Agenda How to Get your Patient to Follow the Special Diet ... · ©Julie Matthews/Nourishing Hope...

©Julie Matthews/Nourishing Hope • NourishingHope.com

How to Get your Patient to Follow the Special Diet you Recommend

Julie Ma)hews Cer$fied Nutri$on Consultant

Julie Matthews is not a physician. She does not diagnose or treat disease. This information and her statements are not intended to replace a one-on-one relationship with a qualified health-care professional, and is not intended to provide medical advice. For medical advice, always seek a physician. This information is intended for educational purposes only, and is solely as a sharing of knowledge and information based upon the experience and research of Julie Matthews/Nourishing Hope.

Agenda

• Pa$ent’s Perspec$ve and Prac$$oner Pi6alls • GFCF Implementa$on • Prac$$oner $ps and resources • Bedside manner • Working with children

Applies to any Special Diet

• Gluten-‐Free and Casein-‐Free • Specific Carbohydrate Diet/GAPS Diet • Low Oxalate Diet • Feingold and Failsafe Diets • Primal/Paleo • And more

While individual diet rules differ the ideas we will discuss apply to any special diet

Top Healing Diets GFCF (Gluten-‐free and Casein-‐free) No gluten (wheat, rye, barley, spelt, kamut, and oats) or casein (dairy)

Food Sensi:vity Elimina:on/Rota:on Elimina$ng all other food sensi$vi$es: Soy, corn, eggs, citrus, peanuts, chocolate, cane sugar

SCD (Specific Carbohydrate Diet)/GAPS Restricts carbohydrates to only fruits, non-‐starchy vegetables, and honey. No grains, starchy vegetables, or mucilaginous fiber

Paleo/Primal Blueprint Meat, fruit, vegetables, fat and nuts. No grains or beans. OUen removes potatoes and dairy too.

Low Oxalate Diet Restricts high oxalate foods (nuts, beans, greens)

Low FODMAPS Diet Low in fermentable, poorly absorbed carbs such as fructose, lactose and FOS.

Body Ecology Diet & other Yeast Diets An$-‐yeast diet combining principles of an$-‐yeast diets including no sugar, acid/alkaline, fermented foods

Feingold/FAILSAFE Diets Restricts high phenolic foods, including all ar$ficial ingredients and high salicylate fruits (and more)

Weston A Price Dietary Principles: Solid nutri$on founda$on for everyone

Healing Diets

1.   Remove: Avoid offending foods and substances – Ar$ficial addi$ves – Gluten, casein, soy, corn, phenols, oxalates, starches

2.   Replenish: Increase healthy foods – Whole and unprocessed foods (sweet potatoes not potato chips)

– Organic and locally grown –  Fermented foods: rich in probio$cs – Grass-‐fed/pastured meat and eggs – Good fats

Compliance Obstacles

• Being depressed • Too overwhelmed to do a special diet • Changing a child’s diet – can’t control what a picky eater eats

• No hope that it will work – maybe even based on past diet “failures”

• Fear of being deprived • Fear of succeeding • Feelings of guilt -‐ “I should have tried this sooner”


Patient’s Questions

• WHY am I doing this? • Do I need to do this? • Is there an easier way? • How long do I need to do it? • What if I don’t do it 100%?

Ø HOW do I do it?

Practitioner Pitfalls

• Not understanding the varied diets, which to use, and if/how to combine mul$ple diets

• Only men$oning the diet in the last two minutes of the appt as they are leaving

• Not providing detail on how to do the diet • Not providing resources on where to find more informa$on on the diet

• Lack of confidence that diet will help

Become Educated

• Understand the diet you are recommending – science and applica$on

• Learn crea$ve meal ideas you can share • Try some recipes – ideally, try the diet • Taste fermented foods and know sources for buying good brands. Try making your own.

• If needed: Refer to an experienced nutri$on professional or resource for implementa$on – don’t leave them on their own

Be Prepared

• Have resources for pa$ents – Diet implementa$on guides (use my GFCF Success Guide or Nourishing Hope for Au$sm book) or other self-‐made guides

– Meal ideas & Recipes

• An$cipate ques$ons – have answers

Strategize For Success

• Set acainable goals • Start with something small that will make a big impact, such as removing gluten first.

