Diets for chronic conditions

Scope of practice: Across all of these diets, the medical assistant reinforces and helps patients follow a plan the provider or registered dietitian has directed. Prescribing a diet and providing detailed nutritional counseling fall to the provider or dietitian, not the medical assistant.

Diabetic eating plans

People with diabetes mellitus need to monitor their carbohydrate intake. Remember that carbohydrates are broken down into glucose in the body. Insulin moves the glucose from the blood into the cells. For people with diabetes, the body either does not make enough insulin or does not respond to the insulin produced. As a result, their blood glucose levels are high. In the absence of insulin, the body burns fat for energy instead, producing ketones that can build up and lead to diabetic ketoacidosis, a life-threatening condition.

Over the years, several different diabetic eating plans have been created for people with diabetes mellitus. You may hear of patients being on diet plans, such as the exchange list system. This diet plan grouped similar foods with the same amount of carbohydrates, protein, fat, and calories. Each food item had a measurement (e.g., 1 cup) to indicate how much could be eaten for that exchange. Three main groups were given in the plan: carbohydrate, meat, and fat.

The American Diabetes Association encourages the following diabetes meal plans: the glycemic index approach, the Create Your Plate method, and carb counting. The glycemic index (GI) ranks carbohydrate-containing foods by how quickly they raise blood glucose after eating; foods like beans, lentils, and oats have a low GI. Eating lower-GI foods helps one to maintain a more stable blood glucose level.

The Create Your Plate method uses a 9-inch dinner plate. To follow this meal plan, a person would do the following:

• Fill half of the plate with nonstarchy vegetables (e.g., beans, broccoli, carrots, salad greens, and peppers).
• Split the remaining unfilled side of the plate in half. Fill one half with a protein (e.g., lean meat, poultry, and fish) and fill the other half with a grain or a starchy vegetable (e.g., brown rice, potatoes, squash, green peas, and corn).
• Complete the meal with a serving of fruit, a serving of dairy (a milk product), and a non sweetened beverage.

Carb counting, or carbohydrate counting, is another meal planning tool used by people with diabetes mellitus. Using this method, a person keeps track of the amount of carbohydrates eaten each day. Carbohydrates are measured in grams. This system may give some people better control of their diabetes, but adapting to this system is a learning process. The person needs to identify which foods contain carbohydrates and how to estimate the number of grams. The total grams are calculated over the day. Some people with type 1 diabetes may need to adjust the amount of insulin they take for a specific meal based on the amount of carbohydrates they will consume.

Example: Carb counting for a meal

A patient’s lunch contains 1 cup of rice (45 g carbohydrate), a small apple (15 g carbohydrate), and grilled chicken with vegetables (0 g carbohydrate). The total for the meal is $45+15+0=60$ g of carbohydrate. If the patient’s insulin plan calls for 1 unit of rapid-acting insulin per 15 g of carbohydrate, the mealtime dose would be $60÷15=4$ units.

Low-sodium diet

Sodium is essential to our bodies because it helps to regulate fluid balance. The Food and Drug Administration (FDA) recommends that healthy adults consume no more than 2300 mg of sodium per day. Patients with high blood pressure, heart disease, or kidney disease are usually on reduced-sodium diets. Excessive sodium in a person’s diet can lead to increased blood pressure, thus increasing the risk for heart disease and stroke.

If a patient is on a reduced-sodium diet, the provider will usually refer that person to a registered dietitian. The dietitian will help educate the individual on the sources of sodium. The following foods are high in sodium:

• Processed meats (e.g., deli meats, bacon, frankfurters, and sausage)
• Frozen dinners and ready-to-eat cereals
• Canned foods (e.g., soups, vegetables, and vegetable juice)
• Salted nuts and peanut butter, chips and pretzels, salted crackers
• Buttermilk, cheese, and processed cheese products
• Quick breads and instant cakes and puddings
• Prepackaged mixes for potatoes, rice, and pasta
• Olives, pickles, sauerkraut, pickled vegetables, and spaghetti sauce
• Soy sauce, seasoning salt, marinades, ketchup, mustard, and salad dressings

Typically, alternative lower-sodium foods are discussed. Reading labels is also an important skill for those on reduced-sodium diets. Patients recovering from GI upset or surgery may also be placed on a bland diet, which limits fiber, spicy foods, and fried or fatty foods to reduce irritation to the digestive tract.

Dietary approaches to stop hypertension

Dietary approaches to stop hypertension (DASH) is a flexible eating plan recommended for those with hypertension and cardiovascular disease. The goal of the plan is to reduce blood pressure and LDL and triglyceride levels. Here are some of the foods included in the DASH eating plan:

• Fruits and vegetables
• Low-fat or fat-free dairy foods
• Whole grains
• Poultry and fish
• Beans, nuts, and vegetable oils
• Foods high in potassium, calcium, magnesium, protein, and fiber
• Foods low in salt (sodium)

These foods are prohibited or limited on the DASH eating plan:

• Foods high in saturated fat, total fat, and cholesterol
• Red meats
• Sugar-sweetened beverages and sweets
• High-salt (sodium) foods
• Full-fat dairy foods
• Tropical oils (coconut, palm kernel, and palm oil)

Heart-healthy diet

The diet and lifestyle recommendations of the American Heart Association (AHA) closely resemble the DASH diet and the MyPlate guidelines. The AHA incorporates a focus on exercise, along with a healthy diet. The following are the AHA’s recommendations:

• Limit sugary drinks, sweets, fatty meats, and salty or highly processed foods.
• Read labels and select products with the lowest amounts of sodium, added sugar, and saturated fats. Aim for no more than 2,300 mg of sodium a day, with an ideal limit of 1,500 mg for most adults; even cutting back by 1,000 mg a day helps lower blood pressure.
• Be physically active, balancing the calories burned through exercise with the calories consumed to maintain a healthy weight.
• Drink alcohol in moderation, if at all.

Low-protein diet

The body uses protein for tissue repair, growth, healing, and the ability to fight infection. When protein is broken down in the body, the waste products (e.g., urea and ammonia) are eliminated in the urine. People with liver and kidney disease are often prescribed a low-protein diet. They limit or restrict foods that contain high amounts of protein. Their bodies cannot clear the protein waste products. They can have nausea, headaches, fatigue, and a bad taste in their mouth. Eating a low-protein diet helps to prevent the disease from worsening. Remember, protein cannot be eliminated from the diet. It plays an essential role in the body.

Foods high in protein include milk products (e.g., yogurt and cheese), peanut butter, nuts (e.g., almonds, pistachios, and cashews), quinoa, legumes (e.g., lentils, soybeans, kidney beans, and chickpeas), meat, fish, poultry, and eggs. Foods with small amounts of protein include vegetables and starches (e.g., bread, cereals, and pasta). Fruits, sugars, and fats have trace amounts of protein.