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Ellen SwaryDiet Instruction: High-Iron DietMarch 13, 2014Description of Patient and DiagnosisAllie is a 21 year-old female who is 5 feet 5 inches (165 cm) and weighs 124 pounds (56 kg). Allie is a college student who is active in her studies and loves to run and has recently been diagnosed with iron deficient anemia due to her Celiac’s Disease. Because she is always on the go, Allie tends to consume lots of pre-packaged, fast-food meals and lacks fruits and vegetables in her diet. Allie has recently been feeling very fatigued and occasionally is short of breath, dizzy or has headaches. After doing a physical exam as well as running some blood tests, her doctor found her hemoglobin level to be at 8.0 g/dL, indicating moderate anemia, and a hematocrit level below 36%, which is an indicator of anemia. Her doctor has referred her to a Registered Dietitian in order to help her improve her eating habits and anemia status. Discussion of the DiseaseA. Etiology- Causation or origination of diseaseAnemia is a disease, which occurs when an individual’s blood does not have enough healthy red blood cells. Anemia can be temporary, or long term, and can range from mild to severe cases. This can occur in a few circumstances, including when the body does not make enough red blood cells, bleeding causes loss of red blood cells more quickly than the body can replace them, or when the body destroys red blood cells. Red blood cells are contained within hemoglobin, which is the red, iron-rich protein that gives blood its red color. Hemoglobin allows red blood cells to carry oxygen to the lungs and carry carbon dioxide from other parts of the body to the lungs to be expelled from the body. In order for the body to make enough blood cells, certain vitamins, minerals and nutrients are needed for proper function. Three important vitamins and minerals to consider are iron, vitamin B12, and folic acid. Essentially, without these three components, the body can’t effectively carry oxygen throughout the body, making it difficult for individuals to live their daily life. Individuals with Celiac’s Disease are prone to inflammation and damage to the lining of the intestine, which can prevent the absorption of iron, vitamin B12 and folic acid. Additionally, poor diet (where there is a lack of vegetables and fruits rich in vitamins, minerals and iron) and blood loss (heavy menstrual periods) can also contribute to symptoms of anemia. B. Diagnostic Measures Suspicion of anemia may result due to general findings in a physical examination and medical history, which may include tiring easily, pale skin and lips, or a fast heartbeat. Additionally, it can be detected through medical examination and blood tests that measure the concentration of hemoglobin and the number of red blood cells. A complete blood count (CBC) should be conducted in order to measure the red blood cells, white blood cells and platelets, this will include measurements of hemoglobin, hematocrit and mean corpuscular volume, which can help indicate whether a patient is anemic or not. Other blood tests can indicate the status of iron levels, including the serum ferritin, serum iron, and total iron binding capacity, which are also indicators for anemia. Below are the lab values summarized, which would indicate an individual to be anemic:Severity of anemia can be measured through hemoglobin levels:SeverityHemoglobin ConcentrationMild Anemia9.5-13.0 g/dLModerate Anemia8.0-9.5 g/dLSevere Anemia<8.0 g/dLA diagnosis of anemia can be clarified if hematocrit levels fall below:39% for adult men36% for adult non-pregnant women33% for adult pregnant womenThe following chart summarizes iron levels that would be normal, but if lower or higher may indicate anemia (depending on the specific type)TestLevel (for women)Serum Ferritin12-150 ng/mL High- hemolytic anemiaLow- iron deficient anemiaSerum Iron60-170 mcg/dLHigh- hemolytic anemia or Vitamin B12Low- iron deficient anemia or anemia of chronic diseaseTotal Iron Binding CapacityHigh- iron deficient anemiaLow- anemia of chronic diseaseC. Treatment i. Medical, surgical and/or psychological treatment The status of Allie’s anemia is not harmful enough for surgical treatment, but medical treatment may be necessary. Oral iron supplements are often recommended for anemic patients. Depending on the severity, age, and weight, the doctor can prescribe a oral supplement in doses ranging from 60-200mg. Oral iron supplementation is the best way to restore iron levels for people who are iron deficient, but this should only be used when dietary measures have failed. In extreme cases, procedures including blood transfusions and blood and marrow stem cell transplants may be needed. Evaluating Allie’s diet and making adjustments where necessary would be beneficial for beginning her treatment plan. ii. Medical Nutrition Therapy Using a nutrient calculator while reviewing Allie’s 24-hour recall, it is evident that she is lacking in her iron intake as well as her total caloric needs. With someone who always on the go and busy in school, it is important that she consumes the right balance of foods