Case Studies
“These are a selection of case studies to help you see how something simple can have such layering of complexity – a simple diet sheet will never work for clients I am privileged to see, because the workings of metabolism are usually multi-layered,” Prem Nand, Clinical Dietitian – Nutritionist
MULTIPLE MEDICAL ISSUES FOLLOWING AN UNKNOWN VIRAL INDUCED MENINGO-ENCEPHALITIS: 4 YEARS SUFFERING ALLEVIATED IN 8 WEEKS.
She was referred to Prem Nand, Clinical Dietitian-Nutritionist for weight related issues (weight gain), and irregular cycle. Indepth assessment showed more issues: chronic fatigue, slurred and slow speech, a loss of peripheral vision, when tired, hormone imbalance, skin rash, gut issues and hypersensitivity to waste. By the time she came to a Maximised Nutrition clinic, she had suffered this way for 4 years.
Prem Nand diagnosed her to have HPO dysfunction with post viral inflammation with mitochondrial dysfunction, microbiota imbalance: gut-brain issues. Her story was published in the front page of Whangarei Leader "Determined to help others". She is happy for me to share this online.
Prem Nand rang her after reading this article. She was so thankful and so happy to share her story. She said that her skin rash disappeared within 6 weeks, her gut settled within 3 weeks of being on the nutrition plan. Other symptoms including her energy levels improved within 8 weeks. She stated that the energy levels were much better with higher threshold but she had to not overdo things.
"What's genuinely humbled me today is that she has gone on to share about the need for holistic health care with brain injury including the right diet internationally." Prem's comments
BOWEL AND NEUROLOGICAL ISSUES WITH PAST HISTORY OF FORMALDEHYDE POISONING
Lovely female in her 60s with a tenacious personality, post-menopausal with childhood history of high level of nerve pain (but was told that she was a sensitive child) with two incidence of formaldehyde poisoning.
Bowel motions were more towards runny, emptying of bowel multiple times during the day. Had started eating whole foods, no preservatives, organic diet. Had skin fungus on starting this summer. She had falling hair and brittle nails.
Diet was high in carbohydrate, low in protein and blood test showed that she had copper to zinc imbalance with lower than ideal zinc levels.
After a thorough analysis, Prem’s view was that it was likely that she had methylation issues starting during childhood, related to stressful environment she was growing with and with multiple formaldehyde poisoning, likely further damage to her DNA structure. Prem explained the role of stress and HPA dysfunction and her mitochondrial health.
A comprehensive whole food nutrition plan with nutrient balancing and supplementation to correct HPA dysfunction, reduce the reactive oxidative stress on her mitochondria and cells and to repair her DNA was initiated. Also steps to improve her bowel form through detox and probiotic was also put in place. Skin fungus issues was to be addressed through improvement of bowel health and for client to take regular turmeric baths.
IRRITABLE BOWEL SYNDROME
Female in her late 30s with repeated hospital admission for constipation, bloating and extreme pain levels. At times, this would lead her to vomiting. She was referred to a gastroenterologist and had both endoscopy and colonoscopy. She was diagnosed as IBS and given laxatives. She was also told that this was stress related (Client did have high level of stress but mostly related to her symptoms).
Prem Nand as part of her assessment asked her gynaecological history. Client had heavy menses and had also been diagnosed with ovarian cysts in past that had ruptured. In inquiring about the area of her pain and also the times when she had these episodes. the impression Prem Nand got was her symptoms were more related to her gonadal harmonal issue and also likely a mechanical bowel issue. Prem Nand recommended nutritional plan and treatment by an osteopath. Report from osteopath was that client’s intestine some areas which were tight. Client is continuing with the nutritional therapy. Client has not had a repeated episode of her symptoms coming to MN Clinic.
TWO EXPOSURES TO LEPTOPIROSIS LEADING TO EXTREME FATIGUE, WEIGHT LOSS AND SHUTTING DOWN OF HIS BODY
Male, in 50s, was working on Farm when he contracted Leptospirosis. A few months later, he was diagnosed with Chronic Fatigue Syndrome. He went through an extreme level of personal stress. 8 years later, he had another exposure to Leptospirosis. This second incident led to extreme fatigue. He would only walk a limited distance and then his body would freeze. He stated that he felt that his thigh muscle was concrete and he felt cold all over his body especially the chest. He would lay down wherever he was or if he was inside the house, he would put layers of blanket and have the heater on. It took his body a few hours to get warm and then he could move again. He also had spikes of blood sugar.
