Instruction: Nutritional Advice33F, currently 150 lbs, 5'6", white. Previous diagnoses: PCOS, migraines with aura, acid reflux, several skin allergies. Medication: None currently. Alcohol: 1-2 glass of red wine per week, no recreational drugs.TL;DR: How the hell is one supposed to eat 18 mg of iron daily?Very bad choices led me to gain a lot of weight in my 20s, got to be a max of ~220 lbs by the end of 2018. GP told me I needed to lose weight, so I did. I started eating healthier and exercising more. For the past 4 months I've been eating below 1400 calories on average. I'm still losing weight, but I started to feel very tired in general, and get easily out of breath while exercising. GP send my to take a blood panel 2 months ago. Results came back and he said I was ok but said that since CBC values came considerably lower than the last few times, I needed to eat more iron rich foods. Since I'm already logging the foods with an app that tells me the nutrients, he said I should aim on getting 18 mg of iron daily, and explained all the ways of maxing iron absorption (vitamin C with heme iron, avoid dairy in same meal, etc).So it's been 6 weeks since I started paying attention to the iron. I use a digital scale, and verified sources (like USDA) to check iron amounts on every food. I still have severe issues trying to reach that daily amount. It seems like the only days I'm able to reach it is when I ether eat beef liver, mussels or a huge amount of spinach. I love spinach, but I don't really enjoy liver or mussels so I have to find ways to have them. Beans, lentils and seeds are good, but I can't have too many since I'm still losing weight. The days I have those with some eggs, I still can't reach 10 mg of iron.Past 2 to 3 weeks have been worse, I feel even more fatigued and dizzy than before. I think because of the pandemic measures in my country, my GP's office have stopped answering phones. I left a voice message but haven't hear back from them yet.So question is.. how do people do it? It seems an insane amount to get daily.If it matters, here's my last BP:Hc: 36%Hb: 11.9 g/dLRBC: 3.880.000 /mm3Colour Index: 79.33%MCV: 92.78 /um3MCH: 30.67 pgMCHC: 33.06 g/dLI would greatly appreciate any input on how to improve my nutrition

Output: Hmm, based on those results your hemoglobin is low, however the pattern doesn't really look like iron deficiency. With the PCOS do you have a lot of bleeding? It could be that your body is just unable to keep up with the blood loss. You might ask your doctor to check your iron levels to be sure. I think the amount of iron you are eating is probably okay based on the results you posted. If you want to try to get more, you could try an iron supplement, but if you do start at a fairly low dose and go up gradually because it can cause some stomach upset. If you can't find iron supplements, you could try prenatal vitamins which tend to be well balanced and have high levels of iron. It's hard to tell just from the parameters you posted, but I would also be concerned about your vitamin B12 levels. Make sure you are getting the recommended dose of B12, and consider adding a B12 supplement. If you are still having trouble after a couple weeks of this, and your hemoglobin remains low, you should probably have your iron and B12 levels checked. (for the sake of clarity, we usually don't actually check B12, we check some other chemicals in the B12 pathway)

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nutritional Advice33F, currently 150 lbs, 5'6", white. Previous diagnoses: PCOS, migraines with aura, acid reflux, several skin allergies. Medication: None currently. Alcohol: 1-2 glass of red wine per week, no recreational drugs.TL;DR: How the hell is one supposed to eat 18 mg of iron daily?Very bad choices led me to gain a lot of weight in my 20s, got to be a max of ~220 lbs by the end of 2018. GP told me I needed to lose weight, so I did. I started eating healthier and exercising more. For the past 4 months I've been eating below 1400 calories on average. I'm still losing weight, but I started to feel very tired in general, and get easily out of breath while exercising. GP send my to take a blood panel 2 months ago. Results came back and he said I was ok but said that since CBC values came considerably lower than the last few times, I needed to eat more iron rich foods. Since I'm already logging the foods with an app that tells me the nutrients, he said I should aim on getting 18 mg of iron daily, and explained all the ways of maxing iron absorption (vitamin C with heme iron, avoid dairy in same meal, etc).So it's been 6 weeks since I started paying attention to the iron. I use a digital scale, and verified sources (like USDA) to check iron amounts on every food. I still have severe issues trying to reach that daily amount. It seems like the only days I'm able to reach it is when I ether eat beef liver, mussels or a huge amount of spinach. I love spinach, but I don't really enjoy liver or mussels so I have to find ways to have them. Beans, lentils and seeds are good, but I can't have too many since I'm still losing weight. The days I have those with some eggs, I still can't reach 10 mg of iron.Past 2 to 3 weeks have been worse, I feel even more fatigued and dizzy than before. I think because of the pandemic measures in my country, my GP's office have stopped answering phones. I left a voice message but haven't hear back from them yet.So question is.. how do people do it? It seems an insane amount to get daily.If it matters, here's my last BP:Hc: 36%Hb: 11.9 g/dLRBC: 3.880.000 /mm3Colour Index: 79.33%MCV: 92.78 /um3MCH: 30.67 pgMCHC: 33.06 g/dLI would greatly appreciate any input on how to improve my nutrition. ### Response: Hmm, based on those results your hemoglobin is low, however the pattern doesn't really look like iron deficiency. With the PCOS do you have a lot of bleeding? It could be that your body is just unable to keep up with the blood loss. You might ask your doctor to check your iron levels to be sure. I think the amount of iron you are eating is probably okay based on the results you posted. If you want to try to get more, you could try an iron supplement, but if you do start at a fairly low dose and go up gradually because it can cause some stomach upset. If you can't find iron supplements, you could try prenatal vitamins which tend to be well balanced and have high levels of iron. It's hard to tell just from the parameters you posted, but I would also be concerned about your vitamin B12 levels. Make sure you are getting the recommended dose of B12, and consider adding a B12 supplement. If you are still having trouble after a couple weeks of this, and your hemoglobin remains low, you should probably have your iron and B12 levels checked. (for the sake of clarity, we usually don't actually check B12, we check some other chemicals in the B12 pathway).


Instruction: I have not noted an increase in bleeding. I also go yearly to my gyno, last time I did a check was on January, PAP smear was normal, and last TV ultrasound showed normal follicles, gyno said she thinks losing weight might have helped.I haven't had my B12 checked, but the app to track nutrients tells me I'm almost always good on B12 levels.I'll see if I can find the supplements you suggested, and start from that. I don't see being able to take a blood sample again soon because of the COVID situation here, since only emergency appointments are allowed.Thanks a lot for your time and answer and have a lovely day!

Output: The amount of B12 you're eating might be good for maintenance (to keep your level stable), but if you are low, you might need more. Especially if you have Had a poor diet in the past, the levels stored in your body might be low

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I have not noted an increase in bleeding. I also go yearly to my gyno, last time I did a check was on January, PAP smear was normal, and last TV ultrasound showed normal follicles, gyno said she thinks losing weight might have helped.I haven't had my B12 checked, but the app to track nutrients tells me I'm almost always good on B12 levels.I'll see if I can find the supplements you suggested, and start from that. I don't see being able to take a blood sample again soon because of the COVID situation here, since only emergency appointments are allowed.Thanks a lot for your time and answer and have a lovely day!. ### Response: The amount of B12 you're eating might be good for maintenance (to keep your level stable), but if you are low, you might need more. Especially if you have Had a poor diet in the past, the levels stored in your body might be low.


Instruction: Child Weight/NutritionMy son is 4 years old and one month. He's 39.36 inches tall and weighs 40 pounds even. According to bmi he is obese. I am asking what would be good numbers of calories and nutrients to feed him? He's very active so I'm not concerned about excercise. Also his pediatrician says his weights fine and that bmi's don't always work right for children, is that accurate? Should I just not worry because a growth spurts close? I'm prone to worrying when there's no problem so maybe the doctors right? The only reason I'm even doubting the doctor is because he is, at a guess 375-400 pounds, and I worry he is more okay with obesity than he should be. My son was 9 ppunds and 8.9 ounces at birth, caucasian, non-Hispanic. If that's relevantEdited to add: He has just gotten over pneumonia twice and has low IGG, we are seeing an immunologist soon to figure out why. So taking him places to figure out calories and nutrients isn't really possible right now because we are staying inside. Just hoping for advice until I can take him out, thank you :)

Output: Obesity at his age is highly associated with adult obesity, but far easier to fix now than later. Some kids slim down but many do not.Easiest solution is to meet with a registered dietician (NOT a nutritionist). They can help you plan meals so he has the right number of calories / balance of nutrients.That being said, the easiest (and one of the more effective) ways to slow weight gain is elimination of all liquid calories, even milk. Only water to drink.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Child Weight/NutritionMy son is 4 years old and one month. He's 39.36 inches tall and weighs 40 pounds even. According to bmi he is obese. I am asking what would be good numbers of calories and nutrients to feed him? He's very active so I'm not concerned about excercise. Also his pediatrician says his weights fine and that bmi's don't always work right for children, is that accurate? Should I just not worry because a growth spurts close? I'm prone to worrying when there's no problem so maybe the doctors right? The only reason I'm even doubting the doctor is because he is, at a guess 375-400 pounds, and I worry he is more okay with obesity than he should be. My son was 9 ppunds and 8.9 ounces at birth, caucasian, non-Hispanic. If that's relevantEdited to add: He has just gotten over pneumonia twice and has low IGG, we are seeing an immunologist soon to figure out why. So taking him places to figure out calories and nutrients isn't really possible right now because we are staying inside. Just hoping for advice until I can take him out, thank you :). ### Response: Obesity at his age is highly associated with adult obesity, but far easier to fix now than later. Some kids slim down but many do not.Easiest solution is to meet with a registered dietician (NOT a nutritionist). They can help you plan meals so he has the right number of calories / balance of nutrients.That being said, the easiest (and one of the more effective) ways to slow weight gain is elimination of all liquid calories, even milk. Only water to drink..


