Download Dialysis And Fad diets - Heartland Kidney Network

1/24/2014
FAD DIETS
What’s hot right now?
How do they affect our patients?
OBJECTIVES
• Obesity in the U.S. – facts and stats
• The Diet Industry
• Fad Diets, Top 5
• Potential Implications for the Dialysis Patient
OBESITY
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OBESITY
OBESITY
OBESITY
• History of Obesity
• Dramatic increase in U.S. from 1990 – 2010
• Historical information
• Healthy People 2010 – no state met goal
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OBESITY
OBEISTY
• 35.7% U.S. adults are obese
• >60% U.S. adults are overweight or obese
• 17% youth < 19 y/o are obese
• > 60 y/o more likely to be obese
• No discrimination between men and women
http://www.cdc.gov/obesity/data/adult.html
OBESITY
• Trend for men and women from 2000 – 2010
• Men 27.5% - 35.5%
• Women 33.4% - 35.8%
• Trends for youth from 2000 – 2010
• Boys 14.0% - 18.6%
• Girls 13.8% - 15%
• Obesity in children defined a BMI greater than or equal to the age- and sex-specific
95th percentile of the 2000 CDC growth charts.
http://www.cdc.gov/obesity/data/adult.html
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OBESITY
• Highest rates of obesity
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Non-Hispanic African-American men 49.5%
Mexican Americans 40.4%
All Hispanics 39.1%
Non-Hispanic whites 34.3%
JAMA 2012;307(5):491-497
http://www.cdc.gov/obesity/data/adult.html
• Socio-economic relationship
• Highest obesity rates among non-Hispanic black and Mexican-American men with
higher incomes
• Higher income women are less likely to be obese
• No relationship between education and obesity among men
• Women with college degrees are less likely to obese
• Between 1988 – 2008 obesity increased in adults at ALL income and education levels
OBESITY
THE PRICE WE PAY….
$147 BILLION ANNUALLY
$1429 MORE THAN NORMAL WEIGHT INDIVIDUALS
http://www.cdc.gov/obesity/data/adult.html
THE COST TO OUR HEALTH….
Coronary Heart Disease, Stroke, HTN, Diabetes type 2, Cancers (endometrial, breast,
colon), High Cholesterol, High Triglycerides, Liver and Gall Bladder Disease, Sleep
Apnea and Respiratory Problems, Osteoarthritis, Infertility and Reproductive Health
Problems, and Mental Health Conditions
THE DIET INDUSTRY
• Over $40 billion spent on dieting
• Over 50% of women on a diet at a given time
• Average diet lasts 42 days
• Only 5-10% maintain significant weight loss
• Dieting becomes addictive and contagious
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THE DIET INDUSTRY
• Long-term successful weight reduction…does it happen?
• Enter the FAD DIET
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Lots of promises
Tell us what we want to hear
Feed the obsession
Quick weight loss
Too good to be true
Help see a product
Lack valid scientific research to support claims
Lists of good and bad
DO YOU REMEMBER
• 1900’s Fletcherism
• 1988 Optifast Liquid Diet
• 1920’s Calorie Counting
• 1991 Protein Power
• 1930’s Hay Diet
• 1991 Fen Phen Diet pill
• 1960 Drinking Man’s Diet
• 1995 Enter The Zone
• 1967 Dr. Stillman’s Diet
• 1997 Fen Phen pulled from market
• 1972 Dr. Atkin’s Diet Revolution
• 1997 Blood Type Diet
• 1973 Richard Simmons Fitness Guru
• 2000’s Dukan Diet
• 1978 Scarsdale Diet
• 2002 The New Atkin’s Diet Revolution
• 1979 Pritikin Diet
• 2005 South Beach Diet
• 1980 Beverly Hills Diet
• 2012 Fasting Diet
SO WHAT’S HOT RIGHT
NOW?
