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theintegratedhealthacademy.com.au Please rate each of the following symptoms according to your recent health status: 0 1 2
Never or almost never have the symptom Occasionally have it, effect is not severe Occasionally have it, effect is severe
3 4
EARS
Frequently have it, effect is not severe Frequently have it, effect is severe
NOSE
DIGESTIVE TRACT
EYES
Stuffy Nose or nasal discharge Sinus congestion/Sinus Infection Hay Fever or sneezing attacks Postnasal drip or excessive mucus production TOTAL MOUTH/THROAT
Watery or itchy eyes ___ Swollen, red or sticky eyelids ___ Bags or dark circles under eyes ___ Blurred or tunnel vision or visual disturbance ___ (Does not include near or farsightedness) ___
Chronic coughing or clearing of throat Frequent gagging or difficulty swallowing Sore throat, hoarseness or loss of voice Swollen or discoloured tongue, gums or lips Mouth ulcers or sore gums
Itchy Ears Earache/ear infections Hearing Loss/Blocked Ears Ringing/Buzzing Ears
___ ___ ___ ___
TOTAL
TOTAL
___ ___ ___ ___
___ ___ ___ ___ ___
___ ___
___ ___ ___
TOTAL
___ ___ ___ ___ ___ ___ ___
Mood swings Anxiety, fear or nervousness Anger, irritability or aggressiveness Depression Hyperactivity or restlessness
___ ___ ___ ___ ___
TOTAL ENERGY/ACTIVITY
Pain or aches in the joints or arthritis Pain or aches in muscles Stiffness or limitation of movement
___ ___ ___
Fatigue, sluggishness or lethargy Apathy or loss of motivation Feeling of weakness or tiredness
___ ___ ___
___
TOTAL
TOTAL
TOTAL
APPETITE/EATING BEHAVIOUR
TOTAL
___ ___ ___ ___ ___
EMOTIONS/FEELINGS
JOINTS/MUSCLES
Irregular or skipped heartbeat Rapid or pounding heartbeat Chest Pain
Acne Hives, rashes or dry skin Hair Loss Flushing or hot flushes Excessive Sweating
___
HEAD Headaches Faintness/light headedness Dizziness or vertigo Insomnia or sleep disturbance
Poor memory Confusion, poor comprehension Poor concentration Poor physical co-ordination Difficulty in making decisions Stuttering, stammering or slurred speech Learning disabilities
___ ___ ___ ___ ___
TOTAL
HEART
Recurrent/ chronic bronchitis Asthma – wheezing or coughing spasms Shortness of breath or difficulty breathing Chest congestion or productive chest cough
Indigestion or abdominal discomfort/pain Abdominal bloating – episodic or recurrent Episodic nausea or vomiting Flatulence – burping or passing gas Heartburn – episodic or recurrent TOTAL MIND/COGNITION
TOTAL
LUNGS
SKIN
___ ___ ___ ___
TOTAL
OTHER
Loss of appetite Food cravings Binge eating, drinking or compulsive eating Excessive weight or weight gain
___ ___ ___ ___
GRAND TOTAL POINTS
Recent illness or recurrence of illness Underweight or rapid weight loss Fluid or water retention Frequent or urgent urination Genital itch or discharge
TOTAL
SIGNATURE ........................................................................... DATE .....................................................................................
