062211Handouts
6/15/2011FacultyYou Are on WhatKind of Diet?Overview of CommonlyOrdered TherapeuticpDietsLinda Jennings, MS, RD, LDNutrition Assistant AdministratorAlabama Department of Public HealthSatellite Conference and Live WebcastWednesday, June 22, 20112:00 – 4:00 p.m. Central TimeProduced by the Alabama Department of Public HealthVideo Communications and Distance Learning DivisionDifferent Reasons for Changesor Restrictions in Diets Need for weight loss– Appearance and/or healthconcerns To reduce risk of developing healthproblemsDifferent Reasons for Changesor Restrictions in Diets Minimize disease progression ifperson has condition– Like diabetes or cardiac disease In severe disease states, dietrestrictions necessary to prolong life– Renal disease, congestive heartfailureMost CommonDiet Restrictions Total calorie restriction Change in % of energy nutrients– Carbohydrates,Carbohydrates protein,protein fat Mineral and/or vitamin restriction Specific food restrictions/allergies Alternate feedingCalorie Restriction Reasons for diet:– Usually for weight loss– To reduce risk of developing healthproblems– Often see in combination withDiabetic or Cardiac restrictions– Weight loss may reducehypertension1
6/15/2011Calorie Restriction Principles of dietCalorie Restriction– Calories are divided into:– Diet emphasizes overall reductionin calories 50% carbohydrates– 1200,1200 1500,1500 and 1800 calories aremost common calorie levelsrecommended 30% fatExample of Standard %Energy Nutrients 20% proteinExample of Standard %Energy Nutrients Carbohydrates from:– Fruits– Vegetables– Starch/whole grains– Milk/dairy Low fat or skimExample of Standard %Energy Nutrients Protein from:– Lean meat, fish, poultry– Meat substitutes BeansExample of Standard %Energy Nutrients Fats from:– Monounsaturated Olive Canola oils Peas Nuts2
6/15/2011Example of Standard %Energy Nutrients– Polyunsaturated Corn Safflower oils– Saturated – limitedExample of Standard %Energy Nutrients Basic messages– Eat more fruits, vegetables, low fatdairyy and whole ggrains– Limit meat and fat Meats Butter, dairyExample of Standard %Energy Nutrients– Don’t ‘drink’ a lot of your calories Fruit juiceExample of Standard %Energy Nutrients The amount of carbohydrates areespecially important for diabetics Sports drinks For a 1500 calorie diet, the followingservings of carbohydrates areusually recommended: AlcoholBreakfast ColasExample of Standard %Energy Nutrients Alabama Elderly and Disabled (ED)Waiver Clients receiving frozenHome Delivered Meals should not eatthe entire meal at one timeLunchDinnerSnack3441(45 grams)(60 grams)(60 grams)(15 grams)Example of Standard %Energy Nutrients Valley Home Delivered Meals Havethe Following Amount ofCarbohydrates:BreakfastFrozen8.5(127 grams)6.8-7.5(102-113 grams)3
6/15/2011Change in % Energy Nutrients Reasons for diet– Generally used for weight loss Promise of rapid loss– Certain competitive athletics– May focus on specific conditions,like uncontrollable seizuresChange in % Energy Nutrients Increased protein, decreasedcarbohydratesChange in % Energy Nutrients Principles of diet– Change from the standard energynutrient percentages of 50%carbohydrates, 20% protein, 30%fatfat– The amount of one energy nutrientis increased; the others decreased– With some diets carbohydrates arereduced, others fat is reducedResource for Ketogenic DietThe Charlie Foundationhttp://www.charliefoundation.org/– Diets like Atkins, South Beach, etc. SeverelySl restrictedt i t d carbohydrates,b h d tlimited protein, high % fat– Ketogenic diet for uncontrolledseizuresAltered % Energy Nutrients:Atkins, South Beach, Ketogenic Carbohydrates– 30-40% total calories– Could be limited to less than 10grams in Ketogenic Diet Fruit–Very little, or totally eliminatedAltered % Energy Nutrients:Atkins, South Beach, Ketogenic Vegetables–Limited, only green or orange Starches/grains–No starchy vegetable, fewwhole grains Dairy–Limited, use whole milkinstead of low fat4
