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Northwestern University Feinberg School of Medicine
Healthy Diet and Scleroderma
Bethany Doerfler MS, RD, LDN
Top Nutrition Concerns
Healthy Diet
Should I be on an anti-
inflammatory diet?
How do I control gas &
bloating?
How should I handle
feeling full early? How do I
keep my muscle?
Do I need vitamins
Is a Mediterranean Diet Anti-Inflammatory?
Fruits &Vegetables
Whole Grains
Healthy Fats
Lean Proteins
REDUCE Inflammation
Refined sugars
Refined starches
Saturated fats &trans fats
INCREASE inflammatory markers
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.
Portion Controlled Mediterranean Diet
• Think fruits or veggies
as base meal
• Include each meal
• 3 colors day – Red/purple
– Orange/yellow
– Green
Tips: Fruits and Vegetables
• Purchase pre-cut fruits and veggies for convenience
• Keep them at eye-level in your fridge
• Pack bag night before with easy-to-carry options
– Bananas, citrus, canned and dried fruit, apples, pears
• Purchase with soup or sandwich over crackers and chips
• Use as “bread” for peanut butter and cheese
• Take fruit smoothie in a travel mug for a quick breakfast
• http://www.choosemyplate.gov/food-groups/downloads/TenTips/DGTipsheet9SmartShopping.pdf
Healthy Fats Add Healthy Calories
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 Wheat
Added Margarine
Ripe Fruit
Milk or Kefir
Pureed Butternut Squash Soup
6 brown rice crackers, 1-2 oz cheese
3-4 oz Baked Fish
Medium Baked Potato
Cooked Carrots
Milk or Kefir
Ripe Banana
1-2 tbsp Creamy Peanut Butter
½ Sandwich
Canned Fruit
Fruit Smoothie:
Mango & Greek Yogurt or Protein Powder
Snac
ks
M
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 water
Dinner
•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
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
Muscle: Distribute Protein
Adults need 60-100 gm protein daily
Muscle rebuild itself every 3-5 hours
20-30 gm burst of muscle synthesis
60 gm properly distributed safe kidneys and bones
Layman DK, Nutr Metab 2009;6:12
What Does 20 gm Look Like?
• BREAKFAST: Greek Yogurt & fruit – 2 eggs & whole grain toast
– Vegan protein shake & fruit
• LUNCH: 2-3 oz lean turkey breast & veggie soup – 1 cup cooked Quinoa & 2-3 shrimp
– 1 cup split pea soup, crackers & one oz cheese
• DINNER: 3 oz meat, fish, poultry, tofu » Add veggies and grain complete
Northwestern University Feinberg School of Medicine
Medical Nutrition Therapy for Patients with Advanced Scleroderma (MNT PASS)
PIs: Ikuo Hirano and Patricia Sheean Co-I: Bethany Doerfler
Collaboration between UIC and Northwestern
What are we collecting?
• 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
Sample DXA results
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
• Add – general multivitamin/multi-mineral supplement – Calcium & Vitamin D
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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THANK YOU