The Suggested Meal Pattern (Questions and Answers)

The suggested meal pattern must be based on good nutrition principles of variety, regularity of mealtime, and adequacy. The pattern must provide for an easy-to-follow guide and, at the same time, flexibility for a wide array of food choices.

Which should be your biggest meal?

Breakfast should be the heaviest meal and supper the lightest. This is because most of your activities are concentrated early in the day, and you need more energy in the morning. Taking a heavy (not overloaded) breakfast will help you eat less during supper. This is the first step to weight control.

How often should you eat?

There should be at least a 5-hour interval between meals for digestion efficiency. A regular meal will be digested in 4 to 5 hours depending on its composition (kinds and amount of food). This makes the 3-regular-meal pattern practical.

If your digestive system is to continue working for the rest of your life, it deserves breaktimes! Having at least a 5-hour break in between meals automatically discharges snacking! This way, you do not overburden your digestive system.

It would be very easy for you to wait until the next mealtime if you eat enough food. The variety of food groups represented every meal is better than just eating one kind of food in a meal. Following your dietitian’s advice or, in its absence, the Food Pyramid allowances, you can be confident that you neither overeat nor undereat.

How late should you take your supper?

Early breakfast means early supper. It is highly recommended that you take your day’s last meal at least 3 hours before bedtime. This will ensure you of a more restful sleep and better weight control.

What about fruits every meal?

Fruits and vegetables must not be together in one meal. You digest these foods better and easier if they are not eaten together. Remember that you want to lighten your digestive system’s work. So, fruits are scheduled during breakfast and supper; and vegetables, during lunch. Thus, your fruit and vegetable requirements will be met by the end of the day.

Have you forgotten anything?

By the way, you should not forget your water needs. Water is both a nutrient and a food. Unfortunately, it is often not given due attention. About 6 to 8 (at least) glasses of plain, clean water is generally enough. It would be best for you to take juices and other healthful drinks in addition to the daily recommended water intake.

You drink almost 2 glasses of water every meal…

It is best to drink water at least 30 minutes before mealtime or at least one and a half hours after mealtime. If you drink plenty of water or any other fluid during mealtime, the perfectly proportioned enzymes and juices will be diluted and digestion may be less than efficient. This again will make the work of your digestive system heavier. If ever you need to drink during mealtime, do it by sips rather than gulps.

Your own schedule of meal pattern…

You may be engaged in a work with night duties or evening shifts. You may have an emergency overtime. You may be used to eating just twice a day. Hence, the heavy-breakfast-light-supper pattern may not be suited for you.

The general rule is for you to eat the heaviest meal before working hours and the lightest meal before sleeping. If you eat two times a day, both meals should be heavy. Be sure that the second meal is taken at least 3 hours before bedtime.

What counts as one serving?

To make wise and healthy food choices, you have to identify which foods are included in the different pyramid groups. It is clear where most foods belong. Combination foods may include foods in more than one pyramid group. Say for example, a serving of spaghetti with tomato sauce and cheese can be included in the rice/bread group, the vegetable group and also meat group. But what counts as one serving?

The term one serving is very relative. A serving at a certain restaurant may be bigger or smaller compared to a serving at another eating place. Portion control may vary from server to server. Fortunately, research has made standardized serving sizes possible.

The food items are grouped according to the major nutrients that they contribute to the diet and in their 1 standardized serving sizes. A serving portion is called an exchange. Each food item can be exchanged with any other item within the same food group/list provided the serving size is followed. This makes much more room for flexibility and variety in meals.

A serving portion of the following can be considered an exchange if it provides:

1)      Vegetables (about 16 kilocalories)

2)      Fruits (about 40 kilocalories)

3)      Milk (about 80 [nonfat] or 170 [whole] kilocalories)

4)      Rice/bread (about100 kilocalories)

5)      Meat (about 68 kilocalories)

6)      Fat (about 45 kilocalories)

Reference: Healing Wonders of Diet Effective Guide to Diet Therapy p.224-227 © 2003 Philippine Publishing House ISBN 971-581-013-6

Vitamin A Deficiency

Depletion of the body’s Vitamin A stores is brought about by a prolonged intake of diet lacking in vitamin A.

