• Section 7. Case Studies

    Section Summary

    The following case studies are included in this section:

    • Case Study #1: Nichole K. - Broad Range of Allergies
    • Case Study #2: Lindsay M. - Celiac Disease
    • Case Study #3: Deb J. - IBS


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    Food Allergy Case Studies

    The Dietitian serves as a coach and a guide to the client offering support with change and helping to bridge the gap between old habits and foods into different habits and foods that help support the client with where they are in their health and life at the time.

    Making changes is overwhelming and difficult for some clients. With the knowledge of the registered dietitian, the client is guided toward change using foods that may be similar to what they are used to. The dietitian can also offer the client a list of items that would be fitting for the client’s needs based on their likes, dislikes and demographic area (what’s available to the client).


    Case Study #1: Nichole K. - Broad Range of Allergies

    Nichole K is a 14 year old female. She began experiencing blotchy, itchy skin, abdominal distention and swelling of skin on some areas of the body. She had a difficult time connecting which substances gave her the discomfort.

    After an Allergist did a series of prick skin tests and skin grafts, she was told that she was allergic to oats, beef, shellfish and hops.  Her family decided to seek the help of a dietitian that met with Nichole once a week for four months.

    It just so happens that her family prepared brats on a regular basis using beer. Her mother would prepare her oatmeal on most mornings and her family enjoyed seafood several times a week. Since she was exposed to these items on a regular basis, it was difficult to see what would be causing her discomfort.

    Nichole decided to eliminate the offending food items all together as the reaction she had from those items was so uncomfortable she did not want to test out her tolerance levels right away.  After replacing the items above, her conditions improved. She was also experiencing asthma and that too improved.

    Nichole continues to watch for these interactions when she is out with friends or in other social settings where others are unaware of her allergies. She is able to identify more clearly if she has an allergic reaction to an item. On occasion, this continues to happen due to servers not knowing what is in a product, mislabeling on packaged items, and from cross contamination in restaurants.


    Case Study #2: Lindsay M. - Celiac Disease

    Lindsay M. is a 24 year old female. She had been experiencing painful bouts of cramping followed by diarrhea alternating with constipation.  She went to see an Allergist and Gastroentologist and after a complete exam, was diagnosed as having celiac disease, an allergy to eggs and intolerance to lactose. After discovering this information, she sought out the services of a dietitian to help her manage her condition.

    Lindsay was very overweight. She had been exercising and struggling with times of binging and purging through exercise.

    Her new diet consisted of 35gms of fiber coming from lots of fruits and vegetables, oats and rice. She began using soy milk and other dairy alternatives. Because managing celiac disease can be challenging and overwhelming, she began making her own sauces to put on rice pasta and potatoes giving her complete control with ingredients. She ate very consistently for about four weeks and experienced much relief. She had regular and normal bowel movements, very little gas and bloating and decreased pain and tenderness in her abdomen.

    Lindsay also started to exercise more regularly. She started walking, then taking some aerobics classes, followed by the addition of a weight routine and then running.

    After four-weeks of consistency, Lindsay decided to experiment with the occasional wheat product, such as a large soft pretzel or regular pizza crust. She found that she was uncomfortable after eating those items, but nothing like the pain she experienced before.

    As with most food allergies or intolerances, we all seem to have our own level of tolerance. The tolerance level can change, but generally people decide how much pain they want to endure in order to add things back into their diet.


    Case Study #3: Deb J. - IBS

    At 53 years old, Deb J. sought out the services of a registered dietitian.  Her goals at the time were to lose weight and become more conditioned. She was battling the same 30 pounds for a span of about 30 years. She had complained of constant pain and bloat in her abdomen. Her physician had said she had a slight case of Irritable Bowl Syndrome (IBS).  Since IBS is such a broadly defined condition, it was necessary to start by incorporating some basic diet and lifestyle changes.

    Since Deb’s diet needed tweaking and there were no big dietary changes the first appointment was for an hour with a weekly session that ranged from 30 – 60 minutes, depending on the complexity and the questions or challenges from the client. With the help of a dietitian, Deb kept a general food log guide to track what was causing the irritation.

    Deb’s usual daily diet that was causing her IBS consisted of:

    • Breakfast - Lucky Charms or a Slim Fast or nothing, then coffee at work and all morning.
    • Lunch -  A frozen entrée of some sort and maybe a piece of fruit
    • Afternoon snack - Something from the vending machines, Doritos, pretzels or cookies. or if there was some candy at work then that would be the choice of the day 
    • Dinner - More red meat than chicken, turkey or fish, usually prepared with oils or butters and coupled by mashed potatoes made with dairy, a glass of milk and on occasion, a veggie.
    • Evening snack - Usually ice cream or cookies


    She started to decrease the total fat and more specifically the saturated fat in her diet.  She went from 65 – 90 grams of fat each day to an average of 35 – 40 grams of fat per day. She increased her intake of omega-3 fatty acids through the addition of fish in her diet about twice a week as well as the addition of a flax seed supplement. This client was using a flax seed supplement in the form of a gel capsules by Barleans. She started with 3 capsules a day and eventually increased up to 9 capsules a day. This helped her with the inflammation. She is currently on 3 – 6 day depending on her own level of comfort. She would take more on days she exercised more heavily and less on days that she wasn’t as physically active.

    She increased her fiber intake from about 15gms gradually to 35gms a day because her satiety levels were poor. She was bloated and would experience bouts of hypoglycemia. Increasing her fiber intake helped level out her blood sugar levels. She was struggling with being hungry often before starting to clean her diet up. Since she wasn’t taking in much fiber before, she needed to slowly get her level up.

    Deb worked on developing some different stress relievers. She started incorporating more exercise and stretching and became more involved in leisure activities such as knitting and gardening. She increased her exercise in the morning to 15 –30 minutes of walking before work.   She walked away from her desk while at work and would go into the bathroom and do 10 deep breathes and ‘squats”. She said this technique helped her calm down and just felt good to her body.

    After working with these changes for several months, she was feeling better than she had. However, she still didn’t feel great. She could definitely target that when she would have the occasional high fat food or entrée that she would experience bouts of diarrhea as well as abdominal cramping

    At her 3-month follow-up, Deb decided she wanted to see what more she could do to help herself. At the suggestion of the dietitian, she decided to eliminate dairy and wheat products from her diet. The dietitian helped her develop a working plan with specific foods and plenty of variety to deal with this change.

    Her new typical daily menu now consisted of:

    • Breakfast – Oatmeal, buckwheat or brown rice cereal with soy or rice milk
    • Lunch -Large salad with chicken or tuna and rice crackers
    • Afternoon snack – Fruit and 6 almonds
    • Dinner – shrimp, chicken, or turkey in the form of a stir-fry or baked with a vegetable and sometimes rice or potato


    Deb had a difficult time at first, just because everything was new and she was so used to preparing specific things for her husband, so there were some emotional issues involved as well.

    She was able to experiment with adding a dairy serving every now and again to see how her body would respond. She loves yogurt and cottage cheese, and was anxious to experiment with these items.  At times her body can handle them and at other times rejects them and she will have cramping and diarrhea followed by headaches and fatigue.

    This final change in her diet seemed to have made the most change in how she felt. Deb has been able to maintain this way of living now for the past 5 years. She ended up taking classes to become a Master Gardener.  The program opened her world up to more social events with people who had similar passions. She also started volunteering at a Stray Cat Home. This is a place that takes baby, stray or abandoned kittens and gets them used to living with humans. She loves it!

    Section 6. Managing Food AllergiesSection 8. Glossary