Post on 26-Dec-2015
DIET/GIZI PADA SISTEM NEUROBEHAVIOUR 1
Atikah Proverawati
• AUTISM• RETARDASI MENTAL
• ADHD• KEJANG DEMAM
AUTISM
AUTISM
• SOSIAL → kurang aktif, menghindari kontak mata
• KOMUNIKASI → lemah dalam menerima bahasa dan mengutarakan pendapat
• KEBIASAAN YANG ANEH → mengulang gerakan, hand flapping, picky eating
• FISIKAL → konstipasi, diare, hiperaktif, fatigue, aches and pains, digestive pain and gas, difficulty sleeping, anxiety
PENYEBAB AUTISM
• Genetik → Involving the systems of detoxification, digestion, gut/brain barrier, inflammation, immune function.
• Lingkungan → racun, vaksinasi, defisiensi gizi, antibiotik
THE HEALTH OF THE GI SYSTEM DETERMINES FUNCTION OF BODY • Physical barrier of defense against bacteria,
viruses, etc.• The largest part of the immune system is
contained within the gut (70%)• Vitamins/minerals cofactors for enzymatic
reactions and metabolism, etc.• Nutrients are precursors for neurotransmitters • The greatest concentration of serotonin, 90%,
is found in the GI tract
©Julie Matthews, CNC 2007
HOW DIET CAN HELP - SUPPORT DIGESTION & BIOCHEMISTRY
• Leaky Gut and Gut Inflammation– Remove foods that inflame gut– Add foods that heal the gut– Add foods that supply beneficial bacteria
• Nutrient Deficiencies– Increase the quality of food and digestibility
• Yeast Overgrowth– Remove sugars– Remove starches– Add probiotic-rich foods
• Toxicity and Poor Detoxification– Avoid food additives– Avoid toxins in food supply and meal preparation
• Faulty Methylation and Sulfation– Remove phenolic foods– Improve methylation and sulfation through supplementation
Feeling Better >>> Learning BetterFeeling Better >>> Learning Better
©Julie Matthews, CNC 2007
BAHAN MAKANAN YANG HARUS DIHINDARI
• Artificial colors/flavors and preservatives
• MSG (hydrolyzed protein, yeast extracts)
• Pesticides
• Aspartame and other artificial sweeteners
• Trans fats (hydrogenated fat)
• Excessive/Refined Sugar
• Nitrates/nitrites (bacon, hotdogs, lunch meat)
©Julie Matthews, CNC 2007
MAKANAN SEHAT
• Whole foods
• Unprocessed
• Organic
• Fermented foods: rich in probiotics
• Grass-fed/pastured meat and eggs
• Good fats
• Free of food intolerancesQuality
is Key!
Quality is Key!
©Julie Matthews, CNC 2007
©Julie Matthews, CNC 2007
LEMAK• Brain development and brain function • Hormone balance and mood• Formation/fluidity of cell membrane• Creating energy in cell and helps burns fat• Reduces inflammation
Supplement with vitamin E to prevent oxidation of fats.
