being overweight also increases the risk of developing hyperruricemia and
gout because there are more tissues available for turnover or breakdown,
which leads to excess uric acid production.
• Drinking too much alcohol can also lead to gout as it interferes with the
removal of uric acid from the body. Eating too many foods rich in purines can
cause or aggravate gout in some. An enzyme defect that interferes with the
way the body break down purines causes gout in small number of people.
• Exposure to lead may also cause gout.

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Symptoms:

Sudden unexpected burning pain, swelling, redness, warmness and stiffness in the
joint may occur. Low-grade fever may also be present. The patient usually suffer
from two sources of pain. The crystal inside the joints cause intense pain where the
affected area is moved. The inflammation of the tissues around the joint also
causes the skin to be swollen, tender and sore if it is even slightly touched.

Gout affects joints such as the ankle, heel, instep, knee, wrist, elbow, fingers, and
spine. In some cases, the condition may appear in the joints of small toes that have
become immobile due to impact injury earlier in life, causing poor blood circulation
that leads to gout.

Treatment/dietary management:

• Treatment of gout often may include the diet of lower purine intake. A bout
one third of the body’s uric acid can be attributed to diet.
• Exclusion of foods extremely high in purines may be helpful. All meats, fish,
fish, poultry contain moderate to high amounts of purine and pulses and
lentils needs to be avoided.
• Drugs are also affective in lowering the serum urate concentration that rigid
restriction of dietary purine is rarely necessary.
• Avoid red meats, organ meats like brains, kidneys, liver and heart, shellfish
like mussels, oysters, sea eggs, peas and beans, alcohol like beer and wine.
• Intake of fluid must be encouraged to assist with the excretion of uric and
minimize the possibility of renal stone formation.
• Because the urate excretion tends to be reduced by fats and enhanced by
carbohydrates, the diet should be relatively high in carbohydrates and low in
fat, modified in carbohydrates.
• The patients should be encouraged to reduce weight, take moderate
proteins, and Use low fat dairy products, eggs and cheese. Take liberal
carbohydrates, refined cereals, and beverages, fruits, and fruit juices.

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HYPOTHYROIDISM:

Hypothyroidism occurs when your body doesn’t produce enough thyroid

hormones. The thyroid is a small
butter fly shaped gland that sits at
the front of your neck. It releases
hormones to help your body
regulate and use energy. Your
thyroid is responsible for providing
energy to nearly every organ in your
body. It control function like how
your heart beats and how your
digestive system works. Without the
right amount of thyroid hormones, your body’s natural functions begin to slow
down.

SYMPTOMS:

• Slow body function both physical and mental.

• Easy fatigability, lethargy, ache, muscle cramp and pain.
• Facial puffiness, generalised oedema.
• Weight gain.
• Intolerance to cold.
• Skin dry and thick, loss of hair, brittle nail.
• Slow gruff speech.
• Constipation.
• Excessive sleep, forgetfulness, hearing loss, emotional instability,
depression.
• Anaemia.
• Menstrual disturbance, infertility.

In cretinism – mental retardation and short stature are the characteristic

features apart from above mention symptoms

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TREATMENT:

• Oral replacement of thyroxin is the main stay of management.

Replacement therapy should be taken regularly and most of the time has
to continue for life long.
• Diet comprising of low calorie, adequate protein, fat, minerals and
vitamins should be given.
• In hypothyroidism the basal metabolic rate is low is low so the calories
should be reduced to 30-40% of the normal requirements.
• The protein should be adequate to meet normal requirement.
• Fat should consist mainly from vegetable oil, which are rich in essential
acids. It should not exceed more than 30gm per day.
• Vitamins and minerals should be just adequate to meet the daily needs.
But the sodium chloride as common salt should be kept at the minimum
and avoid salted confectioneries, chips and pickles.
• In case of endemic goitre iodine supplementation is required.

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HYPERTHYROIDISM:

Hyperthyroidism is a condition of the thyroid. The thyroid is a small, butterfly

shaped gland located at the front of your neck. It produces tetraiodothroni-ne
(T4) and triodothyronine (T3), which are two primary hormones that control how
your cells use energy. Your thyroid gland regulates your metabolism through the
release of their hormones.

SYMPTOMS:

• Increased appetite
• Nervousness
• Restlessness
• Inability to concentrate
• Weakness
• Irregular heartbeat
• Difficulty sleeping
• Fine brittle hair
• Itching
• Hair loss
• Nausea and vomiting
• Breast development in men

The following symptoms requires immediate medical attention.

• Dizziness
• Shortness of breath
• Loss of consciousness
• Fast irregular heart rate

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TREATMENT:

• Hyperthyroidism is treated with radioactive iodine. Anti-thyroid drugs or

surgery.
• A liberal diet providing adequate amount of calories, vitamins and minerals
is indicated because patients have severe malnutrition since the basal
metabolic rate is increased thus the calorie requirement are also increased.
4000-5000kcal will be allowed.
• Protein requirement is also increased to 50% more than the actual
requirement which is about 120- 130gm per day. This should come mainly
from good quality protein egg, meat, poultry and cereal and pulse
combination.
• A diet rich in vitamin A, B complex and C should be increased to twice the
daily requirement.
• Pulse and wheat spout combination will enhance the B complex and C
vitamins. Carotene rich foods like papaya will be converted to vitamin Ain
the body.
• Calcium and phosphorous excretion is greatly increased in the urine. So
liberal calcium and phosphorus rich food like milk and milk production, dark
green leafy vegetables, ragi, must be part of the diet every day. Ragi and milk
preparation is an excellent source of calcium and phosphorus. Fish is also a
god source of calcium. Small fish eaten with the bones are very good sources.
• A person suffering from hyperthyroidism, by limited smoking, alcohol,
caffeine found in tea, coffee, cola and chocolate may feel reduced symptoms
as they all can raise the metabolic rate.

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MENOPAUSE:

Menopause is the term used to

indicate the end of the period of
possible sexual reproduction in
women, as evidenced by the
cessation of menstrual periods.
This is absolutely normal and
occurs between 45 to 55 years.

Menopause does not decrease

women’s physical capacity,
sexual vigour and enjoyment of life. Menopause brings certain freedom to female
life. For example, no longer do they have to worry about the monthly bleeding and
about birth control. Even then during this period women undergo a lot of
emotional stress. Ovaries stop producing oestrogen and this leads to oestrogen
deficiency. This hormonal imbalance may cause short-term symptoms and long
term health risks.

Etiology:

Short term symptoms

• Some women experience severe symptoms and others experience nil or

limited symptoms or view it as a positive life enhancing process. 50% to 60%
of women seek medical help for the short-term symptoms due to oestrogen
deficiency associated with menopause.
• Hot flushes and night sweats
• Vaginal dryness
• Urinary problem
• Anxiety
• Mood swings
• Depression
• Tiredness
• Loss of libido

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• Irritability
• Loss of concentration
• Crying spells

Long term health risks

• Oestrogen deficiency is associated with many long-term changes in the body.

Before menopause the oestrogen in the body helps to protect from the
diseases. After menopause when oestrogen level falls this protection is lost.
• Cardiovascular disease
• Osteoporosis
• Alzheimer’s disease
• Age related muscular degeneration
• Changes in cholesterol level

Treatment/ dietary management:

• Hormone replacement therapy (HRT) can counter act many of the

unpleasant symptoms of menopause and reduce the risk of the diseases.
Oestrogen replacement therapy can ease the short-term health risks
associated with Oestrogen deficiency. Studies have shown that women who
use Oestrogen replacement reduce their risk of cardiovascular disease by at
least one half compared to women who do not use Oestrogen replacement,
it decreases the level of LDL cholesterol (bad) and increase level of HDL
cholesterol (good). This can help to protect from atherosclerosis. Oestrogen
replacement also increases the bone density even in women with
established osteoporosis, (types of oestrogen replacement – Oral tablets,
transdermal patches, vaginal creams/ gels, vaginal inserts, Ingestion’s).
• Hot flushes may be reduced by taking vitamin E rich foods like wheat germ,
nuts, eggs and olive oil. Vitamin A, D, calcium, phosphorus and magnesium
can help to prevent osteoporosis. Fish, drumstick leaves, ragi and dairy
products are excellent source of calcium.
• Avoid eating raw bran, which inhibits calcium absorption and cut down on
tea, coffee which may promote the excretion of calcium.

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• Many women put on weight and increase the blood cholesterol level. To
control body weight and blood cholesterol select low fat dairy foods and cut
down on saturated fats like butter, cheese and ghee.
• Research has found that substances from plants called phytoestrogens might
help to reduce the severity of hot flushes and other symptoms of the
menopause. Phytoestrogens, which mimic human oestrogen, are found
mainly in soybeans and alfalfa sprouts. Soya bean flour can be mixed with
what flour for making rotis. Other soya products are soymilk, tofu, and soy
sauce.
• Carrot and beet root juice is found very use full in menopausal disorders.
Oats, corn, barley, brown rice, whole wheat are also excellent sources of
phytoestrogens. Regular exercise is essential during this period.

Foods to be restricted

• Spicy foods like pickles,

• Coffee, tea
• Chocolate
• Alcoholic drinks
• Refined products

This period is to be viewed as a normal stage in a lady’s life. However the members
of the family must realise that during this stage in the life of a woman needs lot of
attention, care and understanding to make the day to day life tension free.

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POLYCYSTIC OVARIAN DISORDER (PCOS):

PCOS is a problem with hormones that

affects women during their childbearing

Years (Age 15 to 44) between 2.2 and

26.7% of women in this age group have
PCOS.

Many women have PCOS but don’t know

it. In one study up to 70% of women with
PCOS had not been diagnosed. PCOS
affects a women’s ovaries the
reproductive organs the produce estrogen and progesterone hormones that
regulate the menstrual cycle. The ovaries also produce a small amount of male
hormones called androgens.

PCOS is a syndrome or group of symptoms that affects the ovaries. Its three main
feature are

- Cysts in the ovaries

- High levels of male hormones
- Irregular or skipped periods

Common symptoms of PCOS:-

Some women start seeing symptoms around the time of their first period. Others
only discover they have PCOS after they have gained a lot of weight or they have
had trouble getting pregnant.

The most common PCOS symptoms are:-

- Irregular periods
- Heavy bleeding
- Hair growth
- Weight gain
- Male pattern baldness

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- Headaches

How is polycystic Ovarian Syndrome (PCOS) treated?

Diabetes Medications: the medicine, Metformin, also called Glucophage, which is

used to treat type 2 diabetes, also helps with PCOS symptoms. Metformin affects
the way insulin regulates glucose and decrease the testosterone production.
Abnormal health growth will slow down and ovulation may return after a few
months of use. These medications will not cause a person to become diabetic.

A healthy weight: Maintaining a healthy weight is another way women can help
manage PCOS. Since obesity is common with PCOS, a healthy diet and physical
activity help maintain a healthy weight, which will help the body lower glucose
levels, use insulin more efficiently, and may help restore a normal period. Even loss
of 10% of her body weight can help make a woman’s cycle more regular.

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PREMENSTRUAL SYNDROME:

Premenstrual syndrome (PMS) is a condition that affects a women’s emotions,

physical health, and behaviour during
certain days of the menstrual cycle,
generally just before her menses. PMS
is a very common condition. Its
symptoms affects more than 90% of
menstruating women. PMS symptoms
start 5 to 11 days before menstruation
and typically go away once
menstruation begins.

Symptoms
• Abdominal bloating
• Abdominal pain
• Sore breasts
• Food cravings, especially for sweets
• Constipation
• Headaches
• Sensitivity to light sound
• Fatigue
• Irritability
• Changes in sleep patterns
• Anxiety depression
• Sadness
• Emotional outbursts

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Measure to control symptoms of PMS:-

1. Drinking plenty of fluids to ease abdominal bloating

2. Eating a balanced diet to improve your overall health and energy level.
Which means eating plenty of fruits and vegetables and reducing your
intake of sugar, salt, caffeine and alcohol.
3. Taking supplement, such as folic acid. Vitamin B6, calcium, magnesium to
reduce cramps and mood swings.
4. Taking vitamin D to reduce symptoms
5. Sleeping at least eight hours per night to reduce fatigue
6. Exercising to decrease bloating and improve your mental health.
7. Reducing stress. Such as through exercising and reading.
8. Going to cognitive behavioural therapy. Which has been shown to be
effective.

AVOID

• Caffeine containing food items like coffee, tea and chocolate in excess.
• Refined carbohydrates, sugars and tobacco.
• Foods those are oily, fried or spicy.

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CARDIOVASCULAR DISORDERS
RISK FACTORS:

Risk factors

The risk factors for all the root cause

of cardiovascular disorders & high
blood pressure include:

• Heredity
• Obesity
• Smoking
• Age
• Stress
• Kidney diseases and hormonal diseases such as hypothyroidism and
Cushing’s syndrome.
• Use of oral contraceptives in women.

TYPES OF HEART DISORDERS:

Coronary heart disease

A disease in which there is a narrowing or blockage of the coronary arteries (blood

vessels that carry blood and oxygen to the heart). Coronary heart disease is usually
caused of fatty material which is inside the coronary arteries.

Congenital heart disease

Heart diseases caused during the birth time is known as congenital heart disease
due to unavoidable genetic defects.

Hypertension

There may be several causes of hypertension like high blood pressure due to
tension, anxiety, confusion, fatigue, headache, obesity etc.

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Congestive Heart failure

All the other heart diseases along with the congestion lead to heart stroke. It is a
condition that may result from any structural or functional cardiac disorder that
impairs the ability of the heart to fill up or pump a sufficient amount of blood
throughout the body.

