I know I have been a bit absent, but I assure you I am still working in the GI realm. Along with seeing patients at my private practice, I have had the opportunity to speak at a few GI conferences. Back in late May, I had the honor of speaking at the Society of Gastroenterology Nurses and Associates (SGNA) annual meeting in Orlando, Florida. Of course, my mother & I took a side trip to Disney World & Epcot (because how could we not?!). At SGNA, I co-presented with the wonderful, knowledgeable Patricia Raymond (check out one of her YouTube videos here). Our topic was: Four Out of Five Doctors: Evolving Diets in GI Disease. We covered a variety of GI diseases and below I have included some of the highlights along with the research.
I recently learned that two of my abstracts were accepted for next year’s annual meeting in Portland, Oregon. Next spring I will be discussing colorectal cancer & diet and chronic constipation & diet.
Enjoy reading and learning about a few gastrointestinal diseases.
Gastroparesis: Research has indicated that the Small Particle Size Diet may be beneficial for those with gastroparesis1. Moreover, a low fat diet still proves to be beneficial time and time again. I have actually started to implement the Small Particle Size Diet in some of my gastroparesis patients that I think would benefit!
Non-Alcoholic Fatty Liver Disease (NAFLD): For those with NAFLD, a Mediterranean diet can help decrease steatosis2. Sugary drinks with high fructose corn syrup are still problematic for those with NAFLD3. Moreover, reducing calories and achieving a healthy body weight may decrease severity of NAFLD.
Irritable Bowel Syndrome (IBS): Fiber tolerance in those with IBS can vary but remember that not all fibers are created equal. Some research indicates that fiber supplementation with soluble fiber like psyllium, Citrucel, or Benefiber may significantly improve symptoms4. My personal favorite fiber is Partially Hydrolzyed Guar Gum which is water soluble, taste-free, and a prebiotic fiber5. Moreover, there is a lot of information on the low FODMAP diet and its effect on decreasing IBS symptoms, but remember that not all FODMAPs are created equal. Some research indicates that the low FODMAP diet improves GI symptoms in all subgroups of IBS6.
Small Intestinal Bacterial Overgrowth (SIBO): Symptoms of SIBO and IBS can overlap and we still aren’t sure if SIBO is a cause of IBS or a bystander associated with IBS. We do know that those with IBS develop SIBO at a higher rate7. Research also indicates that the Migrating Motor Complex (MMC) play a big role in the development of SIBO. The MMC is a ‘sweeper’ that sweeps the contents of the small intestines into the large intestines when the body is in the fasting state8.
Inflammatory Bowel Disease (IBD): There is a high rate of food avoidance in those with IBD. These food avoidances may put a person at risk of developing a B12and/or folate deficiency. Exclusive Enteral Nutrition (EEN), although not mainstream in the U.S. adult population, can change bacterial diversity and metabolic function9. But, for some individuals with Crohn’s Disease, EEN can lead to remission. The Specific Carbohydrate Diet (SCD) also has many research studies backing up its efficacy in those with IBD. In fact, one study of 12 children on the SCD diet who met with a dietitian had great remission rates (66%)10.
Diverticulosis/Diverticulitis: Obesity increases the risk of diverticulitis so weight management is critical. A high fiber diet is beneficial for those with diverticulitis – in fact, nuts, corn, and popcorn do not actually increase the risk of developing diverticulitis11! Of course, I wouldn’t suggest going overboard, but research on this topic is very interesting!
Sources
1. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Olausson EA, Störsrud S, Grundin H, et al. Am J Gastroenterol. 2014 Mar;109(3):375-85. Epub 2014 Jan 14.
2. Zelber-Sagi S, et al. Liver Int. 2017
3. Basaranoglu M, Basaranoglu G, Bugianesi E. Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction. Hepatobiliary Surgery and Nutrition. 2015;4(2):109-116. doi:10.3978/j.issn.2304-3881.2014.11.05.
4. Bijkerk CJ, de Wit NJ, Muris JW, Whorwell PJ, Knottnerus JA, Hoes AW. Soluble or insoluble fibre in irritable bowel syndrome in primary care? Randomised placebo controlled trial. BMJ. 2009;339:b3154.51.
5. Bijkerk CJ, Muris JW, Knottnerus JA, Hoes AW, de Wit NJ. Systematic review: the role of different types of fibre in the treatment of irritable bowel syndrome. Aliment Pharmacol Ther. 2004;19(3):245-2
6. Halmos, Emma, et al. “A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome.” Gastroenterology, W.B. Saunders, 25 Sept. 2013, www.sciencedirect.com/science/article/pii/S0016508513014078.
7. Sachdeva S, Rawat AK, Reddy RS, Puri AS. Small intestinal bacterial overgrowth (SIBO) in irritable bowel syndrome: Frequency and predictors. Journal of Gastroenterology and Hepatology. 2011;26:135-138. doi:10.1111/j.1440-1746.2011.06654.x.
8. Pimentel M, Soffer EE, Chow EJ, Kong Y, Lin HC. Lower frequency of MMC is found in IBS subjects with abnormal lactulose breath test, suggesting bacterial overgrowth. Dig Dis Sci. 2002;47:2639–2643.
9. MacLellan A, Moore-Connors J, Grant S et al. e impact of exclusive enteral nutrition (EEN) on the gut microbiome in Crohn’s disease: a review. Nutrients 2017;9:447–60.
10. Suskind DL, Wahbeh G, Gregory N, Vendettuoli H, Christie D. Nutritional therapy in pediatric Crohn disease: the specific carbohydrate diet. J Pediatr Gastroenterol Nutr. 2014;58(1):87-91.
11. Nut, corn, and popcorn consumption and the incidence of diverticular disease. Strate LL, Liu YL, Syngal S, Aldoori WH, Giovannucci EL JAMA. 2008;300(8):907.