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Understanding
normal and
Clinical nutrition
eleventh e d i t i o n

Rolfes pinna
whitney
Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Brief Contents
ChaPtER 1 An Overview of Nutrition 3
highlight 1 > Nutrition Information and Misinformation 30
ChaPtER 2 Planning a Healthy Diet 37
highlight 2 > Vegetarian Diets 64
ChaPtER 3 Digestion, Absorption, and Transport 71
highlight 3 > Common Digestive Problems 90
ChaPtER 4 The Carbohydrates: Sugars, Starches, and Fibers 99
highlight 4 > Carbs, kCalories, and Controversies 128
ChaPtER 5 The Lipids: Triglycerides, Phospholipids, and Sterols 133
highlight 5 > High-Fat Foods—Friend or Foe? 164
ChaPtER 6 Protein: Amino Acids 171
highlight 6 > Nutritional Genomics 194
ChaPtER 7 Energy Metabolism 201
highlight 7 > Alcohol in the Body 222
ChaPtER 8 Energy Balance and Body Composition 235
highlight 8 > Eating Disorders 256
ChaPtER 9 Weight Management: Overweight, Obesity, and Underweight 265
highlight 9 > The Latest and Greatest Weight-Loss Diet—Again 296
ChaPtER 10 The Water-Soluble Vitamins: B Vitamins and Vitamin C 301
highlight > 10 > Vitamin and Mineral Supplements 335
ChaPtER 11 The Fat-Soluble Vitamins: A, D, E, and K 343
highlight 11 > Antioxidant Nutrients in Disease Prevention 364
ChaPtER 12 Water and the Major Minerals 371
highlight 12 > Osteoporosis and Calcium 400
ChaPtER 13 The Trace Minerals 407
highlight 13 > Phytochemicals and Functional Foods 433
ChaPtER 14 Life Cycle Nutrition: Pregnancy and Lactation 441
highlight > 14 > Fetal Alcohol Syndrome 473
ChaPtER 15 Life Cycle Nutrition: Infancy, Childhood, and Adolescence 477
highlight 15 > Childhood Obesity and the Early Development of Chronic Diseases 516
ChaPtER 16 Life Cycle Nutrition: Adulthood and the Later Years 523
highlight 16 > Hunger and Community Nutrition 547
ChaPtER 17 Nutrition Care and Assessment 555
highlight 17 > Nutrition and Immunity 574

vii

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Chapter 18 Nutrition Intervention 581
highlight 18 > Food Allergies 595
Chapter 19 Medications, Diet-Drug Interactions, and Herbal Products 599
highlight 19 > Complementary and Alternative Medicine 613
Chapter 20 Enteral Nutrition Support 619
highlight 20 > Inborn Errors of Metabolism 638
Chapter 21 Parenteral Nutrition Support 643
highlight 21 > Ethical Issues in Nutrition Care 659
Chapter 22 Metabolic and Respiratory Stress 663
highlight 22 > Multiple Organ Dysfunction Syndrome 681
Chapter 23 Upper Gastrointestinal Disorders 685
highlight 23 > Oral Health and Chronic Illness 704
Chapter 24 Lower Gastrointestinal Disorders 709
highlight 24 > Probiotics and Intestinal Health 735
Chapter 25 Liver Disease and Gallstones 739
highlight 25 > Anemia in Illness 757
Chapter 26 Diabetes Mellitus 763
highlight 26 > The Metabolic Syndrome 788
Chapter 27 Cardiovascular Diseases 793
highlight 27 > Coping with Feeding Disabilities 820
Chapter 28 Kidney Diseases 825
highlight 28 > Dialysis 847
Chapter 29 Cancer and HIV Infection 851
highlight 29 > Foodborne Illness 871
appendix a Cells, Hormones, and Nerves
appendix B Basic Chemistry Concepts
appendix C Biochemical Structures and Pathways
appendix d Measures of Protein Quality
appendix e Nutrition Assessment: Supplemental Information
appendix F Estimated Energy Needs
appendix G Choose Your Foods: Food Lists for Diabetes and Weight Management
appendix h Table of Food Composition
appendix i WHO Nutrition Recommendations
appendix J Healthy People 2020
appendix K Aids to Calculation
appendix L Enteral Formulas
Glossary GL-1
Index IN-1

inside Covers
Dietary Reference Intakes (DRI) A
Daily Values (DV) for Food Labels Y
Body Mass Index (BMI) Z
viii Brief Contents

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Table of Contents
Preface xvii 2-2 Diet-Planning Guides 42
Acknowledgments xxiii USDA Food Patterns 42
Reviewers xxiv Food Lists 49
Putting the Plan into Action 50
ChaPtER 1 From Guidelines to Groceries 51
an overview of nutrition 3 2-3 Food Labels 56
1-1 Food Choices 4 The Ingredient List 56
Nutrition Facts Panel 56
1-2 The Nutrients 6
Claims on Labels 60
Nutrients in Foods and in the Body 6 Consumer Education 60
The Energy-Yielding Nutrients: Carbohydrate, Fat,
highlight 2 > Vegetarian Diets 64
and Protein 8
The Vitamins 11
The Minerals 11 ChaPtER 3
Water 12 digestion, absorption, and transport 71
1-3 The Science of Nutrition 12 3-1 Digestion 72
Conducting Research 12 Anatomy of the Digestive Tract 72
Analyzing Research Findings 16 The Muscular Action of Digestion 75
Publishing Research 17 The Secretions of Digestion 76
1-4 Dietary Reference Intakes 18 The Final Stage 77
Establishing Nutrient Recommendations 18 3-2 Absorption 78
Establishing Energy Recommendations 20 Anatomy of the Absorptive System 79
Using Nutrient Recommendations 21 A Closer Look at the Intestinal Cells 80
Comparing Nutrient Recommendations 21 3-3 The Circulatory Systems 82
1-5 Nutrition Assessment 22 The Vascular System 82
Nutrition Assessment of Individuals 22 The Lymphatic System 84
Nutrition Assessment of Populations 24 3-4 The Health and Regulation of the GI Tract 85
1-6 Diet and Health 26 Gastrointestinal Microbiome 85
Chronic Diseases 26 Gastrointestinal Hormones and Nerve Pathways 85
Risk Factors for Chronic Diseases 27 The System at Its Best 87
highlight 1 > Nutrition Information and Misinformation 30 highlight 3 > Common Digestive Problems 90

ChaPtER 2 ChaPtER 4
Planning a healthy diet 37 the Carbohydrates: Sugars, Starches,
2-1 Principles and Guidelines 38 and Fibers 99
Diet-Planning Principles 38 4-1 The Chemist’s View of Carbohydrates 100
Dietary Guidelines for Americans 40 Monosaccharides 100
Disaccharides 102
Polysaccharides 103
4-2 Digestion and Absorption of Carbohydrates 105
HSNphotography/Shutterstock.com

Carbohydrate Digestion 105

Carbohydrate Absorption 107
Lactose Intolerance 107
4-3 Glucose in the Body 108
A Preview of Carbohydrate Metabolism 109
The Constancy of Blood Glucose 110
ix

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
4-4 Health Effects and Recommended Intakes of Sugars 113 Roles of Proteins 179
Health Effects of Sugars 114 A Preview of Protein Metabolism 182
Recommended Intakes of Sugars 117 6-4 Protein in Foods 185
Alternative Sweeteners 118 Protein Quality 185
4-5 Health Effects and Recommended Intakes of Starch Complementary Proteins 185
and Fibers 120 6-5 Health Effects and Recommended Intakes of Protein 186
Health Effects of Starch and Fibers 121 Health Effects of Protein 186
Recommended Intakes of Starch and Fibers 123 Recommended Intakes of Protein 188
From Guidelines to Groceries 124 From Guidelines to Groceries 189
highlight 4 > Carbs, kCalories, and Controversies 128 Read Food Labels 190
Protein and Amino Acid Supplements 190
ChaPtER 5 highlight 6 > Nutritional Genomics 194
the Lipids: triglycerides, Phospholipids,
and Sterols 133 ChaPtER 7
5-1 The Chemist’s View of Fatty Acids and Triglycerides 134 Energy Metabolism 201
Fatty Acids 134 7-1 Chemical Reactions in the Body 202
Triglycerides 136
7-2 Breaking Down Nutrients for Energy 205
Characteristics of Solid Fats and Oils 136
Glucose 206
5-2 The Chemist’s View of Phospholipids and Sterols 140 Glycerol and Fatty Acids 208
Phospholipids 140 Amino Acids 210
Sterols 140 The Final Steps of Energy Metabolism 211
5-3 Digestion, Absorption, and Transport of Lipids 142 7-3 Feasting and Fasting 216
Lipid Digestion 142 Feasting—Excess Energy 217
Lipid Absorption 144 The Transition from Feasting to Fasting 218
Lipid Transport 144 Fasting—Inadequate Energy 218
5-4 Lipids in the Body 148 Low-Carbohydrate Diets 220
Roles of Triglycerides 148 highlight 7 > Alcohol in the Body 222
Essential Fatty Acids 148
A Preview of Lipid Metabolism 150 ChaPtER 8
5-5 Health Effects and Recommended Intakes of Saturated Fats, Energy Balance and Body Composition 235
Trans Fats, and Cholesterol 150
8-1 Energy Balance 236
Health Effects of Saturated Fats, Trans Fats,
and Cholesterol 151 8-2 Energy In: The kCalories Foods Provide 236
Recommended Intakes of Saturated Fat, Trans Fat, Food Composition 236
and Cholesterol 152 Food Intake 237
5-6 Health Effects and Recommended Intakes of 8-3 Energy Out: The kCalories the Body Expends 240
Monounsaturated and Polyunsaturated Fats 153 Components of Energy Expenditure 240
Health Effects of Monounsaturated and Estimating Energy Requirements 244
Polyunsaturated Fats 153 8-4 Body Weight and Body Composition 245
Recommended Intakes of Monounsaturated Defining Healthy Body Weight 246
and Polyunsaturated Fats 154 Body Fat and Its Distribution 248
From Guidelines to Groceries 154 8-5 Health Risks Associated with Body Weight and Body Fat 251
highlight 5 > High-Fat Foods—Friend or Foe? 164 Health Risks of Underweight 252
Health Risks of Overweight 252
ChaPtER 6 Fit and Fat versus Sedentary and Slim 253
Protein: amino acids 171 highlight 8 > Eating Disorders 256
6-1 The Chemist’s View of Proteins 172
Amino Acids 172
Proteins 173
Nejron Photo/Shutterstock.com

6-2 Digestion and Absorption of Proteins 175

Protein Digestion 175
Protein Absorption 175
6-3 Proteins in the Body 177
Protein Synthesis 177
x table of Contents

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
 Nonvitamins 323
Interactions among the B Vitamins 323
10-3 Vitamin C 327

