Staying Healthy and Strong with Scleroderma
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Bethany Doerfler MS, RD, LDN discusses top nutrition concerns of scleroderma patients, as well as the results of a recent medical nutrition therapy study. She also discusses strategies for healthy eating, combating GI issues, maintaining muscle, a Mediterranean diet, supplements and more.
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Staying Healthy and Strong with Scleroderma
- 1. Staying Healthy & Strong with Scleroderma Bethany DoerflerMS, RD, LDN
- 2. Top Nutrition Concerns Healthy Diet How do I control gas & bloating? What Should I Eat? How should I handle feeling full early? How do I keep my muscle? Should I take Supplements?
- 3. Is a Mediterranean Diet Good for Scleroderma? Heart Healthy Diet : Not Specific to Scleroderma 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.
- 5. Portion Controlled Mediterranean Diet
- 7. Healthy Fats Add Healthy Calories Type of Fat is More Important than the Amount
- 8. 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
- 9. What Did We Collect? 18 subjects total •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
- 10. 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
- 11. Percent of MNT PASS Subjects Below Normal Blood Limits TABLE 3: Percent of MNT PASS subjects below normal limits for key nutrients MNTPASS Study Participants N=18 Characteristics Table 3 Labs Value Percent Below Normal Limits Mean (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%
- 13. 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
- 14. How Do I Keep My Muscle?
- 15. • Check weight monthly • Discuss weight loss with Rheumatologist and Gastroenterologist • Work with dietitian to improve weight status • Nutritional supplements as necessary
- 16. 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
- 17. SarcopenicMuscles Note difference in muscle mass and fat tissue Multifactorial disease: loss of hormones & less activity Exercise attenuate age related muscle loss Inflammation can speed up muscle loss
- 18. 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
- 19. Don’t Push Too Hard: Work Way Up
- 20. 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
- 21. 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 ozmeat, fish, poultry, tofu • Add veggies and rice to complete
- 22. Nutrition RX for Gas & Bloating How do I control bloating? Cook Veggies & Peel Skin Fruits Moderate Fiber if bloated Try FODMAPS
- 23. Common GI Complaints • Reflux (GERD) • Difficulty Swallowing (Dysphagia) • Early Fullness • Bloating • Constipation • Diarrhea • Fatigue • Weight loss
- 24. Dietary Therapy for Fullness Balanced Diet Small frequent meals Liquid nutrition supplementation Healthy liquid fats less solid fats Cook Fibers Control blood sugars 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
- 25. 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 Snacks Meals
- 26. 26
- 27. 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
- 28. 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
- 29. 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/ 29
Editor's Notes
- To be clear Inflammation does not cause autoimmune diseases or SSC but reducing inflammation may improve overall wellness and how the organs function and risk of developing other chronic diseases such as CVD. This is not the same thing as saying you need to be gluten free or dairy free. Although we see a lot of cross over with Celiac and other auto immune disorders, simply eliminating gluten or dairy is not the whole picture
- Example of whole grain (oat) product
- Experts agree that maintaining weight is one of the most important nutritional outcomes we can focus on. We will hear from Dr. Sheean shortly about nutrition study that we are conducting and the importance of maintaining weight and lean body mass
- Notice that we are not flooding you with protein- we are simply distributing your protein better to make this more appropriate. Younger patients and men or those who exercise quite a bit might need to achieve 30 gm/meal
- This is a short look at some of the many MNT principles we might discuss with you. To give you a flavor of what you might accomplish with the help of an RD we look to develop strategies for each GI/nutrition complaint. One example- laying in healthy calories. Healthy fats such as olive oil contain 150 calories for each tbsp. Adding healthy fats to cooked proteins at meal time can help layer calories in an important way
- Which dietary component matters most? Meal volume is the most important factor. Liquid fats often empty easily and thus high fat shakes can be an important source of calories for patients with weight loss. SFF are key recommendation to allowing patients to get adequate nutrition. Goals prevent malnutrition and decrease symptoms. Two calorically identical meals will empty at different rates when one is chopped and blenderized. I tell patients think of doing as much physical digestion outside of your mouth as possible. In age of goole, typically patients come in having restricted all fruit and veggies unnecessarily. There are ways to improve and liberalize an overly restricted diet?