Narrative review: Risk of eating disorders and nutritional deficiencies with dietary therapies for irritable bowel syndrome

Abstract

Elimination diets are growing in popularity and are increasingly utilized for gastrointestinal conditions including celiac disease, 1 eosinophilic esophagitis (EoE), 2 inflammatory bowel disease (IBD), 3 and more recently, for disorders of gut-brain interaction (DGBIs), formerly known as functional gastrointestinal disorders. 4 A large number of patients with DGBIs, including irritable bowel syndrome (IBS), change eating habits based on specific beliefs about how food impacts symptoms, especially during episodes of heightened symptoms. [5][6][7] Upward of 60% of patients with gastrointestinal disorders eat a restrictive diet. 8 The literature on the benefits of elimination diet therapies is growing. 9 However, the way diets are implemented in clinical trials is not always how they are implemented

Diet as a therapeutic tool in chronic gastrointestinal disorders: Lessons from the FODMAP journey

“…It is for this reason that expert commentaries recommend that diet therapies be included in the multidisciplinary management of IBS, led by dietitians and psychologists. 50,51,54,55 Clinicians should also consider the psychosocial implications of therapeutic diets, including social isolation, perceived difficulties with travel and eating out, and the additional cost of specialty food items. 56 Finally, attention should be paid to the use of language to avoid demonizing specific foods 50 and to avoid linear thinking about the pathogenesis of symptoms (i.e.…”

“…50,51,54,55 Clinicians should also consider the psychosocial implications of therapeutic diets, including social isolation, perceived difficulties with travel and eating out, and the additional cost of specialty food items. 56 Finally, attention should be paid to the use of language to avoid demonizing specific foods 50 and to avoid linear thinking about the pathogenesis of symptoms (i.e. all related to food).…”

“…Determining the actual prevalence of these conditions in patients with IBS is complicated, because more than 60% of patients modify their diet in an effort to control symptoms and validated screening tools are lacking. Nonetheless, concerning eating behaviors are common (possibly affecting up to 44%) 50 and, disturbingly, there appears to be little awareness of disordered eating behaviors and their importance in dietary management among gastroenterologists 51 . While little is known about the risk of precipitating eating disorders by initiating a FODMAP diet, restrictive diets are contraindicated in patients with a history of disordered eating behaviors, particularly without adequate psychological support.…”

“…Thus, the dietitian forms an integral part of patient management via their unique ability to undertake nutritional assessments, to mitigate the risks of dietary manipulation, 50 to optimally deliver dietary instruction, 53 and to monitor patients and troubleshoot when dietary issues arise.…”

“…However, there is limited awareness among clinicians and patients of the key risks of restrictive diets. This may be the exacerbation or precipitation of disordered eating behaviors/eating disorders and nutritional problems, 50,51 but also the common false belief that diet always has a better safety profile than pharmacological agents. It is for this reason that expert commentaries recommend that diet therapies be included in the multidisciplinary management of IBS, led by dietitians and psychologists 50,51,54,55 .…”