Omega 3 Omega 6 Omega 9 Saturated Fat
Borage oil (GLA) Evening primrose oil (GLA)
Black currant oil (GLA)
Nuts/seeds and their oil Hemp seeds/oil (GLA)
Grapeseed oil
Fish oil or
cod liver oil Flax seed oil
DHA and EPA supplements
AVOID Vegetable oil: canola, safflower, corn,
soy oils
Olive oil Avocado
Nuts/seeds
Coconut oil
Palm/Red Palm oil
Animal fats Ğ ghee/dairy,
bacon
©Julie Matthews, CNC 2007
VITAL ROLES OF SATURATED FAT Brain—Saturated fats are important for
development of the brain
Bones – Saturated fats help the body put calcium in the bones
Liver – Saturated fats protect the liver from poisons
Lungs – Can’t function without saturated fats—protects against asthma
Immune System – Enhanced by saturated fats—fights infection
Essential Fatty Acids – Work together with saturated fats
Coconut Oil:Coconut Oil:
• Contains many antifungal and antiviral components
• Anti-inflammatory effects
• More easily digested and absorbed
• Used immediately to create energy
• Enhances absorption of minerals
Coconut Oil:Coconut Oil:
• Contains many antifungal and antiviral components
• Anti-inflammatory effects
• More easily digested and absorbed
• Used immediately to create energy
• Enhances absorption of minerals
©Julie Matthews, CNC 2007
MANFAAT KOLESTEROL• Brain development and function
• Boosts mental performance
• Aids digestion
• Builds strong bones
• Builds muscle
• Building block for hormones
• Regulates your blood sugar
• Repairs damaged tissue
• Protects against infectious diseases
©Julie Matthews, CNC 2007
ZAT GIZI UTAMA BAGI PERKEMBANGAN OTAK
• Vitamin A - Cod liver oil; liver, butterand egg yolks from grass-fed animals
• Vitamin D - Cod liver oil; lard, butter and egg yolks from grass-fed animals
• Choline - Cod liver oil, egg yolks
• DHA - Cod liver oil; liver, butter, egg yolks from grass-fed animals
• Zinc - Red meat of grass-fed animals, shellfish
• Tryptophan - Meat of grass-fed animals
• Cholesterol - Dairy foods, eggs, seafood, meat of grass-fed animals
©Julie Matthews, CNC 2007
Vitamin A• Protein assimilation
• Calcium absorption
• Proper growth and healing
• Speech/language
• Vision
• Proper function of the glands
• Thyroid function
• Immune system function
• Production of stress and sex hormones
Vitamin D• Healthy bones• Proper growth• Mineral absorption• Muscle tone• Immune system function• Healthy nervous system • Cell function • Insulin production• Reproduction
Animal Fat (Grass-fed) is High in Vitamins A and D
©Julie Matthews, CNC 2007
Animal Products - Quality is essential
Grass-fed/pastured Commercial•Rich in DHA (brain development)
•Rich in Vitamin A •Rich in Vitamin D •Higher in CLA•Higher in Tryptophan (sleep and mood)
*Organic is not necessarily grass-fed
•Unhealthy animals - unhealthy food
•Inflammatory grains -create inflammatory food
•Low in Vitamins A and D•Low in anti-inflammatory fats
•Higher in arachidonic acid (inflammatory)
©Julie Matthews, CNC 2007
©Julie Matthews, CNC 2007
Protein• Protein (essential amino acids) building blocks for:
– Muscle and tissue growth and repair, neurotransmitters, immune responses, enzymes, detoxification
• Bio individuality - amounts vary. • Some children cannot process protein well:
– High ammonia, low HCl, low zinc, B6, or iron
Signs of protein deficiency: Stunted growth,lack of appetite, edema, suppressed immune system, muscle wasting, anxiety, sparse hair, dry skin
©Julie Matthews, CNC 2007
Avoid Soy
• Not good substitute for dairy
• Very difficult to digest
• Irritate the gastrointestinal tract
• Blocks absorption - calcium, magnesium, iron, copper and especially zinc - due to phytic acid and oxalates
• Blocks thyroid function
• Endocrine disruption in the reproductive hormones of both males and females
©Julie Matthews, CNC 2007
• When eggs (and dairy) are not tolerated, protein becomes limited • When nuts and beans are not tolerated, protein intake becomes even more
