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NETA Instructor Guide to accompany Understanding Nutrition, Second Canadian Edition 6-1
Chapter 6
Protein: Amino Acids
IF NOTHING ELSE, MY STUDENTS SHOULD LEARN…
1. That protein is vital to the structural and working materials of all cells.
Protein serves the following functions: (1) growth and maintenance of
tissues, (2) acting as enzymes, hormones, and antibodies, (3) maintenance of
fluid and acid–base balance, (4) assisting in the transport of nutrients,
clotting of blood, and provision of eyesight.
3. That not all protein‐containing foods are digested and absorbed in the same
quantities, as different foods can be classified as being high or low quality
protein sources.
LEARNING OBJECTIVES
• LO 6.3: Describe how the body makes proteins and uses them to perform
various roles. [Understand/Apply]
• LO 6.5: Identify the health benefits of, and recommendations for, protein.
[Understand/Apply]
• Many people take protein and amino acid supplements for various reasons
(to build muscle, to lose weight, to induce sleep, to cure infection, or to
relieve pain). Scientists are studying whether these supplements actually
work and whether they are safe. Research is also needed on the long‐term
effects of consumption of amino acid supplements by healthy people and of
the possible adverse effects.
• As many people have adopted high‐protein diets in order to lose weight, the
health‐care practitioner should understand the benefits and potential
health risks involved with such a diet.
• Students should know that proteins are unique among the macronutrients in
that they are comprised of 20 different dietary amino acids and are classified
as essential or nonessential. Amino acids link into long strands that coil and
fold to make a wide variety of different proteins. Each type of protein has a
distinctive sequence of amino acids and so has great specificity.
• Students also should have some insight as to the metabolic rate of amino
acids. Amino acids are constituted into protein, metabolized for energy, or
converted glucose or fat. An adequate diet should provide the full
complement of essential amino acids.
• Students should be aware of the important role that proteins have in the
body. The body requires dietary amino acids to synthesize new protein that
functions to provide cell structures and to serve as enzymes, ion channels,
and receptors. Antibodies are proteins that defend against foreign substances
in the body. Proteins help to regulate the body’s electrolytes and fluids.
Proteins buffer the blood against excess acidity or alkalinity. Proteins have a
role in blood clotting and prevent uncontrolled bleeding from injuries.
• Students should understand that the digestibility of protein varies from food
to food, and cooking can improve or impair it. When insufficient
carbohydrate and fat are consumed to meet the body’s energy need, the body
breaks down protein, primarily in skeletal muscle, to provide much needed
energy.
• Students should know that there are adverse effects associated with the
consumption of too little protein or too much protein in the diet. Protein‐
deficiency symptoms are always observed when either protein or energy is
There are a variety of activities that can be done in class. Listed below are some
activities that will help introduce the topic of nutrition, and the students to each
other.
2. List the roles of proteins in the body and detail the importance of each role
identified.
3. Many Canadians consume beyond the RDA for protein. However, there are many
individuals that have difficulty acquiring enough food to feed themselves and
their families, or are simply unable to eat enough to meet the RDA for protein.
Many times, individuals having difficulty financially may consume inexpensive
1 Activity provided by Robin S. Bagby, M. Ed., R.D., Penn State Nutrition Center
2 Activity provided by Dorothy G. Herron, Orangeburg‐Calhoun Technical College
3 Contributed by Kathleen Rourke.
staples or leftovers from others. Discuss how the RD would go about assessing
such an individual’s protein status. What suggestions would you have for this
person to improve his or her protein intake and balance?
6. The Human Genome Project is forging the way for many scientists, including the
nutrition science field. Discuss some of the pros and cons of this project for
patients and professionals in the nutrition field.
Case Study4
Erin is a 28‐year‐old professional woman who is 1.73 m (5′ 8″) tall and vigilantly
maintains her weight at 53 kg (118 lbs) by following a lacto‐ovo‐ (non‐fat milk and
egg whites only) vegetarian diet that supplies approximately 1200 calories a day.
With her understanding that protein should provide between 10 and 35 percent of
her daily calories, she reasons that her daily intake of 40 grams of protein from milk,
eggs, legumes, and nuts is adequate for her needs. She is concerned, however, that
she has been sick more than usual and has experienced two stress fractures in her
leg over the past three years while exercising.
