-
What is an ulcer
eroded mucosal lesion
-
Ulcer treatment
- antacids
- antibiotics to eradicate Helicobacter pylori bacteria
-
Ulcer diet
- as tolerated
- well-balanced
- avoid late night snacks
- omit: cayenne and black pepper, large amounts of chili powder, avoid excess caffeine and alcohol
-
What is a hiatal hernia
Protrusion of a portion of the stomach above the diaphragm into the chest
-
Hiatal hernia diet:
- small, bland feedings
- avoid late night snacks, caffeine, chili powder, black pepper
-
Dumping syndrome follows a ______
gastrectomy (Billroth I,II)
-
Symptoms of the dumping syndrome
cramps, rapid pulse, weakness, perspiration, dizziness
-
What causes dumping syndrome
- rapidly hydrolyzed carbohydrate enters the jejunum, water is drawn in to achieve osmotic balance.
- this causes a rapid decrease in the vascular fluid compartment and a decrease in peripheral vascular resistance
- BP drops and signs of cardiac insufficiency appear
- ~2 hours later, the CHO is digested and absorbed rapidly
- BS rises, stimulating an overproduction of insulin, causing a drop in BS below fasting
- This is reactive or alimentary hypoglycemia
-
What is Billroth I
- Gastroduodenostomy
- attaches the remaining stomach to the duodenum
-
What is Billroth II
- Gastrojejunostomy
- attaches the remaining stomach to the jejunum
-
Why is pancreatic secretion decreased with Billroth II
- food bypasses the duodenum, which secretion of secretin and pancreozymin by the duodenum is reduced
- These hormones normally stimulate the pancreas
-
2 nutrients adversely affected with Billroth II
- Calcium (most rapid absorption in duodenum)
- Iron absorption (requires acid)
-
Deficiencies due to Dumping Syndrom
- B12: lack of intrinic factor
- Folate: needs B12 for transport inside cell
-
Pernicious anemia (B12 deficiency) diagnosed using the
Schilling test
-
Dumping Syndrome diet
- Frequent small, dry feedings
- Fluids before or after meals (to slow passage)
- Restrict hypertonic concentrated sweets
- give 50-60% complex CHO
- Protein at each meal
- Moderate fat
- B12 injections may be needed
- Lactose may be poorly tolerated due to rapid transport
-
What is Gastroparesis? What are its causes
- Delayed gastric emptying
- surgery, diabetes, viral infections, obstructions
-
Gastroparesis can lead to
- moderate to severe hyperglycemia -- due to slowing of both stomach and intestinal movement
- detrimental effects on gastric nerves
-
Gastroparesis drugs
- Prokinetics -- increases stomach contractility
- Erythromycin, metoclopramide
-
Gastroparesis diet
- small, frequent meals
- pureed foods
- avoid high fiber
- avoid high fat (liquid fat may be better tolerated)
-
For pts. with gastroparesis, _____ may be due to undigested food or medications
Bezoar formation
-
Treatment for bezoar formation (especially in gastroparesis patients)
enzyme or endoscopic therapy
-
Tropical Sprue
- bacterial, viral, parasitic infection
- chronic GI disease, intestinal lesions
-
Tropical Sprue symptoms
- diarrhea
- malnutrition
- deficiencies of B12 and folate due to decreased HCL and intrinsic factor
-
Tropical sprue treatment
- antibiotics
- high calorie, high protein
- IM b12 and oral folate supplements
-
Non-tropical sprue is also known as
Celiac disease, gluten-induced enteropathy
-
Gluten refers to _____
storage proteins
-
Prolamins (plant storage proteins): Wheat
gliadin
-
Prolamins (plant storage proteins): rye
secalin
-
Prolamins (plant storage proteins): barley
hordein
-
Prolamins (plant storage proteins): oats
avenin
-
Non-tropical sprue (Celiac disease) is a reaction to ____ and affects _____
-
Non-tropical sprue symptoms
- malabsorption (leads to loss of fat-soluble vitamins)
- macrocytic anemia
- weight loss
- diarrhea
- steatorrhea
- iron deficiency anemia
-
Non-tropical sprue diet
- Need (gliadin-free) gluten-restricted diet: NO wheat, rye, oats (if harvested and milled with what), barley, (buckwheat may be contaminated with WROB)
- NO: bran, graham, malt, bulgur, couscous, durum, orzo, thickening agents
- OK: corn, potato, rice, soybean, tapioca, arrowroot, carob bean, guar gum, flax
-
Constipation diet
- high fluid
- high fiber
- exercise
-
What is Diverticulosis:
the presence of diverticula - small mucosal sacs that protrude through the intestinal wall due to structural weakness
-
Diverticulosis is due to
- constipation
- lifelong intra-colonic pressures
-
Diverticulosis diet
high fiber - increases volume and weight of residue, provides rapid transit
-
What is Diverticulitis
When diverticula become inflamed as a result of food and residue accumulation and bacterial action
-
Diverticulitis diet
- Clear liquids
- low-residue or elemental
- gradual return to high fiber
-
How does dietary fiber help with digestion
binds water and increases fecal bulk
-
-
Dietary fiber foods
- legumes
- wheat bran
- fruits
- vegetables
- whole grains
-
Oat bran (insoluble) and soluble fibers decrease serum cholesterol by...
