Chapter 11

[Audio] Nutrition Concepts and Controversies (16th Edition) Chapter 11 Nutrition and Chronic Diseases.

[Audio] You can read this slide.. Learning Objectives (1 of 2).

[Audio] You can read this slide.. Learning Objectives (2 of 2).

[Audio] Chronic Diseases. Chronic Diseases.

[Audio] A disease is a disorder that impairs or disrupts normal body or organ functioning, and often produces characteristic signs or symptoms. One class of diseases, infectious diseases, are caused by specific pathogens. Pathogens are organisms that cause diseases, like bacteria, viruses, fungi, and parasites. They invade our bodies, multiply, and can disrupt normal body functions. For example, the flu is caused by a virus and strep throat is caused by bacteria. Against these pathogens, the body's best defenses are its own natural immunity and preventive measures provided by public health services—vaccines and sanitation. Two infectious diseases make the "top ten" list of killers, pneumonia and influenza, Infectious diseases have a single cause—exposure to a specific pathogen What are Chronic diseases? Chronic diseases are health conditions that last a long time, often for years or even a lifetime. Unlike a cold or the flu, which you get over in a week or two, chronic diseases persist and usually require ongoing medical attention. Today's predominant diseases are chronic diseases—cardiovascular diseases, type 2 diabetes, and cancer. This chapter describes three types of chronic diseases: cardiovascular disease, diabetes, and cancer. These were selected for special attention because they are leading causes of morbidity (the presence of illness or disease in a population) and mortality (the number of deaths in a population) in the United States, and because good nutrition can make major contributions to their prevention..

[Audio] Figure 11-1 shows the final rankings for leading causes of death in 2019 (prior to the COVID-19 pandemic). The red bars in Figure 11-1 show heart disease heads the list, cancers are next, strokes are fifth on the list, and diabetes is in the second tier. Note also that these four threats to life are diet related. These four killers are chronic diseases; they are very much preventable by good nutrition habits and practices..

[Audio] In contrast with the infectious diseases, each of which has a distinct pathogenic cause such as a bacterium or virus, the chronic diseases have suspected contributors known as risk factors. Risk factors are correlated with diseases—that is, they often occur together with diseases, but no single risk factor can be blamed for a disease because the factors work in teams. We can say that a certain virus causes influenza, but we cannot name just a single dietary cause of cancer. We cannot, for example, blame a low-fiber diet. It is a risk factor, yes, but there are many risk factors for cancer, and a low-fiber diet is only one of them. Moreover, every risk factor is implicated in the causation of more than one chronic disease—sometimes, many. Table 11-1 displays the whole, complex picture of the relationships among chronic diseases and their risk factors. (Other risk factors, specific to individual diseases, will appear in later discussions.) And one disease (such as diabetes) may itself contribute to other diseases (such as atherosclerosis and hypertension). The chronic diseases have many risk factors in common—among them, excessive alcohol intake, lack of physical activity, smoking/tobacco use, and diet..

[Audio] You can read this slide.. Table 11-1 Chronic Disease Risk Factors (2 of 2).

[Audio] Cardiovascular Diseases (CVD). Cardiovascular Diseases (CVD).

[Audio] Table 11-2 Cardiovascular disease or CVD Terms 1. Aneurysm the ballooning out of an artery wall at a point that is weakened by deterioration. 2. Coronary Heart Disease a chronic, progressive disease characterized by obstructive blood flow in the coronary arteries; also called coronary artery disease. The coronary arteries are those that feed the heart muscle itself. See also peripheral artery disease. 3. Embolus a clot that travels through the circulatory system (embol means "to insert"). 4. Embolism: the event in which an embolus lodges in an artery and suddenly cuts off the blood supply to a part of the body. 5. Fatty Streaks deposits of fat on the inner surfaces of arteries, an early stage in the formation of plaques. 6. Foam Cells foamy-looking cells formed during plaque formation: they develop from white blood cells that, while clearing fat from plaques, become engorged with it. 7. Heart Attack sudden, unexpected cessation of the heartbeat, respiration, and consciousness, usually caused by a clot lodging in a coronary artery (thrombosis). If not quickly reversed, this is followed by death. Also called cardiac arrest or myocardial infarction (myo means muscle; infarction means blockage of blood supply). 8. Hemorrhage uncontrolled bleeding. 9. Peripheral Artery Disease any disease or disorder that affects the peripheral arteries, those that carry blood to the body's organs other than the heart. See also coronary artery disease. 10. Plaques mounds of lipid material mixed with smooth muscle cells and calcium that develop in the artery walls in atherosclerosis (placken means "patch"). (The same word is also used to describe the accumulation of a different kind of deposit on teeth, which promotes dental caries.) 11. Stroke the shutting off of the blood flow to a part of the brain by a thrombus, an embolus, or the bursting of a blood vessel; these events are termed cerebral thrombosis, cerebral embolism, and cerebral hemorrhage, respectively. (The cerebrum is part of the brain.) 12. Thrombosis: the event in which a thrombus grows large enough to close off a blood vessel and gradually cuts off the blood supply to a part of the body. See also embolism. 13. Thrombus a stationary blood clot in the circulatory system..

[Audio] In the United States today, more than 100 million people suffer some form of disease of the heart and blood vessels, collectively known as cardiovascular disease (CVD). Cardiovascular disease claims the lives of more than 650,000 people each year in the United States and has been the leading cause of death in this country for decades. CVD is often called "heart disease," but that is an oversimplification. As the term cardiovascular disease implies, CVD includes diseases of the blood vessels as well as the heart. Thus, the term cardiovascular disease represents multiple diseases rolled into one. Cardiovascular disease is the leading cause of death in the United States. Atherosclerosis is the major underlying cause of cardiovascular disease, and hypertension is the most prevalent form of cardiovascular disease. Atherosclerosis and hypertension are risk factors for each other..

[Audio] Continuation of Previous Slide Atherosclerosis, the common form of hardening of the arteries, is a major underlying cause of most forms of CVD, including hypertension. Hypertension in turn, worsens atherosclerosis. The two diseases are so interrelated that each is a risk factor for the other. As a later section describes, dietary patterns that lower the risk of atherosclerosis protect against hypertension as well. No one is completely free of all signs of atherosclerosis. The question is not whether you are developing it, but how far advanced it is and what you can do to slow or reverse it. Chronic hypertension is one of the most prevalent forms of CVD, afflicting more than 100 million U.S. adults, and its incidence has been rising steadily. Hypertension is a primary cause of stroke, a leading cause of death in the United States. People with normal blood pressure generally enjoy longer lives and less commonly suffer from all forms of CVD than those with high blood pressure. An abundance of terminology pertains to cardiovascular diseases. Cardiovascular disease is the leading cause of death in the United States. Atherosclerosis is the major underlying cause of cardiovascular disease, and hypertension is the most prevalent form of cardiovascular disease. Atherosclerosis and hypertension are risk factors for each other..

