CH-11-13 Eating Disorders – Wardlaw’s Contemporary Nutrition : Chapter Notes

This Document Contains Chapters 11 to 13 CHAPTER 11 EATING DISORDERS OVERVIEW This chapter discusses eating disorders including anorexia nervosa, bulimia nervosa, and binge-eating disorder. Other disordered eating patterns discussed include PICA, purging, night-eating syndrome, muscle dysmorphia, diabulimia, orthorexia, and the female athlete triad. Characteristics of each eating disorder or disordered eating pattern are described, including signs, symptoms, health-related problems, as well as treatment. Thoughts of an anorexic woman and a bulimic woman are shared. The significance of prevention and early recognition is emphasized. KEY TERMS Anorexia nervosa Atypial anorexia nervosa Binge-eating Binge-eating disorder Bulimia nervosa Cognitive behavior therapy Compensatory behaviors Disordered eating Eating disorder Endorphins Epigenetics Female athlete triad Lanugo Night eating syndrome Purging disorder STUDENT LEARNING OUTCOMES Chapter 11 is designed to allow you to: 11.1 Contrast healthy attitudes toward uses of food with behavior patterns that could lead to unhealthy uses of food. 11.2 Describe current hypotheses about the origins of eating disorders. 11.3 Enumerate physical and mental characteristics of anorexia nervosa, and outline current best practices for its treatment. 11.4 Enumerate physical and mental characteristics of bulimia nervosa, and outline current best practices for its treatment. 11.5 Enumerate physical and mental characteristics of binge-eating disorder, and outline current best practices for its treatment. 11.6 Describe still other forms of eating disorders, including night-eating syndrome and the female athlete triad. 11.7 Describe methods to reduce the development of eating disorders, including the use of warning signs to identify early causes. LECTURE OUTLINE From Ordered to Disordered Eating Habits Overview In addition to meeting physical needs, eating serves many psychological, social, and cultural purposes Mass media promote unattainable body image ideals even as society becomes more overweight and obese Negative perception of overweight and obesity begins early in life Disparity between ideal body image and reality pushes some to disordered eating habits or eating disorders Food: More Than Just a Source of Nutrients Eating can stimulate release of neurotransmitters and endorphins which produce feelings of calmness (comfort) or euphoria (pleasure) Food is often used as a bribe Disordered eating: mild, short-term change in eating in response to a stressful event, illness, health concern, etc. Origins of Eating Disorders Eating disorder: sustained changes in eating patterns along with emotional, cognitive, and body perception changes Eating disorders can result in serious health complications, possibly leading to death Frequently coincide with other psychological disorders (e.g., depression, substance abuse, anxiety disorders) Little evidence shows unhealthy family relationships as causal Genetic link to eating disorders Association between eating disorders and abuse Link between stressful life events (i.e., war) and development of eating disorders The Changing Face of Eating Disorders More than 5 million people in North America have eating disorders; women outnumber men 9:1 Male athletes more at risk than nonathletes, especially in sports with weight classes Homosexual men 2–3x more likely to develop eating disorders than heterosexual men Diagnosis is occurring at younger age Cultural changes have mostly equalized rates of eating disorders across racial and ethnic groups Anorexia Nervosa Overview Extreme weight loss, distorted body image, irrational fear of obesity and weight gain (see Table 11-1) Affects 0.8% of American women Severe restriction in diet Common Behaviors of Anorexia Nervosa Refusal to eat enough to maintain an acceptable weight Competitive and often obsessive Holds self to high standards May begin as a simple attempt to lose weight May be triggered by seemingly harmless comment, social stress to look attractive, life changes (e.g., loss of a friend), or stress of leaving childhood (e.g., changes that occur with puberty) Evaluate self-worth in terms of self-control Feelings of hopelessness about human relationships Extreme dieting is the most important predictor of an eating disorder. May exhibit compensatory behaviors such as vomiting, use of laxatives or diuretics, excessive exercise Foods divided into safe and unsafe ones Excessively critical of self and others Very low caloric intake 300 to 600 kilocalories daily Up to 20 cans per day of diet soft drinks Chew numerous pieces of sugarless gum daily Physical Effects of Anorexia Nervosa (see Fig. 11-1) Lowered body temperature Slower metabolic rate Decreased heart rate (may lead to fatigue, fainting) Iron-deficiency anemia Rough, dry, scaly, and cold skin Low white blood cell count—increased risk for infections Abnormal feeling of fullness or bloating after eating Hair loss Lanugo Constipation Low blood potassium increases risk of heart rhythm disturbances Loss of menstrual periods, leading to loss of bone mass (osteoporosis) Changes in brain size, blood flow to brain, and neurotransmitter function Sleep disturbances and depression Osteopenia Tooth decay Muscle tears and stress fractures Recovery most possible if it happens within 6 years of developing the disorder Treatment for the Person with Anorexia Nervosa Social isolation—withdraw from family and friends Friends and family may stage an intervention Treatment requires a team of physicians, dietitians, psychologists, and other health professionals Outpatient therapy (3–5 days per week) Day hospitalization (6–12 hours per day) Full hospitalization may be necessary Under 75% of expected weight Acute medical problems Severe psychological problems (e.g., suicide risk) Average recovery time is 7 years Nutrition therapy First goal is to gain cooperation and trust Increase food intake enough to achieve normal metabolic rate and reverse physical signs of disease Initial food intake to minimize or stop further weight loss Later focus on restoring appropriate food habits Gradual weight gain (2–3 pounds per week) Tube or IV feeding only used if immediate renourishment is required Patient may fear loss of control with weight gain and accompanying physical changes Monitoring of potassium, phosphorus, and magnesium is critical during refeeding Restore healthy attitude toward food; learn to eat in response to natural hunger cues Goal weight: BMI ≥ 20 Multivitamin and mineral supplement plus additional calcium to meet 1500 mg/d Moderate physical activity; possibly bed rest during early treatment Psychological therapy Begins after physical problems are addressed and kilocalorie intake is sufficient Begin to accept healthy body weight and address reasons for disorder Education about medical consequences of semi-starvation Develop alternate healthful coping strategies and skills Family-based therapy preferred method among younger individuals who still live with families Cognitive behavior therapy helps individuals learn to confront and change irrational beliefs about body image, eating, and relationships. Guided self-help groups Pharmacological therapy No FDA approved medication to treat directly Medications (e.g., Prozac® and Zyprexa®) may be useful adjunct therapy once 85% of expected body weight is achieved. Bulimia Nervosa Overview “Reavenous (ox) hunger” Alternating episodes of binge eating and compensatory behavior to prevent weight gain (at least 4x/month) Often secretive behavior which makes diagnosis uncommon 4% or more college-age women affected 10% of cases of occur in men Common Behaviors of Bulimia Nervosa Bingeing often alternates with