binding bile acids converting more cholesterol into bile
-
How does soluble fibers help with digestion
- delay gastric emptying, absorb water, and form soft gel in small intestine
- This slows passage and delays or inhibits absorption of glucose and cholesterol
-
Types of soluble fiber
- fruits
- veg
- legumes
- oats
- barley
- carrots
- apples
- citrus fruits
- strawberries
- bananas
-
High fiber diet may increase the need for...
-
What is Gastritis
inflammation of stomach
-
Gastritis symptoms
anorexia, nausea, vomiting, diarrhea
-
Gastritis diet:
- clear liquids
- advance as tolerated
- avoid gastric irritants
-
2 types of inflammatory bowel disease
- Crohn's disease
- chronic ulcerative colitis
-
Another name for reginal enteritis
Crohn's disease
-
Crohn's disease affects
terminal ileum
-
Crohn's diseas symptoms
- weight loss
- anorexia
- diarrhea
-
deficiencies common with Crohn's disease
B12 and iron
-
B12 deficiency in Crohn's disease leads to..
- megaloblastic anemia -- blood disorder in which the number of red blood cells is lower than normal. Red blood cells are larger than normal also
- megaloblastic anemia is caused when your body does not have enough of two key nutrients to produce healthy red blood cells
-
Chronic ulcerative colitis (UC) symptoms
- chronic bloody diarrhea
- weight loss
- anorexia
- electrolyte (Na, K) disturbance
- dehydration
- anemia
- fever
- negative nitrogen balance
-
Inflammatory bowel disease treatment
- maintain fluid and electrolyte balance
- acute Crohn's flare-ups -- bowel rest, pn or minimal residue
- acute UC -- elemental diet may be needed to minimize fecal volume
- energy needs based on BMI
- limit fat ONLY if steatorrhea -- assess Ca, Mg, Zn; MCT oil
- water soluble and fat soluble vitamins
- iron & folate
- watch lactose
- frequent feedings
- high fat may improve energy balance
-
Irritable bowel syndrome symptoms
- chronic abdominal discomfort
- altered intestinal motility
- bloating
-
Irritable bowel syndrome goals
- adequate nutrient intake
- tailor pattern to specific GI issues
-
Irritable bowel syndrome diet
- avoid: large meals, excesss caffeine, alcohol, and sugars
- use food diary to track intake, emotions, environment, symptoms
-
Lactose intolerance is due to ____ deficiency
Lactase
-
Cause of lactose intolerance
- Lactose is split into glucose and galactose by lactase. In its absence lactose remains intact, exerting hyperosmolar pressure.
- Water is drawn into the intestine to dilute the load causing distention, cramps, diarrhea.