[Audio] Plaque Development Inflammation leads to many more events. The immune system responds by sending white blood cells to the site to try to repair the damage. Particles of Low density lipoprotein or LDL cholesterol become trapped in the blood vessel walls, and these become oxidized by abundant free radicals produced during inflammation. White blood cells flood the scene to scavenge and remove the oxidized LDLs, and as they become engorged with oxidized LDL, they take on a foamy appearance (hence the name foam cells). Then these foam cells become triggers of oxidation and inflammation that attract more scavengers to the scene. The smooth muscle cells of the arterial walls proliferate in order to heal the damage, but they, too, may become trapped in the plaques. Some plaques become covered with fibrous coatings; some are hardened by calcium deposits. Ultimately, many inner artery walls are virtually covered with rigid, disfiguring plaques. Once plaques have formed, a spasm of an artery wall or a surge in blood pressure can tear the surface of a plaque, causing it to rupture. Then the body responds to the damage as to an injury—by clotting the blood..

[Audio] Continuation Previous Slide Blood Clot Formation Clots form and dissolve in the blood all the time, and when the processes are balanced, the clots do no harm. Blood clots are a normal and necessary response to injuries that bleed: they shut down blood flow and begin the healing process. In atherosclerosis, though, the balance is upset and clots form faster than they dissolve. Arterial damage, plaques in the arteries, and inflammation all favor the formation of blood clots. When the words cerebral (brain) or coronary (heart) modify the terms just introduced, they describe life-threatening events in the brain or heart. For example, such an event in the brain is called a stroke, and such an event in the heart is a heart attack. Atherosclerosis Raises Blood Pressure Plaques in arteries also promote and aggravate hypertension (high blood pressure). Normally, arteries expand with each heartbeat, accommodating the pulses of blood that flow through them, but arteries hardened and narrowed by plaques cannot expand, so the blood pressure rises. High blood pressure then becomes a symptom of atherosclerosis. Hardened arteries also fail to let the blood flow freely through the kidneys, which respond as if the blood pressure is low: they release hormones that stimulate the body to retain sodium and water. This, of course, enlarges blood volume and makes the blood pressure still higher in a vicious cycle. High Blood Pressure Accelerates Atherosclerosis High blood pressure also worsens atherosclerosis. High pressure damages the artery walls, making fatalities more likely. And because plaques are most likely to form at damage sites, atherosclerosis progresses most rapidly at those sites. Thus, the manifestation of each chronic disease precipitates and aggravates the other..

[Audio] Figure 11.3 The Formation of Plaque in Atherosclerosis. An illustrated graphic shows how plaques are formed in the arteries of a person with atherosclerosis. The graphic shows an illustration of the heart. The lower portion of the heart is shaded in brown. Text below this illustration reads, "These coronary arteries bring nourishment to the heart muscle. If one of these arteries becomes blocked by plaques, the part of the heart muscle that it feeds will die." An arrow leads from the illustration of the heart to a zoomed-in view of the artery, which has a thin yellow layer forming on it. Text beside this zoomed-in reads, "Plaques begin to form." Another arrow leads from this view to another zoomed-in view of the artery, which has thicker layers of the yellow substance. Text beside this zoomed-in view reads, "Well-developed plaques are now established." A photo beside this shows the insides of an artery that has a thick layer of deposit on it. Text below this photo reads, "Plaques form along the artery's inner wall, reducing blood flow.".

[Audio] Cardiovascular disease is the leading cause of death in the United States. Atherosclerosis is the major underlying cause of cardiovascular disease, and hypertension is the most prevalent form of cardiovascular disease. Atherosclerosis and hypertension are risk factors for each other. As most people age, atherosclerosis progresses steadily. The development of atherosclerosis involves plaque development, blood clot formation, and hypertension. Atherosclerosis and hypertension accelerate each other. Table 11-3 lists only those risk factors specific to heart disease. All people reaching middle or old age exhibit at least one of these factors (advancing age itself is a risk factor), and many people have several factors silently increasing their risks. The more of these risks you can and do control, the lower your risks of CVD-induced disability and death. In recognition of the urgency to reduce the prevalence of major risk factors for CVD, the American Heart Association (AHA) has initiated My Life Check, an interactive online tool useful for assessing risks for heart disease and stroke. In addition, Life's Simple Seven lists seven actions associated with ideal cardiovascular health. They include: Manage blood pressure. Control cholesterol. Reduce blood sugar. Be active. Eat better. Lose weight. Stop smoking..

[Audio] Many chronic diseases are themselves risk factors for other chronic diseases, and all of them are linked to obesity. The risk factors highlighted in blue define the metabolic syndrome..

[Audio] What is the relationship between hypertension and atherosclerosis?.

[Audio] Answer: 1. Atherosclerosis raises blood pressure and high blood pressure accelerates atherosclerosis. 2. Plaques in arteries also promote and aggravate hypertension. Normally, arteries expand with each heartbeat, accommodating the pulses of blood that flow through them, but arteries hardened and narrowed by plaques cannot expand, so the blood pressure rises. High blood pressure then becomes a symptom of atherosclerosis. 3. High blood pressure also worsens atherosclerosis. High pressure damages the artery walls, making fatalities more likely. And because plaques are most likely to form at damage sites, atherosclerosis progresses most rapidly at those sites..

[Audio] Figure 11.5 Adult Standards for Blood Lipids High density lipoprotein or HDL carry cholesterol away from the body's cells to the liver to be assigned to other uses or disposed of. HDL also carry proteins that inhibit inflammation, plaque accumulation, and lipid oxidation—all, valuable services to the body. Thus, low HDL levels can contribute to the development of atherosclerosis. (One might think, then, that the higher the HDL concentration, the better, but above a certain level, higher HDL concentrations produce no greater benefits.) Triglyceride transporters (Very low density lipoproteins or VLDLs) are influential too: high blood triglyceride concentrations promote atherosclerosis. About one-fifth of adults in the United States have high blood triglyceride concentrations. These high blood triglyceride levels are associated with a sedentary lifestyle, overweight and obesity (especially abdominal obesity), and type 2 diabetes. A blood test that reports "high blood triglycerides," "high LDL cholesterol," and "low HDL cholesterol" predicts the further development of plaques and the progression of atherosclerosis. It is clear, then, that one thing you can do to reduce your risk of CVD is to take actions to achieve healthy blood levels of cholesterol and triglycerides (see the top row of Figure 11-5)..

