Reflections of a Healthcare Professional… Exploring Supportive Strategies in Functional Gastrointestinal Care

Introduction
I am a Registered Dietitian and member of the British Dietetic Association (BDA), committed to delivering evidence-based nutritional care in line with professional standards. As a Senior Dietitian specialising in gastroenterology, Bowel surgery, and nutrition support, I manage people with complex gastrointestinal conditions requiring advanced and individualised dietary interventions.
In my practice, I frequently see patients presenting with a range of gastrointestinal disorders. Emerging research suggests that the gut microbiome may play a vital role in the management of these conditions, highlighting the importance of considering microbiome-targeted interventions alongside dietary and lifestyle strategies. Evidence indicates that the effects of probiotics are strain-specific, therefore careful 
selection based on symptom profile and research evidence is essential.
My dietetic management approach for individuals experiencing gastrointestinal symptoms, such as bloating and abdominal pain, focuses on providing personalised dietary and lifestyle guidance tailored to each person’s needs.

Dietetic Review
Daniel, a 56-year-old male was referred for dietary management to address persistent 
gastrointestinal symptoms. He reported experiencing near-daily bloating and 
abdominal pain, with bowel habits ranging from once every two days to up to five 
times per day, often accompanied by urgency. Daniel noted that his symptoms were 
exacerbated by stress and described increasing embarrassment, as the impact on 
his social life and participation in community activities was contributing to reduced 
confidence and heightened feelings of stress and anxiety. Daniel’s dietary history indicated regular consumption of home-cooked meals, with occasional social meals eaten out. He reported a high intake of vegetables, fruit, wheat, and dairy, following a 
predominantly plant-based and pescatarian diet, with chicken and red meat consumed no more than once every two weeks. Alcohol intake was minimal, averaging less than four units per week. Prior to consultation, Daniel had not attempted any dietary or lifestyle modifications, including a low FODMAP approach. He reported no other medical conditions and was not taking any medications.

Dietetic Management Plan
In collaboration with Daniel, we agreed on a multi-faceted approach to address his symptoms. This included incorporating stress-management strategies, such as daily walks and social support through talking with friends, with techniques carefully selected to integrate seamlessly into his routine and encourage long-term adherence.
A low FODMAP diet was introduced as part of the management plan. This dietary approach involves limiting foods high in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols—short-chain carbohydrates that can be poorly absorbed in the small intestine and fermented by gut bacteria, leading to gas, bloating, abdominal pain, and altered bowel habits.
Aligned with emerging evidence on the role of strain-specific probiotics in supporting gastrointestinal health, we also discussed incorporating a probiotic into his management plan. Given that probiotic strains confer distinct, targeted benefits, I reviewed the available research to select strains shown to help manage gastrointestinal symptoms and, where evidence supported, to help modulate stressrelated effects on gut function. The Bifidobacterium longum 35624™ strain has been extensively investigated in both randomised, placebo-controlled trials and real-world studies, providing a 
robust evidence base for its effects in people with irritable bowel syndrome. Clinical trials have reported significant improvements in symptom scores for all IBS symptoms in all IBS sub-categories, abdominal pain/discomfort, bloating, bowel habit satisfaction and quality of life. Separately, in further quality studies in healthy adults, Bifidobacterium longum 1714™ was shown to improve perceived stress and cortisol output. Therefore, as part of a holistic approach to supporting Daniel’s dietary management, I recommended an initial eight week trial of a probiotic containing 1 x 109 colony forming units (CFU) of a 
combination of Bifidobacterium longum 35624™ and 1714™.

Dietetic Aims and Outcomes
The overall aim of the management plan was to reduce bloating, discomfort and achieve a more regular bowel habit, whilst also trying to reduce associated stress and embarrassment. In collaboration with Daniel, we chose the following as outcomes that would indicate whether this aim had been achieved:
• Less bloating and fewer episodes of bloating
• Fewer occasions of looser stools
• Fewer occasions of constipation
• Feeling less embarrassed, more confident and less anxious

Dietetic Follow-up
After eight weeks, I conducted a face-to-face follow-up in clinic to review Daniel’s progress. He reported a noticeable improvement in bloating, although occasional episodes persisted, which were relieved upon defaecation. Bowel habits had improved significantly, with regular movements occurring twice daily, normal stool consistency, and no urgency. At this point we discussed the slow and gradual reintroduction of the higher FODMAP foods in planned succession. I met with Daniel again six months later for a follow-up consultation. During this period, he had continued to adhere to the dietetic approach recommended at his initial visit. At this consultation, he reported feeling “much better,” with further improvements in his symptoms. Bloating was now infrequent, and bowel movements remained regular, occurring 1–2 times per day with normal 
consistency. Daniel noted improvements in mood and confidence, alongside reduced feelings of anxiety and stress. He described his symptoms as “generally fairly controlled” and expressed being “very pleased” with his progress. Specifically, he reported greater confidence in performing community duties and no longer needed to worry about urgently needing the bathroom during activities such as giving a speech.

At the conclusion of the appointment, it was agreed that Daniel would continue incorporating regular walks and other stress-reduction techniques into his routine. He was advised to continue to gradually reintroduce FODMAP-containing foods according to his tolerance while maintaining dietary variety. Continued use of the probiotic formulation was recommended as appropriate to support ongoing gastrointestinal health.