FH Final Exam

Case 1: Diabetes with a Tie to a Meal Plan

Brian, a retired accountant, is a 68-year-old man from Kansas City, Missouri. Since his wife died from cancer two years ago, he has lived alone. He has two adult children who both live on the East Coast and visit once per year. His retired colleagues and friends are all starting to die or have health problems. 

Brian has had type 2 diabetes for 10 years and has been taking metformin, which his doctor prescribed when he was diagnosed. His wife took care of all the grocery shopping and cooking. She helped him follow the carb-control diabetic diet prescribed by his doctor’s dietitian. She also helped him check his blood sugar levels about twice per week. Since his wife passed away, he has been both heartbroken with a poor appetite and lost in the kitchen.

He was recently hospitalized for a painful infection in his pinky toe, which had to be amputated. In the hospital, his fasting blood sugar was 240 and his hemoglobin A1c was 7.5 percent. His body mass index (BMI) was 29.5. The hospital dietitian briefly met with Brian and gave him a handout on a diabetic carb-control diet. This experience was a big wake-up call for Brian and a reminder of his dream to travel, visit his kids and grandkids more, and live with the rest of his toes. 

During his recovery, his neighbor, who is very healthy and has been following a Paleo diet for several years, brought him a meal. As he shared with her how he wanted to turn his health around, she told him about a non-conventional dietitian who could help him. Brian called her the next day to set up an appointment. The dietitian also mentioned that she plans to have him work with a health coach, who is also located in her office.

APC Question 1:

During his first session with the health coach, Brian sets the goal of eating a Paleo meal for breakfast each morning until his next session. Based on this goal, the coach asks Brian to rate his confidence on a 10-point scale, in which 0 is “not at all confident” and 10 is “extremely confident.” Brian responds with a rating of 6. Which of the following is the most appropriate response from the coach?

Case 1: Diabetes with a Tie to a Meal Plan

Brian, a retired accountant, is a 68-year-old man from Kansas City, Missouri. Since his wife died from cancer two years ago, he has lived alone. He has two adult children who both live on the East Coast and visit once per year. His retired colleagues and friends are all starting to die or have health problems. 

Brian has had type 2 diabetes for 10 years and has been taking metformin, which his doctor prescribed when he was diagnosed. His wife took care of all the grocery shopping and cooking. She helped him follow the carb-control diabetic diet prescribed by his doctor’s dietitian. She also helped him check his blood sugar levels about twice per week. Since his wife passed away, he has been both heartbroken with a poor appetite and lost in the kitchen.

He was recently hospitalized for a painful infection in his pinky toe, which had to be amputated. In the hospital, his fasting blood sugar was 240 and his hemoglobin A1c was 7.5 percent. His body mass index (BMI) was 29.5. The hospital dietitian briefly met with Brian and gave him a handout on a diabetic carb-control diet. This experience was a big wake-up call for Brian and a reminder of his dream to travel, visit his kids and grandkids more, and live with the rest of his toes. 

During his recovery, his neighbor, who is very healthy and has been following a Paleo diet for several years, brought him a meal. As he shared with her how he wanted to turn his health around, she told him about a non-conventional dietitian who could help him. Brian called her the next day to set up an appointment. The dietitian also mentioned that she plans to have him work with a health coach, who is also located in her office.

APC Question 2:

Before his third session with the health coach, Brian took a strengths assessment. His top five strengths were honesty, kindness, fairness, spirituality, and humor. His five lowest categories were self-regulation, zest, gratitude, creativity, and perspective. Which of the following is the most appropriate approach for Brian?

Case 1: Diabetes with a Tie to a Meal Plan

Brian, a retired accountant, is a 68-year-old man from Kansas City, Missouri. Since his wife died from cancer two years ago, he has lived alone. He has two adult children who both live on the East Coast and visit once per year. His retired colleagues and friends are all starting to die or have health problems. 

Brian has had type 2 diabetes for 10 years and has been taking metformin, which his doctor prescribed when he was diagnosed. His wife took care of all the grocery shopping and cooking. She helped him follow the carb-control diabetic diet prescribed by his doctor’s dietitian. She also helped him check his blood sugar levels about twice per week. Since his wife passed away, he has been both heartbroken with a poor appetite and lost in the kitchen.

He was recently hospitalized for a painful infection in his pinky toe, which had to be amputated. In the hospital, his fasting blood sugar was 240 and his hemoglobin A1c was 7.5 percent. His body mass index (BMI) was 29.5. The hospital dietitian briefly met with Brian and gave him a handout on a diabetic carb-control diet. This experience was a big wake-up call for Brian and a reminder of his dream to travel, visit his kids and grandkids more, and live with the rest of his toes. 

During his recovery, his neighbor, who is very healthy and has been following a Paleo diet for several years, brought him a meal. As he shared with her how he wanted to turn his health around, she told him about a non-conventional dietitian who could help him. Brian called her the next day to set up an appointment. The dietitian also mentioned that she plans to have him work with a health coach, who is also located in her office.

APC Question 3:

At his fourth health coaching session, Brian says “I have been thinking of visiting my kids next month.” Having staged the client as being in contemplation, which of the following is the most appropriate approach?