various means to rid body of excess calories (see Fig. 11-3) Predisposition to being overweight (lifestyle and genetic factors) Have tried many diets as child Impulsive behavior; may stem from inability to control impulses and desires More likely to be sexually active than people with AN Stealing Drug or alcohol abuse Self-mutilation Suicide attempts History of abuse is common Feelings of loss of control, shame, and frustration Characteristics of binge Consumption of large quantity of high-carbohydrate convenience foods (e.g., 3000 kcal) Elaborate food rules common Consumption of high amounts of carbs common Follows period of strict dieting; linked to intense hunger Loss of control over eating Lack of enjoyment of eating Purging Vomiting (evidence of bite marks on knuckles) Laxatives or enemas Excessive exercise (“debting”) Even with purge, 33% to 75% of calories are still absorbed When laxatives are used to purge, 90% calories are absorbed Feelings of guilt and shame accompany Physical effects of Bulimia Nervosa Demineralization of teeth from exposure to stomach acid (see Fig. 11-3) Blood potassium can drop, causing heart rhythm disturbances Salivary glands may swell Stomach ulcers, bleeding, and esophageal tears Constipation from frequent laxative use Accidental poisoning from use of Ipecac syrup Treatment for the Person with Bulimia Nervosa Overview Team approach Hospitalization may be necessary Extreme laxative abuse Regular vomiting Substance abuse Depression with evidence of physical harm Nutritional therapy Correct misconceptions about food Re-establish regular eating habits Avoid binge foods Avoid frequent weighing Meal plan Record food intake (aids in identification of triggers for bingeing) Recognition of normal hunger and satiety cues Set time guidelines for meals to slow eating With emphasis on regular eating habits, the binge-purge cycle often stops by itself Psychological therapy Improve self-acceptance; decrease concern with body weight Cognitive behavior therapy to correct all-or-none thinking Establish food habits to minimize bingeing Avoid fasting Eat regular meals Find effective coping strategies for stressful situations Pharmacological therapy Fluoxetine (Prozac®) Other antidepressants Other psychiatric medications Antiseizure medications (e.g., Topamax®) Treatment is long term; 50% recover completely Binge-Eating Disorder Overview Binge-eating episodes without compensatory behaviors at least 1 time per week on average for at least 3 months. (see Table 11-3 for diagnostic criteria) 40% affected are men Lifetime prevalence is 3.5% for women and 2% for men. Number of cases is far greater than that of anorexia nervosa or bulimia nervosa. Common Behaviors of Binge-Eating Disorder Consume large food quantities (often "junk" or "bad" foods) at one sitting or graze over a period of time Use food as coping mechanism because they never learned how to appropriately express and deal with feelings Isolate themselves Frequent dieting beginning in childhood or adolescence is a precursor Perceive themselves as hungry more often than normal Physical Effects of Binge-Eating Disorder Physical effects reflect comorbid obesity (70% of those with disorder are obese) Hypertension Elevated Cholesterol due to increased insulin and high triglycerides Cardiovascular disease Type 2 diabetes Treatment for the Person with Binge-Eating Disorder Psychological therapy Cognitive behavioral therapy Identify personal needs and learn to express emotions Nutrition therapy Learn to respond to hunger Avoid diets, limit binge foods Pharmacological therapy Some antidepressants (e.g., Prozac®, Cymbalta®, Topamax®) have been found to help reduce binge eating Weight loss medications can help (e.g., Orlistat, phenteramine, and lorcaserin) Medications used to treat substance abuse can help Stimulant use is being investigated as possible therapy Other Eating Disorders Overview Other disorders described in DSM-5 include: Pica Other specified feeding or eating disorders Disorders of eating that do not meet diagnostic criteria for any specific eating disorder Have some, but not all, characteristics anorexia, bulimia, or binge-eating disorder Subthreshold eating disorders include purging disorder, night-eating syndrome PICA Consuming nonnutritive, nonfood substances over a period of at least 1 month Examples: clay, dirt, ice, chalk, or wood Coexists with autism or obsessive compulsive disorder Subthreshold Eating Disorders Five categories Ex: Atypical anorexia nervosa—normal BMI Ex: Bulimia or binge-eating disorder with binging occurring less often Purging Disorder Repeated purging to promote weight loss; due to dissatisfaction with body, anxiety, and depression Physical effects are same as bulimia nervosa Night eating syndrome Evening hyperphagia and nocturnal awakening with ingestion of food Occurs in 1.5% of general population and 8.9% of those treated in obesity clinics Signs and symptoms of night eating syndrome Lack of hunger in the morning; delay of first meal Overeating more than 25% daily food intake after dinner Difficulty falling asleep; needing to eat to fall asleep Waking at least once during the night to eat Eating produces feelings of guilt and shame Feeling depressed, especially at night May be due to abnormal body rhythm Use of antidepressants (e.g., Zoloft®) may improve symptoms Additional Disordered Eating Patterns Female athlete triad: disordered eating, lack of menstrual periods, and osteoporosis Often seen in women participating in appearance-based or endurance sports (e.g., swimming, gymnastics, varsity athletics) Identifying characteristics (see Fig. 11-4) Disordered eating Lack of menstrual periods (NOT a normal part of being an athlete) Compromised bone density—osteoporosis Treatment: multidisciplinary team to include athletic coach if possible Reduce preoccupation with food Gradually increase caloric intake Achieve appropriate weight Establish regular menstruation Decrease training time or intensity Multivitamin and calcium supplementation Muscle Dysmorphia Men and some women perceive self as too thin Preoccupied with strict weightlifting and diet regimens to increase mass Use of ergogenic aids or steroids common Avoid social contact and eating out Diabulimia Occurs in those taking insulin as therapy for diabetes Adolescents with diabetes at risk Skip dose of insulin to prevent carbohydrates from food from being taken up by cell and used Can lead to severe hyperglycemia, retinopathy, nephropathy, neuropathy, coma, and possibly death Orthorexia Strict food rules interfere with lifestyle Healthful eating becomes an obsession Not driven by desire to be thin Desire for perfection or purity Prevention of Eating Disorders Discourage restrictive dieting, meal skipping, and fasting Provide information about normal changes that occur during puberty Correct misconceptions Moderate concern about diet, health, and weight is normal Small daily weight variations are normal Carefully phrase weight-related recommendations and comments Don't overemphasize numbers on a scale Encourage normal expression of disruptive emotions Encourage children to eat only when they are hungry Provide adolescents with an appropriate degree of independence, choice, responsibility, and self-accountability for their actions Increase self-acceptance and appreciation of the power and pleasure emerging from one's body Enhance tolerance for diversity in body weight and shape, and personal food choices Build respectful environment and supportive relationships Encourage coaches to be sensitive to weight and body-image issues Emphasize that thinness is not associated with enhanced athletic performance Nutrition and Your Health: Eating Disorder Reflections Thoughts of an Anorexic Woman Attempt at dieting