Gluten-Free Eating with Scleroderma. Tenille Sonnichsen, RD (204)

Transcription

1 Gluten-Free Eating with Scleroderma Tenille Sonnichsen, RD (204)

2 Outline Nutrition concerns for Scleroderma Eating guidelines for Scleroderma Gluten-free diet Low FODMAP diet Nutrition management of symptoms Local gluten-free grocery stores 2

3 Nutrition Management of Scleroderma: What have you heard? -nutrition management, symptoms, concerns?? 3

4 GI Symptoms Digestive system- the most commonly affected organ system second to the skin (75-90%) Scleroderma gut = decreased blood supply to the nerves that stimulate the bowel Weakening of muscle strength resulting in slowed gut mobility Frequency of GI Symptoms (n= 209) Symptom Prevalence (%) Heartburn 71 Trouble Swallowing 52 Bloating 80 Diarrhea 51 Constipation 51 Fecal Incontience 35 Scleroderma Foundation survey

5 Anti-Reflux Measures Elevate the head of the bed 6-8 inches (wedge pillow, blocks under mattress, electric bed) Largest meal of the day at noon, smaller breakfast and supper meals Avoid eating or drinking anything for 2 hours before bedtime Eat small frequent meals (5-6 meals/day) Avoid using extra pillows. No tight garments around the waist (increased pressure over the stomach) Medications Stop smoking Minimize acid-producing foods (fatty foods, chocolate, coffee) 5

6 Nutrition Concerns for Scleroderma Manage symptoms Fight inflammation Adequate energy, protein, vitamins and minerals Malnutrition Not always symptoms - vitamin/mineral deficiencies can occur from: inadequate intake poor absorption of nutrients by the GI tract 6

7 Symptoms of Malnutrition unexplained wt loss of >10% in 3 months weakness, muscle wasting excessive fatigue frequent infections, weakened immune system delayed wound healing brittle nails, excessive hair loss excessively dry/flaky skin 7

8 Eating Guidelines for Scleroderma Small, frequent meals (every 3-4 hours) Whole, fresh, unprocessed foods Avoid preservatives, artificial ingredients, hydrogenated fats Antioxidant-rich foods- fruit, vegetables, herbs and spices Anti-inflammatory foods- omega-3 rich fish (8-12oz per week), fruit, vegetables, herbs and spices 8

9 Eating Guidelines (cont d) Reduce added sugars Sugar, sucrose, fructose, evaporated cane juice, concentrated fruit juice, agave nectar, honey, brown rice syrup, molasses, corn syrup, maple syrup Multivitamin/mineral supplement 15mg zinc, 10-18mg iron, vitamins A, D, E and K, folate, B12 Probiotic supplements may help with intestinal symptoms such as bloating and distension Align, Culturelle, Bio Gaia, Florastor Filtered water that has never been exposed to plastic- glass or stainless steel cups or water bottles Drink half your body weight (lbs) in water (oz) each day 150lb person should drink 75oz (9.5 cups) water 9

