advise_patients_about_food_intake

1. What Community Pharmacists
advise Patients about Food
Intake (Nutrition)?
Prof. Dr. Haydar Al-Tukmagi

2. Community pharmacist is one of the most prominent
and accessible healthcare professions.
They are ideally located to play a key role in
disease prevention through education of the public
about modifiable behaviours such as dietary intake.
They can be considered as the first, and sometimes
only, point of contact patients have with a
healthcare professional.

3. As a community pharmacist!!!Do you have
enough confidence in providing nutritional
advice to patients?
“Patients truly value your recommendations and advice, as a
pharmacist, so refrain from offering advice based on fad diets or
trend”
“There is no one ‘nutrition prescription’ that works for everyone.
What works for you may not work for your patients or your patient’s
sister’s aunt’s neighbor.”
Pharmacists should rely on science. “As a pharmacist, it is important
to use evidence-based practices [like you would for medications],
even when talking about nutrition.”
Ask patients what they eat and what they are interested in changing.
Then offer resources and guides to help in those areas. Again, let the
patient drive the decision making and goal setting.”

4. Attitudes towards the importance of nutrition in public health (opinion)
How important is nutrition in reducing the global burden of disease?
How important is nutritional advice in patients with digestive complaints?
Do you think patients would value nutritional advice from a pharmacist?

5. Attitudes towards ability to provide nutritional advice (confidence)
How well are nutritional problems managed in the community pharmacy
setting?
How confident are you in providing dietary advice to a diabetic?
How equipped do you feel to offer weight loss advice?
Practice
Advising increased energy intake when required due to medication side
effects
Advising patient about food‒drug interactions
Advising specific patient groups about nutritional supplements (vitamins)
Use of the Malnutrition Universal Screening Tool
Recommendation of OTC supplements

6. What is our contribution?
 Highlight the foods that have the greatest impact on their disease state so
that they know what affects their bodies. “Simple carbohydrates and
sugar affect diabetes the most. Saturated fat and cholesterol will affect
heart disease. Sodium and salt affect hypertension. Potassium, protein,
phosphorus, and sodium affect chronic kidney disease patients.”
 Education about nutrition can help patients reduce their reliance on
medications and supplements and aid in deprescribing.
 Patients may be exposed to misinformation and bad advice. For example,
despite what they see in magazines, online, or on social media, patients
need to know that their bodies require all macronutrients to function
properly. “That includes carbohydrates,”.

7. When we educate people and patients
about what do they eat?
1-Over weight people
2-low weight people
3-low energy people
4-Infants feeding
5-Chronic disease patients
6-Pregnants need
7-Food supplements and vitamins
8-Hydration importance
9-Food-drug interaction
10-Herbs
11-Food Allergy

8. 1-Over weight people
Specifically, excess weight is a major risk factor for cardiovascular disease, Type 2
diabetes, some musculoskeletal conditions and some cancers.
 The pharmacist must provide patient with information on how to lose weight
safely, set realistic weight loss goals, and provide extra support if you are trying
to lose weight.
The pharmacist can advise you on medicines or diets designed to assist with weight
loss, or whether a certain product is right for each patient.
The pharmacist may be able to offer the patient the following additional services to
assist in weight loss or management of risk factors associated with obesity:
 Weight management service, tailored to meet individual needs
 Risk assessment and screening services for:
-Cardiovascular diseases
-Diabetes

9. 2-low weight people
 People may ask the pharmacist advice to gain weigh if they are underweight (body mass index is
less than 18.5).
 To gain weight, you need to eat more calories than your body uses each day.
Such advices may include:
 Eat more frequently. When you're underweight, you may feel full faster. ...
 Choose nutrient-rich foods. ...
 Try smoothies and shakes. ...
 Make every bite count. ...
 Top it off. ...
 Have an occasional treat. ...
 Exercise.

10. 3-low energy people
Nutrition throughout the lifecycle Nutrition requirements change over our lifespan.
“Obviously, we require NUTRITION the most kcal/kg when we are infants, child, and
adolescent,”. “As we age, our overall kcal needs decrease due to lack of activity and loss
of muscle mass.”
What are calories?
 Calories are a measure of how much energy food or drink contains. The amount of
energy you need will depend on:
 your age – for example, growing children and teenagers may need more energy
 your lifestyle – for example, how active you are
 your size – your height and weight can affect how quickly you use energy
 Other factors can also affect how much energy you burn. For example:
-some hormones (chemicals produced by the body) – such as thyroid hormones
-some medicines – such as glucocorticoids, a type of steroid used to treat inflammation
-being unwell

