Situation Overview

John, a 45-year-old special education teacher, contacted NetNutritionist with a several diagnoses: Hypertriglyceridemia, noninsulin dependent diabetes and obesity.

His recent physical exam revealed high triglycerides and his fasting blood sugar was 350 mg/dL.

Even though John weighed 285 pounds, he stated that he felt fine. John usually skipped breakfast, consumed high fat foods, and indulged in at least 2 pastries or doughnuts every day. John never ate vegetables and rarely ate fruit except for an occasional banana.

The NetNutritionist Solution

After evaluating John's present diet, food preferences and lifestyle, Gay prescribed a 2000-calorie diet with 45% of his calories from carbohydrates, mostly a concentration of low-glycemic carbohydrates. The diet was rounded out with lean protein and monounsaturated fats. Working together, Gay and John found substitutes for doughnuts and pastries to enjoy on occasion and he started eating fruit -- liked baked apples with yogurt -- to increase his fiber and satisfy his sweet tooth. John learned to broaden his food horizons by trying new foods so he would not miss the old stand-bys that were high in fat. Next, Gay instructed John on how to incorporate healthy fats like olive oil, avocado, and peanuts into his diet rather than the unhealthy fats in butter and cream gravy. He discovered that he could cheat once or twice a month without sabotaging his health goals. He supplemented with a multivitamin, and other supplements Gay recommended as a part of his medical nutrition therapy. John started walking or riding his bicycle for 20-30 minutes 4 to 6 times a week.

The Results

John lost 18 pounds within the first month. By the fourth month he had lost 50 pounds with a 14% reduction of body fat. His triglycerides went dropped from 325 mg/dL to 125 mg/dL and his fasting blood sugar dropped to 98 mg/dL. John has joined the local cycling club and goes on long distance rides every weekend. He says now he knows what feeling good really means and is enjoying his life more than ever.

Situation Overview

Rosemary, a 32 year old female, contacted NetNutritionist with a diagnosis of weight loss, hypercholesterolemia, and amenorrhea (no menstrual periods). She was 5'4" and had lost 40 pounds over the past year, down to a body weight of 98 pounds. Her recent physical revealed her elevated blood cholesterol of 320 mg/dL. She not had a menstrual period for 18 months. Her physician referred Rosemary to Gay.

Rosemary was mainly concerned about her elevated cholesterol and she wanted a low-cholesterol diet plan. She was quite surprised that her cholesterol was high because she was meticulous about watching her fat intake carefully. Rosemary's daily food intake was only about 600 calories. She also worked out at the gym 3 days a week and walked with her husband every night. Her husband was very concerned about her weight loss, but she just attributed it to a phase – a result of the success of her business and overwork.

The NetNutritionist Solution

Rosemary had no idea she had an eating disorder. Two weeks after the first contact with Rosemary her weight had fallen to 93 pounds. Gay discussed Rosemary's eating habits with her and the possible reasons why she was losing weight. She did not really know what the reason, but she, too, was beginning to worry. Gay convinced her that she did not need a cholesterol lowering food plan. The reason for her elevated cholesterol was because she was starving herself and the elevated cholesterol was a severe symptom of starvation. Gay suggested that anorexia was a possibility, and, at the end of the second contact, Rosemary agreed to interview with several recommended therapists that specialize in working with anorexia nervosa.

Following her positive diagnosis with anorexia nervosa, Rosemary attended continuous therapy and support throughout 3 years of recovery. Gay assisted Rosemary as she followed a very slow progression with food intake and weight gain and concentrated her energy and efforts on the cause of her illness. When she was ready to focus on the eating phase of her illness, Gay helped Rosemary plan tiny snacks several times a day balanced with a few of her favorite foods. The small snacks were to prevent her from feeling bloated and full and the favorite foods made the experience more desirable. As she began to gain weight Rosemary started taking a daily multiple vitamin mineral supplement, calcium with magnesium and vitamin D and several other recommended supplements.

The Results

Rosemary gained 10 pounds the first year, 12 pounds the second year and 8 pounds over the past year. She began having normal menstrual periods after the first 2 years of recovery and her cholesterol dropped to 180 when she reached 105 pounds. Rosemary likes the way she looks now and is more relaxed about her body. She feels more spiritually grounded and does not worry about what food she may encounter throughout the day. Rosemary's weight has been stable for 4 years and she says she just eats moderate amounts of the foods she enjoys. Today Rosemary weighs 127 pounds and expecting her first child.

