NS270 Nutrition Assessment and Management Unit 8 Drug-Nutrient Interactions Diabetic Meal Planning Amy Habeck, RD, MS, LDN

Unit 8 Learning Objectives: o Discuss o Drug-nutrient interactions o Diabetic meal planning o Review- Nutrition and Diet Therapy o Stanfield and Hui, Chapter 10 – Drugs and Nutrition o Answer your questions

General Actions of Drugs What are the five categories of general actions of drugs?

General Actions of Drugs Additive Cumulative Synergistic Tolerance Toxicity

Drugs Affect Intake What are five ways drugs affect nutrient intake?

Drugs Affect Intake Taste Appetite Intestinal motility Absorption Metabolism

Drugs Affect Nutrients What are four ways drugs affect nutrients?

Drugs Affect Nutrients Destroy or change nutrient Damage intestinal walls Lower absorption Directly destroy, displace or change nutrients

Nutrients Affect Drugs Delayed drug absorption Altered drug metabolism Enzyme induction Enzyme inhibition Altered rate of excretion Altered drug response

Bioavailability Most frequently reported diet-drug interaction Decreased drug bioavailability Altered nutrient absorption Drug absorption affected by Physical form Particle size GI pH Solubility in fats Side effects of malabsorption

Important Nutrients Altered metabolism creates change in therapeutic effect Niacin, riboflavin, pantothenic acid, Vit C, folic acid, B12, protein, fat, glucose, iron, Cu, Ca, Zn, Mg

Oral Medications Affected by: Presence of food in GI tract pH of the stomach and small bowel Motility of GI tract

Why is this medication prescribed and how should you take it? What side effects may occur from this medication? Are there any possible food and drug interactions? Are there any other special considerations? Adderall Cipro Coumadin Glucophage/ metformin Humalog Lipitor Prozac Levothyroxine Zithromax

Meal Plan Determine calories Mifflin St. Jeor Equation Determine if management goal is Weight maintenance Weight gain Weight loss Adjust recommended calorie intake based on goal Calculate grams of each macronutrient

Example-Carbohydrate 1500 kcal/day (using AMDR) Carbohydrate 45-65% (1500 x 0.45) = ____ kcal from carbohydrate 675 kcal ÷ 4 kcal/gm = ____ gm carbohydrate (1500 x 0.65) = ____ kcal from carbohydrate 975 kcal ÷ 4 kcal/gm = ____ gm carbohydrate Range = ____ gm carbohydrate/day

Example-Carbohydrate 1500 kcal/day (using AMDR) Carbohydrate 45-65% (1500 x 0.45) = 675 kcal from carbohydrate 675 kcal ÷ 4 kcal/gm = 169 gm carbohydrate (1500 x 0.65) = 975 kcal from carbohydrate 975 kcal ÷ 4 kcal/gm = 244 gm carbohydrate Range = gm carbohydrate/day

Example-Protein 1500 kcal/day Protein 10-20% (1500 x 0.10) = ____ kcal from protein 150 kcal ÷ 4 kcal/gm = ____ gm protein (1500 x 0.20) = ____ kcal from protein 300 kcal ÷ 4 kcal/gm = ____ gm protein Range = ____ gm protein /day

Example-Protein 1500 kcal/day Protein 10-20% (1500 x 0.10) = 150 kcal from protein 150 kcal ÷ 4 kcal/gm = 37.5 gm protein (1500 x 0.20) = 300 kcal from protein 300 kcal ÷ 4 kcal/gm = 75 gm protein Range = gm protein /day

Example-Fat 1500 kcal/day Fat 20-30% (1500 x 0.20) = ____ kcal from fat 300 kcal ÷ 9 kcal/gm = ____ gm fat (1500 x 0.30) = ____ kcal from fat 450 kcal ÷ 9 kcal/gm = ____ gm fat Range = ____ gm fat /day

