Case study: 24-year old woman with bloating and stomach aches
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Today I’d like to share a story with you about one of the clients I recently worked with. By telling you her story, I expect to give you more insight into possible solutions to reduce IBS-symptoms.
The information on Positive Gut is for informational purposes only. The information is not meant to be a substitute for professional medical advice, diagnosis or treatment. If you have any concerns about your health, always seek the advice of your doctor.
Who is Vanessa?
For the purpose of this case study, I will call my client Vanessa. This is not her real name.
Vanessa first contacted me through my online dietitian practice in summer 2019. She was 24 years old and had been struggling with daily digestive issues for over a year and a half now. She would start out her day with a calm belly, and during the day she would get more and more bloated. At the end of the day she looked like she was several months pregnant, she was frequently burping, she had stomach aches and often felt like she needed to go to the toilet without actually being able to do so. On top of that, her stools were very inconsistent. She would have to go to the toilet between once every 3 days and 3-5 times a day and had normal stools to diarrhea. (Bristol Stool Chart Type 3 to 7, check the image below)
Vanessa had been to the doctor and got referred to the hospital to do some testing. Her blood was tested for allergies, she had an ultrasound of her stomach and a lactose and fructose breath-test.
All of the tests came back negative. There was no explanation found for her symptoms. The doctor gave her some medication to calm her belly, and sent her home.
Vanessa was happy that nothing was wrong, but she soon found out the medication didn’t help too much. That was the moment she decided to search for a gut health dietitian and reached out to me. She just wanted to have a calm belly and identify the reason she got symptoms at all.
My First Consultation With Vanessa
My first consultation with Vanessa was on a Wednesday afternoon. Before the consultation, she had filled out my questionnaire and had kept a food and symptoms diary.
She started telling her story and answered all my questions to get her story as clear as possible.
We found out that stress and night shifts at work (she works in health care) had a negative effect on the symptoms.
2x a week she went to the gym, and that always gave some relief.
Vanessa told me she thought apples and cauliflowers were bad-guys too. In the past, she had tried to use psyllium fiber and tried to adjust her diet to a healthy diet with as little snacks and sugar as possible. None of this had helped.
At the time of the first consultation, she was about to move out of her parent’s house and live with her boyfriend. This was very exciting to her, but also made her symptoms worse.
The Food and Symptoms Diary
After Vanessa and I had thoroughly discussed her symptoms and lifestyle, it was time to check her food and symptoms diary. She had tracked 5 days before the consultation in the diary format I had sent her. And I asked additional questions about her eating habits.
A couple of things stood out to me.
– Vanessa used sweeteners on a regular basis.
– She has a food pattern that was low on fiber.
– Vanessa ate fast, and didn’t chew properly.
– She drank water with her meals.
– She used high FODMAP foods on a daily basis.
Plenty to go on with, in my experience! I gave her a verbal summary on my findings, and continued on to the plan.
The Diet Plan
Based on Vanessa’s symptoms, eating habits and diet we discussed a diet plan. It came down to this:
A modified low FODMAP diet. Vanessa had been tested negative for lactose and fructose. And although those test are not reliable a 100% of the time, It doesn’t make sense to completely abandon them. If Vanessa would keep symptoms on the modified FODMAP diet, we could always add the lactose and fructose later.
More focus on eating habits. Vanessa was going to be more mindfull about chewing to aid her digestion, and make sure not to drink with her meals.
Aim for stress relief. With the help of Youtube videos, Vanessa was going to start using yoga poses that can help reduce bloat.
I explained to Vanessa everything she needed to know to get started and she would try this for 4 weeks until our next consultation. And gave her the resources to do so. If she had any questions or insecurities, she could always contact me.
Do you want to follow the FODMAP diet, or change your food pattern? Schedule a free discovery call to discuss your options!
The Follow-up Consultations
During our first follow up consultation it became clear that the modified FODMAP diet and changing of the eating habits was doing its part! Vanessa had only experienced a stomach ache once (which she could relate to stress regarding her moving), had far less bloating and normal stools!
She had not managed to start yoga, and didn’t feel like she would have the time to do so with the moving. Since she already felt better, we let that goal go.
A side effect of the diet was that she had also lost some weight, which wasn’t really the goal.
We discussed ways to limit weight loss on the FODMAP diet, shared recipes, and moved on to the reintroduction of FODMAPs.
During the second consultation, Vanessa told me she had tested the FODMAP-fructans with garlic and had tested bread. Bread went well, but she could not eat it for more than 2 meals a day, then she would get symptoms. Garlic did not go well.
Her body weight had not gone down anymore.
She was going to continue her testing, and leave garlic for later.
During the third consultation, Vanessa has tested onion and wasn’t too sure about it. She tried banana, sprouts, and blueberries and those were no problem! It seemed that Fructans- grains, fruit, and vegetables were no problem. And fructans- onion and garlic might be triggers.
We planned to test polyols and discussed supplements that can help break down fructans if she was eating out.
During the fourth consultation, Vanessa explained that she had experienced some digestive symptoms. Most of them were related to stress at work, and they definitely weren’t as extreme as they were before.
She had tested mannitol (which did not go well, so she was right about cauliflower!), sorbitol (which did not cause too many problems), and GOS (which went fine).
Vanessa had completed the reintroduction, and now had a good idea about which foods trigger her symptoms. She wanted to get less strict with the FODMAP diet, and decided to make her food choices based on her intolerances. She wouldn’t be too strict while eating out. If she did get symptoms she would try and think back to connect the symptoms to a food she ate. This would give some peace of mind because she would know where it went wrong.
Vanessa felt like she had her symptoms under control and felt so much better. The understanding of where her symptoms came from, and how to prevent it made it far more enjoyable to eat.
We decided this would be the right time to end the consultations. If Vanessa would have any more questions, or if she noticed a different flare up of symptoms, she would reach out to me again.
For Vanessa, the solution to her symptoms lay in proper eating habits and a modified FODMAP diet. It was not necessary for her to follow the complete FODMAP diet, which made it easier to do.
A FODMAP diet is best followed under the guidance of a specialized dietitian. It is a difficult diet, and it can be easy to eat too little and lose weight. Like Vanessa did in her first month.
If you recognize yourself in Vanessa, I hope this case study can help you gain an understanding of solutions for your symptoms. Nonetheless, everyone is different and what works for Vanessa might not work for you.
To help you find the solution to your problems, I can be of help.
If you’re done with your IBS symptoms. Don’t want to feel bloated anymore and just want to enjoy life without worrying about your gut, reach out to me!
YES! I’m done with my IBS symptoms!
I can help you! Schedule a free 1:1 Discovery Call and we can talk to see if we’re the right fit for each other.
Hi there, I’m Manon.
In my daily life I work as a registered dietitian in the Netherlands with a special interest in gut health.
During my workday I get loads of questions about healthy food, recipes and lifestyle to make it a little easier to get healthy. On Positive Gut I collect my best recommendations, tips and recipes to make your healthy lifestyle a little easier!