Blacknote/Shutterstock.com
Vitamin C Roles 327
Vitamin C Recommendations 329
Vitamin C Deficiency 329
Vitamin C Toxicity 330
Vitamin C Food Sources 330
highlight 10 > Vitamin and Mineral Supplements 335
ChaPtER 9
Weight Management: overweight, obesity, ChaPtER 11
and Underweight 265 the Fat-Soluble vitamins: a, d, E, and K 343
9-1 Overweight and Obesity 266 11-1 Vitamin A and Beta-Carotene 344
Fat Cell Development 266 Roles in the Body 344
Fat Cell Metabolism 267 Vitamin A Deficiency 346
Set-Point Theory 267 Vitamin A Toxicity 347
9-2 Causes of Overweight and Obesity 268 Vitamin A Recommendations 348
Genetics and Epigenetics 268 Vitamin A in Foods 349
Environment 270 11-2 Vitamin D 351
9-3 Problems of Overweight and Obesity 272 Roles in the Body 351
Health Risks 272 Vitamin D Deficiency 353
Perceptions and Prejudices 273 Vitamin D Toxicity 354
Dangerous Interventions 273 Vitamin D Recommendations and Sources 354
9-4 Aggressive Treatments for Obesity 274 11-3 Vitamin E 357
Drugs 275 Vitamin E as an Antioxidant 357
Surgery 275 Vitamin E Deficiency 357
9-5 Weight-Loss Strategies 276 Vitamin E Toxicity 357
Changes, Losses, and Goals 277 Vitamin E Recommendations 358
Eating Patterns 277 Vitamin E in Foods 358
Physical Activity 281 11-4 Vitamin K 358
Environmental Influences 284 Roles in the Body 358
Behavior and Attitude 285 Vitamin K Deficiency 359
Weight Maintenance 287 Vitamin K Toxicity 359
Prevention 288 Vitamin K Recommendations and Sources 360
Community Programs 289 highlight 11 > Antioxidant Nutrients in Disease Prevention 364
9-6 Underweight 289
Problems of Underweight 289 ChaPtER 12
Weight-Gain Strategies 290 Water and the Major Minerals 371
highlight 9 > The Latest and Greatest Weight-Loss
12-1 Water and the Body Fluids 372
Diet—Again 296
Water Balance and Recommended Intakes 372
Blood Volume and Blood Pressure 374
ChaPtER 10
Fluid and Electrolyte Balance 376
the Water-Soluble vitamins: B vitamins Fluid and Electrolyte Imbalance 379
and vitamin C 301 Acid-Base Balance 379
10-1 The Vitamins—An Overview 302 12-2 The Minerals—An Overview 381
10-2 The B Vitamins 304 12-3 The Major Minerals 382
Thiamin 305 Sodium 382
Riboflavin 308 Chloride 386
Niacin 309 Potassium 387
Biotin 312 Calcium 388
Pantothenic Acid 313 Phosphorus 394
Vitamin B6 313 Magnesium 395
Folate 315 Sulfate 397
Vitamin B12 320 highlight 12 > Osteoporosis and Calcium 400
Choline 322
table of Contents xi

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
CHAPTER 13 Infant Formula 483
The Trace Minerals 407 Special Needs of Preterm Infants 484
Introducing Cow’s Milk 484
13-1 The Trace Minerals—An Overview 408 Introducing Solid Foods 485
13-2 The Trace Minerals 410 Mealtimes with Toddlers 488
Iron 410 15-2 Nutrition during Childhood 488
Zinc 419 Energy and Nutrient Needs 488
Iodine 422 Hunger and Malnutrition in Children 491
Selenium 424 The Malnutrition-Lead Connection 492
Copper 425 Hyperactivity and “Hyper” Behavior 494
Manganese 426 Food Allergy and Intolerance 495
Fluoride 426 Childhood Obesity 496
Chromium 427 Mealtimes at Home 502
Molybdenum 428 Nutrition at School 504
13-3 Contaminant Minerals 429 15-3 Nutrition during Adolescence 507
Highlight 13 > Phytochemicals and Functional Foods 433 Growth and Development 507
Energy and Nutrient Needs 507
CHAPTER 14 Food Choices and Health Habits 509
Life Cycle Nutrition: Pregnancy and Lactation 441 Highlight 15 > Childhood Obesity and the Early Development
14-1 Nutrition prior to Pregnancy 442
of Chronic Diseases 516
14-2 Growth and Development during Pregnancy 443
CHAPTER 16
Placental Development 443
Fetal Growth and Development 443
Life Cycle Nutrition: Adulthood and the Later
Critical Periods 444 Years 523
14-3 Maternal Weight 448 16-1 Nutrition and Longevity 524
Weight prior to Conception 448 Observation of Older Adults 525
Weight Gain during Pregnancy 448 Manipulation of Diet 526
Exercise during Pregnancy 450 16-2 The Aging Process 528
14-4 Nutrition during Pregnancy 451 Physiological Changes 529
Energy and Nutrient Needs during Pregnancy 452 Other Changes 531
Vegetarian Diets during Pregnancy and Lactation 455 16-3 Energy and Nutrient Needs
Common Nutrition-Related Concerns of Pregnancy 455 of Older Adults 532
14-5 High-Risk Pregnancies 456 Water 532
The Infant’s Birthweight 457 Energy and Energy Nutrients 533
Malnutrition and Pregnancy 457 Vitamins and Minerals 533
Food Assistance Programs 458 Dietary Supplements 534
Maternal Health 458 16-4 Nutrition-Related Concerns
The Mother’s Age 460 of Older Adults 535
Practices Incompatible with Pregnancy 461 Vision 535
14-6 Nutrition during Lactation 464 Arthritis 536
Lactation: A Physiological Process 464 The Aging Brain 537
Breastfeeding: A Learned Behavior 465 Alcohol 539
Maternal Energy and Nutrient Needs during 16-5 Food Choices and Eating Habits of Older Adults 540
Lactation 465 Malnutrition 541
Maternal Health 467 Food Assistance Programs 541
Practices Incompatible with Lactation 468 Meals for Singles 542
Highlight 14 > Fetal Alcohol Syndrome 473 Highlight 16 > Hunger and Community Nutrition 547

CHAPTER 15
Life Cycle Nutrition: Infancy, Childhood,
Aydindurdu/ Dreamstime.com

and Adolescence 477

15-1 Nutrition during Infancy 478
Energy and Nutrient Needs 478
Breast Milk 480
xii Table of Contents

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 19-2 Diet-Drug Interactions 602
Drug Effects on Food Intake 604
Drug Effects on Nutrient Absorption 604
Dietary Effects on Drug Absorption 604
Drug Effects on Nutrient Metabolism 605
Dietary Effects on Drug Metabolism 606
Drug Effects on Nutrient Excretion 607

Rob Lewine/Getty Images

Dietary Effects on Drug Excretion 607
Diet-Drug Interactions and Toxicity 607
19-3 Herbal Supplements 608
Effectiveness and Safety of Herbal Products 609
Use of Herbal Products in Illness 611
ChaPtER 17 highlight 19 > Complementary and Alternative
nutrition Care and assessment 555 Medicine 613

17-1 Nutrition in Health Care 555

ChaPtER 20
Effects of Illness on Nutrition Status 556
Responsibility for Nutrition Care 556
Enteral nutrition Support 619
Nutrition Screening 557 20-1 Oral Supplements 620
The Nutrition Care Process 558 20-2 Tube Feedings in Medical Care 621
17-2 Nutrition Assessment 561 Candidates for Tube Feedings 621
Historical Information 561 Tube-Feeding Routes 621
Food Intake Data 562 20-3 Enteral Formulas 624
Anthropometric Data 565 Types of Enteral Formulas 624
Biochemical Data 569 Formula Characteristics 625
Physical Examination 571 Formula Selection 626
highlight 17 > Nutrition and Immunity 574 20-4 Administration of Tube Feedings 627
Safe Handling 627
ChaPtER 18 Initiating and Advancing a Tube Feeding 628
nutrition intervention 581 Meeting Water Needs 631
Medication Delivery during Tube Feedings 632
18-1 Implementing Nutrition Care 581
Tube-Feeding Complications 632
Approaches to Nutrition Care 582
Transition to Table Foods 634
Documenting Nutrition Care 584
highlight 20 > Inborn Errors of Metabolism 638
18-2 Energy Intakes in Hospital Patients 585
Indirect Calorimetry 586
Predictive Equations 586
ChaPtER 21
18-3 Dietary Modifications 588
Parenteral nutrition Support 643
Modified Diets 588 21-1 Indications for Parenteral Nutrition 643
Alternative Feeding Routes 591 Peripheral Parenteral Nutrition 644
Nothing by Mouth (NPO) 592 Total Parenteral Nutrition 645
18-4 Foodservice 592 21-2 Parenteral Solutions 646
Menu Planning 592 Parenteral Nutrients 646
Food Selection 592 Solution Preparation 648
Food Safety 592 21-3 Administering Parenteral Nutrition 650
Improving Food Intake 593 Insertion and Care of Intravenous Catheters 650
highlight 18 > Food Allergies 595 Administration of Parenteral Solutions 651
Discontinuing Parenteral Nutrition 652
ChaPtER 19 Managing Metabolic Complications 653
Medications, diet-drug interactions, 21-4 Nutrition Support at Home 655
and herbal Products 599 Candidates for Home Nutrition Support 655
Planning Home Nutrition Care 655
19-1 Medications in Disease Treatment 599
Quality-of-Life Issues 656
Medication Administration 600
Risks from Medications 600
highlight 21 > Ethical Issues in Nutrition Care 659
Patients at High Risk of Adverse Effects 602

table of Contents xiii

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
ChaPtER 22 ChaPtER 25
Metabolic and Respiratory Stress 663 Liver disease and Gallstones 739
22-1 The Body’s Responses to Stress and Injury 664 25-1 Fatty Liver and Hepatitis 740
Hormonal Responses to Stress 664 Fatty Liver 740
The Inflammatory Response 665 Hepatitis 741
22-2 Nutrition Treatment of Acute Stress 666 25-2 Cirrhosis 742
Determining Nutritional Requirements 667 Consequences of Cirrhosis 743
Approaches to Nutrition Care in Acute Stress 670 Treatment of Cirrhosis 746
Patients with Burn Injuries 670 Nutrition Therapy for Cirrhosis 746
22-3 Respiratory Stress 672 25-3 Liver Transplantation 750
Chronic Obstructive Pulmonary Disease 673 25-4 Gallstone Disease 751
Respiratory Failure 676 Types of Gallstones 751
highlight 22 > Multiple Organ Dysfunction Syndrome 681 Consequences of Gallstones 752
Risk Factors for Cholesterol Gallstones 752
ChaPtER 23 Treatment of Gallstones 753
Upper Gastrointestinal disorders 685 highlight 25 > Anemia in Illness 757
23-1 Conditions Affecting the Esophagus 686
Dysphagia 686 ChaPtER 26
Gastroesophageal Reflux Disease 689 diabetes Mellitus 763
23-2 Conditions Affecting the Stomach 692 26-1 Overview of Diabetes Mellitus 763
Dyspepsia 692 Symptoms of Diabetes Mellitus 765
Nausea and Vomiting 693 Diagnosis of Diabetes Mellitus 765
Gastroparesis 693 Types of Diabetes Mellitus 765
Gastritis 694 Prevention of Type 2 Diabetes Mellitus 767
Peptic Ulcer Disease 694 Acute Complications of Diabetes Mellitus 767
23-3 Gastric Surgery 696 Chronic Complications of Diabetes Mellitus 769
Gastrectomy 696 26-2 Treatment of Diabetes Mellitus 771
Bariatric Surgery 699 Treatment Goals 771
highlight 23 > Oral Health and Chronic Illness 704 Evaluating Diabetes Treatment 772
Nutrition Therapy: Dietary Recommendations 773
ChaPtER 24 Nutrition Therapy: Meal-Planning Strategies 775
Insulin Therapy 778
Lower Gastrointestinal disorders 709
Antidiabetic Drugs 781
24-1 Common Intestinal Problems 709 Physical Activity and Diabetes Management 781
Constipation 710 Sick-Day Management 783
Intestinal Gas 712 26-3 Diabetes Management in Pregnancy 784
Diarrhea 712 Pregnancy in Type 1 or Type 2 Diabetes 784
24-2 Malabsorption 714 Gestational Diabetes 784
Fat Malabsorption 714 highlight 26 > The Metabolic Syndrome 788
Bacterial Overgrowth 715
24-3 Conditions Affecting the Pancreas 717
Pancreatitis 717
Cystic Fibrosis 719
24.4 Conditions Affecting the Small Intestine 721
Celiac Disease 721
Inflammatory Bowel Diseases 723
Dmitry Lobanov/Shutterstock.com

