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									 Nutrition News For Health Care Providers

       Innocent until Proven Guilty:
           The Facts about Fats
   If you've heard conflicting information about
 saturated fat and trans-fatty acids and felt a bit
 confused about the terminology and its
 applications to health, this may be the time to
                                                      organs from trauma and provides insulation to
                                                      maintain a stable body temperature. Avoiding
                                                      fats altogether is dangerous since two fatty
                                                      acids are essential for health and must be
 get it all straight. Life was much simpler when      supplied in the diet daily.
 cholesterol was the only villain that you hunted
 for on food labels. Now there's new terms that       Breaking the Code:
 have replaced cholesterol as the “bad guy” on           Fat is only part of a larger group of
 food labels and unless you have a scorecard it       substances that are insoluble in water, known
 may be hard to know the winners from the             scientifically as lipids. The majority of lipids
 losers.                                              are categorized as either; triglycerides,
                                                      phospholipids or sterols, based on their
 Basic Truths:                                        chemical properties. Triglycerides, including
   The only nutrients in food that supply             fats and oils, are the most abundant group of
 energy are carbohydrates, proteins and fats.         dietary fats and are the predominant storage
 Fats are the most concentrated source of             form of fat in your body. Structurally,
 energy at nine kilocalories per gram.                triglycerides are three fatty acids
 Functionally, fat aids in the absorption and         attached to a glycerol backbone.
 utilization of many of the essential vitamins        The predominate fatty acid
 and minerals needed for health maintenance.          component of the triglyceride will
 Fat adds flavor to food and gives a sustained        determine whether it is known as
 feeling of satisfaction from hunger. When            a saturated fat, monounsaturated
 stored in the body, a layer of fat protects body     fat, polyunsaturated fat, or
                                                      hydrogenated fat.
                                                      continued on page 2
   I n     T h i s       I s s u e …

Innocent until          Phospholipids
Proven Guilty           pg. 4
pgs. 1-2                Knowing what to eat
Essential Fatty         pg. 4
                        Questions from
pg. 2                   the clinic
Sterols, including      pg. 5
                        Dietary Fats
pg. 3                   Cholestrol metabolism
Lipoproteins            pg. 6
pg. 3
continued from front page                               industry as a solid saturated fat such as butter or
Triglycerides revealed:                                 lard. Food scientists were able add hydrogen to
   All lipids contain atoms of carbon, hydrogen         some of the double bonds in a process known as
and oxygen. When a fatty acid has all single            hydrogenation, to make a hydrogenated fat.
bonds and all the carbon, hydrogen and oxygen it        Hydrogenation gives liquid fat a creamier texture
can hold, it is considered saturated. When the          in spreads like margarine or shortening. It also
majority of fatty acids in a trigylceride are           stabilizes the oil making it less likely to
saturated, the fat is generally solid at room           deteriorate in deep fat frying and packaged foods.
temperature and usually comes from an animal            During the process of hydrogenation, the fatty
source like beef or pork. When a fatty acid has         acids in the triglyceride can take on a new spatial
double bonds between two carbon atoms, it is            orientation. The new structural orientation
liquid at room temperature and more                     produces a type of fat different from the natural
unsaturated. If the fatty acid contains many            cis-fat form and generates a trans-fat. Current
double bonds, it is known as a polyunsaturated          research indicates negative health implications
fatty acid. If the fatty acid contains only one         associated with trans-fat consumption. Concern
double bond, it is known as a monounsaturated           by health authorities has led to recommendations
fatty acid. Since polyunsaturated fats are liquid at    that trans-fat content of foods appear on the
                                                        Nutrition Facts Label.                            r
room temperature as vegetable oil for example,                                                          n
they don't have the same applications in the food        cis-fatty acid
trans-fatty acid

