By Susan Kundrat, MS, RD, LD
Learn what individual food plans a nutritionist would recommend for three typical clients you may work with.
n a recent survey of 623 fitness and dietetics professionals, 81 percent
of the dietetics professionals said they provided clients with physical activity information, while 93 percent of the fitness professionals said they gave clients information on healthful eating (American College of Sports Medicine 1999). The more years dietetics professionals and fitness professionals had worked in their fields, the more apt they were to provide both nutrition and exercise information to clients. Seventy-eight percent of fitness professionals said they referred some of their clients to dietetics professionals for nutrition counseling. While your main job is to ensure that your clients are exercising safely and effectively, it's likely that you, like the fitness professionals interviewed in this survey, occasionally give out nutrition information. Just as clients are seeking personal exercise plans, they are also looking for nutrition advice that considers their health needs, lifestyle challenges, time constraints, age concerns, tastes and goals for disease management and prevention. Clients also need specific help clearing through the myriad of general nutrition information and misinformation hitting the airways, newspapers and magazines. What should you recommend? It's best if you work in tandem with a local registered dietitian to help develop individualized meal plans for your clients. However, you can make certain recommendations based on clients' goals and stages in life. This article looks at case studies for three typical clients with different needs: a 50-year-old woman going through menopause; a 64-yearold man worried about getting heart disease; and a 25-year-old male "weekend warrior turned marathoner." Although fictitious, these three characters represent common types. You may even have clients just like them! The advice comes from me, a nutritionist, and includes sample daily eating plans and specific recommendations for people with special concerns. Share this information with clients who are similar to these three case studies.
February 2000 IDEA HEALTH & FITNESS SOURCE
Food Plan: Maneuvering through Menopause
any physical and emotional manifestations have been associated with menopause; they include depression, weight gain, irritability, insomnia, increased urinary tract infections, dry skin, thinning hair, loss of concentration, hot flashes, diminished sense of smell and taste, diminished vision and vaginal dryness (Kasdan 1997; Shangold & Sherman 1998). Having a sound nutrition and exercise plan, such as that detailed below, can help women positively influence many of the common side effects of menopause.
Linda: Case Study
Linda: Caloric Breakdown
Fifty-year-old Linda is frustrated with her lack of control over her body's changes now that she's going through menopause. She is currently on hormone replacement therapy and has been struggling with her weight, especially in the last year. She's challenged with hot flashes and constant low energy. As a busy mom of two active teenagers, she's on the go a lot during the day. She works part-time and is the primary grocery shopper and meal preparer for the family. Until recently, she never had to worry much about her weight. Although her exercise plan and diet have not changed drastically, about 20 pounds have crept up on her. She's 5 feet 3 inches tall and currently weighs 150 pounds. She says she feels "more herself" at 130 to 135 pounds. Linda has developed a habit of forgoing breakfast at home and buying a coffee and muffin at a drive-through restaurant. She doesn't make time to eat during the day. She skips lunch altogether or grabs a quick snack of chips or candy from the vending machine at work. She drinks an average of four cans of diet caffeinated cola per day to keep her going and is ravenous when she gets out of work around 4:00 PM, when she goes to exercise. Once home, she constantly snacks while preparing dinner. She rarely drinks alcohol. Linda wants practical tips for losing weight and getting all the nutrients she needs. She also wants to decrease her risk of developing heart disease and other chronic diseases, such as cancer, later in life.
Linda is devoted to her exercise program. She gets in 30 minutes of aerobic exercise three times per week and 30 minutes of strength training with a personal trainer three times per week. On an average day she burns about 225 calories from exercise. If she eats 1,675 calories per day and continues with her exercise program, she will be on track to lose 1/2 to 1 pound per week--that's 15 pounds in 15 to 30 weeks. Here's a suggested nutrition breakdown per day: 250 grams (g) of carbohydrate (1,000 calories, or 60% of intake); 75 g of protein (300 calories, or 18% of intake); and 40 g of fat (370 calories, or 22% of intake). If Linda wants to lose weight, she must not eat too few calories. Doing so could decrease her metabolic rate, which would make long-term weight loss more difficult (Shangold & Sherman 1998).
