Alvina Begay

Alvina
Begay,
RD
Professional
Runner
Nike
N7
Ambassador
Registered
Dietitian
at
Flagstaff
Medical
Center
Objec&ves:
  Become
knowledgeable
about
the
Academy
of
Nutrition
and
Dietetics’
guidelines
on
healthy
weight
loss.
  Become
knowledgeable
about
the
GAPs,
Paleo,
8‐
Hour
and
Intermittent
Fasting
diets.
  Make
appropriate
recommendations
as
to
whether
a
specific
diet
may
or
may
not
work
for
particular
patients
and
make
RD
referrals
if
necessary.
Talk
Descrip&on:
People
who
try
to
lose
weight
are
always
looking
for
the
latest
in
how
to
lose
weight
fast
and
eat
healthfully.
Fad
diets
come
and
go,
as
does
the
weight
that
people
lose
and
regain.
I
will
discuss
the
latest
on
weight
loss
recommendations
by
the
Academy
of
Nutrition
and
Dietetics.
I
will
also
discuss
some
of
the
popular
diets
that
people
are
on
to
lose
weight,
fight
food
allergy
symptoms
and
support
digestive
healing.
GAPs
Diet
GAPS
Diet
  GAPS
Diet
refers
to
the
treatment
program
that
people
with
GAPS
(Gut
and
Psychology/Physiology
Syndrome)
go
on
to
heal.
  Purpose
of
the
treatment
is
to
detoxify
the
person,
to
lift
the
toxic
fog
off
the
brain
to
allow
it
to
develop
and
function
properly.
To
do
this,
the
digestive
tract
needs
to
heal
so
it
stops
being
the
major
source
of
toxicity
in
the
body.
As
more
than
90%
of
everything
toxic
floating
in
our
blood
(and
getting
into
the
brain)
comes
from
the
gut,
healing
it
will
drop
the
level
of
toxicity
in
the
body
dramatically.
Leaky
Gut
GAPS
Diet:
What
can
damage
the
gut
flora?
  Sugar,
grains‐
esp.
empty
carbohydrates
  Anti‐inflammatory
drugs
or
any
medications
  Antibiotics
  Diet
off
balance
between
Omega
6’s
and
omega
3’s
  Transfats
  Stress,
infections
  Chemotherapy
  Toxins
–
pesticides,
preservatives,
hormones,
fake
colorings
GAPS
Diet:
The
GAPS
Diet
involves
three
steps:
1.  The
Diet.
The
digestive
system
is
a
long
tube.
What
you
fill
that
tube
with
has
a
direct
effect
on
its
well‐being.
Diet
is
the
most
important
and
the
number
one
treatment.
Everything
else
takes
a
second
place.
The
diet
is
implemented
in
two
parts‐
first
is
called
GAPS
Intro
(or
the
Intro
Diet)
which
an
intensive
healing
diet:
mostly
boiled
meat,
homemade
bone
broth
and
boiled
veggies
for
a
period
of
time
until
digestive
symptoms
clear.
Then,
through
a
series
of
several
stages,
you
move
into
Full
GAPS.
Full
GAPS
is
a
much
less
restricted
diet
that
includes
plenty
of
healthy
proteins
and
fats,
along
with
vegetables
and
some
fruits.
Harder
to
digest
starches
and
sugars
are
avoided
to
allow
the
gut
time
to
heal.
2
.
Appropriate
Supplementation.
Probiotics,
essential
fatty
acids,
fermented
cod
liver
oil
and
digestive
support
are
generally
recommended.
3
.
Detoxification
and
Lifestyle
Changes.
Reducing
stress,
making
sure
to
get
proper
sleep
and
reducing
toxic
load
in
the
home
and
personal
care
products
are
all
important.
Cons
of
the
GAPs
Diet:
  Not
a
quick
fix:
can
take
anywhere
from
several
months
up
to
2
years.
  Expensive
  Eat
organ
meats
  Calls
for
fermented
foods
  High
amount
of
lead
in
broth
  Time
put
into
making
food
Paleo
Diet
  Caveman
Diet,
Stone
Age
diet
or
Hunter‐Gatherer
Diet.
  Premise:
Modern
humans
are
genetically
adapted
to
the
diet
of
their
Paleolithic
ancestors
and
that
human
genetics
have
scarcely
changed
since
the
dawn
of
agriculture
and
therefore
an
ideal
diet
for
human
health
and
wellbeing
is
one
that
resembles
this
ancestral
diet.
Paleo
Diet
Yes
No
  Fish
  Grass‐fed
raised
meats
  Grains
  Legumes
  Eggs
  Dairy
products
  Vegetables
  Fruit
  Potatoes
  Refined
salts
  Roots
  Refined
sugar
  Nuts
  Processed
oils
Paleo
Diet:
1.  Eat
whole
unprocessed,
nutrient‐dense,
nourishing
foods.
Grass
fed
and
pastured
meats
and
eggs,
wild‐
caught
seafood
and
vegetables
are
prioritize.
Fruit,
nuts
and
seeds
are
eaten
in
moderation.
