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Osteochondritis dissecans occurs when a fragment of bone in a joint separates from the rest of the bone because its blood supply is faulty, and there is not enough blood to maintain it. It often affects the knee or the elbow.

Sometimes, the separated fragment stays in place or repairs on its own. However, in the later stages, the bone can splinter and fall into the joint space, resulting in pain and dysfunction. These fragments are sometimes called “joint mice.”

The exact prevalence is unknown, but there may be between 15 and 29 cases in every 100,000 people. It is more common in males, especially those between the ages of 10 and 20 years who are physically active.

However, the incidence is increasing in females.

It usually affects teens and young adults, but it can occur in younger children who are active in sports.

Osteochondritis dissecans (os-tee-o-kon-DRY-tis DIS-uh-kanz) is a joint condition in which bone underneath the cartilage of a joint dies due to lack of blood flow. This bone and cartilage can then break loose, causing pain and possibly hindering joint motion.

Osteochondritis dissecans occurs most often in children and adolescents. It can cause symptoms either after an injury to a joint or after several months of activity, especially high-impact activity such as jumping and running, that affects the joint. The condition occurs most commonly in the knee, but also occurs in elbows, ankles and other joints.

Doctors stage osteochondritis dissecans according to the size of the injury, whether the fragment is partially or completely detached, and whether the fragment stays in place. If the loosened piece of cartilage and bone stays in place, you may have few or no symptoms. For young children whose bones are still developing, the injury might heal by itself.

Surgery might be necessary if the fragment comes loose and gets caught between the moving parts of your joint or if you have persistent pain.

Causes

The exact cause is unknown, but they may include:

Ischemia: a restriction of blood supply starves the bone of essential nutrients. The restricted blood supply is usually caused by some problem with blood vessels, or vascular problems. The bone undergoes avascular necrosis, a deterioration caused by lack of blood supply. Ischemia usually occurs in conjunction with a history of trauma.

Genetic factors: OCD sometimes affects more than one family member. This may indicate an inherited genetic susceptibility.

Repeated stress to the bone or joint: this can significantly increase the risk of developing OCD. Individuals who play competitive sports are more likely to regularly stress their joints.

Other factors may be weak ligaments or meniscal lesions in the knee.

Symptoms

Depending on the joint that’s affected, signs and symptoms of osteochondritis dissecans might include:

• Pain. This most common symptom of osteochondritis dissecans might be triggered by physical activity — walking up stairs, climbing a hill or playing sports.
• Swelling and tenderness. The skin around your joint might be swollen and tender.
• Joint popping or locking. Your joint might pop or stick in one position if a loose fragment gets caught between bones during movement.
• Joint weakness. You might feel as though your joint is “giving way” or weakening.
• Decreased range of motion. You might be unable to straighten the affected limb completely.

When to see a doctor

If you have persistent pain or soreness in your knee, elbow or another joint, see your doctor. Other signs and symptoms that should prompt a call or visit to your doctor include joint swelling or an inability to move a joint through its full range of motion.

Risk factors

Osteochondritis dissecans occurs most commonly in children and adolescents between the ages of 10 and 20 who are highly active in sports.

Complications

Osteochondritis dissecans can increase your risk of eventually developing osteoarthritis in that joint.

Diagnosis

A person who experiences the symptoms of OCD in a joint should seek medical advice. An early diagnosis can mean more effective treatment and a lower risk of complications.

The doctor will carry out a physical examination and ask the patient about their medical history, family history and lifestyle, including sporting activities.

There may be some imaging tests, such as an X-ray, CT, MRI scan, or ultrasound. This may show whether there is any necrosis, or tissue death, or loose fragments. A bone scan may also be recommended.

In the early stages, tests will show that the cartilage is thickening. In the later stages, there will be loose fragments.

The early stages are considered stable, and treatment is more likely to be effective at this point.

Conditions, with similar symptoms need to be ruled out. These include inflammatory arthritis, osteoarthritis, bone cysts and septic arthritis.

Differential Diagnosis

• Meniscus and collateral ligament injuries – physical examination can rule this out.

If there is no certain radiological determination of osteochondritis dissecans, there can also be alternative causes of the same symptoms that should be sought for e.g.:

• Inflammatory arthritites: a group of conditions which affect your own immune system.
• Osteoarthritis: degradation of joints
• Bone cysts: type of cyst in joints
• Septic arthritis: purulent invasion of the knee which produces arthritis
• Ideopathic osteonecrosis
• Chondral seperations
• Osteochondral fractures

An x-ray, ct scan or MRI scan can be performed to show necrosis of subschondral bone or formation of loose fragments. This can lead to a better diagnosis. 

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Examination

• The knee feels warmer than the non-injured knee.
• There is an intermittent swelling palpable.
• Quadriceps muscle atrophy
• The passive and active extension of the knee is limited .
• Catching or locking of the knee .
• Tibial external rotation during gait.
• Fluid effusion
• It is possible that both capsular and non-capsular movement restrictions can be found during functional assessment, the severity is dependent on a possible herniation of the knee joint and the degree of joint irritation .
• The sensitive location of the abandoned section of the osteochondral fracture can be felt, when the knee is in 90° of flexion .
• Wilson’s Test: The knee is held in 90° to 30° from full extension while rotating the tibia.  The test is positive when internal rotation is painful and external rotation relieves symptoms

Prevention

Adolescents participating in organized sports might benefit from education on the risks to their joints associated with overuse. Learning the proper mechanics and techniques of their sport, using the proper protective gear, and participating in strength training and stability training exercises can help reduce the chance of injury.

Diagnosis

A person who experiences the symptoms of OCD in a joint should seek medical advice. An early diagnosis can mean more effective treatment and a lower risk of complications.

The doctor will carry out a physical examination and ask the patient about their medical history, family history and lifestyle, including sporting activities.

There may be some imaging tests, such as an X-ray, CT, MRI scan, or ultrasound. This may show whether there is any necrosis, or tissue death, or loose fragments. A bone scan may also be recommended.

In the early stages, tests will show that the cartilage is thickening. In the later stages, there will be loose fragments.

The early stages are considered stable, and treatment is more likely to be effective at this point.

Conditions, with similar symptoms need to be ruled out. These include inflammatory arthritis, osteoarthritis, bone cysts and septic arthritis.

Treatment

Conservative measures include changes of activity or rest. This can give the bone time to heal and to prevent future fracture, crater formation, or chondral (cartilage) collapse. Rest and the use of crutches may help.

If the patient has been involved in sports, they may need to stop for a while.

The doctor may immobilize the joint with a medical device, such as a splint or a brace. Crutches may be necessary.

A non-steroidal anti-inflammatory medication (NSAID) can help with pain. A physical therapist may offer guidance with stretching and specific exercises.

Children can normally return to sports after 2 to 4 months. In young children, OCD normally heals with rest, as the bones are still growing.

In older children and adults, the effects can be more severe.

Surgery

Surgery aims to:

• restore normal bloodflow
• get the joint to work normally again

It may be recommended if conservative measures have not worked, if a lesion has become detached and is moving around inside the joint, or if the lesion is over 1 centimeter in diameter.

Drilling into the lesion can create pathways for new blood vessels to form in. This allows blood to flow, and encourages the bone to heal.

The surgeon makes a small incision. Using some long, thin instruments, they either remove or reattach the loose fragments of bone. If the cartilage is still attached to the bone, pins or screws can be used to secure it.

Osteochondral autograft transfer (OATS) uses healthy cartilage to replace damaged cartilage on the surface of the joint that receives weight-bearing stress. It is like a cartilage transplant, but the recipient and donor is the same person.

After surgery the patient will undergo a rehabilitation program. After an initial period of immobilization, physical therapy can help regain joint strength and stability.

According to the American Academy of Orthopedic Surgeons (AAOS), the patient will probably need:

• crutches for about 6 weeks after surgery
• physical therapy for 2 to 4 months, to recover strength and motion

After 4 to 5 months, a gradual return to sports may be possible.

Minimally invasive arthroscopic surgery is less painful, the recovery time is faster, and the risk of complications is lower.

Medical Management

In minor cases rest can be prescribed. The patient has to stop activities for three to six months and the lesion will heal spontaneously, especially with young adolescents.

Normally, immobilization of the knee for a couple of weeks is sufficient in the treatment of growing children. In case immobilization is insufficient, as would normally be the case for adults, a mobilization procedure must be started up. In this procedure, stretching exercises are performed. The range of motion and strengthening ability of the muscles will be gradually increased in the next 3 to 6 months. In the end, in case the knee is not fully recovered, surgery should be necessary. (Level of evidence: C5, F5)

Stages three and four are always treated surgically. Surgery is also required when the conservative treatment in stages one and two was inadequate. It is recommended to treat surgically when a large part of the femoral condyle has been excavated, because of the risk to develop osteoarthritis.

A variety of surgical methods exist for the management of articular cartilage lesions at the knee, such as OCD. These include the use of arthroscopic lavage or debridement, radio frequency energy, bone drilling, osteochondral autografts or allografts, internal fixation of bone fragments, and autologous chondrocyte implantation . ^{(level of evidence: 3B)}

Surgical techniques:

• In stages one and two the articular cartilage is still intact, through retrograde operation trying to tap into to the affected bone ‘from behind’ and clear it. The advantage of this surgical technique is that the articular cartilage stays intact .
• Not yet dissected fragment will be fixed by means of an operation Excision of the fragment and removal of loose bodies.
• Repair of blood supply by drilling arthroscopic through the cartilage and the hearth of osteochondrosis into the healthy bones
• Stabilization of the fragment through pinning or through screw fixation
• Osteochondral autograft transplantation (OATS).
• Osteochondral allograft transplantation.
• Autologous chondrocyte implantation (ACI).
  

Physical Therapy Management

In stages one and two the condition is localized in the subchondral bone, the cartilage is still intact and gets its nourishment from synovial fluid. In these two stages conservative therapy can be applied. The goals of conservative therapy are: pain reduction, promote the repair of the cartilage and prevent degeneration of the surface of the knee joint.  There is no standard treatment.

Immobilisation

Adaption of the strain is needed so that the bone can heal. 2 weeks of immobilization and partial support is recommended when having an acute injury. With children whose bones will still grow, the bone defect may heal by resting the joint. Long-term immobilization has to be prevented, because joint motion is necessary for the nutrition and strengthening of the cartilage. Sport activities should be stopped temporally.

Physical Therapy

• Stretching to improve range of motion
• Strengthening exercises for the muscles
• First exercises: closed chain exercises, low impact activities like cycle and swim. Using exercises as straight leg raises and ankle band exercises, strength can be maintained.
• Coactivation or setting of the quadriceps and hamstring can be performed while in an immobilizer or cast.
• Using neuromuscular electrical stimulation to the quadriceps and hamstrings for coactivation contractions can further augment the strength maintenance program.
• Following immobilization, range of motion exercises, as well as progressive quadriceps and hamstring strengthening should be performed.
• Weight-bearing progression throughout rehabilitation should be to patient tolerance.
• In facilitating the return to full-weight-bearing status is aquatic therapy very beneficial.
• To adress any gait deviations that developed during the immobilization and decreased weight-bearing phases of rehabilitation gait training techniques may be used, such as manual facilitation and visual feedback tot the patient via a full length mirror.
• Additional exercises to restore ankle joint and normal knee proprioception, such as biomechanical ankle platform systems (BAPS board) exercises or unilateral stance, are also beneficial to the athlete planning to return to competition.
• After this period the sport activities can be partly restart.
• Next criteria should be managed: the patient is pain free, has a full joint mobility, no swelling, no pressure sensitivity and there’s radiological prove of recovery.

Post-operative Physical Therapy

An operative treatment is indicated if, after a treatment of three to six months and no recovery has occurred, or when the loose fragment is to big. The surgery goals would be to remove loose fragments or to reattach fragments.

Immobilization is not necessary before surgery. Immediately after the intervention the knee get scontinuous passive motion for 48 hours. After this therapy is recommend, including 8 weeks of rehabilitation exercises for limb function and recruitment. Between week 6 and 8 weight-bearing is gradually introduced to full weight bearing.