Aside from promoting good night vision, Vitamin A plays a host of other important roles. It plays a part in:

• Promoting health of mucus membranes and skin

• Bone growth

• Reproduction

• Maintenance of cell membrane stability

• Helping the adrenal glands to synthesize a hormone

• Helping to ensure a normal output of thyroxine from the thyroid gland

• Helping to maintain nerve cell coverings

• Assisting in immune reactions

• Helping to manufacture red blood cells

With all these and other functions, you can just imagine the terrible problems that arise when Vitamin A is lacking or absent in the body.

The body can store up to one year’s supply of vitamin A, keeping 90% in the liver. Deficiency symptoms will only start to appear after your stores are depleted. Appearance of symptoms suggests that you have stopped eating good food sources of Vitamin A for quite some time.

Probable Causes

• Prolonged starvation

• Too little food intake

• Anorexia (See Underweight)

• Zinc deficiency (plays a major role in Vitamin A bioavailability)

• Poor food choices (lack of variety)

• Refusal to eat vegetables

Probable Symptoms
Area Affected	Main Effects	Technical Name for Symptoms
Eye       Retina       Membranes                General        Drying       (mildest         form)   Skin GI Tract Respiratory Tract Urogenital Tract Bones Teeth Nervous System Immune System Blood	Night Blindness Failure to secrete mucopolysaccharide causes change in epithelial tissue Triangular gray spots on eye Irreversible drying and degeneration of the cornea causes blindness (most severe) The eye’s symptoms of Vitamin A deficiency   Hair follicles plug with keratin, forming white lumps Changes in lining; diarrhea Changes in lining; infections Changes in lining favor Calcium deposition, resulting in kidney stones, bladder disorders Infections of bladder and kidney Infections of vagina Bone growth ceases; shapes of bones change; joints are painful Enamel-forming cells malfunction; teeth develop cracks and tend to decay; dentin-forming cells atrophy Brain and spinal cord grow too fast for stunted skull and spine; injury to brain and nerves causes paralysis Depression of immune reactions Anemia, often masked by dehydration	Xerophthalmia Xerosis Bitot’s spots Keratomalacia Hyperkeratinization Hyperkeratosis

Helpful Dietary Management

• Eat a balanced diet including dark green leafy and yellow vegetables. (See Foods Rich in Vitamin A)

Reference: Healing Wonders of Diet Effective Guide to Diet Therapy p.66-67 © 2003 Philippine Publishing House ISBN 971-581-013-6

Simple Goiter (Iodine Deficiency)

Simple goiter is a visible enlargement of the thyroid gland due to lack of available iodine in the blood.

Iodine is needed by the thyroid gland to synthesize thyroxine, a hormone responsible for regulating the rate of energy release within every body’s cell. When the iodine level of the blood is low, the cells of the thyroid gland work harder and enlarge in an attempt to get as many particles of iodine as possible.

About 96% of all goiter cases are caused by iodine deficiency (simple goiter).

Probable Causes

• Poor iodine content of soil from which food is grown

• Overconsumption of antithyroid-containing plants

Note: The cabbage family contains antithyroid (goitrogen). Its effect cannot be counteracted by dietary iodine.

Probable Symptoms

• Sluggishness

• Weight gain

• Enlargement of thyroid gland (frontal neck part)

Note: Severe iodine deficiency during pregnancy causes cretinism characterized by severe and irreversible mental and physical retardation. However, much of the mental retardation associated with cretinism can be averted by diagnosis and treatment of iodine deficiency early in pregnancy.

Helpful Dietary Management

• Eat seaweeds and vegetables grown in iodine-rich soil. (See Iodine in Foods)

• Use iodized salt.

• Eat a well-planned balanced diet.

Reference: Healing Wonders of Diet Effective Guide to Diet Therapy p.64-65 © 2003 Philippine Publishing House ISBN 971-581-013-6

Anemia

Anemia is a condition wherein there is a decrease in hemoglobin (red coloring and oxygen carrier of the blood) per unit volume of blood below the established normal level for a certain age and sex.

The World Health Organization description for anemia is below 12 gm Hb/dl of blood for women and below 14 gm Hb/dl for men; and a hematocrit below 34%. 

Probable Causes

• Iron deficiency-nutritional anemia

• Loss of blood-hemorrhagic anemia

• Deficiency of Vitamin B12 or folic acid-pernicious anemia

Having greater risk of developing anemia are those with increased iron requirement such as:

• Frequent blood donor

• A woman having one pregnancy after another

• A woman with heavy menstrual bleeding

Note: Infections must be treated as these can easily depress blood formation.