1. Explain why Erin’s assumptions about her protein needs are unrealistic based on
her current weight.
2. Assuming a healthy weight for Erin is 64 kg (141 lbs), use the information from
Table 6‐4 on page 199 of this chapter to calculate her recommended daily
protein requirement. Show your calculations.
3. What percentage of Erin’s energy comes from protein? Is this adequate? Why or
why not?
4. Erin’s energy needs for a healthy weight are closer to 1600 calories a day. What
are some consequences of her low calorie intake on her body’s need for protein?
5. How does Erin’s low intake of calories and protein contribute to her risk for
osteoporosis?
6. Assuming Erin consumes 20 grams of protein from whole grains, vegetables, and
legumes each day, calculate how she can meet the remainder of her protein
needs with dairy foods and egg whites.
You can look up information about government policy as well as any health
condition that you are interested in learning more about. Consult the following
websites to get reliable information on the following:
• Find out more about licensed natural health products (including proteins) at
Health Canada: http://www.hc‐sc.gc.ca/dhp‐
mps/prodnatur/applications/licen‐prod/lnhpd‐bdpsnh‐eng.php
• To learn more about Canadian eating habits, including protein intake, go to
http://www.statcan.gc.ca/pub/82‐620‐m/82‐620‐m2006002‐eng.pdf
• To find out more information about protein energy malnutrition go to the
World Health Organization website:
http://www.who.int/nutrition/publications/en/childgrowth_database_over
view.pdf
To learn more about vegetarian eating habits and menu planning, go to the
Dietitians of Canada website: http://www.dietitians.ca/Your‐
Health/Nutrition‐A‐Z/Vegetarian‐Diets.aspx
1. Answer: Proteins contain a nitrogen group along with carbons, oxygen, and
hydrogen. These nitrogen molecules become part of the amino group,
distinguishing proteins from carbohydrates and fats. This part of the protein is
eventually excreted as urea, a process that requires additional work of the
kidneys, one limiting factor in overconsumption of proteins.
Proteins are very complex molecules that have primary, secondary, tertiary, and
quaternary structures. Because they are much larger molecules than
carbohydrates and fats, they are able to fold and configure themselves in unique
ways. This allows them to perform many functions that are not performed by
carbohydrates and fats.
Given the above, proteins are very susceptible to acid and heat and can be
denatured readily. A denatured protein is not able to perform its given function.
While fats can become rancid, neither fats nor carbohydrates become denatured
2. Answer: Growth and Maintenance of Body Tissues: One of the major roles for
which proteins are noted or known is providing for growth and development of
body tissues such as the muscles, skin, hair, etc. Proteins are also important in
the repair of body tissues that are damaged or require replacement. Most
consumers identify proteins with this function in the body; however, proteins
have many more functions in the human body.
Functioning as Enzymes: Enzymes are important molecules in our bodies that
are required for the many chemical reactions that release energy and allow our
bodies to function. All enzymes are made of proteins; therefore, without protein,
our bodies would be unable to carry out the chemical reactions required for life.
Maintenance of Fluid Balance: Fluid balance in and out of cells and within the
blood is maintained by proteins. Proteins are very large molecules that do not
normally cross cellular membranes. However, in times of critical illness, proteins
are able to leak out, attracting water to themselves and causing a build‐up of
fluid or edema. When there is edema, the vascular system is less functional in its
ability to carry all nutrients as well as oxygen around the body; therefore, the
entire body becomes deprived of oxygen and nutrients. When this happens,
depending on the length of time the situation lingers, tissues can and will die.
Maintenance of Acid–Base Balance: In the normal course of daily events of the
body, the body works hard to maintain homeostasis. Proteins are an important
part of this process through their work in maintaining acid–base balance.
Proteins do so by attracting positively charged ions from hydrogen molecules to
their negatively charged surfaces. Proteins can release these negative charges
elsewhere in a basic environment, protecting themselves from denaturation.