DIETARY MANAGEMENT / TREATMENT:

• Energy needs to be restricted in case of overweight individuals. Even normal

weigh individuals benefit with a slight reduction in energy. Therefore, the
energy intake should be adjusted in such a way so as to bring about a weight
loss maintain slightly below the normal level.
• A diet of 60 g protein is necessary to maintain proper nutrition. Excess
amount of proteins should be avoided, as these foods are usually high in
animal fat as well as sodium.
• Sodium restriction along with weight reduction is effective in controlling mild
to moderate hypertension. Therefore, use of salt for cooking and also for
table purpose should be restricted.
Mild sodium restriction (2 to 3 g)
Moderate sodium restriction (1 g)
Strict sodium restriction (500 mg)
Severe sodium restriction (200 mg)
• Use polyunsaturated fats. (Polyunsaturated fats are the major fat source in
vegetable oils such as sunflower oil and corn oil. They generally lower total
cholesterol, although they may also lower HDL cholesterol (good
cholesterol). Try to use less hydrogenated margarine; liquid and tub
margarine are better than stick margarine. Some less hydrogenated products
may contain Tran’s fatty acids, but you can avoid them by reading labels. The
newest type of margarine is labelled “without trans-fats”. The primary
polyunsaturated fatty acid is Omega-6, or linoleic acid, a fatty acid that is
essential to our growth and development. Widespread use of Omeaga-6,
however, may have upset the balance with Omega-3. This imbalance may be
a cancer risk. Avoid saturated fats. Less than one-third of your fat intake

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should come from saturated fat. You find saturated fat in dairy fats such as
cream, butter and cheese. Saturated fat is also in animal fats like chicken
skin, visible fat or meat, and lard. The chemical structure of saturated fats
makes them solid at room temperature.
• Eat less cholesterol- rich food. Your daily cholesterol intake should be 300
milligrams or less. Certain animal foods are rich in cholesterol, but no plant
foods contain cholesterol. Keep these food facts in mind. A single yolk has
225 milligrams of cholesterol; if you are healthy, you should eat no more than
two egg yolks per week. Egg white has no fat or cholesterol, so you might
consider eating egg whites and egg substitutes frequently. Egg white is also
an excellent form of protein. Organ meats and certain sea foods - shrimp,
lobster and calamari- have high levels of cholesterol.
• Increase the soluble fibre in your diet, eating a lot of soluble fibre- which is
found in oat bran, in abundance- if you want to lower your cholesterol. The
soluble fibre in oats, called beta- glace, has specifically been proven to
reduce blood cholesterol. A high daily intake of soluble fibre, through
generous servings of oat- and bean- based foods, helps to eliminate
cholesterol- laden bile acids and fats from your body.
• There is also evidence to indicate that anti- oxidants may prevent clogging of
the arteries by blocking LDL from being oxidized. Vitamin E and vitamin c are
showing great promise in this area, and dietary beta- carotene also has
shown some effect.
• As obesity is also one of the causes of heart disease, exercise is
recommended to reduce weight and to keep the body health.

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EFFECT OF CHOLESTEROL:

If you want to know about your risk of heart disease, the first thing you need to do
is get a blood test to check your cholesterol level. The test will measure the amount
of cholesterol in your blood, which is an extremely important indicator of your risk
for heart disease. While it is normal to have some cholesterol in your blood, it can
be dangerous to have too much. This can happen if you eat a diet that is too high
in cholesterol or in the saturated fats that can increase your cholesterol level.

Cholesterol levels:

High 240 or more

Borderline-high 200-239

Desirable below 200

A high cholesterol level is a huge risk factor for CHD (coronary heart disease). Men
with average blood cholesterol levels of 260 had three times more heart attacks
than men with average blood cholesterol levels of 195.

Reducing the cholesterol level:

• Reduce your saturated fat intake to less than 10 percent of the total fat in
your diet.
• Reduce the amount of dietary cholesterol you eat.
• Reduce your fat intake to less than 30 percent of your total diet.
• Eat more soluble fibre.
• Maintain your ideal weight.

Total cholesterol level includes two different types of cholesterol in your blood-
high density lipoprotein (HDL , Good) cholesterol and low density lipoprotein (LDL
, bad cholesterol) , protein- containing packages in which cholesterol is considered
undesirable; read on to find out way.

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HDL LEVELS

Low Below 35

Intermediate 35 - 39

High 60 or more

LDL LEVELS

High 160 or above

Borderline below 130

Desirable below 130

Desirable for people with heart disease below 100

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HYPERTENSION:

High blood pressure or hypertension occurs when your blood pressure increase
to unhealthy levels. Your blood pressure measurement takes into account how
much blood is passing through
your blood vessels and the
amount of resistance the blood
meets while the heart is
pumping.

Narrow arteries increase

resistance. The narrower your
arteries are the higher your
blood pressure will be over the
long term increased pressure can cause health issue including heart disease.
Hypertension typically develops over the causes of several years. Usually, you
don’t notice any symptoms but even without symptoms high blood pressure can
causes damage to your blood vessels and organs, especially the brain, heart,
eyes and kidneys.

Symptoms of hypertension:-

1. Headaches
2. Shortness and breath
3. Nosebleeds
4. Flushing
5. Dizziness
6. Chest pain
7. Visual changes
8. Blood in the urine

Causes of high blood pressure:-

1. Primary hypertension: - primary hypertension is also called essential

hypertension. This kind of hypertension develops over time with no
identifiable cause. Most people have this type on high blood pressure.

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2. Secondary hypertension: - secondary hypertension often occurs quickly and

can become more severe than primary hypertension. Several conditions that
may causes secondary hypertension include:-

➢ Kidney disease
➢ Problems with your thyroid
➢ Use of illegal drugs
➢ Alcohol abuse
➢ Certain endocrine tumour’s

How to understand high blood pressure reading:-

➢ Systolic pressure: - this is the first or top number. It indicate the pressure in
your arteries when your heart beats and pumps out blood.
➢ Diastolic pressure: - this is the second or bottom number. It’s the reading of
the pressure in your arteries between beats of your heart.

Five categories define blood pressure reading for adult-

➢ Healthy: - a healthy blood pressure reading is less than 120/80 millimetres

of mercury.
➢ Elevated: - the systolic numbers is between 120 and 129 mm Hg, and the
diastolic number is less than 80mm hg. Doctors usually don’t treat elevated
blood pressure with medication. Changes to help lower your numbers.
➢ Stage 1 hypertension: - the systolic number is between 130 and 139mm Hg,
or the diastolic number is between 80 and 89mm Hg.
➢ Stage 2 hypertension: - the systolic numbers is 140 mm Hg or higher, or the
diastolic numbers is 90mm Hg or higher.
➢ Hypertension crisis: - the systolic number is over 180mm Hg, or the diastolic
number is over 120mm Hg. Blood pressure in this range requires urgent
medical attention. If any symptoms such as chest pain, headache, shortness
of breath, or visual changes occurs when blood pressure is this high medical
care in the emergency room is needed.

Home remedies for high blood pressure:-

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1. Developing a healthy diet: - a healthy diet is vital for helping to reduce

high blood pressure. It’s also important for managing hypertension
that is under control and reducing the risk of complication. These
complications include heart diseases, stroke and heart attack. Fruits,
vegetables, whole grains, lean protein like fish can take.
2. Increasing physical activity reaching a healthy heart weight should
include being more physically active. Exercise can help reduce stress
lower blood pressure naturally, and strengthen your cardiovascular
system.
3. Reaching a healthy weight: - if you are overweight or obese, losing
weight through a healthy diet and increased physical activity can help
lower your blood pressure.
4. Managing stress: - exercise is a great way to manage stress other
activity can also be helpful.
These include:-
- Meditation
- Deep breathing
- Massage
- Muscle relaxation
- Yoga
5. Adopting a cleaner lifestyle: - if you are a smoker, try to quit. The
chemicals in tobacco smoke damage the body’s tissue and harden blood
vessels walls.
If you regularly consume too much alcohol or have an alcohol
dependency, seek help to reduce the amount your drink or stop
altogether, alcohol can raise blood pressure.

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Dietary recommendations for people with high blood pressure-

1. Eat less meat more plants: - a plant based diet is an easy way to increase
fibre and reduce the amount of sodium and unhealthy saturated and Tran’s
fat you take in from dairy foods and meat. Increase the number of fruits,
vegetables, leafy greens, whole grains you are eating.
2. Reduce dietary sodium: - people with hypertension and those with an
increased risk for heart disease may need to keep their daily sodium intake
between 1500mg and 2300mg milligrams per day. The best way to reduce
sodium is to cook fresh foods more often. Avoid eating restaurant food
which are very high in sodium.
3. Cut back on sweets: - sugary foods and beverages contain empty calories
but don’t have nutritional content. If you want something sweet, try eating
fresh fruits or small amounts of dark chocolate that haven’t been
sweetened as much with sugar.

What are the effects of high blood pressure on the body?

1. Damaged arteries: - healthy arteries are flexible and strong. Blood flows
freely and unobstructed through healthy arteries and vessels. Hypertension
makes arteries tougher tighter and less elastic. This damage makes it easier
for dietary fats to deposits in your arteries and restrict blood flow. This
damage can lead to increased blood pressure, blockages and eventually,
heart attack and stroke.
2. Damaged heart: - hypertension makes your heart work too hard. The
increased pressure in your blood vessels forces your heart’s muscle to pump
more frequently and with more force than a healthy heart should have to
this may cause an enlarged heart. An enlarged heart increases your risk for
the following
- Heart failure
- Sudden cardiac death
- Heart attack

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3. Damaged brain: - your brain relies on a healthy supply of oxygen rich blood
to work properly. High blood pressure can reduce your brains supply of blood.
Uncontrolled hypertension may also affect your memory and ability to learn,
recall, speak and reason. Treating hypertension often doesn’t erase or reverse
effect of uncontrolled hypertension.

High blood pressure tips for prevention:-

- Add healthy foods to your diet

- Cut sugar
- Set weight loss goals
- Monitor your blood pressure regularly

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Atherosclerosis:

Atherosclerosis is a narrowing of the arteries caused by a buildup of plaque.

Arteries are the blood vessels that carry oxygen and nutrients from your heart to
the rest of your body. As you get
older fats, cholesterol, and calcium
can collect in your arteries and from
plaque. The buildup of plaque makes
it difficult for blood to flow through
your arteries. This build up may
occur in any artery in your body.
Including your heart, legs and
kidney. It can result in a shortage of
blood and oxygen in various tissues
of your body. Pieces of plaque can also break off causing a blood clot. It left
untreated atherosclerosis can lead to heart attack. Stroke or heart failure.

Causes:-

1. High cholesterol
2. Diet
3. Aging: - as you age your heart and blood vessels work harder to pump and
receive blood. Your arteries may weaken and become less elastic. Making
them more susceptible to plaque buildup.
4. Family history
5. Lack of exercise
6. High blood pressure
7. Smoking
8. Diabetes

Symptoms:-

1. Chest pain
2. Pain in your leg, arm and anywhere else that has a blocked artery.
3. Shortness of breath

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4. Fatigue
5. Confusion, which occurs if the blockage affects circulation to your brain.
6. Muscle weakness in your legs from lack of circulation.

Treatment:-

Treatment involves changing your current lifestyle to decrease the amount of

fat and cholesterol you consume. You may need to exercise more to improve
the health of your heart and blood vessels. Unless your atherosclerosis is
severe. Your doctor may recommend lifestyle changes as the first line of
treatment. You may also need additional medical treatment such as
medication or surgery.

Lifestyle changes can help to prevent as well as treat atherosclerosis,

especially for people with type 2 diabetes.

1. Eating a healthy diet that’s low in saturated fat and cholesterol.

2. Avoiding fatty foods.
3. Adding fish to your diet twice per week.
4. Getting at least 75 minutes of vigorous exercise or 150 minutes of
moderate exercise each week.
5. Quitting smoking if you’re a smoker.
6. Losing weight if you’re overweight or obese.
7. Managing stress.
8. Treating conditions associated with atherosclerosis. Such as hypertension
high cholesterol and diabetes.

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MYOCARDIAL INFACTON:

Acute myocardial infarction is also known as sudden

heart attack characterized by various degrees of chest
pain and discomfort, weakness, sweating, nausea,
vomiting and arrhythmias, sometimes causing loss of
consciousness.

If occurs when a part of heart muscle is injured, and may

die because of sudden total interruption of blood flow
to the area.

DIETARY MODIFICATION:

• A low calorie diet is used to avoid the metabolic stress caused by large
intakes and for weight loss. The initial intake may begin with 800k which can
be slowly progressed to 1200 kcal diet till the patient is discharged.
Thereafter, the diet should be monitored and maintained according to the
body weight.
• Large meals should be avoided as they increase heart rate stoke volume.
Small frequent meals are recommended.
• 60% of carbohydrates of the total energy is required, however simple and
easy forms of carbohydrates should be encouraged. Low fibre cereals, roots
and tubers should be served in a soft well -cooked/ blended form.
• A moderate sodium restriction to control tendency of oedema and
congestive heart failure.
• Oil with poly unsaturated fatty acids should be encouraged in the cooking
especially n-3 poly unsaturated fats like canola, olive oil, soybeans oil.

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Liver disorders
The liver is the largest organ of the body, constituting 2.5 to 3% of body weight. It
is also the largest gland in the body. The liver is also considered a gland because,
among its various function, it makes and secretes bile. (Glands are organs or parts
of organs that make
and secrete
substances and bile is a
fluid that both aids in
digestion and
transport fats as well
as waste products into
the intestine). Thus the
liver has an important
bearing on one’s nutritional status and diseases of this organ markedly affect
health.

The main functions of the liver are:

• Proteins metabolism
• Carbohydrate metabolism
• Lipid metabolism
• Mineral and vitamin metabolism
• Immunological (important part of lymph reticular system)
• Detoxification of bacterial decomposition products, mineral poisons, certain
drugs like morphine and dyes.

The pathological changes of liver are:

• Atrophy (degeneration of hepatic cells)

• Fatty infiltration. Deposition of fat droplets in the hepatic cells. This
completely reversible, but if the change is severe or long lasting, it may be
followed by necrosis or fibrosis.

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• Fibrosis (End result of any liver damage where in the functioning hepatic cells
are replaced by connective tissue cells), gives rise to cirrhosis.
• Necrosis (death of hepatic cells.

Jaundice:

Jaundice is not a disease but rather a sign can occur in many different diseases.
Jaundice is the yellowish
staining of the skin and
sclera (the whites of the
eyes) that is caused by high
levels of bilirubin (normal
plasma bilirubin levels are
2 – 8mg/litre) in the blood.
Bilirubin, a breakdown
product of red blood cells,
is normally excreted with
bile in the stools. This is
responsible for characteristic colour of stools. However, in jaundice, this pigment
is not excreted in stools, thus making them appear chalky white).

