You Are What You Eat - Food as Preventive Medicine

University of Nevada, Reno
Southern Area Cooperative Extension
Seniors CAN

Lesson Plan

Lesson: You Are What You Eat - Food as Preventive Medicine

Lesson Number: N-2

Introduction:

The “Food as Preventive Medicine” lesson is designed to introduce Learners to the concept that food plays a major role in reducing risks of disease and complications of disease, as well as in how one feels on a day-to-day basis. Learning Overview: The Learner will participate in a lesson designed to teach him/her how food choices can reduce risks of major illness and/or their complications as well as influence daily energy levels.

Lesson Objectives:

  1. During the lesson, the Learner will be exposed to information on how food choices can reduce risks of major illnesses and complications of major illnesses as well as influence how one feels on a day-to day basis. The Learner will also be exposed to information about the benefits of incorporating soy into the diet.
    • Long-term risk-reduction benefits:
      • a. Foods to eat (fruits, vegetables, calcium and vitamin D).
      • b. Foods to limit (sodium, alcohol, caffeine, sugar, fat, unsaturated fat, trans-fat and cholesterol).
    • Short-term Benefits:
      • a. Feeling more energetic.
      • b. More energy means being more able to exercise and socialize with others.
        Doing these things, in turn, helps to avoid depression.
    • Introduction to soy.
  2. During the lesson, the Learner will engage in group discussion regarding how eating can affect health, describing with clarity at least one example from his/her life experience.
  3. During group discussion, either spontaneously or in response to Facilitator request, each Learner will state with clarity that s/he has selected at least one idea presented during the lesson, what that idea is, and that s/he will try this idea during the following week to see if it works for him/her. Alternatively, the Learner will state with clarity that s/he does not want to try out any of the ideas presented, and the reason for the decision.

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Set up at previous meeting:

Next week, we will be exploring the topic of food as preventative medicine.

Optional Activity:

We will be trying a tofu vegetable stir-fry or a tofu pie. I’ll bring the prepared dish.

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Set up immediately prior to this meeting:

Optional Activity:

Facilitator prepares the tofu food dish (using the lesson recipes) prior to the meeting and refrigerates the food item at the facility the day of the meeting.

Facilitator assures that lighting is appropriate for Learners to read recipe and other lesson material.

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Materials:

Provided by the Facilitator:

One of the following for each Learner:

Optional Activity:

Note: Facilitator should review lesson plan for this week, last week and next week because information provided at the beginning of each lesson plan is needed for smooth transition between lessons.

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Optional Activity:

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References:

National Institute on Aging (Reprinted April 2008). Osteoporosis: The Bone Thief (Age Page, online). http://www.nia.nih.gov/HealthInformation/Publications/osteoporosis.htm (Access date 7/25/08).

National Institute on Aging (April 2008). Stroke (Age Page, online). http://www.nia.nih.gov/HealthInformation/Publications/stroke.html

United States Department of Agriculture, & United States Department of Health and Human Services. (2005). Finding a Way to a Healthier You: Based on the Dietary Guidelines for Americans. USDA Publication number: Home and Garden Bulletin No. 232-CP. Washington, DC: U.S. Government Printing Office.

National Center for Health Statistics, CDC (March 2006). Deaths-Leading Causes. Retrieved July 23, 2008 from http://www.cdc.gov/nchs/fastats/lcod.htm. United Soybean Board (2004). Soyfoods Guide. Indianapolis: Steven’s & Associates, Inc.

The American Dietetic Association Nutrition Fact Sheets. Dietary Fats: Clarifying an Age-Old Issue (2006) & Eat Your Way to Better Health (2007).

The American Heart Association (2007). Nutrition Facts: Sodium, Calcium, Fiber. Retrieved July 23, 2007 from http://www.americanheart.org/presenter.jhtml?identifier=855.

The American Institute for Cancer Research (2005). Nutrition After Fifty. Publication number E57-SF.

Lesson:

Begin Lesson:

Transition from last week

Last week we talked about (name of last week’s unit). Each of us selected one idea to try out. Let’s talk about how those worked (or didn’t work) for us, and also what we learned from last week’s meeting.

Anticipatory Set:

Today we will explore food as preventative medicine. There are three reasons that we think this topic is important:

  1. How you feel today relates to what you eat. When you eat properly, you have more energy to exercise, to socialize and to do the things you want to do.
  2. It’s never too late to change eating habits to improve your health and how you feel.
  3. Food choices have an impact on your risks for getting major long-term diseases. Food also has an effect on how serious complications of long-term illnesses become.

