Dietary Interventions for IBS, IBD & Coeliac Disease. Debbie Blissitt Registered Dietitian

Transcription

1 Dietary Interventions for IBS, IBD & Coeliac Disease Debbie Blissitt Registered Dietitian

2 This session will cover 1. Coeliac 2. IBS First Line 3. IBS FODMAP 4. IBD 5. Dietetic Services 6. Questions

3 Coeliac Gluten free diet for life No wheat, rye, barley No oats for 6 months post diagnosis Naturally gluten free foods Gluten removed alternative foods (e.g. flour, bread, pasta, biscuits) Cross contamination Eating out

4 Coeliac (cont.) Increased risk of osteopenia or osteoporosis Calcium mg/day 1/3 pint of semi skimmed milk gives 230mg Vitamin D Oily fish, eggs & fortified breakfast cereals Iron deficiency common Coeliac UK

5 Coeliac Annual Review Patients seen once or twice by dietitian GP annual review (British Society of Gastroenterologists (BSG)) Symptoms Blood tests Prescriptions DEXA bone scan Re-refer to dietitian if required

6 IBS - Allergy or Intolerance True food allergies are rare and unlikely to cause IBS symptoms No evidence to support commercial tests for food intolerances Food intolerances can be diagnosed with a dietitian supervised elimination and reintroduction diet

7 IBS First Line Advice Regular meal pattern three meals / day Limit alcohol and caffeine consumption Reduce high fat foods Reduce intake of processed foods Try a probiotic supplement for 4 weeks Food and symptom diary Eat slowly and chew well Regular exercise Include relaxation time in daily routine

8 IBS Symptom Specific 1 Constipation Drink plenty (2l/day) Gradually increase fibre intake 5 a day Wholegrain foods Brown or golden linseeds, whole or ground Avoid extra wheat bran

9 IBS Symptom Specific 2 Diarrhoea Drink plenty (2l/day) Reduce wholewheat foods choose white Limit fruit juice Lactose free trial for 2-4 weeks Avoid sugar free sweets, mints and gum

10 IBS Symptom Specific 3 Bloating & wind Reduce intake of gas producing veg Reduce intake of resistant starch Limit fruit juice Avoid sugar free sweets, mints and gum Lactose free trial for 2-4 weeks

11 Low FODMAP Diet Fermentable Oligo-Di-Monosaccharides & Polyols Fructose, lactose, fructans, galactans, polyols Pros Evidence based, effective approach Cons Requires a highly motivated patient Risk of incomplete diet without dietetic supervision

12 Crohn s Disease Often require nutrition support Symptom specific advice Food and symptoms diary Enteral, or oral liquid nutrition, as an alternative primary or adjunctive treatment, may help to induce remission Elemental or polymeric formula? Poor compliance

13 Reintroduction Diets Elimination diets Structured process of re-introducing foods Process may take 3 months Re-test foods after 2-3 symptom free years LOFFLEX Low fat, fibre limited, exclusion diet Includes food least likely to cause intolerance 2-3 weeks then a structured reintroduction of other foods

14 F.S.A. 8 TIPS 1. Base meals on starchy foods 2. Eat lots of fruit and veg (>5/day) 3. Eat more fish 4. Reduce saturated fat and sugar 5. Eat less salt 6. Maintain a healthy weight 7. Drink more fluid 8. Eat breakfast

15 Resources Dietitians at The Hillingdon Hospital

16 Dietetic Services at THH Specialist Dietitians provide the following out patient services: Gastro clinic at MVH and THH FODMAP clinic at THH (pts. can be seen at MVH) Coeliac group

17 Refer to Dietitian We accept GP referrals via: 1. Choose and Book 2. Written referral post/fax to: Nutrition and Dietetics Department The Hillingdon Hospital Pield Heath Road Uxbridge UB8 3NN (fax)

18 Any questions?

19 Crohn s Disease References not for presentation nutritional intervention in ibd by elaine neary Evidence-based practice guidelines for the dietetic management of Crohn s disease in adults Produced by the Crohn s disease Dietetic Development Group