Description
Episode 91: Nutrition Introduction.
Sapna Patel and Danish Khalid present the basics of macronutrients and the definition of basic energy expenditure (BEE), they explain basic concepts on macronutrients.
Introduction: Unable to control the epidemic of obesity
By Hector Arreaza, MD.
Today is April 27, 2022. In this episode, we will cover the very basics of classic nutrition. As we know, obesity is reaching epidemic proportions in the United States. Regardless of all the advances in science, we have not been able to control one of the most detrimental diseases in our communities.
Obesity is among the most difficult to treat chronic diseases. There are countless recommendations about what to eat and not to eat, best workouts, miraculous shakes, magical weight-loss supplements, innovative devices, promising programs, novel medications, and the latest surgeries, however, we still have millions of patients who are suffering every day the consequences of undiagnosed and untreated obesity. We are hoping this is the first of multiple episodes addressing the problem of obesity, we hope you enjoy it.
This is Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it’s sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.
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Nutrition Introduction.
By Sapna Patel, MS4, and Danish Ross University School of Medicine. Comments by Hector Arreaza, MD.
Obesity is a disease when the patient has excessive body fat resulting in “sick fat disease” with metabolic consequences or “fat mass disease.” Excessive body fat is caused by genetic or developmental errors, infections, hypothalamic injury, adverse reactions to medications, nutritional /energy imbalance, and/or adverse environmental factors. Let us talk about one of the pillars of the treatment of obesity.
S: Hi, my name is Sapna Patel. I am a 4th-year medical student. I am passionate about fitness and cooking. I have been active all my life doing soccer, taekwondo, kickboxing, and weightlifting. I am joined here today with Danish.
D: Hi, my name is Danish. I am also a fourth-year medical student. I have a background in mixed martial arts, boxing, and karate. And just like Sapna, I too am passionate about fitness, and nutrition.
S: Today we are here to talk about nutrition. One of the most neglected subjects in medicine, yet the most important subjects. As we speak, we are sitting in Kern County, which has the highest obesity rate in the whole state of California with more than 60% of the population considered overweight. Poor nutrition is the leading cause of people being overweight and obese, and in turn, obesity leads to various other medical conditions.
It is important to educate ourselves on nutrition, not only as medical professionals but as someone who lives in the most obese country. And it is as simple as knowing how to balance calories and macronutrients.
D: To maintain a healthy weight and lifestyle over time, it is important that we maintain caloric balance. Oftentimes we tend to overeat, tipping us into a caloric surplus. This leads us to being overweight and obese which are the most important factors associated with poor health outcomes. It is associated with premature mortality as well as increased incidence of cardiovascular disease, diabetes, hypertension, cancer, and other important conditions. Calculating total energy expenditure for recommended daily caloric intake is based on age, sex, weight, and activity level.
Basal Energy Expenditure (BEE) (male/female): 66.5 + (13.5/9.5 x weight (kg)) + (5/2 x height (cm)) - (7/5 x age).
S: Another easier way to know your basal energy expenditure, is to use the table made by the USDA guideline which has an average estimate energy expenditure per day based on age, sex, activity level. Or a lot of bodybuilders use a rough calculation for basal energy expenditure which is:
Formula = BW (lbs) x 14-16 (where 14=moderately active, and 16=very active)
For example, one of my goals is to increase muscle mass. And based on the calculations, my BEE is 1458 kcal/day with my current activity level. Thus, if I wanted to gain muscle without gaining fat, I would have to keep to this number. Whereas, Danish I know you have a different goal
D: Yes so, one of my goals is to achieve fat loss. For me, my basal energy expenditure is 2400 kcal/day with my current activity level. However, this number is to maintain my current weight. If I need to lose weight, I will have to subtract calories from my daily balance. Typically, I would subtract 500 kcal/day, as this allows for a fat loss of 1 pound per week or 3500 kcal/week.
Many should aim for 0.5 pounds to 2 pounds per week, but nothing more than 2 pounds as this could lead to undesirable appearances such as excess skin. If you are looking to gain weight, it is the same concept, however the opposite. You add calories instead. Of course, it is not as simple as just over-eating. That is where macronutrients come in, it is important to balance your proteins, fats, and carbohydrates.
