Tuesday, January 27, 2015

5 Uncommon Diabetes Diagnoses

We all know about diabetes, type I and II. However, there are many different and uncommon diabetes diagnosis that we as dietitians need to be familiar with. Between 1 and 5% of people diagnosed with diabetes do not have the traditional type one or type two diabetes. This article discusses the five types of diabetes that are uncommon. LADA is known as "type 1.5 diabetes". It is a slowly progressing type of type one diabetes that is often misdiagnosed as type 2. MODY is a type of diabetes that is most often found in young people. People with this type of diabetes are unable to have their beta cells release insulin. CFRD occurs when damage is done to the pancreas and is caused due to decreased numbers of beta cells. Cushing's Syndrome can cause diabetes and is seen in many cases. Antiretroviral-associated diabetes results from therapies for HIV. This article dives into more detail on each of these different diagnosis and processes of diabetes progression. Seeing as how diabetes is one of the top diseases we are dealing with in the US, it is really important for us as dietitians to know the disease in and out. This article really gives a good overview to condition that would otherwise remain unknown by many dietitians.
-JR

Brown-Riggs, C. (2014). 5 uncommon diabetes diagnoses. Today's Dietitian, 16(10), 36.
http://www.todaysdietitian.com/newarchives/100614p36.shtml

Starving for Two

"Pregorexia" has been a term recently used in the media, it is not currently a medical term and therefor has no medical definition. However, it is becoming more and more common in the world of pregnant women struggling to maintain their weight while pregnant. This can occur in women that have previously had an eating disorder, but can also occur in women who have never had trouble with eating disorders in the past but are horrified to see a weight on the scale they are not use to.  OB/GYN's see their pregnant patients the most, and would therefore be the best line of defense when it comes to pregnancy eating disorders. Unfortunatly, most OB/GYN's do not know the signs and symptoms to look for when evaluating for an eating disorder. And with new standards and hospital regulations, patients are in and out of the office in 15 minutes or less, making it difficult to have the time to get the answers need to diagnose. Treatment requires counseling and looking out for tricks (such as overexercising to compensate for calorie intake) that OB/GYN's might miss. It is important to be educated about the signs to avoid life threatening complications.

I think this article is really cool for anyone going into the prenatal nutrition area of practice. I have been at WIC for weeks now, and have worked with pregnant women before, and NEVER have I though, "I wonder if she has an eating disorder". This article is a real eye opener for anyone working with soon-to-be moms!
-JR

Getz, L. (2015). Starving for Two. Today's Dietitian, 17(1), 14-           16. http://www.todaysdietitian.com/newarchives/011315p14.shtml.

Monday, January 19, 2015

Preoperative Nutrition Protocols


“Traditional beliefs still persist among surgeons to delay initiating nutrition support, despite recommendations to the contrary” said David Evans, MD at last year’s Food & Nutrition Conference and Expo in October 2014. David Evans is an Assistant Professor of Surgery, Medical Director, and Director of Nutrition Support Service at The Ohio State University. And the recommendations in question, a collection of strategies to improve surgical outcomes before, during, and after surgery, are garnering some press. The Sweden-based society, known as Enhanced Recovery After Surgery (ERAS) have considered the application of pre- and postsurgical nutrition interventions to surgical patients. Some of the interventions selected include “nutrition assessments and counseling; prebiotic/probiotics administration; limiting preoperative fasting to two to three hours, rather than the traditional six to 12 hours; and immediate postoperative fluid and diet initiation” (Webb, 2015), carbohydrate loading presurgery and increasing protein intake. Such interventions have shown to benefit postoperative mobilization, reduce post-op complications, prevent nutritional deficiencies, reduce aspiration risk, minimize incidence of post-op insulin resistance, promote healing and preservation of lean tissue, and improve recovery time, to a few (Hegazi et al., 2014; Hayhurst, et al., 2014; Webb, 2015).

Not all patients benefit from preoperative nutritional assessment equally. Two basic rules for nutritional assessment presurgery: 1. Determine nutritional status and nutrition risk in patients and 2. Identify high- vs low-risk surgeries. Practical guidelines for dietitians to be mindful of in a surgical patient’s initial nutritional assessment are listed below:

·       Degree of weight loss/trends in recent month(s)

·       BMI

·       Current dietary intake  

·       Supplementation and medication use

·       Clinical status – current diagnosis, type, severity of the disease, etc.

·       Nitrogen balance

·       Hydration status

Given the above guidelines, characteristics that predominate among high-risk patients include weight loss >5% over the past 1-3 months, BMI <18.5, food intake ≤75% of requirements, take steroids and have immunosuppression or cancer (Webb, 2015). Parenteral nutrition (PN) administration would be beneficial in this case, however, do bear in mind the solution’s composition and rate. (To those interested, I included a review article written by Evans and colleagues that further discusses the nutrition screening protocols). Doing so can help avoid complications and infections. Esophageal, gastric, colorectal surgeries, major orthopedic and neurological surgeries are cited as surgeries with high nutrition risk.