Linda: Nutrition Goals
Linda should eat a variety of whole grains, soy products, fruits and vegetables to meet her nutrient needs and decrease her risk of chronic disease. She should start the day with a sound, balanced breakfast. This will prevent overeating later on and boost her energy all day. Eating Soy. Soy foods are important for Linda because the phytoestrogens, or estrogen-like compounds, found in them may help offset the effects of reduced estrogen production by her ovaries. Eating 25 g of soy protein per day as part of a low-fat diet may help lower blood cholesterol levels; eating 60 g per day may decrease hot flashes (Albertazzi et al. 1998; FDA 1999). Good sources of soy protein include canned soybeans (13 g per 1/2 cup), textured vegetable protein (13 g per 1/4 cup dry--can be mixed with tomato sauce), 1 ounce soy nuts (10 g) or 31/2 ounces tofu (8 g). Preventing Osteoporosis. To reduce her risk of osteoporosis, Linda should make sure she gets at least 1,000 milligrams (mg) of calcium per day. That's the amount she needs since she is taking estrogen (Duyff 1998). Estrogen replacement has a protective effect on bone density, so she'd need more--1,500 mg per day-- if she were not taking estrogen. Linda should drink more water and less soda. She should gradually switch to a clear, decaffeinated soda because dark sodas containing phosphorus
February 2000 IDEA HEALTH & FITNESS SOURCE
and sodas with caffeine may decrease calcium absorption. She should limit her Linda: Sample Nutrition Plan intake of sodium and protein because a high intake of either of these can also Total calories per day: 1,675 (1,000 carbohydrate calories, or 60% of intake; decrease calcium absorption (ADA & 300 protein calories, or 18% of intake; and 370 fat calories, or 22% of intake) Dietitians of Canada 1999). Vitamin D, Breakfast: available from fortified milk, soy milk, 1 cup (c) Shreded Wheat and Bran cereal carbohydrate/protein cheese, eggs and some fish, helps with the 2 tablespoons (tbs) raisins carbohydrate absorption of calcium. Magnesium, a 1 c skim milk carbohydrate/protein component in bones, is also important 1/2 c calcium-fortified orange juice carbohydrate for bone health. Good sources include 1/2 c low-fat yogurt carbohydrate/protein/fat legumes, nuts, whole grains and spinach. Iron needs drop with menopause from Lunch: 15 mg per day to 10 mg per day (Kasdan 2 slices whole wheat bread carbohydrate/protein 1997), so Linda doesn't need as much 1 ounce (oz) low-fat soy cheese protein/carbohydrate/fat iron as before. 2 oz turkey breast/1 tbs mustard protein For general good health it's also impor1 c red grapes carbohydrate tant that Linda's diet meet the minimum 12 oz diet ginger ale n/a 2 chocolate kisses carbohydrate/fat requirements (100% of the Recommended Dietary Allowance) for Snack: the following vitamins and minerals: zinc, banana carbohydrate copper, manganese and vitamins C and B12 . Sample food choices for zinc include Dinner: meat, seafood, liver, wheat germ, tofu and 3 oz veggie soy burger on whole wheat bun carbohydrate/protein nuts. Copper is found in liver, seafood, 1 c dark greens with 1/2 c red peppers carbohydrate nuts and seeds. Manganese occurs in 2 tbs sunflower seeds (on salad) protein/fat whole grains, fruits and vegetables. Sources 2 tbs low-fat salad dressing fat/carbohydrate of vitamin C include citrus fruits, berries, 1 c steamed broccoli with lemon carbohydrate/protein tomatoes, potatoes and many fruits and 1 c skim milk carbohydrate/protein vegetables. Vitamin B12 is found in meat, Snack: fish, poultry, eggs, milk, nutritional yeast 1/2 c fresh strawberries carbohydrate and foods fortified with the vitamin. Eating Fruits and Vegetables. For overall health benefits, Linda should fruit and keep it refrigerated in containers so she's more apt to eat maximize fruit and vegetable intake. At her calorie level, she it! Dried fruits are handy to throw in a purse or keep at her desk. should be able to get in seven to eight servings of fruits and However, she should eat these in moderation because they have vegetables a day. She will find this easier if she buys some readymore calories than other forms of fruit. to-eat fruits and keeps them in plain sight (e.g., she can place Recommended Resource. The Weeknight Survival Cookbook apples, bananas and oranges in a bowl on the kitchen counter). by Dena Irwin, RD, is a great book for Linda. With her busy After grocery shopping, she can wash fruits like grapes and schedule, she needs a resource like this complete with sample strawberries and cut up and rinse vegetables (or use prewashed menus, grocery lists and fast, healthy recipes. baby carrots); these can be stored in the refrigerator in recloseable bags or plastic containers. This way, when she's on the run, she can grab fruits and vegetables and go. She can also open canned
February 2000 IDEA HEALTH & FITNESS SOURCE
Food Plan: Preventing Heart Disease
any people are concerned about learning ways to reduce their risk of heart disease, which is the number one killer of both men and women in the United States (American Heart Association 1998). One risk factor for heart disease is high blood cholesterol. Over 50 percent of American adults have total blood cholesterol levels of 200 to 239 mg per deciliter (mg/dl), which is considered borderline high; and about 20 percent have levels of 240 mg/dl or above, which is considered high (American Heart Association 1998). Other risk factors for heart disease include tobacco use, high blood pressure or hypertension, physical inactivity, overweight/obesity and diabetes mellitus. How can clients lower their blood cholesterol to reduce their risk of heart disease? Read what's recommended in the following case study.
