Question

Jen is on the college cross-country team. She is a vegan and tries to eat plenty of grains and fruits to get the carbohydrates needed for her high level of physical activity. She eats 3 meals a day and a snack in the evenings. A typical day for Jen would include eating whole grain toast and coffee for breakfast; a peanut butter sandwich, apple, bag of pretzels, and iced tea for lunch; spaghetti with marinara sauce, garlic bread, salad for dinner; and a banana for an evening snack. This semester, she feels very fatigued and takes a sweatshirt to class to keep warm. Upon physical exam, she appears pale and has spoon shaped nails.

What mineral deficiency or toxicity do you suspect? (4 points) What factors led you to that conclusion? (5 points)

What laboratory tests would you recommend to help to confirm your diagnosis? (5 points)

What realistic recommendations would you make to Jen to treat the problem?

Answer 1

I suspect iron deficiency in Jen's case. She is a vegan on a diet without an adequate amount of iron content. Any form of toxicity can be ruled out from the given symptoms. Fatigue, pallor, spoon-shaped nails, etc point to iron deficiency. There are several factors from which such a conclusion can be reached. She is a vegan who tries to eat plenty of grains and fruits to get the required amount of carbohydrates but her diet doesn't have the required amount of iron-containing food. Her pallor, fatigue, and spoon-shaped nails are typical iron-deficiency symptoms. Her iron-deficiency fatigue is further reiterated by the fact that she takes a sweatshirt to keep herself warm. She is comparatively active, but her diet given here is not that of an active young adult.

Laboratory tests to confirm iron deficiency are hemoglobin, hematocrit, MCV, serum iron, TIBC, transferrin, and serum ferritin. Low hemoglobin, hematocrit, MCV, serum iron, serum ferritin, etc show iron deficiency. High TIBC or total iron-binding capacity also show iron deficiency. Hemoglobin, hematocrit, and MCV levels can be obtained from CBC or complete blood count.

Recommendations to treat Jen's problem are:

a. Include more iron-rich vegan food like vegetables.

b. Check iron levels frequently.

c. Take an iron supplement daily.

d. Eat more food containing iron-absorption-enhancing vitamins like vitamin C.

e. Blood transfusion for severe iron-deficiency.