What Should I Eat?
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What Should I Eat includes information and answers to patient questions regarding diet, nutrition and scleroderma. It is presented by Bethany Doerfler, MS, RD, LDN
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What Should I Eat?
- 1. What should I eat? Patient Questions Bethany Doerfler MS, RD, LDN
- 2. Answering Your Questions • Someone who I know that had scleroderma said that she is feeling much better on gluten free diet. Is there any scientific basis to it? • Besides sugar, white carbs and saturated fats, what are foods to avoid and reduce inflammation? • What supplements help gain energy? What are the best juices to fight inflammation? How does dairy effect digestive tract? • Benefits of vegan and gluten free diet Implications of low iron ferritin level • Wondering why my child does not gain weight even if she eats whatever? • What is the best way to obtain calcium if you are lactose intolerant? • What is the best way for someone with scleroderma to lose weight? • What are anti-inflammatory foods?
- 3. How Do I Lose Weight?
- 4. Average daily per capita calories from the US food availability, adjusted for spoilage and other waste ERS Food Availability (Per Capita) Data System http://www.ers.usda.gov/Data/FoodConsumption/
- 5. Portion Controlled Mediterranean Diet
- 6. Structured Meal Plans UNLIMITED Vegetable Fruit Protein Whole Grain/ Starchy Veggies Green beans sauté Pear (1 medium) Chicken breast (3 oz) Instant brown rice (3/4 cup, cooked) Fresh tomato slices and green beans Strawberries (1 cup) Baked Tofu or tempeh, diced (3 oz) Whole wheat pasta (3/4 cup cooked) Spinach salad Pineapple (1 cup juice removed) Turkey meatloaf (3 oz) Baked sweet potato (small; size of soap bar) Spinach salad Peach (1 medium) Three bean salad (¾ cup) Whole wheat couscous (3/4 cup) Romaine lettuce, and tomatoes & raw veggies Plums (2 small) Turkey breast (3 oz) Hummus (2 Tbsp.) Whole grain bun (1 small) Tomato slices, romaine lettuce, and pickle slices Orange (1 medium or 2 “cutie” mandarins) Lean ground beef/turkey patty (3 oz) Whole wheat pita (1) Sautéed spinach and mushrooms Banana (½ of medium), Eggs ( 2) scrambled Whole grain tortilla (1)
- 9. Healthy Fats TypeofFatis MoreImportant than the Amount
- 10. Is a Mediterranean Diet Anti-Inflammatory? Fruits &Vegetables Whole Grains Healthy Fats Lean Proteins REDUCE Inflammation Refined sugars Refined starches Saturated fats &trans fats INCREASE inflammatory markers Esposito K. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004; 292: 1440– 6.
- 12. How do I eat Healthy on Lower Fiber Diet? Breakfast: cooked oatmeal sliced bananas or berries & lactose free milk Lunch: Chicken & vegetable soup, Reduced fat Greek Yogurt & ¼ cup crushed cheerios for crunch Snack: banana & creamy nut or seed butter Dinner: Baked chicken, roasted sweet potato & cooked string beans or peas Dessert: 1 oz dark chocolate or ½ cup sorbet or 1 all fruit popsicle
- 14. Diet Therapy for GERD: Conventional Wisdom ACG Guidelines: Weight loss HOB elevation Cessation of eating 2-3 hours before bed Smoking cessation Routine and global elimination of foods is not recommended Katz PO et al. Am J Gastroenterol 2013;108:308-328
- 15. Small Particle Size Improves Symptoms of GP RCT 20 weeks, each subject got 7 visits with RD Nutrient Composition Same across groups 25%-30% fat calories 6 mini meals All symptoms of GP improved No difference in changes in body weight or blood sugars
- 16. Large Particle vs. Small Particle Size Foods: Improved GP symptoms DM Eggs Pureed cabbage Rye Crisp Fruit Sauce Eggs cabbage Fresh bread Fresh fruit Olausson EA. Am J Gastroenterol. March 2014
- 17. Consequences Malabsorbed Fructose Consequences Excess Substrate Osmotic Load Fermentation GI Motility • Fructose Osmotic effect →water to distal small Intestine & colon → Speeds motility • Fructose and fructans rapidly fermented by bacteria in distal small bowel & proximal colon • Luminal distention Gibson PR. Aliment Pharmacol Ther 25,349-363.
