Building Demand for California Dried Plums

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2. Contextual analysis . Mrs. K: 32 y/o AAF official at her PMD\'s office Feels

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Building Demand for California Dried Plums 2007-2008 Public Relations Recommendations June 28, 2007

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Case Study Mrs. K: 32 y/o AAF official at her PMD's office Feels "bloated", gassy, rare stools Lower stomach issues Improved with BM's (approx 3/week) Occurs erratically, for most recent 7 months Lasts for few days, then leaves No obstruction w/day by day exercises Worried it may be "something genuine"

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Case Study proceeded with Mrs. K: History and Physical PMH: "sustenance harming" one year prior PSH: none MEDS: colace qd FH: mother has "minor despondency" SH: hitched, exceptionally dynamic, no T/E/D Physical exam: ordinary; BMI = 24 Labs: no frailty, ESR & CRP typical

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DIGESTIVE HEALTH: THE RD's PERSPECTIVE Leslie Bonci,MPH,RD,LDN,CSSD Director of Sports Nutrition University of Pittsburgh Medical Center

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WHAT ARE WE HEARING? Shake hard abs Commercials for different GI medicines Increased item accessibility OTC/supplements Diarrhea/Constipation are supper table discussion Detox Colon purifying

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THE FACTS Eating can be a trigger for gut issues Good stomach related wellbeing is the capacity to process, ingest and use supplements It is about the nourishment, as well as the dietary patterns: Timing Quantity Where one eats How one eats

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GETTING TO GOOD DIGESTIVE HEALTH Achieving/keeping up a suitable weight Eating an eating routine that is adjusted, fluctuated, and individualized to address stomach related concerns Stress decrease Physical movement

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LIFESTYLE INFLUENCERS Stress Irregular timetable Travel's impact on sustenance decisions Busy lives

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BARRIERS Patients are not continually prospective with indications/grievances Patients may attempt to self-treat Power of proposal Sensitive subject Food security concerns

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TREATING DIGESTIVE DISORDERS WITH DIET Not high contrast No certification that manifestations will lessen May need to explore more than a while Outcomes might be more subjective than goal

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DIETS THAT CAN AFFECT THE GUT High protein/high fat Low-carb items High sugar High fiber Fad diets Cabbage soup/sustenance joining

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SUPPLEMENTS THAT AFFECT THE GUT Vitamin Mineral supplements Mega measurements Vitamin C Potassium supplements Calcium Iron supplements Large dosages of Magnesium "Vitality" Drinks Flaxseed/Flaxseed oil

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OTHER POTENTIAL OFFENDERS Echinacea Chitosan Dieter's Tea Glucosamine Fish oil containers

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THINGS TO KEEP IN MIND There is not ONE eating arrangement Need to alter and individualize eating Need to roll out improvements step by step Need to screen eating to find potential nourishment and propensity stressors, and in addition nourishments that are very much endured

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WHAT TO TELL PATIENTS Make dinner times loose Take time to eat Allow time for nourishment to process Eat at standard interims Eat littler sums at any given eating scene Take little nibbles Focus on eating, not everything else

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WHAT SHOULD THEY DO? Keep a sustenance/side effect journal posting : Foods eaten Quantity Time expended Document results: Symptom help Decrease in manifestation recurrence Better rest designs Improved vitality Different gut designs

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FOCUS ON FUNCTIONAL FOODS Yogurt-probiotics Dried plums-fiber/sorbitol Oats-beta-glucan,prebiotics Orange juice, eggs, nutty spread, spreads-Omega-3 upgraded nourishments

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TRAVEL GUIDELINES Bottled water on planes Travel with "safe" nourishments bundles of oats, nuts, dried organic products www.cdc.gov/travel List of sustenance concerns if heading out to different nations Travel with bouillon 3D shapes , sports drink powder Wash hands every now and again, or utilize wipes

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GOOD GUT TRAVEL KIT Nausea Sports drink Candied gingerroot Constipation Ground flaxseed Dried plums/fig bars IBS/Abdominal spasms Chamomile tea Diarrhea Raspberry tea/Blackberry root bark tea Sure-Jel or Certo Carob powder

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FINAL WORDS The accentuation should be on what patients can have-NOT what they can't!!!

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DIET RECOMMENDATIONS FOR MRS K Ask about late change in eating regimen Food journal to learn potential guilty parties: bloat and gas bringing on sustenances/drinks Discuss nourishment propensities eating in a hurry, or taking a seat to dinners Ask about supplement utilize Ask about exercise routine Discuss approaches to GRADUALLY add fiber to the eating routine, alongside sufficient liquids

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CONTACT Leslie Bonci, MPH, RD Phone (412) 432-3674 email: boncilj@upmc.edu American Dietetic Association's Guide to Better Digestion!

