- Email: [email protected]
Treatment Protocols for Irritable Bowel Syndrome
SUNDAY, NOVEMBER 7
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY Variation in Carbohydrate Intake of Type 2 Diabetes Participants Author(s): M. E. Rodriguez,1 K. S. Keim,1 K. Chapman-Novakofski,2 E. B. Lynch,3 M. K. Morgan4; 1Clinical Nutrition, Rush University, Chicago, IL, 2Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL, 3Department of Preventive Medicine, Rush University, Chicago, IL, 4Diabetes Center, Rush University Medical Center, Chicago, IL Learning Outcome: Describe the variation in carbohydrate intake within and across days in type 2 diabetes participants. Objective: To describe the variation in carbohydrate intake within and across days in type 2 diabetes participants. Methods: A cross-sectional design was used to collect food intake data. The multiple pass method was used to obtain four 24-hour food recalls from 73 type 2 diabetes participants at an urban academic medical center. Coefficient of variation (CV) was calculated to determine variation in grams of carbohydrate intake within each day, across meals and snacks and across days. Results: Seventy-one percent of the participants were female and 57% were black. The majority of participants (76%) were obese. Mean selfreport hemoglobin A1c was 7.4%. Median caloric intake was 1533 kcal and percent calories from carbohydrate, protein, total fat, and saturated fat were 45%, 18%, 38% and 12%, respectively. Median CV of meal carbohydrate intake within each day was 43.2%, 53.5%, 52.9% and 43.8%. Median CV of snack carbohydrate intake for each day was 78.4%, 70.7%, 48.3% and 56.4%. Median CV of grams carbohydrate intake across all days was 27.5%. Median CV of carbohydrate for each meal (breakfast, lunch and dinner) across days was 44.4%, 51.0% and 55.0%, respectively. Conclusion: Participants were not consuming a high carbohydrate diet, but a diet that was high in total and saturated fat. The variability in carbohydrate intake within each day appeared to be lower for meals than snacks. Carbohydrate intake across days was more variable at dinner than breakfast. Methods were approved by the Institutional Review Board for Human Subjects.
Fatty, Fatty Two-by-Four: Weight Teasing History Is Associated with Disordered Eating Behaviors in Healthy Young Adult Women Author(s): V. Quick, C. Byrd-Bredbenner; Nutritional Sciences, Rutgers University, New Brunswick, NJ Learning Outcome: To determine the relationship between weight teasing history and disordered eating behaviors in healthy young adult women. Women with unhealthy BMIs who were teased about their weight during childhood are at increased risk for disordered eating behaviors. However, little research has examined disordered eating behaviors and weight teasing history of women with healthy BMIs (i.e.,18.5-24.9). Thus, healthy BMI women (n⫽538), aged 18-25 years with no history of eating disorders or chronic nutrition-related disease, were recruited to participate in a study assessing eating behaviors and weight teasing history. Using the sample’s median BMI (21.61), participants were split into lower (n⫽269) and upper (n⫽269) healthy BMI groups. Unpaired t-tests of ShortPerception of Teasing Scale results showed that the higher healthy BMI group was significantly (p⫽0.01) more likely to have experienced weight teasing during childhood. Of the subset who experienced teasing (n⫽189), women in the higher healthy BMI group reported the teasing was significantly (p⫽0.003) more upsetting than those in the lower healthy BMI group. Teased, higher healthy BMI women had significantly (p⬍0.04) higher Eating Disorders Examination-Questionnaire’s (EDE-Q) eating, weight, and shape concerns subscale scores (i.e.,1.17⫾0.94SD vs 0.93⫾0.92SD; 2.54⫾1.50SD vs 1.63⫾1.44SD; 2.87⫾1.58SD vs 2.14⫾1.48SD, respectively), with higher scores indicating greater eating disorder symptomology. EDE-Q scores rose significantly as teasing severity increased. Thus, even healthy BMI women who were teased about their weight during childhood are at elevated risk for disordered eating behaviors. Although it is not known whether the increased disordered eating behavior risk was caused by weight teasing, this study suggests it is prudent to consider child weight teasing prevention interventions for parents, teachers, and other caregivers of children. Funding Disclosure: Kappa Omicron Nu Fellowship
Funding Disclosure: Illinois AMVETS
The Body Balance Disordered Eating and Mentoring Program
Treatment Protocols for Irritable Bowel Syndrome
Author(s): L. Fredenberg; Nutrition Services, Summit Medical Fitness Center, Kalispell, MT
Learning Outcome: Treatment of Irritable Bowel Syndrome
