Pharm - nutrition and the gut

Question 1

what are the primary sources of gluten in the diet?

Answer 1

• wheat
• rye
• barley
• multitude of prepared foods

Question 2

gluten free diet

Answer 2

• 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

Question 3

What does the term “gluten free” mean on a food label?

Answer 3

• 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

Question 4

What are the common nutritional deficiencies in people w/ celiac dz?

Answer 4

• vit. A, D, E, B12, B6, B1
• minerals: copper, zinc, magnesium, carotene, folic acid, ferritin, iron, selenium
• vit. K (get PT if suspected)

Question 5

Describe the physiology of lactose intolerance

Answer 5

• 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

Question 6

What is the goal in treating lactose intolerance?

Answer 6

• eliminate sx

- maintain Ca intake and vit. D intake

Question 7

What is the use of lactase enzyme replacement for people w/ lactose intolerance?

Answer 7

• 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

Question 8

What is the use of Ca and Vit D in the tx of people w/ lactose intolerance?

Answer 8

• 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

Question 9

What are the 3 levels of the dysphagia diet?

Answer 9

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

Question 10

prebiotics

Answer 10

• dietary components that promote the growth and metabolic activity of beneficial bacteria
• serve as food source for probiotics

Question 11

probiotics

Answer 11

• beneficial bacteria

- live microorganisms which when administered in adequate amounts confer a health benefit to the host

Question 12

synbiotics

Answer 12

combo of pre and pro biotics

Question 13

probiotic species

Answer 13

• lactobacillus
• bifidobacterium
• accharomyces boulardii
• bacillus coagulans
• e. coli strain Nissle
• enterococcus faecium

Question 14

What are the health benefits of pre and pro biotics?

Answer 14

• 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

Question 15

What are the enzymes used in pancreatic enzyme replacement therapy?

Answer 15

• lipase
• amylase
• protease

Question 16

immediate vs delayed release pancreatic enzyme replacement products

Answer 16

• immediate:
• Viokace (only one)
• delayed:
• creon
• pancreaze
• pertzye
• zenpep

Question 17

What should Viokace tabs be taken with?

Answer 17

PPI - to improve release of enzymes in the duodenum

Question 18

What is used to titrate the dose of pancreatic enzyme replacement products?

Answer 18

lipase content

Question 19

what is the usual adult dose of pancreatic lipase replacement products?

Answer 19

-30,000 IU, swallowed during each full meal

Question 20

What is the administration schedule of pancreatic lipase replacement?

Answer 20

• 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

Question 21

What is the expected outcome for pancreatic enzyme replacement?

Answer 21

• relief of target sx
• achievement of nutritional goals
• reducing or abolishing steatorrhea
• preventing weight loss

Question 22

important ADRs associated w/ pancreatic enzyme replacement

Answer 22

• CNS: HA
• GI: **mucosal irritation
• Neuromuscular and skeletal: **Gout and hyperuricemia (porcine products)

Question 23

define FODMAP

Answer 23

• short-chain carbs that, if poorly digested, ferment in the bowel to cause severe digestive stress
• Fermentable, Oligosaccharides, Disaccharides, Monosaccharides, and Polyols

Question 24

What to look for on the label for FODMAPS

Answer 24

• Fructose
• Lactose
• Fructans
• Galactans
• Polyols: xylitol, maltitol, etc

Question 25

What are the sx associated w/ intolerance of FODMAP

Answer 25

• strong pain
• bloating
• visible abdominal distension
• other related sx

Question 26

What is the role of a low FODMAP diet in the tx of IBS?

Answer 26

• lower intake of FODMAP foods may be beneficial
• can reduce sx by 50%
• improves bloating, abdominal pain, flatulence and dissatisfaction w/ stool consistency

Question 27

Define fructose intolerance

Answer 27

• 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

Question 28

How would you advise a pt on low fructose intake?

Answer 28

• 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