Nutritional Approaches for Functional Bowel Disorders in an Integrative Medicine Clinic

Abstract

Introduction Functional bowel disorders (FBDs) are gastrointestinal (GI) conditions based on patient-reported symptoms. Irritable bowel syndrome (IBS) is the most common FBD and despite extensive research on IBS, pathophysiology, etiology, and treatments for FBDs are still being researched. Treatment of FBDs involves a range of therapies including pharmaceutical treatments, psychological treatment, and lifestyle interventions like physical activity and dietary interventions. The evidence for efficacy of lifestyle interventions is still sparse. Integrative Medicine (IM) is a medical specialty that emphasizes lifestyle interventions, including dietary therapies. Studying lifestyle interventions in an IM clinic is useful because IM therapies are often sought out in addition to conventional medical treatment, thus patients may be more motivated to follow recommendations given by providers. The aims of this study include describing the interventions for FBDs in an IM clinic at an academic medical center (University of Kansas (KU)), and determining if the FBD interventions were effective. Finally, because little is known about the nutritional status (micronutrient) of patients with FBDs, we describe the vitamin and mineral status (vitamins B6, B12, D and zinc, magnesium and copper) of FBD patients. Methods This was a retrospective chart review in a population of 74 IM patients at KU IM. Charts were reviewed to collect data about FBD interventions, demographics, symptoms measurement (via medical symptoms questionnaire (MSQ), and micronutrient status. Results IM providers used 9 common interventions: elimination diets, vitamin/mineral supplementation, GI-related supplementation (probiotics, etc.), magnesium supplementation, non-dietary lifestyle intervention, GI-related prescriptions, water, referral to other healthcare providers, and fermented foods. The 3 most common interventions for patients with FBDs were (in descending order): elimination diets, vitamin/mineral supplementation and GI-related supplementation. FBD interventions by IM practitioners were effective (75.4% of patients had symptom improvement). For all patients, digestive tract symptoms improved by an average of 3.0 points (p<0.0000001) on a scale from 0-28. Symptoms of IBS patients also improved significantly: IBS-C (p=0.005), IBS-D (p=0.0004), and IBS-M (p=0.02). Micronutrient status of FBD patients was generally adequate except for vitamin D deficiency among 23% (n=17) of FBD patients. Most patients (50.7%, n=36) had elevated levels for vitamin B6 and several (14.9%, n=11) had elevated vitamin B12 levels; both vitamins being elevated were likely related to patients taking nutritional supplements before their IM consultation. Conclusion IM interventions for FBD primarily center on diet and nutrition-based interventions. These interventions are effective for lowering GI-related symptoms; GI specialists should consider referring IBS patients to RDNs who are skilled at elimination and exclusion diets and may be knowledgeable about dietary supplement use and monitoring. Micronutrient status of FBD patients in this IM clinic was adequate except for vitamin D deficiency. Nutritional adequacy may be related to baseline supplement intake prior to IM consultation among 85% of the patients.