Learning Outcome: Learn how to incorporate the mentoring skills of an eating disorder survivor as part of the multidisciplinary treatment team. Body Balance is a unique, skill building program designed to motivate clients suffering from eating disorders into a healthy relationship with food. The registered dietitian provides nutrition counseling in conjuction with a mentor who is an eating disorder survivor. The role of the registered dietitian is to conduct a clinical assessment and determine estimated nutrient requirements, evaluate the client’s current food intake patterns, develop a meal plan and help the client normalize eating patterns. The dietitian provides nutrition education and information on the health consequences of eating disorders, effect on basal metabolism, impact of hydration shifts on body weight and indicators of recovery. The Body Balance mentor provides support, guidance and knowledge based on her own experience and shares behavioral coping skills which aid the client in their eating disorder recovery. Mentor services are strongly encouraged for any client referred to the program but are not mandatory. The mentoring component of our program is billed through the Summit Medical Fitness Center, since it is considered a complimentary therapy and not covered by insurance. Participation in the Body Balance program requires a physician, physician’s assistant or nurse practitioner referral. Funding Disclosure: None
Author(s): J. A. Mabel; Nutrition Boston, Brookline, MA IBS has been difficult to treat successfully because of the difficulty in finding the specific causes. Some of the causes are: (1) Candida overgrowth, (2) small intestinal bacterial overgrowth, (3) food sensitivities, (4) stress, and (5) liver effects. Candida overgrowth and Small Intestinal Bacterial Overgrowth (SIBO) can be tested for. Food sensitivities There is a lot known about testing for food sensitivities using labs. We can also do an elimination diet if the patient is willing to restrict a number of foods. The foods most commonly eliminated are gluten, dairy, beef, and eggs. Stress Sometimes we have evidence through testing and/or questionnaires. I ask patients to do calm, meditative practices such as yoga, meditation, and breathing exercises. 5) Liver effects Liver function is usually assessed through a symptom questionnaire. Treatment is use of a cleanse product containing cofactors for the two-phase liver detoxification processes. This usually happens at the same time as the food elimination diet. Case #1: JR 57 y/o male, c/o IBS. Symptoms were pain and constipation. He agreed to use the cleanse product and the food elimination diet for 3 weeks. Upon returning visits, we saw many fewer symptoms. Case #2: JL 57 y/o male, diagnosed with IBS 10 years prior. Symptoms included pain, blockage, and diarrhea. Tests showed candida and bacterial overgrowth. Treatment consisted of anti-candida and anti-bacterial supplements, a probiotic, and glutamine. IBS is a set of symptoms which can be effectively handled by RDs using a minimum of tests, food elimination diets, and supplementation. Funding Disclosure: None
Journal of the AMERICAN DIETETIC ASSOCIATION / A-43
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY Variation in Carbohydrate Intake of Type 2 Diabetes Participants Author(s): M. E. Rodriguez,1 K. S. Keim,1 K. Chapman-Novakofski,2 E. B. Lynch,3 M. K. Morgan4; 1Clinical Nutrition, Rush University, Chicago, IL, 2Department of Food Science and Human Nutrition, University of Illinois, Urbana, IL, 3Department of Preventive Medicine, Rush University, Chicago, IL, 4Diabetes Center, Rush University Medical Center, Chicago, IL Learning Outcome: Describe the variation in carbohydrate intake within and across days in type 2 diabetes participants. Objective: To describe the variation in carbohydrate intake within and across days in type 2 diabetes participants. Methods: A cross-sectional design was used to collect food intake data. The multiple pass method was used to obtain four 24-hour food recalls from 73 type 2 diabetes participants at an urban academic medical center. Coefficient of variation (CV) was calculated to determine variation in grams of carbohydrate intake within each day, across meals and snacks and across days. Results: Seventy-one percent of the participants were female and 57% were black. The majority of participants (76%) were obese. Mean selfreport hemoglobin A1c was 7.4%. Median caloric intake was 1533 kcal and percent calories from carbohydrate, protein, total fat, and saturated fat were 45%, 18%, 38% and 12%, respectively. Median CV of meal carbohydrate intake within each day was 43.2%, 53.5%, 52.9% and 43.8%. Median CV of snack carbohydrate intake for each day was 78.4%, 70.7%, 48.3% and 56.4%. Median CV of grams carbohydrate intake across all days was 27.5%. Median CV of carbohydrate for each meal (breakfast, lunch and dinner) across days was 44.4%, 51.0% and 55.0%, respectively. Conclusion: Participants were not consuming a high carbohydrate diet, but a diet that was high in total and saturated fat. The variability in carbohydrate intake within each day appeared to be lower for meals than snacks. Carbohydrate intake across days was more variable at dinner than breakfast. Methods were approved by the Institutional Review Board for Human Subjects.
