Search Results (152)

Background/Objectives: Intense physical activity can cause gastrointestinal symptoms, negatively impacting athletic performance. A low-FODMAP diet has the potential to reduce these symptoms and is increasingly being considered by physically active individuals. The aim of this review is to present the current knowledge on the importance of FODMAPs in sports nutrition. Methods: A narrative review was conducted in PubMed, Web of Science, ScienceDirect, and Google Scholar, covering publications published up to October 2025. Original studies, reviews, and meta-analyses addressing the relationship between FODMAP intake and gastrointestinal symptoms during physical activity were included. Selected articles were assessed for specific criteria, and the results were grouped thematically to present the current state of knowledge. Results: FODMAP consumption increases the risk of intestinal symptoms. Short-term FODMAP restriction, especially before and during exercise, reduced the severity of symptoms in most of the analyzed studies. Data on the long-term effects of a low FODMAP diet on the health, nutrition, and gut microbiota of athletes remain limited. Conclusions: A strategy of short-term FODMAP restriction in athletes’ diets shows potential for reducing gastrointestinal symptoms. An optimal approach requires individualization. Further research is needed to monitor potential side effects and long-term outcomes. Full article

Background/Objectives: Recent reports on the co-occurrence of allergies and endometriosis have provided grounds for expanding research in this area, suggesting that diagnostics should be extended to women with endometriosis. However, numerous studies on nutrients and antioxidants do not specify the type of diet that supports the treatment process. In our review, we focus on the types of food elimination and dietary approaches that have been used. Methods: This systematic review was conducted according to the PRISMA guidelines. We searched the EMBASE, PUBMED and SCOPUS databases, as well as the bibliographies of research papers and reviews, including the latest reports from June 2025. The search keywords were “endometriosis” and “type of diet”, “nutrition”, “food products”, “nutrients”, “elimination diet”, and “allergies”. Results: Excluding coexisting allergies and introducing an anti-inflammatory diet low in animal products, limiting butter and margarine, and eliminating fried foods and refined simple sugars may be the best solution to help treat endometriosis. Conclusions: Personalised nutritional counselling for patients with endometriosis is particularly helpful and necessary, as there is no single elimination diet that can be recommended for all patients with endometriosis. The first step should be an anti-inflammatory diet, such as the Mediterranean diet or the MIND diet (Mediterranean-DASH diet intervention for neurological delay), followed by more in-depth allergy screening. The phenotypic diversity of this group of patients may require the use of a low-FODMAP (fermentable oligo-, di-, monosaccharides and polyols), low-nickel, gluten-free or other elimination diet. Full article

Irritable bowel syndrome (IBS) is a disorder of gut–brain interaction characterized by recurrent abdominal pain associated with a change in the frequency and/or form of stools. Approximately one in three patients with quiescent inflammatory bowel disease (IBD), defined as the absence of endoscopic evidence of active inflammation, experience IBS-type symptoms. These symptoms are associated with reduced quality of life and increased psychological burden, and can complicate clinical assessment by mimicking conditions such as small intestinal bacterial overgrowth, bile acid malabsorption, or post-inflammatory complications. This up-to-date narrative review examines the mechanisms, diagnostic challenges, and management of IBS-type symptoms in quiescent IBD. Evidence suggests that these symptoms arise from a complex “matrimony” of functional and organic processes, including low-grade residual inflammation, altered intestinal permeability, microbiota dysbiosis, visceral hypersensitivity, and psychosocial impairment. Diagnosing IBS-type symptoms in IBD requires a “positive”, symptom-focused approach while carefully excluding active inflammation. Management should adopt a biopsychosocial approach, integrating dietary strategies (e.g., low-FODMAP diet), brain–gut behavioral therapy, biofeedback therapy, and/or pharmacological treatments such as antispasmodics, antidiarrheals, laxatives, and neuromodulators to address both physiological and psychological factors. Future research should integrate sensitive biomarkers and longitudinal follow-up to enhance diagnostic precision and guide personalized therapy. Understanding and addressing the overlap between IBS and IBD is essential to reduce the multidimensional burden on physical health, psychological well-being, and daily functioning. Full article