Short Bowel Syndrome 726

24.5 Conditions Affecting the Large Intestine 728
Irritable Bowel Syndrome 728
Diverticular Disease of the Colon 729
Colostomies and Ileostomies 730
highlight 24 > Probiotics and Intestinal Health 735

xiv table of Contents

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
CHAPTER 27 CHAPTER 29
Cardiovascular Diseases 793 Cancer and HIV Infection 851
27-1 Atherosclerosis 794 29-1 Cancer 851
Consequences of Atherosclerosis 794 How Cancer Develops 852
Development of Atherosclerosis 795 Nutrition and Cancer Risk 852
Causes of Atherosclerosis 796 Consequences of Cancer 854
27-2 Coronary Heart Disease (CHD) 797 Treatments for Cancer 856
Symptoms of Coronary Heart Disease 797 Nutrition Therapy for Cancer 858
Evaluating Risk for Coronary Heart Disease 797 29-2 HIV Infection 862
Lifestyle Management to Reduce CHD Risk 799 Prevention of HIV Infection 862
Vitamin Supplementation and CHD Risk 803 Consequences of HIV Infection 863
Lifestyle Changes for Hypertriglyceridemia 803 Treatments for HIV Infection 865
Drug Therapies for CHD Prevention 805 Nutrition Therapy for HIV Infection 866
Treatment of Heart Attack 805 Highlight 29 > Foodborne Illness 871
27-3 Stroke 807
Stroke Prevention 807
Stroke Management 807
APPEnDIx A
Cells, Hormones, and Nerves
27-4 Hypertension 808
Factors That Influence Blood Pressure 808 APPEnDIx B
Factors That Contribute to Hypertension 809 Basic Chemistry Concepts
Treatment of Hypertension 810 APPEnDIx C
27-5 Heart Failure 814 Biochemical Structures and Pathways
Consequences of Heart Failure 814
Medical Management of Heart Failure 815
APPEnDIx D
Measures of Protein Quality
Highlight 27 > Coping with Feeding Disabilities 820
APPEnDIx E
CHAPTER 28 Nutrition Assessment: Supplemental Information
Kidney Diseases 825 APPEnDIx F
28-1 Functions of the Kidneys 825 Estimated Energy Needs
28-2 The Nephrotic Syndrome 827 APPEnDIx G
Consequences of the Nephrotic Syndrome 827 Choose Your Foods: Food Lists for Diabetes and Weight
Treatment of the Nephrotic Syndrome 827 Management
28-3 Acute Kidney Injury 830 APPEnDIx H
Causes of Acute Kidney Injury 830 Table of Food Composition
Consequences of Acute Kidney Injury 830
Treatment of Acute Kidney Injury 831 APPEnDIx I
WHO Nutrition Recommendations
28-4 Chronic Kidney Disease 833
Consequences of Chronic Kidney Disease 833 APPEnDIx J
Treatment of Chronic Kidney Disease 834 Healthy People 2020
Kidney Transplants 838
APPEnDIx K
28-5 Kidney Stones 841 Aids to Calculation
Formation of Kidney Stones 841
Consequences of Kidney Stones 842 APPEnDIx L
Prevention and Treatment of Kidney Stones 842 Enteral Formulas
Highlight 28 > Dialysis 847 Glossary GL-1
Index IN-1

InsIDE CoVERs
AJPhoto/Science Source

Dietary Reference Intakes (DRI) A

Daily Values (DV) for Food Labels Y
Body Mass Index (BMI) Z

Table of Contents xv

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
 >how to
t
Think Metric 9 Help Hospital Patients Improve Their Food Intakes 593
Calculate the Energy Available from Foods 10 Reduce the Risks of Adverse Effects from Medications 602
Determine Whether a Website Is Reliable 31 Prevent Diet-Drug Interactions 608
Compare Foods Based on Nutrient Density 39 Help Patients Improve Intakes with Oral Supplements 620
Calculate Personal Daily Values 59 Help Patients Cope with Tube Feedings 629
Reduce the Intake of Added Sugars 118 Plan a Tube-Feeding Schedule 630
Make Heart-Healthy Choices—by Food Group 157 Administer Medications to Patients Receiving Tube Feedings 632
Calculate a Personal Daily Value for Fat 160 Express the Osmolar Concentration of a Solution 645
Understand “% Daily Value” and “% kCalories from Fat” 161 Calculate the Macronutrient and Energy Content of a
Calculate Recommended Protein Intakes 189 Parenteral Solution 649
Estimate Energy Requirements 245 Estimate the Osmolarity of a Parenteral Solution 650
Determine BMI 249 Estimate Energy Needs Using Disease-Specific Stress Factors 668
Compare Foods Based on Energy Density 280 Improve Acceptance of Mechanically Altered Foods 689
Identify a Fad Diet or Weight-Loss Scam 299 Manage Gastroesophageal Reflux Disease 691
Evaluate Foods for Their Nutrient Contributions 306 Alter the Diet to Reduce Symptoms of Dumping Syndrome 698
Estimate Niacin Equivalents 310 Alter Dietary Habits to Achieve and Maintain Weight Loss after
Estimate Dietary Folate Equivalents 317 Bariatric Surgery 701
Cut Salt (and Sodium) Intake 384 Follow a Fat-Restricted Diet 717
Estimate Your Calcium Intake 392 Help the Cirrhosis Patient Eat Enough Food 748
Estimate the Recommended Daily Intake for Iron 416 Use Carbohydrate Counting in Clinical Practice 776
Plot Measures on a Growth Chart 479 Treat High Blood Cholesterol to Reduce Atherosclerotic CVD Risk 799
Protect against Lead Toxicity 494 Implement a Heart-Healthy Diet 804
Stretch Food Dollars and Reduce Waste 550 Reduce Sodium Intake 813
Measure Length and Height 566 Help Patients Comply with a Renal Diet 839
Measure Weight 567 Increase kCalories and Protein in Meals 859
Estimate and Evaluate Changes in Body Weight 568 Help Patients Handle Food-Related Problems 860
Estimate Appropriate Energy Intakes for Hospital Patients 587 Prevent Foodborne Illnesses 875

CaSE
StUdY
Nutrition Screening and Assessment 572 Patient with Short Bowel Syndrome 728
Implementing Nutrition Care 594 Young Adult with Irritable Bowel Syndrome 729
Injured Hiker Requiring Enteral Nutrition Support 635 Man with Cirrhosis 749
Patient with Intestinal Disease Requiring Parenteral Child with Type 1 Diabetes 783
Nutrition 654 Woman with Type 2 Diabetes 785
Patient with a Severe Burn 672 Patient with Cardiovascular Disease 813
Elderly Man with Emphysema 676 Woman with Acute Kidney Injury 832
Woman with GERD 692 Man with Chronic Kidney Disease 840
Nutrition Care after Gastric Surgery 699 Woman with Cancer 862
Child with Cystic Fibrosis 720 Man with HIV Infection 868

xvi table of Contents

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Preface
As we launch this eleventh edition of Understanding Normal through 13 describe the vitamins, the minerals, and water—
and Clinical Nutrition, nutrition research continues to un- their roles in the body, deficiency and toxicity symptoms, and
cover the many complex relationships between nutrition and sources. Chapters 14 through 16 complete the “normal” chap-
health. Our goals for this edition are to incorporate these ters by presenting the special nutrient needs of people through
current research findings into the core information neces- the life cycle—pregnancy and lactation; infancy, childhood,
sary for an introductory course in nutrition. As with previous adolescence; and adulthood and the later years.
editions, each chapter has been substantially updated and The remaining “clinical” chapters of the book focus on the
revised to include new topics as well as expand on existing nutrition care of individuals with health problems. Chapter
topics. The chapters include practical information and valu- 17 explains how illnesses and their treatments influence nu-
able resources to help readers apply nutrition knowledge and trient needs and describes the process of nutrition assessment.
skills to their daily lives and the clinical setting. Chapter 18 discusses how nutrition care is implemented and
A main objective in writing this book has always been to introduces the different types of therapeutic diets used in
share our enthusiasm about nutrition in a manner that mo- patient care. Chapter 19 explores the potential interactions
tivates students to study and learn. Moreover, we seek to pro- between nutrients and medications and examines the ben-
vide accurate information that is meaningful to the student or efits and risks associated with herbal products. Chapters 20
health professional. Students of nutrition often find the subject and 21 describe specialized methods for providing nutrients
to be both fascinating and overwhelming; there are so many to people who are unable to consume a regular diet. Chapter
details to learn—new terms, new chemical structures, and new 22 describes the inflammatory process and shows how meta-
biological concepts. Taken one step at a time, however, the sci- bolic and respiratory stress influence nutrient needs. Chap-
ence of nutrition may seem less daunting and the facts more ters 23 through 29 explore the pathology, medical treatment,
memorable. We hope that this book serves you well. and nutrition therapy for specific diseases, including gastro-
intestinal disorders, liver disease, diabetes mellitus, cardio-
vascular diseases, renal diseases, cancer, and HIV infection.
a Book tour of this Edition the highlights Every chapter is followed by a highlight
Understanding Normal and Clinical Nutrition presents updated, that provides readers with an in-depth look at a current, and of-
comprehensive coverage of the fundamentals of nutrition and ten controversial, topic that may relate to its companion chap-
nutrition therapy for an introductory nutrition course. The early ter. For example, Highlight 4 examines the scientific evidence
chapters introduce the nutrients and their work in the body as behind some of the current controversies surrounding carbohy-
well as recommendations about nutrition that are essential for drates and their role in weight gain and weight loss. New to this
maintaining health and preventing disease. The later chapters edition are Critical Thinking Questions designed to encourage
provide instruction in clinical nutrition—the pathophysiology readers to develop clear, rational, open-minded, and informed
and nutrition care for a wide range of medical conditions. thoughts based on the evidence presented in the highlight.

