Diet discord between patients with inflammatory bowel disease and their clinicians has prompted calls to establish a uniform set of dietary guidelines for patients with IBD.
This follows a study which showed that while IBD patients consider diet to be important, IBD clinicians from different disciplines have “diverse views on the role of diet”.
“Advice given to patients is heterogeneous, often perceived as inadequate and poorly followed,” the authors concluded.
The study by Monash Health researchers, including gastroenterologists Dr Darcy Holt and Dr Greg Moore, who is also head of IBD at Monash Medical Centre in Melbourne and is a Senior Lecturer at Monash University, was published in the Journal of Human Nutrition and Dietetics.
Dr Moore said the study responded to the high frequency of questions from patients about whether diet caused their IBD or if changing their diet was an effective therapy.
“Many have extensively searched on the internet and found a large amount of poor research, opinion or non-scientific commercial products purporting benefit,” he told the limbic.
He said researchers and clinicians were still in the infancy of understanding if and how diet plays a role in the causation of IBD, the perpetuation of inflammation or the treatment.
“Only in the last year have quality studies been conducted showing a role of food additives such as emulsifiers in changes to the gut lining and bacteria in mice,” he said.
“Human studies are complex and the large differences between us all make these studies very difficult to undertake.”
An important finding of the study was the large discrepancy between the number of patients (26%) who reported receiving dietary advice from their IBD specialist and the gastroenterologists who reported advice provision (98%).
And while he agreed this was an important finding, he said that without directly observed interviews it was not possible to validate the accuracy of either groups’ recollections.
Dr Holt agreed, but said the discord highlighted the need for more research and the development of IBD-specific dietary guidelines.
“It’s very difficult as there were a lot of recall-based answers,” he said. “I think clinicians generally like to think they are doing better than they are.”
Dr Moore said it was important to gastroenterologists to be aware that diet affects patients’ symptoms.
“Dietary changes in our modern lives are likely to be one of the environmental contributors to the increase incidence of IBD,” he said.
“Evidence is now emerging of potential mechanisms by which these dietary changes may affect the gut and microbiota in a pro-inflammatory way that may in the future be amenable to be treated by dietary means.”
The research strengthens the case for not only more government-funding for IBD nurses, but even more so for specialist dieticians, Dr Moore said.
In the meantime, general advice on diet could be given as try to minimise processed or packet foods, eat as many fresh foods as possible of a wide variety and identify specific foods that might trigger symptoms.
“Every patient is different,” he said. “Recognising that many symptoms are in fact from Irritable Bowel Syndrome co-existing with Inflammatory Bowel Disease is important as not all symptoms are related to inflammation and may be food intolerance. Seeking individualised help from a specialised IBD dietitian is always worthwhile, but we still need more research to provide more robust guidelines.”