DFM 655 Alternative Topic.docx



Treating Type II Diabetes with Raw FoodMarissa Clark and Julia DiazDFM 655Fall 2013Part One: IntroductionDiabetes mellitus is characteristic of high blood sugar due to problems with either a person’s ability to produce insulin, improper insulin function, or a combination of the two. People with type II Diabetes Mellitus (T2DM) are able to produce insulin but it is ineffective on their cells. Type II Diabetes Mellitus is the most common form of diagnosed diabetes cases (Lee, p.498).Over the past few decades the incidence of T2DM have increased in both adults and children. Typically adults and people of color have higher rates of developing T2DM, but childhood incidences have been increasing. Genetics, obesity, and lack of physical activity are also risk factors for developing T2DM (Lee, p.498). Managing weight, diet, and exercise are usually recommended as part of treatment since obesity and lack of physical activity can be treated by these changes. There are many diets that claim to help people can lose weight quickly and easily, without exercising just by following a certain diet plan. These diets appear to work at first in the beginning because people are losing mostly water weight and not fat. Usually this weight loss is not maintained because it doesn’t take into account long-term behavioral changes. Unlike fad diets, a raw food diet is considered to be a lifestyle choice. A raw food diet consists of unprocessed and uncooked foods, and alcohol, processed sugars, and tobacco are strongly discouraged. Most raw food diets are vegetarian and vegan, but some do include raw meats, eggs and dairy products. The belief behind raw food is that cooking food destroys beneficial enzymes and nutrients. For a food to be considered raw, it cannot be heated above 118 degrees Fahrenheit (“Raw Food Diet,” 2012). It takes a lot of preparation to make raw meals, such as, soaking nuts and seeds, blending, and dehydrating foods. There is much debate about whether or not this diet is healthy. Some studies have shown that raw foods may decrease the risk of developing certain diseases and cancers. At the same time there are other studies that show that a strict raw food diet is low in vitamin B12 and lycopene, and have a higher risk of getting sick from foodborne bacteria from not cooking certain foods (“Raw Food Diet,” 2012). Raw plant based foods are naturally high in fiber, and lower in fat and calories than most typical western diets. It would be beneficial to incorporate more raw foods, specifically raw plant based food, into one’s diet in addition to their normal diet. Part Two: Describe Your CaseThe client, Julia, is a 45-year-old Hispanic, single mother who takes care of her two children, and works a full-time job. She is 5’6 and 175lbs with a BMI score of 28. Her blood tested positive for high glucose levels. For generations, Julia’s family has a history of diabetes and other minor complications. Julia comes in to see a dietitian because she recently found out that she has type 2 diabetes and is very scared that it will be uncontrollable and eventually take her life. As a single mother, she feels it is her responsibility to make breakfast every morning and tries hard to support and provide as much as she can for kids. Throughout the day she tends to drink a lot of sugary caffeine drinks and eats a lot of processed fatty foods during the day because of her busy schedule. She works right next to a Starbucks and usually stops in a couple of times a day to get some coffee. Her company usually has lunch catered for employees, so she doesn’t worry about bringing her lunch to work. Lately she has been too busy, or too tired to cook dinner because of her recent promotion at work, and her current divorce. Since her life is so hectic right now she has been getting take-out for dinner, although she would prefer to cook.Part 3: The Sample InterviewThe interview begins with Julia coming into the office to see a nutrition counselor due to her recent diagnosis with Type 2 Diabetes. She explains how she feels overwhelmed and scared her life is going to end early because of her genetic inheritance of this disease. The counselor begins by actively listening and empathizing with Julia’s feelings and concerns. She assures Julia there are multiple ways to manage her blood sugar and that she will work with her every step of the way and find a good solution for her to try that will work with her schedule. Julia expresses that she is extremely dedicated and willing to try everything and anything to ensure that she will be around long enough to watch her children grow.The counselor then asks Julia how familiar she is with the disease she has been recently diagnosed with and if she can explain what she thinks it means. Julia explains her understanding that the disease is related to the amount of sugar in the blood and diet has an effect on levels, but doesn’t fully understand what is happening in the body biochemically. The counselor explains to Julia the type of diabetes she has and how her body is not responding to insulin like it should be, so glucose in the blood is not being regulated and that this is what causes blood sugar to rise higher than normal. Then the counselor asks Julia for her permission to evaluate and explain what her blood test results mean. She explains the Hgb-A1c is the average blood sugar level from the past 2-3 months by measuring how much blood sugar is attached to hemoglobin and that normal values are on average below 6mg/dl. She mentions to Julia that her levels are at 10.3 mg/dl and asks her to reflect