[Audio] Table 11-4 Metabolic Syndrome What is Metabolic Syndrome? Metabolic syndrome is a group of health problems, like high blood pressure, high blood sugar, extra body fat around the waist, and abnormal cholesterol levels. These issues increase the risk of heart disease and other health problems..

[Audio] You can read this slide.. Recommendations to Reduce CVD Risk.

[Audio] Table 11-5 How Much Does Changing the Dietary Pattern Lower LDL Cholesterol? You can read this Slide..

[Audio] Diabetes At the start of this chapter, diabetes was identified not only as a major risk factor for CVD, but also as a leading cause of death in the United States. Recent decades have seen a sharp rise in the rate of type 2 diabetes afflicting both adults and children: more than 34 million people in all have diabetes. In addition, well over one-third of U.S. adults, or 88 million more, have prediabetes, exhibiting warning signs of diabetes to come. What is Prediabetes? Prediabetes is when your blood sugar levels are higher than normal but not high enough to be classified as diabetes. It's a warning sign that you are at risk of developing type 2 diabetes if you don't make healthy changes..

[Audio] There are two common forms of diabetes, type 1 and type 2. Both disorders involve insulin and blood glucose and both pose similar risks to health; they differ in their typical ages of onset and in the presence or absence of insulin. Type 1 diabetes accounts for 5 to 10 percent of all cases. It usually sets in during childhood or adolescence but it can begin at any age, even late in life. Although type 1 diabetes is far less common than type 2, worldwide an estimated 1.1 million children and adolescents (under age 20) have type 1 diabetes and it is increasing in prevalence each year. The predominant type of diabetes, type 2 diabetes, is closely linked with obesity and is responsible for 90 to 95 percent of cases in both adults and children. Although type 2 diabetes typically appears later in life, it has been on the rise among children and adolescents, following current trends in obesity among U.S. youth. In type 2 diabetes, there is an inadequate response of the body's cells to the hormone insulin—that is, insulin resistance. Table 11-7 displays other distinguishing characteristics. Type 1 diabetes is an autoimmune disorder. A person's own immune cells mistakenly attack and destroy the insulin-producing cells of the pancreas. The rate of pancreatic cell destruction in type 1 diabetes varies. In infants and children, destruction is rapid; in adults, it is slow. Eventually, the damaged pancreas no longer produces enough insulin to control blood glucose adequately. Then, after each meal, glucose concentration builds up in the blood, while body tissues are simultaneously starving for glucose, a life-threatening situation. The person must receive insulin from an external source to assist the tissues in taking up the glucose they need from the bloodstream. Insulin is a protein, and if it were taken orally, the digestive tract would digest it. Insulin must therefore be taken as daily injections, inhaled in powder form, or pumped from an insulin pump that delivers it through a tiny tube implanted under the skin. Some insulin pumps also monitor blood glucose and report its levels throughout the day. Fast-acting and long-lasting forms of insulin allow more flexibility in managing meals and treatments, but users must still plan ahead to balance blood insulin and glucose consumption..

[Audio] How Does Type 2 Diabetes Develop? In type 2 diabetes, the body's cells are deprived of some or all of the glucose energy they need, even as both glucose and insulin build up in the blood. The glucose that is circulating in the blood would normally enter cells freely with the help of insulin from the pancreas, but now the cells are failing to respond to it. When the muscle, fat, and other cells become insulin resistant and fail to take up glucose from the blood, the blood glucose concentration rises. The pancreas responds by producing more and more insulin, but to no avail Eventually, the overtaxed cells of the pancreas begin to fail and reduce their insulin output, while blood glucose soars farther out of control. Chronically elevated blood glucose taxes the kidneys with the task of excreting the excess (this produces the familiar diabetes symptom of sugar in the urine) and alters metabolism in virtually every cell of the body. Some cells convert excess glucose to toxic alcohols. In other cells, glucose becomes attached to working protein molecules, rendering them nonfunctional. When blood glucose is high and the cells are starved for energy, a triad of telltale symptoms appears: Intense hunger, although there is plenty of glucose in the blood, the cells are starved for energy Frequent urination, because the kidneys are filtering excess sugar out of the blood and having to draw water from the body to excrete Intense thirst, because the frequent urination brings about dehydration Recognizing these symptoms and seeking medical help as soon as possible can often help to minimize the consequences of untreated diabetes..

[Audio] Figure 11 – 8 Diabetes Test Standards You can read this Slide..

[Audio] Table 11-8 Common Misconceptions about Diabetes Harm from Diabetes A common misconception still held by too many people is that diabetes is of little real consequence to health. In fact, diabetes is a dangerous disease that can strike anyone at any time (Table 11-8 dispels other false ideas.) The altered metabolism from uncontrolled blood glucose damages many organs and tissues. Should these critical systems begin to fail, both health and life are jeopardized. In type 2 diabetes, atherosclerosis develops early and progresses rapidly. Chronically elevated blood glucose alters metabolism in virtually every cell in the body. Type 2 diabetes damages blood vessels and nerves, impairing circulation and nerve function, and causing kidney damage, vision problems, and infections. Read this slide to understand other misconceptions about diabetes..