                                                         H – O –C
   H          H
     – –


H–C                                 0

     H                              C–O–H                   H –C                H


                       H                                        H

 Get Them Daily:
 Essential Fatty Acids
      Most fats can be made by          energy is recommended to
    the body when dietary intake is     be an adequate intake of
    adequate. The body only             linoleic acid. Omega-6 fatty
    requires two essential              acid's major function is to
    polyunsaturated fatty acids to      promote blood clotting and        body. (Note this is the
    be supplied in the diet. The        inflammatory response. The        opposite effect of omega-6
    body uses these essential fatty     American diet generally           fatty acid). Recommendations
    acids to maintain the structural    provides enough omega-6 fatty     to eat at least two fish meals a
    integrity of cell membranes         acids to meet daily needs.        week are based on findings
    and as a component of                  Alpha-Linolenic Acid           that diets high in omega-3
    eicosanoids; hormone-like           18:3∆9,12,15 (omega-3 fatty       fatty acids may protect against
    compounds that help regulate        acid) the other essential fatty   heart disease. A target of 1
    blood pressure, clot formation,     acid. Although linolenic acid     gram of EPA plus DHA per
    maintenance of immune               cannot be produced by the         day has been suggested to be
    response and vision. The            body, two products of linolenic   both safe and prudent. Oils
    essential fatty acids are:          acid metabolism appear to         from coldwater fish are rich in
      Linoleic Acid 19:2∆9,12           provide cardiovascular            omega-3 fatty acids as well as
    (omega-6 fatty acid) the major      benefits; they are the omega-3    certain vegetable oils including
    essential fatty acid in the diet.   fatty acids: eicosapentaenoic     canola, soybean, flaxseed and
    Most commonly, found in             acid (EPA) and                    wheat germ. Generally, the
    vegetable oils such as corn,        docosahezaenoic acid (DHA).       American diet lacks
    soybean, safflower and              Omega-3 fatty acids tend to       appreciable amounts of
    sunflower and meats. An             decrease blood clotting and       omega-3 fatty acids compared
    intake of 1% to 2% of total         inflammatory response in the      to its omega-6 content.       nr
                                               Allies, Not Enemies:
                                              Sterols including Cholesterol
                                                              H 3C                             returned to the liver controls the activity
                                                                               CH 3            of the HMGCoA reductase enzyme in the
                                                               CH 3
                                                                                               liver. An increased return of biliary

                                                       CH 3                    CH 3            cholesterol from the intestine suppresses

   Through research, we are learning that                           Cholesterol                HMGCoA reductase activity and liver
eating too much saturated fat can increase                                                     cholesterol production.
the level of lipids in the blood and                                                              About 97% of the bile acids are
contribute to an increased risk of heart
                                                              H 3C                             reabsorbed in the intestine, while 3% is
                                                                               CH 3
disease. Another type of lipid produced                        CH 3                            excreted in the stool. Once bile acids are

by animals often associated with saturated             CH 2                                    reabsorbed, they are extracted by the liver.
                                                                               CH 3

fat because it is generally found in the                             Vitamin D3                In the liver, the bile acids regulate their
same foods, is cholesterol. Cholesterol is                                                     own synthesis rate by feedback regulation.
a sterol and, unlike triglyceride, has no      HO                                              About 300-500mg of cholesterol are
fatty acids. It is the precursor of some      cholesterol, about 800-1500 mg/day, that         converted into bile acids daily.
important hormones such as                    ends up in the blood. The body tissues              Unfortunately, when tissue cholesterol
corticosteroids, estrogens, testosterone      can make cholesterol from carbohydrates,         production is not slowed or excess
and a form of the active vitamin D            proteins and fats. Body synthesis of             lipoprotein cholesterol is not cleared by
hormone. Cholesterol is also the              cholesterol begins with acetate (a product       the liver, cholesterol continues to build
precursor of bile acids, which are            of protein, fat and carbohydrate                 up in the blood. This has been shown to
required for digestion and absorption of      metabolism), in the presence of a cellular       increase heart disease risk. Excess
other lipids. In addition, cholesterol is a   enzyme, HMGCoA reductase. The                    cholesterol causes harm to the body when
structural component of cell membranes        availability of the enzyme HMGCoA                it deposits on arterial walls leading to a
and plays a part in transporting lipids       reductase is a limiting factor that helps        narrowing of blood vessels and
within the blood.                             the body control the amount of                   diminishing blood flow to body organs.
   Cholesterol is made by the liver and       cholesterol produced. Once cholesterol              All cholesterol that is transported to
other body tissues. Normally the body         is produced it has 3 different fates: it can     the body tissues must be carried by
maintains a constant plasma level by          be used as a substrate for bile acids, it can    proteins to keep it in solution within the
slowing production when it senses a rise      be added to bile and sent to the intestine       blood. Receptor sites on the cell surface
in blood cholesterol. Genes control how       to aid in fat digestion, or it can enter the     recognize and bind the lipoprotein and
much cholesterol the body makes and           blood serum attached to a protein carrier        begin the process of utilizing the
how much cholesterol is absorbed from         (lipoprotein).                                   cholesterol.
the intestines. People are often unaware         About 55% of the cholesterol that enters         Blood cholesterol can be divided into
that less than one fourth (25%) of the        the intestine in the bile is reabsorbed and      three major categories by their
cholesterol in the body is from dietary       returned to the liver while the other 45%        association with protein carriers known as
sources. The body makes most of the           is excreted in the stool. The amount that is     lipoproteins.

