A-6: Readings, References, Study Questions

It can be hard to distinguish between reliable and unreliable sources. Be suspicious of websites with advertising. Our federal government provides a wealth of reliable information online (look for the .gov designation), e.g., cdc.gov (Center for Disease Control and Prevention),

Chapter 1 ‑ Behind the Soundbite
The History of Scurvy and Vitamin C (1986) by Kenneth Carpenter [Ph.D. in Nutrition from Cambridge Univ. and former Chairman of the Nutrition Dept. at the Univ. of Calif. at Berkeley. He also wrote the nutrition history books Protein and Energy (1994) and Pellagra (1981).]

Chapter 2 ‑ Scientific Method
An Evaluation of Internal‑Mammary‑Artery Ligation by a Double‑blind Technic by Cobb et al. New Eng. J. Med., volume 260, pages 1115‑1118, 1959. [This study was mentioned in discussing the positive results of a “placebo” surgery.]

Final Report on the Aspirin Component of the Ongoing Physicians’ Health Study. New Eng. J. Med., vol. 321, pp. 129‑135, 1989. [This was the example given of a study stopped early by the monitoring committee because the death rate for heart disease was clearly lower in the aspirin group. The study was to see if taking aspirin every other day lowers the risk of death from heart disease, and if taking carotene every other day lowers the risk of cancer. The carotene supplements didn’t lower cancer risk.]

PubMed.gov [Search our National Library of Medicine database for articles on health, medicine, and nutrition in peer-reviewed science journals.]

ClinicalTrials.gov [Searchable database of clinical trials with information about participating, etc.]

Q1 Professor Jones found that students who sit at the front of the classroom get higher grades than those who sit in the back. He concluded that sitting in the front results in better grades. Is this a scientifically valid conclusion?

Q2 Countries whose native diet is a high‑fat diet generally have a higher rate of breast and colon cancers than countries whose diet is low in fat. Why is this insufficient proof that a high‑fat diet causes breast and colon cancers? What are other possible explanations?

Q3 Human studies which are (a) prospective, (b) randomized, and (c) double-blind are highly valued. What does each of these three terms mean, and why is each important?

Chapter 3 ‑ Chemistry
PeriodicVideos.com [Click on an element in the periodic table for a fun and informative YouTube video on the element. Created by videojournalist Brady Haran, featuring Univ. of Nottingham chemists, including the “wild” and delightful Professor Martyn Poliakoff.]

On Food and Cooking. The Science and Lore of the Kitchen. (2004) by Harold McGee. [“Scientific explanations throw light on such mysteries as why you can whip cream but not milk; what makes white meat white; why fruits ripen and vegetables don’t—hundreds of unusual questions answered.” Mr. McGee has a penchant for science and a Ph.D. in English literature, and uses this combination in making delightful what could be dull reading.]

The Food Lab: Better Home Cooking Through Science (2015) by J. Kenji Lopez-Alt.

Modernist Cuisine: The Art and Science of Cooking (2011) by Nathan Myhrvold. An incredible 6-volume treatise of culinary history, modern techniques (e.g., sous vide cooking), equipment, recipes, etc. Scientist/chef Myhrvold was formerly chief technology officer at Microsoft Corp.

Q1 McDonald’s Big Mac has about: 45 gm carbohydrate, 31 gm fat, 26 gm protein, 3 gm fiber, and 1 gm sodium. How many calories in a Big Mac? What % of the calories comes from fat?

Q2 How are calories in food measured?

Q3 Women often take iron supplements in the form of ferrous sulfate: FeSO₄. How many milligrams of iron is there in a 30 mg tablet? Atomic weights for iron (Fe), sulfur (S), and oxygen (0) are given in Appendix A‑3.

Q4 Why was the 18th century revelation that “life is a chemical function,” such a milestone in nutrition science?

Q5 When a sample of granola is burned in a bomb calorimeter, it’s found to have 15 calories. Yet, when we eat the same amount, we only get about 13 calories. Why the discrepancy?

Q6 Ionizing radiation hasn’t been mentioned. But based on what you learned in this chapter, what do you think ionizing radiation does to atoms it encounters?

Q7 What is the connection between photosynthesis and metabolism? How does this explain the statement that the energy our body uses comes ultimately from the sun?

