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Building Demand for California Dried Plums

Building Demand for California Dried Plums. 2007-2008 Public Relations Recommendations June 28, 2007. Case Study . Mrs. K: 32 y/o AAF executive at her PMD’s office Feels “bloated”, gassy, infrequent stools Lower abdominal cramps Improved with BM’s (approx 3/week)

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Building Demand for California Dried Plums

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  1. Building Demand for California Dried Plums 2007-2008 Public Relations Recommendations June 28, 2007

  2. Case Study Mrs. K: 32 y/o AAF executive at her PMD’s office • Feels “bloated”, gassy, infrequent stools • Lower abdominal cramps • Improved with BM’s (approx 3/week) • Occurs unpredictably, for last 7 months • Lasts for few days, then goes away • No interference w/ daily activities • Worried it might be “something serious”

  3. Case Study continued Mrs. K: History and Physical • PMH: “food poisoning” one year ago • PSH: none • MEDS: colace qd • FH: mother has “minor depression” • SH: married, highly active, no T/E/D • Physical exam: normal; BMI = 24 • Labs: no anemia, ESR & CRP normal

  4. DIGESTIVE HEALTH: THE RD’s PERSPECTIVE Leslie Bonci,MPH,RD,LDN,CSSD Director of Sports Nutrition University of Pittsburgh Medical Center

  5. WHAT ARE WE HEARING? • Rock hard abs • Commercials for various GI medications • Increased product availability- OTC/supplements • Diarrhea/Constipation are dinner table conversation • Detox • Colon cleansing

  6. THE FACTS • Eating can be a trigger for gut problems Good digestive health is the ability to digest, absorb and utilize nutrients • It is not just about the food, but also the eating habits: • Timing • Quantity • Where one eats • How one eats

  7. GETTING TO GOOD DIGESTIVE HEALTH • Achieving/maintaining an appropriate weight • Eating a diet that is balanced, varied, and individualized to address digestive concerns • Stress reduction • Physical activity

  8. LIFESTYLE INFLUENCERS • Stress • Irregular schedule • Travel’s effect on food choices • Busy lives

  9. BARRIERS • Patients are not always forthcoming with symptoms/complaints • Patients may try to self-treat • Power of suggestion • Sensitive subject • Food safety concerns

  10. TREATING DIGESTIVE DISORDERS WITH DIET • Not black and white • No guarantee that symptoms will abate • May have to experiment over several months • Outcomes may be more subjective than objective

  11. DIETS THAT CAN AFFECT THE GUT • High protein/high fat • Low-carb products • High carbohydrate • High fiber • Fad diets • Cabbage soup/food combining

  12. SUPPLEMENTS THAT AFFECT THE GUT • Vitamin Mineral supplements • Mega dose Vitamin C • Potassium supplements • Calcium • Iron supplements • Large doses of Magnesium • “Energy” Drinks • Flaxseed/Flaxseed oil

  13. OTHER POTENTIAL OFFENDERS • Echinacea • Chitosan • Dieter’s Tea • Glucosamine • Fish oil capsules

  14. THINGS TO KEEP IN MIND • There is not ONE eating plan • Need to customize and individualize eating • Need to make changes gradually • Need to monitor eating to discover potential food and habit stressors, as well as foods that are well tolerated

  15. WHAT TO TELL PATIENTS • Make meal times relaxed • Take time to eat • Allow time for food to digest • Eat at regular intervals • Eat smaller amounts at any given eating episode • Take small bites • Focus on eating, not everything else

  16. WHAT SHOULD THEY DO? • Keep a food/symptom diary listing : • Foods eaten • Quantity • Time consumed • Document outcomes: • Symptom relief • Decrease in symptom frequency • Better sleep patterns • Improved energy • Different bowel patterns

  17. FOCUS ON FUNCTIONAL FOODS • Yogurt- probiotics • Dried plums- fiber/sorbitol • Oats- beta-glucan,prebiotics • Orange juice, eggs, peanut butter, spreads- Omega-3 enhanced foods