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A patient’s nutritional status can be evaluated by using and integrating information obtained from a past medical history, family history and a social history. It is worthwhile to assess the nutritional status of every patient. Many complaints such as fatigue, headaches, and digestive disturbances can be improved by simple changes in diet. Nutrition also plays a pivotal role in prevention. Nutritional assessment becomes especially important when the patient has certain nutritional “red flags”, such as:

• Elderly
• No regular exercise regime and/or sedentary lifestyle
• Recent loss of 10% or more of usual body weight
• Alcoholism
• Taking drugs such as steroids, immunosuppressants
• Infection, protracted fever, trauma
• Malabsorption syndromes, draining abscesses, renal dialysis
• Receiving simple intravenous solutions without oral intake for >10 days

Past Medical History

• Immunizations, hospitalizations, operations, major injuries, chronic illnesses, and significant acute illnesses
• Current or recent prescription medications, vitamins and minerals, laxatives, topical medications, OTC medications, and nutritional supplements
• Potential drug-nutrient interactions, such as those caused by potassium-wasting diuretics
• Food allergies or lactose intolerance

Family History

• Family history of cancer, diabetes, heart disease, hypertension, obesity, and osteoporosis
• Parents, siblings, children, spouse: include ages, current health status, and cause of death if deceased

Social History

• Occupation, daily exercise pattern, marital and family status
• Economic status, educational level, residence, emotional response to illness and coping skills
• Duration and frequency of use of substances, including tobacco, alcohol, illegal drugs, and caffeine

Assessing Your Patient’s Dietary Intake

There are several methods for obtaining a dietary history. Each has its advantages and disadvantages.

24-hour Recall

• An informal, qualitative method in which you ask the patient to recall all of the foods and beverages that were consumed in the last 24 hours, including the quantities and methods of preparation.
• An advantage of this method is that dietary information is easily obtained. It is also good during a first encounter with a new patient in which there is no other nutritional data. Patients should be able to recall all that they have consumed in the last 24 hours.
• A disadvantage of this method is that it is very limited and may not represent an adequate food intake for the patient. Data achieved using this method may not represent the long-term dietary habits of the patient. Estimating food quantities and food ingredients may be difficult especially if the patient ate in restaurants.

Usual Intake/Diet History

• This method asks the patient to recall a typical daily intake pattern, including amount, frequencies and methods of preparation. This intake history should include all meals, beverages and snacks.
• Advantages of this method are that it evaluates long-term dietary habits and is quick and easy to do. Based on the information acquired, you may identify patients who would benefit from meeting with a registered dietitian.
• A disadvantage of this method is that a limited amount of information on the actual quantities of food and beverages is obtained. Also, this method only works if a patient can actually describe a “typical” daily intake, which is difficult for those who vary their food intake greatly. In these patients it is would be advisable to use the 24-hour recall method. Another disadvantage is that patients may not include foods that they know are unhealthy.
• An excellent method to better understand a patient’s nutritional status is to use a usual intake and lifestyle recall. This consists of asking the patient to run through a typical day in chronological order, describing all food consumption as well as activities. This method is very helpful because it may reveal other factors that can affect the patient’s nutritional and overall health. [For example: (1) the patient sits in traffic for a 3-hour round trip each day; (2) the patient comes home from work late and eat dinner just before bedtime; or (3) the most exercise the patient gets is walking to and from the parking lot at work.]

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Food Frequency Questionnaire

• This method makes use of a standardized written checklist where patients check off the particular foods or type of foods they consume. It is used to determine trends in patients’ consumption of certain foods. The checklist puts together foods with similar nutrient content, and frequencies are listed to identify daily, weekly, or monthly consumption.
• An advantage of this method is that it makes it possible to identify inadequate intake of any food group, so that dietary and nutrient deficiencies may be identified. The questionnaire can be geared to a patient’s pre-existing medical conditions.
• Disadvantages include patient error in filling out the questionnaire and no way to find out how foods are prepared. Patients may over- or under-estimate food quantities.

Dietary Food Log

• This method asks the patient to record all food, beverage and snack consumption for a one- week period. Specific foods and quantities should be recorded. The data from the food log may later be entered into a computer program, which will analyze the nutrient components of the foods eaten according to specific name brands or food types. Patients are asked to enter data into the food log immediately after food is consumed so they do not forget.
• The most important advantage of this method is that a computer can objectively analyze data obtained. Data on calorie, fat, protein and carbohydrate consumption can be obtained. Also, since patients are asked to enter data immediately after eating, the data is more accurate than other methods.
• Disadvantages include patient error in entering accurate food quantities. In addition, it is possible that the week long food log does not accurately represent a patient’s normal eating habits since they know the foods they eat will be analyzed and therefore may eat healthier.

Generic Nutrition Questionnaire

Do not be daunted by the following list. Reading through the sample questions will simply give you an idea of probing questions you might use to ascertain your patient’s nutritional status.

1. Would you describe you appetite as hearty, moderate, or poor?
2. Are you on a special diet? Specify the type of diet. Who recommended the diet? If you have been on a special diet in the past, define it.
3. Have you ever had any problems with weight? Underweight or overweight?
4. Do you eat at approximately the same time every day?
5. Do you skip meals? If so, when?
6. Do you usually eat between meals? What do you snack on most often?
7. Are there any foods you do not eat because you don’t think they are good for you? If yes, what?
8. Are there any foods you do eat regularly because you think they are good for you? If yes, what?
9. Are there any foods you cannot eat? What happens when you eat this food?
10. Are there foods you avoid because you don’t like them?
11. How is your food usually prepared, e.g. baked, broiled, fried?
12. Are you on a diet now to lose or gain weight? If yes, what kind? Who recommended it?
13. How do you feel about your weight?
14. Are you taking any vitamin or mineral supplements? What and how often?
15. Do you smoke? How many cigarettes (cigars or chewing tobacco) per day?
16. Do you drink any alcohol? How much per day and when?
17. How often do you exercise? What types of exercise do you do?
18. Who in the house plans the meals? Buys the food? Prepares the food?
19. Are there times in the month when there isn’t enough money for food or you run out of food?
20. How many of your meals are eaten at home? School? Work? Restaurants?
21. How many hot meals do you eat per week?
22. What condiments do you use? Examples include butter on bread, sugar on cereal, salad dressing, gravy, etc.

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Gout is a painful form of arthritis that occurs when high levels of uric acid in the blood cause crystals to form and accumulate in and around a joint.

Uric acid is produced when the body breaks down a chemical called purine. Purine occurs naturally in your body, but it’s also found in certain foods. Uric acid is eliminated from the body in urine.

A gout diet may help decrease uric acid levels in the blood. A gout diet isn’t a cure. But it may lower the risk of recurring gout attacks and slow the progression of joint damage.

People with gout who follow a gout diet generally still need medication to manage pain and to lower levels of uric acid. click here to read more

Gout diet goals

A gout diet is designed to help you:

• Achieve a healthy weight and good eating habits
• Avoid some, but not all, foods with purines
• Include some foods that can control uric acid levels

A good rule of thumb is to eat moderate portions of healthy foods.

Diet details

The general principles of a gout diet follow typical healthy-diet recommendations:

• Weight loss. Being overweight increases the risk of developing gout, and losing weight lowers the risk of gout. Research suggests that reducing the number of calories and losing weight — even without a purine-restricted diet — lower uric acid levels and reduce the number of gout attacks. Losing weight also lessens the overall stress on joints.
• Complex carbs. Eat more fruits, vegetables and whole grains, which provide complex carbohydrates. Avoid foods and beverages with high-fructose corn syrup, and limit consumption of naturally sweet fruit juices.
• Water. Stay well-hydrated by drinking water.
• Fats. Cut back on saturated fats from red meat, fatty poultry and high-fat dairy products.
• Proteins. Focus on lean meat and poultry, low-fat dairy and lentils as sources of protein.

Recommendations for specific foods or supplements include:

• Organ and glandular meats. Avoid meats such as liver, kidney and sweetbreads, which have high purine levels and contribute to high blood levels of uric acid.
• Red meat. Limit serving sizes of beef, lamb and pork.
• Seafood. Some types of seafood — such as anchovies, shellfish, sardines and tuna — are higher in purines than are other types. But the overall health benefits of eating fish may outweigh the risks for people with gout. Moderate portions of fish can be part of a gout diet.
• High-purine vegetables. Studies have shown that vegetables high in purines, such as asparagus and spinach, don’t increase the risk of gout or recurring gout attacks.
• Alcohol. Beer and distilled liquors are associated with an increased risk of gout and recurring attacks. Moderate consumption of wine doesn’t appear to increase the risk of gout attacks. Avoid alcohol during gout attacks, and limit alcohol, especially beer, between attacks.
• Sugary foods and beverages. Limit or avoid sugar-sweetened foods such as sweetened cereals, bakery goods and candies. Limit consumption of naturally sweet fruit juices.
• Vitamin C. Vitamin C may help lower uric acid levels. Talk to your doctor about whether a 500-milligram vitamin C supplement fits into your diet and medication plan.
• Coffee. Some research suggests that drinking coffee in moderation, especially regular caffeinated coffee, may be associated with a reduced risk of gout. Drinking coffee may not be appropriate if you have other medical conditions. Talk to your doctor about how much coffee is right for you.
• Cherries. There is some evidence that eating cherries is associated with a reduced risk of gout attacks.

Sample menu

Here’s what you might eat during a typical day on a gout diet.

Breakfast

• Whole-grain, unsweetened cereal with skim or low-fat milk
• 1 cup fresh strawberries
• Coffee
• Water

Lunch

• Roasted chicken breast slices (2 ounces) on a whole-grain roll with mustard
• Mixed green salad with vegetables, 1 tablespoon nuts, and balsamic vinegar and olive oil dressing
• Skim or low-fat milk or water

Afternoon snack

• 1 cup fresh cherries
• Water

Dinner

• Roasted salmon (3 to 4 ounces)
• Roasted or steamed green beans
• 1/2 to 1 cup whole-grain pasta with olive oil and lemon pepper
• Water
• Low-fat yogurt
• 1 cup fresh melon
• Caffeine-free beverage, such as herbal tea

Results

Following a gout diet can help limit uric acid production and increase its elimination. A gout diet isn’t likely to lower the uric acid concentration in your blood enough to treat your gout without medication. But it may help decrease the number of attacks and limit their severity.

Following a gout diet, along with limiting calories and getting regular exercise, can also improve your overall health by helping you achieve and maintain a healthy weight.

How Does Food Affect Gout?

If you have gout, certain foods may trigger an attack by raising your uric acid levels.

Trigger foods are commonly high in purines, a substance found naturally in foods. When you digest purines, your body makes uric acid as a waste product.

This is not a concern for healthy people, as they efficiently remove excess uric acid from the body.

However, people with gout can’t efficiently remove excess uric acid. Thus, a high-purine diet may let uric acid accumulate and cause a gout attack.

Fortunately, research shows that restricting high-purine foods and taking the appropriate medication can prevent gout attacks.

Foods that commonly trigger gout attacks include organ meats, red meats, seafood, alcohol and beer. They contain a moderate-to-high amount of purines.

However, there is one exception to this rule. Research shows that high-purine vegetables do not trigger gout attacks.

And interestingly, fructose and sugar-sweetened beverages can increase the risk of gout and gout attacks, even though they’re not purine-rich.

Instead, they may raise uric acid levels by accelerating several cellular processes .

For instance, a study including over 125,000 participants found that people who consumed the most fructose had a 62% higher risk of developing gout.

On the other hand, research shows that low-fat dairy products, soy products and vitamin C supplements may help prevent gout attacks by reducing blood uric acid levels.

Full-fat and high-fat dairy products don’t seem to affect uric acid levels.

Summary: Foods can either raise or lower your uric acid
levels, depending on their purine content. However, fructose can raise your
uric acid levels even though it is not purine-rich.

Healthier eating shouldn’t be a hassle. We’ll send you our evidence-based tips on meal planning and nutrition.

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What Foods Should You Avoid?

If you’re susceptible to sudden gout attacks, avoid the main culprits — high-purine foods.

These are foods that contain more than 200 mg of purines per 3.5 ounces (100 grams) .

