Patient's Diet Discussion

After attending the Elluminate session or watching the recording:
Write a half page summary on any three special diets that some patients require.
Explain, which patients need these diets, and what foods they need to avoid, when on these special diets.

Dialysis patients; End stage renal disease; Hem dialysis - diet; Peritoneal dialysis: Most dialysis patients urinate very little, or not at all. Therefore, fluid restriction between treatments is very important. Without urination, fluid will accumulate in the body and cause excess fluid in the heart, lungs, and ankles. The purpose of this diet is to maintain a balance of electrolytes, minerals, and fluid in patients on dialysis. The special diet is important because dialysis alone does not effectively eliminate all wastes. These wastes can accumulate between dialysis treatments. Patients on dialysis need a high protein intake to maintain adequate nutrition. With a risk that a patient can become malnourished. The dialysis diet controls the intake of fluid, protein, sodium, potassium, and phosphorus. The controlled amounts of each of these nutrients are based on the person’s blood levels of these sources. Fluid restriction is based on the amount of urine output and weight gain between dialysis treatments. List of suggestive approach to Dialysis Patients:

Protein

Pre - Dialysis patients must limit protein intake to slow the progression of kidney disease. These changes with the start of dialysis, which in turn causes the patient to need more protein. Patients on peritoneal dialysis need even higher protein, because a large amount of protein can be lost in the peritoneal fluid which is discarded.

Sodium

Most patients need to control the sodium (salt) intake in their diet. This helps maintain fluid balance in the body to avoid fluid retention and elevated blood pressure (When the heart is Relaxed the sodium cells come in, when the heart contracts the sodium gets pushed out, and the potassium comes in) (You’ll learn this is Cardiopulmonary).

Potassium

The daily intake of potassium is also controlled. This helps prevent hyperkalemia (a high level of potassium).

Phosphorous

The mineral phosphorus is also controlled by this diet. Patients need to reduce their intake of dairy products, and other foods high in phosphorus. Calcium supplements, which bind the phosphorus in food. It is important to take these calcium tablets with meals. The amount of binders (Sometimes given as non-calcium phosphorus binder, such as Rena gel) that need to be taken by each patient is determined by their blood levels of phosphorus and their intake.

Fluids

During kidney failure, the amount of urine produced drops. Patients on peritoneal dialysis usually retain their urine output for a longer time and have less restriction on fluid intake (The urine output stops once patients have been on dialysis for more than 6 months). Based on the amount of urine produced in a 24-hour period, the amount of weight gained between dialysis treatments is the recommended daily amount of fluid (The amount of fluid retention, the level of dietary sodium, and whether the patient has congestive heart failure needs to be considered).

Vitamins

People with kidney disease are more prone to heart disease, and often need to follow a low-fat diet. Depending on the persons weight, protein status, and daily calorie intake needs to be maintained to prevent the breakdown of body tissue. Multivitamin, works really well for this condition. The fat-soluble vitamins (A, D, E, and K) are usually met by the diet. Vitamin D is supplemented depending on calcium, phosphorus, parathyroid hormone levels, and given intravenously during the dialysis treatment. Intake of water-soluble vitamins is inadequate, as water-soluble vitamins are lost during the dialysis treatment (Keep the patient hydrated).
Calcium and iron are monitored supplementation of daily intake. Depending on the patient’s blood calcium levels, it is given in the dialysis solution, and adjusted. Most dialysis patients are iron deficient (Iron supplementation is based on iron studies, usually monitored every 3 months).

Many experts speculate that claims of nutritional remedies and cures with food or dietary supplements are related to the “Placebo affect”. The ‘Placebo Effect’ is the patient’s perception of improved symptoms and well being. Regardless of evidence for actual physical improvement.

A Healthy Diet:

= Eat a ‘Variety’ of foods, do not be picky.
= Balance the food you eat with physical activities (Maintain or improve your weight).
= Choose a diet w/plenty of grain products and vegetables, and fruits.
= Choose a diet low in fat, saturated fat and cholesterol
= Be careful w/ sugar intake (Very little).
= Moderate alcoholic intake (If you must Red Wine is healthier).
= Malnutrition (You must eat, do not starve yourself).

Patients with RA (Rheumatoid Arthritis) are considered to be nutritional risks. Their ‘Poor’ nutritional status in this patient population is thought to be the result of the weight loss. Cachexia linked to Cytokine production (The production of Cytokines, such as Interleukin - 1, and tumor Necrosis factor). Chronic inflammation, increases resting metabolic rate and protein breakdown. Prolonged dosing of other RA medications may be associated with conditions such as gastritis or peptic ulcer, frequently reducing a person’s desire to eat (Most patients, are prescribed Medical Marijuana, so that they are forced to eat).

The most common Vitamin, Mineral deficiencies in patients with RA, are; Folic acid, Vitamin C, Vitamin D, Vitamin B6, Vitamin B12, Vitamin E, Calcium, Magnesium, Zinc and Selenium. Essential use of supplementation to assist in counterbalancing the outlined deficiencies and improving nutritional status for patients with RA (Supplementation of Calcium, and Vitamin D is recommended to decrease the risk of Osteoporosis).