Example-Fat 1500 kcal/day Fat 20-30% (1500 x 0.20) = 300 kcal from fat 300 kcal ÷ 9 kcal/gm = 33 gm fat (1500 x 0.30) = 450 kcal from fat 450 kcal ÷ 9 kcal/gm = 50 gm fat Range = gm fat /day

Example-All Macronutrients 1500 kcal/day 45-65% carbohydrate gm carbohydrate/day 10-20% protein gm protein/day 20-30% fat gm fat/day

Food GroupGrams CHOGrams ProGrams Fat Starch1530 Fruit1500 Milk1280 Fat free 5 Low fat Vegetable520 Meat072-3 Very lean 5 Medium fat Fat005

Diabetic Meal Plan-Exchanges 1500 kcal/day gm carbohydrate/day gm protein/day gm fat/day 200 gm CHO/day ÷ 15 gm CHO/serving = 13.3 servings CHO/day 55 gm pro/day ÷ 7 gm pro/serving = 8 servings protein/day (1 oz each) 40 gm fat/day ÷ 5 gm fat/serving = 8 servings fat/day

1-day meal plan 13.3 servings CHO/day 8 servings protein/day (1 oz each) 8 servings fat/day Breakfast – 3 CHO, 2 pro, 2 fat servings Lunch – 3 CHO, 2 pro, 2 fat servings PM snack – 2 CHO, 1 pro, 1 fat serving Dinner - 3 CHO, 2 pro, 2 fat servings HS snack – 2 CHO, 1 pro, 1 fat serving

1-day meal plan 13.3 servings CHO/day 8 servings protein/day (1 oz each) 8 servings fat/day MealCHOProFat Breakfast322 Lunch322 PM snack211 Dinner322 HS snack211

Carbohydrate Counting and Diabetic Meal Plans Example 2000 kcal diet 30% fat 40% CHO 30% pro

Carbohydrate Counting and Diabetic Meal Plans Example 2000 kcal diet 30% fat = 2000 kcal x 0.30 = 600 kcal from fat ÷ 9 kcal/gm = ____ gm fat/day 40% CHO = 2000 kcal x 0.40 = 800 kcal from CHO ÷ 4 kcal/gm= ____ gm CHO 30% pro = 2000 kcal x 0.30 = 600 kcal from protein ÷ 4 kcal/gm= ____ gm pro

Carbohydrate Counting and Diabetic Meal Plans Example 2000 kcal diet 30% fat = 2000 kcal x 0.30 = 600 kcal from fat ÷ 9 kcal/gm = 67 gm fat/day 40% CHO = 2000 kcal x 0.40 = 800 kcal from CHO ÷ 4 kcal/gm= 200 gm CHO 30% pro = 2000 kcal x 0.30 = 600 kcal from protein ÷ 4 kcal/gm= 150 gm pro

Food GroupGrams CHOGrams ProGrams Fat Starch1530 Fruit1500 Milk1280 Fat free 5 Low fat Vegetable520 Meat072-3 Very lean 5 Medium fat Fat005

Diabetic Meal Plan-Exchanges 2000 kcal/day 200 gm carbohydrate/day 150 gm protein/day 67 gm fat/day 200 gm CHO/day ÷ 15 gm CHO/serving = ____ servings CHO/day 150 gm pro/day ÷ 7 gm pro/serving = ____ servings protein/day (1 oz each) 67 gm fat/day ÷ 5 gm fat/serving = ____ servings fat/day

Diabetic Meal Plan-Exchanges 2000 kcal/day 200 gm carbohydrate/day 150 gm protein/day 67 gm fat/day 200 gm CHO/day ÷ 15 gm CHO/serving = 13.3 servings CHO/day 150 gm pro/day ÷ 7 gm pro/serving = 21 servings protein/day (1 oz each) 67 gm fat/day ÷ 5 gm fat/serving = 13.4 servings fat/day

1-day meal plan-Divide up the exchanges by meal 13.3 servings CHO/day 21 servings protein/day (1 oz each) 13.4 servings fat/day MealCHOProFat Breakfast Lunch PM snack Dinner HS snack

