Session 1 - Introduction

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A Low-Fat Diet for Fatigue in MS Session 1: Introduction


Study Team • Carly Vong, MPH, RD, Dietitian – 503-494-0174 • Emma Chase, MS, Study Coordinator – 503-494-3549 • Vijayshree Yadav, MD, Principal Investigator • Michael Lane, MD, Co-Investigator

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Menu for today • Welcome & Introduction • Brief background on diet and MS • Introduction to the Manual • Introduction to the Eating Plan • Reading Nutrition Labels • How to Track & Measure Fat Break • Building a balanced meal without a recipe • Tips: Getting Started. • Recap 3


Objectives By the end of the session, you should… • Understand the “do’s and “don’ts” of the study diet • Know how to track and measure fat grams • Know how to build a simple balanced meal • Feel confident that you know where to find more information/answers to your questions about the study diet

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Fat in Health & Disease • Dietary fat has a role in promoting or protecting against coronary heart disease.

• Based on the 2015 U.S. Dietary Guidelines there is

no upper limit on the % calories from fat, but the general recommendation is 25-30% of calories.

• We don’t know if this recommendation should be different for people with MS.

• Type of fat may be more important than calories from fat.

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Types of Fat


Types of Fat State at room temperature

Dietary sources

Unsaturated Fat

Liquid

Avocado Nuts/Seeds Olive oil Fish

Trans Fat

Solid

Processed foods (rarely found in nature)

Saturated Fat

Solid

Animal products (meat and dairy) Coconut Oil Palm Oil


“Good Fats�

Unsaturated Fat

Liquid at room temperature

Avocado Nuts/Seeds Olive oil Fish

Fats are long chains of carbon and hydrogen. Because of the double bond, the chain is not fully saturated with hydrogen ions.


Diet and MS • Interest is growing in diet as a therapy for MS.

• Several diets are popular among people with MS, such as Swank, McDougall & Wahls diets

• What we do know: eating a healthy

diet that benefits overall health will also likely help MS.

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The Swank Observations In Norway, Dr Swank observed that people in the mountains seemed to be more likely to develop MS than people in the villages on the coast. Those in the mountains ate more meat and dairy, while those on the coast ate more fish. The observations led to the Swank Diet, a low-fat diet that that limits red meat and dairy, and encourages lean fish, fruits & vegetables, and whole grains.

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Why a low-fat diet?


Why low-fat? • 32 people with MS followed a low-fat, vegan diet for one year. (~10% daily calories from fat) • 29 people followed their usual diets for the same time period. • Low-fat dieters reported less fatigue while following the diet, and had less fatigue than those following their usual diets. • However, It was very hard to stick to. • If we make the diet more permissive (~20% daily calories from fat), some meat and fish allowed, will we see the same benefits?


A Low-Fat Diet for Fatigue in MS 20% of daily calories from fat DO eat lots of veggies, grains, and lean protein. DON’T eat dairy, red meat, or lots of processed foods.

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Implement changes gradually: by the end of the month of training, less than 20% of the calories you eat every day should come from fat.

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20% fat. What does that mean? • You have been given a target fat amount in grams of fat. This is calculated based on the number of calories you eat per day. • For someone eating a 2000 calorie diet, 20% is 40 grams of fat. • Find this information HERE:

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What Should You Eat?

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What Should You Eat? Carbohydrates 60 % vegetables fruits grains

Protein 20 %

egg whites

peas, lentils

Fat 20 %

oils seeds avocados

chicken, fish nuts, beans, soy beans

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Sources of Dietary Fat


Oil • Oil is pure fat • Vegetable oils (Avocado, Canola, Coconut, Corn, Flax,

Nut, Olive, Sesame, Sunflower, Soybean oils) are allowed on the diet.

• However, use as little oil as possible. • 1 Tbsp (3 tsp) vegetable oil = 14 grams fat •

When “rounding up”, this means 1 tsp (1/3 Tbsp) would count for 5g. A short spray of a cooking spray (e.g. PAM) would count for 1g.