Transportation of Many Substances throughout the Body: Proteins are especially
good transporters of many substances, including nutrients such as vitamins and
minerals, lipids (i.e., the lipoproteins), oxygen in hemoglobin, etc. Proteins are
very large, complex, and multidimensional, allowing them to function in a variety
of ways, some of which we are still discovering. In this regard, their role in
transportation of nutrients about the body may still teach us more about the
fundamentals of nutrition and micronutrient utilization.
Function as Antibodies: Antibodies are large protein molecules that are made by
our bodies to help us fight against a particular disease or illness that is viral in
nature. When an individual becomes ill with a virus, the virus leaves in the body
materials or particles that are called antigens. Antigens are informational units
about the virus that allow the body to make an antibody that can help it fight
against that particular virus with greater strength and speed. These antibodies
are made of proteins from the body. Once the body has fought the disease, the
work in producing the antibody from the antigen leaves behind memory
information that stays in the body forever, producing “immunity” to that specific
virus in the future. In this manner, each person’s body has a unique and
wonderful ability to manufacture its own fighting army for viruses with proteins,
for the most part! The body, of course, must be healthy and well nourished, and
there are times when viruses (like AIDS) outwit our body’s unique defences.
Role in Energy: As discussed in earlier chapters, the body can break down
protein to serve as a source of glucose and energy when needed. While there are
many other more important roles for protein and utilizing protein for energy can
be costly to those other roles, protein will be supplied as an energy source
in times of need. In these cases, protein can be taken from the cells, body
tissues, etc.
Other: Protein does serve in many other roles via its role in chemical reactions.
For example, as outlined in your textbook, a cascade of events is required for the
formation of a blood clot. A few of these events include the formation of fibrin,
which is a stringy glob of protein fibres that will eventually lead to a collagen
scar. Protein is also involved in vision, a sequence of events in which light
permeates the cells of the retina. The protein molecule opsin responds to the
light and decides how much light it will allow into the eye by changing the shape
of the retina.
Clearly, protein is multifunctional, and vastly important to our bodies. Students
should be able to gain a better understanding of the depth and breadth of the
role of protein in human function.
3. Answer: The average Canadian eats about 100 grams of protein/day compared
to a recommended 50–60 grams, depending on gender and activity level (for
those over 25 years). While protein intake is generally not a problem in
Canadian culture, there are enough cases of protein malnutrition and individuals
who are unable to consume high‐quality proteins in their diets that this question
is posed to assist students in understanding the broad array of individuals they
may come into contact with as practitioners.
The RD would generally perform multiple types of assessment to attain the best
data for decision making. Therefore, the RD might investigate the following:
Dietary History: A food frequency and a three‐day diet recall—with these
assessments the RD is looking for types of protein eaten. The RD would want to
determine the quality of the protein, the frequency through an average week,
and the amount. Does the patient have to combine proteins to make sure all
essential amino acids are being consumed? Is the patient eating enough protein
for his or her age, gender, weight, and height? Is the patient of a high‐risk group
that should be supplemented (i.e., pregnant, breastfeeding, elderly, etc.)?
Social/Behaviour History: Does the patient eat alone? Does the patient have any
relatives or friends who can help with dietary issues? Has the patient had diet
problems in the past? Do religion or cultural beliefs affect the diet? Has the
patient lost any significant others in the recent past? Etc.
Medical History: Does the patient have any significant medical problems/issues
that affect diet or ability to eat? Has the patient had any issues in the recent past?
Is the patient on medications that affect his or her ability to eat? Are the any
drug–nutrient interactions? Does the patient have any wounds or wound‐healing
issues? Does the patient suffer from loss of hair or edema? What does the N‐
balance study show? Is the patient in N‐balance? Was the patient assessed for
protein malnutrition? albumin? Does the patient have a history of heart disease,
cancer, or bone disease? any other diseases?
Physical Assessment: What does the patient look like? Does the patient look
tired? Does the skin look dry? What about the turgor? Does the patient have
edema? Is the hair thin, or are the nails weak? Does the patient have any
unhealed wounds?
The goal here is for students to pursue a full assessment of the patient in an
effort to acquire the most accurate information possible. While students may list
other types of information, what is important is that students pursue multiple
areas of assessment in an effort to ensure that they have many means of
assessing protein intake and metabolism.
