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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.
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
Drugs.com Web site. https://www.drugs.com/. Published 2000. Accessed October 26, 2016.
Edgar, Julie. Irritable Bowel Syndrome (IBS) Health Center. Web MD Web site.
http://www.webmd.com/ibs/features/supplements-for-ibs-what-works. Accessed October
26, 2016.
Nelms M, Sucher K, Lacey K. Nutrition Therapy and Pathophysiology. 3rd ed. Boston, MA:
Cengage Learning; 2015: 268-270.
Thatcher, Peter. IBS Hep Online. IBS Help Online Web site.
http://www.ibshelponline.com/amitriptyline-for-ibs.html. Published 2016. Accessed
October 26, 2016.