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

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 What are 4 ways nutrients affect drugs?

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

11. 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

12. 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

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

14. Questions About Nutrition and Drug Therapy?

15. Unit 9 Project

16. 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

17. 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

18. Calculating CHO, FAT, PRO from % Determine Calorie Level (MSJ) - 1800 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

19. 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

20. 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

21. 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

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

23. 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

24. Calorie and CHO counting Calorie King Calorie/CHO counter www.calorieking.com www.fitday.com - on line journal. ADA My Meal Plan for counting CHO and using exchanges also in text

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

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

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

28. 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

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

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

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

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

33. Example-All Macronutrients 1500 kcal/day 55% carbohydrate 206 gm carbohydrate/day 15% protein 56 gm protein/day 30% fat 50 gm fat/day

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

35. 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

36. 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

37. 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

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

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

40. 15 gm CHO

41. 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

42. 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

43. 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

44. 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

45. 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

46. 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

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

48. 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

49. 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=DiabeticExchangeList Calculating Exchanges, Calories and Percentages http://riverflag.com/nutrition/diabeticexchange.html Exchange Lists http://www.uaex.edu/Other_Areas/publications/PDF/FSHED-86.pdf

50. 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

51. 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.

52. Farewell  Thank you for your kind attention and participation!  Office hours by appointment  Email any time - ahabeck@kaplan.eduahabeck@kaplan.edu  Follow me on Twitter  @ProfAmyH