Alvina Begay, RD Professional Runner Nike N7 Ambassador Registered Dietitian at Flagstaff Medical Center

Transcription

1 Alvina Begay, RD Professional Runner Nike N7 Ambassador Registered Dietitian at Flagstaff Medical Center

2 Objec&ves: Become knowledgeable about the Academy of Nutrition and Dietetics guidelines on healthy weight loss. Become knowledgeable about the GAPs, Paleo, 8 Hour and Intermittent Fasting diets. Make appropriate recommendations as to whether a specific diet may or may not work for particular patients and make RD referrals if necessary.

3 Talk Descrip&on: People who try to lose weight are always looking for the latest in how to lose weight fast and eat healthfully. Fad diets come and go, as does the weight that people lose and regain. I will discuss the latest on weight loss recommendations by the Academy of Nutrition and Dietetics. I will also discuss some of the popular diets that people are on to lose weight, fight food allergy symptoms and support digestive healing.

4 GAPs Diet

5 GAPS Diet GAPS Diet refers to the treatment program that people with GAPS (Gut and Psychology/Physiology Syndrome) go on to heal. Purpose of the treatment is to detoxify the person, to lift the toxic fog off the brain to allow it to develop and function properly. To do this, the digestive tract needs to heal so it stops being the major source of toxicity in the body. As more than 90% of everything toxic floating in our blood (and getting into the brain) comes from the gut, healing it will drop the level of toxicity in the body dramatically.

6 Leaky Gut

7 GAPS Diet: What can damage the gut flora? Sugar, grains esp. empty carbohydrates Anti inflammatory drugs or any medications Antibiotics Diet off balance between Omega 6 s and omega 3 s Transfats Stress, infections Chemotherapy Toxins pesticides, preservatives, hormones, fake colorings

8 GAPS Diet: The GAPS Diet involves three steps: 1. The Diet. The digestive system is a long tube. What you fill that tube with has a direct effect on its well being. Diet is the most important and the number one treatment. Everything else takes a second place. The diet is implemented in two parts first is called GAPS Intro (or the Intro Diet) which an intensive healing diet: mostly boiled meat, homemade bone broth and boiled veggies for a period of time until digestive symptoms clear. Then, through a series of several stages, you move into Full GAPS. Full GAPS is a much less restricted diet that includes plenty of healthy proteins and fats, along with vegetables and some fruits. Harder to digest starches and sugars are avoided to allow the gut time to heal. 2. Appropriate Supplementation. Probiotics, essential fatty acids, fermented cod liver oil and digestive support are generally recommended. 3. Detoxification and Lifestyle Changes. Reducing stress, making sure to get proper sleep and reducing toxic load in the home and personal care products are all important.

9 Cons of the GAPs Diet: Not a quick fix: can take anywhere from several months up to 2 years. Expensive Eat organ meats Calls for fermented foods High amount of lead in broth Time put into making food

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11 Paleo Diet Caveman Diet, Stone Age diet or Hunter Gatherer Diet. Premise: Modern humans are genetically adapted to the diet of their Paleolithic ancestors and that human genetics have scarcely changed since the dawn of agriculture and therefore an ideal diet for human health and wellbeing is one that resembles this ancestral diet.

12 Paleo Diet Yes Fish Grass fed raised meats Eggs Vegetables Fruit Roots Nuts No Grains Legumes Dairy products Potatoes Refined salts Refined sugar Processed oils

13 Paleo Diet: 1. Eat whole unprocessed, nutrient dense, nourishing foods. Grass fed and pastured meats and eggs, wildcaught seafood and vegetables are prioritize. Fruit, nuts and seeds are eaten in moderation. 2. Foods that harm by causing systemic inflammation, wrecking the guts or derailing our natural metabolic processes are avoided. Abstain from toxic, proinflammatory foods like gluten containing grains, legumes and sugar. 3. The Paleo Diet is not a weight loss cure all

14 Pros of the Paleo Diet: Putting protein on your plate. The Paleo advocates eating fish, poultry (Omega 3 fatty acids reduce risk of chronic diseases). Eating nuts and seeds Filling up on extra veggies Guzzling down water Ridding yourself of refined sugar

15 Cons of Paleo Diet: Ditching dairy: low fat yogurts, cheese and milk can be a great source of calcium and protein. Giving up grains: Not all grains are bad for you. Grains such as quinoa and oats are good sources of vitamins and minerals and fiber. Fiber found in these foods helps to keep us fuller for longer. Letting go of legumes: good source of protein and antioxidants.

16 8 Hour Diet

17 8 Hour Diet Eat in a 8 Hr window for three days Feast 8 hours and then fast for 16 hours Eat whatever you want. Hopefully you won t eat junk Suppose to help stay full longer Cons: doesn t promote eating healthy foods

18 IntermiEent Fas&ng Diet

19 IntermiEent Fas&ng Diet: Drastically restrict calories 1 2 days a week and then eat normally on others How does it work: Our bodies need fuel to operate and if there isn t any food in the stomach to pull from, it uses stored fat within the body for energy. The fat gets burned for energy, the body keeps moving and thus becomes leaner.

20 Risks: Feel hungry, fatigued and irritable. Fasting not comfortable. People try to cut back one day and the next day they re starving and they overeat. Still eating junk food. Abuse stimulants coffee Obsess over the clock You think that more = better. Why not fast for 48 hours? 72 hours?

