Kaitlin Poillon

NTDT 450: Case Study #11

November 4, 2016

4. Mrs. Clarkes physician prescribed Elavil and Metamucil for her IBS. Lotronex was
recommended if Elavil and Metamucil failed to relieve symptoms.
Elavil (amitriptyline): a tricyclic anti-depressant which affects the balance of chemicals
in the brain. It is most commonly used to treat depression, however, it can also be used to
treat Irritable Bowel Syndrome (IBS), particularly the pain of IBS. It is prescribed to IBS
patients because it modifies pain messengers in the brain. Drug-nutrient interactions
include alcohol. Do not take Elavil with alcohol.
Metamucil: a fiber supplement made from psyllium (a soluble plant fiber) designed to
add bulk to the stool to help waste travel smoothly through the digestive tract. When
taking Metamucil for IBS, it is imperative that it is introduced to the body slowly with
plenty of water in order to reduce gas, bloating, and constipation. Psyllium may interact
with other medications if given at the same time, causing other medications to become
less effective. All oral medications should be administered at least 2 hours before or 2
hours after dosing of psyllium.
Lotronex: a medicine used in women to treat severe IBS with the main problem being
diarrhea. It blocks the action of serotonin in the intestines, slowing the movement of
bowel movements through the intestines. Drug-nutrient interactions include caffeine.
Combining this medication with caffeine may increase the blood levels and the effects of
the medication.

6. FODMAP is an acronym that stands for Fermentable, Oligosaccharides, Disaccharides,

Monosaccharides, and Polyols. FODMAPs are a collection of short-chain carbohydrates and
sugar alcohols that can be found naturally in foods or in added quantities; they are harder for the
body to completely digest. FODMAP foods include fructose, fructans, galacto-oligosaccharides,
lactose, and polyols. A diet low in FODMAP foods is proven to be the most effective dietary
therapy for IBS and symptoms of an irritable bowel. Foods to monitor include fruits, dried fruits,
fruit juice, fructose, high fructose corn syrup, honey, coconut, fortified wines, onion, leek,
asparagus, artichokes, cabbage, brussel sprouts, beans, legumes, sorbitol, mannitol, isomalt, and
xylitol.

7. A prebiotic is a non-digestible food ingredient that promotes the growth of beneficial

microorganisms in the intestines. Probiotics are products containing microorganisms
manufactured and sold as food products and supplements, sometimes in an attempt to combat
gastrointestinal side effects. Prebiotics are naturally found in many foods, and while clinical
studies have been done, results are mixed. Some studies show that IBS patients given a
combination of probiotics and prebiotics experienced a significant improvement in abdominal
pain, bloating, and constipation. Other studies, though, show that prebiotics had no effect. More
studies suggest that probiotic supplements alleviate IBS symptoms. Currently, there is still not a
definitive answer as to whether or not prebiotics or probiotics are helpful for IBS sufferers. There
is no particular strain or type of bacteria that has been proven to be the most effective when
treating IBS. When guiding Mrs. Clarke on choosing an appropriate probiotic for her symptoms,
however, research generally recommends a probiotic with a variety of bacteria, particularly from
the Lactobacillus and Bifidobacterium genus.

10. Mrs. Clarkes other medications include:

Omeprazole: This medication is a proton-pump inhibitor that can treat heartburn, a
damaged esophagus, stomach ulcers, and gastroesophageal reflux disease (GERD). Mrs.
Clarke would be taking this medicine at home because she has GERD. Alcohol
consumption should be avoided when taking this medication due to serious interactions
that can occur.
Levothyroxine: A hormone that can treat hypothyroidism, an enlarged thyroid gland, and
thyroid cancer. Since Mrs. Clarke has been diagnosed with hypothyroidism, this
prescription is appropriate.
Lomotil: A diarrhea medication; prescribed to Mrs. Clarke because she has been
experiencing severe symptoms of IBS, including diarrhea, for a few years. Serious
interactions can occur with the consumption of alcohol with this drug.

12. According to the Mifflin St.-Jeour equation, Mrs. Clarkes expected energy needs based on
her current weight of 191 pounds are about 1530 kcals/day. After assessing her food intake, she
consumes approximately 1890 kcals/day, about 360 calories over her estimated caloric needs.
According to Mrs. Clarkes recent diet history, there are many FODMAP foods in her diet that
may potentially be aggravating her IBS symptoms. First are the artificial sweeteners. Polyols,
including mannitol and sorbitol, are FODMAP foods that cause symptoms of IBS. Mrs. Clarke
consumes artificial sweeteners with her coffee in the morning, every time she drinks a Diet
Pepsi, and when she eats sugar-free candies. High intakes of lactose, another FODMAP food, can
be another indicator of increased IBS symptoms. Yogurt for breakfast, half and half in her coffee,
cheese on her salad, butter on bread, and ice cream are all foods that Mrs. Clarke frequently eats
that could be contributing to her symptoms. Another FODMAP food is fructose, which is the
sugar found in fruit. According to her diet record, Mrs. Clarke consumes a decent amount of fruit
in a day, causing IBS symptoms to arise. Lastly, Mrs. Clarke consumes lentils, kidney beans, and
wheat crackers that are high in galacto-oligosaccharides. Galacto-oligosaccharides are on the list
of FODMAP foods, therefore, they could be causing her IBS symptoms to become exacerbated.

References
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