Unit 8 Drug-Nutrient Interactions Diabetic Meal Planning Amy Habeck, RD, MS, LDN NS270 Nutrition Assessment and Management
Unit 8Drug-Nutrient Interactions
Diabetic Meal PlanningAmy Habeck, RD, MS, LDN
NS270 Nutrition Assessment and Management
Unit 8 Learning Objectives:
o Discusso Drug-nutrient interactionso Diabetic meal planning
o Review- Nutrition and Diet Therapyo Stanfield and Hui, Chapter 10 – Drugs and
Nutrition
o Answer your questions
General Actions of DrugsWhat are the five categories of general
actions of drugs?
General Actions of DrugsAdditiveCumulativeSynergisticToleranceToxicity
Drugs Affect IntakeWhat are five ways drugs affect nutrient
intake?
Drugs Affect IntakeTasteAppetiteIntestinal motilityAbsorptionMetabolism
Drugs Affect NutrientsWhat are four ways drugs affect nutrients?
Drugs Affect NutrientsDestroy or change nutrientDamage intestinal wallsLower absorptionDirectly destroy, displace or change
nutrients
Nutrients Affect DrugsWhat are 4 ways nutrients affect drugs?
Nutrients Affect DrugsDelayed drug absorptionAltered drug metabolism
Enzyme inductionEnzyme inhibition
Altered rate of excretionAltered drug response
BioavailabilityMost frequently reported diet-drug
interactionDecreased drug bioavailabilityAltered nutrient absorption
Drug absorption affected byPhysical formParticle sizeGI pHSolubility in fats
Side effects of malabsorption
Important NutrientsAltered metabolism creates change in
therapeutic effectNiacin, 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 tractpH of the stomach and small bowelMotility of GI tract
Questions About Nutrition and Drug Therapy?
Unit 9 Project
Meal PlanDetermine calories
Mifflin St. Jeor EquationDetermine if management goal is
Weight maintenanceWeight gainWeight loss
Adjust recommended calorie intake based on goalWhat equation is the base for the calorie
intake recommendation? Calculate grams of each macronutrient
Determine Calorie LevelREE Mifflin St JeorMultiply by activity factorFor weight loss
3500 calories = 1 pound3500 calories/ 7 days = 500 kcal/day = 1
pound/week7000 calories/ 7 days = 1000 kcal/day = 2
pound/weekSubtract 500 or 1000 calories from energy needs
for weight loss
Calculating CHO, FAT, PRO from %
Determine Calorie Level (MSJ) - 1800 calories example
Determine Nutrition Standards – Sports Nutrition example50-70% CHO, 20-35% Fat, <10% Saturated Fat, 12-15%
ProCHO: 1800 calories x 60% = 1080 calories
CHO = 4 calories/gram1080 divided by 4 = 270 grams CHO /day
Fat: 1800 calories x 25% = 450 caloriesFat = 9 calories/gm 450/9= 50 grams fat/day
Pro: 1800 calories x 15% = 270 caloriesPro = 4 calories/gm 270/4= 68 gm protein/day
Individualized Meal PlanCalorie & CHO goal (typically high fiber) Exercise recommendations Coaching & support for behavior changeWeight lossAdditional factors for other health concerns
SodiumFatsCalcium/Magnesium/PotassiumFluids/Fiber
Survival Skills3 meals per day Limit sugar in beverages, jello, candy,
overt source of glucose etc. Somewhat even distribution of CHO foods
per mealInclude 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
Example2000 kcal diet
30% fat40% CHO30% pro
Carbohydrate distribution3 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
SnacksWomen/weight loss 0-15 grams/ add
protein or veggiesMen/weight loss 0-30 grams/add protein
or veggies
Calorie and CHO countingCalorie King Calorie/CHO counterwww.calorieking.comwww.fitday.com - on line journal. ADA My Meal Plan for counting CHO and
using exchanges also in text
Diabetic Meal Plans-ExchangesThey don’t just count carbohydratesExchanges are used to plan meals
Food Group Grams CHO Grams Pro Grams Fat
Starch 15 3 0
Fruit 15 0 0
Milk 12 8 0 Fat free5 Low fat
Vegetable 5 2 0
Meat 0 7 2-3 Very lean5 Medium fat
Fat 0 0 5
Example-Carbohydrate1500 kcal/day (using AMDR)
Carbohydrate 55%(1500 x 0.55) = ____ kcal from carbohydrate _____ kcal from CHO ÷ 4 kcal/gm = ____ gm
carbohydrate
Example-Carbohydrate1500 kcal/day (using AMDR)
Carbohydrate 55%(1500 x 0.55) = 825 kcal from carbohydrate825 kcal ÷ 4 kcal/gm = 206 gm carbohydrate
Example-Protein1500 kcal/day