Recommendations for the patient might be as follows: Inexpensive yet nutrient‐
rich sources of protein can include such food staples as peanut butter and
legumes, and using powdered milk and oatmeal in meals such as meatloaf and
hamburgers. Also advising that a patient utilize a food pantry, where such
staples can be secured freely or for minimal cost, can stretch a budget a long
way. Adding powdered milk or oatmeal to meat meals can not only stretch the
meal but add to its protein value. This also holds true for adding beans to a meal.
4. Answer: As stated above, in Canada, consumers eat much more protein than is
required for their bodies. There might be many reasons for this. One is that most
consumers do not understand what an appropriate portion size for a “protein” is.
Another is that many Canadians believe that protein is a miracle nutrient for
everything that ails anyone. Many diets begin with the concept that more protein
and less carbohydrate are good because many individuals have lost the notion
that food is fuel for the body, not the next drug of choice. Given that we are
fortunate to have a plentiful supply of food in Canada, food in general might be
thought of as an abused substance; however, of all the nutrient categories,
marketers see that protein appears to be the “miracle substance” sought by
consumers that are desperate to win the battle of the bulge.
The need for protein in the body has been thoroughly investigated for many
years, and while nutrition is a young science and more can always be learned, it
appears to be fairly clear that the healthy adult body’s need for protein is
0.8 g/kg/day or about 10–35 percent of energy intake. Over time, more work has
been done on athletes; a higher goal has been established at 1.2–1.5 g/kg/day
for athletes, given that there is much tissue breakdown with training, etc.
with fat. Therefore, it is very important for consumers to understand that they
must balance their calories in protein with exercise and that the best diet
includes other types of nutrients, so that they are able to achieve a balance of all
nutrients for optimal health.
5. Answer: Proteins are sequenced through a process that is quite complex, but is
described in this chapter as a two‐step process: transcription and translation.
A portion of DNA is needed to make a template for the mRNA (messenger RNA),
which will transport the template code to the RNA on the ribosomes. In this first
sequence, the DNA lines up with the mRNA―the mRNA coding with the exact
sequence of the DNA. This process is called transcription of the template of DNA.
The genetic code is being transcribed onto the template of mRNA. The mRNA
dissociates with the DNA after it acquires the sequence and takes the sequence
to the ribosomes in the cell cytoplasm, where synthesis of the protein occurs
with help from the tRNA. The tRNA acquires amino acids from the materials
around the cell and in the body fluids. The tRNAs then usher the amino acids into
position to form the correct primary protein structure. This process is called
translation, in that the mRNA is translating to the tRNA the genetic code for the
protein. Once the protein is completed, it is attached to its appropriate
component, may undergo further processing, and moves on to assume its
function.
Every protein is made for a very separate and different function and if, in the
course of transcription, mRNA transcribes even one different amino acid, the
protein may function poorly or not at all. Your textbook describes the
misplacement of a valine in the position of a glutamic acid in the case of
hemoglobin, which drastically alters the hemoglobin, resulting in sickle cell
anemia. While your body carries out the process an amazing number of times a
day, seldom does it error in its mission. Yet, on occasion, there are protein‐
sequencing errors that can be problematic to fatal—and due to only one amino
acid. The Human Gemone Project’s work will allow scientists to further study
these sequencing errors, predict them, and counsel and advise patients. The
science of nutrition is on the verge of many new discoveries as well as
challenges.
6. Answer: Students are being asked to use not only the information in the
textbook to answer this question but also to develop a heightened
understanding for how patients as well as professionals might react to the
changing paradigms that form nutrition education programs with the Human
Genome Project. As science advances, some patients and health‐care
professionals remain steadfast or tried and true to the “don’t change what is not
broken” theory, while others are anxious to try new things and forge new
frontiers. The risks in this latter approach can be great indeed for both the
patient and the professional, yet the payoff may be worth it. As a professional,
the obligation to maintain standards of professional licensure, practice based on
solid scientific evidence, and to guide the patient accordingly must be carefully
followed, despite unique therapies the patient might try. Therefore, in this
question, the student must think about the advantages and disadvantages of
gene profiling and consider where patients might believe there are great
opportunities and great risks to their health. Professionals must weigh advances
they may provide for a patient and decide when a patient is better off following a
traditional therapy.