Instruction: I'm probably not going to make an appointment with a dietitian right now because of the coronavirus and my son also has a weakend immune system which I probably should have mentioned, so any ballparks would be helpful until I can get in. We have been cutting out calorie drinks besides milk at breakfast and juice with dinner. The confusing thing for me is he really doesn't snack, maybe he was just having way too much juice before. Thank you!

Output: You can do a phone appointment with an RD.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I'm probably not going to make an appointment with a dietitian right now because of the coronavirus and my son also has a weakend immune system which I probably should have mentioned, so any ballparks would be helpful until I can get in. We have been cutting out calorie drinks besides milk at breakfast and juice with dinner. The confusing thing for me is he really doesn't snack, maybe he was just having way too much juice before. Thank you!. ### Response: You can do a phone appointment with an RD..


Instruction: What will happen to someone (29F) drinking only one 330 Calorie nutrition shake a day?A friend has been having a mysterious, very serious neck/jaw issue for the last two years, rendering her unable to eat solid food. She has been to many doctors, who were all unable to diagnose or treat the issue.She often lives on Kate Farms nutrition shakes, which have 330 Calories each. She would usually drink 4-5 a day, plus whatever else she felt able to swallow. Recently however, in particular after restarting taking her antidepressant medication, the feeling of choking on anything she tries to drink has worsened  she describes it being possible to drink a shake in the morning after waking up, but getting more and more difficult throughout the day.She reports that she has only had an average of one a day for the last 3 or 4 days. There's no sign that it's getting better, and she is feeling resistant to trying to drink more of them because it is so physically unpleasant/scary to do so. I'd like to present her with some solid information about the progression of malnutrition  what kind of symptom timeline can she expect if she stays at this extremely low Calorie intake?She is already obviously very low-energy and depressed. I'm looking for concrete info on how many days of 1 shake/day average it will take before other serious physical symptoms of malnutrition emerge.Thanks!Age: 29Sex: FemaleHeight: 5'4"Weight: ~130, reports losing 50lbs from normal weight a year agoRace: ChineseLocation: Eastern US

Output: They will die. This is not enough food to live. She needs to go to the hospital.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: What will happen to someone (29F) drinking only one 330 Calorie nutrition shake a day?A friend has been having a mysterious, very serious neck/jaw issue for the last two years, rendering her unable to eat solid food. She has been to many doctors, who were all unable to diagnose or treat the issue.She often lives on Kate Farms nutrition shakes, which have 330 Calories each. She would usually drink 4-5 a day, plus whatever else she felt able to swallow. Recently however, in particular after restarting taking her antidepressant medication, the feeling of choking on anything she tries to drink has worsened  she describes it being possible to drink a shake in the morning after waking up, but getting more and more difficult throughout the day.She reports that she has only had an average of one a day for the last 3 or 4 days. There's no sign that it's getting better, and she is feeling resistant to trying to drink more of them because it is so physically unpleasant/scary to do so. I'd like to present her with some solid information about the progression of malnutrition  what kind of symptom timeline can she expect if she stays at this extremely low Calorie intake?She is already obviously very low-energy and depressed. I'm looking for concrete info on how many days of 1 shake/day average it will take before other serious physical symptoms of malnutrition emerge.Thanks!Age: 29Sex: FemaleHeight: 5'4"Weight: ~130, reports losing 50lbs from normal weight a year agoRace: ChineseLocation: Eastern US. ### Response: They will die. This is not enough food to live. She needs to go to the hospital..


Instruction: Flu-like ache but definitely not the flu. Could it be linked to a nutritional deficiency?32 F.Height 5' 11. Weight 145lbs.Vegan diet, health-conscious, mildly-moderately active.I've basically had fatigue and consistent mild pain since I was a teenager (my doctor put it down to depression). But this has continued into adulthood and I'm becoming determined to get to the bottom of it.But for the past couple of weeks I've been having this really weird sensation of a deep ache and tightness throughout my body, like it's in my bones and my joints. The closest thing I can describe it as is that it's similar to when you have body aches with the flu, but not nearly that bad. It's quite mild, but I feel like I can feel it throughout my chest/back/ribs, in my arms and hands, and occasionally in my legs. It's not debilitating, it's just weird and a little uncomfortable. It's not consistent either, it sort of comes in little waves/pulses. I get a deep pain in my leg bones sometimes when the weather is very hot or very cold, and it's a similar ache to that but again not as severe, just a similar 'deep'ness.Have you heard of this before?!I'm looking into getting some tests done to see if I have a chronic deficiency. Last time I was tested I was told I don't have anaemia, but I'm also interested in vitamin B12 and D deficiencies. Also considering getting the genetic sequencing test to look for MTHFR mutation, because from my own research it seems that a lot of my symptoms link up with this.Is there anything else I should get tested for?I typically eat a very healthy, balanced diet. I get plenty of protein, supplement with a good quality B12, take vitamin D drops in winter, occasionally take Floradix for iron if I know I haven't eaten much iron that day. Occasionally I take K2 and hemp seed oil for omega 3-6-9.

Output: With vague non-specific body aches like that, a doctor can help elucidate a more thorough and specific history and exam. Not sure how long ago the last set of labs were and what exactly the hemoglobin and MCV values were, Id start with repeating routine labs like CBC and CMP, maybe a CK to check for muscle breakdown. TSH and vitamin D levels would not be unreasonable. The presence or lack of anemia on repeat testing can guide whether or not a B12 or homocysteine should be checked. Not sure why one would bypass these cheaper and possibly indicated tests for an expensive test for a gene variant that wouldnt change management without starting with routine labs and going from there.If one were truly concerned about malabsorption from diet, then consider celiacs testing and ruling out IBD if there are other GI issues.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Flu-like ache but definitely not the flu. Could it be linked to a nutritional deficiency?32 F.Height 5' 11. Weight 145lbs.Vegan diet, health-conscious, mildly-moderately active.I've basically had fatigue and consistent mild pain since I was a teenager (my doctor put it down to depression). But this has continued into adulthood and I'm becoming determined to get to the bottom of it.But for the past couple of weeks I've been having this really weird sensation of a deep ache and tightness throughout my body, like it's in my bones and my joints. The closest thing I can describe it as is that it's similar to when you have body aches with the flu, but not nearly that bad. It's quite mild, but I feel like I can feel it throughout my chest/back/ribs, in my arms and hands, and occasionally in my legs. It's not debilitating, it's just weird and a little uncomfortable. It's not consistent either, it sort of comes in little waves/pulses. I get a deep pain in my leg bones sometimes when the weather is very hot or very cold, and it's a similar ache to that but again not as severe, just a similar 'deep'ness.Have you heard of this before?!I'm looking into getting some tests done to see if I have a chronic deficiency. Last time I was tested I was told I don't have anaemia, but I'm also interested in vitamin B12 and D deficiencies. Also considering getting the genetic sequencing test to look for MTHFR mutation, because from my own research it seems that a lot of my symptoms link up with this.Is there anything else I should get tested for?I typically eat a very healthy, balanced diet. I get plenty of protein, supplement with a good quality B12, take vitamin D drops in winter, occasionally take Floradix for iron if I know I haven't eaten much iron that day. Occasionally I take K2 and hemp seed oil for omega 3-6-9.. ### Response: With vague non-specific body aches like that, a doctor can help elucidate a more thorough and specific history and exam. Not sure how long ago the last set of labs were and what exactly the hemoglobin and MCV values were, Id start with repeating routine labs like CBC and CMP, maybe a CK to check for muscle breakdown. TSH and vitamin D levels would not be unreasonable. The presence or lack of anemia on repeat testing can guide whether or not a B12 or homocysteine should be checked. Not sure why one would bypass these cheaper and possibly indicated tests for an expensive test for a gene variant that wouldnt change management without starting with routine labs and going from there.If one were truly concerned about malabsorption from diet, then consider celiacs testing and ruling out IBD if there are other GI issues..


Instruction: Nutritional Advice needed/AlcoholismThis is kinda a weird one, and I'm not sure if it belongs here or some more niche subreddit.I am 25 years old, an alcoholic, I drink approximately 300mL of vodka every day or every other day. I have generally healthy eating habits, avoid pasta, carbs, eat primarily meat, vegetables, kefir, cottage cheese, low carb wraps, etc.. I do not drink anything containing sugar barring clear liquors. I have a family history of high blood pressure, which mine is manageable and better than most of my family. I think all things considered, barring my weight and alcoholism, I am relatively healthy, although I know I won't be forever with some of my habits.Through my insurance, I get gym memberships to basically everywhere for free, and just learned about this, and have been taking advantage of it. I'm not used to prolonged goal-oriented activity, and haven't been since maybe highschool track and field, though I went to the gym in college as well to a lesser degree. I didn't get a car until last year, and my exercise then consisted of a two mile commute by foot to work. I have hovered around the same weight for a long time, about three years maybe.I understand that alcohol has caloric content, which may impede my physical development as well as eat into my daily intake calorically.My big questions are as follows: Does it [alcohol] impede muscle recovery to your knowledge?If I exercise when I still hurt from a prior day's exercise, is that a bad thing? I want to go to the gym literally every available bit of off time I can spare, but I know overdoing things can cause bad effects depending on what they are. I'm not like, in agony, just tight in my legs and other places.I want to work on my alcoholism, but I've been very focused on dieting and exercise lately, and working in a pushy sales job during the holiday season means I got a lot on my plate in addition to those and I can't just fix everything at once I guess.