Plant-Based Fats • Avocado • Nuts & seeds • Beans & lentils Low-fat choices: Beans, soy beans, edamame, lentils, split peas, tofu, non-dairy milk (rice, almond, oat, soy) supplemental foods: nutritional yeast, vegetarian protein powders


Poultry & Fish Low-fat choices: Chicken breast, cod, canned tuna, snapper, sole, sea bass, tilapia Darker meat will be higher in fat Chicken- avoid rib meat, fryers of broilers Fish- Atlantic or Chinook salmon, Bluefin Tuna


Fat Content of Some Common Foods (how much fat is in X?) 1 tablespoon of oil: 14g of fat 4oz of grilled chicken: 4g of fat A handful of nuts (about Âź cup): 15g of fat Starbucks chocolate chip cookie: 15g


What does 40g of fat look like? For someone eating a 2000-calorie diet, 20% fat is about 40g.

3 Tbsp oil = 45g fat

2 small avocados= 40g fat


What does 40g of fat look like?

20 oreos = 40g fat


What does 40g of fat look like?

40g fat 40g fat


40g fat

40g fat


How to Track and Measure Fat • Why it’s important • How to measure and count fat grams • How precisely to measure? (don’t just eyeball, measure precisely and log it!)

• Sometimes it’s straightforward (when eating packaged foods)

• Sometimes less straighforward (when eating a complex cooked meal)

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Tracking fat when following a recipe Identify ingredients that contain fat and add together the fat content of each ingredient. Divide by the number of servings.

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1. Identify ingredients that contain fat

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1. Identify ingredients that contain fat 1.5 cups x 1.2 g fat per cup = 1.8 g fat

0.5 cups x 2 g fat per cup = 1 g fat

½ cup x 57 g fat per cup = 28.5 g fat 1 tbsp x 3.6 g fat per tbsp = 3.6 g fat 33


2. Add together total fat content of all ingredients in the recipe 1.5 cups x 1 g fat per cup = 1.8 g fat

0.5 cups x 2 g fat per cup = 1 g fat ½ cup x 57 g fat per cup = 28.5 g fat 1 tbsp x 3.6 g fat per tbsp = 3.6 g fat 34.9 g fat (round up to 35 g)

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1.5 cups x 1 g fat per cup = 1.8 g fat

0.5 cups x 2 g fat per cup = 1 g fat ½ cup x 57 g fat per cup = 28.5 g fat 1 tbsp x 3.6 g fat per tbsp = 3.6 g fat 35 g fat

3. Divide by the number of servings

35 g fat / 10 muffins = 3.5 g fat per muffin 35


Reading Nutrition Labels Note the serving size

Check fat Aim for less than 2 grams of fat per serving

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Tracking fat: Use real measuring spoons to ensure you measure amounts accurately.


Tracking Fat: When in doubt, round up


Tracking Fat: Oil used in cooking counts toward fat allowance (including oil used to coat pans)


Ways to reduce oil use in cooking and baking


Mobile apps like “My Fitness Pal” can help keep track of fat intake


Where to Start Know your baseline (use a food log) Plan your meals Use the recipes and resources provided Prepare your kitchen Avoid temptation (learn to recognize situations in which you’ll be tempted to “indulge”, don’t keep “bad” foods in your home or office)

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What is in the manual • Diet parameters • Tips and tricks for planning, shopping for, and cooking your meals

• Tools: meal planner, grocery list template, food diary • More than 100 low-fat recipes. • Resources: books, videos, apps, websites…. that may be helpful in making this change.

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Break?


Building a balanced, low-fat meal •

Working without a recipe? Use this simple strategy to build a balanced meal with what’s in your refrigerator

1 Starch + 1 Protein + Lots of Veggies + Sauce or Seasonings Balanced meal


For example…

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STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled Chicken

Beets

Garlic, ginger & soy sauce

Rice

Black Beans

Broccoli

Sesame Seeds

Quinoa

Egg Whites

Carrots

Chutney

Pasta

Tuna

Corn

Hot sauce (oil-free)

Sweet Potato

Roast Turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red cabbage

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled Chicken

Cucumber

Cilantro


Pick one of these

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STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled Chicken

Beets

Garlic, ginger & soy sauce

Rice

Black Beans

Broccoli

Sesame Seeds

Quinoa

Egg Whites

Carrots

Chutney

Pasta

Tuna

Corn

Hot sauce (oil-free)

Sweet Potato

Roast Turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red cabbage

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled Chicken

Cucumber

Cilantro


And one of these

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STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled Chicken

Beets

Garlic, ginger & soy sauce

Rice

Black Beans

Broccoli

Sesame seeds

Quinoa

Egg Whites

Carrots

Chutney

Pasta

Tuna

Corn

Hot sauce (oil-free)

