eNutrition
a LaFrance Consulting Services™ e-Course
Nutrition for Nursing Students, independent study

The most serious nutrition problem I have seen in traditional-aged College students is the apparent failure to learn¹ the two most critical feeding skills for adults: selecting appropriate nutrient dense foods, and eating only until satiety is achieved. A larger, and probably underlying problem in this population is a general lack of self-awareness; they behave as if they are unaware that their bodies provide information to the CNS concerning their state of well-being so the CNS has the opportunity to respond either instinctively [innate, genetically determined behaviors controlled by the brainstem] or intuitively [learned² behaviors essential to survival, controlled by the primitive brain but subject to conscious responses] to deviations from “normal” as defined as body image by the individual's brain. This body image is subject to learned² revision based on mid- to long- term behaviors [typically 3 months to a few years] in response to deviations from the previous body image.

Footnotes: I am using to learn in two very different ways, so definitions are needed to clarify my intended meanings.
¹ to learn in an intellectual sense is “to acquire knowledge either by instruction or by experience (or by experiment)”
² to learn in the behavioral sense is “to develop reactions to stimuli which become 'automatic' similar to an instinctive response; or to modify an instinctive response to a different response (such as changing the instinctive blocking motion of the hand and arm to an oncoming object to the learned behavior of catching a ball). In this context, there are three levels of subconscious responses to stimuli:
      1) reflex involving a sensory neuron (to detect the stimulus, such as a hot stove touching your hand), an accessory neuron usually located in the spinal cord (to relay the sensory information to the appropriate motor neuron and to the CNS for subsequent, conscious behavior, such as selecting an interjection to yell), and a motor neuron to stimulate the muscles required to remove the hand from the potentially dangerous situation.
      2) instinct a complex, subconscious behavior usually associated with survival which is “hard-wired” into the brainstem [and therefore does not need to be learned] such as blinking, ducking, and moving the hand and arm up to deflect an object moving through the air toward the head.
      3) learned defined above
.

Adult

The adult population includes those individuals from 20-something to 50-ish. Most dietary advice for this age [as well as other age groups] consists of “blanket guidelines.” It has been suggested that this population would benefit the most from individualized diet planning (due to the accumulated effects of specific errors in past diet); but it seems to me to be impractical to suggest they should hire their own dietician and personal trainer no matter how beneficial it would be.
    An advertising campaign for a prescription cholesterol management medication points out correctly than there are two sources of cholesterol: dietary [“from the frankfurter you ate”] and “genetic” [“from your Uncle Frank,” or cholesterol produced by the body (where the ability to make cholesterol does vary depending on family history, and hence possibly genetic). Where the ad ceases to describe reality is when it promises to get rid of both. The reason that Humans can make cholesterol is because we need cholesterol as a substrate on which we build our steroidal hormones (such as estrogen and testoserone), and as an ingredient in construction of cell membranes to grow scar tissue. If it were possible to reduce cholesterol from both sources, it would be highly undesirable to do so. Once the patient reaches the age of 20-something the need for dietary cholesterol drops dramatically [essentially to zero mg/day], and normal production by the body is adequate to meet the cholesterol needs. In the 20-something to 50ish population, non-essential fatty acids for diet tend to plaque out on arterial walls and to increase the risk of premature death due to heart disease. The essential fatty acids (omega-3 and omega-6) should be included in the diet, while the non-essential (omega-9 [mono-unsaturated] and saturated) fats should be minimized. The hydrogenated oils should be excluded from the adult diet, and the trans-fats are to be avoided to the maximum extent possible.