You should also avoid high-fructose foods, as well as moderately-high-purine foods, which contain 150–200 mg of purines per 3.5 ounces. These may trigger a gout attack.

Here are a few major high-purine foods, moderately-high-purine foods and high-fructose foods to avoid:

• All organ
  meats: These include liver, kidneys, sweetbreads and
  brain
• Game
  meats: Examples include pheasant, veal and venison
• Fish: Herring, trout, mackerel, tuna, sardines, anchovies, haddock and
  more
• Other
  seafood: Scallops, crab, shrimp and roe
• Sugary
  beverages: Especially fruit juices and sugary sodas
• Added
  sugars: Honey, agave nectar and high-fructose corn syrup
• Yeasts: Nutritional yeast, brewer’s yeast and other yeast supplements

Additionally, refined carbs like white bread, cakes and cookies should be avoided. Although they are not high in purines or fructose, they are low in nutrients and may raise your uric acid levels.

Summary: If you have gout, you should avoid foods like organ
meats, game meats, fish and seafood, sugary beverages, refined carbs, added
sugars and yeast.

What Foods Should You Eat?

Although a gout-friendly diet eliminates many foods, there are still plenty of low-purine foods you can enjoy.

Foods are considered low-purine when they have less than 100 mg of purines per 3.5 ounces (100 grams).

Here are some low-purine foods that are generally safe for people with gou:

• Fruits: All fruits are generally fine for gout. Cherries may even help
  prevent attacks by lowering uric acid levels and reducing inflammation.
• Vegetables: All vegetables are fine, including potatoes, peas, mushrooms,
  eggplants and dark green leafy vegetables.
• Legumes: All legumes are fine, including lentils, beans, soybeans and tofu.
• Nuts: All nuts and seeds.
• Whole
  grains: These include oats, brown rice and barley.
• Dairy
  products: All dairy is safe, but low-fat dairy appears to
  be especially beneficial.
• Eggs
• Beverages: Coffee, tea and green tea.
• Herbs and
  spices: All herbs and spices.
• Plant-based
  oils: Including canola, coconut, olive and flax oils.

Foods You Can Eat in Moderation

Aside from organ meats, game meats and certain fish, most meats can be consumed in moderation. You should limit yourself to 4–6 ounces (115–170 grams) of these a few times per week.

They contain a moderate amount of purines, which is considered to be 100–200 mg per 100 grams. Thus, eating too much of them may trigger a gout attack.

• Meats: These include chicken, beef, pork and lamb.
• Other fish: Fresh or
  canned salmon generally contains lower levels of purines than most other
  fish.

Summary: Foods you should eat with gout include all fruits and
vegetables, whole grains, low-fat dairy products, eggs and most beverages.
Limit your consumption of non-organ meats and fish like salmon to servings of
4–6 ounces (115–170 grams) a few times weekly.

A Gout-Friendly Menu for One Week

Eating a gout-friendly diet will help you relieve the pain and swelling, while preventing future attacks.

Here is a sample gout-friendly menu for one week.

Monday

• Breakfast:
  Oats with Greek yogurt and 1/4 cup (about 31
  grams) berries.
• Lunch: Quinoa salad with boiled eggs and fresh veggies.
• Dinner: Whole wheat pasta with roasted chicken, spinach, bell peppers and
  low-fat feta cheese.

Tuesday

• Breakfast: Smoothie with 1/2 cup (74 grams) blueberries, 1/2 cup (15 grams)
  spinach, 1/4 cup (59 ml) Greek yogurt and 1/4 cup (59 ml) low-fat milk.
• Lunch: Whole grain sandwich with eggs and salad.
• Dinner: Stir-fried chicken and vegetables with brown rice.

Wednesday

• Breakfast:
  Overnight oats — 1/3 cup (27 grams) rolled oats,
  1/4 cup (59 ml) Greek yogurt, 1/3 cup (79 ml) low-fat milk, 1 tbsp (14
  grams) chia seeds, 1/4 cup (about 31 grams) berries and 1/4 tsp (1.2 ml)
  vanilla extract. Let sit overnight.
• Lunch: Chickpeas and fresh vegetables in a whole wheat wrap.
• Dinner: Herb-baked salmon with asparagus and cherry tomatoes.

Thursday

• Breakfast: Overnight chia seed pudding — 2 tbsp (28 grams) chia seeds, 1 cup
  (240 ml) Greek yogurt and 1/2 tsp (2.5 ml) vanilla extract with sliced
  fruits of your choice. Let sit in a bowl or mason jar overnight.
• Lunch: Leftover salmon with salad.
• Dinner: Quinoa, spinach, eggplant and feta salad.

Friday

• Breakfast: French toast with strawberries.
• Lunch: Whole grain sandwich with boiled eggs and salad.
• Dinner: Stir-fried tofu and vegetables with brown rice.

Saturday

• Breakfast: Mushroom and zucchini frittata.
• Lunch: Leftover stir-fried tofu and brown rice.
• Dinner: Homemade chicken burgers with a fresh salad.

Sunday

• Breakfast: Two-egg omelet with spinach and mushrooms.
• Lunch: Chickpeas and fresh vegetables in a whole wheat wrap.
• Dinner: Scrambled egg tacos — scrambled eggs with spinach and bell peppers
  on whole wheat tortillas.

Summary: A gout-friendly diet has plenty of options for a
healthy and delicious menu. The chapter above provides a sample gout-friendly
menu for one week.

Other Lifestyle Changes You Can Make

Aside from your diet, there are several lifestyle changes that can help you lower your risk of gout and gout attacks.

Lose Weight

If you have gout, carrying excess weight can increase your risk of gout attacks.

That’s because excess weight can make you more resistant to insulin, leading to insulin resistance. In these cases, the body can’t use insulin properly to remove sugar from the blood. Insulin resistance also promotes high uric acid levels.

Research shows that losing weight can help reduce insulin resistance and lower uric acid levels.

That said, avoid crash dieting — that is, trying to lose weight very fast by eating very little. Research shows that rapid weight loss can increase the risk of gout attacks.

Exercise More

Regular exercise is another way to prevent gout attacks.

Not only can exercise help you maintain a healthy weight, but it can also keep uric acid levels low.

One study in 228 men found that those who ran more than 5 miles (8 km) daily had a 50% lower risk of gout. This was also partly due to carrying less weight.

Stay Hydrated

Staying hydrated can help reduce the risk of gout attacks.

That’s because adequate water intake helps the body remove excess uric acid from the blood, flushing it out in the urine.

If you exercise a lot, then it’s even more important to stay hydrated, because you may lose a lot of water through sweat.

Limit Alcohol Intake

Alcohol is a common trigger for gout attacks.

That’s because the body may prioritize removing alcohol over removing uric acid, letting uric acid accumulate and form crystals.

One study including 724 people found that drinking wine, beer or liquor increased the risk of gout attacks. One to two beverages per day increased the risk by 36%, and two to four beverages per day increased it by 51%.

Try a Vitamin C Supplement

Research shows that vitamin C supplements may help prevent gout attacks by lowering uric acid levels.

It seems that vitamin C does this by helping the kidneys remove more uric acid in the urine.

However, one study found that vitamin C supplements had no effect on gout.

Research on vitamin C supplements for gout is new, so more studies are needed before strong conclusions can be made.

Summary: Losing weight, exercising, staying hydrated, limiting
alcohol and possibly taking vitamin C may also help prevent gout attacks

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What is hyperlipidemia?

Hyperlipidemia is a medical term for abnormally high levels of fats (lipids) in the blood. The two major types of lipids found in the blood are triglycerides and cholesterol.

Triglycerides are made when your body stores the extra calories it doesn’t need for energy. They also come directly from your diet in foods such as red meat and whole-fat dairy. A diet high in refined sugar, fructose, and alcohol raises triglycerides.

Cholesterol is produced naturally in your liver because every cell in your body uses it. Similar to triglycerides, cholesterol is also found in fatty foods like eggs, red meat, and cheese.

Hyperlipidemia is more commonly known as high cholesterol. Although high cholesterol can be inherited, it’s more often the result of unhealthy lifestyle choices.

Understanding cholesterol

Cholesterol is a fatty substance that travels through your bloodstream on proteins called lipoproteins. When you have too much cholesterol in your blood, it can build up on the walls of your blood vessels and form plaque. Over time, plaque deposits grow larger and begin to clog up your arteries, which can lead to heart disease, heart attack, and stroke.

Getting a diagnosis

Hyperlipidemia has no symptoms, so the only way to detect it is to have your doctor perform a blood test called a lipid panel or a lipid profile. This test determines your cholesterol levels. Your doctor will take a sample of your blood and send it to a lab for testing, then get back to you with a full report. Your report will show your levels of:

• total cholesterol
• low-density lipoprotein (LDL) cholesterol
• high-density lipoprotein (HDL) cholesterol
• triglycerides

Your doctor may ask you to fast for 8 to 12 hours before getting your blood drawn. That means you’ll need to avoid eating or drinking anything other than water during that time. However, recent studies suggest that fasting isn’t always necessary, so follow your doctor’s instructions in regard to your particular health concerns.

Generally, a total cholesterol level above 200 milligrams per deciliter is considered high. However, safe levels of cholesterol can vary from person to person depending on health history and current health concerns, and are best determined by your doctor. Your doctor will use your lipid panel to make a hyperlipidemia diagnosis.

Are you at risk for hyperlipidemia?

There are two types of cholesterol, LDL and HDL. You’ve probably heard them called “bad” and “good” cholesterol, respectively. LDL (“bad”) cholesterol builds up in your artery walls, making them hard and narrow. HDL (“good”) cholesterol cleans up excess “bad” cholesterol and moves it away from the arteries, back to your liver. Hyperlipidemia is caused by having too much LDL cholesterol in your blood and not enough HDL cholesterol to clear it up.

Unhealthy lifestyle choices can raise “bad” cholesterol levels and lower “good” cholesterol levels. If you’re overweight, eating lots of fatty foods, smoking, or not getting enough exercise, then you’re at risk.

Lifestyle choices that put you at risk for high cholesterol include:

• eating foods with saturated and trans fats
• eating animal protein, like meat and dairy
• not getting enough exercise
• not eating enough healthy fats
• obesity
• large waist circumference
• smoking
• drinking alcohol excessively

Abnormal cholesterol levels are also found in some people with certain health conditions, including:

• kidney disease
• diabetes
• polycystic ovary syndrome
• pregnancy
• underactive thyroid
• inherited conditions

As well, your cholesterol levels may be affected by certain medications:

• birth control pills
• diuretics
• some depression medications

Familial combined hyperlipidemia

There’s a type of hyperlipidemia that you can inherit from your parents or grandparents. It’s called familial combined hyperlipidemia. Familial combined hyperlipidemia causes high cholesterol and high triglycerides. People with this condition often develop high cholesterol or high triglyceride levels in their teens and receive a diagnosis in their 20s or 30s. This condition increases the risk of early coronary artery disease and heart attack.

Unlike people with typical hyperlipidemia, people with familial combined hyperlipidemia may experience symptoms of cardiovascular disease after a few years, such as:

• chest pain (at a young age)
• heart attack (at a young age)
• cramping in the calves while walking
• sores on the toes that don’t heal properly
• stroke symptoms, including trouble speaking, drooping on one side of the face, or weakness in the extremities

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How to treat and manage hyperlipidemia at home

Lifestyle changes are the key to managing hyperlipidemia at home. Even if your hyperlipidemia is inherited (familial combined hyperlipidemia), lifestyle changes are still an essential part of treatment. These changes alone may be enough to reduce your risk of complications like heart disease and stroke. If you’re already taking medications, lifestyle changes can improve their cholesterol-lowering effects.

