Commentary: Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?

Chumpitazi, Bruno P.; Alfaro-Cruz, Ligia; Zia, Jasmine; Shulman, Robert J.; Heitkemper, Margaret

doi:10.3389/fnut.2019.00136

Cited by 11 publications

(11 citation statements)

References 15 publications

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“…We also found that a smaller but still substantial proportion (13%) met our conservative cutoff for shape/weight‐motivated ED symptoms (EDE‐Q‐Global ≥4.0), primarily consisting of patients with binge eating. Our study further supports the need for a growing clinical awareness of the full ED spectrum, especially ARFID, in patients with DGBI 9,23,24 …”

Section: Discussionsupporting

confidence: 81%

“…Our study further supports the need for a growing clinical awareness of the full ED spectrum, especially ARFID, in patients with DGBI. 9,23,24 We also conducted an exploratory analysis of potential factors that could relate to presence of ED symptoms. Notably only the shape-weight-motivated ED group, and not the ARFID group, had higher depression, anxiety, and pain interference scores than the no-ED group.…”

Section: Discussionmentioning

confidence: 99%

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Eating disorder symptoms, including avoidant/restrictive food intake disorder, in patients with disorders of gut‐brain interaction

Murray

Riddle

Rao

et al. 2021

Neurogastroenterology Motil

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Background Previous studies show some patients with functional gastrointestinal disorders (disorders of gut‐brain interaction) may be at risk for or already have an eating disorder (ED). Avoidant/restrictive food intake disorder (ARFID) (ED not primarily motivated by body shape/weight concerns) may be particularly relevant but previous studies have been unable to fully apply diagnostic criteria. This study aimed to determine the frequency and nature of the full spectrum of ED symptoms, among adults with disorders of gut‐brain interaction. Methods Adults with disorders of gut‐brain interaction (n = 99, 77.1% female, ages 18–82 years) from academic medical center gastroenterology clinics completed a modified ARFID Canadian Paediatric Surveillance Program Questionnaire, the ED Examination Questionnaire (EDE‐Q), and other self‐report measures of depression, generalized anxiety, and pain interference. Key Results Of the 93 participants who completed the measures, 37 (39.8%) had ARFID symptoms and 12 (12.9%) had clinically significant shape/weight‐motivated ED symptoms (EDE‐Q‐Global ≥4.0). Exploratory comparisons among ARFID, shape/weight‐motivated ED, and no‐ED groups revealed that ARFID symptom presence was associated with lower body mass index (BMI), and shape/weight‐motivated ED presence was associated with higher depression, anxiety, and pain interference. However, the majority (86%) of patients with ARFID symptoms had a BMI >18.5 kg/m2. Conclusions & Inferences The full spectrum of ED symptoms was frequent among patients with disorders of gut‐brain interaction, particularly ARFID symptoms. Further research is needed to understand risk and maintenance factors to inform prevention and intervention efforts.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Eating disorder symptoms, including avoidant/restrictive food intake disorder, in patients with disorders of gut‐brain interaction

Murray

Riddle

Rao

et al. 2021

Neurogastroenterology Motil

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“…This may make it a more attractive option than other therapies. For example, elimination diets may have long‐term health risks, including the development of eating disorders 46 and micronutrient deficiencies 47 . Tricyclic antidepressants have various side effects, including dry mouth, insomnia, constipation, flushing, palpitations, and loss of appetite due to their anticholinergic actions 48 .…”

Section: Discussionmentioning

confidence: 99%

Vitamin D supplementation for irritable bowel syndrome: A systematic review and meta‐analysis

Chong

Yaow

Loh

et al. 2022

J of Gastro and Hepatol

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Background and Aim Irritable bowel syndrome (IBS) is a prevalent and complex gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits. Observational studies have suggested a relationship between serum vitamin D levels and IBS symptoms. This systematic review and meta‐analysis aimed to investigate the clinical effects of vitamin D supplementation on IBS symptom severity and quality of life (QoL) measures. Methods Medline, Embase, Scopus, Web of Science, and The Cochrane Library databases were systematically searched. Data abstraction and quality assessment were conducted by four authors independently, and discrepancies were resolved through consensus from the senior author. Continuous data were pooled with standardized mean difference (SMD) using the DerSimonian and Laird's random‐effects model. Sensitivity analysis by risk of bias and potentially “predatory” publication were performed as well. Results A total of 685 patients across eight studies were included in the meta‐analysis. Vitamin D supplementation significantly improved IBS symptom severity scale scores, with a SMD of −0.77 (95% confidence interval [CI] −1.47 to −0.07, P = 0.04, I2 = 91%). Improvements in IBS‐QoL scores were also observed, albeit not statistically significant (SMD 0.54; 95% CI −0.34 to 1.41, P = 0.15, I2 = 87%). However, small sample sizes, a relatively young study population, limited ethnicities, and varied vitamin D dosing strategies across the studies were notable limitations. Conclusions Vitamin D supplementation could be part of our clinical armamentarium when managing IBS patients due to the potential efficacy and good safety profile. Further randomized, controlled trials are required to confirm the therapeutic effects.

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“…used in the SCOFF questionnaire, may not be appropriate in DGBI, as food can be a symptom trigger. 96 Hence, development of a DGBI-specific tool may provide a more accurate picture. Studies should assess clinical characteristics that may predict a patient more likely to develop orthorexic traits if a restrictive diet is implemented.…”

Section: Early Data Suggest Link Between Dgbi and Orthorexiamentioning

confidence: 99%

Orthorexia nervosa is a concern in gastroenterology: A scoping review

Tuck

Sultan

Tonkovic

et al. 2022

Neurogastroenterology Motil

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There is concern that use of restrictive therapeutic diets, such as those used in disorders of the gut‐brain interaction (DGBI), may increase disordered eating. In this issue of Neurogastroenterology and Motility, Burton Murray et al. and Peters et al. both demonstrate a high prevalence of disordered eating in patients with gastrointestinal conditions, particularly those with DGBI. Given these findings, it is likely that orthorexia is common in this patient group, although this was not directly examined in these studies. Orthorexia nervosa is described as an obsessive and unsafe focus on eating foods perceived as healthy. This mini‐review therefore focuses on orthorexia by conducting a scoping review, as per the PRISMA extension for scoping reviews, aimed to assess the prevalence of orthorexia, and associations between orthorexia and restrictive eating practices. While a wide range of orthorexia prevalence has been reported (0%–97%) across the 57 studies included, no studies assessed prevalence specifically in gastrointestinal conditions. Four of eight studies describing diseases associated with specific dietary patterns suggested that participants who followed a diet for “digestive issues” or “food intolerances” were at higher orthorexia risk. These results suggest that dietary modifications may be a factor contributing to orthorexia. Additionally, we provide a commentary on the clinical implications of the findings for gastrointestinal conditions including a clinical flow chart. Clinicians should consider if a restrictive diet is appropriate for individuals with DGBI and include screening for disordered eating prior to implementation of dietary modifications. Future prospective studies should evaluate orthorexia within this patient group.

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Commentary: Adherence with a low-FODMAP diet in irritable bowel syndrome: are eating disorders the missing link?

Cited by 11 publications

References 15 publications

Eating disorder symptoms, including avoidant/restrictive food intake disorder, in patients with disorders of gut‐brain interaction

Eating disorder symptoms, including avoidant/restrictive food intake disorder, in patients with disorders of gut‐brain interaction

Vitamin D supplementation for irritable bowel syndrome: A systematic review and meta‐analysis

Orthorexia nervosa is a concern in gastroenterology: A scoping review

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