These reactions are most commonly associated with milk buy fenofibrate online high cholesterol foods beef, eggs order 160 mg fenofibrate with amex cholesterol medication debate, peanuts buy fenofibrate 160 mg on line cholesterol ratio vs total, tree nuts (walnuts), soy, strawberries, wheat, ﬁsh, and shellﬁsh. People who get this type of reaction must be diligent in avoiding contact with the allergen and also carry an Epi-pen with them at all times in case they have a reaction. An elimination diet is not recommended for those with immediate hypersensitivity reactions. Delayed hypersensitivities do not appear right after consuming an allergen, mak- ing them difﬁcult to pinpoint. These reactions may not appear for days and can cause a wide range of symptoms such as dark circles or pufﬁness under the eyes, ﬂuid retention, skin rash, sinus congestion, fatigue, abdominal pain or bloating, joint inﬂammation, mood swings, indigestion, headaches, chronic ear infections, asthma, poor memory, anxiety, and depression. It is thought that over half of the population suffers with delayed food hypersensitivities. Food intolerances are food reactions that are not caused by an immune sys- tem reaction. For example, sulphites are a common food preservative added to dried fruits, wine, and processed foods that can cause severe reactions, particularly in those with asthma. The most common food intolerance is lactose intolerance, which occurs when the body does not produce enough of the digestive enzyme called lactase, which breaks down the milk sugar (lactose) found in dairy products. When too much undigested lactose makes its way into the large intestine, people suffer from gas and/or diarrhea. Another common source of food intolerance is gluten, a protein found in wheat, barley, and rye. In people with celiac disease, gluten damages the absorptive surface of the intestine. Symptoms include diarrhea or constipation, gas, bloating, fatigue, weight loss, ane- mia, hair loss, and depression. There are also naturally occurring substances in foods that can cause reactions in some people, such as salicylates, which are found in many vegetables, herbs, spices, fruits, and chocolate. Salicylates have been associated with various mental health prob- lems such as attention deﬁcit hyperactivity disorder, depression, and headaches. Many health care practitioners believe that the only deﬁnitive way to identify and manage adverse food reactions is through the use of an elimination diet followed by carefully organized food challenges. However, it can be incredibly rewarding to identify foods that are causing unpleasant reactions. Follow these dietary guidelines for at least one month to cleanse the body of the offending food. Read food labels and ﬁnd out about food ingredients and preparation methods when dining out. Keep a food diary, noting what you are eating and any symptoms that you experience. It is not uncommon to experience withdrawal symptoms within the ﬁrst week, such as headaches, food cravings, and changes in bowel function. Coffee drinkers typically experience more severe symptoms such as headache and a foggy-headed feeling when caffeine is stopped. After following the diet for 30 days, reintroduce one food item at a time into your diet. On the ﬁrst day of food challenges, a food is eaten one to three times during the day. Over the next few days, return to the elimination diet, and watch for the return of any symp- toms. If any symptoms develop, it is possible that you are allergic or intolerant to that reintroduced food. Cheating will defeat the purpose and hinder your ability to detect potential allergens or intoleranc- es. Keep in mind that if you’ve had a severe (anaphylactic) reaction to certain foods, this method can’t be used. It is advisable to work with a health care professional when considering an elimination diet so that you can get proper nutritional advice, recommendations on supplements, and monitoring throughout this process. Imbalanced hormones can affect many areas of health and cause problems such as depression, sleep distur- bances, weight gain or loss, bone loss, breast swelling and tenderness, ﬁbroids, low libido, sexual dysfunction, and many other aspects of health. While blood tests are most commonly done to check hormone levels, testing saliva for hormones is becoming increasingly popular. In fact, if you’re experiencing hormone-related symptoms, a saliva hormone test is possibly the best way to uncover hormone causes of symptoms. For example, Rocky Mountain Analytical, a Canadian saliva hormone testing lab, has data that shows that 7 out of 10 women with self-reported symptoms of depression and 4 out of 5 women with hot ﬂashes and/or low sex drive had laboratory-conﬁrmed hormone imbalance. This tells us that saliva hormone test results correlate very well with how patients