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medical-practice

Your health is important to you.

An assessment with a registered dietitian should include:

  1. Computerized fluid and nutrition analysis using Bioelectrical Impedance and related body measures
  2. Computerized three day food intake analysis with symptoms of any fatigue or gastrointestinal problems
  3. Exercise Record (perhaps a pedometer, accelerometer or heart rate monitor may be recommended)
  4. Glucose screening if you have a family history of diabetes
  5. Heart disease risk profile if you have a family history of heart disease
  6. A review of laboratory results from your doctor
  7. Information on losses to your nutritional status via sweat or other health conditions.

 

After an assessment is completed, a nutrition plan from a registered dietitian should include:

  1. Some a basic direction on how to improve exercise with professional help if needed.
  2. A sample meal plan or some basic suggestions depending on your goals, learning style and readiness to make changes
  3. An idea of what vitamins and minerals may need replacement in your diet
  4. Food replacement for exercise
  5. A food intake and exercise diary
  6. Some targets related to your nutritional goals
  7. A follow-up plan

 

Diabetes

If you think you have diabetes, there are some things you should know.

A visit to a registered dietitian can help. Your dietitian should have a glucose meter to check your blood glucose (blood sugar). They may use it as part of an assessment if you have had weight gain and a family history of diabetes. The Diabetes Association has worked with medical experts to determine the best possible glucose values for you as seen in the below chart .

Test taken 

Value (mmol/l)

Action

Fasting Blood Glucose (before breakfast) <  5.8  None – continue healthy life with regular diet and exercise
Fasting Blood Glucose (before breakfast) >  5.8 Ask your MD for a glucose tolerance test and ask your RD about regular diet and exercise
Random Blood Glucose (anytime) <  7.8  None – continue healthy life with regular diet and exercise
Random Blood Glucose (anytime)  > 7.8  Ask your MD for a glucose tolerance test and ask your RD about regular diet and exercise

A dietitian will need to know the following to make the best possible treatment plan/diet plan for you.
  1. Family history of medical conditions (on assessment template)
  2. Activity level (can benefit from a pedometer if you are not sure how much walking you do each day, in assessment package)
  3. Your waist circumference (in assessment package)
  4. A recent blood pressure reading
  5. A recent HgbA1c (the measure your doctor takes to determine your blood glucose over the past 3 months)
  6. A three day food intake record with several blood glucose readings (template given with assessment)
  7. Current medications if any.
  8. Cholesterol levels (LDL, HDL, Triglycerides, the ratio of Total Cholesterol/HDL)
  9. How your kidney function is (urine micro albumin, serum creatinine and e GFR)
A treatment plan will include targets for all of the above: physical activity, nutrition plan with portion or carbohydrate counting, waist circumference target, blood pressure target, HgbA1c target, cholesterol and kidney function targets.

Nutritionassessment.com is happy to work with your MD in establishing goals for your diabetes care when your condition is mild to moderate or you are wishing to prevent future complications from high blood glucose

High Blood Pressure

Salt, Alcohol, Fruit and Vegetables and Weight Management

High Blood Pressure is often in your family medical history. Before an assessment if possible, take time to contact primary relatives and ask them about their blood pressure, blood sugar and cholesterol. Determine if they had risk factors such as a large waist measure, high stress, inactivity, smoked or had other lifestyle issues such as excessive alcohol consumption.

If you think your blood pressure is only high occasionally, ask your doctor for a 24 Hour Heart Rate Monitor machine to help determine if you have a problem. The Heart and Stroke Foundation has worked with medical teams to set the maximum blood pressure ranges for health in the table below.