___ ___ ___ ___ ___ TOTAL
TOTAL POINTS
____
Measuring*Skinfolds* To#work#out#a#patientâ&#x20AC;&#x2122;s#body#composition#you#will#need#to#measure#4#skin#folds:# 1) mid;triceps,## 2) mid;biceps,## 3) subscapular#and## 4) suprailiac,# Record#each#measurement.### Take#the#measurement#twice#~## if#there#is#a#5mm#difference#between#the#2#readings#at#any#one#site#do#a#third# measurement,#and#a#fourth#if#necessary,#until#you#have#two#measurements# within#5mm.#Average#the#two#closest#readings#for#each#site.### # Analysis*of*body*composition* Information#needed:# 1) The#four#skinfold#measurements#as#discussed#above.# 2) The#weight#of#the#patient#in#kilograms.# 3) The#age#of#the#patient# 4) The#recommended#body;fat#percentage#for#that#age:# Males* Males* Females* Females* <40* <40* <40*yrs* >40*yrs* yrs* yrs* 20%# 25%# 15%# 20%# # * Calculations:* 1. Sum#of#the#skinfolds,#add#the#four#measurements#together:# ## Triceps#+#Biceps#+#Subscapular#+#Suprailiac#=#Total#(mm)# 2. To#determine#the#percentage#of#body#fat#use#the#following#tables:## Table#A#for#females#and#Table#B#for#males.### 3. Use#the#left#hand#column#to#find#the#number#closest#to#the#skin#fold# total.##Match#this#number#up#with#the#appropriate#age#group,#and#that#is# the#body#fat#percentage.# 4. To#work#out#fat#weight#use#the#following#calculation:#
#
Body#fat#weight#=## Percent#Fat#x#Body#weight# 100# 5. To#work#out#the#patients#ideal#weight#use#the#following#calculation:# # Target#weight##=##100#x#(Body#weight#–#fat#weight)# (100#–#average#%#fat#for#age)# # 6##Measurement#of#lean#weight# ### ####Total#weight;#fat#weight#=#Lean#body#mass#
# # Example*measurement* Female*age*45*years* The#average#skin#fold#measurements:# Mid#triceps;#24mm# Mid#biceps;#14mm# Suprascapular;#38mm# Supra#iliac;#28mm#########Added#total=#104# # According#to#the#table#provided,#her#body#fat#percentage#is#40.4# # Body#fat#weight#=## Percent#Fat#x#Body#weight# # 100# # ########################Body#fat#weight#=#40.4#x#74# ##########################################################100# ###################################################=#29.89#kg# # Target#weight##=##100#x#(Body#weight#–#fat#weight)# (100#–#average#%#fat#for#age)# # # #########################Target#weight#=#100x#(74;#29.89)# ########################################################(100;25)# ################################################=#58.8#kg# #
# Her#lean#body#mass# # Total#weight;fat#weight#=#74#;#29.89# ###########################################=#44.11kg# ## The#following#formula#may#be#used# For#men:#LBM#=#(0.32810#*#W)#+#(0.33929#*#H)#;#29.5336# For#women:#LBM#=#(#0.29569#*#W)#+#(0.41813#*#H)#;#43.2933# This#is#based#on#an#average#and#is#not#accurate#for#the#individual.# #
BODY FAT PERCENTAGE: TABLE A - FEMALES FATFOLDS 16-29 years 30-39 years 40-49 years 50-70 years 15 10.5 20 14.1 17 19.8 21.4 25 16.8 19.4 22.2 24 30 19.5 21.8 24.5 26.6 35 21.5 23.7 26.4 28.5 40 23.4 25.5 28.2 30.3 45 25 26.9 29.6 31.9 50 26.5 28.2 31 33.4 55 27.8 29.4 32.1 34.6 60 29.1 30.6 33.2 35.7 65 30.2 31.6 34.1 36.7 70 31.2 32.5 35 37.7 75 32.2 33.4 35.9 38.7 80 33.1 34.3 36.7 39.6 85 34 35.1 37.5 40.4 90 34.8 35.8 38.3 41.2 95 35.6 36.5 39 41.9 100 36.4 37.2 39.7 42.6 105 37.1 37.9 40.4 43.3 110 37.8 38.6 41 43.9 115 38.4 39.1 41.5 44.5 120 39 39.6 42 45.1 125 39.6 40.1 42.5 45.7 130 40.2 40.6 43 46.2 135 40.8 41.1 43.5 46.7 140 41.3 41.6 44 47.2 145 41.8 42.1 44.5 47.7 150 42.3 42.6 45 48.2 155 42.8 43.1 45.4 48.7 160 43.3 43.6 45.8 49.2 165 43.7 44 46.2 49.6 170 44.1 44.4 46.6 50 175 44.8 47 50.4 180 45.2 47.4 50.8 185 45.6 47.8 51.2 190 45.9 48.2 51.6 195 46.2 48.5 52 200 46.5 48.8 52.4 205 49.1 52.7 210 49.4 53 (From Durnin, J.V.G.A. and J. Wormersley, 1974, British Journal of Nutrition, Vol. 32, pp.77-97).
