Case Study Excerpt: Medical Nutrition Therapy for Immune Health

Patient Information

Veronica is a 47-year-old mother of two working as a sales agent in Southern California. She lives with her husband and children, and juggles a demanding job, hectic work schedule, and busy family life. Though she considers herself happy and fulfilled, she says she struggles constantly with her health and often lets her own wellbeing suffer.

• Health Concerns: Frequent cold and flu symptoms, chronic stress, trouble sleeping
• Medications: Alprazolam (for anxiety), occasional aspirin tables

Practitioner Perspective: Kellie Blake, RDN, LD, IFNCP

Food can make a significant difference in the way a person feels and the health of their immune system, but if other lifestyle strategies aren’t implemented, people may not experience complete healing. For Veronica, Kellie would work with her to look beyond food and exercise, and address sleep, stress, and social aspects of her health as well. The focus would be on all the pieces of the health and wellness puzzle to help Veronica feel better and improve her immune system function.

Care Plan

During the initial visit, Kellie would map out a custom care plan to be adopted over four weeks. After four weeks, Veronica would come back to meet with Kellie and identify what worked, what didn’t work, and where tweaks might be needed to move forward.  The eight-point care plan tailored for Veronica would include:

1. Meal Plan. Kellie would recommend a meal plan designed to target gut health. The complexity of the meal plan would be based on Veronica’s motivation, so there would be different levels of commitment based on what Veronica is willing to do up front. Kellie said Veronica would benefit from a full elimination diet, but with her hectic lifestyle it may not be realistic to implement. If that’s the case, Kellie would provide Veronica with a plan to eliminate gluten, dairy, processed foods, and alcohol. She would have Veronica focus on adding five servings of vegetables per day to boost phytonutrient intake. Additionally, she would provide Veronica with a detailed meal plan including sample menus and recipes that would be easy to incorporate.
2. Movement. Veronica is very sedentary, which Kellie said is likely contributing to several of the issues she is experiencing. For Veronica, Kellie would emphasize simple strategies to implement more movement. For example, she would suggest walking for 10 minutes after every meal and one 20-minute total body strength training session on the weekends. She would also suggest a standing or treadmill desk to increase activity during the day.
3. Stress Management. Kellie would work with Veronica to create a solid routine to help manage stress. Her morning routine should include a five-minute meditation when she wakes up and in the middle of the day to help get her stress response under control. Stress hinders immune function, Kellie said, and she would want to help Veronica understand how her lifestyle contributes to her stress levels.
4. Sleep. Additionally, Kellie would want to help Veronica establish a relaxing bedtime routine. She would suggest taking an Epsom salt bath 30 minutes before bed, no blue light an hour before bed, no alcohol or eating within three hours of bedtime, and being in bed by 10 p.m. to start the process of unwinding and relaxing to get more restful sleep. This routine could be challenging for Veronica as she is used to going to bed late and getting up early, but she needs to focus on sleep, Kellie said. If sleep is not under control, it makes improving other areas of her health and wellbeing very difficult, she said.
5. Social Life. Veronica has many social obligations, but Kellie would suggest decreasing her obligations in the first four weeks to prioritize rest. Kellie would want her to do something relaxing and enjoyable, like reading a book or listening to a non-work-related podcast, for at least 30 minutes per day.
6. Lab Work. Kellie would work with Veronica’s primary care provider to order various tests, including comprehensive stool testing, hormone testing, fasting insulin, triglycerides, vitamin D, omega-3 index, full thyroid panel with antibodies, and an ApoA1 and APOB baseline to identify possible issues with insulin resistance.
7. Supplementation. While Kellie would not typically recommend adding supplements in the first visit, preferring to eliminate inflammatory components as a top priority, for Veronica foundational supplements may help her feel better. Kellie would suggest Veronica take a good quality multivitamin every other day, and add in vitamin D3 with K2, magnesium before bed, a B vitamin complex, and vitamin C, which are all in increased demand during periods of high stress. These supplements would help Veronica fill gaps in her diet. Later on, Kellie would have Veronica add in a multi-strain probiotic, omega-3 fatty acids, and L-theanine and gamma-aminobutyric acid (GABA) to help further manage anxiety and stress.
8. Counseling. Kellie would suggest Veronica meet with a counselor to discuss her stress and anxiety, to help uncover if there are other things that may need to be addressed in her lifestyle. Kellie would walk through the plan with Veronica step-by step and answer any questions or troubleshoot any problems before she leaves the office. Throughout this implementation period, Kellie would make herself available via her mobile app or email for specific questions, so Veronica feels supported and is able to troubleshoot should questions or concerns arise.

Editor’s Note: This is an excerpt from the case study, Medical Nutrition Therapy for Immune Health. To access the full e-book, click here.