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



#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


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.