the Chapters Chapter 1 begins by exploring why we eat Special Features The art and layout in this edition have
the foods we do and continues with a brief overview of the nu-
been carefully designed to be inviting while enhancing stu-
trients, the science of nutrition, recommended nutrient intakes,
dent learning. For example, numbered steps have been added
and important relationships between diet and health. Chapter
to several figures to clarify sequences and processes. In addi-
2 describes the menu-planning principles and food guides used
tion, special features help readers identify key concepts and
to create diets that support good health and includes instruc-
apply nutrition knowledge. For example, when a new term
tions on how to read a food label. In Chapter 3, readers follow
is introduced, it is printed in bold type, and a definition is
the journey of digestion and absorption as the body breaks
provided. These definitions often include pronunciations and
down foods into absorbable nutrients. Chapters 4 through 6
derivations to facilitate understanding. The glossary at the
describe carbohydrates, fats, and proteins—their chemistry,
end of the text includes all defined terms.
roles in the body, and places in the diet. Chapter 7 shows how
the body derives energy from these three nutrients. Chapters definition (DEF-eh-NISH-en): the meaning of a word.
8 and 9 continue the story with a look at energy balance, the ● de = from
factors associated with overweight and underweight, and the ● finis = boundary

benefits and risks of weight loss and weight gain. Chapters 10

xvii

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 how to
LEaRninG GPS Many of the chapters include To” in Chapter 1 presents the
The opening page of each chapter provides a Learning GPS that “How To” features that guide steps in calculating energy in-
serves as an outline and directs readers to the main headings (and readers through problem-solv- take from the grams of carbohy-
subheadings) within the chapter. Each main heading is followed ing tasks. For example, a “How drate, fat, and protein in a food.
by a Learn It—a learning objective for the content covered in that
section. The Learn It also appears within the text at the start of
❯ tRY it Each “How To” feature ends with a “Try It” activ-
each main section as well as at the start of each Review It. After
ity that gives readers an opportunity to practice these new
reading and studying the chapter, students should be able to
lessons.
demonstrate competency in the Learn It objectives.

Nutrition in Your Life/Nutrition CaSE

in the Clinical Setting StUdY
Chapters 1 through 16 open with a paragraph called Nutri- The clinical chapters include case studies that present prob-
tion in Your Life that introduces the chapter’s content in a lems and pose questions that allow readers to apply chapter
friendly and familiar way. This short paragraph closes with material to hypothetical situations. Readers who successfully
a preview of how readers might apply that content to their master these exercises will be better prepared to face real-
daily lives by inviting them to use the Nutrition Portfolio life challenges that arise in the clinical setting.
section at the end of those chapters. Similarly, Chapters 17
through 29 open with a Nutrition in the Clinical Setting
paragraph, which introduces real-life concerns associated
with diseases or their treatments. Nutrition Assessment Checklist
The clinical chapters close with Nutrition Assessment Check-
lists that help readers evaluate how various disorders impair
Nutrition Por tfolio/Clinical nutrition status. These sections highlight the medical, di-
etary, anthropometric, biochemical, and physical findings
Portfolio most relevant to patients with specific diseases.

At the end of Chapters 1 through 16, a Nutrition Portfolio

prompts readers to consider whether their personal choices are Diet-
meeting the dietary goals presented in the chapter. Chapters 17 Drug interactions
through 29 finish with a Clinical Portfolio section, which
enables readers to practice their clinical skills by addressing Most of the clinical chapters also include a section on Diet-
hypothetical clinical situations. Many of these assignments in- Drug Interactions that presents the nutrition-related concerns
clude instructions that use the Diet & Wellness Plus program. associated with the medications commonly used to treat the
Such tools help students assess their current choices and make disorders described in the chapter.
informed decisions about healthy options.

❯ REVIEW IT Each major section within a chapter concludes the appendixes The appendixes are valuable references
with a Review It paragraph that summarizes key concepts. Simi- for a number of purposes. Appendix A summarizes back-
larly, Review It tables cue readers to important summaries. ground information on the hormonal and nervous systems,
complementing Appendixes B and C on basic chemistry, the
Also featured in this edition are the 2015–2020 Dietary chemical structures of nutrients, and major metabolic path-
Guidelines for Americans, which are introduced in Chapter 2 ways. Appendix D describes measures of protein quality.
and presented throughout the text whenever their subjects Appendix E provides supplemental coverage of nutrition assess-
are discussed. Look for the following design. ment, and Appendix F presents the estimated energy require-
ments for men and women at various levels of physical activity.
Appendix G presents the 2014 Choose Your Foods: Food Lists for
> diE ta RY GUidEL inE S F oR a MERiC a nS 2 0 15 – 2 0 2 0
Diabetes and Weight Management. Appendix H is a 4000-item
These guidelines provide science-based advice to promote health and
food composition table. Appendix I presents nutrition recom-
to reduce the risk of chronic disease through diet and physical activity.
mendations from the World Health Organization (WHO).

xviii Preface

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Appendix J presents the Healthy People 2020 nutrition- Chapter 3
related objectives. Appendix K features aids to calculations, ● Introduced microbiome and revised section on gastroin-
a short tutorial on converting metric measures and handling
testinal bacteria
basic math problems commonly found in the world of nu-
trition. Appendix L provides examples of commercial enteral
formulas commonly used in tube feedings or to supplement
Chapter 4
oral diets. ● Revised table showing nutrients in sugars and other
foods to include potassium and vitamin D
the inside Covers The inside covers put commonly ● Created tables to define glucose for normal and diabetes;
used information at your fingertips. The inside front covers to show the glycemic index of a few common foods; to
(pp. A–C) present the current nutrient recommendations, list the functions of sugars in foods; and to present ways
and the inside back covers feature the Daily Values used on to prevent dental caries
food labels and a glossary of nutrient measures (p. Y on the ● Included fructose metabolism in the highlight
left) as well as suggested weight ranges for various heights
(p. Z on the right). Chapter 5
● Created tables to define blood lipids for heart health; to
notable Changes in this Edition list fat choices among protein foods and among milk
products; to show omega-3 fatty acid quantities in a vari-
Because nutrition is an active science, staying current is para- ety of fish and seafood
mount. Just as nutrition research continuously adds to and ● Created new figure on how to read fish oil supplement
revises the accepted body of knowledge, this edition builds
labels
on the science of previous editions with the latest in nutrition
research. Much has changed in the world of nutrition and in
● Added definitions for resistin and adiponectin
our daily lives since the first edition. The number of foods has
increased dramatically—even as we spend less time than ever Chapter 6
in the kitchen preparing meals. The connections between ● Expanded discussion on the association between dietary
diet and disease have become more apparent—and consumer protein and body weight
interest in making smart health choices has followed. More
people are living longer and healthier lives. The science of Chapter 7
nutrition has grown rapidly, with new facts emerging daily. ● Created new figure illustrating labels on beer, wine, and
In this edition, as with all previous editions, every chapter liquor
has been revised to enhance learning by presenting current
information accurately and attractively. For all chapters and Chapter 8
highlights we have:
● Discussed “3500 kcalorie rule” and its limitations
● Reviewed and updated content
● Created new tables for estimating energy expended on
● Created several new figures and tables and revised others basal metabolism and on thermic effect of foods and for
to enhance learning percent body fat at various BMI
● Included 2015-2020 Dietary Guidelines for Americans ● Revised section on female athlete triad to include
new expanded term—Relative Energy Deficiency in
Chapter 1 Sports (RED-S)—and created new table of its adverse
● Created table to summarize ways to describe six classes consequences
of nutrients ● Added discussion of food addiction to section on binge
● Introduced registered dietitian nutritionist (RDN), another eating disorder
term to describe an RD
Chapter 9
Chapter 2 ● Added discussion of brite adipocytes to section on brown
● Revised section on Dietary Guidelines to reflect 2015– adipocyte tissue and uncoupling proteins
2020 recommendations
● Updated table on FDA-approved weight loss drugs
● Revised figure comparing nutrient density of two break-
● Revised figure on gastric surgery used to treat obesity
fasts to include potassium and vitamin D
● Deleted discussion and figure on unrealistic expectations
● Introduced proposed food labels and revised figure to il-
lustrate differences ● Created new table of national strategies to prevent
obesity
● Introduced front-of-package labeling and added figure to
illustrate ● Updated table on popular weight loss diets

Preface xix

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Chapter 11 Chapter 20
● Added a paragraph on “golden rice,” a genetically modi- ● Refined the terms related to nutrition support: intro-
fied rice used in the worldwide fight against vitamin A duced the terms specialized nutrition support and oral
deficiency nutrition support
● Added details on vitamin D’s non-bone-related roles ● Shortened the section on oral supplements
● Rewrote the introduction to vitamin E ● Updated the feeding tube photo
● Rewrote the food sources of vitamin K paragraph to ● Modified the sections on initiating and advancing tube
include the terms phylloquinone (vitamin K 1) and feedings and meeting water needs
menaquinone (vitamin K2)
Chapter 21
Chapter 12 ● Added additional details in the table on patient moni-
● Revised calcium balance figure toring during parenteral nutrition
● Revised the section on discontinuing parenteral nutrition
Chapter 13 ● Revised the glossary definitions in the highlight on ethi-
● Created table of factors influencing iron absorption cal issues

Chapter 14 Chapter 22
● Created several new tables: benefits of WIC, risk factors ● Added glossary definitions for complement, indirect calo-
for gestational diabetes, signs and symptoms of pre- rimetry, and minute ventilation
eclampsia, complications from smoking during preg- ● Revised the sections on estimating energy needs during
nancy, tips to prevent listeriosis
acute stress, use of glutamine or arginine during acute
● Reorganized sections on fetal programming and fetal de- illness, and micronutrient needs in acute stress
velopment of chronic diseases ● Modified the How To feature for estimating energy needs
using stress factors
Chapter 15
● In the table on predictive equations used in ventilator-
● Created several new tables: protective factors in breast
dependent patients, updated the Ireton-Jones and Penn
milk, tips for picky eaters, examples of foods and non-
State equations, and used the Penn State equation in the
food items children can choke on, iron recommenda-
example
tions for adolescents
● Shortened the section on causes of chronic obstructive
● Added information about fluoride and formula
pulmonary disease, and modified some sections on nu-
preparation
trition therapy for respiratory failure
● Added brief discussion about new AAP guidelines for re-
duced, low-fat, and fat-free milk for toddlers Chapter 23
● Added discussion of new school meal initiatives ● Added a discussion about gastroparesis
Modified some material in the sections on gastritis, gas-
Chapter 16
●

troesophageal reflux disease, and bariatric surgery; added

● Created new figure comparing healthy lens with cataract lens glossary definitions for bloating and bacterial overgrowth
In the section on bariatric surgery, added a figure show-
Chapter 17
●