becomes obsession Issues of control Disordered food rituals Distorted body image Excessive exercise Denial of appetite Perfectionism Abnormal feelings of bloating after eating Dire physiological outcomes Thoughts of a Bulimic Woman Social isolation Secretive behavior Bingeing/purging Distorted body image Preoccupation with food All-or-none mentality for dieting/exercising Loss of control Depression BEST PRACTICES: TEACHING STRATEGIES, DEMONSTRATIONS, ACTIVITIES, ASSIGNMENTS, AND MORE Ask a professional from your community who treats eating disorders to give a guest presentation in the class. It might be preferable to have someone from the campus counseling center do this presentation so students can become familiar with a campus resource for treating eating disorders. Ask an individual who is recovering from an eating disorder to give a presentation in class about his or her history and condition, and give opportunities for students to ask questions. Ask the guest speaker to discuss how he/she developed the disorder, triggers or cues to binging, his/her life characteristics, and what prompted him/her to get treatment. Assign students the Rate Your Plate activity, "Assessing Risk of Developing an Eating Disorder", at the end of the chapter. Use it as a springboard for a class discussion on "What to Do If You or Someone You Know Has an Eating Disorder." Discuss ways to get help and resources in the area that could be contacted. As a class project, have students divide into groups. Have each group contact one of the self-help groups listed at the end of the chapter to get information. Have each group give an oral report about the group, its philosophy, and the kind of help and support it gives. Have students investigate resources in the university or the community for individual and/or group services to help students with eating disorders. Prepare a "case study" description of anorexia nervosa or bulimia (or use one of the available films) and have students analyze the "case" to identify: Initiation or triggering factors Signs and symptoms Presence of "typical" characteristics Warning signs Prognosis with treatment Have students bring to class examples from the media related to body image. Discuss what the media is telling us about our bodies/images. What influence do these messages have on an individual who is at risk to develop an eating disorder? CHAPTER 12 UNDERNUTRITION THROUGHOUT THE WORLD OVERVIEW This chapter addresses the issue of undernutrition in North America and the world. The causes and effects of hunger, malnutrition, and famine are discussed. High-risk populations and countries are identified. Undernutrition in the United States is addressed, focusing on potential causes, public assistance programs, and possible solutions for the problem of hunger. Undernutrition in the developing world is also presented. Obstacles to solving the worldwide problem are examined and include: population control, food-to-population ratio, war and civil unrest, depletion of natural resources, inadequate infrastructure, and HIV/AIDS. The role of biotechnology in relation to world hunger is addressed. The Nutrition and Your Health section explores the impact of undernutrition at critical life stages, such as during pregnancy, infancy, childhood, and older adulthood. KEY TERMS Acquired immunodeficiency syndrome (AIDS) Biotechnology Famine Food desert Food insecure Food insecurity Gender and development (GAD) approach Genetic engineering Genetically modified organism (GMO) Green revolution Human immunodeficiency virus (HIV) Hunger Infrastructure Malnutrition Nutrition security Recombinant DNA technology Sustainable agriculture Sustainable development Transgenic organism Undernutrition STUDENT LEARNING OUTCOMES Chapter 12 is designed to allow you to: 12.1 Define and characterize the terms hunger, malnutrition, and undernutrition. 12.2 Examine undernutrition in the United States and highlight several programs established to combat this problem. 12.3 Examine undernutrition in the developing world and evaluate the major obstacles that hinder a solution. 12.4 Outline some possible solutions to undernutrition in the developing world. 12.5 Evaluate the consequences of undernutrition during critical periods in a person’s life. LECTURE OUTLINE 12.1 World Hunger: A Crisis of Nutrition and Security A. Overview 1. Although worldwide agriculture produces adequate food, 12.4% of world population were unable to access enough food in 2012 to lead active, healthy lives. They were thus food insecure (see Fig. 12-1). 2. Pillars of food security: availability, access, utilization, and stability 3. Food insecure: condition in which the quality, variety, and/or desirability of the diet is reduced and there is difficulty at times providing enough food for everyone in the household. 4. Nutrition security: secure access to a nutritious diet coupled with a sanitary environment and adequate health services and care. 5. UN Millennium Development Goals (MDGs) were established for 2015. a. Eight goals to address poverty, hunger, disease, illiteracy, environmental degradation, and discrimination against women. b. See Table 12-1 for goals and targets for MDGs by 2015 B. Hunger 1. Physiological state that results from inadequate food intake 2. Uneasiness, discomfort, weakness, or pain caused by lack of food 3. Medical and social costs a. Preterm births b. Mental disabilities c. Inadequate growth and development in childhood d. Poor school performance e. Decreased work output f. Chronic disease 4. Primary causes of malnutrition in North America a. NOT poverty b. Eating disorders c. Alcoholism d. Homelessness e. Nursing homes 5. Food assistance programs, and food banks, help as long as bureaucratic obstacles don't get in the way. 6. Food insecurity: anxiety about running out of food 7. Primary cause of hunger and malnutrition around the world is poverty. C. Malnutrition and micronutrient deficiencies 1. Malnutrition: condition of impaired development or function caused by either long-term deficiency or excess in energy and/or nutrient intake a. Overnutrition 1) Ample food supply, incorrect choices, and excessive intake 2) Leads to chronic diseases like type 2 diabetes b. Undernutrition 1) Nutritional deficiency 2) Seen in areas of low food supply, large population 3) Most common form of malnutrition among poor 4) Can result in muscle wasting, blindness, scurvy, pellagra, beriberi, anemia, rickets, goiter, and other problems 5) Most critical micronutrients missing from diets worldwide (see Fig. 12-2) a) Iron (1 billion people in developing countries suffer from iron deficiency) b) Vitamin A (250–500,000 preschool-age children are blinded by vitamin A deficiency each year) c) Iodide (50 million people suffer preventable brain damage from preventable maternal iodide deficiency) d) Zinc (1 billion people in developing countries suffer from zinc deficiency) e) B vitamins f) Selenium g) Vitamin C 6) UNICEF reports the cost of preventing vitamin A deficiency worldwide is 6 cents per child. 7) Depressed immune functions leads to increased death from infections (e.g., diarrheal or respiratory disease) 8) Protein-calorie malnutrition (PCM): extremely deficient intake of kilocalories or protein a) Kwashiorkor b) Marasmus D. Famine 1. Extreme form of chronic hunger 2. Characterized by large-scale loss of life, social disruption, and economic chaos that slows food production 3. Special efforts are needed to eradicate the fundamental causes 4. Common underlying cause is crop failure from bad weather, war or civil unrest. E. General Effects of Semi-Starvation 1. Early stages of undernutrition are hard to detect as clinical and biochemical symptoms are absent. 2. Can lead to reduced reproductive capacity, decreased immunity, fatigue, decreased work output, and behavior problems. 