Output: This question is the quintessential rearranging deck chairs on the Titanic. Instead of dealing with the alcoholism you quibble over other issues.Please find a drug and alcohol therapist, preferably someone who specializes in motivational enhancement therapy. Having seen a friend in his 40s go through fulminant liver failure from alcohol use, I can attest that it ain't pretty. His liver is still shitty but he's functional, but his brain is toast...

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nutritional Advice needed/AlcoholismThis is kinda a weird one, and I'm not sure if it belongs here or some more niche subreddit.I am 25 years old, an alcoholic, I drink approximately 300mL of vodka every day or every other day. I have generally healthy eating habits, avoid pasta, carbs, eat primarily meat, vegetables, kefir, cottage cheese, low carb wraps, etc.. I do not drink anything containing sugar barring clear liquors. I have a family history of high blood pressure, which mine is manageable and better than most of my family. I think all things considered, barring my weight and alcoholism, I am relatively healthy, although I know I won't be forever with some of my habits.Through my insurance, I get gym memberships to basically everywhere for free, and just learned about this, and have been taking advantage of it. I'm not used to prolonged goal-oriented activity, and haven't been since maybe highschool track and field, though I went to the gym in college as well to a lesser degree. I didn't get a car until last year, and my exercise then consisted of a two mile commute by foot to work. I have hovered around the same weight for a long time, about three years maybe.I understand that alcohol has caloric content, which may impede my physical development as well as eat into my daily intake calorically.My big questions are as follows: Does it [alcohol] impede muscle recovery to your knowledge?If I exercise when I still hurt from a prior day's exercise, is that a bad thing? I want to go to the gym literally every available bit of off time I can spare, but I know overdoing things can cause bad effects depending on what they are. I'm not like, in agony, just tight in my legs and other places.I want to work on my alcoholism, but I've been very focused on dieting and exercise lately, and working in a pushy sales job during the holiday season means I got a lot on my plate in addition to those and I can't just fix everything at once I guess.. ### Response: This question is the quintessential rearranging deck chairs on the Titanic. Instead of dealing with the alcoholism you quibble over other issues.Please find a drug and alcohol therapist, preferably someone who specializes in motivational enhancement therapy. Having seen a friend in his 40s go through fulminant liver failure from alcohol use, I can attest that it ain't pretty. His liver is still shitty but he's functional, but his brain is toast....


Instruction: Kidney stones training nutrition adviceThree weeks ago I've got my first kidney stone experience, and it wasn't pleasant. I just expelled it recently and went back to the hospital to do one more check up and also to give the stone to them in order to determine what kind of stone it is... After the check up they told me the stone went out and I was ok. But apparently I have another small one forming in my other kidney. They said it's small and even if it started moving I'll probably just expel it without any problems or pain, but I need to be careful on not making it grow bigger so I should drink plenty of water. So far so good.Now my problem is; I'm underweight and I've got a sedentary job, and I'm starting an intensive six months program at the gym to build muscle mass. This program include a very strict diet plan and the consumption of protein whey powder and creatine. I read in many forums that protein powder and creatine are not ideal for subjects with kidney stones history. And when I asked the doctor after my check up he just said "doesn't matter what you eat, just drink a lot of water". Now, I'm not an expert, but I do believe that what you eat does matter...I'm asking for advice here because I cannot see a specialist at the moment. I was wondering if taking protein powder and creatine wont have any negative effect on the formation of other stones as long as I drink plenty of water, or if I should avoid them...And if I should avoid them, are there any substitutes I can take?To give some context. I'm male, 32 years old, 187 cm and 69 kilos, never had kidney stones before, never took creatine before, I took some protein whey powder for about 40 days one year ago. I'm not under medications. I don't have any history of diseases.Any advice is really much appreciated.

Output: If you can drink enough water, you can consume a bit more protein (not too much more; up to 60-65g is ok. More is not helpful and is wasted, unless you're training for the Olympics) without problems. Generally, taking more creatine won't help....it gets digested, and is no different than any other (much cheaper) protein. The issue is that the amount of water you need to drink to markedly reduce kidney stone formation is a lot...at least 2.5 liters a day. Most people don't manage to make it to 2 liters a day unless they force themselves to drink more water. It helps if you add a bit of flavoring (e.g lemon flavor) to it. Especially if you exercise a lot, you will need to drink even more. How much more? If your urine is totally colorless (not yellow), you're drinking enough. You can do your weight training and eat a bit more protein with no problem, but generally, one will not see any additional muscle increase by eating much more protein (more than 60 g or 65g per day). So eating 100 g of protein per day will not increase your muscle mass, and will increase the risk of kidney stones. All the protein whey powder and creatine are more psychological...you can get the same benefits by eating a couple of extra egg whites per day.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Kidney stones training nutrition adviceThree weeks ago I've got my first kidney stone experience, and it wasn't pleasant. I just expelled it recently and went back to the hospital to do one more check up and also to give the stone to them in order to determine what kind of stone it is... After the check up they told me the stone went out and I was ok. But apparently I have another small one forming in my other kidney. They said it's small and even if it started moving I'll probably just expel it without any problems or pain, but I need to be careful on not making it grow bigger so I should drink plenty of water. So far so good.Now my problem is; I'm underweight and I've got a sedentary job, and I'm starting an intensive six months program at the gym to build muscle mass. This program include a very strict diet plan and the consumption of protein whey powder and creatine. I read in many forums that protein powder and creatine are not ideal for subjects with kidney stones history. And when I asked the doctor after my check up he just said "doesn't matter what you eat, just drink a lot of water". Now, I'm not an expert, but I do believe that what you eat does matter...I'm asking for advice here because I cannot see a specialist at the moment. I was wondering if taking protein powder and creatine wont have any negative effect on the formation of other stones as long as I drink plenty of water, or if I should avoid them...And if I should avoid them, are there any substitutes I can take?To give some context. I'm male, 32 years old, 187 cm and 69 kilos, never had kidney stones before, never took creatine before, I took some protein whey powder for about 40 days one year ago. I'm not under medications. I don't have any history of diseases.Any advice is really much appreciated.. ### Response: If you can drink enough water, you can consume a bit more protein (not too much more; up to 60-65g is ok. More is not helpful and is wasted, unless you're training for the Olympics) without problems. Generally, taking more creatine won't help....it gets digested, and is no different than any other (much cheaper) protein. The issue is that the amount of water you need to drink to markedly reduce kidney stone formation is a lot...at least 2.5 liters a day. Most people don't manage to make it to 2 liters a day unless they force themselves to drink more water. It helps if you add a bit of flavoring (e.g lemon flavor) to it. Especially if you exercise a lot, you will need to drink even more. How much more? If your urine is totally colorless (not yellow), you're drinking enough. You can do your weight training and eat a bit more protein with no problem, but generally, one will not see any additional muscle increase by eating much more protein (more than 60 g or 65g per day). So eating 100 g of protein per day will not increase your muscle mass, and will increase the risk of kidney stones. All the protein whey powder and creatine are more psychological...you can get the same benefits by eating a couple of extra egg whites per day..


Instruction: My arms fall asleep daily while sleeping and usually when using armrests in planes. Do I need to consult my physician on this?Hi there. I'm 28F 5'8" 160lbs white, and generally very healthy and active. I have no major medical conditions, good nutrition, don't drink alcohol, workout several times per week (yoga, lifting, indoor climbing). I take hormonal BC to avoid painful periods (been on it for more than a year) and I started taking a long-term antibiotic for a skin issue a week ago (yes I'm aware they interfere).I've noticed that almost every day while sleeping lately, I wake up at some point with some of my fingers numb and prickly up to my entire arm being limp (where it flops around, can't move it, and have to "shake it back to life" so to speak). I remember this happening occasionally as a kid, as well, so it's not a new development. I take several work trips per year that involve flights and I tend to get a similar problem sometimes when using the armrests in planes.I'd say it mostly happens in my right arm (dominant) but I think it happens in the left arm sometimes, as well. I'm a bit alarmed that this seems to be happening so often. I'm guessing my brain wakes me up when this starts to happen so it can't be that long that it happens but I can't be sure, obviously. I'm just concerned that it may at some point cause damage if this keeps happening.I have a memory foam type of mattress, so I'm wondering if a different type of mattress would help? A side sleeping pillow? Maybe it could somehow be nutrition related?Any advice is appreciated, thank you!

Output: Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.Most commonly, the sensation of a limb "falling asleep" is from an issue with a peripheral nerve, and not (as is commonly believed) from an issue of blood circulation.Some people (and I am one) are more susceptible to this phenomenon, but it can happen to anyone. When a nerve is compressed, it will stop functioning temporarily.There are places in your body that are more susceptible to this - generally where a nerve is running close to a bone, and where there is little flesh surrounding the nerve that might diffuse the pressure.One nerve that is very susceptible to compression or injury is the ulnar nerve, commonly known as the "funny bone". If you let your arm dangle at your side with the palm facing forward, the "funny bone" is at the back of the elbow, just above and towards the middle of the body from the bony lump you feel behind your elbow.A sudden blow to this area often produces a sudden sting / burning sensation that radiates down to the hand (this event is the reason behind the name "funny bone"). However, prolonged pressure on the area will also produce symptoms, and is the most likely cause of numbness and tingling in the hand and fingers while leaning on the elbow.Typically, the sensation of the pinky and ring fingers is the most affected, as well as the same side of the hand and forearm as those fingers.The solution that I have worked out for myself is simply to avoid leaning on that part of the elbow. Place the forearm on the armrest instead, or lean on the outside of the elbow, not the inside.This is not, of course, the only place that is affected by nerve compressing. Many people, when sleeping, have their arms under their head and / or pillow, or even under their body. Using trial and errors, you can probably find a sleeping position that will minimize the chance your limbs will "fall asleep".