Chapter 4 ‑ Dietary Requirements and Recommendations
Academy of Nutrition and Dietetics [EatRight.org]. The Academy is a professional organization of mostly Registered Dieticians (R.D.), who must have a bachelor’s degree in the field from an accredited college, a year’s internship, and a passing score on an exam given by the Academy. Their website offers a lot of practical information. They have been criticized for ties to the food industry that can present conflicts of interest.

Dietary Reference Intakes (see below) by the Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, and published by National Academy Press nap.edu

for Sodium and Potassium (2019)

for Calcium and Vitamin D (2011)

for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (macronutrients) (2005)

for Water, Potassium, Sodium, Chloride, and Sulfate (2005) for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc (2001)

for Vitamin C, Vitamin E, Selenium, and Carotenoids (2000)

for Thiamin, Riboflavin, Niacin, Vitamin B₆, Folate, Vitamin B₁₂, Pantothenic Acid, Biotin, and Choline (1998)

for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride (1997)

nap.edu [National Academy Press publications. [Download PDF versions of their 4,000+ books for free, including the Dietary Reference Intakes volumes listed above.]

Nutrition.gov [Nutrition Information website sponsored by U.S. Dept. of Agriculture]

nal.usda.gov/main/information-centers [Food and Nutrition Information Center, National Agricultural Library, U.S. Dept. of Agriculture]

ods.od.nih.gov [Office of Dietary Supplements at the National Institutes of Health. Fact Sheets on various dietary supplements, general info on supplements]

DietaryGuidelines.gov [Dietary Guideines for Americans 2020-2025]

ChooseMyPlate.gov [U.S. Dept. of Agriculture’s graphic and information on using food groups to plan and eat a healthy diet.]

Hyponatremia (low blood-sodium) Among Runners in the Boston Marathon by Christopher Almond et al. New England Journal of Medicine, vol. 352, pp. 1550-1556, 2005.

Q1 What is meant by % Daily Value on a food label?

Chapter 5 ‑ Energy‑Providing Nutrients

Q1 How is margarine made?

Q2 As Tim butters his potato, Sue cringes and says, “you just doubled the calories!” The potato weighs 5 ounces. How many ounces of butter did Tim put on his potato? Explain your answer.

Q3 Simplesse is a fat substitute made from egg and milk proteins; the proteins are shaped to give the mouth‑­feel of fat. It has 1/9 the calories of fat. Why is this? Why can’t Simplesse be used in products that have to be heated?

Q4 What’s meant by the statement that cholesterol is essential in the body but not in the diet?

Q5 Dietary fat has been given a bad reputation lately, and we tend to forget that dietary fat also has nutritional value. What are some of these positive aspects of dietary fat?

Q6 What are partially hydrogenated fats? Why do food manufacturers use them?

Q7 Explain why an ounce of salad oil has about 10 times more calories than an ounce of cooked, brown rice.

Q8 In what form do we store carbohydrates in our liver and muscles? What aspect of its structure is very important to its function as a storage form of carbohydrate?

Chapter 6 ‑ Digestive Tract
American Dental Association ada.org [information on dental health, including use of fluorides to prevent tooth decay.]

Q1 NutraSweet is made of 2 amino acids (phenylalanine and aspartate) linked together. Why is it sweet? Is it absorbed from the digestive tract? If so, in what form?

Q2 How might fiber help prevent diverticulosis, constipation, and colon cancer?

Q3 Why do we get flatus (gas) after eating beans?

Q4 There has been a tremendous increase in the use of high-fructose corn syrup in food products. Why might food companies prefer to use this rather than regular table sugar? How is high‑fructose corn syrup made from cornstarch?

Q5 What’s the cause and symptoms of lactose intolerance? How are the cause & symptoms related?

Q6 Why does a banana get sweeter as it ripens?

Q7 In what form are carbohydrates, protein, and fat absorbed from the digestive tract? Q8 What is “heartburn”? How might it be prevented? Q9 How does fluoride help prevent tooth decay?

Chapter 7 ‑ Circulatory System

Q1 Kim has always been sedentary and starts to become more active. As she becomes more physically fit, she notes that her pulse is now slower at rest. She is concerned that her blood circulation has slowed. Why is this not true despite her lower pulse?

Q2 Why are blood donors asked if they’ve taken aspirin within the past week?

Q3 Vegetarians who eat only plant foods can have diets that are deficient in vitamin B₁₂ and high in folate. What is worrisome about this combination of B₁₂ deficiency and high folate?