what this value means to her. Julia realizes her levels are nearly twice the amount of what they are supposed to be and wants to change. After they discuss her lab results, the counselor then reviews her 24-hour recall and reflects what she eats on a typical day in order to look for ways to alter her diet to decrease her blood sugar levels. The dietitian notes that Julia makes breakfast for herself and her children, but throughout the rest of the day she tends to drink a lot of sugary drinks and eats out often. The counselor gives Julia positive reinforcement and that it is great that even with her busy schedule how it is important to her in making her children breakfast. The counselor asks Julia if there were anyways she could reduce her sugar and fat intake. Julia mentions the first place she can limit her sugar intake is by limiting her coffee intake. The counselor recommends options such as, decreasing the portions of her drinks and asks to chose sugar free syrup or opt for coffee drinks using Stevia or Splenda to sweeten them. Julia also brings up that she would like to try more vegetarian meals and considers the raw food diet. After learning more about raw food, its limitations, and benefits, she decides to incorporate more fruits and vegetables into her current diet, and makes it a future goal to work up to a raw food diet. She plans to start bringing prepared crudités for her to snack on while she is at work, and try more vegetarian options when she gets lunch and dinner. Part 4: The ReflectionIn this counseling session, the counselor decided to use the motivational interviewing approach to her client. Our evidence based approach towards this client would be effective because when someone is recently diagnosed with disease they become very overwhelmed, stressed and afraid of what might happen to them if it remains uncontrolled. The counselor wanted the session to be client-centered and directive in order to assess where the client needs to change her behavior. In the beginning of the session, the counselor opens with an empathetic statement, “that must feel very detrimental for you to know you have had previous family members pass away with a disease you have recently been diagnosed with,” when she reflects on her family’s history with the disease. This causes the client to feel comfortable and motivated to try anything and become a role model for herself and her kids. The counselor then asks a few open ended questions about diabetes, like: “how familiar are you with what diabetes is,” and “normal A1c levels are somewhere below 5.7 and your results show that your A1c levels are 10.3. What does this mean to you?” By doing this, the counselor allows the client to think about what diabetes means to her allowing her to reflect where she can begin to make a change. The client then asks the counselor about raw foods and if she thinks that is something that would be good for her to try. The then counselor explains the positives and negatives about the diet and asks, “on a scale of 1-10 how well do you think you could stick to a raw food diet” This gave Julia the opportunity to think about what is realistic for her and if she thinks she can stick to making such a dramatic diet change. The client then mentions her confidence level isn’t that high but reassures herself that it is good goal to work towards. After the counselor asks Julia about her 24-hour recall, she begins to question how can change the types of foods that she normally eats. When she recognizes the majority of her diet consists of sugary coffee drinks and take-out foods, she provides her with multiple recommendations to try and elicits a reflective statement on her plan by saying, “Awesome, so let’s recap our plan. We are going start trying to reduce the size of sugary caffeine drinks and either go for sugar free options or opt for sweetening them with splenda, correct?” This statement helps Julia realize it is important to start small by reducing the size of her caffeine drinks and looking for other options that will work for her. These statements are important for the intervention because the counselor needed to have Julia become aware of what her daily intake of sugar is. The counselor was also trying to get her client to understand what her current level of commitment towards making a change by setting small, realistic, and measurable goals. The counselor also tried to relate to her client on a personal level in order to gain trust and avoid discouragement by enthusiastically motivating her client by providing multiple recommendations for her to try in order to change her habits. It is important for the client to self-reflect to develop his or her own self-motivations about what is important to establish a behavior change. It is important for the counselor to encourage the client to think of new ways to begin behavior modification. This motivational interviewing approach helped allow the counselor to gain “empathetic insight to enhance counseling” and to become apart of the client’s “experience without losing one’s own sense of self.” (Bauer, 2012, p.55). This approach also significantly impacts the client during the early stages of behavior change. By letting motivation begin intrinsically within the client, the outcome leads to “enhanced performance, persistence and creativity to accomplish the task.” (Bauer, 2012, p.30). By allowing the client to be involved in goal setting increases the likelihood of adherence to plans and goals. Part 5: The ConclusionMany people have ideas of what a healthy diet entails due to media and advertising of different diets and