Pros for Patients: With the sequencing of the human genome, the potential to
identify genetic predispositions to any variety of illnesses is advanced. Many
scientists and medical professionals predict that with this possibility, patients
will be provided with advance information as to potential medical issues and
therefore these same patients can alter their lifestyle and health habits
accordingly. Nutrition and dietary habits would be a primary area in which to
seek improvements to prevent and/or reduce one’s risk for diseases of any sort.
For example, if an individual is notified through their genetic profile that they
have a gene for diabetes, this individual would pursue regular medical care,
blood sugar monitoring, a diabetic nutrition program, etc. If the individual were
to pursue such a program with care, he or she might be able to avoid becoming
diabetic, minimize some of the complications of diabetes, and reduce the number
of medications needed to control diabetes, given a strict program of medical and
lifestyle interventions.
Outcomes from the Human Genome Project will allow patients to approach and
plan their health, medical care, and lifestyle habits differently. In addition, the
information can help patients planning to have children understand what types
of genetic risks the fetus may have and make their family planning decisions
based on such information. Again, in some cases, nutrition and nutrition
education could be a vital part of improving the outcome or enhancing the
outcome for these patients.
Data from the Human Genome Project will, over time, allow scientists to develop
more effective treatments for patients with medical and nutritional illnesses and
hopefully also work to advance a cure for illnesses. For instance, with the many
types of cancer, the potential to understand the mutation and develop a
treatment is conceivable.
Genetic counsellors work with patients who have family histories of inherited
genetic disorders or fear the possibility of having a child with a genetic disorder
and use the data available to them through blood samples and family profiles to
assist a couple who is beginning to plan a family. Through their work, a couple
can better understand their risks and the potential risks to the unborn fetus (for
a genetic disorder) prior to trying to conceive. Should the genetic counsellor
have information that dictates that a couple will most definitely produce a child
with a genetic defect, the couple can then decide if they want to avoid pregnancy
or initiate it knowing the outcome. They are then informed and can prepare
accordingly for the child, should they choose to have one.
Food Production: While there are already many examples of genetic engineering
in the area of agriculture, the Human Genome Project does open the possibility
for many new areas. Given that we are already capable of producing babies and
animals in test tubes, clearly the possibilities to develop, grow, and invent many
types of food products are endless.
The goal in genetic engineering of fruits and vegetables and/or food products is
to be able to develop and produce a “better” product by manipulating the genetic
profile with the best profile possible and then producing the items in the best
environment possible.
Cons for Patient: While the Human Genome Project does have the potential to
provide enormous volumes of information to any particular patient, the overload
of information and the technical detail of this information alone could be very
overwhelming to some consumers. In addition, a consumer’s ability to fully
understand such information is quite variable and does truly impact the
outcome of successful nutrition education programs. How much information any
one person needs and understands will be variable as will how much any one
person will want this information. How will standards be set for the information
provided? Also, who will be able to have access to the information? If individuals
have genetic predispositions to diabetes or cancer and the information can be
accessed by insurance companies, will these same individuals be denied access
to critical care/disability/extended health insurance?
Genetic testing is an expensive undertaking. Who pays for this testing? Is it
required or optional? If individuals find out that they have a genetic profile for a
particular illness, how can a system be developed to optimize the chances that a
particular patient will follow the medical, nutritional, and lifestyle regime that is
required to minimize the health‐care costs? Who would be responsible for
oversight of that system? Should patients be required to follow any particular
regime if they are genetically profiled for a particular disease? Should they be
denied medical care if they do not follow their prescribed program?
While the information from a genetic profile could be quite helpful to an
individual, some individuals may not want to be informed in advance of such
information. Some individuals would “rather take their chances” and live life as it
is played out. Critics of genetic counselling believe that it takes the spontaneity
out of living and in some cases places individuals in a mode of “waiting for the
other shoe to drop.” These individuals see having such information as a burden
rather than a window of opportunity. Others believe that information from the
Human Genome Project that is used to predict illness and better understand the
health status of an individual is somewhat like “playing God,” as one may base
their entire life on genetic data to the point of not really living. A person might be
so focused and fearful of the genetic information that he or she adheres to a rigid
lifestyle of exercise, nutrient‐rich foods, and frequent medical testing, yet dies
from a car accident, never suffering any issues from the purported genetic
illness.
