what should i eat?
TRANSCRIPT
What should I eat? Patient Questions Bethany Doerfler MS, RD, LDN
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?
How Do I Lose Weight?
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/
Portion Controlled Mediterranean Diet
Structured Meal Plans UNLIMITE
D 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)
Is Butter Back?
What Foods Are Anti-Inflammatory?
Healthy FatsType of Fat is More Important than the Amount
Is a Mediterranean Diet Anti-Inflammatory?
Fruits &VegetablesWhole GrainsHealthy FatsLean ProteinsREDUCE Inflammation
Refined sugarsRefined starchesSaturated fats &trans fatsINCREASE 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.
Mediterranean Diet
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
GI Symptoms: Gastroparesis & GERD & Bloating
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
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
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
Consequences Malabsorbed Fructose
Consequences Excess
Substrate
Osmotic Load
FermentationGI
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.
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.
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 production40
35
30
25
20
15
10
5
0
Health-HFD Healthy-LFDIBS-HFD IBS-LFD
N=29
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14Hours
Bre
ath
hydr
ogen
(ppm
)
HFD=high-FODMAP diet; LFD=low-FODMAP dietOng DK et al. J Gastroenteorl Hepatol. 2010;25:1366-1373.
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
Non-Celiac Gluten Sensitivity (NCGS)
Also known as:Gluten sensitivity (GS) Gluten intolerance
Verdu EF, et al. Am J Gastroenterol 2009; 104:1587–1594
”
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
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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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