6/15/2011Altered % Energy Nutrients:Atkins, South Beach, Ketogenic Protein – 30-40% total caloriesAltered % Energy Nutrients:Atkins, South Beach, Ketogenic Fat – 30-35% total calories– None limited– More saturated fat– Red meat encouraged– High fat meats like steaksteak, deli– Fatty meats like bacon andsausage included– Butter– Whole dairy included– Meats in breading (fried chicken)not includedExamples of Altered %Energy NutrientsVitamin/Mineral Restrictions Reasons for diet– To reduce risk of developing healthproblems like high blood pressure– Minimize disease progression ifperson has condition Cardiac disease– Reduce food – drug interactionsVitamin/Mineral Restrictions– May be necessary to prolong life Renal diseaseVitamin/Mineral Restrictions Principles of diet– Sodium restriction for high bloodpressure, cardiac disease– Vitamin K restriction for certainmedications, like Coumadin– Sodium, phosphorus, potassium –possibly calcium, protein and fluidrestriction for advanced renaldisease5
6/15/2011Vitamin/Mineral RestrictionsVitamin/Mineral Restrictions Sodium Sodium– Salt intake is reduced to 1500-2000milligrams (mg) per day– Where is the hidden salt?Vitamin/Mineral RestrictionsVitamin/Mineral Restrictions Sodium Sodium– Frozen dinners – check the label– Alabama ED Waiver Clientsreceiving frozen Home DeliveredMeals pprobablyy shouldn’t eat allthe meal at a time– Need to limit amount of othermeals of the dayVitamin/Mineral Restrictions– Valley Home Delivered Meals Havethe Following Amount of lligramsVitamin/Mineral Restrictions Sodium:HealthyChoiceEntree6
6/15/2011Vitamin/Mineral RestrictionsVitamin/Mineral Restrictions Sodium - regular canned vegetables Sodium – soups– Use low salt canned vegetables OR– Choose low salt soup OR– Rinse and drain regular cannedvegetables OR– Check the label of the “healthy”versionioff theth regularl soup– Choose frozen vegetablesSalt by Any Other NameStill Raises Your Blood PressureSalt by Any Other NameStill Raises Your Blood Pressure Sodium alginate Sodium chloride Sodium ascorbate Sodium citrate Sodium bicarbonate Sodium hydroxide– Baking soda Sodium saccharin Sodium benzoate Sodium stearoyl lactylate Sodium caseinate Sodium sulfiteSalt by Any Other NameStill Raises Your Blood Pressure Disodium phosphate Monosodium glutamate– MSG Trisodium phosphate NaVitamin/Mineral Restrictions Vitamin K– Helps our blood to clot– Can work against blood thinningddrugslikelik WarfarinW f i– Vitamin K foods should be eaten inabout the same amount should beeaten from week to week7
6/15/2011Vitamin/Mineral Restrictions– Greatly increasing Vitamin Kdecreases the drugs’ effect– Greatly decreasing Vitamin K canincrease the drugs’drugs effectVitamin/Mineral Restrictions High Vitamin K Foods– Broccoli– Brussels sprouts– Cabbage– Greens Collards, mustard, turnip,spinachVitamin/Mineral Restrictions– Lettuce Bib, Red Leaf– MayonnaiseVitamin/Mineral Restrictions Renal restrictions– In renal failure the followingnutrients are often restricted:– Canola oil Sodium– Green tea Phosphorus Potassium Possibly calcium, protein, fluidVitamin/Mineral Restrictions Phosphorus– As kidneys fail, problem balancingPhosphorus (P) and Calcium (Ca)Vitamin/Mineral Restrictions– In high Phosphorus levels you cansee: Itchy skin– PhosphorusPhhlevelsll increasei BoneBandd jointj i t paini– Body ‘steals’ calcium from bonesand weakens them Brittle bones8