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DIETS A – Z
• African Mango * Alkaline Diet * Alli * Atkins * Baby Food Diet * Belly Fat Cure *
Best Life Diet * Big Breakfast Diet * Biggest Loser Diet * Biggest Loser Simple
Swaps * Body for Life * Brown Fat Revolution * Cabbage Soup Diet * Carb
Lovers Diet * Paleo Diet * Cheater’s Diet * Cinch Diet * Cookie Diet * Detox
Diets * DHEA * The Diet Solution * Dr. Oz Ultimate Diet * Dr. Phil’s Ultimate
Weight Solution * Dukan Diet * The Eat-Clean Diet * Eat more, weight less? *
Eat Right for your Type * Eat this, Not that * Eat What you Love * Eco Atkins
Diet * Fast Food Diet * Fat Smash Diet * Flat Belly Diet * Flexitarian Diet * 5
Factor Diet * Flavor Point Diet * 4 Day Diet * Fruit Flush Diet * French Women
Don’t Get Fat * Fresh Diet * The FullBar Diet * G Free Diet * Gene Smart Diet *
Glycemic Index Diet * Grapefruit Diet * Hallelujah Diet * Hcg Diet * High
School Reunion Diet * The Hormone Diet * Hydroxycut * Instinct Diet * Jenny
Craig * The Kind Diet * LA Weight Loss * Lemonade Diet * Living Low Carb
DIETS A - Z
• Macrobiotic Diet * Martha’s Vineyard Diet Detox * Master Your Metabolism *
Mayo Clinic Diet * Mediterranean Diet * Morning Banan Diet * NaturallyThin
diet * New Stkins for a New You * New Beverly Hills diet * Nutrisystem Diet * 02
Diet * Dr. Ornish Diet * Park Avenue Diet * Perricone Diet * Personality Type
Diet * P.I.N.K Diet * Pritikin Principle * Protein Power * Raspberry Ketones * Raw
Food Diet * Rice Diet Solution * The 17 Day Diet * Shangri-La Diet * Skinny
Vegan Diet * Slim-Fast Plan * Sonoma Diet * South Beach Diet * South Beach
Diet Supercharged * The Spectrum * Step Diet * Sugar Busters * Thin for Life *
This is Why you’re Fat * 3 Day Diet 3-hour Die * 5:2 Diet * UltraMetabolism Diet
* Volumetrics * What Color is your Diet?* The Weigh Down * Weight Loss Cure
* Weight Watchers * Dr. Andrew Weil * You – On a Diet * Yoli * The Zone
THE DIET INDUSTRY
THE GREAT AND POWERFUL OZ
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DR. OZ
• Raspberry ketones
• 100 mg / day up to BID
• Helps body regulate metabolism thru adiponectin
• Garcinia Cambogia
• JAMA. 1998;280(18):1596-1600. doi:10.1001/jama.280.18.1596
• J Obes. 2011; 2011: 509038.
• Green Bean Coffee Extract
• Chlorogenic acid is fat blocking. Claims nearly caffeine free. Increases fat
metabolism in the liver. Works to “melt away the fat”
• 2 week Rapid Weight Loss Program
DR. OZ
ELIMINATE
• No wheat (1/2C brown rice only)
• No artificial sweeteners & soda
• No white sugar
• No alcohol
• No caffeine (only green tea)
• No diary (only Greek yogurt)
• No additional exercise
• No meals 8pm-8am
WHAT YOU CAN EAT
• All the low GI vegetables you want
• Hot lemon water
• Breakfast smoothie
• Probiotics
• Low GI veggie soup (detox broth)
• MVI
• After 2 weeks
• Unlimited meats and nuts
• No over eating carbs
DR. OZ
• Other Things To Do..
• Take probiotic in the morning
• Take a multivitamin ½ in morning and ½ at night
• Detox bath every night
• Soak with 2 cups Epsom salt & 1 cup baking soda
• Breakfast Smoothie
2 tbs rice protein powder
½ c frozen berries
2 tbs ground flaxseeds
½ banana
1 c unsweetened vanilla almond milk
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MEDITERRANIAN DIET
Mediterranean Diet
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A mix of traditional eating habits of people living in the Mediterranean region
Natural, unprocessed foods like fruits, vegetables, whole grains and nuts
Olive oil
Decrease red meat
Low to moderate amounts of fish
1-2 glasses of wine per day ☺
Basics – lots of fruits and veggies, whole grains, legumes, nuts. Fish 2-3 time per
week.
