Special Nutritional Considerations in Disease Flashcards
What is the major killer of Americans?
Heart disease – can be effected by diet, proper sleep, and exercise
What are recommendations for hypertension?
- Weight loss - if overweight, for every 10 pounds of weight loss, blood pressure decreases by 4/4mmHg
- DASH
- eat fewer calories
- eat more fruit, veggies, and low-fat dairy food s
- cut back on high sat and trans fats
- eat more whole-grain foods, fish, poultry, and nuts
- less sodium, sweets, sugary drinks, and red meats
What are ideal habits for those with cardiovascular risk?
- Five serving of veggies and fruits
- two fatty fish meals/week
- replace trans and sat fats with monosaturated fats
- 1-2 drinks max per day if a chronic drinker
- 30 min of exercise a day
- use an exposure to tobacco should be avoided
What are the perferred foods for those at risk of atherosclerotic cardiovascular disesase (ASCVD)?
- whole grains
- raw and cooked veggies
- lentils, beans, fava beans, peas, chickpeas, soybean
- fresh or frozen fruit
- lean and oily fish, poultry without skin
- skim milk and yogurt
- vinegar, mustard, fat free dressing
- grilling, boiling, steaming
- coconut oil is not as bad as sat fat
How does sleep effect heart disease?
- inadequate amounts of sleep increases hunger, body weight, and risk of heart attack and stroke
- sleep apnea is a big killer (heavy snoring, breath pauses, and gasping for breath while sleeping) increases nighttime blood pressure and risk of cardiac disease
What are some tips that can be given to help with sleep?
- Sleep when tired, don’t fight it off
- no screen time 30 min before sleep
- low blue light exposure 2hrs before bed
- use bed for sleeping
- keep room dark and quiet
What is type 1diabetes?
- inability to make insulin
- needed injected insulin
- injected insulin requires consistent carbohydrate intake
What is type 2 diabetes?
- excess of insulin resistant tissue
- patient can make insulin, but not enough
- weight loss can enhance glucose control and improve cardiac and joint health
- diet is incredibly important, drugs or insulin added to attain control
How do we manage a diabetes diet?
- determine a meal plan
- estimate energy needs
- distribute carbohydrate (CHO) exchanged evenly throughout the day
What are zero calorie sweeteners?
- artificial sweeteners = aspartame, saccharine, and sucralose
- natural extract sweetner = RebA
- zero calorie sweetners alter bacteria- kill mouth bacteria that promotes tooth decay (stevia extract containting RebA was found to kill Borrelia (Lyme Disease) and 3 antibiotics)
What are the draw back to zero calorie sweeteners?
- zero calorie sweetners alter bacteria- kill mouth bacteria that promotes tooth decay (stevia extract containting RebA was found to kill Borrelia (Lyme Disease) and 3 antibiotics)
- can change the mix of bacteria in the microbiome
- can impatie the ability of people to use glucose and raises the animals blood sugar concentrations
- those whole consume a lot of artifical sweetener have higher blood sugar concentrations
- RebA doesn’t impact blood glucose concentrations but kills lactobacillus, a goof bacteria in the gut
- consumption of thse foes not promote weight loss
What is celiac disease?
gluten causes local allergic reaction with visible intestinal inflammation or damage
can cause diarrhea, bloating, gut pain, headache, fatigue
can take 3-6 months off gluten to resolve
Where can gluten be found?
Wheat, barley, and rye
What are some non-gluten startches?
corn, oats, rice, quinoa, potato, buckwheat, amaranth, chickpea, millet, sorghum
What is Infalammatory Bowel Disease (IBD)?
- includes ulcerative colitis (just in the rectum) and chron’s disease (large intestine)- cause diarrhea, bloating, gut pain
What are recommeded foods and supplements for IBD?
- Limit red meat, processed meat, and dairy – more plant protien, chicken, and fish
- vitamin B supplementation during bouts
- supplement with probiotics
- eat prebiotic foods (onions, asparagus, fresh fruits, soluble fiber, garlic)
- pre + probiotics = increased small fatty acids like butyrate – help protect the gut
What nutritional factors must be considered for cancer?
- Preventing excessive weight loss
- management of treatment related side effects like N/V/D and mucositis
- N/V - smaller more frequent meals, antiemetics, promobility agenta
- D- water and electrolyte repletion, soluble fiber, antidiarheal drugs
What are the outcomes of chronic kidney disease?
- manage altered electrolytes
- minimize levels of nitrogenous waste
- manage underlying cause of CKD (DM and HTN)
What is the recommended nutrition for CKD?
- Na+ and fluid restriction as needed to control BP and fluid balance
- K is limited to prevent cardiac events
- phosphorus restricted
What are the recommended medications for CKD?
- phosphate binders taken with food
- calcium supplements best binders
- propofol contains ~400mg of phosphorus
- kayexalate: cation exchange resin is a potassium reducer
- dialysate losses of water soluble vitamins
What are the effects of critical illness on nutrition?