Diet elimination therapy is a method of determining food hypersensitivities with patients. Elimination diets avoid a specific food or group of foods such as milk, meat or processed foods that are known to be prime allergies.

Dietary fatty acids such as Omega-3 fatty acids found in oils of fish and sea animals are of particular interest. In most of the studies using fish oils. It is important to note that fish oil supplements may interfere with blood clotting and increase the risk for stroke, consumed in conjunction with Aspirin, or other anti - inflammatory (Non - Steroid) drugs. Taking fish oils has also been linked to changes in bowel habits such as diarrhea (Causing an upset stomach). Omega-3 fatty acids, supplementation in the form of gelatin capsules is rather increased consumption of fish rich in Omega 3 fatty acids such as salmon, herring and mackerel is safer.

Patients who have Ameliorate, or Perpetuate arthritis, follow the US Dietary Guidelines for Healthy Americans and add a multiple vitamin - mineral supplement that contains 100% of the recommendations. Refrain from using a restricted diet in children with autism. (The statement is part of a larger consensus report on evaluating and treating gastrointestinal problems in children w/ Autism Spectrum Disorders) (Children with Autism are on gluten or Casein Free Diets).

Patients with Autism have a gluten-free, casein-free diet, which had no effect on autism symptoms, communication, or other measures after a period of time.

Autism Looked At:

•The prevalence of gastrointestinal problems in children with autism is still unknown, but estimates range widely, from 9% to over 70%.

•Gastrointestinal problems, such as chronic abdominal pain or diarrhea, may present as behavioral problems in autistic children.

Colonoscopy is a procedure used to see inside the colon (The colon and rectum are the two main parts of the large intestine.) and rectum (The rectum is about 6 inches long and connects the colon to the anus. Stool (BUTT) leaves the body. Muscles and nerves in the rectum and anus control bowel movements). This procedure can detect inflamed tissue, ulcers, and abnormal growths, bowel habits, abdominal pain, bleeding from the anus, and weight loss.

The doctor usually provides written instructions about how to prepare for colonoscopy. The process is called bowel prep. Solids must be emptied from the Gastrointestinal Tract by following a clear liquid diet for 1 to 3 days before the procedure. Patients should not drink beverages containing red or purple dye.

A laxative (Laxatives are usually swallowed in pill form or as a powder dissolved in water) or an enema (An enemy is performed by flushing water, or sometimes a mild soap solution, into the anus using a special wash bottle) may be required the night before colonoscopy. Patients should inform the doctor of all medical conditions and any medications, vitamins, or supplements taken regularly:

= Aspirin
= Arthritis medications
= Blood thinners
= Diabetes medications
= Vitamins that contain iron

The doctor and medical staff monitor vital signs and attempt to make patients as comfortable as possible. The doctor inserts a long, flexible, lighted tube called colonoscopies, into the anus; slowly guides it through the rectum, into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view (Don’t get excited this procedure is usually performed on men). A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. Once the scope has reached the opening to the small intestine, it is slowly withdrawn.

A doctor can remove growths, known as Polyps (Polyps are common in adults, and usually harmless. However, most colons - rectal cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer). The procedure, called Biopsy, allows the doctor to later look at the tissue with a microscope for signs of disease.

The doctor removes Polyps, and takes Biopsy tissue using tiny tools passed through the scope. If bleeding occurs, the doctor can usually stop it with an electrical probe or special medications passed through the scope. Tissue removal and the treatments to stop bleeding are usually painless.

If the Patient develops any side effects should contact their doctor immediately:

= Severe abdominal pain
= Fever
= Bloody bowel movements
= Dizziness
= Weakness

When hospitalized your diet might need to be restricted, or enhanced. If you just had surgery on a part of your digestive system, or been diagnosed with an ailment, your diet might need to be altered as well.

The most common diets prescribed for hospital patients are:

Clear liquid diet = Often used first after surgery. It includes liquids you can see through, such as; Broth, Popsicles, Jell-O, and Ginger Ale, any related types of liquids. This is used to digesting food again in preparation for shifting to a more normal menu.

Full Liquid Diet = Adds liquids made of dairy products, such as; Cream Soups, Milk, Pudding, Ice Cream, and Yogurt.

Therapeutic Diets = Are prescribed for patients with specific conditions such as heart disease or diabetes. Heart (Cardiac Diet = Encourages choices of; Fruits and Vegetables, Whole Grains, Lean Meats.) patients are sometimes restricted in the use of; Salt, Cholesterol, and Saturated Fat.

Diabetic Diets = Are normally low in sugar and fat, and the doctor prescribes a specific number of calories per day as well.

Low Sodium Diets = Are ordered for those with kidney disease or high blood pressure, because the kidneys help to regulate sodium, fluid in the body, and blood pressure.

Other types of Diets = Low Bacteria Diet (Well Cooked Foods, cleanliness of preparation, practices such as; not sharing food containers with other patients, Freshly made for chemotherapy patients (Including other conditions that suppress the immune system).

Bland Diets = this consists of food that is easy to digest because it is soft, easy to chew and not heavily seasoned such as; Cooked Fruit, Mashed Potatoes, Cottage Cheese, Grits, and Cream of Wheat.

