Transcript Food Therapy Dr. Alex Alexander Week 1

Food Therapy
Dr. Alex Alexander
Week 1- Components
Components of A healthy
Diet
1.High in multiple, variously colored fruits and
vegetables
a.51% of Americans eat less than 3 veggies per
day
b.72% of Americans eat less than 2 fruits per
day (USDA)
What do You Think?
New for 2011
USDA Recommendations
Balancing Calories: Enjoy your food, but eat less. Avoid oversized portions.
Foods to Increase: Make half your plate fruits and vegetables. Make at least half
your grains whole grains. Switch to fat-free or low-fat (1%) milk.
Foods to Reduce: Compare sodium in foods like soup, bread, and frozen meals ―
and choose the foods with lower numbers. Drink water instead of sugary drinks.
Components
1.High in fiber
a.93% of Americans eat less than 25 grams of
fiber per day
b.fiber regulates pH and provides food for
lacto- bacillus (prebiotics)
Components
1.Low in saturated fat
a.A meal high in saturated fat adversely effects
blood sugar control, even after the next meal
b.Substitution of dietary saturated fat with a
polyunsaturated fat improves blood sugar
control.
c.Foods highest in omega 6 fa’s= (1) farm raised
salmon, (2) chicken
EFAs
Essential Fatty Acid Basics
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The body can synthesize some of the fats it needs
from the foods you eat. However, two essential fatty
acids cannot be synthesized in the body and can be
taken in the diet from plant foods. Their names—
linolenic and linoleic acid—are not important. What is
important is that these basic fats are used to build
specialized fats called omega-3 and omega-6 fatty
acids.
Specific Fatty Acids
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Omega-6 fats are found in leafy vegetables, seeds, nuts, grains, and vegetable oils
(corn, safflower, soybean, cottonseed, sesame, sunflower). Other omega-6 fatty
acids, such as gamma-linolenic acid (GLA), can be found in more rare oils,
including black currant, borage, evening primrose, and hemp oils.3 Most diets
provide adequate amounts of omega-6 fatty acids.
Omega-3 Fatty Acids
It is important for vegetarians to include foods that are rich in omega-3 fatty
acids on a daily basis. Alpha-linolenic acid, a common omega-3 fatty acid, is
found in many vegetables, beans, nuts, seeds, and fruits. The best source of
alpha-linolenic acid is flaxseeds or flaxseed oil. For those seeking to increase
their intake of omega-3 fats, more concentrated sources can be found in oils such
as canola (also known as rapeseed), soybean, walnut, and wheat germ. Omega-3
fatty acids can be found in smaller quantities in nuts, seeds, and soy products, as
well as beans, vegetables, and whole grains. Corn, safflower, sunflower, and
cottonseed oils are generally low in omega-3s.
What about Trans Fats?
Trans fats (or trans fatty acids) are created in an industrial process that adds
hydrogen to liquid vegetable oils to make them more solid. Another name for
trans fats is “partially hydrogenated oils." Look for them on the ingredient list
on food packages.
Trans fats raise your bad (LDL) cholesterol levels and lower your good (HDL)
cholesterol levels. Eating trans fats increases your risk of developing heart
disease and stroke. It’s also associated with a higher risk of developing type 2
diabetes.
Components
1.Low in trans-fatty acidsadding hydrogens to
make fat more stable
a.Trans fats are bad for cholesterol
b.Although some people suspect trans fats
cause coronary artery disease, evidence is still
not clear
c.Dairy is the only food which contains
naturally occurring trans fat (small amounts)
Components
1.Low in sugar
a.Added sugars account for 15.7% of total US
calorie intake (USDA)
b.Even most conservative sources recommend
less than 20% of calories from added sugars
c.Important not to confuse sugars and
carbohydrates
d.Recommends pts get <5% of calories from
refined sugars
Components
1.Moderate salt
a.Just getting rid of the salt shaker has little
effect – most salt now comes from prepared or
pre-packaged foods
b.As high as 80% of patients respond to a low
salt intervention
c.Effect can be disappointingly modest
d.Most recommendations are from 2-2.3 grams
sodium per day
Components
1.Adequate amounts of pure water
a.Vastly overrated recommendation in ND
community, but still important
b.Increasing water intake is recommended for
patients with history of kidney stones
c.Don't recommend distilled because mineral
content is low
d.Recommend spring water or filtered
e.EPA has a searchable database where you put
in zip code and it will tell you the mineral
Components
1.Moderate amounts of protein
a.ND profession has gotten a bit away from the conclusions of
the research world on optimum protein intake
b.The published evidence supports the notion that Americans
eat too much, not too little protein.
c.Research support for protein stabilizing blood sugar is weak,
at best.
i. amino acids  insulin secretion
d.Recommended protein intake is usually between 0.5 and 1.0
grams per kg body weight per day.
i. 2.0 g of protein/day/kg of body weight is thought to be a
safe upper limit
e.Compared to fats and sugars, little is known about the long
Components
1.Good variety
2.Mastication / slow down while eating
a.parasympathetic
b.salivary amylase
Components
1.Caloric moderation
a.Animal data are very clear that too many
calories vastly shorten the life expectancy,
likely in part by overproduction of free
radicals
i.if you take a rat and feed it 30% more
calories than it needs it will die sooner
ii.biochemical process of burning calories
creates free radicals
Nutritional Assessment
How do you determine if your patient’s diet is good?
