Role of DIET in Disease Management

Role of DIET in Disease Management Dr. Matheen Asrar PhD, R.D. Clinical Nutritionist Certified Sports Nutritionist Asst. Prof in Nutrition and Food Science

Many people find it difficult to separate valid recommendations from fad diet advice. Consumers are bombarded with nutrition information from a variety of sources. Web Sites TV and Radio News Food Labels Medical Experts Popular Magazines Nutrition information is often seen as contradictory, even from equally valid sources. Consumer Fad Diet Gurus Media Images Food Ads Friends and Family Gov’t Guidelines SOURCE: IFIC Foundation, 2004

Dietetics • Interpretation and communication of nutrition science to enable people to make informed and practical choices about food • Translate science of nutrition into everyday information about food

Eating right is one of the best preventive medicines there is. But people don’t always know what’s good for them. That’s where dietitians and nutritionists come in.

Nutritionists & Dietitians •monitor, assess, and optimize nutrition status based on the patient's current medical condition. confer with physicians to coordinate medical and nutritional needs • make recommendations for tube and intravenous feedings and/or dietary supplements. •teach patients how to make nutritionally sound food choices to speed the recovery process, prevent disease and maintain a healthy lifestyle.

Guidelines: Enteral vs Parenteral Feeding Nutritional assessment Functional and accessible GI tract? Yes No Enteral feeding Parenteral feeding ASPEN. 2002. Guidelines for the use of Enteral and Parenteral Nutrition in Adult and Pediatric Patients. JPEN 26:S1-S138. 6

Planning Nutrition Intervention Tube Feeding Parenteral Nutrition Oral Diet + Medical Nutritional Supplementation 1. Oral Diet

Dietitians often recommend therapeutic diets • therapeutic diets are special diets developed to treat disease or metabolic disorders.

Examples of Therapeutic Diets • Regular diet • Liquid diet • Soft diet • Diabetic diet • Calorie controlled diet • Low cholesterol diet • Fat restricted (low-fat) diet • Sodium restricted diet • Protein diet • Bland diet • Low residue diet

Regular diet • Balanced diet • At times it has a slightly reduced caloric content • Foods such as rich desserts, cream sauces, salad dressings and fried foods may be decreased or omitted

Which of the following pictures would represent a regular diet? A. B. C. D. E.

Liquid diet • Nutritionally inadequate and should be used for short periods of time • Uses: • After surgery or heart attack • Patients with acute infections or digestive problems • To replace fluids lost by vomiting or diarrhea • Before some Xrays of digestive tract

Which of the following pictures would represent a liquid diet? A. B. C. D. E. F.

2 types of liquid diets • Clear liquid diet • Water, apple of grape juice, fat-free broth, plain gelatin, popsicles, ginger ale, tea, coffee • Full liquid diet • Everything on clear liquid diet plus strained soups and cereals, fruits and vegetable juices, yogurt, hot cocoa, custard, ice cream, pudding, sherbet, and eggnog.

Soft Diet– similar to a regular diet, but foods must require little chewing and be easy to digest. Avoid meat and shellfish, coarse cereals, spicy foods, rich desserts, fried foods, raw fruits and veggies, nuts and coconuts

Which of the following pictures would represent a soft diet? A. B. C. D. E.

Diabetic diet– for people whose body does not produce enough insulin to metabolize carbohydrates. • Avoid sugar-heavy foods such as candy, soft drinks, desserts, cookies, syrup, honey, jams & jellies. • The new trend is to count only carbs since blood sugar levels are most affected by carbs. • The patient then takes an amount of insulin based upon the amount of carbs eaten.

Which of the following pictures would represent a diabetic diet? A. B. C. D. E. F.

Sodium Restricted diet—(low sodium or low salt diet) • Used for patients with cardiovascular diseases such as high blood pressure or congestive heart disease or kidney disease. • Avoid or limit addition of salt to any food, avoid smoked meats, or fish, processed foods, pickles,

Which of the following foods should be avoided on a low salt diet? A. B. C. D. E. F.

High Protein diet—used for children and adolescents who need additional growth, pregnant women, patients before and/or after surgery, patients suffering from burns, fevers, or infections. Regular diet with added protein rich foods such as meats, fish, milk, cheese and eggs

Which of the following foods are high in protein? A. B. C. D. E.

Medical model Problem/Condition Diagnosis Treatment Alleviation of Condition

Disease Prevention Medical Model • Identify risk factors. • Intervention targets risk factors. • Often fear based, desire to avoid disease state.