Transport Agents: Lipoproteins
1. Chylomicrons-the largest and least            the liver to the body tissues. As the           body organs
   dense carrier molecule that circulates        triglycerides are removed from the              like muscle, heart and
   newly digested fatty acids or                 VLDL, they pick up cholesterol and              adipose tissue.
   triglycerides from the intestine to the       become low-density lipoproteins.
                                                                                              4. High Density Lipoproteins
   liver and body tissues. As they flow
                                              3. Low Density Lipoproteins (LDL)-                 (HDL)- Consists mostly of protein and
   through the lymph and blood, cells
                                                 Often considered the “bad” cholesterol          is often considered the “good”
   remove lipids from the chylomicrons
                                                 because of its correlation with heart           cholesterol. It's role is to collect and
   leaving little more than a remnant that
                                                 disease risk. LDL is a carrier molecule         carry cholesterol and phospholipids
   the liver removes from the circulation.
                                                 produced from the remnants of VLDL              back from the body cells to the liver for
2. Very Low Density Lipoproteins                 after the body cells have removed the           recycling or excretion. Maintaining a
   (VLDL)- synthesized in the liver from         triglycerides. LDL becomes loaded               high HDL is believed to be an
   protein and triglycerides, VLDL               with cholesterol and travels through            indication of lowered risk for heart
   transports mainly triglycerides from          the blood distributing cholesterol to           disease.                                 nr
                                       Double Agents That
                                       Keep it Together:
                                       Phospholipids Including Lecithin
                                Phospholipids are another class of lipid, able     preparing salad dressing. Phospholipids play an
                              to dissolve in both water and fat and therefore      important role in transporting fat-soluble
                              can act as an emulsifier to keep fats suspended in   vitamins and hormones through the cell
                              body fluids and blood. An example of this            membranes from sites of production to sites of
                              property is the ability of egg yolk lecithin, to     utilization.                                 nr
                              keep oil and vinegar together in solution when

Course of Action:
Knowing what to eat
   Eating sensibly is one way to
reduce the amount of cholesterol          ✔ It is wise to trim
in your blood. For some,                      meat before
controlling the amount of                     cooking it.
saturated fats and cholesterol that
you eat can help lower your
                                          ✔ When shopping or
                                              eating out of your home,
blood cholesterol. For others                 choose foods that supply
exercise, which increases body                protein without a lot of saturated
production of HDL, is most                    fat. Fish, eggs and chicken are examples
helpful. Still others find eating             of foods that are good sources of protein
more foods that contain whole                 and are moderately low in saturated fat.
grain fiber helps to reduce their                                                                     Generally, eating sensibly means
blood cholesterol. The role of            ✔   Avoid using gravies and sauces unless the fat        keeping serving sizes small,
trans-fats and cholesterol in heart           has been skimmed. To skim the fat from a             choosing moderately low fat meat,
disease risk are still confusing for          soup, stew or gravy just cool it in the              fish, eggs or poultry, including
many.                                         refrigerator and remove the fat that collects        whole grains, fruit and vegetables
    The good news is that certain             on the top.                                          and making enjoyment the focus of
lifestyle changes are helpful for
everyone and can decrease the
                                          ✔ Choose low fat dairy products such as low fat          your meal.
                                                                                                      Although we have been hearing
                                              cheese and low fat milk and try to avoid using
risk of heart disease. These                  butter or cream in sauces or toppings.               about saturated, hydrogenated and
changes are to stop smoking,                                                                       polyunsaturated fats for years, it's
keep your weight within a healthy         ✔ Try to use olive or canola oil when cooking            often confusing and difficult to
range, increase daily exercise to at          because these fats are monounsaturated and           understand how to use these terms
least 30 minutes, and keep your               considered to be the most beneficial.                to improve our personal health
blood level of fat and cholesterol
within a normal range.
                                          ✔ To avoid trans-fats, replace coffee creamers           outlook. Scientific research
                                                                                                   continues to support what we all
                                              with low fat milk, choose to use liquid oils
   To minimize the amount of                  such as canola or olive oil instead of stick         have known for generations: All
saturated and trans-fats in your              margarine or shortening.                             foods are good in moderate amounts
diet here are some healthful tips:                                                                 and all foods are a gift from nature.
                                                                                                                       Published By :
                                                                                                                       Egg Nutrition Center

QUESTIONS FROM                                t                         What quick advice can
                                                                        I offer my patients who
                                              h                         need to reduce their

             How do I explain
             to my patients that              e                         saturated fat intake?
             it's okay to eat an
             egg everyday?                    c        a:      It’s wise to suggest a gradual approach
                                                               to reducing one's saturated fat intake.
                                              l        Rather than cutting out all fat intake, it is
a:     Consumers seem to appreciate
       that scientific research is a step-    i        more realistic to advise patients to lower their
                                                       saturated fat intake by becoming more
wise process and that through
technological advancement our                 n        familiar with certain terms when selecting

