THE NUTRITION GAP

Lecture 2

A. INTRODUCTION

Good health is related to good nutrition. Now, we will continue with an overview of
nutr
iti
on.Al so,wewi lldiscussthenut r
iti
onal“
gaps”int hedi et
sofmanypeopl e.

B. OVERVIEW OF NUTRITION

Human nutrition typically consists of six categories: carbohydrates, fats, proteins,

minerals, vitamins and water.1,2 Carbohydrates, fats, and proteins are sources of
energy for the body. Vitamins and minerals are involved in the chemical reactions,
and water provides a medium for these chemical reactions. Briefly, we will discuss
each of these nutrients.

1. Carbohydrates

Carbohydr ates aret he body’s pr ef

er red sour ce ofenergy and come al mostent i
rely
from plants rather than animals. (Milk contains carbohydrates, however).
Carbohydrates provide 4 kilocalories (kcal) per gram. A diet in which carbohydrates
supply at least 55-60% of the energy is desirous.3

a. Simple Carbohydrates

Plant carbohydrates consist of simple and complex forms. Simple carbohydrates are
sugars such as glucose (dextrose), fructose, galactose, maltose, sucrose and lactose.
Fructose is found in fruits and honey. High-fructose corn syrup is added to many
products such as fruit drinks, desserts, popsicles and soft drinks. White, brown, and
powdered sugars are frequently used sources of sucrose.

Eventually, simple sugars are metabolized to glucose and supplies energy to the
different cells. Red blood cells and most of the brain derive almost all their energy
from glucose.4 However, this does not mean we need to consume a diet in sugar, as
will be discussed later.

b. Complex Carbohydrates

Complex carbohydrates found in plants include digestible starches. Starch is a highly

branched molecule containing thousands of glucose molecules held together by
chemical bonds. Starch is in foods such as bread, pasta, rice, potatoes, beans, corn,
peas, and apples and is metabolized to glucose. Glucose in the blood is referred to as
blood sugar. Glucose is stored in the body in the form of glycogen.5 Glycogen is a
complex carbohydrate like starch, but more complex and dense.

Complex carbohydrates also include indigestible fibers found in fruits, vegetables, and
grains. Animal products, on the other hand, contain no fiber. Fiber has been part of
the American culture since the 1800s when a minister name Sylvester Graham
preached about the virtues of fiber.6 (Mr. Graham created the graham cracker, which
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wasunl i
ket oday’sgr aham cr acker .
) Dur i
ngt hisper i
od oft ime,whol egr ain br eads
were eaten by the poor while eating white breads (low in fiber) was considered a status
symbol.

Today, it is well established that fiber has many health benefits. It is recommended
that adults consume 20-35 grams of dietary fiber daily.7 Dietary fiber creates a feeling
of satiety and slows gastric emptying. In addition, it speeds movement through the
large intestine, potentially preventing constipation, diverticulosis and colon cancer. 8
Fiber is also beneficial for the treatment of diabetes and its management.9

Another important role of fiber is prevention of heart disease. In the Bogalusa Heart
Study, children who consume higher dietary fiber consumed less fat, especially
saturated fat.10 In addition, fiber lowers total serum cholesterol and low-density
lipoproteins.11 In a study of almost 44,000 men in the United States, researchers
found“ t
hatf iber,independentoff atintake,isani mpor tantdi et
arycomponentf ort
he
pr eventi
onofcor onarydisease. ”12

2. Fat

Dietary fat is essential to life. Dietary fat provides us with triglycerides which break
down to essential fatty acids during digestion. Essential fatty acids are used in the:
structure of cell membranes; transport and metabolism of cholesterol; biosynthesis of
prostaglandins to regulate blood clotting; immune and inflammatory responses;
stomach secretions, and biosynthesis of other hormones.13 A healthy percent of body
fat is essential to life.

Most foods contain some fat, including fruits, vegetables, grains and legumes. Nuts
and seeds are concentrated sources of fat. Whether fat is liquid or solid, it yields 9
kcal per gram. We recommend that healthy adults maintain a diet which supplies
approximately 20% of its calories from fat. It is possible to consume an adequate
intake of fat from vegetables, fruits, grains, legumes, nuts, seeds, avocados and olive
with without adding visible fat (i.e., margarine).