Protein 15%(1500 x 0.15) = ____ kcal from protein_____ kcal ÷ 4 kcal/gm = ____ gm protein
Example-Protein1500 kcal/day
Protein 15%(1500 x 0.15) = 225 kcal from protein225 kcal ÷ 4 kcal/gm = 56 gm protein
Example-Fat1500 kcal/day
Fat 30%(1500 x 0.30) = ____ kcal from fat _____ kcal from fat ÷ 9 kcal/gm = ____ gm fat
Example-Fat1500 kcal/day
Fat 30%(1500 x 0.30) = 450 kcal from fat 450 kcal ÷ 9 kcal/gm = 50 gm fat
Example-All Macronutrients1500 kcal/day
55% carbohydrate206 gm carbohydrate/day
15% protein56 gm protein/day
30% fat50 gm fat/day
Food Group Grams CHO Grams Pro Grams Fat
Starch 15 3 0
Fruit 15 0 0
Milk 12 8 0 Fat free5 Low fat
Vegetable 5 2 0
Meat 0 7 2-3 Very lean5 Medium fat
Fat 0 0 5
Diabetic Meal Plan-Exchanges
1500 kcal/day55% carbohydrate
206 gm carbohydrate/day15% protein
56 gm protein/day30% fat
50 gm fat/day206 gm CHO/day ÷ 15 gm CHO/serving = 13.7
servings CHO/day56 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/day8 servings protein/day (1 oz each)10 servings fat/day
Breakfast – 4 CHO, 2 pro, 2 fat servingsLunch – 3 CHO, 2 pro, 3 fat servingsPM snack – 2 CHO, 1 pro, 1 fat servingDinner - 3 CHO, 2 pro, 3 fat servingsHS snack – 2 CHO, 1 pro, 1 fat serving
1-day meal plan
14 servings CHO/day8 servings protein/day (1 oz each)10 servings fat/day
Meal CHO Pro Fat
Breakfast 4 2 2
Lunch 3 2 3
PM snack 2 1 1
Dinner 3 2 3
HS snack 2 1 1
Create a Menu from your meal planBreakfastLunchPM SnackDinnerHS Snack
Fruit15 gm CHO
½ cup fresh fruit or juice¼ cup dried fruit
Fruithttp://www.mayoclinic.com/health/diabetes-d
iet/DA00070
15 gm CHO
Starch15 gm CHO, 3 gm pro
1/2 – 3/4 cup cerealSmall baked potato1/3 cup rice
Starcheshttp://www.mayoclinic.com/health/diabetes-d
iet/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/Dairy12 gm CHO, 8 gm pro, 0/5/8 gm fat
1 cup milk¾ cup plain nonfat yogurt
Dairyhttp://www.mayoclinic.com/health/diabetes-d
iet/DA00071
Vegetables5 gm CHO, 2 gm pro
½ cup cooked vegetables or vegetable juice1 cup raw vegetables
Vegetableshttp://www.mayoclinic.com/health/diabetes-d
iet/DA00073
Meat7 gm pro, varied fat (see lists)
1 oz meat, poultry, fish or cheese½ cup dried beans
Meathttp://www.mayoclinic.com/health/diabetes-d
iet/DA00074
Fat5 gm fat
Mono: 1/8 avocado, 1 tsp canola or olive oilPoly: 1 tsp margarine, 1 Tbs, reduced fat
mayoSat: 1 tsp butter, 1 slice bacon, 2 Tbs
coconutFats
http://www.mayoclinic.com/health/diabetes-diet/DA00075
Analyze your menuProvide
CaloriesProteinTotal fatCarbohydrateFiberSodiumSaturated fat
Exchange Lists-show portions of common foods
Starcheshttp://www.mayoclinic.com/health/diabetes-diet/DA00069
Fruithttp://www.mayoclinic.com/health/diabetes-diet/DA00070
Dairyhttp://www.mayoclinic.com/health/diabetes-diet/DA00071
Vegetableshttp://www.mayoclinic.com/health/diabetes-diet/DA00073
Meathttp://www.mayoclinic.com/health/diabetes-diet/DA00074
Fatshttp://www.mayoclinic.com/health/diabetes-diet/DA00075
Other Helpful Sites for Diabetic Meal Planning
Food Exchangeshttp://www.exrx.net/Nutrition/FoodExchanges.html
Carbohydrate Countinghttp://www.joslin.org/info/
Carbohydrate_Counting_101.htmlDiabetic Exchanges and Food Lists
http://www.diabeteslibrary.org/View.aspx?url=DiabeticExchangeList
Calculating Exchanges, Calories and Percentageshttp://riverflag.com/nutrition/diabeticexchange.html
Exchange Listshttp://www.uaex.edu/Other_Areas/publications/PDF/
FSHED-86.pdf
Unit 9 ProjectGrading Points Time Table
APA format/file 10
In-text citations/reference list
20
Question 1 45 Week 5
Question 2 30 Week 6
Question 3 20 Week 6-7
Question 4 50 Week 5-9
Question 5 20 Week 8-9
Question 6 15 Week 8
Unit 9 ProjectQuestion 4. Create a 1 day meal plan
Identify calorie and % CHO, PRO, FAT goalsIdentify timing for meals and snacksIdentify CHO goals for meals and snacksCreate a sample menu to match your goalsComplete a nutrient analysis on your menu
Question 5. Describe how you would
educate DB on the meal plan you created and health maintenance recommendations.
Farewell Thank you for your kind attention and
participation! Office hours by appointment Email any time - [email protected] Follow me on Twitter
@ProfAmyH