Presentations: times (22 Oct (week 6) and 19 November-week 10), groups, format

1. Presentations: times (22 Oct (week 6) and 19 November-week 10), groups, format clarify criteria-outline presentation includes asking and answering of questions Format of test- 6 short answer questions (5 marks each)-class time- 60 minutes-date=6 Nov 2012- first six weeks of class (ie weeks 1 to 6 inclusive(lectures 1-6)- today is week 3)

2. CBDHA’s Nutrition Services department is starting a brand new volunteer programme for their department called the Dial-to-Dine program.  The purpose of the program is to assist patients in choosing their menus for the week while they’re in hospital.  Many of our patients do not have a lot of family or friends visiting and find it difficult to fill out their own menus.  This means that they end up receiving standard trays which can become pretty bland and boring after awhile.  The Dial-to-Dine menus offer a much larger variety for the patients. We were hoping that some of your Nutrition students might be interested in doing some volunteer work with this program.  This would be something they could do once a week on weekends for just a couple of hours.  It is a fantastic opportunity for the students to become acquainted with the hospital and how the Nutrition Services Department works.  The staff would provide an orientation to their service and to the Dial-to-Dine program.  It is also a great way for the students to get used to interacting with different types of patients with a variety of dietary requirements.  If anyone is interested in learning more about the program or would like to sign-up, please ask them to give Lisa McNeil-Campbell a call at 567-8160 or email pcvolunteers@cbdha.nshealth.ca

3. Suggestion box Question of the week See lecture 2 for changed definitions of functional food and nutraceutical

4. The Lecture 3- 24 September 2013 Type 1 Diabetes

5. Outline of today’s talk I. Pathology II. Socioeconomic factors contributing to the disease III. Elementary nutritional approaches to be taken to avoid and treat these diseases including foods available to those at risk IV. First Nations and other Cape Breton individuals at risk V. How is nutritional assessment made for type I diabetes? VI. How would one assess from a nutritional perspective the socioeconomics, pathology and success of nutritional interventions relative to type I diabetes?

6. Type I diabetes I. Pathology Autoimmune response that b-cells in the pancreas b-cells produce insulin Cow’s milk, viruses, nitrosamines may all attack b-cells

7. Food and hence nutritional choices depend on: Personal preference acceptance of certain foods Habit -caregiver should be careful here- why?

8. Food and hence nutritional choices depend on: Ethnic heritage or tradition which groups would avoid the offending foods? Social interaction impact of this on viral implications -food borne social interaction and communicable viruses

9. Food and hence nutritional choices depend on: Availability of food if only offending foods available this can be concern food borne viruses may be an issue here Convenience of food prepared meats- are convenient but many contain nitrosamines

10. Food and hence nutritional choices depend on: Economy of food -this may encourage type I diabetes due milk being an inexpensive food relative to formula Positive and negative association -child may have associations of milk with pleasant experiences -other examples -negative- examples?

11. Food and hence nutritional choices depend on: Emotional conflict -comfort food-suggestions for this? Values -restrictions on prepared beef, pork may lower incidence of type I diabetes -contrast this point to values that allow prepared beef, pork

12. Food and hence nutritional choices depend on: Body image if meats believed to be fattening then may avoid these items Advertising food companies for milk and nitrosamine containing foods spend lots of money to promote via ease and price, the use of such foods- how might such tactics be overcome?

14. More on socioeconomic factors Prestige -occupational food choices are better? -societal perceptions people listen about food choices -education -more highly educated read more and make more informed choices about food?

15. More on socioeconomic factors Power power to influence-what about the political agenda here in Cape Breton-who has influence over the political agenda in Cape Breton regarding nutrition? Income given that incomes are on average lower here in Cape Breton compared to some other regions of Canada one may say that this dictates certain food choices

16. More on socioeconomic factors Wealth Cape Breton-impact of economic transition from industrial to knowledge based Power given that Cape Breton is less wealthy in monetary terms than some other regions of Canada-food choices may be less

17. More on socioeconomic factors Education tuition is higher in Nova Scotia than in other parts of the country- this may make it more difficult for persons to achieve a level of education that would place them in a position to make more informed choices about foods

18. More on socioeconomic factors Social stratification -ancestry -gender-women in Cape Breton-cow’s milk issue -race-Aboriginals, Blacks -ethnicity-immigration to industrial Cape Breton -mobility-ability to get to food sources -mental and physical illness- mental illness induced disbelief about what one is being told can lead to type I diabetes

19. More on socioeconomic factors Class -uppers -lower uppers -upper middles -average middles -working class -lower class discussion impact on type I diabetes

20. More on socioeconomic factors Global economy poor becoming poorer- issue of viruses and b cell attacking chemicals Government • running nutritional assessment programmes • providing nutritional advice • providing food programmes -how would this affect type I diabetes?

21. More on socioeconomic factors Business advertising, promotion of profits Psychology eg eating habits and social engagement -cured meats in some cultures History in time of war-food availability and quality How would each of these 3 affect type I diabetes?

22. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Planning a healthy diet To do this bear in mind Adequacy Balance Energy control Nutrient density Moderation Variety

23. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Prevention-cows milk, nitrosamines, viruses Post-onset-eat at times synchronised with action of insulin -monitor blood glucose levels -adjust insulin levels for amount of food usually eaten and required

24. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Post-onset -carbohydrate-glycemic index not an issue -fibre-glycemic index is not an issue -fat-not an issue- in those with similar blood fat levels to non-diabetics -alcohol-blocks gluconeogenesis-hypoglycemia -sodium-hypertension not an issue -vitamins and minerals-not indicated as supplements

25. Elementary nutritional biochemistry of nutritional approaches that use foods available to those at risk Post-onset-obesity -protein-convert to carbohydrate depends on insulin resistance

26. IV. First nations and other Cape Breton individuals at risk. Aboriginals Retired Unemployed Genetics Others?

27. How is nutritional assessment made for type I diabetes? Nutrient intake analysis studies can be done where food eaten is observed and assess for nitrosamines, cows’ milk and viruses

28. How is nutritional assessment made for type I diabetes? Daily food record/Diary studies can be done where food eaten is observed and assess for nitrosamines, cows’ milk and viruses

29. How is nutritional assessment made for type I diabetes? Retrospective data food frequency questionaire 24-hour recall do both to act as cross check against each other assess nitrosamines, cows’ milk and viruses

30. How is nutritional assessment made for type I diabetes? Anthropometry weight loss is the main issue here- why?

31. How is nutritional assessment made for type I diabetes? Nutrition focussed physical exam -does not apply significantly to type I diabetes

32. How is nutritional assessment made for type I diabetes? Skin testing may come into play for understanding what has caused the type I diabetes-ie exploring for autoimmune response and what might trigger it or have triggered it- this is probably an unlikely approach- why?

33. How is nutritional assessment made for type I diabetes? Biochemical analysis blood glucose-fasting -post-prandial glycated hemoglobin- only after 3 months-fasting

34. How is nutritional assessment made for type I diabetes? CLASSIFYING MALNUTRITION weight loss a possibility

35. VI. GROUP DISCUSSION-HOW WOULD ONE ASSESS FROM NUTRITIONAL PERSPECTIVE THE SOCIOECONOMICS, PATHOLOGY AND SUCCESS OF NUTRITIONAL INTERVENTIONS RELATIVE TO TYPE I DIABETES ?