Disease Prevention Health Promotion Model • Examine life balance and holistic well-being. • Focus in on maximizing health not just absence of disease.

Chronic Disease • A long-term condition • e.g., obesity, diabetes, and cardiovascular disease • May be prevented or delayed with lifestyle changes • e.g., healthier eating and more physical activity • According to the WHO “…by 2020, chronic diseases will account for almost three-quarters of all deaths worldwide, and that 71% of deaths due to ischaemic heart disease (IHD), 75% of deaths due to stroke, and 70% of deaths due to diabetes will occur in developing countries. The number of people in the developing world with diabetes will increase by more than 2.5-fold, from 84 million in 1995 to 228 million in 2025. On a global basis, 60% of the burden of chronic diseases will occur in developing countries.”

Nutrition for Chronic Disease Prevention and Treatment • Nutrition is a widely accepted tool for prevention of chronic diseases • Nutrition is also very important for management and treatment of a chronic disease • Critical role in nutrition intervention

Nutrition for Diabetes • Goal of nutrition therapy • To help people with diabetes learn how to make healthy food choices, which will optimize glycemic control and prevent complications • A healthy, well-balanced diet • There is no one “diabetic diet” • Healthy eating for diabetes includes whole grain cereals, lean protein foods, fruits, generous portions of non-starchy vegetables • Ideally, a person with diabetes receives an individualized meal plan from a nutritionist or dietitian

Nutrition for Cardiovascular Disease • Eat a diet rich in fruits, vegetables and whole cereal grains • This provides potassium and fiber, both clearly linked to reduced chronic disease risk • Don’t add salt during food preparation • Limit use of processed and pre-prepared food items • They are typically very high in salt • Cook with no or very minimal added fats and oils • If fat or oil is used, unsaturated is healthiest option (canola, olive, etc) • Maintain a healthy body weight • Control blood pressure and blood sugar

Addressing Chronic Disease Medical Model You have an illness, symptoms are treated. Health Promotion You can be well and optimize health through lifestyle, even with a disease.

Diet and Disease Update • Heart Disease • Diabetes • Cancer

Diet and Heart DiseaseWhere we have been… • Saturated Fat • Cholesterol  • Vegetable oils 

Diet and Heart DiseaseWhat’s New…. • Trans fats  • Fish Oil 

Diet and Heart DiseaseWhat’s in the News…. • Nuts / Flaxseed - • Omega 3 vs Omega 6 • Plant Sterols • Tropical Oils

Diet and DiabetesWhere we have been… • Amount of Carbohydrate • Balanced diet

Diet and DiabetesWhat’s new… • Maintain healthy weight • Physical activity 30 minutes a day  • Dietary Fiber

Diet and DiabetesWhat’s in the news… • Glycemic Index / Glycemic Load • High Fructose Corn Syrup • Cinnamon • Chromium

Diet and CancerWhere we have been… • Low in fat, alcohol and salt. • High in whole grains, fruits and vegetables.

Diet and CancerWhat’s New… • Phytochemicals • Antioxidants • Cruciferous vegetables • Omega-3 fatty acids

Diet and Cancer:What’s in the news… • Supplements • Juicers • Sugar substitutes • Green tea • Soy products

Energy Drinks • Contain significant amounts of caffeine and other legal stimulants. • Additional ingredients imply “health” benefits.

Information/ misinformation • Eating according to food pyramid will ensure a healthy diet • Eggs should be avoided as they are high in cholesterol • Nuts are fattening • Exercise makes one lose weight • Foods must be eaten in certain combinations

Role of a nutritionist • Proper nutrition is essential for healthy living and overall well-being • Nutritionist evaluates diet and offers advice • Developing meal plans, education on portion control • Special diets for treatment or prevention of disease

Personally tailored advice One size fits all X XX Health history Favorite foods Eating habits Exercise habits

Medical Nutrition Therapy • A therapeutic method used to treat disease by specifically tailoring the diet • Work with other health care professionals to develop meal plans to provide appropriate nutrients based on medical condition • Formulating meals for feeding tubes

Real Food, Fake Food • Whole grains • Real fruit • Fresh vegetables • Fresh meat, seafood • Raw nuts and seeds • Herbs and spices • Butter • Unfermented green tea • ‘enriched’ flours • Fruit juice concentrate • Canned/ frozen veggies • Ground, smoked, canned or aged meats • Artificial colors/ flavors • Margarine • Processed tea

Role of DIET in Disease Management