Q4 What are the three kinds of blood cells, and what is the function of each?

Q5 Maria found from her diet analysis that her iron intake is far below her RDA. What are symptoms of iron deficiency? She would like to get more iron from her diet. What suggestions would you give her?

Q6 Name two proteins dissolved in the plasma portion of blood. What’s the function of each?

Q7 What does each of the two blood-pressure numbers (e.g., 120/80) mean?

Chapter 8 ‑ Atherosclerosis

American Heart Association: (800) 242‑8721. heart.org [Extensive information about cardiovascular disease-symptoms, risk factors, dietary advice, etc.]

National Stroke Association: (800)‑STROKES (787-6537); stroke.org

nhlbi.nih.gov [National Heart, Lung, and Blood Institute of the National Institutes of Health. Lots of information, including guidelines on blood cholesterol, high blood pressure, obesity]

Q1 What is atherosclerosis? Why can it cause more than one disease?

Q2 Al had a heart attack at age 55 despite eating a healthy diet and exercising most of his life. What are possible risk factors?

Q3 What’s the difference between LDL‑cholesterol and HDL‑cholesterol?

Q4 What changes in our diet and lifestyle can we make to lower our risk of atherosclerosis? Explain how these changes lower risk.

Q5 Why is it that smoking increases the risk of a heart attack?

Chapter 9 ‑ Cells and Metabolism

diabetes.niddk.nih.gov [Diabetes Information, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.]

American Diabetes Association diabetes.org

Juvenile Diabetes Research Foundation jdrf.org

Q1 There are proteins embedded in the membranes of our cells. Give an example of such a membrane protein and explain its purpose.

Q2 Explain the usefulness of ketone production during starvation.

Q3 What is type 2 diabetes? Explain why it is becoming more common in the U.S.

Q4 What is the difference between aerobic and anaerobic metabolism? Which is used predominantly in which type of exercise? Explain why.

Chapter 10 ‑ Genes, Proteins, Viruses, Biotechnology

cdc.gov [Center for Disease Control and Prevention. Extensive health info, including updates on epidemics, food recalls.]

dnalc.org [DNA Learning Center, devoted to educating the public about modern genetics]

The Gene: An Intimate History (2016) by Siddhartha Mukherjee [A superb telling of the discovery of genes and DNA and its challenges today.]

The Code Breaker: Jennifer Doudna, Gene Editing, and the Future of the Human Race (2021) by Walter Isaacson. [Doudna and Emmanuelle Charpentier were awarded a 2020 Nobel Prize for their revolutionary use of CRISPR-Cas9 for gene-editing.]

The Blooding (1989) by Joseph Wambaugh. [True story of the first time that genetic fingerprinting was used to solve a murder. Reads like a mystery novel.]

Flu: The story of the Great Influenza Pandemic of 1918 and the Search for the Virus that Caused it. (2001) by Gina Kolata, science reporter fo the New York Times.

And the Band Played On (1987) by Randy Shilts, reporter for the San Francisco Chronicle. [Story of the early years of the AIDS epidemic. A 20th anniversary edition was released in 2007].

My Own Country: A Doctor’s Story (1995) by Abraham Verghese, M.D. [A personal account of the author’s experience as a physician at the start of the AIDS epidemic in rural Tennessee.]

The Cry and the Covenant (1955) by Morton Thompson. Horrifying look at medicine before “germs” were discovered. Doctors would go from doing autopsies to delivering babies without washing their hands, and many of the women died of “childbed fever.” Story centers on Dr. Ignaz Semmelweiss (1818-1865) who was convinced these deaths could be prevented by the doctors washing their hands in an antiseptic solution, but couldn’t convince his colleagues.]

Q1 List the steps of protein synthesis, beginning with DNA.

Q2 What are some advantages of producing proteins by biotechnology rather than by extracting the proteins from natural sources?

Q3 Retroviruses have both frightening and useful aspects. Explain this, using an aspect of HIV as a frightening example, and an aspect of gene therapy as a useful example.

Q4 What’s a mutation, and what’s meant by, a mutation doesn’t necessarily cause cancer?

Q5 For the past three years, Val has gotten a flu shot. Why is it necessary for her to get a shot every year for the same disease (influenza)?

Q6 Only 20 different amino acids are used to make a seemingly endless variety of proteins. How can this be?

