Menu Planning: Crohn's Disease and Diverticulosis
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    Menu planning project for medical nutrition therapy course at SDSU.
This project was for a Medical Nutrition Therapy lab at San Diego State. With this menu planning project, two days worth of food had to be purchased for under $20 and had to provide 2000 calories per day with 20% protein. Plus there was a medical condition that had to be taken into consideration. This menu planning project  helped me not only shop on a very tight budget, but also allowed me to see where money is better spent (in terms of nutrient dense foods). I was also able to get a better grasp on dietary guidelines and the food guide pyramid.

Maria Rios is a 50-year-old first generation Mexican American woman who resides in Normal Heights, San Diego. She lives with her husband, Vicente and youngest daughter, Christina, who is in her last year of college at San Diego State. Maria and Vicente also have two older children who have families of their own, but live close enough to Maria and Vicente that it feels like they still live at home. Most nights, Maria prepares meals for her husband and daughter, but occasionally her other two children will come join them for dinner. Maria typically consumes and cooks traditional Mexican cuisine. She says some of her favorite foods are corn tortillas, guacamole, refried beans and carne asada.

When Maria was 28 years old, she was diagnosed with Crohn’s Disease. After her most recent colonoscopy, she was told that she had developed diverticulosis. Because of her recent diagnosis as well as her history of Crohn’s Disease, Maria’s doctor recommended she seek the services of a dietitian. Also, since Maria turned 30, she slowly started to gain weight. She got in the habit of over eating when she was in remission phases of her Crohn’s Disease. Now at 5’6,” she weighs 170 lbs, which is 121% her ideal body weight. Her BMI is 27.5, which classifies her as overweight. In addition to helping Maria with her Crohn’s Disease and Diverticulosis, it would be beneficial for her overall health to reduce her daily calorie intake. Maria lives moderately active life as she works full time as a maid at the Mission Valley Hilton. This will make it easier to help her to lose some of her excess weight.

 When reviewing Maria’s usual dietary patterns, there are some troublesome areas that she should focus on. She often eats corn chips and tortillas with salsa and guacamole and avoids fresh fruits and vegetables. Maria also drinks one regular coca-cola per day and very little fluid. She typically consumes up to four servings of meat per day, and prefers red meat, like carne asada and machaca. She also loves to have eggs for breakfast and often will eat chorizo with her eggs. Maria often has about 15g of fiber per day in her diet and consumes large amounts of fat and protein.

 Patients with Crohn’s Disease tend to develop aversions to foods that they believe cause their painful relapses. Maria has not developed too many food aversions over the years, but does hold strong to the two that she has developed. She claims to not be tolerant of certain sugar free products, most notably diet soda, which is why she consumes only regular soda. She also believes she is lactose intolerance and diagnosed herself after a painful relapse about 10 years ago. For this reason, she doesn’t consume milk and only eats cheese in small amounts.

 The first and most important goal for Maria is to increase her fiber consumption, which can be done by switching from corn tortillas to whole wheat and increase her vegetable and fruit consumption. Legumes are also an excellent source of fiber and would be a nice addition to Maria’s diet. This will greatly reduce her risk of developing diverticulitis. Because we are increasing Maria’s fiber intake, she would need to increase her fluids to 2000ml per day. As of now, her only fluid intake is an occasional soda and water when taking her medications.

 Another goal is to decrease her red meat consumption and decrease her saturated fat consumption by switching some red meat items to chicken and fish. Maria also consumes large amounts of avocados, which is a good source of healthy fat but also contributes to her high fat diet. The last goal for Maria is to consume 2000 Calories per day with 20% protein so she can get closer to hear ideal body weight and build lean body mass.

Part B: Budget
A budget of $20 was set for two days worth of meals. This included six regular meals and two snacks. Shopping was done at Pancho Villas Farmer’s Market, which is Maria’s primary grocery store because it is only a few blocks away from her house. See Appendix A for detailed information on the budget and Appendix B for the two days of menus.

