Learning Outcome 2
Comprehend the interrelationship among macro- and micronutrient intakes as they impact human health in normal and disease states.
Artifacts:
Artifact 1 – NUTR7200 – Medical Nutrition Therapy I - Diabetes Meal Plan
Artifact 2 – NUTR7200 – Medical Nutrition Therapy I – Renal Diet Assignment
Artifact 3 – NUTR6106 – Advanced Normal Nutrition Micronutrients – Quiz 1
Reflection:
Understanding the role of macronutrients and micronutrients is essential to becoming a successful Registered Dietitian (RD). Macronutrients: carbohydrates, protein and fat give us energy and comprise the majority of our diets, serving as the foundation on which every meal plan developed by a RD is based. The distribution of macronutrients is specific to each individual, and diseases such as diabetes or renal failure further influence it. Micronutrients such as vitamins and minerals are also needed for survival and more or less of these nutrients are necessary in certain conditions.
During my Medical Nutrition Therapy I class, (MNT) I was able to put this knowledge to work. Our teacher gave us a diabetes meal plan assignment and a renal diet assignment. People with diabetes do not necessarily need special foods, but they do need a lower percentage of calories from carbohydrates than the general population to best manage their condition.
In class we learned that blood glucose levels could be controlled with educated food choices. People with diabetes must monitor the foods they eat, especially carbohydrates, and pay attention to meal times to control blood glucose levels. For the diabetes meal plan, our teacher asked us to use the Mifflin St. Jeor equation to individually calculate our calorie needs. The distribution of macronutrients depends on the number of calories a person requires. Therefore, each meal plan is personal and varies depending on the gender, weight, age and physical activity level in which a person partakes. Following the dietary reference intakes (DRIs – carbohydrate 45 – 65%, protein 10 – 35%, fat 20 – 35%) and focusing on weight management by not exceeding total caloric intake is the best way to determine the macronutrient breakdown. Alternatively, the Joslin Diabetes Center recommendations are used for people with overweight body mass index (BMIs). They suggest 40% carbohydrates, 20 – 30% protein and 30 – 35% fat.
Since I have a normal BMI, I used the DRIs to determine the macronutrient distribution for my hypothetical diabetic meal plan. Once I selected my percentages of each macronutrient, I multiplied them times my total calories to determine the calories from each individual macronutrient. Then I divided by the number of calories in each macronutrient (4kcal/g for protein and carbohydrate and 9kcal/g for fat) to determine the grams of each. I came up with 59g of protein, 236g of carbohydrate and 44g of fat. In class we learned that one carbohydrate choice could come from the grains, milk, starchy vegetables or fruit categories. Three non-starchy vegetable servings also equate to one carbohydrate unit. I used this information combined with the American Diabetes Association Exchange List booklet to determine how many carbohydrate choices I could have, and create a meal plan for myself. It was difficult because I decided to make a realistic plan for my lifestyle and I am a vegetarian. This meant further restrictions beyond the normal diabetic meal plan. We were also asked to create an additional meal plan using the carbohydrate counting method, convert a food label to the carbohydrate exchange list for one serving and determine how many carbohydrate units were in a recipe using carbohydrate counting. I enjoyed the comprehensive nature of this assignment and although it took me a long time to complete, I appreciated the fact that it covered almost all of the diabetes meal planning techniques. The only method it did not test on was the plate method, which is visual and would not have translated well into a written assignment.
Learning how to create a diabetic meal plan deepened my understanding for this particular disease state and provided me with valuable knowledge. Not only will I be able to successfully create these plans with my future clients and explain what a carbohydrate choice is, I also appreciate the difficulties faced by people with diabetes. Understanding how to eat to manage blood glucose is not easy. A patient newly diagnosed with diabetes is surely dealing with many different emotions and increased stress; new medications are prescribed, and lifestyle changes are essential. Being able to empathize with my clients will help me to develop the best nutrition plan possible for them.
