Diet ad­vice work­ing

Kapi-Mana News - - NEWS - By JIM CHIPP

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.

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