- nutrition risk from hypermetabolism and catabolic state
- inflammatory state rapidly depletes protein stores
- bad nutrition means longer hospitlat stay, poor wound healing, compromised immune function, organ dysfunction
What are the nutrition requirements for critically ill patients?
- protein: 1.2-2.5g/kg (disease dependent)
- fluid requirements: depends on need for volume resuscitation (ins and outs of GI tract, and insensible losses)
When wouldbe the best time to provide nutrition?
- 24-48hrs of ICU admission
- hemodynamic stability prior to starting enteral feeds
- arginine enriched products should not be used if pts have HTN (elevated nitric oxide levels reduce BP
What are the different types of nutritional support and monitoring?
- diarrhea: related to Rx, malabsoprtion
- needs soluble fiber to bulk stool (not to be used in pts with ischemic bowel or bowel dysmotility); or probiotics
- Aspiration: reduce this risk by keeping head elevated, high residuals with promotility agents, advancing tube post pyloric
- Hyperglycemia: history of diabetes, insulin resistance, steroid rx
- Refeeding syndrome: reintroducing CHO into diet of starved patients- rapid shift in chemicals– slower advacement of feeding
What is cirrhosis?
- liver is damaged causing issues in nutrient circulation
- all nutrients go through portal circulation reach liver and then the blood stream
What is portal hypertension?
- slowing or block of blood flow through the liver
- decreases the processing of nutrients, hormones, drugs, and toxins and the production of protein (albumin)
What are some complication with nutritional implications?
- ascites - excess abdominal fluid
- encephalopathy- brain disease
- poor gluconeogenesis
- edema
- insulin resistance
- esophageal varices- enlarged vein in the esophagous
What is the recommended nutrition for cirrhosis?
- Na+ to alleviate ascites, edema, portal HTN
- reduce the risk of encephalopathy- small requent meals; lactulose (decreases ammonia absorption by protonating it)
- if caused by alcoholism, thiamine deficienct may be present
What nutrition is needed for wound care?
- if vitamin/mineral deficiencies suspected, recommended a multivitamin & multimineral that contains RDI levels
- when there is no deficiency, supplementation will not decrease risk or aid in healing
- inadequate protein intake impairs would healing (arginine and glutamine are the most relevant)
- arginine is not appropriate in patients with hypotension
How much are OTC supplements worth worldwide?
$60 billion
What companies were included in the cease-and-desist letters?
GNC, Target, Walgreens, and Walmart
Why were cease-and-desist letters sent out?
study failed to detect generic material for plants depicted on the label in most herbal supplement products and detected things that were not on the label.
What are the three important messages to recieve from OTC supplements?
- GMP means it exhibits good manufactoring practices
- Indepenent lab verifcation or USP seal guarantees the contents in the product
- cheap supplements are cheap for a reason
What is vinegar?
- sugar from any plant source that is fermented by yeast to produce alcohol and then converted by acetobacter to acetic acid
What are the benefits to vinegar?
- feeling of fullness after a meal
- blood glucose control in normal
- blood glucose control in pre-diabetes and diabetes
What are the main take home messages from vinegar use?
- If diluted, there is little risk of harm for occasional use
- Small daily use diluted in water or other liquid is safe but chronic use can cause hypokalemia
- there are few instances where vinegar on or in the body may be beneficial but it may not be effecitve or safe for daily use
What are omega-3 fatty acids?
- PUFAs
- three types: EPA (20 carbons), DHA (22 carbons), ALA (18 carbons)
- Sources: EPA/DHA- made by plankton (algae) then eaten and concentrated in fatty fish; land plant sources
Would omega-3 be effective for hypertriglyceridemia patients (very high triglycerides)?
Yes, EPA/DHA 2-4g per day in an effective adjunctive therapy to lower triglycerides
What does the American Heart Association say Omega-3 Supplements are effective for ?
- coronary heart disease
- chonic heart failure
What are the main messages regarding omega 3 fatty acids?
- everyone should eat two servings of fish per week for general health
- hypertriglyceridemics get benefits from high dose EPA/DHA
- EPA/DHA has some benefist in pts with myocardial infarction, angina, or heart failure
- cannnot replace other mortatlity reducing drugs
- no proof of benefit in other groups
What are soy beans?
- made of both good and bad consituents
- high nutrients and fiber
- lectins can block nutirent absoription – cooking can eliminate this
- some components act like estrogen– but does not effect breast cancer
How does soy actually effect health?
- slightly reduce LDL cholesterol and triglycerides
- mildly reduce some menopausal symptoms
Are lectins really harmful?
- anti-nutrients
- pro-inflammatory substances
- aren’t healthy but they are nutritious
- avoiding them is not advisable
Are there benefits from lauric acid, palmitic acid, and sunflower oil?
- modest benefit in total and LDL cholesterol from using monounsaturated or mon/poly oils vs MCT oils
- unknown difference in health outcomes