feel. Unfortunately, blood tests do not look at symptoms, nor do they test all the same hormones. There are basically three ways to test for hormones: in blood, in saliva, or in urine. For example, blood or serum is less accurate for the measurement of testosterone in women because the test is calibrated for the high testosterone levels seen in men. As well, hormones in blood are often bound to proteins and may or may not be available to the tissues that require them. Consequently, blood and serum levels of hormones may not give the best picture of how hormones are behaving at the tissue level. This means that blood test results often don’t match up with the symptoms you are experiencing. Saliva, on the other hand, measures the amount of hormone that actually gets into tissue because salivary hormones have already passed through tissue (the saliva gland) to get into saliva. Saliva samples are also easier to collect—it can be done at home and samples can be mailed Hormone Testing | 435 in. Saliva hormone testing has been in the scientiﬁc literature for over 50 years and is rapidly becoming the test method of choice for hormone monitoring for many practitioners. Some saliva hormone-testing facilities claim that the tests can be used to determine the “right” dose of hormones for a patient, and that supplementing to achieve speciﬁc ratios of one hormone level to another is ideal. Unfortunately, there is no test—blood, saliva, or urine—that tells a doctor exactly how much hormone to give or what dose is right for you. The tests can help guide the doctor in choosing the dose (and in choosing which hormones to supplement with), but you still need to work with a doctor who understands hormone balance and hormone testing. Saliva testing is still the best choice to help uncover the cause of hormone symptoms. You are best to choose an accredited laboratory that includes symptom information in its analy- sis of your saliva specimen.
A third category of eating disorder buy cheap fenofibrate 160 mg cholesterol cheese chart, binge eating disorder cheap fenofibrate 160 mg with mastercard cholesterol foods to avoid chart, is also being considered by the American Psychiatric Association purchase generic fenofibrate pills cholesterol medication in pregnancy. Anorexia Nervosa Deﬁned Anorexia nervosa is a clinical syndrome in which the person has a morbid fear of obesity. It is characterized by the individual’s gross distortion of body image, preoccupation with food, and refusal to eat. Reports “not being hungry,” although it is thought that the actual feelings of hunger do not cease until late in the disorder. Prepares enormous amounts of food for friends and family members but refuses to eat any of it. Amenorrhea is common, often appearing even before notice- able weight loss has occurred. May engage in the binge-and-purge syndrome from time to time (see following section on bulimia nervosa). Bulimia Nervosa Deﬁned Bulimia nervosa is an eating disorder (commonly called “the binge-and-purge syndrome”) characterized by extreme over- eating, followed by self-induced vomiting and abuse of laxatives and diuretics. The disorder occurs predominantly in females and begins in adolescence or early adult life. Binges are usually solitary and secret, and the individual may consume thousands of calories in one episode. After the binge has begun, there is often a feeling of loss of control or inability to stop eating. Following the binge, the individual engages in inappropriate compensatory measures to avoid gaining weight (e. Eating binges may be viewed as pleasurable but are followed by intense self-criticism and depressed mood. Individuals with bulimia are usually within normal weight range, some a few pounds underweight, some a few pounds overweight. Obsession with body image and appearance is a predominant feature of this disorder. Individuals with bulimia display undue concern with sexual attractiveness and how they will appear to others. Excessive vomiting may lead to problems with dehydration and electrolyte imbalance. Genetics: A hereditary predisposition to eating disorders has been hypothesized on the basis of family histories and an apparent association with other disorders for which the likelihood of genetic inﬂuences exist. Neuroendocrine Abnormalities: Some speculation has occurred regarding a primary hypothalamic dysfunction in anorexia nervosa. Studies consistent with this theory have revealed elevated cerebrospinal ﬂuid cortisol levels and a possible impairment of dopaminergic regulation in individuals with anorexia (Halmi, 2008). Neurochemical Inﬂuences: Neurochemical inﬂuences in bulimia may be associated with the neurotransmitters serotonin and norepinephrine. Some studies have found high levels of endogenous opioids in the spinal ﬂuid of cli- ents with anorexia, promoting the speculation that