- Bacteria then ferments the undigested lactose, releasing carbon dioxide gas
-
Lactose tolerance test
- oral dose of lactose after a fast
- If intolerant of lactose, blood glucose will rise <25 mg/dl above fasting (flat curve)
- If tolerant of lactose, the rise of bs would be above 25 mg/dl (normal curve)
-
Lactose intolerance diet
- lactose-free
- no animal milk or milk products
- no whey
- calcium and riboflavin supplements are recommended
- yogurt and small amounts of aged cheese may be tolerated
- OK: lactate, lactalbumin
-
Acute diarrhea treatment in infants and children
aggressive and immediate rehydration
-
WHO recommendation for acute diarrhea in infants and children
glucose electrolyte solution
-
Chronic nonspecific infantile diarrhea treatment
- give 40% calories as fat, balanced with limited fluids
- restrict or dilute fruit juices with high osmolar loads (apple, grape)
-
adult diarrhea treatment
- remove the cause
- bowel rest
- replace lost fluids and electrolytes especially those high in sodium and potassium
- When stops, begin with low fiber foods, followed by protein foods, fat does not need to be limited
- prebiotic components (pectin, fructose, oats, banana flakes)
- probiotics
-
Cause of steatorrhea
malabsorption
-
Normal stool fat value & value indicative of malabsorption
-
Steatorrhea diet
- high protein
- high complex CHO
- fat as tolerated
- vitamins (especially fat-soluble)
- minerals
- MCT (rapidly hydrolyzed in GI tract)
-
Short bowel syndrome consequences associated with...
significant resections of the small intesting
-
Most severe location of resection for short bowel syndrome
- Ileum (especially distal 1/3)
- Ileocecal valve
- Colon
-
Most digestion take place in ______
What remains?
- 1st 100 cm of intestine (in duodenum and upper jejunum)
- small amounts of sugar, starches, fiber, lipids
-
With a jejunal resection _____ can adapt and take over jejunal functions
ileum
-
Biggest concern with ileal resection is _____
fluid
-
distal ileum absorbs:
- B12
- intrinsic factor
- bile salts
-
Fluid recommendations for ileal resection
Drink at least 1 liter more than their ostomy output daily
-
What occurs if ileum cannot recycle bile salts
- lipids are not emulsified
- leads to malabsorption of fat-soluble vitamins
- malabsorbed fats combine with Ca, Zn, Mg, leading to "soaps"
-
Loss of colon concerns:
- water and electrolyte loss
- loss of salvage absorption of CHO and other nutrients
-
Nutrition care for short bowel syndrom
- PN initially to restore and maintain nutrient status
- EN - start early to stimulate growth, increase over time; continuous drip
- may take weeks or months to transition to food
-
Jejunal resection nutrition care
- normal CHO, prot., fat
- avoid lactose, oxalates, large amounts of concentrated sweets
- vitamin and mineral supplements
-
Ileal resection nutrition care
- Ileal - limit fat (cannot recycle bile salts so fats are not emulsified)
- use MCT (does not require bile salts, needs less intestinal surface area)
- supplement fat-soluble vitamins, Ca, Mg, Zn, parenteral B12 followed by monthly injections
-
Sections of the small intestine in order
-
Sections of the large intestine in order
- Cecum
- Appendix
- Colon
- Rectum
- Anus
-
Functions of liver
- stores and releases blood
- filters toxic elements
- metabolizes and stores nutrients
- regulates fluid and electrolyte balance
-
What is enzyme profile
list of major enzymes found in organs and tissues
-
What causes enzyme levels in blood to rise?
tissue damage causes them to leak into the circulation
-
Liver function tests and their lab values
- ALP alkaline phosphatase: 30-120 U/L
- AST, SGOT aspartate amino transferase: 0-35 U/L
- ALT, SGPT alanine aminotransferase: 4-36 U/L
-
Increased ALP may be caused by...
- liver disease
- bone disease
-
Decreased ALP may be caused by...
-
Increased LDH (lactic acid dehydrogenase) may be caused by...