Prem Nand felt that with the Leptospirosis exposure, he had a mitochondrial dysfunction. Mitochondria which is an energy production unit is also the first immune response to infection. When an infection continues, then the mitochondria does not efficiently function as an energy apparatus. Further stress had also likely caused metabolic dysfunction. When this client ate carbohydrates, his body felt real cold. Prem was of the view that the second exposure that lead to slow recycling of the mitochondria. Thus, the body was not able to regenerate the energy cycle, which under activity led to the freezing of his body. He was underweight and unable to put on weight despite having high caloric intake.
Prem worked with the client to reverse the mitochondrial damage, with a very low GIycemic Index diet plan (almost a modified ketogenic diet), with appropriate supplementation (including use of D-ribose. In chronic fatigue syndrome, the enzyme glucose-6-phospate dehydrogenase is reduced, so D-ribose helps to bypass this part of the energy production while the enzyme takes time to activate into function on exertion).
Over a period of months, client showed an improvement in energy levels, was able to exert himself for longer period of time, was able to walk greater distance, no longer had spikes in blood sugar level and did not have the cold body temperature episodes. While he has not fully recovered, his quality of life is much better. His weight improved slowly to within ideal range for his height and age.
UNABLE TO LOSE WEIGHT
Female, early 40s, unable to lose weight despite trying various weight loss programs. Excess weight now affecting knee joints. When Client came to clinic, she was motivated to make whatever changes she needed to make with diet but frustrated to the point of giving up. Found Prem Nand, Clinical Dietitian – Nutritionist on Google Search. Comprehensive initial assessment revealed that she had significant life event that had caused her post traumatic stress. Also disrupted sleep habits. She had a lot of nutrition knowledge.
Prem Nand gave her a nutrition protocol that helped to correct the post traumatic stress impacts and also helped heal her damaged knee cartilage. Client also went to physiotherapist for rehabilitation of her knee.
She also indicated that she was now sleeping deeply and getting clear lucid dreams. She was starting to lose weight (though had not achieved her goal weight yet).
OBESITY WITH DIABETES ON METFORMIN
Client, in her late 50s, after more than 10 years of being on metformin, was put on Insulin. She found Prem Nand, Clinical Dietitian – Nutritionist as highly recommended on a public forum. She wanted to lose weight, get off insulin and reverse her diabetes. At the initial clinic, she stated that she usually was very lethargic during the day. She had been to a Dietitian previously. Prem Nand, Clinical Dietitian – Nutritionist reviewed her dietary habits and lifestyle. Her holistic nutrition plan included getting the right balance of protein to complex carbohydrate mix through out the day with appropriate portion controls.
Within a week, she was off Insulin. Two (2) months later, she had reduced her metformin dosage. She stated having a lot more energy and also being able to work around her garden in the afternoon. She had also started to lose weight. She is still on her journey to her goal weight but Prem Nand, Clinical Dietitian – Nutritionist emphasised to her (and with other clients needing weight loss), habit change is more important than counting of calories. [Disclaimer Alert: Maximised Nutrition does not know if you will get similar results, since individual results vary. Personalised Assessment is recommended. Maximised Nutrition also recommends that Clients make a clinic appointment as soon as they are diagnosed having Pre-Diabetes, in order to prevent complications related to badly controlled Diabetes in later stages).
PRE-DIABETES AND NON-HEALING WOUND
Retired Client, within normal weight range for height, diagnosed by his GP as being Pre-Diabetic. He also had a non-healing wound on his leg from a Spider Bite. Initial assessment revealed that he used to consume a lot of refined sugar products (related to his snacking habit when he was working).. but otherwise had a healthy diet. He had been a very hard worker all his life, running multiple business with manual labour. Prem Nand, Clinical Dietitian – Nutritionist diagnosed that it was likely that his long term stress level (during his working life) had made an impact on his metabolism. Previously he may have been able to burn off the extra sugar due to physical labour but on retiring, this may not have been the case. Anyway, he was advised to remove all refined carbohydrates from his diet. Nutritional analysis showed nutrient deficiencies for some nutrients. This was corrected through a diet plan. Six weeks later, the wound had healed and client stated that his blood HbA1c was all normal.