11. What should my daily intake of calories be?
 An ideal daily intake of calories varies depending on age,
metabolism and levels of physical activity, among other
things.
 Generally, the recommended daily calorie intake is 2,000
calories a day for women and 2,500 for men.
 Calorie Calculator
The Calorie Calculator can be used to estimate the number of
calories a person needs to consume each day. This calculator
can also provide some simple guidelines for gaining or losing
weight.
25

13. What about me????
Maintain weight
2,891 100%
Calories/day
Mild weight loss
0.25 kg/week
2,641 91%
Calories/day
Weight loss
0.5 kg/week
2,391 83%
Calories/day
Extreme weight loss
1 kg/week
1,891 65%
Calories/day

14. What are Macronutrient?
 Macronutrients are the nutrients that provide us with
the energy (measured in calories) needed by our bodies
for growth, metabolism and other functions. The prefix
“macro” means large; macronutrients are needed in
large quantities in contrast to micronutrients (vitamins
and minerals).
 Proteins, fats and carbohydrates make up the group of
macronutrients. Let us take a moment to briefly look
at each of these macronutrients.

15.  Carbohydrates: These are a major source of energy for our bodies and are
stored in our muscles and liver for later use. Foods that contain large
amounts of carbohydrates include fruits, grains (rice, oats, barley, etc)
and roots (potatoes, yams, carrots, etc). Carbohydrates provide 4
Calories of energy per gram.
 Proteins: Our bodies use proteins to grow tissue and muscle, repair
organs and to create hormones and enzymes; proteins are also used for
energy when carbohydrates are unavailable. Foods that contain high
levels of protein include poultry, fish, beans, diary, nuts and
legumes. Proteins provide 4 Calories of energy per gram.
 Fats: In order to absorb vitamins, our bodies need fats. Foods that
contain a high percentage of fat include cooking oils, butter, nuts and
cheese. Of the three macronutrients, fats contain the highest number of
calories per gram; fats provide 9 Calories of energy per gram.

16. Macronutrient requirements also change. Children ages 1
through 3 require 30% to 40% of total kcal from fat, 5% to 20%
from protein, and 45% to 65% from carbohydrates. From 4 to 18
years, kids should get 25% to 35% of total kcal from fat, 10% to
30% from protein, and 45% to 65% from carbohydrates. People
ages 18 or older require 20% to 35% total kcal from fat, 10% to
35%from protein, and 45% to 65% from carbs
Micronutrients like calcium (women need more), vitamin D
(men and women get different benefits), fiber (men need
more), and B vitamins (men need more) tend to be more age-
and gender-specific

17. 4-Infants feeding
Pharmacists must first educate pregnants and mothers with the
golden advices:
-breastmilk is the normal and optimal food for infants
-breastfeeding is an important immediate and long-term preventive
health care measure for child and mother
-increased breastfeeding initiation and duration will result in a
healthier Canadian population and lead to lower health care costs
-breastfeeding provides food security and an economic advantage for
families
-health care providers have a responsibility to promote the initiation
of, and encourage continuance of, exclusive breastfeeding to six
months

18. But not all infants are breastfed!!!
pharmacists who sell breastmilk substitutes and baby food must have enough
knowledge in the nutritional content, proper choice and use of these and
ancillary breastfeeding supplies
Nutrients in Formula
Most infant formulas today are made from cow's milk. They are fortified to make
them as close to breast milk as possible, and to give babies all the nutrients they
need to grow and be healthy.
Most cow's milk formulas contain:
Carbohydrates, in the form of the milk sugar "lactose"
Iron
Protein
Minerals, such as calcium and zinc
Vitamins, including A, C, D, E, and the B vitamins

19. 5-chronic disease patients
Diabetics : Carbohydrates in food
According to the CDC, people living with diabetes should get about 45% of their
total calories each day from carbohydrates.
For females, they recommend 3–4 servings of carbohydrates, at 15 grams (g) per
serving. For males, they recommend a slightly higher amount of 4–5 servings.
This is equivalent to 45–75 g each meal.
Many foods contain carbohydrates. According to the CDC, some common sources
of carbohydrates include:
• grains and foods that contain grains, such as bread, cereal, and pasta
• fruits and fruit juice
• dairy including yogurt, milk, and cheeses
• starchy vegetables, such as potatoes and corn
• beans, legumes, and peas
• soft drinks and sports drinks
• snack foods and desserts

20. However, some types of carbohydrates are more beneficial than others
for people with diabetes. According to the ADA, there are three broad
types of carbohydrate that deserve particular attention:
• Sugar: This includes sugar from sugar cane, honey, fruits, and dairy
products. Sugars can occur naturally in food, or manufacturers may
add sugar to foods.
• Starch: Foods high in starch include starchy vegetables, beans, and
refined and whole grains.
• Fiber: Foods that are high in fiber include fruits, vegetables,
whole grains, nuts, beans, and legumes.
The ADA recommend that people get most of their carbohydrates from
unprocessed carbohydrate sources, such as whole grains and
vegetables, rather than white bread or baked goods.