MEDITERRANEAN DIET
MEDITERRANEAN DIET
• Sample Menu
• Breakfast
• Greek yogurt topped with berries and walnuts; coffee or tea
• Lunch
• Lentil soup with swiss chard topped with taziki sauce; hummus and pita
• Snack
• Whole grain crackers and cheese
• Dinner
• Roasted cod with wheat berry salad including olive oil vinegrette, feta, parsley, and
tomatoes. Red wine.
• Dessert
• Fresh fruit drizzled with honey
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MEDITERRANEAN DIET
• Weight loss occurs because…
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Increased fiber from fresh fruit and veggies
Legumes 8 times per week
Whole grains
Low fat dairy
Olive oil limited to a tablespoon per day
Fish eggs poultry limited to no more than 2 servings per week each
No sugar. Honey for sweetener
30 minutes moderate physical activity daily
Very high in food that are nutrient dense and high in phytochemicals
MEDITERRANEAN DIET
Implications
• High in potassium and phosphorus
• Diet is rich in many fresh fruits and veggies, legumes, whole grains, nuts, avocados
• Low in HBV protein
• Would need to plan mixed plant based protein sources for protein
PALEO DIET
What is it based on?
• Modern foods that mimic the foods of our pre-agricultural, hunter-gatherer
ancestors
• 7 fundamental characteristics which will optimize health, minimize risk of
chronic disease and decrease weight
• 1) higher protein intake – 19-35% meat, seafood, animal products
• 2) lower carbohydrate and glycemic index foods – non-starchy fruits and
vegetables 35-45%
• 3) higher fiber intake – not from whole grains. Fiber is essential for god health
• 4) moderate to higher fat intake (mono, poly, omega-3 -6) – it is type of fat not
total amount of fat
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PALEO DIET
• 7 Fundamental Characteristics
• 5) higher potassium and lower sodium intake – unprocessed foods contain 5-10
times more potassium than sodium
• 6) net dietary alkaline load that balances dietary acid – excessive dietary acid
may promote bone and muscle loss, HTN, and increased risk of kidney stones
• 7) higher intake of vitamins, minerals, antioxidants, and plant phytochemicals –
whole grains contain no vitamin C, A or B12. other minerals and some B vitamins
in whole grains are not well absorbed by the body
PALEO DIET
• Includes
• Tree nuts
• Meats in large quantities
• Natural fats/oils: animal fat,
coconut, walnut, flax, olive oils
• Some fruits
• Vegetables
• Tubers
• Honey or agave
• Excludes
Potatoes
Dairy and milk
Processed grains
Peanuts, lentils, beans, peas, and
other legumes
• Alcohol, fruit juice and coffee
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PALEO DIET
Implications
• 50-65% animals foods many high in fats
• Would need regular follow up with regard to potassium
• Does decrease processed foods high in sodium
• Low in fiber potentially
• Potential for calcium and B-vitamin definicienies
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PALEO DIET
• REALITY
• We DON’T know what our stone age ancestors ate!
• Paleo suggested we are not evolved enough to digest grains and dairy
• Stone age ancestors had to travel to find food
WHEAT BELLY DIET
Lose the Wheat, Lose the Weight and The Wheat Belly Cookbook
• Premise:
• All modern wheat, which is referred to as “Frankenwheat” is toxic and as addictive
as many drugs, and it makes you want to eat more food, especially junk foods.
Proposes that wheat has been genetically modified to the point that our body
cannot digest it
TOXIC
ADDICTIVE
POISONOUS
• Eliminates all things with wheat and gluten
• Puts caution with potato, rice, and corn flours for their potential to cause the
“MUFFIN TOP”
• HEALTH TRANSFORMATION “PROOF”
WHEAT BELLY DIET
Eliminating “Frankenwheat” has potential health benefits including….
