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Navigating Medium Protein Foods for People with Higher PHE Tolerances

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Navigating Medium Protein Foods for People with Higher PHE Tolerances Navigating Medium Protein Foods for People with Higher PHE Tolerances Laura Jeffers, MEd, RD, LD Cleveland Clinic Confidential1 DOS CMEOxtober Course 201420112010 © Cleveland Clinic 2016 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 • Synthetic: –Seafood –Formula/milk –Lean meat –Metabolic food/low phe –Chicken food –Turkey –Eggs –Legumes (beans) –Nuts –Seeds –Soy 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 • Read ingredient lists, • Extra calories also limit: without essential –High fructose corn syrup nutrients –Corn sweetener –Dextrose • Sources –Glucose –White, brown sugar –Sucrose –Honey –Maltose –Corn syrup –Molasses • Limit to no more than 10% of calories 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 –Strong evidence • Sources suggests replace –Beef, pork, veal, lamb with unsaturated fat –Full fat milk, yogurt, to lower cholesterol cheese and reduce risk of –Butter, lard CVD –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 • Swiss chard • Arugula • Mushrooms • Asparagus • Peas • Avocado • Potatoes • Broccoli • Seaweed or Nori • Brussel Sprouts • Spinach • Corn • Yams • Kale • Sweet Potatoes • Mustard greens 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, • Egg noodles (1/2 cup Grains and Snacks • Italian or French bread (1 sm slice) • 3-4 grams of protein • Icecream (1/2 c) – Dinner roll (1) • Ritz crackers, real cheese or PB (1 oz) – Couscous (1/2 cup) – Pillsbury crust (1/8) • Elbow or spaghetti noodles (1/2 cup) – Oatmeal Squares cereal • Hamburger/hotdog bun (1) (1/2 cup • Instant oatmeal (1 package) – Cornbread (1 piece – 60 grams • Flour tortilla (1 medium) – Fried rice (1/2 cup) • French toast (1 slice) – Wild rice (1/2 cup) • Ramon noodles (1/2 package) – Multi-grain bread (1 slice) • Croissant (medium) – Blueberry muffin (66 g) 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 20142011.
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