Virginia “Ginny” Rusy, MPH, MS,RD,LPC Food for Thought Virginia “Ginny” Rusy, MPH, MS,RD,LPC

Role of Nutrition in Primary Care

Too Little Time; too much to do

Assessment: Questions to Ask How many meals and snacks do you eat in a 24 hour period? How many meals are eaten outside of the home? How many high fiber foods are eaten such as cereal, fruits and vegetable? How many times a week do you eat red meat ? How many times a week do you eat chicken or chicken products? How many times per week do you eat fish ? How many times a week do you eat or drink dairy or similar foods? How many times a week do you eat sweets and desserts? What types of beverages do you usually drink? (including alcohol) How many hours of screen time do you typically have per day?

Name the six classes of Nutrients 1. Protein 2. Carbohydrate 3. Fat 4. Vitamins 5. Minerals 6. Water

Protein Facts 4 calories per gram. Made up of 20 amino acids these are used to make 10,000 unique body proteins. Needed for growth and repair of cells, regulation of bodily functions and energy but not body’s preferred source. Best sources lean proteins; meat, poultry, fish, eggs and legumes.

Carbohydrate Facts 4 calories per gram. Fiber –soluble and insoluble. Fiber needs: Men to age 50 need 38 grams daily, 50+ 31 grams. Fiber needs: Women to age 50 need 25 grams per day, 50+ 21 grams. More fiber ;50-60 grams may slow down absorption of iron , magnesium, calcium.

Carbohydrate (cont.) Best sources; whole grain breads, cereals, pastas , brown rice, fruits and vegetables with peels. 5 grams of fiber per serving = Excellent 2.5-4.9 grams per serving = Good Limit added sugars by choosing minimally processed foods.

Fats 9 calories per gram. Saturated: firm at room temperature. Include butter, lard, animal fats in meat and poultry and dairy, palm and palm kernel oils and coconut. Mono-saturated: liquid at room temperature; may cloud in the refrigerator, nuts, olive oil, high oleic safflower oil, sunflower oil. Polyunsaturated: liquid at room ; corn, safflower, soybean, sesame and sunflower. Protein: 4 calories per gram; meats, fish, poultry, some vegetables and some grains. Trans Fats: formed during the process of partial hydrogenation.

Fats (cont.) Omega 3 Fatty Acids: highly polyunsaturated, long chain come from sea foods such as oily fish, mackerel, albacore tuna and salmon. Omega 6 Fatty Acids: highly polyunsaturated. Often found in processed foods and are thought to promote inflammation in the body contributing to chronic pain and other diseases. Trans Fat: partially hydrogenated fats made by forcing bond changes in the oil using nickel. Found in many processed foods such as desserts and pastries. Acts like saturated fat in the body.

Vitamins and Minerals Vitamins: help regulate body processes. Fat and water soluble. Minerals: are part of many cells and parts of enzymes that regulate body functions. Only needed in small amounts. Eat the Rainbow!

Water Needs may vary according to age, gender, lifestyle, activity, and diet. Individuals with lean body mass need more water than those that have more body fat. Needed amounts according to some sources are half an individual’s body weight in ounces.

Processed Foods Convenient. Inexpensive. Readily available. Hyper-rewarding. Popular. Advertised in print and TV. Long shelf life.

Processed Foods Chemically processed from refined ingredients. High in sugar and high fructose corn syrup. High satisfaction leads to over consumption. Contain a variety of many artificial ingredients. High in refined carbohydrates. Low in fiber. Low in nutrients. Require less energy and time to digest. High in trans fats and processed vegetable oils.

Back to the Basics

Choices Choose : lean meats, poultry . Try to eat fish several times per week; eggs and legumes. Limit sandwich meats especially bologna, salami, hot dogs, sausage to occasional use.. Choose: low fat to non fat dairy. Use milk in coffee or tea in place of powered and flavored creamers. Limit butter to occasional use. Use oil type spreads on toast. Choose: whole grains with at least 3 grams per serving. Brown rice instead of white. Sweet potatoes in place of white. Substitute whole wheat flour for part if the white flour in recipes. Choose : a variety of fresh and frozen vegetables. Dark greens and reds as well as orange and purples. Limit corn, peas and “mixed” vegetables (most often a mix of corn, carrots, peas etc.)

Portion Sizes

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Patient education Stages of Change and readiness. What is important to them? May not be your goal. Motivational Interviewing as needed. Client centered “Smart Goal”. Simple, Measurable, Achievable, Realistic and Timely. Baby Steps… small steps moving forward are better than no steps at all. What do they need to be successful? How do they measure success?

References Gans,K.; Ross, E.; Barner, C.; Rosett-Wylie,J.; McMurray,J.; & Eaton,C.; (2003) REAP and WAVE :New tools to rapidly assess/discuss nutrition with patients. The Journal of Nutrition. 133:556S-562S. Miller,M ;(2005), Best questions and tools for quickly assessing your patient’s dietary health :Towards evidence-based determination of nutritional counseling need in the general medical interview .Nutrition Noteworthy, 7 (1). Wolfram,T.(ed), (2016) Processed foods: what’s ok and what to avoid. Academy of Nutrition and Dietetics. Gunnars,K.; Accessed November 9,2016 ; 9 ways processed foods are killing People. Authority Nutrition. Duyff,L. ;Complete Food and Nutrition Guide 4th ed ;Houghton Miffin Harcourt, New York, 2012