Diet

Rachel Adams, MS, RD, on the Effect of Diet on IBS Symptoms

To relieve symptoms of irritable bowel syndrome (IBS), individuals are often recommended to eat more fiber, avoid gluten, or follow a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs), according to the National Institute of Diabetes and Digestive and Kidney Diseases.1

However, diet and any changes in a person’s diet can impact the management of IBS in different ways.

Findings from a study presented at Nutrition 20192 by Rachel Adams, MS, RD, showed how a group of individuals with IBS related their symptoms to diet. Adams, a PhD candidate in the Department of Nutrition and Food Sciences at Texas Woman’s University in Denton, Texas, and her colleague K. Shane Broughton, PhD, MS, professor and chair of the Department of Nutrition and Food Sciences at Texas Woman’s University, evaluated responses to more than 150 questionnaires from individuals with self-reported IBS.

The surveys included questions on whether participants believed their diet influenced their symptoms of IBS, whether their doctor had recommended a specific diet, and whether they had been referred to a registered dietitian nutritionist (RDN).

Gastroenterology Consultant caught up with Adams to talk about the role of diet in IBS.

Gastroenterology Consultant: Why is it important for a gastroenterologist to be educated on the role of diet in IBS?

Rachel Adams: Previous research has shown that a significant number of individuals with IBS who receive medication for their condition are not satisfied with their current treatment. Diet is easily accessible and an affordable treatment option for IBS symptoms. I would like to see more individuals with IBS pursue diet as a therapeutic option in a supervised and meaningful way. What we’ve seen in the literature, and also in our study, is that many patients with IBS try to manage their IBS with dietary changes on their own. We really want to determine how physicians and dietitians can work together to get the right information out to help patients.

GASTRO CON: In the study, only 21 individuals attempted the low-FODMAP diet. Were you surprised by this, given how common the low-FODMAP diet is?

RA: What was surprising to me was the number of patients that were already avoiding what would be considered high-FODMAP foods and were likely following a version of the low-FODMAP diet without even realizing it. The low-FODMAP diet has become increasingly popular; however, information available in terms of its accuracy and credibility is all over the board. Also, a lot of information found on the internet is old. People who are trying a diet might be trying a diet based on previous food lists that are no longer accurate. The most reliable and only actual up‑to‑date FODMAP food list is available through Monash University. For our study, the survey was part of an assessment for a separate clinical trial that investigated the efficacy of an internet‑based intervention of a 2‑week elimination phase followed by a 2‑week reintroduction of the low-FODMAP diet. A key component of that program was using the Monash FODMAP application.

GASTRO CON: Do you think individuals with IBS should always be referred to an RDN by their gastroenterologist?

RA: The most qualified and appropriate person to deliver the low-FODMAP diet is an RDN. If a gastroenterologist is going to recommend the low-FODMAP diet to their patient with IBS, then they should refer them to an RDN. The challenge with this is that most insurances will not cover this type of visit with an RDN. This is a major failure of the insurance system, because the low-FODMAP diet is a complex diet that does potentially put individuals at risk of complications. Individuals have to learn how to look for hidden FODMAPs in labels that go beyond just food lists. Also, if the Monash FODMAP application is used, we have to remember, it was developed in Australia and does not include many of the foods available in the US, because we have a more processed-food diet here. This is also where a dietitian is helpful. A dietitian can walk a patient through the diet and make sure the individual understands the diet’s complexity and where FODMAPs might be hiding within foods. Gastrointestinal dietitians are definitely going to be the most qualified individuals to do this, but a significant portion of the US population are not going to have free access to them. We need accessible and affordable options for patients.

GASTRO CON: Your study found that many individuals with IBS self-manage their symptoms. How can a gastroenterologist and RDN become more involved?

RA: Approximately 12% of the US population have IBS and most are women.3 However, this figure could be an underestimation as 76.6% people with IBS are never formally diagnosed.4 Many of these individuals want to self-manage their symptoms, and there are many different ways they are trying to solve the problem on their own. People are eager to understand the cause and not just find a treatment. Oftentimes, patients are not receiving the answers they want and look to other means outside of traditional medical care. Individuals get frustrated, and this is why you see a lot of them turn to alternative therapies. Psychotherapies, including cognitive behavior therapy and gut hypnotherapy, and yoga have also been studied and shown to be effective at managing IBS symptoms in some individuals. Gastroenterologists can help their patients by presenting nonpharmacological approaches and connecting patients with providers they trust. Recommending an interdisciplinary approach not only benefits the patient, but helps the gastroenterologist develop a stronger relationship with their patients as they become an advisor, as well as a provider.

GASTRO CON: What are the next steps of your research?

RA: I am working on completing my dissertation for an internet‑based low-FODMAP diet education program. We also have to have more accessible and affordable options for individuals with IBS. There is plenty of misinformation out there. My focus is determining how we can get credible and accessible nutrition education to these patients, while involving the dietitian. An important piece of diet and IBS management is that gastroenterologists and dietitians need to work together to make sure that everyone stays current on the right information, because the science is changing.

References:

  1. Eating, diet, & nutrition for irritable bowel syndrome. https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/eating-diet-nutrition. Published November 2017. Accessed August 5, 2019.
  2. Adams R, Broughton KS. The effect of diet on irritable bowel syndrome symptoms and its role in the treatment plan (P12-001-19). Curr Dev Nutr. 2019;3(suppl 1):nzz035.P12-001-19. https://academic.oup.com/cdn/article/3/Supplement_1/nzz035.P12-001-19/5516701. Accessed August 5, 2019.
  3. Chey W, Kurlander J, Eswaran S. Irritable bowel syndrome: a clinical review. JAMA. 2015;313(9):949-958. doi:10.1001/jama.2015.0954.
  4. Hungin AP, Chang L, Locke GR, Dennis EH, Barghout V. Irritable bowel syndrome in the United States: prevalence, symptom patterns and impact. Aliment Pharmacol Ther. 2005;21(11):1365-1375. doi:10.1111/j.1365-2036.2005.02463.x.