3. When a few people in a population have severe deficiency, this may indicate many have milder deficiencies. 4. Because of increased exposure to diseases and other factors, people in developing countries have even higher needs for certain nutrients like iron and zinc. 5. Combined nutrient deficiencies can effect work performance even in absence of clinical symptoms and limits whole communities from thriving (see Fig. 12-3) 6. Vulnerable population groups include: pregnant women, infants, and children as they are growing rapidly. 7. Solutions: Supplementation and fortification of ready-to-use foods. 12.2 Undernutrition in the United States A. Overview 1. 46.5 million (15 %) Americans live at or near the poverty level, which is $23,492 annually for a family of four (in 2012) a. 10% of Caucasians b. 27% of African-Americans c. 26% of Hispanics d. 11% of Asians 2. Difficult choices: pay rent or buy food? 3. Food is one of the flexible financial items 4. Short term consequences of eating less may be less than being evicted B. Helping the Hungry in the United States 1. Overview a. Until the 20th century, churches and charitable organizations provided most of the help for poor b. Earlier programs rarely included cash payments as it was thought to reduce motivation to improve situation. 2. Low-Income people and families a. 1960s: John F. Kennedy revitalized Food Stamp Program (now Supplemental Nutrition Assistance Program, SNAP) b. 1965: School Breakfast and School Lunch Program c. 1965: Congregate (noontime) Meal Programs for the elderly funded d. 1972: Special Supplemental Feeding Program for Women, Infants, and Children (WIC) e. In the U.S., food insecurity is often periodic (e.g., after unemployment, large medical expenses, even holiday shopping) f. Government food assistance programs are like a safety net: strong, yet porous g. Charitable organizations, food pantries provide additional aid h. Recovery Act in 2009 increased benefits and services of federal food and nutrition programs i. Table 12-3 presents some current federally subsidized programs that supply food for people in the U.S. C. Socioeconomic Factors Related to Undernutrition 1. Poverty a. Direct result of underemployment b. Complex: Situational and generational c. Economic recession coupled with decreased welfare funding has led to high rate of poverty and high need for food assistance 2. Access to healthy food a. Many Americans, including children, live in low-income areas that lack the availability and affordability of healthy food options such as vegetables and fruits. b. A “food desert” is defined as an area where 33% or 500 people live more than a mile from a grocery store in an urban area or 10 miles in a rural area 3. Homelessness a. Data from U.S. Department of Housing and Urban Development (HUD) in January 2012, found that 633,732 people in U.S. experience homelessness on any given night. 1) Families with children account for 239,403 of the homeless population 2) Single mothers in late 20s with two children most common heads of homeless families 3) Families become homeless often because of unexpected financial hardship. b. Reasons 1) Lack of affordable housing 2) Poverty, stemming from unemployment or underemployment 3) Unexpected hardship c. Chronic homelessness accounts for 16% of homeless population D. Possible solutions to poverty and hunger in the United States 1. Can/should government programs provide a permanent solution to poverty and undernutrition? a. Increasing number of those in poverty seek out public assistance. b. American Recovery and Reinvestment Act of 2009 increased funding for federal assistance programs but funds will soon expire 2. Food pantries and soup kitchens are important but not sufficient to meet all food needs a. Food availability is limited b. Families lack cooking facilities c. Many cities discourage or prohibit sharing of food with poor or homeless persons by individuals or groups 3. Gaining independence from assistance programs is difficult a. Limited education, possibly due to teen pregnancy b. Expense of reliable and safe child care far exceeds financial resources of a family with minimum-wage job(s) c. Illness may prevent steady employment d. Poor communication skills e. Inability to relocate f. Lack of economic reserves 4. Government programs cannot single-handedly correct poverty and hunger; increase in individual responsibility is a critical goal 5. New additional focus on access to healthy food: Healthy Food Financing Initiative brings grocery stores, small retailers, corner stores, and farmers markets to underserved urban and rural areas 6. Effort to allow use of SNAP benefits at farmers markets is goal of 'Let's Grow Act.' 12.3 Undernutrition in the Developing World A. Food/population ratio 1. Population growth exceeds economic growth in many developing countries 2. 2/3 world’s undernourished live in Asia and Pacific Rim 3. Experts suggest slowing growth is the solution 4. In the short term, food production is adequate, but food is in short supply in developing nations because distribution is uneven 5. In the long term, needs of world population will exceed food supply a. Most good farmland is already in use b. Farmable land decreases annually because of poor farming practices or competing demands for land use 6. Birth control programs have been effective in developed countries but not in developing countries a. Lack of access b. Population Services International subsidizes distribution of birth control c. Promoting breastfeeding can help as exclusive breastfeeding can delay ovulation d. Only when people are fed adequately and feel financially secure do they feel they can have fewer children to provide care from them in their older years B. War and Political/Civil Unrest 1. High defense spending in some developing nations decreases monies available for economic development 2. Wars contribute to massive undernutrition a. War-related famine affects 20 million in Africa b. War disrupts infrastructure 1) Insufficient shelter, clothing, and food 2) Unsafe water supply 3) Increase in diarrheal disease among children 3. Programs designed to help the poor have been undermined by poor administration, corruption, and political influence 4. In the 1960-70s, undernutrition was seen as a technical problem—now it is largely political C. Agriculture and the Rapid Depletion of Natural Resources 1. Productive capacity of agriculture is approaching its limits in many areas 2. Food production is undermined by environmentally unsustainable farming methods 3. Green revolution began in the 1970s when crop yields rose a. Increased use of fertilizers and irrigation b. Careful plant breeding c. Intended as stopgap measure until world leaders could control population growth 4. Such gains in productivity will probably not be seen again a. Less available productive land b. Nearly all irrigation water currently available is being used; ground water supplies are becoming depleted c. Prospects of getting more food from the oceans is poor 5. World population cannot continue to grow as it does without serious famine and death D. Inadequate Shelter and Sanitation 1. Poor sanitation and undernutrition raise risk of infection 2. Inadequate shelter and poor sanitation threaten lives of more people today than war and political unrest 3. Shift from rural to urban life has made it difficult for all to have shelter and sanitation a. Substandard living common: lack of water supply or proper food storage b. Little cash to purchase food since they cannot grow their own c. Risk of infection from unsanitary conditions and poor nutrition d. Infants and children most vulnerable to negative effects 4. Shift from breast milk to infant formula a. May be diluted to save money b. May be prepared with contaminated water 5. Single most effective health advantage is a safe and convenient water supply 6. Poor sanitation also creates critical health problems E. The Impact of AIDS Worldwide 1. 