Dietitian or Nutritionist: Specialized Diets for Gut Health

Highlights

• Dietitian or nutritionist? In the U.S. can perform many similar functions, but have a different training path.
• Dietitians and nutritionists do more than just help people lose weight–they can help adjust the quantity and type of food you consume to improve your health and address your digestive issues.
• They can develop specific diet and nutrition plans to help you with IBS, Crohn’s disease, ulcerative colitis, celiac disease, SIBO or other GI issues.
• Some example diets that could be recommended include the low FODMAP diet, Specific Carbohydrate diet and the low-fiber diet, the gluten-free diet, and the SIBO diet.
• It’s important to treat your gut disease both medically and nutritionally, with the guidance of a nutritionist or dietitian with specific training in GI disorders.

If you have a GI condition, you know that what you eat can have a huge effect on your symptoms. But what you might not know is how to optimally eat for your condition—to keep symptoms in check, and to ultimately work toward healing your area of issue.

If you have IBS, Crohn’s, ulcerative colitis, celiac disease, SIBO, or another GI tract condition, working with a nutritionist or dietitian can have a powerful positive impact on your day-to-day symptoms as well as your long-term outcomes.

The internet is full of diets, and it can be easy to be swayed by big promises on a snazzy website, but working with a trained professional offers you a truly personalized food plan as well as help with onboarding (which can be challenging for various reasons).  

Dietitian or nutritionist – what’s the difference?

In the U.S., the two can perform many similar functions, but have a different training path and educational requirements. There are also other nutrition professionals whose training doesn’t fall into either category—let’s check out these types of providers before we get into how they can help you get set up with specialized diets for your health conditions. 

Registered dietitian nutritionist (RDN)

Registered dietitian nutritionist (RDN): An RDN is qualified to provide medical-grade nutrition therapy to people with medical conditions. To receive a registered dietitian nutritionist credential, the nutritionist must hold a bachelor’s degree, pass a national exam, complete 1,200 hours of supervised practice at an accredited program, and maintain their registration with continuing education.

An RDN is an excellent choice of practitioner to consult for medically complex conditions like GI diseases and where you need medical nutrition therapy. Sessions with an RDN are often covered by health insurance. You may also hear RDN’s referred to as registered dietitians (RD) or clinical dietitians.

The term registered dietitian is interchangeable with registered dietitian nutritionist while clinical dietitians are RDNs who typically work in more institutional settings (e.g. hospitals, nursing homes, long-term care facilities).

Certified clinical nutritionist (CCN)

Certified clinical nutritionist (CCN): A CCN is qualified to give nutrition counsel to the general population. They must hold a degree in nutrition (at minimum, a Bachelor of Science), complete professional training hours (the number of hours required varies depending on how advanced their degree is), pass an exam, and complete regular training every two years.

A CCN who has a proven track record of working with GI clients may be a good choice of practitioner.

Certified nutrition specialist (CNS)

Certified nutrition specialist (CNS): A CNS is a qualification that a nutritionist can apply for once they already have an advanced degree in nutrition (e.g. Masters in Science or doctoral degree in nutrition or related field). They must complete coursework as well as 1,000 hours of supervised practice, pass an exam, and re-certify their credential every five years.

Because a deeper scientific background is required of a CNS than a CCN, a CNS is a strong choice of practitioner to see for nutritional treatment of a GI condition. 

Nutrition or health coach

Nutrition or health coach: In many states, a nutrition or health coach does not need to meet any minimum standard of education. There are wonderful, effective providers who work as un-credentialed coaches in private practice, so don’t necessarily dismiss one—but do your due diligence and make sure they have the experience required to treat your condition.

IBS and the low FODMAP diet

Irritable bowel syndrome, or IBS, is a disorder of the intestines. People with IBS experience some combination of cramping, bloating, gas, diarrhea, constipation, and abdominal pain.

To treat IBS through diet, many nutritionists and dietitians recommend the Low FODMAP Diet (also commonly referred to as “FODMAPs”), which is a diet that eliminates certain sugars that are implicated in intestinal problems.

“FODMAP” is short for “fermentable oligosaccharides, disaccharides, monosaccharides and polyols.” FODMAPs are short-chain carbohydrates that are not handled or absorbed easily by the small intestine. People with IBS can react quite strongly to FODMAPs. 

Because the Low FODMAP Diet restricts a large number of foods of all categories , most nutrition counseling and professionals do not recommend it as an ongoing dietary plan. Rather, it is used as an elimination diet that allows the GI system to rest and reset, and then higher FODMAP foods are cautiously and systematically reintroduced. Foods that persistently cause issues are then eliminated long-term. 