There are three types of jaundice:

1. Preheated (haemolytic) jaundice is due to excessive destruction of red blood

cells resulting in increased bilirubin formation. This kind of jaundice is
jaundice is common in new-borns. It may also arise from congenital defects
like thalassemia, sickle cell anaemia, incompatible blood transfusions or
intake of certain drugs.
2. Post hepatic (obstructive) jaundice which occurs due to obstruction of bile
flow between the liver and duodenum, as in case of patients suffering from
gallstones or cancer of liver and pancreas.
3. Hepatocellular jaundice results from damage to liver cells either by viral
infection or by toxic drugs.

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Symptoms:

• The symptoms of liver disease are extreme weakness,

• Headache,
• Fever,
• Loss of appetite (anorexia)
• Undue fatigue,
• Severe constipation,
• Nausea & vomiting,
• Flatulence &abdominal pain
• Yellow coloration of eyes, tongue, skin and urine.

Causes:

• Dietary deficiencies- fatty changes seen in the liver in kwashiorkor may be

attributed to low protein intake. These are easily reversible and not followed
by fibrosis. Fatty changes are common whenever these is a high proportion
of fat in the metabolic mixture as in starvation, uncontrolled diabetes, some
cases of obesity and when excess carbohydrate has been introduced
intravenously.
• Infective agents- virus can cause infection and damage the liver. Types A, B,
C, D, E and G can cause hepatitis. Hepatitis A and E spread by the focal oral
route. Poor personal and environmental hygiene are responsible for spread
by this infection. Hepatitis B virus spread via blood transfusions. It can also
be spread by improperly sterilized needles.
• Toxic agents-alcohol, natural toxins and even certain drugs may cause liver
damage.
• Storage disease and congenital disorder – excess stores of iron, copper,
galactose and glycogen may accumulate in the liver and lead to cirrhosis.
These may arise due to hereditary defects in transport and conjugation of
bilirubin.

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Treatment /dietary modifications:

• The simple form of jaundice can be cured rapidly by diet therapy and
exercises. Recovery will, however, e slow in serious cases which have
been caused by obstruction or pressure in the bile ducts.
• The patient should rest until the acute symptoms of the disease subside.
• The patient should be put on a juice diet for a week. The juices of oranges,
lemons, grapes, pears, carrots, beets and sugarcane can be taken.
• A hot water enema should be taken daily during this period to ensure
regular bowel elimination, thereby preventing the absorption of
decompose, poisonous material in to the blood stream. The juice diet may
be continued till the acute symptoms subside.
• The patient may adopt an all-fruit diet for further three to five days. In
this regimen, he should have three meals a day of fresh juicy fruits such
as apples, pears, grapes, oranges, and pineapples, but no bananas
(bananas add bulk). Thereafter a simple diet may be resumed.
• All the visible fats like ghee, butter, cream and oils must be avoided for at
least two weeks, and kept down to the minimum.
• A light carbohydrate diet, with exclusion of fats, best obtained from
vegetables and fruits should be taken.
• The patient should take plenty of fresh vegetables and fruit juices.
Dandelion leaves, radishes with leaves, endive should be added to the
daily raw vegetable salad. Raw apples and pears are especially beneficial.
Barley water, several times during the day, is considered a good remedy
for jaundice.
• Digestive disturbance must be avoided. No food with a tendency to
ferment or putrefy in the lower intestines like pulses and legumes should
be included in the diet. Drinking a lot of water with lemon juice will
protect he damaged liver cells.
• A recurrence of liver trouble can be prevented with reasonable care in the
diet and life style, with regular, moderate exercise and frequent exposure
to sun, fresh air and adequate rest.

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HEPATITIS:

Hepatitis (plural hepatitis’s) implies injury to liver characterized by presence of

inflammatory cells in the liver tissue. Etymologically from ancient greek hepar
or hepato meaning ‘liver’ and suffixes denoting ‘inflammation’ the condition can
be self- limiting, healing on its own or can progress to scarring of liver. Acute
hepatitis is when it lasts less than 6 months and chronic hepatitis is when it
persists longer. A group of viruses known as the hepatitis viruses cause most
liver damages worldwide. Hepatitis can also be due to toxins (notably alcohol),
other infection or from autoimmune process. It may run a sub clinical course
when he affected person may not feel ill. The patient becomes unwell and

symptomatic when the disease impairs liver function that include among other
things, screening of harmful substances, regulation of blood composition and
production of bile to help digestion.

Causes:

Acute hepatitis: acute viral hepatitis is inflammation of the liver caused by infection
with one of the five hepatitis viruses. In meet people the inflammation beings
suddenly and lasts only a few weeks. Supplements range from none to very severe.

Chronic hepatitis: - chronic hepatitis is inflammation of the livers that lasts at least
6 months common causes include hepatitis B and C viruses and certain drugs. Most

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people have no symptoms but some have vogue symptoms such as a general
feeling of illness, poor appetite and fatigue.

Symptoms:

Initially non-specific symptoms like anorexia, fatigue, nausea, vomiting, fever,

abdominal discomfort and weight loss occur, followed by jaundice and
enlargement and tenderness of the liver. Generally, the symptoms subside after 2-
8 weeks though a complete recovery may take longer.

Patients of infective jaundice may suffer from any of the four forms of disease:

1. Mild hepatitis- all characteristic symptoms may be present. Usually no

jaundice seen, only biochemical tests confirm. Slight increase in conjugated
serum bilirubin.
2. Moderate hepatitis- most common form where preicteric stages are seen.
3. Acute hepatitis- acute necrosis of liver cells. Condition is very rare and can
be fatal.
4. Chronic hepatitis- if timely treatment is not given any of the hepatitis can
become chronic. Progressive damage to liver cells may occur leading to
cirrhosis.

Treatment:

• A high energy intake is needed to promote weight gain and to ensure

maximum protein utilization. A high intake of carbohydrate to protect liver
from fatty liver infiltration is recommended. Simple carbohydrates like
glucose, sugar, honey, fruits etc… can be used.
• In acute cases with extensive liver damage the protein intake has to be
decreased even below normal. It is important to provide proteins of high
biological value for their maximum utilization.
• Fat intake should be decreased because its digestion and absorption is
affected. Emulsified fat such as milk and eggs should be given.

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• The diet should provide all minerals, particularly calcium and iron, in
adequate amounts in view of the increased tissue catabolism.

Foods recommended:

• Simple carbohydrates like glucose, sugar, honey and starches from cereals
and root vegetables.
• Fruits, fruits juices and squashes.
• Milk and milk products.
• Eggs, poultry etc…
• Vegetables excluding strongly flavoured ones. Carotene rich like dark green
leafy, deep yellow and orange ones.
• Coconut oil is better tolerated.

Foods restricted:

• Fried and fatty foods, fats and oils.

• Nuts and oilseeds
• Meat and products
• Strongly flavoured vegetables.
• Alcohol

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DISEASES OF GALL BLADDER:

The gall bladder is a small pear shaped

sac located underneath your liver. Your
gall bladder main function is to store the
bile produced by your liver and pass it
along through a duct that empties into
the small intestine. Bile helps you digest
fats in your small intestine.

Types of gall bladder disease:-

1. Cholelithisis gallstones: -
gallstones develop when
substances in the bile or
substances from the blend form hard particles that block the passageways
to the gallbladder and bile ducts. Gallstones also tend to form when the
gallbladder doesn’t empty completely or often enough. They can be as
small as a grain of sand or as large as a golf ball.

Numerous factors contribute to your risk of gallstones. These include:-

- Being overweight or obese

- Having diabetes

- Being age 60 or older

- Taking medication that contain estrogen

- Being female

Having crohn’s disease and other conditions that affect how nutrients
are absorbed.

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2. Cholecystitis:-

Cholecystitis is the most common type of gallbladder disease. It presents itself as

either an acute or chronic inflammation of gallbladder.

Acute cholecystitis:- acute cholecystitis is generally caused by gallstones but it

may also be the result of tumors or various other illnesses.

It may present with pain in the upper right or upper middle part of the abdomen.
The pain tends to occur right after a meal and ranges from sharp pangs to dull
aches that can radiate to your right shoulder acute cholecystitis can also cause.

- Fever
- Nausea
- Vomiting
- Jaundice
Chronic choleystitis:- after several attacks of acute cholecystits the gallbladder
can shrink and lose its ability to store and release bile. Abdominal pain and
vomiting may occur. Surgery id often the needed treatment for chronic
cholecystitis.

Treatment /dietary management:

• Lifestyle changes
• Medical treatment
• Surgery
• The main aim of the treatment is to reduce discomfort by providing a diet
restricted in fat. Exclusions of fat is very important to comfort the gall
bladder. In acute attack a ’nil’ by mouth diet is given followed by very fat
content and gradually the fat should be increased from low amounts when
there is improvement. In chronic phase 20 -30 g of fat may be provided in
the initial stage and then may increase to 40-45 g by increasing the
palatability of food.
• A calorie restricted diet with the restriction on intake of refined
carbohydrates is beneficial. Refined sugars increase cholesterol saturation
and lithogencity of the bile.

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• An appropriate selection of low fat foods like toned/ skimmed milk, paneer,
low fat meat options, fish, egg in restricted quantities. Around 25% of the
total calories can come from the fat with a prudent usage of medium chain
triglycerides and good quality fat from invisible sources. Monounsaturated
fats increase the ratio of HDL cholesterol to LDL cholesterol and it may
therefore provide important protection against gallstone formation.
• A high intake of soluble fibre through pulses/sprouts/dals, vegetables, fruits
and oilseeds can help the body to get rid of the bile acids sterol out the gut.
It also provides less time for colonic bacteria to produce secondary bile
acids like deoxycholic acid from cholic acid.
• The degree of food Intolerance needs to be individualized as it may vary
from patient to patient.
• Administration of water soluble forms of fat soluble vitamin may be of
benefit in chronic gall bladder disease patients, as fat mal absorption is
suspected.
• Vitamin C is important as it decreases the incidence of cholelithiasis

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FEBRILE DISORDERS
TYPHOID:

Typhoid fever is a type of acute fever, has a short duration and is accompanied by
infection like chicken pox, tonsillitis,
influenza, pneumonia. The body
temperature elevates to 104 degrees.
Typhoid is an infectious disease caused by a
bacteria salmonella typhosa. The infection is
transmitted through oral- faecal route.
Typhoid fever is also known as enteric fever.

Symptoms:

The incubation period is usually 1-2 weeks and the duration of the illness is about
4-6 weeks. The common symptoms are:

• Poor appetite
• Headaches
• Generalized aches and pains
• Sustained fever, and
• Lethargy
• Chest congestion develops in many in many patients
• Abdominal pain and discomfort are common.
• About 10% of patients have recurrent symptoms (relapse) after feeling
better for one to two weeks.

Causes:

• Typhoid fever is caused by salmonella typhoid bacteria.

• Typhoid fever is contracted by the ingestion of contaminated
• Diagnosis of typhoid fever is made when the salmonella bacteria is detected
with a stool culture
• Typhoid fever is treated with antibiotics.

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• Typhoid fever symptoms are poor appetite, headaches, generalized aches

and pain fever, and lethargy.
• 3-5% of patients become carriers of the bacteria after the acute illness

Treatment:

• The patient needs proper rest and care

• Keep the patient warm
• Treatment through antibiotics and drugs.
• As the patient is actually ill and anorexic, a high energy, high protein and a
full fluid diet is recommended. Small frequent meals in regular interval
should be given. A bland and soft diet can be given to improve the digestive
system.
• Dietary modification – need for energy is increased as the BMR rate is
increased consistently and there the energy needs also increase. Foods
which are rich in carbohydrate should be incorporated in the diet. However
the fats should be given emulsified from to make them easily digested.
• Proteins are relatively required in large amount as there is excessive tissue
loss. Good quality protein foods should be given to the patient. Milk &milk
based foods, egg chesses, tender meats &fish are good sources which should
be included in the meal.
• To compensate for the loss of electrolytes the mineral &vitamin take should
be increased. Dietary fibre should be given in less quantity to avoid irritation
to the stomach.
• Chemical irritants &spices should be avoided. Whole grams and cereals with
husk should not be given as they are high fibre diets which can cause irritable
bowel movements.

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TUBERCULOSIS:

Tuberculosis is a chronic disease. The conditions like malnutrition and poor

sanitation gives rise to such kind of infections. Tuberculosis is caused by bacteria
Mycobacterium tuberculosis which affects the lungs.

ETIOLOGY:

Over one-third of the world’s population has been exposed to the TB bacterium,
and new infections occur at a
rate of one per second. Not
everyone infected develops
the full-blown disease. In
2004, mortality and
morbidity statistics included
14.6 million chronic active TB
cases, 8.9 million new cases,
and 1.6 million deaths,
mostly in developing
countries.

Symptoms:

• Pulmonary tuberculosis is accompanied by wasting of tissues,

• Exhaustion
• Cough
• Expectoration
• Fever, marked rise in body temperature in the early stage BMR increases by
20-30% above normal.
• In acute stage, the disease is quite similar to that of acute fever
• Flushed face
• Increased circulation
• Constant fatigue
• Loss of weight
• A general run down condition.

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CAUSES:

The main cause is unhygienic conditions & poor sanitation. People in developing
countries are ignorant and therefore they do not keep the environment clean and
hygienic. Mycobacterium tuberculosis is responsible for the pulmonary infection.

TREATMENT:

• Rest, fresh air, good nourishment & love and affection are important factors
to be taken care of for the patients suffering from tuberculosis.
• Liberal amount of calcium should be given to promote healing of tuberculin
lesion-
• Iron supplementation if patient suffers from haemorrhages
• Conversion of beta carotene to retinol is adversely affected so diet should
provide good amount of retinol through milk and milk products, eggs and
meats
• Vitamin C requirement increases as it helps in healing. B complex needs are
also increased because energy needs are increased vitamin B6 requirement
also increases because prolonged use of chemotherapeutic agents used in the
treatment may have an adverse effect on its utilization.
• Dietary modification- energy should be provided in adequate amounts to
compensate for the loss.