Case 1: Diabetes with a Tie to a Meal Plan

Brian, a retired accountant, is a 68-year-old man from Kansas City, Missouri. Since his wife died from cancer two years ago, he has lived alone. He has two adult children who both live on the East Coast and visit once per year. His retired colleagues and friends are all starting to die or have health problems. 

Brian has had type 2 diabetes for 10 years and has been taking metformin, which his doctor prescribed when he was diagnosed. His wife took care of all the grocery shopping and cooking. She helped him follow the carb-control diabetic diet prescribed by his doctor’s dietitian. She also helped him check his blood sugar levels about twice per week. Since his wife passed away, he has been both heartbroken with a poor appetite and lost in the kitchen.

He was recently hospitalized for a painful infection in his pinky toe, which had to be amputated. In the hospital, his fasting blood sugar was 240 and his hemoglobin A1c was 7.5 percent. His body mass index (BMI) was 29.5. The hospital dietitian briefly met with Brian and gave him a handout on a diabetic carb-control diet. This experience was a big wake-up call for Brian and a reminder of his dream to travel, visit his kids and grandkids more, and live with the rest of his toes. 

During his recovery, his neighbor, who is very healthy and has been following a Paleo diet for several years, brought him a meal. As he shared with her how he wanted to turn his health around, she told him about a non-conventional dietitian who could help him. Brian called her the next day to set up an appointment. The dietitian also mentioned that she plans to have him work with a health coach, who is also located in her office.

FH Question 1:

Which of the following is an example of an optimal fasting blood glucose level and a hemoglobin A1c level, based on the Functional Health model?

Case 1: Diabetes with a Tie to a Meal Plan

Brian, a retired accountant, is a 68-year-old man from Kansas City, Missouri. Since his wife died from cancer two years ago, he has lived alone. He has two adult children who both live on the East Coast and visit once per year. His retired colleagues and friends are all starting to die or have health problems. 

Brian has had type 2 diabetes for 10 years and has been taking metformin, which his doctor prescribed when he was diagnosed. His wife took care of all the grocery shopping and cooking. She helped him follow the carb-control diabetic diet prescribed by his doctor’s dietitian. She also helped him check his blood sugar levels about twice per week. Since his wife passed away, he has been both heartbroken with a poor appetite and lost in the kitchen.

He was recently hospitalized for a painful infection in his pinky toe, which had to be amputated. In the hospital, his fasting blood sugar was 240 and his hemoglobin A1c was 7.5 percent. His body mass index (BMI) was 29.5. The hospital dietitian briefly met with Brian and gave him a handout on a diabetic carb-control diet. This experience was a big wake-up call for Brian and a reminder of his dream to travel, visit his kids and grandkids more, and live with the rest of his toes. 

During his recovery, his neighbor, who is very healthy and has been following a Paleo diet for several years, brought him a meal. As he shared with her how he wanted to turn his health around, she told him about a non-conventional dietitian who could help him. Brian called her the next day to set up an appointment. The dietitian also mentioned that she plans to have him work with a health coach, who is also located in her office.

FH Question 2:

The best example of an optimal Functional Health food plan for a client aiming to reverse type 2 diabetes is:

Case 2: Physical Activity

Danika is a 34-year-old woman who just made an appointment with a health coach with the primary goal of troubleshooting her diet, since her performance is off. The health coach gathered the following data from Danika:

• • She has trained for and completed a marathon four times per year—about once every quarter—for the past four years. 
  • She is single and wishes she had more time for a relationship, with the goal of getting married and having at least one child before she is 40 years old. 
  • She works full-time at a job she loves as a social worker for the Department of Veterans Affairs, although the interactions with her clients tend to zap her energy. 
  • To train for marathons, she tries to be in bed by 8 p.m. and awakens for runs anywhere between 2:30 a.m. and 4:30 a.m., depending on the length of the run. 

Her BMI is now 22; it used to be steady at 19. This weight gain, despite her high-intensity training, has Danika additionally frustrated. Her food intake is primarily vegetarian and includes eggs, yogurt, and cottage cheese, with fish such as tilapia or tuna twice per week and chicken about one to two times per week. Her macronutrients are currently about 15 percent protein, 25 percent fat, and 60 percent carbohydrates to “provide fuel for my distance running.” Her carbohydrates come primarily from whole-grain pasta, whole-grain bread, occasional sweet potatoes, and a large daily salad “loaded with raw veggies, a hard-boiled egg, and cottage cheese.”

APC Question 1:

Danika asks her health coach for recommendations on how to “tweak her diet to bring her times down.” What is the health coach’s best response to Danika?

Case 2: Physical Activity

Danika is a 34-year-old woman who just made an appointment with a health coach with the primary goal of troubleshooting her diet, since her performance is off. The health coach gathered the following data from Danika:

• • She has trained for and completed a marathon four times per year—about once every quarter—for the past four years. 
  • She is single and wishes she had more time for a relationship, with the goal of getting married and having at least one child before she is 40 years old. 
  • She works full-time at a job she loves as a social worker for the Department of Veterans Affairs, although the interactions with her clients tend to zap her energy. 
  • To train for marathons, she tries to be in bed by 8 p.m. and awakens for runs anywhere between 2:30 a.m. and 4:30 a.m., depending on the length of the run. 

