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NS270 Nutrition Assessment and
Management
Unit 8
Drug-Nutrient Interactions
Diabetic Meal Planning
Amy Habeck, RD, MS, LDN
Unit 8 Learning Objectives:
o Discuss
o
o
Drug-nutrient interactions
Diabetic meal planning
o Review- Nutrition and Diet Therapy
o
Stanfield and Hui, Chapter 10 – Drugs and Nutrition
o Answer your questions
General Actions of Drugs
 What are the five categories of general actions of drugs?
General Actions of Drugs
 Additive
 Cumulative
 Synergistic
 Tolerance
 Toxicity
Drugs Affect Intake
 What are five ways drugs affect nutrient intake?
Drugs Affect Intake
 Taste
 Appetite
 Intestinal motility
 Absorption
 Metabolism
Drugs Affect Nutrients
 What are four ways drugs affect nutrients?
Drugs Affect Nutrients
 Destroy or change nutrient
 Damage intestinal walls
 Lower absorption
 Directly destroy, displace or change nutrients
Nutrients Affect Drugs
 What are 4 ways nutrients affect drugs?
Nutrients Affect Drugs
 Delayed drug absorption
 Altered drug metabolism
 Enzyme induction
 Enzyme inhibition
 Altered rate of excretion
 Altered drug response
Bioavailability
 Most frequently reported diet-drug interaction
 Decreased drug bioavailability
 Altered nutrient absorption
 Drug absorption affected by
 Physical form
 Particle size
 GI pH
 Solubility in fats
 Side effects of malabsorption
Important Nutrients
 Altered metabolism creates change in therapeutic effect
 Niacin, riboflavin, pantothenic acid, Vit C, folic acid, B12,
protein, fat, glucose, iron, Cu, Ca, Zn, Mg
Oral Medications Affected by:
 Presence of food in GI tract
 pH of the stomach and small bowel
 Motility of GI tract
Questions About Nutrition and Drug
Therapy?
Unit 9 Project
Meal Plan
 Determine calories
 Mifflin St. Jeor Equation
 Determine if management goal is
 Weight maintenance
 Weight gain
 Weight loss
 Adjust recommended calorie intake based on goal
 What equation is the base for the calorie intake
recommendation?
 Calculate grams of each macronutrient
Determine Calorie Level
 REE Mifflin St Jeor
 Multiply by activity factor
 For weight loss
 3500 calories = 1 pound
 3500 calories/ 7 days = 500 kcal/day = 1 pound/week
 7000 calories/ 7 days = 1000 kcal/day = 2 pound/week
 Subtract 500 or 1000 calories from energy needs for weight loss
Calculating CHO, FAT, PRO from %
 Determine Calorie Level (MSJ) - 1800 calories example
 Determine Nutrition Standards – Sports Nutrition example
 50-70% CHO, 20-35% Fat, <10% Saturated Fat, 12-15% Pro
 CHO: 1800 calories x 60% = 1080 calories
 CHO = 4 calories/gram
 1080 divided by 4 = 270 grams CHO /day
 Fat: 1800 calories x 25% = 450 calories
 Fat = 9 calories/gm
 450/9= 50 grams fat/day
 Pro: 1800 calories x 15% = 270 calories
 Pro = 4 calories/gm
 270/4= 68 gm protein/day
Individualized Meal Plan
 Calorie & CHO goal (typically high fiber)
 Exercise recommendations
 Coaching & support for behavior change
 Weight loss
 Additional factors for other health concerns
 Sodium
 Fats
 Calcium/Magnesium/Potassium
 Fluids/Fiber
Survival Skills
 3 meals per day
 Limit sugar in beverages, jello, candy, overt source of
glucose etc.
 Somewhat even distribution of CHO foods per meal
 Include protein at each meal and most snacks
Meal Plan for Diabetes -options