in order to receive the proper amount of calories on a daily basis. The following calculations show Allie’s energy needs based on her height, weight, age and activity level: Harris Benedict: Women: 655+ (9.56 x kg) + (1.85 x cm) – (4.68 x age)655+ (9.56 x 56) + (1.85 x 165) – (4.68 x 21)= 1400 kcaloriesPhysical Activity Level: 1.41400 x 1.4 = 2,000 kcaloriesAdditionally, it is recommended that someone Allie’s age should consume at least 18 mg of iron daily in their diet. It is also important to consider that due to her Celiac condition, consuming more than 18 mg of iron would be beneficial to Allie’s health, due to complications with absorption of iron in relation to this disease. Setting an initial goal of receiving 18 mg of iron through her diet would be helpful. It is necessary for Allie to increase her consumption of fruits and vegetables as well as consider combining certain food choices to optimize the iron absorption for her body. While the RDA for someone’s Allie’s age is 18mg, consuming more iron would be beneficial in her case. Iron overload would likely only be of concern if supplementation were to be implemented into her daily intake. It is vital that Allie learn some key factors that will influence the absorption of her iron, as well. Meat proteins and vitamin C will improve the absorption of nonheme iron, which is found in plant sources. Allie should get about 75mg or more of vitamin C per day. To put that into perspective, 1 medium sized orange has about 70 mg of vitamin C. Additionally, tannins, calcium, polyphenols and phytates (found in legumes and whole grains) can decrease the absorption of nonheme iron. Heme iron comes from animal sources, is more readily absorbed than nonheme, and is not significantly affected by other foods in the diet.2743200762024-Hour Recall2 scrambled eggsChobani Greek YogurtMcdonald’s Chicken NuggetsMcdonald’s Medium French FriesGluten free penne pastaTomato Basil pasta sauceKashi Peanut Butter Granola BarNaked Strawberry Banana Fruit SmoothieTotal Calories: 1,780 KcaloriesTotal Iron: 3 gramsAssessmentAge: 21Height: 165 centimetersWeight: 56 kilogramsPreviously diagnosed with Crohn’s DiseaseHemoglobin level to be at 8.0 g/dL - indicating moderate anemiaHematocrit level below 36% (anemic)DiagnosisInadequate iron intake related to food choices as evidence by 24-hour recall.Inadequate energy intake related to food choices as evidence by a 24-hour recall.InterventionGoal: Increase iron intake to a minimum of 18 grams (RDA) by incorporating iron rich foods into the client’s diet. Educate them on good food combinations and food choices to allow for proper iron intake and absorption.Goal: Increase caloric intake to around 2000 kcalories per day and balance of nutrients to allow for adequate energy needs. Educate the client on proper caloric needs and provide menu ideas.Monitor & EvaluateMonitor client compliance with new food suggestions and evaluate changes in energy level. Continue regular check-ups in order to assess whether adjustments in the diet or oral supplements are necessary. iii. Prognosis Although the outcome of anemia depends on the cause, if treated and cared for appropriately through diet and supplementation, if necessary, then the outcomes are likely to be good. In Allie’s case, however, other complications may result due to her status of Celiac’s Disease. References Anemia and Iron-rich Foods. (2010, May). Retrieved from : Diagnostic Procedures | Florida Hospital. (2013). Retrieved from : MedlinePlus Medical Encyclopedia. (2011). Retrieved from | University of Maryland Medical Center. (2013, September 18). Retrieved from disease - sprue: MedlinePlus Medical Encyclopedia. (2012, February 19). Retrieved from Supplement Fact Sheet: Iron — Health Professional Fact Sheet. (2007, August 24). Retrieved from deficiency anemia: MedlinePlus Medical Encyclopedia. (2013, March 3). Retrieved from . (2011). Nutrition therapy and pathophysiology. Belmont, CA: Wadsworth, Cengage Learning. Vitamin C — Health Professional Fact Sheet. (2013, June). Retrieved from Are the Signs and Symptoms of Anemia? - NHLBI, NIH. (2012, May 18). Retrieved from Sources of IronGood Heme Sources: animal sources that are better absorbed in the bodyBeef (chuck roast, lean ground beef) Turkey Tuna Eggs Shrimp Lamb Good Nonheme Sources (from plants):Cereals (check labels for enrichment)Beans (kidney, lima, Navy) Tofu Lentils Spinach QuinoaPeanut butter Brown rice Dried FruitBeans: White, Lima, SoyCombining nonheme iron sources with a source of vitamin C will help with absorption, for example, it would be good to consume an orange at breakfast with iron fortified breakfast cereal. Good Sources of Vitamin CCitrus fruit: oranges, grapefruit, Clementine’sKiwiCanataloupeOrange JuiceGreen & Red PeppersStrawberriesBroccoliTomato juiceSpinach (cooked)Additional education on reading a nutrition facts panel may also be helpful for Allie to monitor the amount of calories she is consuming and knowing the iron content of some of her foods. An example nutrition facts panel (below) could be used for demonstration:center0 ................
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