Stan: Case Study
Stan: Caloric Breakdown
Stan has begun exercising at a local community center, and his workout goal includes 30 minutes of cardiovascular exercise five days per week. If he exercises this much, his energy needs are estimated at 2,015 calories per day for a gradual weight loss of 1 pound per week. This plan will help him lose 15 pounds in 15 weeks, bringing him down to his recommended weight of 185 pounds. Here's a suggested nutrition breakdown per day: 272 g of carbohydrate (1,088 calories, or 54% of intake); 85 g of protein (340 calories, or 17% of intake); 54 g of fat per day (486 calories, or 24% of intake); and an average of 100 calories per day from alcohol (5% of intake).
Stan: Nutrition Goals
Back from a recent visit to his physician, Stan has discovered that his blood cholesterol is 225 mg/dl, which the American Heart Association considers borderline high. Stan has been encouraged to start an exercise program, adopt a cholesterol-lowering diet and lose some weight. He's gained 30 pounds since he was in his 20s and now, at age 64, weighs 200 pounds. He's 6 feet tall. Stan quit smoking 10 years ago and has enjoyed good health and an active lifestyle. Recently widowed, he doesn't like to cook or know how to do it well. He is also on a limited income. Stan eats breakfast out with his buddies most mornings to catch up on the latest happenings. He's used to a "big man's breakfast" of eggs, bacon, toast and coffee or a sweet roll, sausage and coffee. Although Stan doesn't plan to give up his favorite foods entirely, he is open to making changes, starting with his high-fat breakfasts. He's had a few friends go through coronary bypass surgery and wants to do all he can to prevent problems himself. He drinks a 5-ounce glass of red wine every night, which may reduce his risk of coronary heart disease (Ellison 1999). Stan also takes a 100 percent multivitamin for older men and 400 International Units (IU) of natural vitamin E every day. He needs to learn the importance of a heart-healthy nutrition plan and be given practical ideas for shopping, cooking and eating out--all within a limited budget.
Stan needs to eat a low-cholesterol, low-fat diet that incorporates high-fiber foods and increased water consumption to help with regularity. He should focus on foods that bring down his cholesterol while adding important nutrients. These foods include oatmeal, oat bran, whole oat products, vegetables, fruits, psyllium-containing foods, whole grain breads and cereals, fish and garlic (ADA 1999; Ness & Powles 1997). Eating soy foods can also help him decrease blood cholesterol levels. When he gets home after exercising, he can drink a soy shake made with Spiru-tein shake mix (14 g of soy protein) and 11/2 cups of fortified soy milk (12 g of soy protein). He can also eat some of the soy choices listed in Linda's section on page 54. When Stan eats fats, he should consume more monounsaturated fats (like olive oil, canola oil and nuts) and omega-3 fatty acids (found in fatty fish like tuna and salmon) and reduce his intake of saturated fats and trans fats, which often hide in processed foods like baked goods. He needs to avoid saturated fats and trans fats because they can raise total and LDL (bad) cholesterol, while lowering HDL (good) cholesterol. Stan would also be well advised to take 400 IU of vitamin D, because new guidelines say people 51 to 69 years old need this amount (Garrison & Somer 1995). Eating a Healthy Breakfast. Stan needs to make better
February 2000 IDEA HEALTH & FITNESS SOURCE
breakfast choices because he's getting a lot Stan: Sample Nutrition Plan of saturated fat with his "big man" breakfasts. Since eating out with his Total calories per day: 2,015 (1,088 carbohydrate calories, or 54% of intake; friends is an important part of his day, 340 protein calories, or 17% of intake; 486 fat calories, or 24% of intake; there's no reason he should forgo this and 100 alcohol calories, or 5% of intake) pleasure. The restaurant Stan frequents offers oatmeal, skim milk, juices, English Food Primary Macronutrients muffins and even a "low-fat breakfast" of scrambled egg substitute, whole wheat Breakfast: toast and a fruit cup. He can opt for the 1 cup (c) oatmeal carbohydrate/protein low-fat breakfast two days a week and 1 c skim milk carbohydrate/protein 1 English muffin/1 tablespoon (tbs) jelly carbohydrate/protein cereal, English muffins and orange juice 3/ c grapefruit juice carbohydrate 4 on other days. These changes dramatically decrease the amount of saturated fat in his Lunch: diet, while increasing