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 - ahabeck@kaplan.edu Follow me on Twitter

@ProfAmyH