[Audio] Diseases of the Large Blood Vessels? Atherosclerosis tends to develop early, progress rapidly, and become severe in people with diabetes. The interrelationships among insulin resistance, obesity, hypertension, and atherosclerosis help explain why the most common causes of death in people with long-term diabetes are heart attacks and strokes. This close relationship between the CVD and diabetes is reflected in their risk factors. When you study the CVD risk factors listed in Table 11-3, it's easy to spot their overlap with these three risk factors for type 2 diabetes: Advancing age. Diabetes testing should begin at age 45 for everyone. Family history (heredity). Having a close relative with type 2 diabetes increases the risk. Overweight and obesity. Most, but not all, people with type 2 diabetes are overweight, and obesity can foster insulin resistance. In addition, race and ethnicity affect diabetes risk: Black Americans, Hispanic Americans, certain Asian Americans, Native Americans, and Pacific Islanders all have increased risks for type 2 diabetes. Impaired Kidney, Eye, and Nerve Function In diabetes, the structures of the blood vessels and nerves become damaged, leading to diminished blood circulation and nerve function. Poor circulation leads to dry skin and a tendency to develop slow-healing injuries and infections. Critical organs become inefficient and begin to fail all over the body. Reduced blood flow to the kidneys damages them, often making it necessary to cleanse the blood outside of the body by means of kidney dialysis or, in late stages, to undergo kidney transplant. Poor circulation to the eyes impairs vision and can lead to blindness. Diabetes is the leading cause of both kidney failure and blindness in adults in the United States. Poor circulation at the extremities makes the peripheral nerves insensitive to the pain that would otherwise signal injury or infection, so injuries and infections of the feet and hands go undetected. These events can lead to death of tissue (gangrene), necessitating amputation of the affected limbs (most often the feet)..

[Audio] Diabetes Prevention and Management 1. The first steps in diabetes prevention involve self-study: learn your family history and risks and get tested for symptoms of developing diabetes. 2. To slow or halt the progression of diabetes, one should lose weight if overweight, and learn to manage blood glucose levels by balancing physical activity, carbohydrate intake, and drug therapy recommended by a health care provider. 3. A diet consisting of nutrient-dense foods and low in saturated fat and added sugars can play a crucial role in controlling the symptoms and progression of type 2 diabetes..

[Audio] You can read this Slide.. Knowledge Check 1.

[Audio] You can read this Slide.. Knowledge Check 1: Answer.

[Audio] You can Read this Slide.. Diabetes Summary.

[Audio] Cancer Second only to cardiovascular disease as a leading cause of disability and death in the United States is cancer. More than 1.9 million new cancer cases and 608,000 deaths from cancer are expected to occur in the United States in 2021. Still, the past few decades have revealed a small but steady trend toward declining cancer deaths. Early detection and treatment have transformed several common cancers from intractable killers to curable diseases or treatable chronic illnesses. Although the potential for cure is promising, prevention of cancer remains preferable by far. Cancer exists in perhaps the widest variety of types and has the most diverse causes of any chronic disease. Some cancers are known to be caused primarily by genetic factors, and they run in families regardless of lifestyle choices. Others are linked with microbial infections. However, for the vast majority of cancers, lifestyle choices and environmental exposures are the major risk factors. For example, avoiding tobacco in any form, eating a nutritious diet, maintaining a healthy weight, and engaging in physical activity on a regular basis, have the potential to eventually reduce much of the global burden of cancer. Unfortunately, given current trends, overweight and obesity may overtake smoking as the leading risk factor for cancer. As a positive effect of knowledge of this kind, the incidence of hormone-related breast cancer has dropped significantly since women have stopped taking hormone replacement therapy for symptoms of menopause..

[Audio] The Cancer Disease Process Cancer arises in the genetic material inside a person's cells. The process, called carcinogenesis, usually proceeds slowly and continues for several decades. It often begins when a cell's genetic material sustains damage from a carcinogen such as radiation, a free radical, or another cancer-causing chemical. Damage from these insults occurs every day, but cells can often deflect or promptly repair it. If the damage is not repaired and the cell becomes unable to faithfully replicate its genetic material, it dies by way of a sort of cellular suicide, thereby preventing its progeny from inheriting faulty genes. Occasionally, a damaged cell doesn't die off but continues to live and becomes unable to halt its own reproduction. In a healthy, well-nourished person, the immune system steps in to destroy such cells. If, however, the immune system falters, the damaged cell reproduces and grows out of control and the result is a mass of abnormal tissue—a tumor. Life-threatening cancer begins with an event called initiation. Following this, promoters, such as hormones or environmental factors, stimulate tumor growth. Then the tumor overwhelms the healthy tissue in which it originated from, or exports its cells through the bloodstream to other parts of the body to initiate other tumors (metastasis). Figure 11-9 depicts these events. Key Points Cancer arises from genetic damage and develops in steps..

[Audio] Cancer Risk Factors Can people's behaviors affect their risks of contracting cancer? In many cases, they can. This section describes many lifestyle factors that influence cancer risk, and the next section, "Cancer Prevention," gives details of the measures people can take to minimize that risk. Advancing Age First among the unalterable risk factors for cancer, as for all chronic diseases, advancing age makes people increasingly vulnerable to the disease. The effects of habits you have engaged in from the start of your life add up to exert a powerful influence on your later health. Family History (Heredity) This factor, too, is one you cannot change, but knowing whether cancer runs in your family can give you a head start on taking preventive steps. Inherited susceptibility to cancer accounts for only a small proportion of cancer cases. Chronic Inflammation Inflammation plays a central role in cancer. Chronic inflammation may set in during the development of obesity, heart disease, diabetes, or other diseases, and can then accelerate the development of cancer. Diet Certain dietary factors substantially influence cancer development. The degree of risk imposed by food depends partly on the eater's genetic makeup and partly on some other influences still to be discovered. Some dietary factors believed to be important in cancer causation and prevention are discussed below..

[Audio] Cancer Risk Factors (Continued) 5. Weakened Immunity? The immune system can identify and fight cancer cells just as it fights allergens, toxins, and other foreign invaders. However, when immunity is weak, due to nutrient deficiencies, medical procedures, hormone treatments, or other influences, the body becomes defenseless against cancer development. Infections? Certain viral, bacterial, and parasitic infections present risks of specific type of cancer. (To give just one example, infection with human papilloma virus carries a risk of cervical cancer.) In many cases, the mode of action seems to be that these infections weaken the immune system's cancer-fighting ability. Obesity and Estrogen. Obesity is clearly a risk factor for cancers, especially those of the colon, endometrium, pancreas, kidney, esophagus, and breast (in postmenopausal women). These cancers originate differently depending on the organ. For example, in the case of breast cancer in postmenopausal women, the hormone estrogen is involved: women with obesity have more circulating estrogen than women who are lean do, because adipose tissue converts other hormones into estrogen and then releases it into the blood. In women of healthy weight, blood estrogen drops dramatically beyond menopause, but in obesity, fat tissue continues to produce estrogen beyond menopause, extending the exposure and increasing the breast cancer risk. Alcohol with Smoking. Alcohol intake by itself raises the risk of cancers of the mouth, throat, esophagus, colon, and breast, and alcoholism often damages the liver in ways that promote liver cancer. When drinkers add smoking to the insults inflicted on the body by alcohol, the rate of cancers of the head and neck rises significantly..

