Pharm - nutrition and the gut Flashcards
what are the primary sources of gluten in the diet?
- wheat
- rye
- barley
- multitude of prepared foods
gluten free diet
- avoid foods containing wheat, rye, barley
- read labels - pay attention to additives
- avoid beer, ale, lager, and malt vinegars
- dairy products may not be well tolerated
- limit oats to 50-60 g daily or avoid if severe dz
What does the term “gluten free” mean on a food label?
- FDA alls packaged fod w/ less than 20 ppm of gluten to be labeled GF
- wheat free does not = GF
- “certified” GF means the products claim has been verified by an independent organization
What are the common nutritional deficiencies in people w/ celiac dz?
- vit. A, D, E, B12, B6, B1
- minerals: copper, zinc, magnesium, carotene, folic acid, ferritin, iron, selenium
- vit. K (get PT if suspected)
Describe the physiology of lactose intolerance
- lactose digestion is the rate limiting step in its absorption
- lactose is hydrolyzed by intestinal lactase to glucose and galactose in intestinal cells
- lactose that’s not absorbed is passed rapidly into the colon where it’s converted to SCFAs and hydrogen gas by intestinal bacteria
- someone who is lactose intolerant lacks sufficient lactase activity so as much as 75% of lactose passes unabsorbed into the colon
What is the goal in treating lactose intolerance?
- eliminate sx
- maintain Ca intake and vit. D intake
What is the use of lactase enzyme replacement for people w/ lactose intolerance?
- can be taken orally w/ lactose containing foods or added to milk
- the enzyme can reduce sx however cannot completely hydrolyze all dietary lactose so results are variable
What is the use of Ca and Vit D in the tx of people w/ lactose intolerance?
- some pts might have inadequate intake and should be encouraged to increase consumption of Ca rich food or consider Ca supplement
- Vit. D supplementation may be needed as well
What are the 3 levels of the dysphagia diet?
1: pureed - pudding like texture, little chewing required; mashed potatoes and bananas
2: mechanically altered - semisolid and moist, some chewing; oat meal
3: advanced - soft-solid texture, more chewing; cottage cheese, beans
prebiotics
- dietary components that promote the growth and metabolic activity of beneficial bacteria
- serve as food source for probiotics
probiotics
- beneficial bacteria
- live microorganisms which when administered in adequate amounts confer a health benefit to the host
synbiotics
combo of pre and pro biotics
probiotic species
- lactobacillus
- bifidobacterium
- accharomyces boulardii
- bacillus coagulans
- e. coli strain Nissle
- enterococcus faecium
What are the health benefits of pre and pro biotics?
- probiotics help defend the body from infections
- prebiotics enhance the bioavailability and uptake of minerals, lower some risk factors and promote satiety and weight loss
What are the enzymes used in pancreatic enzyme replacement therapy?
- lipase
- amylase
- protease
immediate vs delayed release pancreatic enzyme replacement products
- immediate:
- Viokace (only one)
- delayed:
- creon
- pancreaze
- pertzye
- zenpep
What should Viokace tabs be taken with?
PPI - to improve release of enzymes in the duodenum
What is used to titrate the dose of pancreatic enzyme replacement products?
lipase content
what is the usual adult dose of pancreatic lipase replacement products?
-30,000 IU, swallowed during each full meal
What is the administration schedule of pancreatic lipase replacement?
- taken with meals, 1/2 of dose w/ snacks, and swallow whole w/ generous amount of liquid
- take w/ first bite of meal
- don’t crush or chew
What is the expected outcome for pancreatic enzyme replacement?
- relief of target sx
- achievement of nutritional goals
- reducing or abolishing steatorrhea
- preventing weight loss
important ADRs associated w/ pancreatic enzyme replacement
- CNS: HA
- GI: **mucosal irritation
- Neuromuscular and skeletal: **Gout and hyperuricemia (porcine products)
define FODMAP
- short-chain carbs that, if poorly digested, ferment in the bowel to cause severe digestive stress
- Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols
What to look for on the label for FODMAPS
- Fructose
- Lactose
- Fructans
- Galactans
- Polyols: xylitol, maltitol, etc
What are the sx associated w/ intolerance of FODMAP
- strong pain
- bloating
- visible abdominal distension
- other related sx
What is the role of a low FODMAP diet in the tx of IBS?
- lower intake of FODMAP foods may be beneficial
- can reduce sx by 50%
- improves bloating, abdominal pain, flatulence and dissatisfaction w/ stool consistency
Define fructose intolerance
- the inability to absorb a load of 25 g of fructose while daily intake varies from 11-54 g/day
- unabsorbed fructose provides a substrate for rapid bacterial fermentation leading to possible gas, diarrhea, and change in the bacterial flora
How would you advise a pt on low fructose intake?
- advise to avoid foods that:
- have a high net amount of fructose
- sweetened w/ fructose
- juices and fruits w/ high fructose (apples, pears, sweet cherries, prunes, dates
- beverages sweetened w/ high fructose corn syrup
- honey
- sorbitol containing candies and gums
- if consumed, eat w/ meals
