Category: Case Files

Case File- I cant climb the stairs and feel very weak…Help!!!!!

Case File- I cant climb the stairs and feel very weak…Help!!!!!

climb stairs
climbing stairs

Lack of exercise, poor sleep wake habits and poor nutrition have become a part of the present youth’s lifestyle. I got to see such a case very recently. A girl came into my cabin and I noticed she looked very tired and haggard. On questioning on how she needs my help, she told me that she feels sluggish, no interest to study or do any work. She feels that she has a psychiatric problem and is not mentally strong. And at the end of her tirade, she told me ” I am so weak. I cannot even climb the stairs not even a single flight of stairs. I have to stop for 5 minutes before climbing the next flight of stairs”. I told her to immediately get her Hemoglobin levels checked and come back with the reports. And she came to meet me the next day and her hemoglobin levels were 10 mg/dL. She was a little shocked and she never realized that she has anemia. The normal levels for women are 12-14 ml/dL. Her weight was normal for height. As I took her diet recall, I realized that there was very low protein intake. She was lactose intolerant and hence had to avoid milk in diet. She had no other sources of protein other than pulses occasionally. She was a non vegetarian but still was lazy to cook as she was staying alone so subsisted on cornflakes and instant noodles.

Changing her food routine was a challenge as this would be a total makeover of her eating habits. I advised her to start on dates about 6- 8 Nos. daily in the morning with 2 boiled egg whites and 2 servings of any cereal.

Mid morning a glass of soyamilk and 2 plain crackers.

Lunch 3 servings of any cereal and a cup of any pulse/ paneer (Cottage cheese) with some vegetable and curds. Lunch was not very flexible as she was eating at her work place but she had choices.

Evening after reaching home, A bowl of sprouts( green gram)/ a handful of assorted nuts/ a handful of soya nuts.

Dinner- 3 servings of any cereal plus some Spinach/ fenugreek leaves subji( dry vegetable) with lime juice sprinkled over it and either dal/ soya chunks/chicken/ fish. I asked her to come out of the laziness to cook and to take charge of her health but by now she had realized that she had to make changes in her diet.

If she was having a vegetarian dinner, I asked her to mix soya flour in the Wheat flour while making chapathis to increase the protein intake.

After dinner, a glass of soya milk.

She had to include at least 2 fruits per day out of which one had to be a citrus fruit and a lot of green/ red/yellow peppers to increase her intake of vitamin C and to avoid coffee and tea. I advised her not to have too much of fiber as this can interfere with the absorption of iron. Vitamin C is very much important to bind the iron from vegetarian sources and this makes it available for the body.

She had consulted me 3 months back and has now emailed me telling that she feels better and energetic and is convinced she has no psychiatric problems and has also incorporated an exercise routine to increase her energy levels and is now convinced of cooking at home and advises her work mates too to follow a better routine. I am sure in another year her hemoglobin levels will gradually rise.

The reason why she was sluggish is because the oxygen carrying capacity of the cells reduces once the hemoglobin levels starts decreasing and hemoglobin is an oxygen transporter.

I hope from this example many of us will learn to lead healthy lifestyles.

Case Files: I love Maggie Noodles

Case Files: I love Maggie Noodles

Magie noodles
Noodles- uncooked form

This is one of the most interesting case files I have come across. It has become a fashion to eat instant noodles and hence have risen the cases of stomach infection and pancreatitis. Let me share with you this experience.

I got a call this morning for a reference for a gastroenterology case and when I went to see the patient, I was a little taken aback to see a boy barely 18 years. I read the file and the patient has been diagnosed with acute pancreatitis. The boy was very lean in fact he was underweight. So I started taking down his food habits. Sadly the boy had whatsoever no proper food habits and timings too. He was starving all the time and missed alot of meals.  He was not drinking a drop of water in a day. The parents were not ready to disclose about his drinking and smoking habits but little did they know that i knew about it as it was mentioned in the file. The boy was drinking alcohol daily.

The boy had very high intake of fat and sugar, chugging down only coke instead of water.

Medically his symtoms were nausea, vomiting, sudden weight loss, bloating and stomach cramps.