[Audio] Cancer Risk Factors (Continued) Carcinogens in Red and Processed Meats. Population studies spanning the globe for more than 30 years consistently report that diets high in red meat and processed meat increase the risk of colon cancer. Processed meats are listed among human carcinogens by the WHO. They contain additives, nitrites or nitrates, which contribute a pink color and deter bacterial growth in meats. In the digestive tract, nitrites and nitrates form other nitrogen-containing compounds that may be carcinogenic. Cooking Methods. Cooking meats at high temperatures (frying, broiling) causes amino acids and creatine in the meats to combine and form carcinogens. Grilling meat, fish, or other foods—even vegetables—over a direct flame causes fat and added oils to splash on the fire and then vaporize, creating other carcinogens that rise and stick to the food. Smoking foods has the same effect. Eating these foods, or even well-browned meats cooked to the crispy, well-done stage, introduces carcinogens into the digestive system. A steady diet of foods containing these toxins can overwhelm defenses and increase cancer risk. Iron. Iron, both from the diet and from body stores, is under study for links with promotion of colon cancer. How iron may promote cancer is not known, but iron is suspected because it is a powerful oxidizing agent that can damage DNA. A high-meat diet generously supplies iron and also correlates with colon cancer risks..

[Audio] Cancer Risk Factors (Continued) Fried Foods. French fries and potato chips contain another offending substance, acrylamide, which is produced when they are fried or baked at high temperatures. In the body, some acrylamide is metabolized to a substance that may damage the genes, producing mutations. Based on this finding, acrylamide is classified as "a probable human carcinogen." New to the market is a genetically modified potato that forms less acrylamide when fried or baked. A Note about Environmental Carcinogens? Environmental factors also present risks of cancer. Overexposure to the sun, especially without the use of sunscreen or protective clothing, incurs a risk of skin cancer. Exposure to radiation, as when a nuclear accident occurs, poses a cancer risk; and there are many other such cases. However, these issues are not addressed in this book..

[Audio] Recommendations and Strategies for Reducing Cancer Risk You can read this slide..

[Audio] Recommendations and Strategies for Reducing Cancer Risk (Continued) You can read this Slide..

[Audio] Figure 11-11 Proper Nutrition Shields against Diseases An esteemed former surgeon general once said, "If you do not smoke or drink excessively, your choice of diet can influence your long-term health prospects more than any other action you might take." Indeed, healthy young adults today are privileged to be among the first generations with enough nutrition knowledge to lay a truly strong foundation of health for today and tomorrow. Figure 11-11 illustrates this point. Explanation Figure 11 – 11 An illustration shows a girl in a raincoat, holding up an umbrella over her head. Superimposed on the umbrella are the following labels: high in fiber and fluid; high in fruit; low in saturated and trans fats; high in whole grains; little or no alcohol; high in vegetables; adequate in nutrients; moderate in calories and salt; attention to food safety. The following labels are superimposed on the raindrops falling on the umbrella: stress; hypertension; infectious diseases; atherosclerosis; diabetes; heart disease; obesity; cancer; stroke. Text above the illustration reads, "A well-chosen diet can protect your health.".

[Audio] DASH means Dietary Approaches to Stop Hypertension. The DASH Diet focuses on foods that are rich in calcium, potassium, protein, fiber, and magnesium. These are essential in helping control your blood pressure and letting you lose weight in a healthy way. The diet is also low in sodium, added sugars, and saturated fat contents. Although there are some restrictions, the DASH Diet isn't exactly a strict diet. You are simply guided towards a meal plan that prioritizes foods that are rich in these amazing nutrients and low in sodium and saturated fat. The DASH Diet has proven results with studies showing lower blood pressure levels after starting this diet within two weeks. It is also effective in lowering the body's bad cholesterol levels and a great way to prevent strokes and heart disease. Our DASH Diet Meal Plan, is custom designed to your exact meal preferences, dietary requirements and lifestyle. By creating a diet that reflects how you choose to live and eat, you will be losing weight and lowering your blood pressure in a sustainable and healthy way. Description of the DASH Eating Plan The DASH eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends: 1, Eating vegetables, fruits, and whole grains 2. Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils 3. Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils 4. Limiting sugar-sweetened beverages and sweets.

[Audio] Table 11-10 Strategies for Consuming Enough Fruit, Vegetables, and Legumes You can read this Slide..

[Audio] Concerns about Genetically Modified Organisms or GMOs What are GMOs? Genetically Modified Organisms (GMOs) are organisms (plants, animals, or microorganisms) whose genetic material has been altered using genetic engineering techniques. This involves the introduction, elimination, or alteration of specific genes within an organism's DNA to achieve desired traits. Common goals for creating GMOs include enhancing crop resistance to pests and diseases, improving nutritional content, and increasing crop yield. GMOs are widely used in agriculture, medicine, and research. Consumers rightly want to know about any potential risks from bioengineering. The FDA, too, asks whether genetically altered foods differ substantially from other foods in their nutrient contents or safety..

[Audio] Table C12-1 Biotechnology Terms What is Biotechnology ? Biotechnology is the science of manipulating biological systems or organisms to modify their products or components or create new products; biotechnology includes recombinant DNA technology and traditional and accelerated selective breeding techniques. Advances in biotechnology have raised hopes of solving some of today's most pressing food and energy problems while boosting profits for farmers and other producers. Although recombinant DNA (rDNA) technology may seem futuristic, its roots lie in genetic events that have been occurring unaided for untold millions of years. Human beings have exploited these processes from the advent of agriculture. With or without their awareness, most people in this country consume foods that contain products of bioengineering. As Figure C12–1 illustrates, most U.S. soybeans and animal feed corn (not sweet corn consumed by people) are genetically modified organisms (GMOs). Ubiquitous food additives, such as soy lecithin and high-fructose corn syrup, are made from these genetically engineered plant materials and enter the human food supply in processed foods. Other GMOs, such as apples, papayas, potatoes, and summer squash, are consumed directly. Some consumers recoil from the idea of eating genetically engineered products, and whole countries have banned such foods outright. Some objections are based on credible ideas, but most others arise from emotional fears, distrust of technology, and misinformation. You can read this Slide to learn about other terms in this section..

[Audio] Table C12-2 Some Examples of Bioengineering Research Direction You can read this slide..