Her BMI is now 22; it used to be steady at 19. This weight gain, despite her high-intensity training, has Danika additionally frustrated. Her food intake is primarily vegetarian and includes eggs, yogurt, and cottage cheese, with fish such as tilapia or tuna twice per week and chicken about one to two times per week. Her macronutrients are currently about 15 percent protein, 25 percent fat, and 60 percent carbohydrates to “provide fuel for my distance running.” Her carbohydrates come primarily from whole-grain pasta, whole-grain bread, occasional sweet potatoes, and a large daily salad “loaded with raw veggies, a hard-boiled egg, and cottage cheese.”

APC Question 2:

In this first session, Danika states, “I am healthier than anyone I know! I do everything right and just keep watching my marathon total time and splits increase. I also don’t recover as quickly. I think I just need to tweak my diet, so I need your help.” What is the most effective response for the coach to Danika’s discourse?

Case 2: Physical Activity

Danika is a 34-year-old woman who just made an appointment with a health coach with the primary goal of troubleshooting her diet, since her performance is off. The health coach gathered the following data from Danika:

• • She has trained for and completed a marathon four times per year—about once every quarter—for the past four years. 
  • She is single and wishes she had more time for a relationship, with the goal of getting married and having at least one child before she is 40 years old. 
  • She works full-time at a job she loves as a social worker for the Department of Veterans Affairs, although the interactions with her clients tend to zap her energy. 
  • To train for marathons, she tries to be in bed by 8 p.m. and awakens for runs anywhere between 2:30 a.m. and 4:30 a.m., depending on the length of the run. 

Her BMI is now 22; it used to be steady at 19. This weight gain, despite her high-intensity training, has Danika additionally frustrated. Her food intake is primarily vegetarian and includes eggs, yogurt, and cottage cheese, with fish such as tilapia or tuna twice per week and chicken about one to two times per week. Her macronutrients are currently about 15 percent protein, 25 percent fat, and 60 percent carbohydrates to “provide fuel for my distance running.” Her carbohydrates come primarily from whole-grain pasta, whole-grain bread, occasional sweet potatoes, and a large daily salad “loaded with raw veggies, a hard-boiled egg, and cottage cheese.”

APC Question 3:

Danika’s health coach has a regularly scheduled appointment with Danika every Tuesday at 11 a.m. At 10 a.m. this Tuesday morning, Danika’s health coach receives a call for an on-site interview at 11:30 a.m. with a local practitioner she has wanted to work with. The manager apologizes for the last-minute notice, but due to the doctor’s overbooked schedule and a fortunate last-minute cancellation, this is the one time the doctor can meet this week, and they are eager to hire someone as soon as possible. What is the most appropriate course of action for the health coach to take?

Case 2: Physical Activity

Danika is a 34-year-old woman who just made an appointment with a health coach with the primary goal of troubleshooting her diet, since her performance is off. The health coach gathered the following data from Danika:

• • She has trained for and completed a marathon four times per year—about once every quarter—for the past four years. 
  • She is single and wishes she had more time for a relationship, with the goal of getting married and having at least one child before she is 40 years old. 
  • She works full-time at a job she loves as a social worker for the Department of Veterans Affairs, although the interactions with her clients tend to zap her energy. 
  • To train for marathons, she tries to be in bed by 8 p.m. and awakens for runs anywhere between 2:30 a.m. and 4:30 a.m., depending on the length of the run. 

Her BMI is now 22; it used to be steady at 19. This weight gain, despite her high-intensity training, has Danika additionally frustrated. Her food intake is primarily vegetarian and includes eggs, yogurt, and cottage cheese, with fish such as tilapia or tuna twice per week and chicken about one to two times per week. Her macronutrients are currently about 15 percent protein, 25 percent fat, and 60 percent carbohydrates to “provide fuel for my distance running.” Her carbohydrates come primarily from whole-grain pasta, whole-grain bread, occasional sweet potatoes, and a large daily salad “loaded with raw veggies, a hard-boiled egg, and cottage cheese.”

FH Question 1:

Considering Danika’s longer-term goal of finding a partner and having a child, which nutrient deficiencies could be a concern for prenatal health and planning?

Case 2: Physical Activity

Danika is a 34-year-old woman who just made an appointment with a health coach with the primary goal of troubleshooting her diet, since her performance is off. The health coach gathered the following data from Danika:

• • She has trained for and completed a marathon four times per year—about once every quarter—for the past four years. 
  • She is single and wishes she had more time for a relationship, with the goal of getting married and having at least one child before she is 40 years old. 
  • She works full-time at a job she loves as a social worker for the Department of Veterans Affairs, although the interactions with her clients tend to zap her energy. 
  • To train for marathons, she tries to be in bed by 8 p.m. and awakens for runs anywhere between 2:30 a.m. and 4:30 a.m., depending on the length of the run. 

Her BMI is now 22; it used to be steady at 19. This weight gain, despite her high-intensity training, has Danika additionally frustrated. Her food intake is primarily vegetarian and includes eggs, yogurt, and cottage cheese, with fish such as tilapia or tuna twice per week and chicken about one to two times per week. Her macronutrients are currently about 15 percent protein, 25 percent fat, and 60 percent carbohydrates to “provide fuel for my distance running.” Her carbohydrates come primarily from whole-grain pasta, whole-grain bread, occasional sweet potatoes, and a large daily salad “loaded with raw veggies, a hard-boiled egg, and cottage cheese.”