10 Scleroderma Food Guide Food Group Serving size Choose Avoid Suggestions Fruit 2-3 servings per day one small whole fruit 1 cup pieces (melon, grapes, berries) 1/4 dried (raisins, cherries) 1/2 cup canned All varieties in deep colors of the rainbow: green, red, orange, yellow, purple, & blue. Those that cause excessive gas, bloating, & GI discomfort. See low FODMAP diet for details. Choose organic as often as possible. Choose fresh and frozen over canned varieties. Vegetables 5-7 servings per day 1 cup raw, chopped 1 cup leafy 1/2 cup cooked All varieties in deep colors of the rainbow: green, red, orange, yellow, purple, & blue. Those that cause excessive gas, bloating, & GI discomfort. See low FODMAP diet for details. Choose organic as often as possible. Choose fresh and frozen over canned varieties. Proteins: m eat, cheese, eggs, nuts, beans -aim for: 2-3 oz per meal; 1 oz. per snack 2-3 oz. meat (size of deck of cards) 1 oz. protein equivalents: 1 egg; 1-inch cube cheese; 1 medium slice cheese; 1/4 cup tuna or cottage cheese; 2 Tbsp. nut butter; 1/4 cup nuts; 1/2 cup dried beans lean beef lean pork skinless chicken turkey fish/tuna organic eggs low-fat cheese nuts/seeds nut butters dried beans (as tolerated) Highly processed meats such as bacon, sausage, pepperoni, salami, hot dogs, bologna, corned beef, & pastrami. Breaded and deep-fried fish, chicken, pork and beef. Choose organic or grass fed meat and cheese as often as possible. Remove extra fat and skin from meats before cooking. For healthy omega-3 oils, eat 8-12 oz. of fatty fish, such as salmon, every week. Milk/Dairy 2-3 servings per day 1 cup milk 6-8 oz. yogurt Low-fat or fat free varieties. Try Greek-style yogurt for extra protein. Avoiding lactosecontaining dairy products may help resolve problematic GI symptoms. See low FODMAP diet for details. Choose organic as often as possible. Whole Grains 3-6 servings per day 1 slice bread 1/2 cup pasta or rice 3/4 cup cereal 1/2 cup cooked cereal 4-6 crackers 100% whole grains, such as minimally processed whole wheat bread and cereals, barley, quinoa, oats. Avoiding all foods containing wheat may improve GI symptoms. See low FODMAP diet for details. Look for labels that read "100% whole grain". Choose foods with 3 grams of fibre or more per serving. Limit white, refined wheat products as much as possible. Fats/Oils 1-2 servings per day 1 Tbsp oil 1/4 cup nuts 2 Tbsp. seeds 2 Tbsp. nut butter 1/8 avocado Extra virgin olive, peanut, and canola (rapeseed) oils most often. all nuts, especially almonds, walnuts, flaxseeds, pine nuts. avocado natural peanut butter Avoid trans fats from hydrogenated and partially hydrogenated oils. Minimize use of safflower, sunflower, grapeseed, corn, and soybean oils. Limit solid fats from butter, shortening, and margarine. For healthy omega-3 oils, eat 8-12 oz. of fatty fish, such as salmon, every week. 10

11 Gluten-Free Diet Celiac disease or gluten intolerance Must avoid the protein (gluten) found in wheat, rye, or barley: Barley, beer/ale/lager, brewers yeast, bulgur, couscous, durum*, einkorn*, emmer*, farina, farro/spelt*, hydrolyzed wheat protein, kamut*, malt, modified wheat starch, oats**, pasta, rye bread and flour, semolina, triticale, wheat bran/flour/germ/starch *types of wheat **oats do not contain gluten but are contaminated during processing. Certified gluten free oats include Cream Hill Estates Oats, Only Oats, Bob s Red Mill, Gluten-Free Oats, and Gifts of Nature. 11

12 Gluten-Free Label Reading Check: The Warnings section Ingredients list Warnings: CONTAINS or MAY CONTAIN wheat, rye, barley, oats or gluten = NOT OK If there is a CONTAINS statement and it does not include wheat or a gluten grain, the ingredients are acceptable for a gluten free diet. Ingredient list If there is no CONTAINS statement, check the INGREDIENT list for wheat, rye, barley, oats, etc. If no gluten source is listed, the product is acceptable for a glutenfree diet. If the ingredients just says oats, assume they are contaminated with wheat unless identified as pure uncontaminated oats 12

13 Gluten-Free Foods Plain meat, eggs, poultry, fish, nuts, seeds, legumes, fruit, vegetables, milk, cheese, yogurt, gluten-free flours, cereals and starches Distilled alcohol and wine (not beer made from barley) Vinegars except malt vinegars Gluten-free flours, cereals and starches: amaranth, arrowroot, buckwheat, corn, flax, indian ricegrass (Montina), legume flours (chickpea, lentil, bean, pea), mesquite flour, millet, nut flours (almond, hazelnut, pecan), potato flour or starch, quinoa, rice bran, sago, sorghum, soy, sweet potato flour, rice, tapioca (cassava/manioc), tef 13

14 Gluten-Free Diet Wheat flour substitutes For flouring or breading meats: cornmeal, potato flakes, mixture of rice, bean or sorghum flours, crushed potato chips, crushed rice crackers, gluten-free cereal, gluten-free bread crumbs For gravies and sauces: sweet rice flour or cornstarch. Remember starches break down and get thinner under high heat or long cooking times. For pudding and pie fillings: cornstarch, potato starch, tapioca or arrowroot. Starches get watery after about a day, so a mild flavoured gluten-free flour may be used as an alternative, such as a rice flour and starch mixture. See handout 14

15 Gluten-Free Eating Resources Canadian Celiac Association The Gluten-Free Diet by Shelley Case Cookbooks: 1000 Gluten-Free Recipes by Carol Fenster 125 Best Gluten-Free Bread Machine Recipes by Donna Washburn and Heather Butt 250 Gluten-Free Favourites by Donna Washburn and Heather Butt 15

