Beyond the Basics. Eating well to live well. By Valerie Goldberg, RD, CD

Transcription

1 Goal setting: - smart: Specific, measurable, attainable, realistic, time bound - WHY power: why do I want to make a change. Takes effort to make any change so set yourself up for success by visualizing yourself finishing that goal - goals for today nutrition 101: Macronutrients: why we need them -protein: Amino Acids are the building blocks to muscles, neurotransmitters, cannot be stored as energy -carbs: Simple vs complex carbs, primary source of energy for our brain - majority of vitamins and nutrients - Choose quality carbohydrates minimally processed grains, beans/legumes, vegetables, and fruit. Quality trumps quantity. - Fiber: Indigestible polysaccharide: Keeps us fuller for longer, naturally lowers cholesterol, stabilizes blood sugar levels, increases gut transit time, feeds gut bacteria with prebiotic - foods highest in fiber include the ABCs A: Artichoke, Avocado B: Berries, beans C: Cruciferous vegetables (Broccoli, cauliflower, cabbage) -fats: Change focus increasing omega-3 fats and decreasing omega-6 fats (soy and corn oil and animals feed soy and corn), Essential to life: essential fatty acid - Proper functioning of nerves and brain- fats are part of myelin- a fatty material which wraps around our nerve cells so that they can send electrical messages. Our brains contain large amounts of essential fats Maintaining healthy skin and other tissues. All our body cells need to contain some fats as essential parts of cell membranes, controlling what goes in and out of our cells Transporting fat-soluble vitamins A, D, E and K through the bloodstream to where they are needed Forming steroid hormones needed to regulate many bodily processes Shutting off hunger: what fills us up and keeps us full 1. Protein: 2. fat: healthy option: olive oil, avocado, nuts 3. fiber: whole grains, beans, lentils, vegetables and fruit 4. volume: greens, water

2 2. Standard American diet and the affects, soda consumption, inflammation (omega 3:6) - increases systemic inflammation that can lead to obesity, cancer, CVD, T2DM - excess adiposity produced IL-6 and other pro-inflammatory cytokines that increase systemic inflammation 2. small changes big payoff: increasing consumption of making healthy swaps (increasing: fruit, vegetables, yogurt, nuts, whole grains) for we can lose 1 lb per year and optimize health. 5% weight reduction can decrease risk factors for hypertension, diabetes, CVD. Eating for overall health: Teach and model healthy balanced eating as an enjoyable way of life a habit, not a diet, by making healthy food craveable. 3. balanced plate method Mediterranean diet score: take a minute and score your diet for a measureable way to assess how we are doing and how we can improve even by 2 points Food demo! Part 2 relationship of nutrition and oral disease: The mouth is the portal to the body and inflammation and changes can be detected early. example: swelling, gum recession, plaque buildup, pocketing Endocarditis and dental: - the same bacteria have been found in the mouth and on the lining of the heart in endocarditis - proper oral care and diet can lead to decreased cardiovascular disease - diet and dental caries: etiology & recommendations - recommendations: consumes sweeting in one sitting rather than grazing throughout the day - reduce or eliminate sugary drinks - nutrition and periodontal disease etiology & recommendations - periodontal disease is an indication of chronic inflammation - often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis - lifestyle change is required

3 - micronutrient deficiencies and changes in oral health: Dental hygienist are often the first health care professional to identify eating disorders or malnutrition due to clinical changes in mouth - excessive bleeding gums 2/2 lack of nutrition - micronutrient deficiencies such as calcium, magnesium, vitamin D, iron, B vitamins - changes in oral mucosa: hygienist can see clinical signs and symptoms of nutrient deficiencies see photos for details Acid/ Base balance: Enamel demineralization take place when the teeth are exposed to acidic conditions (i.e. when the ph falls below 5.5). Saliva contains Calcium, phosphate and bicarbonate and healthy saliva has a ph of 6.8 to 7.4 at the point in which teeth can actually heal themselves. Conditions that increase mouth acid: soft drink consumption (high levels of phosphoric and citric acids) Fruit drinks (some acids in fruit drinks are more erosive than battery acid) Low salivary flow or xerostomia (often seen in eating disorders) Diet (high in sugar and starches) Acid reflux disease (GERD) Gastrointestinal problems Genetics (inherited conditions) Environmental factors (friction, wear and tear, stress, and corrosion) Recommendation: rinse with water and increase water consumption to act as a buffer. Water is a very important nutrient and cannot be replaced with any other beverage - ph of water is 7 now can purchase alkaline water also which can help also low abrasion (Sensodyne pronamel) - toothpaste: historically toothpaste was baking soda based (ph 9) recommend - for example adding lemon (ph of 2) to water may be delicious but will be a very acidic drink - consider the use of a straw of carbonated water is between 3 and 4 [15] is approximately in between apple juice and orange juice in acidity eating disorders and protein energy malnutrition: Eating disorders have the highest mortality rate of any mental health illness. Eating disorders are unique among mental health disorders in that they manifest in physical health complications, which can lead to serious and life-threatening illnesses such as diabetes, cancer,

4 organ failure and even death if not treated. Often dental professionals are the 1 st practitioners to detect eating disorders as people suffering with bulimia usually maintain a BMI within normal range. Early intervention is imperative for optimal treatment and recovery. Signs and symptoms - acid erosion on the back - Bulimia nervosa: Purging can lead to redness, scratches and cuts inside the mouth, especially soft palate. Soft palate damage is often accompanied by cuts or bruises on the knuckles. - Binge-and-purge cycle can cause an enlargement of the salivary glands as the bodies defense mechanism. Can see early on in bulimia nervosa - Lack of key nutrients in diet (phosphorus, magnesium, calcium can increase erosion) Recommendations: - Early intervention with eating disorders is needed: contact a PCP or refer directly to an RD - You do not have to tell the client I suspect you have an eating disorder It can be as simple as we routinely work with Registered Dietitians as we know that the food we eat can impact our oral health. I am concerns about your acid erosion I think it might be helpful for you to see a nutrition expert or just call the PCP and let them know your findings - If you are aware that someone is purging discourage brushing teeth immediately after. Recommend rinsing with water and the abrasive nature or the toothbrush while the teeth are still porous can lead to further breakdown - Xerostomia occurs secondary to eating disorders, encourage water consumption 4. nutrition through the lifespan for healthy teeth infants: bottles, pacifiers, fluoride, oral hygiene toddlers: juices, parent education, healthy eating adolescents elderly: how to maintain bone, supplementation 5.habit formation: what is a habit and how can we change it - cue, action, reward - change the cue and make sure you maintain the action and a reward example: cue: see candies, action: eat them, reward: Yum

5 - Add a new Cue: always have water in front of you, action: drink, reward: improved hydration, mental focus, increase oral health 6. How to improve healing surgical - preop: adequate protein intake, consider discussing stress management techniques as stress increased cortisol which and increase inflammation, antioxidants - if diabetic patient check Hgb A1C as >7 can result in poor healing and infection. A1C is the average blood sugar for 3 months so deferring a surgery for 3 months and seeing a RD can make a huge difference on healing -postop: supplementation (Vitamin C and Zinc), adequate protein, smoking cessation - guidance on soft foods, ways to meet nutritional requirements 7. fad diets and the effect on oral hygiene - Ketogenic: acetate as by product and halitosis - vegan/ paleo: potential lack of bioavailable calcium and Vitamin D. Naturally occurring Vitamin D in mushrooms, vegan protein sources 8. supplements and how to refer to a dietitian Questions?