Critics of genetic engineering believe that produce and food products that are a
result of genetic engineering may not be exactly the same as those produced by
nature, thus adding another unknown potential toxin into the food supply. In
these cases, it is a wait‐and‐see situation, as any new element added to the food
supply might take approximately 20 years to demonstrate any potential negative
outcome in humans or in the environment. Therefore, there are a few more
years to wait before the final verdict is in on genetic engineering of products, etc.
Pros for Nutritional Professional: The Human Genome Project has great
potential for the nutrition field. First, the science of nutrition is actually quite
young when compared to other sciences such as chemistry, physics, and biology.
While much is known, so much more is still to be discovered. Through the
Human Genome Project, the science and discoveries in nutrition are poised to be
expanded. Second, in knowing of potential genetic mutations in humans, we
learn how to treat and perhaps cure these diseases and we assist patients in
pursuing medical care and lifestyles that support enhanced health. Certainly
nutrition is primary to the majority of chronic diseases that plague Canadians.
This factor increases the importance of nutrition, nutritional care, and nutrition
education in health care and will increase the visibility of registered dietitians as
part of the health‐care team.
To enjoy the opportunities, nutritional professionals must keep current in their
knowledge of the advances in the Human Genome Project and impacts to the
profession. Readings in the professional literature as well as a firm
understanding of biochemistry and genetics will be essential to the growth of
our profession. Expanded career opportunities will emerge from the Human
Genome Project in the field of nutrition science, not only broadening career
opportunities for students studying nutrition but also potential salary advances.
Growth in collaborating with other health‐care professionals is necessary now
and will continue. Physicians and other health‐care providers will look to the
nutrition professional (registered dietitian) to work with patients on their diets
in an effort to minimize or avoid any negative health consequence from a genetic
inheritance.
Given the advance knowledge of a potential illness, the RD can work with
patients to fully realize better health and better eating habits. Many individuals
retain poor eating habits as a result of “denial” that they will be confronted with
any adverse health event. However, if patients are assured that they are
genetically coded for any particular disease, this knowledge can heighten their
willingness to faithfully follow better nutritional habits. Given that nutritional
habits are often similar among family members, if one family member retains
positive dietary habits, the chances are very good that the remaining family
members will also follow similar positive dietary habits. The potential for this
type of trend throughout Canada could potentially reduce obesity,
cardiovascular disease, and many chronic diseases that are a result of poor
nutritional/dietary habits.
Genetic Engineering of Produce/Food Products: Mother Nature can be quite
devastating with regard to crops, while multiple issues can result from breeding
poultry, beef, pork, etc. for the food supply. In addition, growing crops and
breeding animals take a great deal of land, space, and sometimes luck!
Genetically engineering produce and other products for the food supply can take
many of the risk factors out of the equation as well as support the growth of a
genetically superior product. For example, instead of growing tomatoes on the
land, there are now multiple processes for growing tomatoes, including growing
them on water. Developments such as these allow growers to avoid the changing
nature of Mother Nature and control the growing environment.
In the case of poultry, beef, etc., breeders are able to control the genetics of the
breed, enhancing the quality of the product. Additionally, the breeding is reliably
done instead of waiting for Mother Nature again, in the event that the animals do
not feel like breeding. The key here may also be the land that animals may
require prior to slaughter. Cattle require a significant amount of land to graze in
order to grow, putting great demands on the capabilities of the land to feed the
population. Genetic engineering has the potential to provide answers to some of
these truly significant environmental dilemmas.
Genetic engineering also has the potential to provide consumers with new,
flavourful, and healthful food products not formerly available through their
innovation and creation. Consumers look for new food products that “break
neither the bank nor the waistline” and science may provide some of those
answers. Food manufacturers work hard to provide consumers with options.
Though they are not genetically engineered, products such as the fat replacers
and alternative sweeteners are examples of recently developed diet alternatives.