- hepatitis
- mycardial infarction
- muscle malignancies
-
Increased AST, SGOT may be caused by...
hepatitis
-
Decreased AST, SGOT may be caused by...
uncontrolled diabetes with acidosis
-
Increased ALT, SGPT may be caused by liver disease
-
Acute viral hepatitis symptoms
- inflammation
- necrosis
- jaundice (when the bile ducts are blocked)
- anorexia
- nausea
- fatigue
-
Acute viral hepatitis HAV:
- fecal - oral transmission
- type most directly connected to food
-
Acute viral hepatitis HBV:
sexually transmitted
-
Acute viral hepatitis HCV:
blood to blood contact
-
Acute viral hepatitis nutrition prescription
- increase fluids to prevent dehydration
- 50-55% CHO to replenish liver glycogen and spare protein
- 1-1.2g proetien/kg
- moderate to liberal fat intake if tolerated; limit fat if steatorrhea
- small, frequent feedings because of the anorexia
- encourage coffee (antioxidant)
- multivitamin with B complex, C, K, zinc
-
Why does a hepatitis patient need high protein
- to prevent fatty liver
- cell regeneration
- provide lipotropic agents to convert fat into lipoproteins for removal from liver
-
What happens during Cirrhosis
damaged liver tissue is replaced by bands of connective tissue which divides liver into clumps and reroutes many of the veins and capillaries
-
Normal blood flow in the liver (chart)
abdominal veins, esophageal veins, collateral veins --> portal vein --> liver --> vena cava
-
Ascites occurs when blood ____ the liver
cannot leave
-
With ascites, connective tissue overgrowth...
- blocks blood flow out of liver into vena cava.
- Blood become built up in the liver causing pressure forcing fluid to sweat through the liver into the peritoneal cavity
-
With ascites, _____ may be due to dilution factor
low serum albumin
-
Esophageal varices occur when blood ____ the liver.
cannot enter
-
With esophageal varices, connective tissue overgrowth...
- causes resistance to blood entering from portal vein
- The increased pressure forces blood back into collateral veings that offer less resistance
- Abdominal, esophageal, and collateral veins enlarge
-
Esophageal varices may be due to ____
portal hypertension
-
Diet for cirrhosis
- high protein
- high calorie
- moderate to low fat (<40 g fat IF malabsorption)
- low fiber if VARICES are present
- low sodium if EDEMA or ASCITES
- with hyponatremia, fluid restrition depending of severity and moderate sodium intake
- B complex vitamins, C, K, Zn, Mg; monitor need for A and D
-
What happens with alcoholic liver disease?
- Alcohol is converted into acetaldehyde and excess hydrogen when disrupts liver metabolism
- Hydrogen replaces fat as fuel (not oxyidized in the Kreb's cycle), so fat accumulates in liver (leading to a fatty liver) and in blood (raising the TG level)
-
What happens during hepatic failure (ESLD)
- liver function decreased to 25% or less
- liver cannot convert ammonia (NH3) into urea - ammonia accumulates
-
Symptoms of hepatic failure
- apathy
- drowsiness
- confusion
- coma (PSE - protal systemic encephalopathy)
- asterisix (flapping, involuntary jerking motions) - sign of impending coma
-
Hepatic failure treatment
- if not comatose: moderate to high levels of protein (increase up to 1-1.5 g prot/kg as tolerated
- 30-35 kcal/kg
- 30-35% calories as fat with MCT if needed
-
Inflammation of gallbadder
cholecystitis
-
Treatment for cholecystitis
- low fat diet (30-45g)
- cholecystectomy - bile now secreted from liver directly into intestine
-
Symptoms of Pancreatitis
inflammation with edema, cellular exudate (mucus accumulation) and fat necrosis
-
Cause of Pancreatitis
- May be due to blockage or reflux of the ductal system
- Premature activation of enzymes within pancreas leads to autodigestion
-
MNT for acute Pancreatitis
- Put pancreas at rest, withhold all feeding, maintain hydration (IV) -- strict NPO
- Progress as tolerated to easily digested foods with a low fat content
- Elemental (pre-digested enteral nutrition into jejunum may be tolerated
-
MNT for chronic Pancreatitis
- -- recurrent attacks of epigastric pain of long duration
- PERT: pancreatic enzymes orally with meals and snacks to minimize fat malabsorption from lack of pancreatic lipase. (MCTs do not require pancreatic lipase -- add to mixed dishes, jams, jellies)
- To promote weight gain give maximum level of fat tolerated without an increase in steatorrhea or pain
- If malabsorbing fat soluble vitamins give water soluble forms; parenteral B12 (deficiency of pancreatic protease which splits off vitamin from carrier)
- Pancreatic bicarbonate secretion may be defective; may need antacids so PERT therapy will work
- In severe prolonged cases, parenteral nutrition may be needed
- To avoid pain: avoid large meals with fatty foods, alcohol
-
-
Disease of exocrine glands - secretion of thick mucus that obstructs glands and ducts; chronic pulmonary disease, pancreatic enzyme deficiency, high perspiration electrolyte levels, malabsorption
Cystic fibrosis
-
What do exocrine glands do?