[Audio] Recombinant DNA Technology With economy, speed, and precision, rDNA technology can change one or more characteristics of a living thing. The genes for a desirable trait in one organism are transferred directly into another organism's DNA. With advancements in gene editing, scientists can now alter molecules within a single gene's DNA strand for increasingly precise results. Figure C12–3 compares the genetic results of selective breeding and rDNA technology. Table C12–2 (Previous Slide) presents examples of biotechnology research directions. Obtaining Desired Traits Using rDNA technology, scientists can confer useful traits, such as disease resistance, on food crops. To make a disease-resistant potato plant, for example, the process begins with the DNA of an immature cell, known as a stem cell, from the "eye" of a potato. Into that stem cell scientists insert a gene snipped from the DNA of a virus that attacks potato plants (enzymes do the snipping). This gene codes for a harmless viral protein, not the infective part. The newly created stem cell is then stimulated to replicate itself, creating clone cells—exact genetic replicas of the modified cell. With time, what was once a single cell grows into a transgenic organism—in this case, a potato plant that makes a piece of viral protein in each of its cells. The presence of the viral protein stimulates the potato plant to develop resistance against an attack from the real wild virus in the potato field. Plants make likely candidates for bioengineering because a single plant cell can often be coaxed into producing an entire new plant. Animals can also be genetically modified, however. Under development is a line of goats that, thanks to a spider's gene, express spider silk protein in their milk. Once processed, the stronger-than-steel silk fiber can be used to make artificial ligaments and bulletproof vests. Suppressing Unwanted Traits This rDNA technology can also remove an unwanted protein from a plant by silencing the genes responsible for its creation. For example, scientists have created a safer peanut by silencing the genes for proteins that commonly cause allergic reactions. Likewise, a GE potato can be made into safer potato chips and French fries because it is engineered to have less of an amino acid that forms a carcinogenic toxin during frying. Apples that stay white after slicing instead of turning brown are available in markets; gluten-free wheat may be next..

[Audio] Figure C12-3 Comparing Selective Breeding and rDNA Technology You can read this Slide..

[Audio] Figure C12-2 Corn: A Product of Selective Breeding The wild corn on the left, with its sparse kernels, bears little resemblance to today's large, full, sweet ears (right). Season after season, farmers influence the genetic makeup of food plants and animals by selecting only the best farm animals and plants for breeding. Today's lush, hefty, healthy agricultural crops and animals, from cabbage and squash to pigs and cattle, are the result of thousands of years of selective breeding. Consumers of today's large cobs of sweet corn, for example, may not recognize the original wild native corn with its sparse four or five kernels to a stalk (shown in Figure C12–2 ). Today, accelerated selective breeding techniques involve hundreds of thousands of cross-bred seeds planted on vast acreages. To develop crops with desired traits, DNA data from successful seedlings are analyzed by computer. Seedlings with the right genes are grown to maturity and reproduced to yield new breeds in a relatively short time. Some unusually colorful carrots, including the purple, light yellow, or deep red varieties now seen in some specialty grocery stores, are products of this kind of selective breeding. Selective breeding must stay within the boundaries of a species—a carrot, for example, cannot be crossed with a mosquito. Recombinant DNA technology, however, knows no such limits..

[Audio] The Promises and Problems of Bioengineering Supporters hail bioengineering as nothing short of a revolutionary means of overcoming many of the planet's pressing problems, such as food shortages, nutrient deficiencies, medicine shortages, dwindling farmland, lack of renewable energy sources, and environmental degradation. A few examples follow. 1. Human Nutrition Rice leads the way in a genomic revolution of the world's food supply. A rice (called Golden Rice) provides up to 35 micrograms of absorbable beta-carotene per gram of rice; white rice provides none. Figure C12–4 compares Golden Rice with white rice. Rice is an excellent vehicle for delivering vitamin A to areas of the world where rice is a staple food: everyone there eats rice, often several times a day. In comparison, carrots, famously rich in beta-carotene, are not a preferred food in those places. A single bowlful (about a cup and a half) of Golden Rice provides about 60 percent of a child's vitamin A need, a significant contribution in the fight against deficiency diseases and childhood blindness worldwide. Uncertainty fostered by anti-GMO activists has cast doubt about the safety of Golden Rice around the world. Twenty years after its development, few countries are growing it. Meanwhile, with each passing year, vitamin A deficiency harms hundreds of thousands of children worldwide. Other GMO rice varieties, some offering supplemental iron and folate, could relieve much iron-deficiency anemia and folate deficiency around the world. Still others may resist drought, floods, or insects and thus provide more food for hungry populations. Not just rice but worldwide staples like cassava roots or potatoes can be "biofortified" with minerals, vitamins, fatty acids, or promising phytochemicals. In the case of cassava, it can also be made safer by reducing its concentration of naturally occurring toxins. 2. Molecules from Microbes The genes of microorganisms have been altered to make pharmaceutical and industrial products. For example, a transgenic bacterial factory now mass-produces the hormone insulin used by people with diabetes. Another bacterium received a bovine gene to make the enzyme rennin, necessary in cheese production. (Historically, rennin was harvested from the stomachs of calves, an expensive process.).

[Audio] Figure C12-4 Golden Rice Beta-carotene, the vitamin A precursor, gives Golden Rice its yellow hue. You can read this slide..

[Audio] The Promises and Problems of Bioengineering 3. Greater Crop Yields Most of today's genetically engineered crops are of two types: herbicide-resistant and insect-resistant, both used to improve yields and protect farmed land. Herbicide-resistant crops, for example, offer weed control with less soil tillage by allowing farmers to spray whole fields, not just weeds, with glyphosate-based herbicides. The weeds die, their roots hold soil in place between the rows, and the crops grow normally. After years of such spraying, however, some weeds have developed vigorous resistance to glyphosate. Weeds grow large and spread fast despite repeated sprayings, forcing many farmers to return to old tillage methods to control them and thereby exposing vast quantities of farm topsoil to wind and water erosion. As for insect-resistant crops, GMOs make what the EPA calls plant pesticides—pesticides made by the plant tissues themselves. For example, a type of feed corn produces a pesticide that kills a common corn-destroying worm, thereby greatly increasing yields per acre of farmland. In areas where people cannot afford to lose a single morsel of food and where plant diseases and insects can claim up to 80 percent of a season's yield, genetically engineered plants can save whole crops, delivering relief to millions of chronically hungry people. 4. A Fast-Growing Fish The FDA recently approved a genetically altered farm-raised salmon that received genes from two other fish species. The added genes code for a hormone that stimulates faster than normal growth in the new salmon, cutting production time, as illustrated in Figure C12–5. After extensive scientific review, the FDA concluded that the salmon is as safe to eat as other fish, and that its new DNA and its growth hormone are also safe both for consumers and the fish itself..

