Menu Development and Diets for Special Populations

Candace S. Johnson, RDN, CSG, FAND Consultant Nutritionist CS Johnson and Associates, Inc. Email: [email protected] You are What You Eat…but

Common Phrase but with Special Populations: They trust you give them what they need They depend on the food provided to meet their special needs They want food that tastes good and is healthy Senior populations want variety and choice Seniors are aware of nutrition and news

What is a Special ?

A special diet, or therapeutic diet is used to treat a medical condition May be changed with food content Examples: No Added Salt, Consistent Carbohydrate, Low Gluten May be changed with food texture Mechanical soft, puree, thickened liquids Nutrition Focus is Primary

To Prevent Malnutrition

Five per week is only partial food intake Meals provided may be more than five meals

Diet Liberalization

Nutrition and Menu Planning

Menus must represent proper and adequate nutrition May be marketable for target populations Gear toward populations served: there may be great differences with groups

Goal is to meet 1/3 of Recommend Daily Allowances for highest need person served What Does This Look Like?

Protein: 30 grams per (90 gm) Calcium: 400 mg (1200 mg) Sodium: 430 mg (1300-2300 mg) Fat: No RDA but 35% calories Fiber: 9 gm (25-30 gm) C: 30 mg (90 mg)

Nutrition analysis to assure levels

Adequate Nutrition

Protein: 3 ounces high quality protein Calcium: 8 ounces milk or substitute Fiber: Whole grains, fruits and vegetables Sodium: Limited processed foods and high sodium meats, soups and sauces Fat: Less saturated, no added trans fats : Look at juice, fruits and vegetables

Special Diets

Trend for more health?

Brain and Heart Foods?

Are gluten restricted diets increasing?

What to do with requests for special foods

Physician Orders

Special Diets, continued

Therapeutic diets are more restrictive with misinformation and may contribute to malnutrition

Diet liberalization in effect in professional nutrition community since mid 1990s per the Academy of Nutrition and Dietetics position papers Current Special Diets

Move to ADD more nutrition and in effect, decrease culprit nutrients which may overall be more effective for overall health

DASH Diet MIND Diet

DASH Diet

Dietary Approaches to Stop

Rich in fruits and vegetables Lower fat or nonfat dairy Whole Grains Lean meats, fish and poultry Includes nuts, seeds, legumes

Rich in potassium, calcium and magnesium DASH Diet

Intended for lowering but proven to lower cholesterol and inflammation. Has shown weight loss benefits

Developed by the US National Institutes of Health Consistently rated as the #1 diet

Mediterranean Diet

Introduced in 1993 when low rates of chronic disease were noted in Crete, Greece and southern Italy. Associated with lower LDL cholesterol Mainly fruits, vegetables, nuts, beans, healthy grains, fish, olive oil, small amounts of dairy, red wine Included daily exercise, sharing meals, appreciating pleasure of eating Mediterranean Diet Update

Fish: twice per week Herbs and Spices to replace salt Limits unhealthy fat: more olive or canola oil Focus on plant based diet Other meats, sweets minimized Included water and wine, physical activity and enjoying meals with others

MIND Diet

Mediterranean-DASH Intervention for Neurodegenerative Delay

Proven to benefit heart and may help prevent Alzheimer’s disease

Developed by M. Morris, PhD from Rush University

Combines Mediterranean and DASH diets

What is Brain-Healthy?

Fifteen components for Healthy Foods Green leafy vegetables Other vegetables Nuts Whole grains Berries Poultry Beans Olive Oil Fish Wine

Five Unhealthy Foods

Foods to reduce:

Red meats Butter and stick margarine Cheese Pastries and sweets Fried and fast food MIND Diet Basics

Daily Three servings of whole grains Salad and additional vegetable Glass of wine Snacks most days with nuts Beans every other day Poultry and berries twice a week Fish once per week

Mind Diet Basics

Limit unhealthy foods to less than once per week

Strong evidence for blueberries and emerging for other berries.