Chapter 11 ‑ Dietary Protein

Q1 In developing countries, protein deficiency occurs much more frequently in children than in adults, even when both eat the same diet. Why is this?

Q2 Val takes an amino acid supplement that has 22 amino acids. Kay boasts that her supplement is superior because it has 25 amino acids. Val asks you if Kay’s right. What would you say?

Q3 What’s meant by essential and nonessential amino acids?

Q4 Joe’s diet has 3 times the amount of protein he needs, plus he takes amino acid supplements. He complains of excessive urination and thirst. What’s the most likely explanation?

Q5 Explain why eating 2 sources of plant proteins together can improve the quality of the protein. Include an example of a specific meal or snack in your answer.

Q6 You groaned when I said that eating the person sitting next to you would give you very high quality protein. Why such high quality protein?

Chapter 12 ‑ Cancer

American Cancer Society: (800) 227‑2345. cancer.org

National Cancer Institute: (800) 4‑CANCER (422-6237) to find out about clinical trials of cancer therapy.

American Lung Association: lungusa.org

University of Pennsylvania Cancer Center: oncolink.upenn.edu

The Emperor of All Maladies. A biography of cancer (2010) by Siddhartha Mukherjee, M.D. (2010). A thrilling and superb telling of the history and biology of cancer. Winner of the 2011 Pulitzer Prize for nonfiction.

The Philadelphia Chromosome: A mutant gene and the quest to cure cancer at the genetic level (2013) by Jessica Wapner. [The amazing story of the painstaking development and successful use of a drug (Gleevac) that targets the genetic mutation that causes chronic myelogenous leukemia.]

Golden Harvest: Origins of the Cigarette Catastrophe and the Case for Abolition (2011) by Robert N. Proctor, professor of the History of Science at Stanford University. [An encyclopedic and compelling treatise that draws on formerly secret tobacco industry documents.]

Alcohol-Attributable Cancer Deaths and Years of Potential Life Lost in the United States by David Nelson et al., American Journal of Public Health, vol. 103, pp. 641-648, 2013. Concluded that alcohol is a major cause of cancer in the U.S., causing 3.2-3.7% of deaths from cancer, and 15% of deaths from breast cancer.

Moderate Alcohol Consumption During Adult Life, Drinking Patterns, and Breast Cancer Risk by Wendy Chen et al., Journal of American Medical Association, vol. 306, pp. 1884-1890, 2011. Prospective study of 121,700 female nurses without breast cancer, age 30-55, followed for 28 years. Alcohol intake was closely related to the 7690 breast cancers diagnosed, with progressively increased risk with progressively higher cumulative intake, even at low alcohol intakes.

Fungus in Corn Crop, a Potent Carcinogen, Invades Food Supplies (The Wall Street Journal, 2/23/89) by Scott Kilman. [The heavy contamination of U.S. corn crops by aflatoxin as a result of the 1988 drought. ]

Q1 Why are cancer occurrence rates a much less reliable statistic than cancer death rates?

Q2 The occurrence rate of cancer is going up in the U.S., even when lung cancer is excluded. It’s popularly believed that this is due to more cancer-causing substances in our food and environment. What are two alternate explanations?

Chapter 13 ‑ Energy Requirements

Q1 Jenny has been off and on “crash” diets since age 25. Most of these diets have included a drastic reduction in calories, and she typically would put the weight back on soon after the end of the diet. She now finds, 20 years later, that she’s having a harder and harder time losing weight. What are probable explanations?

Q2 Although Scott and Juan are the same in age and weight, Juan has a higher basal metabolism. What are some possible explanations?

Q3 Sue wants to know exactly how many calories she uses when working out for 20 minutes on the Stair master. Scientists use one of two methods to make this measurement. Explain how these two methods work.

Q4 As I sit writing this exam, I feel cold. I can turn on the heat, get on my exercise bike, scrub the bathroom, or eat something. Why would eating something make me warmer?

Q5 What is leptin? In what ways might it cause or prevent obesity?

Q6 Where in our bodies do we store most of our fat? Besides fuel storage, what other purposes are served by these fat deposits?

Chapter 14 ‑ Musculoskeletal System

Q1 Lin is 13 years old and has a grandmother with osteoporosis, and wants to know if there’s anything she can do now at age 13 to lower her own risk. What recommendations might you give Lin? Explain how each recommendation is expected to lower her risk.