Share the Objective:

  1. We will be talking about how food choices can, in the long run, reduce risks of major illnesses and complications of major illnesses. We will also talk about how food choices affect how you feel in the short and long term. Well point out foods to eat more of, and food choices to limit. At the end of our discussion, we’ll talk about soy and have a food demonstration using tofu.
  2. During this lesson, I will be providing information, but it is also important that we share information and ask questions in group discussion. I would appreciate it if each of you could bring up at least one example from your life experience.
  3. Also during the lesson today, I’m going to ask each of you to select one idea from the lesson to try out on your own over the next week. I’ll pick one, too. Then each of us can share with the group next week how it worked out.

Share the Handouts:

These summarize the main ideas we will be discussing today. [Pass out handouts.] Please feel free to take notes and ask questions as they arise.

Input:

I. When we learned about the USDA’s MyPlate and Dietary Guidelines for Americans, we learned how many servings of food to eat from each food category daily. Additionally, we talked about the idea that all foods can fit into your diet using the key principles proportion, moderation and variety.

II. Today, we will be talking about which foods to select from the various categories to maximize your chances of reducing risks of major illnesses.

  1. First we will talk about foods to choose more often:
    1. Fiber
    2. Fruits and Vegetables
    3. Foods containing calcium and Vitamin D
  2. Then foods to choose less often:
    1. Sodium
    2. Alcohol
    3. Caffeine
    4. Sugar
    5. Fat, Saturated Fat, Trans-fat, and Cholesterol

III. Major risk factors have been identified for several major illnesses.

  1. Some risk factors cannot be controlled. For example, in general, close relatives of a cancer patient have twice the usual risk for developing the same type of cancer.
  2. However, some risk factors can be controlled. For example, a diet that is low in fiber, grain products, fruits and vegetables, but high in fat, is associated with increased risks for many cancers. The recommendation then to reduce the risk of getting some kinds of cancer is to make adequate fruit, vegetables, fiber and whole-grains a regular part of your diet, and make sure your diet is low-fat.
    1. Diets high in fat have been linked to increased risks of various types of cancer particularly: breast, colon, prostate cancers and possibly cancers of the pancreas, ovary and endometrium.
    2. There is evidence that diets high in fruits, vegetables, and grains have a protective function against several types of cancer, including lung, colon and rectal, breast, oral cavity, esophagus, stomach, pancreas, uterine, cervix and ovary. For most types of cancer, persons with low fruit and vegetable intake have twice the risk of the disease as those with a diet high in fruits and vegetables.
  3. The following diseases are directly related to diet:
    1. Heart Disease (leading cause of death & illness in U.S.). Your risks for heart disease can be reduced by avoiding a diet that is high in saturated fats. Controlling high blood pressure and high blood cholesterol reduces the risk of heart disease. Being overweight increases your risk for diabetes and directly increases your chance for heart disease.
    2. Cancer (No.2 cause of death & illness in U.S.). The National Cancer Institute estimates that 35% of cancer deaths may be related to dietary factors.
    3. Stroke (No.3 cause of death & illness in U.S.). To reduce risk of stroke, eat foods low in fat, saturated fatty acids and cholesterol and eat a variety of fruits and vegetables. Also, controlling high blood pressure and controlling diabetes reduces risk of stroke.
    4. Diabetes (No.7 cause of death & illness in U.S.) also contributes to heart disease, which is the leading cause of death, and to stroke, the No. 3 cause of death. If left untreated, diabetes can lead to atherosclerosis. Becoming overweight can trigger diabetes in susceptible older people.
  4. Here are some more relationships between diet and health:
    1. Obesity: Being overweight increases chances of high blood pressure, atherosclerosis, heart disease, stroke, cancer and adult-onset (type II) diabetes. There is even some recent research from Harvard Medical School suggesting that excess weight can make people more vulnerable to developing asthma. Controlling or losing weight can reduce stress on the joints and can help avoid further damage from arthritis.
    2. High Blood Pressure: Treating high blood pressure reduces the risk for stroke, heart disease and kidney disease. Part of high blood pressure treatment is having your condition monitored by a doctor and taking any high blood pressure medications prescribed. Even moderate weight loss and sodium restriction can reduce blood pressure significantly in older adults, as can exercise and eliminating smoking.
    3. High blood cholesterol levels can contribute to heart disease and stroke. Eating a diet low in saturated fat and cholesterol, and eating soluble fiber, can help to lower blood cholesterol.