 Count Carbohydrate grams (count actual grams)
 Count Carbohydrate servings (15 g CHO/serving)
 Use diabetic exchange system
 We’ll discuss in unit 8 seminar
Carbohydrate Counting and
Diabetic Meal Plans
 Example
 2000 kcal diet
 30% fat
 40% CHO
 30% pro
Joslin Calorie Distribution
Fat
Pro
CHO
30%
40%
30%
Carbohydrate distribution
 3 meals, and snacks as needed – depending on medications.
 Meals:
 Women/weight loss 30 – 45 grams per meal
 Men/weight loss
45 – 60 grams per meal
 Snacks
 Women/weight loss 0-15 grams/ add protein or veggies
 Men/weight loss
0-30 grams/add protein or veggies
Calorie and CHO counting
 Calorie King Calorie/CHO counter
 www.calorieking.com
 www.fitday.com - on line journal.
 ADA My Meal Plan for counting CHO and using
exchanges also in text
Diabetic Meal Plans-Exchanges
 They don’t just count carbohydrates
 Exchanges are used to plan meals
Food Group
Grams CHO
Grams Pro
Grams Fat
Starch
15
3
0
Fruit
15
0
0
Milk
12
8
0 Fat free
5 Low fat
Vegetable
5
2
0
Meat
0
7
2-3 Very lean
5 Medium fat
Fat
0
0
5
Example-Carbohydrate
 1500 kcal/day (using AMDR)
 Carbohydrate 55%
 (1500 x 0.55) = ____ kcal from carbohydrate
 _____ kcal from CHO ÷ 4 kcal/gm = ____ gm carbohydrate
Example-Carbohydrate
 1500 kcal/day (using AMDR)
 Carbohydrate 55%
 (1500 x 0.55) = 825 kcal from carbohydrate
 825 kcal ÷ 4 kcal/gm = 206 gm carbohydrate
Example-Protein
 1500 kcal/day
 Protein 15%
 (1500 x 0.15) = ____ kcal from protein
 _____ kcal ÷ 4 kcal/gm = ____ gm protein
Example-Protein
 1500 kcal/day
 Protein 15%
 (1500 x 0.15) = 225 kcal from protein
 225 kcal ÷ 4 kcal/gm = 56 gm protein
Example-Fat
 1500 kcal/day
 Fat 30%
 (1500 x 0.30) = ____ kcal from fat
 _____ kcal from fat ÷ 9 kcal/gm = ____ gm fat
Example-Fat
 1500 kcal/day
 Fat 30%
 (1500 x 0.30) = 450 kcal from fat
 450 kcal ÷ 9 kcal/gm = 50 gm fat
Example-All Macronutrients
 1500 kcal/day
 55% carbohydrate
 206 gm carbohydrate/day
 15% protein
 56 gm protein/day
 30% fat
 50 gm fat/day
Food Group
Grams CHO
Grams Pro
Grams Fat
Starch
15
3
0
Fruit
15
0
0
Milk
12
8
0 Fat free
5 Low fat
Vegetable
5
2
0
Meat
0
7
2-3 Very lean
5 Medium fat
Fat
0
0
5
Diabetic Meal Plan-Exchanges
 1500 kcal/day
 55% carbohydrate
 206 gm carbohydrate/day
 15% protein
 56 gm protein/day
 30% fat
 50 gm fat/day
 206 gm CHO/day ÷ 15 gm CHO/serving = 13.7 servings
CHO/day
 56 gm pro/day ÷ 7 gm pro/serving = 8 servings protein/day (1 oz
each)
 50 gm fat/day ÷ 5 gm fat/serving = 10 servings fat/day
1-day meal plan
 14 servings CHO/day
 8 servings protein/day (1 oz each)
 10 servings fat/day
 Breakfast – 4 CHO, 2 pro, 2 fat servings
 Lunch – 3 CHO, 2 pro, 3 fat servings
 PM snack – 2 CHO, 1 pro, 1 fat serving
 Dinner - 3 CHO, 2 pro, 3 fat servings
 HS snack – 2 CHO, 1 pro, 1 fat serving
1-day meal plan
 14 servings CHO/day
 8 servings protein/day (1 oz each)
 10 servings fat/day
Meal
CHO
Pro
Fat
Breakfast
4
2
2
Lunch
3
2
3
PM snack
2
1
1
Dinner
3
2
3
HS snack
2
1
1
Create a Menu from your meal plan
 Breakfast
 Lunch
 PM Snack
 Dinner
 HS Snack
Fruit
 15 gm CHO
 ½ cup fresh fruit or juice
 ¼ cup dried fruit
 Fruit
 http://www.mayoclinic.com/health/diabetes-diet/DA00070
15 gm
CHO
Starch
 15 gm CHO, 3 gm pro
 1/2 – 3/4 cup cereal
 Small baked potato
 1/3 cup rice
 Starches
 http://www.mayoclinic.com/health/diabetes-diet/DA00069
15 gm CHO