  18. TRAVEL GUIDELINES • Bottled water on planes • Travel with “safe” foods- packets of oatmeal, nuts, dried fruits • www.cdc.gov/travel • List of food concerns if traveling to other countries • Travel with bouillon cubes, sports drink powder • Wash hands frequently, or use wipes

  19. GOOD GUT TRAVEL KIT • Nausea • Sports drink • Candied gingerroot • Constipation • Ground flaxseed • Dried plums/fig bars • IBS/Abdominal cramps • Chamomile tea • Diarrhea • Raspberry tea/Blackberry root bark tea • Sure-Jel or Certo • Carob powder

  20. FINAL WORDS • The emphasis needs to be on what patients can have- NOT what they can’t!!!

  21. DIET RECOMMENDATIONS FOR MRS K • Ask about recent change in diet • Food diary to ascertain potential offenders: bloat and gas causing foods/beverages • Discuss food habits- eating on the go, or sitting down to meals • Ask about supplement use • Ask about exercise routine • Discuss ways to GRADUALLY add fiber to the diet, along with adequate fluids

  22. CONTACT • Leslie Bonci, MPH, RD • Phone (412) 432-3674 • e-mail: boncilj@upmc.edu • American Dietetic Association’s Guide to Better Digestion!

  23. Identifying and Achieving Digestive Health – A Look to the Future Leo Treyzon M.D. Divisions of Digestive Diseases & Clinical Nutrition David Geffen School of Medicine at UCLA

  24. Disclosures • NIH Training Grant • UCLA STAR Program • Annenberg GI Fellowship Award • UCLA Center for Human Nutrition • Digestive Health Organization and CDPB

  25. Why is this an important topic? • Unpredictable, uncomfortable and embarrassing • Large economic burden • Next frontier in health care is prevention

  26. Hard to Define I can’t describe it, but… “I know when I see it” • Justice Stewart, Ohio Supreme Court Jacobellis v. Ohio, 378 U.S. 184, 197 (1964)

  27. Defining Digestive Health “Good digestive health indicates an ability to process nutrients through properly functioning gastrointestinal organs, including the stomach, intestines, liver, pancreas, esophagus and gallbladder. Most people who are in good digestive health are of appropriate weight and don’t regularly experience symptoms like heartburn, gas, constipation, diarrhea, nausea or stomach pain. Eating a nutritious diet is needed to maintain a healthy digestive system and may prevent and treat certain digestive diseases.” American Gastroenterology Association

  28. Definition – Digestive Health • Ability to digest, absorb and utilize nutrients • Eliminate waste products • Optimizes vitality, and resilience • Appropriate weight is central theme • Don't regularly experience bothersome digestive symptoms • This state of well-being is achieved by: • consuming a nutritious diet • minimizing emotional stressors • embracing physical activity • Oriented to the prevention of chronic disease.

  29. Other Approaches to Health Bio-Medical – the body as machine; disease oriented Behavioral – health as energy – lifestyle Bio-psycho-social – attempts to address deficiencies of behavioral model within biomedical context Socio-environmental – a means to realize aspirations and change environments

  30. Strengths of Digestive Health Approach • Individualized to the person • Creates energy and balance in self • Focus on individual responsibility • Focus on lifestyle change for health and disease prevention • Spiritual connection to natural environment

  31. Leading GI Symptoms Prompting U.S. Outpatient Clinic Visits in 2002 Shaheen NJ et al . Am J Gastroenter 2006. National Ambulatory Medical Care Survey 2002.

  32. Physician Diagnoses for GI Disorders in Outpatient Clinic Visits Shaheen NJ et al . Am J Gastroenter 2006. National Ambulatory Medical Care Survey 2002.