FH Question 2:

What are examples of common comments from individuals who overtrain and do not allow enough recovery time or variety in exercise?

Case 3: Hypertension

Roger works on Wall Street as a day trader, commonly putting in eight- to 10-hour days. He is a 44-year-old man who is 5’11” and 180 pounds. He started having a problem with occasional headaches about a year ago that have increased to three times per week. He finally made an appointment to see his primary care provider for a physical exam. 

At the appointment, his blood pressure was 145/90, but he was otherwise deemed healthy. His doctor told him to track his morning and evening blood pressure with a monitor for three weeks. In the mornings, his blood pressure averaged 130/85, and in the evenings, the average was 140/87. His doctor gave him the option of trying a blood pressure-lowering medication or a three-month period to adjust his diet and lifestyle, including losing 5 to 8 percent of his current body weight. He decided to try the medicine-free option. A friend referred him to a health coaching practice for assistance.

On his intake form and at the initial visit, the health coach learns that he has been increasing his pants size about every two years since taking on this new job. His commute is about an hour each way. He says he has no time for exercise during the week and tries to hit the gym once on the weekend, and about once per month takes a three- to four-mile hike with his family. 

Food intake is a grab-and-go breakfast, lunch at a local deli or fast-food place, and a snack from the vending machine for his ride home. Once per week, he stays late and heads out for several beers with a group from work. Dinner during the week is whatever his partner makes—usually grilled meat with potatoes or pasta and a steamed vegetable like broccoli.

APC Question 1:

At his first visit, Roger says he wants to focus on getting his blood pressure down. The health coach’s best response is:

Case 3: Hypertension

Roger works on Wall Street as a day trader, commonly putting in eight- to 10-hour days. He is a 44-year-old man who is 5’11” and 180 pounds. He started having a problem with occasional headaches about a year ago that have increased to three times per week. He finally made an appointment to see his primary care provider for a physical exam. 

At the appointment, his blood pressure was 145/90, but he was otherwise deemed healthy. His doctor told him to track his morning and evening blood pressure with a monitor for three weeks. In the mornings, his blood pressure averaged 130/85, and in the evenings, the average was 140/87. His doctor gave him the option of trying a blood pressure-lowering medication or a three-month period to adjust his diet and lifestyle, including losing 5 to 8 percent of his current body weight. He decided to try the medicine-free option. A friend referred him to a health coaching practice for assistance.

On his intake form and at the initial visit, the health coach learns that he has been increasing his pants size about every two years since taking on this new job. His commute is about an hour each way. He says he has no time for exercise during the week and tries to hit the gym once on the weekend, and about once per month takes a three- to four-mile hike with his family. 

Food intake is a grab-and-go breakfast, lunch at a local deli or fast-food place, and a snack from the vending machine for his ride home. Once per week, he stays late and heads out for several beers with a group from work. Dinner during the week is whatever his partner makes—usually grilled meat with potatoes or pasta and a steamed vegetable like broccoli.

APC Question 2:

During his second appointment, Roger and his health coach focus on developing a vision statement and long-term goals. The most appropriate example of a response to Roger’s effort is:

Case 3: Hypertension

Roger works on Wall Street as a day trader, commonly putting in eight- to 10-hour days. He is a 44-year-old man who is 5’11” and 180 pounds. He started having a problem with occasional headaches about a year ago that have increased to three times per week. He finally made an appointment to see his primary care provider for a physical exam. 

At the appointment, his blood pressure was 145/90, but he was otherwise deemed healthy. His doctor told him to track his morning and evening blood pressure with a monitor for three weeks. In the mornings, his blood pressure averaged 130/85, and in the evenings, the average was 140/87. His doctor gave him the option of trying a blood pressure-lowering medication or a three-month period to adjust his diet and lifestyle, including losing 5 to 8 percent of his current body weight. He decided to try the medicine-free option. A friend referred him to a health coaching practice for assistance.

On his intake form and at the initial visit, the health coach learns that he has been increasing his pants size about every two years since taking on this new job. His commute is about an hour each way. He says he has no time for exercise during the week and tries to hit the gym once on the weekend, and about once per month takes a three- to four-mile hike with his family. 

Food intake is a grab-and-go breakfast, lunch at a local deli or fast-food place, and a snack from the vending machine for his ride home. Once per week, he stays late and heads out for several beers with a group from work. Dinner during the week is whatever his partner makes—usually grilled meat with potatoes or pasta and a steamed vegetable like broccoli.

APC Question 3:

Roger mentions to his health coach that he is feeling down and a bit hopeless about his blood pressure. The most appropriate response from his coach would be:

Case 3: Hypertension

Roger works on Wall Street as a day trader, commonly putting in eight- to 10-hour days. He is a 44-year-old man who is 5’11” and 180 pounds. He started having a problem with occasional headaches about a year ago that have increased to three times per week. He finally made an appointment to see his primary care provider for a physical exam. 