Eat a heart-healthy diet

Making changes to your diet can lower your “bad” cholesterol levels and increase your “good” cholesterol levels. Here are a few changes you can make:

• Choose healthy fats. Avoid saturated fats that are found primarily in red meat, bacon, sausage, and full-fat dairy products. Choose lean proteins like chicken, turkey, and fish when possible. Switch to low-fat or fat-free dairy. And use monounsaturated fats like olive and canola oil for cooking.
• Cut out the trans fats. Trans fats are found in fried food and processed foods, like cookies, crackers, and other snacks. Check the ingredients on product labels. Skip any product that lists “partially hydrogenated oil.”
• Eat more omega-3s. Omega-3 fatty acids have many heart benefits. You can find them in some types of fish, including salmon, mackerel, and herring. They can also be found in some nuts and seeds, like walnuts and flax seeds.
• Increase your fiber intake. All fiber is heart-healthy, but soluble fiber, which is found in oats, brain, fruits, beans, and vegetables, can lower your LDL cholesterol levels.
• Learn heart-healthy recipes. Check out thetips on delicious meals, snacks, and desserts that won’t raise your cholesterol.
• Eat more fruits and veggies. They’re high in fiber and vitamins and low in saturated fat.

Lose weight

If you’re overweight or obese, losing weight can help lower your total cholesterol levels. Even 5 to 10 pounds can make a difference.

Losing weight starts with figuring out how many calories you’re taking in and how many you’re burning. It takes cutting 3,500 calories from your diet to lose a pound.

To lose weight, adopt a low-calorie diet and increase your physical activity so that you’re burning more calories than you’re eating. It helps to cut out sugary drinks and alcohol, and practice portion control.

Get active

Physical activity is important for overall health, weight loss, and cholesterol levels. When you aren’t getting enough physical activity, your HDL cholesterol levels go down. This means there isn’t enough “good” cholesterol to carry the “bad” cholesterol away from your arteries.

You only need 40 minutes of moderate to vigorous exercise three or four times a week to lower your total cholesterol levels. The goal should be 150 minutes of exercise total each week. Any of the following can help you add exercise to your daily routine:

• Try biking to work.
• Take brisk walks with your dog.
• Swim laps at the local pool.
• Join a gym.
• Take the stairs instead of the elevator.
• If you use public transportation, get off a stop or two sooner.

Quit smoking

Smoking lowersyour “good” cholesterol levels and raises your triglycerides. Even if you haven’t been diagnosed with hyperlipidemia, smoking can increase your risk of heart disease. Talk to your doctor about quitting or try the nicotine patch. Nicotine patches are available at the pharmacy without a prescription.

Hyperlipidemia medications

If lifestyle changes aren’t enough to treat your hyperlipidemia, your doctor may prescribe medication. Common cholesterol- and triglyceride-lowering medications include:

• statins, such as:
  • atorvastatin (Lipitor)
  • fluvastatin (Lescol XL)
  • lovastatin (Altoprev)
  • pitavastatin (Livalo)
  • pravastatin (Pravachol)
  • rosuvastatin (Crestor)
  • simvastatin (Zocor)
• bile-acid-binding resins, such as:
  • cholestyramine (Prevalite)
  • colesevelam (WelChol)
  • colestipol (Colestid)
• cholesterol absorption inhibitors, such asezetimibe (Zetia)
• injectable medications, such as alirocumab(Praluent) or evolocumab (Repatha)
• fibrates, like fenofibrate (Fenoglide, Tricor, Triglide) or gemfibrozil (Lopid)
• niacin (Niacor)
• omega-3 fatty acid supplements
• other cholesterol-lowing supplements

Outlook

People with untreated hyperlipidemia have a greater chance of getting coronary heart disease than the general population. Heart disease is a condition in which plaque builds up inside the coronary (heart) arteries. Hardening of the arteries, called atherosclerosis, happens when plaque builds up on the walls of arteries. Over time, plaque buildup narrows the arteries and can block them completely, preventing normal blood flow. This can lead to heart attack, stroke, or other problems.

How to prevent high cholesterol

You can make changes to your lifestyle to prevent high cholesterol or reduce your risk of developing hyperlipidemia:

• Exercise several days per week.
• Eat a diet low in saturated and trans fats.
• Include lots of fruits, vegetables, beans, nuts, whole grains, and fish regularly into your diet. (The Mediterranean diet is an excellent heart-healthy eating plan.)
• Stop eating red meat and processed meats like bacon, sausage, and cold cuts.
• Drink skim or low-fat milk.
• Maintain a healthy weight.
• Eat lots of healthy fats, like avocado, almonds, and olive oil.

Heart Disease is the leading cause of death in the United States. Understanding the physiology of nutrition and effects of your behaviors could save a life. Your diet and consumption play a direct role in your overall health and mental state.

The most common type of heart disease in this country is Coronary Artery Disease (CAD). CAD develops due to a buildup of plaque in the walls of the coronary arteries (the arteries that supply blood to the heart and other areas as well). Some of this plaque is made up of deposits of cholesterol. As a result of this buildup of plaque inside the arteries, these arteries tend to narrow over time, which can partly or completely block the flow of blood – also known as atherosclerosis.

Hypercholesterolemia and hyperlipidemia are two risk factors of heart disease. Hyperlipidemia is defined as your blood having too many lipids – examples of lipids (also known as fats) include cholesterol and triglycerides.
Hypercholesterolemia is defined as having too much bad cholesterol (LDL) in your blood. Not enough good cholesterol (HDL) to remove your cholesterol from your arteries can also increase your risk of a blockage due to the fatty deposits left in your arteries.

So how do you prevent hyperlipidemia and hypercholesterolemia through diet?

• Limit saturated fat intake to <14 g/day
  • Foods high in saturated fat include: fried foods, butter, high fat dairy products (i.e., whole milk, cheese – stick to low-fat cheese), bacon, sausage, red meat
  • When looking at a nutrition label, you want the saturated fat content to be as close to 0 as possible
  • Limit trans fat intake– found in margarine, fried foods, packaged foods, foods with hydrogenated oil under the ingredient list
• Increase your intake of heart healthy fats (omega 3 fatty acids)
  • Salmon, walnuts, flaxseed, avocado are some examples of healthy fats
• Limit the fat you eat to 25-35% of total calories you eat
• Aim for 20-30 g of dietary fiber daily
• Fruits, vegetables, whole grains and beans are some sources of fiber
• Get in 30 minutes of exercise daily
• Limit cholesterol in your diet
  • Foods high in cholesterol include egg yolks (one egg yolk has about 212 mg of cholesterol), fatty meat, whole milk, cheese, shrimp, lobster, and crab.
    • Limit egg intake to one per day
    • Limit shrimp intake to 3 oz. as a 3 oz. serving of shrimp is equivalent to one egg
    • For those who do not have high cholesterol, 2 eggs per day is acceptable

Nutritional Counseling

Behavioral Nutrition specializes in providing support for patients who need help eating healthier to prevent more serious issues like heart disease. We understand that there is no one size fits all approach when it comes to dieting and nutrition. Everyone has different preferences and unique tastes so our Nutritionists work hard to create a nutrition plan that works for each of our patients. We take a holistic approach to find sustainable solutions that give our patients the tools they need to eat healthy and stay active so they can stay healthy. Contact us to learn more about how our Behavioral Therapy Services can help you improve your diet for a healthier lifestyle.

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• Sodium restricted diet,
• level of sodium restriction,
• sources of sodium,
• danger of severe sodium restriction.

What is high blood pressure?

Blood pressure is the force of blood pushing against blood vessel walls. The heart pumps blood into the arteries (blood vessels) which carry the blood throughout the body. High blood pressure, also called hypertension, means the pressure in your arteries is above the normal range. In most cases, no one knows what causes high blood pressure. What you eat can affect your blood pressure.

How does nutrition affect blood pressure?

• Certain foods can increase blood pressure.
• Certain foods can lower blood pressure.
• Gaining weight can increase blood pressure.
• Losing weight can reduce blood pressure.

What should I eat to control high blood pressure?

• Eat foods lower in fat, salt, and calories.
• Use spices and herbs, vinegar, lemon or fruit juices instead of salt to flavor foods.
• Use less oil, butter, margarine, shortening, and salad dressings.

What are some of the foods I should eat?

• Skim or 1% milk, yogurt, Greek yogurt (calcium-rich foods can lower blood pressure).
• Lean meat.
• Skinless turkey and chicken.
• Low-salt, ready-to-eat cereals.
• Cooked hot cereal (not instant).
• Low-fat and low-salt cheeses.
• Fruits (fresh, frozen, or canned without added salt).
• Vegetables (fresh, frozen or canned, no added salt).
  • Richly colored green, orange, and red items are high in potassium and minerals that help lower blood pressure.
  • The goal is 5-9 servings of fruits and vegetables per day.
• Plain rice, pasta, and potatoes.
• Breads (English muffins, bagels, rolls, and tortillas).
• Lower salt “prepared” convenience food.

Unsalted seeds (pumpkin, squash, sunflower) and unsalted nuts are mineral-rich foods that lower blood pressure.

What foods should I eat less of?

• Butter and margarine.
• Regular salad dressings.
• Fatty meats.
• Whole milk dairy products.
• Fried foods.
• Salted snacks.
• Canned soups.
• Fast foods.
• Deli meats.

What’s the difference between sodium and salt?

Salt is mostly sodium, a mineral that occurs naturally in foods. Sodium is the substance that may cause your blood pressure to increase. Other forms of sodium are also present in food. MSG (monosodium glutamate) is another example of a sodium added to food (common in Chinese food).

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How does salt increase blood pressure?

When you eat too much salt, which contains sodium, your body holds extra water to “wash” the salt from your body. In some people, this may cause blood pressure to rise. The added water puts stress on your heart and blood vessels.

How much sodium is too much?

The American Heart Association recommends limiting daily sodium intake no more than 1,500 milligrams. (A teaspoon of salt has about 2,400 milligrams of sodium.) Most people greatly exceed these sodium guidelines.

How can I reduce my sodium intake?

• Don’t use table salt.
• Read nutrition labels and choose foods lower in sodium.
• Choose foods marked “sodium-free,” “low sodium,” and “unsalted.”
• Use salt substitutes (ask your healthcare provider first).
• Don’t use lite salt as a substitute.
• Read content labels. (Contents are listed in order of greatest amount.)
• Purchase sodium-free herbs and seasoning mixes like Mrs. Dash®.

What foods are high in sodium?

• Processed foods such as lunch meats, sausage, bacon, and ham.
• Canned soups, bouillon, dried soup mixes.
• Deli meats.
• Condiments (catsup, soy sauce, salad dressings).
• Frozen and boxed mixes for potatoes, rice, and pasta.
• Snack foods (pretzels, popcorn, peanuts, chips).
• Pickled or marinated food in brine. (Vinegar- and lemon juice-based marinades are ok.)

What else should I do to change my diet?

• Avoid alcohol.
• Eat a variety of foods.
• Eat foods high in dietary fiber (whole grain breads, cereals, pasta, fresh fruit, and vegetables).

Comparison of Sodium in Foods

Meats, poultry, fish, and shellfish

Food: Milligrams (mg.) sodium

Fresh meat, 3 oz. cooked: Less than 90 mg

Shellfish, 3 oz: 100 to 325 mg

Tuna, canned, 3 oz: 300 mg

Lean ham, 3 oz.: 1,025 mg

Dairy products

Food: Milligrams sodium

*Whole milk, 1 cup: 120 mg

Skim or 1% milk, 1 cup: 125 mg

*Buttermilk (salt added), 1 cup: 260 mg

*Swiss cheese, 1 oz: 75 mg

*Cheddar cheese, 1 oz : 175 mg

Low-fat cheese, 1 oz.: 150 mg

*Cottage cheese (regular), 1/2 cup: 455 mg

Vegetables

Food: Milligrams sodium

Fresh or frozen vegetables, and no-salt-added canned (cooked without salt), 1/2 cup: Less than 70 mg

Vegetables canned or frozen (without sauce), 1/2 cup: 55-470 mg

Tomato juice, canned, 3/4 cup: 660 mg

Breads, cereals, rice and pasta

Food: Milligrams sodium

Bread, 1 slice: 110-175 mg

English muffin (half): 130 mg

Ready-to-eat, shredded wheat, 3/4 cup: Less than 5 mg

Cooked cereal (unsalted), 1/2 cup: Less than 5 mg

Instant cooked cereal, 1 packet: 180 mg

Canned soups, 1 cup: 600-1,300 mg

Convenience foods

Food: Milligrams sodium

Canned and frozen main dishes, 8 oz: 500-1,570 mg

*These can also be high in saturated fat, unless low-fat or reduced fat options are purchased.