It is important for the RD to stay current with all new products as consumers
will challenge the RD about them.
Cons for Nutritional Professional: Innovation is a wonderful thing but what
happened to “leaving well enough alone and living for today”? As noted with the
consumers or patients, even if genetic information is available to assist them in
making the most informed medical decision, patients may well want to be
uninformed. And, as with the patients, who then becomes responsible for the
number of issues that surround such decisions? While some patients may be
more motivated to follow strict dietary plans if they know that they are
genetically prone to a heart attack, others may believe that there is nothing that
is going to stop it, so why not “live for today”?
Nutrition education/counselling for a population that has available to them a
massive amount of genetic information can be complex without some standard
guidelines. It will be important for Dietitians of Canada and RDs to prepare
policy guidelines for patient counselling and education with genetic information.
Should practitioners practise consistently if patients want to experiment, or
should practitioners work with each individual patient and his or her ability to
understand the information given and his or her ability to use it? An excellent
example would be the sports nutrition movement. The American Dietetic
Association’s position on supplementation at the beginning of significant
endurance events where athletes were seeking nutrition counselling was that it
should not be encouraged. However, RDs who worked with professional and
world‐class athletes knew that if they were to be taken seriously, they had to be
Case Study
1. Protein needs are based on “healthy body weight.” Erin is underweight so her
actual weight is not a good parameter for calculating her protein needs.
2. RDA for protein = Weight in kg × 0.8 = 64 kg × 0.8 grams per kg = 51 grams
protein per day.
3. 40 grams protein × 4 kcal per gram = 160 kcalories divided by 1200 kcalories
per day = 13.3 percent of her daily calories from protein. Although this falls into
the recommended percentage of calories from protein, it is not adequate because
the requirement for protein assumes that adequate calories to meet dietary
needs are consumed. Erin is consuming inadequate calories.
4. An inadequate intake of calories forces the body to use protein to meet energy
needs and less is left to meet the body’s protein needs. Immune function and
bone loss are two important consequences of inadequate protein.
5. Protein, as well as calcium, is needed for bone health. When calories are
restricted, essential protein is used for energy needs and less is available for
essential functions like synthesis of collagen, the primary protein in bone.
6. 750 mL (3 c) milk × 8 g protein/250 mL = 24 g protein + 1 egg white = 7 g
protein = 31 g + 20 g from vegetables, legumes, and vegetables = 51 g protein
per day.
Elderly female X* X* X*
diagnosed with Variable amino Variable amino Variable amino
PEM acids levels seen → acids levels seen → acids levels seen →
usually decreased usually decreased usually decreased
Adult male with X
partial thickness Branched chain
burns over 20% amino acids
BSA (leucine, valine,
and isoleucine)
Glutamine
Reference: http://ageing.oxfordjournals.org/cgi/reprint/26/6/457.pdf
WORKSHEET ACTIVITIES
For each of the following clinical examples, indicate whether the patient is at risk to
develop a problem related to amino acids.
Conditionally Sequencing
Patient Essential Nonessential Acquired Error
Newborn baby
diagnosed with
PKU
Elderly female
diagnosed with
PEM
Most people in Canada and the United States receive more protein than they need.
This is not surprising considering the abundance of food eaten and the central role
meats hold in the North American diet. Using your food diary from the Nutrition
Portfolio in Chapter 1, estimate your protein intake for the day. Multiply the number
of servings you consumed by the estimated protein per serving to approximate your
total protein intake.
Servings Estimated
Food Groups Consumed Protein Totals
Grains 3 grams/serving
Vegetables 2 grams/serving
Fruit 0 grams/serving
The protein RDA for young adults (19 to 24 years old) is 46 grams for women and
58 grams for men. Health experts advise people to maintain moderate protein
intakes—between the RDA and twice the RDA.