At the appointment, his blood pressure was 145/90, but he was otherwise deemed healthy. His doctor told him to track his morning and evening blood pressure with a monitor for three weeks. In the mornings, his blood pressure averaged 130/85, and in the evenings, the average was 140/87. His doctor gave him the option of trying a blood pressure-lowering medication or a three-month period to adjust his diet and lifestyle, including losing 5 to 8 percent of his current body weight. He decided to try the medicine-free option. A friend referred him to a health coaching practice for assistance.

On his intake form and at the initial visit, the health coach learns that he has been increasing his pants size about every two years since taking on this new job. His commute is about an hour each way. He says he has no time for exercise during the week and tries to hit the gym once on the weekend, and about once per month takes a three- to four-mile hike with his family. 

Food intake is a grab-and-go breakfast, lunch at a local deli or fast-food place, and a snack from the vending machine for his ride home. Once per week, he stays late and heads out for several beers with a group from work. Dinner during the week is whatever his partner makes—usually grilled meat with potatoes or pasta and a steamed vegetable like broccoli.

FH Question 1:

Which of the following diet and lifestyle strategies would likely be most effective in helping Roger lower his blood pressure in the three-month trial offered by his doctor?

Case 3: Hypertension

Roger works on Wall Street as a day trader, commonly putting in eight- to 10-hour days. He is a 44-year-old man who is 5’11” and 180 pounds. He started having a problem with occasional headaches about a year ago that have increased to three times per week. He finally made an appointment to see his primary care provider for a physical exam. 

At the appointment, his blood pressure was 145/90, but he was otherwise deemed healthy. His doctor told him to track his morning and evening blood pressure with a monitor for three weeks. In the mornings, his blood pressure averaged 130/85, and in the evenings, the average was 140/87. His doctor gave him the option of trying a blood pressure-lowering medication or a three-month period to adjust his diet and lifestyle, including losing 5 to 8 percent of his current body weight. He decided to try the medicine-free option. A friend referred him to a health coaching practice for assistance.

On his intake form and at the initial visit, the health coach learns that he has been increasing his pants size about every two years since taking on this new job. His commute is about an hour each way. He says he has no time for exercise during the week and tries to hit the gym once on the weekend, and about once per month takes a three- to four-mile hike with his family. 

Food intake is a grab-and-go breakfast, lunch at a local deli or fast-food place, and a snack from the vending machine for his ride home. Once per week, he stays late and heads out for several beers with a group from work. Dinner during the week is whatever his partner makes—usually grilled meat with potatoes or pasta and a steamed vegetable like broccoli.

FH Question 2:

What is an example of the best lunch restaurant meal for Roger, considering his goal to lower his blood pressure?

Case 4: Autoimmune Disease

Robyn is a 22-year-old woman starting the first year of a three-year doctor of physical therapy (DPT) program. She was a basically healthy kid and pre-teen, but shortly after her cycle started at age 13, she began experiencing what she described as red, scaly, and painful rashes, mostly on her arms and legs.

She was diagnosed with an autoimmune skin condition called psoriasis at age 14. Between ages 14 and 18, the condition was minimized using a variety of creams and medications. However, the stress of going away to college at age 18 seemed to trigger the condition, which resulted in her doctor prescribing a heavy-duty immune-suppressing medication called methotrexate. While she did not like some of the side effects of the medication, the rash was better, and Robyn was able to stop the medication during her last year of undergraduate school. 

When she started her DPT program, which required a move to another state, she had another bad flare-up that now included gastrointestinal symptoms, including diarrhea, smelly gas, and nausea. Desperate to improve her health and stay in school, she got an emergency appointment with a Functional Medicine-trained doctor nearby. This provider helped Robyn understand two important things: 1) once a person has one autoimmune condition, she is highly susceptible to additional autoimmune conditions; and 2) autoimmune conditions might be reversible by applying diet, lifestyle, and supplementation strategies.

The doctor did advanced testing on Robyn to rule out celiac disease and assess for nutrient deficiencies and her fatty-acid profile. She was negative for celiac disease but positive for non-celiac gluten sensitivity and a dairy sensitivity. She was also high in omega-6 fatty acids and low in omega-3 fatty acids. She was very high in arachidonic acid. Her high-sensitivity C-reactive protein was 5.5. The doctor supported Robyn with supplements and referred her to his office health coach for assistance in implementing his protocol for a gluten- and dairy-free Paleo reset plan focusing on foods rich in skin and gut health nutrients that was also anti-inflammatory. The health coach was also asked to support Robyn with optimizing her social connections, exercise, sleep, and stress management.

APC Question 1:

Before beginning the relationship with Robyn, the health coach sends her a contract to review and sign. Which of the following is mandatory to include in any coaching agreement?

Case 4: Autoimmune Disease

Robyn is a 22-year-old woman starting the first year of a three-year doctor of physical therapy (DPT) program. She was a basically healthy kid and pre-teen, but shortly after her cycle started at age 13, she began experiencing what she described as red, scaly, and painful rashes, mostly on her arms and legs.

She was diagnosed with an autoimmune skin condition called psoriasis at age 14. Between ages 14 and 18, the condition was minimized using a variety of creams and medications. However, the stress of going away to college at age 18 seemed to trigger the condition, which resulted in her doctor prescribing a heavy-duty immune-suppressing medication called methotrexate. While she did not like some of the side effects of the medication, the rash was better, and Robyn was able to stop the medication during her last year of undergraduate school. 