In MNT, we also had a renal diet assignment. Prior to the assignment, we learned about the five stages of chronic kidney disease (CKD) and the nutritional needs for each stage. In stages 1-4, protein is restricted to 0.6g – 0.75g/kg. This is because waste products are created from protein breakdown. A person with compromised kidney function is unable to filter the waste and remove it. Micronutrients other than sodium do not need to be limited in the early stages of CKD unless lab results reflect elevated values. CKD stage 5 is considered end stage renal disease. People with stage 5 are placed on dialysis, a treatment that uses a machine to filter waste from the blood and removes fluid. During dialysis, protein is also filtered from the blood, so patients with CKD stage 5 require extra protein, 1.2g/kg. Half of this protein should be high biological value (HBV) protein, which is higher quality protein that comes from animal products. These patients also must restrict their phosphorus, potassium, sodium and fluid intake. The kidneys control the amount of potassium in the blood. When the kidneys aren’t working properly, potassium can build up in the blood and negatively influence the heart. Certain fruits and vegetables are high in potassium, so limiting them is advised. Phosphorus is typically associated with bone health, but kidney disease causes phosphorus to build up and can result in weaker bones. For this reason, patients are counseled to limit phosphorus intake to 1,000mg. This is virtually impossible to do as phosphorus is found in many of the foods we eat. There are phosphorus binders that patients can take with meals and snacks that bind to the phosphorus in food and help lower the levels of this mineral in the blood.
After we learned the nutritional requirements, we were asked to create three different meal plans for differing stages of the disease. The most challenging plan to create was for a patient that had stage 5 CKD. I started by calculating the patient’s energy needs, which were 35kcal/kg. Next I determined protein needs by multiplying their weight in kg by 1.2g/kg. Then, I needed to figure out how many HBV protein choices to include. After that, I indicated how the remaining protein would be distributed: fruit, vegetable, starch and non-dairy substitutes. I used the Georgia Dietetic Association Diet Manual as a guide for which meats were higher in sodium and phosphorus. The diet manual also grouped fruits and vegetables into three categories of high, medium and low potassium. I created a grid that included all of the choices and average nutrient level each contained. After I had the number of choices for each category completed, I added up the total calories, protein, sodium, potassium and phosphorus to make sure I was within the recommended amounts. I received points off on this meal plan for exceeding 1,000mg on phosphorus. I tried to decrease the final value, but was unsuccessful. I recommended that the patient take a phosphorus binder with his meal to maintain a normal blood level. I found planning a renal diet incorporating the proper distribution of macro- and micronutrients to be a complicated process. However, I believe it is an important tool to help end stage renal patients ensure the best quality of life possible while on dialysis.
My third artifact for this learning outcome is quiz one from NUTR6106 – Advanced Normal Nutrition – Micronutrients. This course focuses on the metabolic pathways of micronutrients and the regulatory role these nutrients play in both healthy and unhealthy individuals. While studying for this quiz, I was nervous. I had previously taken Biochemistry with this professor and had already experienced his challenging testing style. He used mostly short answer and fill in the blank questions, and I knew the quiz would be difficult. Quizzes like this require knowing all of the material backwards and forwards. When I took Biochemistry, I found the best way to study was with a classmate. It helped to bounce information off of each other and talk out challenging concepts. Unfortunately, finding enough time to study was a challenge for me. I was taking three other courses and rotating at Grady Memorial Hospital three days a week. I spent all weekend looking over the PowerPoint slides and created flashcards to help learn the material. Quiz day came and I spent the few minutes I had between classes reviewing the subject matter one last time. The quiz was difficult and as expected, it was mostly fill in the blank and short answer. While I was unsure of some answers, I felt confident that I did well on the exam.
The quizzes were returned at the end of the class period. I was pleased to see I had only gotten one question wrong and received a 23/25. As we were going over the quiz, we discovered that the entire class received points off for the question I had missed. Our professor determined that the question was worded unfairly and decided to award points back to the entire class. The additional points bumped my score up to 25/25. I was pleased to be starting off on the right foot.
Although my time management was tested while taking Micronutrients along with several other courses and interning at Grady, it did not stop me from excelling. This proves I will be able to handle challenging environments and stressful situations when I become a RD.
