Staying Healthy and Strong with Scleroderma
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Transcript of Staying Healthy and Strong with Scleroderma
Staying Healthy & Strong with SclerodermaBethany Doerfler MS, RD, LDN
Top Nutrition Concerns
Healthy Diet
What Should I Eat?
How do I control gas &
bloating?
How should I handle feeling
full early?How do I keep
my muscle?
Should I take Supplements?
Is a Mediterranean Diet Good for Scleroderma?
Fruits &VegetablesWhole GrainsHealthy FatsLean ProteinsREDUCE Inflammation
Refined sugarsRefined starchesSaturated fats &trans fatsINCREASE inflammatory markers
Heart Healthy Diet : Not Specific to Scleroderma
Esposito K. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004; 292: 1440– 6.
Mediterranean Diet
Portion Controlled Mediterranean Diet
Healthy Fats Add Healthy CaloriesType of Fat is More Important than the Amount
Medical Nutrition Therapy for Patients with Advanced Scleroderma (MNT PASS)PIs: Ikuo Hirano and Patricia SheeanCo-I: Bethany Doerfler
Collaboration between UIC and Northwestern
What Did We Collect?
•Nutrition status and symptom tracking- Patient Generated Subjective Global
Assessment- Nutrient status (Vitamin A, D, K, iron, folate,
B12)- 24 hour diet recall- GI symptoms using UCLA SSc GI tool- CDC Health Related Quality of Life- Body composition to assess bone, fat and
muscle health
18 subjects total
What Did Our Sample Look Like?
• 18 patients total• Average age 51• Average BMI= 22 ± 6 (desirable)• 100% GI involvement of some type
- 100% GERD- Gastroparesis, dysphagia, bacterial overgrowth, diarrhea and
constipation• 50% Sample sarcopenic across BMI category
- Appear normal weight
Percent of MNT PASS Subjects Below Normal Blood Limits
TABLE 3: Percent of MNT PASS subjects below normal limits for key nutrientsMNTPASS Study Participants Characteristics Table 3 N=18
LabsValue
Percent Below Normal LimitsMean (SD)
Zinc (mcg/dl) 68.8 (16.6) 63%
TIBC (mg/ml) 296.2 (70.2) 36%
Vitamin D (ng/ml) 39.7 (20) 33%
Transferrin Saturation (%) 21.1 (12.5) 31%
Ferritin (mg/ml) 111.3 (166.3) 25%
Retinol (ug/dl) 59.1 (23.3) 25%
Vitamin B12 (g/dl) 554.6 (363.8) 0%
Folic Acid (ng/ml) 20.9 (6.5) 0%
Supplements
•Check:- Vitamin D- Adults aim for 600-1000 IU daily- Ask MD check especially if you take acid blocking medications
• B12/folic acid- If you are on acid blocking medications
• Iron panel and iron stores• Zinc levels if you struggle with diarrhea or have high crp
•Add - general multivitamin/multi-mineral supplement- Calcium & Vitamin D
How Do I Keep My Muscle?
• Check weight monthly• Discuss weight loss with Rheumatologist and
Gastroenterologist• Work with dietitian to improve weight status • Nutritional supplements as necessary
Sarcopenia:
• Loss of Muscle Mass and Function • Sarcopenia can begin in 40s• 70-80 maximum loss. • Muscles lose 20-40% Contractile strength for
both men and women • Translates to lower metabolic rate, loss of muscle function, higher risk of
diabetes
Sarcopenic Muscles
Note difference in muscle mass and fat tissueMultifactorial disease: loss of hormones & less activityExercise attenuate age related muscle lossInflammation can speed up muscle loss
Important Steps in Weight Training http://www.icaa.cc/category.asp?categoryID=63&type=1
Proper warm up and form key to prevent injury
Ask for adaptive equipment from gym, physical therapist or occupational therapist
8-12 reps of 6 different exercises is ideal
Use of resistance bands and body weight work as well as weight training
Don’t Push Too Hard: Work Way Up
Muscle: Distribute Protein
Adults need 60-100 gm protein daily
Muscle rebuild itself every 3-5 hours
20-30 gm improves muscle synthesis
60 gm properly distributed safe kidneys and bones
Moderate protein intake for 150 lb person is 70-80 gm/daily
Layman DK, Nutr Metab 2009;6:12
What Does 20 gm Look Like?
• BREAKFAST: Greek Yogurt & fruit or• 2 eggs & whole grain toast or• 1 scoop protein powder (rice based, soy, egg or whey) & fruit
• LUNCH: 2-3 oz lean turkey breast & veggie soup or• 1 cup cooked Quinoa & 2-3 shrimp or• 1 cup split pea soup, crackers & 1 oz cheese
• DINNER: 3 oz meat, fish, poultry, tofu• Add veggies and rice to complete
Nutrition RX for Gas & Bloating
How do I control
bloating?
Cook Veggies & Peel Skin
Fruits
Moderate Fiber if bloated
Try FODMAPS
Common GI Complaints
• Reflux (GERD)• Difficulty Swallowing (Dysphagia)• Early Fullness• Bloating• Constipation• Diarrhea• Fatigue• Weight loss
Dietary Therapy for Fullness
Balanced Diet
Small frequent meals
Liquid nutrition supplementation
Cook Fibers
Control blood sugars
Healthy liquid fats less solid fats
Camilleri M. Gastroenterology 131(2);2006: 640-658; Keld R. J Hum Nutr Diet, 24: 421-430; Olausson EA. Diabetes Research and Clinical Practice 80:231-237; Gastroenterology. 2011 Jan;140(1):101-15
Q: What is Small Frequent Meal?A: 3 Meals & 3 Snacks
Cream of WheatAdded Margarine
Ripe FruitMilk or Kefir
Pureed Butternut Squash Soup
6 brown rice crackers, 1-2 oz cheese
3-4 oz Baked FishMedium Baked Potato
Cooked CarrotsMilk or Kefir
Ripe Banana1-2 tbsp Creamy Peanut
Butter
½ SandwichCanned Fruit
Fruit Smoothie: Mango & Greek Yogurt
or Protein PowderSnac
ksM
eals
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FODMAPS Sample Menu
Breakfast: • Poached Egg• corn tortilla or toast• ½ cup- 1 cup ripe melon or berries• Coffee or tea
Lunch• Cooked vegetable soup• Brown Rice crackers & almond butter• Banana• Sparkling waterDinner• Roasted fish or poultry• Roasted green beans• Sweet potato cooked with olive oil• Berries & Greek Yogurt
Snacks: Yogurt, fruit, nut butters, cheese, veggie soups, sushi rolls, dairy free frozen treats, dry cereal (oat/rice based), crackers, cold or hot cereal with milk alternative
Other Strategies for Healthy Eating
• Weekend pre-planning- Batch cooking- Crock pot- Freeze in pre-packaged ready-to-go
• Change expectations of Healthy Meal- Cereal with fruit and egg whites great dinner
• Frozen just as good as fresh• Pre-cut/chopped fruits and veggies retain nutritional value• Focus on meal assembly• Cook and puree hard to digest veggies• Consider liquid smoothies at night when motility worst
Seeking Information on Supplements & Complementary Therapies
• National Institute of Health Office of Dietary Supplements:- http://dietary-supplements.info.nih.gov/
• Look up your supplement:- http://ods.od.nih.gov/health_information/health_information.aspx
• Complementary and Alternative Medicine- http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm
• Institute of Medicine- http://www.iom.edu/?ID=4829
• Department of Health and Human Services Agency for Healthcare Research and Quality- http://www.ahrq.gov/
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