*High in saturated fat.

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• Modern methods of improvement or nutritional quality of food,
• food fortification,enrichment and nutrient supplementations.
• Nutrition education themes and messages in nutrition and health,
• Antenatal and postnatal care.

Modern methods of improvement or nutritional quality of food

objective:

The increasing consumer interest in health prompted Unilever to develop a globally applicable method (Nutrition Score) to evaluate and improve the nutritional composition of its foods and beverages portfolio.

Methods:

Based on (inter)national dietary recommendations, generic benchmarks were developed to evaluate foods and beverages on their content of trans fatty acids, saturated fatty acids, sodium and sugars. High intakes of these key nutrients are associated with undesirable health effects. In principle, the developed generic benchmarks can be applied globally for any food and beverage product. Product category-specific benchmarks were developed when it was not feasible to meet generic benchmarks because of technological and/or taste factors.

Results:

The whole Unilever global foods and beverages portfolio has been evaluated and actions have been taken to improve the nutritional quality. The advantages of this method over other initiatives to assess the nutritional quality of foods are that it is based on the latest nutritional scientific insights and its global applicability.

Conclusions:

The Nutrition Score is the first simple, transparent and straightforward method that can be applied globally and across all food and beverage categories to evaluate the nutritional composition. It can help food manufacturers to improve the nutritional value of their products. In addition, the Nutrition Score can be a starting point for a powerful health indicator front-of-pack. This can have a significant positive impact on public health, especially when implemented by all food manufacturers.

Are Fortified and Enriched Foods Healthy?

More than two-thirds of Americans don’t eat fruits or vegetables at least twice a day, and most don’t meet the recommended dietary guidelines.

Worldwide, more than 2 billion people have micronutrient deficiencies because they aren’t getting enough essential vitamins and minerals each day. Many Americans also aren’t meeting the requirement for vitamins and minerals, especially children.

Fortified and enriched foods were introduced in the 1930s and 1940s. They were intended to help boost vitamin and mineral intake with foods that adults and children were already eating, like grains and milk.

What’s a fortified or enriched food?

Fortified foods are those that have nutrients added to them that don’t naturally occur in the food. These foods are meant to improve nutrition and add health benefits. For example, milk is often fortified with vitamin D, and calcium may be added to fruit juices.

An enriched food means that nutrients that were lost during processing are added back in. Many refined grains are enriched. Wheat flour, for example, may have folic acid, riboflavin, and iron added back in after processing. This is intended to restore its original vitamin levels.

Are fortified and enriched foods healthy?

Historically, fortifying foods has been widely successful in the United States. Common diseases that are caused by nutrient deficiencies, like rickets and pellagra, have been virtually eliminated.

Even though fortification has increased vitamin and mineral consumption in the United States, there haven’t been studies on nutrients other than folic acid that show that fortified foods are improving our health. There are also concerns that fortified and enriched foods may be causing people to get harmful amounts of certain vitamins and minerals.

Fortified and enriched foods can be a part of a healthy, nutrient-rich diet. But whether or not they’re beneficial depends on age and a few other factors.

To inspire you to exercise and eat well, we’ll send you our top health tips and stories, plus must-read news.

Fortified and enriched foods for kids

Children are particularly vulnerable to nutrient deficiencies. Without added vitamins and minerals, many children and teens don’t meet daily nutrient requirements. Fortified and enriched foods are important sources of nutrients for kids, especially for iron, zinc, and B vitamins.

Unfortunately, many fortified or enriched foods are heavily processed and packaged. They often come with high sodium, fat, and sugar content. Fortification doesn’t make them inherently healthy or good for you.

Many younger children are also at risk of overdosing on some added vitamins, according to a report from the Environmental Working Group (EWG). The report showed that many fortified foods currently available contain levels of vitamins that aren’t appropriate for children. Many children may also exceed daily recommended values by eating a variety of fortified foods throughout the day, or by eating more than one serving. Nearly half of children ages 2 to 8 get too much zinc, and 13 percent consume too much vitamin A. These overdoses are potentially dangerous.

Fortified and enriched foods, especially foods not formulated for children, may not be safe for all children. The EWG recommends that children eat products with no more than 20 to 25 percent of the adult recommended daily value for vitamin A, niacin, and zinc. You can find this value on the nutrition label. While it’s still important to keep an eye on these nutrients, tweens and teens may benefit from including fortified or enriched foods in a balanced diet.

Fortified and enriched foods for adults

While adults also avoid vegetables, the majority of people get enough of most nutrients, according to the Academy of Nutrition and Dietetics. However, many adults are not getting enough:

• calcium
• magnesium
• dietary fiber
• vitamins A, D, E, and C.

Older adults and pregnant women are especially vulnerable to vitamin deficiencies.

People with special diets also need to be aware of potential vitamin deficiencies. Vegans, for example, can benefit from foods fortified with vitamin B-12.

However, adults can overconsume certain vitamins with enriched or fortified foods, especially if they are also taking supplements.

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Pregnant women and older adults can get too much vitamin A. It can cause birth defects, and high levels of vitamin A have been linked to hip fractures in older adults. While many women still have low folate intake, foods fortified with folic acid can cause people to get too much, according to the Harvard T.H. Chan School of Public Health.

Outdated daily value guidelines are also a concern. The U.S. Food and Drug Administration’s (FDA) recommendations have not been updated since they were introduced in 1968. The current guidelines conflict with the levels that the Institute of Medicine of the National Academies consider to be safe. This means that many fortified or enriched foods may be within the FDA’s guidelines, but may in fact have more than is necessary or safe.

Bottom line

In some cases, fortified or enriched foods are helpful. They can fill in the gaps and increase a particular vitamin and mineral consumption that would otherwise be less than the recommended value.

But it’s also easy to get too much. These foods can contribute to nutrient overdoses. Be aware of how much of each nutrient you are eating. Don’t forget to include foods that don’t come with a nutrition label, like dark leafy greens. Keep an eye on serving sizes to make sure you’re not overdosing on added vitamins or minerals.

No matter what, you can’t cover poor nutrition by adding extra vitamins. Desserts made with enriched flours and fortified breakfast cereals coated in sugar aren’t healthy options. The typical diet is already full of nutrient-poor processed foods, added sugars, and refined grains. Avoid foods that contain added sugars, have trans fats, or are high in sodium.

While fortified and enriched foods can certainly add to a healthy diet, they aren’t enough by themselves. You still need to eat a well-rounded, varied diet that is loaded with vegetables and other whole foods. You cannot rely on fortification or enrichment to get all of the nutrients you need.

What is Nutrition Education?

Nutrition education is the process of teaching the science of nutrition to an individual or group. Health professionals have a different role in educating an individual in the clinic, community, or long-term health-care facility. In these settings, the dietician, nutritionist, or nurse serves to assist or enable individuals to incorporate changes in eating patterns and behavior into their lives. The major focus of this type of nutrition is not knowledge and facts, but rather the development of permanent behavioral changes. This is the art of nutrition education – breaking down a large body of knowledge into small, individual components that are represented to a patient or client at a rate and level, at which they are able to absorb and use the information. Effective education is making nutrition information digestible and usable in an everyday setting.

Pregnancy Care

Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare for expectant mothers.

It involves treatments and trainings to ensure a healthy prepregnancy, pregnancy, and labor and delivery for mom and baby.

Prenatal Care

Prenatal care helps decrease risks during pregnancy and increases the chance of a safe and healthy delivery. Regular prenatal visits can help your doctor monitor your pregnancy and identify any problems or complications before they become serious.

Babies born to mothers who lack prenatal care have triple the chance of being born at a low birth weight. Newborns with low birth weight are five times more likely to die than those whose mothers received prenatal care.

Prenatal care ideally starts at least three months before you begin trying to conceive. Some healthy habits to follow during this period include:

• quitting smoking and drinking alcohol
• taking folic acid supplements daily (400 to 800 micrograms)
• talking to your doctor about your medical conditions, dietary supplements, and any over-the-counter or prescription drugs that you take
• avoiding all contact with toxic substances and chemicals at home or work that could be harmful

During Pregnancy

Once you become pregnant, you’ll need to schedule regular healthcare appointments throughout each stage of your pregnancy.

A schedule of visits may involve seeing your doctor:

• every month in the first six months you are pregnant
• every two weeks in the seventh and eighth months you are pregnant
• every week during your ninth month of pregnancy

During these visits, your doctor will check your health and the health of your baby.

Visits may include:

• taking routine tests and screenings, such as a blood test to check for anemia, HIV, and your blood type
• monitoring your blood pressure
• measuring your weight gain
• monitoring the baby’s growth and heart rate
• talking about special diet and exercise

Later visits may also include checking the baby’s position and noting changes in your body as you prepare for birth.

Your doctor may also offer special classes at different stages of your pregnancy.

These classes will:

• discuss what to expect when you are pregnant
• prepare you for the birth
• teach you basic skills for caring for your baby

If your pregnancy is considered high risk because of your age or health conditions, you may require more frequent visits and special care. You may also need to see a doctor who works with high-risk pregnancies.

Postpartum Care

While most attention to pregnancy care focuses on the nine months of pregnancy, postpartum care is important, too. The postpartum period lasts six to eight weeks, beginning right after the baby is born.

During this period, the mother goes through many physical and emotional changes while learning to care for her newborn. Postpartum care involves getting proper rest, nutrition, and vaginal care.

Getting Enough Rest

Rest is crucial for new mothers who need to rebuild their strength. To avoid getting too tired as a new mother, you may need to:

• sleep when your baby sleeps
• keep your bed near your baby’s crib to make night feedings easier
• allow someone else to feed the baby with a bottle while you sleep

Eating Right

Getting proper nutrition in the postpartum period is crucial because of the changes your body goes through during pregnancy and labor.

The weight that you gained during pregnancy helps make sure you have enough nutrition for breast-feeding. However, you need to continue to eat a healthy diet after delivery.

Experts recommend that breast-feeding mothers eat when they feel hungry. Make a special effort to focus on eating when you are actually hungry — not just busy or tired.

• avoid high-fat snacks
• focus on eating low-fat foods that balance protein, carbohydrates, and fruits and vegetables
• drink plenty of fluids

Vaginal Care

New mothers should make vaginal care an essential part of their postpartum care. You may experience:

• vaginal soreness f you had a tear during delivery
• urination problems like pain or a frequent urge to urinate
• discharge, including small blood clots
• contractions during the first few days after delivery

Schedule a checkup with your doctor about six weeks after delivery to discuss symptoms and receive proper treatment. You should abstain from sexual intercourse for four to six weeks after delivery so that your vagina has proper time to heal.

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As a Health Extension Practitioner you will frequently be dealing with your community’s nutritional problems. Using different nutritional assessment methods discussed in this section you will learn how to assess the nutritional status of children, mothers and other adults living in your community.

Nutritional assessment is the interpretation of anthropometric, biochemical (laboratory), clinical and dietary data to determine whether a person or groups of people are well nourished or malnourished (over-nourished or under-nourished).

These refer to the following:

1. Anthropometry
2. Biochemical methods
3. Clinical methods
4. Dietary methods

Anthropometry methods of assessing nutritional status

The word anthropometry comes from two words: Anthropo means ‘human’ and metry means ‘measurement’. The different measurements taken to assess growth and body composition are presented below.

To assess growth, several different measurements including length, height, weight, head circumference, mid-arm circumference, skin-fold thickness, head/chest ratio, and hip/waist ratio can be used. Height and weight measurements are essential in children to evaluate physical growth. As an additional resource, the NHANES Anthropometry Procedures Manual (revised January 2004) can be viewed here

: Measuring Height.

Biochemical methods of assessing nutritional status

Biochemical or laboratory methods of assessment include measuring a nutrient or its metabolite in the blood, feces, urine or other tissues that have a relationship with the nutrient. An example of this method would be to take blood samples to measure levels of glucose in the body. This method is useful for determining if an individual has diabetes.

