CASE STUDY & SUCCESS STORIES
Name: Varalakshmi
Age: 65 yrs
Gender: Female
BMI: 32 kg/m2
Case History: Partha (Varalakshmi’s son) approached us for help with his mother’s health conditions. Partha is in the USA and his 65-year-old mother lives in India. She had Type 2 Diabetes, Hypertension and Diabetic Retinopathy and her CKD was in stage 4. She was an insulin-dependent diabetic for several years, was on 36 no units of insulin, and her fasting sugar levels would be in the 146-160 range. He wanted help in reducing her sugar levels, getting her HbA1C to a healthy range, improve her CKD condition as she was in the verge of getting into the dialysis zone. She is a vegetarian, staying by herself in India and therefore Partha reached out to us to provide a meal plan and suggest her the lifestyle changes that his mother could do independently at her age. Varalakshmi had diabetes for the past 10 years and was on 18 units of day and night insulin. She developed retinopathy because of her constant diabetic condition.
Analysis: Past history, blood analysis, dietary recall and lifestyle choices. Her HbA1C level was at 8.8%, her creatinine level was outside of the range at 2.1 and her eGFR was at 28. Her elevated sugar levels and hypertension had caused her nerve in the eye to burst and there was bleeding which required her to go for a medical intervention once her sugar levels reached a healthy range with medications. Her vitamin profile was low as per her recent medical checkup and therefore recommended regular use of supplements for multivitamins and vitamin D to improve her overall energy levels and gain some strength, under the supervision of her doctor.
Approach by best clinical nutritionist / dietician Telangana, India: We first analyzed her food diary, and observed that she was on a regular Indian grammarian diet. A diet that largely comprised of an assortment of refined cereals & lentils was devoid of the cell walls, fibre, fats and adequate protein that was required to improve her CKD condition. She was consuming several meals in a day out of which 90% of the meals were grain-based since she was a vegetarian which explains the constant spike in her blood sugar levels, increasing her retinopathy condition and aggravating her CKD conditions. We suggested she take stomach-friendly whole grains like hand pound rice, instead of jowar roti as jowar in powdered form lead to spike in insulin levels, Further, we included lots of vegetables in different forms like soups, steamed vegetables and stir-fried vegetables to provide her adequate fiber and comfortable for her digestive health. We kept potassium and phosphorous-rich food items like tomato, cabbage etc. to the minimum so that it does not impact her creatinine levels. We also advised her to avoid gluten for a short period of time to keep her insulin levels in check. Real-time support along with recipes and pre-preparation methods were provided to her. We regularly kept a check on her energy levels and ensured that she ate whatever we gave her in terms of taste and liking to ensure sustainability. CKD patients avoid protein as they believe it would aggravate her medical condition. We gave her adequate lean, efficient & dense protein split throughout the day that was as per norms for a CKD stage 4, stomach-friendly, reducing her sugar levels while ensuring the overall potassium and phosphorus consumption was within the prescribed norms. We also educated and monitored her water intake and exercise like walking, yoga etc on routine basis in order to improve her gut health with better absorption.
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