BODY FAT PERCENTAGE: TABLE B - MALES FATFOLDS 17-29 years 30-39 years 40-49 years 50-70 years 15 4.8 20 8.1 12.2 12.2 12.6 25 10.5 14.2 15 15.6 30 12.9 16.2 17.7 18.6 35 14.7 17.7 19.6 20.8 40 16.4 19.2 21.4 22.9 45 17.7 20.4 23 24.7 50 19 21.5 24.6 26.5 55 20.1 22.5 25.9 27.9 60 21.2 23.5 27.1 29.2 65 22.2 24.3 28.2 30.4 70 23.1 25.1 29.3 31.6 75 24 25.9 30.3 32.7 80 24.8 26.6 31.2 33.8 85 25.5 27.2 32.1 34.8 90 26.2 27.8 33 35.8 95 26.9 28.4 33.7 36.6 100 27.6 29 34.4 37.4 105 28.2 29.6 35.1 38.2 110 28.8 30.1 35.8 39 115 29.4 30.6 36.4 39.7 120 30 31.1 37 40.4 125 30.5 31.5 37.6 41.1 130 31 31.9 38.2 41.8 135 31.5 32.3 38.7 42.4 140 32 32.7 39.2 43 145 32.5 33.1 39.7 43.6 150 32.9 33.5 40.2 44.1 155 33.3 33.9 40.7 44.6 160 33.7 34.3 41.2 45.1 165 34.1 34.6 41.6 45.6 170 34.5 34.8 42 46.1 175 34.9 180 35.3 185 35.6 190 35.9 (From Durnin, J.V.G.A. and J. Wormersley, 1974, British Journal of Nutrition, Vol. 32, pp.77-97).
Deficiency Symptoms and Signs
16/05/14 4:01 PM
This page has been printed from the www.stewartnutrition.co.uk web site.
Deficiency Symptoms and Signs Symptom or Sign
Possible Nutritional Deficiency
Other Possible Causes
General Symptoms and Appearance Fatigue
Protein-energy, iron, magnesium, potassium, vitamins B1, B12 and other B vitamins and vitamin C
Many physical illnesses including hypothyroidism, cardiac failure, anaemia, chronic fatigue syndrome and depression
Loss of appetite
Zinc
Many chronic illnesses
Pica eating non-nutritive substances
General malnutrition and possibly iron, calcium, zinc, vitamins B1 – thiamine, B3 – niacin, C and D
Normal in infants under 2 years of age, pregnancy especially in young women, mental illness
Loss of taste
Zinc
Common cold, many nasal disorders
Cold intolerance
Iron
Hypothyroidism, anaemia and reduced cardiac output
Pale appearance due to anaemia
Iron, folate and vitamin B12
Excessive bleeding and haematological disorders
Carotenoderma – yellow Protein-energy and zinc discolouration of the skin noticeable on the face and trunk
Dietary carotenoid excess especially in women, hypothyroidism
Diffuse hyperpigmentation
Protein-energy
Addison’s disease and haemochromatosis
Muscle wasting e.g. clothes appear too big, loss of limb musculature
Protein-energy
Loss of height and excessive curvature of the spine
Calcium and vitamin D
Increasing age and disease- related osteoporosis
Itchy skin – pruritus
Iron
Many skin diseases, liver disease
Dry skin
Essential Fatty Acids or multiple nutritional deficiencies
Old age, skin conditions e.g. eczema
Skin
Red scaly skin in light-exposed areas Vitamin B3
Excessive sun-exposure in red/fair haired individuals light-exposed areas
Excessive bruising
Old age, trauma and blood disorders
Vitamin C
Haemorrhage or redness around hair Vitamin C follicles Bleeding into a joint or other unusual Vitamin C bleeding
Various blood disorders
Plugging of hair follicles with keratin Vitamin C or coiled hairs Fine downy hair on torso – lanugo
Protein-energy. Typical of Persistent anorexia nervosa
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Deficiency Symptoms and Signs
16/05/14 4:01 PM
Mouth Sore tongue
Iron, vitamin B12, B2, B3 and possibly other B vitamins
Excessively hot drinks and oral disease
Vitamin B2 – riboflavin
Excessive exposure to cold or windy weather
Cracking at the corners of the mouth
Iron, vitamin B2 – riboflavin possibly other B vitamins
Poorly fitting dentures, eczema infection with candida albicans
Recurrent mouth ulcers
Iron, vitamin B12, folate and possibly other B vitamins