ing the sleeve gastrectomy surgery

● Added a table showing the relationship between the rate
of involuntary weight loss and nutritional risk Chapter 24
● Updated the laboratory values in the table on routine ● Revised some of the material in the sections on constipa-
laboratory tests tion, intestinal gas, acute and chronic pancreatitis, cystic
● Added a paragraph about C-reactive protein in the sec- fibrosis, celiac disease, irritable bowel syndrome, and di-
tion on biochemical analyses verticular disease of the colon
● Revised the discussion on fluid retention ● Added calcium channel activators to the table of laxa-
tives and bulk-forming agents
Chapter 19 ● Revised the table of foods that increase intestinal gas
● Reorganized the beginning paragraphs of the highlight ● Introduced the concept of FODMAPs and added a defini-
on complementary and alternative medicine tion for bacterial translocation

xx Preface

Copyright 2018 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-203
Chapter 25 ● In the section on kidney stones, introduced hypocitratu-
ria as a risk factor and reformatted the table on food
● Shortened the paragraph on nutrition treatment for
sources of oxalates
hepatitis
● Modified some sections about cirrhosis complications, Chapter 29
including the table listing the clinical features of hepatic
● Updated the tables on factors that influence cancer risk
encephalopathy
● Revised the section on biological therapies for cancer to
● Revised the section on the medical treatment for cirrhosis
include more examples of cancer immunotherapy; in-
cluded new definitions for monoclonal antibodies and im-
Chapter 26 mune checkpoint inhibitors
● Updated statistics throughout the chapter
● Revised the section about food safety concerns for im-
● Added a margin table comparing glycated hemoglobin munosuppressed cancer patients
(HbA1c) and plasma glucose levels
● Expanded the section on the prevention of HIV infection
● In the section on diabetic neuropathy, distinguished be- to include a discussion about prophylactic medications
tween peripheral and autonomic neuropathy and added used in persons at risk of HIV exposure
glossary definitions for these two different forms of
● Updated the definition of AIDS-wasting syndrome to re-
neuropathy
flect current guidelines
● Revised various sections on nutrition therapy to reflect
the updated clinical guidelines
● Revised the discussion on exchange lists to reflect the Student and instructor Resources
food lists released in 2014 (Appendix G was also up-
dated to show the 2014 food lists) nutrition Mindtap for Understanding normal
● Added inhaled insulin and sodium-glucose cotrans- and Clinical nutrition
porter 2 (SGLT2) inhibitors to the tables listing the dif- MindTap is well beyond an eBook, a homework solution or
ferent types of insulin and antidiabetic drugs digital supplement, a resource center website, a course deliv-
ery platform, or a Learning Management System. More than
● Revised the discussion on insulin use in type 2 diabetes 70 percent of students surveyed said that it was unlike any-
● Updated several sections in the Nutrition in Practice on thing they have ever seen before. MindTap is a new personal
metabolic syndrome learning experience that combines all of your digital assets—
● Added a figure showing how metabolic syndrome varies readings, multimedia, activities, and assessments—into a
among ethnic groups and removed the figure showing singular learning path to improve student outcomes.
how it varies with age
diet & Wellness Plus
Chapter 27 Diet & Wellness Plus helps you gain a better understanding
● Revised various paragraphs in the sections on atheroscle- of how nutrition relates to your personal health goals. It en-
rosis, cardiovascular disease (CVD) risk assessment, CVD ables you to track your diet and activity, generate reports,
lifestyle management, hypertension, and heart failure and analyze the nutritional value of the food you eat! It in-
cludes over 55,000 foods in the database, custom food and
● Revised the How To feature about identifying and treat- recipe features, the latest Dietary References, as well as your
ing high blood cholesterol goal and actual percentages of essential nutrients, vitamins,
● Eliminated the box on assessing risk of heart disease and minerals. It also helps you to identify a problem behav-
● Updated the section on hypertension treatment ior and make a positive change. After completing a Wellness
● In the highlight on feeding disabilities, revised the sec- Profile questionnaire, Diet & Wellness Plus will rate the level
tion related to altered energy requirements of concern for eight different areas of wellness, helping you
determine the areas where you are most at risk. It then helps
Chapter 28 you put together a plan for positive change by helping you
select a goal to work toward, complete with a reward for all
● Modified the table on causes of acute kidney injury, and your hard work. Diet & Wellness Plus is also available as an
revised the discussion about the evaluation of acute kid- App that can accessed from the App dock in MindTap and
ney injury can be used throughout the course for students to track their
● Updated the section on the evaluation of chronic kidney diet, activity, and behavior change.
disease to reflect new clinical practice guidelines
● Clarified and updated some sections related to nutri- Global health Watch
tion therapy for chronic kidney disease to reflect current Updated with today’s current headlines, Global Health
recommendations Watch is your one-stop resource for classroom discussion
and research projects. This resource center provides access to

Preface xxi

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thousands of trusted health sources, including academic
journals, magazines, newspapers, videos, podcasts, and more.
Closing Comments
It is updated daily to offer the most current news about topics We have taken great care to provide accurate information
related to your health course. and have included many references at the end of each chap-
ter and highlight. To keep the number of references man-
Cognero test Bank ageable over the decades, however, many statements that
Cengage Learning Testing Powered by Cognero is a flexible, appeared in previous editions with references now appear
online system that allows you to: without them. All statements reflect current nutrition knowl-
● Author, edit, and manage test bank content from mul- edge, and the authors will supply references upon request.
tiple Cengage Learning solutions In addition to supporting text statements, the end-of-chapter
references provide readers with resources for finding a good
● Create multiple test versions in an instant
overview or more details on the subject. Nutrition is a fas-
● Deliver tests from your learning management system cinating subject, and we hope our enthusiasm for it comes
(LMS), your classroom, or wherever you want through on every page.

instructor’s Companion Site Sharon Rady Rolfes

Everything you need for your course in one place! This col- Kathryn Pinna
lection of book-specific lecture and class tools is available Ellie Whitney
online via www.cengage.com/login. Access and download
PowerPoint presentations, images, the instructor’s manual,
videos, and more.

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Another Random Scribd Document
with Unrelated Content
The text on this page is estimated to be only 26.32%
accurate

PARADISE AND THE PERL H3 For the bright Spirit at the

gate Smil'd as she gave that offering in ; And she already hears the
trees Of Eden, with their crystal bells Ringing in that ambrosial
breeze That from the throne of ALLA swells ; And she can see the
starry bowls That lie around that lucid lake, Upon whose banks
admitted Souls Their first sweet draught of glory take ! 1M But, ah !
even PERIS' hopes are vain — Again the Fates forbade, again The
immortal barrier clos'd — " Not yet," The Angel said as, with regret,
He shut from her that glimpse of glory — "True was the maiden, and
her story, Written in light o'er ALLA'S head, By seraph eyes shall long
be read. But, PEKI, see — the crystal bar Of Eden moves not —
holier far Than even this sigh the boon must be That opes the Gates
of Heaven for thee." Now, upon SYRIA'S land of roses186 Softly the
light of Eve reposes, And, like ft glory, the broad sun Hangs over
sainted LKHANOX ; Whose hc;id in wintry grandeur towers, And
whitens with eternal sleet, While summer, in a vale of flowers, Is
sleeping rosy at his feet. To one, who look'd from upper air O'er all
the enchanted regions there.
The text on this page is estimated to be only 27.22%
accurate

LALLA EOOKH. How beauteous must have been the glow,

The life, the sparkling from below ! Fair gardens, shining streams,
with ranks Of golden melons on their banks, More golden where the
sunlight falls ; Gay lizards, glittering on the walls 186 Of ruin'd
shrines, busy and bright As they were all alive with light ; And, yet
more splendid, numerous flocks Of pigeons, settling on the rocks,
With their rich restless wings, that gleam Variously in the crimson
beam Of the warm West, — as if inlaid With brilliants from the mine,
or made Of tearless rainbows, such as span The unclouded skies of
PERISTAN. And then the mingling sounds that come Of shepherd's
ancient reed,187 with hum Of the wild bees of PALESTINE,188
Banqueting through the flow'ry vales ; And, JORDAN, those sweet
banks of thine, And woods, so full of nightingales.189 But nought
can charm the luckless PERI ; Her soul is sad — her wings are weary
— Joyless she sees the Sun look down On that great Temple, once
his own,190 Whose lonely columns stand sublime, Flinging their
shadows from on high, Like dials, which the wizard, Time, Had rais'd
to count his ages by ! Yet haply there may lie conceal'd Beneath
those Chambers of the Suii, Some amulet of gems anneal'd
The text on this page is estimated to be only 26.05%
accurate

PARADISE AND THE PERL 115 In upper fires, some tablet

seal'd With the great name of SOLOMON-, Which, spell'd by her
illumin'd eyes, May teach her where, beneath the moon, In earth or
ocean, lies the boon, The charm, that can restore so soon An erring
Spirit to the skies. Cheer'd by this hope she bends her thither; —
Still laughs the radiant eye of Heaven, Nor have the golden bowers
of Even In the rich West begun to wither ; — When, o'er the vale of
BALBEC winging Slowly, she sees a child at play, Among the rosy
wild flowers singing, As rosy and as wild as they ; Chasing, with
eager hands and eyes, The beautiful blue damsel flies,191 That
flutter'd round the jasmine stems, Like winged flowers or flying
gems : — And, near the boy, who tir'd with play Now nestling 'mid
the roses lay, She saw a wearied man dismount From his hot steed,
and on the brink Of a small imaret's rustic fount 19a Impatient fling
him down to drink. Then swift his haggard brow he tnrn'd To the fair
child, who fearless sat, Though never yet hath day -beam burn'd
Upon a brow more fierce than that, — Sullenly fieree — a mixture
dire, Like thunder-clouds, of gloom and fire ; In which tin1 PKKI'S
eye could read Dark tales of many a ruthless deed ; The ruin'd maid
— the shrine profan'd —
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116 LALLA EOOKH. Oaths broken — and the threshold

stain'd With blood of guests ! — there written, all, Black as the
damning drops that fall From the denouncing Angel's pen, Ere Mercy
weeps them out again. Yet tranquil now that man of crime (As if the
balmy evening time Soften'd his spirit) look'd and lay, Watching the
rosy infant's play : — Though still, whene'er his eye by chance Fell
on the boy's, its lurid glance Met that unclouded joyous gaze, As
torches that have burnt all night Through some impure and godless
rite, Encounter morning's glorious rays. But, hark ! the vesper call to
prayer, As slow the orb of daylight sets, Is rising sweetly on the air,
From SYRIA'S thousand minarets ! The boy has started from the bed
Of flowers, where he had laid his head, And down upon the fragrant
sod Kneels,198 with his forehead to the south, Lisping the eternal
name of God From Purity's own cherub mouth, And looking, while
his hands and eyes Are lifted to the glowing skies, Like a stray babe
of Paradise, Just lighted on that floAvery plain, And seeking for its
home again. Oh ! 'twas a sight — that Heaven — that child A scene,
which might have well beguil'd
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PARADISE AND THE PERL 117 Even haughty EBLIS of a

sigh For glories lost and peace gone by ! And how felt he, the
wretched Man Reclining there — while memory ran O'er many a year
of guilt and strife, Flew o'er the dark flood of his life, Nor found one
sunny resting-place, Nor brought him back one branch of grace I "
There was a time," he said, in mild, Heart-humbled tones — " thou
blessed child ! When, young and haply pure as thou, I look'd and
pray'd like thee ; but now — " He hung his head — each nobler aim,
And hope, and feeling, which had slept From boyhood's hour, that
instant came Fresh o'er him, and he wept — lie wept ! Blest tears of
soul-felt penitence ! In whose benign, redeeming flow Is felt the
first, the only sense Of guiltless joy that guilt can know. " There's a
drop," said the PERI, " that down from the moon Falls through the
withering airs of June Upon EGYPT'S land,194 of so healing a power,
So balmy a virtue, that e'en in the hour The droj) descends,
contagion dies, And health re-animates earth and skies ! — Oh, is it
not thus, thou man of sin, The precious tears of repentance fall ?
Though foul thy fiery plagues within, One. heavenly drop hath
dispell'd them all 1" And now — behold him kneeling there By the
child's side, in humble prayer,
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118 LALLA ROOKH. While the same sunbeam shines upon

