Northwestern University Feinberg School of Medicine

Healthy Diet and Scleroderma

Bethany Doerfler MS, RD, LDN

Top Nutrition Concerns

Healthy Diet

Should I be on an anti-

inflammatory diet?

How do I control gas &

bloating?

How should I handle

feeling full early? How do I

keep my muscle?

Do I need vitamins

Is a Mediterranean Diet Anti-Inflammatory?

Fruits &Vegetables

Whole Grains

Healthy Fats

Lean Proteins

REDUCE Inflammation

Refined sugars

Refined starches

Saturated fats &trans fats

INCREASE inflammatory markers

Esposito K. Effect of a Mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA 2004; 292: 1440– 6.

Portion Controlled Mediterranean Diet

• Think fruits or veggies

as base meal

• Include each meal

• 3 colors day – Red/purple

– Orange/yellow

– Green

Tips: Fruits and Vegetables

• Purchase pre-cut fruits and veggies for convenience

• Keep them at eye-level in your fridge

• Pack bag night before with easy-to-carry options

– Bananas, citrus, canned and dried fruit, apples, pears

• Purchase with soup or sandwich over crackers and chips

• Use as “bread” for peanut butter and cheese

• Take fruit smoothie in a travel mug for a quick breakfast

• http://www.choosemyplate.gov/food-groups/downloads/TenTips/DGTipsheet9SmartShopping.pdf

Healthy Fats Add Healthy Calories

Nutrition RX for Gas & Bloating

How do I control

bloating?

Cook Veggies & Peel Skin

Fruits

Moderate Fiber if bloated

Try FODMAPS

Common GI Complaints

• Reflux (GERD)

• Difficulty Swallowing (Dysphagia)

• Early Fullness

• Bloating

• Constipation

• Diarrhea

• Fatigue

• Weight loss

Dietary Therapy for Fullness

Balanced Diet

Small frequent meals

Liquid nutrition supplementation

Cook Fibers

Control blood sugars

Healthy liquid fats less solid fats

Camilleri M. Gastroenterology 131(2);2006: 640-658; Keld R. J Hum Nutr Diet, 24: 421-430; Olausson EA. Diabetes Research and Clinical Practice 80:231-237; Gastroenterology. 2011 Jan;140(1):101-15

Q: What is Small Frequent Meal? A: 3 Meals & 3 Snacks

Cream of Wheat

Added Margarine

Ripe Fruit

Milk or Kefir

Pureed Butternut Squash Soup

6 brown rice crackers, 1-2 oz cheese

3-4 oz Baked Fish

Medium Baked Potato

Cooked Carrots

Milk or Kefir

Ripe Banana

1-2 tbsp Creamy Peanut Butter

½ Sandwich

Canned Fruit

Fruit Smoothie:

Mango & Greek Yogurt or Protein Powder

Snac

ks

M

eals

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FODMAPS Sample Menu Breakfast:

• Poached Egg

• corn tortilla or toast

• ½ cup- 1 cup ripe melon or berries

• Coffee or tea

Lunch

•Cooked vegetable soup

•Brown Rice crackers & almond butter

•Banana

• Sparkling water

Dinner

•Roasted fish or poultry

•Roasted green beans

• Sweet potato cooked with olive oil

•Berries & Greek Yogurt

Snacks: Yogurt, fruit, nut butters, cheese, veggie soups, sushi rolls, dairy free frozen

treats, dry cereal (oat/rice based), crackers, cold or hot cereal with milk alternative

Other Strategies for Healthy Eating

• Weekend pre-planning – Batch cooking

– Crock pot

– Freeze in pre-packaged ready-to-go

• Change expectations of Healthy Meal – Cereal with fruit and egg whites great dinner

• Frozen just as good as fresh

• Pre-cut/chopped fruits and veggies retain nutritional value

• Focus on meal assembly

• Cook and puree hard to digest veggies

How Do I Keep My Muscle?

• Check weight monthly • Discuss weight loss with Rheumatologist and

Gastroenterologist • Work with dietitian to improve weight status • Nutritional supplements as necessary

Muscle: Distribute Protein

Adults need 60-100 gm protein daily

Muscle rebuild itself every 3-5 hours

20-30 gm burst of muscle synthesis

60 gm properly distributed safe kidneys and bones

Layman DK, Nutr Metab 2009;6:12

What Does 20 gm Look Like?

• BREAKFAST: Greek Yogurt & fruit – 2 eggs & whole grain toast

– Vegan protein shake & fruit

• LUNCH: 2-3 oz lean turkey breast & veggie soup – 1 cup cooked Quinoa & 2-3 shrimp

– 1 cup split pea soup, crackers & one oz cheese

• DINNER: 3 oz meat, fish, poultry, tofu » Add veggies and grain complete

Northwestern University Feinberg School of Medicine

Medical Nutrition Therapy for Patients with Advanced Scleroderma (MNT PASS)

PIs: Ikuo Hirano and Patricia Sheean Co-I: Bethany Doerfler

Collaboration between UIC and Northwestern

What are we collecting?

• Nutrition status and symptom tracking

– Patient Generated Subjective Global Assessment

– Nutrient status (Vitamin A, D, K, iron, folate, B12)

– 24 hour diet recall

– GI symptoms using UCLA SSc GI tool

– CDC Health Related Quality of Life

– Body composition

Sample DXA results

Supplements

• Check: – Vitamin D

– Adults aim for 600-1000 IU daily – Ask MD check especially if you take acid blocking medications

• B12/folic acid – If you are on acid blocking medications

• Iron panel and iron stores

• Add – general multivitamin/multi-mineral supplement – Calcium & Vitamin D

Seeking Information on Supplements & Complementary Therapies

• National Institute of Health Office of Dietary Supplements: – http://dietary-supplements.info.nih.gov/

• Look up your supplement: – http://ods.od.nih.gov/health_information/health_information.aspx

• Complementary and Alternative Medicine – http://nccam.nih.gov/news/camstats/2007/camsurvey_fs1.htm

• Institute of Medicine – http://www.iom.edu/?ID=4829

• Department of Health and Human Services Agency for Healthcare Research and Quality – http://www.ahrq.gov/

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THANK YOU