Pancreatic Complications in Cystic Fibrosis

The pancreas, located behind the stomach in the center of the abdomen, extends into the left side of the abdomen. It is connected to the first part of the intestine, the duodenum. The pancreas secretes enzymes that aid food digestion and help to regulate blood sugar.

In CF, the altered transport of electrolytes across pancreatic tissues leads to abnormal production of digestive enzymes. Decreased production of sodium bicarbonate makes pancreatic secretions dehydrated and thickened, blocking the pancreatic ducts. Despite these blockages, the pancreas continues to make more enzymes required for food digestion. These abundant enzymes damage the pancreatic tissue, eventually leading to fibrosis of the pancreas until it is no longer able to produce enough enzymes to properly digest food.

Pancreatic insufficiency occurs when the pancreas loses about 90% of its ability to secrete digestive enzymes. Patients become unable to digest food properly, which leads to the malabsorption of nutrients, or even malnutrition. Vitamins, such as A, B12, D, E, and K, and fats, are the most important nutrients that are not absorbed when a patient has pancreatic insufficiency. 

The impaired absorption of fats causes diarrhea, weight loss, and malnutrition, but supplemental pancreatic enzymes can help with digestion of fats and reduce diarrhea. Approximately 80% of CF patients develop pancreatic insufficiency.

The following vitamin deficiencies result from pancreatic insufficiency:

Vitamin A: Visual and Skin Changes

Vitamin B12: Anemia

Vitamin D: BoneAbnormalities

Vitamin E: NeurologicalProblems

Vitamin K: BloodClottingProblems

CK vitamins

CF2

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Sixty Five Roses

Cystic fibrosis is the most common fatal genetic disorder in North America. The disorder produces thick, sticky mucus secretions that may seriously impair the function of multiple organs in the body. Most notably, these organs are the pancreas and lungs. Just a few decades ago, an infant born with CF seldom survived to adulthood. Today, the outlook is much brighter, with adults reaching their 30’s, 40’s, and some even into their 50’s.

Cystic fibrosis has three major consequences: chronic lung disease, pancreatic insufficiency, and abnormally high electrolyte concentrations in the sweat. Chronic lung disease develops because the airways in the lungs become congested with mucus, causing breathings to be strenuous. As the thick mucus stagnates in the bronchial tubes, bacteria multiply there. Lung infections are the usual cause of death in people with cystic fibrosis.

Cystic fibrosis causes some degree of pancreatic insufficiency in all cases, with about 90% of cases serious enough to require enzyme replacement therapy. With aging, damage to the pancreas deteriorates. The thick mucus obstructs the pancreatic ducts and interferes with the secretion of digestive enzymes, pancreatic juices, and pancreatic hormones. Eventually, the pancreatic cells are surrounded by mucus and are gradually replaced by fibrous tissues. Malabsorption of many nutrients including fat, protein, vitamins, and minerals often leads to malnutrition. Additionally, the secretion of insulin may be affected resulting in glucose intolerance and diabetes.

The therapy of cystic fibrosis aims to promote appropriate growth and development and prevent respiratory failure and complications. Treatment includes respiratory, diet, and drug therapy.

Nutrient losses through malabsorption, frequent infections, rapid turnover rate of protein and essential fatty acids, high protein catabolism, and high basal energy expenditures raise energy needs for people with cystic fibrosis to between 120%-150% of the RDA for gender and age. Extra energy is needed simply to breathe. RDs estimate individual energy requirements based on basal metabolic rate, activity level, pulmonary function, and degree of malabsorption.

Obtaining enough energy can be complicated, but because people with CF frequently experience a loss of appetite that is aggravated by repeated infections, emotional stress, and drug therapy. Coughing to clear the lungs may trigger vomiting or reflux of foods from the stomach. Thus the person with cystic fibrosis finds it difficult to take in enough food energy, protein, and other nutrients to meet needs.

NIH- Cystic Fibrosis

Cystic Fibrosis Foundation

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What’s Trending in Food for 2013?

Top 10 Food Trends in 2013

1.     Repositioned Palate

        One in 10 shoppers now choose higher-end cuts of meat in order to recreate a restaurant dining experience. In the past, consumers used to eat food for substance, today more people are having eating occasions that can be described as “savoring”, which conveys a new upscale eating experience defined by freshness, distinct flavors, and more.