lifestyles. It is important for nutrition counselors to be familiar with different diets to help guide their client to something that will work for them. The belief with raw food diets is that consuming more whole, unprocessed food the more intact the nutrients will be and the healthier a person will be. Since this diet is naturally low in fat and calories a person can lose weight on it, can have better energy, lower lipid level, and are at a decreased risk of certain diseases. At the same time, however, they are also at risk of not getting adequate nutrient intake due to different bioavailability of different vitamins and minerals in raw food as opposed to cooked food. This type of diet can also require a lot of organization and preparation ahead of time. (Medical News Today, What is the Raw Food Diet?). Having a varied diet of both raw and cooked foods, especially if it is high in plant-based foods can have a beneficial effect on a person’s health.ReferencesBauer, K. D. (2012). Nutrition counseling and education skill development (2nd ed.). Cengage Learning.Lee, R. D. (2011). Diseases of the endocrine system. In Nutrition therapy & Pathophysiology (2nd ed., p. 498). Cengage Learning.Medical News Today. (may 8, 2009). What is the Raw Food Diet? Retrieved October 12, 2013 from . (September 21, 2012). Raw Food Diet. Retrieved October 14, 2013 from A: ScriptMarissa open with: This counseling session is a reenactment of a middle aged Hispanic woman that was recently diagnosed with Type 2 Diabetes. She is 5’6 and 175lbs with a BMI score of 28. Her blood tested positive for high glucose levels as well as a high triglyceride count. Counselor: Hello, my name is Marissa and I will be your Nutrition Counselor todayJulia: Hello Marissa, my name is Julia Counselor: Nice to meet you, Julia. How are you feeling today?Julia: Very overwhelmed. I was recently diagnosed with Type 2 Diabetes and can’t even begin to tell you what's going through my head right nowCounselor: I understand you feel overwhelmed since this is new and a lot of information to take in. I can assure you that I will help every step of the way and get you on the right track to help control this.Julia: I just don’t even know what to think. My family has a history of being diagnosed with diabetes and 3 has passed away from this disease. I am scared the same will happen to me.Counselor: That must feel very detrimental for you knowing that you’ve had previous family members pass away with a disease you have recently been diagnosed with.Julia: Not only that, I feel there is no hope and Diabetes is going to take over my life and become out of controlCounselor: Well, diabetes can get out of control if it’s not properly managed. But, there are multiple ways of treating this type of condition and we are going to work together in finding the right one for you. Julia: Okay that sounds great, I am willing to do anything to reverse this process and be a role model for my kidsCounselor: I’m glad to hear that you are so committed to this. As long as you keep that passion and determination to change, you will be able to do anything! You mentioned that some of your relatives have been diagnosed with diabetes. How familiar are you with what diabetes is? Julia: I know it has something to do with blood sugar, and that one needs to be careful with what they eat--but I’m not exactly sure what it isCounselor: Yes, diet plays a big role in blood sugar. May I briefly explain to you what the definition of what type 2 Diabetes is?Julia: Yes please!Counselor: Diabetes is a problem with your body that causes blood glucose, or blood sugar, levels to rise higher than normal. This is also called hyperglycemia. Your body has an impaired glucose tolerance and isn’t responding to insulin correctly. Insulin is the hormone that is signaled when glucose levels are high in the blood and help move excess sugar into storage. Does that make sense?Julia: Ya, that makes sense. My blood sugar levels are elevated because the insulin in my body is unable to absorb sugar from the blood effectively, right?Counselor: Exactly. So, do you have any questions about your lab results?Julia: Yes...after receiving my blood work I’m a little confused what an A1c is?Counselor: The A1c test shows your average blood sugar level from the past 2-3 months by measuring how much blood sugar is attached to hemoglobin, which is the oxygen carrying part of blood. normal A1c levels are somewhere below 5.7. your test shows that your A1c levels are 10.3. What does this mean to you?Julia: Wow- that means my blood sugar levels are almost twice as high as they should be. I had no idea they would be that high. I really want to get all of these numbers down to where they should be.Counselor: Ok well, now that you have a better sense of what your lab results mean would you be comfortable going over your food record together, so we can look for ways to alter your diet to decrease your blood sugar levels?Julia: Ya that sounds great! (hands food record)Counselor: It’s great that you take time to make breakfast for your family in the morning. Based on your food recall, you mention that you make scrambled eggs with sausage, pinto beans and tortillas. You mention that your company provides burritos for lunch and order pizza for dinner. I see that you also have numerous cups of coffee throughout the day--Is this 24-hour food recall reflective of what you regularly eat?Julia: Yes, since my divorce and promotion I’ve been very busy and I haven’t got the time or energy to make dinner. I do enjoy making it for my kids when I get the chance.Counselor: Usually