16 FODMAPs Fermentable Oligosaccharides (fructans and galactans) Disaccharides (lactose) Monosaccharides (excess fructose) And Polyols (sugar alcohols ie. sorbitol, maltitol, xylitol, isomalt) 16

17 FODMAP Food Guide FODMAP Category Foods to avoid Foods to choose Oligosaccharides: -Fructans and Galactans -Fructooligosaccharides (FOS) -Galactooligosaccharides (GOS) all wheat & rye containing grains breaded meats brown rice bran cereals inulin (check ingredient list) balsamic, red wine, & cider vinegar soy legumes (black, kidney, pinto beans, garbanzo, etc.) lentils asparagus, cabbage, broccoli, artichokes, leeks, shallots, squash, green beans, onion, garlic corn tortillas, grits, oatmeal, unsweetened corn or rice cereals, white rice, barley, rice noodles products labeled "glutenfree" are usually well-tolerated, such as GF bread and pasta celery, spinach, potatoes (white) Disaccharides: -Lactose Monosaccharides: -containing excess Fructose milk and milk products such as yogurt, cheese, pudding, ice cream, custard apple, pear, watermelon, honeydew, papaya, mango, starfruit, guava, some grape varieties dates, figs, raisins, currants high fructose corn syrup corn syrup solids (check ingredients) honey agave nectar fruit juices contain apple or pear lactose-free milk & milk products unsweetened almond milk unsweetened rice milk blueberry, blackberry, boysenberry, cranberry, raspberry, strawberry, loganberry kumquat, grapefruit, lemon, lime, mandarin, orange, tangelo ripe banana, jackfruit, kiwi fruit, passion fruit, pineapple, rhubarb Polyols apricot, nectarine, plum, peach pear, apple, cherries, prunes avocado, mushrooms "diet" or "sugar free" labeled foods containing added sugar alcohols (listed previous slide) None (no diet or sugar free foods) 17

18 Nutrition Management of Scleroderma Symptoms Reflux/Heartburn eat small frequent meals; avoid overfilling stomach avoid eating for 2-3 hours before bed avoid foods that may aggravate symptoms citrus, tomato products, coffee, greasy foods, garlic, onions, peppermint, spicy foods, carbonated drinks, alcohol, gas-producing foods (raw peppers, cauliflower, broccoli, beans, raw onions) elevate head of the bed to prevent regurgitation Constipation/Slow GI Motility High fibre foods ie. 100% whole grains, fruit, vegetables Probiotics daily- yogurt or supplement (Align or Culturelle) Increase fluid intake Exercise such as walking 18

19 Nutrition Management of Scleroderma Symptoms Inflammation Increase antioxidant intake Brightly coloured vegetables and fruit (dark green, orange, yellow, blue and purple), fatty fish, ground flaxseed, walnuts, nuts, seeds, extra-virgin olive oil Take 1000iu Vitamin D3 daily (with fattiest meal) Fatigue Eat small, frequent meals Increase fluid intake Check blood iron levels. If low, eat iron-rich food, and possibly an iron supplement along with vitamin C rich foods or fruit juice. Exercise mins daily Sleep 7-8 hours per night 19

20 Nutrition Management of Scleroderma Symptoms Poor circulation/renaud s Exercise If you have finger ulcers, eat animals sources of protein with zinc and iron (beef, pork, liver) to speed wound healing Tight/thickened skin Eat foods rich in vitamin E Nuts, seeds, wheat germ, and canola, olive, peanut oils Supplement biotin 5mg (5000mcg) daily (may help skin and nails) 20

21 Winnipeg Gluten-Free Grocery Stores Gluten-Free Grocery Stores Lorenzo s Specialty Foods St. Mary s Rd Meyers Whole Foods- 483 William Ave Cocoabeans Bake Shop- 268 Tache Ave Central Products and Foods- 630 Nairn Ave Grocery stores with some gluten-free products Superstore Sobeys Costco Family Foods Co-op Shopper s Drug Mart +More listed on Canadian Celiac Association website 21

22 Questions? Tenille Sonnichsen, RD (204) References: Canadian Celiac Association. Case, S. The Gluten-Free Diet: A Comprehensive Resource Guide. Kaminski, L. and Khanna, D. Eating Well with Scleroderma. The Department of Internal Medicine; Scleroderma Program, Division of Rheumatology. Scleroderma Foundation. 22