34 million around the world are infected with HIV 2. African countries are home to more than 69% of HIV-positive people in the world 3. HIV among children is a growing problem 4. Productivity and income decrease in families where AIDS is present 5. United Nations is leading an effort to raise funds to fight the disease 6. Goals for combating HIV/AIDS a. Preventing new cases through education about safer sex and use of clean needles b. Provision of AIDS drugs to pregnant women to reduce risk of transmission to offspring c. Eliminate new infections for children and substantially reduce the number of mothers dying from AIDS-related causes. 7. North Americans living with AIDS is estimated at 1.1 million 8. Figure 12-4 presents a global view of 34 million people living with HIV infection 9. Toward universal treatment a. No vaccine can prevent AIDS b. Antiretroviral drugs can slow the progression and help prevent transfer of virus from mother to fetus. 1) Three different drugs which require adherence to regimen to avoid drug resistance 2) Drug regimen can cost $14000/year 3) Drug companies help defray costs in developing countries 10. Nutrition and AIDS a. Adequate nutritional status can lessen impact of infections associated with AIDS b. Adults with HIV need 10 to 30% more energy per day c. Children with HIV need 10% more energy per day 12.4 Reducing Undernutrition in the Developing World A. Overview 1. Direct food aid is not a long-term solution 2. Improving infrastructure needs to be the long-term focus 3. Development tailored to local conditions is important a. Create independent, self-sustaining economies b. Economic opportunities and family planning for women must be augmented c. Suitable technologies for processing, preserving, marketing, and distributing nutritious local staples d. Supplement indigenous foods with nutrients that are in short supply e. Ensure safe water supply f. Promote extensive land ownership g. Increasing food supply without increasing employment doesn't work; employ people, not machines B. Sustainable agriculture 1. Negative impact of current agricultural practices a. Depletion of topsoil b. Contamination of groundwater c. Decline of family farms d. Neglect of living/working conditions for farm laborers e. Increasing costs of production f. Lack of integration of economic and social conditions in rural communities 2. Sustainable agriculture a. Provides secure living for farm families b. Maintains the natural environment and resources c. Supports rural community d. Offers respect and fair treatment at all levels 3. Biotechnology: use of biological systems (e.g., plants, animals, or bacteria) to manufacture products a. Selective breeding improves plant and animal production by increasing resistance to pests and improving tolerance to adverse conditions b. Use of hormones affects growth of livestock C. Biotechnology 1. Cross breeding for better plant hybrids is no longer the only tool 2. Genetic engineering began in the 1970s 3. Recombinant DNA technology: deleting, adding, or replacing part of the DNA sequence to produce a genetically modified organism (GMO) a. Input trait 1) Herbicide tolerance 2) Insect and virus protection 3) Tolerance to environmental stressors b. Output trait 1) Increased omega-3 fatty acid content of plant oils 2) Crops that produce pharmaceuticals 3) Fruits and grains that provide greater amounts of vitamins and minerals 4. FDA has approved some genetically engineered foods as safe for human consumption a. 72% of corn and 94% of soybeans in U.S. are genetically modified b. Manufacturers are not required to disclose GMO on the label c. Connecticut became first state in 2013 to pass law requiring a package label indicate that a food is made from GMOs. d. Potential concerns by consumers regarding GMOs 1) Environmental hazard of introducing genes from one species into another 2) Promotion of resistance to insecticides 3) Modified varieties may harm wild varieties 4) Possible allergic effects D. The Role of the New Biotechnology in the Developing World 1. Unknown whether GMO technology will truly help undernutrition in developing world 2. Larger farms will use new developments first; increasing number of large farms may undermine the efforts to reduce undernutrition 3. Plant breeding for micronutrients may be the most promising E. Some Concluding Thoughts 1. Even with extensive efforts to combat world undernutrition, it is still rampant 2. Undernutrition and underlying problems affect not only developing countries, but developed countries, as well, due to economic instability 3. The world has the food and technical expertise to end hunger, but concerted political effort is lacking Nutrition and Your Health: Undernutrition at Critical Life Stages A. Pregnancy 1. Period of greatest health risk due to high nutrient needs 2. 500,000 women die worldwide from pregnancy complications 3. Pregnancy-related death is a social indicator that shows disparity between developing and industrialized countries B. Fetal and infant stages 1. Greatest risk to fetus during gestation 2. Associated with premature birth and low birth weight a. Reduced lung function b. Weakened immune system c. Long-term problems in growth and development 3. Low birth weight (LBW) infants face 5–10 times risk of death during first year 4. Rate of LBW worldwide is 15%, with higher rates in developing countries. 5. Rate of LBW is 8% in United States and 6% in Canada 6. Although undernutrition increases risk for LBW, other important factors include: a. Cigarette smoking b. Teenage pregnancy c. Increase in multiple births (e.g., twin, triplets) C. Childhood 1. Brain and nervous system vulnerable 2. Poor children are at greatest risk of nutritional deprivation and overall illness 3. Effects a. Stunted growth b. Iron-deficiency anemia results in fatigue, reduced stamina, stunted growth, impaired motor development, and learning problems c. Weakened resistance to infections (due to deficient protein, vitamin A, and zinc) 4. Cyclical relationship: not only does undernutrition cause illness, but illness also causes undernutrition D. Later years 1. Older adults, especially older women living alone in poverty, are at risk for undernutrition. 2. Require nutrient-dense foods 3. Food often becomes a low-priority item a. Fixed income b. Social isolation c. Declining physical and mental health BEST PRACTICES: TEACHING STRATEGIES, DEMONSTRATIONS, ACTIVITIES, ASSIGNMENTS, AND MORE 1. There are a number of activities suggested in the Rate Your Plate activity, "Fighting World Undernutrition on a Personal Level." Some activities are particularly good for the entire class. Others can be creatively organized at the discretion of the instructor. There are numerous suggested activities in the Rate Your Plate section at the end of the chapter. 2. Have students read the book, Rich Christians in an Age of Hunger. Have them each write a book report. Discuss the book in class. 3. Consider offering extra credit to your students for volunteering at a local food bank or soup kitchen. Have them prepare a presentation to the class about their experience. 4. Assign students to investigate organizations, such as Heifer International (www.heifer.org), America’s Second Harvest (www.americassecondharvest.org), and the UCLA Hunger Project (http://uclahungerproject.wix.com/care). Discuss the positive impacts of such programs and ways in which students on your campus can become active in the fight against hunger. 