As discussed last week, too much fat is detrimental. It leads to obesity and is a risk
factor for cancer and heart disease. Large amounts of saturated fat in the blood
stream can cause the platelets to clump and result in a heart attack.14

The emphasis on the relationship between dietary fat and heart disease, cancer, and
obesity has generated a new market of food products. Low-fat foods and fat
replacements such as Olestra, are more widely available in the United States than
other parts of the world. It is important to be an informed consumer. Many of these
products have more sugar added to them when the fat is reduced. Although fat
replacement products have been approved, they are not without potential health
consequences. For example, one fat replacement product decreases the absorption of
Vitamin E.15

3. Protein

Dietary protein is also essential to life. Although it provides 4 kcal per gram, it is a
very inefficient source of energy because of the amount of metabolism required to use
it as energy.16 The recommendations for protein are met with normal diets containing
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9 to 10% of the calories as protein. Too much protein, as in meat-based diets, can be
detrimental. (We will discuss the topic more during lecture seven.)

Dietary protein is available from nuts, seeds, whole grains, and legumes. Most
cultures combine these foods to provide adequate protein intake. For example, in
Latin counties, the people eat beans and rice or tortillas; in the Middle East, they
combine dishes containing garbanzos, wheat and sesame seeds. Thus, the intake of
meat becomes unnecessary.

When metabolized, proteins are broken down into basic units called amino acids.
Essential amino acids must be supplied by our diet. Nonessential amino acids are
made by the body. Amino acids are necessary for the growth and repair of damaged
cells, immunity, fluid balance, vision and the production of hormones and enzymes.17

Enzymes are proteins synthesized from amino acids by the body. Enzymes act as
catalysts for chemical reactions. You may have heard that you need to eat your food
raw or take dietary supplements in order to get enough enzymes. We do not need to
eat enzymes to have enzymes. In fact, enzymes and other proteins become biologically
inactive in the presence of hydrochloric acid in the stomach.18

4. Minerals

Minerals such as calcium and magnesium are used as building blocks in teeth and
bones. They function as regulators in the contraction and relaxation of every muscle
in the body and the transmission of nerves impulses. Minerals facilitate the work of
enzymes, and are needed in many chemical reactions in the body.

5. Vitamins

These are two groups of vitamins: fat-soluble and water-soluble vitamins. Fat soluble
vitamins tend to accumulate in the fat stores of the body and include vitamins A, D, E,
and K. Vitamins B1, B2, B3, B6, and C are water-soluble.

Vitamins are necessary for healthy skin, eyes, immunity, blood clotting, vision, growth
and other functions. They enable hundreds of chemical reactions to occur in the body
and are involved in energy production. Without the presence of a needed vitamin, a
chain of chemical reactions is broken, leaving a diseased body.

6. Water

The last category of nutrients we will mention is water. We are 50%-70% water. An
adult can survive approximately 8 weeks without food but only a few days without
water.19 Water is important t hatwedevot edt oday’ sdailyrouti
net
othisnutr
ient .All
the chemical reactions in our body take place in a fluid medium.

C. THE NUTRITION GAP

The nutrition gap refers to the lace of vitamins, mineral, and fiber in refined products.
Sometimes we ref ert othese“ foods”as“ emptycal ori
es.” 20 The three main sources of

thisnut ri
tion gap ar e: refi
ned sugar ,r efi
ned flours,and f atsknown as“ added”or
visible fats and oils.
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Vitamins and minerals must be present in order for food to be used by the body.
When they are absent from the food we eat, the body utilizes its own metabolized food.
As a result, nutritional deficiencies may occur.

Statistics differ regarding the trends in food consumption, depending on methods used
to gather information. The following table displays the caloric contributions of certain
foods in the North American Diet. The nutrition gap will become clear.

FOOD % of Calories/ Lbs/Perso Tsp/Day

Calories Day n/
Year
Sugars, Syrups 12-17 525 118 35

Visible Fats (Oils) Shortening, 18 550 13

Butter, Oleo, etc.