Case Study 3

The Situation

Maya, a 42-year-old female, contacted NetNutritionist by referral from her obstetrician. She was having her first child and, in the 24^th week of pregnancy, was diagnosed with gestational diabetes. Maya was very concerned and motivated to do whatever was necessary to have a healthy baby.

By her 24^th week she had gained 36 pounds. She was entering the 3^rd trimester with an average weight gain of 4-6 pounds every 2 weeks. Maya was eating cookies daily, drinking at least 2 large glasses of apple or orange juice everyday and eating out with clients 3 nights a week. She was the head of the R and D division for a fortune 500 company. Her job was very demanding with long hours so she did not take the time to exercise and plan her meals.

The NetNutritionist Solution

After evaluating Maya's present diet, food preferences and lifestyle, Gay prescribed a 2500-calorie diet with 48% of her calories from complex carbohydrates. Gay had Maya eat 5 small, balanced meals and taught her how to substitute foods using the Exchange System for Meal Planning. She replaced her fruit juice drinks with whole fruit high in fiber, and ate a peanut butter (natural peanut butter) sandwich with banana on whole wheat bread instead of chocolate chip cookies. Gay and Maya explored ways she could incorporate exercise in her busy life and Maya started walking during her lunch break and riding her exercise bike for 10 minutes 3 times a week. When she took clients out during the week she scheduled the dinners early and on the days she did not have client dinners she would go home a little early and ride her exercise bike. At restaurants she learned to eat a protein, vegetables, and a starch and keep it as simple as possible. She had her secretary keep an afternoon snack ready for her and she would eat that 2 hours before she left the office. At bedtime she would have a glass of milk and a banana. For breakfast, Gay suggested Maya eat more protein and fat, such as eggs, cheese, or a peanut butter sandwich. She did not add fruit until the noon meal. Maya took a prenatal multivitamin throughout her pregnancy and consumed at least 10 large glasses of water daily for adequate hydration.

The Results

Within 1 week Maya's blood sugars were normal. She gained only 4 pounds during the last trimester of her pregnancy. Maya had a normal labor and delivery with no complications. She now has a healthy baby boy, Samuel. Samuel was 8 pounds, 14 ounces at birth.

Situation Overview

June contacted NetNutritionist with several problems. She was experiencing gas, bloating and dry itchy skin breakouts. June stayed at home with her 3 year old son, her 4 year old nephew, and her 3 month old whom she was breastfeeding and who had colic and cried constantly. Although June had a history of lactose intolerance and sensitivities to wheat, tomatoes, corn, and eggs, she often ate those foods because she prepared them for the family. She was also getting into the habit of having a cocktail, wine or screwdriver in the evening several times a week. With the demands from her growing family and lack of time, June's energy level was low.

The NetNutritionist Solution

Gay prescribed an elimination diet for 10 days and then monitored June's reactions as she slowly began to add the foods that she was sensitive to back into her diet, keeping in mind that June's breast milk, while eating the foods she was sensitive to, was also causing her baby to have cramping, gas and diarrhea. Gay helped June plan meals to exclude wheat of any kind. June ate potatoes, lean chicken and rice, wheat free spelt bread, peanut butter, grapes, apples, broccoli and cream of rice for breakfast. She avoided all tomatoes, acidic fruit, alcohol, milk and milk products, pork, eggs, and wheat. She also eliminated most convenience and processed foods. June prepared meals with one or two main foods she could eat and completed the meal for her family with foods she had to avoid like cornbread and tomatoes.

The Results

During those 10 days of the elimination diet, June's baby did not experience the colic and gas that he had before eliminating the sensitive foods. June also noticed her rash and itching went away and the bloating disappeared. June slowly added one food every several days back into her diet to determine what foods were causing the problem.

When milk, tomatoes, ice cream, pork and alcohol were reintroduced the problems returned. June eliminated them permanently. She now uses caution and pays attention when introducing the sensitive foods into her baby's diet. She and her baby both feel much healthier and have experienced a rise in energy.

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