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Age 45

Sex: AMAB (assigned male at birth)

BMI: Pre surgery 34 Post surgery 26

My client is a 45 yo male. His starting BMI before surgery was around 34. After gastric bypass and some weeks in recovery including occupational therapy and fitness exercises, my client now has a BMI of about 26. Explaining the changes in the functionality of the GI tract to my client, I have made it clear that because of this surgery, his surface area for absorption has changed significantly.

“Gastric surgery of the body of the stomach reduces mechanical digestion and acid secretion, which impairs digestion and absorption of iron, vitamin B12 and other protein-bound nutrients, and diminishes the secretion of intrinsic factor, further impairing the absorption of vitamin B12 [and other nutrients]” (Xanthakos, S. A., 2009).

Gastric bypass changes the structure of the stomach and small intestine and because of that and the risk of malabsorption can be significant because of the length of bypassed proximal small intestine ((Xanthakos, S. A., 2009). In order to make sure the my client recieves all of these necessary nutrients, I will suggest supplementation and monitoring. Research has shown that not all diet changes and nutrient supplementation are effective at sustaining DRI’s and so additional therapies may be required.

Xanthakos, S. A. (2009, October). Nutritional deficiencies in obesity and after bariatric surgery. Pediatric clinics of North America. Retrieved April 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784422/

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Age: 50
Sex: Male
BMI:23

My client is a 50 year old male, who has been a vegetarian most of his life. He does eat fish occasionally but only when it is prepared for him. He was raised in a meat eating household, but his love for animals deterred him from eating meat beginning at the age of 15. He used to be diligent at taking his supplements but as he has gotten older, he continues to forget. He has been noticing fatigue, dizziness, skin lesions and blurred vision over the past few months and his concerned that his diet is no longer giving him what he needs for his aging body.

From the blood panel, he was deficient in B1, B2, B3, and B5. These vitamins are crucial not only in the creation of energy through the metabolic reactions converting macronutrients into usable energy, but also for cell development, and repair (Kennedy, D. O., 2016, January 27).

The cause behind this client’s aforementioned symptoms has to do with the reported B deficiencies. Deficiencies of all of the noted B vitamins may result in all of the listed symptoms. In addition, deficiency of B12, may also influence skin health, presenting as skin lesions and compromised vision (Vitamin B12 (cobalamin). Mount Sinai Health System).

By presenting the client with a more thorough picture of the daily required values as well as the roles of each vitamin and mineral and the consequences of deficiency, there may be a greater effort to make comprehensive changes to incorporate not only more supplements, but also foods like fish and more diary products like eggs, yogurt and cottage cheese.

Kennedy, D. O. (2016, January 27). B vitamins and the brain: Mechanisms, dose and efficacy--a

review. Nutrients. Retrieved April 17, 2022, from https://www.ncbi.nlm.nih.gov/pmc/

articles/PMC4772032/

Vitamin B12 (cobalamin). Mount Sinai Health System. (n.d.). Retrieved April 17, 2022, from

https://www.mountsinai.org/health-library/supplement/vitamin-b12-cobalamin

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https://www.goodrx.com/conditions/osteoporosis/understanding-osteoporosis

Resource
GoodRx. (n.d.). Osteoporosis, explained in
under 2 minutes. GoodRx. Retrieved April 10, 2022, from https://www.goodrx.com/conditions/osteoporosis/understanding-osteoporosis

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Bone often looks lifeless as a rock-especially in cartoon skeletons. But just like the rest of your body, bone is actually living tissue that's constantly changing and replacing itself with new bone cells.

This process of swapping out old bone cells with new ones is called bone remodeling. When you're younger, you deposit new cells (formation) at a greater rate than you dissolve old ones (resorption), resulting in high bone density for your first decades of life. After your 20s, bone formation slows down, and resorption eventually starts to outspeed new bone cell deposits.

In other words, it's normal to lose some bone density as you age. However, some people lose too much bone mass, resulting in extremely fragile bones. This is known as osteoporosis. ( Learn more about what happens to your body during osteoporosis.)

What makes osteoporosis so dangerous is that these delicate bones are very prone to fracture, especially in the hips, spine, and wrists. Hip and spine fractures in particular can be devastating to quality of life and overall health, and it can lead to loss of mobility and independence. Fractures can also lead to reduced height and bone deformities.