• Keep the dialog open to their success-‐ Adjust the diet and provide more support/ideas

• Scale back and simplify diet. Start with fewer changes (for example GFCF instead of a full elimina$on diet, do one diet concept at a $me)

– However, realize that some$mes benefits aren’t seen un$l several foods are removed at once

Not Easy to Change Diet

• People want a quick fix • Food is emo$onally charged • Food can be an addic$on • Food is comfort • Food is love • Etc…


Keep Communication Open • Pa$ents may tell you what you want to hear, but do something else

• They may mean well, but are embarrassed when they aren’t able to follow the diet

• Create dialog for success and “failure” – that anything is OK, so you can offer proper support.

• Use a diet record. There is great learning about how the body responds – so success is based on doing their best and recording the results.

•  Good way to ensure foods are compliant with diet •  Chart: Time, foods, and mood/symptoms (and improvements) •  Make one dietary change at a $me •  Avoid changing foods & supplements simultaneously. • Watch for symptoms or regression:

–  Some$mes a “regression” is actually a sign of healing, i.e. removal of gluten/casein may cause opiate withdrawal

–  However, some$mes a new food subs$tu$on (corn) is problema$c and needs to be removed

•  Have them chart improvements •  See what’s remaining, and consider addi$onal diets/dietary interven$on, i.e. changing the diet or layering diets

Keeping a Diet Record is Key Time Food & Supplements Notes: Mood, symptoms

9 am Scrambled eggs (in ghee) with gluten-‐free toast

Calm, sa$sfied

Believe in Your Client • Demonstrate your belief that they can change • Scien$fic study indicates that the student’s success directly correlates with teacher’s belief in the student

• Nourish their hope • Tell them you’ve seen diet make a huge difference, convey that it’s possible

• Don’t get frustrated with their slow pace or lack of implementa$on. Some$mes it takes year or more before they make diet changes.

Steps for a Successful GFCF Diet Implementa$on

Emailed to you along with ppt slides

1.  Get educated on the Gluten-‐Free and Casein-‐Free Diet (GFCF), as well as Soy-‐Free (SF)

2.  Experiment. Discover choices your child likes. Before removing any foods from the diet, iden$fy new GFCF alterna$ves.

3.  Create a meal plan. Develop a list of diet compliant meals and snacks your child will eat or ideas that you would like to try.

4.  Shop 5.  Begin the GFCF diet! 6.  Keep a diet record.

© J

ulie

Mat

thew

s, N

ouris

hing

Hop

e

© J

ulie

Mat

thew

s, N

ouris

hing

Hop

e

•  Learn the gluten grains and hidden sources of gluten, casein-‐containing foods, along with gluten-‐free and casein-‐free op$ons.

•  Gather recipes from cookbooks and food blogs. (Step 2 will be to cook them and experiment)

•  Community support. Join a Facebook, Yahoo, or other community group to ask ques$ons and get support. Connect with us at “Nourishing Hope for Au$sm” on Facebook and ask your ques$ons.

•  Watch instruc$onal videos -‐ Watch the Cooking to Heal video and accompanying cookbook. Many addi$onal videos are available at YouTube channel: NourishingHope


Grains Hidden Sources Wheat Rye Barley Spelt Kamut Tri$cale Oats (commercial) Semolina

Hydrolyzed Vegetable Proteins MSG Dextrin Malt Citric acid Ar$ficial flavors & coloring “Spices” Soy sauce (unless wheat-‐free) Potato chips/fries

Gluten Grains & Ingredients to Avoid

Rice Millet Quinoa

Amaranth Buckwheat

Corn Wild rice Mon$na Teff

Sorghum Tapioca Nut flours Seed flours

Coconut flour Chestnut flour Bean flours

Roots (taro, yam) Yucca/casava

Thickeners Agar

Guar gum Gela$n

Kudzu powder Tapioca

Sweet rice flour Xanthan gum Arrowroot

Gluten-Free Grains & Foods

Casein Containing Foods to Avoid

Casein Hidden Sources Milk of all animals Cheese Yogurt Bucer Bucermilk Ice cream and cream Kefir Sour cream

