Norhaishah H1, Shanthi K1, Nurul HR1
1Universiti Kebangsaan Malaysia, Universiti Kebangsaan Malaysia
A 64-years old married Malay male, a pensioner, was diagnosed with diarrhea predominant IBS (IBS-D) with 5-year history of intermittent episodes of lower abdominal cramping and bloating associated with 4-6 episodes of loose stools occurring 2 days/week related to stress. However, upon retirement, patient reported reduced frequency of loose stool; 3-4 times occurring 2 days/week. He was referred to dietitian for low FODMAP diet. Patient had a normal BMI of 23.4 kg/m2 and dietary assessment showed adequate energy and protein intake. He consumed a total of 6 meals/day and a large amount of FODMAPs in his diet was from wheat, onion and garlic, dairy product, honey and dates which are high in fructan, lactose and fructose.
Intake of type of carbohydrate (FODMAPs) inconsistent with needs related to physiological cause (IBS-D) as evidenced by GI symptoms and diet history.
Nutrition education and counselling on low FODMAP diet for 2 weeks (FODMAP restriction) followed by FODMAP reintroduction for 2 months. Monthly follow up sessions was done to guide patient until FODMAP personalization, focusing on personalized diet plan based on reactions during FODMAP reintroduction.
Monitoring & Evaluation
Upon review, patient claimed he has improved on his symptoms from 3-4 to 1-2 loose stools and had no bloating and abdominal cramps after FODMAP restriction. Monitoring was done using Irritable Bowel Syndrome Severity Score (IBSSS) to assess symptoms such as abdominal pain, bloating, bowel output and life in general during first visit and follow ups. During FODMAPs reintroduction, patient kept a personal FODMAP diary whereby he was recording the type and amount of FODMAPs which was triggering his symptoms.
Lesson Learnt: The 3 phases of low FODMAP dietary intervention under the guidance of dietitian is highly recommended to improve compliant which results in symptom improvements and enhanced quality of life.