Make the DASH

Two new things happened today: one, I taught a class on the DASH diet. Secondly, I worked up a patient with hepatic encephalopathy and learned interesting things about liver disease and how to encourage doctors to listen to you.

1. DASH Class: I taught a class today to stroke patients about the DASH diet. One man left after the recreational therapist talked before me, but I had been in an education with him earlier during the week and he was not interested. One lady left because she said she wasn't going to cook, but her daughter stayed and was very interested and eager to change. After my short power point, we talked about each others diets (there was only 3 people in the class, and one of them comes every time to ask random questions the dietitian with me said), so then I had a work sheet for them to write down some change goals. I also gave out some great recipes from Mayo Clinic (they look AMAZING), a DASH shopping list and a handout on 30 ways to sneak fruits and veggies into your diet. So I feel like that was a success.

2. Hepatic Encephalopathy: this patient had a BMI of 50 (apparently pretty common around here) and cirrhosis. I looked at his current diet order: 1800 kcal diabetic diet, no salt added and 40 grams of protein. So I figured out how many g/kg of actual body weight that is: 0.25!!! My RD looked at it and was shocked, because even though we used ideal body weight to calculate protein needs in obese, she checks it against what they actually weight to see if it is appropriate. So she proceeded to print me out a really great article from this really great journal (UVA's Nutrition Issues in Gastroenterology series) about calories and protein for hepatic failure. Studies have apparently shown that protein restriction is not necessary in these patients and protein of around 1.5 g/kg proves to be beneficial for treatment. The current evidence suggests that lactulose should be prescribed alongside normal to elevated protein depending on the mental status of the patient. So my patient was mentally fine now so we relaxed his diet. Lastly, the RD had me highlight the important points in the article and attach the article to the chart and reference the doctor to it in the order because she says doctors really appreciate evidence like that when they go to sign off on our orders. Have a great weekend!