Attached is the initial DB post and below is the student’s response There are s

Attached is the initial DB post and below is the student’s response
There are several concerning symptoms in this 17-year-old female. She has the following disposition:
HT: 67”; WT: 143 lbs; BP: 114/72

Given her lack of sleep, loss of appetite, momentary loss of vision upon standing, and frequent migraine headaches, it is essential to look closely at her diet and lifestyle habits. Some observations are that because her IgG Allergy Assessment test is positive for cow’s milk, her body’s immune system has produced antibodies to combat the proteins found in cow’s milk, which causes her adverse reactions.
Also, her highly positive result with molds indicates that the body’s immune system has produced many antibodies to combat the mold spores in areas with high humidity and moisture, such as bathrooms, kitchens, and basements.
An equivocal result to wheat, cheddar cheese, and candida means that the test results were inconclusive, which requires further testing to confirm whether the body’s immune system has produced antibodies to combat these substances.
With with her condition, there is most likely a gastrointestinal issue, inflammation, and some serious work that needs to happen for recovery.

Calculate this pt’s BMR and determine the amount of calories she should consume
Her estimated basal metabolic rate (BMR) is approximately 1,512 calories daily based on her height and weight, with normal blood pressure calculated by:
BMR=(4.35 x 143lbs)+(4.7 x 67″h) – (4.7 x 17 yo)
However, given her high level of physical activity, it is essential to factor in her exercise routine to determine her total daily calories needed. With a factor of 1.725, she will need about 2,608 calories per day.

List type of diet you would recommend and reason why you chose this diet
We do not know the preferred foods, which will make a difference in the recommendations. However, with our limited information, the debate is between an Elimination Diet or a Mediterranean Diet (MD). I recommend a combination. She demonstrates many allergies and potential allergies. Therefore, a blend of eliminating offenders like potential glutens and, indeed, cow’s milk, but adherence to a Mediterranean diet for anti-inflammatory benefits. Given her low-protein diet, education is essential to help her understand the value of increasing protein to support her muscle growth and repair from heavy exercise. Gardner, C. D. et al.1 also found that a higher-protein diet will maintain a stable blood sugar balance, but factoring in the MD is easier to follow over time, compared to a Keto Diet. Ultimately, the goal is to find a healthy, easy-to-follow diet. A 2021 meta-analysis by Illescas, O. et al.2 boldly state their findings demonstrate the unique effects of a Mediterranean diet on the gut microbiota and suggest that this lifestyle change may serve to prevent cancer and other gut-related diseases since it is rich in anti-inflammatory foods like healthy fats, fruits, and vegetables.

List any other supplements/botanicals you would recommend and the reason(s) you made these choices.
Supplement recommendations are
1. Vitamin D at 2000 IU/day and Omega-3 fatty acids at 1000mg/day are beneficial, given her deficiency indicated in her red blood cell fatty acid profile. Both show benefits in reducing autoimmune disease, and Omega-3 reduces inflammation, which may help to alleviate some of her symptoms. Hahn, J. et al.3 found that Vitamin D reduced autoimmune disease by 22% and Omega-3 15% in a randomized control trial over five years.
2. Digestive Vibrance4 is a great supplement powder for nourishment and detox. One scoop (14.5g) added to water or a smoothie daily provides a complex nutrient base for compromised guts. It contains prebiotics, probiotics matching her deficiency, and anti-inflammatory herbs to reduce inflammation and support gut health, such as ginger, ginkgo, green tea, and more to improve digestion and reduce inflammation. Prebiotics, such as psyllium or wheatgrass, may help to flush out the bowels and mitigate reabsorption.
Botanicals like ginger and turmeric may help reduce inflammation and improve digestion.5,6
The variety of lactobacillus probiotics included may also be beneficial for restoring balance to her gut microbiome, particularly given the lack of lactobacilli in her stool culture.
There may be consideration warranted to include activated charcoal due to the mold, once these significant changes are made and her gut is healed up a bit.
A higher protein, anti-inflammatory MD diet rich in fruits, vegetables, healthy fats, targeted supplementation, and botanical support may be the best therapeutic approach for this individual.

Amanda Blume

References
1. Gardner, C. D., Landry, M. J., Perelman, D., Petlura, C., Durand, L. R., Aronica, L., Crimarco, A., Cunanan, K. M., Chang, A., Dant, C. C., Robinson, J. L., & Kim, S. H. (2022). Effect of a Ketogenic Diet versus Mediterranean Diet on HbA1c in Individuals with Prediabetes and Type 2 Diabetes Mellitus: the Interventional Keto-Med Randomized Crossover Trial. The American Journal of Clinical Nutrition, 116(3). https://doi.org/10.1093/ajcn/nqac154
2. Illescas, O., Rodríguez-Sosa, M., & Gariboldi, M. (2021). Mediterranean Diet to Prevent the Development of Colon Diseases: A Meta-Analysis of Gut Microbiota Studies. Nutrients, 13(7), 2234. https://doi.org/10.3390/nu13072234
‌3.Hahn, J., Cook, N. R., Alexander, E. K., Friedman, S., Walter, J., Bubes, V., Kotler, G., Lee, I. M., Manson, J. E., & Costenbader, K. H. (2022). Vitamin D and marine omega 3 fatty acid supplementation and incident autoimmune disease: VITAL randomized controlled trial. BMJ (Clinical research ed.), 376, e066452. https://doi.org/10.1136/bmj-2021-066452
4. Bowel Health Supplement, Digestive Vibrance Online. (n.d.). Vibrant Health. Retrieved October 19, 2023, from https://vibranthealth.com/products/vibrant-flora-improved-bowel-support
5. Zingiber (U. S. P.)—Ginger. | Henriette’s Herbal Homepage. (n.d.). Www.henriettes-Herb.com. https://www.henriettes-herb.com/eclectic/kings/zingiber.html
‌6. Curcuma.—Turmeric. | Henriette’s Herbal Homepage. (n.d.). Www.henriettes-Herb.com. https://www.henriettes-herb.com/eclectic/kings/curcuma.html