EVERYONE LIES! (or conveniently forgets to reports
accurately)
When do you need to do a nutritional assessment?
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There are numerous risk factors for poor nutritional status, including major trauma, burns, sepsis,
substance abuse, recent weight loss, and many gastrointestinal disorders. Additional information learned
through a careful medical history can also suggest possible risk factors for malnutrition. The factors listed
below may place a patient at risk for developing, or may denote the presence of, nutrient deficiencies.
Risk Factors
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Age < 18 years or > 65 years (increased risk age >75 years)
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Recent significant, unintentional weight loss: > 5% in 1 month or >10% in 6 months
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Weight loss calculated as follows:
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Percent weight loss = (UBW-CBW)/UBW
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Where: UBW = usual body weight, CBW =current body weight
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Excessive alcohol intake, other substance abuse
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Homelessness, limited access to food
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Limited capacity for oral intake (dysphagia, odynophagia, stomatitis, mucositis)
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NPO > 3 days
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Increased metabolic demands: extensive burns, major surgery, trauma, fever, infection, draining, abscesses,
wounds, fistulae, pregnancy
Detailed Diet History
A detailed diet history provides insight into a patient's
baseline nutritional status and may detect subclinical
nutrient deficiencies or toxicities. Assessment
includes questions regarding chewing or swallowing
problems, avoidance of eating related to abdominal
pain, changes in appetite, taste, or intake, as well as
use of a special diet or nutritional supplements.
Detailed Medical History
A review of past medical history includes identifying
existence of conditions resulting in increased
metabolic needs, altered gastrointestinal function and
absorptive capacity, chronic disease states, organ
failure, and levels of physical activity. A review of
current medications may further elucidate at-risk
nutrient status.
Nutritional Assessment
1.History
a.Still the best way to assess an ambulatory
individual’s nutritional status
b.Self-reporting of dietary habits will often
underestimate the bad and overestimate the
good (Am J Clin Nutr. 2002 Oct;76(4):766-73)
c.Diet diary can be a useful tool, as long as
limitations are understood
Nutritional Assessment
Diet Diary:
At least 4 days
Over one weekend
MOre on the Diet Diary
Food Allergies, Intolerances, Weight Loss Pitfalls
The evidence: August 2008 issue of The Journal of Preventive Medicine.
Researchers at Kaiser Permanente found that when people used a food diary they
lost twice as much weight. And that's without making any other changes. Just the
diary.
So what happens when you write down what you eat? You face what you are
doing. You face your weight/moods/allergies head on. Keeping a food diary isn't
keeping notes. It's THERAPY! Once you face the facts -- whatever those facts are
-- you will be able to take control.
Nutritional Assessment
1. Physical exam
a.Obvious stuff: vital signs (particularly weight), skin health, oral mucosa.
Non-obvious stuff?
b.Oral mucosa changes w/ low Vit A, B-vit’s, folic acid, antioxidants
c. Skin changes w/FA deficiency and some vitamin defs
Nutritional assessment
a.Standard tests will often reveal plenty
b.CMP/Chem panel, CBC, ferritin as first tests
c. Standard tests from large labscovered by insurance and normals are based
on more characteristic populations
d.Specific labs will be covered as appropriate under nutrients (e.g.
methylmalonic acid for B12 deficiency)
e. Some ND’s advocate narrowing the reference range for interpretation of lab
values. Very controversial
f. Tasting zinc has no predictive value of your RBC zinc status
g.When to check nutritional status: Fatigue, GI problems, Wasting
h.What can you find in a chem. Panel about someone’s nutrition:
i. Proteinalbumin, BUNmay need hospital intervention
ii. electrolytesif high K think about kidney disorder
Nutritional Assessment
1.Hair mineral analysis
a.Reliability for the most part better in toxic
and/or higher weight minerals
b.Commercially available hair mineral analysis of
questionable quality. This may be an artifact of
poor sample preparation procedures.
c.compared 5 different labs and found no
statistical correlation between any nutrient or
any anti-nutrient so may not be a good use of
patients $$$
Nutritional Assessment
1. Esoteric tests
a.Kinesiology (applied kinesiology- AK) is not apparently very reproducible
or reliable as a screening tool. One study has found a positive correlation
between results on objective tests and AK.
b.IgG food allergy tests have not been checked for reliability. The clinical
significance of IgG antibodies to foods has been questioned in recent
papers
c. Consider sending a split sample to any lab you are considering using and
see if they can reproduce the same results on the same sample
d.Transdermal electro-impedance (Vega) testing is again not well
documented. The best study showed the only predictor of test outcome
was the operator of the machine [e.g not clinical symptoms, use of
placebo as test substrate, etc]. Transdermal electro-impedance/Vega
testing- measures changes in energy flow (electrical impedance) w/
introduction of various foods/allergens.
Discussion
Components of Healthy Diet Basics:
Problems with resources for eating right?
Other potential real-world considerations
Nutritional Assessment
Consider several options and pick one to stick with