Question

30 year old female. 135 lbs. She is single with two children. She works 5 days a week and moderately active. She is currently on the Atkins diet. She has a history of crohns disease. I need help calculating the following for the patient: BMI, BMR, CHO, PRO, and fat needs and any other relevant calculations that will help me develop a nutritional plan..

Answer 1

Atkins diets are categorized as a low carbohydrate diet and while restricting carbs the client would eat proteins and fats. This is usually used for weight loss but it is very important to make sure you are getting the correct amount of carbohydrates, protein and fats for optimal weight loss. The minimum amount of carbohydrates needed to give us sufficient energy and brainpower is 130g/day

The average daily-recommended intake of protein is 0.8g/kg for healthy adults (Henry, 2016). Protein will provide us with tissue growth, for energy to keep our body going and transport nutrients and provide nitrogen homeostasis (Nutrients and Health benefits, 2018). Recommended fat intake would be approximately 20%-30% of total calories (Henry, 2016).

If my patient continues this diet she will have a deficiency in carbohydrates and according to the RDA this will not allow her to have proper brainpower. When I plugged this diet into my fitness pal it showed that the patient only had 58 grams of carbohydrates leaving the patient with 92g of more carbohydrates she needed to consume. When plugging the foods consumed into my fitness pal it ended up being 908 calories, she could probably incorporate a Greek yogurt in her morning snack after she eats breakfast, this is high in calories and has probiotics in it that are great for digestive health. The Atkins diet does not focus on calorie counting or limiting your food you can eat as much as you want as long as you are cutting carbohydrates out of your diet. Its approach to carbs will burn off body fat stores, regulate your blood sugar while not having to restrict your food intake and this will help you reach your optimum health (Atkins Diet, 2017).

Part 1, Criteria #2: Meeting RDA analysis
My patient C.J. is a 30 year old female, Jewish, 5’7, 135lbs. She is currently doing Atkins diet and has Crohn’s disease. Specifically to this patient it makes Atkins diet more challenging because she is Jewish she practices a Kosher diet. With that being said meats that are allowed are Sheep, cattle, goats, deer, chicken, geese, ducks and turkey (Jewish Dietary Laws, n.d). According to Kosher diet are unable to eat meat and diary are the same time and some opinions are different but they say you should wait two to six hours between meals before consuming diary or meat. When plugging C.J’s diet into my fitness pal all of her meats and diary were from 2-6 hours apart.

With the Atkins diet since you are restricting carbohydrates and your body is burning stored fat it is likely that my patient is losing weight. Since she has a normal BMI she does not seem to be malnourished but there is a risk that she can have nutritional deficiencies and a decreased intake of fiber. Education to my patient on making sure she is eating correct fiber with fiber supplements such as psyllium husk and eating more vegetables, this will allow her to have regular bowel movements especially with Crohn’s disease. As for sodium intake with Atkins diet, most of the sodium will come from how we season our meat. It is not usual to have hyponatremia but some affects of this would be confusion, lethargy and altered personality (Takahashi, 2017). There are no limits for protein and fat consumption on Atkins diet so based off my fitness pal she is in excess for the recommended dietary consumption. Fat is needed as a source of energy, it helps with building of cell walls, absorption of vitamin A, D, E and K and its used as a way to protect organs (Healthy Fat Intake, 2014). If we consume too much trans fat this will increase our LDL cholesterol, which is known to not be very good for us because it can cause atherosclerosis and heart disease. This can be corrected by using olive oil instead of margarine and drinking coffee black instead of putting liquid flavored coffee cream and processed food. A general rule of thumb to improve healthier eating is shopping on the outsides of the grocery store, everything that must be refrigerated tends to be healthier. At most grocery stores, foods like chips, soda and cookies are usually stored in the middle of the grocery store. One fat serving is 45 calories and 5g of fat, which is important to know when reading labels (Healthy Fat Intake, 2014). Lastly, protein is good for tissue repair and the it is important for the function of the human body, it is one of the macronutrients and as I spoke about five in this paragraph but this one is the most important as far as Atkins diet. As

said above the RDA for protein is 0.8grams/kg so if my patient weighs 135lbs I will divide 2.2 to get 61kg and multiply by 0.8 that is 49 grams. On the Atkins diet my patient would be exceeding that by a lot, which can potentially be harmful and cause some things like constipation, kidney disease, kidney stones and increased risk of cancer but has only happened on occasions (Harvard Health Publishing, n.d.). Everything could be done successfully in moderation like once my patient has maintained her goal weight or if she is happy with where she is at maybe cutting down on all the protein could be a topic of conversation.

Part 2 Criteria #1 Nutrition and Crohn’s Disease
Crohn disease is a chronic inflammatory bowel disease that can affect any part of the GI tract but it often times affects the colon and distal ileum. Inflammation starts and abscesses and they become tiny ulcers with mucosal edema this then has a cobblestoned appearance in the bowel (Walfish, 2017). If Crohns disease is located in the small intestine it can interfere with digestion and interfering with our digestion and absorption of food. Symptoms can include gas, bloating, diarrhea and pain due to undigested foods (Shah, 2016). Every patient is different with Crohns disease and depending on how certain foods can either upset the stomach or not would indicate how he or she can manage his or her daily intake. It is also important to know where exactly in the stomach the patients Crohns disease is located. An example of a specific macronutrient that we can manage would be fat, Stanford MPH, RD Neha Shah, said in research it is unnecessary to cut all fat out but instead get low fat food options like baked fish, grilled fish or broth based soups instead of cream based soups. Managing our portions can play a huge role when it comes to this disease because if educate the patient on eating slower to see how he/she feels and that will determine whether to continue to eat that type of food or not. Another example would be Lactose, which is sugar in milk, Crohns disease can interfere with the digestion process of lactose down to the enzymatic level. My patient is Jewish so she cannot eat any dairy with meats which works out in her benefit because dairy should be a small snack if anything because it may cause discomfort and pain for the patient. If Crohns is in the large intestine it can affect to absorption of water and electrolytes (Shah, 2016). This can impair electrolyte balance and it is important that they meet with a registered dietician so the deficiencies can be resolved or managed (Shah, 2016). The main goal is to manage symptoms of Crohns disease but to prevent nutritional deficiencies a consult with a registered dietician and Doctor would be imperative to see how Crohns is specifically affecting my patient.

Part 2 C.J’s Medications
The medications that my patient is taking are 2grams of Sulfasalazine t.i.d and 1,000mg of Calcium. With Crohn’s disease absorption of vitamins and medications due to the inflammation and absorption can be impaired as well. Sulfasalazine is used to treat C.J’s Crohn’s, it works as an ant inflammatory in the colon to reduce irritating symptoms (Vallerand, 2015). Sulfasalazine can decrease folic acid absorption and that can cause a folate deficiency. This drug can cause nausea, vomiting, abdominal discomfort and upset stomach (Vallerand, 2015). This can become problematic if the patient is unable to keep down food they wont be consuming adequate calories per day but since my patients BMI is evidence that she is not malnourished this drug would not be of concern. The supplement my patient is taking is Calcium to prevent osteoporosis. It is common that patients with Crohn’s disease develop osteoporosis due to the body having to constantly form cells to create a healthy bone (Ali, 2009). When this is not done it is an imbalance in bone formation and this leads to the development of osteoporosis. Some risk factors include age, malnutrition, corticosteroid use, deficiency and the body being in an inflamed state already We must never give Calcium orally with bran, foods high in oxalates or whole grain cereals as it is a contraindication and a nutrient restriction while taking this medication.