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MUSCULOSKELETAL DISORDERS

OSTEOARTHRITIS

Definition:

Osteoarthritis is the most common chronic (long-lasting) joint condition. A joint

where two bones come together. The ends of
these bones are covered with protective tissue
called cartilage with OA this cartilage break
down causing the bones within the joint to rub
together. This can cause pain, stiffness and
other symptoms.

OA occurs most often in older people,

although it can in adults of any age.

Causes:-

OA is caused by joint damage. This damage can a accumulate over time, which is
why age is one of the main causes of the joint damage leading to osteoarthritis.
The older you are the more wear and tear you have had on your joints. Other
causes of joints damage include past injury such as:-

- Torn cartilage
- Dislocated joints
- Ligament injuries
They also include obesity, poor posture. Certain risk factors, such as family history
and gender. Increase your risk of OA.

Symptoms:-

OA can occur in any joint. However, the most commonly affected areas of the
body include the:-
- Hands

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- Fingertips
- Knees
- Hips
- Spine, typically at the neck or lower back. The most common symptoms
of osteoarthritis include:-
- Pain
- Tenderness
- Stiffness
- Inflammation
Severe osteoarthritis:-

- Increased swelling and inflammation

- Increased pain
- Decreased range of motion
- Joint instability

Treatment:-

- Exercise:- physical activity strengthens the muscles around your joints and
may help relive stiffness. Aim for at least 20 to 30 minutes of physical
movement, at least every other day. Choose gentle, low impact activities,
such as walking or swimming.
- Weight loss: - being overweight can put strain on your joints and cause
pain. Shedding excess pounds helps relieve this pressure and reduce pain.
A healthy weight healthy problem, such as diabetes and heart disease.
- Adequate sleep: - resting your muscles can reduce swelling and
inflammation. Be kind to yourself and don’t overdo it. Getting enough
sleep at night can also help you to manage pain more effectively.
- Heart and cold therapy: - you can experiment with heat or cold therapy to
relieve muscle pain and stiffness. Apply a cold or hot compress to sore
joints for 15 to 20 minutes several times a day.

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OSTEOPOROSIS:
Osteoporosis affects the bones of millions of people worldwide. The disease is
characterized by low bone mass and deterioration of bones tissue, which leads to
fragile bones and a greater risk of fracture, particularly in older people.
Osteoporosis fractures are a significant cause of disability and premature death.

Fracture rates vary between

men and women. In
countries where fracture are
frequent, women are
affected tree to four times
more often than men. In
countries were fracture
rates are low, men and
women are nearly equally
affected. In both genders,
the risk of vertebral and hip
fractures increases with age,
while the risk of wrist fracture levels off after the age of 60.

Hip fracture rates are highest for Caucasian woman living in temperate climates
and lowest for women in Africa. The frequency of fractures has generally increased
in countries in economic transition while rates in developed countries have levelled
off.

Approximately1.66 million hip fracture occur each year. This number is expected to
increase four –fold by 2050 because of the increasing number of older people.

How can diet and physical activity and other factors affect osteoporosis?

Calcium and vitamin D deficiencies increase the risk of osteoporosis in older

people. Appropriate supply of certain nutrients, particularly calcium and vitamin D
have been shown to play a role in limiting the risk of osteoporosis in older people.
Other nutrients that might be important for bone health included zinc, copper,
manganese, boron, vitamin A, vitamin C, Vitamin K, B vitamins, and potassium.

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Calcium is a mineral that is essential to bone health in all stages of life, although
the recommended daily intake is currently a subject of debate.

Vitamin D can be acquired from certain foods or can be produced in the body
through the action of sunlight on the skin. Deficiency in vitamin D can cause the
softening of bones, leading to rickets in children and osteomalacia in adults. In
older people less severe deficiencies have been linked to loss of bone minerals and
osteoporotic fractures.

Evidence shows that sufficient intake of both vitamin D and calcium reduces the
risk of osteoporosis in older people. In contrast, low body weight and high alcohol
consumption increase the risk of osteoporosis. Fluoride intake does not appear to
affect the risk of osteoporosis in older people.

How osteoporosis could be prevented

The risk of osteoporosis in older in older people may be reduced a diet providing
more calcium and vitamin D. however, such preventive measures should not
necessarily be applied to all population groups across the world, but should rather
focus on high sub –groups of populations. Indeed, calcium requirements vary
between geographic regions and cultures because of differing dietary, genetic, and
lifestyle factors. Furthermore, the interaction between calcium intake and physical
activity, sun exposure, and intake of other dietary components needs to be
considered before recommending increased calcium intake in countries with low
fracture incidence in order to be In line with recommendation for developed
counties.

In countries where fractures are very common, a calcium intake of at least 400-500
mg per day is required to prevent osteoporosis. It is also recommended that in
order to obtain sufficient vitamin D, especially when sunshine is limited, the diet
should provide 5-10 mg per day.

Sources of calcium include dairy products, fish with edible bones, tortillas
processed with lime, certain green vegetables such as broccoli, legumes, and tofu.

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Even though calcium intakes through dairy products are higher in developed, hip
fractures are more frequent there than in developing countries, this may be
explained by the negative effect of animal protein which may out weight the
beneficial effect of calcium intake.

Prudent measures that contribute to preventing other diseases may also be helpful
in reducing fracture risk:

• Increase physical activity (especially activities that increase muscle strength,

coordination and balance)
• Reduce sodium intake
• Increase intake of fruits and vegetables
• Maintain healthy body weight
• Avoid smoking
• Limit alcohol intake

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DIET FOR HEALTHY SKIN, HAIR AND NAILS:

There is a saying that says our nails, hair and skin often tell us how healthy we are
and are signs of how healthy our diet is. Foods that inflame our cells and cause a
breakdown end up tearing apart the collagen, keratin and elastin that provide
supple skin, strong fast growing nails. Toxic overload, stress and poor diet all
contribute to lackluster skin, dry and brittle hair, and brittle nails that never seem
to grow.

One of the neatest things about eating a healthy diet is your nails, hair and skin
are often the first things to change for the better when your diet improves. A
plant based diet provides all the nutrients your nail, hair and skin are often the
first things to change for the better when your diet improves. A plant based diet
provides all the nutrients your nails, hair and skin need to look their best. Some
foods, however do contain more nutritional properties that support their growth
and overall health than others do. Here are five to the best to offer up some of
the most overall. Nutritional components to provide amazing nail, hair and skin
quickly.

Raw organic almonds:-

Almonds are rich in vitamin E, a natural antioxidant that supports collagen

production and provides anti-inflammatory benefits for the body. Almonds also
contain a large amount of plant
based protein, rich in amino acids
that are needed to support collagen
growth and strengthen the body.
Almonds are also a great source of
calcium, which provides nutritional
support for our bones, hair, skin,
teeth and nails.

Almonds are rich in the B vitamin

biotin. Which is needed to strengthen the nails and hair. It is the main vitamin
found in most nail, hair and skin vitamins. Always go for raw organic almonds or

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raw, organic almond butter. Roasted nuts and seeds are more acidic and
processed and inorganic nuts and seeds are often contaminated with pesticides,
mold, toxins and other environmentally dangerous chemicals. Raw foods are also
rich in enzymes that increase absorption and digestion of nutrients.

Greens:-

Your body soaks up the nutrients from green foods like a magical nutritional
sponge. Vitamins A, C, E, K and even B vitamins and Iron are all provided to your
body when you eat leafy
greens. Green foods such
as spinach, broccoli, kale,
watercress and collards
also contain good amount
of calcium, magnesium
and potassium. Minerals
are crucial to the health
of your nail, hair and skin.
They are also water rich
so they won’t dehydrate.
Your body and they provide an alkaline environment to clear our toxins in the
body. Spiruline, a dark green seaweed is also a fantastic source of biotin, protein,
iron and vitamins B12 that will support your nails, hair and skin even further.

Orange root veggies:-

Sweet potatoes, carrots, pumpkin and winter

squash all contain high amount of vitamin A
which support your nails, hair and skin as well.
These foods are also rich in vitamin C, an
antioxidant that lower stress which can weaken
collagen, elastin and keratin in the body. Vitamin
C also acts as an antioxidant to combat free
radical production that can lead to aging. When

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cooking these foods always steam, bake or cook in a slow cooker instead of frying
them.

Raw organic pumping seeds:-

Every part of the pumping is a super food

pumping seeds arte some of the most
potent, alkaline, nutritious seeds you can
eat. They are rich in protein, iron,
magnesium, potassium, biotin and omega
3 fatty acids. They are also alkaline
forming like almonds so they build the
body instead of breaking it down.
Pumping seeds improve your mood, energy and of course your nails, hair and
skin.

Oats:-

Oats are one of the most inexpensive super foods you can eat. Even if you don’t
digest glutinous grains well
gluten free oats are important
for most everyone’s diets.
Whether you choose wild rice,
wheat products, oats, barley,
brown rice or quinoa. They are
all filled with certain
properties to provide your
body with support. Oats have
specific benefits that your
nails, hair and skin will
appreciate. These nutrients
include protein, biotin and other B vitamins, anti-inflammatory properties,
magnesium and potassium. They are also filled with fiber and antioxidant. Oats
lower inflammation. Clear the skin, reduce stress and provide your cells with
nutritional support.

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Vitamin A: This antioxidant helps maintain the structural integrity of cells and
healthy functioning of mucous linings. It has been shown to virtually eliminate
milder cases of acne as it helps reduce the production of sebum, which clogs pores.
Vitamin A along with adequate protein intake generates healthy hair. Look to
yellow and orange fruits and vegetables, dark green leafy vegetables, liver, and fish
liver oil for food sources of vitamin A.

Vitamin C: vitamin c is an important antioxidant for the skin. If fights wrinkles and
helps the body produce and maintain healthy collagen. Vitamin c is found in citrus
fruits, rose hips, aerial cherries, red and green peppers, broccoli, and bean sprouts.

Zinc: zinc works with vitamin c make collagen, an important component of

connective tissue.it also supports the tissue-rebuilding action of vitamin a, which
helps maintain healthy skin cells and may be helpful in generating new skin after
burns or injury. Nails and hair contain zinc; therefore, this mineral is important for
their maintenance. Zinc is found pecans, pumpkin seeds, whole-wheat flour, rye
flour, oat flour, oysters, and meat.

Vitamin E: This powerful antioxidant helps the body retain moisture and can
prevent sun damage. Its cell protection qualities contribute to vitamin E’s
prevention of tissue degeneration and premature aging. Vitamin e also promotes
the absorption of vitamin a. although found cold-pressed wheat germ oil and cold-
pressed safflower oil, it is difficult to get therapeutic amounts from foods;
therefore, supplementation is essential.

Selenium: This mineral greatly reduces the incidence of UV –induced skin cancer.
It may help with dry skin of the scalp (dandruff) and enhance vitamin e absorption.
Selenium is found in garlic, onions, brewer’s yeast, wheat germ and Brazil nuts.

Essential fatty acids: these include the good omega-3 and omega-6 fatty acids.
These fats are “essential” because our bodies can’t manufacture them and they
must be obtained from foods. Essential fatty acids help hydrate and increase the
skin’s moisture content. They also makes nails glossier and more flexible, and help
hair retain moisture. Flaxseed oil is high in omega-3 and omega-6 fatty acids.

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B complex vitamins: This group of vitamins is very important for the health of skin
and hair. B complex vitamins are helpful for dry or itchy dermatitis, rashes, or cracks
at the corners of the mouth. A deficiency can result in various skin problems and
hair loss, to name a few. B complex vitamins are found in a wide variety of foods.

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NUTRITION FOR NIGHT SHIFT WORKERS:

Night shift workers are probably losing their good health faster than you can say
“hello”. Long hours of work along with a hectic work schedule, have put an
increasing number of young professionals burning the midnight the midnight oil at
risk of major health disorders.

Typically, shift workers experience

irregular appetites, weight gain or loss,
and high rates of gastro-intestinal
disorder. Some possible reasons for
this are too much caffeine, high –fat
snacking, infrequent eating during the
day, over –eating at night and a lack of
exercise. Minor complaints range from
premature greying, hair loss of sleep,
digestive diseases and stress.

Physical problems include back and shoulder pain and now with excessive exposure
to computers, headphones and other equipment, there are many ear and eye
problems as well.

Poor eating can lead to malnutrition, indigestion, heartburn and stomach ache. It
can also lead to changes in body weight and body fat. For some shift workers, it
results in loss of appetite.

Hyperacidity is a constant companion, as are ulcers, irritability and general sense

of fatigue.

By mistake the right nutrition choices, you could save yourself not just the trouble,
but the heartburn of having to lose a lot of weight later on.

Too much of spices can aggravate gastric secretion, leading to hyperacidity. It is

important to avoid fatty and greasy food at night, and control the intake of spicy
food.

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Eat a big meals at the start of your work schedule, and a moderate meal around
midnight. Before going to bed in the morning, you can eat a regular breakfast meal
in a small quantity

For example, cereals with milk and fruits or two hulks with dal and vegetables
should do. Alternately, you can also eat a light sandwich, to avoid adding on calories
which don’t get burnt while sleeping.