[Audio] Figure C12-5 Two Salmon Compared These two salmon are the same age, but the GMO salmon reached market size much faster. You can red this slide..

[Audio] Concerns about GMOs 1. Nutrient Composition Except for intentional variation created through bioengineering, the nutrient composition of genetically modified foods is identical to that of traditional foods. From the body's point of view, Golden Rice is the same as plain rice, plus a beta-carotene supplement. GMOs may contribute to overdoses of nutrients or phytochemicals, but they pose no unusual threat of deficiencies. Accidental Ingestion of Drugs from Foods Genetically modified corn, soybeans, rice, and other food crops that make human and animal drugs and industrial proteins must be grown indoors in selected locations. Their containment areas, however, often border on farms where conventional or organic food crops are grown. Critics fear that DNA from drug-producing GMOs might contaminate the food supply by cross-pollination, despite USDA oversight. Disasters such as tornadoes, floods, or other events could carry the pollen long distances, thereby inadvertently introducing the man-made genes into ordinary farm crops, in which they would not be detected and from which they could not be retrieved. 3. Pesticide Residues Industry scientists contend that bioengineering could virtually end problems associated with pesticide use on foods. The consequences of human error can be eliminated, they say, when introduced genes determine not only the nature but also the quantity of pesticide produced. Critics counter that although GMOs may be protected from one or two common pests that may or may not be present on a particular field, farmers must still spray insecticides to kill other pests that are devouring their crops. Also, still more worrisome, constant exposure is inducing crop-destroying insects to develop resistance to natural plant pesticides. Pesticides that are sprayed onto crops can be largely removed from food by washing or peeling produce, but consumers cannot remove pesticides that form within the tissues of a genetically modified fruit or vegetable. Still, plant pesticides are highly unlikely to cause health problems because they are made of peptide chains (small protein strands) that human digestive enzymes readily denature. Plant pesticides, like other pesticide residues, are regulated and approved by the FDA..

[Audio] Concerns about GMOs (Continued) 4. Unintended Health Effects The possibility exists that GMOs may have unintended and therefore unpredictable effects on human health. A lesson comes from an unexpected negative effect of selective breeding. Over many years, celery growers had crossed their most attractive celery plants because consumers paid a premium for good-looking celery. Unknown to the growers, however, the most beautiful celery contained a great deal of a natural plant pesticide, and its concentration increased with each breeding cycle. Farm and grocery workers who handled the celery began suffering from serious skin rashes until the problem was finally traced to high levels of the natural pesticide in the beautiful plants. Another example (this time an unintended benefit of bioengineering) involves a carcinogenic fungus that sometimes grows on corn. Upon producing a strain of corn that carried a plant pesticide to control worm damage and then observing this corn for several generations, scientists discovered that the crop suffered far fewer attacks by the dangerous fungus. It turns out that the worms spread the fungus as they burrowed into cobs of ordinary corn, but the plant pesticide in the genetically engineered corn killed the worms and stopped the fungus from spreading.

[Audio] Concerns about GMOs (Continued) 5. Environmental Effects Between 1996 and 2018, farming with genetically engineered crops reduced the use of insecticides by almost 2 billion pounds of active ingredients worldwide. At the same time, the use of glyphosate herbicides that GMOs resist, has greatly increased, making it unnecessary to use more highly toxic and persistent herbicides in the fields. Also, herbicide-resistant crops require far less plowing to kill weeds and so minimize soil erosion The possibility of outcrossing, the accidental cross-pollination of plant pesticide crops with related wild weeds remains a concern. If a weed inherits a pest-resistant trait from a neighboring field of genetically engineered crops, it gains an enormous survival advantage over other, possibly important, wild species and crowds them out. Loss of species is another serious threat. By propagating only a few crop varieties worldwide, humankind becomes vulnerable to serious losses in a changing environment. Species that teeter on the brink of extinction today may hold critical genetic traits that could help food crops to survive in harsher future conditions. Concerns for wildlife also exist. In the laboratory, monarch butterfly larvae die when fed pollen from pesticide-producing corn. In real life, wild butterflies do not seem to consume enough toxic corn pollen for populations to be harmed. The new technology may even protect some percentage of the dwindling monarchs and other harmless or beneficial insects that die when they feed on conventionally sprayed fields..

[Audio] Table C12-3 (1 of 2) Bioengineering of Foods: Point, Counterpoint Ethical Arguments about Bioengineering In the end, consumer acceptance determines the applications of genetic engineering. Some people fear that by tampering with the basic blueprint of life, bioengineering will sooner or later unleash mayhem into the defenseless world. No degree of risk is justified, they say, because although it raises profits for biotechnology companies and farmers, its products provide little direct benefit to consumers. Others object to bioengineering on religious grounds, holding that genetic decisions are best left to nature or a higher power. Table C12–3 Bioengineering of Foods: Points, Counterpoint summarizes some of these issues. You can read this Slide..

[Audio] Table C12-3 (2 of 2) Bioengineering of Foods: Point, Counterpoint (Continued) You can read this Slide..

[Audio] Figure C12-6 Bioengineering Food Labels Most bioengineered foods and foods with ingredients derived from them may soon bear labels such as these. Regulation of GMOs The FDA evaluates the safety of today's genetically modified fruit, vegetables, and grains for human consumption and takes the position that we can confidently assume that they are safe unless they differ substantially from similar foods already in use. To help consumers who wish to avoid GMOs, Congress passed a law to mandate uniform labeling of GMO foods, and these labels are displayed in Figure C12–6. Meanwhile, consumers are snapping up foods and other products—even detergents and other items unrelated to bioengineering—that bear "non-GMO" labels..