Crohn’s disease and the specific carbohydrate diet

Crohn’s disease is an inflammatory bowel disease that can affect large areas of the GI tract, anywhere in the large and/or small intestines. Crohn’s can cause diarrhea, cramping, abdominal pain, fever, fatigue, and weight loss, and can be debilitating. Diet changes can be a great approach to consider as a Crohn’s disease natural treatment.

The Specific Carbohydrate Diet, or SCD, was developed to treat GI disease and can be highly effective for some people with Crohn’s. The SCD completely eliminates grains and splits other carbohydrates by sugar type: easily digestible monosaccharides are permitted, while harder-to-process disaccharides and polysaccharides are not. 

The principle of the diet is that those more challenging carbohydrates feed harmful bacteria in the gut, thus causing bacterial overgrowth, inflammation, and irritation.

The SCD uses a multi-phase program that first addresses the acute symptoms of a flare with a highly restrictive onboarding menu, and then gradually includes broader varieties of food if the gut responds well. Processed foods, added sugars (including maple and agave), and fresh dairy, as well as a specific list of vegetables, starches, and legumes are never reintroduced. 

Low-fiber diet for ulcerative colitis

Ulcerative colitis is an inflammatory bowel disease that causes inflammation and ulcers in the colon and rectum. People with ulcerative colitis may have diarrhea with blood, rectal pain, abdominal pain, cramping, issues with defecation, weight loss, fever, and fatigue.

To manage the symptoms of ulcerative colitis, or UC, nutritionists often turn to a low-fiber diet for their clients, to reduce the bulk of their bowel movements. Because the colon and rectum can become severely inflamed with UC, this reduction in fecal mass can reduce the amount of pain and damage caused by the process of moving feces through and out of the lower GI tract.

For some people with UC, a low-fiber diet can be used periodically to manage flares, while dietitians will recommend that others stay low-fiber long-term. This diet aims to keep foods like beans and legumes, raw vegetables and fruit as well as their skins, nuts and seeds, and whole grains to a bare minimum. 

Gluten-free diet for celiac disease

Celiac disease is a condition that causes an immune system reaction to gluten. The reaction occurs in the small intestine and causes damage to the lining of the small intestine. People with celiac can experience diarrhea, fatigue, bloating, weight loss, rash, and anemia, amongst other symptoms.  

Because celiac disease reacts to gluten, it is very important to completely eliminate all gluten, even trace amounts, from your diet if you have celiac. Unlike some diets, there isn’t an option to use moderation or to someday reintroduce gluten—it needs to be treated like an allergy, and wheat, rye, and barley must be completely avoided.

At home, you’ll cut out most grains, pastas, cereal, beer and grain-based spirits, and all processed foods. At restaurants, you’ll need to make choices that don’t risk gluten contamination, or to order specific gluten-free options.

Luckily, with this nutrition program, a huge array of gluten-free ingredients and options are commercially available, so you don’t have to give up your favorite foods—but you do need to find celiac-safe versions. Your nutritionist can recommend their go-to gluten-free products that are tasty and minimally processed. 

The SIBO diet

Small intestinal bacterial overgrowth, or SIBO, is an unhealthy amount and type of bacteria in the small intestine. SIBO can follow abdominal surgery or can occur on its own. Its symptoms include abdominal pain, nausea, bloating, diarrhea, weight loss, and loss of appetite. 

The SIBO diet is very similar to the Low FODMAP diet, eliminating the sugars that overgrow in the small intestine and then cautiously reintroducing them once the harmful bacteria have been starved out. It is typically prescribed by nutrition professionals and gastroenterologists in conjunction with a course of antibiotics or probiotics, which work with the diet to optimize the bacterial populations in the GI tract. 

Seek help from a dietitian or nutritionist

If you have a gut disease, it’s important to treat it from both angles: medically, under the care of a trusted gastroenterologist who ideally specializes in your condition, and nutritionally, with the guidance of a dietitian or nutritionist with specific training in GI disorders.

Unfortunately, following a healthy nutrition plan that is geared toward the general population can actually exacerbate GI conditions, so the key is to get information from someone who knows your particular case and can make nutrition recommendations that are personalized for you. GI conditions can be tricky to treat, and getting a therapeutic specialized diet dialed in is vital for your ability to manage your condition well and, hopefully, to keep it in remission as much as possible. 

If you think you could benefit from a specialized diet, the right nutritionist or dietitian can help you build a personalized plan to support your wellbeing. Connect with a credentialed expert for who serves your area here.