You should be liberal with veggies and fruits, at the same time cutting back on
greasy food, sweets, soft drinks and caffeine

Too much caffeine causes irritability, anxiety and blood pressure. It also interferes
with iron and calcium absorption, which is very harmful for women. Two cups of
tea or coffee are ideal

Apart from nutrition, manage your stress level, get some exercise before you go to
work and avoid smoking and alcohol

Get a good nights (or mornings as the case may be!) sleep before you get to work
on your next shift

Eat early: a balanced meal should include protein, carbohydrates, vegetables and
fruits. Pack small meals like salads, sandwiches or fruits and increase fluid intake.
Lack of fluid can lead to dehydration, leading to headaches, dry skin and nasal
irritation and cramps making you more susceptible to colds, coughs, sore throats
and the flu. Consume high biological value protein foods

Avoid eating a large meal: never eat a large meal before going to bed. Small,
frequent meals made up of whole grains, fruits and vegetables provide energy in a
low-fat package, when they are eaten throughout the day. It might also be a good
idea o loss in some lean protein to keep your muscles fuelled and your appetite
under control. A few good choices include pasta, grilled chicken with vegetable and
beans and rice

Eat small, nutritional snacks throughout the shift: snacks are a very important part
of helping you stay energized throughout the night. Your best bet is to choose foods
that contain complex carbohydrates combined with some protein and moderate

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amount of mono –saturated fatty acids like rice and dal, salad with olive oil
dressing, flax –seed powder (jaws) chutney or sprinkled over dishes, food cooked
in oil and low-fat yogurt. Carbohydrates for heavy works is very vital as it a primary
source of energy

Workout before you work: regular physical activity keeps your blood circulation
and your heart pumping. Getting in a workout before heading to work can help
energize your body in preparation for the hours ahead. Water consumption should
also be kept high

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FOOD ALLERGIES &FOOD INTOLERANCE:

FOOD ALLERGY:

Food allergy is an
immunological reaction to a
certain type of food protein. A
person can be allergic to any
kind of food. A wide range of
symptoms can manifest from
foods. The respiratory system,
the immune system, and the
digestive system can all be
affected. Any food or additive
can theoretically cause
problems in certain people.
Even rice can be troublesome
for some.

People with food allergies typically react to one or two foods. Allergy is produced
by a combination of susceptibility and exposure so allergens vary. In Japan,
buckwheat, and in the Mediterranean countries, lentils are common allergens. In
Australia the most common foods are milk, soy, egg, peanut and fish.

Aetiology:

Allergies are most affect babies and young children because of their
underdeveloped immune system. Food allergies (not airborne allergies such as
pollens) are considered to be relatively rare-affecting up to 8% of babies under 12
months, 3% of children under five, and less than 1% of adults. Example-: hay fever,
eczema or asthma.

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Symptoms:

• Allergic reaction can be itching

• Swelling, rash & spreading hives
• Vomiting, diarrhea, breathing difficulties and in the most severe of the
allergic disorders
• Anaphylaxis can lead to collapse and death. (Anaphylaxis is an allergic
reaction which involves two of the body’s systems e.g. respiratory and
gastrointestinal or risk). Anaphylactic deaths as a result of insect bites or
penicillin are usually very quick- within minutes- and due cardiac arrest,
anaphylactic deaths due to food allergies are usually due to suffocation
(breathing difficulties).

Treatment:

Scrupulous avoidance and retest once a year in the case of babies and
children who may grow out of it. Life – threatening peanut allergies in
particular are increasing. In allergic families, complete avoidance of peanuts,
peanut-b containing products (and also cow’s milk) is recommended for
pregnant women for the last six weeks of pregnancy and throughout
breastfeeding. Some allergic foods can be avoided in the meals.

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FOOD INTOLRANCE

Food intolerance is a pharmacological reaction (like the side effects of a drug) to

the chemicals in foods. There are only 4 main types of food intolerance:

• Intolerance to gluten
• Dairy
• Fructose
• Yeast

With food intolerance, food chemicals such as 50 additives and some natural food
chemicals are involved. These can be in many different foods. For example,
asthmatics are most likely to be affected by sulphite preservatives (220-228) in a
wide range of foods and drugs including fruit flavoured cordials and drinks, wine,
bread, sausages and dried fruit and some medications. Food intolerance reactions
can be delayed up to 48 hours or more. Identification of reactions can be difficult.

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When problem foods are consumed frequently, symptoms can appear to be a

chronic condition rather than a food traction

Aetiology:

Children are vulnerable because dose for weight they consume a higher dose of
food chemicals than adults. Women of child-bearing age are vulnerable because of
hormonal influence. Senior citizen are vulnerable because ageing livers are kidneys
are slower to excrete chemicals from the body. Exposure to toxic chemicals,
pharmaceutical drugs or illness such as gastrointestinal infection can trigger food
intolerance.

Food intolerance is much more common, affecting babies (through breast milk),
children and adults. Some experts suggest 10%are affected, although, in theory,
everyone will react if the dose is high enough, so you would expect more people to
be affected as levels of additives rise.

Symptoms:

• Food intolerance reactions can be the same as above.

• It can also affect skin (rashes, swelling)
• Through air it can give symptoms like asthma, stuffy or runny nose, frequent
colds and infections.
• Gastrointestinal tract can also be affected , (irritable bowel symptoms, colic,
bloating, diarrhoea, vomiting, frequent mouth ulcers, reflux, bedwetting,
‘sneaky poos’, ’sticky poos’)
• Effects on central nervous system (migraines, headaches, anxiety,
depression, lethargy, impairment of memory and concentration, panic
attacks, irritability, restlessness, inattention, sleep disturbance, restless legs,
mood swings, PMT). Symptoms of food intolerance can come and go and
change throughout life

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Treatment:

An elimination of the diet which contains certain chemicals to ascertain tolerance

should be avoided. For a period of time when the intolerance continues, the
specific foods should be avoided.

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WEIGHT MANAGEMENT & OBESITY

Body weight is the sum of bone, muscle, organs, body fluids and adipose tissue.
Some or all of these component are subject to normal change as a reflection of
growth, reproductive states,
variation in exercise levels and the
effects of aging. Water, which makes
up 60-65% of body weight, is the
most variable component and the
state of hydration can induce
fluctuations of several pounds.
Muscle and even skeletal mass
adjust to some extent to support the
changing burden of adipose tissue.

Obesity is a state in which there is a generalized accumulation of excess adipose

tissue in the body leading to more than 20% of the required weight.

❖ There are two types of obesity:

➢ Developmental obesity
This category begins in the early years of a child’s life and continues steadily
over the adult years. The cells become saturated with fat and as the child
grow older more and more fat accumulates in the body. Muscle and bone
mass also increase since the body has to carry the additional weight. This
type of obesity results in a high LBM along with the fat.
➢ Reactive obesity
This type develops due to periods of emotional stress in a child’s life. During
such stress periods the child may overeat resulting in increase of weight.
However since those periods are intermittent, the weight also reflects ups
and downs. Such type of obesity results in a child having more lean mass as
compared to the fat content.

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FACTORS RESPONSIBLE FOR OBESTY

Hereditary factors

Although genetically the child is not determined to be obese yet obesity in parents
influences obesity in the child since the food habits of parents mould those of
parents. Other genetically associated factors are the activities of the child such as
fidgeting which is an important way of burning up calories.

Social and cultural factors

People in the upper socio-economic strata tend to be more obese mainly due to
their rich food intake and luxurious lifestyle which involves minimum physical
activity. Cultural factors which influence our food habits and thus predispose us
towards obesity.

Emotional factors

The correlation between obesity and emotional factors has been well established.
Overeating may result from boredom, loneliness or a sense of social rejection.

Abnormalities of glandular functioning or metabolism

A minor group of people suffer from obesity due to malfunctioning of one or more
of endocrine glands i.e. thyroid, pituitary or sex glands.

❖ Assessment and classification of overweight and obesity

Body mass index (BMI)

BMI is a common measure expressing the relationship of weight to height. It is

mathematical formula in which a person’s body weight in kilograms is divided by
the square of his or her height in meters. (i.e. wt. / (ht) 2). The BMI is more highly
correlated with body fat than any other indicator of height and weight.

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BMI (KG/M2)

Body mass index is a value derived from the mass and height of a person. The BMI
is defined as the body mass divided by the square of the body height, and is
expressed in units of kg/m², resulting from mass in kilograms and height in
metres.

Category Index
Underweight <18.5
Normal weight 18.5-24.9
Over weight 25-29.9
Obesity (class 1) 30-34.9
Obesity (class 2) 35-39.9
Obesity (class 3) >=40

Find out BMI of below weight category.

Example:-

➢ 57
➢ 67
➢ 79
➢ 82
➢ 91

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BMR

Basal metabolic rate is the rate of

energy expenditure per unit time by
endothermic animals at rest. It is
reported in energy units per unit
time ranging from watt to ml O₂/min
or joule per hour per kg body mass
J/. Proper measurement requires a
strict set of criteria to be met.

“ BMR= 2.2 * Body weight per kg * 11 (kcal) “

Ex.:-

Body weight= 80kg

BMR= 2.2 * 80 * 11= 1936 kcal

Find out BMR of below weight category.

Example:-

➢ 52
➢ 67
➢ 72
➢ 89
➢ 96

Category Kcal

Low BMR <1400 kcal

Ideal BMR 1500-1700 kcal

High BMR >1800 kcal

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CALCULATION OF IDEA BODY WEIGHT (IBW)

IBW is defined in reference to average weight, according to height and frame. Age
should also be considered.

BROCA’S INDEX FORMULA

First convert the height into centimetres.

Subtract 105 from the height to get IBW for

females in kg and subtract 100 to get IBW for
males in kg.

Calculation of day’s energy requirements

Ex.

Height: - 180cm, Weight: - 96kg

IBW= 180-100= 80kg (person is 16kg over weight)

Find out IBW of below weight category.

Example:-

➢ 52
➢ 67
➢ 72
➢ 89
➢ 96

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The calculation of the day’s energy requirements is based on the activity of the
individual. This is done according to the calories prescribed/kg IBW for
obese/normal/ underweight individuals at various activity levels as given in the
table below:

ACTIVITY OBESE NORMAL UNDERWEIGHT

Sedentary 20-25 30 35
Moderate 30 35 40
heavy 35 40 45-50

The major health consequence associated with overweight & obesity are:

a. Mechanical disabilities like osteoarthritis , gout, hernia, varicose, veins &

pulmonary diseases
b. Cardiovascular problems including HT, stock & CHD.
c. Conditions associated with insulin resistance i.e. NIDDM
d. Endocrinal disturbances such as PCOD
e. Gall bladder disease
f. Complications of child birth
g. Psychological disturbances
h. Certain types of cancer e.g. colon cancer.

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Weight management techniques

Effective weight control involves multiple techniques and strategies including:

1. taking a propare physical assessment:-

Case Study: - For Female

- Age:- 38 years
- Weight:- 120kg
- Height:- 165cm
- Medical Condition:- Blood Pressure
- Physical Activity:- None

Lifestyle:-

Breakfast (10 Am) Lunch (3 Pm) Dinner (9 Pm)

- Halka Nasta - 2 Roti, Sabji, Dal - Fast Food
- Poha or Upma Rice

2. Make a customized &

proper diet Diet Chart
1500 1200 1200
➢ Balance diet 900 900
1000
Calories

500 500
➢ Low carb diet
500

➢ Keto Diet 0
BALANCE LOW CARB KETO (WEEK FASTING LOW CARB BALANCE
(WEEK 1-3) (WEEK 3-6) 6-9) (WEEK 9-12) (WEEK 12- (WEEK 15-
➢ Fasting Diet 15) 18)
Diet

➢ Balance diet Time(week)

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3. Physical activity
➢ cardiovascular activity
➢ Muscular Endurance activity
➢ stretching or flexibility
➢ Functional Training
➢ Recovery training
1. Massage therapy
2. Foam rolling therapy
3. PMS stretching therapy

4. Behaviour therapy
In order to get your behaviour therapy right obese person should follow below
instruction:-

- Water Intake

- Slipping Pattern

- Healthy Snacking

- Discipline in the routine

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COUNSELING SKILLS

WHAT IS COUNSELING?

Counseling is therapeutic processes between two people where the issues at

hand are resolved

and the client is heiped to acquire the ability to selfmanage his or her goals.
Counseling successfully

helps in making behavior change with resultant healthy behaviors. Expected

outcomes of counseling

would include the client achieving the identified goals in changing his or her
behavior, which would

be reflected in improved management of the crisis situation Achieving success

is also likely to

improve self-image of the client and will positively affect other aspects of
client's life.

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What are counseling skills?

The counselor's job is to help the other person, the client, help him/her self. If
the client s to feelmsecure enough to be open about her/his thoughts and
feelings, he/she needs to feel safe, respectedand understood. Some of the
skills required are :
The counsellor must So that the client can

• Listen • Develop his/her thinking

• Not judge • Feel safe and respected
• Pay attention • Know you care
• Accept the client's feelings • Know he/she is not being
Understand the client's world and judged
feelings; put yourself in the client's • Know you are with him/her
shoes. • Get the best help possible
• Express that understanding.
• Think about the client

The•counsellor may So that the client can

• Ask questions Summaries • Develop her/his own

• Ask the client to try new thinking
behavior in the • Hear her/his thoughts and
know she/he is understood.

The counsellor should not This will make the client

• Argue • Defensive
• Dwell on their own • Withdraw
Difficulties • Dependent
• Solve the problem for the • Dependent or hostile
client give advice. withdraw or attack Be
• Belittle the client’s concern frustrated.
avoid painful areas.

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Following is the process and the skills discussed in detail which may help in
enhancing client's/ community's compliance with the programme.

Rapport Formation with the client is the first step and must be started from
the first interaction.

This will form the key for a successful programme. This can be achieved by
showing respect and genuine concern for the client. To maximize client
satisfaction and compliance, the counselor must be perceived as being caring
and concerned. On the other hand, the counselor must avoid fostering
dependency in the client. The client must recognize that the ultimate
responsibility for change lies with
himself or herself. The dietary
counselor is the helping vehicle, the
change agent, and the facilitator of
process, a process that involves
active participation and commitment
by both sides.

In an effort to understand the client, the counsellor may find it helpful to learn
something of client's past. Once the needed information has been discussed;
the focus needs to move to the present. It is usually much more comfortable
for the client to discuss past events than to confront the present.

It is counsellor's responsibility to maintain the focus of counselling on

present- whether related to diet, activity level or lifestyle.

Be reasonably conventional in dress and manner, to avoid stimulating any

client attitudes which may interfere with rapport formation.Greet the client
fully and warmly and by name. Introduce yourself briefly, giving your name
and professional status.

If the client seems agitated, it may help to start by engaging in small talk for
example, his journey

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Diploma in Ditetics FGIIT,

to the center) and to take down formal details like name,address,telephone

number, marital status and occupation. Ask the client about any anxieties or
worries about coming for counseling. Give the client reassurance.

