Prescription for nutritional

Question 1

Coeliac disease- causes

Answer 1

• A lifelong autoimmune disease caused by the immune system reacting to gluten
• It is common and affects 1 in 100 people

Question 2

Signs and symptoms

Answer 2

• Variable from person to person ranging from mild to severe
• Include
  
  • Diarrhoea, wind and constipation
  • Nausea and vomiting
  • Stomach pain, cramping and bloating
  • Tiredness and headache
  • Mouth ulcers

Question 3

Coeliac disease- Diagnosis

Answer 3

• Coeliac disease is a diagnosed by blood test and biopsy
• The blood tests measure IgA (total immunoglobulin A) and tTG (IgA tissue transglutaminase) which are antibodies produced by someone with coeliac disease when gluten is ingested

Question 4

Coeliac disease- Management

Answer 4

• There is no cure for Coeliac disease
• It is a lifelong disease and treatment involves adherence to a strict, lifelong gluten free diet
• Gluten is a protein found in wheat, rye and barley; some coeliacs are also sensitive to oats

Question 5

Which of the following foods would be suitable for coeliac patient

Answer 5

• Pizza margerita
• Porridge with fresh fruit
• Sausages and mash
• Spaghetti bolognese
• Rice krispies
• Lamb tagine with couscous

Question 6

Associated conditions

Answer 6

• Evidence that coeliac disease has an increased incadence in people with
  
  • Type 1 diabetes
  • Autoimmune thyroid disease
  • IBS
  • Dermatitis herpetiformis

Question 7

Complications

Answer 7

• Delayed diagnosis of coeliac disease or undiagnosed coeliac disease can result in long term complications
  
  • Malabsorption
  • Malnutrition
  • Lactose intolerance
  • Osteoporosis
  • Cancer

Question 8

Cystic Fibrosis

Answer 8

• A chronic, progressive condition that primarily affects the body’s respiratory and digestive systems
• It is due to a gene defect that causes the body to produce abnormally thick mucous
• It is caused by an abnormal gene known as CF gene

Question 9

Symptoms

Answer 9

• Abnormally thick, sticky mucous
  
  • Can clog the lungs leading to coughing, wheezing and recurring infections
  • Obstruct the ducts of the pancreas
• Affect the reproductive systems of men and women
• Unusally high concentration of salt in the sweat

Question 10

Diagnosis

Answer 10

• All babies born in the UK can now be screened for CF as part of a heel-prick test called the Guthrie test
• Older children or adults may be diagnosed following an illness, it might be suspected in a child who has poor growth or repeated respiratory or sinus infection

Question 11

Cystic Fibrosis- management

Answer 11

• Respiratory problems
  
  • Chest physiotherapy
  • Regular exercise
  • Antibiotics
• Digestive problems
  
  • Digestive enzymes
  • Vit and supplements

Question 12

Nutrition

Answer 12

• Adults with CF have higher energy needs so need a high energy and protein intake
• Strict vegan fiets are not advisable but a high energy vegetarian diet is possible with expert help from a dietitian
• Vit A,D,E and K supplements must be take regularly

Question 13

Vit A

Answer 13

• Essential to the normal structure and function of the skin and mucous membranes such as in the eyes, lungs and digestive system
• Vit A deficiency is a serious health problem worldwide
• It can lead to night blindness, an eye condition called xerophthalmia and eventually total blindness

Question 14

Thiamin (Vit B1)

Answer 14

• Involved in the normal function of the nervous system and other excitable tissues, such as skeletal muscles and the heart
• Deficiency of thiamin causes the peripheral nervous system disease beri-beriwhich is rare in the UK
• Wenicke-Korsakoff syndrome

Question 15

Cyanocobalamin (vitB12)

Answer 15

• Serves as a co-factor for enzymes involved in the normal function of the nervous system, the formation of red blood cells and the metabolism of folate
• Deficiency rare in younger people but can occur in strict vegans; more common in older people
• Deficiency results in the development of pernicious anaemia in which red blood cells are enlarged (megaloblastic) and peripheral neurological damage occurs

Question 16

Folate/Folic acid

Answer 16

• Folate functions together with B12 to form healthy red blood cells and in the development of the neural tube in the embryo
• Deficiency results in megaloblastic anaemia and may be due to poor diet, increased requirement, prolonged drug use, or malabsorption

Question 17

Vit C

Answer 17

• Involved in the synthesis of collagen which is required for the normal structure and function of connective tissues such as skin, cartilage and bones; it is therefore an important nutrient in healing
• It also increases the absorption of non-haem Fe from the gut
• Severe deficiency leads to scurvy- symptoms include fatigue, weakness, aching joints and muscles

Question 18

Vitamin D

Answer 18

• Synthesised in the skin from exposure to sunlight or UV rays
• In a pro-hormone and acts as a precursor to one of the hormones involved in calcium homestasis
• Deficiency of vitD results in poor calcification of the skeleton and skeletal deformity in children (rickets) and pain and bone fragility in adults (osteomalacia)

Question 19

Vit K

Answer 19

• Required for the synthesis of several proteins required for normal blood clotting and bone structure
• Deficiency is rare
• New born babies up to 6 weeks old have low levels of vitK which can lead to vit K deficiency bleading in infancy therefore all new borns are given prophylactic vit K

Question 20

Iron

Answer 20

• Essential for the formation of haemoglobin in red blood cells, it also has important role in the immune system
• A lack of dietary iron depletes iron stores in the body and this can eventually lead to iron deficiency anaemia
• More than 2 billion people worldwide suffer from iron deficiency anaemia making it the most common nutritional defficiency condition