1 2
4 5
10
Across Down
4. Many (10 or more) amino acids bonded 1. Two amino acids bonded together
together 2. Compounds that help keep a solution’s
6. Above‐normal alkalinity (base) in the acidity or alkalinity constant
blood and body fluids 3. Above‐normal acidity in the blood and
7. Three amino acids bonded together body fluids
9. An enzyme that enables two or more 5. Enzymes that hydrolyze protein
substances to form a more complex 8. A gastric protease
structure
10. Removal of the amino (NH2) group
from a compound such as an amino
acid
2. Research studies have changed the idea that foods must be eaten at the same
meal to achieve the concept of complementary proteins.
a. True
b. False
5. Proteins can be used interchangeably in the body because they have similar
structures.
a. True
b. False
Myth Reality
Plant proteins are not complete; they lack Most dietary combinations of proteins are
certain amino acids. complete; certain food proteins may be low
in specific amino acids.
Plant proteins are lower in quality than Protein quality depends not only on the
animal proteins. source but also on the dietary mixture of
plant proteins; plant proteins can be as high
in quality as animal proteins.
Proteins from different plant foods must be Proteins do not have to been eaten at the
carefully mixed and eaten together in the same meal; the mixture over a day is
same meal. important for nutritional value.
Plant proteins are difficult to digest. Depending on the source and method of
food preparation, plant proteins can be easy
to digest.
People cannot meet protein needs with Plant protein or animal protein can provide
plant proteins alone. adequate protein for human needs.
Plant proteins are lacking in nutritional Plant proteins do not create a practical
value because they are not balanced. problem in terms of balance; possible
imbalances are observed in amino acid
supplementation.
Food PDCAAs1
Egg white 100
Ground beef 100
Chicken hot dogs 100
Milk protein (casein) 100
Fat‐free milk powder 100
Beef salami 100
Tuna 100
Soybean protein 94
Whole wheat pea flour 822
Chick peas (garbanzos) 69
Kidney beans 68
Peas 67
Sausage, pork 63
Pinto beans 61
Rolled oats 57
Black beans 53
Lentils 52
Peanut meal 52
Whole wheat 40
Wheat protein (gluten) 25
1 Proteins with ideal digestion and amino acid balance are given a score of 100; others are scored against this
standard.
2 An example of mutual supplementation. Combining whole wheat and pea flours yields a protein with higher
Handout 6‐3: Do You Get Enough or Too Much Protein Each Day?
2. Record a day’s worth of your food and drink intakes in a table like the one below.
Example of part of a day’s intake:
Protein
Meal Food and Amount (grams)
1 banana 1g
30 mL (2 tablespoons) sugar 0g
You can determine your protein intake in several different ways. You can use the
food composition table in APPENDIX H of the textbook to help you calculate the total
grams of protein. You can also use software such as Diet Analysis Plus that your
instructor has chosen for the course. These programs can automatically calculate
the protein amounts.
Analysis: Was your protein intake higher or lower than your recommended amount?
If it was higher or lower, suggest ways that you could change your daily intakes to
bring your daily protein intake closer to your recommended level.
You can repeat the exercise, but design an improved diet and enter the information
into a second table like the one above. Check to see whether your new diet brings
your protein intake closer to the recommended levels.
People who eat animal products but do not eat meat are called lacto‐ovo‐
vegetarians. They eat eggs and dairy products such as milk, cheese, or eggs. People
who eat no animal products are called vegans. They eat beans, grains, nuts, fruits,
and vegetables. Both types of vegetarians eat this way for many years and are as
healthy as anyone else. How do they do it?
Can you get enough proteins if you don’t eat meat? What if you don’t eat any animal
products? How can you find out? You can try some diet planning and diet analysis to
find out where the protein is found in foods.
Design a one‐day diet as if you are a meat eater, lacto‐ovo‐vegetarian, or vegan. You
can analyze the food using the food composition table in APPENDIX H of your
textbook or by using Diet Analysis Plus. Prepare a table (or computer printout)
including each food/amount, grams of protein, grams of saturated + trans fats, and
grams of unsaturated fats (polyunsaturated + monounsaturated).
Can you get enough (or too much) protein if you eat a lacto‐ovo‐vegetarian diet? a
vegan diet? If you did not get enough protein for your body weight, suggest ways
that you could get more. Consider trying food substitutions or adjusting portion
sizes.
Compare the fat content of the three diets. Which of your diet plans most closely
followed dietary recommendations for the amounts and types of fats as presented in
your textbook?