: Measuring Blood Glucose Levels.

Clinical methods of assessing nutritional status

In addition to the anthropometric assessments, you can also assess clinical signs and symptoms that might indicate potential specific nutrient deficiency. Special attention are given to organs such as skin, eyes, tongue, ears, mouth, hair, nails, and gums. Clinical methods of assessing nutritional status involve checking signs of deficiency at specific places on the body or asking the patient whether they have any symptoms that might suggest nutrient deficiency.

Dietary methods of assessing nutritional status

Dietary methods of assessment include looking at past or current intakes of nutrients from food by individuals or a group to determine their nutritional status. There are several methods used to do this:

24 hour recall

A trained professional asks the subject to recall all food and drink consumed in the previous 24 hours. This is a quick and easy method. However, it is dependent upon the subject’s short-term memory and may not be very accurate.

Food frequency questionnaire

The subject is given a list of foods and asked to indicate intake per day, per week, and per month. This method is inexpensive and easy to administer. It is more accurate than the 24 hour recall.

Food Diary

Food intake is recorded by the subject at the time of eating. This method is reliable but difficult to maintain. Also known as a food journal or food record.

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Observed food consumption

This method requires food to be weighed and exactly calculated. It is very accurate but rarely used because it is time-consuming and expensive.

Evolving Science

Science is always moving forward, albeit sometimes slowly. One study is not enough to make a guideline or a recommendation, or cure a disease. Science is a stepwise process that builds on past evidence and finally culminates into a well-accepted conclusion. Unfortunately, not all scientific conclusions are developed in the interest of human health, and some can be biased. Therefore, it is important to know where a scientific study was conducted and who provided the funding, as this can have an impact on the scientific conclusions being made. For example, an air quality study paid for by a tobacco company diminishes its value in the minds of readers as well as a red meat study performed at a laboratory funded by a national beef association.

Nutritional Science Evolution

One of the newest areas in the realm of nutritional science is the scientific discipline of nutritional genetics, also called nutrigenomics. Genes are part of DNA and contain the genetic information that make up all of our traits. Genes are codes for proteins and when they are turned “on” or “off,” they change how the body works. While we know that health is defined as more than just the absence of disease, there are currently very few accurate genetic markers of good health. Rather, there are many more genetic markers for disease. However, science is evolving, and nutritional genetics aims to identify what nutrients to eat to “turn on” healthy genes and “turn off” genes that cause disease.

Using Science and Technology to Change the Future

As science evolves, so does technology. Both can be used to create a healthy diet, optimize health, and prevent disease. Picture yourself not too far into the future: you are wearing a small “dietary watch” that painlessly samples your blood, and downloads the information to your cell phone, which has an app that evaluates the nutrient profile of your blood and then recommends a snack or dinner menu to assure you maintain adequate nutrient levels. What else is not far off? How about another app that provides a shopping list that adheres to all dietary guidelines and is emailed to the central server at your local grocer, who then delivers the food to your home? The food is then stored in your smart fridge which documents your daily diet at home and delivers your weekly dietary assessment to your home computer. At your computer, you can compare your diet with other diets aimed at weight loss, optimal strength training, reduction in risk for specific diseases or any other health goals you may have. You also may delve into the field of nutritional genetics and download your gene expression profiles to a database that analyzes your genes against millions of others.

Nutrition and the Media

A motivational speaker once said, “A smart person believes half of what they read. An intelligent person knows which half to believe.” In this age of information, where instant Internet access is just a click away, it is easy to be misled if you do not know where to go for reliable nutrition information.

Using Eyes of Discernment

“New study shows that margarine contributes to arterial plaque.”

“Asian study reveals that two cups of coffee per day can have detrimental effects on the nervous system.”

How do you react when you read news of this nature? Do you boycott margarine and coffee? When reading nutrition-related claims, articles, websites, or advertisements, always remember that one study does not substantiate a fact. One study neither proves nor disproves anything. Readers who may be looking for complex answers to nutritional dilemmas can quickly misconstrue such statements and be led down a path of misinformation. Listed below are ways that you can develop discerning eyes when reading nutritional news.

1. The scientific study under discussion should be published in a peer reviewed journal, such as the Journal of Nutrition. Question studies that come from less trustworthy sources (such as non peer-reviewed journals or websites) or that are not formally published.
2. The report should disclose the methods used by the researcher(s). Did the study last for three or thirty weeks? Were there ten or one hundred participants? What did the participants actually do? Did the researcher(s) observe the results themselves or did they rely on self reports from program participants?
3. Who were the subjects of this study? Humans or animals? If human, are any traits/characteristics noted? You may realize you have more in common with certain program participants and can use that as a basis to gauge if the study applies to you.
4. Credible reports often disseminate new findings in the context of previous research. A single study on its own gives you very limited information, but if a body of literature supports a finding, it adds to credibility.
5. Peer-reviewed articles deliver a broad perspective and are inclusive of findings of many studies on the exact same subject.
6. When reading such news, ask yourself, “Is this making sense?” Even if coffee does adversely affect the nervous system, do you drink enough of it to see any negative effects? Remember, if a headline professes a new remedy for a nutrition-related topic, it may well be a research-supported piece of news, but more often than not, it is a sensational story designed to catch the attention of an unsuspecting consumer. Track down the original journal article to see if it really supports the conclusions being drawn in the news report.

When reading information on websites, remember the following criteria for discerning if the site is valid:

1. Who sponsors the website?
2. Are names and credentials disclosed?
3. Is an editorial board identified?
4. Does the site contain links to other credible informational websites?
5. Even better, does it reference peer-reviewed journal articles? If so, do those journal articles actually back up the claims being made on the website?
6. How often is the website updated?
7. Are you being sold something at this website?
8. Does the website charge a fee?

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• Immunization and its importance,
• Food borne infection and intoxication diseases,
• foods involved, methods of prevention,
• Infestation of food borne diseases ,
• Outbreak,
• Prevention signs and control of infection.

Immunisation is important

Immunisation is one of the best ways you can protect yourself, your children and future generations from infectious diseases. In other words, if you vaccinate, you help wipe out disease that could spread now and into the future.

By making sure you and your family are fully vaccinated (by following the National Immunisation Program schedule set by the Australian Government), you are not only looking after your own family but also protecting vulnerable people in your community. The more people who are vaccinated, the fewer people will be infected, and the less widely a disease can spread.

Immunisation saves lives. As recently as the 1950s, thousands of children died every year from diseases such as tetanus, diphtheria and whooping cough (pertussis). Luckily, it is rare for anyone in Australia to die from these infectious diseases now, thanks to the major vaccination programs introduced in the 1960s and 1970s, which continue today.

How do vaccinations work?

All immunisations work in the same way. The vaccination uses your body’s immune system to increase protection to an infection before you come into contact with that infection. In other words, it is like being infected with the disease without suffering the actual symptoms.

If you come into contact with an infection after you’ve been vaccinated, your body works to stop you from getting the disease, or you may get just a mild case. Unlike other proposed approaches to immunisation (such as homeopathy), vaccinations have been rigorously tested to demonstrate their safety and effectiveness in protecting against infectious disease. 

What about people who cannot be immunised?

Some people in our community cannot be vaccinated. This might be because they are too young or too sick. You can help protect these vulnerable people by keeping your family’s vaccinations up to date. 

When you get vaccinated, you are playing an important role in keeping yourself and your community safe. When enough people in the community are vaccinated, the spread of a disease slows down or stops completely – this is because the disease can’t move easily from person to person. So as long as enough people are vaccinated, the disease will not spread. This is called herd immunity or community immunity and protects friends, family and others, especially those who cannot be immunised. 

Foods contaminated with pathogenic microorganisms usually do not look bad, taste bad, or smell bad.  It is impossible to determine whether a food is contaminated with pathogenic microorganisms without microbiological testing. To avoid potential problems in foods, it is very important to control or eliminate these microorganisms in food products.

Pathogenic microorganisms can be transmitted to humans by a number of routes.

Diseases which result from pathogenic microorganisms are of two types: infection and intoxication.

• Foodborne infection is caused by the ingestion of food containing live bacteria which grow and establish themselves in the human intestinal tract.
• Foodborne intoxication is caused by ingesting food containing toxins formed by bacteria which resulted from the bacterial growth in the food item. The live microorganism does not have to be consumed.

For a foodborne illness (poisoning) to occur, the following conditions must be present:

• The microorganism or its toxin must be present in food.
• The food must be suitable for the microorganism
  to grow.
• The temperature must be suitable for the microorganism
  to grow.
• Enough time must be given for the microorganism
   to grow (and to produce a toxin).
• The food must be eaten.

Symptoms of Foodborne Illness

The most common symptom associated with foodborne illnesses is diarrhea. Each pathogenic microorganism has its set of characteristic symptoms.

The severity of the foodborne illness depends on the pathogenic microorganism or toxin ingested, the amount of food consumed (dose), and the health status of the individual. For individuals who have immunocompromised health conditions, or for the aged, children, or pregnant women, any foodborne illness may be life-threatening.

Food Microbiology and Food borne Illness

(Taken from EC 92-2307 by Julie A. Albrecht and Susan S. Sumner archived/posted in Digital Commons, University of Nebraska-Lincoln)

Bacteria, yeasts, and mold are microorganisms associated with foods. The individual microorganism cannot be seen without the aid of a microscope. The size of these microorganisms are measured in microns (1 micron is 1/1000 of a millimeter or U25,40A of an inch). More than a thousand microorganisms in a cluster are barely visible to the eye.

Microorganisms may be classified into three groups according to their activity:

1. Beneficial microorganisms may be used in the process of making new foods. Cheese is made with microorganisms which convert the milk sugar to an acid.
2. Spoilage microorganisms cause food to spoil and are not harmful to humans. A spoilage microorganism is responsible for souring milk.
3. Pathogenic microorganisms are disease-causing microorganisms. The living microorganism or a toxin (microbial waste product) must be consumed to cause symptoms associated with specific pathogenic microorganisms.

Microorganisms can be found virtually everywhere. Bacteria and molds are found in the soil and water. Yeasts are found mainly in the soil. Plant and animal food products support the growth of microorganisms. Bacteria have been detected on plants and animals; molds are usually found on fruits and vegetables; yeasts are generally found on fruits. Many bacteria are part of the normal microflora of the intestinal tracts of man and animals.

• Microorganisms may be transferred from soil and water to plants and animals.
• Raw food stuffs contain microorganisms which may be transferred to processed foods by careless handling.
• Food handlers with poor hygiene practices may transfer microorganisms to food.
• If suitable conditions exist, some of these microorganisms may grow to create a public health concern.
• Specific bacterial species (pathogenic microorganisms) are the main causes of foodborne illnesses in humans.

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Growth Factors of Microorganisms

All microorganisms require moisture, a food source, enough time, and suitable temperatures to grow and multiply.

Moisture

Microorganisms are composed of about 80% water which is an essential requirement for microorganisms to grow. Moisture requirements vary for each species of microorganism. In general bacteria need more water than yeasts. Yeasts require more water than molds to grow. If water is not available for microorganisms in a food product, the microorganisms may remain but will not grow and multiply.

Certain components in foods will make water unavailable for microorganisms (and thus can inhibit growth).

Salt & Sugar

Salt and sugar added to foods “tie” up water and lower the water activity. When enough salt or sugar is added to a food, the water activity will be lowered to a level that will prevent microorganisms from growing.

• In general, bacterial growth is inhibited by the addition of 5-15% salt. Yeasts and molds can tolerate up to 15% salt.
• To inhibit mold growth, 65-70% sugar must be added. The addition of up to 50% sugar will inhibit bacteria and yeast growth.

Some microorganisms are tolerant of certain conditions.

• Halophilic (salt-liking) microorganisms require salt to be present for the organism to grow.
• Osmiophilic ( sugar-liking) microorganisms, usually yeasts, grow best at high concentrations of sugar.
• Xerophilic (dry-liking) microorganisms can grow with limited moisture.

Food

Microorganisms need a source of nutrients to grow and multiply.

Time

Microorganisms need time to grow and multiply. Under favorable conditions (enough moisture and food available with the desired temperature), cell division (reproductive growth) may occur every 20 to 30 minutes. The time for a microbial cell to double is called the generation time.