2.  Foods
that
harm
by
causing
systemic
inflammation,
wrecking
the
guts
or
derailing
our
natural
metabolic
processes
are
avoided.
Abstain
from
toxic,
pro‐
inflammatory
foods
like
gluten‐containing
grains,
legumes
and
sugar.
3.  The
Paleo
Diet
is
not
a
weight
loss
cure‐all
Pros
of
the
Paleo
Diet:
  Putting
protein
on
your
plate.
The
Paleo
advocates
eating
fish,
poultry
(Omega‐3
fatty
acids
reduce
risk
of
chronic
diseases).
  Eating
nuts
and
seeds
  Filling
up
on
extra
veggies
  Guzzling
down
water
  Ridding
yourself
of
refined
sugar
Cons
of
Paleo
Diet:
  Ditching
dairy:
low‐fat
yogurts,
cheese
and
milk
can
be
a
great
source
of
calcium
and
protein.
  Giving
up
grains:
Not
all
grains
are
“bad”
for
you.
Grains
such
as
quinoa
and
oats
are
good
sources
of
vitamins
and
minerals
and
fiber.
Fiber
found
in
these
foods
helps
to
keep
us
fuller
for
longer.
  Letting
go
of
legumes:
good
source
of
protein
and
antioxidants.
8‐Hour
Diet
8‐Hour
Diet
  Eat
in
a
8‐Hr
window
for
three
days
  Feast
8‐hours
and
then
fast
for
16‐hours
  Eat
whatever
you
want.
Hopefully
you
won’t
eat
junk
  Suppose
to
help
stay
full
longer
  Cons:
doesn’t
promote
eating
healthy
foods
IntermiEent‐Fas&ng
Diet
IntermiEent
Fas&ng
Diet:
  Drastically
restrict
calories
1‐2
days
a
week
and
then
eat
normally
on
others
  How
does
it
work:
Our
bodies
need
fuel
to
operate
and
if
there
isn’t
any
food
in
the
stomach
to
pull
from,
it
uses
stored
fat
within
the
body
for
energy.
The
fat
gets
burned
for
energy,
the
body
keeps
moving
and
thus
becomes
leaner.
Risks:
  Feel
hungry,
fatigued
and
irritable.
Fasting
not
comfortable.
People
try
to
cut
back
one
day
and
the
next
day
they’re
starving
and
they
overeat.
  Still
eating
junk
food.
  Abuse
stimulants
–
coffee
  Obsess
over
the
clock
  You
think
that
more
=
better.
Why
not
fast
for
48
hours?
72
hours?
Academy
of
Nutri0on
and
Diete0cs’
Guidelines
on
Healthy
Weight
Loss
Guideline
Objec&ve
  To
provide
Medical
Nutrition
Therapy
(MNT)
guideline
recommendations
for
adult
weight
management
that
reduce
body
weight,
prevent
further
weight
gain
and
maintain
weight
loss
over
a
prolonged
period.
  Focus
of
this
guideline
is
on
the
treatment
of
adult
overweight
and
obesity.
Overweight
is
defined
as
a
body
mass
index
(BMI)
of
25.0‐29.9
kg/m2
and
obesity
as
a
BMI>/=
30.0
kg/m2
Academy’s
Guideline
for
Weight
Loss
  Body
weight
and
waist
circumference
should
be
used
to
determine
the
effectiveness
of
therapy
in
the
reassessment.
BMI
and
waist
circumference
are
highly
correlated
to
obesity
or
fat
mass.
  Comprehensive
weight
management
program
including
diet,
physical
activity
and
behavior
therapy.
The
combination
therapy
is
more
successful
than
using
any
one
intervention
alone.
  Individualized
goals
of
weight
loss
therapy
should
be
to
reduce
body
weight
at
an
optimal
rate
of
1‐2
lbs
per
week
for
the
first
6
months
and
to
achieve
an
initial
weight
loss
goal
of
up
to
10%
from
baseline.
These
goal
are
realistic,
achievable
and
sustainable.
Academy’s
Recommended
Dietary
Interven&ons
  Reduced
Calorie
Diet:
Reducing
dietary
fat
and/or
carbohydrates
is
a
practical
way
to
create
a
caloric
deficit
of
500‐1000
Kcals
below
estimated
energy
needs
and
should
result
in
a
weight
loss
of
1‐2
lbs
per
week.
  Total
caloric
intake
should
be
distributed
throughout
the
day,
with
the
consumption
of
4‐5
meals/snacks
per
day
including
breakfast.
  Portion
Control:
Portion
control
should
be
included
as
part
of
a
comprehensive
weight
management
program.
Portion
control
at
meals
and
snacks
results
in
reduced
energy
intake
and
weight
loss.
Academy’s
recommended
Dietary
Interven&ons
  Meal
Replacement:
For
people
who
have
difficulty
with
self
selection
and/or
portion
control,
meal
replacements
(liquid
meals,
meal
bars,
calorie‐controlled
packaged
meals)
may
be
used
as
part
of
the
diet
component
of
a
comprehensive
weight
management
program.
Substituting
one
or
two
daily
meals
or
snacks
with
meal
replacements
is
a
successful
weight
loss
and
weight
maintenance
strategy.
