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Navigating Medium Protein Foods for
People with Higher PHE Tolerances
Laura Jeffers, MEd, RD, LD
Cleveland Clinic
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Confidential
© Cleveland Clinic 2016
DOS CMEOxtober
Course 2011
2014
2010
Disclosure Statement
I am a paid speaker on the BioMarin PKU Speakers
Bureau
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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…..
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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
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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
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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
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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
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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?
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DOS CME Course 2011
2014