IV. Foods to choose MORE often:

  1. Fruits and Vegetables
    1. Fruits and vegetables are known to reduce risks of cancer and may reduce the risk of heart disease.
    2. Fruits and vegetables are very complex and contain more than 100 substances - including vitamins, minerals and fiber which may offer protection from cancer.
    3. The recommendation is that you eat 5 or more servings of fruits and vegetables per day. Choose a variety of deeply colored fruits and vegetables to obtain necessary nutrients.
    4. If fruit or vegetables are difficult for you to chew or swallow, try letting your knife do your work for you. Chop the fruits and vegetables as much as you need to or cook them.
  2. Foods Rich in Fiber
    1. High fiber foods, particularly when combined with a low-fat diet, might help protect against colon and rectal cancer. Generally, a high-fiber diet is usually low in fat as well, and a low-fat diet also helps to prevent cancer. Some types of fiber (soluble fiber) help to protect against high blood cholesterol levels as well. As we stated previously, high blood cholesterol levels can contribute to heart disease and stroke. Also, fiber can help us to feel better on a day to day basis because it is so effective in preventing constipation.
    2. Fruits and vegetables are good sources of fiber. Fruits with edible skins are especially good sources of fiber.
      • a. Be aware that the more that food is processed, the less fiber it has. For example, an apple with the peel still on it has 3 grams of fiber. If you remove the peel, it has only 2.4 grams of fiber. If you instead eat ½ cup of applesauce, you get only 1.8 grams of fiber. And ¾ cup of apple juice has 0.2 grams of fiber. So choose whole fruits more often than juice.
    3. There are also other sources of fiber:
      • a. Legumes—Beans, peas, lentils. These are good, healthy, low-cost choices.
      • b. Whole-grain breads, cereals, pasta—the way you know whether these items are whole-grain is to look on the label. If the label says “made with whole grains” it is at least partially made with whole grains. Look for food labels that say “100% whole grain” or “100% whole wheat.” Bran is also a good source of fiber. So is brown rice (the only kind of rice that is whole-grain). Whole-grain pasta can be found if you look for it—most pasta available in the stores is not whole-grain pasta. Popcorn is a good source of fiber.
        1. Whole grains are not only an excellent source of fiber, but they also are sources of antioxidant nutrients such as Vitamin E and selenium. They also provide minerals (zinc, copper, iron) and vitamins (B6 and A in addition to E.)
        2. Whole grain breads tend to be more expensive than breads that are made from refined grains. The best thing to do is to buy some 100% wholewheat bread and keep it in the freezer. Use it as needed by taking 1 or 2 slices out at a time.
      • c. Nuts and seeds also are high in fiber, but you need to watch your intake of these because they tend to be high in fat. They also tend to be expensive, but you can buy small amounts of broken nuts in bulk and add a tablespoon or so to stir fry, salad or yogurt. Also, edible seeds that are in fruit, such as those in all kinds of berries and in kiwi fruit, are not high in fat, and are a good source of fiber. (Caution, those with diverticular disease should avoid nuts.)
      • d. The following foods do not supply fiber: meat, milk and eggs.
    4. To increase health benefits of your food, get 20 to 35 grams of fiber daily. On the average, most people get only 11 grams of fiber daily —only about half of what the body needs.
      • a. To get enough fiber, eat at least 2 servings of fruit and 3 servings of vegetables daily. Try to choose at least 3, whole-grain foods for your daily servings from the bread, rice, pasta and cereal group. Eat legumes three times per week.
      • b. Beware of two things with fiber (including fiber from fruits and vegetables):
        1. It is best to talk to your doctor before you increase fiber in your diet (1) if you are older than age 65, and/or (2) if you have had surgery on any part of your stomach, intestines, colon or rectum.
        2. Add fiber to your diet gradually. Otherwise, you may have problems like diarrhea or constipation. Also, suddenly adding fiber could result in a flare-up of diverticular disease.
    5. Eat a variety of fiber-rich foods. Fiber-rich foods have varying amounts of soluble and insoluble types of fiber. Both have health benefits. Studies suggest eating more soluble fiber may reduce blood cholesterol levels, and insoluble fiber helps prevent constipation, diverticulitis, and possibly colon cancer and diabetes. You don’t have to worry how much of each kind you get as long as you eat a variety of fiber-rich foods.
  3. Calcium and Vitamin D
    1. Not eating enough food rich in calcium will weaken your bones. Scientists agree that good nutrition can reduce the risk of getting osteoporosis by as much as half. Osteoporosis is a slow, progressive bone-weakening disease that can affect both men and women as they age. It does affect more women than men. Almost half of women over 50 suffer from bone fractures due to osteoporosis. Osteoporosis affects the majority of people over age 70. Bones become so fragile that they fracture with normal use and a fall has a much greater likelihood of causing life-threatening injury.
      • a. It is never too late to improve your bone health by eating enough calcium-rich foods. The National Institute on Aging recommends that men and women ages 50 and older take 1,200 mg/day of calcium and women past menopause should have 1,200 to 1,500 mg daily. That would be equivalent to four 8-oz. glasses of milk. One 8-oz glass of milk has 300 mg. of calcium.
      • b. Good sources of calcium include many dairy foods such as yogurt, milk and cheese. Low-fat and non-fat dairy foods generally have a calcium content comparable to whole dairy products. These foods provide 75% of the calcium in the food supply of the United States. Other good sources of calcium include broccoli, kale, okra, collard greens and sardines or salmon with the bones. But remember you would need to eat 4 cups of cooked broccoli to get the calcium you would get in 8oz. of milk. 3 cups of cooked kale = one 8 oz. glass of milk. 4 ½ oz. of salmon with the bones = 8 oz. glass of milk. One easy way to get a serving of milk is to add low fat milk to canned soup.
      • c. You can also get calcium from calcium enriched foods like breads made with calcium, fortified flour, calcium-fortified cereal and calcium-enriched orange juice.
      • d. Surprisingly, cottage cheese is not really a good source of calcium. You would need to eat 2 cups to get the same amount of calcium you would with an 8- oz glass of milk.
    2. It is better to obtain calcium from food rather than from a supplement. People with diets low in calcium often consume low levels of other important nutrients. And unlike supplements, foods can provide the other nutrients that your bones and body need to stay healthy. On the other hand, if you really cannot get enough calcium from your food, you might consider taking a calcium supplement. But you should always check with your doctor before taking this or any kind of dietary supplement.
    3. In order for your body to use the calcium you take in, you also need vitamin D. Milk fortified with vitamin D is a good source of vitamin D. Your body can make its own vitamin D if you go outside and get some sunshine a few times a week.
    4. Some studies suggest that calcium may play a protective role in colon cancer.

