A 5Ad Dietary Protocol for Functional Bowel Disorders

Abstract

Functional bowel disorders (FBDs) affect around 20% of the population worldwide and are associated with reduced quality of life and high healthcare costs. Dietary therapies are frequently implemented to assist with symptom relief in these individuals, however, there are concerns regarding their complexity, restrictiveness, nutritional adequacy, and effectiveness. Thus, to overcome these limitations, a novel approach, the 5Ad Dietary Protocol, was designed and tested for its efficacy in reducing the severity of a range of gastrointestinal symptoms in 22 subjects with FBDs. The protocol was evaluated in a repeated measures MANOVA design (baseline week and intervention week). Measures of stool consistency and frequency were subtyped based on the subject baseline status. Significant improvements were seen in all abdominal symptom measures (p < 0.01). The effect was independent of body mass index (BMI), age, gender, physical activity level, and whether or not the subjects were formally diagnosed with irritable bowel syndrome (IBS) prior to participation. Stool consistency and frequency also improved in the respective contrasting subtypes. The 5Ad Dietary Protocol proved to be a promising universal approach for varying forms and severities of FBDs. The present study paves the way for future research encompassing a longer study duration and the exploration of underlying physiological mechanisms.

Reply to “A Gluten Reduction Is the Patients’ Choice for a Dietary ‘Bottom Up’ Approach in IBS—A Comment on “A 5Ad Dietary Protocol for Functional Bowel Disorders” Nutrients 2019, 11, 1938”

“…However, as FODMAPs are all within the carbohydrate category, there are still people who would not benefit from a LFD approach if, for example, their symptoms arise in response to gluten, dietary lectins, or food additives/chemicals. Additionally, the requirement of supervision from a dietitian for those following the LFD implies inherent safety concerns with the LFD and also confirms our own and the authors' published view about the LFD [18], that is, Shaw et al (2019) [1]. A recent meta-analysis concluded that very low-quality evidence exists that the LFD is effective in reducing symptoms in IBS patients [23].…”

“…These factors, combined, are likely responsible for the significant improvements observed within a week in the studied group [18]. Thus, the 5AdD is deemed a natural development, built on the common dietary therapies, and aims to streamline the delivery and adherence without compromising safety and nutritional adequacy [18].…”

“…The foods included within the 5AdD are not a random selection of food items, chosen by trial and error, but have instead been chosen based on the current evidence of the available dietary therapies, as well as some novel aspects unique to the 5AdD. These factors, combined, are likely responsible for the significant improvements observed within a week in the studied group [18]. Thus, the 5AdD is deemed a natural development, built on the common dietary therapies, and aims to streamline the delivery and adherence without compromising safety and nutritional adequacy [18].…”

A Gluten Reduction Is the Patients’ Choice for a Dietary ‘Bottom Up’ Approach in IBS—A Comment on “A 5Ad Dietary Protocol for Functional Bowel Disorders” Nutrients 2019, 11, 1938

“…We read the article by Ibrahim and Stribling [1] with interest, as dietary therapies for functional disorders can be challenging to implement, such as the initial phase of the low fermentable oligo-, di-, mono-saccharide and polyols (FODMAPs) diet. In view of this, streamlined approaches to achieve symptom management maybe warranted, such as a 'bottom up' approach.…”

Review article: current and future treatment approaches for pain in IBS

“…117 The 5Ad Dietary Protocol, is said to be a less restrictive dietary approach than low FODMAP and helped abdominal pain in a small pilot study (22 subjects, mixed functional bowel disorders). 118 A 4-week starch-and sucrose-reduced diet reduced abdominal pain in patients with IBS (80 patients) compared to controls (25 patients) with a 74%, responder rate. 119 Sustained (small intestine) release peppermint oil is classed as a medical food and in a small, 4-week RCT for patients (35 patients) with non-constipated IBS was better than placebo (37 patients) in reducing abdominal pain severity.…”