                                                                                                                               r e a l i t i e s
                                                       prepared foods or foods from a menu:
understanding of health and nutrition         i           LIMIT: Alfredo sauce, au gratin, battered,
has improved.
   They will understand that before we        c        cheese sauce, cream sauce, crispy, deep
had today's scientific evidence                        fried, fried, prime cut, scalloped.
demonstrating the minimal effect dietary                  CHOOSE: Preparation methods for
cholesterol intake has on blood cholesterol            favorite foods that are steamed, boiled,
levels (2mg/dl increase in blood cholesterol           poached, baked, broiled or roasted.
when dietary cholesterol intake is increased              In addition, suggest that they substitute
100 mg), and the lack of significant                   onions, mushrooms or peppers on their pizza
association between egg consumption and                in place of sausage, pepperoni or extra
heart disease risk, it was prudent to advise a         cheese. Choose baked or grilled chicken or
tightly controlled dietary cholesterol intake.         leaner cuts of beef such as round, loin or
   Now many years later, we recognize the              sirloin. Instead of avoiding all rich desserts,
many nutritional benefits of egg                       top a sliver of a rich dessert such as ice
consumption. Rather than cholesterol,                  cream or pie with fresh fruit to get a very
research has made the link between                     similar experience.
saturated fat intake and heart disease much

clearer. In fact, the American Heart                                    What are other
Association has stopped recommending any                                sources of omega-3
specific limitation on daily egg intake. To                             fatty acids for patients
learn more about the American Heart                                     who don't like fish?
Association's total dietary approach to
healthy eating visit their website:           a:     Although certain fishes are potent
                                                              sources of those heart healthy omega-
?identifier=4547                                       3 fatty acids, there are other food sources:

D I E TA RY S O U R C E S O F O M E G A - 6 A N D O M E G A - 3 FAT T Y A C I D S
Food Item (per 100 gms.)      Omega-6 Fatty Acids (g)      Omega-3 Fatty Acids (g)
Salmon, Atlantic              0.7                          0.2
Tuna, albacore                0.3                          0.2
Cod, Atlantic                 Trace                        Trace
Mackerel, Atlantic            1.1                          0.1
Lake trout                    1.4                          0.4
Canola oil (Rapeseed)         22.2                         11.1
Butter                        1.8                          1.2
Egg yolk, chicken, raw        4.2                          0.1
Wheat germ oil                54.8                         6.9
Walnut oil                    52.9                         10.4
Walnuts, black                34.2                         3.3
Flaxseed oil                  12.7                         53.5
Mayonnaise, comm.,            16.0                         2.0
Broccoli, raw                 .03                          0.1
                                   Source: The Omega Plan, Artemis Simopoulos and Jo Robinson, Harper Collins, 1998.
   C O M P A R I S O N                                          O F        D I E T A R Y                   F A T S
 Dietary                        Cholesterol    Saturated fats    Monounsaturated fats       Polyunsaturated fats
 Fat                             (mg/tbs)

 Coconut oil                              0
 Butter                                   33
 Beef tallow                              14
 Palm oil                                 0
 • Animal fats and the tropical oils of coconut and palm are mostly saturated

 Olive oil                                0
 Canola oil                               0
 Peanut oil                               0
 Lard                                     12
 • Some vegetable oils, such as olive and canola, are rich in monosaturated fatty acids

 Safflower oil                            0
 Sunflower oil                            0
 Corn oil                                 0
 Soybean oil                              0
 Cottonseed oil                           0
 • Many vegetable oils are rich in polyunsaturated fatty acids

Endogenous Cholesterol Metabolism (mg/kg-day)
The Fate of Cholesterol in the body:
Liver and cellular synthesis of cholesterol= 12.0 mg/kg/day
Dietary intake of cholesterol= 3.75 mg/kg/day                                BILE
Re-absorption of cholesterol from intestine= 11.30 mg/kg/day
Excretion of cholesterol from intestine= 15.75 mg/kg/day                                                           3.75



                                                                               11 . 3 0                    INTESTINE

 r e        a     l    i    t    i    e    s                          Biliary=9.25
 Executive Editor:                                                    Dietary=2.05
   Donald J. McNamara, Ph.D.
   Marcia D. Greenblum, M.S., R.D.
                                                                                                   Neutral Steroids=9.25
 1050 17th Street, NW Suite 560                                                                    Bile Acids=6.50
 Washington, DC 20036
 (202) 833-8850 Fax: (202) 463-0102
 e-mail:                                                               15.75                           6

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