ISSA Nutritionist Chapter 18: Special Nutrition Scenarios

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Chapter Goals:

• Find and be able to define the special nutrition scenarios.
• Be able to discuss the key terms that relate to common nutrition scenarios.
• Find the scenarios that are outside of the scope of practice and require a professional referral.
• Be able to give talking points when discussing special scenarios with affected clients.

Beyond The Scope of Practice

The local laws and governing bodies will set the scope of practice for the certified nutritionist. Typically, nutrition coaches may not practice medical nutrition therapy for conditions like diabetes, disordered eating, alcoholism, morbid obesity, and other serious health conditions.

The nutrition coach must still be aware of the special scenarios and conditions and the differences in nutrition information regarding those populations.

Diabetes Management

Over 75 percent of adults with diabetes are overweight and obese. 

Some common dietary interventions for those with diabetes are hard to identify since no single approach works with most people. 

Some general eating patterns have been found to work in certain scenarios. One thing is the Mediterranean diet that we discussed in the last chapter. Or even the DASH eating plan for reducing hypertension. 

The goals for these eating plans for people with diabetes are:

• The promotion and support of healthy eating patterns.
• The emphasis on variety and nutrient density.
• The teaching of proper sizes of portions of food.
• The achievement and maintenance of a healthy body weight level.
• The delay or prevention of complications with diabetes.

Some other elements of diabetes counseling are things such as:

• Weekly self-weighing
• Daily breakfast to control your blood sugar.
• Reduction in the consumption of fast foods.
• Meal replacement foods or supplements to reduce the intake of calories.

The blood lipid profiles should be at these levels for good health:

• LDL <100 mg / dL
• Triglycerides < 150 mg / dL 
• HDL for men should be > 40 mg / dL
• HDL for women should be > 50 mg / dL

Disordered Eating

Disordered eating and eating disorders are not the same. 

Disordered eating is an unhealthy eating behavior and feelings about body image.

Eating disorders are abnormal or disturbed patterns or habits in eating.

Some common types of disordered eating are:

• Orthorexia: unhealthy preoccupation with eating healthy.
• Cognitive dietary restraint: someone who is constantly thinking about food, diets, or restrictions.
• Body dysmorphia: this mental disorder is when someone constantly worries about their appearance and flaws.
• Food addiction: when the need to eat or consume calories becomes compulsive or unpredictable.

When eating disorder symptoms are found, the client should be referred to a professional for an actual diagnosis and things to follow. 

Alcohol Use Disorder

There is no globally set recommendation for the consumption of alcohol. The disease control and prevention center recommends one drink per day for women and two drinks per day for men.

The estimates put 15 million people in the US as having some alcohol use disorder.

Acute symptoms include slower reaction time, blacking out, trouble with motor control in some way, impairments in judgment, increase in the taking of risks, impairment of memory, memory lapses, and slurring of speech.

Morbid Obesity

Morbid obesity is when someone has an excessive amount of body fat. More specifically, it is someone with a BMI equal to or higher than 35.

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Clients that are morbidly obese will usually have a vast array of health problems.

The best treatment, and most common one, is going to be a very low-calorie diet. Calories here are restricted to 450 – 800 calories every day, and you will often see weight loss that is quite significant in just 6 to 16 percent.

Health Management

Some of the health conditions just mentioned are outside of the scope of practice for a nutrition coach due to the high level of care, management, and expertise required.

Hypertension

This is the high blood pressure of the individual. Blood pressure is the pressure that the circulating blood puts on the walls of the blood vessels.

Hypertension is considered to be when the blood pressure is over 130/80.

For this, a main thing to change is the diet, where the person would implement some of the main parts of DASH.

Osteoporosis

This is the breakdown or the loss of strength in the bones that support our body. 

This condition is often seen in older populations and is often offset by training and increased calcium in the diet. Osteopenia is a precursor to the condition.

Heart Disease

The phrase heart disease may actually describe many different conditions in which the blood vessels, the heart, or the blood is affected, and it is also going to be the number one cause we see of death in the united states. 

The best treatment for this condition is through prevention early on. 

The AHA suggests that Americans follow these guidelines when they are trying to avoid or correct heart disease:

• Try to aim to burn as many calories as you consume daily.
• Everyone should get 150 minutes of moderate activity or 75 minutes of high-intensity activity each week.
• People need to eat varieties of foods from all the food groups.
• People should take in fewer calorie-dense foods.

The DASH eating plan can also be helpful in the prevention of heart disease in general.

Clients with heart conditions must see their physician regularly to help monitor how they are responding. 

Life Span Considerations

It is important to consider the needs of young people in infancy, all the way to old adults. The needs change throughout the span of life, and a basic comprehension of those changes is needed in nutrition coaching. 

Youth

Nutrition habits begin to form when we are young and in infancy. 

Of course, breastfeeding is ideal at this stage of life, and nutrition outcomes will improve when breastfeeding lasts for one year or more. 

Infants and younger children are going to self-regulate their own calorie intake innately. They may eat small amounts one time and then even larger ones the next, but it will be mostly well regulated. 

As children age, they begin to start eating for emotions instead of just for sustenance. When children reach around 6 months, some solid food will start to enter the diet, and here is when the importance is placed on eating whole foods to develop the proper habits for the rest of life. 

In the teenage years, as puberty starts, there are massive changes in the body and hormones, and it is important to support the growth and changes. 