A nutrition analysis of each day was conducted through and the results of Maria’s diet plan were compared to the DRI guidelines and the food guide pyramid. Full results can be seen in Appendix C. Some of the specific foods on Maria’s diet plan were not found in the mypyramid database because they are specialty items. This might have an effect on certain micronutrients, sodium and fat.

 The food guide pyramid recommends that an overweight woman who is 50 years old eat about 2000 calories a day to meet her daily need. The food guide pyramid also suggests that she has 6 oz of grains per day (at least half of which are whole grain), 2.5 cups of vegetables per day, 2 cups of fruits, 3 cups of milk, and 5.5 oz of meat and beans per day. They suggest a variety of vegetables and 6 tsp of oil per day.

 The meal plan that was developed for Maria Rios included a variety of fruits and vegetables such as bell peppers, oranges, avocados, onions, cucumbers, mangoes, plums, potatoes, corn and bananas. The meal plan also incorporated more whole grain products, such as whole-wheat tortillas and tortilla chips and had on average 9.5 oz of grains. The servings of meat were reduced to only 2 servings per day, which equated to an average of 8.6 oz per day. That was a little more than the food guide pyramid suggested, but was necessary to reach the 20% protein intake that was prescribed. Three servings of milk recommended by the food guide pyramid was not included in Maria’s eating plan because she considers herself lactose intolerance. She was encouraged to try to incorporate more calcium fortified foods or begin a Calcium supplement of 1200mg per day along with Vitamin D. Most of the other micronutrients were abundant and DRIs were met for all micronutrients except for potassium, even with a banana incorperated into each day’s eating plan. For this, Maria could add more potatoes, apricots and potentially add a supplement or multi vitamin and mineral to meet the DRI of potassium.

 The macronutrient dietary reference intakes for a woman between the age of 50-70, would need 46g Protein (10-35% AMDR), 130g CHO (45-65% AMDR), 25g fiber with an AMDR of fat between 20-35%. Because Maria’s diet prescription was for 2000 calories with 20% protein, she needed to consume around 100g of protein, which was the two day average of the diet plan. The menu plans averaged 28% fat and 52% carbohydrate for each day, which sits in the middle of the AMDR. Most notably, the menu plans created would increase her fiber intake to an average of 33g per day. Her saturated fat intake would decrease to 5% (which is below the recommended 7%), and sodium intake would decrease to an average of 2467mg per day, which is very close to the recommended 2.3g per day. The amount of fat in Maria’s diet was also reduced by cutting her avocado consumption to only a half of an avocado per day. Her saturated fat consumption was reduced to by reducing the servings of meat down from four per day to two per day.

 Overall, the goals for the patient were met by increasing fiber and fluid intake, increasing fruit and vegetable intake and decreasing overall fat and red meat intake. This is the best diet for Maria to consume while in remission from her Crohn’s disease, and will hopefully prevent her diverticulosis from turning into diverticulitis.
Part D: My reflection

 The purpose of this paper is to understand the difficulty people have with making healthy food choices while staying under a certain dollar amount. Most of the time, fruits and vegetables are very expensive and often go bad before they can be consumed, so most people do not buy them when they are on a budget. In order to stay under budget, I went to a grocery store in the inner city called Pancho Villa’s Farmer’s Market. All of the produce is from Mexico, and the prices are very affordable, especially foods that are commonly found in traditional Mexican cuisine. Also, purchasing name brand foods were out of the question because they were too expensive. I also chose most of the items according to what was on special that day.

 It is very easy to tell someone to eat healthier and plan out healthy menus for clients and patients who have a limitless budget to spend on food. When someone is allotted only $10 per day to spend on food, I can see how easy it would be to spend it on fast food and unhealthy items. It is important to be sensitive to the needs of our clients and understand that the diet prescribed to them that will better their health might not always be in alignment with their pocketbook.
Menu analysis for day one using for analysis.
Comparison to the dietary guidelines

Analysis of nutrients
Comparison to recommendations.