- 18. What are FODMAPs? Lentils, cabbage, brussel sprouts, legumes Sorbitol Raffinose Honey, apples, pears, peaches, mangos, fruit juice, dried fruit Apricots, peaches, artificial sweeteners, artificially sweetened gums Wheat (large amounts), rye (large amounts), onions, leeks Excess Fructose Fructans Fermentable oligo-, di-, monosaccharides and polyols 1. Shepherd SJ, et al. Clin Gastroenterol Hepatol. 2008;6:765-771; 2. Shepherd SJ, Gibson PR. J Am Diet Assoc. 2006;106:1631-1639.
- 19. High FODMAP Diets Induce Increased Breath Hydrogen and Symptoms in IBS Patients • Design Single-blind crossover study in 15 healthy and 15 IBS patients 2-day consumption of high-FODMAP diet (50 g/d) or low-FODMAP diet (9 g/d) • Results Higher levels of breath hydrogen produced with high FODMAP diet Gastrointestinal symptoms and lethargy induced by high FODMAP diet in IBS but not control patients Breath hydrogen production 40 35 30 25 20 15 10 5 0 Health-HFD Healthy-LFD IBS-HFD IBS-LFD N=29 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 Hours Breathhydrogen(ppm) HFD=high-FODMAP diet; LFD=low-FODMAP diet Ong DK et al. J Gastroenteorl Hepatol. 2010;25:1366-1373.
- 20. Non-Celiac Gluten Sensitivity (NCGS) • Defined by panel of experts from 14 countries in 2011 • “Non-allergic and non-autoimmune condition in which the consumption of gluten can lead to symptoms similar to those seen in Celiac Disease” • Negative antibodies (except IgG) • Grossly normal histology • Clinical improvement on a GFD in the absence of antibodies and intestinal mucosal abnormalities Sapone et al. BMC Medicine 2012 10:13
- 21. Non-Celiac Gluten Sensitivity (NCGS) Also known as: Gluten sensitivity (GS) Gluten intolerance Verdu EF, et al. Am J Gastroenterol 2009; 104:1587– 1594 ”
- 22. Summary •Global limitation of acidic foods not necessary •Weight loss •Technique driven weight loss aids patients GERD •Utilize texture modifications •5-6 small meals •Avoid excessive weight loss •Assess and treat malnutrition Gastroparesis & Nausea •Modify Textures •Low FODMAP diet Gas, Bloating & Diarrhea
- 23. Seeking Information on Supplements & Complementary Therapies • National Institute of Health Office of Dietary Supplements: http://dietary-supplements.info.nih.gov/ • Look up your supplement: http://ods.od.nih.gov/health_information/health_information.aspx • Complementary and Alternative Medicine http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm • Institute of Medicine http://www.iom.edu/?ID=4829 • Department of Health and Human Services Agency for Healthcare Research and Quality http://www.ahrq.gov/ 23
- 24. What do I tell my patients? • Eat real food • Limit refined sugars Sugar Sweetened Beverages and excess carbohydrates • Balance dietary fats Plant based is best • Include more plant based foods: cooking peeling help improve tolerance • Balanced animal protein Nitrate Free • Multivitamin, Calcium & Vitamin D, B12 and sometimes iron
Hinweis der Redaktion
- To be clear Inflammation does not cause autoimmune diseases or SSC but reducing inflammation may improve overall wellness and how the organs function and risk of developing other chronic diseases such as CVD. This is not the same thing as saying you need to be gluten free or dairy free. Although we see a lot of cross over with Celiac and other auto immune disorders, simply eliminating gluten or dairy is not the whole picture
- Randomized controlled trial where DM What is really important is that there was no
- Sugary drinks are the largest single source of calories in the American diet and account for half of all added sugars Americans consume. Calorie consumption from sugary drinks doubled between 1977 and 2002.The American Heart Association wants us to consume no more than 150 calories of added sweets in the diet daily. Americans eat more PUFA from Omega-6 than anything else and need specific suggestions on improving the Omega-3:Omega-6 ratio of diet. In order to be successful with any diet or healthy eating approach, patients need extensive resources and strategies. Although several resources exist, directing people towards resources can be helpful for patients.