limited• Grains, nuts, beans, and other starches - inflammatory to the gut. • Difficult to be vegetarian with some diets, as meat is relied upon with SCD and
other diets. • Can be difficult to get enough protein
–Eat eggs if tolerated–Free form amino acids (5 grams amino acids = 30 grams dietary protein)
Note on Vegetarian Diets
©Julie Matthews, CNC 2007
Carbohydrates• Add complex carbohydrates: whole grains, vegetables, fruit,
starchy vegetables• Reduce refined carbohydrates: flour products (bread, crackers,
chips), cookies, pasta• Avoid Sugars: Refined sugar, honey, juices
– 4-5 grams per serving (1 teaspoon “sugars”) = 2 oz fruit juice, 2 tsp dried fruit, 1 TBSP ketchup
– Keep to 4 servings/day
• Sugar cravings - Yeast overgrowth, stress/anxiety (sensory sensitivity), and blood sugar imbalances All grains problematic for some
• All starches & sugars (except monosaccharides) problematic for some (SCD)
©Julie Matthews, CNC 2007
Digestive EnzymesDigestive Enzymes
Probiotics Probiotics
Cod liver oil/fish oil/EFAs Cod liver oil/fish oil/EFAs
MagnesiumMagnesium
CalciumCalcium
ZincZinc
B6B6
Vitamins A, C, and EVitamins A, C, and E
CoQ10CoQ10
Glutathione/NACGlutathione/NAC
Methylation: B12, folinic or 5MTHF, TMG/DMGMethylation: B12, folinic or 5MTHF, TMG/DMG
Transfer factorTransfer factor
Amino acidsAmino acids
Helpful Supplements
©Julie Matthews, CNC 2007
Nutrient-dense Foods• Sweet potatoes: beta carotene, vitamin C, magnesium, fiber
• Leafy greens: calcium, vitamin C, folic acid, beta carotene, magnesium, iron
• Whole grains: selenium, vitamin E, magnesium, B6
• Nuts and seeds: calcium, magnesium, iron, zinc, B6, vitamin E, folic acid
• Beans and legumes: folic acid, B6, zinc, iron
• Blackstrap molasses: iron, magnesium
• Organic liver: iron, vitamin C, B12, folic acid, beta carotene, vitamin A
• Hemp seeds: GLA, omega-3, vitamin E, L-arginine. All essential amino acid.
• Nettles (can make a tea ): calcium, magnesium, potassium, iron, antioxidants
• Kombu and seaweed: calcium, magnesium, iron
• Eggs, from pastured hens (if not sensitive): B12, vitamin A, B-vitamins, vitamin D, vitamin E, selenium, calcium, iodine, zinc, iron, choline
• Animal protein and fats (grass-fed): Vitamin A, vitamin D, DHA, tryptophan
©Julie Matthews, CNC 2007
Good ways to Boost Nutrient Levels
• Cook and puree orange vegetables (or any). Freeze in ice cube trays and add to smoothies
• Cook and puree any vegetables and add to meatballs, meat patties, meatloaf, or pasta sauce
• Cook allowable grains or gluten-free pasta in homemade broth
• Nettles can be consumed as a tea, or added to a homemade broth
• Seaweed - Add kombu or other sea vegetable to cooking grains, soups, tomato sauce, even boiling pasta
©Julie Matthews, CNC 2007
Juicing
• Higher concentration of nutrients – Chlorophyll and phytonutrients
• Get nutrients without needing to eat/chew vegetables • Children that like liquids, juices and smoothies
Add vegetable juice to smoothies. Add a bit of fruit to vegetable juice for flavor or added sweetness
Add supplements to vegetable juice (instead of fruit juices)
Preparation tip
Preparation tip
Start with Add as you evolve taste Go cautiously (high sugar)
•Cucumber•Celery•Fennel•Ginger•Lemon•Green apples
•Parsley, cilantro•Kale or other greens•Cabbage (ulcers)•Cranberries
•Carrot•Beet•Fruit: Apple, pear
©Julie Matthews, CNC 2007
Soaking “seeds” – easy to doGrains, nuts, seeds, beans
• Increases digestibility
• Reduces inflammatory response
• Breaks down phytic acid and oxalates
• Fermenting grains breaks down lectins
Nuts - Soak in water (with or w/o salt) for 7-12 hours. Drain and
refrigerate, use to make nut milk, or drain and dehydrate (eat or make nut butter)
Grains - Soak in water for 8-24 hours with 2 TBSP lemon juice
or vinegar. Drain and cook with fresh water.