  33. Physician Visits per Year (GI and non-GI) 6 5 GI Non-GI MD Visits Per Year 4 3 2 1 0 IBS Normal Complaints Drossman DA, et al., Dig Dis Sci 1993; 38:1569

  34. Work or School Absences 14 12 10 Days per Year 8 6 4 2 0 IBS Normal Drossman DA, et al., Dig Dis Sci 1993; 38:1569

  35. Beyond the economic costs… QOL matters too!

  36. Barriers toward Digestive Health Promotion • Medical culture oriented towards cure • Doctors’ preference vs. patients’ preference • ER and House vs. “The Preventionist” • If you cannot avoid an illness, at least catch it early and prevent it from causing harm. • Identification of risk factors • Modification of risk factors early in course • “Periodic Health Examination”

  37. Where is Digestive Health Accomplished? • Health Provider Level • learning how to screen effectively • counseling effectively (integrative health approach) • Societal Level • public education • regulations oriented toward healthy lifestyle • national prevention guidelines • Patient Level • being inquisitive • taking interest in health

  38. What is new in Digestive Health research in 2007? • Dietary fructose • Weight Disorders • CNS role in eating behaviors • Weight Loss and Longevity • Doctor-Dietitian Duo • Gut ecology and Obesity • Probiotics

  39. Fructose Malabsorption in Normal Persons • Dose-response study from which they developed a fructose malabsorption breath test . • 20 persons got on 4 separate days: • 10% solution of 15 g, 25 g, or 50g fructose • 33% solution 50 g fructose • Analyzed H2 and CH4 over 5 hours Rao, S, et al. Clin Gastro and Hepatol 2007.

  40. H2 and CH4 concentration after intake of different doses of fructose Rao, S, et al. Clin Gastro and Hepatol 2007.

  41. Results • No subject tested (+) with 15 g. No gender differences. • 10% (+) with 25 g fructose but were asymptomatic. • 50 g (10% solution) • 80% (+) breath test • H2 - 65% • CH4 in 5% • Both H2 and CH4 10% • 55% had symptoms • 50 g (33% solution) • 60% (+) • 45% experienced symptoms. Rao, S, et al. Clin Gastro and Hepatol 2007.

  42. Conclusions • Healthy subjects absorb up to 25 g • Many exhibit malabsorption and intolerance with 50 g • For suspected malabsorption: 25 g should be test dose, and measure at 30 minute intervals for 3 hours Rao, S, et al. Clin Gastro and Hepatol 2007.

  43. Brain Areas Involved in the Regulation of Food Intake and Schematic Representation of Their Interactions Alonso-Alonso, M. et al. JAMA 2007;297:1819-1822.

  44. Mean Percent Weight Change during a 15-Year Period in the Control Group and the Surgery Group, According to the Method of Bariatric Surgery Sjostrom L et al. N Engl J Med 2007;357:741-752

  45. Unadjusted Cumulative Mortality Sjostrom L et al. N Engl J Med 2007;357:741-752

  46. Survival According to BMI in the Surgery Group and the Control Group Adams TD et al. N Engl J Med 2007;357:753-761

  47. Effect of Onsite Dietitian (D) Counseling on Outpatient Weight Loss and Lipidsin a Physician (MD) Office • Intro: D sees patients at same visit w/ MD (fully reimbursable). • Intervention: D counsels on diet (DASH) + exercise (30 min/d). One f/u w MD and D. • Results: Max WL = 5.6%; average WL @ 2.6 years = 5.3%; Δ LDL = - 9%; Δ TG = - 34%; Δ HDL = + 10%; Δ SBP = - 3 mmHg; Δ DBP = - 4 mmHg. • Conclusion: concurrent counseling is effective in achieving & maintaining WL & is reimbursable Welty, FK et al. Am J Cardiol 2007;100:73–75

  48. Using Bugs as Drugs: How to be a Probioticist in 2007

  49. Definitions Probiotic: • live microorganisms that when administered in adequate amounts confer a health benefit on the host Prebiotic: • nondigestible food ingredients (e.g. oligasaccharides) that may beneficially affect the host by selectively stimulating the growth and/or the activity of a limited number of bacteria in the colon Synbiotics: • combination nutritional supplements comprised of probiotics and prebiotics Neutraceutical: • Original: food that provided medical or health benefit • Current: dietary supplements that contain a concentrated form of a bioactive substance originally derived from a food. FAO/WHO. Guidelines for the evaluation of probiotics in food. 2002

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