Temperature

Microorganisms grow best within certain temperature ranges. Bacteria are classified into three groups, depending on the temperature at which the bacteria grows best.

• Psychrophilic (cold-liking) bacteria (responsible for food spoilage in refrigerators, grow rapidly at room temp.)
  – Growth range 32-77°F
  – Optimum temperature 68-77°F
• Mesophilic (middle-liking) bacteria
  – Growth range 68-110°F
  – Optimum temperature 68-113°F
• Thermophilic (heat-liking) bacteria
  – Growth range 113-158°F
  – Optimum temperature 122-131°F

Other factors affecting growth:

• Varying requirements for Oxygen (aerobic vs. anaerobic bacteria, e.g.)
• pH – acidity or alkalinity  (most microorganisms prefer a pH near neutral [pH = 7.0])
• Darkness vs. Light (Ultraviolet light is lethal to microorganisms)

Chemicals caused by contaminated food

Food contaminated with naturally occurring toxins and environmental pollutions are a major health concern due to their ability to cause food-borne illnesses.

Naturally occurring toxins

There are a whole range of naturally occurring toxins which can lead to becoming infected with a food borne disease.

Naturally occurring toxins in food can range from the toxins found in poisonous mushrooms, to the high levels of mycotoxins such as aflatoxin and ochratoxin found in corn and cereals.

Long term exposure to these toxins can severely affect the immune system, and in some cases, cause cancer, according to the WHO.

Persistent organic pollutants

Persistent organic pollutants (POPs) refer to compounds which accumulate in the environment and the human body.

The most well known examples of POPs are dioxins and polychlorinated biphenyls. These are the chemicals released as a result of industrial processes and waste incineration, and are found worldwide in the environment and infect animal food chains.

Humans are at risk by consuming food products contaminated by POPs. Dioxins are extremely toxic. Dioxins cause reproductive and developmental problems and damages to the immune system. They are also known to interfere with hormones as well as cause cancer.

Metals

Food can become contaminated with metals such as lead, calcium and mercury. This happens via pollution of the air, water and soil. These lead to illnesses such as lead and mercury poisoning which can result in neurological and kidney damage.

Of course there are a lot more food borne diseases circulating the world, the ones mentioned above are the most common.

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Who is at risk of food poisoning?

Unlike some diseases, food borne illnesses can affect everyone. Anyone can catch food poisoning, and relatively easily.

Some people are more likely to develop food poisoning than others. Apparently some people are naturally more resistant to food poisoning that others. Factors such as stress can also play a part in a person’s resistance to food borne diseases.

Certain groups of people are naturally less resistant to food borne illnesses due to a weaker immune system, these are:

• The elderly
• Sick people
• Babies and young children
• Pregnant women

Food borne illness symptoms

Although there is a wide range of different foodborne diseases you can catch, they all show relatively the same symptoms.

Foodborne illness can have various symptoms including:

• Diarrhea
• Vomiting
• Nausea
• Abdominal cramps
• Fever

The number of these symptoms present and their severity depends on the type of food borne illness.

Treating food poisoning

Whilst food borne infections are fairly common, thankfully treatment can be quite simple. Food poisoning can usually be treated at home on your own, without the need for medical intervention.

Treatment

When treating a foodborne illness it is important to replenish your fluids by drinking plenty of water. Avoiding dehydration is key to recovery.

You can also treat food poisoning by:

• Resting as much as possible.
• Try to eat, if and when you feel up to it. But stick to small, light, non-fatty meals first. Bland carbohydrates such as toast, crackers and rice are a good option.
• Avoid alcoholic, caffeinated and carbonated drinks as well as spicy and fatty foods. These will make you feel worse.

If you find yourself not recovering after a few days, or if you’re showing severe signs of a food borne illness, get professional medical help.

Preventing foodborne illness

Preventing foodborne illnesses is relatively simple. In order to prevent food contamination from harmful pathogens, always follow food safety guidelines and basic food hygiene practises.

Food safety

Food safety is a scientific discipline that ensures the prevention of foodborne illnesses through the handling, preparation, and storage of food. It includes a number of food hygiene routines that should be adhered to in order to prevent the potentially severe health hazards food borne diseases can cause.

5 Principles to safer food

According to WHO the five key principles to safer food are:

1. Keep clean
2. Separate raw and cooked
3. Cook thoroughly
4. Keep food at safe temperatures
5. Use safe water and raw materials

Keep clean

Following proper food hygiene and hand hygiene practices can ensure the spread of foodborne illnesses is kept to a minimum.

The harmful microorganisms which cause food borne illnesses are carried on hands, wiping cloths, and cooking utensils. Even the slightest bit of contact can transfer these organisms to food.

You can prevent food borne illnesses by:

• Ensuring hands are washed regularly — before and after handling food, during preparation, and after using a washroom.
• If wearing gloves, remember to dispose of them safely and wear a fresh pair when handling different items of food.
• Wash, sanitize and disinfect all surfaces and equipment used within the food processing cycle.
• Protect food supply and preparation areas from pests such as rodents, cockroaches, flies and stored product insects.

Separate raw and cooked

Raw food, and in particular meat, poultry and seafood are riddled with dangerous microorganisms (which are eliminated during the cooking process). These microorganisms can easily be transferred during food preparation, transportation and storage and lead to infection from a variety of different food-borne illnesses.

You can prevent foodborne illnesses by:

• Separating raw meat, poultry and seafood from other foods during preparation, transportation and storage.
• Use separate equipment and utensils such as knives, chopping boards and plates whilst handling raw foods.
• Store raw foods in airtight containers and away from cooked foods, and items such as fruit and vegetables which don’t require cooking before consumption.

Cook thoroughly

The majority of the microorganisms that cause food-borne infections are eliminated through heat. Studies have shown that cooking food to a temperature of 70℃ can help ensure it is safe for consumption by thoroughly eradicating any pathogens on the item. 70℃ is the advised temperature as it can kill off even the highest concentrations of microorganisms within 30 seconds. However, in the UK it is advised by food safety professionals that food is held at 70℃ for 2 minutes to reduce harmful bacteria to a safe level.

However, foods such as large joints of meat require special attention to ensure they are thoroughly cooked.

You can prevent food-borne illnesses by:

• Ensure all food is cooked through thoroughly, especially meat, poultry and seafood.
• Use a thermometer to check food has reached 70℃ before serving. For meat and poultry make sure the juices run clear.
• Reheat cooked food thoroughly before serving.

Keep food at safe temperatures

Improper food storing methods can lead to products becoming infected with foodborne illnesses. The microorganisms responsible for causing these diseases can multiply very quickly in food stored at room temperatures.

Ensuring that food is stored at temperatures below 5℃ and above 60℃ (63℃ in the UK) slows down and stops the growth of these microorganisms. However, it is worth noting that some dangerous microorganisms can still grow below 5℃.

You can prevent foodborne diseases by:

• Ensuring cooked food is not left at room temperature for more than 2 hours.
• Promptly refrigerating all cooked and perishable food, preferably below 5℃.
• Keep cooked food at 60℃ (63℃ in the UK) or above before serving.
• Quickly cool and store leftovers.
• Prepare food in smaller amounts to reduce the amount of leftovers.
• Do not store food for longer than 3 days, even in the refrigerator.
• Do not thaw frozen food at room temperature, use a refrigerator or another cool location instead.

Use safe water and raw materials

Raw materials, ice, and water can be contaminated with dangerous microorganisms and chemicals. Damaged and mouldy foods are often littered with toxic chemicals as well. The same can also be said for soil.

You can prevent food-borne infections by:

• Taking care in the selection of raw materials.
• Washing and peeling fruit and vegetables before using.
• If growing produce, ensure the soil and water used is free from chemicals.
• Do not use food beyond expiry date.
• Opt for foods processed for safety such as pasteurized milk.
• Avoid using food which is damaged or rotting.
• Throw away smashed, swollen or oxidized cans.

Modern outbreaks of infectious diseases

Many infectious diseases are rare or not around anymore, thanks to vaccination. But there are still infectious disease outbreaks happening around the world today:

• COVID-19 – a new disease that the world is still learning about. New research is happening all the time so we can understand more about the disease, including the long-term effects.
• Flu, chicken pox, whooping cough, measles – these diseases still have occasional outbreaks in Australia, mainly when introduced from overseas. They could make a strong comeback if people stop vaccinating. In January 2019, 62,225 measles cases were notified globally compared to the same period in 2018 when only 23,535 cases were notified.
• Zika – in February 2016 the World Health Organization (WHO) declared the Zika virus an international public health emergency following outbreaks in Central and South America. There is ongoing evidence of transmission throughout the Americas, Africa and other regions of the world. As of 2018, a total of 86 countries and territories have reported evidence of mosquito-transmitted Zika infection.
• Ebola – the latest outbreak of Ebola virus disease started in Democratic Republic of Congo in August 2018, and is ongoing.
• HIV/AIDS – the first cases of HIV/AIDS were identified in the gay community in America in 1981 and, by 1985, at least one case had been reported from each region of the world. In 2019, more than 38 million people around the world were living with HIV/AIDS. There is still no cure, but current treatments allow patients to live long and healthy lives.

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INTERNATIONAL AGENCIES. The second half of the twentieth century witnessed the growth of a type of social institution that plays an important role in food and nutrition policies and programs throughout the world. These institutions, which are commonly referred to as “international agencies,” are usually constituted as sub organizations within larger sociopolitical organizational structures. One set of such institutions are the “multilaterals, ” which include many governments, particularly the agencies of the United Nations (UN), or those of the European Union. A second set of agencies, often referred to as “bilaterals,” are the aid organizations established by national governments in the industrialized world, including those of the European states, the United States, and Canada, as well as Australia and Japan. A third type, with activities that closely parallel those of the UN and governmental agencies, includes nongovernmental organizations (NGOs) or private voluntary organizations (PVOs). These may be religious or “faith-based” agencies that are administratively connected to religious organizations or are closely affiliated with such organizations, or they may be independent groups, such as the Helen Keller Foundation or Save the Children. Many of these NGOs receive funds from bilateral and multilateral agencies.

Agencies of the United Nations

The establishment of the various agencies in the UN system began with the founding of the UN in 1945. During the following half-century, new agencies were added as needs were redefined and expanded. The current body of UN agencies whose work involves food and/or nutrition are the Asian Development Bank (ADB), Food and Agriculture Organization (FAO), International Atomic Energy Agency (IAEA), International Fund for Agricultural Development (IFAD), International Labor Organization (ILO), Joint United Nations Programme on HIV/AIDS (UNAIDS), United Nations Development Programme (UNDP), United Nations Educational, Scientific, and Cultural Organization (UNESCO), United Nations Population Fund (UNFPA), United Nations High Commissioner for Refugees (UNHCR), United Nations Children’s Fund (UNICEF), United Nations Research Institute for Social Development (UNRISD), World Food Programme (WFP), World Health Organization (WHO), and the World Bank.Encyclopedia 1080×

Agency Goals and Functions

One of the principal motivations underlying the establishment and operation of international agencies was to provide vehicles for directing resources—economic, technical, and technological—from resource-rich countries to resource-poor countries. Other political, economic, and social interests also shape the motivations and activities of agencies. Moreover, the fact that international agencies are generally not freestanding institutions, but part of larger sociopolitical units, is one of several characteristics that affect their mission, administrative organization, philosophy, policy, and activities.

The purposes of both UN and non-UN agencies whose work relates to food and nutrition can be summarized by one or more of the following goals: establishing technical norms, providing funding, providing technical assistance, or delivering services. Within the UN system, the various agencies were established with distinct, yet complementary, mandates and were given different, but often overlapping, sectors of action. Thus, WHO and FAO were set up as technical agencies with responsibilities for technical norms and technical assistance, whereas UNICEF was designed to support and deliver services through funding and technical support, and the World Bank was designed to provide funds.