secrete their products into ducts
-
What do endocrine glands do?
secrete products directly into the bloodstream
-
MNT for cystic fibrosis
- Use age-appropriate BMI to assess height and weight
- PERT - pancreatic enzyme replacement therapy with meals and snacks
- High protein, high calorie, unrestricted fat, liberal salt
- 1) If fails to grow --> BEE x activity factors plus disease coefficients; may need 110-200% of normal energy needs
- 2) Protein 15-20% calories - malabsorption due to pancreatic deficiency
- 3) Carbs 45-55% total calories
- 4) Liberal fat to compensate for high energy needs - 35-40% of calories
- 5) Additional 2-4 grams salt/day in hot weather, with heavy perspiration
- 6) Age-appropriate doses of water-soluble vitamins and minerals
- 7) Supplement water-soluble forms of fat-soluble vitamins (A & E)
-
BP criteria for hypertension
systolic >140, or diastolic >90, or both
-
contraction of the heart, greatest pressure
systolic
-
relaxation of the heart, least pressure
diastolic
-
____ is a major factor in the cause and treatment of hypertension
obesity
-
-
Hypertension: Thiazide diuretics may induce
hypokalemia (potassium)
-
Four modifiable factors in primary prevention and treatment of hypertension:
- Overweight
- High salt intake
- Alcohol consumption
- Physical inactivity
-
Salt restriction for hypertension
≤2400 mg Na (6 g salt)
-
What does the DASH diet consist of
- Dietary Approaches to Stop Hypertension
- Whole greains, fruits, vegetables, low fat dairy, poultry, fish, moderate sodium, limit alcohol, decrease sweets, calcium to meet DRI (not supplements)
-
What does the Mediterranean diet consist of
- rich in alpha linolenic acid (Polyunsaturated Fatty Acid), high in monounsaturated fats
- Olive, canola, soybean oils; walnut, almond, pecan, peanuts, pistachios
- Fish, poultry eggs rather than beef, breads, fruits and vegetables in abundance, beans, legumes, yogurt, cheese
-
Resveratrol is found where and what are it's benefits
- In skin of red grapes
- May lower BP
-
Accumulation of lipids; structural and compositional changes in the intimal layer of the large arteries
Atherosclerosis
-
Risks of Atherosclerosis
hypertension, obesity, smoking, elevated blood lipids, heredity
-
Atherosclerosis: hard, narrow arteries from plaque buildup
coronary artery disease (CAD)
-
Atherosclerosis: deficiency of blood due to obstruction
ischemia
-
Atherosclerosis:loss of elasticity of blood vessel walls
arteriosclerosis
-
Atherosclerosis: reduction of coronary flow to myocardium due to blood clot blocking a narrowed coronary artery
- myocardial infarction
- 1) angina pectoris - chest pain
- 2) heparin - medication for blood clots
-
Atherosclerosis: includes high triglycerides and low HDL
dyslipidemia
-
Classification of lipoproteins
-
transports dietary triglycerides from gut to adipose cells; synthesized in intestine from dietary fat; lowest density due to smallest amount of protien
chylomicron
-
Transports endogenous triglyceride from liver to adipose cell
VLDL (pre-beta)
-
Transports cholesterol from diet and liver to all cells
LDL (beta)
-
Reverse cholesterol transport; moves cholesterol from cells to liver and extretion
HDL (alpha)
-
LDL precursor; found in circulation secondary to catabolism of other lipoproteins
IDL (pre-beta to beta)
-
Atherosclerosis: Metabolic Syndrome symptoms (pt must have at least 3)
- Elevated blood pressure
- Elevated TG
- Elevated fasting serum glucose
- Increased waist measurement
- low HDL
-
National Cholesterol Education Program (NCEP) and the National Heart, Lung and Blood Institute are endorsed by
American Heart Association
-
NCEP assessment of risk: LDL C levels
<100
-
NCEP assessment of risk Total Cholesterol levels
<200
-
NCEP assessment of risk HDL C levels
<40 low (M) <50 low (F); ≥60 high
-
____ levels are independent risk factors for CHD
High Homocysteine
-
-
TLC acronym and what it consist of
- Therapeutic Lifestyle Change - from Adult Treatment Panel III (ATP III)
- upt ot 35% calories from total fat, <7% from saturated fat, 5-10% PUFA, up to 20% MUFA, <200 mg cholesterol
- 25-30g fiber (half soluble)
- Stanols and sterols inhibit cholesterol absorption (2-3g/day)
- Maintain DBW, prevent weight gain
- Increase physical activity to at least 30 minutes of moderate intensity most days (to expend at least 200 calories)
-
Etiology for heart failure
weakened heart fails to maintain adequate output, resulting in diminished blood flow so fluid is held in tissues (edema); dyspnea (shortness of breath)
-
Heart Failure: Reduced blood flow to kidneys causes..