V. Foods to choose LESS often

  1. Sodium
    1. One of the recommendations from the National Heart, Lung, and Blood Institute, for both treating and preventing high blood pressure, is to keep daily salt intake to no more than 2,300 milligrams, or about 1 teaspoon, daily. The Dietary Guidelines advise people who have high blood pressure, African Americans, and middle aged and older adults to aim for no more than 1,500 mg. of sodium per day.
    2. Remember that the 2300 mg. limit includes sodium (or salt) from all sources—added, as in canned or homemade soups, or naturally occurring as in milk, fruits and vegetables. Therefore, you are may not be within recommended limits if you sprinkle a teaspoon of salt on your food over the course of a day because you haven’t counted the sodium in your other foods.
    3. A tip: In general, milk, cheese, fresh fruits and fresh vegetables aren’t nearly as high in sodium as are canned/packaged/prepared foods like canned peas or prepared dinners.
    4. Always remember to taste your food before adding salt and consider adding other seasonings first before adding salt.
  2. Alcohol
    1. High levels of alcohol consumption increases the risks for many conditions, including high blood pressure, stroke, heart disease and certain cancers, such as breast cancer. High alcohol consumption is a risk factor for osteoporosis.
    2. Heavy drinkers are at risk for malnutrition because calories from alcohol may be substituted for calories from more nutritious foods.
  3. Caffeine
    1. According to the American Dietetic Association, for most people moderate amounts (two to three cups of coffee a day) of caffeine cause no physical harm to healthy adults. Yet for some people, excessive caffeine can cause anxiety, insomnia, headaches or stomach irritation. However, caffeine may also help protect against gallstones, cavities, type 2 diabetes and Parkinson’s disease, but more research is needed before caffeine can be proclaimed a “disease preventer.”
  4. Sugar
    1. Many foods containing added sugar supply a lot of calories but few nutrients. Older adults have lower calorie needs but still have high nutrient needs. If you get many of your calories from high sugar foods, chances are you will not be getting all of the nutrients you need. ii By the way, there is no evidence that eating sugar causes diabetes. Intake of sugar is, however, something that must be closely monitored by a person who is diabetic.
  5. Fat, Saturated Fat, Trans-Fat and Cholesterol
    1. Fat
      • a. Fat is needed within our body. It insulates the skin, transports fat-soluble vitamins and provides energy and feelings of satiety after a meal.
      • b. However, foods high in fat often contain more calories and a diet high in saturated fat is associated with a greater risk of heart disease and increased blood cholesterol levels.
      • c. Choose low-fat options between the milk and meat groups. As an example, a glass of skim milk has the same amount of calcium as whole milk but 8 grams less of fat.
      • d. No more than 30% of the calories per day that you take in should come from fat. No more than 1/3 of that should be saturated fat. No more than 10% of your total daily calories should be from saturated fat.
      • e. A diet high in saturated fat is associated with greater risk of heart disease and with increased blood cholesterol levels.
    2. Trans-fat
      • a. Promotes heart disease and should be avoided.
      • b. They are found in anything with “hydrogenated” or “partially hydrogenated” vegetable oils listed in the ingredients. These are often put into foods with a long shelf life—margarine, crackers, cookies, cakes and many deep-fried foods.
    3. Cholesterol
      • a. Your body makes the cholesterol it requires. You also take in dietary cholesterol through food. In general, limit dietary cholesterol to no more than 300 mg. per day.
  6. There are special diets that have been shown to help reduce high blood pressure and high blood cholesterol. The DASH Diet is effective with high blood pressure, while the American Heart Association Diets are effective in lowering high blood cholesterol. Each is similar to the recommendations by the USDA Dietary Guidelines for Americans and MyPlate. If you have either of these health conditions talk with your doctor about which may be best for you.