• acid reflux, acne, ADHD, alopecia areata, asthma, atherosclerosis, autism,
bloating, brain fog, breast cancer, cancer, cataracts, celiac disease,
cramps, dementia, dermatitis herpetiformis (DH), diabetes, diarrhea,
elevated estrogen levels, erectile dysfunction, food addiction, gangrene,
gas, glycation, gynecomastia, heart disease, incontinence, irritable bowel
syndrome, kidney disease, mouth sores, overweight/obesity, osteoporosis,
overweight, peripheral neuropathy, pH imbalances, psoriasis, rashes,
rheumatoid arthritis, schizophrenia, seizures, ulcerative colitis, ulcers, vitiligo,
wheat-dependent exercised-induced anaphylaxis (WDEIA), wheat-induced
cerebellar ataxia, wrinkles
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WHEAT BELLY DIET
FOODS ALLOWED
• Organic vegetables or WASH thoroughly eat any time of the day (Except potatoes and corn)
• Organic diary and full fat cheese
• Fish and Shellfish
• Organic meat and poultry NO processed or cured meats
• Any kind of eggs including yolks
• Fats: healthy oils use generously including avocado, olive, coconut, flax, walnut, macadamia, sesame
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Butter -organic and use lightly
Wheat free and gluten free flours
No gluten free junk carbs
Nut flours, chickpea, coconut, flax flours
• Spices and herbs
• Stevia xylitol or splenda
• Water, tea, almond or coconut milk, coconut water, coffee
WHEAT BELLY DIET
• Grocery shopping tips
• Buy single-ingredient natural foods found in the produce aisle, butcher shop,
and farmers’ market that don’t require labels
• Ignore all claims of “heart healthy,” “low-fat,” “low in cholesterol,” “part of a
balanced diet,” etc
WHEAT BELLY DIET
FOODS TO LIMIT OR AVOID
• Non cheese dairy
• Fruits
• Wheat & gluten grains may - limit nonwheat & nongluten grains to very small
amounts
• Legumes
• Starchy vegetables
• Sweets, chocolate, processed items, multiple ingredient foods
• Unhealthy oils hydrogenated and trans fats, polyunsaturated, fried meats
• Alcohol
• Allowed – limit wine to 2 glasses, 2 cocktails, or 1 higher-carb beer. Gluten free beer,
wine, brandy, cognac, liqueurs, rum and some vodkas.
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WHEAT BELLY DIET
Implications
• High maintenance
• A lot to learn and foods lists!! Good’s Bad’s and Maybe’s
• Higher in potassium by design
• Obvious lack of nutrient from the grains and fruits
• Vitamin supplement
• Phosphorus in nuts and flour choices
HCG DIET
THE PROMISE
• Take hCG, the hormone the body makes during pregnancy, and lose a lot of
weight.
• hCG, human chorionic gonadotropin, and an ultra-low-calorie diet will “reset
your metabolism” without feeling hungry or week.
HCG DIET
What You Need To Do
• Limit daily caloric intake to 500 for 8 weeks.
• Take hCG injection, or OTC homeopathic products in oral drops, pellets, or sprays
Foods Allowed
• Meats broiled or grilled
• Veal, beef, chicken breast, fresh white fish, lobster, crab, or shrimp. Cannot eat any visible fat
• Vegetables
• Spinach, chard, beet greens, chicory, green salad, tomatoes, celery, fennel, onions, red radishes,
cucumbers, asparagus, cabbage
• Bread - ONE breadstick or ONE piece of melba toast
• Fruit
• AN…orange, apple, handful of strawberries or half a grapefruit
• Dairy – UP TO 1 tablespoon of milk per day
• Beverages – ALL the water, coffee and tea you want
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HCG DIET
Implications
• hCG injection are legal, but NOT approved by the FDA for weight loss
• hCG likely has nothing to do with the weight loss, and the 500 calorie per
day restriction has everything to do with it
• Most very low calorie diets are recommended by a doctor and carefully
supervised for cases of obesity and medical conditions
• Very difficult to stick with uncomfortable
• Deficient in nutrients, vitamins, minerals and protein
• Supplementation would be needed
• Main vegetables allowed are high in potassium
THE MAYO CLINIC DIET
Proclaims the following:
• A weight loss and lifestyle program
• Designed by mayo clinic health experts
• Lifelong approach to help improve weight and maintain a healthy weight
THE MAYO CLINIC DIET
Purpose
• Teaches how to lose excess weight
• Teaches eating changes for a lifetime
• Teaches you how to choose healthy foods and portions
Declares
• Making healthy changes can reduce risk of weight –related health problems
such as diabetes, heart disease, high blood pressure and sleep apnea
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THE MAYO CLINIC DIET
Why follow the Mayo Clinic Diet?