  Nutrition
education
should
be
individualized
and
included
as
part
of
the
diet
component
of
a
comprehensive
weight
management
program.
Short
term
studies
show
that
nutrition
education
(reading
nutrition
labels,
recipe
modification,
cooking
classes)
increases
knowledge
and
may
lead
to
improved
food
choices.
Selected
Dietary
Approaches
  Low
Glycemic
Index
Diets:
a
low
glycemic
diet
is
not
recommended
for
weight
loss
or
weight
maintenance
as
part
of
a
comprehensive
weight
management
program.
Has
not
been
shown
to
be
effective
in
these
areas.
  Dairy/Calcium
and
Weight
Management:
Incorporate
3‐4
servings
of
low
fat
dairy
foods
a
day
as
part
of
the
diet
component
of
a
comprehensive
weight
management
program.
Research
suggests
that
calcium
intake
lower
than
recommended
levels
is
associated
with
increased
body
weight.
However,
the
effect
of
dairy
and/or
calcium
at
or
above
recommended
levels
on
weight
management
is
unclear.
  Low
Carbohydrate
Diet:
Having
patient
focus
on
reducing
carbohydrates
rather
than
reducing
calories
and/or
fat
may
be
a
short
term
strategy
for
some
individuals.
Research
indicates
that
focusing
on
reducing
carbohydrate
intake
results
in
reduced
energy
intake.
Consumption
of
a
low‐carbohydrate
diet
is
associated
with
a
great
weight
loss
and
fat
loss
than
traditional
reduced
calorie
diets
during
the
first
6
months,
but
these
differences
are
not
significant
after
1
year.
Physical
Ac&vity
Interven&ons
  Physical
activity
should
be
part
of
a
comprehensive
weight
management
program.
Physical
activity
level
should
be
assessed
and
individualized
long‐term
goal
established
to
accumulate
at
least
30
minutes
or
more
of
moderate
intensity
physical
activity
on
most,
and
preferably,
all
days
of
the
week,
unless
medically
contraindicated.
Physical
activity
contributes
to
weight
loss,
may
decrease
abdominal
fat,
and
may
help
with
maintenance
of
weight
loss.
Behavioral
Interven&ons
  Multiple
Behavior
Therapy
Strategies:
A
comprehensive
weight
program
should
make
maximum
use
of
multiple
strategies
for
behavior
therapy
(self
monitoring,
stress
management,
stimulus
control,
problem
solving,
contingency
management,
cognitive
restructuring,
and
social
support).
Behavior
therapy
in
addition
to
diet
and
physical
activity
leads
to
additional
weight
loss.
Continued
behavioral
interventions
may
be
necessary
to
prevent
return
to
baseline
weight.
Bariatric
Surgery
for
Weight
Loss
  Dietitians
should
collaborate
with
other
members
of
the
health
care
team
regarding
the
appropriateness
of
bariatric
surgery
for
people
who
have
not
achieved
weight
loss
goals
with
less
invasive
weight
loss
methods
and
who
meet
NHLBI
criteria.
Separate
ADA
evidence
based
guidelines
are
being
developed
on
nutrition
care
in
bariatric
surgery.
Tips
for
Primary
Care
Providers
  How
do
I
bring
up
the
topic?
  Be
respectful.
Use
terms
such
as
“weight,”
“excess
weight,”
“unhealthy
weight,”
and
“BMI,”
or
ask
what
terms
he
or
she
prefers
  What
do
patients
want
to
know?
  Patients
often
want
info
on
safe
and
effective
ways
to
control
their
weight.
Ask
patient
about
their
eating
habits.
Encourage
them
choose
healthier
options.
Make
them
aware
that
being
inactive
may
not
be
good
for
their
health.
  How
can
I
help
my
patient’s
set
goals?   Ask
your
patients
how
ready
they
are
to
adopt
healthier
eating
and
physical
activity
habits.
Tips
for
Primary
Care
Providers
  How
can
I
help
my
patients
stick
with
their
goals?
  Praise
can
help
inspire
your
patients
to
maintain
new
behaviors.
Note
their
progress.
Offer
praise
to
boost
self‐esteem
and
keep
them
motivated.
Discuss
setbacks.
Set
new
goals.
  What
if
my
patient
needs
more
help?
  Refer
to
Registered
Dietitian.
Cita&on:
  Gut
and
Psychology
Syndrome.
2010.
Available
at
www.gaps.me
Assessed
June
22,
2013
  The
Paleo
Diet.
2010.
Available
at
www.paleodiet.com
Assessed
June
22,
2013
  8‐Hour
Diet
Book.
2013.
Available
at
www.8hourdietbook.com
Assessed
June
22,
2013
  Intermittent‐Fasting
Diet.
2008.
Available
at
http://www.theiflife.com/intermittent‐fasting‐101‐how‐to‐start‐part‐i/
Assessed
June
22,
2013
  Evidenced‐based
Nutrition
Practice
Guideline
on
Adult
Weight
Management
published
at
www.adaevidencelibrary.com
and
copyrighted
by
the
Academy
of
Nutrition
and
Dietetics;
assessed
on
June
22,
2013