Q2 Besides providing structural support, what are other functions of bone?

Q3 Why can’t we assess a dietary deficiency of calcium by measuring the amount of calcium in blood?

Chapter 15 ‑ Nervous System

Alzheimers Association (800) 272‑3900, alz.org]

Effects of Diets High in Sucrose or Aspartame on the Behavior and Cognitive Performance of Children by M.L. Wolraich et al. New Eng. J. Med., vol. 330, pp. 301‑307, 1994. [It’s a common belief that sugar (sucrose) causes hyperactivity in children. This well-controlled double-blind study showed no behavioral or cognitive differences in children (described by their parents as “sugars‑­sensitive”) given diets high in sugar, aspartame (NutraSweet), or saccharin.]

The Tennis Partner (1999) by Abraham Verghese, M.D. [The author’s tennis partner was a medical student who was addicted to cocaine. A moving, personal story of cocaine addiction. There are also many tennis tidbits for tennis enthusiasts.]

Beautiful Boy (2008) by David Sheff [The author relates his and his family’s harrowing experiences with his son’s addiction to crystal meth.]

An Anatomy of Addiction (2011) by Howard Markel, M.D. [In the early days, cocaine was touted as a “miracle drug,” and many people became addicted, including the central characters of this book, psychoanalyst Sigmund Freud and surgeon William Halsted.]

Empire of Pain: The Secret History of the Sackler Dynasty (2021) by Patrick Radden Keefe. [The Sacker Family deceptively promoted OxyContin, setting off today’s opioid crisis.]

The Broken Cord (1990) by Michael Dorris [The author tells the tragic story of his son who was born with Fetal Alcohol Syndrome. Winner of a National Book Critics Circle Award.]

Q1 Describe how a nerve impulse is transmitted across the gap between neurons (nerve cells).

Q2 What are distinguishing characteristics of fetal alcohol syndrome, and why is it that a child can have brain damage from prenatal exposure to alcohol, yet not look like a child with fetal alcohol syndrome?

Q3 It’s commonly believed that sugar causes hyperactivity in children. But double‑blind studies show that sugar can have a calming effect. How might sugar do this?

Chapter 16 ‑ Food Safety

FoodSafety.gov [Federal food safety information, including recalls, tips, news. Can chat online with a food safety expert.]

Q1 Why is it that for some minerals, plant content varies according to local soil content?

Q2 What are some alternatives to pesticide use in controlling crop pests and disease?

Q3 What is meant by, “the dose determines the poison”?

Q4 How does the public perception of food hazards differ from that of the experts?

Q5 Do you think we should irradiate food to reduce spoilage or microbes that cause illness? Explain and support your answer.

Q6 What are some functions of food additives?

Final Exam Study Questions

Q1 A study of 6,500 people in China shows that as compared to Americans, their diets are 3X lower in fat, 2X higher in starch, and 30% lower in protein. Suggest explanations for 2 of the findings: (a) Obesity is much more common in the U.S., even though the Chinese eat about 20% more calories. (b) Osteoporosis is much more common in the U.S. (age‑adjusted), even though our calcium intake is 2X higher.

Q2 As in most things, moderation is advised. What are problems associated with too little AND too much: (a) salt, (b) sunshine, (c) vitamin A, (d) calories, (e) fat, (f) iron, (g) protein?

Q3 A dietary guideline is to eat a variety of foods. What’s the rationale behind this advice in terms of: (a) nutrients and (b) contaminants or toxicants in food?

Q4 If the typical American diet (diet A) could be “mixed with” the diet of those in low-income countries (diet B) to form a composite diet (diet C), would diet C be healthier for both countries? Discuss 3 dietary substances in your answer.

Q5 The Dietary Guidelines for Americans, American Cancer Society, and American Heart Association all have similar advice for a healthy diet. List 3 dietary recommendations that would lower the risk of both cancer and heart disease. Explain your answer.

Q6 Smoking increases the risk of a heart attack, lung cancer, osteoporosis, and a smaller baby at birth. For each of these, give a scientific explanation.

Q7 The soundbite, people who drink orange juice get fewer cancers, doesn’t tell you if this is a link or a cause‑and‑effect relationship. Explain why a proven link in this case isn’t proof that drinking orange juice helps prevent cancer. Give an alternate explanation for the finding.