Alcohol
3 100 11
Subtotal Empty 33-38 1175 162
Calories
Refined Breads, Cereals 20 650
(Over 80% is refined)
53-58 1825
Total Empty Calories

1. Sugar

From this table, we see that 12 to 17% of the total calories for the average American
comes from sugar and syrups. Therefore, 12-17% of the diet has virtually no
vitamins, minerals, or fiber. Sugars contribute approximately 525 calories per day.
That equals 118 pounds of sugar a year or 35 teaspoon per day. The World Health
Organization recommends we consume no more than 10% of our calories from sugars
(or 13 teaspoon on a 2400 calories diet).21 This recommendation is quite liberal and
we recommend no more than 6-7 teaspoons of refined sugar per day.

a. Tooth Decay

Excess sugar contributes to tooth decay.22 The introduction of sugars, refined flour,
and the availability of confections and sweet baked foods has dramatically increased
the prevalence of dental caries over a relatively short period.23 As a result of the
increased consumption of refined foods and the absence of adequate fluoride intake in
developed countries, there is a higher prevalence of caries in some of these countries
than many industrialized countries.24 It is obvioust hat“ ifyou ar enott ruetoyour
teeth,theywi llbef alset oyou. ”

b. Sugar Lacks Vitamins and Minerals

Sugar is devoid of vitamins and minerals. In order to utilize sugar in the body,
vi
tamins and mi neral s ar
e needed. Sugar wi lluse t he body’ s reserves of these
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nutrients if they are not in the food itself. Within natural food, God placed the
nutrients that are needed to utilize the energy supply in foods. For example, citrus
fruit in high sugar but also contains many of the nutrients needed for the body to
utilize those calories. Furthermore, when people eat too many sweeteners instead of
nutrient-dense foods, they are at risk for a sub-optimal intake of nutrients.

D. PHAGOCYTIC ACTION

Phagocytes include white blood cells which destroy and engulf bacteria.

15
Bacteria Destroyed

11 11

8
7
7

0 1 2 3 4 5

= 10 Bacteria Level

= After eating Unrefined Carbohydrates (Starch)

In one study of 10 people, carbohydrates were given in the form of glucose, fructose,
sucrose, honey, orange juice and starch.26 Phagocytic activity was measured initially,
and at 30 minutes, 1, 2, 3, and 5 hours. The phagocytic activity is the ability of white
blood cells to engulf bacteria and thus, defend the body against disease. In general,
prior to ingesting carbohydrates, blood tests showed that the phagocytes engulfed
(ingested) 14 bacteria. However, after ingesting the simple carbohydrates, phagocytic
activity decreased. In other words, when sugar or honey (equal to 24 teaspoons, 2
cans of soda or a Banana split) was consumed, the white blood cells destroyed only 7
bacteria. This represented a 50% decrease in phagocytic activity. Only starch
ingestion did not significantly lower phagocytic activity. (Note: some bacteria double
in number every 20-30 minutes.)

Honey is considered by many to be more natural than sugar because it does not go
through the refining process as sugar cane does. However, it is a simple sugar just as
sucrose is a simple sugar and therefore, can have similar health effects. Interestingly,
theBiblesay,“ My son eat honey because it is good, and the honey comb which is sweet
toyourt aste”(Proverb 24:13). God gave us good food to enjoy. On the other hand, it
isimpor tantt ofoll
ow t hepr incipl
esofmoder ati
on in ver se27,“ It is not good to eat
muc hhoney. ”

Science is learning the reasons God told us long ago not to eat too much honey (or too
much of anything). When we consider the potential health effects of eating too many
sweets, His advice is not insignificant. Following such advice could eliminate the
multimillion dollar dental, nutrition supplement and laxative industries.
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1. Visible Fats

Visible fats are fats you can see, such as: shortening, butter, margarine, oils, lard or
the fat trimmings from meat. Invisible fats in wheat germ, olives, seeds, and nuts and
fat marbled in meats are not included here. Together, they contribute 34% of the
calories to the average American diet.27 Other westernized countries also have diets
high in fat and as developing counties become more westernized, the fat content
increases in some populations.28 The calories from visible fats have no fiber, protein,
minerals, and very few vitamins. A high-fat diet (especially animal fat) increases the
risk of: obesity, cancer, and heat attacks. Eliminating animal and visible fats would
stil
lpr ovi deadi etadequat et omeett hebody’ sr equi
rement sf oressent ialf
at tyaci ds.
Many food are healthy to consume until the fat is needed. Note what happens to the
calories when fat is added to the following foods.

