1. Specialized Diets In-Service Presentation MUSC Dietetic Interns 2011

2. Renal Diet At MUSC a renal diet is ordered for patients with kidney failure. The kidneys play an important role in body function: – Filtering the blood – Removing waste products – Balancing electrolytes - Sodium and Potassium – Fluid balance

3. Renal Diet At MUSC renal diet patients are limited to: – 2000mg Sodium – 2000mg Potassium – 1200mg Phosphorus – Protein intake is monitored and/or restricted on an individual basis.

4. High Potassium Foods to Avoid Fruits: Vegetables:

5. Foods to Limit Milk: Dairy: Protein:

6. Foods to Enjoy Low Protein: Low Sodium: Low Potassium: Low Phosphorus:

7. Soaking Potatoes A special process called leaching or soaking helps remove the potassium from potatoes. This can be done at MUSC giving renal patients more food choices.

8. Renal Sample Diet Dinner 2oz grilled pork chop ½ cup rice ½ cup green beans with onion and basil ½ cup applesauce Dinner Roll 1 cup water with lemon

9. Low Sodium Diet At MUSC low sodium diets are given to those who have hypertension (high blood pressure), cardiac, liver or renal disease. o Sodium raises blood pressure. Low Sodium Diet = 2 grams sodium/day. o Each meal can exceed the sodium limit by 100 mg.

10. Why Low Sodium? Sodium raises blood pressure. If untreated, high blood pressure will eventually damage the heart, causing: o Stroke o Heart attack o Heart failure

11. Foods to Limit Sodium is typically higher in processed and convenience foods, such as: oHam, bacon, sausage, and other deli-style meats oCanned vegetables At MUSC low sodium diets do not allow: Ham, Bacon, or Sausage Soups (except reduced sodium chicken noodle) Stir-Fry

12. Foods to Limit Continued… Low sodium diets do not allow salt packets to be added to a meal. If patients complain about their food with no flavor, suggest spicing it up with: – Mrs. Dash – Pepper – Lettuce – Tomatoes – Mustard – Green Peppers – Onions

13. Low Sodium Diet Example Breakfast: – Veggie Omelet – Wheat Toast – Fruit – Juice – Coffee with Sugar and Creamer

14. Carbohydrate Counting

15. Type 1 Diabetes What is it? – Insulin not produced in pancreas – Must supplement with insulin Who is at risk? – Only 5% of the population – Mostly children and young adults – Genetics and environment

16. Type 2 Diabetes What is it? Increased at risk cultures: African Americans, Native Americans, Latino Can have insulin resistance OR insulin shortage Insulin helps to absorb glucose, so lack of it can lead to diabetic complications.

17. Carbohydrate Counting Diet Carbs in food raise blood sugar levels. Level I, II, III Limits fat, cholesterol, and salt intake Consuming a consistent level of carbohydrates avoids spikes in blood sugar!

18. Foods to Monitor Breads Fruits/Starchy Vegetables Dairy Sweets

19. Foods to Enjoy Non-Starchy Vegetables Low Fat Cheeses Eggs/Lean Meats Dairy with No Added Sugar

20. Sample Meal – Level II Lunch – 75 grams of carbohydrates – 1 cup vegetable soup with 4-6 crackers – 1 turkey sandwich (2 slices whole wheat bread, 1 oz turkey, 1 oz low fat cheese, 1 tsp mayo) – 1 small apple

21. Gluten-Free Diet

22. What is Gluten? Gluten is protein found in: – Wheat – Rye – Barley – Oats Gluten can severely damage the intestines ability to absorb nutrients in those with gluten sensitivity.

23. Foods to Avoid Wheat Products (Flour) – Breads, Wraps, Pancakes, Waffles, Cookies, Cereals, etc. Oatmeal Processed Meats – Sausage, Deli Meats Breaded meats – Oven Fried Chicken, Meatloaf Pasta French Fries Soy Sauce

24. Foods to Enjoy Corn Baked Potatoes Soaked Potatoes Rice Meat – Marinated Chicken Breast, BBQ Chicken, Baked Fish, BBQ Pork, Hamburger Patty Fruit Vegetables Milk and Milk Products

25. Gluten-Free Sample Meals Breakfast: – Rice Krispies with skim milk, fresh fruit cup, eggs, yogurt Lunch – Hamburger patty with ketchup, tossed salad with oil and vinegar, baked potato with margarine and sour cream, sherbet Dinner – Baked fish with green beans, corn, tossed salad with oil & vinegar dressing, pudding

26. Cross-Contamination Store gluten-free foods separately from foods that contain gluten. Separate cooking equipment – Pans, pots, plates, etc. Personal containers for condiments – Peanut butter, mayonnaise, mustard, etc. Prepare gluten-free foods in a separate area from foods that contain gluten. – OR sanitize kitchen areas

27. Toddler Diet – For Ages 12 months to 3 years Balanced Meals for Healthy Children Fruits and Vegetables Small Portions and Finger Foods

28. Toddler Diet - Reasoning Little mouths need little bites – prevent choking. Children may not be able to use utensils.

29. Foods to Avoid Food that has not been cut up Hot Dogs Grapes Big Sandwiches Skim Milk Salad Tater Tots Junk Food or Sugary Foods

30. Diet Jeopardy

31. Thank You!