Follow The Diet- Cystic Fibrosis With Lung Disease

Due: 5/1/16

Morea Donahue

FSN 430-01, Lab: Mon 3-6 pm

Client Hx:

Pt is a 22YOF recently diagnosed with cystic fibrosis (CF) with the presence of lung disease. Pt

reports SOB, fatigue, and early satiety. Pt will be graduating from college next month and

moving back home to her family. Pt’s grandfather died of lung cancer. Pt is an ex-high school

athlete and currently works out 4 times/week and walks to and from school 4 times/wek. Pt has

allergies to Vicodin. No current supplement use.

Anthropometrics: Ht: 5’6” (66”, 167.6 cm) Wt: 127# (57.7 kg) BMI: 20 (normal) UBW: 127#

Diet:

MD has prescribed a diet order as follows:

150% normal energy requirements, 40% fat, 20% protein with liberal use of sodium

due to losses in sweat.

Macronutrients: (See attached for work)

Kcals for maintenance: 3,180 kcals (55 kcals/kg; MSJ Equation with 1.4 AF)

Protein: 159 g pro/day (20% kcal, 2.75 g/kg)

CHO: 325 g CHO/day (41% kcals, 5.63 g/kg)

Fat: 141 g fat/day (40% kcals, 2.4 g/kg)

Fluids: ~3,180 mls/day

Micronutrients:

Sodium: ~5,000 mg

Zinc: 8 mg/day

Calcium: 1,000 mg/day

Iron: 18 g/day

Nutrients to be monitored: -Vitamin A,D,E &K

-Sodium

-Iron

-Zinc

-Calcium

Pt Education: There are no particular foods to be avoided while diagnosed with CF. An RD can meet

with patients to discuss ways to increase energy and fat intake which are much higher than the

RDA. Pt to eat numerous meals a day with large portion sizes and extra snacks. Tips for

incorporating high-calorie foods in the diet include using whole milk, half and half in oatmeal,

butter as main cooking method, red meats such as beef and peanut butter. Pt’s suffering with CF

must also have a large amount of protein and liberal use of sodium. Ways to increase protein in

the diet include protein shakes with peanut butter, whole eggs, cheese and nuts. Tips for

increasing sodium in the diet include sports drinks like gatorade, added table salt on food and

while cooking, soy sauce on rice and vegetable dishes and cured meats.

Exchanges:

Item Exchange Kcal Pro (gr) CHO (gr) Fat (gr)

Breakfast, 9:30am

1 cup oats, rolled, dry

4 starch 320 8 60 0

2 tbsp peanut butter 1 HFM + 2 Fat

190 7 0 18

1 medium banana, 7”

2 fruit 120 0 30 0

1 tbsp chia seeds 0.5 2% Milk 60 4 6 2.5

1 tbsp coconut, shredded

0.5 Fat 22.5 0 0 2.5

2 slices WW bread 2 starch 160 4 30 0

2 ounces avocado 2 fat 90 0 0 10

Snack, 11am

Item

Deviations: **Note that water consumption was not included in ESHA after realizing it was not inputted

after ESHA was completed. On top of the 8 fl oz of vanilla unsweetened almond milk and 12 fl

oz gatorade, the pt consumed 85 fl oz of water, equivalent to 3,105 total mls fluid. This is a 75

ml deficit. This is not significant.

1.5 scoop chocolate soy protein powder with water

3 1% 300 24 36 9

2/3 cup coconut greek yogurt (6oz)

1 FF 90 8 12 0

Lunch, 1pm

12 fl oz grape sports drink

1.5 fruit 90 0 22.5 0

1 ounce cheddar & sour cream potato chips

2 starch 160 4 30 0

0.5 cup brown rice 1.5 starch 120 3 22.5 0

8 kalamata olives 1 fat 45 0 0 5

1.5 pork sausage link

1.5 HFM 150 10.5 0 4

0.5 cup trail mix 1.5 WM 240 12 18 12

Snack, 3:30pm

8 fl oz vanilla unsweetened almond milk

1 fat 45 0 0 5

3 scrambled eggs (122 g)

3 MFM 225 21 0 15

0.25 cup shredded cheddar cheese

1 HFM 100 7 0 8

Dinner, 6pm

1 frozen turkey burger

3.5 LM 157.5 24.5 0 23.5

1.2 servings macaroni and cheese (300 g)

3 2% 360 24 36 15

Totals 3,040 161 303 129.5

Exchange Kcal Pro (gr) CHO (gr) Fat (gr)Item

Photo Journal *Not pictured: 85 fl oz water

Breakfast 11 AM Snack

Lunch

3:30 PM Snack

Dinner

Impression of Meals/Snack:

Breakfast: Breakfast was very delicious, in that it is very similar to what I normally eat every day. I

love oatmeal, and I love avocado on toast, however I found it difficult to eat it all in one sitting. I

was extremely full afterward. The chia seeds, peanut butter and shredded coconut complimented

the banana in the oatmeal well and kept me feeling very full.

11 AM Snack: I also really enjoyed my AM snack, because it was the perfect amount of sweetness that

was lacking in my breakfast. The protein shake was delicious after my early morning workout

and the coconut greek yogurt from Trader Joe’s is my favorite yogurt that is packed with protein

which this patient needs.