Create a Menu from your meal plan Breakfast Lunch PM Snack Dinner HS Snack

Fruit 15 gm CHO ½ cup fresh fruit or juice ¼ cup dried fruit Fruit diet/DA diet/DA00070

15 gm CHO

Starch 15 gm CHO, 3 gm pro 1/2 – 3/4 cup cereal Small baked potato 1/3 cup rice Starches diet/DA diet/DA00069

15 gm CHO 1 small piece of fresh fruit (4 oz) 1/2 cup of canned or frozen fruit 1 slice of bread (1 oz) or 1 (6 inch) tortilla 1/2 cup of oatmeal 1/3 cup of pasta or rice 4-6 crackers 1/2 English muffin or hamburger bun 1/2 cup of black beans or starchy vegetable 1/4 of a large baked potato (3 oz) 2/3 cup of plain or sugar sub. yogurt 2 small cookies 2 inch square brownie /cake without frosting 1/2 cup ice cream or sherbet 1 Tbsp syrup, jam, jelly, sugar or honey 2 Tbsp light syrup 6 chicken nuggets 1/2 cup of casserole 1 cup of soup 1/4 serving of a medium French fry

Milk/Dairy 12 gm CHO, 8 gm pro, 0/5/8 gm fat 1 cup milk ¾ cup plain nonfat yogurt Dairy diet/DA diet/DA00071

Vegetables 5 gm CHO, 2 gm pro ½ cup cooked vegetables or vegetable juice 1 cup raw vegetables Vegetables diet/DA diet/DA00073

Meat 7 gm pro, varied fat (see lists) 1 oz meat, poultry, fish or cheese ½ cup dried beans Meat diet/DA diet/DA00074

Fat 5 gm fat Mono: 1/8 avocado, 1 tsp canola or olive oil Poly: 1 tsp margarine, 1 Tbs, reduced fat mayo Sat: 1 tsp butter, 1 slice bacon, 2 Tbs coconut Fats diet/DA diet/DA00075

Analyze your menu Provide Calories Protein Total fat Carbohydrate Fiber Sodium Saturated fat

Exchange Lists-show portions of common foods Starches Fruit Dairy Vegetables Meat Fats

Other Helpful Sites for Diabetic Meal Planning Food Exchanges Carbohydrate Counting Diabetic Exchanges and Food Lists angeList angeList Calculating Exchanges, Calories and Percentages Exchange Lists D-86.pdf D-86.pdf

MealMeal PlanSample One day menu Time Breakfast ___ 3 __ CHO choices or ___ 45 __ g CHO Protein (oz): __2 ________________ Time AM snack _____ CHO choices or _____ g CHO Time Lunch ___ 3 __ CHO choices or ___ 45 __ g CHO Protein (oz):____ 2 _______________ Vegetable: ___ 1-2 __________________ Time PM Snack ___ 2 __ CHO choices or ____ 30 _ g CHO Time Dinner ____ 3 _ CHO choices or ___ 45 __ g CHO Protein (oz): 2 __________________ Vegetable: ________ 1-3 _____________ Time HS Snack ____ 2 _ CHO choices or ____ 30 _ g CHO Sample Meal Plan Meal Plan – ___ 1500 _ Calories ___ 53 ___ % CHO __ 15 ____% PRO __ 24 ___ % FAT ___10__ % Saturated Fat ____ 3 ___ Meals _____ 2 __ Snacks

Unit 9 Project GradingPointsTime Table APA format/file10 In-text citations/reference list 20 Question 145Week 5 Question 230Week 6 Question 320Week 6-7 Question 450Week 5-9 Question 520Week 8-9 Question 615Week 8

Unit 9 Project Question 4. Create a 1 day meal plan Identify calorie and % CHO, PRO, FAT goals Identify timing for meals and snacks Identify CHO goals for meals and snacks Create a sample menu to match your goals Complete a nutrient analysis on your menu Question 5. Describe how you would educate DB on the meal plan you created and health maintenance recommendations.

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