Beans - Soak in water for 8-24 hours with hearty pinch of baking soda. Drain and cook with fresh water.
Preparation tip
Preparation tip
©Julie Matthews, CNC 2007
Fermented Foods – Rich in ProbioticsFunctions of good bacteria
– Regulate peristalsis and bowel movements– Break down bacterial toxins – Make vitamins needed and utilize: B1, B2, B3, B5, B6, B12, A and
K– Digest protein into amino acids (for use by the body)– Produce antibiotics and antifungals – Help breakdown sugars, lactose, and oxalates– Support immune system and increase number of immune cells– Balance intestinal pH– Protect against environmental toxins: mercury, pesticides,
pollution
Raw fermented foods contain billions of bacteria/serving!
©Julie Matthews, CNC 2007
Fermented Foods – Rich in ProbioticsDairy-free:• Raw sauerkraut • Beverages (contain yeast that kills candida):
• Kombucha • Coconut juice kefir• “Sodas” (hibiscus/rosehip tea with kefir starter)
• Nut milk yogurt
Dairy: Milk-based yogurt/kefir
Dairy-free:• Raw sauerkraut • Beverages (contain yeast that kills candida):
• Kombucha • Coconut juice kefir• “Sodas” (hibiscus/rosehip tea with kefir starter)
• Nut milk yogurt
Dairy: Milk-based yogurt/kefir
©Julie Matthews, CNC 2007
HomemadeBone & Vegetable Broths
• Grass-fed/pastured chickens or beef bones– Add 2 Tablespoons of vinegar - increases the calcium
and magnesium
• Vegetables, seaweed, greens, nettles• Nutrient dense, easy to assimilate nutrients
– trace minerals, amino acids, calcium, magnesium, potassium, iron
Cook grains, soups, and/or pasta in broths - nutrients will absorb into food
Preparation tip
Preparation tip
Grandmaknew bestGrandmaknew best
©Julie Matthews, CNC 2007
Bone Broths and Gelatin
Bone broth contains gelatin:
• Gelatin’s colloidal properties aid digestion of all foods
• Glycine: Sleep, detox environmental toxins,
component of glutathione, improves gastic acid
secretions and protein digestion
• Proline: Formation of connective tissue: skin, gut,
ligaments
• Broken down by DPPIV
• Free glutamate - potentially problematic for
glutamate sensitive children
Bone broth contains gelatin:
• Gelatin’s colloidal properties aid digestion of all foods
• Glycine: Sleep, detox environmental toxins,
component of glutathione, improves gastic acid
secretions and protein digestion
• Proline: Formation of connective tissue: skin, gut,
ligaments
• Broken down by DPPIV
• Free glutamate - potentially problematic for
glutamate sensitive children
©Julie Matthews, CNC 2007
Water and Salt• Purified Water
– Avoid tap water, fluoridated and chlorinated water– Get a water filter (point of entry, reverse osmosis, carbon block or ionic -
not Brita). Avoid bottled water (plastic and transportation).