2.     Redefining Health

        Data shows that consumers relate the word “fresh” with “healthy”. Nine in 10 people think fresh foods are healthier, and 80% look for the descriptor “fresh” when it comes to retail and 58% in restaurants.

3.     Generational Cooking

        Young adults are continuing to cut back on restaurant visits for the fifth year in a row, which means the market for the food industry to develop at-home meal products that appeal to the newest generation of cooks is on the rise.

4.     Eating Alone

        There has been a dramatic increase in the number of adults who are eating solo, regardless of family dynamics. In addition to adults, children are also eating alone more often opening the market for new fresh/refrigerated meals for kids.

5.     Seeking True Transparency

        Food safety is trending and doesn’t seem to be stopping anytime soon. 17 % of consumers have stopped buying a certain food or brand due to certain safety concerns.

6.     Global Look-Alikes

        The integration of ethnic flavors, food items, and ingredients into American foods. Children’s sushi is predicted to be a hot trend for 2013.

7.     Farmstead Formulations

        Hyper-local sourcing, like restaurant gardens, farm/estate brands, small-producer suppliers, and the mainstreaming of farmers’ markets all attest to consumers’ fascination and appreciation for all things agricultural related.

8.     Craveable Finger Foods

        Restaurants have added bite-sized food to their menus and 67% of consumers find it “extremely appealing” to get their flavor through dips/condiments.

9.     Nutritional Insiders

        In 2012 alone, 78% of consumers made a strong effort to get more vitamins and 57% tried to consume more products with specialty nutritional ingredients. The top vitamins were vitamin D, vitamin C, B-vitamins and omega-3s, antioxidants, vitamin E, and vitamin A.

10.  Mother Hens

        Moms are more likely to buy nutritionally enhanced food and beverages. They are also more likely to seek out nutritional information. Moms want healthier kids’ food away from home.

Top 10 Food Trends in 2013

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Chain Restaurants Impact on Kids’ Meals and their Health

Kids Meals Get an “F” in Nutrition at Chain Restaurants

Nearly all of the meal possibilities offered to kids at America’s top chain restaurants are of poor nutritional quality. A report released today found that fried chicken fingers, burgers, French fries, and sugar drinks continue to dominate kids’ meal setting, with 97% of the nearly 3,500 meal possibilities not meeting CSPI‘s nutrition criteria for 4- to 8-year-olds.

And if you don’t believe CSPI, ask the National Restaurant Association (NRA): 91% of kids’ meals at America’s major chains do not even meet the nutritional standards of the industry lobbying group’s Kids LiveWell program.

One out of every three American children is overweight or obese, but it’s as if the chain restaurant industries didn’t get the message. The Institute of Medicine (IOM) released “Accelerating Progress in Obesity Prevention” and addressed these health concerns for further research and studies to use in the fight against childhood obesity.

Two-thirds of adults and almost one-third of children in the United States are overweight or obese, representing young and old, urban and rural, and majority and minority populations. This epidemic of excess weight is associated with major causes of chronic disease, disability, and death. Obesity-related illness is estimated to carry an annual cost of $190.2 billion.

Most chains seem stuck in this time warp, serving the same dated meals based on chicken nuggets, burgers, macaroni and cheese, fries, and soda. I know that they can come up with healthier, cost-effective, nutritionally beneficial meals that are more current than these.

One chain that has gotten the message is Subway. All eight of Subway restaurants’ Fresh Fit for Kids meal combinations met CSPI’s nutrition criteria. Subway is the only restaurant chain that does not offer sugar drinks as an option with its kids’ meals, instead including low-fat milk or bottled water along with apple slices with all of its kid-sized subs.

“Our goal has always been to provide the most nutritious, balanced kids meals in the industry and we are proud to be recognized by CSPI for achieving that goal,” said Lanette Kovachi, corporate dietitian for the Subway brand.