First I had to tell the patient first to stop his intake of junk, oily snacks and coke. When I was explaining him about his diet, he happened to mention that he was addicted to Maggie instant noodles and was having it regularly for dinner. Now I could deduce that his problem was from eating instant noodles. The noodles have an harmful waxy coat which can cause a lot of digestive problems and do not form the part of a balanced diet and nor do they give any valuable nutrients.

He was prescribed to have a diet with very high caloric load. A high carbohydrate, high protein and a low fat diet was prescribed. He was supposed to eat every 2 hourly starting from 7 a.m in the morning.

Simple carbohydrates such as juices, glucose water was provided in every alternate meal. Every meal had to have some protein to prevent weight loss and gain some muscle. Low fat were provided from MCT oils which are easily absorbed in the body and the best example is coconut oil.

Egg yolks, fried meats, potato wafers and coke were replaced by egg whites, lean well cooked meats, boiled potatos and skimmed milk. Fermented milk products like low fat yogurt was used to replenish the gut friendly bacteria and mainly was asked to chew very slowly and was also referred to a psychiatrist for learning relaxation techniques and counseling. His family was encouraged to give him a calm environment and to allow him to heal both physically and mentally.

There was considerable difference in his energy levels and has been better than ever and also has realized the toll his body had taken due to unhealthy eating habits.

It would be very important for him to stick to a healthy diet as many of the cases are prone to Diabetes due to the strain on the pancreas which are the main organ for blood sugar metabolism.

Encourage healthy eating habits from a younger age and reap the benefits later.

Eat and write : How to maintain weight with a Food diary

Eat and write : How to maintain weight with a Food diary

Many people decide to start on a diet regime for several reasons such as weight loss, weight gain etc. Initially the motivational levels are very high and then it starts dwindling as time passes. Many of them come back to square one and the interest deteriorates. Now this is not a good sign. I have patients who try to visualize themselves with the physiques of movie stars but then give up when they realize that it is not an easy task.

Hence I have a perfect plan to stick to a routine is by maintaining a food diary. I use this technique for many of my clients and believe me it works.

Food diary basically involves writing down the food routine i.e. the every morsel of food taken inclusive of fluids. This helps you to keep track of what you are eating. All you need is book/diary, a pen and color markers and last but not the least the virtue of honesty.

It is written either after every meal or after the last meal of the day. This will help you to maintain an accurate track of food intake.

It should also consist the timings of the meal and the place where the food was eaten such as office, restaurant or at home.

Every detail should be mentioned such as the type of gravies, what kind of flavors, deserts, sauces etc.

Do not think this is only a methodical way of checking your food intake. It has an emotional side too. Food intake can also depend on a person’s mood (happiness/ sadness) and environment too.

Even the activity done while you are eating too can be written such as watching television or reading a book.

It should be divided into 3 large meals and 2-3 small meals. Large meals can de breakfast, lunch and dinner. Small meals can be a midmorning snacks, evening teatime, pre or post exercise snack and after dinner.

Any extra snacks should be also written on a separate column and the number of beverages per day too should be mentioned.

This should be written daily without fail on a regular basis and the quantities should be written as accurate as possible such as three cookies, half a glass of milk etc.

After a week, the diary can be reviewed to see whether you have been following a good diet routine or not. All the high calorie foods, wrong snacks, foods eaten out can all be highlighted with different colors.

After 4 weeks, again a review can be done and to find out the week which you have the least color markings or vice versa. This will help you to remain focused. Be true to your self as you will be the winner or loser.

I am sure by this method, even a doctor or a dietitian can review your eating habits and correlate if there is any medical condition to be treated or managed.

Get the pens out and start writing.

Case Files – I am too thin…Please help me!!!!!

Case Files – I am too thin…Please help me!!!!!

As a dietitian, we are generally bombarded with cases who are over weight. But I had come across this case who wants to built muscle instantly. He came to me and explained that he has been working out from 3 months. His weight was 65 kilos and was 180 cms in height. Hid ideal weight which should have attained was 78-80 kilos ideally but yes I agree he was underweight.