• Nutritive Salt– Salt cravings - sign of nutrient deficiencies– Avoid stripped white “table salt” - may contain aluminum– Choose nutritive salt with trace minerals – Celtic Sea Salt or Himalayan crystal salt
• Sole - water and salt combine to make minerals ionic – They are highly absorbable, alkalizing, and help with elimination– Add 1 tsp to 8 oz glass of water– See Water and Salt, by Handel and Ferreira
©Julie Matthews, CNC 2007
Beginning and Evolving a Diet
©Julie Matthews, CNC 2007
Begin by Removing Artificial Ingredients
Avoid trans fats (hydrogenated oil, fried foods, margarine, mayo, commercial peanut butter)
Avoid artificial sweetener & high fructose corn syrup
Avoid artificial ingredients (artificial colors, flavors, and preservatives)
Avoid MSG (hydrolyzed vegetable/soy protein, autolyzed yeast, yeast extract, natural flavors)
Avoid Nitrates/nitrites
©Julie Matthews, CNC 2007
Food intolerances (IgG test and LEAP test)
MSG
Carageenan
Olestra
Lectins, oxalates and phytates from “seeds”(grains even non-gluten, bean, nuts, seeds)
Yeast, antibiotics, and some medications (NSAIDS)
Eliminate Foods, Additives and Factors that Irritate the GI Tract
MENCEGAH KERACUNAN DI DAPUR
Toxins Around the Kitchen Safer Cooking Alternatives
Avoid aluminum cans Buy in glass
Avoid storing in plastic Store in glass w/metal or plastic lid
Avoid Teflon, copper, and aluminum pans
Use stainless steel (attracts a magnet), cast iron or enameled cast iron
Avoid the microwave, do not reheat in plastic
Heat in oven or on stove
Avoid plastic wrap & aluminum foil Use wax paper or glass with lid
©Julie Matthews, CNC 2007
FOR PICKY EATERS• Always provide food child likes in addition to "new" food.• Only offer one new food at a time. • Include small portion of new food and serve everyone at the table.• Involve your children in food preparation of "new" food.• Small taste ~ 1/2 teaspoon. Let child determine amount.• Inform them. Let child know whether it is sweet, salty or sour. • Let them spit it out. • If at First You Don't Succeed, Try and Try Again! At least 15 times!• Try new food in a texture they prefer - crunchy, smooth, etc.• Avoid being emotionally “attached” - children sense anxiety.
– Keep mealtime calm. Visualize child eating/enjoying new foods.• Avoid forcing or pushing - maintain trust. • Choose rewards or other encouragement.• Make sure the whole family participates.• Make it fun!
RETARDASI MENTAL
RETARDASI MENTAL
• Jenis penyakit dan penyebabnya sangat banyak dan bervariasi
• Penatalaksanaan gizi/diet → bagian utama pendukung selama pengobatan
RETARDASI MENTAL
• Mental retardation is a condition diagnosed before age 18 that includes below-average general intellectual function, and a lack of the skills necessary for daily living.
FAKTOR2 YANG BERHUBUNGAN
• Predisposisi genetik• Faktor lingkungan, contoh nutrisi, radiasi dan
psikososial• Waktu terjadinya paparan
MENTAL VS NUTRISI
• Gangguan gizi yang berat dan yang berlangsung lama sebelum umur 4 tahun sangat mempengaruhi perkembangan otak dan dapat juga mengakibatkan retardasi mental.
• Keadaan dapat diperbaiki dengan memperbaiki gizi sebelum umur 6 tahun, sesudah ini meskipun anak diberikan dengan makanan bergizi, intelegensi yang rendah itu sudah sukar ditingkatkan.