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: My arms fall asleep daily while sleeping and usually when using armrests in planes. Do I need to consult my physician on this?Hi there. I'm 28F 5'8" 160lbs white, and generally very healthy and active. I have no major medical conditions, good nutrition, don't drink alcohol, workout several times per week (yoga, lifting, indoor climbing). I take hormonal BC to avoid painful periods (been on it for more than a year) and I started taking a long-term antibiotic for a skin issue a week ago (yes I'm aware they interfere).I've noticed that almost every day while sleeping lately, I wake up at some point with some of my fingers numb and prickly up to my entire arm being limp (where it flops around, can't move it, and have to "shake it back to life" so to speak). I remember this happening occasionally as a kid, as well, so it's not a new development. I take several work trips per year that involve flights and I tend to get a similar problem sometimes when using the armrests in planes.I'd say it mostly happens in my right arm (dominant) but I think it happens in the left arm sometimes, as well. I'm a bit alarmed that this seems to be happening so often. I'm guessing my brain wakes me up when this starts to happen so it can't be that long that it happens but I can't be sure, obviously. I'm just concerned that it may at some point cause damage if this keeps happening.I have a memory foam type of mattress, so I'm wondering if a different type of mattress would help? A side sleeping pillow? Maybe it could somehow be nutrition related?Any advice is appreciated, thank you!. ### Response: Usual disclaimer: no one can provide specific medical advice for a person or condition without an in-person interview and physical examination, and a review of the available medical records and recent and past testing. This comment is for general information purposes only, and not intended to provide medical advice. No physician-patient relationship is implied or established.Most commonly, the sensation of a limb "falling asleep" is from an issue with a peripheral nerve, and not (as is commonly believed) from an issue of blood circulation.Some people (and I am one) are more susceptible to this phenomenon, but it can happen to anyone. When a nerve is compressed, it will stop functioning temporarily.There are places in your body that are more susceptible to this - generally where a nerve is running close to a bone, and where there is little flesh surrounding the nerve that might diffuse the pressure.One nerve that is very susceptible to compression or injury is the ulnar nerve, commonly known as the "funny bone". If you let your arm dangle at your side with the palm facing forward, the "funny bone" is at the back of the elbow, just above and towards the middle of the body from the bony lump you feel behind your elbow.A sudden blow to this area often produces a sudden sting / burning sensation that radiates down to the hand (this event is the reason behind the name "funny bone"). However, prolonged pressure on the area will also produce symptoms, and is the most likely cause of numbness and tingling in the hand and fingers while leaning on the elbow.Typically, the sensation of the pinky and ring fingers is the most affected, as well as the same side of the hand and forearm as those fingers.The solution that I have worked out for myself is simply to avoid leaning on that part of the elbow. Place the forearm on the armrest instead, or lean on the outside of the elbow, not the inside.This is not, of course, the only place that is affected by nerve compressing. Many people, when sleeping, have their arms under their head and / or pillow, or even under their body. Using trial and errors, you can probably find a sleeping position that will minimize the chance your limbs will "fall asleep"..


Instruction: 2 year old admitted to hospital, unresponsiveLatest update (since coming back to the US after private hospital was unable to treat him in February, and he was having retractions): For future parents that might be in a similar situation and trying to find answers, I thought I would share what we have learned since coming back to the US.While in the hospital, the doctor kept saying he was unconscious because of inflammation. However, as I was trying to gather medical information, his theory at the time was sepsis. He did have a UTI a month or two earlier that we struggled to find antibiotics to treat (although he seemed to respond well and quickly when our pediatrician prescribed Augmentin).Our pediatrician here suspects encephalitis because he was fully up to date on vaccines (including pneumococcal), and the timeline was so fast from a cold to eyes fluttering open but not responding to pain or voices. Hopefully we will never know, because the most likely way to be able to correctly diagnose what happened is that it happens again while in an area with better ability to treat and test.That being said, information that would have been nice to have included a blood culture and a brain scan (according to our pediatrician here). Our pediatrician at the hospital where he was admitted did not have the ability to do either of these, and I still think it was our best option, but I wish I had known that the hospital was so limited because I wish I had at least had the opportunity to consider medical evacuation. I truly believe his pediatrician at the time was doing the best he could, and quite frankly, I still completely believe he saved his life, but I have learned that there are cultural differences. Doctors in some cultures may not be as forthcoming as would be expected in Europe and the US.Although to say, he is fine now. Because of the mystery surrounding the diagnosis in December, we don't really know how likely another similar episode is. However, now he seems like a perfectly healthy, developmental normal, energetic and talkative 2 year old boy! And we have learned to ask A LOT more questions about medical care before moving overseas ;)Update: His primary care just came in. He believes it is a combination of factors. Firstly, he is fighting a virus. Secondly, his glucose level was low and he was dehydrated at admission. He anticipates sending us home maybe tomorrow. For right now, he said he just needs IV nutrition and fluids, and time for his body to kick whatever the virus is that he's fighting.My son, 2 year old male, 12 kg, 85 cm, was admitted to the hospital about 9 hours ago. Our whole family has had a virus. Both he and my daughter received IV nutrition day 36 hours ago. My daughter recovered yesterday almost completely, but my son slept all day. I think it's been several days since he stood on his own. I brought him to the hospital, anticipating needing another round of saline, vitamins, and glucose.As I was transporting him, though, it became apparent that he was even sicker than I realized. He was completely limp, and failed to respond in any way to checking his glucose levels. His eyes would flutter open and sometimes hed briefly make eye contact, but he didn't respond to his name.He has been admitted at least overnight. His glucose and electrolytes were low, as well his leukocytes. One of his liver enzymes was also high (I believe AST...whichever one, it was 42). His urinalysis came back with ammonium urate, mucus, and acetone (according to Google Translate...I am a beginner in the language here, and the doctors and nurses don't speak English, so everything I know is through Google Translate). His O2 was also a little low (94), so he is on oxygen. They have given him glucose and electrolytes and vitamins, as well as an antibiotic.Can anyone explain why he became unresponsive? His BMI was perfectly healthy. I thought fat was able to sustain through sickness like this until able to eat again, and not only that, he had IVs yesterday of vitamins, saline, and glucose. Is he going to be ok? How long is the road to recovery likely going to last? Any theories as to what's going on?I'll also attach a copy of the urinalysis, translated. I don't have a copy of the blood work, though.Edited to add: He has since woken up for brief periods. Maybe 4 hours or so on IVs, he woke up and asked to nurse. He also fought the nurse and doctor while having his nose aspirated... the doctor, nurse, and I all had to hold him. He fell asleep shortly after that, and has not woken up since.

Output: There's not nearly enough info to say why he's unresponsive. I know youre stressed and looking for answers but you won't find them here.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: 2 year old admitted to hospital, unresponsiveLatest update (since coming back to the US after private hospital was unable to treat him in February, and he was having retractions): For future parents that might be in a similar situation and trying to find answers, I thought I would share what we have learned since coming back to the US.While in the hospital, the doctor kept saying he was unconscious because of inflammation. However, as I was trying to gather medical information, his theory at the time was sepsis. He did have a UTI a month or two earlier that we struggled to find antibiotics to treat (although he seemed to respond well and quickly when our pediatrician prescribed Augmentin).Our pediatrician here suspects encephalitis because he was fully up to date on vaccines (including pneumococcal), and the timeline was so fast from a cold to eyes fluttering open but not responding to pain or voices. Hopefully we will never know, because the most likely way to be able to correctly diagnose what happened is that it happens again while in an area with better ability to treat and test.That being said, information that would have been nice to have included a blood culture and a brain scan (according to our pediatrician here). Our pediatrician at the hospital where he was admitted did not have the ability to do either of these, and I still think it was our best option, but I wish I had known that the hospital was so limited because I wish I had at least had the opportunity to consider medical evacuation. I truly believe his pediatrician at the time was doing the best he could, and quite frankly, I still completely believe he saved his life, but I have learned that there are cultural differences. Doctors in some cultures may not be as forthcoming as would be expected in Europe and the US.Although to say, he is fine now. Because of the mystery surrounding the diagnosis in December, we don't really know how likely another similar episode is. However, now he seems like a perfectly healthy, developmental normal, energetic and talkative 2 year old boy! And we have learned to ask A LOT more questions about medical care before moving overseas ;)Update: His primary care just came in. He believes it is a combination of factors. Firstly, he is fighting a virus. Secondly, his glucose level was low and he was dehydrated at admission. He anticipates sending us home maybe tomorrow. For right now, he said he just needs IV nutrition and fluids, and time for his body to kick whatever the virus is that he's fighting.My son, 2 year old male, 12 kg, 85 cm, was admitted to the hospital about 9 hours ago. Our whole family has had a virus. Both he and my daughter received IV nutrition day 36 hours ago. My daughter recovered yesterday almost completely, but my son slept all day. I think it's been several days since he stood on his own. I brought him to the hospital, anticipating needing another round of saline, vitamins, and glucose.As I was transporting him, though, it became apparent that he was even sicker than I realized. He was completely limp, and failed to respond in any way to checking his glucose levels. His eyes would flutter open and sometimes hed briefly make eye contact, but he didn't respond to his name.He has been admitted at least overnight. His glucose and electrolytes were low, as well his leukocytes. One of his liver enzymes was also high (I believe AST...whichever one, it was 42). His urinalysis came back with ammonium urate, mucus, and acetone (according to Google Translate...I am a beginner in the language here, and the doctors and nurses don't speak English, so everything I know is through Google Translate). His O2 was also a little low (94), so he is on oxygen. They have given him glucose and electrolytes and vitamins, as well as an antibiotic.Can anyone explain why he became unresponsive? His BMI was perfectly healthy. I thought fat was able to sustain through sickness like this until able to eat again, and not only that, he had IVs yesterday of vitamins, saline, and glucose. Is he going to be ok? How long is the road to recovery likely going to last? Any theories as to what's going on?I'll also attach a copy of the urinalysis, translated. I don't have a copy of the blood work, though.Edited to add: He has since woken up for brief periods. Maybe 4 hours or so on IVs, he woke up and asked to nurse. He also fought the nurse and doctor while having his nose aspirated... the doctor, nurse, and I all had to hold him. He fell asleep shortly after that, and has not woken up since.. ### Response: There's not nearly enough info to say why he's unresponsive. I know youre stressed and looking for answers but you won't find them here..