[Audio] Nutrient Drug Interactions A 45-year-old Chicago business executive attempts to give up smoking with the help of nicotine gum. She replaces smoking breaks with beverage breaks, drinking frequent servings of tomato juice, coffee, and colas. She is discouraged when her stomach becomes upset and her craving for tobacco continues unabated, despite the nicotine gum. Problem: nutrient–drug interaction. A 14-year-old girl develops frequent and prolonged respiratory infections. Over the past 6 months, she has suffered constant fatigue despite adequate sleep, has had trouble completing school assignments, and has given up playing volleyball because she runs out of energy on the court. During the same 6 months, she has been taking antacid pills several times a day because she heard this was a sure way to lose weight. Her pediatrician has diagnosed iron–deficiency anemia. Problem: nutrient–drug interaction. A 30-year-old schoolteacher who benefits from antidepressant medication attends a faculty wine and cheese party. After sampling the cheese with a glass or two of red wine, his face becomes flushed. His behavior prompts others to drive him home. In the early morning hours, he awakens with severe dizziness, a migraine headache, vomiting, and trembling. An ambulance delivers him to an emergency room where a physician takes swift action to save his life. Problem: nutrient–drug interaction..

[Audio] The Potential for Harm People sometimes think that medical drugs do only good, not harm. As the opening stories illustrate, however, both prescription and over-the-counter (OTC) medicines can have unintended consequences, among which are significant interactions with nutrition. Factors that Make Interactions Likely Significant interactions do not occur every time a person takes a drug. The potential for interactions is greatest in those who take medicines for a long time, who take multiple drugs, who drink alcohol daily, or who are poorly nourished to begin with. The risk of an adverse effect rises substantially among people with chronic diseases or other conditions that may require five or more daily medications for months or years. The risks compound further when herbs and other supplements are added to the mix. The details of nutrient–drug interactions are many and far more extensive than can be presented here. These discussions are intended to raise awareness of the most common ones and offer a preventive strategy..

[Audio] Some drugs are known to interact with specific nutrients (see Table C11-1 next slide). In addition, alcohol is infamous for its interactions with nutrients, and the more alcohol ingested, the more likely that a significant nutrient interaction will occur. Figure C11-1 shows that drugs can mix with foods, nutrients, and herbs in different ways. Each can change how the others are absorbed, work, are broken down, or removed from the body. The arrows show that foods, drugs, and herbs can interfere with each other's absorption, actions, metabolism, or excretion..

[Audio] Table C11-1 Selected Nutrient-Drug Interactions Some drugs are known to interact with specific nutrients (see Table C11-1). In addition, alcohol is infamous for its interactions with nutrients, and the more alcohol ingested, the more likely that a significant nutrient interaction will occur. You can read this slide..

[Audio] Table C11-2 Some Foods High in Tyramine Metabolic Interactions The teacher who landed in the emergency room was taking an antidepressant medicine, one of the monoamine oxidase inhibitors (MAOI). At the party, he suffered a dangerous chemical interaction between the medicine and the compound tyramine in his cheese and wine. Tyramine is produced during the fermenting process in cheese and wine manufacturing. Table C11-2 lists some foods high in tyramine. The MAOI medication works by depressing the activity of enzymes that destroy the brain neurotransmitter dopamine. With less enzyme activity, more dopamine is left, and depression lifts. As a side effect, the drug also depresses enzymes in the liver that destroy tyramine. Ordinarily, the man's liver would have quickly destroyed the tyramine from the cheese and wine, but due to the MAOI medication, tyramine built up and caused the potentially fatal reaction. Phytochemicals in foods, spices, and herbal supplements also affect drug metabolism. A chemical constituent of grapefruit juice suppresses an enzyme responsible for breaking down many kinds of medical drugs. With less drug breakdown, doses build up to toxic levels in the body. A person who drinks either grapefruit or cranberry juice and takes the blood-thinning drug Warfarin may exhibit delayed blood clotting with dangerously prolonged bleeding times..

[Audio] Figure C11-2 The Amount of Caffeine in Selected Food or Drink Products These foods and drinks in Figure C11-2 contain caffeine, but their labels usually don't say how much caffeine is contained in either their food or drink product. You might find this information on the manufacturer's website.. People in every society use caffeine in some form for its well-known "wake-up" effect. Caffeine is a true stimulant drug. Like all stimulants, it increases the respiratory rate, heart rate, and secretion of stress and other hormones. Caffeine also raises the blood pressure, an effect that lasts for hours after consumption. In addition, caffeine interacts with a wide range of medical drugs, such as antibiotics and heart and lung medications. The same set of liver enzymes that metabolize the drugs also break down caffeine, and competition for the enzymes slows the body's clearance of both. Caffeine's interactions with foods and nutrients are subtle but may be significant because caffeine is ubiquitous in foods and beverages—see Figure C11-2. Chocolate bars, colas, and other foods favored by children contain caffeine, and children are most sensitive to its effects. Many popular cold and headache remedies also offer about a cup of coffee's worth of caffeine per dose. Besides being a mild pain reliever, this amount of caffeine can stop a caffeine withdrawal headache that other pain relievers can't fix. Excessive intakes of caffeine (<400 milligrams per day for adults) can lead to caffeine toxicity and fatal cardiovascular events. Deaths are reported from consuming pure powdered caffeine which is sold as a "dietary supplement" . But, powdered caffeine is actually a strong drug. Because of pure powdered caffeine's toxicity, the Food and Drug Administration (FDA) sent a warning to its manufacturers and take other actions and warn consumers. A single teaspoon of the pure powdered caffeine delivers the caffeine of more than 30 cups of coffee.

[Audio] Nicotine Products Both tobacco and electronic vaping products are delivery systems for the drug nicotine. Tobacco's dangers are well known, and most are beyond the scope of nutrition. Smoking does depress hunger and, as a result, sometimes reduces body fat; it also accelerates the breakdown of vitamin C, upping requirements..

[Audio] The Research regarding e-Cigarettes and Vaping continues. You can read this slide..

[Audio] Research continues on Health and e-Cigarettes and Vaping. Here are some Resources..

[Audio] Table C11-3 Selected Herb and Drug Interactions Herbs can also interact with drugs, sometimes dangerously (see Table C11-3, p. 430). For example, people may take ginkgo biloba hoping to improve memory (evidence disproves this effect), but they may instead experience increased bleeding (ginkgo opposes blood clotting). When combined with other blood-thinning medications, such as aspirin or vitamin E, ginkgo biloba is associated with dangerous hemorrhaging..

[Audio] You can read this slide. Summary. Now that the lesson has ended, you should have learned: About the relationship between risk factors and chronic diseases. What the risk factors are for cardiovascular diseases (CVD). The causes, consequences, and management of type 2 diabetes. About the relationships between diet and cancer and the importance of including sufficient fruit and vegetables in a diet. How nutrients can interact with drugs. The debate around using bioengineering to produce foods..