However, it's a myth that osteoporosis is just a natural part of aging. Good bone health can help prevent bones from becoming too porous, and prevention starts in childhood. Think of bone remodeling like a checking account: Making big bone cell deposits during youth can save you from overdrafting later on.

Most people associate strong bones with getting enough calcium, but healthy bones require much more than that. For the healthiest bones, experts recommend the following:

Eat a balanced and nutritious diet, including lots of fruits and vegetables and a good supply of calcium and vitamin D. Sources of calcium besides dairy include leafy greens and fatty fish, like salmon.

Exercise regularly, and include strength training to bolster your bones. ( Learn more about how exercise helps treat and prevent osteoporosis.)

Skip extreme weight-loss diets. Here are tips to lose weight without harming bone health.

Quit smoking, or don't start smoking.

Avoid heavy drinking.

If you have risk factors for osteoporosis, it's not too late to make bone-boosting changes. Ask your doctor for tips to temper bone loss as you age and help prevent osteoporosis and fracture.

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Osteoporosis, Explained in Under 2 Minutes - GoodRx

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Bone often looks lifeless as a rock-especially in cartoon skeletons. But just like the rest of your body, bone is actually living tissue that's constantly changing and replacing itself with new bone cells. This process of swapping out old bone cells with new ones is called bone remodeling.

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CCIP Week 4- Education Pamphlet Osteoporosis 

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CCIP Week 4- Education Pamphlet Osteoporosis 

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CCIP Week 4-Patient Profile & Assessment 

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CCIP Week 4-Patient Profile & Assessment 

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Age 66

Sex Female

BMI: 24

My client is a woman in her sixties, who is postmenopausal. She is retired and has been trying to enjoy her new free time but is beginning to experience reoccurring fractures and other symptoms such as nausea, diarrhea and vomiting. She has always struggled with food sensitivity but never paid much mind to the cramping and discomfort. She takes vitamins but inconsistently and only recently started doing so upon her daughter’s recommendation.

Advising this client would begin with her diet. Understanding the foods she eats consistently and when she experiences sensitivity and responses such as nausea and diarrhea will help not only with treatment but also diagnosis. Knowing the connection between gastrointestinal conditions such as IBS and Celiac disease, and, osteoporosis, has me concerned that her more recent and reoccurring fractures are directly connected to and underlying gastrointestinal disease that has gone untreated. “Gastrointestinal disease is often overlooked or simply forgotten as a cause of osteoporosis” (Katz, S., & Weinerman, S., 2010).

This connection may allow treatment to look different than simply taking medications, as diet will be crucial to alleviating the aforementioned symptoms. I addition to having her get tested for osteoporosis, she will also undergo tests for potential underlying gastrointestinal disease. Like the fractures may be initial signs of osteoporosis, “osteoporosis may also be the initial sign of bowel disease” (Katz).

As we know with bowel disease, malabsorption and maldigestion directly impact level of crucial vitamins and minerals such as zinc, vitamin D and calcium. With potentially years of malabsorption, my client was never truly getting the nutrients needed to build strong bones. Even with healthy habits such as working out, her underlying gut health condition prevented her from achieving optimal bone health.

In order to treat this client, I will begin with recommending testing for osteoporosis as the multiple fractures are a pressing danger and beginning medication to prevent bone loss will give her the chance to begin healing while we then asses gut health. I would then recommend seeing a gastroenterologist to discuss her current symptoms and diagnose any underlying disease. Knowing if there is a connection will then allow me as her nutritionist to develop a plan for her to treat her gut health while also helping build bone health.

Katz, S., & Weinerman, S. (2010, August). Osteoporosis and gastrointestinal disease. Gastroenterology & hepatology. Retrieved April 10, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950667/

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https://nutritiouslife.com/eat-empowered/simple-antioxidant-packed-recipes-healthy-meals/

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Nutritious Life: Healthy Tips, Healthy Recipes, Exercise

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12 Simple Recipes for Antioxidant-Packed Meals

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We went through our recipe database to pull out all of the most antioxidant-packed dishes. These meals are high in foods known for their high antioxidant levels, like berries, turmeric, and the darkest greens.

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Age 66
Sex: AFAB
BMI: 24

My client is a middle aged woman who lives alone, she rarely makes time to take care of herself as her job as a social worker is demanding. She works in a nursing home so rate of infection is often high. She does not really work out and her diet consists primarily of coffee in the morning, snack of popcorn and granola throughout the day and then premade meals she picks up on her way home for dinner.