fiber and vitamins 1/ c tuna salad with 1 tbs canola-based, 2 and minerals. low-fat mayonnaise protein/fat Eating a Fast, Healthy Lunch. Stan's 2 slices whole wheat bread carbohydrate/protein usually home for lunch and wants fast, lettuce and tomato carbohydrate easy ideas for meals. He's happy with 1 c low-salt bean soup carbohydrate/protein sandwiches, soup and fruit most days. For 1 raw carrot cut in sticks carbohydrate/protein 1/ c canned peaches in juice sandwiches, he should use whole grain carbohydrate 2 bread with at least 2 g of fiber per serving; decaffeinated tea n/a low-fat sandwich fillings, such as lean Snack: turkey breast, grilled chicken breast, lean soy shake mixed with 11/2 c low-fat soy milk carbohydrate/protein/fat roast beef or tuna in water; and canolabased, low-fat mayonnaise. He can add Dinner: extra vegetables and fruits by piling low-fat chicken parmigiana frozen dinner protein/carbohydrate/fat sandwiches with tomatoes, onions and 1 dinner roll with 1 teaspoon trans-fatdark, leafy lettuce; and by opening canned free margarine carbohydrate/fat fruit or slicing an apple to eat with lunch. 5 ounces of red wine alcohol If he adds a glass of skim milk, he's all set. For soups, Stan should buy low-salt, lowsalad or frozen, packaged vegetables and fresh, canned or frozen fat premade soups, especially those with at least 5 g of fiber per fruit, his meal is complete. For an occasional fast-food dinner, his serving. Good choices are split pea, bean and ham or bean best bets are grilled chicken, regular roast beef sandwiches, turkey vegetable. subs with vegetables, baked potatoes with chili, and bean Eating a Healthy Dinner. Dinner can be a challenge for Stan burritos. Instead of buying french fries and soda with the because he's in the habit of buying fast food and eating it in front sandwiches, he should open a can of vegetables and have a glass of the television. He should try fast meal ideas like healthy frozen of skim milk or fruit juice at home with his fast-food purchases. entrees, ready-to-cook fish pieces and skinned chicken breasts. Recommended Resource. The Supermarket Guide by Mary His best choices for frozen dinners are roast chicken, teriyaki Abbott Hess, LHD, MS, RD, will give Stan an easy-tochicken, grilled chicken, roast turkey, sirloin tips, pasta with understand tour of grocery basics. chicken in tomato sauce, pasta with lean meat and grilled fish. He should choose a meal with fewer than 400 calories, under 15 g of fat and no more than 800 mg of sodium. If he adds a fresh
February 2000 IDEA HEALTH & FITNESS SOURCE
Food Plan: Maximizing Nutrition for Performance
thletes have special food needs that must be met if they want to perform at the top of their game. Although research on the relationship between the glycemic index of certain foods and exercise performance is limited, athletes may want to try eating more carbohydrate foods with low glycemic index values. These foods break down slowly, releasing glucose gradually into the bloodstream (Brand-Miller et al. 1999). Eating them before exercise may moderate the decline in blood glucose that occurs at the beginning of exercise and reduce the reliance on carbohydrate as a fuel during exercise. What specific foods should recreational endurance athletes eat? See the case study below.
Dave: Case Study
plies about 4 to 5 g of carbohydrate per kilogram (kg) of body weight per day--not enough for an endurance athlete (Coleman 1997). Dave should get at least 6 g per kg of body weight per day (Coleman 1997). At his weight of 170 pounds, or 77 kg, he needs a minimum of 462 g of carbohydrate. I recommend that he get 1.77 g of protein per kg of body weight, or 0.8 g per pound, since he does strength training as well as endurance training. This way he needs 136 g of protein per day. Dave's estimated energy needs are 3,200 calories per day. A suggested breakdown is 504 g of carbohydrate (2,016 calories, or 63% of intake); 136 g of protein (544 calories, or 17% of intake) and 71 g of fat (640 calories, or 20% of intake).
Dave: Nutrition Goals
Dave is a 25-year-old "weekend warrior turned marathoner." He's always been active, playing football and baseball in high school, running off and on and lifting weights with his buddies when time allowed. Now, however, he's getting serious about training. He's always wanted to train to run a marathon and is shooting for his first one this summer. He is looking for a nutrition plan to help him train better and harder. He feels he's at a good weight (he's 5
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