Unfolding Case 2.1
Krista Larson
Krista is 24-year-old graduate student who complains of chronic constipation. In an effort to control her weight, she has used laxatives for years and eliminates as much carbohydrate from her diet as she can. She recently tried to stop using laxatives but is unable to have a bowel movement on her own.

Unfolding Case 2.2

Recall Krista. Her restricted carbohydrate intake provides negligible fiber because fiber occurs naturally only in plant sources of carbohydrates. What other nutrients may be lacking in her eating pattern due to her restricted intake of grains, fruits, vegetables, and legumes? What would you teach Krista about the role of carbohydrates and fiber in health? What does she need to know about increasing her fiber intake?

Krista’s restricted carbohydrate intake may be lacking in several key nutrients, including fiber, B vitamins (especially thiamin and folate), minerals (such as magnesium and potassium), and antioxidants. By limiting her intake of grains, fruits, vegetables, and legumes, Krista may be missing out on important sources of these nutrients.

As a healthcare provider, I would teach Krista about the important role of carbohydrates and fiber in health. Carbohydrates are a key source of energy for the body, and they are especially important for brain function and physical activity. Fiber is a type of carbohydrate that is not digested by the body but plays an important role in maintaining digestive health, regulating blood sugar levels, reducing cholesterol levels, and promoting feelings of fullness and satiety.

To increase her fiber intake, I would encourage Krista to gradually increase her intake of plant-based foods such as fruits, vegetables, whole grains, and legumes. It is recommended that adults aim for at least 25-30 grams of fiber per day, and increasing intake gradually can help prevent digestive discomfort.

I would also caution Krista against using laxatives for long-term constipation relief, as this can lead to dependence and may worsen the underlying problem. Instead, I would recommend lifestyle modifications such as increasing fiber intake, staying hydrated, and engaging in regular physical activity to promote regular bowel movements.

In addition, I would recommend that Krista speak with her healthcare provider about her constipation and laxative use, as this may require further evaluation and treatment. By addressing her dietary habits and seeking appropriate medical care, Krista can take steps to improve her digestive health and overall well-being.

HUM 103 Unfolding Case 2.3

Consider Krista. After increasing her fiber and fluid intake, she experiences cramping, distention, and gas and decides to go back to using a laxative daily. Why is Krista experiencing these symptoms? What questions would you ask to help identify the cause?

Krista may be experiencing these symptoms because of the sudden increase in fiber intake. When fiber intake is increased too quickly, it can cause digestive discomfort, including cramping, distention, and gas. This is because fiber is not broken down by the body like other nutrients, and instead, it moves through the digestive tract intact, helping to promote regular bowel movements and support digestive health.

To help identify the cause of Krista’s symptoms, I would ask her several questions, such as:

  • How quickly did she increase her fiber intake?
  • What types of foods did she add to her diet to increase fiber intake?
  • Is she drinking enough fluids?
  • Is she engaging in regular physical activity?
  • Has she had any recent changes in her bowel habits or medical history?

Based on Krista’s answers, I would assess whether she has made any sudden or drastic changes to her diet, as this can cause digestive discomfort. I would also evaluate her fluid intake and physical activity level to ensure she is supporting her digestive health in other ways.

If Krista’s symptoms persist, I would recommend that she speak with her healthcare provider to rule out any underlying medical conditions and to develop an appropriate treatment plan. Laxative use should be monitored by a healthcare provider and should not be used long-term without medical supervision.

HUM 103 Unfolding Case 2.4

Think of Krista. She has increased her intake of grains, fruits, vegetables, and legumes but admits she doesn’t like whole wheat bread or whole grains in any form. What other specific strategies should she try to increase her fiber intake?

If Krista does not enjoy whole wheat bread or whole grains, there are still many other fiber-rich foods she can incorporate into her diet. Some specific strategies she can try to increase her fiber intake include:

  1. Choosing high-fiber breakfast cereals made with bran, oats, or whole grains.
  2. Adding ground flaxseeds, chia seeds, or psyllium husk to smoothies, yogurt, or oatmeal.
  3. Incorporating more nuts and seeds into her diet, such as almonds, walnuts, sunflower seeds, or pumpkin seeds.
  4. Snacking on fresh fruits or vegetables throughout the day, such as apples, berries, carrots, or celery.
  5. Experimenting with different types of beans, such as black beans, chickpeas, or lentils, which are all high in fiber and can be used in a variety of dishes.

It’s important for Krista to find fiber-rich foods that she enjoys and can easily incorporate into her daily routine. Gradually increasing her fiber intake and staying well-hydrated can also help minimize any digestive discomfort she may experience.

HUM 103 Unfolding Case 2.5

Consider Krista. She wondered if eating several pieces of dietetic chocolate candy sweetened with sugar alcohols every day would help prevent constipation. She was shocked to discover that 5 pieces of sugarless dark chocolate contains almost 200 calories, mostly from fat, and quickly ruled candy out as an option. She asks if she can chew several pieces of sugarless gum every day to improve laxation without consuming calories. How do you respond?

While chewing sugarless gum may increase saliva production and help stimulate bowel movements, it is not a reliable or effective method for preventing or treating chronic constipation. Additionally, chewing excessive amounts of gum can lead to digestive problems such as bloating, gas, and stomach discomfort.

It’s important for Krista to focus on incorporating more fiber-rich foods into her diet and staying well-hydrated to improve laxation. There are many high-fiber options that are low in calories, such as fruits, vegetables, whole grains, and legumes. Additionally, staying physically active and avoiding the use of laxatives can also help regulate bowel movements.

If Krista is having trouble finding high-fiber foods that she enjoys, a registered dietitian can work with her to develop a personalized nutrition plan that meets her specific needs and preferences.

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