When she started her DPT program, which required a move to another state, she had another bad flare-up that now included gastrointestinal symptoms, including diarrhea, smelly gas, and nausea. Desperate to improve her health and stay in school, she got an emergency appointment with a Functional Medicine-trained doctor nearby. This provider helped Robyn understand two important things: 1) once a person has one autoimmune condition, she is highly susceptible to additional autoimmune conditions; and 2) autoimmune conditions might be reversible by applying diet, lifestyle, and supplementation strategies.

The doctor did advanced testing on Robyn to rule out celiac disease and assess for nutrient deficiencies and her fatty-acid profile. She was negative for celiac disease but positive for non-celiac gluten sensitivity and a dairy sensitivity. She was also high in omega-6 fatty acids and low in omega-3 fatty acids. She was very high in arachidonic acid. Her high-sensitivity C-reactive protein was 5.5. The doctor supported Robyn with supplements and referred her to his office health coach for assistance in implementing his protocol for a gluten- and dairy-free Paleo reset plan focusing on foods rich in skin and gut health nutrients that was also anti-inflammatory. The health coach was also asked to support Robyn with optimizing her social connections, exercise, sleep, and stress management.

APC Question 2:

This particular health coach also sells essential oils to her clients, and she tells them ahead of time this is a feature of her practice. During her sessions, she suggests that Robyn use specific oils to alleviate symptoms. The recommendations always include the suggestion to buy the type of oils that the health coach sells. What is the issue with the coach’s approach?

Case 4: Autoimmune Disease

Robyn is a 22-year-old woman starting the first year of a three-year doctor of physical therapy (DPT) program. She was a basically healthy kid and pre-teen, but shortly after her cycle started at age 13, she began experiencing what she described as red, scaly, and painful rashes, mostly on her arms and legs.

She was diagnosed with an autoimmune skin condition called psoriasis at age 14. Between ages 14 and 18, the condition was minimized using a variety of creams and medications. However, the stress of going away to college at age 18 seemed to trigger the condition, which resulted in her doctor prescribing a heavy-duty immune-suppressing medication called methotrexate. While she did not like some of the side effects of the medication, the rash was better, and Robyn was able to stop the medication during her last year of undergraduate school. 

When she started her DPT program, which required a move to another state, she had another bad flare-up that now included gastrointestinal symptoms, including diarrhea, smelly gas, and nausea. Desperate to improve her health and stay in school, she got an emergency appointment with a Functional Medicine-trained doctor nearby. This provider helped Robyn understand two important things: 1) once a person has one autoimmune condition, she is highly susceptible to additional autoimmune conditions; and 2) autoimmune conditions might be reversible by applying diet, lifestyle, and supplementation strategies.

The doctor did advanced testing on Robyn to rule out celiac disease and assess for nutrient deficiencies and her fatty-acid profile. She was negative for celiac disease but positive for non-celiac gluten sensitivity and a dairy sensitivity. She was also high in omega-6 fatty acids and low in omega-3 fatty acids. She was very high in arachidonic acid. Her high-sensitivity C-reactive protein was 5.5. The doctor supported Robyn with supplements and referred her to his office health coach for assistance in implementing his protocol for a gluten- and dairy-free Paleo reset plan focusing on foods rich in skin and gut health nutrients that was also anti-inflammatory. The health coach was also asked to support Robyn with optimizing her social connections, exercise, sleep, and stress management.

APC Question 3:

During the second coaching session, Robyn shares with the coach that her mother will not leave her alone regarding her eating habits. She says, “My mother is constantly nagging me about what I should or shouldn’t eat.” What is the appropriate response from the health coach?

Case 4: Autoimmune Disease

Robyn is a 22-year-old woman starting the first year of a three-year doctor of physical therapy (DPT) program. She was a basically healthy kid and pre-teen, but shortly after her cycle started at age 13, she began experiencing what she described as red, scaly, and painful rashes, mostly on her arms and legs.

She was diagnosed with an autoimmune skin condition called psoriasis at age 14. Between ages 14 and 18, the condition was minimized using a variety of creams and medications. However, the stress of going away to college at age 18 seemed to trigger the condition, which resulted in her doctor prescribing a heavy-duty immune-suppressing medication called methotrexate. While she did not like some of the side effects of the medication, the rash was better, and Robyn was able to stop the medication during her last year of undergraduate school. 

When she started her DPT program, which required a move to another state, she had another bad flare-up that now included gastrointestinal symptoms, including diarrhea, smelly gas, and nausea. Desperate to improve her health and stay in school, she got an emergency appointment with a Functional Medicine-trained doctor nearby. This provider helped Robyn understand two important things: 1) once a person has one autoimmune condition, she is highly susceptible to additional autoimmune conditions; and 2) autoimmune conditions might be reversible by applying diet, lifestyle, and supplementation strategies.