His complaint was ” I am too thin. I have been working out for 3 months. I have only toned up and gained 500 grams in 3 months. I am eating very well. All the men in my gym are bulky and muscular. What supplements can I take to get muscular ? What about creatine ? A fellow gym mate takes 4 scoops of creatine daily. Can I start too?” This patient was in a desperate situation.

My first advice was to this patient to have realistic goals. Movie stars use alot of unhealthy techniques to look the way they are. But if he would see realistically it was not possible. Heredity determines the physique too. His family members are all from the lean side and he too would inherit the feature. He did not realize that.

He needed emotional counselling too. From his diet history, I came to know that as he is a vegeterian(eggatarian)and his protein intake was very low (50 grams). His requirement was approximately 70-80 grams of protein. For this I started him on a protien supplement which was very safe and not designed for body builders and 2 egg whites per day and the rest of his protein was included in his designed food pattern. I do not have faith in supplements designed for body building. He was exercising on an empty stomach and this was hindering his performance. His caloric requirement was designed for 2200 kCals and I planned a diet chart as per his requirements. He snacked on a lot of junk food and coke. All these foods were removed from his diet and now all he had to do was follow a balanced diet with healthy options. The protein supplement was to be used as a pre-exercise drink.

When he came for a repeat consultation, he was happier and satisfied as he had now realized the benefits of exercise and was focusing on getting fit and healthy rather than only bulking up. He had gained another kilo and was now more determined to follow the diet plan.

My advise to all is that you become what your genetic makeup is. You have to consider your limitations. Do not run after something unrealistic and and stress your self emotionally. Do not resort to unhealhy measures to look good as in the long run, this can effect you. Seek out a dietitian’s advise for such diet changes and do not believe any unqualified gym instructor who will advice you on what protien supplements one can take. Many people end up having very high uric acid levels and weight gain due to high intake of protien supplements. Kidney distress too can occur. If you are an Indian, do observe on the product label that the muscular men on the cover are westerners, who have a different physical makeup. Every individual’s requirements are unique.

Case Files : Why do I need to follow a diet if I am diabetic?

Case Files : Why do I need to follow a diet if I am diabetic?

Diabetes is a disorder that is spreading like wild fire. The main cause for this are faulty diets and lack of exercise. I meet a lot of such cases daily and it is shocking to hear about their food habits. There are innumerable patients who dont even flinch nor are they worried about the consequences of the disorder.

Let us look at a case I had met 2 weeks back.

The lady was diabetic from 2 years and had been referred to me by the consultant doctor. Her blood sugar was 345 mg/dL. She came to my cabin with a very bored look on her face. Her weight for her height was alright. After checking her reports, I took a diet recall and I roughly estimated her daily intake of calories. It was approximately 1800 kCal which was her requirement. But her carbohydrate intake was very high. She was roughly taking about 350g of carbohydrates which was covering about 3/4 th of her caloric intake and this clearly showed the lack of control. Her intake of foods of high glycemic index was very high.

When I was explaining to her about her requirements, she interrupted me and asked  “Why do I need to follow a diet if I am diabetic?” Although this lady was educated, the seriousness of the disorder was not known to her.

I explained to her what are the consequences of Diabetes and its complications such as loss of eye sight, kidney failure, impaired nerve functions such as loss of sensation and cardiac problems.

This information was an eye opener to her. I removed all the high glycemic index foods ( I will write about these foods too) and replaced her diet with a balanced diet with adequate protein, moderate fats and moderate carbohydrates. I advised her on the need of exercise to lower blood sugars and the importance of fiber in her diet.

This morning I received a call from her and she informed me that her blood sugars are 135 mg/dL on fasting and she feels better than ever. Now this has convinced her to continue and come for follow ups on a regular basis. She has started reading about diabetes and is now ready to combat all the consequences of the disorder. Her aim is to maintain her fasting blood sugars between 90- 110 mg/dL which are the desired levels. She has started walking on a regular basis and follows the planned diet. From this case I have learnt about the difference one can do to a person’s life as long as the individual is convinced about themselves and is determined to make changes.