secretion of hormones that hold in sodium and fluid leading to weight gain
-
Treatment for heart failure
- digitalis increases strength of heart contraction
- diuretics - nutrient loss, glucose intolerance, increased serum uric acid diet
- evaluate thiamin status (loss with loop diuretics). Without tiamin, pyruvate cannot be converted into acetyle CoA for energy, so heart muscle is deprived.
- DRI for folate, Mg; MV with B12
-
Diet for heart failure
- low sodium (2-3g), DASH diet, fluid reestriction if needed1.2g protein/kg (normally nourished, stable); >1.37g/kg (stable, depleted)
- DRI for folate, Mg; MV with B12
-
What is cardiac cacheia and what occurs
- Complex metabolic disorder involving progressive weight loss accompanied by muscle wasting, fatigue, and weakness
- blood backs up into liver and intestines causing nausea and decreased appetite.
-
MNT for cardiac cachexia
- Arginine and glutamine may help
- Low saturated fat, low cholesterol, low trans fat, <2g sodium, high calorie
-
What does the nephron consist of
- glomerulus
- proximal convoluted tubule
- Loop of Henle
- distal tubule
-
tuft of capillaries held closely by Bwoman's capsule - produces ultrafiltrate which then passes through tubules. Capsule blocks passage of red blood cells and large molecules like protein
glomerulus
-
part of the nephron where major nutrient reabsorption takes place
Proximal convoluted tubule
-
Part of the nephron that deals with water and sodium balance
Loop of Henle
-
Part of the nephron that deals with acid-base balance
distal tubule
-
Renal funtions
- Filtration - red blood cells, protein stay in blood; all else filters through tubules
- Absorption - 100% glucose, amino acids; 85% water, sodium, potassium
- Excretion - wastes, urea, excess ketones
- Secretion - secretes hormones that control blood pressure, blood components; secretes ions that maintain acid-base balance
-
The hormones involved in renal function
- Vaopressin (ADH)
- Renin
- Erythropoietin EPO
-
Vasopressin: where in the body, what it does
- from hypothalamus (stored in pituitary)
- exerts pressing effect; elevates blood pressure (vasopressin = blood pressing)
- increases water reabsorption from distal and collecting tubules
- SIADH - hyndrome of inappropriate antidiuretic hormone -- hyponatremia caused by hemodilution, treated with fluid restrition
-
Renin: where in the body, what it does
- secreted by glomerulus (kidney) when blood volume decreases
- stimulates aldosterone to increase sodium absorption and return blood pressure to normal
-
Erythropoietin: where in the body, what it does
- produced by kidney
- stimulates bone marrow to produce RBC
-
Lab tests in renal disease
- decreased glomerular filtration rate, creatinine clearance
- increased serum creatinine, BUN
- BUN:creatinine ratio of >20:1 indicates a "pre-renal state" in which BUN reabsorption is increased due to acute kidney damage (may be reversible and may not require dialysis)
- renal solute load - solutes excreted in 1 L urine; daily fixed load of 600mOsm -- mainly measures nitrogen (60%) and electrolytes (sodium)
-
Manifestations of renal disease
- Anemia due to decreased production of erythropoietin
- Upset in BP
- Decreased activation of vit D (kidney produces active form which promotes efficient absorption of calcium by the gut)
-
Renal disorders and Endocrinology... look at notes!
