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. 2022 Jun 1;117(6):947-957.
doi: 10.14309/ajg.0000000000001767. Epub 2022 Apr 8.

The Role of Food in the Treatment of Bowel Disorders: Focus on Irritable Bowel Syndrome and Functional Constipation

Prashant Singh  1 , Caroline Tuck  2 , Peter R Gibson  3 , William D Chey  1
Affiliations

The Role of Food in the Treatment of Bowel Disorders: Focus on Irritable Bowel Syndrome and Functional Constipation

Prashant Singh et al. Am J Gastroenterol. .

Erratum in

Abstract

Irritable bowel syndrome (IBS) and functional constipation (FC) are among the most common disorders of gut-brain interaction, affecting millions of individuals worldwide. Most patients with disorders of gut-brain interaction perceive food as a trigger for their gastrointestinal symptoms, and specific dietary manipulations/advice have now been recognized as a cornerstone therapeutic option for IBS and FC. We discuss in detail the 2 most common dietary interventions used for the management of IBS-general dietary advice based on the National Institute for Health and Care Excellence guidelines and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). We summarize the literature around the possible mechanisms of FODMAP-mediated IBS pathophysiology, the current 3-step, top-down approach of administering a low FODMAP diet (LFD) (restriction phase, followed by reintroduction and personalization), the efficacy data of its restriction and personalization phases, and possible biomarkers for response to an LFD. We also summarize the limitations and challenges of an LFD along with the alternative approach to administering an LFD (e.g., bottom-up). Finally, we discuss the available efficacy data for fiber, other dietary interventions (e.g., Mediterranean diet, gluten-free diet, and holistic dietary interventions), and functional foods (e.g., kiwifruit, rhubarb, aloe, and prunes) in the management of IBS and FC.

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Conflict of interest statement

Guarantor of the article: William D. Chey, MD.

Specific author contributions: All authors participated in the conception, preparation of the first draft, critical revision of subsequent drafts, and approval of the final manuscript.

Financial support: None to report.

Potential competing interests: P.S.: None. C.T. has received research funding from DSM Nutritional Products and Yakult Australia. P.R.G. has served as a consultant or advisory board member for Anatara, Atmo Biosciences, Falk Pharma, Immunic Therapeutics, Novozymes, Novoviah, Comvita, and Takeda. He has received research grants for investigator‐driven studies from Atmo Biosciences. He holds shares in Atmo Biosciences. His department financially benefits from the sales of a digital application, booklets, and online courses on the FODMAP diet. W.D.C. is a consultant for Abbvie, Allakos, Alnylam, Ardelyx, Arena, Bayer, Biomerica, Ironwood, Nestle, QOL Medical, Salix/Valeant, Takeda, Urovant Sciences, and Vibrant; has received grant and/or research study funding from Biomerica, Commonwealth Diagnostics International, QOL Medical, and Salix; has stock options in GI on Demand, Modify Health; serves on the Rome Board of Directors; and is a member of the Board of Trustees of the American College of Gastroenterology and Board of Directors of the International Foundation for Gastrointestinal Disorders.

Figures

Figure 1.
Figure 1.
FODMAPs exert multiple effects in the GI tract.
Figure 2.
Figure 2.
The low FODMAP diet is a three step process.
Figure 3.
Figure 3.
“Top-down” or “Bottom-up” approaches to the low FODMAP diet.
See this image and copyright information in PMC

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