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What dietary considerations will suggest for Jenny, given what you know about her current eating habits and what you suspect might be going on.

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General Diet

optimal nutrition as intake will be limited as on GLP 1- increase protein and good fats

liver detox - dandelion tea or coffee, rocket leaves, gentian

possible intermittent fasting with larger window so not to cause too much stress

Breakfast

soaked oats, chia seeds, berries, greek yoghurt, nuts, flax seeds

eggs and smoked salmon, green leaves and olive oil, kimchi, sourdough toast

Lunch

chicken broth

cold potato salad

Dinner

vegetable stew - could be asparagus, artichok

sardines, red pesto with steamed veg

Snack

humous and carrot sticks

power balls - date/nut balls

dark chocolate

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What dietary considerations will suggest for Jenny, given what you know about her current eating habits and what you suspect might be going on.

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General Diet

.Real whole food / lower UPF

. Lower refined carbs

.Protein at every meal

Low fodmap veg with meals

Reducing caffeine in drinks

Reduce salt (less UPF)

More hydration ( Herbal teas, water, decaf drinks)

Breakfast

.Plain yogurt with berries, nuts and flaxseed

.Eggs and avocado and smoked salmon on 1 piece of sour dough

Lunch

.Chicken and green salad, tomato soup

.Greek salad with hummus (keep feta in)

Dinner

.Sweet potato and lentil curry with cauliflower rice (slow cooker)

.Roasted veg tray bake with fish or chicken

Snack

.Berries with plain popcorn and dark chocolate

.Hummus and veg sticks

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What dietary considerations will suggest for Jenny, given what you know about her current eating habits and what you suspect might be going on.

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General Diet

Whole food if possible; reduce processed food

Reduce carbohydrate - Pizzas/ Macaroni Cheese, carbonara (Low-carb)

Replace saturated fat with polyunsaturated fat (i.e. olive oil, flaxseed oil)

CYP2A1 genotype - reduce tea (caffeine) - protect heart; switch to herbal tea

Increase hydration; sparkling water if needed

Suggest Intermittent fasting

Breakfast

Add nuts

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Lunch

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Leon - coleslaw & salad

Dinner

Incorporate vegetables

Snack

dark chocolate - 75% above - polyphenol -> cardioprotection

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Jenny is a 51-year-old female client who works in a College of Further Education as Head of Year for biosciences. She is married, husband retired, with no children.

Height is 1.67m (5’ 4’’)

Weight is 104.8kg (16st 7lbs).

Apple shaped.

BMI 39

She has been this weight for 10 years.

For most of her life she has been overweight.

Online GLP-1s

Motivating event: six weeks ago, experienced chest pain when going up a flight of stairs.

Jenny has three main reasons for consulting a Nutritional Therapist:

1. High blood pressure – and getting worse. Last BP reading was 146/100 two weeks ago, it does get higher. GP has warned her is at high risk of a stroke.

2. High stress levels and fatigue – ‘I find it hard to relax and feel rushed most of the time’.

3. Weight concerns – ‘I have tried lots of diets to lose weight, but nothing has really worked. I lost a lot of weight in my early 20s but since then I’ve gained more, and I struggle to lose it now. I am feeling a bit depressed about this’. She believes she's tried every diet there is: Atkins, Paleo, South Beach, Slimming World, Keto, Intermittent Fasting, cabbage soup diet! GLP-1 injections appear to be working, but she's worried if she stops it will all come back

4. Elevated cholesterol, her GP is concerned. See results below

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Medical History Jenny’s medical history is extensive:

•Premature birth – induced early, wgt. 2.2kg (1959)

•Not breast fed

•In childhood tonsils removed.

•Boils (staphylococcal bacteria) up to age 8.

•In her early 20’s she was diagnosed with diverticulosis (barium enema).

•Constipation is an on-going problem since childhood.

•From childhood to current diffuse pain in upper legs at night.

•As a young women she experienced severe dysmenorrhea, put on birth control at age 13 to present.

•Fibroid embolization in her late 30’s helped to stop the pain.

•In late 40’s the fibroid grew again, repeated embolization was unsuccessful.

•She is considering a hysterectomy.

•She has never tolerated perfumes, sprays etc. these cause migraines.

•Recently has developed a silicone allergy (contact).

•Lately she has had crippling inflammatory pains (bursts) in elbows, wrist and thumb and forefingers and ankles - ‘Like a hot poker has been thrust through my ankle’.

•Right knee swells, increasingly walks with a stick.

• She gets bouts of unexplained nausea in the morning but no vomiting.

•Aged 47, she was diagnosed with high blood pressure. She tried several medications to reduce her BP including beta blockers and ACE inhibitors. However, she stopped all drugs due to their excessive side-effects and she is very adverse to try anything else.

•Her GP is aware of her reluctance to take medication and knows she is seeking lifestyle and dietary approaches.

•Jenny has confided she had a very unhappy childhood and adult relationship with her now deceased mother. She feels she has no life and uses food for comfort in times of bingeing, when she's "off" her diet.