The Ohio State University surgeon, David Evans, MD, has this to say about delivering convincing evidence to surgeons and anesthesiologists of routine preoperative nutrition screening and support: “Bring evidence that will encourage them to buy into these nutrition protocols."
CP

References

Evans, D., Martindale, R., Kiraly, L., & Jones, C. Nutrition optimization prior to surgery. Nutr Clin Pract. 2014;29(1):10-21. doi: 10.1177/0884533613517006

Hayhurst C, Durieux ME. Enteral hydration prior to surgery: the benefits are clear. Anesth Analg. 2014;118(6):1163-1164.

Hegazi RA, Hustead DS, Evans DC. Preoperative standard oral nutrition supplements vs immunonutrition: results of systematic review and meta-analysis. J Am Coll Surg. 2014;219(5):1078-1087.

Webb, D. Optimizing nutrition before surgery. Today’s Dietitian. 2015;17(1):19. http://www.todaysdietitian.com/newarchives/011315p10.shtml. Accessed January 19, 2015.

Saturday, January 17, 2015

Nutrition management for postmenopausal women with PCOS

Polycystic ovary syndrome (PCOS) is an endocrine disorder associated with metabolic dysfunction, menstrual irregularities, hyperandrogenism, insulin resistance, and decreased fertility (Grassi, 2014; Puurunen et al., 2011). Glucose intolerance tends to be more apparent in women with PCOS and often “occurs earlier than expected compared to the general population” (Gambineri, et al., 2012; Grassi, 2014). Elevated abdominal adiposity contribute to greater incidence of insulin resistance, type 2 diabetes, dyslipidemia, and cardiovascular disease. The risk of developing heart disease and type 2 diabetes are potentially increased five-fold in postmenopausal women with PCOS (Boudreaux et al., 2006; Grassi, 2014). Dietary and lifestyle interventions for prevention (e.g., nutritional deficiencies), early diagnosis and treatment (e.g. impaired glucose tolerance) and management are important for improving outcomes.

Optimal management of PCOS requires lifestyle modification often in combination with pharmacologic therapy (e.g., insulin-sensitizing medications such as metformin) (Grassi, 2014). Diet and lifestyle intervention studies that led to moderate weight loss (roughly 5 to 10 percent of total body weight) “have shown beneficial effects on the endocrine, metabolic and reproductive profile” (Crosignani, et al., 2003; Grassi, 2014; Kiddy et al., 1992; Panidis et al., 2008; Thomson, et al., 2008). Common nutritional interventions used for PCOS include calorie restriction, glycemic index and glycemic load modification, and moderate dietary carbohydrate reduction with reasonable increases in protein (improves glucose tolerance and assists with weight loss). Diets that deliver 40% or more of its calories as protein appear to result in “greater weight loss and body fat” (Grassi, 2014). Diets that incorporates fiber-rich foods, red wine, and omega-3 fat also prove to be of benefit – decreases the inflammation (C-reactive protein) and other metabolic abnormalities that often accompany PCOS (Grassi, 2014). Effective drugs and dietary supplements currently available for older women with PCOS include myo-inositol, D-chiro-inositol, oral magnesium supplements, alpha-lipoic acid, vitamin D, omega-3 fatty acid supplementation, cinnamon, and licorice root (Armamani et al., 2007; Costantino et al, 2009; Grassi, 2014; Masharani et al., 2010; Rashidi, 2009).

            While nutritional interventions and various supplements are certainly effective in aging women with PCOS, potential barriers to weight management have to be considered. The challenges dietitians often face when counseling PCOS patients are summarized in the article written by Angela Grassi, MS, RDN, LDN, founder of the PCOS Nutrition Center.
CP
References

Armanini D., Castello, R., Scaroni, C., Bonanni, G., Faccini, G., Pellati, D., … & Moghetti, P. (2007). Treatment of polycystic ovary syndrome with spironolactone plus licorice. Eur. J. Obstet  Gynecol Reprod Biol. 131 (1), 61-67

Boudreaux, M., Talbott, E., Kip K., Brooks, M., &Witchel., S. (2006). Risk of T2DM and impaired fasting glucose among PCOS subjects: Results of an 8-year follow-up. Current Diabetes Reports 6 (1), 77-83
 
Costantino, D., Minozzi, G., Minozzi, E., & Guaraldi, C. (2009). Metabolic and hormonal effects of myo-inositol in women with polycystic ovary syndrome: A double-blind trial. European Review for Medical and Pharmacological Sciences 13 (2), 105-110.
 
Crosignani, P., Colombo, M., Vegetti, W., Somigliana, E., Gessati, A., & Ragni, G. (2003). Overweight and obese anovulatory patients with polycystic ovaries: Parallel improvements in anthropometric indices, ovarian physiology and fertility rate induced by diet. Hum. Reprod. 18 (9), 1928-1932. doi: 10.1093/humrep/deg367

Gambineri A., Patton, L., Altieri, P, et al., (2012). Polycystic ovary syndrome is a risk factor for type 2 diabetes: Results from a long-term prospective study. Diabetes 61 (9), 2369-2374. doi: 10.2337/db11-1360.