Instruction: Can adolescent anorexia have long term effects? Does it have long term effects if it occurs during puberty?26m. No known health conditions. From upstate NY.Ive struggled with my weight my entire life. At birth I was 9lbs. By the time I was 12, I was clocking in around 190 lbs. By the time I was 15, I was well over 200lbs.When I was 15, I had multiple surgeries on my feet. I had arthritis, and flat feet. I had 5 back to back surgeries to correct it. They put me on a ton of pain meds from 15-17. As a result, my appetite was severely suppressed during those 2 years. I remember losing a ton of weight, and people started to notice. I barely ate, due to the low appetite from the pain meds. I remember being 15, and thinking Wow. This was easier than I thought. This led to some pretty terrible choices. Throughout puberty, you probably couldve defined me as a textbook anorexic. I barely ate, and the weight just fell off. I really didnt notice how bad it was until I was 20. I was 20 years old and severely underweight. I was skin and bonesToday, I dont deal with it at all. Im 511 and weigh around 170-175. I dont really check. I eat well, and long distance cycle 3-4 times a week. I do strength training a couple of times a week. Not as much as I should, but I try. I watch what I eat, but definitely consume at least 2000 calories a day. Theres no question about that.But the more and more I read up on this, the more I fear how the prescription pain meds, and anorexia was detrimental to my growth during puberty. Thats such an important time for human beings, and I fear what long term effects my poor decisions caused.Can adolescent anorexia and drug use have detrimental effects during puberty? Maybe Im just paranoid. I fear it stunted my body. I fear I didnt give my body the proper chance to grow and mature

Output: Most boys are done growing by 16. You were likely close to your adult height regardless by age 15.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Can adolescent anorexia have long term effects? Does it have long term effects if it occurs during puberty?26m. No known health conditions. From upstate NY.Ive struggled with my weight my entire life. At birth I was 9lbs. By the time I was 12, I was clocking in around 190 lbs. By the time I was 15, I was well over 200lbs.When I was 15, I had multiple surgeries on my feet. I had arthritis, and flat feet. I had 5 back to back surgeries to correct it. They put me on a ton of pain meds from 15-17. As a result, my appetite was severely suppressed during those 2 years. I remember losing a ton of weight, and people started to notice. I barely ate, due to the low appetite from the pain meds. I remember being 15, and thinking Wow. This was easier than I thought. This led to some pretty terrible choices. Throughout puberty, you probably couldve defined me as a textbook anorexic. I barely ate, and the weight just fell off. I really didnt notice how bad it was until I was 20. I was 20 years old and severely underweight. I was skin and bonesToday, I dont deal with it at all. Im 511 and weigh around 170-175. I dont really check. I eat well, and long distance cycle 3-4 times a week. I do strength training a couple of times a week. Not as much as I should, but I try. I watch what I eat, but definitely consume at least 2000 calories a day. Theres no question about that.But the more and more I read up on this, the more I fear how the prescription pain meds, and anorexia was detrimental to my growth during puberty. Thats such an important time for human beings, and I fear what long term effects my poor decisions caused.Can adolescent anorexia and drug use have detrimental effects during puberty? Maybe Im just paranoid. I fear it stunted my body. I fear I didnt give my body the proper chance to grow and mature. ### Response: Most boys are done growing by 16. You were likely close to your adult height regardless by age 15..


Instruction: I already take calcium/vitD combination tablets since my anti hormonal treatment started and got worse despite it. I asked my oncologist about vitamin K and she waved it off saying she had never heard of it. So I'd have to look into evidence for that if I want to have mine measured and supplemented I think. Hadn't heard about the combination with vitamine C either. Here they're just like 'oh the calcium and vitamin D don't do enough? Well guess we'll bombard with bisfosfonates then'

Output: Possibly. But it can be significantly improved with strength training and good nutrition.It's not clearly wrong. It's a medical fact."Boys tend to show the first physical changes of puberty between the ages of 10 and 16. They tend to grow most quickly between ages 12 and 15. The growth spurt of boys is, on average, about 2 years later than that of girls. By age 16, most boys have stopped growing, but their muscles will continue to develop."https://kidshealth.org/en/parents/growth-13-to-18.html#:~:text=Changes%20in%20Boys&text=They%20tend%20to%20grow%20most,muscles%20will%20continue%20to%20develop.I didn't say ALL boys stop growing at 16.Most resources say 16. Some say 16-18.Most boys are NOT still growing into their 20s.Everybody has anecdotes about somebody they know that grew 4 inches in university. Those are mostly exaggerated, and/or outliers.Your anecdotes about your friends getting taller doesn't change what happens for "most" boys.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I already take calcium/vitD combination tablets since my anti hormonal treatment started and got worse despite it. I asked my oncologist about vitamin K and she waved it off saying she had never heard of it. So I'd have to look into evidence for that if I want to have mine measured and supplemented I think. Hadn't heard about the combination with vitamine C either. Here they're just like 'oh the calcium and vitamin D don't do enough? Well guess we'll bombard with bisfosfonates then'. ### Response: Possibly. But it can be significantly improved with strength training and good nutrition.It's not clearly wrong. It's a medical fact."Boys tend to show the first physical changes of puberty between the ages of 10 and 16. They tend to grow most quickly between ages 12 and 15. The growth spurt of boys is, on average, about 2 years later than that of girls. By age 16, most boys have stopped growing, but their muscles will continue to develop."https://kidshealth.org/en/parents/growth-13-to-18.html#:~:text=Changes%20in%20Boys&text=They%20tend%20to%20grow%20most,muscles%20will%20continue%20to%20develop.I didn't say ALL boys stop growing at 16.Most resources say 16. Some say 16-18.Most boys are NOT still growing into their 20s.Everybody has anecdotes about somebody they know that grew 4 inches in university. Those are mostly exaggerated, and/or outliers.Your anecdotes about your friends getting taller doesn't change what happens for "most" boys..


Instruction: It is just quite frankly wrong, every countries education system and reliable sources all say boys stop growing at about 19-21

Output: No, they don't.https://www.google.com/search?q=average+age+boys+stop+growing&oq=average&aqs=chrome.0.69i59j69i57j35i39j0i512l2j0i433i512j0i433i457i512j0i402j0i271l3.1317j0j4&client=ms-android-oneplus-rvo3&sourceid=chrome-mobile&ie=UTF-8#ip=1You can easily see differently by simply googling this.Most resources say 16. Some say 16-18.Most boys do not continue to grow past 19. Some do. Most do not.This is why male growth charts norms plateau at 16-17 years, but weight continues upward.It might be commonly said to be 19-21 in your country's education system, but that's not accurate.If you're able to find a source that says it's typical to keep growing into your 20s, there 100 others that say it's not.This is common pediatric knowledge.You think you're right here, because lay people have told you this while growing up, but it's not medically accurate.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: It is just quite frankly wrong, every countries education system and reliable sources all say boys stop growing at about 19-21. ### Response: No, they don't.https://www.google.com/search?q=average+age+boys+stop+growing&oq=average&aqs=chrome.0.69i59j69i57j35i39j0i512l2j0i433i512j0i433i457i512j0i402j0i271l3.1317j0j4&client=ms-android-oneplus-rvo3&sourceid=chrome-mobile&ie=UTF-8#ip=1You can easily see differently by simply googling this.Most resources say 16. Some say 16-18.Most boys do not continue to grow past 19. Some do. Most do not.This is why male growth charts norms plateau at 16-17 years, but weight continues upward.It might be commonly said to be 19-21 in your country's education system, but that's not accurate.If you're able to find a source that says it's typical to keep growing into your 20s, there 100 others that say it's not.This is common pediatric knowledge.You think you're right here, because lay people have told you this while growing up, but it's not medically accurate..