Gastro paresis Diet = For Delayed Stomach Emptying, the stomach must contract to empty itself of food and liquid. Caused by; various conditions such as diabetes mellitus, certain disorders of the nervous system, or certain drugs. A viral infection is suspected in some. This is to reduce symptoms and maintain adequate fluids and nutrition.

"It's easy to buy into some pretty popular nutrition misconceptions: Myths and Half-truths that ultimately find us making far fewer healthier food choices than we realize," says New York University nutritionist Samantha Heller, MS, RD.

Mistake No. 1: Assuming your choices are better than they actually are.

Mistake No. 2: Being confused about carbohydrates.

Mistake No. 3: Eating too much.

Mistake No. 4: Not eating enough -- or often enough.

Mistake No. 5: Taking too many supplements.

Mistake No. 6: Excluding exercise.

Mistake No. 7: Believing everything you read about nutrition and weight loss.

Digesting food = the human body is like an Oil Refinery. Through a complex process the Enzymes in the food are broken up, the necessary nutrients are absorbed, and the waste products are excreted. A disruption in any part of this process can lead to deficiencies, diseases, or even death.

Disorders and diseases in the Digestive Tract:

= Gastro esophageal reflux disease (GERD)


= Gastritis and ulcers


= Irritable bowel syndrome (IBS)


= Inflammatory bowel disease - this includes ulcerative colitis and Crown’s disease


= Celiac disease


= Diverticulitis

Celiac Disease = is also known as celiac spruce, no tropical spruce, and gluten (Gluten is a protein found in wheat, rye, and barley) sensitive enteropathy. This effects the small intestine and its ability to absorb nutrients, resulting in deficiencies and health complications. With Celiac Disease your body reacts to gluten as if it were toxic, where this ends up damaging the Mucosal surface (The inner lining of the small intestine), causing the nutrients not absorb properly. Nutrients that include; vitamins, calcium, carbohydrates, protein, and fats.

Symptoms of Celiac Disease include (Peptic Ulcers falls into this category too):

= Gas

= Recurring stomach pain and bloating

= Diarrhea

= Constipation

= Weight loss/weight gain

= Fatigue

= Change in mood

= Pale, foul-smelling, or fatty stools

= Bone or joint pain

= Unexplained anemia

= Very itchy skin rash with blisters called dermatitis herpetiformis

= Muscle cramps

= Tingling numbness in the legs

= Pale sores in the mouth, called aphthous ulcers

= Osteoporosis

= Tooth discoloration or loss of enamel

= Failure to thrive in infants

= Delayed growth

Omitting patients with Gluten Diet = is the key to controlling Celiac Disease, strict dietary gluten elimination will heal the small intestine over time (weeks to months). It is imperative that your diet remains gluten-free. Any gluten in your diet will cause the damage to your intestine to reoccur.

Food and Beverages:

The CDC says listeriosis, a food-borne illness with mild flu-like symptoms that can be overlooked, can result in premature delivery, miscarriage, severe illness, or death of the baby. Heidi Murkoff, author of What to Expect When You're Expecting, concurs with the U.S. Department of Agriculture, which cautions that you not eat unpasteurized soft cheeses (and other unpasteurized dairy products), hotdogs, or lunch meat unless cooked. Cheeses made in the U.S. must be made from pasteurized milk (this process kills the listeria organism), so they are fairly safe. In March 2004, the FDA and EPA issued joint guidelines regarding eating fish during pregnancy. They advise women who are pregnant, nursing, or even considering having children to eat no more than two servings of fish each week in order to protect developing babies from high levels of potentially brain-damaging mercury. Every woman experiences different menopause symptoms. Most women have some hot flashes, some feel irritable, a smaller number of women battle headaches, nausea or night sweats. Remember, what works for one woman may not work for another, and what works for you now may not work as well a year from now.

= Certain foods are thought to trigger headaches.
= Dietary habits, like skipping meals, and not drinking enough fluids.

Causes of Migraines = Often, foods are triggers only when they are combined with other triggers. For example, they may act as triggers only when stress or hormonal changes are also at work.

Certain substances in food may cause changes in blood-vessel tone, bringing on migraines in susceptible people.

5 items, suspected of causing Migraines:

1. Chocolate.

2. Caffeine.

3. Alcohol.

4. Tyramine, may be found in:

5. Food additives such as nitrites/nitrates and MSG. Some consider certain food additives, including nitrites/nitrates and MSG (monosodium glutamate), to be common headache triggers.

Avoid High-Fat Diet = Believe it or not, changes in the level of certain fats circulating in your bloodstream coincide with the triggering of migraine headaches. The bottom line is that you want to lower the levels of blood lipids and free fatty acids in your bloodstream.

Step 1. Drink clear soda
Step 2. Flat Soda
Step 3. Clear Liquids
Step 4. Dairy Products

Whole grains, beans and legumes, nuts, fatty fish, and teas are just as important in offering all sorts of complex heart protective Phytonutrients (This applies to Breastfeeding patients too); Alcohol, Caffeine, Smoking