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Identifying and Achieving Digestive Health – A Look to the Future Leo Treyzon M.D. Divisions of Digestive Diseases & Clinical Nutrition David Geffen School of Medicine at UCLA

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Disclosures NIH Training Grant UCLA STAR Program Annenberg GI Fellowship Award UCLA Center for Human Nutrition Digestive Health Organization and CDPB

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Why is this a critical theme? Eccentric, awkward and humiliating Large monetary weight Next outskirts in medicinal services is counteractive action

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Hard to Define I can't portray it, yet… "I know when I see it" Justice Stewart, Ohio Supreme Court Jacobellis v. Ohio, 378 U.S. 184, 197 (1964)

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Defining Digestive Health "Great stomach related wellbeing demonstrates a capacity to process supplements through legitimately working gastrointestinal organs, including the stomach, digestive organs, liver, pancreas, throat and gallbladder. The vast majority who are in great stomach related wellbeing are of suitable weight and don't routinely encounter manifestations like acid reflux, gas, clogging, loose bowels, queasiness or stomach torment. Eating a nutritious eating routine is expected to keep up a sound stomach related framework and may avoid and treat certain stomach related illnesses." American Gastroenterology Association

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Definition – Digestive Health Ability to process, assimilate and utilize nutrients Eliminate squander items Optimizes imperativeness, and versatility Appropriate weight is focal topic Don't consistently encounter irksome stomach related manifestations This condition of prosperity is achieved by: devouring a nutritious abstain from food limiting enthusiastic stressors grasping physical movement Oriented to the aversion of endless ailment.

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Other Approaches to Health Bio-Medical – the body as machine; sickness situated Behavioral – wellbeing as vitality – way of life Bio-psycho-social – endeavors to address lacks of behavioral model inside biomedical setting Socio-ecological – a way to acknowledge goals and change conditions

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Strengths of Digestive Health Approach Individualized to the individual Creates vitality and adjust in self Focus on individual obligation Focus on way of life change for wellbeing and illness counteractive action Spiritual association with indigenous habitat

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Leading GI Symptoms Prompting U.S. Outpatient Clinic Visits in 2002 Shaheen NJ et al . Am J Gastroenter 2006. National Ambulatory Medical Care Survey 2002.

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Physician Diagnoses for GI Disorders in Outpatient Clinic Visits Shaheen NJ et al . Am J Gastroenter 2006. National Ambulatory Medical Care Survey 2002.

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Physician Visits every Year (GI and non-GI) 6 5 GI Non-GI MD Visits Per Year 4 3 2 1 0 IBS Normal Complaints Drossman DA, et al., Dig Dis Sci 1993; 38:1569

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Work or School Absences 14 12 10 Days for each Year 8 6 4 2 0 IBS Normal Drossman DA, et al., Dig Dis Sci 1993; 38:1569

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Beyond the monetary costs… QOL matters as well!

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Barriers toward Digestive Health Promotion Medical culture arranged towards cure Doctors' inclination versus patients' inclination ER and House versus "The Preventionist" If you can't stay away from a sickness, in any event get it early and keep it from bringing on damage. Distinguishing proof of hazard elements Modification of hazard calculates early course "Intermittent Health Examination"

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Where is Digestive Health Accomplished? Wellbeing Provider Level figuring out how to screen viably directing adequately (integrative wellbeing approach) Societal Level state funded training controls situated toward solid way of life national counteractive action rules Patient Level being curious appreciating wellbeing

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What is new in Digestive Health examine in 2007? Dietary fructose Weight Disorders CNS part in eating practices Weight Loss and Longevity Doctor-Dietitian Duo Gut biology and Obesity Probiotics

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Fructose Malabsorption in Normal Persons Dose-reaction ponder from which they built up a fructose malabsorption breath test . 20 people got on 4 isolate days: 10% arrangement of 15 g, 25 g, or 50g fructose 33% arrangement 50 g fructose Analyzed H2 and CH4 more than 5 hours Rao, S, et al. Clin Gastro and Hepatol 2007.

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H2 and CH4 focus after admission of various dosages of fructose Rao, S, et al. Clin Gastro and Hepatol 2007.

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Results No subject tried (+) with 15 g. No sexual orientation contrasts. 10% (+) with 25 g fructose yet were asymptomatic. 50 g (10% arrangement) 80% (+) breath test H2 - 65% CH4 in 5% Both H2 and CH4 10% 55% had indications 50 g (33% arrangement) 60% (+) 45% experienced side effects. Rao, S, et al. Clin Gastro and Hepatol 2007.

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Conclusions Healthy subjects retain up to 25 g Many display malabsorption and narrow mindedness with 50 g For suspected malabsorption: 25 g ought to be test dosage, and measure at 30 minute interims for 3 hours Rao, S, et al. Clin Gastro and Hepatol 2007.

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Brain Areas Involved in the Regulation of Food Intake and Schematic Representation of Their Interactions Alonso-Alonso, M. et al. JAMA 2007;297:1819-1822.

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Mean Percent Weight Change amid a 15-Year Period in the Control Group and the Surgery Group, According to the Method of Bariatric Surgery Sjostrom L et al. N Engl J Med 2007;357:741-752

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Unadjusted Cumulative Mortality Sjostrom L et al. N En

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