The guilty and the guiltless one, And hymns of joy proclaim through
Heaven The triumph of a Soul Forgiven ! 'Twas when the golden orb
had set, While on their knees they linger'd yet, There fell a light
more lovely far Than ever came from sun or star, Upon the tear that,
warm and meek, Dew'd that repentant sinner's cheek. To mortal eye
this light might seem A northern flash or meteor beam — But well
the enraptur'd PERI knew 'Twas a bright smile the Angel threw From
Heaven's gate, to hail that tear Her harbinger of glory near ! " Joy,
joy forever ! my task is done — The Gates are pass'd, and Heaven is
won ! Oh ! am I not happy ? I am, I am — To thee, sweet Eden !
how dark and sad Are the diamond turrets of SnADUKiAM,196 And
the fragrant bowers of AMBERABAD ! Farewell, ye odors of Earth,
that die Passing away like a lover's sigh ; — My feast is now of the
Tooba Tree,196 Whose scent is the breath of Eternity ! Farewell, ye
vanishing flowers, that shone In my fairy wreath, so bright and brief
; — Oh ! what are the brightest that e'er have blown, To the lote-
tree, springing by ALLA'S throne,197 Whose flowers have a soul in
every leaf ! Joy, joy forever! — my task is done — The Gates are
pass'd, and Heaven is won ! "
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LALLA ItOOKH. 119 " AXD this," said the Great

Chamberlain, " is poetry ! this flimsy manufacture of the brain,
which, in comparison with the lofty and durable monuments of
genius, is as the gold filigree-work of Zamara beside the eternal
architecture of Egypt ! " After this gorgeous sentence, which, with a
few more of the same kind, FADLADEKN kept by him for rare and
important occasions, he proceeded to the anatomy of the short
poem just recited. The lax and easy kind of metre in which it was
written ought to be denounced, he said, as one of the leading
causes of the alarming growth of poetry in our times. If some check
were not given to this lawless facility, we should soon be overrun by
a race of bards as numerous and as shallow as the hundred and
twenty thousand Streams of Basra.198 They who succeeded in this
style deserved chastisement for their very success ; — as warriors
have been punished, even after gaining a victory, because they had
taken the liberty of gaining it in an irregular or unestablished
manner. What, then, was to be said to those who failed ? to those
who presumed, as in the present lamentable instance, to imitate the
license and ease of the bolder sons of song, without any of that
grace or vigor which gave a dignity even to negligence; — who, like
them, flung the jereed 199 carelessly, but not, like them, to the
mark ; — " and who," said he, raising his voice, to excite a proper
degree of wakefulness in his hearers, "contrive to appear heavy and
constrained in the midst of all the latitude they allow themselves,
like one of those young pagans that dance Iw-fore the 1'rincess,
who is ingenious enough to move as it' her limbs wore fettered, in a
pair of the lightest and loosest drawers of Mosul ipnt am !"
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120 LALLA KOOKH. It was but little suitable, he continued,

to the grave march of criticism to follow this fantastical Peri, of
whom they had just heard, through all her flights and adventures
between earth and heaven ; but he could not help adverting to the
puerile conceitedness of the Three Gifts which she is supposed to
carry to the skies, — a drop of blood, forsooth, a sigh, and a tear !
How the first of these articles was delivered into the Angel's "radiant
hand" he professed himself at a loss to discover ; and as to the safe
carriage of the sigh and the tear, such Peris and such poets were
beings by far too incomprehensible for him even to guess how they
managed such matters. " But, in short," said he, " it is a waste of
time and patience to dwell longer upon a thing so incurably
frivolous, — puny even among its own puny race, and such as only
the Banyan Hospital 20° for Sick Insects should undertake." In vain
did LALLA ROOKH try to soften this inexorable critic ; in vain did she
resort to her most eloquent common-places, — reminding him that
poets were a timid and sensitive race, whose sweetness was not to
be drawn forth, like that of the fragrant grass near the Ganges, by
crushing and trampling upon them;201 — that severity often
extinguished every chance of the perfection which it demanded ;
and that, after all, perfection was like the Mountain of the Talisman,
— no one had ever yet reached its summit.202 Neither these gentle
axioms, nor the still gentler looks with which they were inculcated,
could lower for one instant the elevation of FADLADEEN'S eyebrows,
or charm him into anything like encouragement, or even toleration of
her poet. Toleration, indeed, was not among the weaknesses of
FADLADEEN : — he carried the same spirit into matters of poetry
and of religion, and, though little versed in the beauties or sub 
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LALLA ROOKH. 121 limities of either, was a perfect master

of the art of persecution in both. His zeal was the same, too, in
either pursuit; whether the game before him was pagans or
poetasters, — worshippers of cows, or writers of epics. They had
now arrived at the splendid city of Lahore, whose mausoleums and
shrines, magnificent and numberless, where Death appeared to
share equal honors with Heaven, would have powerfully affected the
heart and imagination of LALLA ROOKH, if feelings more of this earth
had not taken entire possession of her already. She was here met by
messengers, despatched from Cashmere, who informed her that the
King had arrived in the Valley, and was himself superintending the
sumptuous preparations that were then making in the Saloons of the
Shalimar for her reception. The chill she felt on receiving this
intelligence, — which to a bride whose heart was free and light
would have brought only images of affection and pleasure, —
convinced her that her peace was gone forever, and that she was in
love, irretrievably in love, with young FEHAMOKZ. The veil had fallen
off in which this passion at first disguises itself, and to know that she
loved was now as painful as to love irithout knowing it had been
delicious. FKRAMORZ, too, — what misery would be his, if the sweet
hours of intercourse so imprudently allowed them should have stolen
into his heart the same fatal fascination as into hers; — if,
notwithstanding her rank, and the modest homage he always paid to
it, even he should have yielded to the Influence of those long and
happy intet views, where music, poetry, the delightful scenes of
nature, — all had tended to bring their hearts close together, anil to
waken by every means that too ready passion, which often, like the
young of the desert-bird, is warmed into life by tho
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122 LALLA ROOKH. eyes alone ! 208 She saw but one way
to preserve herself from being culpable as well as unhappy, and this,
however painful, she was resolved to adopt. FERAMORZ must no
more be admitted to her presence. To have strayed so far into the
dangerous labyrinth was wrong, but to linger in it, while the clew
was yet in her hand, would be criminal. Though the heart she had to
offer to the King of Bucharia might be cold and broken, it should at
least be pure ; and she must only endeavor to forget the short
dream of happiness she had enjoyed, — like that Arabian shepherd,
who, in wandering into the wilderness, caught a glimpse of the
Gardens of Irem, and then lost them again forever ! 204 The arrival
of the young Bride at Lahore was celebrated in the most enthusiastic
manner. The Rajas and Omras in her train, who had kept at a certain
distance during the journey, and never encamped nearer to the
Princess than was strictly necessary for her safeguard, here rode in
splendid cavalcade through the city, and distributed the most costly
presents to the crowd. Engines were erected in all the squares,
which cast forth showers of confectionery among the people ; while
the artisans, in chariots205 adorned with tinsel and flying streamers,
exhibited the badges of their respective trades through the streets.
Such brilliant displays of life and pageantry among the palaces, and
domes, and gilded minarets of Lahore, made the city altogether like
a place of enchantment; — particularly on the day when LALLA
ROOKH set out again upon her journey, when she was accompanied
to the gate by all the fairest and richest of the nobility, and rode
along between ranks of beautiful boys and girls, who kept waving
over their heads plates of gold and silver flowers,206 and then threw
them around to be gathered by the populace.
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LALLA KOOKH, 123 For many days after their departure

from Lahore, a considerable degree of gloom hung over the whole
party. LALLA ROOKII, who had intended to make illness her excuse
for not admitting the young minstrel, as usual, to the pavilion, soon
found that to feign indisposition was unnecessary; — FADLADEEN
felt the loss of the good road they had hitherto travelled, and was
very near cursing Jehan-Guire (of blessed memory !) for not having
continued his delectable alley of trees,207 at least as far as the
mountains of Cashmere ; — while the Ladies, who had nothing now
to do all day but to be fanned by peacocks' feathers and listen to
FADLADEEN, seemed heartily weary of the life they led, and, in spite
of all the Great Chamberlain's criticisms, were so tasteless as to wish
for the poet again. One evening, as they were proceeding to their
place of rest for the night, the Princess, who, for the freer enjoyment
of the air, had mounted her favorite Arabian palfrey, in passing by a
small grove, heard the notes of a lute from within its leaves, and a
voice, which she but too well knew, singing the following words : —
TELL me not of joys above, If that world can give no bliss, Truer,
happier than the Love Which enslaves our souls in this. Tell me not
of Houris' eyes ; — Far from me their dangerous glow, If those looks
that light the skies Wound like some that burn below. Who, that
fools what Love is here, All its falsehood — all its pain — Would, for
even Elysium's sphere, Risk tho fatal dream attain '.'
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124 LALLA ROOEH. Who, that midst a desert's heat Sees

the waters fade away, Would not rather die than meet Streams again
as false as they ? The tone of melancholy defiance in which these
words were uttered, went to LALLA ROOKH'S heart ; — and, as she
reluctantly rode on, she could not help feeling it to be a sad but still
sweet certainty, that FERAMORZ was to the full as enamoured and
miserable as herself. The place where they encamped that evening
was the first delightful spot they had come to since they left Lahore.
On each side of them was a grove full of small Hindoo temples, and
planted with the most graceful trees of the East ; where the
tamarind, the cassia, and the silken plantains of Ceylon were
mingled in rich contrast with the high fan-like foliage of the Palmyra,
— that favorite tree of the luxurious bird that lights up the chambers
of its nest with fire-flies.208 In the middle of the lawn wrhere the
pavilion stood there was a tank surrounded by small mango-trees,
on the clear cold waters of which floated multitudes of the beautiful
red lotus ; 209 while at a distance stood the ruins of a strange and
awful-looking tower, which seemed old enough to have been the
temple of some religion no longer known, and which spoke the voice
of desolation in the midst of all that bloom and loveliness. This
singular ruin excited the wonder and conjectures of all. LALLA
EOOKH guessed in vain, and the all-pretending FADLADEEN, who
had never till this journey been beyond the precincts of Delhi, was
proceeding most learnedly to show that he knew nothing whatever
about the matter, when one of the Ladies suggested that perhaps
FERAMORZ could
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LALLA KOOKH. 125 satisfy their curiosity. They were now