Before winding up each session, summarize what has been discussed of done
in the session and give a brief idea about what to expect in the next session.

Goal formulation is important to make and implement decision, to modify an

undesired and unwanted behaviour, to help clients journey of growth towards
achieving potential.

Effective interventions combine nutrition education with behaviorally-

oriented counseling to help patients acquire the skills, motivation, and
support needed to alter their daily eating patterns and food preparation
practices. Examples of behaviorally-oriented counseling interventions include
teaching self monitoring, training to overcome common barriers to selecting a
healthy diet, helping patients to set their own goals, providing guidance in
shopping and food preparation, role playing, and arranging for social support.
The following sequence is usually followed:

Assess: This phase is to gather and evaluate data that serve to identify the
client's nutritional status, dietary practices, lifestyle, relevant medical
information, related risk factors and environment.

Plan: According to the information gathered, a plan needs to be developed

that applies the principles of food
and nutrition sciences to the
client's social, economic,
psychological and physical
environment. As the plan is
implemented, the client begins to
accept responsibility for
planning, preparing, supervising

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the preparation and consumption of appropriate meals. The client must feel
that he or she has a say in the decision-making process and are in charge of
their life. Informed suggestions and preferences must be elicited from the
client. Any disagreements between the client and counselor must be
negotiated and resolved. This will alleviate the scope for confusion and
misunderstanding.

Evaluation: The client and diet counsellor are co-operatively involved in the
evaluation wherein

they attempt to answer Has the plan ben successful? Has the goal been
achieved? What changes are required?

Readjust as needed: Identify the areas that need change and accordingly
readjust the goals. If due to certain reasons, the client is unable to achieve a
target, the target must be broken into small achievable goals (Chunk Changes).

Follow Up: The follow up serves to keep the client on the target and can be
done either telephonically or face to face.

Effective Communication: The counsellor must be sensitive to the client's

verbal and non- verbal behavior. He or she must appropriately use nonverbal
cues such as touch, gaze, voice, and tone and body posture. Skills such as
usage of correct language, presentation of information to maximize
understanding (use simple, short sentences, not to use scientific jargon of
words, repeat information) plays key role in effective diet counselling. Use of
person-centered speech will help in influencing client's attitudes, beliefs, and
values on health behaviors. Simply changing the way, you speak makes a
difference in how your messages are received. Using" you' and "yours," or "
you'll find. rather than "T think" or "Let me tell you about," brings your
message a little closer to home and may grab clients attention more quickly.
This can be achieved by using "I' statements which focuses on the client, For
example, "I am concerned about your Health." Approach the client from your
point of view. Tell the person "I am concerned about your weight gain". This
language lets them know that you care.

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This language helps avoid placing shame, blame, and guilt on the person
regarding their actions or attitudes. Do not use accusatory " you' statements
like "You just need to stop eating" or "You are acting irresponsibly". Instead
use "I' statements. For e.g., 'I am concerned because you are suffering by not
following the diet plan drawn for you. Probing and Clarification; Rather than
assuming things for the client, it is always a wise decision to clarify issues
from the client. Always sit down with the client and seek clarification.

Positive Reinforcement: Positive reinforcement is one of the key concepts in

behavior modification.

Positive reinforcers are something like rewards, or things we will generally

work to get. Positive reinforcement is the presentation of something pleasant
or rewarding immediately following behavior.

It makes that behavior more likely to occur in the future. Consistency in

providing positive strokes is also essential. Everyone concerned with the
behavior in question must give the same feedback. Consistency also means
always rewarding the desired behavior and never rewarding undesired
behavior. The client can be motivated by saying positive words.

Time Frame: Any form of effective counselling can not take place in 10-20
minute block of time. At least 30 minutes of one to one, individual counselling
will be required in the initial phases and gradually the follow up session can
be conducted for 15-20 minutes according to the need of the client and the
situation. Review meeting will require good amount of time.

Maintain Confidentiality: Confidentiality is fundamental to counselling

because, by its very nature, counselling is an intimate relationship which often
involves the client divulging information about their personal and intimate
feelings and situations. These disclosures are made on the assumption that
whatever is shared will remain confidential between the client and the
counsellor.

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Drawing the Line: Maintaining a critical perspective towards the counsellor-

client relationship is essential in order to avoid emotional burnout,
misjudgment and unproductive distribution of power. A common mistake
(especially for beginners) is to worry too much about clients. There is a
danger of sympathizing rather than empathizing with the client and may lead
towards lack of objectivity in counseling relationship and intervention.

Termination of Sessions: It's essential to prepare the client for completion of

the programme.

Do talk and emphasize what the client must follow to maintain his/her
progress. Inform them about the maintenance and follow up sessions.

The speed and complexity of modern life continue to increase as do people's

expectations from it. Coping well requires autonomous and flexible thinking
and clear decisions. Unfortunately, most of us have been conditioned to
conform, not think for ourselves.

Counselling skills help people to change as they learn to think things through
for themselves and make their own decisions, free of the effects of past
conditioning.

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SPORTS NUTRITION

Fitness is defined as-caring on daily tasks without undue fatigue, having ample
energy left over to enjoy leisure-time activities and managing stress effectively.

Physical fitness is the ability to function effectively in physical work, training, and
other activities and still have enough energy left over to handle any emergencies
which may arise.

Exercise scientists have identified ten components that comprise the definition of
fitness.

The following lists each of the ten components and an example of how they are
used:-

Cardiovascular endurance – the heart ‘s ability to

deliver blood (oxygen and nutrients) to working
muscles and their ability to use it effectively.(e.g.
running long distances)

Muscle endurance – the ability sub-y of a muscle or muscle group to perfect

repeated movements with a sub –maximal force for extended periods time and an
ability to perform sustained work (e.g. rowing or cycling)

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Muscle strength – the greatest amount of force a muscle or muscle group can exert
in a single effort against resistance (e.g. holding or restraining an object or person).

Strength endurance – a muscle’s ability to perform a maximum contraction time

after time (e.g. continuous explosive rebounding through an entire basketball
game).

Flexibility – the ability to move the joints (for example, elbow, knee) or any group
of joints through an entire, normal range of motion without being impeded by
excess tissue. i.e. fat or muscle (e.g. executing a leg split)

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Power – the ability to exert Maximum muscular contraction instantly in an

explosive burst of movements. The two components of power are strength and
speed. (e.g. jumping or a sprint start)

Agility - the ability to perform a series of explosive power movements in rapid

succession in opposing directions (e.g. Zigzag running or cutting movements)

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Balance – the ability to control the body’s position, either stationary (e.g. a
handstand) or while moving ( e.g. a gymnastics stunt)

Co-ordination – the ability to integrate the above listed components so that

effective moments are achieved.

Body composition is used to describe the percentages of fat, bone and muscle in
human bodies. The percentages of fat is of most interest because it can be very
helpful in judging health in addition to body weight.

Because muscular tissue takes up less space in our body than fat tissue, our body
composition, as well as our weight, determines how lean we appear. Two people
at the same height and same body weight may look completely different from each
other because they have a different body composition.

Factors such as speed, agility, muscle power, balance a person’s survivability in the
wilderness. Appropriate training can improve these factors within the limits of each
person’s potential.

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PRINCIPLES OF EXERCISE:

Adherence to certain basic exercise principles is important for developing an

effective program. The principles of exercise apply to everyone at all levels of
physical training, from the Olympic-calibre athlete to the weekend jogger. They
also apply to fitness training for military personnel.

• Regularity – to achieve a training effect, one should strive to exercise each

of the first four fitness components at least three times a week …regularity
is also important in resting, sleeping, and following a good diet.
• Progression – the intensity (how hard) and/or duration (how long) of
exercise must gradually increase to improve the level of fitness.
• Balance – to be effective, a program should include activities that address all
the fitness components, since overemphasizing any one of them may hurt
the others.
• Variety – providing a variety of activities reduces bordures boredom and
increases motivation and progress.
• Specificity – training must be geared toward specific goals. For example,
people become better runners if their training emphasizes running. Although
swimming is great exercise, it does not improve a 2 –mile-run time as much
as a running program does.
• Recovery – a hard day of training for a given component of fitness should be
followed by an earlier training day or rest day for that component and/or
muscle group(s) to help permit recovery. Another way to allow recovery is to
alternate the muscle groups exercised every other day, especially when
training for strength and/or muscle endurance.
• Overload – the work load of each exercise session must exceed the normal
demands placed on the body in order to bring about a training effect.

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FITT FACTORS:

Certain factors must be part of any fitness and cardio – respiratory training
program for it to be successful. These factors are frequency, intensity, time,
and type. The acronym fit makes it easier to remember them. A warm – up
and cool – down should also be part of each workout.

FREQUENCY:
Frequency refers to how offer one exercises. It is related to the intensity and
duration of the exercise session.

INTENSITY:
Intensity is related to how head one exercises. It represents the degree of
effort with which one trains and is probably the single most important factor
for improving performance. Unfortunately, it is the factor many people
ignore.

TIME:
Time, or duration, refers to how long one exercises. It is inversely related to
intensity. The more intense the activity, the shorter the time needed to
produce or maintain a training effect; the less intense the activity, the longer
the required duration. To improve CR fitness, a person must train for at least
20 to 30 minutes at his THR.

TYPE:
Type refers to the kind of exercise performed. When choosing the type, one
should consider the principle of specificity. To improve one’s level of CR
(cardio respiratory fitness –the major fitness component in the 2-mile run),
one should do CR types of exercises.

The basic rule is that to improve performance, one must practice the
particular exercise, activity, or skill he wants to improve. For example, to be

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good at push-ups, one must do push-ups. No other exercise will improve

push-up performance as effectively.
Factors for a successful training program are frequency, intensity, time, and
type: “FITT”.

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SUPPLEMENTS

A thing added to something else in order to complete or enhance it.

Supplement type:

• Natural supplement
• Ergonic Aids

Natural Supplement:-

1. Whey protein

Whey protein is a mixture of proteins isolated from whey which is the liquid
part of milk that separates during cheese production. Milk actually contains
two main types of protein casein (80%) and whey (20%). Whey is found in the
watery portion of milk. When cheese is produced, the fatty parts of the milk
coagulate and the whey is separated from it as a byproduct. After being
separated during cheese production, whey goes through various processing
steps to become what people generally recognize as whey protein a powder
that is added to shakes, meal replacements and protein bar.

Whey protein doesn’t taste very good on its own which is why it’s usually
flavored. Chocolate vanilla and strawberry flavored powder are popular. It’s
important to read the ingredients list as some products may have un-healthy
additives like refined sugar. Taking whey protein is a convenient way to add
protein on top of your daily intake.

This can be important for body builder and gym enthusiasts as well as people
who need to lose weight or are simple lacking protein in their diet. Whey is
generally well tolerated through people with lactose intolerance need to be
careful and some people may even be allergic to it.

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Types of whey protein:-

There are several popular types of whey protein.

1. Concentrate: - About 70-80% protein, contain some lactose (milk sugar) and
fat and has best flavor.
2. Isolate: - 90% protein or higher contains less lactose and fat and lacks a lot
of the beneficial nutrients found in whey protein concentrate.
3. Hydro lysate: - also known as hydrolyzed, when this type has been pre-
digested. So that it gets absorbed faster. It causes a 28-43% grater spike in
insulin levels than isolate.

Effects of whey protein:-

1. Building blocks- It provides protein and amino acids. Which serve as

building blocks for increased muscle growth.
2. Hormones- It increase the release of anabolic hormones that can stimulate
muscle growth such as insulin.
3. Leucine- It’s high in the amino acid leucine which known to stimulate
muscle protein synthesis at the molecular and genetic level.
4. Fast absorption- whey protein is an absorbed and utilized very quickly
compared to other types of protein.

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5. Weight loss- protein can boost energy expenditure by 80-100 calories per
day. And make people eat up to 441 fewer calories per day. In one study,
eating 25% of the daily calories in protein cut cravings by 60% and reduced
the desire for late time snacking by half. Taking whey protein is a great way
to increase your protein intake, which should have major benefits for
weight loss. Protein has been shown to aid weight loss by boosting
metabolism and reducing appetite. Whey protein can help increase fat loss
while preserving lean muscle mass.

Other health benefits:-

Whey protein lowering blood pressure, blood sugar and reducing symptoms of
stress and depression.

It also protects against cancer, reduces symptoms of hepatitis increases bone

mineral density improves immune function in HIV patients and increases the
lifespan of mice.

Side Effects:-

A commonly recommended dosage is 1-2 scoops (are 25-50gm) pre day,

usually after workout.

Keep in mind that if your protein intake is already high adding whey protein on
top of your current intake may be completely unnecessary. Concerns about
protein causing kidney damage and contributing to osteoporosis are
unwarranted.

In fact protein has been shown to protect against osteoporosis while having no
impact on healthy kidneys. However people with current kidney or liver issues
may want to avoid whey protein or at least consult with a medical professional
before taking it. Eating too much whey protein can Cause digestive issues such
as nausea, flatulence, diarrhea, pain and cramping. Some people are also
allergic to whey. If you can’t tolerate regular whey protein concentrate, isolate

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or hydro lysate may be more appropriate. Alternatively, you could simply avoid
whey protein and other protein rich foods instead.

The Bottom line:-

Whey protein is an exceptionally healthy way to add more protein to your diet.
It’s a quality protein source that is absorbed and utilized efficiently by the
human body. This is particularly important for athletes, bodybuilders or people
who need to gain muscle mass and strength while losing fat. When it comes to
muscle gain and fat loss, protein is the king of nutrients.
Whey protein seems to be even better than other form
of quality protein.

How BCAA are important for the body?

There are 20 different amino acids that makes up the
thousands of different proteins in the human body. Nine
of the 20 are considered essential amino acids, meaning
they cannot be made by your body and must be obtained
through your diet.

Here are five proven benefits of BCAA:-

1. Increase Muscle Growth: - one of the most popular uses of BCAA is to
increase muscle growth. In one study people who consumed a drink with 5-
6gm of BCAA after their resistance workout had a 22% greater increase in
muscle protein synthesis compared to those who consumed a placebo drink.
That being said, this increase in muscle protein synthesis is approximately 50%
less than what was observed in other studies where people consumed a whey
protein shake containing a similar amount of BCAA.

