How Patients with IBS Use Low FODMAP Dietary Information Provided by General Practitioners and Gastroenterologists: A Qualitative Study

Abstract

There is a lack of dietitians trained to deliver the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet (LFD) for irritable bowel syndrome (IBS). Many patients receive nutritional information from general practitioners (GPs) or gastroenterologists (GEs). Since the LFD is dietitian-led, the aim of this research was to qualitatively explore the effects of GP- and GE-delivered LFD information, in IBS self-management. Semi-structured interviews were conducted in a purposive sample of 8 people with IBS (6 female), who used the LFD as their primary treatment. Interpretive Phenomenological Analysis (IPA) was used to develop themes on the lived experience of the participant’s use of LFD information from GPs and GEs. This information was perceived as trustworthy but simplistic; often just ”food lists” with little personalisation to meet individual needs and difficult to apply in ”real life”. The information required substantial interpretation and the familial and social effects of implementation were not addressed in the materials provided. Supplementary digital resources were regarded as more practical but the participants expressed concern in relation to the validity of these materials. The findings in this study support current clinical guidelines proposed by both the National Institute for Health and Care Excellence and the British Dietetic Association that the LFD should be considered a dietitian-led only intervention.

Behavioral and Diet Therapies in Integrated Care for Patients With Irritable Bowel Syndrome

“…Meanwhile, a qualitative interview study of patients who had received low-FODMAP dietary education from a family physician or gastroenterologist, but not a dietitian, reported the advice to be too simplistic, with little personalization and requiring substantial interpretation. 116 Indeed, in a retrospective analysis of dietary change in patients prescribed a low-FODMAP diet, education by a dietitian achieved the goals of the dietary strategy to a significantly greater extent than nondietitian education in which poor implementation led to incomplete FODMAP restriction and unsuccessful or absent reintroduction and personalization. 117 These are likely to reduce the chance of achieving optimal clinical benefit and patient self-empowerment.…”

Low FODMAP Diet: Evidence, Doubts, and Hopes

“…A recent study by Trott et al showed how general practitioners in the UK, who are often the first contact of the IBS patient with the health system, do not have the knowledge to propose the LFD without the risk of encountering several nutritional risks, such as causing a micronutrient deficiency micronutrients or an unnecessary weight loss [69]. Educational groups could be timesaving for health professionals and could be useful for improving the patients' knowledge of LFDs.…”

Food Intolerances

“…In addition to the need for long-term data, future studies should assess the ability of patients to be compliant with the low FODMAP diet. It is thought that dietitian guidance is key to the success of the diet [38], but further data is needed to understand dietary compliance, nutritional adequacy and effects on the microbiota profile both in the short- and long-term depending on mode of education (i.e., dietitian taught, physician taught or self-implemented).…”