Questions for Medical Nutrition Therapy: A Case Study Approach 5th ed.
Case Study B – Irritable Bowel Syndrome (IBS)
(Case study 11 in the text)
1. IBS is considered to be a functional disorder. What does this mean? How does this relate to Mrs. Clarke’s history of having a colonoscopy and her physician’s order for a hydrogen breath test and measurements of anti-tTG?
2. What are the Rome III criteria that were used as part of Dr. Mohammed's diagnosis? Using the information from Mrs. Clarke’s history and physical, determine how Dr. Mohammed made his diagnosis of IBS.
3. Discuss the primary factors that may be involved in IBS etiology. You must include in your discussion the possible roles of genetics, infection, and serotonin.
4. For each of the following foods, outline the possible effect on IBS symptoms:
c. sugar alcohols
5. What is FODMAP? What does the current literature tell us about this intervention?
6. Define the terms prebiotic and probiotic. What does the current research indicate regarding their use for treatment of IBS? What guidance would you give Mrs. Clarke for choosing a probiotic?
7. Assess Mrs. Clarke’s weight and BMI. What is her desirable weight?
8. Identify any abnormal laboratory values measured at this clinic visit and explain their significance for the patient with IBS.
9. Determine Mrs. Clarke’s energy and protein requirements. Be sure to explain what standards you used to make this estimation.
10. Assess Mrs. Clarke’s recent diet history. How does this compare to her estimated energy and protein needs? Identify foods that may potentially aggravate her IBS symptoms.
11. The RDN that counsels Mrs. Clarke discusses the use of an elimination diet. How may this be used to treat Mrs. Clarke’s IBS?
12. The RD discusses the use of the FODMAP assessment to identify potential trigger foods. Describe the use of this approach for Mrs. Clarke. How might a food diary help her determine which foods she should avoid?
13. Mrs. Clarke is interested in trying other types of treatment for IBS including acupuncture, herbal supplements, and hypnotherapy. What would you tell her about the use of each of these in IBS? What is the role of the RDN in discussing =
14. What was God’s original diet for man? How could this help prevent some gastrointestinal disease? Cite specific verses to support your answer.
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