6/15/2011Vitamin/Mineral RestrictionsVitamin/Mineral Restrictions High Phosphorus foods Potassium– Colas– Kidneys maintain blood level ofPotassium (K)– Peanut butter– Cheese– Nuts Potassium levels can increasewhen the kidneys don’t workproperly– Ice cream Heart can beat irregularly– Chicken/beef liver– BeerVitamin/Mineral Restrictions Heart may stop suddenly Don’t limit unless told to byphysicianVitamin/Mineral Restrictions High Potassium foods– Fruits Bananas Prunes Oranges Raisins Cantaloupe ApricotsVitamin/Mineral RestrictionsVitamin/Mineral Restrictions High Potassium foods Other high Potassium foods– Vegetables Broccoli– Chocolate Greens– Coffee (2 cups/day) Potatoes–Collards– Brand Tomatoes–Mustard– Salt substitutes–Beet– Nuts9
6/15/2011Specific FoodRestrictions/Allergies Reasons for diet:– Reduce risk of developing GI upset– Food – drug interaction– In severe cases, prevent possibleloss of life due to anaphylacticshockSpecific FoodRestrictions/Allergies Principles of diet– Food avoidance to prevent mildmoderate reaction– Total elimination of food andmonitoring of environment toprevent interference withmedications or severeanaphylactic responseSpecific FoodRestrictions/AllergiesInside of the Small IntestineNutrients Celiac Disease– Increased number reported to begluten intolerantgVillidamagedby CeliacDiseaseHealthyvilli– Affects 1 in 133 people in U.S.– Disease damages small intestineand prevents absorption ofnutrientsSpecific FoodRestrictions/Allergies Some symptoms of Celiac Disease– Abdominal pain, nausea– AnemiaA. In a healthy person, nutrients getabsorbed by villi in the small intestineand go into the bloodstreamB. In a person with Celiac Disease, the villihave been damaged by inflammation, sofewer nutrients pass into the bloodstreamSpecific FoodRestrictions/Allergies– Dermatitis Herpetiformis Itchy, blistering skin on elbows,knees, and buttock– Easy bruising– Diarrhea– Fatigue, general tired feeling10
6/15/2011Dermatitis HerpetiformisSpecific FoodRestrictions/Allergies Gluten found in:– Wheat– Barley– Rye– Many processed foods, medicines,vitamins, and lip balms alsocontain glutenGluten Found in Many ProductsGluten Found in Many Products Brown rice syrup Marinades Breeding and coating mixes Pastas Croutons Processed luncheon meats Energy bars Sauces, gravies Flour or cereal products Self-basting poultry Imitation bacon Soy sauce and soy sauce solids Imitation seafood Soup basesGluten Found in Many ProductsGluten Found in Many Products Stuffings, dressing Vitamins and mineral supplements Thickeners (roux) Play dough Communion wafers Malt liquor Herbal supplements Cosmetics Drugs and over-the-countermedications Nutritional supplements11
6/15/2011Where is the Hidden Gluten?Check the Label for These TermsWhere is the Hidden Gluten?Check the Label for These Terms Bread crumbs Farina Bran Flour Bulgur Couscous Cracker meal DurumWhere is the Hidden Gluten?Check the Label for These Terms– All purposepurpose, breadbread, durumdurum, cakecake,enriched, graham, high gluten,high protein, instant pastry, selfrising, soft wheat, steel ground,stone ground, whole wheatWhere is the Hidden Gluten?Check the Label for These Terms Gluten Semolina Kamut Spelt Matzoh Vital gluten– Matzoh meal – also spelled Mazo Pasta SeitanWhere is the Hidden Gluten?Check the Label for These Terms Whole-wheat berries Flavoring– Natural and artificial Hydrolyzed protein Soy sauce Wheat– Bran, germ, gluten, malt, sprouts Wheat grassWhere is the Hidden Gluten?Check the Label for These Terms Starch– Gelatinized starch, modifiedstarch, modified food starch,vegetable starch, wheat starch Surimi12