Strong adherence lowered risk by 53%, moderate adherence lowered by 35%

MIND Diet Science

What is good for the heart is good for the brain

Antioxidants in berry fruits may protect from harmful free radical damage

Resveratrol found in red wine and grape skins may also help neuron signaling

Polyphenols and anthocyanins

Gluten Restriction

Gluten free for celiac disease

Low gluten maybe for other digestive disorders

Requests for gluten restriction changing

Gluten sensitivity and intolerance Low Gluten Diets

Celiac disease need gluten free for treatment

Few programs can claim a sterile environment so diet cannot be gluten free

Traces make a difference but benefit can be offered

Gluten Free Diets

Requires firm diagnosis of celiac and label reading for proper foods to avoid Undiagnosed can cause other complications such as osteoporosis and other immune disorders Estimated 18 million have non-celiac gluten sensitivity and require a low gluten diet

Some may react to wheat proteins and need to avoid wheat but not other grains Gluten Free Grains

Amaranth Millet Rice: brown, white, wild Pea flour Buckwheat Potato flour Almond meal flour Potatoes Coconut flour Quinoa Corn and cornstarch Sorghum Guar gum Soy flour Teff

All need watch due to contamination

Nutrient Focus Diets

Low Sodium: Varying opinions for level of sodium for an older person. 1500-2300mg

Consistent Carbohydrate Terms: Avoid low sugar, reduced sugar, low/no concentrated sweets, no added sugar

Calcium Rich: for bone health with

Low Lactose: Does not mean no dairy, use of low lactose milk products

Menu Planning

Goals to have acceptable menus, great flavor and socialization with budget adherence

Adequate menus assumed with all food groups represented

Amounts are standard for nutrition and also for marketing

Trends with Menus

Fresh, local and healthy

Healthy may stated but not eaten

Desire for choice

Assume what is offered is good to eat Educating our Clients

Provide education for nutrition

Focus on healthy and eating more health vs limiting culprits

Culprits: Sugar, fat – Can you include them?

Note portions of culprits

Menu Strategies

Cost concerns: use seasonal, effective purchasing and proper portions

Waste Not! Means to reduce waste

Food preferences for clientele Can Any Diet Fit?

MIND diet can fit with number of salads, vegetables, fish, whole grains and poultry

Wine most likely will not fit

Snacks: could have added nuts in dishes

Can Any Diet Fit?

Low Gluten: May have low gluten products for some items, substitutes with lower gluten foods

May have cost affect and more food production with time

Education for adequacy and other meals Can Any Diet Fit?

Consistent Carbohydrate: Smaller portions of high carbohydrate foods or reduced portions of CHO foods Example: Fruit for dessert, half portion of dessert, no roll or bread. Do not have to purchase low sugar desserts

Can Any Diet Fit?

Low Sodium: Avoid cured meats, bacon excess cheese. Homemade casseroles vs. prepared product “Au Gratin” for special occasions Encourage use of herbs, spices Herb mixtures at the table

Educate for not adding salt at table and lower sodium strategies at home

Foods Avoided

Client are becoming more educated

No milk – try shelf stable milk or volume once a week for home delivered meals

Fresh fruits and vegetables for chewing/swallowing disorders: Can we make this work? YES

Summary

Yes: We are what we eat and nutrition is changing

Diets for heart and brain health are in the news and can be provided with strong evidence of effect

You taste it and eat it – the importance of good food Questions and Answers

Nutrition is a science and changing. Diets are what we eat to provide the body with nutrition.

Menus are the delivery of diets

As a science, changes, recommendations, and findings are expected to evolve. More to come for our exciting times for food and health

Thank You

For coming to Denver!

Travel safe, wear your seatbelt, and eat lots of FRUITS and VEGETABLES!!

Candace S. Johnson, RDN, CSG, FAND [email protected]