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https://www.myfitnesspal.com

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https://cronometer.com

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Cronometer: Track nutrition & count calories

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A web app for counting calories and tracking your diet and health metrics.

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In order to help the client understand the basics of hydration and electrolytes without being too complicated, I developed a colorful and interactive powerpoint. This power point reviews the basics, while also providing additional resources to aid in the clients incorporation of fitness.

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Age 33
Sex: AMAB (Assigned Male at Birth)
BMI: 21.5

Client is new to fitness, and wants to begin getting in shape. He follows online personalities to get his fitness and nutrition instruction since a lot of the information out there is wordy and oversaturated with details and not speaking to exactly what he needs. He wants the basics so he can get started.

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Age: 16
Sex: AFAB (assigned female at birth) Female
BMI: 21

Client is a teenager, she is a junior in high school, is a long distance runner. On weekends she does party and drink alcohol and eat greasy foods. Before a race she consumes refined carbohydrates such as bagels and pasta.

School has been very stressful. She is an honor student and a varsity captain on her running team. She is in the process of applying for college and preparing for the SAT's.

She eats what she wants as she knows she will burn it off training. She knows that she shouldn't be drinking but feels pressured by her peers to participate.

Her mother is slightly overweight and also struggles with IBS.

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What is IBS?

IBS, Irritable Bowel Syndrome, is a disorder that impacts the large intestine. This is a chronic condition that will  often need to be managed long term. No one cause has been determined, however IBS is commonly linked to hormonal changes, stress, certain medications, and, intestinal infection. In addition, improper GI functioning and gut brain connection may also play a role in IBS presentation.

IBS presents with different severities, ranging from light discomfort to debilitating pain. Persistent contracting of the colon causes discomfort and sudden urges to use the bathroom.

The condition occurs most commonly in people in their late teens and early 40's, women being twice as likely to be affected.

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Questions to ask yourself. Is my gut healthy?

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Questions to ask yourself. Is my gut healthy?

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Is there little to no bloating after meals? If yes, that is a sign of healthy digestion.

How long food takes to move through your gut? How frequent you poop? Rule of "Three and Three".
If you poop three times a day or at least three times a week, this is often predicted as healthy.

What your poop looks like? Hard poop, watery poop and poop that floats (filled with undigested fat) may be an indicator of gut health conditions.

Are you in pain? Pooping should be pain free, without constipation, cramping and straining.

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Abdominal pain, cramping or bloating that is related to passing a bowel movement

Changes in appearance of bowel movement

Changes in how often you are having a bowel movement

Increased mucous in stool

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To help with stress, a trigger of IBS, incorporate therapy. A therapist will help work through the pressures of school, athletics and social life.

To help with gut, consult a nutritionist, or even begin to take simple steps to alleviate symptoms by following the FODMAP chart which has shown to be very helpful for IBS sufferers. Eliminating or cutting back on triggering foods, may show a significant reduction in symptoms.

As an athlete, IBS can feel very debilitating, but viewing food as a important component of training may shift not only performance but also help with day to day discomforts.

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Controlling and treating symptoms and condition

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Controlling and treating symptoms and condition

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Treating IBS, like to condition itself, varies from person to person. Introducing a diet plan that monitors and eliminates triggering foods is one example of controlling symptoms.

For my client,  a comprehensive diet plan might not be enough to treat her symptoms. As aforementioned, IBS is correlated with emotional wellbeing. As a female teen who is subject to the pressures of school, sports and maintaining a social life, incorporating mental health treatment such as therapy, may influence how she handles her stress and anxiety.

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How to find a therapist

Breathing exercises to help with anxiety

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Irritable bowel syndrome (IBS) is a GI disorder that causes abdominal pain, bloating, constipation, and diarrhea. Learn about treatment, diet, and symptoms.

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Gut health check: 5 signs of a healthy gut. Zoe. (n.d.).
Retrieved March 20, 2022, from https://joinzoe.com/post/5-healthy-gut-signs

Irritable bowel syndrome: IBS, symptoms, causes, treatment. Cleveland Clinic. (n.d.). Retrieved March 20, 2022, from https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs

Let's bring attention to IBS. Needham Gastroenterology Associates. (2022, March 18). Retrieved March 20, 2022, from https://www.needhamgastro.com/articles/lets-bring-attention-to-ibs