Unit 1: Chapter 4 Case Study

Brittany is a 33-year-old woman who was recently diagnosed with IBS. She alternates between episodes of diarrhea and constipation and complains of distention and abdominal pain. Her doctor suggested she eat more fiber and take Metamucil. She dislikes whole wheat bread. She is reluctant to take a fiber supplement; she knows fiber helps people with constipation, and because she also has diarrhea, she believes it will only make her problem worse. She is thinking about adding yogurt to her usual diet to see if that helps. She drinks an “irritable bowel syndrome–friendly tea” that is supposed to help, but she hasn’t noticed any improvement.

Her usual intake is as follows:

Breakfast: Orange juice, White toast with peanut butter, Coffee

Snacks: Small bag of chips from the vending machine

Lunch: Fast-food hamburger on a bun, Small French fries, Diet coke

Snacks: Cheese and crackers, Glass of wine

Dinner: Beef or chicken, Mashed potatoes, Broccoli, Tossed salad with Italian dressing, Ice cream, Coffee

Snacks: Milk and cookies, apples

QUESTIONS
1. What does Brittany need to know about fiber and bowel function?

• It is possible to get fiber from other sources besides Metamucil and whole-wheat bread.  
• It is possible she is eating foods that lack fiber and lead to constipation and then eating foods that work as laxatives and cause diarrhea.  (Coffee)
• If she eats a more consistent diet that contains adequate fiber she may also want to consider avoiding laxatives or foods that mimic laxatives

2. What would you say to her about eating more fiber? About taking a fiber supplement? About yogurt? And about “irritable bowel syndrome–friendly tea”?

• There are many sources of fiber available, so don't stress out too much about not being able to get enough.  At the same time, if you're the type of person who literally hates all vegetables, you may have to make some undesirable lifestyle changes.  However, over time the body often adjusts to the taste of new foods and you may find yourself enjoying food that you did not like in the beginning.  
• Taking a fiber supplement may help with symptoms, but changing your lifestyle is a much better idea overall because that will benefit health in a larger way over the long haul.
• Yogurt is known to relieve constipation (https://www.webmd.com/digestive-disorders/ss/worst-foods-for-constipation), so it may be worthwhile to eat some.  
• I would do some research on the tea to see if there's any scientific evidence proving it actually has benefits.  It may, or it may not.  There is a lot of false advertising, and overly confident statements made on products that aren't backed by proof.

3. What else do you need to know about Brittany to help relieve her symptoms?

• How much water is she drinking per day
• Does she have intolerances or allergies to any of the foods she's consuming
• Is she regularly washing her hands and practicing good hygiene

4. What other diet interventions could she implement to try to improve her symptoms?

• Drink regular and adequate water
• Avoid laxatives and laxative-like substances unless absolutely necessary
• Find and consume sources of fiber along with a variety of healthy foods
• Practice hygiene
• Get evaluated for allergies and intolerances