Question

Recently, mealtimes have become frustrating for John’s mother. Her four-year old son refuses to eat, does not want to drink his milk, and begs for juice instead. He often complains ‘that his stomach hurts’ and cries until his mother gives in to his requests. He also goes through periods where he has diarrhea or constipation. After several visits to the local health clinic, his mom finally learns that John has lost weight and his tests reveal that he is lactose intolerant, allergic to citrus fruits, and may be developing celiac disease, all of which are contributing to his malnutrition. Even small amounts of milk or cheese seemed to upset his stomach and orange juice caused him to break out in hives.

If John is lactose intolerant, allergic to citrus fruits and has celiac disease, which foods may he need to eliminate from his diet?





What nutrients would John lack if these foods are eliminated from his diet?







What symptoms could John experience due to a lack of these nutrients? Would you expect deficiency symptoms in these nutrients to appear immediately or long term? Explain.







Suggest several foods that are nutrient-dense and could be served in place of the foods listed in #1.

Answer 1

John may need to eliminate foods containing lactose (milk, cheese, yogurt, ice cream, etc.), citrus fruits (oranges, lemons, limes, etc.), and gluten (wheat, barley, rye, etc.) from his diet.
If John eliminates these foods from his diet, he may lack calcium, vitamin D, vitamin C, fiber, and B vitamins. Milk and dairy products are good sources of calcium and vitamin D, citrus fruits are high in vitamin C, and grains containing gluten are often fortified with B vitamins and are a good source of fiber.
Due to a lack of calcium and vitamin D, John may experience weak bones and teeth, as well as an increased risk of osteoporosis later in life. Without vitamin C, he may have weakened immunity and may be more prone to infections. A lack of fiber may lead to constipation, while a lack of B vitamins may cause fatigue, weakness, and nerve problems. Some deficiency symptoms may appear immediately, while others may take longer to appear, depending on the nutrient and the extent of the deficiency.
Foods that are nutrient-dense and could be served in place of the eliminated foods include:
Non-dairy sources of calcium, such as leafy greens (kale, collard greens, spinach), tofu, almonds, and fortified plant milks (soy, almond, etc.)
Foods high in vitamin C, such as strawberries, kiwi, papaya, bell peppers, broccoli, and kale
Gluten-free whole grains, such as rice, quinoa, amaranth, and buckwheat, as well as gluten-free bread, pasta, and crackers made from these grains
Foods high in B vitamins, such as legumes (beans, lentils, peas), nuts, seeds, whole grains, and fortified plant milks