Identifying GI Issues with Nutrition Focused Physical Exams

Pretty much everyone has gone to the doctor and had a physical exam performed. 

This is where the Doctor evaluates your body to determine if you have any physical problems. 

One type of exam that is becoming more common practice within the Dietitian community is the Nutrition-Focused Physical Exam or NFPE. 

According to the Academy of Nutrition and Dietetics, Registered Dietitians use Nutrition Focused Physical Exams as a means to assess nutrition status during evaluations. Dietitians will look at muscles and fat stores to determine if there are any signs of malnutrition and this physical exam can also help determine if there are any vitamin/mineral deficiencies that can manifest in physical characteristics. 

Where physical signs of malnutrition are easier to spot with noticeable wasting in the face, limbs, and joint areas, the challenge lies in identifying vitamin and mineral deficiencies. Specifically when they occur in individuals who have undiagnosed Irritable Bowel Syndrome (IBS) or disease. Oftentimes, sufferers feel constant fatigue and changes in their skin, hair, and nails, as well as deteriorations in oral health, can present.

I have the privilege of working at a Pediatric Children’s Hospital where a lab draw is a common practice so I can request specific lab results to confirm my findings. The problem lies when you are going to a private practice or any standard office where getting a set of labs requires a whole separate visit to a completely different location. 

Having a Dietitian who is trained in performing NFPE can be very beneficial when you know something is wrong, but you haven’t been diagnosed with anything yet. Examples of what a head-to-toe assessment include are looking at muscles and fat store locations; skin turgor (color, elasticity, texture, etc); eyes (color, dilation); oral cavity (tongue, gums, teeth, breath), hair (texture, palpability), nails (shape, texture); grip strength, and the list goes on. 

How does having undiagnosed IBS/IBD tie into this? 

When either of these two conditions occurs, there is a change in the gut's ability to absorb. The small intestine is where the body absorbs most of the nutrients found in your food. The circulatory system will then move the nutrients along to other parts of the body to use or store. There are cells that aid in helping nutrients move across the intestinal lining into the bloodstream. The microvilli (tiny little finger-like protrusions) that line the GI tract can become smooth, or worse, develop ulcerations or fistulas, all inhibiting the gut’s ability to absorb and digest nutrients.

In one long-term case I encountered, the patient had multiple contributing factors that could have led to their current state of malnutrition; liver cancer, followed by transplant, followed by transplant complications, and so on. They were having 10-14 liquid stools daily, constant abdominal pain, and no matter what we tried, their nutrition labs would always come back wonky. 

Finally, they had a complete GI work-up and it was discovered they not only had undiagnosed Crohn’s disease but also a fistula (where the wall of the small intestine connects with the wall of the large intestine and creates a bypass hole). Because of this, anything they ate would either travel the correct path through the GI tract or take a bypass through the fistula. 

Mystery solved, this was why they were so deficient in certain nutrients. 

Throughout the digestion pathway, in your GI tract, there are specific locations where nutrients get absorbed. When those locations are compromised, deficiencies can manifest. Finding these deficiencies can help with discovering the root of what is causing them. When the root problem is recognized then appropriate treatment can begin and these deficiencies can be corrected. The result is more energy, improved physical outcomes (thicker hair, smoother nails, glowing skin), and most importantly, improved quality of life. 

1. _{Barbara Gordon, RDN,LD and Esther Ellis, MS, RDN, LDN (2022) What is the Nutrition Focused Physical Exam, a review. Academy of Nutrition and Dietetics; https://www.eatright.org/food/nutrition/healthy-eating/what-is-the-nutrition-focused-physical-exam} 
2. _{National Institute of Diabetes and Digestive and Kidney Diseases (2021) Your Digestive System & How it Works. National Institute of Health; https://www.niddk.nih.gov/health-information/digestive-diseases/digestive-system-how-it-works.}