5. Host a Hunger Banquet. The event is designed to simulate global food circumstances. Not everyone will eat the same food: 15% will eat in elegance, 30% will eat "simple food" and 55% will eat rice. Based on a lottery ticket system, banquet diners will eat according to the ticket they draw—the idea is to simulate the global distribution of food. Visit (www.hungerhurts.org or www.hungerbanquet.org) to learn more about the Hunger Banquet concept. 6. Have students investigate GMO legislation. Use the http://www.righttoknow-gmo.org/states website as a resource for the most up-to-date information. Have student research culminate in a debate over the right to know if our foods have GMOs. CHAPTER 13 SAFETY OF OUR FOOD SUPPLY OVERVIEW This chapter covers an array of food safety issues. Foodborne illness and its symptoms and causes are discussed at length. The organisms that most commonly cause, foods most associated with, and measures to prevent foodborne illness are described. The purpose, regulation, and safety of food additives are addressed. The government's role in regulating these substances is discussed briefly throughout the chapter. Substances that occur naturally in foods that can cause illness and environmental contaminants are also covered. Updated information on the growing trends of organic foods, sustainable agricultural practices, and community supported agriculture is also included. The Nutrition and Your Health section provides information on preventing foodborne illness. KEY TERMS Additives Aseptic processing Bacteria Biological pest management Delaney Clause Foodborne illness Fungi Generally recognized as safe (GRAS) Helminth Incidental food additives Intentional food additives Irradiation Locavore Parasite Pasteurizing Preservatives Protozoa Radiation Sequestrants Spores Sustainable agriculture Toxins Virus STUDENT LEARNING OUTCOMES Chapter 13 is designed to allow you to: 13.1 List some of the types and common sources of viruses, bacteria, fungi, and parasites that can make their way into food. 13.2 Compare and contrast food-preservation methods. 13.3 Understand the foodborne illnesses caused by bacteria, viruses, and parasites. 13.4 Describe the main reasons for using chemical additives in foods, the general classes of additives, and the functions of each class. 13.5 Identify sources of toxic environmental contaminants in food and the consequences of their ingestion. 13.6 Understand the reasons behind pesticide use, the possible long-term health complications, and the safety limits set for their use. 13.7 Understand the effects of conventional and sustainable agriculture on our food choices. 13.8 Describe the procedures that can be used to limit the risk of foodborne illness. LECTURE OUTLINE 13.1 Food Safety: Setting the Stage A. Overview 1. During early urbanization of North America, food, water, and milk contamination posed severe risk of devastating human disease 2. This led to the development of water purification, sewage treatment, and pasteurization 3. Greatest risk today is foodborne illness from viruses, bacteria, and to a lesser extent, fungi and parasites 4. Although they cause only 4% of all cases of foodborne illness, the population seems to be more concerned about chemical contamination from food additives. B. Effects of Foodborne Illness 1. Foodborne illness causes about 3,000 deaths/year 2. Populations most at risk a. Infants and children b. Older adults c. Those with liver disease, diabetes, HIV infection (and AIDS), or cancer d. Postsurgical patients e. Pregnant women f. People taking immunosuppressant agents 3. Often due to poor food-handling practices at home 4. Table 13-1 presents examples of various cases of foodborne illness and how they were contracted 5. The 2011 FDA Food Safety Modernization Act strengthens the food safety systems currently in place a. Focuses on prevention of food safety problems b. Allows for additional inspection and compliance among imported foods c. Directs the FDA to become involved with state and local authorities to improve food safety issues 6. Table 13-2 lists the government agencies responsible for monitoring food safety C. Why Is Foodborne Illness so Common? 1. Transmitted through foods in which microorganisms are able to grow quickly a. These foods are moist, high protein, neutral, or slightly acidic pH b. Greater consumption of animal meat that is raw or undercooked 2. More people receive medications that suppress their ability to combat foodborne infectious agents 3. Increase in older population 4. Food industry trying to increase product shelf-life 5. More reliance on food prepared outside the home 6. Greater consumption of convenience foods 7. Higher consumption of imported ready-to-eat foods 8. Use of antibiotics in animal feeds increases severity 9. More cases are being reported due to increased awareness 13.2 Food Preservation: Past, Present, and Future A. Food preservation methods have been used for centuries 1. Decrease water content to deter growth of microbes a. Salt b. Sugar c. Drying 2. Exposure to heat kills microbes a. Smoking 3. Fermentation yields acids or alcohol to minimize growth of microbes a. Pickles b. Sauerkraut c. Yogurt d. Wine 4. Sulfites disinfect wine containers and preserve wine B. Present day food preservation methods include: 1. Pasteurization 2. Sterilization 3. Refrigeration 4. Freezing 5. Irradiation 6. Canning 7. Chemical preservatives 8. Aseptic processing C. Irradiation 1. FDA has permitted food irradiation for over a decade 2. Food not radioactive, no radioactive residue left 3. Destroys cell walls and cell membranes, which kills microbes 4. Extends shelf life 5. Radura symbol and statement that the food was treated by irradiation is mandatory for all irradiated foods (except dried seasonings) 6. Controversy a. Diminished nutritional value b. Formation of carcinogens 13.3 Foodborne Illness Caused by Microorganisms A. Overview 1. Infection a. Microorganisms are ingested, invade the intestinal wall, and produce a toxin b. Delayed onset of symptoms 2. Intoxication a. Microorganisms produce toxin in food, which is then ingested and causes illness b. Rapid onset of symptoms (within 4 hours) 3. Foodborne illnesses are caused by specific viruses, bacteria, and other fungi. B. Bacteria 1. Single-cell organisms that are everywhere; small number pose a threat 2. Table 13-3 lists bacterial causes of foodborne illness 3. Common types a. Bacillus b. Campylobacter c. Clostridium d. Escherichia e. Listeria f. Salmonella g. Staphylococcus aureus h. Vibrio 4. Cause infection or intoxication 5. Typical symptoms of infection a. Vomiting b. Diarrhea c. Abdominal cramps 6. Bacteria that are most often associated with death include a. Salmonella b. Listeria—particular concern for pregnant women; may cause spontaneous abortion or stillbirth c. E. coli O157:H7—hemolytic uremic syndrome d. Campylobacter 7. Ideal environment for growth (nutrients, water, warmth) a. Proliferate in temperature danger zone: 40°–140°F (although Listeria bacteria can grow at refrigeration temperatures) b. Oxygen (although Clostridium botulinum and Clostridium perfringens are anaerobic) c. Low-acid (although E. coli can grow in acidic foods) C. Viruses 1. Can reproduce only after invading body cells (e.g., intestinal cells) 2. Sudden onset, short duration of infection 3. 