Whey Galactose Casein, Caseinate Lactose, Lactalbumin Lac$c acid Sherbet Canned tuna Cool Whip Ar$ficial bucer flavor

• 

Milk & Yogurts Rice milk

Almond, hazelnut or hemp milk

Homemade Nut milk

Coconut milk Potato milk-‐Vance’s

DariFree

Pudding Non-‐dairy versions Avocado base

Oil/Bu)er Coconut oil Olive oil

Ghee (cert.) Lard or tallow Earth Balance

(not good nutri$onally)

Cheeses Daiya Cheese Galaxy Foods

Ice Cream Sorbets w/o milk

Non-‐dairy ice cream

Coconut ice cream

Fruit popsicles

Chocolate

GFCF chocolate

Casein-Free Foods

•  Discover choices your child likes. Before removing any foods from the diet, identify new GFCF alternatives.

•  Take note of prepared/frozen foods, mixes, and ingredients you can use. Buy some different options and practice cooking them and serve them to your children.

•  Cook new recipes and see which your child likes, and how to make them appealing with a dipping sauce or visual presentation.

•  Look for ideas Cooking to Heal by Julie Matthews

© J

ulie

Mat

thew

s, N

ouris

hing

Hop

e

•  Develop a list of diet compliant meals and snacks your child will eat or ideas that you would like to try.

•  Draw four columns on a page and $tle the columns: Breakfast, Lunch, Dinner and Snacks. Begin filling in meal choices

© J

ulie

Mat

thew

s, N

ouris

hing

Hop

e

•  Many foods are inherently GFCF such as fruits, vegetables, meat and eggs, nuts and beans, fats and oils.

•  Add GFCF versions of foods your child already likes: GFCF pancake in place of their normal, rice pasta instead of wheat-‐based, chicken nuggets with a gluten-‐free breading.


Meal Plan Breakfast Lunch/Dinner Snacks

Bacon Eggs

Meat pates with liver Bucernut squash fries Apple or pear with nut bucer

Pancakes with pureed vegetables and/or added protein

Sausage pacy

GF pasta and meatballs Pureed veggie in sauce

Peas Chicken pancakes

French toast or GF toast with nut bucer

Chicken nuggets Dipping sauce

Steamed vegetables Smoothie or fresh vegetable juice

Gluten-‐free porridge Chicken or turkey sausage

Nut-‐free PB&J -‐ Sunflower bucer and jam sandwich

Carrot s$cks

Hummus and raw vegetables or gluten-‐free bread/crackers

Smoothie Meat/sausage pacy

Bean burgers or Indian len$l pancakes with cooked or shredded

vegetables Veggie latkes

Chicken pancakes and fruit (Add fruit to any breakfast)

Roasted meat Potatoes or Cauliflower mashed

“potatoes” Veggie latkes

Applesauce Carrot chips

Meals: Add fruit, starches, and more vegetables as tolerated.

•  Making a meal plan, Step 3, will make shopping easy. •  Keeping your shelves stocked – this will allow you to have food on

hand when your kids are hungry, and help prevent the tempta$on or accident of going off the diet.

•  Purchase diet compliant flours, milks, and other cooking staples to make the basics. Many of these you can get a natural foods store. Conven$onal supermarkets are beginning to have a gluten-‐free sec$on, and dairy-‐free op$ons.

•  Special items like nut flours can be ordered online.

© J

ulie

Mat

thew

s, N

ouris

hing

Hop

e

•  1st step: Begin by removing casein and soy from the diet -‐ for a week

•  2nd step: Week 2, Remove gluten as well, and con$nue (GFCFSF) for at least three to six months.

© J

ulie

Mat

thew

s, N

ouris

hing

Hop

e

•  Keep a regular journal of changes in your child’s diet and daily condi$on.

•  Make notes of posi$ve changes, as well as difficult days.