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Semaglutide - Ozempic

1mg daily

Started at .25mg bid

titrated slowly up to current dose to avoid nausea

started 2 months ago

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Private Testing (Breakspear hospital self-referral) https://www.breakspearmedical.com/about-us/)

• B12 and folic acid in normal range

• Oxidative Stress Index – indicated reduction in oxidative stress protection

• Received IV Mg 23 & Me Genetic Testing Results:

• A genetic variant in the SLCO1B1 gene rs4149056 that is associated with increased risk for myopathy in people taking simvastatin.

• Ve- APOE4 Genotype: ε2/ε3 variants

• Rapid CYP2C19 gene – PPIs unlikely to work or dose will need increasing Symptoms

• Muscle Performance: CT genotype - one working copy of alpha-actinin-3 in fasttwitch muscle fibre (sprinters and some endurance athletes have this genotype).

• Marker rs762551 AC genotype, slow caffeine metabolizer: drinking coffee increased subjects' heart attack risk. Caffeine is primarily metabolized by the liver enzyme cytochrome P450 1A2 (CYP1A2). The form of the SNP rs762551 a person has determines how fast CYP1A2 metabolizes caffeine. In this study (Cornelis MC et al. (2006) “Coffee, CYP1A2 genotype, and risk of myocardial infarction.” JAMA 295(10):1135-41), people with the slower version of the CYP1A2 enzyme who also drank at least two to three cups of coffee per day had a significantly increased risk of a non-fatal heart attack.

• Marker rs16991615 genotype GG Typical odds of early menopause.

• Ve- the APOB variants. • Does not have any of the variants linked to hereditary hemochromatosis

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Jenny has recently had a series of tests that showed:

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NHS

• raised alanine transferase 38 iu/L (NR 10-35)

• raised gamma GT 106 iu/L (NR 9-35)

• elevated fibrinogen 414 mg/dl (NR 180-400)

• elevated retinol 3.30 umol/L (NR 1.05-2.97)

• See advanced lipid panel below

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Considering what we know about Jenny's life, work, social life, physical limitations and age, along with the underlying mechanisms of her symptoms, what would you suggest for lifestyle modifications:

Recommendations:

Top recommendation :

1. Stress management - mindfulness, chair yoga

2. Sleep hygiene

3. Regular sit down mealtimes

4. Moving from desk once an hour

5. Gentle walk after lunch and dinner

6. .

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What dietary considerations will suggest for Jenny, given what you know about her current eating habits and what you suspect might be going on.

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General Diet

Increase hydration

Increase fibre

Low-carbohydrate / low GL

Increase Antioxidants

Whole food diet/ remove UPF's

Breakfast

5% greek yoghurt with ground flaxseed and berries, Overngiht oats/porridge

Weekend when more time, sourdough with eggs/Omlet with vegetables.

Lunch

Stick to Pret - Greek salad, wholegrain salads

Bring a container for homemade salad dressing - EVOO + lemon + sea salt

Discuss making salad at home with pre-cooked protein chicken, prawns, boiled egg, dark leafy greens, + fresh veg for lunch

top with easy fibre options, avocado, nuts + seeds,

add slow release carb to lunch salad, wholegrain crackers, lentil cakes to reduce overeating at night

Remove LEON + Subway to reduce UPFs, Glycemic load, and refined oils

Dinner

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Snack

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•Cardiac – early stroke and death on both sides of family

•Father stroke died at 56 years of age.

•Mother: constant weight issues, Type II diabetes, high BP, depression, possible OCD, hypothyroid, first stroke at 47, died age 52 by refusing dialysis.

•Maternal aunt died at 41 ischemia.

•Sister (younger) OCD and hypothyroid.

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Considering what we know about Jenny's life, work, social life, physical limitations and age, along with the underlying mechanisms of her symptoms, what would you suggest for lifestyle modifications:

Recommendations:

Top recommendation :

1. .

2. .

3. .

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Jenny describes her lifestyle as sedentary.

She does not drink alcohol, neither does she smoke.

Work:

She finds her job very stressful at times and generally stressful most of the time.

Sleep:

She wakes up early most mornings as she is worried about her work. Jenny will often stay up late, watching TV, writing reports (laptop) or marking (online). She finds the light in her office too bright and night driving difficult. She does not sleep well. Her bedroom window faces a street with lighting.

Social Life:

Jenny has very little social life, she used to dance, swim and walk when younger.

Motivation:

Issues with pill burden. Not good at remembering to take tablets. Jenny is willing to try anything that might help her condition and feels she can cope with a moderate amount of change although realises something drastic might be needed. She is very motivated as she does not want to end up like her mother and have a stroke at an early age.

