Nutrition professionals, can you share an experience where you had to navigate a client's food allergies while ensuring a balanced diet?

I was introduced to a young patient with food protein-induced enterocolitis syndrome (FPIES) that was quite ill 2-4 hours after the eating of breast milk, but also attempted formulas that were based off of cow's milk. The use of soy milk presented a similar challenge and we ended choosing a balanced, amino acid-based formula instead. Luckily, this was enough to manage this patient's nutritional needs and the hard work of balancing a proper diet was done via standardized formula after the challenging task of discovering food triggers to FPIES. As much as I wish we had a test for FPIES, the best (and only) test that we have is a patient's response to foods.

One tip when navigating a client's food allergies is to focus on nutrient-dense whole foods that provide the widest range of vitamins and minerals. An example experience was when I supported a client allergic to wheat, dairy, eggs, and peanuts. I recommended aiming for high protein foods like lean meats, legumes, nuts, and seeds. I suggested upping vegetable intake for fiber, vitamins, and antioxidants. I advised avoiding processed foods full of allergens, and instead focusing on fresh produce, gluten-free whole grains, and healthy fats like olive oil. With this balanced, whole-food approach tailored to meet the client's allergies, we were able to ensure an optimal diet for overall health and wellbeing.

Working in senior living, many of our residents have food allergies or dietary restrictions. One of the major food allergens we manage is lactose intolerance. Dairy is a major food group containing calcium, which helps to increase bone density and reduce the risk of bone fractures. Calcium is critical in senior living because bone loss accelerates after 50 years of age. However, most dairy products containing calcium also contain lactose. For residents who have lactose intolerance, ensuring a balanced diet entails providing alternative food items that contain calcium without containing lactose. Such examples include calcium-fortified soy milk or orange juice, canned salmon or sardines, calcium-fortified cereals, or tofu made with calcium. As the nutrition professional at my organization, I provide dietary education to residents who are lactose intolerant, detailing the benefits of calcium and listing the lactose-free food sources that contain calcium. I offer these food suggestions to our culinary team, to ensure that calcium-fortified food and beverage items are on our menus and available to our residents.

I had a vegetarian client who was lactose intolerant and allergic to soy and peanuts, which presented a unique challenge in ensuring she consumed enough protein-rich and calcium-rich foods. We worked together to incorporate alternative protein sources such as lentils, quinoa, chia seeds, and various beans. Additionally, we explored egg options to further boost her protein intake. To address her calcium needs, we included calcium-fortified plant milks and leafy greens. By focusing on a diverse range of whole foods, we were able to meet her protein and calcium requirements while ensuring a balanced diet rich in essential vitamins and minerals. This collaborative approach helped my client maintain her dietary preferences and health goals despite her allergies.

I have had many clients who struggle with lactose intolerance. At first, some are not sure if they are lactose intolerant because they can eat some dairy products without symptoms, while others cause discomfort. After some education and discussion about how various dairy products have different amounts of lactose in them, and that people with lactose intolerance can usually tolerate a small amount, we can make a nutrition plan together. This plan usually includes a list of low-lactose dairy products to try and then record any symptoms, as well as a list of foods and products that are similar in nutrient profile to dairy. In a balanced diet, if you remove a food or food group, you have to find foods that replace most of those lost nutrients. Dairy is a good source of calcium, protein, vitamin D, and potassium, so I provide a list of foods rich in those nutrients.

It is easy to navigate a clients food allergies and still ensure a balanced diet. There are always substitutions for those foods that may cause a reaction. For example, substitute a nightshade vegetable such as green pepper for zucchini. For an egg allergy one may consider a tofu scramble instead. Regarding a nut allergy, dried lentils, edamame or air-popped popcorn is a crunchy snack. All nutrients are available through various foods so food allergies should not stop anyone from getting in a health, varied diet.