To meet the CSPI’s nutrition criteria, kids’ meals must be at or below 430 calories, no more than 35% of calories from fat, or no more than 10% of calories from saturated plus trans-fat. Meals that meet CSPI’s criteria cannot have more than 35% added sugars by weight or more than 770mg. of sodium. The criteria require meals to make a proactive nutritional impact either by providing at least half a serving of fruit or vegetable, including an item that is 51% or more whole grain, or including specified levels of vitamins or fiber. CSPI’s criteria exclude sugar drinks in favor of water, juice, or low-fat milk. The NRA’s standards are quite similar, though they allow more calories.

Here are some of the least healthy kids’ meals available at chain restaurants:

–        Applebee’s Grilled Cheese on Sourdough with Fries and 2% Chocolate Milk has 1,210 calories with 62g of total fat (46% of kcal), 21g of saturated fat (16%), and 2,340mg. of sodium. That meal has nearly three times as many calories, and three times as much sodium, as CSPI’s criteria for four-to eight-year-olds allow.

–        Chili’s Pepperoni Pizza with Homestyle Fries and Soda has 1,010 calories, 45g of total fat (40% of kcal), 18g of saturated fat (16% of kcal, and about as much saturated fat as an adult should consume in an entire day), and 2,020mg. of sodium.

–        Denny’s Jr. Cheeseburger and French Fries has 980 calories, 55g of total fat (50% of kcal), 20g of saturated fat (18%) and 1,110mg. of sodium. Denny’s does not include beverages with kids’ meals.

–        Ruby Tuesday’s Mac ‘n Cheese, White Cheddar Mashed Potatoes, and Fruit Punch has 860 calories, 46g of total fat (48% of kcal) and 1,730mg. of sodium. Ruby Tuesday’s does not disclose saturated or trans-fat content on its menus or website.

–        Dairy Queen’s Chicken Strips, Kids’ Fries, Sauce, Arctic Rush (a Slushee-type frozen drink) and Dilly Bar has 1,030 calories, 45g of total fat (39% of kcal), 15g of saturated fat (13% of calories), and 1,730mg of sodium.

At 19 chain restaurants reported on, not a single possible combination of the items offered for children met the CSPI’s nutrition standards. Out of these restaurants, 9 (that included McDonald’s Popeye’s, Chipotle, and Hardee’s) not a single kids’ meal met the National Restaurant Association’s Kids LiveWell standards. At Wendy’s, only 5% of 40 possible kids’ meals met the CSPI’s standards. Most of these items were either too high in sodium or saturated fat. At Burger King, just 20% of the 15 possible kids’ meals met CSPI’s criteria.

The last time the CSPI reviewed the nutritional quality of kids’ meals at chain restaurants, in 2008, it is reported that these restaurants have made little progress. In 2008, just 1% of kids’ meals met the CSPI nutrition standards, compared to only 3% in 2012. Only one-third of the chains had at least 1 meal that met the nutritional standards in 2008. This number scaled to 44% in 2012- good, but not great improvement.

While the CSPI report recommends that companies consider several changes, it also encourages the chains to participate in the NRA’s Kids LiveWell program. For these restaurants to do so, they would need to restructure their kids’ meals to meet these standards. The bottom line is that these restaurants should offer more fruits and veggies, and to offer these fresh options as an alternative side to French fries. Whole grains should be offered more, as well as removing soda or other sugar sweetened beverages from the kids’ menus. And just because Subway was the only chain restaurant to meet CSPI’s criteria for all kids’ meals, it should increase the whole grain content of its breads and continue to lower sodium.

The long-term problem I see in this article is that the chain restaurant industry is conditioning children to accept a really narrow range of food options. More chains are adding fruits and veggies at this point, but realistically- a lot more could offer these options. And given the childhood obesity epidemic that America is currently attempting at combating- you would think that more restaurants would want to take action in the health of their future consumers.

CBS News Clip

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This is a standard Subway Kids’ Meal option

Southern Grocery Shopping

Southern Grocery Cart

It’s easy to throw healthy eating habits out the window when you’re away from home and your regular routine. Andrea D’Ambrosio, RD talks about ways to create a healthy winter routine while staying on a budget.

Plan ahead and stick to a list
Being prepared before you grab your grocery cart will help you avoid impulse purchases. It also gives you time to look at flyers, find sales and clip coupons. Try taking advantage of no-name products and avoiding shopping while you’re hungry.