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Considering what we know about Jenny's life, work, social life, physical limitations and age, along with the underlying mechanisms of her symptoms, what would you suggest for lifestyle modifications:

Recommendations:

Top recommendation :

1. Eye masks for sleep

2. Blackout curtains

3. Meditation; mindfulness

4. sleep hygiene

5. Exercise and incorporate short periods of movement throughout the day

6. Anti-bluelight covers for laptops or screen; anti-bluelight eyeglasses

7. Community-based activity for support network and motivation for movements

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Considering what we know about Jenny's life, work, social life, physical limitations and age, along with the underlying mechanisms of her symptoms, what would you suggest for lifestyle modifications:

Recommendations:

Top recommendation :

1. .

2. .

3. .

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https://forms.office.com/Pages/ResponsePage.aspx?id=WzVmShSLlUysGYqxfm2PyowD96bwlv5FmhG-Wq9NdTVUM04xQU5CUVVLUVFLRTdaQzdQR0dPS1dJMi4u

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QRCode for GDip CM 2025 - End of Live Session Feedback - 08_10_25__

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Whole Padlet Link:

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List your Recommended nutraceuticals for Jenny and why. Form and dose if possible

1. Turmeric and Black Pepper

2. Magnesium for sleep, constipation and energy

3. possibly Vitamin D and K2 after testing

4. Bitters, ACV

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List your Recommended nutraceuticals for Jenny and why. Form and dose if possible

1. .

2. .

3. .

4. .

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List your Recommended nutraceuticals for Jenny and why. Form and dose if possible

1. Liquid Omega-3 - Does not like pills

2. Tumeric Ginger powder

3. Pycnogenol

4. Co-Q10

5. Berberine

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List your Recommended nutraceuticals for Jenny and why. Form and dose if possible

1. magnesium citrate

2. supplements for liver detox -eg milk thistle

3. pre biotic eg PHGG

4. gut barrier support - l glutamine, glutathione

5. sacc. boulardi

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List which tests you'd recommend and why:

1. Food Sensitivity/Allergy Testing

2. Liver Scan -> NAFLD?

3. ECG

4. Gut Microbiome

5. DUTCH for hormone

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List which tests you'd recommend and why:

1. SIBO, gut microbiome test - GI MAP

2. Hormone profile - DUTCH/OAT

3. Thyroid profile

4. U&E, anti CCP, ESR

5. ? food sensitivities

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List which tests you'd recommend and why:

1. .cardiac investigation

2. .HBA1c

3. .Opthalmology referal

4. .DUTCH test

5. Renal profile

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List which tests you'd recommend and why:

1. Fe panel

2. Thyroid panel

3. Homer IR

4. Renal panel

5. .

6. .

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https://www.canva.com/design/DAG0jEUu_pk/JqZp-Fq4kZoox6GMizmTTA/edit?utm_content=DAG0jEUu_pk&utm_campaign=designshare&utm_medium=link2&utm_source=sharebutton

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Poor Memory √

Poor concentration √

Headache (Migraine) √

Irregular or skipped heartbeat √

Rapid or pounding heartbeat √

Chest pain √

Pain in upper legs at night √

Pains in elbows, wrist, thumb, forefingers and ankles√

Right knee swelling

Nausea √

Bloated feeling √

Constipation √

Binge eating or drinking √

Cravings for certain foods √

Compulsive eating √

Excessive thirst √

Mood change before period √

Mood changes √

Mood swings √

Anxiety, fear or nervousness √

Depression – low mood √

Fatigue, sluggishness

New onset Allergies (cat and silicone)

What else do we want to know?

Are there any red flags?

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Current Diet

In an effort to lose weight, Jenny has adapted a version of the Mediterranean diet. She has been on this diet on and off for 3 months. She was keen to show an effort to lose weight before going on GLP-1s 2 months ago.

One of the reasons she's coming to you is because she hasn't felt well on this diet, when she's been able to stick to it. Her stomach feels bloated all the time, her energy has become very low, feeling tired all the time. She tries her best to limit servings of meat, eggs or dairy to 1x day. On days she has an egg for breakfast, she will have a salad for lunch.

Breakfast:

Usually skips, if not:

Low fat Greek yogurt with berries

2 slices of whole grain toast with peanut butter (he doesn't like the taste or texture of the 'natural' peanut butter) with sugar free jam.

Lunch:

Subway whole-grain veggie wrap with low-fat dressing

Pret-manger

Greek salad with olives (takes feta out if had too much dairy/meat/egg that day)

Avo, olive and toms baguette with low-fat dressing

Leon

VEGAN LOVE BURGER with vegan

cheeze and chili sauce

Krunchy Korean chicken wrap with LEON vegan mayo

Dinner:

Charlie Bigham Macaroni Cheese

Charlie Bigham Spaghetti carbonara

Charlie Bigham Chicken and Mushroom Pie

Dominoes pepperoni pizza

Drinks:

Tea with skim milk 3-4x day

1-2 glasses water

Diet Coke with lunch / dinner sometimes

Sofa Snacks:

Pop-chips

occasional chocolate bars

Candy Kittens

Salted Peanuts

Wild Strawberry