Low-Fat Food Calories Visible Fats (Cals) Total

Lettuce & Tomato Salad 20 + Mayonnaise (80) = 100
Bread 60 + Butter (60) = 120
Peas 100 + Butter (60) = 160
Entrée 150 + Gravy (100) = 250
Baked Potato 100 + Butter (60) = 160

2. Alcohol

Alcohol contributes 3% of the calories per man, woman, and child. When calculated
for adults only, the figure is 5%; some reports indicate that alcohol contributes as
much as 11% of the total calories. Alcohol yields 7kcal per gram.37 If we total the
calories of the average American diet from sugar, visible fats and alcohol,
approximately 1175 calories per day (or 38%) have virtually no vitamins, minerals, or
fibers.

3. Refined Breads and Cereals

When discussing the nutrition gap, refined breads and cereals must be included also.
Twenty percent of the American diet comes from grains. The majority of the grain
products are refined. Refined flour retains some protein, but removes dozens of
nut ri
ents. These ar er emoved wi tht he ger m and t he br an. “ Enriched”adds f our
nutrients back to the flour: Iron, Thiamine (B1), Riboflavin (B2) and Niacin (B3). Does
it sound enriched to remove dozens of nutrients and return only four? Refining food
also removes much of the fiber. Remember, consuming high-fiber foods such as whole
grains, whole fruits vegetables correlates with a low risk of colon cancer, heart disease,
diabetes, and obesity.

4. Total

Let ’
ssum 16-18% of calories from refined flour to the 33-38% of calories from refined
sugar, fats, and alcohol. All totaled, 49-56% of the American diet virtually has no
vitamins, minerals, or fiber. This diet supplies most of the calories from items that are
not part of the ideal diet God planned for human beings.
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5. Vitamin Supplements

One might say that the answer to the problem of nutritional deficiencies is to take
vitamin and mineral supplements. Nutrients are best obtained from food rather than
from pills. Pills do not provide all the phytonutrients available in foods. Science is
continually finding important new substances in foods when consumed in their
natural state.

Carotenoids are pigments found in plants and micro-organisms but they are not made
by the body. Human plasma contains only a few of the carotenoids found in food.
Five different carotenoids accounts for 90% of all the carotenoids in the blood.32
Lycopene is one example. Tomatoes and tomato products are the most important
sources of lycopene.33,34 An increased intake of fruits and vegetables is associated with
a reduced risk of certain types of cancer, due in part to the carotenoids content. 35

If one buys only a beta-carotene (vitamin A precursor from plants such as carrots)
supplement, he misses other important carotenoids. Therefore,
consuming only a beta-carotene supplement to reduce the risk of epithelial tissue
cancer or a heart attach is not the answer. Eat the carrot; tomatoes, guava,
cant al
oupe)…!

E.MAN’
SDI
ETCONTRASTED WI
TH GOD’
SRECOMMENDED DI
ET

This table shows the caloric contribution of each food group to the average American
diet.

Table 3
U.S. FOOD GROUP CONSUMPTION

FOOD GROUP % of Total Calories

Milk Group 11%
Eggs 2%
Meat (All Types) 20%
Dry Beans, Peas, Nuts, Soy Flour 3%

Bread & Cereal Group 20%

Fruit & Vegetable Group 8.6%

Fats & Oils, Visible* 18%

Sugars & Sweeteners 17%
86%
*37% of Calories in U.S. diet is from fat. 18% is from
visible fat, and 19% is from hidden fat.

One significant cbservation in that 82-84% ofaper son’scalori

escomef rom meat ,
dairy products, fats and oils, flour, cereal products, sugar and other sweeteners. Only
8.6% of the calories come from fruits and vegetables. Yet, fruits and vegetables are
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the best sources of Vitamin C and beta-carotene, and good sources of other vitamins
and minerals. If we were to eliminate meat, most sugars, and visible fats from our
diet, and increased the intake of fruits and vegetables, most of us would not need a
vitamin pill.

Also, note that dried beans, peas, nuts, and soy flour form a very small percentage of
the average American diet. However, these foods are an important component of the
vegetarian diet. Increasing the consumption of beans, peas, and nuts (remember,
nuts are high in fat) would increase the fiber content of the diet.

What man has done to his food supply by putting most of it through an animal or a
processing plant has created a major nutrition problem in industrialized countries.
Food, as God gave it, is the most wholesome and nutritious way to eat. God has
advised us against:

1. Excess sweets

“
Iti
snotgoodt hhoney”(Prov 25:27).
oeatmuc

2. Animal Fat

“Speakt ot hec hil

drenofI sreal
,sayi
ng:“
Youshal
lnoteatanyf
at,ofox
or sheep or goat”(Lev 7:23).