Coeliac disease, Crohn’s disease recurrent herpes and oral disease
Enlarged veins under the tongue with micro-haemorrhages
Vitamin C
Smoking and old age
Smooth, shinny and sore tongue: atrophic glossitis
Iron, vitamin B12 and folate
Cracking and peeling of the lips
skin on
Head, Face and Neck Scalp hair loss
Iron
Any scalp disease, alopecia from other causes
Dandruff
Essential fatty acids and biotin
Fungal infection of scalp
Redness at the sides of the nose
Vitamin B2 –riboflavin, vitamin B6 and zinc
Seborrhoeic dermatitis
Redness or cracking at the outer angle of the eyes
Vitamins B2 or B6
Goitre
Iodine deficiency is likely if goitre is present in > 20% of population – endemic goitre
Adolescence, pregnancy and various forms of thyroid disease
Nails - brittle or flaking
Iron acids
Poor circulation and old age
Nails - upturned or spoon-shaped nails
Iron
Hands and Nails and possibly essential fatty
Carotenoderma – yellow Protein-energy and zinc discolouration of the skin noticeable on the palms
Psoriasis or other diseases of the nail bed Dietary carotenoid excess especially in women, hypothyroidism
Musculo-skeletal Muscle pains and cramps
Magnesium, potassium, sodium, vitamin B1 and vitamin D if there is hypocalcaemia
Muscle or neurological disease, polymyalgia rheumatica and hypocalcaemia
Calf muscle pain after minimal exercise
Vitamin B1 – thiamine
Torn muscle, peripheral vascular disease and myopathy
Excessive calf muscle tenderness
Vitamin B1- thiamine
Torn muscle, thrombosis
Walking with a waddling gait
Vitamin D and resultant myopathy
Osteoarthritis of the hips or disease of the hip-girdle muscles
Difficulty getting up from a low chair Vitamin D and resultant myopathy or climbing the stairs or weakness of shoulder muscles
Arthritis of the hips or knees, diseases of the nerves or muscles
Bowed legs
Vitamin D - rickets in childhood
Paget’s disease and syphilis
Twitching of facial muscles when tapping on the facial nerve in front of the ear: Chvostek’s sign
Calcium and vitamin D if Hypocalcaemia for other reasons e.g. hypocalcaemia or severe magnesium hypoparathyroidism deficiency
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Deficiency Symptoms and Signs
16/05/14 4:01 PM
Eyes Poor night vision
Zinc, vitamin A and possibly vitamin Retinal disease B2 - riboflavin
Conjunctival dryness
Vitamin A
Old age and Sjogren’s syndrome
Diarrhoea
Vitamin B3
Irritable bowel syndrome, malabsorption, infective diarrhoea and many other causes
Constipation
Dehydration, fibre, potassium, magnesium and folate
Irritable bowel syndrome, diverticulosis, cancer of the colon
Restless legs
Iron or folate
Various neurological disorders, pregnancy, rheumatoid arthritis, and renal failure
Burning feet syndrome
Vitamin B2 –riboflavin
Early peripheral neuropathy
Loss of balance when standing upright with feet together and the eyes closed: Romberg’s test
Vitamin B12 and possibly vitamin B3 Many neurological disorders affecting the cerebellum, spinal chord or peripheral nerves
Loss of vibration sensation in the lower limbs
Vitamin B12 and possibly vitamin B3 Increasing age and peripheral neuropathy
Gastrointestinal
Neurological
Peripheral neuropathy – numbness, Vitamins B1, B12 and possibly B3, Diabetes and many other causes tingling, disordered sensation, pain B6 and folate and very rarely copper and or weakness in the hands or feet (following gastrointestinal surgery or excess zinc ingestion). Relative lack of essential fatty acids. Unsteady movement or walking (cerebellar ataxia)
Vitamin B1, vitamin E and Coenzyme Q10
