Lecture IV: Nutritional Applications PDF

BY DR EHAB MOHAMMED ND Lecture IV Nutritional Applications LEARNING OUTCOMES Outline factors to consider when conducting a nutritional assessment and integrate that information into a patient's treatment plan. Define and apply dietary interventions used to assess and treat common digestive issues in...

BY DR EHAB MOHAMMED ND Lecture IV Nutritional Applications LEARNING OUTCOMES Outline factors to consider when conducting a nutritional assessment and integrate that information into a patient's treatment plan. Define and apply dietary interventions used to assess and treat common digestive issues including elimination diets, food sensitivity testing, food intolerances (sulfites, histamine, FODMAPs), Specific Carbohydrate Diet, GAPS and low sulfur diet Impact of malnutrition on the population - As much as 20%-50% of people are malnourished or at a high risk of malnutrition - Improper nutrition can result or lead to many health issues such as Weight problems (either over or under weight). Nutritional deficiencies (such as iron, B12, vitamin D deficiency). Poor immune system function. Muscle weakness. Digestive disorders digestive disorders can be a result and a cause of malnutrition Nutrition assessment Values of clinical nutrition assessment 1- Early nutritional assessment can point out to the risk factor(s) that may negatively affect the person’s overall health 2- Implementation of proper nutritional plans to support the person’s nutritional status There is no universal nutritional assessment system Not all clinics and hospitals perform a nutrition assessment NUTRITIONAL ASSESSMENT METHODOLOGIES MAIN METHODS OF NUTRITIONAL ASSESSMENT/EVALUATION IN THE CLINICAL PRACTICE Group Discussion The class will be divided into 2 groups 1- First group will discuss the Traditional Nutritional assessment tools based on the provided reading material as well any readings / Research they can do during the class 2- Second group will discuss the modern/ new methodology for dietary / nutritional assessment tools GROUP DISCUSSION What is required from each group? 1- To read well/understand the given reading material 2- read more relevant researches/ scientific material of that topic. 3- summarize each assessment methodology motioning the details of every method, advantages/ disadvantages, possible costs, necessary training / honing skills, and create a flyer for your patient in the outpatient clinic to demonstrate the technique clearly The reading and research work lasts for 40 minutes 4- Hire a representative from each group to start the discussion 3- create a 20-25 minutes power point presentation that includes all the points mentioned above Open discussion After the 2 groups present their material an open discussion for 15-20 minutes between the 2 groups for questions/comments and final conclusions CONCLUSION Which methodology you will be adopting in practice? Kindly mention the reason(s) to support your claim An open discussion forum for 10-15 minutes Assignment is due today at 23:55 (Can be submitted during the class today). Posted on Moodle course shell: Activity will take place after the class, Guidance on completing the activity will be provided during class. Evidence of completion of the activity can be uploaded to this Assignment drop box Completion and timely submission is required. Common Digestive Disorders - Food intolerances (sometimes called food sensitivities) Food allergies: are an acute allergic response to foods associated with an elevated IgE Antibodies and can result in Anaphylaxis if the reaction is severe. Question: I this context do you consider Celiac disease a food allergy? Food sensitivities /Intolerances Are milder reactions than food allergies and are not associated with an elevated Ig E Ab titers and not associated with any anaphylaxis Irritable Bowel Syndrome Rome IV Criteria for diagnosis of IBS To diagnose a patient with IBS, 2 of these criteria should be satisfied: An abdominal pains/colic/discomfort that are not associated with an organic disease and : 2- Associated with a change in the stool frequencies. 1- Related to defecation. 3- Associated with a change in the stool consistencies. Diagnosis of Food allergies Diagnostic Criteria for food allergies - Clinical Diagnosis (Most important): An immediate allergic response to foods (sometimes with GI symptoms such as severe pain, gases, bloating or burping), however other symptoms of allergies can coexist such as 1- Skin rash (usually hives, or urticaria like rash), but purpura or papules may arise. 2- Joint pains/arthritis. 3- Respiratory symptoms (allergic rhinitis or asthma) 4- Rarely Anaphylaxis and shock could happen. Diagnostic Criteria for food allergies - Lab testing: Ig E antibody titer is usually high in these patients - Skin prick test is usually positive. Nuts, eggs and shellfish Definition of Food sensitivities /Intolerances They are NonImmune Mediated responses /reactions to foods They can constitute up to 25% of IBS patient’s population DIAGNOSIS FOOD SENSITIVITY/INTOLERANCES? MANY WAYS - Either clinical diagnosis: Monitoring the associated bowel changes/discomfort after certain types/foods - There are challenges/ flaws associated with the clinical diagnosis OR LAB TESTING - IgG food sensitivity testing Management of IBS Food Elimination Diet FOOD ELIMINATION DIET The theory behind it is that the human microbiome is linked to the foods you eat, So, eliminating the foods that can possibly trigger inflammation can possibly improve the microbiome qualities and quantities and this reduces the inflammation and help managing the symptoms of the IBS. Food elimination diet To discontinue eating the most inflammatory foods such as wheat, dairy and eggs for 3 months Food elimination diet VS IgG food sensitivity testig There is a weak evidence that implementing the food sensitivity testing (IgG) and or Elimination diets have significant role in relieving the IBS/Food Intolerance symptoms This is because the amount of data and research evidence on these interventions are very little or nonsignificant. Low-FODMAP Diet Given the fact that, IgG based, or elimination diets-based food changes are not evidence based, a new alternative direction to manage the IBS/Food sensitivity symptoms arose which is elimination of FODMAP Diet. FODMAP foods contain short chain CHOs > Fermented by Gut bacteria to> Methane + Hydrogen gases that are poorly absorbed> classical symptoms of bloating and gases and abdominal discomfort for the IBS/ Food intolerance symptoms LOW FODMAP DIET - It is mainly exclusion of FODMAP diets for 6-8 weeks then slowly reintroducing them ADVANTAGES - Better tolerable the Food Elimination diet. - More evidence based than the IgG or the food elimination diet plans. Future research - Fecal assays: targeting tryptase, eosinophile cationic protein and calprotectin. - Or Evaluating real-time microscopic changes to the gut mucosa - Gluten free diets REFERENCES Ahmed I: ABCDE OF COMMUNITY NUTRITIONAL ASSESSMENT, Gomal Journal of Medical Sciences AprilJune 2019, Vol. 17, No. 2. Zhao X et al: Emerging trends of technology-based dietary assessment: a perspective study, European Journal of Clinical Nutrition (2021) 75:582–587. REFERENCES Smith E et al: Food Sensitivity Testing and Elimination Diets in the Management of Irritable Bowel Syndrome, Any questions? Thank you for your attendance and best wishes of success and achievements