3. Alcohol

“Winei
samocker,i
ntoxi
catingdr i
nkarousesbr
awl
ingandwhoeveri
sled
ast
raybyi
tisnotwise”(Prov 20:1).

4. Misuse of money for food (or anything)

“Whydoyouspendmoneyf orwhati snotbr ead,andyourwagesf or what

does not satisfy? Listen diligently to Me and eat what is good. And let
yoursouldel ightit
selfinabundanc e”(Isa 55:2).

F. CONCLUSION

The best diet for human beings is one from a variety of: grains, legumes, fruits, nuts,
and vegetables in as natural a form as palatable and in sufficient quantity to maintain
ideal weight.

REFERENCES

1. Whitney EN and Nunnelley-Hamilton EM. Understanding Nutrition. 4th ed. St.

Paul, MN: West Publishing Company, 1987, p. 2

2. Wardlaw GM and Insel PM. Perspectives in Nutrition. 3rd ed. St. Louis, MO:
Mosby-Year Book, Inc., 1996, p. 3.

3. Ibid, p. 86.
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4. Ibid, p. 74.

5. Ibid, p. 80, 81.

5. Ibid.

7. Position Statement of the American Dietetic Association: Health Implications of

Dietary Fiber. J Am Diet Assoc 93:1446-1447, 1993.

8. Ibid.

9. Ibid.

10. Nicklas TA, Farris RP, Myers L, Berenson GS. Dietary Fiber Intake of Children
and Young Adults: The Bogulusa Heart Study, J Am Diet Assoc 95:209-214, 1995.

11. Glore SR, Van Treeck D. Knehams AW, Guild M. Soluble Fiber and Serum Lipids:
A Literature Review. J Am Diet Assoc 94_425-436, 1994.

12. Rimm EB, Ascherio A. Giovanucci E. Spiegelman D, Stampfer MJ and Willett WC.
Vegetable, Fruit and Cereal Fiber Intake and Risk of Coronary Heart Disease Among
Men. JaMA 375:447-451, 1996.

13. Wardlow, op, cit., p. 112

14. Fraser G. Preventive Cardiology. NY: Oxford University Press, 1986, p. 100-101.

15. Position of the American Dietetic Association: Fat Replacement. J Am Diet Assoc
91:1285-1288, 1991.

16. Wardlow, op. cit., p. 163, 164.

17. Ibid, p. 152.

18. Ibid, p. 160

19. Ibid, p. 488.

20. Ibid, p.52.

21. Diet, Nutrition and the Prevention of Chronic Disease: A Report of the WHO
Study Group on Diet, Nutrition and Prevention of Noncommunicable Diseases. Nutr
Rev 49:219-230, 1991.

22. Glinsman WH, Irausquin H and Park YK. Executive Summary, Evaluation of
Health Aspect of Sugars Contained in Carbohydrate Sweeteners, J Nutr 116 (Suppl):
S5-S15, 1986.

23 Diet, Nutrition and the Prevention of Chronic Disease, op. cit., p. 78.

24. Ibid, p. 79.

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25 Ibid.

26. Sanchez A. Reeser JL, Lou HS, Yahiku PY, Willard RE, McMillan PJ, Cho SY,
Magie AR and Register UD. Role of Sugars in Human Neutrophilic Phagocytosis. Am
J Clin Nutr, 26: 1180-1184, 1993.

27. Daily Dietary Fat and Total Food-Energy Intake NHANES III Pase, 1, 1988-91.
JAMA 271: 1309, 1994.

28. Diet, Nutrition and the Prevention of Chronic Diseases, Report of a WHO Study
Group. World Health Organization. Technical Report Series 797, 1990, p. 44-51.

29. Block G, Dresser CM, Hartman AM and Carroll MD. Nutrient Sources in the
American Diet. AM J Epi 122:27-40, 1985.

30. Wardlaw, op. cit., p. 14.

31. Ibid, p. 7.

32. Rock CL, Jacob RA, and Bowen PE. Update on the Biological Characteristics of
the Antioxidant Micronutrients: Vitamin C, Vitamin E, and the Carotenoids. J Am
Diet Assoc 96:693-702, 1996.

33. Chug-Ahuja JK, Holden JM, Foreman MR, Mangels AR, Beecher GR and Lanza E.
The Development and Application of a Carotenoid Database for Fruits, Vegetables and
Selected Multicomponent Foods. J Am Diet Assoc 93:318-323, 1993.