Instruction: Is it unreasonable to try to ask for IV foods, or is this feasible? How else can I stop withering away? Please help.Im not sure what the technical term for IV food is, but here we go:Basic info: Male, white, 33 y.o., 6 foot, down from 190 lbs to 129 lbs. Im in the U.S. and do have insurance.Background info: for the past four years, I have had increasingly bad health issues that doctors cannot diagnose. It started with joints that felt like they were tearing spontaneously and not healing (which makes them to where I have no strength or movement) and it is literally almost every joint in my body. Then it became muscles and other soft tissue that seems to be contracting out of nowhere, and I am losing all range of motion. Then, I have other health issues that pop up and never seem to heal. Examples are erosive gastritis for the past 2 years that wont heal with medicine and prohibits much of what I eat, eyes that were hurt after being outside for 30 minutes and have now made it to where I cannot tolerate light or screens without searing pain, and weird things like that. I have seen so many specialists, and they are all baffled, think something is seriously wrong, but say they cant help. Extensive bloodwork has shown nothing but a TPO antibody, but normal thyroid levels.My main question: with my joint problems, I have not been able to close my jaw for almost a year, which means I havent been able to eat solid food in almost a year. Then, my erosive gastritis limits most high calorie foods from my diet. I stuff my mouth with the foods that I can eat, and if I try really hard, I still struggle to get 1500 cal a day. I have tried everything I personally have control over, but it is just not possible to get enough, and my nutrients are low and making it to where I can hardly stay awake. I have asked doctors if there would be any way that I could get IV food so I can get enough nutrition to, at the bare minimum, not keep getting worse and worse. Ideally, I would be able to get enough to gain weight so I can maybe improve my muscle mass. However, I mentioned this to a doctor and was laughed at like it was the dumbest question on earth. When I say laughed at, he literally said oh my god and rolled his eyes.Is this a crazy request? Is this a feasible option? If you have ANY suggestions, please help. I hate to sound dramatic, but my entire family thinks Im dying, and I feel Im on my way there as well. My stomach and colon have been torn up from all the medicines that have been tried, and I am all out of ideas.

Output: If you cant tolerate enough oral intake for nutrition then an appropriate next step would be consideration for a feeding tube of some sort. Either into your stomach or small intestine.IV nutrition is inferior and prone to a lot of problems (also super expensive and hard to get insurance approval). Its not typically used unless you absolutely cant use the intestines for one reason or another.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Is it unreasonable to try to ask for IV foods, or is this feasible? How else can I stop withering away? Please help.Im not sure what the technical term for IV food is, but here we go:Basic info: Male, white, 33 y.o., 6 foot, down from 190 lbs to 129 lbs. Im in the U.S. and do have insurance.Background info: for the past four years, I have had increasingly bad health issues that doctors cannot diagnose. It started with joints that felt like they were tearing spontaneously and not healing (which makes them to where I have no strength or movement) and it is literally almost every joint in my body. Then it became muscles and other soft tissue that seems to be contracting out of nowhere, and I am losing all range of motion. Then, I have other health issues that pop up and never seem to heal. Examples are erosive gastritis for the past 2 years that wont heal with medicine and prohibits much of what I eat, eyes that were hurt after being outside for 30 minutes and have now made it to where I cannot tolerate light or screens without searing pain, and weird things like that. I have seen so many specialists, and they are all baffled, think something is seriously wrong, but say they cant help. Extensive bloodwork has shown nothing but a TPO antibody, but normal thyroid levels.My main question: with my joint problems, I have not been able to close my jaw for almost a year, which means I havent been able to eat solid food in almost a year. Then, my erosive gastritis limits most high calorie foods from my diet. I stuff my mouth with the foods that I can eat, and if I try really hard, I still struggle to get 1500 cal a day. I have tried everything I personally have control over, but it is just not possible to get enough, and my nutrients are low and making it to where I can hardly stay awake. I have asked doctors if there would be any way that I could get IV food so I can get enough nutrition to, at the bare minimum, not keep getting worse and worse. Ideally, I would be able to get enough to gain weight so I can maybe improve my muscle mass. However, I mentioned this to a doctor and was laughed at like it was the dumbest question on earth. When I say laughed at, he literally said oh my god and rolled his eyes.Is this a crazy request? Is this a feasible option? If you have ANY suggestions, please help. I hate to sound dramatic, but my entire family thinks Im dying, and I feel Im on my way there as well. My stomach and colon have been torn up from all the medicines that have been tried, and I am all out of ideas.. ### Response: If you cant tolerate enough oral intake for nutrition then an appropriate next step would be consideration for a feeding tube of some sort. Either into your stomach or small intestine.IV nutrition is inferior and prone to a lot of problems (also super expensive and hard to get insurance approval). Its not typically used unless you absolutely cant use the intestines for one reason or another..


Instruction: Before they would consider IV nutrition, they would exhaust all the other ways of feeding you.IV nutrition comes with significant risks. If there is zero other way to tolerate food, it's better than starvation, but putting things in your intestines for nutrition is the safest and best in most situations

Output: I also agree. You are not a candidate for IV nutrition. So presumably a gastroenterologist diagnosed you with erosive gastritis after an endoscopy? What was the treatment plan for that diagnosis?Putting this all together: unhealing joint injuries, muscles contracting, light intolerance, stomach and colon torn up, and extensive normal testing raises the possibility of a somatic symptom disorder.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Before they would consider IV nutrition, they would exhaust all the other ways of feeding you.IV nutrition comes with significant risks. If there is zero other way to tolerate food, it's better than starvation, but putting things in your intestines for nutrition is the safest and best in most situations. ### Response: I also agree. You are not a candidate for IV nutrition. So presumably a gastroenterologist diagnosed you with erosive gastritis after an endoscopy? What was the treatment plan for that diagnosis?Putting this all together: unhealing joint injuries, muscles contracting, light intolerance, stomach and colon torn up, and extensive normal testing raises the possibility of a somatic symptom disorder..


Instruction: Yes, I was diagnosed with an endoscopy, and I believe there were erosions in 3 places. At first I was on sucralfate 3x daily, Pantaprazole 1x daily, and dicyclomine 3x daily. That hasnt worked, so Im now on Pantaprazole 2x daily, sucralfate as needed, and dicyclomine 1x daily. That might change, however, as I have sought out a new gastro after the last one dismissed me passing a lot of blood in my stool and colon pain (likely from a large amount of antibiotics I had been prescribed).My symptoms have been strange, and I dont at all understand them. On MRIs they have seen torn ligaments, but there were no reasons for it to be torn; they have seen inflammation in my eyes, but there was no reason for it to be inflamed; and they can feel the popping/tightened muscles and described them as being constantly kicked on. But, the bloodwork comes back fine; the silver lining is that maybe Ill get something named after me?

Output: There's a lot that remains unanswered so it's hard to say anything with certainty. I agree with my colleague - IV nutrition is reserved for people with no gut, or a biologically nonfunctional gut.However, if erosive gastritis is the issue preventing you from eating, and you have lost that much weight in 6-12 months, you may be a candidate for a feeding tube placed in your small intestine, past the level of your stomach.I don't understand why the gastritis has been this refractory to treatment (it is usually fairly simple to treat). In general the answer would be fixing the stomach problem. But a feeding tube could be used here while trying to solve the medical issues.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Yes, I was diagnosed with an endoscopy, and I believe there were erosions in 3 places. At first I was on sucralfate 3x daily, Pantaprazole 1x daily, and dicyclomine 3x daily. That hasnt worked, so Im now on Pantaprazole 2x daily, sucralfate as needed, and dicyclomine 1x daily. That might change, however, as I have sought out a new gastro after the last one dismissed me passing a lot of blood in my stool and colon pain (likely from a large amount of antibiotics I had been prescribed).My symptoms have been strange, and I dont at all understand them. On MRIs they have seen torn ligaments, but there were no reasons for it to be torn; they have seen inflammation in my eyes, but there was no reason for it to be inflamed; and they can feel the popping/tightened muscles and described them as being constantly kicked on. But, the bloodwork comes back fine; the silver lining is that maybe Ill get something named after me?. ### Response: There's a lot that remains unanswered so it's hard to say anything with certainty. I agree with my colleague - IV nutrition is reserved for people with no gut, or a biologically nonfunctional gut.However, if erosive gastritis is the issue preventing you from eating, and you have lost that much weight in 6-12 months, you may be a candidate for a feeding tube placed in your small intestine, past the level of your stomach.I don't understand why the gastritis has been this refractory to treatment (it is usually fairly simple to treat). In general the answer would be fixing the stomach problem. But a feeding tube could be used here while trying to solve the medical issues..


Instruction: can i still grow taller? (16f)it's my biggest insecurity to the point i feel like taking my life over it, i know it sounds like i'm exaggerating but it's just been so bad for the last few years. i don't even want to leave the house over it most times.i'm 16, 5"2, 40kg. i had a really bad eating disorder for the last few years and i'm barely eating 600/700 calories a day. i know this is making me malnourished and probably is a reason why i didn't grow that much. but i will put in the effort to recover if it means i'll grow taller. my parents are 5"0 and 5"9. i want to be at least 5"4 which is only two inches but it seems impossible. i just really want to know if i can grow still because it's eating me up alive.

Output: 5'2" is an extremely normal height. I'm sorry to hear about your eating disorder but you're a completely normal height

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: can i still grow taller? (16f)it's my biggest insecurity to the point i feel like taking my life over it, i know it sounds like i'm exaggerating but it's just been so bad for the last few years. i don't even want to leave the house over it most times.i'm 16, 5"2, 40kg. i had a really bad eating disorder for the last few years and i'm barely eating 600/700 calories a day. i know this is making me malnourished and probably is a reason why i didn't grow that much. but i will put in the effort to recover if it means i'll grow taller. my parents are 5"0 and 5"9. i want to be at least 5"4 which is only two inches but it seems impossible. i just really want to know if i can grow still because it's eating me up alive.. ### Response: 5'2" is an extremely normal height. I'm sorry to hear about your eating disorder but you're a completely normal height.