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2. Decrease Muscle Soreness: - supplementing with BCAA may decrease

muscle soreness by reducing damage in exercised muscle.

3. Reduce Exercise Fatigue: - BCAA may be useful in decreasing exercise

induced fatigue, but they are unlikely to improve exercise performance.

4. Prevent Muscle Wasting: - taking BCAA supplements can prevent the

breakdown of protein in certain populations with muscle wasting.

5. Benefits People With Liver Disease: - BCAA supplements may improve the
health outcomes of people with liver disease. While also possible protecting
against liver cancer.

Foods high in BCAAs:-

Beef, chicken breast, whey protein powder, soy protein powder, salmon,
turkey breast, eggs, Greek yogurt. Many protein rich foods contain high
amounts of BCAAs. If you consume enough protein in your diet, BCAA
supplements are unlikely to provide additional benefits.

The bottom line:-

The branched chain amino acids (BCAAs) are a group of three essential amino
acids, leucine, isoleucine and valine. There are essential meaning they can’t be
produced by your body and must be obtained for food. BCAA supplements
have been shown to build muscle, decrease muscle fatigue and alleviate
muscle soreness. They have also successfully been used in a hospital setting to
prevent or slow muscle loss and to improve symptoms of liver disease.

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ERGOGENIC AIDS:

Ergogenic aids are the various different means by which performance and health
are said to be enhanced.

They can be classified as:-

1) Nutrition ergogenic supplements.

2) Mechanical ergogenic aids.
3) Psychological ergogenic aids.

They are dietary supplements that supposedly enhance performance and health.
They are taken routinely by athletes to gain that competitive edge. Nowadays,
many athletics competitions are won by 1/100th of a second, hence it is the wish of
every athlete to have that extra advantage over others.

By definition, a supplement is something which is taken other than the diet to

meet the nutritional needs. But, athletes take them to enhance their performance.
This type of supplementation has been in place since a long time. Previously,
hunters used to kill and eat the heart of lions and deer because they felt that these
practices will gain them extra courage, boldness, swiftness and killer instinct.

Dietary supplements are a billion dollar industry. The industry targets the entire
population range from a sedentary individual to elite supplements are safe and that
they work. As a result, they make such blanket statements and get away with
disclaimers like “this product has not been evaluated by the FDA (food and drug
administration).It is not intended to diagnose, prevent or treat disease.” Most of
these products do not have any scientific evidence which says that they are
effective. Often the studies that are quoted to show their efficacy are never found
in other scientific journals. Even if the studies are authentic, they are never
performed on the sample of the sample of the population that are actually going
to us the product.

Manufacturers use the word “natural” for their supplements. Many people and
athletes fall for these ‘natural’ supplements thinking that natural means “safe” and

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“legal”. But, that is not so all time. Many ephedrine-containing substance might be
natural but, they are by no means safe and legal.

Governing organizations such as natural collegiate athletic association (NCAA)

and international Olympic committee (IOC) have published lists of banned
substances which will disqualify the athlete form competing if the athlete tests
positive for one of these banned substances. The NCAA says that not knowing
whether a substance is on the banned list is not an acceptable excuse for a positive
drug test.

Newer supplements are hitting the market almost daily with tall claims of
stunning transformations and superhuman performances. Many elite athletes are
asked to endorse these products by proclaiming that they have been using them
since ages and they are the reason for their trophies and awards. To determine
whether a supplement is safe and effective, I suggest you research thoroughly
before emptying your wallet. You should exercise caution when the following
statements appear as regarding a product:

• Boasts that it is quick and easy.

• Uses testimonials from ‘real users’ such as elite athletes and professional
bodybuilders.
• Gives a generalised statement that it is applicable for each and every one.
• Goes against scientific and medical evidence.
• Claims that it has been in use since ancient times.
• The product has a secret formulation known only to the manufacturer.

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ANDROSTENEDIONE

Androstenedione is formed in the body during the synthesis of testosterone.

Despite claims that it increases muscle mass, it has not been proven to be as
efficacious as it claims. It is not recommended in pregnant women, adolescents and
people with medical diseases like coronary artery disease, hypertension or prostate
enlargement.

DEHYDROEPIANDROSTERONE (DHEA)

DHEA is a hormone mainly produced in your adrenal glands. It is also formed in the
testis in the testosterone producing pathway. Medically, DHEA is not
recommended below the age of forty years in males because their bodies are
already making enough DHEA and there is no use to give it in supplementation. Its
beneficial effects have not yet been proved but it seems to confer some physical
and psychological benefit to male athletes over the age of forty years and in female
athletes. It is banned by most sports committees and hence, should not be used.

CAFFEINE

Doses:- 200 mcg per scoop(5gm)

Caffeine has been claimed to increase energy, increase

fat loss and increase endurance. It acts as a stimulant of
the brain and decreases fatigue. It is also said to increase
force of muscle contraction and facilitates fat utilisation.
Taking caffeine pre-workout can increase its intensity.
But, make sure that your sport allows you to take caffeine
as it is banned in certain sports.

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CHROMIUM PLCOLINATE

Doses:- 1000 mcg/day

Chromium is a co-factor to insulin action. It potencies the

action of insulin by sensitizing body’s tissues to insulin. It
increases protein synthesis by increasing the uptake and
utilisation of amino acids. Chromium is widely obtained from
various dietary sources and usually doesn’t need extra
supplementation.

CREATINE

Doses:- 5-8 gm/day Per Scoop

Creatine is known to increase power output of the muscles

during high intensity exercise and activity. This is amply in
many research studies. It increases total body weight
especially fat free mass.

CONJUGATED LINOEIC ACID (CLA)

Doses:- 750 mg / day

CLA has been claimed to increase Lear body mass and decrease
fat percentage. They are naturally occurring fatty acids found
in meat and dairy products. It is claimed to increase hormonal
responses in cells thereby leading to anabolism (growth). But,
there is no conclusive evidence to prove these claims.

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GLUCOSAMINE

Doses:- 600- 750 mg can take twice a day

Glucosamine is a sugar formed from glucose and amino

acids and plays an important role in forming the structure
of cartilage, tendons and ligaments. In theory,
glucosamine should repair damaged cartilages, but actual
evidence suggests that it plays a role in regeneration of
cartilage in the early stages of osteoarthritis. During later
stages, glucosamine role is yet to be proved.

L-carnitine

Doses:- 1capsule = 898 mg

L-carnitine is an amine made by the body. Its main role is that it

transports fatty acids for oxidation and energy production in
structures known as mitochondria which generate power within
cells. Mitochondria are power proteins and fats. This action
might be considered important in that l-carnitine might increase
the fat burning process. But, clinical research studies have not
conclusively proved its role in fat loss.

COENZYME Q10 (UBIQUINONE)

Doses:- 100 mg to 200 mg /day

Coenzyme q10 is an enzyme found in every mitochondria. It

participates in the production of ATP form glucose and fatty
acids.it is supposed to provide energy for long distance
events such as marathons by continuously oxidising the fuels
available to the cell for constant energy. Clinical studies in
athletes give equivocal results.

INOSINE

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Doses:- 500 mg = 1 capsule

Ionise forms a part of ATP (adenosine triphosphate) which is the energy currency
of the body. It is shown to increase energy during strenuous workouts and also
endurance sports.

BLOFLAVONOIDS

Doses:- 1000 mg/day per scoop

Bioflavonoids are the brightly coloured chemical

compounds found in fresh fruits and vegetables. They
are supposed to assist vitamin c in its absorption and
action. They are supposed to have strong anti-oxidant
properties. The ergogenic effects of bioflavonoids have
not yet been proved, but they are supposed to
enchance recovery after strenuous exercise and reduce
stress.

MELATONIN

Doses:- 5mg/day 1 capsule

Melatonin is a sleep producing substance formed in the

body. It has not been proven to benefit health of to
improve athleticism. Nevertheless, it has been
postulated to induce a sound and longer lasting sleep
thus, enchanting recovery. But. nothing is proved so far.

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GIANSENG

Doses:- 400 mg/day 1 capsule

There are three types of ginseng used for many centuries. It

has been claimed to increase energy levels and reduce stress.
The three types are Chinese ginseng, Siberian ginseng and
American ginseng. Formulations containing 2-4% ginseng are
available in the market. The various research studies
performed for the effect of ginseng have produced
conflicting results. Ginseng is a component of good multi-
vitamins/minerals supplements.

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HERBS

Herbs have long been used by humans for health. Some herbs form part of a
healthy diet and some form ingredients for various herbal medicines or potions.
These herbs can be of use to an athlete or an exercising individual. But, their use
has to be done under strict guidance of a horologist or a person who has a thorough
knowledge of herbs. Your doctor will definitely not know anything about herbs.
Herbs used correctly may give you an extra edge over other individuals but, if an
Asian herbal practice of using herbs for their specific actions e.g. caffeine content
in Guarani. Both approaches are sound. If you seek to be a professional athlete,
then you should definitely use herbs in your supplementation. Herbs come in many
forms: whole herbs to make tea with or as tablets or soft gels or as potions and
herbal extracts. Standardized herbal products are what you should aim for as many
herbal products also have side-effects if taken in too large a dose.

• Arjuna
• Ashvagandha
• Bael
• Brahmi tablet
• Brahmi syrup
• Gokshura
• Guduchi
• Hadjod
• Haridra
• Kapikachhu
• Karela
• Lasuna
• Manjishtha
• Meshashringi
• Neem tablet
• Neem syrup

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MACHANICAL ERGOGENIC AIDS

Mechanical forms of ergogenic aids include specially designed clothing, enhanced

forms of sports equipment and/or some physics in contact with a person’s body.

Some examples of mechanical ergogenic aids are:

❖ Altitude training.
❖ Heart rate monitors.
❖ Computers used for analysis of various
parameters like VO2 max etc.
❖ Video recorders to analyse technique.
❖ Weight.
❖ Parachutes.
❖ Elastic cords (resistance tubing).
❖ Uphill and downhill running.
❖ Weigh vests.
❖ Sports clothing, footwear and other
equipment.
❖ Timing equipment.

All of these mechanical aids are just used to enhance the training of an athlete
and are perfectly legal.

PSYCHOLOGICAL ERGOGENIC ALDS

These techniques are easy to learn and can be practised anywhere:

❖ Hypnosis to distract the mind from negative thoughts before an event.

❖ Cheering.
❖ Positive visualisation.
❖ Soothing music.
❖ Deep breathing techniques and relaxation.
❖ Yoga can relax tension in the muscles and the mind.

These are various performance enhancing aids for maintaining good health in an
individual and also increase performance of an athlete. As regarding the

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nutritional ergogenic aids, please research and then only try them out. My advice
to the athletes is that these nutritional and mechanical ergogenic aids are costly
and not easily available. Tall claims have been made regarding the nutritional
supplements but, research is showing conflicting results in most cases. So, the ball
is in your court now.

USE OF PERFORMANCE ENHANCING DRUGS IN ATHLETES AND BODYBUILDING

The main idea behind this book is to promote fitness and bodybuilding naturally.
But, let me put in a word here that these compounds are used extensively by
bodybuilders as they promote growth of lean body mass, much beyond the
physiological range. During the leaning phase, when the physique athletes are on
hypo caloric diets, these compounds are to the body. They can be the cause of liver
or kidney failure. All the sports, except professional bodybuilding have banned the
use of these substances. Very few bodybuilders openly admit that they have taken
steroids and peptides as part of their pre-competition preparations.

The aping of these athletes is so prevalent now that youngsters are resorting to
these substances for getting a lean and ripped look of their heroes. Bodybuilding
competitions are very common nowadays and hence, more and more young
athletes, including females are hooked onto these drugs. These drugs lay havoc
with your sex hormones and their associated metabolic effects. Even if you aspire
to become a physique model or a professional bodybuilder, that does not give you
an excuse to inject yourself indiscriminately. Safe prescription of these drugs under
the guidance of a super-specialist who has exquisite knowledge of this ‘dark side of
bodybuilding’ is still tolerable. But, please do not listen to uncertified people who
only have their financial interests at heart.

