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From the Epicurators: 3 Tips for a Holistic Approach to Gut Health

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#1 Give Cognitive Behavioral Therapy a Try

Nutrition interventions like the low FODMAP diet and behavioral therapies like cognitive behavioral therapy and self-directed hypnosis work as well as medical therapies for many patients with Irritable Bowel Syndrome. We’re in an age where there is a lot more to offer IBS patients than just medications.

#2 Look for an Integrated Care Team

Collaborative care teams consisting of dietitians, behavioral therapists, and gastroenterologists provide more effective care for IBS patients than traditional care offered by a gastroenterologist or even just a gastroenterologist and a dietitian or just a gastroenterologist (GI) and psychologist.

Here’s the thing: there’s a big difference between a fully-trained GI dietitian or a GI behavioral therapist and a general dietitian or a general psychologist. The application of specific dietary interventions like the low FODMAP diet or GI-focused cognitive behavioral therapy or hypnosis really does require some additional training. Here’s the proof: there are recent studies that were conducted in Melbourne, Australia that showed that integrative care with a team consisting of a GI dietitian, a GI behavioral psychologist, as well as a gastroenterologist offered tremendously increased outcomes compared to traditional, GI-only care. Traditional GI care in the study was a gastroenterologist who could order a consultation with a dietitian or a psychologist from outside of his or her health system.

In the United States, it’s sad to say, but many gastroenterologists don’t have access to any dietitian or psychologist, let alone a GI dietitian or a GI behavioral therapist. To attach some numbers, the collaborative care model led to around 84% response rate in terms of improvement and overall IBS symptoms compared to 57% response rate with traditional GI care. The results of this study were published in The Lancet Journal of Gastroenterology and Hepatology.

Not sure where to find these practitioners? Here are a few great resources:
- Gastroenterologist Directory from the American College of Gastroenterology
- Low FODMAP-trained Dietitian Directory from FODMAP Everyday
- GI Psychologist Directory from the ROME Foundation


#3 Try Nutritional or Natural Therapies for Constipation

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Nutritional therapies or natural therapies are another potential option for patients with chronic constipation. I think everybody at least has heard that things like prunes or psyllium, which is of course Metamucil, can offer benefits for patients with chronic constipation. We just completed a randomized, controlled trial that evaluated kiwifruit, prunes, and psyllium in patients with chronic constipation symptoms to determine their comparative effectiveness. We confirmed that prunes and psyllium lead to an increase in stool frequency in patients with chronic constipation. We found that kiwi also leads to an increase in stool frequency in patients with chronic constipation and it’s perhaps arguably better tolerated. There were fewer dissatisfied people in the kiwi group compared to the other two groups. The proportion of patients with an adverse event was also substantially lower in the kiwi group.

Kiwi offers a modest effect for patients with chronic constipation but it’s big claim to fame is it’s really well-tolerated. If you're thinking about natural treatments in case of chronic constipation: you can use prunes, you can use fiber supplements like a psyllium, or a new edition to the United States is kiwifruit.

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About Author

William D. Chey, MD, AGAF, FACG, FACP
William D. Chey, MD, AGAF, FACG, FACP

Dr. Chey received a medical degree & training in internal medicine at Emory University School of Medicine. He completed a fellowship in gastroenterology and has remained as faculty at the University of Michigan in Ann Arbor where he is currently the Timothy T. Nostrant Collegiate Professor of Gastroenterology. He holds a joint appointment in the Department of Nutrition Sciences. His research interests focus on the diagnosis & treatment of functional bowel disorders and H. pylori infection. He has mentored more than 50 students, residents, fellows and junior faculty, many of which are leaders in Gastroenterology. He is a medical innovator and holds several patents. Dr. Chey is former co-Editor-in-Chief of the American Journal of Gastroenterology and has authored more than 350 manuscripts, reviews, chapters & books. Dr. Chey is a member of the Board of Trustees of the American College of Gastroenterology, Board of Directors of the Rome Foundation, Council of the American Neurogastroenterology & Motility Society, and Board of Directors of the international Foundation of Functional GI Disorders. He has been elected to “Best Doctors” since 2001 and received the Dean’s Outstanding Clinician Award and Dean’s Award for Innovation and Commercialization at the University of Michigan. He has also received the Distinguished Clinician Award from the American Gastroenterological Association. In 2020 he was awarded honorary membership to the Academy of Nutrition & Dietetics and the prestigious Berk-Fise Award from the American College of Gastroenterology.

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