MOTHER - DAUGTHER CONSULTATION: A HIGH ACHIEVING DAUGHTER WITH AMONERROHEA
This case is a typical teenage case I see in clinic where the teenage girl is an over-achiever, very focused on school work and also sports. Only that body image issues also cause the teenager to implement dietary regimes that end up causing her to have Amonerrohea. In a case like this, it is usually the Mother that will contact Prem Nand, Clinical Dietitian-Nutritionist for a consultation. Prem Nand emphasises that the daughter has to be committed to making the required changes needed to get her hormonal levels in the right place to get the menstruation cycle going.
Amonerrohea can occur due to either too much exercise, or not enough food intake or the wrong food intake and other lifestyle factors. It is important to note that for a teenage girl, getting the menstruation cycle right can impact her future ability to conceive. Prem Nand then works with the teenager to bring a balance with her training, her recreation times and to provide the right diet plan with nutritional supplements for her to achieve both her sports goals and regular menstrual cycle.
HARDWORKING TRADESPERSON WITH LOW BODY TEMPERATURE, HEART ARRHYTHMIA AND INSOMNIA
Female in her late 50s who suddenly developed these symptoms.
Assessment showed that she had irregular bowel motions, a major period of work related stress and her symptoms started post menopause. She had had ECGs, seen multiple specialists, had monitoring and ECGs done.
Prem Nand got her do get a Fit Bit watch that could monitor her heart rate and sleep pattern and also asked her to do a week of blood sugar monitoring, especially recording the blood sugars when she had felt the body temperature change and when she had arrhythmia. After looking through the collated data with the reports from the specialists, Prem Nand diagnosed this patient to have a complex interplay of multiple organ systems including mitochondria dysfunction.
Thus Prem Nand provided her nutrition plan that worked at correcting the energy metabolism system and also with her gut. Client showed improvement in her symptoms, being able to sleep now. Prem Nand advised that after three months, Client to get her GP to review her current medications and to make adjustments / reductions in dosage if the GP felt that this was appropriate.
MITOCHONDRIA DYSFUNCTION AFTER EXPOSURES TO LEPTOSPIROSIS LEADING TO CHRONIC FATIGUE SYMPTOMS
Male, in 50s, was working on Farm when he contracted Leptospirosis. A few months later, he was diagnosed with Chronic Fatigue Syndrome. He went through an extreme level of personal stress. 8 years later, he had another exposure to Leptospirosis. This second incident led to extreme fatigue. He would only walk a limited distance and then his body would freeze. He stated that he felt that his thigh muscle was concrete and he felt cold all over his body especially the chest. He would lay down wherever he was or if he was inside the house, he would put layers of blanket and have the heater on. It took his body a few hours to get warm and then he could move again. He also had spikes of blood sugar.
Prem Nand felt that with the Leptospirosis exposure, he had a mitochondrial dysfunction. Mitochondria which is an energy production unit is also the first immune response to infection. When an infection continues, then the mitochondria does not efficiently function as an energy apparatus. Further stress had also likely caused metabolic dysfunction. When this client ate carbohydrates, his body felt real cold. Prem was of the view that the second exposure that lead to slow recycling of the mitochondria. Thus, the body was not able to regenerate the energy cycle, which under activity led to the freezing of his body. He was underweight and unable to put on weight despite having high caloric intake.
Prem worked with the client to reverse the mitochondrial damage, with a very low GIycemic Index diet plan (almost a modified ketogenic diet), with appropriate supplementation (including use of D-ribose. In chronic fatigue syndrome, the enzyme glucose-6-phospate dehydrogenase is reduced, so D-ribose helps to bypass this part of the energy production while the enzyme takes time to activate into function on exertion).
Over a period of months, client showed an improvement in energy levels, was able to exert himself for longer period of time, was able to walk greater distance, no longer had spikes in blood sugar level and did not have the cold body temperature episodes. While he has not fully recovered, his quality of life is much better. His weight improved slowly to within ideal range for his height and age.
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