Dietary Interventions for GI Disorders
By: Emily Haller, MS, RDN

This talk highlights various diet interventions for several different gastrointestinal (GI) disorders:

• Celiac Disease
• Eosinophilic esophagitis (EoE)
• Functional Dyspepsia
• Gastroesophageal Reflux Disease (GERD)
• Gastroparesis
• Inflammatory Bowel Disease (IBD)
• Irritable Bowel Syndrome (IBS)
• Short Bowel Syndrome (SBS)

Celiac Disease

The only treatment for those with celiac disease is to follow a gluten-free diet. Gluten is a protein present in wheat, barley, and rye. Many foods are naturally gluten free, including rice, corn, quinoa, meats, poultry, fish, fruits, vegetables, legumes, and dairy when they are in their natural or unprocessed state. Label reading is important when following a gluten free diet. Gluten can be found in less obvious sources, for example: regular soy sauce, seasoning packets, and broth. Oats without a gluten-free label are not considered safe for those who have celiac disease. A gluten free multivitamin may be necessary for individuals who are unable to meet their recommended nutrient needs from diet alone.

Irritable Bowel Syndrome (IBS)

Many individuals associate their IBS symptoms with eating a meal and restrict their diet to prevent or improve symptoms. Research has shown a diet low in Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols (FODMAP diet can help improve GI symptoms in people with IBS. FODMAPs are short-chain sugars and fibers that are often poorly absorbed in the small intestine and delivered to the colon. This may cause GI symptoms such as bloating, gas and abdominal pain for some people. The low FODMAP diet is not a “forever diet”. It is very important to understand the Low FODMAP diet is done in 3 phases: 1) Elimination phase; 2) Reintroduction phase; 3) Personalization Phase

The goal of this approach is for you to figure out which FODMAPs you tolerate and which trigger your symptoms. This will help you best manage symptoms and eat a well-balanced diet with the most variety possible long-term. 

It is also important to note that not everyone feels better on a low FODMAP diet. If your symptoms do not improve on the elimination phase you should add back in all the high FODMAP foods you were avoiding and consider other therapies available to improve symptoms.

Short Bowel Syndrome (SBS)

There is no single “SBS diet”. The diet a person with SBS will tolerate is going to depend on the portion and length of their remaining bowel and how well it functions. Some people with SBS receive some or all of their nutrition through parenteral nutrition (nutrition through and IV).

Some general diet tips:

• If you have some colon remaining, a high complex carbohydrate diet is recommended.
• If you have a jejunostomy or high output ileostomy, a higher fat diet is recommended.
• Chew foods well to help break them down.
• Avoid concentrated sweets and beverages such as desserts, sodas, sweet drinks/tea, fruit juices, sweet coffee drinks, etc.
• Eat up to 6-8 smaller meals per day.
• Limit beverages with meals. Instead, sip allowed beverages between meals
• Salt foods liberally

More information on Nutrition on short bowel syndrome is available at www.GInutrition.virginia.edu.  

Eosinophilic Esophagitis (EoE)

An elimination diet can be used in place of medications for those with EoE. Generally, people will be on an elimination diet for 6 weeks and then have a scope to assess their response. There are a couple options when it comes to what foods to avoid:

• 2: Food Elimination Diet: No Dairy or Wheat
• 4: Food Elimination Diet: No Dairy, Wheat, Egg, or Soy
• 6: Food Elimination Diet: No Dairy, Wheat, Egg or Soy

If the elimination diet works, the person will add foods back in one at a time and have a scope after adding each new food in identify their trigger(s). EoE triggers cannot be found/identified using symptoms. Label reading when on this diet is important.

Other Nutrition Interventions:

Certain diet changes and eating strategies can be helpful for people with certain GI conditions. This next section is going to highlight certain recommendations, who they may benefit, and some tips to try.

The diet change: Smaller portion sizes and a lower fat diet

• Who may benefit: People with GERD, functional dyspepsia, and gastroparesis
• What to try:
  • Eating regular meals, snacks throughout the day
  • Avoid having one “main meal” daily
  • Consistency of foods: focus on soft/tender foods and liquids vs “tough” and roughage
  • Spread fat intake throughout the day, avoid large greasy meals, fried foods

The diet change: Higher fiber diet

• Who may benefit: People with IBD in remission, Diverticulous, Constipation
• What to try: fruits, vegetables, whole grains, nuts, seeds, beans and lentils.
  • Gradually increase fiber intake
  • Add fruit, nuts, seeds to morning cereal or yogurt
  • Try a new whole grain like quinoa, millet, oatmeal, or a bean/lentil pasta
  • Add chickpeas to a salad or soup
  • Add extra veggies of choice (fresh, frozen, or canned)
  • Stay hydrated by drinking enough fluids – aim for 8 to 10, 8-ounce glasses per day

The diet change: Lower fiber diet

• Who may benefit: People with Diverticulitis, Gastroparesis, IBD in flare, or intestinal strictures
• What to try:
  • Peeling thick skins of fruits and veggies
  • Blending / pureeing fiber containing foods
  • Cooking produce until tender
  • Chopping / grating fruits and veggies
  • Chewing foods well

Diet Interventions Goals: There are some common goals among all of these different nutrition interventions and they including improving a person’s overall diet quality by increasing the variety of healthy foods a person can tolerate while minimizing their gut symptoms.

If you are struggling with what/how to eat or are consuming a limited diet it is recommended to partner with a GI dietitian. GI dietitians are food and nutrition experts who can help you navigate how to eat with GI disorder.  

How to find a GI dietitian: IFFGD has dietitian search option, the American Gastroenterological Association (AGA) is coming out with a vetted GI dietitian list, GIonDEMAND is a virtual platform where you can meet with a specialized GI dietitian plus there are online patient education webinars and courses.