Pgs II MNT 13-18
-
Carb counting: Carbs, prot., fat, and calories in Starch/bread
-
Carb counting: Carbs, prot., fat, and calories in Fruit
-
Carb counting: Carbs, prot., fat, and calories in fat-free, low fat milk
- Carbs: 12
- P: 8
- F: 0-3
- Cal: 100
-
Carb counting: Carbs, prot., fat, and calories in reduced fat (2%) milk
- Carbs: 12
- P: 8
- F: 5
- Cal: 120
-
Carb counting: Carbs, prot., fat, and calories in Whole milk
- Carbs: 12
- P: 8
- F: 8
- Cal: 160
-
Carb counting: Carbs, prot., fat, and calories in sweets, desserts, other CHO
- Carbs: 15
- P: varies
- F: varies
- Cal: varies
-
Carb counting: Carbs, prot., fat, and calories in non-starchy vegetable
-
Carb counting: Carbs, prot., fat, and calories in Lean protein
- Carbs: 0
- P: 7
- F: 2
- Cal: 45
- (Canadian bacon)
-
Carb counting: Carbs, prot., fat, and calories in Medium-fat protein
-
Carb counting: Carbs, prot., fat, and calories in High-fat protein
-
Carb counting: Carbs, prot., fat, and calories in plant-based proteins
- Carbs: varies
- P: 7
- F: varies
- Cal: varies
-
Carb counting: Carbs, prot., fat, and calories in Fats
-
Carb counting: Carbs, prot., fat, and calories in Alcohol (1 equivalent)
- Carbs: varies
- P: 0
- F: 0
- Cal: 100
-
Carb counting: Carbs and calories in Free Foods
<20 calories and < 5 grams CHO per serving
-
Insulin types: Rapid-acting
- Aspart (Novolog), Lispro (Humalog)
- take 5-15 minutes before eating
- Usual duration 4 hours
-
Insulin types: Short-acting
- (Regular)
- take 30-45 minutes before meal (burst of insulin to cover the meal just about to be eaten)
- One unit covers 10-15 grams CHO
- Duration 3-6 hours
-
Insulin Types: Intermediate-acting
- NPH - Neutral Protamine Hagedorn (Humulin, Novolin)
- Onset 2-4 hours
- Duration 10-16 hours
-
Insulin Types: Long-acting
- Glargine (Lantus), Determir (Levemir)
- Onset 2-4 hours
- Duration 20-24 hours
-
Common insulin regimens
- Regular + NPH twice a day -- pre-breakfast 1/3 Reg, 2/3 NPH; pre-supper equal Reg + NPH
- Regular + NPH pre-breakfast, Regular pre-supper, NPH bedtime (to control early AM surge)
- MDI multiple daily injections; Regular before meals, NPH 1-2X
- Glargine (Lantus) basal insulin at bedtime; rapid-acting as bolus for meals
- Insulin pump therapy provides basal or raid-acting or short-acting insulin pumped continuously; boluses of insulin are given before meals
-
Oral Glucose-lowering medication: insulin secretagogues
- sulfonylureas, meglitinides (Glucotrol)
- promote insulin secretion
-
Oral Glucose-lowering medication:biguanides
- Metformin (Glucophage)
- Enhance insulin action, suppress hepatic glucose production
-
Hyperthyroidism: what it is and MNT
- excess secretion of thyroid hormone
- Elevated T3 (triiodothyronine) and T4 (thyroxine)
- Increased BMR leading to weight loss
- Diet: increase calories
-
Hypothyroidism: what it is and MNT
- Deficiency of thyroid hormone
- T4 low; T3 low or normal
- Decreased BMR leading to weight gain
- Diet: weight reduction
- (>5% of people)
-
Etiology of Goiter and the diet
- Enlargement of thyroid gland due to insufficient thyroid hormone
- Endemic goiter - inadequate iodine intake
- Diet: iodized salt; free of goitrogens (contains goitrin which inhibits synthesis of thyroid hormone
- Goitrogens: cruciferous vegetable (brussel sprouts, cabbage, broc, cauliflower, mustard greens, kale, turnips, and collards) and canola oil
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Etiology of gout and its diet
- Disorder of purine metabolism
- Increased serum uric acid; deposit in joints causing pain, swelling
- Diet: low purine may not be effective; may need weight reduction -- moderate protein, liberal carbohydrate, low to moderate fat, decrease alcohol, liberal fluid, avoid high purine foods (broth, anchovies, sardines, organ meats, sweetbreads, herring, mackerel)