70% of foodborne illness cases go undetected because they result from viruses, with no easy way to test for them. 4. Hardy; survive freezing, high temperatures, and chlorination up to 10 ppm 5. Table 13-4 lists viral causes of foodborne illness 6. Norovirus is the number one pathogen contributing to domestically acquired foodborne illness. D. Parasites 1. Live in or on another organism (i.e., host) from which they absorb nutrients 2. Table 13-5 describes common parasitic causes of foodborne illness 3. Common types a. Protozoa: one-celled organisms 1) Cyclospora 2) Cryptosporidium b. Helminths: parasitic worms 1) Trichinella spiralis (roundworm) 2) Tapeworms 13.4 Food Additives A. Overview 1. Food additives: substances added to foods, either intentionally or incidentally 2. FDA evaluates all intentional food additives. B. Why Are Food Additives Used? 1. Used to limit food spoilage by retarding growth of microbes a. Preservative: preserve color or flavor of foods b. Acidic or alkaline agents c. Antimicrobial agents d. Curing and pickling agents e. Antioxidant: vitamins E and C and sulfites are used to limit oxidation 2. Used to reduce activity of some enzymes that leads to undesirable changes in color and flavor 3. Without them, impossible to safely produce mass food quantities 4. Proved safe when FDA guidelines for their use are followed 5. Table 13-6 summarizes various types of food additives a. Acid or alkaline agents b. Alternative sweeteners c. Anticaking agents d. Antimicrobial agents e. Antioxidants f. Color additives g. Curing and pickling agents h. Emulsifiers i. Fat replacements j. Flavors and flavoring agents k. Flavor enhancers l. Humectants m. Leavening agents n. Maturing and bleaching agents o. Nutrient supplements p. Stabilizers and thickeners q. Sequestrants C. Intentional Versus Incidental Food Additives 1. Intentional a. Directly added to foods b. > 2,800 substances 2. Incidental: contaminants a. Indirectly enter foods through surface contact with processing equipment or packaging materials b. 10,000 substances D. The GRAS List 1. Generally recognized as safe (GRAS) 2. If a substance has been used in food for a long time, the manufacturer does not need to prove its safety 3. Initiated in 1958; continually reviewed, revised, and updated 4. American Heart Association (AHA) have questioned the appropriateness of sodium chloride on the GRAS list. E. Are Synthetic Chemicals Always Harmful? 1. Natural isn't necessarily safer than synthetic 2. We ingest 10,000 times more natural toxins than synthetics F. Tests of Food Additives for Safety 1. Tested on at least two animal species (usually rats and mice) 2. Scientists determine highest dose that exhibits no observable effect, then divide that dose by at least 100 to establish margin of safety for human use 3. Delaney Clause: 1958 a. If an additive is shown to cause cancer at any dosage, no margin of safety is allowed b. Food additive cannot be used c. There are some exceptions, including contaminants (Table 13-6) 4. Consuming a variety of foods in moderation minimizes any negative health impact of food additives 5. In perspective, excess calories, saturated fat, cholesterol, trans fat, and salt pose greater risk than presence of additives in food supply G. Approval for a New Food Additive 1. FDA must approve use 2. Manufacturers must supply FDA with the following a. Identity of the new additive b. Chemical composition c. Statement of how it is manufactured d. Lab methods to measure its presence in food e. Proof that it will accomplish its intended purpose 3. Easily avoid food additives by consuming whole foods 13.5 Substances that Occur Naturally in Foods and Can Cause Illness A. Overview 1. Pose little health risk 2. Cooking and food-preparation methods can limit potency 3. Common naturally occurring substances a. Safrole: sassafras, mace, nutmeg; high doses cause cancer b. Solanine: inhibits action of neurotransmitters; green spots on potatoes c. Mushroom toxins: neurological symptoms, kidney failure, even death d. Avidin: raw egg whites; prevents biotin absorption e. Thiaminase: raw fish, clams and mussels; destroys thiamin f. Tetrodotoxin: puffer fish; causes respiratory paralysis g. Oxalic acid: spinach, strawberries; limits calcium and iron absorption h. Herbal teas: if contain senna or comfrey can cause diarrhea or liver damage B. Is Caffeine a Cause for Concern? 1. Stimulant 2. Table 13-7 lists common caffeine content of common sources 3. Caffeine is difficult to study because it is contained in foods with cream, sugar, alternative sweeteners, and flavorings 4. Does not accumulate—excreted within hours of consumption 5. Negative health effects a. Anxiety b. Increased heart rate c. Insomnia d. Increased urination e. Diarrhea f. Gastrointestinal upset g. Increased stomach acid production h. Worsened anxiety or panic attacks i. Worsened heartburn symptoms j. Increased risk for miscarriage and birth defects (at high doses) k. Increased excretion of calcium—possible increased risk of osteoporosis 6. Withdrawal symptoms include headache, nausea, and depression 7. Suspected link to cancer has not been supported by recent research 8. Regular coffee consumption has been linked to decreased risk of colon cancer 9. Suspected link to cardiovascular disease is not supported 10. Possible benefits of caffeine a. Fewer headaches b. Decreased risk of liver cirrhosis c. Decreased risk of kidney stones and gallbladder stones d. Decreased risk of nerve-related diseases e. Improves blood glucose regulation f. Improved physical performance proven in highly trained athletes 11. Prudent dose is 200–300 mg/d 13.6 Environmental Contaminants in Food A. Overview 1. Best prevention: know foods which pose greater risk and consume wide variety of foods in moderation 2. Table 13-8 lists potential environmental contaminants in our food supply a. Acrylamide b. Cadmium c. Dioxin d. Lead e. Mercury f. Polychlorinated biphenyls (PCBs) g. Urethane B. Pesticides in Foods 1. Pesticides contribute to safe food supply at a reasonable cost 2. Pesticide pose some avoidable health risks a. Although residues present in foods are minimal, effects of long-term accumulation are unknown b. Eliminating some pests leads to appearance of new ones c. Contamination of ground water d. Destruction of wildlife habitats C. What Is a Pesticide? 1. Any substance of mixture thereof intended to prevent, destroy, repel, or mitigate any pest 2. Insecticides, herbicides, fungicides, rodenticides 3. Chemical or bacterial 4. Natural or synthetic 5. May affect organisms other than intended target 6. May appear in unintended places, end up in food chain 7. FDA allows 10,000 pesticide uses, 300 active ingredients D. Why Use Pesticides? 1. Economic: increases production and lowers food cost 2. Consumer demands: would you buy an apple with a worm hole? 3. Some pesticides prevent rotting or other naturally occurring substances that cause disease, even cancer E. Regulation of Pesticides 1. FDA regulates all foods except meat, poultry, and some egg products, which are monitored by USDA 2. EPA 3. Food Safety and Inspection Service of USDA F. How Safe Are Pesticides? 1. Depends on potency of the chemical toxin and the amount consumed 2. Some cancer risks increase with higher-than-average ingestion 3. Some pesticides persist in the environment for years 4. Many experts argue that risks from pesticide consumption are far less than risks from consuming naturally-occurring plant toxins G. Personal action 1. Weigh pros and cons 2. We can't avoid pesticides completely but limit exposure (see Table 13-10) a. Consume variety of foods b. Rinse and scrub produce c. Remove outer leaves d. Trim fat/remove skin from meat, poultry, fish; discard drippings e. Choose smaller fish; heed local warnings about fishing in contaminated waters f. Avoid lawns, gardens, and flower beds after treatment with pesticides and herbicides 3. See Table 13-9 for a list of foods considered "Dirty Dozen" and "Clean Fifteen" H. Environmental Contaminants in Fish 1. Mercury and polychlorinated biphenyls (PCBs) are by-products of industrial processes and accumulate in fat tissue. 