Nutrition Therapy for Irritable Bowel Syndrome
Learning Objectives
1.
Describe the pathophysiology of the FODMAP diet in irritable bowel syndrome treatment.
2.
Analyze dietary data for FODMAP sources.
3.
Articulate to a patient the FODMAP diet plan.
4.
Plan nutrition therapy goals for a patient with IBS through the restriction phase of the
FODMAP diet.
5.
Construct a long-term plan, conducive to a patient’s lifestyle, through the re-challenge
process of the FODMAP diet.
Introduction
The gastro-intestinal (GI) tract has an important role in overall health maintenance. Unfortunately, there
are multitudes of disorders that affect the proper functioning of the GI tract, including irritable bowel
syndrome (IBS). IBS is a common functional GI disorder (FGID) affecting one in seven adults. Because IBS
effects the way nerves and muscles in the digestive tract work, this can lead to a cluster of symptoms
that, as a whole, increase sensitivity in the bowel (Lee & Park, 2015).
These symptoms—including
bloating, flatulence, diarrhea, and constipation—can significantly alter a patient’s quality of life. It is
important that other serious GI disorders and gynecological conditions be ruled out, as the clinical
presentation of IBS can be non-distinct (Clayton, 2013; Staudacher, 2017).
Diagnosis of IBS and all other FGIDs involves the Rome criteria.
This criteria states that patients may be
diagnosed with IBS after experiencing a set of symptoms for a period of 3, or in some cases 6, months.
The key symptoms assessed are the presence and persistence of abdominal pain or discomfort, bloating,
and changes in bowel habits, motility, or stool appearances.
Management of IBS involves nutrition therapy in which foods that have been shown to trigger the
symptoms of IBS are reduced.
For many years, patients have related their symptoms to ingestion of fatty
foods, alcohol, gluten, and coffee (Clayton, 2013). More recently, research has focused on a large group
of dietary sugars called FODMAPs (Fermentable Oligo-saccharides, Di-saccharides, Mono-saccharides
and Polyols). These sugars can be poorly absorbed in the small intestine and fermented by bacteria to
produce gas (Staudacher, 2017).
FODMAPs are digested rapidly by the bacteria in the bowel, leading to
heightened GI discomfort and relative symptoms in those with IBS.
Important areas of education for
patients embarking on the low FODMAP diet is to ensure the overall diet is restricted in FODMAPs,
nutritionally balanced and adequate, and of high diet quality.
Case Description
Lauri is a 48-year old stay-at-home mom of four school-age children.
Due to the international travel
demands of her husband’s work, Lauri is the sole caregiver of the children on week days, week nights,
and about two weekends a month.
Lauri’s children are involved in a number of after school activities, so
she feels that her car is always in motion.
In addition to her hectic schedule, Lauri enjoys staying
physically active.
However, she has a lingering back injury caused by a car accident.
Lauri had been