Fatty, Fatty Two-by-Four: Weight Teasing History Is Associated with Disordered Eating Behaviors in Healthy Young Adult Women Author(s): V. Quick, C. Byrd-Bredbenner; Nutritional Sciences, Rutgers University, New Brunswick, NJ Learning Outcome: To determine the relationship between weight teasing history and disordered eating behaviors in healthy young adult women. Women with unhealthy BMIs who were teased about their weight during childhood are at increased risk for disordered eating behaviors. However, little research has examined disordered eating behaviors and weight teasing history of women with healthy BMIs (i.e.,18.5-24.9). Thus, healthy BMI women (n⫽538), aged 18-25 years with no history of eating disorders or chronic nutrition-related disease, were recruited to participate in a study assessing eating behaviors and weight teasing history. Using the sample’s median BMI (21.61), participants were split into lower (n⫽269) and upper (n⫽269) healthy BMI groups. Unpaired t-tests of ShortPerception of Teasing Scale results showed that the higher healthy BMI group was significantly (p⫽0.01) more likely to have experienced weight teasing during childhood. Of the subset who experienced teasing (n⫽189), women in the higher healthy BMI group reported the teasing was significantly (p⫽0.003) more upsetting than those in the lower healthy BMI group. Teased, higher healthy BMI women had significantly (p⬍0.04) higher Eating Disorders Examination-Questionnaire’s (EDE-Q) eating, weight, and shape concerns subscale scores (i.e.,1.17⫾0.94SD vs 0.93⫾0.92SD; 2.54⫾1.50SD vs 1.63⫾1.44SD; 2.87⫾1.58SD vs 2.14⫾1.48SD, respectively), with higher scores indicating greater eating disorder symptomology. EDE-Q scores rose significantly as teasing severity increased. Thus, even healthy BMI women who were teased about their weight during childhood are at elevated risk for disordered eating behaviors. Although it is not known whether the increased disordered eating behavior risk was caused by weight teasing, this study suggests it is prudent to consider child weight teasing prevention interventions for parents, teachers, and other caregivers of children. Funding Disclosure: Kappa Omicron Nu Fellowship
Funding Disclosure: Illinois AMVETS
The Body Balance Disordered Eating and Mentoring Program
Treatment Protocols for Irritable Bowel Syndrome
Author(s): L. Fredenberg; Nutrition Services, Summit Medical Fitness Center, Kalispell, MT
Learning Outcome: Treatment of Irritable Bowel Syndrome
Learning Outcome: Learn how to incorporate the mentoring skills of an eating disorder survivor as part of the multidisciplinary treatment team. Body Balance is a unique, skill building program designed to motivate clients suffering from eating disorders into a healthy relationship with food. The registered dietitian provides nutrition counseling in conjuction with a mentor who is an eating disorder survivor. The role of the registered dietitian is to conduct a clinical assessment and determine estimated nutrient requirements, evaluate the client’s current food intake patterns, develop a meal plan and help the client normalize eating patterns. The dietitian provides nutrition education and information on the health consequences of eating disorders, effect on basal metabolism, impact of hydration shifts on body weight and indicators of recovery. The Body Balance mentor provides support, guidance and knowledge based on her own experience and shares behavioral coping skills which aid the client in their eating disorder recovery. Mentor services are strongly encouraged for any client referred to the program but are not mandatory. The mentoring component of our program is billed through the Summit Medical Fitness Center, since it is considered a complimentary therapy and not covered by insurance. Participation in the Body Balance program requires a physician, physician’s assistant or nurse practitioner referral. Funding Disclosure: None
Author(s): J. A. Mabel; Nutrition Boston, Brookline, MA IBS has been difficult to treat successfully because of the difficulty in finding the specific causes. Some of the causes are: (1) Candida overgrowth, (2) small intestinal bacterial overgrowth, (3) food sensitivities, (4) stress, and (5) liver effects. Candida overgrowth and Small Intestinal Bacterial Overgrowth (SIBO) can be tested for. Food sensitivities There is a lot known about testing for food sensitivities using labs. We can also do an elimination diet if the patient is willing to restrict a number of foods. The foods most commonly eliminated are gluten, dairy, beef, and eggs. Stress Sometimes we have evidence through testing and/or questionnaires. I ask patients to do calm, meditative practices such as yoga, meditation, and breathing exercises. 5) Liver effects Liver function is usually assessed through a symptom questionnaire. Treatment is use of a cleanse product containing cofactors for the two-phase liver detoxification processes. This usually happens at the same time as the food elimination diet. Case #1: JR 57 y/o male, c/o IBS. Symptoms were pain and constipation. He agreed to use the cleanse product and the food elimination diet for 3 weeks. Upon returning visits, we saw many fewer symptoms. Case #2: JL 57 y/o male, diagnosed with IBS 10 years prior. Symptoms included pain, blockage, and diarrhea. Tests showed candida and bacterial overgrowth. Treatment consisted of anti-candida and anti-bacterial supplements, a probiotic, and glutamine. IBS is a set of symptoms which can be effectively handled by RDs using a minimum of tests, food elimination diets, and supplementation. Funding Disclosure: None
Journal of the AMERICAN DIETETIC ASSOCIATION / A-43