34. Mangels AR, Holden JM, Beecher GR, Forman MR and Lanza E. Carotenoid
Content of Fruits and Vegetables: An Evolution of Analytic Data. J Am Diet Assoc
93:284-296, 1993.

35. Ibid, p. 284.

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NIGHT #2
THE DAILY ROUTINE
DRINKING WATER

Our bodies are 50-70% water. Approximately 60-65% and 50-60% of the body weight
for men and women, respectively, is water.1 Infants and children have an even
greater proportion of body water (70-75%). The functions of water are many. Every
chemical reaction within the cells takes place within a fluid medium.

Water maintained blood volume and hence, blood pressure. Water transports
nutrients to cells and carries away waste products which are eliminated by the kidney,
lungs, and colon. Adequate water intake is essential to maintain body temperature.
Water helps lubricate the joints and keep the skin and mucous membranes moist. In
addition, water is a significant component of secretions, including digestive juices.

An adequate intake of water is also necessary for muscular strength and endurance.
Muscle tissue contains more than 70% water while adipose tissue (fat cells) contains
almost no water. Thus, the more obese an individual is, the less body water that is
present.2

In order to maintain a proper water balance because of water lost through

perspiration, respiration, urination and the stools, we must consume water. Most of
the food we eatcont ainssome wat erbutnotenough t o meetthe body’sdemands.
Therefore, we need to consume approximately 8 glasses of water a day. One rule of
thumbt odet er minet headequacyofone’ sf l
uidi ntakei stonoti
cethecol orofur i
ne.
When the urine is light yellow to clear, fluid intake is probably adequate. This rule is
especi all
yhel pf uldur ingsituat i
onswhent hebody’ sneedf orwaterincreasessuchas,
illness with a fever, exercise, hot climates, and lactation.

Thirst can be an unreliable indicator of water needs. Often, thirst is not noticed until
after dehydration occurs. Also, the thirst mechanism may be ignored by the elderly;
those who are ill; children; busy people; and those who exercise, or work in the yard or
outdoors.

People may experience dry skin with inadequate water intake. Headaches may be
associated with inadequate intake of water also. When fluid losses equal 2% of the
body weight, muscular strength and endurance decreases; weakness and heat
intolerance occurs at 10-12% decreases in body weight; at a 20% reduction, coma and
death may occur.3 Please note that children are especially vulnerable to dehydration
as they have a high proportion of body water than adults.

Many people complain that they do not like the taste of water; cannot remember to
drink it or feel bloated after drinking water. Pure water has a pleasant taste; however,
some water does taste unpleasant. In this case, a slice of lemon or lime in a glass of
water can improve the taste.

Try to drink 2 glasses of water at a time. This means one has to remember to drink
only times a day. Drink upon arising, 9-10 am, 1-2 pm, and 4-6 pm. When 2 glasses
of water are consumed at a time, the majority of water will be out of the stomach and
absorbed into the small intestine with in 15-30 minutes. Some people avoid drinking
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water or liquids with meals. They feel that consuming liquids with meals slows the
digestion process.

Not consuming fluids after 6 pm allows sleep to occur without having to go to the
bedroom. When exercising, drink 16 ounces of water immediately before exercising, 8
ounces every 15 minutes during exercise, and 16 ounces after exercise.5

Water has many important and necessary functions in body. A person can live several
weeks without food but only a few days without water. Yet, many people have an
inadequate intake of this precious nutrient on a daily basis and the efficiency of the
body suffers. Start tomorrow by drinking 5-6 glasses of water and increase to 8
glasses per day. At first, it may seem like one is constantly running to the restroom
but after a couple of weeks, the body adapts. Notice the benefits of yourself!

REFERENCE

1. Soltis B and Cassmeyer, Fluid and Electrolyte Imbalance. Medical-Surgical

Nursing. 3rd ed. St Louis: The C.V. Mosby Company, 1987, p. 215.

2. Wardlaw GM and Insel PM. Perspectives in Nutrition. 3rd ed. St. Louis Mosby-
Year Book Inc., 1996, p. 489.

3. Ibid, p. 493.

4. Nieman DC. Fitness and Sports Medicine 3rd. Palo Alto, CA. Bull Publishing
Company, 1995, p. 264.

5. Ibid, p. 259.