Probable Symptoms

• Weakness

• Easy fatigability

• Pallor (Paleness)

• Breathing difficulty on exertion

• Palpitation

• Headache

• “Deadtired” feeling

• Thin and brittle fingernails

Note: The diagnosis of anemia is based on analysis of blood constituents.

Iron Deficiency Symptoms

• Effects on muscular work:

                -reduced work productivity

                -reduced work tolerance

                -reduced voluntary work

• Reduced physical fitness, weakness and fatigue

• Reduced resistance to cold, inability to regulate body temperature

• Reduced resistance to infection (lowered immunity)

• Itchy skin

• Pale nailbeds, eye membranes, palm creases, concave nails

• Pica (clay eating, ice eating)

• Lactose intolerance and possibly intolerance to other sugars

• Impaired wound healing

• Increased risk of lead and cadmium poisoning

• Impaired cognitive function (children): reduced learning ability, impaired visual discrimination, increased distractibility (inability to pay attention)

• Impaired reactivity and coordination (infants)

Helpful Dietary Management

• Eat a high-protein diet with emphasis on other nutrients that aid red blood cell formation including iron, Vitamin C and B-complex vitamins.

• Provide supplementary foods which are iron-rich for infants as early as 4 to 6 months.

Reference: Healing Wonders of Diet Effective Guide to Diet Therapy p.62-63 © 2003 Philippine Publishing House ISBN 971-581-013-6

Infection

Infection is an invasion by a disease-causing microorganism. After exposure to an infective agent, a period of time called incubation period (usually a few days) passes before the first symptoms appear. Shortly after this period, fever develops.

Mostly, the body’s response to infection is similar to its response to other injuries or to surgery. However, early body protein losses (muscle wasting) are more severe.

Infection often develops in persons already stressed by malnutrition, surgery, or other injury.

A well-nourished person can tolerate a short period of severe stress without adverse effects.

Probable Causes

• Exposure to an infective agent

• Poor hygiene

• Poor sanitation

• Lowered resistance brought about by lack of food intake, rest and sleep, and peace of mind

Probable Symptoms

• Fever

• Nausea

• Vomiting

• Anorexia

• Diarrhea

• Marked weight loss (See Underweight)

• Immobilization

• Inflammation of infected area

• Lymphadenopathy

Helpful Dietary Management

• Eat a high-calorie, high-protein diet including plenty of fruits and vegetables rich in Vitamin C.

• Avoid concentrated sweets and sugars. They tend to incapacitate body soldier cells to fight infective invaders.

• Drink plenty of fluids to prevent dehydration. (See The Importance of Water)

Helpful Tips for Minimizing Nausea and Vomiting

• Eat small meals.

• Avoid high-fat foods.

• Sip clear liquids or suck popsicles to prevent dehydration

• Lie down after eating.

• Loosen clothing after eating.

• Get fresh air.

• Avoid smells that cause nausea.

Reference: Healing Wonders of Diet Effective Guide to Diet Therapy p.60-61 & 246 © 2003 Philippine Publishing House ISBN 971-581-013-6

Diabetes

Diabetes is a condition characterized by the lessened ability, or the complete inability of body tissues to handle and use body sugar (carbohydrate).

Probable Causes

Diabetes can result from a host of factors which can be grouped into primary and secondary.

• Primary factors include:

1. Heredity
2. Obesity
3. Infections
4. Stress (pregnancy can be form of stress)
5. Mental strain
6. Worry (40 years and older are more prone)

• Secondary factors include:

1. Hormonal imbalance
2. Disease of the pancreas (viral infection bringing about pancreatitis, carcinoma of the pancreas, TB of the pancreas)
3. Gallbladder, thyroid, pituitary and liver diseases (See Gallbladder Inflammation, Gallstone Formation, Simple Goiter, Hepatitis)
4. Presence of unidentified insulin inhibitor
5. Nutritional factors (active-turned-obese persons due to decline in physical activity and increased food intake)

Probable Symptoms

• Hyperglycemia (increased blood glucose concentration)

• Fasting blood sugar (FBS) reading of more than 120 mg/100 ml of blood

• Polyuria (frequent and abnormally large volume of urine)

• Polydipsia (excessive thirst)

• Polyphagia (increased appetite)

• Dehydration

• General weakness

• Weight loss (See Underweight)

• Lowered resistance to infection

• Poor wound healing

• Degenerative changes (inflammation of nerves, atherosclerosis)

• Acidosis as reflected by an acetone smelling breath

Note: Treatment for diabetes should be prescribed by the physician. A careful treatment and control of the disease may prevent long-term complications (blindness, amputated limbs, cardiovascular disease, kidney failure, etc.). Balancing the right kind and amount of food, exercise, medication (if necessary), maintenance of desirable body weight, and a positive outlook in life are the keys to efficient control.