Sweet Potato

Roast Turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red cabbage

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled Chicken

Cucumber

Cilantro


Add a few of these

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STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled Chicken

Beets

Garlic, ginger & soy sauce

Rice

Black Beans

Broccoli

Sesame seeds

Quinoa

Egg Whites

Carrots

Chutney

Pasta

Tuna

Corn

Hot sauce (oil-free)

Sweet Potato

Roast Turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red cabbage

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled Chicken

Cucumber

Cilantro


And your favorite sauce or seasonings

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STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled Chicken

Beets

Garlic, ginger & soy sauce

Rice

Black Beans

Broccoli

Sesame seeds

Quinoa

Egg Whites

Carrots

Chutney

Pasta

Tuna

Corn

Hot sauce (oil-free)

Sweet Potato

Roast Turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red cabbage

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled Chicken

Cucumber

Cilantro


A veggie and grain bowl is nutritious, filling, and easy to make without a recipe using ingredients you have on hand.

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One more example…

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STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled Chicken

Broccoli

Garlic, ginger & soy sauce

Rice

Canned Black Beans

Bell pepper

Sesame Seeds

Quinoa

Egg Whites

Canned Tomato

Chutney

Pasta

Tuna

Canned Corn

Hot sauce (oil-free)

Sweet Potato

Roast Turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red onion

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled Chicken

Cucumber

Cilantro


Pick one of these

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STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled chicken

Broccoli

Garlic, ginger & soy sauce

Rice

Canned black beans

Bell pepper

Sesame Seeds

Quinoa

Egg whites

Canned tomato

Chutney

Pasta

Tuna

Canned corn

Hot sauce (oil-free)

Sweet Potato

Roast turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red onion

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled chicken

Cucumber

Cilantro


And one of these

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STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled chicken

Broccoli

Garlic, ginger & soy sauce

Rice

Canned black beans

Bell pepper

Sesame seeds

Quinoa

Egg whites

Canned tomato

Chutney

Pasta

Tuna

Canned corn

Hot sauce (oil-free)

Sweet Potato

Roast turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red onion

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled chicken

Cucumber

Cilantro


Add a few of these

55

STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled chicken

Broccoli

Garlic, ginger & soy sauce

Rice

Canned black beans

Bell pepper

Sesame seeds

Quinoa

Egg whites

Canned tomato

Chutney

Pasta

Tuna

Canned corn

Hot sauce (oil-free)

Sweet potato

Roast turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red onion

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled chicken

Cucumber

Cilantro


And your favorite sauce or seasonings

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STARCH

PROTEIN

VEGGIES

SAUCE/ SEASONING

Bread

Tofu

Leafy greens (spinach, bok choy, arugula)

Barbecue sauce (oilfree)

Tortilla

Grilled chicken

Broccoli

Garlic, ginger & soy sauce

Rice

Canned black Beans

Bell pepper

Sesame seeds

Quinoa

Egg whites

Canned tomato

Chutney

Pasta

Tuna

Canned corn

Hot sauce (oil-free)

Sweet Potato

Roast turkey

Eggplant

Teriyaki sauce

Noodles

Salmon

Red onion

Salsa

Squash

Chickpeas

Green onion

Marinara Sauce

Potatoes

Pulled chicken

Cucumber

Cilantro


Use pre-cut or canned veggies and microwave-inbag grains to cut down on prep and cooking time 57

Use a low-fat tortilla to turn a salad or grain bowl into a wrap or burrito


Recap • Goal: Decrease Fat intake to 20% of daily calories • Avoid dairy and red meat

• Questions? Consult the manual or contact Carly Vong, RD (503-494-0174)


Start slowly. Over the next week….. • Start reading food labels • Try to count fat at dinner tonight • Pay attention to the fat content of the foods you eat (and drink!) regularly

• Keep an informal food log (write down the things you eat). Notice any dairy or red meat.

• Reach out to Carly if questions arise


Be patient. This way of eating will probably represent a big change. Allow yourself time to adjust and form new habits.

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Resources • Mary McDougall Videos – “Planning Meals” – “Dining Out When You Must” • Cookbooks • Websites – Pinterest (for recipe inspiration) – Nutritiondata.com (nutrition database of foods) – geniuskitchen.com (recipes) – minimalistbaker.com (recipes)


Questions?


Thank You


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