- Medications (urate eliminant, colchicine) induce loos of nutrients
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Etiology of galactosemia and MNT
- due to missing enzyme that would have converted galactose-1-PO4 into glucose-1-PO4
- Treated solely by diet - galactose and lactose free
- NO: organ meats (naturally contain galactose), MSG extenders, milk, lactose, galactose, whey, casein, dry milk solids, curds, calcium or sodium caseinate, dates, bell peppers
- OKAY: soy, hydrolyzed casein, lactate, lactic acid, lactalbumin, pure MSG
- NO DRUGS
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Etiology of Urea Cycle defects and MNT
- Unable to synthesize urea from ammonia resulting in ammonia accumulation
- vomiting, lethargy, seizures, coma, anorexia, irritability
- Diet: protein restriction (1.0, 1.5, 2.0 g/kg based on tolerance, age, projected growth rate) to lower ammonia; therapeutic formulas to adjust protein composition to limit ammonia production
- Example: OTC Ornithine transcarbamylase deficiency
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Etiology of Phenylketonuria (PKU)
- Missing enzyme - phenylalanine hydroxylase - which would convert phenylalanine into tyrosine; phenylalanine and metabolites accumulate leading to poor intellectual function
- detected with Guthrie blood test
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Phenylketonuria (PKU) diet
- restrict the substrate phenylalanine (PHE), supplement the product tyrosine (TYR)
- low in phenylalanine, but provide enough to promote normal growth -- Phenex-1,2, Phenyl-Free 1,2 (low phenylalanine formulas)
- Avoid aspartame
- Low protein, high CHO intakes may lead to increased dental caries
- Need for phenylalanine decreases with age, infection
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Etiology for glycogen storage disease and MNT
- deficiency of glucose-6-phosphatease in liver; impares gluconeogenesis and glycogenolysis
- Liver can't convert glycogen (storage form of glucose) into glucose leading to hypoglycemia
- Provide a consistent supply of exogenous glucose with raw cornstarch at regular intervals, and a high carb, low fat diet
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Etiology for homocystinurias and MNT
- Treatable inherited disorder of amino acid metabolism
- Characterized by severe elevations of methionine and homocysteine in plasma, and excessive excretion of homocystine in urine
- Associated with low levels of folate, B6, B12
- Newly diagnosed patients received increased doses of folate, pyridoxine (B6), B12
- If they don't respond: low protein, low methionine diet (nuts, beef, cheese, turkey, pork, fish, shellfish, soy eggs, dairy, and beans)
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Etiology for maple syrup urine disease (MSUD) and MNT
- Inborn error of metabolism of the BCAAs leucine, isoleucine, valine
- Poor sucking reflex, anorexia, FTT, irritability, sweet burnt maple syrup odor of sweat and urine
- Restrict BCAA 45-62 mg/day (may use MSUD powder)
- Provide adequate energy from CHO and fat to spare amino acids
- Include small amounts of milk to support growth; gelatin may be used
- Avoid: eggs, meat, nuts, other dairy products
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Etiology for Arthritis and MNT
- Inflammation of peripheral joints
- Regular, well-balanced diet with vitamin intake to at least DRI's
- Bed rest, aspirin, reduce overweight to decrease stresss
- Normocytic anemia may develop (cells normal size but not enough of)
- -Not diet-related, inflammation of arthritis prevents reuse of iron
- - "anti-inflammatory diet" may help osteoarthritis - fresh fruits and vegetables, resembles Mediterranean diet
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