BEBERAPA PENYEBAB RM YANG DAPAT DICEGAH
• Infeksi• Malnutrisi berat• Defisiensi yodium
TATALAKSANA GIZI
• Diet:– Memenuhi kebutuhan zat gizi harian → makanan
yang bergizi – Meningkatkan kecerdasan otak → “nutrisi otak”– Meningkatkan kemampuan skill makan
BEBERAPA NUTRISI OTAK• AA dan DHA:
– Asam Arakhidonat → kacang2an, daging, susu– DHA → salah satu bentuk asam lemak tak jenuh (misal: aneka
jenis ikan laut)• Protein:
– Zat pembangun/pembentuk sel dan DNA– Menyempurnakan pembentukan sel saraf– Bahan baku neurotransmitter (penghantar rangsang antal sel) →
perkembangan otak optimal• Yodium:
– Zat pembentuk kecerdasan– Bahan baku hormon tiroid
ATTENTION DEFICIT/HIPERACTIVITY DISORDER (ADHD)
ADHD
• Gangguan kurang perhatian• Tanda-tanda:
– Pemfokusan pada rangsangan yang tidak ada hubungannya tingkah laku yang meledak-ledak
– Terlampau aktif– Inkonsistensi– Kurang ulet
DIET ADHD• DIET FEINGOLD:
– Melarang konsumsi makanan yang mengandung:• Salisilat• Senyawa yang bereaksi silang dengan salisilat• Citarasa buatan, warna, dan pengawet
– Kekurangan: salisilat terkandung pada makanan yang bergizi dan disukai anak-anak, seperti: jeruk, anggur, kismis, apel, berry dan cherry
• DIET FEINGOLD YANG DIMODIFIKASI:– Hanya melarang konsumsi pengawet– Kekurangan: meningkatkan kesulitan dalam
pembelian dan penyiapan makanan
DAFTAR MAKANAN YANG MENGANDUNG SALISILAT
BAHAN MAKANAN BAHAN MAKANAN
Anggur Kentang
Apel Kopi
Ceri Teh
Jeruk Coklat
Lemon Gandum dan olahannya
Murbei Jagung dan olahnnya
Mangga muda Nektarin Kacang almond
Plum Cengkeh
Persik Terung ungu
Prem Mentimun
Stroberi Tomat
DAFTAR MAKANAN YANG MENGANDUNG BAHAN ADITIF
BAHAN MAKANAN BAHAN MAKANAN
Mie instant Permen dengan rasa dan warna buatan
Susu dalam kemasan siap minum Minuman dalam kemasan siap minum
Daging dan ikan yang diawetkan Selai dalam kemasan
Buah dalam kaleng Bumbu penyedap buatan
Sayur dalam kaleng Camilan dengan aroma, rasa dan warna buatan
DIET PENCEGAHAN ADHD
• Diet ideal = adekuat, kalori tidak berlebihan:– Rendah lemak– Tinggi kalsium– Tinggi karbihidrat kompleks (serat dan pati)
PENDIDIKAN GIZI BAGI KELUARGA/PASIEN
• TUJUAN:– Mengembangkan kebiasaan makan yang baik (pemilihan
diet seimbang):• Jadwalkan acara makan bersama keluarga sekali dalam sehari• Sertakan anak dalam penyiapan makanan• Dorong anak-anak untuk memilih salad segar dan ikan atau ayam
bakar/panggang daripada makanan goreng-gorengan• Buat snack bergizi tersedia setiap waktu, ketika anak ditinggal
sendiri di rumah setelah pulang sekolah• Pilih snack:
– Buah segar/kering– Popcorn– Keju rendah lemak– Jus buah– Kacang/bijian tak bergaram
– Mendorong kegiatan fisik:• Olahraga berkelompok • Olahraga aerobik individual
KEJANG DEMAM
KEJANG DEMAM
• Bangkitan kejang yang tejadi pada kenaikan suhu tubuh (suhu rektal lebih dari 38˚ C)
• Pada bayi dan anak usia antara 3 bulan dan 5 tahun
• Kejang: gangguan syaraf/step/stuip
KEJANG DEMAM
• CIRI:– Kedua kaki dan tangan kaku disertai gerakan2 kejut yang
kuat dan kejang2 selama 5 menit– Bola mata berbalik ke atas– Gigi terkatup– Muntah– Berhenti nafassejenak– Terkadang tidak bisa mengontrol pengeluaran BAB/BAK– Tidak sadarkan diri, dengan intensitas waktu kejang
bervariasi
• KOMPLIKASI:– Retardasi mental → o/k kejang terlalu lama → sel
otak rusak– Aspirasi
TATALAKSANA GIZI
• Memberikan keseimbangan air dan elektrolit• Agar cairan tubuh yang menguap o/k suhu
tinggi dapat cepat tergantikan:– Banyak minum (contoh: susu, teh, air putih)– Makan buah-buahan maupun jus– Makan makanan berkuah
• Makanan/minuman tidak diberikan langsung setelah kejang berhenti o/k berpeluang membuat anak tersedak