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Navigating Medium Protein Foods for People with Higher PHE Tolerances Laura Jeffers, MEd, RD, LD Cleveland Clinic 1 Confidential © Cleveland Clinic 2016 DOS CMEOxtober Course 2011 2014 2010 Disclosure Statement I am a paid speaker on the BioMarin PKU Speakers Bureau 2 DOS CME Course 2014 Objectives • Identify healthy eating pattern for Americans • Identify healthy eating opportunity for PKU population • Awareness of medium protein foods • Increase knowledge about ideas to incorporate medium protein foods into lifestyle How to eat healthy….. 4 DOS CME Course 2014 2015-2020 Dietary Guidelines for Americans (DGA) • Who created these? –United States Department of Health & Human Service (USHHS) –United States Department of Agriculture (USDA) What do these guidelines mean? • Recommendations on how to follow a nutritionally balanced diet Why were they created? • To promote health and prevent chronic disease for current and future generations Key Recommendations • Consume a healthy eating pattern that includes all food groups and beverages within proper calorie level • Healthy eating pattern includes: – Variety of colorful vegetables – Fruit – Grains – Fat free or low-fat dairy (PKU differences) – Variety of protein sources (PKU differences) – Oils DGA Key Recommendations • Healthy eating pattern cautions – Saturated fat – Trans fat – Added sugar – Sodium – Alcohol Recommended Eating Patterns • Healthy U.S. Eating Pattern • Healthy Mediterranean-Style Eating Pattern • Healthy Vegetarian Eating Pattern • All provide recommended amounts of food for each food group at 12 calorie levels Vegetable Recommendations • 2.5 cups – Men and women are not meeting – Fresh, frozen, canned, and dried – Dark green, red, orange; legumes, starchy – Cooked or raw – Vegetable juice Fruit Recommendations • 2 cups – At least 1 cup whole fruit – Most men & women are low – Whole fruit: – Fresh – Frozen – Canned fruit low in added sugar – Dried – 100% fruit juice without added sugar 12 DOS CME Course 2014 Grain Recommendations • 6 servings – At least half whole grain – Men and women are not meeting – Whole grains – Include the entire kernel made up of endosperm, bran, and germ – Oatmeal, brown rice, whole grain: bread, cereal, crackers, and pasta – Refined grains – The bran and germ are removed – Takes away the fiber, iron, and other nutrients – White: bread, rice, pasta; snack foods, cookies, cakes – Men and women consuming greater than recommended intake – Limit – Cookies, cakes, snack foods Dairy Recommendations • Milk, yogurt, cheese, and/or fortified soy drinks * – 3 cups per day – Most men and women are not meeting – Milk & Yogurt – Fat free or low-fat – Great source of calcium, vitamin D, potassium – Cheese – Higher in sodium, saturated fat – Lower in potassium, vitamin A & D – Choose milk and yogurt more than cheese • *PKU friendly alternatives available or formula here Protein Sources • Intact – Seafood – Lean meat – Chicken – Turkey – Eggs – Legumes (beans) – Nuts – Seeds – Soy • Synthetic: – Formula/milk – Metabolic food/low phe food Oil Recommendations • Not a food group – Replace solid fats – 5 teaspoons per day – Concentrated source calories – Most do no meet this – Source of essential fatty acids and vitamin E – Recommended plant based oils – Canola, olive, corn, peanut, safflower, soybean, and sunflower Added Sugar • Extra calories without essential nutrients • Sources – White, brown sugar – Honey – Corn syrup – Molasses • Limit to no more than 10% of calories • Read ingredient lists, also limit: – High fructose corn syrup – Corn sweetener – Dextrose – Glucose – Sucrose – Maltose Limit Trans Fat • Trans Fat – Avoid partially hydrogenated oils – Sources – Margarine – Snack foods – Prepared desserts – Association between trans fat and increased risk of CVD DOS CME Course 2014 Limit Saturated Fat • <10% of calories • Sources – Strong evidence suggests replace with unsaturated fat to lower cholesterol and reduce risk of CVD – Beef, pork, veal, lamb – Full fat milk, yogurt, cheese – Butter, lard – Pizza, burgers, sandwich 20 DOS CME Course 2014 Limit Cholesterol • Eat as little as possible – Body makes cholesterol, therefore do not need to obtain from diet – Foods high in cholesterol are also high in saturated fat Limit Sodium • <2,300mg per day – Average intake=3,440mg – Evidence shows association between increased sodium intake and increased blood pressure – Control portion and read nutrition