Dietary treatment for irritable bowel syndrome: a pathway to disordered eating? A pilot study
Dietary treatment for irritable bowel syndrome in adults: a pathway to disordered eating? A pilot study
Swinburne University of Technology
27 participants
May 28, 2024
Interventional
Conditions
Summary
Dietary therapies are at the forefront of irritable bowel syndrome (IBS) management, but their restrictive nature has led to concern they may cause disordered eating. This study seeks to understand if dietary treatment influences disordered eating in IBS, and to clarify the validity of screening tools in this population. We will recruit 27 patients with IBS from the community. Participants will be provided with the first-line dietary treatment for IBS, the low FODMAP (fermentable carbohydrate) diet by a specialist dietitian. Participants will meet with the dietitian twice (Week 0 and Week 6) for 1 hour each, and have additional support via the Monash University Low FODMAP App. At weeks 0 and 6, participants will complete questionnaires (assessing symptoms, dietary intake, and disordered eating screen) and meet with a provisional psychologist to assess for disordered eating. The primary aim is to assess the number of participants classified as meeting disordered eating criteria based on a psychologist’s clinical assessment following the intervention. Secondary aim is to compare the reliability of a screening questionnaire compared to the psychologist’s clinical assessment.
Eligibility
Inclusion Criteria6
- Males and females aged 18 years and older
- Meet the Rome IV criteria for IBS (all subtypes)
- Not have previously undertaken dietary interventions
- Stable medications and psychological therapies for their gastrointestinal symptoms for at least 8-weeks.
- Proficient in English
- Based on clinical assessment by the provisional psychologist, not meet the DIAMOND Criteria for disordered eating at baseline.
Exclusion Criteria5
- Mild IBS symptoms (score <75 on the IBS-SSS)
- Known history of other gastrointestinal conditions or an eating disorder
- Taking psychotropic medications
- Taken antibiotics or probiotics in the past 4 weeks.
- Meet disordered eating criteria at baseline as per clinical assessment.
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Interventions
Dietary intervention: The dietary intervention is designed to mimic exactly what is used in clinical practice when instituting the low FODMAP (fermentable oligo- di- mono-saccharides and polyols) diet. Participants will have 2 visits (6 weeks apart) with the dietitian, each up to 1 hour in length either face-to-face or via videoconference. As such at Week-0, participants will be instructed by an experienced dietitian to follow a low FODMAP diet for 6-weeks. The low FODMAP diet involves reducing intake of specific foods high in FODMAPs such as wheat, rye, onion, garlic, honey, apples and pears. In replacement of these foods, low FODMAP options will be encouraged such as gluten free bread, rice, carrots, zucchini, maple syrup, oranges and kiwifruit. At Week-6, participants will be instructed to reintroduce FODMAPs to determine their level of tolerance. Using strategic re-challenges, participants will re-introduce 1 food at a time to monitor their symptom response, if symptoms do not occur, it is assumed they can tolerate that FODMAP and re-introduce it back into the diet. Once the participant has completed the re-challenges (usually ~6 weeks later), they will be asked to return (via email) their re-challenge record to the researchers. Should they have any questions the participants can contact the study dietitian via email. To assist with compliance and be consistent with clinical practice, Dr Caroline Tuck’s email address will be provided to participants should they have any specific questions regarding the dietary modifications between visits. Participants will complete a 3-day food diary at week 0 and week 6 to monitor adherence to the diet. Each visit will be 60 minutes, and standardized language and written information will be provided. Additionally, to enhance clinical outcomes participants will be provided with the Monash University Low FODMAP diet Smartphone App. A code will be generated for participants to access and download the app on their phone for free. Participants can use the app at their own discretion. The app provides details on the FODMAP rating (i.e. low, moderate or high in FODMAPs) of a large range of foods and also provides recipes. No monitoring of app usage will occur in the study, it will be provided as a supportive/educational tool.
Locations(1)
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ACTRN12624000340538