The doctor did advanced testing on Robyn to rule out celiac disease and assess for nutrient deficiencies and her fatty-acid profile. She was negative for celiac disease but positive for non-celiac gluten sensitivity and a dairy sensitivity. She was also high in omega-6 fatty acids and low in omega-3 fatty acids. She was very high in arachidonic acid. Her high-sensitivity C-reactive protein was 5.5. The doctor supported Robyn with supplements and referred her to his office health coach for assistance in implementing his protocol for a gluten- and dairy-free Paleo reset plan focusing on foods rich in skin and gut health nutrients that was also anti-inflammatory. The health coach was also asked to support Robyn with optimizing her social connections, exercise, sleep, and stress management.

FH Question 1:

To better balance her omega-3 and omega-6 fats, Robyn should eat:

Case 4: Autoimmune Disease

Robyn is a 22-year-old woman starting the first year of a three-year doctor of physical therapy (DPT) program. She was a basically healthy kid and pre-teen, but shortly after her cycle started at age 13, she began experiencing what she described as red, scaly, and painful rashes, mostly on her arms and legs.

She was diagnosed with an autoimmune skin condition called psoriasis at age 14. Between ages 14 and 18, the condition was minimized using a variety of creams and medications. However, the stress of going away to college at age 18 seemed to trigger the condition, which resulted in her doctor prescribing a heavy-duty immune-suppressing medication called methotrexate. While she did not like some of the side effects of the medication, the rash was better, and Robyn was able to stop the medication during her last year of undergraduate school. 

When she started her DPT program, which required a move to another state, she had another bad flare-up that now included gastrointestinal symptoms, including diarrhea, smelly gas, and nausea. Desperate to improve her health and stay in school, she got an emergency appointment with a Functional Medicine-trained doctor nearby. This provider helped Robyn understand two important things: 1) once a person has one autoimmune condition, she is highly susceptible to additional autoimmune conditions; and 2) autoimmune conditions might be reversible by applying diet, lifestyle, and supplementation strategies.

The doctor did advanced testing on Robyn to rule out celiac disease and assess for nutrient deficiencies and her fatty-acid profile. She was negative for celiac disease but positive for non-celiac gluten sensitivity and a dairy sensitivity. She was also high in omega-6 fatty acids and low in omega-3 fatty acids. She was very high in arachidonic acid. Her high-sensitivity C-reactive protein was 5.5. The doctor supported Robyn with supplements and referred her to his office health coach for assistance in implementing his protocol for a gluten- and dairy-free Paleo reset plan focusing on foods rich in skin and gut health nutrients that was also anti-inflammatory. The health coach was also asked to support Robyn with optimizing her social connections, exercise, sleep, and stress management.

FH Question 2:

For Robyn’s health concerns, what is the primary goal of a gluten-free and dairy-free Paleo reset?

Case 5: Gastrointestinal Condition

Peg is a 67-year-old woman who is seeing her doctor due to recurrent diarrhea. This is her third visit in the past month. She stated that she thinks the bouts of diarrhea are tied to food, but she is not sure. A stool test run by the doctor came back negative for common infections. Peg said that taking an over-the-counter medicine, Imodium, has been helpful, but she wants to figure out what the problem is so she does not have to take the medicine all the time. Also, she has had a couple of incidents where she had really embarrassing sudden diarrhea where she did not make it to the bathroom in time. She is very fearful that this might happen again. She also mentioned that she has smelly gas.

  The doctor referred Peg to a consultation with the team’s registered dietitian (RD) regarding a trial elimination diet to help Peg troubleshoot possible suspect foods. The RD provided Peg with a trial elimination plan taking out suspect foods—dairy, gluten, and high-fructose fruits and beverages—for three weeks, followed by challenging each of the foods back in one at a time while monitoring diarrhea. The RD provided Peg with lists of foods to avoid and foods to use as alternatives, including a couple of recipes. 

After the first week, Peg called the RD to say she was still having trouble with ideas for food and recipes and that she needed help with how to eat out and where to go. She also said she did not understand how to add the foods back in for the challenge and needed additional help there. The doctor and RD decided to refer Peg to the office health coach for additional guidance with these topics, with a follow-up appointment planned with the RD in six weeks, or sooner if deemed necessary.

APC Question 1:

During her first meeting with the health coach, Peg says, “I just want you to tell me what to do. I need ideas for food and recipes.” What is the appropriate response for the health coach?

Case 5: Gastrointestinal Condition

Peg is a 67-year-old woman who is seeing her doctor due to recurrent diarrhea. This is her third visit in the past month. She stated that she thinks the bouts of diarrhea are tied to food, but she is not sure. A stool test run by the doctor came back negative for common infections. Peg said that taking an over-the-counter medicine, Imodium, has been helpful, but she wants to figure out what the problem is so she does not have to take the medicine all the time. Also, she has had a couple of incidents where she had really embarrassing sudden diarrhea where she did not make it to the bathroom in time. She is very fearful that this might happen again. She also mentioned that she has smelly gas.

  The doctor referred Peg to a consultation with the team’s registered dietitian (RD) regarding a trial elimination diet to help Peg troubleshoot possible suspect foods. The RD provided Peg with a trial elimination plan taking out suspect foods—dairy, gluten, and high-fructose fruits and beverages—for three weeks, followed by challenging each of the foods back in one at a time while monitoring diarrhea. The RD provided Peg with lists of foods to avoid and foods to use as alternatives, including a couple of recipes. 