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How to Make Diet Sample

Case Study 1:

Name:- Rahul Sharma

Age:- 25 years
Medical Condition:- None
Weight:- 67 kg
Height:- 157 cm.
Goal:- Fat loss
Food preference: Non-Vegetarian
Activity levels: sedentary
Medical Condition:- none

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Physical Assesment:

- Ideal weight 100- 157 cm = 57 kg

- BMR= 2.2 × 11× body weight (2.2 ×11× 67= 1600 kcal per day)

- BMR + Activity= 1600 kcal + 500 kcal daily activity like walking and job

- Total daily calory = 2100 kcal

- Calories deficit = 300 kcal calory per day

- Total calories = 1800 kcal calory per day

- Macro calculation = 60 percent carbs , 25 percent protein, 15 percent fat

- Carbs = 1800 %60 =1080 ÷4=270 gram carb per day

- Protein =1800%25=450÷4=112 gram protein per day

- Fat = 1800%15=270÷9= 30 gram fat per day

- Per meal = carbs 270÷4 meal =67.5 gram/per meal

- Per meal = protein 112÷4 meal= 28 gram/per meal

- Per meal = fat 30 ÷3 meal = 10 gram/per meal

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Meals | Time Food source

Wake up - Black coffee early morning

- 1 digestive sugar free biscuits

Meal 1 - 2 slice brown bread

- Low fat cheese – 1 slice
Breakfast
- Tofu 50 gram
(8:00 – 9:00 AM) - 1 cup low fat milk
- 1 apple 100 gram

- 2 multigrain chapati (25gm weight roti)

- ½ cup crooked moongdal
Meal 2 Lunch
- One plate salad
(1:00 – 2:00 pm) - Butter milk (150ml)
- Cooked vegetables

Meal 3 - 1 orange
- Whey protein 1 scoop
Evening snack
- 14 Almonds
(4:00 – 5:00 pm)

- Rice 100gm
Meal 4 Dinner - 1 plate salad
- 1 serving mix veg curry
(8:00 – 9:00 pm) - 100gm grilled chicken
- Mustard chilli pickle (oil free)1 serving
- Low fat curd 50 gram

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Notes:

1. Avoid all desserts in every meal.

2. Use Broccoli, Capsicum, onion, Spinach, and Fenugreek as green vegetables.

3. Use ½ teaspoon rock salt while cooking.

4. Use 1 Tbsp. oil while cooking.

5. Avoid outside junk and oily foods.

6. Drink at least 4 liters water daily.

7. Sleep 7 - 8 hours at night.

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Case Study 2:
Name:- Krishna Solanki
Age:- 20 years
Medical Condition:- None
Weight:- 70 kg
Height:- 170 cm.
Goal:- Sports person (CRICKET)
Food preference: Non-vegetarian
Activity levels: Intense

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Physical Assesment:

- Ideal weight 100- 157 cm = 70 kg

- BMR= 2.2 × 11× body weight (2.2 ×11× 70= 1694 kcal per day)

- BMR + Activity= 1700 kcal + 700 kcal daily Intense activity

- Total daily calory = 2400 kcal

- Macro calculation = 50 percent carbs , 40 percent protein, 10 percent fat

- Carbs = 2400 %50 = 1200 ÷ 4 = 300 gram carb per day

- Protein =2400%45 = 960 ÷ 4 = 240 gram protein per day

- Fat = 2400%10=240÷9= 26 gram fat per day

- Per meal = carbs 300÷4 meal =50 gram/per meal

- Per meal = protein 240÷4 meal= 40 gram/per meal

- Per meal = fat 26 ÷1 meal = 26 gram/per meal

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Meals | Time Food source

\

Morning • Pre-workout
Breakfast • 100 gm. Oats + 200 ml. milk
• Post-workout recovery
• 1 scoop whey protein

Mid Morning • Post-workout meal

• 1 Bowl Fruit (Banana, Apple, Grapes, Papaya,
Watermelon)
• 6 Egg White + 1 Whole Egg
• 14 almonds

• 1 Raggi Roti (25 gm. * 2)

Lunch • 100 gm. Rice
• 1 Katori Dal
• 1 Bowl Panner Sabji (150 gm.)
• 1 Bowl Salad
• 1 Bowl Curd (200 gm. Curd)

Before Workout • 2 Egg Sandwich

• 4 Brown Bread + 6 Egg White + 1 Whole Egg
• 1 cucumbut, Tomato, onion, 1 TBS Butter

After Workout • 1 scoop whey protein in 200 ml. water

• After 30 minutes
• 2-3 sweet potatos

• 2 Shorgum Roti
Dinner • 100 gm. Vegetable Khichdi (25 gm. * 2)
• Chicken Salad ( 150gm)
• 1 Glass mint butter milk

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Notes:

1. Avoid all desserts in every meal.

2. Use Broccoli, Capsicum, onion, Spinach, and Fenugreek as green vegetables.

3. Use ½ teaspoon rock salt while cooking.

4. Use 1 Tbsp. oil while cooking.

5. Avoid outside junk and oily foods.

6. Drink at least 4 liters water daily.

7. Sleep 7 - 8 hours at night.

8. Use Intra workout BCAA or Electrolyte if needed.

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Case Study 3:

Name:- Ravina Soni

Age:- 29 years
Medical Condition:- Diabetes & Thyroid
Weight:- 75
Height:- 156 cm.
Goal:- Fat loss & Diabetes & Thyroid Reversal
Food preference: Vegetarian
Activity levels: Sedentary

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Physical Assesment:

- Ideal weight 105- 156 cm = 51 kg

- BMR= 2.2 × 11× body weight (2.2 ×11× 75= 1815 kcal per day)

- BMR - Activity= 1815 kcal + 500 kcal daily activity like walking and job

- Total daily calory = 1315 kcal

- Calories deficit = 500 kcal calory per day

- Total calories = 1315 kcal calory per day

- Macro calculation = 50 percent carbs , 30 percent protein, 20 percent fat

- Carbs = 1315 %50 =657÷4=164 gram carb per day

- Protein =1315 %25 =394÷4=98.6 gram protein per day

- Fat = 1315 %20=263÷9= 29 gram fat per day

- Per meal = carbs 164÷4 meal =41 gram/per meal

- Per meal = protein 98.6÷4 meal= 24.65 gram/per meal

- Per meal = fat 29 ÷3 meal = 9.66 gram/per meal

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Meals | Time Food source

Meal 1 - 12 TBS Poha ( onion, Capcicum, Peanuts, lemon,

Breakfast tomato)
- Musk melon
- 50 gm Paneer

- Sorghum 1 roti ( 25-30 gm )

Meal 2 Lunch - 200 gm Curd
- 1 Plate Salad
- Green Vegetable Sabji

Meal 3 - 14 Almonds
Evening snack - Pomegrantes
- Sprouts Bowl

Meal 4 Dinner - Vegetable Soup

- 10 TBS Khichdi
- 50 gm Paneer
- 1 Bowl salad

Before Bed - Skimmed Milk With Turmeric

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Notes:

1. Avoid all desserts in every meal.

2. Use Broccoli, Capsicum, onion, Spinach, and Fenugreek as green vegetables.

3. Use ½ teaspoon rock salt while cooking.

4. Use 1 Tbsp. oil while cooking.

5. Avoid outside junk and oily foods.

6. Drink at least 4 liters water daily.

7. Sleep 7 - 8 hours at night.

8. Use Low Glycemic Index Food to Control your Sugar Levels.

9. Avoid Table Sugar or Refined Sugar Completely.

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Case Study:-
1. for Cricket Player:-

- Gender: - Male

- Age: - 35 years

- Weight: - 62kg

- Height: - 172cm

- Training Time: - 7:00 to 9:00 AM

* Make a proper & customized diet in order to enhance his performance.

2. for Football Player:-

- Gender: - Male

- Age: - 30 years

- Weight: - 60.5kg

- Height: - 162cm

- Training Time: - 4:00 to 6:00 PM

* Make a proper & customized diet in order to enhance his performance.

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3. for Kabaddi Player:-

- Gender: - Female

- Age: - 25 years

- Weight: - 60kg

- Height: - 163cm

- Training Time: - 9:00 to 11:00 AM

* Make a proper & customized diet in order to enhance his performance.

4. for Bodybuilding Player:-

- Gender: - Male

- Age: - 25 years

- Weight: - 80kg

- Height: - 170cm

- Training Time: - 7:00 to 9:00 AM

* Make a proper & customized diet in order to enhance his performance.

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Job placement & Interview training:-

1. How to make a resume?
Well have you ever think of making a resume well if you did here are top 5
common mistakes people do while making a resume, which you should not do
next time you make one resume.

First thing first what is resume: “Well it is a

representation of your personal information,
Qualification, expertise and skills”

Resume follow simple rules too like,

1) It Should be short.

2) It should have a preview of your personal

and educational information.

3) It should pass the clear message of your

character or nature.

4) It should have attachments or proof of your

written information.

5) It should be graphically represented.

You can check sample resume besides.

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A Good resume can represent you,

1) Organized
2) Confident
3) Qualified
4) Trustworthy
5) Attractive

Next we are coming to Top 5 mistakes most of the job seekers do is as below,

1) Make resume too long:

Making a resume long will through away the interest of the Employer to read the
full resume and that is never good it will create less impact of you and once you
actually go for interview he don’t know you at all.

So Employer ask you a same old boring personal question which frustrate you
both.

2) Write wrong information on resume:

It is neither ethical nor useful in terms of making resumes. It can lower your
chances of getting hired and also straight away big no for final round of interview.

For ex you have lied about a salary and your interviewer is an friend of your last
employer he can double check and you can lose your job too.

Even the last employer also doesn’t take you back due to this.

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After all this if you get the job then also you will have a constant hanging knife on
your neck they anyone would have find out.

3) Forget to attach all necessary information with resume:

You need to attach your Certification, Degree, NOC of last job, Adhar card things
like this to the resume otherwise it does not look professional

You will shock due to this reasons also many of candidates does not get the job.

Carry all this document attach with a pin and get them into a good file so you can
submit it once it needed at the company you are going to interview.

It should be a photocopy and not the original once also every paper should have a
sign of yours at below which can testify that you your self only submitted those
records.

4) Show you’re self-boring:

Personally as a employer when I see someone have a passion or hobby other then
music, reading and singing it excite me more.

I mean to say your hobby shows your personality, which is very important to have
in life, hobby keeps you going and make sure that you don’t get discourage in
difficult situation.

For example If I go to any interview I write my hobbies are:

- Bodybuilding
- Learning new skills each day (Coding, Designing, Digital marketing, AI)
- Listening to podcast
- Making videos on YouTube
- Speaking and taking seminars

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Like this your hobby also show your additional skills which is very attractive to
interview

5) Answer the same thing written in resume to interviewer:

This is little bit after you make your resume I would like to explain this with one
small example.

Interviewer: Tell me something about your self.

Candidate: Well everything is already written in resume I will tell you what is not
written on the resume “I Love Modi and not Rahul Gandhi”

Interviewer laughed a lot.

Well you can sense the hint that nobody likes to repeat which is already known.

So don’t talk much talk less & act more.

Wait Wait Wait don’t go Main part is still remain….

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How to make resume step by step:

Step 1 – Select a right format of resume, which is, accepted universal.

Step 2 – Don’t miss your contact information part

Step 3 – Write down your personal and professional summary

Step 4 – Mention your achievement and qualification

Step 5 – Write down your skills

Step 6 – Customized your information as per job role

Step 7 – How can you be useful resource to the company

Step 8 – Double check your resume

Comparison Good resume VS Bad resume:

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2. How to present yourself in interview?

Have you ever felt shaking legs or your heart beating so fast that it comes out of
your chest or feeling goosebums and cold, well there may be a time when you
have given your first interview? It is called nervousness by the way which we all
are aware of.

I still remember my first interview back in 2014. I was very young and thought
about the part-time job after my college and went for an interview at a fashion
design institute as they frequently needed male models at that time I was a
fitness model (use my photo with abs) and did many freelancing projects but
worked somewhere was a different thing.

I
was

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passed out from a local school in the regional Gujarati language and couldn’t able
to speak English very well. (Remember this it has a big relevance in this story).

So as I entered in the interview room same feeling of nervousness started and I

was highly frightened due to that. They called me in I went and ask permission to
sit,

Me (in gujarati): shu hu besi saku chu? English translation (may I sit?)

Interview: yes you can gautam. Tell me something about your self please.

“he didn’t wait even for a second after I realize I was there for an interview not
for an chit-chat why should he waste time after that”

Me: (tried to speak in broken english) my name is gautam jani, my school is.. My
father’s name is etc...

Interviewer: I don’t want to know about that tell me something is not in your
resume

Me: stared the interviewer for 1 minute and roll my eyes down, he understood I
don’t have anything to say.

Interviewer: so tell me why this industry and not anything else? What are your
goals in life, how you see your self in 5 years.

Me: I thought and told me self the boy who stopped at tell me more how can
answer this question because that time my goal was to take money and purchase
the protein shake for my bodybuilding nothing else.

Right most of young bodybuilder can relevant on that because back in the time I
didn’t have any pocket money although “ghar pew o concept hi nahi tha”

pg. 364
Diploma in Ditetics FGIIT,

Again I rolled my eyes down that time I thought it is finished I failed the interview
and waiting for the answer that please go and don’t waste my time.

Interviewer: after thinking 5 mins and finished 2 phone calls in front of me said
“kal se kaam pea a jana aur salary ki baat front desk pe kar lena”

Conclusion: interview should not be a bigger deal neither for you nor for the
employer so chill a bit and feel relaxed.

It is 21'st century you need to have a clear mindset of why you want to do the job
and it is high time for you to become independent or not if not please don’t waste
anyone’s precious opportunity to working at any business.

Today we will be going to understand key parameter of interviews. Top 5 things

you need to take care of when you are into interview.

1-non-verbal communication:

Do you know whatever you act or not act has a certain meaning there is a way of
sitting, standing or even watching to someone during interview.

For example,

Little been lean posture towards interviewer give a signal to interviews that you
are highly interested and motivated.

Sit with opening your legs and arms means you are open to suggestions.

Smile once after you see that person not before and not after exactly after 2
second show that your smile is meant for that person and not fake.

pg. 365
Diploma in Ditetics FGIIT,

Here I have showed you few signals in images watch and learn.

2-listening:

Listening is a art which not everyone can master. Listening means listen more and
analyze it and then answer.

When you listen well your brain can think multiple possible answer and then from
them you can select from them plus when you interrupt someone that also shows
dominance in your nature.

Most of the people like a person who listen more and talk less.

It shows that you are 3c (don’t think bad) I mean calm, cool, confident.

Most of the time happens you get a good package from interviewer better then
you thought of. Better time, holidays and office also.

I have listed out potential benefits of listening below.

3-Truth:

Interviewer impress by person who said right things and don’t hide anything
because trust is a quality, which is mode admirable.

Have you ever thought why dogs are loved more then men due to their loyalty
and that loyalty comes from speaking truth.

Now a days everyone has connection and everyone has technology if you lied
anything you will be caught early then expected.

Mostly people lie about previous salary, references, reason why they left job,
education or skills.

pg. 366
Diploma in Ditetics FGIIT,

4-resume is your first and last impression:

Making a good resume is not that difficult of you have read our last bog if you
haven’t watch it now on:

Well let me tell you how you step by step how you can make a resume

Name and contact details

• Qualification
• Skills
• Qualities
• Experience
Also don’t forget to attach all necessary documents and proof with the resume.

Resume reach to interviewer before you so it is important it should be graphically

represented and neat and clean.

5-do your background research:

It is a very well-known practice of doing background checks on the company

where you are going to work on.

For that you can search on google, LinkedIn and companies website.

You need to know their policy, vision, goals (STG, LTG) if you know what is STG &
LTG comment down the full name.

Because according to that you can answer the question better.

How to prepare for your interview.

pg. 367
Diploma in Ditetics FGIIT,

Whether you like it or not it is your first and last impression

If you like the blog and want to get hired in health and fitness industry call us on
8866842520.

pg. 368
Diploma in Ditetics FGIIT,

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