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

2. 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

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

4. General Actions of Drugs Additive Cumulative Synergistic Tolerance Toxicity

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

6. Drugs Affect Intake Taste Appetite Intestinal motility Absorption Metabolism

7. Drugs Affect Nutrients What are four ways drugs affect nutrients?

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

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

10. 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

11. 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

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

13. http://www.pdrhealth.com/drugs/rx/rx-a-z.aspx http://www.drugs.com/drug_information.html 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

14. 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

15. 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

16. 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 = 169-244 gm carbohydrate/day

17. 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

18. 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 = 38-75 gm protein /day

19. 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

20. 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 = 33-50 gm fat /day

21. Example-All Macronutrients 1500 kcal/day 45-65% carbohydrate 169-244 gm carbohydrate/day 10-20% protein 38-75 gm protein/day 20-30% fat 33-50 gm fat/day

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

23. Diabetic Meal Plan-Exchanges 1500 kcal/day 169-244 gm carbohydrate/day 38-75 gm protein/day 33-50 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

24. 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

25. 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

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

27. 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

28. 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

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

30. 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

31. 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

32. 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

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

34. Fruit 15 gm CHO ½ cup fresh fruit or juice ¼ cup dried fruit Fruit http://www.mayoclinic.com/health/diabetes- diet/DA00070 http://www.mayoclinic.com/health/diabetes- diet/DA00070

35. 15 gm CHO

36. Starch 15 gm CHO, 3 gm pro 1/2 – 3/4 cup cereal Small baked potato 1/3 cup rice Starches http://www.mayoclinic.com/health/diabetes- diet/DA00069 http://www.mayoclinic.com/health/diabetes- diet/DA00069

37. 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

38. Milk/Dairy 12 gm CHO, 8 gm pro, 0/5/8 gm fat 1 cup milk ¾ cup plain nonfat yogurt Dairy http://www.mayoclinic.com/health/diabetes- diet/DA00071 http://www.mayoclinic.com/health/diabetes- diet/DA00071

39. Vegetables 5 gm CHO, 2 gm pro ½ cup cooked vegetables or vegetable juice 1 cup raw vegetables Vegetables http://www.mayoclinic.com/health/diabetes- diet/DA00073 http://www.mayoclinic.com/health/diabetes- diet/DA00073

40. Meat 7 gm pro, varied fat (see lists) 1 oz meat, poultry, fish or cheese ½ cup dried beans Meat http://www.mayoclinic.com/health/diabetes- diet/DA00074 http://www.mayoclinic.com/health/diabetes- diet/DA00074

41. 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 http://www.mayoclinic.com/health/diabetes- diet/DA00075 http://www.mayoclinic.com/health/diabetes- diet/DA00075

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

43. Exchange Lists-show portions of common foods Starches http://www.mayoclinic.com/health/diabetes-diet/DA00069 Fruit http://www.mayoclinic.com/health/diabetes-diet/DA00070 Dairy http://www.mayoclinic.com/health/diabetes-diet/DA00071 Vegetables http://www.mayoclinic.com/health/diabetes-diet/DA00073 Meat http://www.mayoclinic.com/health/diabetes-diet/DA00074 Fats http://www.mayoclinic.com/health/diabetes-diet/DA00075

44. Other Helpful Sites for Diabetic Meal Planning Food Exchanges http://www.exrx.net/Nutrition/FoodExchanges.html Carbohydrate Counting http://www.joslin.org/info/Carbohydrate_Counting_101.html Diabetic Exchanges and Food Lists http://www.diabeteslibrary.org/View.aspx?url=DiabeticExch angeList http://www.diabeteslibrary.org/View.aspx?url=DiabeticExch angeList Calculating Exchanges, Calories and Percentages http://riverflag.com/nutrition/diabeticexchange.html Exchange Lists http://www.uaex.edu/Other_Areas/publications/PDF/FSHE D-86.pdf http://www.uaex.edu/Other_Areas/publications/PDF/FSHE D-86.pdf

45. 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

46. 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

47. 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.

48. Farewell  Thank you for your kind attention and participation!  Office hours by appointment  Email any time - ahabeck@kaplan.edu