Gertrude is six months pregnant. She loves hamburgers and milkshakes

Case Study: Gertrude
Gertrude is six months pregnant. She loves hamburgers and milkshakes. She is a woman
of European descent who has anemia, but she did not respond to iron supplements.
Henry turned vegan three years ago after his father was diagnosed with cancer. He eats a
diet of whole foods and does not use vitamin and mineral supplements. He also read a
book by John Robbins about reclaiming health, which pointed out the environmental and
resource inefficiencies of raising animal protein, the negative health data generated by the
overuse of animal products, and the health-promoting characteristics of vegetarian diets.
He was recently diagnosed with anemia and complained of numb, cold-feeling fingers
and toes.
1). What could be Gertrude’s problem?
a).She could have iron toxicity as this also causes anemia.
b).She could have another type of anemia besides iron deficiency anemia.
c). She could have calcium toxicity from the milkshakes
2). Gertrude’s European ancestry could increase her risk of having low folate status if she
exposed her skin to excess sunlight (UV radiation).
a).True
b).False
3). Why did it take three years before Henry’s deficiency showed up?
a). His folate intake masked his vitamin B12 deficiency.
b).Vitamin B12 can be stored long term in the liver
c).His stomach had a vitamin B12 storage reservoir.
d). He had extra intrinsic factor to increase absorption of his low vitamin B12 intake.
4). Gertrude’s anemia is probably not due to a vitamin B12 deficiency, because vitamin B12
is found in animal food sources and Gertrude eats plenty of these.
a).True
b).False
5). Gertrude’s unborn baby is at risk for spina bifida.
a).True
b).False

6). How could you confirm the cause of Gertrude’s nutritional deficiency?
a).Do a complete dietary analysis to verify low dietary intake of the suspected nutrient
b).Verify clinical symptoms of anemia (weakness, pallor, fatigue, etc.)
c).Perform biochemical tests to show a low level of the nutrient in her body
d).Provide the nutrient that is believed to cause her anemia back in her diet and consider
supplementation
e). all of these
7).What is most likely causing Gertrude’s anemia? A deficiency of ________.
a).iron
b).folate
c).vitamin B12
d).vitamin B6
e).vitamin E
8). Henry can correct his deficiency and maintain his vegan lifestyle by
a). taking a vitamin B12 supplement.
b).eating foods that are designed for vegans and have vitamin B12 added to them.
c).eating more broccoli and cauliflower.
d).taking a vitamin B12 supplement; eating foods that are designed for vegans and have
vitamin B12 added to them.
e).taking a vitamin B12 supplement; eating foods that are designed for vegans and have
vitamin B12 added to them; eating more broccoli and cauliflower.
9). What foods in Gertrude’s diet are lacking in the nutrient(s) that she needs to correct
her anemia?
a).Starchy Vegetables
b).Melons and Berries
c).Dark Green Vegetables
d).Fats and Oil
e).Red and Orange Vegetables
10).Henry could have a vitamin B12 deficiency because he doesn’t consume animal
products and doesn’t take a vitamin B12 supplement.
a).True

b).False

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