    Nursing intervention mey be required to reinforce, or establish, the importance of heathly eating habits for wellness into senior years. This includes vitamins, minerals and (to the extent that there is supporting clinical data) phytochemicals. Basically the typical American diet for adults would benefit from an dramatic increase in vegetables (particularly the dark green vegetables, leafy vegetables, and yellow and orange vegetables). Red meat can be reduced to a single (no more than 6 oz) serving per week, and fish increased to two or more serving per week. The typical adult American needs to re-learn [both in the intellectual and the behavioral sense] what food actually tastes like by cutting way back on the addition of salt and all sweeteners. Corn syrup and high fructose corn syrup should be avoided to the maximum extent possible; and artificial sweeteners should be used only for their original purpose of providing a sweetener which diabetics can tolerate; there is no reason for non-diabetics to use these substances, when reducing the added sugar to less than one fourth what they have learned [defined in the behavioral sense] to expect will accomplish the same calorie reduction. In most foods, the taste can be enhanced far more by the use of spices and seasonings other than salt and sugar, with impressive wellness benefits. Adults need to understand that “fast food” and “convenience [prepared] food” are suitable for emergency situations only [and are to be limited to no more than two per month]. The only sensible way to benefit from the “drive-up” window is to avoid it; park as far as you can from the restaurant (in the parking lot for the restaurant) and walk to the serving counter, purchase your meal, sit down in the restaurant and eat slowly, then walk back to the car. [I realize that the dining area in most fast-food restaurants is an unpleasant place to eat; so demanding that you use it is another way of suggesting that the best use of fast-food restaurants by adults is to leave them to the adolescents].
    As long as we are going to park within walking distance of the fast-food restaurant, we should also park within walking distance of any destination to which we are driving, and spend the couple of minutes needed to walk the remaining distance at a brisk pace (like we're in a hurry to get there [which most of us claim to be anyway]). When I served as the Chair of the Division of Science, Math and IT (plus Chair of the Faculty Senate) at Ancilla College, I found the best way to use e-mail is to send the e-mail as “written confirmation of the message,” then leave my office, walk to my employees office(s) and tell them what the e-mail said [this is called “walk-around management” and most employees react most of the time as if they appreciate the personal contact]. The point here is that almost all adult Americans suffer [carefully chosen word, intended to actually refer to suffering] from a lack of exercise [it shortens their life expectancy, and diminishes their quality of life]. To reduce this suffering, they should walk briskly for about five minutes more each day than the previous day, until they average no less than 30 minutes per day each week. For those of you who don't do algebra on Monday mornings, this means
30 minutes a day 7 days a week
35 minutes a day 6 days a week
42 minutes a day 5 days a week
50 minutes a day 4 days a week plus 10 minutes another day this week
60 minutes a day 3 days a week plus 30 minutes over 2 other days this week
60 minutes a day 2 days a week plus 90 minutes over 3 other days this week

Geezers

One major advantage of joining the ranks of the old geezers is that in exchange for being known to be a senior [or some other euphemism for old person] you get a discount of 10%, sometimes 20%, off your bill at restaurants, motels, car rentals and other travel related expenses, and most movie theaters. But wait, how do you know if you are qualified to claim the discount. Different organizations and for profit companies have different minimum age requirements, typically 65 or 70. The American Association of Retired Persons (AARP, pronounced “arp!” as an interjection) sets the bar at 50 (or be the spouse of a 50+ year old who joins AARP), but you need to know that AARP is an insurance broker and a lobbyist organization.
    A major issue on the minds of many geezers is the possibility of their own death. Earlier, I suggested that teenagers will not give up sun-bathing when taught that sun exposure increases the risk of skin cancers 60 years [or more] into the future because Humans tend to believe that forever began when they did, and expect forever to continue as long as it has already lasted. For a 15 year old forever is 15 years, so at the end of forever they can expect to be 30 years old and to be cancer-free. For a 65 year old, forever has already lasted 65 years and is expected to last 65 more years at the end of which the currently 65 year old can expect to be dead. There are two terms to describe the expected length of life for Humans, life span and life expectancy. Life span is defined as the “maximum document age at the time of death,” which for Humans is 122 years for females, and 114+ years for males (the documented 114 year old man is still alive). The most recent theoretical estimate I have seen is 135 years. Life expectancy is defined as the “age at which 50% of cohort is expected to die” [a cohort is the population of similar individuals born in a define time frame (usually one year for Humans)]. For all Americans [2006 data from National Vital Statistics Reports, vol 57 number 14, CDC, April 2009] females can expect to live 80.2 years; and males, 75.1 years. For the population of Nurses who plan to deal with adult (20-something to 50-ish) and geezer (50ish plus) patients, you need to know [or hopefully remember from earlier lectures] that the quality of life for the 50-ish plus patient depends on wellness & fitness, which in turn depend on nutrition & exercise habits before achieving geezer status.

    The geezer population has a number of unique feeding problems not found in younger patients. Their metabolism normally slows gradually in the senior years, and triggers a corresponding decline in hunger plus arriving at satiety quicker than in their younger life. There is a tendency in the geezer population to revert to “comfort foods” which also tend to be high in carbs and fats yet low in vitamins. The increase in fats is not entirely bad, because their cholesterol production also declines, and they gradually lose the ability to heal from injury due to low cholesterol levels, unless supplemented by dietary cholesterol. If there are dental issues, this population tends to avoid hard to chew foods such as fruits and vegetables, with resulting decline in wellness (in this age group, this decline is often called “aging”). Separate from the decline in hunger driven by the decline in BMR (Basal Metabolic Rate), many of the elderly population also experience a loss of appetite. When “aging” produces a decline in cognitive and memory abilities, the loss of appetite frequently leads to forgetting to eat, which of course aggravates the loss of nutrition. Eventually most married elderly patients (actually not more than half of 'em) lose their spouse to death, and may simultaneously lose the will to live. It has been suggested that many of the problems with the elderly population could be avoided by maintaining good nutrition and exercise habits from young adulthood on. The bottom line is that an unacceptable percent of the elderly population lives with an extremely poor quality of life, that may be as preventable as heart disease and other illness processes related to life style choices.



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revised: 17 Jun 2009