Editorial: Food for Thought—Addressing the Nuances of Diet and Mood When Evaluating Dietary Intervention in IBS. Authors' Reply

Abstract

We thank Drs Katzenstein and Keefer for their editorial on our paper [1, 2]. We fully agree on the need for progress towards an integrated, personalised model of care for patients with disorders of gut-brain interaction. We are aware of the limitations of the Hospital Anxiety and Depression Scale (HADS) and concur that it does not capture all the psychological nuances seen in patients with irritable bowel syndrome (IBS). However, it is easily understood and administered by non-specialist practitioners and has been used across a range of DGBIs by others [3]. Although the imperative for the development of symptom-specific questionnaires, specific psychosocial questionnaires and inclusion of psychosocial well-being have been championed by expert opinion, none was in use at the time of our study, and none has since emerged [4].

As the study was conducted in routine clinical practice and at the time of the Coronavirus pandemic, many patients were consulted with remotely. We believed it would have been difficult to repeat the HADS post-intervention. In addition, around the time of lockdown restrictions related to the pandemic, observed incidences of anxiety and depression were increased [5]. In such a setting, to infer that any changes observed in HADS over the period of the intervention were due to dietary therapy or IBS symptom status alone may have been an over-simplification.

The vast majority of patients with IBS are, and will continue to be, treated in primary and secondary care by either generalist physicians and dietitians or others with a subspeciality interest in the field. We, therefore, contend that the design and findings of our study are broadly generalisable to existing models of care and show promising results even in patients with more severe symptoms, overlapping symptomatology and poor psychological health, which will resonate with clinical practitioners across disciplines. Like Drs Katzenstein and Keefer, we look forward to the type of studies that will lead to greater comprehension of the intersection of food and mood, and to uncover the underlying mechanisms at play. Until then, evidence from studies such as our own—that may improve understanding of how psychological parameters could predict response to commonly used interventions—is an important step towards personalising care for patients with IBS.

Anthony O'Connor: conceptualization, investigation, writing – original draft, methodology, writing – review and editing, visualization, validation, formal analysis, data curation, project administration. Sarah Gill: conceptualization, investigation, methodology, validation, formal analysis, data curation. Elaine Neary: conceptualization, investigation, methodology, validation, data curation. Sarah White: conceptualization, investigation, methodology, formal analysis. Alexander C. Ford: writing – original draft, writing – review and editing, formal analysis, supervision.

This article is linked to O’Connor et al papers. To view these articles, visit https://doi.org/10.1111/apt.18337 and https://doi.org/10.1111/apt.18372.