Expert dietitians play ‘powerful role’ in the care of GI patients
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In my more than 30-year career as a registered dietitian in gastroenterology, it has been exciting to see the role of dietitians in gastrointestinal conditions become validated and expanded upon, most markedly over the past 10 years.
As credentialed food and nutrition experts, dietitians play a powerful role in the care of GI patients. This makes sense — food first meets our body via the GI tract and is essential for life. Adequate, well-balanced nutrition is vital to our well-being, gut function and gut microbiota, and also improves health outcomes and GI symptom management.
In a 1-hour initial consultation, dietitians can provide a comprehensive assessment and clinical approach to addressing nutritional status and malnutrition risks and mitigating GI symptoms through a shared-decision model.
While an individualized nutrition plan is fundamental to fueling the body, we cannot forget its prime importance in celebrating life’s special moments and making memories. “Breaking bread” with one another is an important way humans socialize and bond, both of which are significant components to well-being.
In disease states in which food intolerance and food-related fears can lead to unintended consequences, dietitian-led care is poised to help enhance food intake and variety and foster a positive relationship with food.
While diet is of great interest to many gastroenterologists, a small survey study of GI providers revealed that 77% provide 10 minutes or less on nutrition counseling for irritable bowel syndrome. This makes sense: GI providers are busy with other aspects of patient care and many lack the proper education to provide nutrition education. On average, medical students receive about 19.6 hours of nutrition instruction.
Dietitian-led care allows time to establish a solid review of a patient’s baseline diet and clinical background while also assessing potential social determinants of health that may affect care, such as food insecurity, skills and supplies to prepare a meal, and medical literacy. Dietitians also evaluate cultural aspects of the diet to provide inclusive care, improved health equity and more.
Research Supports Multidisciplinary Care
Data provided from the MANTRA study found that an integrative care model — including gastroenterologists, registered dietitians, gut-directed hypnotherapists, psychiatrists and biofeedback physiotherapists — improved symptom severity, psychological state and quality of life more than standard care provided only by a gastroenterologist in functional gut disorders.
Results revealed that patients in the multi-disciplinary-care group had greater global symptom improvement (84%) compared with those in the standard-care group (57%), and that patients in the multidisciplinary care group also had more clinically meaningful reduction in IBS Severity Scoring Symptom scores (66% vs. 38%, respectively).
There is no doubt patients are interested in the role nutrition plays in their condition. In a survey study of nearly 200 respondents who completed a questionnaire on treatment options for IBS, the most preferred treatment was dietary intervention (48.1 %), followed by medication (29.2%) and psychotherapy (22.7%).
Enlisting the Help of a GI-Expert Dietitian
Finding a dietitian with GI expertise remains a challenge. While there is not yet a credential to identify whether a dietitian is a generalist or has a solid foundation in GI care, the effort for a dietitian certification in gastroenterology is underway.
This certification will provide more dietitians with knowledge of the intersection of GI conditions and nutritional care while simultaneously helping patients and providers find the right dietitian with expertise to guide GI care.
At this time, you can search for GI-expert dietitians at eatright.org, via the Monash University FODMAP app or at katescarlata.com.
Read more about specific diet interventions and approaches by GI-expert dietitians on conditions such as inflammatory bowel disease, GERD, IBS and celiac disease.
- References:
- Adams KM, et al. Acad Med. 2010;doi:10.1097/ACM.0b013e3181eab71b.
- Basnayake C, et al. Lancet Gastroenterol Hepatol. 2020;doi:10.1016/S2468-1253(20)30215-6.
- Scarlata K, et al. Am J Gastroenterol. 2022;doi:10.14309/ajg.0000000000001602.
- Sturkenboom R, et al. Clin Gastroenterol Hepatol. 2022;doi:10.1016/j.cgh.2022.02.016.
- For more information:
- Kate Scarlata, MPH, RDN, is a New York Times bestselling author and Boston-based, GI expert dietitian who writes “For A Digestive Peace of Mind” blog. She can be reached at kate@katescarlata.com.
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