21. How to determine how many carbs is best?
A person can find out the most suitable amount of carbohydrates for
them by counting them. Counting carbohydrates can help someone
understand how many carbohydrates they need to eat to reach their
target blood sugar level.
To count carbohydrates, a person needs to:
1. learn which foods contain carbohydrates
2. take note of the carbohydrates on the food label, or look them up
online
3. add the gram measurements together to calculate the total for each
meal and each day

22. What is your answer if a client asked
you the following question?
Can I get diabetes from
eating too much sugar?

23. Sugar intake recommendations
The body needs glucose to function. Glucose is widely present in food
and therefore impossible to avoid. However, there is no need to add
extra sugar to snacks or meals.
Sweetened sodas, candy, and processed foods are particularly
harmful.
The American Heart Association (AHA) recommend the following
limits on added sugars each day:
• For the average male: No more than 9 teaspoons, 36 grams, or
150 calories from sugar.
• For the average female: No more than 6 teaspoons, 25 grams, or
100 calories from sugar.

24. 7-pregnants need
When building your healthy eating plan, you’ll want to focus on whole
foods that give you higher amounts of the good stuff you’d need when
not pregnant such as:
 protein
 vitamins and minerals
 healthy types of fat
 complex carbohydrates
 fiber and fluids

25. 13 Foods to Eat When You’re Pregnant
1.Dairy products
2. Legumes
3. Sweet potatoes
4-Fish (Salmon)
5. Eggs
6. Broccoli and dark, leafy greens
7. Lean meat and proteins
8.Berries
9. Whole grains
10. Avocados
11. Dried fruit
12. Fish liver oil

26. QUICK TIPS FOR FOODS TO EAT WHEN PREGNANTDairy products,
especially yogurt, are a great choice. They help you meet increased
protein and calcium needs.
 Legumes are super sources of folate, fiber, and many other
nutrients. Folate is a very important nutrient during pregnancy.
 Sweet potatoes are an excellent source of beta carotene, which
your body transforms into vitamin A. Vitamin A is important for the
growth and differentiation of cells in your growing baby.
 Salmon contains the essential omega-3 fatty acids EPA and DHA,
which are important for brain and eye development in your
growing baby. It’s also a natural source of vitamin D.
 Whole eggs are incredibly nutritious and a great way to increase
your overall nutrient intake. They also contain choline, an
essential nutrient for brain health and development.

27.  Broccoli and leafy greens contain most of the nutrients that you’ll need.
They’re also rich in fiber, which may help prevent or treat constipation.
 Lean meat is a good source of high-quality protein. Beef and pork are also rich
in iron, choline, and B vitamins, all of which are important nutrients during
pregnancy.
 Berries contain water, carbs, vitamin C, fiber, vitamins, antioxidants, and plant
compounds. They may help you increase your nutrient and water intake.
 Whole grains are packed with fiber, vitamins, and plant compounds. They’re
also rich in B vitamins, fiber, and magnesium.
 Avocados contain high amounts of monounsaturated fatty acids, fiber, folate,
and potassium. They may help relieve leg cramps, too.
 Dried fruit may be highly beneficial for pregnant women since they’re small
and nutrient-dense. Just make sure to limit your portions and avoid candied
varieties, to prevent excess sugar intake.
 Drinking water is important as your blood volume increases during pregnancy.
Adequate hydration may also help prevent constipation and urinary tract
infections.

28. 8-Food supplements and vitamins
Let us take Vit D as an example:
Foods that provide vitamin D include:
 Fatty fish, like tuna, mackerel, and salmon.
 Foods fortified with vitamin D, like some dairy products, orange juice, soy milk,
and cereals.
 Beef liver. Cheese. Egg yolks.
Three ounces of cooked salmon has about 570 international units (IU).
How Much Do You Need?
 Age 1-70: 600 IU
 Age 71 and older: 800 IU
 People who don’t eat fish should know that seafood is not the only source of
vitamin D. Whole eggs are another good source, as well as a wonderfully nutritious
food.
 While most of the protein in an egg is found in the white, the fat, vitamins, and
minerals are found mostly in the yolk.
 One typical egg yolk contains 37 IU of vitamin D, or 5% of the DV