S: On that note, let us talk about macronutrients. Macronutrients are the chemical compounds consumed in the largest quantities and provide bulk energy. The three primary macronutrients include proteins, carbohydrates, and fats. Let us start with protein.
D: Protein should make up 10- 35% of total caloric intake, as recommended by the United States Dietary Guidelines. Or consume 0.8-1.2 grams of your body weight in pounds.
Common sources of dietary protein include whole foods such as fish, eggs, lean meat, vegetables (specifically peas, lentils, soybeans), and protein powders such as casein, whey, and soy.
S: So, for me being a vegetarian, I must only rely on eggs, vegetables, and milk proteins.
In terms of milk protein, there are two different types, rapidly versus slowly digested. Rapidly digested milk proteins are what we see termed whey or soy protein. Whereas slowly digested milk proteins are termed casein.
Whey hydrolysate and soy are digested and absorbed quickly, only 90 mins after you consume whey. It delivers essential amino acids, branched-chain amino acids, and leucine, making it the perfect end to your workouts, as it will kickstart the muscle repair and rebuilding process.
Casein protein provides your body with a slow, steady release of amino acids, and stay elevated in your blood for 4-5hrs after you consume it. making it ideal before fasting situations, such as sleep. The peptides found in casein work similarly to ACE-I (angiotensin converting enzyme inhibitors) and lower blood pressure and reduce the formation of blood clots. It also contains several bioactive peptides that are beneficial to your digestive system.
D: Let's move on to fats. Fat should make up 20- 35% of total caloric intake, as recommended by the United States Dietary Guidelines. The type of fat consumed is more important than the amount of total fat. There are technically 4 types of fats: saturated, trans, mono- and polyunsaturated fats.
Saturated and trans fats contribute to coronary heart disease, while mono/polyunsaturated fats are protective. The major sources of saturated fats include butter, ghee, ice creams, sausages, bacon, and cheese with the list going on.
The major sources of trans fats include margarine and partially hydrogenated vegetable fats. Guidelines recommend limiting consumption of saturated and trans-fat to under 10% of calories per day. The major sources of mono/polyunsaturated fats include omega-3, fish oil, avocados, nuts, and seeds. Furthermore, some evidence shows that long-term consumption of fish oil and n-3 fatty acids reduces the risk of cardiovascular disease. So, the next time you are out shopping, keep an eye on those fats.
S: Last but not least, carbohydrates. As recommended by US Dietary Guidelines, carbs should make up 45-65% of total caloric intake. Here quantity and type of carbohydrate matter because they can have different effects on postprandial (after meal) glucose levels, termed glycemic index. Studies have shown that diets with a high glycemic index (foods that increase your blood sugar levels substantially) have been associated with developing type 2 diabetes mellitus and coronary heart disease.
One important way of achieving a healthy diet is to replace carbohydrates having a high glycemic index (e.g., white rice, pancakes) with a low glycemic index (e.g., fruits, vegetables). Additionally, adding sugars should be limited and comprise no more than 10% of total calories consumed. These added sugars often come from sweetened beverages and almost all processed foods. They should be substituted with naturally occurring sugars in fruits or milk.
S: As you can see, nutrition is not as simple as just eating the right things. It includes knowing your caloric balance and having the appropriate number of macronutrients. However, it does not just stop there. There is no “whey” we can fit all this information into just one podcast so stay tuned as we continue to further discuss nutrition.
D: Before we leave, just a few tips. With any goal, diet is 80% of the work whereas exercise is 20%. If your diet is not healthy, it will not matter how much you work out. And lastly, keep consistent and be disciplined. Good day to you all.
Walle, Gavin Van De. “What's the Difference between Casein and Whey Protein?” Healthline, Healthline Media, 30 Aug. 2018, https://www.healthline.com/nutrition/casein-vs-whey#benefits.
Tang JE, Moore DR, Kujbida GW, Tarnopolsky MA, Phillips SM. Ingestion of whey hydrolysate, casein, or soy protein isolate: effects on mixed muscle protein synthesis at rest and following resistance exercise in young men. J Appl Physiol (1985). 2009 Sep;107(3):987-92. doi: 10.1152/japplphysiol.00076.2009. Epub 2009 Jul 9. PMID: 19589961.
Dietary Guidelines for Americans, 2020-2025. U.S. Department of Agriculture, USDA, https://www.dietaryguidelines.gov/.