Helpful Dietary Management

• Give calculated or measured low fat diet with normal protein.

• Eat complex carbohydrate foods with high-fiber content.

• Avoid added sugars and concentrated sweets. (See Diabetic Diet)

• Distribute foods into 3 regular meals.

• Give snacks only when action of medication dictates so.

• Eat regularly.

Reference: Healing Wonders of Diet Effective Guide to Diet Therapy p.58-59 © 2003 Philippine Publishing House ISBN 971-581-013-6

Arthritis

Arthritis is a group of diseases that causes joints and connecting tissues to become painful and inflamed. Once acquired, arthritis may continue for life. In most cases, damage remains permanent. At times, arthritis can be corrected by surgery. Although arthritis can be controlled, it cannot be cured. Proper diagnosis and treatment are essential, without delay, to minimize pain and crippling deformities.

There are almost a hundred types of arthritis. Gout arthritis, rheumatoid arthritis, and osteoarthritis are among the most popular ones.

Gout

Description A

Gout is a form of arthritis that is easiest to detect and treat. Excess uric acid in the body, as reflected in blood analysis, forms needle–like crystals in joints leading to severe inflammation. The affected joint becomes hot, swollen and very tender. Acute, painful attacks often start in the big toe, but frequently affect other joints in the feet, hands, knees and elbows.

Probable Causes

• Inherited defect in body chemistry (primary gout)

• Disturbances such as when the uric acid is either produced excessively or produced faster than kidneys can get rid of them (secondary gout)

Probable Symptoms

• Severe pain in a joint (big toe, wrist, ankle, thumb)

• Shiny, swollen and extremely tender-to-touch joints

Note: These are the characteristics of an acute attack.

Helpful Dietary Management

• Eat a low-purine diet, giving emphasis not to overeat protein-rich foods—even those which are not purine-rich.

• Eat a low fat diet for possible excretion of uric acid.

Note: All protein, when metabolized inside the body, will eventually contribute to uric acid pool.

Osteoarthritis

Description B

Osteoarthritis, the most common type, is a wear-and-tear disease that comes with old age. The elastic tissue becomes soft and wears away, sometimes even exposing the underlying bone. Most commonly affected are the weight-bearing joints—hips, knees and spine plus fingers and big toes.

Primary osteoarthritis—the onset is without apparent cause. It occurs earlier in life and mostly affects the small joints.

Secondary osteoarthritis—this results from injury or wear-and-tear. It occurs later in life in large or excessively used joints.

Probable Causes

• Mechanical stress. It is a combination of aging, chronic irritation of joints and normal wear and tear.

• Heredity. Some people inherit weaker cartilage, or have chemical abnormalities, ranking them as highly prone to osteoarthritis.

Probable Symptoms

• Localized pain

• Localized stiffness

• Loss of ability to move joints comfortably

• Appearance of bony enlargements of joints especially the fingers

Helpful Dietary Management

• Eat a balanced diet. Include food preparations that are easily handled and transported to the mouth by painful arthritic fingers.

Rheumatoid

Description C

Rheumatoid arthritis is the most common disabling and destructive type, often affecting the whole body. This disease often inflames and thickens the lining and tissues around the joints. In addition to joints, it can also affect heart, lungs, eyes, skin, blood vessels and the muscles.

Probable Cause

• Unknown

Probable Symptoms

• Fatigue

• Muscular stiffness

• Loss of appetite

• Weight loss (See Underweight)

• Swollen joints

• Presence of fever

Helpful Dietary Management

• Eat a high-calorie diet with abundant fruits and vegetables (balanced diet) if losing weight and with fever

• Eat a small frequent feedings rather than just 3 big meals to improve a failing appetite.

• Adjust diet to 3 regular meals as appetite improves.

Reference: Healing Wonders of Diet Effective Guide to Diet Therapy p.55-57 © 2003 Philippine Publishing House ISBN 971-581-013-6