approaching his native mountains, and this tower might perhaps be
a relic of some of those dark superstitions which had prevailed in
that country before the light of Islam dawned upon it. The
Chamberlain, who usually preferred his own ignorance to the best
knowledge that any one else could give him, was by no means
pleased with this officious reference ; and the Princess, too, was
about to interpose a faint word of objection, but, before either of
them could speak, a slave was despatched for FERAMOHZ, who, in a
very few minutes, made his appearance before them — looking so
pale and unhappy in LALLA ROOKII'S eyes, that she repented
already of her cruelty in having so long excluded him. That
venerable tower, he told them, was the remains of an ancient Fire-
temple, built by those Ghebers or Persians of the old religion, who,
many hundred years since, had fled hither from their Arab
conquerors,210 preferring lilM?rty and their altars in a foreign land
to the alternative of apostasy or persecution in their own. It was
impossible, he added, not to feel interested in the many glorious but
unsuccessful struggles which had been made by these original
natives of Persia to cast off the yoke of their bigoted conquerors.
Like their own Fire in the Burning Field at Bakou,211 when
suppressed in one place, they had but broken out with fresh flame in
another ; and, as a native of Cashmere, of that fair and Holy Valley
which had in the same manner become the prey of strangers,81*
and seen her ancient shrines and native princes swept away before
the inarch of her intolerant invaders, he felt a sympathy, he owned,
with the sufferings of the persecuted (Jhebers, which every
monument like this before them but tended more powerfully to
awaken.
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126 LALLA EOOKII. It was the first time that FERAMORZ

had ever ventured upon so much prose before FADLADEEN, and it
may easily be conceived what effect such prose as this must have
produced upon that most orthodox and most paganhating
personage. He sat for some minutes aghast, ejaculating only at
intervals, "Bigoted conquerors! — sympathy with Fire-worshippers ! "
213 — while FERAMORE, happy to take advantage of this almost
speechless horror of the Chamberlain, proceeded to say that he
knew a melancholy story, connected with the events of one of those
struggles of the brave Fire-worshippers against their Arab masters,
which, if the evening was not too far advanced, he should have
much pleasure in being allowed to relate to the Princess. It was
impossible foi LALLA ROOKH to refuse ; — he had never before
looked half so animated ; and when he spoke of the Holy Valley, his
eyes had sparkled, she thought, like the talismanic characters on the
scimitar of Solomon. Her consent was therefore most readily granted
; and while FADLADEEN sat in unspeakable dismay, expecting
treason and abomination in every line, the poet thus began his story
of the Fire-worshippers : —
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THE FIRE-WORSHIPPERS. 'Tis moonlight over OMAN'S SEA

; 2U Her banks of pearl and balmy isles Bask in the night-beam
beauteously, And her blue waters sleep in smiles. 'Tis moonlight in
HARMOZIA'S 216 walls, And through her EM IK'S porphyry halls,
Where, some hours since, was heard the swell Of trumpet and the
clash of zel,218 Bidding the bright-eyed sun farewell ; — The
peaceful sun, whom better suits The music of the bulbul's nest, Or
the light touch of lovers' lutes, To sing him to his golden rest. All
hush'd — there's not a breeze in motion; The shore is silent as the
ocean. If zephyrs come, so light they come, Nor leaf is stirr'd nor
wave is driven; — The wind-tower on the KM i it's dome217 Can
hardly win a breath from heaven. Even he, that tyrant Arab, sleeps
Culm, while a nation round him weeps; \Vhiie curses load the air lie
breathes, And falchions from unnuinber'd sheaths Are starting to
avenge the shame His rare h;>th brought on IRAN'S •IH name.
Hard, heartless Chief, unmov'd alike 'Mill eyes that weep, and swords
that strike ;127
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128 LALLA HOOKH. One of that saintly, murderous brood,

To carnage and the Koran given, Who think through unbeliever's
blood Lies their directest path to heaven ; — One, who will pause
and kneel unshod In the warm blood his hand hath pour'd, To
mutter o'er some text of God Engraven on his reeking sword ; 219
Nay, who can coolly note the line, The letter of those words divine,
To which his blade, with searching art, Had sunk into its victim's
heart ! Just ALLA ! what must be thy look, When such a wretch
before thee stands Unblushing, with thy Sacred Book, — Turning the
leaves with blood-stain'd hands, And wresting from its page sublime
His creed of lust, and hate, and crime ; Even as those bees of
TREBIZOND, Which, from the sunniest flowers that glad With their
pure smile the gardens round, Draw venom forth that drives men
mad.220 Never did fierce ARABIA send A satrap forth more direly
great ; Never was IRAX doom'd to bend Beneath a yoke of deadlier
weight. Her throne had fallen — her pride was crush'd — Her sons
were willing slaves, nor blush'd, In their own land, — no more their
own, — To crouch beneath a stranger's throne. Her towers, where
MITHRA once had burn'd, To Moslem shrines — oh shame ! — were
turn'd, Where slaves, converted by the sword,
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THE FIRE-WORSHIPPERS. 129 Their mean, apostate

worship pour'd, And curs'd the faith their sires ador'd. Yet has she
hearts, 'mid all this ill, O'er all this wreck high, buoyant still With
hope and vengeance ; — hearts that yet — Like gems, in darkness,
issuing rays They've treasur'd from the sun that's set, — Beam all
the light of long-lost days ! And swords she hath, nor weak nor slow
To second all such hearts can dare ; As he shall know, well, dearly
know, Who sleeps in moonlight luxury there, Tranquil as if his spirit
lay Becalm'd in Heaven's approving ray. Sleep on — for purer eyes
than thine Those waves are hush'd, those planets shine ; Sleep on,
and be thy rest unmov'd By the white moonbeam's dazzling power ;
— None but the loving and the lov'd Should be awake at this sweet
hour. And see — where, high above those rocks That o'er the deep
their shadows fling, Yon turret stands ; — where ebon locks, As
glossy as a heron's wing Upon the turban of a king,221 Hang from
the lattice, long and wild — 'Tis she, that EMIR'S blooming child, All
truth and tenderness and grace, Though born of such ungentle r;u-e
; — • An image of Youth's radiant Fountain Springing in a desolate
mountain !2M Oh what a pure and sacred thing la beauty, curtain'd
from the sijjht
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130 LALLA ROOEH. Of the gross world, illumining One only

mansion with, her light ! Unseen by man's disturbing eye, — The
flower that blooms beneath the sea, Too deep for sunbeams, doth
not lie Hid in more chaste obscurity. So, HINDA, have thy face and
mind, Like holy mysteries, lain enshrin'd. And oh, what transport for
a lover To lift the veil that shades them o'er ! — Like those who, all
at once, discover In the lone deep some fairy shore, Where mortal
never trod before, And sleep and wake in scented airs No lip had
ever breath'd but theirs. Beautiful are the maids that glide, On
summer-eves, through YEMEN'S 228 dales, And bright the glancing
looks they hide Behind their litters' roseate veils ; — And brides, as
delicate and fair As the white jasmine flowers they wear, Hath
YEMEN in her blissful clime, Who, lull'd in cool kiosk or bower,224
Before their mirrors count the time,226 And grow still lovelier every
hour. But never yet hath bride or maid In ARABY'S gay Haram smil'd,
Whose boasted brightness would not fade Before AL HASSAN'S
blooming child. Light as the angel shapes that bless An infant's
dream, yet not the less Rich in all woman's loveliness ; — With eyes
so pure, that from their ray
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THE FIRE-WORSHIPPERS. Dark Vice would turn abash'd

away, Blinded like serpents, when they gaze Upon the emerald's
virgin blaze ; 226 — Yet fill'd with all youth's sweet desires, Mingling
the meek and vestal fires Of other worlds with all the bliss, The
fond, weak tenderness of this : A soul, too, more than half divine,
Where, through some shades of earthly feeling, Religion's soften'd
glories shine, Like light through summer foliage stealing, Shedding a
glow of such mild hue, So warm, and yet so shadowy too, As makes
the very darkness there More beautiful than light elsewhere. Such is
the maid who, at this hour, Hath risen from her restless sleep, And
sits alone in that high bower, Watching the still and shining deep. Ah
! 'twas not thus, — with tearful eyes And beating heart, — she used
to gaze On the magnificent earth and skies, In her own land, in
happier days. Why looks she now so anxious down Among those
rocks, whose rugged frown Blackens the mirror of the deep? Whom
waits she all this lonely night? Too rough the rocks, too bold the
steep, For man to scale that turret's height ! — So deenfd at least
her thoughtful sire, When high, to catch the cool night-air, After the
day-beam's withering fire,227 He built her bower of freshness there,
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132 LALLA EOOKB.. And had it deck'd with costliest skill,

And fondly thought it safe as fair : — Think, reverend dreamer !
think so still, Nor wake to learn what Love can dare ; — Love, all-
defying Love, who sees No charm in trophies won with ease ; Whose
rarest, dearest fruits of bliss Are pluck' d on Danger's precipice !
Bolder than they who dare not dive For pearls, but when the sea's at
rest, Love, in the tempest most alive, Hath ever held that pearl the
best He finds beneath the stormiest water. Yes — ARABY'S unrivall'd
daughter, Though high that tower, that rock-way rude, There's one
who, but to kiss thy cheek, Would climb the untrodden solitude Of
ARARAT'S tremendous peak,228 And think its steeps, though dark
and dread, Heaven's pathways, if to thee they led ! Even now thou
seest the flashing spray, That lights his oar's impatient way ; — Even
now thou hear'st the sudden shock Of his swift bark against the
rock, And stretchest down thy arms of snow, As if to lift him from
below ! Like her to whom, at dead of night, The bridegroom, with
his locks of light,229 ' Came, in the flush of love and pride, And
scal'd the terrace of his bride ; — When, as she saw him rashly
spring, And midway up in danger cling, She flung him down her long
black hair, Exclaiming, breathless, u There, love, there ! " And scarce
did manlier nerve uphold
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THE FIRE-WORSIIIPPEES. 133 The hero ZAL in that fond

