Irritable bowel syndrome: IBS, symptoms, causes, treatment. Cleveland Clinic. (n.d.). Retrieved March 20, 2022, from https://my.clevelandclinic.org/health/diseases/4342-irritable-bowel-syndrome-ibs 

Let's bring attention to IBS. Needham Gastroenterology Associates. (2022, March 18). Retrieved March 20, 2022, from https://www.needhamgastro.com/articles/lets-bring-attention-to-ibs 

Age 66
Sex: AFAB
BMI: 24

My client is a middle aged woman who lives alone, she rarely makes time to take care of herself as her job as a social worker is demanding. She works in a nursing home so rate of infection is often high. She does not really work out and her diet consists primarily of coffee in the morning, snack of popcorn and granola throughout the day and then premade meals she picks up on her way home for dinner. 

Sex Female

BMI: 24

My client is a woman in her sixties, who is postmenopausal. She is retired and has been trying to enjoy her new free time but is beginning to experience reoccurring fractures and other symptoms such as nausea, diarrhea and vomiting. She has always struggled with food sensitivity but never paid much mind to the cramping and discomfort. She takes vitamins but inconsistently and only recently started doing so upon her daughter’s recommendation. 

Advising this client would begin with her diet. Understanding the foods she eats consistently and when she experiences sensitivity and responses such as nausea and diarrhea will help not only with treatment but also diagnosis. Knowing the connection between gastrointestinal conditions such as IBS and Celiac disease, and, osteoporosis, has me concerned that her more recent and reoccurring fractures are directly connected to and underlying gastrointestinal disease that has gone untreated. “Gastrointestinal disease is often overlooked or simply forgotten as a cause of osteoporosis” (Katz, S., & Weinerman, S., 2010).

This connection may allow treatment to look different than simply taking medications, as diet will be crucial to alleviating the aforementioned symptoms. I addition to having her get tested for osteoporosis, she will also undergo tests for potential underlying gastrointestinal disease. Like the fractures may be initial signs of osteoporosis, “osteoporosis may also be the initial sign of bowel disease” (Katz).

As we know with bowel disease, malabsorption and maldigestion directly impact level of crucial vitamins and minerals such as zinc, vitamin D and calcium. With potentially years of malabsorption, my client was never truly getting the nutrients needed to build strong bones. Even with healthy habits such as working out, her underlying gut health condition prevented her from achieving optimal bone health. 

In order to treat this client, I will begin with recommending testing for osteoporosis as the multiple fractures are a pressing danger and beginning medication to prevent bone loss will give her the chance to begin healing while we then asses gut health. I would then recommend seeing a gastroenterologist to discuss her current symptoms and diagnose any underlying disease. Knowing if there is a connection will then allow me as her nutritionist to develop a plan for her to treat her gut health while also helping build bone health.  

Katz, S., & Weinerman, S. (2010, August). Osteoporosis and gastrointestinal disease. Gastroenterology & hepatology. Retrieved April 10, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2950667/ 

From the blood panel, he was deficient in B1, B2, B3, and B5. These vitamins are crucial not only in the creation of energy through the metabolic reactions converting macronutrients into usable energy, but also for cell development, and repair (Kennedy, D. O., 2016, January 27).

The cause behind this client’s aforementioned symptoms has to do with the reported B deficiencies. Deficiencies of all of the noted B vitamins may result in all of the listed symptoms. In addition, deficiency of B12, may also influence skin health, presenting as skin lesions and compromised vision (Vitamin B12 (cobalamin). Mount Sinai Health System). 

By presenting the client with a more thorough picture of the daily required values as well as the roles of each vitamin and mineral and the consequences of deficiency, there may be a greater effort to make comprehensive changes to incorporate not only more supplements, but also foods like fish and more diary products like eggs, yogurt and cottage cheese.

Kennedy, D. O. (2016, January 27). B vitamins and the brain: Mechanisms, dose and efficacy--a 

review. Nutrients. Retrieved April 17, 2022, from https://www.ncbi.nlm.nih.gov/pmc/

articles/PMC4772032/ 

Vitamin B12 (cobalamin). Mount Sinai Health System. (n.d.). Retrieved April 17, 2022, from 

https://www.mountsinai.org/health-library/supplement/vitamin-b12-cobalamin

Sex: AMAB (assigned male at birth)

BMI: Pre surgery 34 Post surgery 26

My client is a 45 yo male. His starting BMI before surgery was around 34. After gastric bypass and some weeks in recovery including occupational therapy and fitness exercises, my client now has a BMI of about 26. Explaining the changes in the functionality of the GI tract to my client, I have made it clear that because of this surgery, his surface area for absorption has changed significantly. 

“Gastric surgery of the body of the stomach reduces mechanical digestion and acid secretion, which impairs digestion and absorption of iron, vitamin B12 and other protein-bound nutrients, and diminishes the secretion of intrinsic factor, further impairing the absorption of vitamin B12 [and other nutrients]” (Xanthakos, S. A., 2009).

Gastric bypass changes the structure of the stomach and small intestine and because of that and the risk of malabsorption can be significant because of the length of bypassed proximal small intestine ((Xanthakos, S. A., 2009). In order to make sure the my client recieves all of these necessary nutrients, I will suggest supplementation and monitoring. Research has shown that not all diet changes and nutrient supplementation are effective at sustaining DRI’s and so additional therapies may be required.

Xanthakos, S. A. (2009, October). Nutritional deficiencies in obesity and after bariatric surgery. Pediatric clinics of North America. Retrieved April 22, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2784422/