Hydration is very important to look at for these age groups.

Malnutrition

When people think of malnutrition, they often immediately think of starvation. This is not really what it is. It is the deficiency, excess, or imbalance in a person’s energy and/or nutrient intake. 

This condition is actually common in both developed countries and those that are considered third world countries. 

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Undernutrition is the first form of malnutrition, including wasting, stunting, and being underweight. 

Micronutrient related malnutrition is when someone is deficient or gets an excess intake of micronutrients. 

Being overweight, obesity, and diet-related non-communicable diseases like heart disease, stroke, diabetes, and some cancers will also fall under the malnutrition category. 

Picky eating is likely to develop around the age of 3, which can affect the person for the remainder of their life. Parents must attempt to help with this and prepare for it even before it happens. 

Pregnancy and Nursing

Nutrition is very important for pregnancy, as the mom will be trying to support the development of another body within them.

Whole foods are pretty much needed, but a balanced diet can be hard with all of the stomach’s reduced capacities and nausea. 

The physician should monitor weight gain throughout the pregnancy, and the mom can expect to gain between 10 and 35 pounds throughout the entire pregnancy.

Pregnant women will need a lot of vitamin D to help prevent preeclampsia.

Other critical nutrients and minerals to focus on are zinc, iron, vitamin b12, folate, protein, iodine, and omega-3 fatty acids.

For breastfeeding, again, the mom is working to make food for another person, and the minerals and nutrients she gets in her diet will still be quite important, even after the baby is born.

Menopause

This is part of a natural aging process for women. It starts around the age of 50 when the ovaries cease to produce estrogen. The body still uses other processes to make this hormone, but the levels are significantly lower. 

Andropause

This is like menopause, but it is when it occurs in men, and it sees a gradual drop in their main hormones. 

Old-Age

Barriers to nutrition increase as people age, and some specific factors occur here, like the loss of appetite, changes in someone’s tastes, the reduction in the ability to smell, and the reduction in the ability to swallow. 

These factors influence people to make poorer nutrition and eating choices; in the long run, the person sees even more malnutrition. 

We also see decreases in the level of mobility that older adults have compared to younger ages. 

Some really vital nutrients for older adults are going to be things like calcium, vitamin D, Vitamin B 12, fiber, and potassium.

Food Allergies and Hypersensitivities

A food allergy is when the body’s immune system responds to a portion of food like it is harmful and then attempts to destroy it. 

Food intolerance is when the body has difficulty digesting food or food ingredients.

Some signs and symptoms of these two conditions include rash, trouble breathing, swelling, cough, and watery eyes.

The most common food hypersensitivities are gluten, soy, lactose, shellfish, FODMAP, caffeine, and nuts.

Other Special Scenarios

Other scenarios come from times when clients are injured or recovering from some form of injury.

Injury

Injury may happen in a variety of ways and it may or may not include the presence or loss of blood. 

Injuries come in the form of cuts, bruises, muscle trauma, dislocations, and swelling, to name a few.

Healing and recovery usually take some time to happen, so the body needs to rest sometimes. 

The first phase of healing is the phase of hemostasis.

The second stage of healing is the stage of inflammation.

The third phase is known as the phase of remodeling.

Inflammation

The inflammation stage is important to discuss in more depth as the term is often seen negatively. 

Many people take measures to try to reduce the inflammation in the acute stages, which causes many problems in the act of healing.

Nutrition is important in managing inflammation, and letting the body go through the process naturally is good.

Injuries involving some form of immobilization will likely result in some form of atrophy. 

When in energy restricted states, the increase in energy consumed will sometimes lead to increases in the total and fat mass.

Someone who usually has 2,000 calories might need to take in up to 2,400 after minor surgery. This accounts for the injury that happens to the body and helps it recover faster.

Protein and amino acids are important during injuries and special conditions like that. They work to build the vital materials of the body and optimally heal. 

For concussions and brain injuries, we see a loss in normal energy production, oxidative stresses, and long term inflammation in the brain. Magnesium and zinc are very useful in these scenarios. 

Bodybuilding is an important consideration that may change the outlook of nutrition past that of the general public. When someone does bodybuilding, they usually use one or more of methods to help gain muscle, like protein supplementation, the timing of nutrients and protein, bulking phases, and carbohydrate loading.

Protein supplementation is a common method for people to accelerate their gains in lean muscle mass. Skeletal muscle is mostly water and protein, so increasing protein intake while stressing the muscles will likely lead to gains.

Many experienced athletes and fitness enthusiasts use protein timing. It involves choosing the proper time to take protein sources, even though a lot of science says that the timing is not quite as important as just having it in the diet. 

The bulking phase of training that someone may go through is often just seen as overconsuming calories without any true increase in intensity or exercise levels. In reality, it is a delicate balance between calories and increased training to prevent fat and focus on muscle. 

Carbohydrate loading is the practice of taking in a lot of carbs after not having many. This causes the body to store a lot and the body keeps a lot of extra energy to use. 

Weight Loss is another special condition, and many diets trend and try to aid in losing weight. 

Some supplements are found to aid in weight loss.

Healthy weight loss should have a reasonable and realistic goal, a reduction in calories, nutritional balance in the eating plan, regular levels of physical activity, and a behavior change plan for supporting these healthy new habits. 

Athletes are in a special condition when we look at nutrition and training. Coaches need to consider how these nutrition changes will affect performance and recovery.