1 small piece of fresh fruit (4 oz)

1/2 cup of canned or frozen fruit

1 slice of bread (1 oz) or 1 (6 inch) tortilla

1/2 cup of oatmeal

1/3 cup of pasta or rice

4-6 crackers

1/2 English muffin or hamburger bun

1/2 cup of black beans or starchy vegetable

1/4 of a large baked potato (3 oz)

2/3 cup of plain or sugar sub. yogurt

2 small cookies

2 inch square brownie /cake without frosting

1/2 cup ice cream or sherbet

1 Tbsp syrup, jam, jelly, sugar or honey

2 Tbsp light syrup

6 chicken nuggets

1/2 cup of casserole

1 cup of soup
Milk/Dairy
 12 gm CHO, 8 gm pro, 0/5/8 gm fat
 1 cup milk
 ¾ cup plain nonfat yogurt
 Dairy
 http://www.mayoclinic.com/health/diabetes-diet/DA00071
Vegetables
 5 gm CHO, 2 gm pro
 ½ cup cooked vegetables or vegetable juice
 1 cup raw vegetables
 Vegetables
 http://www.mayoclinic.com/health/diabetes-diet/DA00073
Meat
 7 gm pro, varied fat (see lists)
1 oz meat, poultry, fish or cheese
½ cup dried beans
 Meat
 http://www.mayoclinic.com/health/diabetes-diet/DA00074
Fat
 5 gm fat
 Mono: 1/8 avocado, 1 tsp canola or olive oil
 Poly: 1 tsp margarine, 1 Tbs, reduced fat mayo
 Sat: 1 tsp butter, 1 slice bacon, 2 Tbs coconut
 Fats
 http://www.mayoclinic.com/health/diabetes-diet/DA00075
Analyze your menu
 Provide
 Calories
 Protein
 Total fat
 Carbohydrate
 Fiber
 Sodium
 Saturated fat
Exchange Lists-show portions of
common foods
 Starches
 http://www.mayoclinic.com/health/diabetes-diet/DA00069
 Fruit
 http://www.mayoclinic.com/health/diabetes-diet/DA00070
 Dairy
 http://www.mayoclinic.com/health/diabetes-diet/DA00071
 Vegetables
 http://www.mayoclinic.com/health/diabetes-diet/DA00073
 Meat
 http://www.mayoclinic.com/health/diabetes-diet/DA00074
 Fats
 http://www.mayoclinic.com/health/diabetes-diet/DA00075
Other Helpful Sites for Diabetic
Meal Planning
 Food Exchanges
 http://www.exrx.net/Nutrition/FoodExchanges.html
 Carbohydrate Counting
 http://www.joslin.org/info/Carbohydrate_Counting_101.html
 Diabetic Exchanges and Food Lists
 http://www.diabeteslibrary.org/View.aspx?url=DiabeticExchangeList
 Calculating Exchanges, Calories and Percentages
 http://riverflag.com/nutrition/diabeticexchange.html
 Exchange Lists
 http://www.uaex.edu/Other_Areas/publications/PDF/FSHED-86.pdf
Unit 9 Project
Grading
Points
Time Table
APA format/file
10
In-text citations/reference list
20
Question 1
45
Week 5
Question 2
30
Week 6
Question 3
20
Week 6-7
Question 4
50
Week 5-9
Question 5
20
Week 8-9
Question 6
15
Week 8
Unit 9 Project
 Question 4. Create a 1 day meal plan
 Identify calorie and % CHO, PRO, FAT goals
 Identify timing for meals and snacks
 Identify CHO goals for meals and snacks
 Create a sample menu to match your goals
 Complete a nutrient analysis on your menu
 Question 5. Describe how you would educate DB on the
meal plan you created and health maintenance recommendations.
Farewell
 Thank you for your kind attention and participation!
 Office hours by appointment
 Email any time - [email protected]
 Follow me on Twitter
 @ProfAmyH