21 Academy of Nutri0on and Diete0cs Guidelines on Healthy Weight Loss

22 Guideline Objec&ve To provide Medical Nutrition Therapy (MNT) guideline recommendations for adult weight management that reduce body weight, prevent further weight gain and maintain weight loss over a prolonged period. Focus of this guideline is on the treatment of adult overweight and obesity. Overweight is defined as a body mass index (BMI) of kg/m2 and obesity as a BMI>/= 30.0 kg/m2

23 Academy s Guideline for Weight Loss Body weight and waist circumference should be used to determine the effectiveness of therapy in the reassessment. BMI and waist circumference are highly correlated to obesity or fat mass. Comprehensive weight management program including diet, physical activity and behavior therapy. The combination therapy is more successful than using any one intervention alone. Individualized goals of weight loss therapy should be to reduce body weight at an optimal rate of 1 2 lbs per week for the first 6 months and to achieve an initial weight loss goal of up to 10% from baseline. These goal are realistic, achievable and sustainable.

24 Academy s Recommended Dietary Interven&ons Reduced Calorie Diet: Reducing dietary fat and/or carbohydrates is a practical way to create a caloric deficit of Kcals below estimated energy needs and should result in a weight loss of 1 2 lbs per week. Total caloric intake should be distributed throughout the day, with the consumption of 4 5 meals/snacks per day including breakfast. Portion Control: Portion control should be included as part of a comprehensive weight management program. Portion control at meals and snacks results in reduced energy intake and weight loss.

25 Academy s recommended Dietary Interven&ons Meal Replacement: For people who have difficulty with self selection and/or portion control, meal replacements (liquid meals, meal bars, calorie controlled packaged meals) may be used as part of the diet component of a comprehensive weight management program. Substituting one or two daily meals or snacks with meal replacements is a successful weight loss and weight maintenance strategy. Nutrition education should be individualized and included as part of the diet component of a comprehensive weight management program. Short term studies show that nutrition education (reading nutrition labels, recipe modification, cooking classes) increases knowledge and may lead to improved food choices.

26 Selected Dietary Approaches Low Glycemic Index Diets: a low glycemic diet is not recommended for weight loss or weight maintenance as part of a comprehensive weight management program. Has not been shown to be effective in these areas. Dairy/Calcium and Weight Management: Incorporate 3 4 servings of low fat dairy foods a day as part of the diet component of a comprehensive weight management program. Research suggests that calcium intake lower than recommended levels is associated with increased body weight. However, the effect of dairy and/or calcium at or above recommended levels on weight management is unclear. Low Carbohydrate Diet: Having patient focus on reducing carbohydrates rather than reducing calories and/or fat may be a short term strategy for some individuals. Research indicates that focusing on reducing carbohydrate intake results in reduced energy intake. Consumption of a low carbohydrate diet is associated with a great weight loss and fat loss than traditional reduced calorie diets during the first 6 months, but these differences are not significant after 1 year.

27 Physical Ac&vity Interven&ons Physical activity should be part of a comprehensive weight management program. Physical activity level should be assessed and individualized long term goal established to accumulate at least 30 minutes or more of moderate intensity physical activity on most, and preferably, all days of the week, unless medically contraindicated. Physical activity contributes to weight loss, may decrease abdominal fat, and may help with maintenance of weight loss.

28 Behavioral Interven&ons Multiple Behavior Therapy Strategies: A comprehensive weight program should make maximum use of multiple strategies for behavior therapy (self monitoring, stress management, stimulus control, problem solving, contingency management, cognitive restructuring, and social support). Behavior therapy in addition to diet and physical activity leads to additional weight loss. Continued behavioral interventions may be necessary to prevent return to baseline weight.

29 Bariatric Surgery for Weight Loss Dietitians should collaborate with other members of the health care team regarding the appropriateness of bariatric surgery for people who have not achieved weight loss goals with less invasive weight loss methods and who meet NHLBI criteria. Separate ADA evidence based guidelines are being developed on nutrition care in bariatric surgery.

30 Tips for Primary Care Providers How do I bring up the topic? Be respectful. Use terms such as weight, excess weight, unhealthy weight, and BMI, or ask what terms he or she prefers What do patients want to know? Patients often want info on safe and effective ways to control their weight. Ask patient about their eating habits. Encourage them choose healthier options. Make them aware that being inactive may not be good for their health. How can I help my patient s set goals? Ask your patients how ready they are to adopt healthier eating and physical activity habits.

31 Tips for Primary Care Providers How can I help my patients stick with their goals? Praise can help inspire your patients to maintain new behaviors. Note their progress. Offer praise to boost self esteem and keep them motivated. Discuss setbacks. Set new goals. What if my patient needs more help? Refer to Registered Dietitian.

32 Cita&on: Gut and Psychology Syndrome Available at Assessed June 22, 2013 The Paleo Diet Available at Assessed June 22, Hour Diet Book Available at Assessed June 22, 2013 Intermittent Fasting Diet Available at fasting 101 how to start part i/ Assessed June 22, 2013 Evidenced based Nutrition Practice Guideline on Adult Weight Management published at and copyrighted by the Academy of Nutrition and Dietetics; assessed on June 22, 2013