staying healthy and strong with scleroderma
DESCRIPTION
Bethany Doerfler MS, RD, LDN discusses top nutrition concerns of scleroderma patients, as well as the results of a recent medical nutrition therapy study. She also discusses strategies for healthy eating, combating GI issues, maintaining muscle, a Mediterranean diet, supplements and more.TRANSCRIPT
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Staying Healthy & Strong with SclerodermaBethany Doerfler MS, RD, LDN
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Top Nutrition Concerns
Healthy Diet
What Should I Eat?
How do I control gas &
bloating?
How should I handle feeling
full early?How do I keep
my muscle?
Should I take Supplements?
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Is a Mediterranean Diet Good for Scleroderma?
Fruits &VegetablesWhole GrainsHealthy FatsLean ProteinsREDUCE Inflammation
Refined sugarsRefined starchesSaturated fats &trans fatsINCREASE inflammatory markers
Heart Healthy Diet : Not Specific to Scleroderma
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.
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Mediterranean Diet
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Portion Controlled Mediterranean Diet
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Healthy Fats Add Healthy CaloriesType of Fat is More Important than the Amount
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Medical Nutrition Therapy for Patients with Advanced Scleroderma (MNT PASS)PIs: Ikuo Hirano and Patricia SheeanCo-I: Bethany Doerfler
Collaboration between UIC and Northwestern
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What Did We Collect?
•Nutrition status and symptom tracking- Patient Generated Subjective Global
Assessment- Nutrient status (Vitamin A, D, K, iron, folate,
B12)- 24 hour diet recall- GI symptoms using UCLA SSc GI tool- CDC Health Related Quality of Life- Body composition to assess bone, fat and
muscle health
18 subjects total
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What Did Our Sample Look Like?
• 18 patients total• Average age 51• Average BMI= 22 ± 6 (desirable)• 100% GI involvement of some type
- 100% GERD- Gastroparesis, dysphagia, bacterial overgrowth, diarrhea and
constipation• 50% Sample sarcopenic across BMI category
- Appear normal weight
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Percent of MNT PASS Subjects Below Normal Blood Limits
TABLE 3: Percent of MNT PASS subjects below normal limits for key nutrientsMNTPASS Study Participants Characteristics Table 3 N=18
LabsValue
Percent Below Normal LimitsMean (SD)
Zinc (mcg/dl) 68.8 (16.6) 63%
TIBC (mg/ml) 296.2 (70.2) 36%
Vitamin D (ng/ml) 39.7 (20) 33%
Transferrin Saturation (%) 21.1 (12.5) 31%
Ferritin (mg/ml) 111.3 (166.3) 25%
Retinol (ug/dl) 59.1 (23.3) 25%
Vitamin B12 (g/dl) 554.6 (363.8) 0%
Folic Acid (ng/ml) 20.9 (6.5) 0%
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Supplements
•Check:- Vitamin D- Adults aim for 600-1000 IU daily- Ask MD check especially if you take acid blocking medications
• B12/folic acid- If you are on acid blocking medications
• Iron panel and iron stores• Zinc levels if you struggle with diarrhea or have high crp
•Add - general multivitamin/multi-mineral supplement- Calcium & Vitamin D
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How Do I Keep My Muscle?
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• Check weight monthly• Discuss weight loss with Rheumatologist and
Gastroenterologist• Work with dietitian to improve weight status • Nutritional supplements as necessary
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Sarcopenia:
• Loss of Muscle Mass and Function • Sarcopenia can begin in 40s• 70-80 maximum loss. • Muscles lose 20-40% Contractile strength for
both men and women • Translates to lower metabolic rate, loss of muscle function, higher risk of
diabetes
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Sarcopenic Muscles
Note difference in muscle mass and fat tissueMultifactorial disease: loss of hormones & less activityExercise attenuate age related muscle lossInflammation can speed up muscle loss
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Important Steps in Weight Training http://www.icaa.cc/category.asp?categoryID=63&type=1
Proper warm up and form key to prevent injury
Ask for adaptive equipment from gym, physical therapist or occupational therapist
8-12 reps of 6 different exercises is ideal
Use of resistance bands and body weight work as well as weight training
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Don’t Push Too Hard: Work Way Up
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Muscle: Distribute Protein
Adults need 60-100 gm protein daily
Muscle rebuild itself every 3-5 hours
20-30 gm improves muscle synthesis
60 gm properly distributed safe kidneys and bones
Moderate protein intake for 150 lb person is 70-80 gm/daily
Layman DK, Nutr Metab 2009;6:12
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What Does 20 gm Look Like?
• BREAKFAST: Greek Yogurt & fruit or• 2 eggs & whole grain toast or• 1 scoop protein powder (rice based, soy, egg or whey) & fruit
• LUNCH: 2-3 oz lean turkey breast & veggie soup or• 1 cup cooked Quinoa & 2-3 shrimp or• 1 cup split pea soup, crackers & 1 oz cheese
• DINNER: 3 oz meat, fish, poultry, tofu• Add veggies and rice to complete
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Nutrition RX for Gas & Bloating
How do I control
bloating?
Cook Veggies & Peel Skin
Fruits
Moderate Fiber if bloated
Try FODMAPS
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Common GI Complaints
• Reflux (GERD)• Difficulty Swallowing (Dysphagia)• Early Fullness• Bloating• Constipation• Diarrhea• Fatigue• Weight loss
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Dietary Therapy for Fullness
Balanced Diet
Small frequent meals
Liquid nutrition supplementation
Cook Fibers
Control blood sugars
Healthy liquid fats less solid fats
Camilleri M. Gastroenterology 131(2);2006: 640-658; Keld R. J Hum Nutr Diet, 24: 421-430; Olausson EA. Diabetes Research and Clinical Practice 80:231-237; Gastroenterology. 2011 Jan;140(1):101-15
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Q: What is Small Frequent Meal?A: 3 Meals & 3 Snacks
Cream of WheatAdded Margarine
Ripe FruitMilk or Kefir
Pureed Butternut Squash Soup
6 brown rice crackers, 1-2 oz cheese
3-4 oz Baked FishMedium Baked Potato
Cooked CarrotsMilk or Kefir
Ripe Banana1-2 tbsp Creamy Peanut
Butter
½ SandwichCanned Fruit
Fruit Smoothie: Mango & Greek Yogurt
or Protein PowderSnac
ksM
eals
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FODMAPS Sample Menu
Breakfast: • Poached Egg• corn tortilla or toast• ½ cup- 1 cup ripe melon or berries• Coffee or tea
Lunch• Cooked vegetable soup• Brown Rice crackers & almond butter• Banana• Sparkling waterDinner• Roasted fish or poultry• Roasted green beans• Sweet potato cooked with olive oil• Berries & Greek Yogurt
Snacks: Yogurt, fruit, nut butters, cheese, veggie soups, sushi rolls, dairy free frozen treats, dry cereal (oat/rice based), crackers, cold or hot cereal with milk alternative
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Other Strategies for Healthy Eating
• Weekend pre-planning- Batch cooking- Crock pot- Freeze in pre-packaged ready-to-go
• Change expectations of Healthy Meal- Cereal with fruit and egg whites great dinner
• Frozen just as good as fresh• Pre-cut/chopped fruits and veggies retain nutritional value• Focus on meal assembly• Cook and puree hard to digest veggies• Consider liquid smoothies at night when motility worst
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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/
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