6/15/2011TreatmentTreatment Complete avoidance of gluten Immunosuppressive medications Use exotic grains such as quinoa,teff, sorghum, buckwheat, amaranth Endopeptidase enzyme may soon beavailable Check cosmetics,cosmetics medications forcross-contamination Use supplements– Iron, folate, zinc, niacin, B12,calcium, phosphorusResource of Celiac Disease For a more complete list of foods:– National Digestive DiseaseInformation Clearing HouseSpecific FoodRestrictions/Allergies Food-drug interactions– ac/– Interaction can cause delayed,decreased or increased absorptionpof medications– www.celiac.org– Common drug interactions are:– www.glutenfreemall.com Drugs with beverages– www.foodallergy.org Drugs with foodsSpecific FoodRestrictions/AllergiesSpecific FoodRestrictions/Allergies Food-drug interactions– Drugs with beverages Alcohol–Generally should not be takenwith any drug–Vinegar, apple cider, flavoringextracts with alcohol – avoidwith Metformin Grapefruit juice – avoid with:–Buspar (buspirone) – anti-anxiety–Quinite (Quinine) – anti-malaria–Halcion (Triazolam) - treatinsomnia13
6/15/2011Specific FoodRestrictions/Allergies–Coreg, Cardizem – heartdisease/hypertensionSpecific FoodRestrictions/Allergies– Drugs with Food Tyramine - avoid with:–Lipitor,pZocor, Mevacor(statins) – lowerscholesterol–MAO inhibitors (Marplan,(MarplanNardil) - used to treatdepression, Parkinson’sDiseaseSpecific FoodRestrictions/AllergiesSpecific FoodRestrictions/Allergies Foods with tyramine are:–Aged cheese (swiss, cheddar,blue))–Game meat (deer, rabbit)–Sauerkraut–Smoked or pickled meats–Aged sausages (bologna,salami, pepperoni)–Liver–Yeast extractsSpecific FoodRestrictions/Allergies– Drugs with Food Chocolate – avoid with:–MAO inhibitors (Marplan,(MarplanNardil) used to treatdepression, Parkinson’sDiseaseSpecific FoodRestrictions/Allergies Licorice - avoid with:–Lanoxin (digoxin) – heartdisease–Aldactone thiazide)hypertension/diuretic14
6/15/2011Specific FoodRestrictions/Allergies Food-drug interactions– Latex allergy The following foods can crossreact in someone with a latexallergy:Specific ana–Nuts – hazelnut, chestnutSpecific FoodRestrictions/Allergies Most common food allergies are:– Milk– Peanuts– Wheat– Tree nuts– Shell fishSpecific FoodRestrictions/Allergies– Skin eruptions – hives, eczema– Anaphylaxis – drop in bloodpressure, lightheaded,pgweakSpecific FoodRestrictions/Allergies Symptoms of allergies:– Occurs within a few minutes to 1hour after eatingg– May experience itching in mouthand difficulty swallowing andbreathing– Nausea, vomiting, abdominal painSpecific FoodRestrictions/Allergies Food allergies– Primary treatment is avoidance– Have to read labels carefully– Some allergies are out grown– People with allergies need to haveepinephrine available15
6/15/2011Specific FoodRestrictions/AllergiesMost Common Diet Restrictions Alternate feeding methods– Reduce risk of health problemsmalnutrition– NecessaryNtto prolongllifelif– Altered food consistency Chopping, grinding, blendingMost Common DietRestrictions– Alternate route – tube feedings Enteral – Nasogastric or gastric–Into stomach Parenteral – TPN–Into blood streamMost Common DietRestrictions– Altered food consistency Generally easy to do Difficulty may be acceptance andreachinghispecificifi consistencyi t Equipment needed:–Knife and/or fork–Food processor–BlenderMost Common DietRestrictionsChopped Consistency Altered food consistency–Chopped–Ground–Pureed16