• Enjoy the types of foods featured
• Desires overall improvement to eating habits
• Learn how to change unhealthy lifestyle habits
• Learn to form new healthy habits
• Seeks improvement to health and reduction in healthy risks
• Looking for a program that can be maintained for life
• Wants a diet designed my medical professionals
THE MAYO CLINIC DIET
• Not a One-Size Fits All
• 2 Main Parts
• Lose it!
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2 week phase to jump start weight loss
Goal 6-10 lbs weight loss
Focus on lifestyle habits to break and add
Includes at least 30 mins of physical activity daily
• Live it!
• Learn more about food choices, potion sizes, menu planning, maintaining new habits
• Continue weight loss of 1-2 lbs per week
• Goal setting for long-term healthy eating patterns and success
THE MAYO CLINIC DIET
THE FOODS and THE PLAN
• Focus on generous amounts of low calorie healthy foods – VOLUME
• Stresses fruits and vegetables
• Pyramid approach
• Includes whole-grain carbs, leans proteins, low-fat dairy, heart-healthy
unsaturated fats
• Portion size estimation and meal planning
• NO counting calories
• NO food eliminations
• 30 minutes of moderately intense exercise – MD approval
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THE MAYO CLINIC DIET
THE MAYO CLINIC DIET
• Breakfast. A fruit yogurt parfait (1 cup fat-free yogurt mixed with 1 serving
fruit).
• Lunch. 1 serving tuna and pasta salad (combine 1 can water-packed tuna,
4 cups cooked shell pasta, 2 cups diced carrots and zucchini, and 4
tablespoons low-calorie mayonnaise — serves 4); 1 small orange.
• Dinner. One-third of a 12-inch crust cheese pizza; green salad (2 cups lettuce
with 1/2 cup sliced tomatoes, red onions and mushrooms); 2 tablespoons fatfree salad dressing.
• Snack. 1 small apple, sliced.
• You can include a calorie-free beverage with each meal
THE MAYO CLINIC DIET
5 HABITS TO ADD
• 1) Eat a healthy breakfast
• 2) Eat fruits and vegetables
• 3) Eat whole grains
• 4) Eat healthy fats
• 5) MOVE!
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THE MAYO CLINIC DIET
5 HABITS TO BREAK
• 1) No TV while eating
• 2) No Sugar
• 3)No Snacks …..WHAT??
• 4) Moderate Meat and Dairy
• 5) No Eating at Restaurants
THE MAYO CLINIC DIET
• 5 BONUS HABITS
• 1) Keep Food Records
• 2) Keep Activity Records
• 3) Move More
• 4) Eat Real Food
• 5) Write You Daily Goals
THE MAYO CLINIC DIET
Implications
• Low in protein from HBV sources
• Legumes and phosphorus and potassium
• “unlimited” fruits and veggies may not work with dialysis population, would
need to be choose wisely
• Labor intensive. Homework.
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TOP RANKED DIETS
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1) DASH Diet - Dietary Approaches to Stop Hypertension
2) TLC – Therapeutic Lifestyle Changes
3) Mayo Clinic Diet
3) Mediterranean Diet
3) Weight Watchers
6) Flexitarian Diet
6) Volumetrics
8) Jenny Craig
9) Biggest Loser Diet
9) Ornish Diet
THE BIG PICTURE
• Each diet has at least some very healthy characteristics
• Not one single diet would match all the specific needs of the dialysis patient
• RD involvement
• Encourage the safe diet strategies in a diet and offer modifications
• If the diet helps to motivate them, work off that
• Evaluate their relationship with food
• Deprivation rarely equal long-term success. Starving makes it IMPOSSIBLE to be disciplined.
THE REALISTIC AND DELICIOUS DIET
My Personal Favorite
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THE RD DIET
Principles
• REAL FOOD
• Enjoy eating healthy
• Face Time - Actual one-on-one nutrition and health assessment
• Nutrition prescription tailored to individual for all areas of health concerns
• A live nutrition professional
• Fact not fiction
• Science and evidence based recommendations
• No “good” and “bad” foods
• No eliminating
• SUSTAINABLE
THANK YOU
Kay Taylor, RD LMNT
Hy-Vee Dietitian
[email protected]
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