Grassi, A. (2014). PCOS in aging women – Beyond hormones and hot flashes. Today’s Dietitian 16 (2), 40. Retrieved from: http://www.todaysdietitian.com/newarchives/020314p40.shtml
Kiddy, D., Hammilton-Fairley, D., Bush, A., Short, F., Anyaoku, V., Reed, M., & Franks, S. (1992). Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clinical Endocrinology (Oxf) 36 (1), 105-111.


Masharani, U., Gjerde, C., Evans, J., Youngren, J., & Goldfine, I., Effects of controlled-release alpha lipoic acid in lean, nondiabetic patients with polycystic ovary syndrome. J Diabetes Sci Technol. 4(2), 359-364

Panidis, D., Farmakiotis, D., Rousso, D., Kourtis, A., Katsikis, I., & Krassas, G. (2008). Obesity weight loss, and the polycystic ovary syndrome: Effect of treatment with diet and orlistat for 24 weeks on insulin resistance and androgen levels. Fertility and Sterility 89 (4), 899-906. doi: http://dx.doi.org/10.1016/j.fertnstert.2007.04.043

Puurunen, J. Piltonen, T., Morin-Papunen., L, et al. (2011). Unfavorable hormonal, metabolic, and inflammatory alterations persist after menopause in women with PCOS. The Journal of Clinical Endocrinoly and Metabolism 96 (6), 1827-1834. doi: 10.1210/jc.2011-0039.

Rashidi, B., Haghollahi, F., Shariat, M., & Zayerii, F. (2009). The effects of calcium-vitamin D and metformin on polycystic ovary syndrome: a pilot study. Taiwan J Obstet Gynecol. 48 (2), 142-147.

Thomson, R., Buckley, J., Noakes, M., Clifton, P., Norman, R., & Brinkworth, G. (2008). The effect of a hypocaloric diet with and without exercise training on body composition cardiometabolic risk profile, and reproductive function in overweight and obese women with polycystic ovary syndrome. The Journal of Clinical of Endocrinology and Metabolism 93(9), 3373-3380. doi: 10.1210/jc.2008-0751

Thursday, January 15, 2015

Vegetarian Value

Loma Linda University is a college in San Bernardino, California. It is known for many things, one being that people around the university tend to have incredible longevity of life. It is actually one of the top three highest longevity cities in the world. There are many theories on why people at this university are living longer, but it seems that it can be attributed mainly to the large Seventh-Day Adventists. Many Seventh-Day Adventists are vegetarians, and the school even went so far as to make their entire campus "meat-free". Adventists also avoid smoking, drinking alcohol, pork, lamb, shellfish, coffee, and tea. This article describes how this university campus and surrounding community are prime ground for studying long term effects of certain diet restrictions. In a two part clinical study, nutritional scientists were able to study over 50,000 people and evaluate how their diet and lifestyle effects their longevity. This could be very valuable to clinical dietetics. If we can show that one food, or even a certain group of foods can be a major impairment on longevity, it will help us better council clients into living healthier, longer lives. 

-JR

Palmer, S. (2013). Vegetarian Value. Today's Dietitian, 15(10), 24-24.

Thursday, December 4, 2014

Making Sense of Antioxidants


            In recent history the words, “high in antioxidants” started to appear on food labels left and right. But what does that mean? What is considered high and why is it important to have antioxidants and what do they do? Where should they get antioxidants?

            Lindsey Getz gives people a very good first few steps into the understanding of antioxidants in her article in Today’s Dietitian. She provides lists of where to find which antioxidants, talks about supplementation, and even gives a very refreshing opinion about the fact that scientist don’t have a complete understanding of all of them or what they do so the science will continue to change with time.


Getz, L. (2008). Making sense of antioxidants. Today’s Dietitian, 10(9), 50.
-ES

Fish Oils and Cognitive Function


            It bothers to me to great extent when older Americans are roped into buying things and using things that they don’t need and can’t afford. In this case I’m talking about fish oils. Every person over the age of 50 I know is taking them. Sometimes it’s because their doctor tells them to, sometimes a friend, and sometimes just some quack who surfs the trend wave in nutrition.

            “Fish is Brain Food” looks at both the “sunrise and sunset years” of life and talks to some degree about if fish oils really do make a difference. The studies are becoming more common and the subject better understood. There is some controversy but for the most part they are linking fish oils to increased cognitive ability for longs, but scientists still can not say if Omega-3’s or something else in fish are causing the improvement, or if whatever the fish is replacing was causing the damage.

 

Harris, W.S. (2014). Fish oils and cognitive function. Today’s Dietitian, 16(9). 21.

-ES