these chemicals may contribute to denial of hunger (Sadock & Sadock, 2007). Some of these individuals have been shown to gain weight when given naloxone, an opioid antagonist. Psychodynamic Theory: The psychodynamic theory sug- gests that behaviors associated with eating disorders reﬂect a developmental arrest in the very early years of childhood caused by disturbances in mother-infant interactions. The tasks of trust, autonomy, and separation-individuation go unfulﬁlled, and the individual remains in the depen- dent position. The problem is compounded when the mother responds to the child’s physical and emotional needs with food. Manifestations include a disturbance in body identity and a distortion in body image. When events occur that threaten the vulner- able ego, feelings emerge of lack of control over one’s body (self). Behaviors associated with food and eating provide feelings of control over one’s life. Family Dynamics: This theory proposes that the issue of control becomes the overriding factor in the family of the individual with an eating disorder. These families often consist of a passive father, a domineering mother, and an overly dependent child. A high value is placed on perfec- tionism in this family, and the child feels he or she must satisfy these standards. Parental criticism promotes an increase in obsessive and perfectionistic behavior on the Eating Disorders ● 221 part of the child, who continues to seek love, approval, and recognition. In adolescence, these distorted eating patterns may represent a rebellion against the parents, viewed by the child as a means of gaining and remaining in control. The symptoms are often triggered by a stressor that the adolescent perceives as a loss of con- trol in some aspect of his or her life. These guidelines, which were released by the National Heart, Lung, and Blood Institute in July 1998, markedly increased the number of Americans considered to be overweight. Obesity is known to contribute to a number of health prob- lems, including hyperlipidemia, diabetes mellitus, osteoarthritis, and increased workload on the heart and lungs. Genetics: Genetics have been implicated in the develop- ment of obesity in that 80% of offspring of two obese parents are obese (Halmi, 2008). This hypothesis has also been supported by studies of twins reared by normal and overweight parents. Physical Factors: Overeating and/or obesity has also been associated with lesions in the appetite and satiety centers of the hypothalamus, hypothyroidism, decreased insulin production in diabetes mellitus, and increased cortisone production in Cushing’s disease. Lifestyle Factors: On a more basic level, obesity can be viewed as the ingestion of a greater number of calories than are expended. Weight gain occurs when caloric in- take exceeds caloric output in terms of basal metabolism and physical activity. Psychoanalytical Theory: This theory suggests that obe- sity is the result of unresolved dependency needs, with the individual being ﬁxed in the oral stage of psychosex- ual development. The symptoms of obesity are viewed as depressive equivalents, attempts to regain “lost” or frus- trated nurturance and care. Common Nursing Diagnoses and Interventions for Anorexia and Bulimia (Interventions are applicable to various health-care settings, such as inpatient and partial hospitalization, community outpatient clinic, home health, and private practice. Possible Etiologies (“related to”) [Refusal to eat] [Ingestion of large amounts of food, followed by self-induced vomiting] [Abuse of laxatives, diuretics, and/or diet pills] [Physical exertion in excess of energy produced through caloric intake] Deﬁning Characteristics (“evidenced by”) [Loss of 15% of expected body weight (anorexia nervosa)] Pale mucous membranes Poor muscle tone Excessive loss of hair [or increased growth of hair on body (lanugo)] [Amenorrhea] [Poor skin turgor] [Electrolyte imbalances] [Hypothermia] [Bradycardia] [Hypotension] [Cardiac irregularities] [Edema] Eating Disorders ● 223 Goals/Objectives Short-term Goal Client will gain lbs per week (amount to be established by client, nurse, and dietitian). Long-term Goal By discharge from treatment, client will exhibit no signs or symptoms of malnutrition. If client is unable or unwilling to maintain adequate oral in- take, physician may order a liquid diet to be administered via nasogastric tube. Nursing care of the individual receiving tube feedings should be administered according to established hospital procedures. The client’s physical safety is a nursing priority, and without adequate nutrition, a life-threatening situation exists. In collaboration with dietitian, determine number of cal- ories required to provide adequate nutrition and realistic (according to body structure and height) weight gain.
T. Esiel. Cleveland State University.