2. FDA and EPA indicate salmon is safe to eat, low in mercury 3. Environmental Defense Fund (EDF) recommends limiting wild salmon consumption to on serving per month and farmed raised salmon to no more than two servings per month based on PCB contamination 4. Pregnant women should consume fish 2x/week for omega-3 consumption as benefits are greater than risks 13.7 Food Production Choices A. Organic foods 1. Rapid growth of availability in recent years, but 4.2% of all foods sold are organic 2. Cost more to grow and produce; usually more expensive than conventional foods 3. Production of organic agricultural products a. Biological pest management b. Composting c. Manure applications d. Crop rotation e. No synthetic pesticides f. No fertilizers g. No hormones h. No antibiotics i. No sewage sludges j. No genetic engineering k. No irradiation l. Outdoor grazing for animals m. Organic feed 4. Organic Foods Production Act of 1990 a. Established standards for production of organic foods 1) Foods made from multiple ingredients must have at least 95% organic ingredients 2) “Made with organic:” at least 70% of ingredients are organic b. USDA Organic seal used to identify and market organic foods 5. Organic foods and health a. Reduced pesticide intake 1) Only 1 in 4 organically grown fruits and vegetables contains pesticides; levels are lower than in conventionally-grown produce 2) Long-term health benefits are unknown 3) Pesticides in foods probably pose greatest risk to children b. Environmental protection: encourage sustainable agriculture practices c. Belief that organic foods improve nutritional quality of diet 1) Most studies do not demonstrate appreciable nutritional difference 2) Some organic fruits and vegetables contain more vitamin C and antioxidants d. Possible food safety concerns due to use of animal manure fertilizers; consumers should wash or scrub all produce under running water e. “Natural” is not regulated 1) Minimally processed, no artificial flavoring, coloring, chemical preservative, or other artificial or synthetic ingredients 2) All organic products are natural, but not all natural products are organic B. Sustainable Agriculture 1. Integrated system of plant and animal production that will: a. Satisfy human food needs b. Enhance environmental quality c. Efficiency use nonrenewable resources d. Sustain economic viability of farm operations e. Enhance quality of life for famers and society 2. Lifestyle of Health and Sustainability (LOHAS): demographic group focused on sustainable living 3. Slow Food Nation: nonprofit dedicated to creating a framework for a deeper environmental connection to our food 4. Sustainable seafood a. 2010 Dietary Guidelines for Americans recommends consuming 8 oz fish per week b. Rigorous standards and close monitoring of fish and aquaculture operations by National Oceanic and Atmospheric Administration (NOAA) c. Most seafood eaten in U.S. is imported d. Both farmed and wild-caught fish can be healthy, sustainable, and economical. C. Locally Grown Foods 1. Consumer demand for fresh, safe products that support small, local farmers and help environment 2. There was a 16% increase, from 2009 to 2010, in the number of operating famers’ markets in the U.S. 3. Locavore: person who eats food grown locally or within defined radius 4. No evidence of improved safety 5. No regulations for “locally grown” D. Community Supported Agriculture 1. Partnership between local food producers and local consumers; farmers provide foods in exchange for finances or labor 2. National Farm to School Program: non-profit effort to connect local farmers with school cafeterias a. Currently, there are programs in 50 states b. If kids can meet the farmer who grew the food, they are more likely to eat it. Nutrition and Your Health: Preventing Foodborne Illness A. General rules for preventing foodborne illness 1. Purchasing Food a. When shopping, select frozen and perishable foods last b. Don't buy or use food from damaged, dented, or bulging containers c. Purchase only pasteurized juice, milk, and cheese d. Purchase only the amount of produce needed for a week’s time e. When purchasing precut produce, avoid those that look slimy, brownish, or dry f. Observe sell-by and expiration dates 2. Preparing Food a. Wash hands for 20 seconds with hot water and soap before and after handling food b. Sanitize counters, cutting boards, dishes, and other equipment before use c. Always clean cutting board with hot soapy water between uses d. Use separate cutting boards for raw and cooked foods when possible e. Cut foods to be eaten raw first and meat last f. USDA recommends plastic, marble, or glass cutting boards g. Thaw foods in the refrigerator, under cold running water (if cooking immediately), or in microwave h. Marinate food in the refrigerator i. Avoid coughing or sneezing over food j. Cover cuts with bandage k. Carefully wash fresh fruit and vegetables under running water l. When in doubt, throw food out m. Use refrigerated ground meat and patties within 1 to 2 days n. Use frozen meat and patties within 3 to 4 months 3. Cooking Food a. Cook food thoroughly, checking temperature with a food thermometer b. Beef, fish: 145F c. Pork: 160F d. Poultry: 165F e. Eggs: yolk and white cooked until hard f. Cook stuffing separately from poultry g. Once food is cooked, consume it right away, or cool it within 2 hours h. Serve meat, poultry, and fish on a clean plate, never the same plate that was used to hold the raw product i. Cook food completely at the picnic site; no partial cooking in advance 4. Storing and Reheating Cooked Food a. Keep foods out of “danger zone” which is 40–140F b. Reheat leftovers to 165F c. Store peeled or cut-up produce in the refrigerator d. Make sure the refrigerator stays below 40F e. Consume leftovers within recommended time (see Figure 13-3) f. Keep raw foods on lower shelves of refrigerator to avoid contaminating cooked products g. Observe the methods used by restaurants where you eat BEST PRACTICES: TEACHING STRATEGIES, DEMONSTRATIONS, ACTIVITIES, ASSIGNMENTS, AND MORE 1. Buy 10 inexpensive thermometers. Have students check throughout a week the internal temperature of refrigerators to which they have access. Are they at temperatures lower than 40F? If not, what implications might this have for the potential of foodborne illness? Use this as a springboard for discussion of proper food preparation, cooking, and storing methods. 2. Have students complete the Rate Your Plate activity, "Take a Closer Look at Organic Foods". Students should complete it and turn it in. Use the activity to launch a discussion of the students’ use of organic foods. 3. Have students visit a local supermarket, select 10 food products in a specific category, and make a list of the food additives present and their function. Categories could include: canned soups, frozen entrees, frozen vegetable dishes, mayonnaise and salad dressings, cheeses, margarines and spreads, and cake mixes. 4. Have students prepare a chart of the common causes of foodborne illness, symptoms, time of onset, and factors that promote growth. 5. Using the guidelines for preventing foodborne illness presented in the textbook, have students outline for which microorganisms the particular steps would be appropriate and why. 6. Have someone from the local food sanitation department come and present a lecture on good food handling practices. Ask him/her to tell interesting stories regarding how these practices were violated in food establishments that were inspected. 7. Do a demonstration with students using “Glo-germ” and a black-light to illustrate the need for proper hand-washing. Students are always amazed at the amount of “germs” left on their hands, even after careful washing. Instructor Manual for Wardlaw's Contemporary Nutrition Anne M. Smith , Angela L. Collene 9780078021374, 9781260092189