Our interview with Dr Eirini Dimidi
Dr Eirini Dimidi is a registered dietitian and post-doctoral research associate at the Department of Nutritional Sciences at King’s College London. Her research focuses predominantly on nutritional interventions in patients with functional bowel disorders. Ahead of her talk at our upcoming Study Day in June, we caught up with her to find out more about her career and research…
1. Can you tell us about your career path, and how you got to your current position as a Post-Doctoral Research Associate in Nutritional Sciences?
I was first exposed to the world of research while I was doing my dissertation for my BSc in Nutrition and Dietetics at the University of Surrey; that is when I decided research was the career path for me! I then proceeded onto an MSc in Clinical and Public Health Nutrition at University College London, which re-enforced my passion for nutrition and gastroenterology. Having decided I wanted to undertake research on the impact of nutrition in gut health and disease, I then did a PhD in Nutritional Sciences at King’s College London (KCL) where I investigated the effects of probiotics in the management of functional constipation. My projects included a systematic review and meta-analysis of randomised controlled trials (RCTs) on the effect of probiotics in functional constipation, a RCT on the effect of a specific probiotic strain in people with functional constipation, and a national survey of perceptions of constipation diagnosis. After I was awarded my PhD in 2016, I was appointed as a post-doctoral research associate in the department of Nutritional Sciences at KCL, where I investigated the impact of the low FODMAP diet in the management of functional bowel disorders. Since then, I have had the pleasure to be involved in multiple research projects investigating the impact of diet, predominantly plant-based foods, prebiotics and probiotics, in gut health and disease.
2. What led to your interest in functional gut disorders and the low FODMAP diet?
My interest in gut health and disease was sparked during my MSc in Clinical and Public Health Nutrition, but I established my expertise and interest in diet and functional gut disorders specifically during my doctoral and post-doctoral research. During this time, I worked with many patients who suffered from functional bowel disorders and explored the literature in this area in great detail! This allowed me to gain a clear insight of the uncertainty in the evidence available, as well as of the experiences and struggles patients face, which made me determined to research this area further and improve their dietary care.
3. You have been involved in lots of research projects, but could you share with us one of the key projects you have been involved in recently and what were the findings?
We recently undertook a systematic review and meta-analysis on the effect of prebiotics in irritable bowel syndrome (IBS). Prebiotics feed our gut microbiota, the composition of which is known to be altered in patients with IBS; therefore, from a mechanistic point of view, prebiotics may improve IBS symptoms by modulating the gut microbiota composition. As expected, our systematic review and meta-analysis found an increased Bifidobacteria concentration in the prebiotic group compared to the control (Wilson et al. Am J Clin Nutr 2019). However, symptoms were improved in only 54% of patients receiving prebiotics and 63% in patients receiving the placebo, and this was not significantly different between the groups. This indicates that although prebiotics affect the gut microbiota composition, overall they do not improve symptoms of IBS and therefore may not be an appropriate treatment option for IBS symptoms.
4. What does a typical working day look like for you?
This varies a lot which is why being a researcher is so interesting and stimulating! Some days are filled with appointments with study participants, during which I provide dietary advice, collect blood and stool samples, carry out investigative tests and collect questionnaires. Other days, I work on statistical analysis, write grants and papers, mark students’ essays and read new research studies. More rarely, I spend days in the lab carrying out experiments, usually involving quantification of the gut microbiota and their by-products.
5. What are some important things a patient with IBS should be aware of before going on the low FODMAP diet?
Firstly, it is crucial that patients have visited their doctor and received a formal diagnosis of IBS before they embark on a low FODMAP diet. Secondly, patients need to be aware that the low FODMAP diet is a complex and highly restrictive diet, and should only be followed under the supervision of a registered dietitian. Lastly, it is important to note that the low FODMAP diet consists of 3 separate stages: the restriction stage, re-introduction stage and personalisation stage. It is crucial to ensure patients don’t remain in the restriction stage for more than 8 weeks and that they progress to the re-introduction stage once (and if) their symptoms improve – this is to avoid being on such a restrictive diet for a long period of time unnecessarily.
6. Is the low FODMAP diet solely intended for IBS patients? What are the potential consequences that may arise if a non-IBS patient starts following the diet without the supervision of a healthcare professional?
Currently, studies have only established the effectiveness of the low FODMAP diet in IBS, and there is preliminary evidence to show that this diet may improve symptoms in patients with inflammatory bowel disease in remission; therefore, this diet is to be followed by patients with functional bowel symptoms only. There is no need to follow a low FODMAP diet unless functional bowel symptoms are experienced. There are very good reasons why people without functional bowel symptoms should not follow the low FODMAP diet: firstly, studies have shown that the low FODMAP diet may lead to nutritional deficiencies and changes in the gut microbiota composition, raising concerns regarding the long-term safety of the diet; it is for this reason that even patients with IBS should not follow the restrictive stage of the diet for more than 8 weeks. Secondly, although FODMAPs may contribute to symptom exacerbation in patients with IBS, they are actually beneficial for gut health in general as they act as prebiotics and feed our gut microbiota. Restricting them unnecessarily would mean that we may “starve” some important gut microbiota species and therefore decrease their number and beneficial effects they exert in our gut!
7. What research is needed in the field?
From establishing the long-term impact of the low FODMAP diet in symptom management and the gut microbiota composition, to gaining more information on the re-introduction stage of the low FODMAP diet and which specific FODMAPs patients are more likely to not tolerate – a lot of research is still needed! I am also particularly interested in understanding the experiences and struggles patients face while following this complex diet, as well as who is more likely to benefit from the diet!
8. Nowadays there are many gut health books out there which claim to provide a solution to the perfect diet for having a healthy gut. What are your thoughts on this?
Gut health has been a very popular topic in the past couple of years! Indeed, many books claim to provide the perfect diet for gut health, but it is important to remember that there is no one-size-fits-all when it comes to diet! A ‘perfect’ diet for gut health would depend on numerous factors, such as pre-existing conditions, symptoms, food availability etc. which the vast majority of these books do not take into consideration! Thankfully, there are books written by excellent registered dietitians and nutritionists that provide balanced and evidence-based recommendations. So my advice is to always choose books from registered dietitians and nutritionists when it comes to dietary advice!
9. What do you like to do in your spare time?
Catching up with friends and family – for the latter that always involves a trip to Greece!
10. If you could give one tip to aspiring students, what would it be?
Three things that have worked for me and that I would recommend to aspiring students and researchers are: perseverance, reflection, and willingness to expose yourself to new challenges!