•  A diet record will help you keep track of how the diet is going, help iden$fy any infrac$ons, and determine other factors (dietary or otherwise) that may be affec$ng your child.

© J

ulie

Mat

thew

s, N

ouris

hing

Hop

e Patient Compliance Success •  Let client know WHY you are sugges$ng the diet and HOW the diet works

•  Explain what they should expect – they might feel worse first, or becer in a few days, or it might take several weeks to see changes

–  Overes$mate the $me, but not too far

• Give them a trial period they can manage • Make sure they know that any small infrac$on may alter results and to be strict on the diet

• Be understanding and encouraging –  Bedside manner MATTERS

Words of Encouragement

• While diet isn’t always easy at the beginning, the improvements pa$ents see make it all worthwhile

• Once they get going on a special diet it is not hard to do – the learning curve is steep but easy (not $me consuming) once they get the hang of it

•  Individuals and children improve physically and emo$onally on a special diet. Once symptoms decrease, pa$ents/parents have more free $me to enjoy life and any extra cooking $me is worth it.

•  There is licle to no downside to trying a special diet


Customize Meal Suggestions

• Talk through dietary elimina$ons and addi$ons – make sure you include what they CAN eat

• Ask them if where they are concerned about complying (i.e. ea$ng at restaurants, traveling, a par$cular meal)

• Create a meal plan or brainstorm a few meal choices

Special Diets for Children

• Work with the parents • May be becer to talk about the diet without the child there (depends on the age and individual)

• Diet you choose has to be “doable” • Get crea$ve with kid-‐friendly meals: Chicken pancakes for protein, Vegetable Laktes and Carrot/Kale Chips for vegetables

• Provide ideas and sugges$ons for picky eaters

Possible Causes Picky Eating •  Addic$ons to opiates (gluten/casein) cause consump$on of primarily wheat and dairy containing foods

•  Addic$ons to chemicals (MSG, ar$ficial addi$ves) cause restric$on to one brand or large preference for processed foods

• Nutrient deficiencies (zinc) makes everything taste bad or bland.

•  Yeast, viral, and microbial overgrowth may cause focus on ea$ng mainly high carb and sugar foods

•  Sensory sensi$vi$es can restrict the consump$on of certain textures -‐ Seek a feeding therapist when needed

Support for Picky Eaters

• Children AND adults can be picky eaters –  Adults oUen won’t tell you

• Remove addic$ve foods •  Improve nutrient status with supplementa$on • Get crea$ve with TEXTURE

–  Chicken pancakes and meatballs for protein –  Vegetable Laktes and Carrot/Kale Chips for vegetables

•  Incorporate (“hide”) pureed vegetables in muffins, pancakes, meatballs, pasta sauce

• Visual Presenta$on

• Add non-‐dairy yogurt to fruit and puree into a smoothie • Use a small amount of fruit and yogurt to make a fruit-‐yogurt dipping sauce for fruit kebabs.

• Apple Kraut: Shred apple and add 50/50 with raw sauerkraut to reduce sourness. Serve as shredded fruit salad.

• Puree raw sauerkraut or other cultured vegetables in food processor with apple sauce (or other fruit sauce)

•  Fermented drinks: Young coconut kefir, non-‐dairy kefired sodas, kombucha

Kid-Friendly Fermented Foods Resources for Support

ü FREE: My GFCF Success Guide ü Meal ideas and recipes

q Cooking to Heal q Mom bloggers and special diet blogs (SpunkyCoconut.com, LexiesKitchen.com, GlutenfreeGirl.com

q Specific diet resources: Diet websites and Yahoo groups ü How to Choose the best Special Diet and resources for them q Free Parents Guide on Special Diets for Au$sm q Nourishing Hope for Au$sm


Julie’s Nourishing Hope Support Tools

NourishingHope.com

Nutri$onForPregnancy.com

Contact & Consulta$ons [email protected]

415-‐235-‐2960

Agenda How to Get your Patient to Follow the Special Diet ... · ©Julie Matthews/Nourishing Hope...

Documents

Transcript of Agenda How to Get your Patient to Follow the Special Diet ... · ©Julie Matthews/Nourishing Hope...