Instruction: Any fitness/wellness tips for a 29F, 4'11'', 177 pound jogger?I recently started jogging. I'm up to jogging 2 miles on a treadmill slowly and consistently at 3.5 mph speed. Did it the other day, did it again today. I'm strength training a bit, too.. I can plank for 70 seconds. I'm doing about 65 pounds on 5 rep X 5 set chest press machine routine. I can lat pull down over 100 pounds, and I can shoulder press 55 pounds on the 5 X 5's. I lost 25 pounds in the last year, but it is going so slowly. I bought a scale, and now when I look often, I just feel like I have plateaued. Any tips? Am I doing the right thing here with my routine? Will I ever lose more weight? I JUST now am getting down from stage 2 to stage 1 obesity, almost. Is there something that's supposed to be happening at this point? My blood sugar is now normal, although cholesterol was a bit high at my yearly checkup for the second year in a row.

Output: Plateaus are common in weight loss. It'll pass with time. Keep track of nutrition, continue exercise. Look at the positives. You're down 25lbs and are increasing your activity in a meaningful way.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Any fitness/wellness tips for a 29F, 4'11'', 177 pound jogger?I recently started jogging. I'm up to jogging 2 miles on a treadmill slowly and consistently at 3.5 mph speed. Did it the other day, did it again today. I'm strength training a bit, too.. I can plank for 70 seconds. I'm doing about 65 pounds on 5 rep X 5 set chest press machine routine. I can lat pull down over 100 pounds, and I can shoulder press 55 pounds on the 5 X 5's. I lost 25 pounds in the last year, but it is going so slowly. I bought a scale, and now when I look often, I just feel like I have plateaued. Any tips? Am I doing the right thing here with my routine? Will I ever lose more weight? I JUST now am getting down from stage 2 to stage 1 obesity, almost. Is there something that's supposed to be happening at this point? My blood sugar is now normal, although cholesterol was a bit high at my yearly checkup for the second year in a row.. ### Response: Plateaus are common in weight loss. It'll pass with time. Keep track of nutrition, continue exercise. Look at the positives. You're down 25lbs and are increasing your activity in a meaningful way..


Instruction: Blood work off after MTX. Should I hold the next dose until Rheum consult?30F non-smoker 147 lb 5ft 2in tall, years long history of rheumatoid symptoms and indicative blood work. My degree is in clinical nutrition which means unfortunately I understand the basics of my blood work but am not sure what to do with it. My rheumatologist is out for a week.After 7 weeks of 10 mg oral methotrexate weekly with absolutely no contraindicated medications (sulfa, alcohol, etc) my blood work has come back. I'm just hoping for clarification on if these results are expected with methotrexate, or if I may want to hold a dose until Rheumatology is back in office next week.Creatinine has dropped to 0.51 and was 0.70 prior to treatment. BUN has risen to 24 and was 17 prior to treatment. CRP at 1.4, was 1.3 prior to treatment.If I can ask for any input just to ease my mind, I'd really appreciate it!

Output: I would not worry about these labs. They are inconsequentially different from prior.For your information - Creatinine is a measure of how well the kidneys are working. We worry more about kidney injury when it is high. BUN is not as specific and should be interpreted in the context of your creatinine. Your CRP is basically unchanged.Your rheumatologist would likely go more based off your symptoms in adjusting your meds, they are probably monitoring side effects of methotrexate so looking at blood counts for signs of low counts and liver function tests. Methotrexate is cleared through the kidneys so if there was a major change in your creatinine it may prompt a dose change. CRP and ESR are inflammatory markers that will be trended.Hope this helps!

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Blood work off after MTX. Should I hold the next dose until Rheum consult?30F non-smoker 147 lb 5ft 2in tall, years long history of rheumatoid symptoms and indicative blood work. My degree is in clinical nutrition which means unfortunately I understand the basics of my blood work but am not sure what to do with it. My rheumatologist is out for a week.After 7 weeks of 10 mg oral methotrexate weekly with absolutely no contraindicated medications (sulfa, alcohol, etc) my blood work has come back. I'm just hoping for clarification on if these results are expected with methotrexate, or if I may want to hold a dose until Rheumatology is back in office next week.Creatinine has dropped to 0.51 and was 0.70 prior to treatment. BUN has risen to 24 and was 17 prior to treatment. CRP at 1.4, was 1.3 prior to treatment.If I can ask for any input just to ease my mind, I'd really appreciate it!. ### Response: I would not worry about these labs. They are inconsequentially different from prior.For your information - Creatinine is a measure of how well the kidneys are working. We worry more about kidney injury when it is high. BUN is not as specific and should be interpreted in the context of your creatinine. Your CRP is basically unchanged.Your rheumatologist would likely go more based off your symptoms in adjusting your meds, they are probably monitoring side effects of methotrexate so looking at blood counts for signs of low counts and liver function tests. Methotrexate is cleared through the kidneys so if there was a major change in your creatinine it may prompt a dose change. CRP and ESR are inflammatory markers that will be trended.Hope this helps!.


Instruction: Nutritional RecommendationsHi, are there any nutritional recommendations for cancer patients? As a caregiver, I am specifically looking into any protein powders to help my dad fight weight loss. Thank you.

Output: There are multiple factors that go into creating a nutritional plan, ranging from lab values such as kidney function, to muscle mass, desire to eat, ability to eat, etc. Id recommend speaking with a nutritionist as they are typically even more knowledgeable than physicians for nutritional advice. It should be covered under palliative/supportive care for the cancer. Youll want to consult them anyway depending on the state your dad is in physically as this point to ensure he doesnt have any nutritional deficiencies specific to the cancer he is fighting (e.g. GI cancers scan affect absorption of vitamins, minerals, fats, etc).Realistically if youre just looking for a caloric supplement, any of a number of protein drinks, such as ensure, will work. It will really come down to whether hes willing to drink them, find a flavor or brand he can tolerate and dont be afraid to switch it up for variety

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Nutritional RecommendationsHi, are there any nutritional recommendations for cancer patients? As a caregiver, I am specifically looking into any protein powders to help my dad fight weight loss. Thank you.. ### Response: There are multiple factors that go into creating a nutritional plan, ranging from lab values such as kidney function, to muscle mass, desire to eat, ability to eat, etc. Id recommend speaking with a nutritionist as they are typically even more knowledgeable than physicians for nutritional advice. It should be covered under palliative/supportive care for the cancer. Youll want to consult them anyway depending on the state your dad is in physically as this point to ensure he doesnt have any nutritional deficiencies specific to the cancer he is fighting (e.g. GI cancers scan affect absorption of vitamins, minerals, fats, etc).Realistically if youre just looking for a caloric supplement, any of a number of protein drinks, such as ensure, will work. It will really come down to whether hes willing to drink them, find a flavor or brand he can tolerate and dont be afraid to switch it up for variety.


Instruction: Failure to thrive, possible causes to consider?Kiddo born last week of October 2022 at 39+1 (vaginal birth via induction) weighed 5lb 9 oz, looked quite small for the weight and had short, withered looking legs and a disproportionately small butt. At 5 months, weighted 12lb 5.5 oz. Has consistently been 0.5 percentile although recently scraped up tp 0.6. Legs have filled out and lengthened, butt is more or a normal size. kid has been hitting motor and social developmentsl markers very well, but is deemed failure to thrive. Baby is breastfed, milk supply not the problem. Bottle is offered after every nursing, but not forced by parents, as this leads to vomiting.Mother 42 at delivery, pregnancy the result of IVF with a PG tested embryo. IUGR was first diagnosed in the second trimester, amnio and weekly placenta monitoring followed. Amnio revealed a microdeletion of unknown significance on 6p which was at length deemed unlikely to be the cause of anything by maternal fetal medicine genetic specialists - even before testing revealed the microdeletion to be inherited from the father, who has no disadvantages or disability.Mother contracted Covid in the early/mid second trimester, was fully vaccinated and fully recovered in 1-2 weeks. Mother struggled to eat during the pregnancy and after birth weighed 10lb less than she had when the embryo was transferred. Mother took diclegis, tums and omeprazole daily throughout the pregnancy to manage nausea. Mother had a UTI from week 10-20 that took 3 treatments to clear. Both the covid and the nausea were dismissed as a cause of the IUGR by both the OB and the Maternal Fetal Medicine Doctors.Currently waiting on a referral to genetics at a local hospital to investigate the possibility of skeletal dysplasia. The only visible symptom for dwarfism is a very, very slightly protruding forehead. Head circumference has always been in the 50th perventile despite the little body.So.What could be causing this, or have caused it? The final opinion from the Doctors at the MFM clinic was "Hes just a little guy." For the sake of assuaging parental guilt, it would be good to know how likely it is that the inability to eat could have contributed to the problem.

Output: If the child is growing along a percentile curve and staying on that curve, technically this is "failure to thrive" (also known as growth faltering) but my concern is generally low. If they're gaining weight at a lower amount than they should be or crossing percentile lines, that's where we really get concerned. How does his weight for length curve look?