29. Vitamin D intake is recommended at 400–800 IU/day, or 10–
20 micrograms. However, some studies suggest that a
higher daily intake of 1000–4000 IU (25–100 micrograms)
is needed to maintain optimal blood levels
Current guidelines say adults shouldn't take more than the
equivalent of 100 micrograms a day. But vitamin D is a 'fat-
soluble' vitamin, so your body can store it for months
and you don't need it every day. That means you could
equally safely take a supplement of 20 micrograms a day or
500 micrograms once a month

30. 9-Hydration importance :
“Patients should drink plenty of water—minimum 16 oz in
the morning, 16 oz at lunch, 16 oz at dinner, and 16 oz
before bed,”
“Many times, we may think we have a headache, but we’re
actually dehydrated.” It’s okay to add fresh fruit to water to
change its flavor, and carbonated water counts too.
Adequate hydration can improve mood and sleepiness—and
help kick the caffeine habit. It can also help with weight loss
and maintenance and curtail overeating.

31. 10-Food-drug interaction
Pharmacists should tell patients about possible food–drug
interactions and how to manage them. For example, green
leafy vegetables and other foods that contain vitamin K can
have an effect on efficacy of warfarin therapy.
Grapefruit and grapefruit juice can affect the concentration
of CYP3A4 inhibitors, such as statins and some calcium
channel blockers.
Calcium binds to certain antibiotics and can make them
ineffective. Using alcohol and acetaminophen can be
dangerous because both are metabolized by the liver

32. 11-Herbs
"herb" refers to any green or leafy part of a plant used for seasoning and
flavoring a recipe, but not used as the main ingredient. What exactly does
this mean?
Here's an example: Spinach is the green part of a plant, but spinach is a
vegetable, not an herb because spinach is prepared as a food itself, not
merely to add flavoring to another food. Similarly, a leaf of lettuce is the
green part of a plant, but when you make a salad, the lettuce is the main
ingredient, so lettuce isn't an herb either.
So What Exactly Is an Herb?
Herbs are plants with fragrant or aromatic properties. Herbs can be used
to flavor food, included in fragrances, and even a part of natural
medicines. Basil, parsley, rosemary, thyme, and dill are all herbs. Note
that for each of these, the herb is the green or leafy part of some kind of
plant. In the case of basil, the leaves can be quite large, whereas
rosemary leaves are more like spines of an evergreen plant.

33. 12-Allergy
Milk, egg, wheat, soy, crustacean shellfish, tree
nut, and peanut (Arachis hypogea) are the foods
most commonly associated with FA in the United
States.
Onset typically occurs in childhood, except for
shellfish, which more often begins in adulthood.
Children regularly develop tolerance to the common
food allergens before adulthood, with the exception
of tree nuts and peanut.

34. Some Pharmacists Comments from Real
Pharmacy Work
 “I often ask patients if they take their nutritional supplements (e.g., Fortisip)
and they often admit to not tolerating them and not being fully compliant”.
 “Insufficient review and follow-up, or when changes are made wastage of
prescribed supplements when new ones introduced”.
 “Use of sip feeds and nutritional supplements is very expensive but seems to
be poorly managed”.
 “Nurses and doctors do not really give advice apart from telling people to
take a supplement, or just prescribe them Complan or Ensure and that’s it”.
 “Seems to be infrequent reviews and no follow up if patients actually use
supplements appropriately”.

35.  More training “I don’t think pharmacists are able to advise or comment at all appropriate
supplements for patients”.
 “Pharmacists are not given adequate training on these products”.
 “I know very little about PEG feeding but these patients and their families naturally still expect
advice when they are lifting their prescription items”.
 Education
 Interprofessional “A lot of the blame lies with dieticians. They rarely reach out to educate
other professionals and allow charlatan nutritionists to propagate nonsense”.
 “Due to insufficient knowledge base and poor, if any, contact between community dietician
team and pharmacist”.
 “GPs and community pharmacists need to work together to promote good nutrition, weight loss
and a healthy lifestyle and diet”.
 “Not enough emphasis on the information and advice pharmacists could provide for patients”.

36.  “I would be concerned about evidence for certain baby milk prescribed by GPs;
it seems to me that the company reps decide what patients get—not the
independent experts”.
 “Infant nutrition advice is limited as the training provided is usually by the
formula milk companies so is biased”.
 More training “Lack of knowledge”.
 “Feel it is an important area we can recommend for health promotion but
confidence in our knowledge is lacking”.
 “I always refer to a dietician as I do not have sufficient knowledge to advise”.
 “Neither doctors or pharmacists are properly trained on nutrition”.
 “I think there is a lot of education to be done and that poor nutrition is
contributing to ill health in many of our patients”.
 “I believe many health professionals are missing opportunities to intervene in
patient nutrition”.
 “Nutritional problems need to be addressed more proactively. Pharmacy needs
to step up a gear to accommodate the public desire for more evidence-based
education”.