Shop in season and avoid being wasteful
Buy in-season foods from local farmer’s markets, which is cheaper, and be resourceful with leftovers, using up excess food before it goes to waste, she says.

Consider vegetarian alternatives
If you study your grocery bill, meat products are often among the most expensive items. Consider planning meals with vegetarian alternatives like lentils, beans and soy. Check out vegetarian websites for heart- and budget-healthy meal ideas, she suggests.

Here are 5 friendly foods and the reasons you should add them to your grocery list:

  1. Fresh, seasonal fruit: A favorite snack to boost energy levels between meals if you feel a little hungry (power of carbs) and allows you to benefit from vitamins, minerals and antioxidants.
  1. Low-fat (1 percent) or non-fat milk: In order to maintain our bone density, we need to consume adequate dairy to receive calcium, phosphorous, magnesium and protein, which are all essential for bone growth and development.
  1. Whole grains: According to the Journal of Nutrition (2011), oats, barley, rice and quinoa all lower risk of chronic diseases such as coronary heart disease, diabetes and cancer, as well contribute to body-weight management and gastrointestinal health. Try buying whole-grain pasta and remember to look for the words “whole grain” on the label.
  1. Almonds: But just a handful a day, and make them unsalted! A portion-controlled (quarter cup) serving of almonds is excellent for lowering cholesterol because of the unsaturated fats, making them a heart-healthy choice. Almonds are high in vitamin E, a powerful antioxidant, and are naturally high in fiber and a good source of protein!
  1. Edamame: Green soybeans, made popular in Japanese cuisine but available in grocery stores, add a nice nutritional punch. These tasty soybeans can be added as a side dish, steamed in the pod or consumed as a snack or appetizer. Nutritionally speaking, they are another heart-healthy source of protein, fiber and vitamins.

http://www.thestar.com/specialsections/snowbirds/article/1301135–fill-your-southern-grocery-cart-with-healthy-foods

http://www.dieteticdirections.com/

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Shingles and Nutrition

shinglesShingles and Your Diet

Shingles, also known as herpes zoster, is a viral infection that causes a rash that can be painful. According to MayoClinic.com, shingles typically resolves on its own, but medications can help hustle up the healing process and relieve pain. Certain nutrients have displayed pain-relieving assets, and incorporating these into your diet can help with shingles or painful difficulties.

First

Add foods to your diet that are rich in lysine. Or you can take a lysine supplement. Lysine is an amino acid that may prevent herpes virus outbreaks, says the University of Maryland Medical Center. Dietary sources of this amino acid include meat, cheese, sardines, eggs, soybeans, beans and legumes. Fenugreek seed is also a good source of lysine.

Second

Eat shellfish, eggs, beef and dairy products, all of which contain vitamin B-12.

Third

Take a vitamin E supplement. Mount Auburn Hospital recommends taking 1,200 to 1,600 international units per day of vitamin E for postherpetic neuralgia. Dietary sources of vitamin E include almonds, spinach, broccoli, mangoes, tomatoes, peanuts and peanut butter.

Fourth

Stock up on foods high in vitamin C and zinc. MayoClinic.com states that shingles outbreaks can occur due to an impaired immune system, and vitamin C and zinc are essential in promoting a healthy immune system. Good sources of vitamin C include oranges, strawberries, broccoli, leafy greens, peppers and potatoes. Oysters, red meats, chicken, legumes and whole grains are also good sources of zinc.

What to Avoid when you have Shingles

Shingles

According to the Mayo Clinic, shingles are red, raw and very painful blisters that can appear anywhere on your body but typically appear as blisters that wrap around your torso. If you have previously had chicken pox, are over 50 and have a weakened immune system, you are most at risk for contracting shingles. The CDC advises you to stay away from infants, pregnant women and others who have compromised immune systems until your shingles outbreak has passed.

Foods to Avoid

Avoiding certain foods can help alleviate symptoms of shingles. Arginine is an amino acid that your body produces naturally, but you should avoid foods that contain it. Arginine helps the herpes zoster virus to replicate. Chocolate, nuts and gelatin contain high levels of arginine. Also, don’t consume foods such as saturated fats or refined carbohydrates, because those might cause further inflammation. In addition, avoid alcohol and caffeine because these can weaken the immune system.