6/15/2011Ground ConsistencyPureed ConsistencyMost Common Diet RestrictionsMost Common Diet Restrictions Alternate feeding methods:– Nectar– Altered food consistency Tomato juice consistency– Liquids Some liquids will needthi k i agentt (Thithickening(Thick-It)k It)– Thin All liquids No restrictionsMost Common Diet Restrictions– HoneyMost Common Diet Restrictions Alternate feeding methods: Liquids pour very slowly– Alternate route – tube feedings Will need thickening agent– Enteral– Pudding Liquids spoonable– Nasogastric Should be for short term use,usually no more than 3 months17
6/15/2011Most Common Diet RestrictionsNasogastric or NG Tube Feeding– Gastric When alternate feeding is goingto be long term– AdultsAd lt – PEG tubet b– Children – often see Mic KeyEnd usStomachPercutaneous EndoscopicGastrostomy PEG Tube When the tube goes into thestomach, it is called a G-tubeMic Key Button Is OftenUsed in Children18
6/15/2011Most Common Diet Restrictions Alternate feeding methods:Most Common Diet Restrictions Special conditions:– Alternate route – formulas–Diabetes– Vary based on:–Renal Calories – 1cal/ml to 2 cal/ml–Pulmonary distress Digestibility – fiber or hydrolized–Wound healingFunding for Formulas Medicare – if total tube fed Medicaid – level varied with state Senior Services – in AL this is– SeniorRX/Wellness– http://www.alabama.gov/sliverheader/Welcome.do?url http://adss.alabama.gov/Funding for Formulas Pharmacy/Company programs –– Abbott Patient Assistance –Medical Nutritional Products http://www.needymeds.org/papfohtt //dd/frms/abbmed0407.pdf– Partnership for PrescriptionAssistance www. helpingpatients.org19
6/15/2011 2 Calorie Restriction Principles of diet –Diet emphasizes overall reduction in calories –1200 1500 and 1800 calories are1200, 1500, and 1800 calories are most common calorie levels recommended Calorie Restriction –Calories are divided into: 50% carbohydrates 20% protein 30% fat Example of Standard % Energy Nutrients
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Charness et al. / Journal of Economic Behavior & Organization 87 (2013) 43–51 more understanding and mathematical sophistication from the subjects, or else comprehension suffers and the results may be less meaningful. Simple elicitation methods tend to be substantially easier for participants to understand. For example, the Balloon Ana- logue RiskTask(Lejuezetal.,2002 .
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The Cambridge Guide to Second Language Assessment Edited by Coombe, C., Davidson, P., O’Sullivan, B., and Stoynoff, S. Assessing Young Learners 11 Assessing Young Learners By Sophie Ioannou-Georgiou If you teach young learners, this book is essential reading as it focuses on helping teachers to engage with assessment in a way which is age-appropriate for learners. This book has a practical .
Careers & Enterprise Company: Guide for new Careers Leaders in schools. Essential information, helpful resources and practical tools to help newly appointed Careers Leaders get started in the role. National Careers Service. The National Careers Service provides information, advice and guidance to help people make decisions on learning, training and work opportunities. The service .
children are most likely to live in a conflict zone. In 2016, about 2 in 5 children in this region were living within 50km of a conflict event in their country, and children in Syria, Iraq, Yemen and other warzones in the region are at high risk of all six grave violations. Africa is second, with 1 in 5 children affected by conflict. Syria, Afghanistan and Somalia are at the top of our ranking .
