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

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 What are 4 ways nutrients affect drugs?

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

Questions About Nutrition and Drug Therapy?

Unit 9 Project

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 What equation is the base for the calorie intake recommendation? Calculate grams of each macronutrient

Determine Calorie Level REE Mifflin St Jeor Multiply by activity factor For weight loss 3500 calories = 1 pound 3500 calories/ 7 days = 500 kcal/day = 1 pound/week 7000 calories/ 7 days = 1000 kcal/day = 2 pound/week Subtract 500 or 1000 calories from energy needs for weight loss

Calculating CHO, FAT, PRO from % Determine Calorie Level (MSJ) calories example Determine Nutrition Standards – Sports Nutrition example 50-70% CHO, 20-35% Fat, <10% Saturated Fat, 12-15% Pro CHO: 1800 calories x 60% = 1080 calories CHO = 4 calories/gram 1080 divided by 4 = 270 grams CHO /day Fat: 1800 calories x 25% = 450 calories Fat = 9 calories/gm 450/9= 50 grams fat/day Pro: 1800 calories x 15% = 270 calories Pro = 4 calories/gm 270/4= 68 gm protein/day

Individualized Meal Plan Calorie & CHO goal (typically high fiber) Exercise recommendations Coaching & support for behavior change Weight loss Additional factors for other health concerns Sodium Fats Calcium/Magnesium/Potassium Fluids/Fiber

Survival Skills 3 meals per day Limit sugar in beverages, jello, candy, overt source of glucose etc. Somewhat even distribution of CHO foods per meal Include protein at each meal and most snacks

Meal Plan for Diabetes -options Count Carbohydrate grams (count actual grams) Count Carbohydrate servings (15 g CHO/serving) Use diabetic exchange system We’ll discuss in unit 8 seminar

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

Carbohydrate distribution 3 meals, and snacks as needed – depending on medications. Meals: Women/weight loss 30 – 45 grams per meal Men/weight loss 45 – 60 grams per meal Snacks Women/weight loss 0-15 grams/ add protein or veggies Men/weight loss 0-30 grams/add protein or veggies

Calorie and CHO counting Calorie King Calorie/CHO counter on line journal. ADA My Meal Plan for counting CHO and using exchanges also in text

Diabetic Meal Plans-Exchanges They don’t just count carbohydrates Exchanges are used to plan meals

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

Example-Carbohydrate 1500 kcal/day (using AMDR) Carbohydrate 55% (1500 x 0.55) = ____ kcal from carbohydrate _____ kcal from CHO ÷ 4 kcal/gm = ____ gm carbohydrate

Example-Carbohydrate 1500 kcal/day (using AMDR) Carbohydrate 55% (1500 x 0.55) = 825 kcal from carbohydrate 825 kcal ÷ 4 kcal/gm = 206 gm carbohydrate

Example-Protein 1500 kcal/day Protein 15% (1500 x 0.15) = ____ kcal from protein _____ kcal ÷ 4 kcal/gm = ____ gm protein

Example-Protein 1500 kcal/day Protein 15% (1500 x 0.15) = 225 kcal from protein 225 kcal ÷ 4 kcal/gm = 56 gm protein

Example-Fat 1500 kcal/day Fat 30% (1500 x 0.30) = ____ kcal from fat _____ kcal from fat ÷ 9 kcal/gm = ____ gm fat

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

Example-All Macronutrients 1500 kcal/day 55% carbohydrate 206 gm carbohydrate/day 15% protein 56 gm protein/day 30% fat 50 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 55% carbohydrate 206 gm carbohydrate/day 15% protein 56 gm protein/day 30% fat 50 gm fat/day 206 gm CHO/day ÷ 15 gm CHO/serving = 13.7 servings CHO/day 56 gm pro/day ÷ 7 gm pro/serving = 8 servings protein/day (1 oz each) 50 gm fat/day ÷ 5 gm fat/serving = 10 servings fat/day

1-day meal plan 14 servings CHO/day 8 servings protein/day (1 oz each) 10 servings fat/day Breakfast – 4 CHO, 2 pro, 2 fat servings Lunch – 3 CHO, 2 pro, 3 fat servings PM snack – 2 CHO, 1 pro, 1 fat serving Dinner - 3 CHO, 2 pro, 3 fat servings HS snack – 2 CHO, 1 pro, 1 fat serving

1-day meal plan 14 servings CHO/day 8 servings protein/day (1 oz each) 10 servings fat/day MealCHOProFat Breakfast422 Lunch323 PM snack211 Dinner323 HS snack211

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

15 gm CHO

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

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

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

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

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

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 Calculating Exchanges, Calories and Percentages Exchange Lists

Unit 9 Project GradingPointsTime Table APA format/file10 In-text citations/reference list20 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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