take-out foods have a high amount of unnecessary fats and coffee drinks can have too much sugar. Is there any way you think you can cut back on these types of foods?Julia: I guess a good place to start would be to cut out all of that extra sugar in my coffees. but i always have them, i don’t think that it will be easy to stop drinking them especially since there’s a starbucks at my work I pass by multiple times a day. Counselor: reducing the amount of sugar in your coffee is a great place to start and giving it up cold turkey would be extremely difficult. so lets start small. maybe you can decrease the sizes of the drinks you get and ask for sugar free syrup options, or opt for plain espresso drinks or coffee and use stevia or splenda, to sweeten them. Does this sound reasonable?Julia: Yes that does sound reasonable. I think I could definitely try using different sweeteners in my coffee.Counselor: Great! By substituting your sugar with sugar free coffee sweeteners can drastically cut back your intake of sugar. What about take-out---do you think there is a way you would try other menu dishes that tend to have more vegetables in them?Julia: Yes definitely, one of my cousin’s is a vegetarian and I have tried a few dishes she has made and brought over to grandma’s house the last few times the whole family has gotten together. Maybe----for the times I order take-out I can opt for more vegetarian meal options to start and try to order a side salad or some sort of vegetable to go with it? Hey…. I was reading in People magazine the other day about something to do with raw foods and its health benefits. Do you think that is something I could try to do? I don’t know much about it only that you don’t cook your food. It sounds like that would be a good option for me to try because it seems that I wouldn’t save time and energy preparing meals for my family.Counselor: It is possible, by incorporating raw fruits and vegetables in your diet it can drastically bring your blood sugar levels down. The benefits of consuming raw foods are that they are high in fiber,nutrients, and low in fat and calories. However, a strict raw diet can be difficult to maintain. Even though it is not cooked some dishes do require a lot of preparation and is known for being very low in certain nutrients, such as: B12, calcium, iron and protein if you’re not eating a wide variety of plant based foods. Well tell me this, on a scale of 1-10 how well do you think you could stick to a raw food dietJulia: About a 6, I know that changing my diet will be effective, I am afraid of the days I feel tired and weak and might give into cravingsCounselor: You would like to try a raw diet to bring your blood sugar levels down, but you are concerned about giving into cravings. That’s understandable. such a drastic diet change would be difficult. You don’t have to switch to a 100% raw diet to receive benefits of raw foods. you could incorporate more raw fruits and vegetables into your present diet. You said that you could start eating more salads. are there any other ways you could eat some raw vegetables or fruits?Julia: Yes, whenever I go to a company banquet they always have some sort of veggie tray. I enjoy eating carrots, cherry or grape tomatoes, and raw celery sticks Counselor: How do you feel about being able to prepare these snacks ahead of time for work?Julia: I feel like that is a good start. I can even go to costco and just buy one of those veggie platters that already has everything pre-cut. That way it’ll be easy for me when I don't have much time. I think I should just try to incorporate more vegetables in my day and gradually work up to a raw food diet in the future. Counselor: That is excellent. See, you are already planning ahead! I know you are going to get the hang of it in no time. can you see yourself adding any veggies to your breakfasts? Julia: I know I dont have any vegetables in the morning, but veggies aren’t really a breakfast food to me.Counselor: How about substituting a piece of fresh fruit for your sausage?Julia: Ya I could definitely do that.Counselor: Awesome, so let’s recap our plan. We are going start trying to reduce the size of sugary caffeine drinks and either go for sugar free options or opt for sweetening them with splenda, correct?Julia: Yes, I am actually feeling excited in trying these chances!Counselor: That is wonderful. It is only going to get better with time and you will adopt more delicious recipes to try. How about we schedule for an appointment in 2 weeks and see how your progress is going? Julia: That sounds great! Thank you for all of your recommendations, it gives me hope that I can do this!Counselor: You're welcome, I look forward to hearing about all the progress you will make!Appendix B: Youtube Link C: Food RecordTimeFood/DrinkTypePreparationAmount5:00 amCoffeeGround beans (Starbucks)Home coffee maker32 oz coffee3 tsp granulated sugar1/8c half & half7:00 amEggsScrambledSauteed 3 eggs w/ yolk1/8c milk1 green onion7:00 amSausagesJimmy DeanSauteed3 3oz7:00 am TortillasCornGrilled2 slices7:00 am BeansPintoBoiled and sauteed1 cup with 6oz mozzarella cheese8:30 am CoffeeCaramel Frappuccino None16 oz2 oz whipped cream2 T caramel8:30 amLemon cakeBakedNone6 oz2:00 pmChipotle burritoBraised carnitas Braised 1 Flour tortilla6 oz black beans6 oz braised carnitas3 c rice? c sour cream? c pico de gallo? c guacamole4:30 pmCoffeeRegularNone8 oz ? c half & half9:00 pmPizzaVegetarianRound Table Pizza3 slices9:00 pmBreaksticksGarlicRound Table Pizza4 x 5oz with 3 T ranch dressing ................
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