Question

Mr. Bonilla is an 88-year-old male of Asian descent with a height of 5'3". He is a retired head of a family- owned textile business. Until two years ago, he was generally healthy despite being overweight. At that time, his wife passed way and his health began to decline drastically. His weight dropped from 162 to 102 pounds. He became severely dehydrated and was hospitalized briefly for rehydration. One major factor contributing to this significant weight loss, aside from dealing with the grief of losing his wife, was that his wife prepared all of his meals, and he did not know how to take over the task himself. With this deterioration, Mr. Bonilla also developed occasional bowel incontinence, causing him to retire from his business and further isolating him from the support of his family and friends, He has since moved in with his daughter, and she provides him with a number of small meals throughout the day. His current weight is 126 lbs. Mr. Bonilla was recently seen by his physician for strep throat, and was started on antibiotics. During the course of taking the medication, his bowel incontinence increased, and he developed gas, abdominal pain, and changes in stool consistency. He was eventually diagnosed with irritable bowel syndrome (IBS). He reported that during his adolescence he had been diagnosed with lactose intolerance and several food allergies, including wheat, which appeared to be the main trigger for episodes of eczema during his childhood. According to his daughter, he maintains a fairly repetitive diet including turkey, chicken, tofu, white rice, potatoes, brown rice cakes, baked yams, and a variety of vegetables served in a soup (peas, carrots, green beans, onions, and broccoli). He gets at least 64 to 72 ounces of water a day served with his meals or in the soup. His diet lacks dairy products and fruits. He states he cannot tolerate anything acidic such as citrus fruits without nausea. His daughter also avoids using oil or butter in food preparation since this seems to trigger pain related to the IBS. 1. How are the symptoms of IBS and lactose intolerance related? 2. What kind of dietary adjustments are necessary with lactose tolerance? 3. What effect might the administration of an antibiotic have upon Mr. Bonilla's problems with lactose intolerance? 4. What sources of calcium are available in Mr. Bonilla's diet, considering his restriction of milk products? 5. Comment on Mr. Bonilla's dietary patterns in relation to his IBS

Answer 1

1.Several symptoms of lactose intolerance are similar to IBS such as nausea, diarrhea, abdominal bloating, flatulence, abdominal cramps. Symptoms caused by lactose intolerance are usually experienced 30 minutes to two hours after ingesting dairy products and worsens according to the amount consumed.In IBS there may be constipation,mucus in stool, incomplete emptying of colon apart from the above symptoms.The IBS symptoms can change over time and flare up,get better or disappear regardless of food intake.

2.Complete avoidance of foods and beverages that contain lactose such as milk and milk products is not recommended as it may cause inability to meet the RDA of calcium and vitamin Researches suggest that many people could have 12 grams of lactose without symptoms or with only mild symptoms.

.Add Milk and milk products to diet a little at a time and see how you feel,

.Try eating yogurt and hard cheeses which are lower in lactose than other milk products.

.Use lactase products to help digest the lactose in. Milk and milk products

.To ensure enough calcium and vitamin D include foods that don't contain lactose but are good sourse of calcium such as

-Fish with soft bones such as canned salmon or sardines

-Broccoli and leafy greens and vegetables

-Oranges

-Almonds,Brazil nuts and dried bean

-Tofu

-Products with labels that show they have added calcium such as some cereals, fruit juices and soy milk

. Avoid boxed,canned, frozen,packaged and prepared foods that may contain lactose such as bread and other baked foods, pancakes, biscuits,cookies and cakes, processed meats such as bacon, sausage,lunch meats,non dairy liquid and powdered coffee creamers and non-dairy whipped toppings.

3.Clinically antibiotics have no role in treating the symptoms associated with lactose intolerance, infact the may some times irritate the gastrointestinal mucosa thus worsens the symptoms.In IBS if it is causes by any bacteria the antibiotics will be beneficial.

4.Calcium fortified soy,almond and rice beverages, calcium fortified orange juice, vegetables such as book choy, broccoli,rapini,collards and kale,canned fish with bones such as salmon, sardines and anchovies, soybean based foods such as edamame,soy nuts,tofu, Beans like chickpeas, kidney beans,white,navy and pinto beans, nuts seeds like almonds and sesame seeds,Blackstrap molasses.

5.Different changes that may help in IBS include ,

1.Eat more fibre-Add foods with fiber to your diet a little at a time.Too much fibre to your diet at once can cause gas,so 2-3grams per day is recommended.

2.Avoid foods that contain gluten such as grains,pasta and processed foods

3.Follow Low FODMAP diet-To avoid certain foods that contain carbohydrates that are hard to digest,examples include

-fruits such as apple, apricot,mango.blac berry,plum,water melon

-canned fruit in natural fruit juice or large amount of fruit juice or dried fruit

-Vegetables such as asparagus,beans, cauliflower,garlic and garlic salts, lentils and mushrooms

-Wheat products

-Honey and foods with high fructose corn syrup l