Diet advice working
Simple diet adjustments are keeping patients out of hospital and off medication, saving precious health service dollars at the same time.
One in every seven adults are affected by irritable bowel syndrome and in 2009 Capital & Coast District Health Board set up the Gastroenterology Clinical Pathways Collaborative to try a different approach.
Patients referred to Wellington Hospital with the condition who are at low risk of serious disease are referred to dietitians rather than gastro-enterologists.
Clinical leader John Wyeth said normal gut function relies on muscles and nerves.
‘‘ Irritable bowel syndrome is some disorder of the nerves and the muscles.’’
It sometimes causes constipation, sometimes diarrhoea and sometimes patients alternate from one to the other, he said.
Though it has no serious longterm consequences its painful cramps cost patients lost time from work.
The study led to a better understanding of the low-FODMAP diet, he said.
FODMAPs are fermentable carbohydrates and reducing them in the diet can reduce or eliminate irritable bowel symptoms.
‘‘Components of your diet which can be fermented in your gut then produce gas and distension,’’ Dr Wyeth said.
‘‘A common one is fructose [fruit sugar] – some people have difficulty absorbing fructose. As a result it goes through the small intestine into the large intestine and it is fermented.’’
However, glucose can help the digestion of fructose, he said.
‘‘It is not saying ‘beware of fructose’, but ‘ beware of foods that have fructose in excess of glucose’.’’
Others problem nutrients include wheat and lactose, he said.
Clinicians assess the patient’s referral letter from their general practitioner and decide whether trying diet advice is appropriate.
Certain symptoms, such as blood in stools, anaemia or weight loss would sound alarm bells, he said.
‘‘Seeing any of those alarms we are immediately thinking ‘ cancer’.’’
Those patients would be referred to a specialist for further investigation. However, patients who were suitable for diet advice would be sent to a hospital dietician for one or two visits.
‘‘ The low FODMAP diet is determined by a dietician with the patient over a period of months. It’s not exactly one-size-fits all. Some people might be able to have one fruit, other people might be able to have another form of fruit.’’
He warns against patients selfdiagnosing and changing their own diets without appropriate advice.
‘‘ The simple rule is that if you take something out of your diet, you’ve got to put something back into your diet.’’
The programme has resulted in a 10 per cent reduction in the number of gastro-
Dr intestinal patients being referred on to specialists and medical imaging, about 20 patients each month.
That equates to saving of about $45,000 to the health board over six months.
More clever: John Wyeth, clinical leader of a team trying a nonmedical approach to treating irritable bowel syndrome.