Blood Pressure Test

Systolic BP

Diastolic BP

Normal <120 <80
Well person with slightly high blood pressure (no treatment given but diet change may help lower) <140 <90
Diabetes Targets <130 <80
Chronic Kidney Disease Targets <130 <80

Did you know you can reduce your blood pressure 11.4/5.5 mm Hg with a nutrition assessment and advice on the Dash diet and your sodium (salt) intake? Did you know that for every 10 pounds extra weight you loss, your blood pressure will go down 7.2/5.9 mm Hg? Did you know limiting your alcohol consumption will reduce your blood pressure ? Did you know that with the help of a dietitian you may not need as many blood pressure pills? Nutritionassessment.com is happy to work with your MD in establishing goals for your blood pressure when your condition is mild to moderate or you are wishing to avoid adding another blood pressure medication to gain control.

High Cholesterol

If you have high cholesterol it is likely that it is in your family history. Before an assessment, if possible, take time to contact primary relatives and ask them about their blood pressure, blood sugar and cholesterol. Determine if they had risk factors such as a large waist measure, were stressed, were inactive, were smokers or other lifestyle issues such as excessive alcohol consumption.

You can ask your MD to check your cholesterol and they will order a lipid profile for you through a lab. The Heart and Stroke Foundation has worked with medical teams to set the maximum cholesterol ranges for health in the table below . Your physician or nurse practitioner will help you determine your risk for cardiovascular disease with your family history, blood levels of cholesterol, your history of diabetes if any, blood pressure, body weight and lifestyle factors. The dietitians at nutritionassessment.com can help with the lifestyle factors that will help lower your cholesterol and blood pressure.



Cholesterol Test High Risk mmol/l Moderate Risk mmol/l Low Risk mmol/l
LDL < 2  < 3.5 < 5
HDL > 1 > 1 > 1
Triglycerides < 2 < 2 < 2
Ratio Total/HDL < 4 < 5 < 6


The dietitians at nutritionassessment.com know what foods will impove the specific cholesterol targets. They use a step-wise approach to treatment over a 3 month period and then have your lipid profile re-taken to see the results of the diet changes. Its important to review this with a dietitian regularly to have access to new strategies and foods to reduce your LDL or improve your HDL.

Gluten Sensitivity

People, who have acquired a gastrointestinal condition, can benefit from a nutrition assessment. Often some entire food groups are removed due to an allergy or intolerance. There are issues of malabsorption of specific nutrients and replacements are needed. Below are a few more common conditions.

Celiac Disease (Gluten Sensitivity)

Celiac disease is an autoimmune disease usually found in the family tree and is when we cannot digest gluten found in the wheat family of products. It is felt this condition is wide spread in our population. Some people decide they have this condition without a thorough assessment and testing. To be diagnosed your MD would order a blood test. In order for the test to be definitive a diet containing wheat must be taken continuously. It is incorrect to stop eating wheat products and then have the test. The authority on celiac is Shelley Case the author of the 'Gluten Free Diet'[1]. The Dietitians at nutritionassessment.com can help with food lists, recipes and menu planning help especially for multiple food intolerances.

[1] Case, Shelley, Gluten-Free Diet, Revised Edition, http://www.glutenfreediet.ca/index.php

Irritable Bowel Syndrome (IBS)

IBS is a chronic, often debilitating, functional (meaning disordered function or movement along the bowel) gastrointestinal disorder with symptoms including abdominal pain, bloating, and altered bowel behaviour such as constipation or diarrhea, or alternating between the two stool consistency extremes. It is the most common gastrointestinal diagnosis worldwide and the most common disorder presented by patients consulting a specialist for gastrointestinal conditions . Perhaps 13-20% of people have this condition and it is more difficult to manage in times of stress. For example students have more problems during mid-terms and final exams than the rest of the term. The treatment of the condition is complex and different for nearly every person. The Dietitians at nutritionassessment.com can help with a 'step-wise approach to food intolerances. For example eliminating coffee even if it is decaf taken on an empty stomach is the first step to reducing this problem. There are several steps to go through and the Dietitian will decide the best sequence to try. It is important to go one step at a time and record your food intake and symptoms to achieve a happier bowel. Too many attempts that are not well monitored will result in elimination of too many foods in the diet and may not meet with success in stopping symptoms of IBS.  Ask the dietitian if the low FODMAP diet is appropriate for you.