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Failure to thrive, possible causes to consider?Kiddo born last week of October 2022 at 39+1 (vaginal birth via induction) weighed 5lb 9 oz, looked quite small for the weight and had short, withered looking legs and a disproportionately small butt. At 5 months, weighted 12lb 5.5 oz. Has consistently been 0.5 percentile although recently scraped up tp 0.6. Legs have filled out and lengthened, butt is more or a normal size. kid has been hitting motor and social developmentsl markers very well, but is deemed failure to thrive. Baby is breastfed, milk supply not the problem. Bottle is offered after every nursing, but not forced by parents, as this leads to vomiting.Mother 42 at delivery, pregnancy the result of IVF with a PG tested embryo. IUGR was first diagnosed in the second trimester, amnio and weekly placenta monitoring followed. Amnio revealed a microdeletion of unknown significance on 6p which was at length deemed unlikely to be the cause of anything by maternal fetal medicine genetic specialists - even before testing revealed the microdeletion to be inherited from the father, who has no disadvantages or disability.Mother contracted Covid in the early/mid second trimester, was fully vaccinated and fully recovered in 1-2 weeks. Mother struggled to eat during the pregnancy and after birth weighed 10lb less than she had when the embryo was transferred. Mother took diclegis, tums and omeprazole daily throughout the pregnancy to manage nausea. Mother had a UTI from week 10-20 that took 3 treatments to clear. Both the covid and the nausea were dismissed as a cause of the IUGR by both the OB and the Maternal Fetal Medicine Doctors.Currently waiting on a referral to genetics at a local hospital to investigate the possibility of skeletal dysplasia. The only visible symptom for dwarfism is a very, very slightly protruding forehead. Head circumference has always been in the 50th perventile despite the little body.So.What could be causing this, or have caused it? The final opinion from the Doctors at the MFM clinic was "Hes just a little guy." For the sake of assuaging parental guilt, it would be good to know how likely it is that the inability to eat could have contributed to the problem.. ### Response: If the child is growing along a percentile curve and staying on that curve, technically this is "failure to thrive" (also known as growth faltering) but my concern is generally low. If they're gaining weight at a lower amount than they should be or crossing percentile lines, that's where we really get concerned. How does his weight for length curve look?.


Instruction: Thank you for responding!Weight for length curve doesn't look great, even to a layperson like me.I do think the numbers here are can in part be explained by the fact that the legs that were withered and disproportionately short at birth seem a lot more proportionate to overall body length at current time. Based on photos, I would guess that this was a visible change by 6 weeks. IUGR diagnosis was asymmetric, with normal enough head and torso with shorter arms and significantly shorter legs (legs measured for 32 weeks at last growth scan prior to birth).So ... leg length caught up a little, but weight did not rise at the same rate.WHO Boys 0-2 Percentile goes:43 at birth1.9 at 1 months3.3 at 2 months1.8 at 3 months0.96 at 4 monthsCDC Boys 0-36 months Percentile goes:60 at birth2.5 at 1 months3.4 at 2 months2.2 at 3 months1.2 at 4 months

Output: These percentiles that you record here are for weight-for-length? Then yes, I'd agree that this needs to be worked up further.Given that all this has been post birth, this isn't from any kind of nutritional deficiency during pregnancy

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: Thank you for responding!Weight for length curve doesn't look great, even to a layperson like me.I do think the numbers here are can in part be explained by the fact that the legs that were withered and disproportionately short at birth seem a lot more proportionate to overall body length at current time. Based on photos, I would guess that this was a visible change by 6 weeks. IUGR diagnosis was asymmetric, with normal enough head and torso with shorter arms and significantly shorter legs (legs measured for 32 weeks at last growth scan prior to birth).So ... leg length caught up a little, but weight did not rise at the same rate.WHO Boys 0-2 Percentile goes:43 at birth1.9 at 1 months3.3 at 2 months1.8 at 3 months0.96 at 4 monthsCDC Boys 0-36 months Percentile goes:60 at birth2.5 at 1 months3.4 at 2 months2.2 at 3 months1.2 at 4 months. ### Response: These percentiles that you record here are for weight-for-length? Then yes, I'd agree that this needs to be worked up further.Given that all this has been post birth, this isn't from any kind of nutritional deficiency during pregnancy.


Instruction: I [22F] am prediabetic and prehypertensive and my doctor hasn't been helpfulHi all! I am looking for some guidance here. The stats I provide are also from a DEXA scan I did just this week as a participant in a longitudinal study on my campus:22F;166.4 lb;5'8";27.7% body fat;54.95 kg muscle mass (the form says "muscle mass" and idk if that's just lean body mass or muscle mass);1.055 g/cm3 bone density.Doing the DEXA scan and talking through it with the researchers was helpful because it put my weight into better perspective than just comparing it to my BMI.Summer 2021, I went for my first physical assessment living in the US and here were blood results:my A1c came back at 5.7;lipid panel all borderline high at 206mg/dL for cholesterol, 124 for LDL, 76 for HDL, but 62 for triglyceride;my blood pressure is consistently around 120s/80, including this week;my pulse is consistently in the 50s bpm, including this week at 55;I have mild anemia and take 65mg of iron daily. Over the past year my iron levels are back in normal range.I know of a family history of anemia, hypertension (my maternal uncle was also diagnosed in his 20s despite being seemingly physically healthy) and high cholesterol, but have no idea about diabetes.I freaked out at the blood work, and bombarded my doctor with questions including if I needed medication or if I should start monitoring my blood glucose. He gave the vaguest answers, saying there's no need for medication or monitoring at this time, just that I should change my diet and listed generic things I should eat that included a lot of tubers (huh?). I started monitoring my blood glucose anyway and scavenged reddit to learn what others do, but fell into a depression last year and only started picking up my discipline regarding my eating last December. I'd still been exercising throughout, though.I have a history of challenges with disordered eating behaviors and I have been working to address that and making good strides to recognize my triggers. I was overweight all my life and never learned what balanced nutrition or good regular activity looked like. I've been figuring that out for myself at college. For the past 4 years, I have been exercising pretty consistently 3-4 times/week for 45-60mins. I walk a lot, and have in the past six months increased cooking for myself to increase the protein (really just chicken, lentils, and beans lol) and green vegetables on my plate. I have been substituting rice with green banana (I don't really eat Western food) and have been successful at learning how to intuitively eat as a part of addressing my disordered eating habits.I am confident I can continue to improve my wellness habits, but need guidance on addressing my pre diabetes and prehypertension. I am awaiting bloodwork from the study at my school in a few days to see where my A1c and lipid panel's are nearly two years later. But I don't want to develop full blown diabetes and hypertension if there are things I can do now in the "pre" ranges to nip them in the bud.I have scheduled another physical assessment w my primary doctor in two weeks, where we will repeat those tests. I want to advocate better for myself given his last feedback. Should I ask to be put on metformin? What should I continue to do about being pre-hypertensive?I don't want to ignore my issues and don't want to be hard on myself about them either. I just want to know what I should do to live better and keep myself as well as possible. Thanks!

Output: Relax.You BP 120/80 is normal.. and even the HbA1c is also not at a pre-diabetes level which is usually considered at > 6.0Keep exercising regularly and eat a balanced diet (which you already seem to be doing).. your cholesterol is also something that I would not worry about at this stage..no medical intervention is necessary at this time... lifestyle modification is sufficient.

Below is an instruction that describes a task. Write a response that appropriately completes the request. ### Instruction: I [22F] am prediabetic and prehypertensive and my doctor hasn't been helpfulHi all! I am looking for some guidance here. The stats I provide are also from a DEXA scan I did just this week as a participant in a longitudinal study on my campus:22F;166.4 lb;5'8";27.7% body fat;54.95 kg muscle mass (the form says "muscle mass" and idk if that's just lean body mass or muscle mass);1.055 g/cm3 bone density.Doing the DEXA scan and talking through it with the researchers was helpful because it put my weight into better perspective than just comparing it to my BMI.Summer 2021, I went for my first physical assessment living in the US and here were blood results:my A1c came back at 5.7;lipid panel all borderline high at 206mg/dL for cholesterol, 124 for LDL, 76 for HDL, but 62 for triglyceride;my blood pressure is consistently around 120s/80, including this week;my pulse is consistently in the 50s bpm, including this week at 55;I have mild anemia and take 65mg of iron daily. Over the past year my iron levels are back in normal range.I know of a family history of anemia, hypertension (my maternal uncle was also diagnosed in his 20s despite being seemingly physically healthy) and high cholesterol, but have no idea about diabetes.I freaked out at the blood work, and bombarded my doctor with questions including if I needed medication or if I should start monitoring my blood glucose. He gave the vaguest answers, saying there's no need for medication or monitoring at this time, just that I should change my diet and listed generic things I should eat that included a lot of tubers (huh?). I started monitoring my blood glucose anyway and scavenged reddit to learn what others do, but fell into a depression last year and only started picking up my discipline regarding my eating last December. I'd still been exercising throughout, though.I have a history of challenges with disordered eating behaviors and I have been working to address that and making good strides to recognize my triggers. I was overweight all my life and never learned what balanced nutrition or good regular activity looked like. I've been figuring that out for myself at college. For the past 4 years, I have been exercising pretty consistently 3-4 times/week for 45-60mins. I walk a lot, and have in the past six months increased cooking for myself to increase the protein (really just chicken, lentils, and beans lol) and green vegetables on my plate. I have been substituting rice with green banana (I don't really eat Western food) and have been successful at learning how to intuitively eat as a part of addressing my disordered eating habits.I am confident I can continue to improve my wellness habits, but need guidance on addressing my pre diabetes and prehypertension. I am awaiting bloodwork from the study at my school in a few days to see where my A1c and lipid panel's are nearly two years later. But I don't want to develop full blown diabetes and hypertension if there are things I can do now in the "pre" ranges to nip them in the bud.I have scheduled another physical assessment w my primary doctor in two weeks, where we will repeat those tests. I want to advocate better for myself given his last feedback. Should I ask to be put on metformin? What should I continue to do about being pre-hypertensive?I don't want to ignore my issues and don't want to be hard on myself about them either. I just want to know what I should do to live better and keep myself as well as possible. Thanks!. ### Response: Relax.You BP 120/80 is normal.. and even the HbA1c is also not at a pre-diabetes level which is usually considered at > 6.0Keep exercising regularly and eat a balanced diet (which you already seem to be doing).. your cholesterol is also something that I would not worry about at this stage..no medical intervention is necessary at this time... lifestyle modification is sufficient..