Lunch: Although lunch was delicious, I found it very hard to eat all of it. I was already really full

from my breakfast and AM snack and am not used to eating this many calories in one day. I also

never eat pork, but knew that I had increased sodium needs to meet so that contributed to that

nicely. It has also been a very long time since I drank a gatorade, which was pleasant.The baked

lays are a healthy substitute for regular potato chips. Although this patient could have benefited

from the fat content in normal potato chips, fat needs were easily met from the other foods eaten

throughout the day.

3:30 PM Snack: I eat tons of egg whites in my normal diet, however it has been a very long time since I

have eaten regular eggs. It was very delicious with the shredded cheese on top. I also love

almond milk, however I felt that it did not pair well with the eggs.

Dinner:

Dinner was excellent, as I love macaroni and cheese. It was frozen and heated up. It

paired really nicely with the turkey burger, and I was extremely full afterward. The turkey burger

really boosted my protein intake for the day, and the macaroni and cheese contributed

significantly to my calorie and fat intake.

Reflection

This project was really eye opening in more ways than one. Throughout the process, I

learned what it’s like to be a patient diagnosed with CF and also an RD treating a patient. When I

first found out that I was assigned cystic fibrosis with lung disease, I was slightly hesitant what

all that would entail. The 150% RDA energy requirement and 40% fat was very daunting at first,

but I was ready for the task. Before I did ESHA, I went grocery shopping in order to have a

stocked fridge and pantry. I knew that I was searching for foods that were high in calories and

fat, but still relatively healthy. Once I had a majority of foods that I believed was going to fulfill

this assignment, I was ready to go.

I knew right away that for my lifestyle, this diet would be very difficult. Unfortunately,

you do not have the choice to be diagnosed with cystic fibrosis, so many people do not have any

other option. On an average day, I eat roughly 1,400-1,600 calories depending if I workout of

not. Eating over 3,000 calories was quite difficult, in that I found that I was spending what felt

like the entire day cooking. I was forced to move on to the next meal or snack before I was

anywhere near hungry. I found that I lost my sense of intuitive eating because I wasn’t listening

to my hunger and satiety cues, but rather eating on a certain schedule and large portion sizes in

order to meet my needs. Not only was it difficult to eat this much because I wasn’t hungry, I also

found that this diet would be very expensive due to the amount of food that you consume in just

one day.

I didn’t face too many extreme barriers throughout this project. The biggest thing that I

ran into was keeping track of what time I had to be sure to get in all of my snacks and meals. For

example, I never eat a mid-morning snack and only eat an evening snack on days that I expended

extra energy. I had to set an alarm on my phone to remind myself that even if I wasn’t hungry, I

had to get in those high calorie snacks in order to meet my needs. Other barriers that patients

might face are the financial struggle of buying large portions of food weekly and also having to

mentally push away the thought of how many calories and fat you are consuming, especially if

you are a health-conscious individual. Teenagers with cystic fibrosis may also run into issues

with eating large portion sizes that are calorically dense while at school if their peers are not fully

understanding of the importance of their increased needs. Teenagers are prone to body image

issues and many have trouble maintaining a normal body weight due to malabsorption problems

from sticky mucus secretions.

I recognized many enabling factors that helped me adhere to this diet. I found that doing

a full grocery shop at the start of the week helped me have access to a plethora of food in my

house. I also meal prepped the day before following the meal plan to assure myself that I had the

perfect amount of serving sizes for each meal and snack. If I were truly living with CF, I know

that the stresses of everyday life would not always allow for meal prepping, however I found it

very helpful. As an RD, I would also advise my patient to utilize online recipes, blogs and even

Pinterest boards to get ideas on cooking high-calorie/fat meals that are delicious and still healthy.

I would highly recommend keeping a salt shaker on the kitchen table at all times to help with

reaching increased sodium levels due to losses in sweat. Since CF patients need to eat a

substantial amount of sodium, I would also advise my patients to try assorted flavors of

gatorades and other sports drinks that have a lot of sodium in it and diluting them with water that

way you are still getting the sodium intake but you are saving product by diluting it.

Overall, this project taught me a lot about what CF patients have to deal with nutritionally

everyday. I did not know prior to this project and class that CF patients have an extremely high

caloric and fat need. As luxurious as it may sound to some, I was surprised at how hard it was to

adhere to and get used to. I could not imagine eating this way my entire life. I learned that many

CF patients have trouble maintaining their weight even though many eat incredible amounts.

It makes you realize that everybody is fighting their own battle even though your outer

appearance may not always be portraying that. I know that many of my classmates were assigned

much more difficult diets, such as all blended foods, however adhering to this diet was no walk

in the park. I learned how to increase sodium content in my food simply by utilizing condiments

and eating meats that I normally don’t eat just because I knew it was higher in sodium. Knowing

these tips and becoming even more knowledgeable in the disease is what makes RD’s so

amazing, in that we learn how to tailor diets individually right down to every last characteristic

of a disease. I have aways been interested in nutritional epidemiology and the role of dietetics in

curing diseases, and this project really opened my eyes to just how much food truly nurtures us. I

enjoyed this project through all of the barriers and struggles, and have gained a new appreciation

for the disease as well as the patients that are fighting it every single day.