Question

Case Study: Julia Roberts Julia Roberts, a 66 year-old female has scheduled an appointment to meet with you and find out how the quality of her diet is. She also wants to know how to improve her habits and make more items at home instead of eating out so often. She reports she has a sweet tooth and often eats out because she likes to try new desserts at restaurants and her husband passed away last year so she does not like to make meals for herself. Julia suffered a stroke 2 years ago, but regularly follows up with her doctor and he said she "is in pretty good health now, but her inflammation markers are higher than he would like." She is 5 foot, 6 inches tall and weighs 75 kilograms. She reports not doing much exercise except walking around the mall when she is shopping She reports this is what her usual diet looks like: Breakfast: 2 cups of black coffee, 1 glass of orange juice, instant oatmeal with almonds in it Lunch: tuna fish sandwich from Subway on white bread with Lay's Potato chips, and a chocolate chip cookie Snack: Twinkie and a cup of coffee Dinner: Large bowl of pasta with Alfredo sauce, green beans, garlic bread, and glass of Riesling wine from Macaroni Grill Bedtime: 1 small cup of water and her daily medications, which include Coumadin, 2000 IU vitamin E, 1000 mg calcium, and she just started taking a fish oil because she heard about its benefits on the news related to reducing inflammation. Supplemental Facts Serving Size: 1 Softigel Capsule(s) Ingredients Per Serving % DV Natural Vitamin E (ns d-alpha tocopherol 1000 ku 3333% Notes: VITAMIN E 1000 LU. d-ALPHA TOCOPHEROL AND MXED TOCOPHEROLS. 100 % NATURAL SOURCE VVITAMIN E. Each capsule of Vitamin E contains 100 % naturaly occurring d-apha, beta, gamma and delta tocopherols. Other Ingredients: Gelatin, glycerin, water, (May contain soybean oil andlor beeswax)

1. How many milligrams of vitamin E is she getting from her supplement daily?  How does this compare to the RDA for age and gender?

2. What nutrients or supplements are of concern to Julia? (Think:  Coumadin)

Answer 1

Vitamin E

Vitamin E is one of the fat soluble vitamins and is acting as an antioxidant .

Mrs. Julia's vitamin E intake.

2000 IU per day = 1340 mg/ day

( 1 IU of VitaminE : d alpha tocopherol= 0.67 mg

0.67 mg× 2000iu = 1340 mg)

Mrs. Julia's RDA for Vitamin E

15 mg per day is the RDA for the woman between 50- 70 years. Physician recommended Vitamin E intake for Julia is 2000iu. Vitamin E essential for general health, eye and reproduction. It also act as an antioxidant.

Nutrients or supplements concern of Mrs. Julia

1. Avoid intake of fish oil

Fish oil interacts with Coumadin( anticoagulant) . it also slows the clotting process thereby increases the chance of bleeding.

2. Vitamin E intake .

Julia's intake is 2000iu . Too much vitamin E reduces the effect of Coumadin. Avoid too much Vitamin E.

3. Omega 3 fatty is essential for stroke recovery as it helps the brain cells.

4. Avoid Vitamin K rich food such as brocoli, asparagus, spinach etc. It will reduce the Coumadin effect.