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Obstacles, Challenges, and Persistence

In their efforts to further the health and welfare of populations with respect to food and nutrition, international agencies face multiple challenges. An examination of these challenges helps to explain the gaps between stated goals and realities of agency activities that make them frequent subjects of controversy and criticism. Some of these challenges relate to the structure of international collaboration and conflict regardless of the focus of action, while others are specific to characteristics of social action related to food and nutrition.

A primary challenge for establishing complementary activities at country and community levels is that agencies’ activities are based on widely differing philosophies of how to promote and sustain development. Bilateral agencies represent countries with different economic and political agendas. These differ not only between nations, but also within nations, as is evident from the policy changes that accompany shifts in government when different political parties are in power. Within the UN system itself, there are also different philosophies and constituencies, which are evident not only between agencies, but also within them. The NGOs and PVOs represent still other sets of values and theories about what needs to be done and how to do it.

International agencies face serious challenges in reconciling definitions of needs as perceived on one hand by technical advisers, high-level political representatives, and international advocacy groups, and on the other with the needs articulated by recipient groups, from national-level politicians and civil administrators to regional and community-level spokesmen. These conflicting interpretations arise from multiple sources and cover a range of issues, including ethical concerns and competing values about fairness, justice and “whose reality counts,” priorities for action in the face of limited resources, and differing perspectives on the causes and consequences of food and nutrition problems. A related factor that affects many aspects of food and nutrition policies and programs is that most agencies, especially the bilaterals, have to answer to the political constituencies who control the resources they require to carry out their work. Indeed the basic organization of development activities into the categories of “donors” and “recipients” create structural barriers that pose significant challenges to meeting population needs.

Another common problem, which relates to the demands from “donor constituencies,” is that the time frame for research, program development, and evaluation is typically much too short. As a consequence, agencies are forced to take shortcuts that jeopardize the achievement of goals. As a result, the potential to learn from experience is reduced, and there are inadequate opportunities to make adjustments to improve programs.

Special challenges for food and nutrition activities stem from the fact that throughout the world they relate to multiple and very different social sectors. Food is the provenance of agriculture and various economic sectors of producers and marketing concerns. It is also the source of nutrients, which are the provenance of nutrition and health sectors. Both national governments and international agencies tend to divide food and nutrition responsibilities among multiple organizational units, which often results in conflicting goals and serious fragmentation of efforts. Even within a particular sector, such as health agencies, differing orientations may result in conflicting approaches to nutrition and health education in communities.

In 1977 the UN established the Subcommittee on Nutrition (SCN), under the aegis of the Administrative Committee on Coordination (ACC), as a mechanism for communication among the various UN agencies with responsibilities in food and nutrition. The ACC/SCN, which meets yearly and compiles and disseminates technical reports through its office in Geneva, Switzerland, also seeks the participation of bilaterals and NGOs. This small organization has no mandated authority to resolve differences but provides a forum for exchange and debate. Its existence is threatened by hostility from some of its constituent agencies who fear that SCN activities may reveal weaknesses in their own operations, and at least one of SCN’s components, the Advisory Group on Nutrition (AGN), which was composed of senior experts from outside the UN system, has been dismantled.

The example of the tribulations of the SCN provides a glimpse of the shortcomings in motivations, organization, and action that are typical of international agencies. There are, however, two critical questions to answer before recommending curtailing or abolishing these agencies. The first is, “Would the poor and hungry be better off without these agencies?” Historical comparisons of situations where the agencies have and have not been active reveal that the presence of the agencies has been favorable. Without them, the only major interests affecting food and nutrition are commercial and political—neither of which care much about the poor.

The second question is, “Can the system or its constituents be improved?” Greater intellectual attention is required to address such important issues as updating the mandates of international agencies to modern realities, instituting better accountability for all international agencies (including bilaterals and NGOs), and increasing resources to improve diet and nutrition worldwide. At the level of agencies, a high priority is developing better methods for more effective cooperation between agencies and populations. While there are many difficult barriers to improving agency functioning, dedicated people who work in and with international agencies find many opportunities to make improvements.

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Identification of problem, analysis of causes,resources constraints, selection of interventions, setting a strategy, implementations and evaluation of the programme

Rapid improvements in health and nutrition in developing countries may be ascribed to specific, deliberate, health- and nutrition-related interventions and to changes in the underlying social, economic, and health environments. This chapter is concerned with the contribution of specific interventions, while recognizing that improved living standards in the long run provide the essential basis for improved health. Consideration of the environment as the context for interventions is crucial in determining their initiation and in modifying their effect, and it must be taken into account when assessing this effect.

The WHO asserts that the global food price crisis threatens public health and jeopardizes the health of the most disadvantaged groups such as women, children, the elderly and low-income families. Economic factors play a crucial role and could affect personal nutrition status and health. Economic decision factors such as food price and income do influence people’s food choices. Moreover, food costs are a barrier for low income-families to healthier food choices. Several studies indicate that diet costs are associated with dietary quality and also food safety. Food prices have surged over the past couple of years (2007-9) and raised serious concerns about food security around the world. Rising food prices are having severe impacts on population health and nutritional status. Therefore, people who change their diet pattern for economic reasons may develop a range of nutritionally-related disorders and diseases, from so-called over-nutrition to or with under-nutrition even within the one household. This is likely to increase with growing food insecurity. Presently, economics is not integrated with mainstream nutrition science or practice, other than in “home economics”, but it can enable greater understanding of how socioeconomic status may interplay with human nutritional status and health and how these situations might be resolved. Collaborative, cross-disciplinary nutritional economics research should play a greater role in the prevention and management of food crises.

WHOs response

Nutrition

Nutrition is a critical part of health and development. Better nutrition is related to improved infant, child and maternal health, stronger immune systems, safer pregnancy and childbirth, lower risk of non-communicable diseases (such as diabetes and cardiovascular disease), and longevity.

Healthy children learn better. People with adequate nutrition are more productive and can create opportunities to gradually break the cycles of poverty and hunger.

Malnutrition, in every form, presents significant threats to human health. Today the world faces a double burden of malnutrition that includes both undernutrition and overweight, especially in low- and middle-income countries.

WHO is providing scientific advice and decision-making tools that can help countries take action to address all forms of malnutrition to support health and wellbeing for all, at all ages.

This fact file explores the risks posed by all forms of malnutrition, starting from the earliest stages of development, and the responses that the health system can give directly and through its influence on other sectors, particularly the food system.

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Defining success in nutritional programmes

Before considering the range, combination, and relative weighting of factors contributing to successful community based nutrition programmes (CBNPs), it seems pertinent to question the term “success.” What is a successful programme? The simple, almost facetious answer is “A successful programme is one that achieves its objectives!”There are three issues here concerning attainment of objectives:» Objectives (when they are stated) for CBNPs almost always include “outcome” objectives ranging from narrow nutritional outcomes, e.g., the eradication of grade III malnutrition (Costa Rica), to broader contributions, e.g., the reduction of malnutrition and high mortality rates of children under three (Tamil Nadu) .» Objectives sometimes include “process” objective sranging from narrow nutrition-related processes, e.g.,to enhance mothers’ capability for nutrition surveil-lance (ICDS India), to broader social objectives such as increasing community participation and expanding coverage (UPGK, Indonesia).» Stated objectives frequently do not explicitly include process objectives, yet certain processes may be facilitated or even initiated, either as a result of the programme design, or, in some cases, as an unexpected by-product of the programme, e.g., Zimbabwe child supplementary feeding programmes (CSFP)(strengthened self-organization of village people). In addition to certain processes being facilitated by the development of programmes (e.g., community participation), intended or sometimes unforeseen effects may occur, such as the influencing of policy by successful nutrition programmes, e.g., Zimbabwe’s CSFP/SFPP (supplementary food production programme)influenced agricultural policy). Another important, yet often neglected, measure of success is sustainability. The sustainability of a programme without significant external funding should be one ultimate goal of any community-based programme But financial sustainability is only one, al-beit crucial, aspect of sustainability. The other criticala spect is functional sustainability.

Factors influencing success

Success in CBNPs is a function of sociopolitical, technical, and financial factors. Although each of these factors—or rather group of factors—is essential, the strength and relative weight of each differs from pro-gramme to programme.Sociopolitical factors are those which describe powerarrangements and social relations affecting nutrition programmes and which influence the decision takenin a society to initiate or support such programmes.Technical factors include two broad components,which may be termed programme hardware, which includes the buildings, equipment, transport, and other materials necessary for implementation; and programme software, which has to do with the technical capacity of programme personnel to design, initiate, manage,and evaluate nutrition programmes .Financial factors are both external and internal. Al-though nutrition programmes are often initially funded externally, their sustainability is significantly dependent on internal financial capacity and its reliability.The above groups of factors are explored in more depth below and are illustrated by reference to four well known and successful large-scale nutrition pro-grammes.Sociopolitical factors Community participation In their review of successful nutrition programmes ,Gillespie et al. identify “genuine community involvement [as] a key feature of those programmes that work.”Kavishe, invoking UNICEF’s “triple-A” programm in gcycle, insists that community participation includes a full role in assessment, analysis, and action. Shrimpton has detailed further numerous components of programme development in which communities can successfully engage. Jennings et al. have summarized the pros and cons of community participation in nutrition programmes. According to Jennings et al., the perceived benefits of community participation in nutrition programmes include the following:

i)It increases a sense of ownership of the project by the community, thus leading to sustain ability of the project;

ii) it decreases resistance to project innovations, assists the dissemination of nutrition education messages, and promotes regular and ongoing attendance at programme activities;

iii) it decreases dependence on external assistance and promotes self-help in tackling community problems through the strengthening of community structures and leadership; and

iv) projects which stress community participation tend to be interventions which are more appropriate for the community, in the goals and objectives defined and in the technology employed.One limiting factor of community participation in a project is an increased administrative complexity…. Logistical constraints are also increased due to the frequent location of needy communities in isolated areas with weak infrastructure. The benefits would appear to outweigh these negative aspects.

It should be recognized, however, that the real ways is the potential for local elite groups to use‘community participation’ in a project as a means of extending their own patronage network within the community…. Yet if targets are well defined and the programme is closely monitored to deter-mine coverage and beneficiaries, this should bedetected early in the implementation phase.When community participation is promoted in the planning phase, there can be conflicts between programme goals and community goals. Based ona review of community participation in the health planning process in several health programmes in South east Asia, it was considered that in some cases‘community members did not see health as a priority’…. In recalling the historical developments of nutrition programmes in Tanzania… it is shown that poorly considered attempts to involve community participation in the planning process can possibly hinder efforts to reach programme goals.

“Community participation” is a central principle of the Primary Health Care Approach (PHCA) and a feature distinguishing it from previous approaches to healthcare. Genuine community participation in programme development implies participatory democracy and ameasure of popular democratic control more generally in a society”.

Community- and Facility-based Programs

Protecting and improving health, especially in poor communities, requires a combination of community- and facility-based activities, with support from central levels of organization, as well as some centrally run programs (for example, food fortification). The place of these activities in a strategy is likely to vary, depending on level of development (of infrastructure, health services, and socioeconomic status) and on many local factors. For the poorest societies, the first priorities are basic preventive services, notably immunization, access to basic drugs, and management of the most serious threats to health, such as some access to emergency care. Moving up the development scale, starting community-based activities may soon become cost effective for prevention, referral, and management of some diseases (notably diarrhea) when coverage of health services is poor. Community-based programs continue to play a key role until health services, education, income, and communications have improved to the point that maternal and child mortality has fallen substantially and malnutrition is much reduced; at this intermediate development level, the needs are less felt, and health services again take on a more prominent role. In this scheme, the widely felt need for better access to emergency obstetric services is problematic, requiring a well-developed human and physical infrastructure, yet arguably being one of the highest priorities.

Facility-based programs can be seen either as linking with the community program (referrals, home visits from clinics, and so forth) or as actually being part of the same enterprise. A distinction is that community-based activities take place outside the health facility, in the home or at a community central point, even if they may be supported by health personnel based in health facilities. The local workers in community-based programs may be drawn from the community itself, may be home visitors from a health center or clinic, or may sometimes be volunteers supervised by these home visitors. Many community-based programs come under the health sector, whatever the exact arrangements with local health services. Regarding specific program components, we return to the relative role of community programs and facilities later.

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