hour, Than wings the youth who, fleet and bold, Now climbs the
rocks to HINUA'S bower. See — light as up their granite steeps The
rock-goats of ARABIA clamber,280 Fearless from crag to crag he
leaps, And now is in the maiden's chamber She loves — but knows
not whom she loves. Nor what his race, nor whence he came ; —
Like one who meets, in Indian groves, Some beauteous bird without
a name, Brought by the last ambrosial breeze, From isles in the
undiscover'd seas, To show his plumage for a day To wondering
eyes, and wing away ! Will he thus fly — her nameless lover ? ALLA
forbid ! 'twas by a moon As fair as this, while singing over Some
ditty to her soft Kanoon,281 Alone, at this same witching hour, She
first beheld his radiant eyes Gleam through the lattice of the bower,
Where nightly now they mix their sighs ; And thought some spirit of
the air (For what could waft a mortal there ?) Was pausing on his
moonlit way To listen to her lonely lay ! This fancy ne'er hath left her
mind: And though, when terror's swoon had past, She saw a youth,
of mortal kind, Before her in obeisance cast, Yet often since, when
he hath spoken Strange, awful words, — and gleams have broker,
From his dark eyes, too bright to bear, —
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134 LALLA EOOKIL Oh ! she hath fear'd her soul was given
To some unhallow'd child of air, Some erring Spirit cast from heaven,
Like those angelic youths of old, Who burn'd for maids of mortal
mould, Bewilder'd left the glorious skies, And lost their heaven for
woman's eyes. Fond girl ! nor fiend nor angel he Who woos thy
young simplicity ; But one of earth's impassion'd sons, As warm in
love, as fierce in ire, As the best heart whose current runs Full of the
Day-God's living fire. But quench'd to-night that ardor seems, And
pale his cheek, and sunk his brow ; • Never before, but in her
dreams, Had she beheld him pale as now : And those were dreams
of troubled sleep, From which 'twas joy to wake and weep ; Visions,
that will not be forgot, But sadden every waking scene, Like warning
ghosts, that leave the spot All wither'd where they once have been. "
How sweetly," said the trembling maid, Of her own gentle voice
afraid, So long had they in silence stood, Looking upon that tranquil
flood — " How sweetly does the moonbeam smile To-night upon yon
leafy isle ! Oft, in my fancy's wanderings, I've wish'd that little isle
had wings, And we, within Us fairy bowers, Were wafted off to seas
unknown Where not a pulse should beat but ours,
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THE FIRE-WORSHIPPERS. 135 And we might live, love, die

alone ! Far from the cruel and the cold, — Where the bright eyes of
angels only Should come around us, to behold A paradise so pure
and lonely. Would this be world enough for thee ? " — Playful she
turn'd, that he might see The passing smile her cheek put on ; But
when she mark'd how mournfully His eyes met hers, that smile was
gone ; And, bursting into heartfelt tears, " Yes, yes," she cried, " my
hourly fears, My dreams have boded all too right — We part —
forever part — to-night ! I knew, I knew it could not last — 'Twas
bright, 'twas heavenly, but 'tis past I Oh ! ever thus, from
childhood's hour, I've seen my fondest hopes decay ; I never lov'd a
tree or flower, But 'twas the first to fade away. I never nurs'd a dear
gazelle, To glad me with its soft black eye, But when it came to
know me well, And love me, it was sure to die ! Now too — the joy
most like divine Of all I ever dreamt or knew, To see thee, hear thee,
call thee mine, — Oh misery ! must T lose that too ? Yet go — on
peril's brink we meet; — Those frightful rocks — that treacherous
sea — No, never come again — though sweet, Though heaven, it
may be death to thee. Farewell — and blessings on thy way,
Where'er thou guest, beloved stranger! Better to sit and watch that
ray,
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136 LALLA ROOKH. And think thee safe, though far away,
Than have thee near me, and in danger ! " " Danger ! — oh, tempt
me not to boast — " The youth exclam'd — " thou little know'st
What he can brave, who, born and nurst In Danger's paths, has
dar'd her worst ; Upon whose ear the signal word Of strife and
death is hourly breaking ; Who sleeps with head upon the sword His
fever'd hand must grasp in waking. Danger ! — " " Say on — thou
fear'st not then, And we may meet — oft meet again ? " * " Oh !
look not so — beneath the skies I now fear nothing but those eyes. •
If aught on earth could charm or force My spirit from its destin'd
course, — If aught could make this soul forget The bond to which its
seal is set, 'Twould be those eyes ; — they, only they, Could melt
that sacred seal away ! But no — 'tis fix'd — my awful doom Is fix'd
— on this side of the tomb We meet no more ; — why, why did
Heaven Mingle two souls that earth has riven, Has rent asunder wide
as ours ? 0 Arab maid, as soon the Powers Of Light and Darkness
may combine, As I be link'd with thee or thine ! Thy Father " Holy
ALLA save His gray head from that lightning glance ! Thou know'st
him not — he loves the brave ;
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THE FIRE-WORSHIPPERS. 137 Nor lives there under

heaven's expanse One who would prize, would worship thee And thy
bold spirit, more than he. Oft when, iii childhood, I have play'd With
the bright falchion by his side, I've heard him swear his lisping maid
In time should be a warrior's bride. And still, whene'er at Haram
hours I take him cool sherbets and flowers, He tells me, when in
playful mood, A hero shall my bridegroom be, Since maids are best
in battle woo'd, And won with shouts of victory ! Nay, turn not from
me — thou alone Art form'd to make both hearts thy own. Go — join
his sacred ranks — thou know'st The unholy strife these Persians
wage: — Good Heaven, that frown! — even now thou glow'st With
more than mortal warrior's rage. Haste to the camp by morning's
light, And when that sword is rais'd in tight, Oh still remember, Love
and I Beneath its shadow trembling lie ! One victory o'er those
Slaves of Fire, Those impious Ghebers, whom my sire Abhors "
"Hold, hold — thy words are death—" The stranger cried, as wild he
flung His m;i 11 tli- bark, and show'd beneath The Ghrber belt that
round him clung282 — "Hen-, maiden, look — weep — blush to see
All that thy sire abhors in me ! Yes — / am of that impious race,
Those Slaves of Fire, who, morn and even, Hail their Creator's
dwelling-place
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LALLA EOOKH. Among the living lights of heaven : 288 Yes

— /am of that outcast few, To IRAN and to vengeance true, Who
curse the hour your Arabs came To desolate our shrines of flame,
And swear, before God's burning eye, To break our country's chains,
or die ! Thy bigot sire, — nay, tremble not, — He, who gave birth to
those dear eyes, With me is sacred as the spot From which our fires
of worship rise ! But know — 'twas he I sought that night, When,
from my watch-boat on the sea, I caught this turret's glimmering
light, And up the rude rocks desperately Rush'd to my prey — thou
know'st the rest — I climb'd the gory vulture's nest, And found a
trembling dove within ; — Thine, thine the victory — thine the sin —
If Love hath made one thought his own, That Vengeance claims first
— last — alone ! Oh ! had we, never, never met, Or could this heart
e'en now forget How link'd, how bless'd we might have been, Had
fate not frown'd so dark between ! Hadst thou been born a Persian
maid, In neighboring valleys had we dwelt, Through the same fields
in childhood play'd, At the same kindling altar knelt, — Then, then,
while all those nameless ties, In which the charm of Country lies,
Had round our hearts been hourly spun, Till IRAN'S cause and thine
were one ; While in thy lute's awakening sigh T ^ieard the voice of
days gone by,
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THE FIltE-WORSHIPPERS. 139 And saw, in every smile of

thine, Returning hours of glory shine ; — While the wrong'd Spirit of
our Land Liv'd, look'd, and spoke her wrongs through thee, — ••
God ! who could then this sword withstand ? Its very flash were
victory ! But now — estrang'd, divorc'd forever, Far as the grasp of
Fate can sever ; Our only ties what love has wove, — In faith,
friends, country, sunder'd wide ; And then, then only, true to love,
When false to all that's dear beside ! Thy father, IRAN'S deadliest foe
— Thyself perhaps, even now — but no — Hate never look'd so
lovely yet ! No — sacred to thy soul will be The land of him who
could forget All but that bleeding land for thee. When other eyes
shall see, unmov'd, Her widows mourn, her warriors fall, Thou'lt
think how well one Gheber lov'd, And for his sake thou'lt weep for all
! But look With sudden start he turn'd And pointed to the distant
wave, Where lights, like charnel meteors, burn'd Blucly, as o'er some
seaman's grave ; And fiery darts, at intervals,284 Flew up all
sparkling from the main, As if each star that nightly falls Were
shooting back to heaven again. " My signal lights ! — I must away —
Both, both are ruin'd. if I stay. Farewell — sweet life! thou cling'st in
vain — Now, Vengeance, I am thine again ! "
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140 LALLA ROOKH. Fiercely he broke away, nor stopp'd,

Nor look'd — but from the lattice dropp'd Down 'mid the pointed
crags beneath, As if he fled from love to death. While pale and mute
young HINDA stood; Nor mov'd, till in the silent flood A momentary
plunge below Startled her from her trance of woe ; — Shrieking she
to the lattice flew, " I come — I come — if in that tide Thou sleep'st
to-night, I'll sleep there too, In death's cold wedlock, by thy side. Oh
! I would ask no happier bed Than the chill wave my love lies under
: Sweeter to rest together dead, Far sweeter, than to live asunder ! "
But no — their hour is not yet come — Again she sees his pinnace
fly, Wafting him fleetly to his home, Where'er that ill-starr'd home
may lie ; And calm and smooth it seem'd to win Its moonlit way
before the wind, As if it bore all peace within, Nor left one breaking
heart behind f
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LALLA ROOKH. 141 THE Princess, whose heart was sad

enough already, could have wished that FERAMORZ had chosen a
less melancholy story ; as it is only to the happy that tears are a
luxury. Her ladies, however, were by no means sorry that love was
once more the Poet's theme ; for, whenever he spoke of love, they
said, his voice was as sweet as if he had chewed the leaves of that
enchanted tree which grows over the tomb of the musician, Tan-
Seiu.235 Their road all the morning had lain througn a very dreary
country ; — through valleys, covered with a low bushy jungle,
where, in more than one place, the awful signal of the bamboo
staff,230 with the white flag at its top, reminded the traveller that, in
that very spot, the tiger had made some human creature his victim.
It was, therefore, with much pleasure that they arrived at sunset in
a safe and lovely glen, and encamped under one of those holy trees
whose smooth columns and spreading roofs seem to destine them
for natural temples of religion. Beneath this spacious shade, some
pious hands had erected a row of pillars ornamented with the most
beautiful porcelain,8*1 which now supplied the use of mirrors to the
young maidens, as they adjusted their hair in descending from the
palankeens. Here, while, as usual, the Princess sat listening
anxiously, with FAIU.ADKKX in one of his loftiest moods of criticism
by her side, the young Poet, leaning against a branch of the tree,
thus continued hia story : —
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142 LALLA ROOKH. THE morn hath risen clear and calm,
And o'er the Green Sea 288 palely shines, Revealing BAHREIN'S 289
groves of palm, And lighting KISHMA'S 239 amber vines. Fresh smell
the shores of ABABY, While breezes from the Indian sea Blow round
SELAMA'S 24° sainted cape, And curl the shining flood beneath, —
Whose waves are rich with many a grape, And cocoa-nut and
flowery wreath, Which pious seamen, as they pass'd, Had tow'rd
that holy headland cast — Oblations to the Genii there For gentle
skies and breezes fair ! The nightingale now bends her flight 241
From the high trees, where all the night She sung so sweet, with
none to listen ; And hides her from the morning star Where thickets
of pomegranate glisten In the clear dawn, — bespangled o'er With
dew, whose night drops would not stain The best and brightest
scimitar 242 That ever youthful Sultan wore On the first morning of
his reign. And see — the Sun himself ! — on wings Of glory up the
East he springs. Angel of Light ! who from the time Those heavens
began their march sublime, Hath first of all the starry choir Trod in
his Maker's steps of fire \
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