After the first week, Peg called the RD to say she was still having trouble with ideas for food and recipes and that she needed help with how to eat out and where to go. She also said she did not understand how to add the foods back in for the challenge and needed additional help there. The doctor and RD decided to refer Peg to the office health coach for additional guidance with these topics, with a follow-up appointment planned with the RD in six weeks, or sooner if deemed necessary.

APC Question 2:

At the initial session, based on Peg’s stage of change, what’s the best approach the coach could take?

Case 5: Gastrointestinal Condition

Peg is a 67-year-old woman who is seeing her doctor due to recurrent diarrhea. This is her third visit in the past month. She stated that she thinks the bouts of diarrhea are tied to food, but she is not sure. A stool test run by the doctor came back negative for common infections. Peg said that taking an over-the-counter medicine, Imodium, has been helpful, but she wants to figure out what the problem is so she does not have to take the medicine all the time. Also, she has had a couple of incidents where she had really embarrassing sudden diarrhea where she did not make it to the bathroom in time. She is very fearful that this might happen again. She also mentioned that she has smelly gas.

  The doctor referred Peg to a consultation with the team’s registered dietitian (RD) regarding a trial elimination diet to help Peg troubleshoot possible suspect foods. The RD provided Peg with a trial elimination plan taking out suspect foods—dairy, gluten, and high-fructose fruits and beverages—for three weeks, followed by challenging each of the foods back in one at a time while monitoring diarrhea. The RD provided Peg with lists of foods to avoid and foods to use as alternatives, including a couple of recipes. 

After the first week, Peg called the RD to say she was still having trouble with ideas for food and recipes and that she needed help with how to eat out and where to go. She also said she did not understand how to add the foods back in for the challenge and needed additional help there. The doctor and RD decided to refer Peg to the office health coach for additional guidance with these topics, with a follow-up appointment planned with the RD in six weeks, or sooner if deemed necessary.

APC Question 3:

At one point during this first session, Peg tears up and says that she is tired from worrying about all of this and afraid she won’t be able to change it. What is the most appropriate answer from the health coach?

Case 5: Gastrointestinal Condition

Peg is a 67-year-old woman who is seeing her doctor due to recurrent diarrhea. This is her third visit in the past month. She stated that she thinks the bouts of diarrhea are tied to food, but she is not sure. A stool test run by the doctor came back negative for common infections. Peg said that taking an over-the-counter medicine, Imodium, has been helpful, but she wants to figure out what the problem is so she does not have to take the medicine all the time. Also, she has had a couple of incidents where she had really embarrassing sudden diarrhea where she did not make it to the bathroom in time. She is very fearful that this might happen again. She also mentioned that she has smelly gas.

  The doctor referred Peg to a consultation with the team’s registered dietitian (RD) regarding a trial elimination diet to help Peg troubleshoot possible suspect foods. The RD provided Peg with a trial elimination plan taking out suspect foods—dairy, gluten, and high-fructose fruits and beverages—for three weeks, followed by challenging each of the foods back in one at a time while monitoring diarrhea. The RD provided Peg with lists of foods to avoid and foods to use as alternatives, including a couple of recipes. 

After the first week, Peg called the RD to say she was still having trouble with ideas for food and recipes and that she needed help with how to eat out and where to go. She also said she did not understand how to add the foods back in for the challenge and needed additional help there. The doctor and RD decided to refer Peg to the office health coach for additional guidance with these topics, with a follow-up appointment planned with the RD in six weeks, or sooner if deemed necessary.

FH Question 1:

In addition to the recommendations from the RD, what are some possible strategies that might also help someone with diarrhea that are within the scope of practice of a health coach?

Case 5: Gastrointestinal Condition

Peg is a 67-year-old woman who is seeing her doctor due to recurrent diarrhea. This is her third visit in the past month. She stated that she thinks the bouts of diarrhea are tied to food, but she is not sure. A stool test run by the doctor came back negative for common infections. Peg said that taking an over-the-counter medicine, Imodium, has been helpful, but she wants to figure out what the problem is so she does not have to take the medicine all the time. Also, she has had a couple of incidents where she had really embarrassing sudden diarrhea where she did not make it to the bathroom in time. She is very fearful that this might happen again. She also mentioned that she has smelly gas.

  The doctor referred Peg to a consultation with the team’s registered dietitian (RD) regarding a trial elimination diet to help Peg troubleshoot possible suspect foods. The RD provided Peg with a trial elimination plan taking out suspect foods—dairy, gluten, and high-fructose fruits and beverages—for three weeks, followed by challenging each of the foods back in one at a time while monitoring diarrhea. The RD provided Peg with lists of foods to avoid and foods to use as alternatives, including a couple of recipes. 

After the first week, Peg called the RD to say she was still having trouble with ideas for food and recipes and that she needed help with how to eat out and where to go. She also said she did not understand how to add the foods back in for the challenge and needed additional help there. The doctor and RD decided to refer Peg to the office health coach for additional guidance with these topics, with a follow-up appointment planned with the RD in six weeks, or sooner if deemed necessary.

FH Question 2:

At what point do you know it’s time to refer Peg back to the RD/doctor?