Artifacts:
Artifact 1 – NUTR7200 – Medical Nutrition Therapy I - Diabetes Meal Plan
Artifact 2 – NUTR7200 – Medical Nutrition Therapy I – Renal Diet Assignment
Artifact 3 – NUTR6106 – Advanced Normal Nutrition Micronutrients – Quiz 1
Reflection:
Understanding the role of macronutrients and micronutrients is essential to becoming a successful Registered Dietitian (RD). Macronutrients: carbohydrates, protein and fat give us energy and comprise the majority of our diets, serving as the foundation on which every meal plan developed by a RD is based. The distribution of macronutrients is specific to each individual, and diseases such as diabetes or renal failure further influence it. Micronutrients such as vitamins and minerals are also needed for survival and more or less of these nutrients are necessary in certain conditions.
During my Medical Nutrition Therapy I class, (MNT) I was able to put this knowledge to work. Our teacher gave us a diabetes meal plan assignment and a renal diet assignment. People with diabetes do not necessarily need special foods, but they do need a lower percentage of calories from carbohydrates than the general population to best manage their condition.
In class we learned that blood glucose levels could be controlled with educated food choices. People with diabetes must monitor the foods they eat, especially carbohydrates, and pay attention to meal times to control blood glucose levels. For the diabetes meal plan, our teacher asked us to use the Mifflin St. Jeor equation to individually calculate our calorie needs. The distribution of macronutrients depends on the number of calories a person requires. Therefore, each meal plan is personal and varies depending on the gender, weight, age and physical activity level in which a person partakes. Following the dietary reference intakes (DRIs – carbohydrate 45 – 65%, protein 10 – 35%, fat 20 – 35%) and focusing on weight management by not exceeding total caloric intake is the best way to determine the macronutrient breakdown. Alternatively, the Joslin Diabetes Center recommendations are used for people with overweight body mass index (BMIs). They suggest 40% carbohydrates, 20 – 30% protein and 30 – 35% fat.
Since I have a normal BMI, I used the DRIs to determine the macronutrient distribution for my hypothetical diabetic meal plan. Once I selected my percentages of each macronutrient, I multiplied them times my total calories to determine the calories from each individual macronutrient. Then I divided by the number of calories in each macronutrient (4kcal/g for protein and carbohydrate and 9kcal/g for fat) to determine the grams of each. I came up with 59g of protein, 236g of carbohydrate and 44g of fat. In class we learned that one carbohydrate choice could come from the grains, milk, starchy vegetables or fruit categories. Three non-starchy vegetable servings also equate to one carbohydrate unit. I used this information combined with the American Diabetes Association Exchange List booklet to determine how many carbohydrate choices I could have, and create a meal plan for myself. It was difficult because I decided to make a realistic plan for my lifestyle and I am a vegetarian. This meant further restrictions beyond the normal diabetic meal plan. We were also asked to create an additional meal plan using the carbohydrate counting method, convert a food label to the carbohydrate exchange list for one serving and determine how many carbohydrate units were in a recipe using carbohydrate counting. I enjoyed the comprehensive nature of this assignment and although it took me a long time to complete, I appreciated the fact that it covered almost all of the diabetes meal planning techniques. The only method it did not test on was the plate method, which is visual and would not have translated well into a written assignment.
Learning how to create a diabetic meal plan deepened my understanding for this particular disease state and provided me with valuable knowledge. Not only will I be able to successfully create these plans with my future clients and explain what a carbohydrate choice is, I also appreciate the difficulties faced by people with diabetes. Understanding how to eat to manage blood glucose is not easy. A patient newly diagnosed with diabetes is surely dealing with many different emotions and increased stress; new medications are prescribed, and lifestyle changes are essential. Being able to empathize with my clients will help me to develop the best nutrition plan possible for them.