Alcohol, hypothyroidism and many neurological and inherited disorders
Mental State Depression
Vitamins C, B1, B3, B6, B12, folate, Mental illness, stress and as a biotin and possibly the essential fatty consequence of physical illness acids
Irritability
Folate
Alcoholism, deprcssion and personality disorder
Poor concentration
Iron, vitamins B1, B12, folate and possibly essential fatty acids
Depression, stress, lack of sleep, alcohol, dementia, anaemia, hypothyroidism and many other diseases
Heart failure
Vitamin B1 – thiamin and any deficiency causing anaemia
Coronary, valvular and myocardial disease
Palpitations
Potassium and magnesium and any deficiency causing anaemia
Coronary, valvular and myocardial disease
Cardio-vascular
Copyright © Dr. Alan Stewart M.B. B.S. M.R.C.P. (UK) M.F. Hom. 47 Priory Street, Lewes, East Sussex. BN7 1HJ Tel 01273 487003 Fax: 01273 487576
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Measuring Skinfolds To work out a patient’s body composition you will need to measure 4 skin folds: 1) mid-triceps, 2) mid-biceps, 3) subscapular and 4) suprailiac, Record each measurement. Take the measurement twice ~ if there is a 5mm difference between the 2 readings at any one site do a third measurement, and a fourth if necessary, until you have two measurements within 5mm. Average the two closest readings for each site. Analysis of body composition Information needed: 1) The four skinfold measurements as discussed above. 2) The weight of the patient in kilograms. 3) The age of the patient 4) The recommended body-fat percentage for that age: Females <40 yrs 20%
Females >40 yrs 25%
Males <40 yrs 15%
Males <40 yrs 20%
Calculations: 1. Sum of the skinfolds, add the four measurements together: Triceps + Biceps + Subscapular + Suprailiac = Total (mm) 2. To determine the percentage of body fat use the following tables: Table A for females and Table B for males. 3. Use the left hand column to find the number closest to the skin fold total. Match this number up with the appropriate age group, and that is the body fat percentage. 4. To work out fat weight use the following calculation: Body fat weight = Percent Fat x Body weight 100 5. To work out the patients ideal weight use the following calculation: Target weight = 100 x (Body weight – fat weight) (100 – average % fat for age)
A Practical Guide to Nutrition for Allied Heath Practitioners
Start and Finish Times
Topic or Element DAY 1 Introduction Macronutrients
8:30am – 10:30am
Good Fats / Bad Fats Protein Synthesis and Degradation Practical --- Measuring Body Composition
10:30am – 10:45am
Morning Tea Micronutrients
10:45am – 1:00am
Manifestations of Nutrient Deficiencies Observational Practical --- Micronutrient Deficiencies
1:00pm – 1:45pm
Lunch Inflammatory Mediators
1:45pm – 3:30pm
Insulin Resistance / Type 2 Diabetes Metabolic Syndrome
3:30pm – 3:45pm
Afternoon Tea Fructose
3:45pm – 5:30pm
Appetite Control Gut Health & Food Intolerances
DAY 2 Recap Day One 9:00am – 10:30am
Macronutrient Group Session Chronic Fatigue Syndrome / Fibromyalgia Case Study
10:30am-10:45am
Morning Tea Cholesterol Leptin Resistance
10:45am – 1:00pm
Stress Body Biorhythms Practical --- Abdominal Diagnosis (30mins)
1:00pm – 1:45pm
Lunch Oxidative Stress Antioxidants and Ageing
1:45pm – 3:30pm
Fatty Liver Nutritional Pain Relief Acid / Alkaline Balance Case Study
3:30pm – 3:45pm
Afternoon Tea Osteoporosis Fracture Healing
3:45pm – 5:00pm
Arthritis Discussion on Diets Group Examination END OF SEMINAR
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