VI. Short-term benefits of healthy eating:

  1. Feeling more energetic.
  2. More energy means being more able to exercise and socialize with others. Doing these things, in turn, helps to avoid depression.
  3. Helps the immune system stay strong.
  4. Helps fight constipation.

VII. Introduction to soy

  1. A popular “food as preventative medicine” example is the versatile soybean. The soybean is a member of the legume family and is high in protein, fiber, minerals and fat. Soy protein is a complete protein, while the oils are mostly unsaturated, high in essential fatty acids and without cholesterol. Soy foods are also a dietary source of isoflavones—phytochemicals, some with estrogen-like properties.
  2. Studies suggest that eating a diet high in soy (the FDA recommends 25 grams) can reduce risks of breast cancer & osteoporosis and may help with blood sugar levels and lower cholesterol.
  3. Traditional soy foods include: edamame (green vegetable soybean), miso, soy milk, soynuts, tofu, soy sauce, tempeh, natto, okara and yuba. Soy ingredients include: soybean oil, soy flour, lecithin and soy protein (textured, isolate, concentrate). Soy based products include: soy protein products (i.e. veggie burger), beverages, cheese, nut butter, yogurt and soy (non-dairy) frozen desserts.
  4. We will be taste testing a vegetable stir-fry today, using tofu as a meat substitute. OR We will be taste testing the Pineapple Pie today using the tofu as a substitute for some of the cream cheese.
  5. Tofu is soybean curd. It has a texture kind of like cheese. It has a very mild taste and it tends to take on the taste of the other food that is cooked with it. Although tofu has some fat, it has very little saturated fat.
  6. When you buy tofu, you can get it soft, medium, firm, or extra firm. Soft tofu is used in making salad dressings, dips, and sauces. Medium is often used for cheesecake and pudding. While firm or extra firm is most often used when you use soy as a meat substitute.

Optional Activity:

Let’s now try our stir-fry or cheesecake

Modeling And Optional Guided Practice:

Facilitator and Learners should first all wash their hands. Facilitator, with the help of several Learner volunteers, does the final preparation of the tofu food dish and serves to each Learner.

Monitoring / Discussion:

After Learners have tried the tofu food dish have a group discussion on the lesson.

Q: What are your thoughts on using food as a preventative medicine, as we talked about today?

Q: Based on what we’ve talked about today, would you consider making changes in your diet?

Q: What changes would be the easiest?

Q: Which ones would be the most difficult?

Q: What did you think of the tofu food dish you tried today?

Independent Practice:

This can be done at any time during the lesson. It seems to work better when it is not done in the rush at the end of a meeting.

"I’d like for each of us to select at least one idea, from what we're learning, to try out this week. Let’s choose something easy to experiment with. Next week we can all compare our experiences and see what worked and what didn't."

Closure/ Transition:

Look at next week’s lesson plan for: “Set up at previous meeting.”

It begins: “Next week, we will be exploring . . ..”