In MNT, we also had a renal diet assignment. Prior to the assignment, we learned about the five stages of chronic kidney disease (CKD) and the nutritional needs for each stage. In stages 1-4, protein is restricted to 0.6g – 0.75g/kg. This is because waste products are created from protein breakdown. A person with compromised kidney function is unable to filter the waste and remove it. Micronutrients other than sodium do not need to be limited in the early stages of CKD unless lab results reflect elevated values. CKD stage 5 is considered end stage renal disease. People with stage 5 are placed on dialysis, a treatment that uses a machine to filter waste from the blood and removes fluid. During dialysis, protein is also filtered from the blood, so patients with CKD stage 5 require extra protein, 1.2g/kg. Half of this protein should be high biological value (HBV) protein, which is higher quality protein that comes from animal products. These patients also must restrict their phosphorus, potassium, sodium and fluid intake. The kidneys control the amount of potassium in the blood. When the kidneys aren’t working properly, potassium can build up in the blood and negatively influence the heart. Certain fruits and vegetables are high in potassium, so limiting them is advised. Phosphorus is typically associated with bone health, but kidney disease causes phosphorus to build up and can result in weaker bones. For this reason, patients are counseled to limit phosphorus intake to 1,000mg. This is virtually impossible to do as phosphorus is found in many of the foods we eat. There are phosphorus binders that patients can take with meals and snacks that bind to the phosphorus in food and help lower the levels of this mineral in the blood.
After we learned the nutritional requirements, we were asked to create three different meal plans for differing stages of the disease. The most challenging plan to create was for a patient that had stage 5 CKD. I started by calculating the patient’s energy needs, which were 35kcal/kg. Next I determined protein needs by multiplying their weight in kg by 1.2g/kg. Then, I needed to figure out how many HBV protein choices to include. After that, I indicated how the remaining protein would be distributed: fruit, vegetable, starch and non-dairy substitutes. I used the Georgia Dietetic Association Diet Manual as a guide for which meats were higher in sodium and phosphorus. The diet manual also grouped fruits and vegetables into three categories of high, medium and low potassium. I created a grid that included all of the choices and average nutrient level each contained. After I had the number of choices for each category completed, I added up the total calories, protein, sodium, potassium and phosphorus to make sure I was within the recommended amounts. I received points off on this meal plan for exceeding 1,000mg on phosphorus. I tried to decrease the final value, but was unsuccessful. I recommended that the patient take a phosphorus binder with his meal to maintain a normal blood level. I found planning a renal diet incorporating the proper distribution of macro- and micronutrients to be a complicated process. However, I believe it is an important tool to help end stage renal patients ensure the best quality of life possible while on dialysis.
My third artifact for this learning outcome is quiz one from NUTR6106 – Advanced Normal Nutrition – Micronutrients. This course focuses on the metabolic pathways of micronutrients and the regulatory role these nutrients play in both healthy and unhealthy individuals. While studying for this quiz, I was nervous. I had previously taken Biochemistry with this professor and had already experienced his challenging testing style. He used mostly short answer and fill in the blank questions, and I knew the quiz would be difficult. Quizzes like this require knowing all of the material backwards and forwards. When I took Biochemistry, I found the best way to study was with a classmate. It helped to bounce information off of each other and talk out challenging concepts. Unfortunately, finding enough time to study was a challenge for me. I was taking three other courses and rotating at Grady Memorial Hospital three days a week. I spent all weekend looking over the PowerPoint slides and created flashcards to help learn the material. Quiz day came and I spent the few minutes I had between classes reviewing the subject matter one last time. The quiz was difficult and as expected, it was mostly fill in the blank and short answer. While I was unsure of some answers, I felt confident that I did well on the exam.
The quizzes were returned at the end of the class period. I was pleased to see I had only gotten one question wrong and received a 23/25. As we were going over the quiz, we discovered that the entire class received points off for the question I had missed. Our professor determined that the question was worded unfairly and decided to award points back to the entire class. The additional points bumped my score up to 25/25. I was pleased to be starting off on the right foot.
Although my time management was tested while taking Micronutrients along with several other courses and interning at Grady, it did not stop me from excelling. This proves I will be able to handle challenging environments and stressful situations when I become a RD.