Reference no: EM133434986

Janice is 46 years old. She is 5'5" and weighs 174 lbs. Her chief complaints are chronic congestion, general fatigue, psoriasis/ dry skin, and a poor immune system, and depression. She also has steadily gained weight since her mid-thirties and would like to lose some. She is frustrated that she tries to eat well but is still gaining weight. She is clinically diagnosed with depression and takes an SSRI. She says she always gets sick when anyone around her is sick. She works as a secretary at a big firm in the suburbs. She commutes 45 minutes each way to work by car. Though she likes her job, it is very stressful. She is single and has a hard time socializing outside of work because she's too tired to do much after work.

She is frequently on antibiotics, and has been her entire life. As a child, she was sick a lot with ear infections, colds/ coughs, the flu, and bronchitis. 

Janice goes to the gym on Saturdays and walks on the treadmill for an hour. She always intends to go to the gym during the week, but it hasn't happened yet.

A physical exam reveals the following:

• Dry, rough skin on elbows, legs, some spots on neck.
• Bumps on backs of arms
• Dark circles under eyes
• Brittle hair and nails
• White spots in fingernails
• Scalloped edges of tongue

Typical daily intake:

• Breakfast: 1 cup of coffee with Splenda and fat-free milk, banana, bagel with fat-free cream cheese
• Mid-morning: 1 cup of coffee, Yoplait blueberry yogurt (sometimes a treat if someone brings something to the office; often pastries)
• Lunch: Subway chicken or turkey sandwich, Diet coke
• Afternoon/ commute home: Nature Valley granola bar, apple
• Dinner:  Usually Chinese takeout; pasta with sauce and cheese; or a big iceberg lettuce salad with chicken, cheese, low-fat ranch dressing, and bread.
• Dessert: fat-free frozen yogurt or a fruit popsicle. Sometimes a handful of m&ms while watching TV.

Supplements &  Pharmaceuticals:

• Zoloft (aka Certraline, an SSRI)
• Centrum multi-vitamin

1. What do you think could be causing Janice's symptoms and chief complaints?
2. What do you think about the supplements/pharmaceuticals Janice is taking? What effects might they be having on her health and nutritional status? Would you change/add/adjust anything if you could?
3. Assess Janice's diet (deficiencies, excesses, balance, variety, quality, etc).
4. What changes to her diet would you have her make? List five tangible recommendations you would give her.
5. What other questions about her health would you ask?
6. What overall recommendations would you make for Janice to optimize her health and address his symptoms/condition (and why)?
7. Explain to Janice the importance of physical activity to her physical and mental health.