facts labels 22 DOS CME Course 2014 Limit Alcohol • Not recommending those who do not drink start drinking – If alcohol is consumed, should be in moderation – 1 drink per day for women – 2 drinks per day for men – 1 drink equivalent » 12 ounces of beer » 5 fluid ounces of wine » 1.5 fluid ounces of distilled spirits – Avoid during pregnancy Eating Healthy with PKU What do you count, measure, track? • Mg phe • Grams of protein • Food records • Timing of medication • Other Method of tracking – help you? Healthy “Go To” Foods • Lets hear from the group on what foods they choose Formula/Milk • Usually the foundation of PKU diet – Provides essential nutrition for growth and development – Make sure to update your clinic if you are struggling with formula consumption Other Fluids • #1 choice = water! • Other options: – Cordials, soft drinks, juice (small amounts) = SUGAR!! – Tea and coffee (no milk) – Mineral and soda water Milk Substitutes • ProZero (vitaflo) • Rice or oat drinks • Cream +water (1T cream and 100ml water) • Coffee creamer (coffee mate + water…may need to count) • Vance’s DariFree • Milupa lp drink, LoProfin milk (Nutricia) Are you counting fruits and vegetables? Fruits and Vegetables to Count • Artichokes • Arugula • Asparagus • Avocado • Broccoli • Brussel Sprouts • Corn • Kale • Mustard greens • Swiss chard • Mushrooms • Peas • Potatoes • Seaweed or Nori • Spinach • Yams • Sweet Potatoes Fruits and Vegetables to Count • All dried fruit – Except apples, apricots, craisins, pears, prunes, raisins Free Fruits and Vegetables • All the other fruits and vegetables due to their low phe content – Healthy and important for your diet – Eat them throughout the day – Snacks – Part of meal Ideas for the diet • Add to breakfast meal • Eat as snacks • Make soups and casseroles • Incorporate salads into meals • Add salad ingredients to sandwiches • Use readymade sauces as base for meal • Ideas from NPKUA Low Protein Handbook Free Foods • Are they really that healthy? – Usually sugar-based – We should all limit the amount of added sugar we consume to be at our healthiest – Lead to tooth decay – Use as a treat instead of regular option – Jam, honey, syrup – Jelly (set w/ vegetable gum) – Lollies (without choc, gelatine, ice cream, milk or nuts) – Low pro chocolates Protein Intake / Phe tolerance • Phe tolerance may increase for various reasons • What do you do? Medium Protein Foods • Breads, Cereals, Starches, Grains and Snacks • 3-4 grams of protein – Dinner roll (1) – Couscous (1/2 cup) – Pillsbury crust (1/8) – Oatmeal Squares cereal – (1/2 cup Cornbread (1 piece – 60 grams Fried rice (1/2 cup) – – Wild rice (1/2 cup) – Multi-grain bread (1 slice) – Blueberry muffin (66 g) • Egg noodles (1/2 cup • Italian or French bread (1 sm slice) • Icecream (1/2 c) • Ritz crackers, real cheese or PB (1 oz) • Elbow or spaghetti noodles (1/2 cup) • Hamburger/hotdog bun (1) • Instant oatmeal (1 package) • Flour tortilla (1 medium) • French toast (1 slice) • Ramon noodles (1/2 package) • Croissant (medium) Medium Protein Foods • Fruits – 1-1.5 grams per ½ serving – Raisins (1/4 c) – Plantains (1/2 c cooked or fried – Bananas (1 medium) – Coconut (1/2 c dried) – Peaches (1 medium) – Nectarines (1 medium) Medium Protein Foods • Vegetables – 1-2 grams per ½ cup serving – Cauliflower (raw) – Parsnips (cooked) – Ketchup (1/4 c) – Tomato (raw) – Beets (raw or cooked) – Kate (raw or cooked) – Bamboo shoots (canned or raw) – Cabbage (cooked) – Cauliflower (cooked) – Tomato (cooked) – Broccoli (raw or cooked) – Sweet Potato (canned) – Leeks (raw – 1) Medium Protein Foods - continued • Pumpkin (canned) • Asparagus (raw) • Mushrooms (raw or cooked) • Okra (cooked) • Rutabagas (cooked) • Bean sprouts • Mustard greens (cooked) • Chickory greens (raw) • Tomato sauce • Swiss chard (cooked) • Brussels sprouts (cooked) • Collard gerens (cooked) Introduction of New Foods • Talk with your dietitian and metabolic clinic • Set up a plan for trying new foods • Introduction – slow • Monitor Blood Spots • Important to commit to plan • Test your tolerance of new foods • Test your level Why So Important? • Living your life the healthiest you can • Ability to fit in foods that you are really eating • Making sure your RD is aware of what is working and what is not working What is Working for You? • Share with the group What Can This Group Help You With? • What do you struggle with regularly? • What makes it hard for you to meet your goals? 49 DOS CME Course 2011 2014