Background and Objectives: Fibromyalgia (FM) is associated with chronic pain, oxidative stress, low-grade inflammation, and disturbances in signalling along the gut–brain axis. These pathways may be modulated by plant-derived phytonutrients. This narrative review summarises mechanistic and clinical evidence on phytonutrient-based strategies in FM. Materials and Methods: Following SANRA guidelines, we searched PubMed, Web of Science, Scopus and ScienceDirect for human and relevant preclinical studies published between 2005 and October 2025 that evaluated phytonutrient-rich dietary patterns or isolated bioactives in relation to FM symptoms or underlying mechanisms. Results: There is a consistent association between FM and increased oxidative damage and reduced antioxidant defences. Adopting plant-based diets, particularly Mediterranean-type and low-FODMAP diets, has been linked to improvements in pain, fatigue, sleep, and gastrointestinal symptoms, as well as modest gains in quality of life. However, the effects on inflammatory markers are conflicting. Trials of selected bioactive compounds, such as coenzyme Q10, curcumin-based formulations, L-carnitine and certain probiotics, suggest beneficial effects on symptoms, whereas others show little or no effect. Studies of the microbiome indicate a loss of butyrate-producing bacteria and altered microbial metabolites. Early dietary or probiotic interventions may partially mitigate these changes to some extent. Preclinical studies have identified SIRT1 as a potential mediator, but there is a lack of human data. Reporting on safety, dosage and formulation is often inadequate. Conclusions: Given the narrative design of this review and the methodological heterogeneity of the included studies, the overall certainty of the evidence cannot be formally graded and should be regarded as limited and heterogeneous. Nevertheless, current data supports phytonutrient-rich, food-based approaches as adjuncts rather than alternatives to standard FM care. Well-designed randomised trials with standardised outcomes and reporting of dose, formulation and relevant biomarkers are needed to identify the most effective strategies and the patient subgroups most likely to benefit. Full article

Non-coeliac wheat sensitivity (NCWS) is characterised by gastrointestinal and extra-intestinal symptoms following gluten/wheat ingestion in individuals without coeliac disease or wheat allergy but remains controversial due to symptom overlap with irritable bowel syndrome (IBS). This narrative review aims to provide a comprehensive, critical analysis of NCWS as a clinical and biological entity, examining the evidence for its distinction from related disorders. While self-reported rates are high (often >10%) in the general population, rigorous double-blind, placebo-controlled challenge (DBPCC) studies confirm the diagnosis in only a minority of cases (typically <30%). The clinical presentation is heterogeneous, combining IBS-like symptoms with systemic complaints such as “brain fog,” headaches, and fatigue. The pathophysiology is distinct from coeliac disease, involving innate immune activation, altered intestinal barrier function, and gut dysbiosis. Non-gluten wheat components, particularly fructans and amylase-trypsin inhibitors, are implicated as potential triggers. Diagnosis is challenging, requiring the exclusion of other disorders and adherence to complex dietary challenge protocols such as the Salerno Experts’ Criteria, which are impractical for routine clinical use. The search for validated biomarkers is a key research area and investigated candidates include serological markers such as IgG anti-gliadin antibodies, inflammatory markers such as faecal calprotectin, and proteins related to intestinal permeability such as zonulin, but results have been conflicting and require further validation. Management primarily involves elimination of wheat and gluten from the diet, although a low-FODMAP diet has also proven effective as an adjunctive treatment. In conclusion, NCWS is a clinical entity whose study and management are critically hampered by the absence of validated diagnostic criteria and biomarkers. Progress requires methodologically rigorous DBPCC trials to elucidate its mechanisms and develop reliable diagnostic tools. Full article

Irritable Bowel Syndrome (IBS) is a prevalent and heterogeneous functional gastrointestinal disorder with a complex and multifactorial pathophysiology. Traditional treatment approaches have focused on symptom relief, often overlooking the underlying biological mechanisms driving the disease. Τhis review summarizes the current evidence linking core pathophysiological pathways of IBS with mechanism- and diet- based therapeutic strategies to guide personalized treatment. Serotonergic signaling, microbial dysbiosis, immune activation, epithelial barrier dysfunction, and bile acid malabsorption interact to shape the diverse phenotypes of IBS, contributing to altered motility, visceral hypersensitivity, and gut-brain axis dysregulation. Increasing evidence supports that targeted dietary and biological interventions including low-FODMAP and Mediterranean low-FODMAP diets, targeted use of probiotics and psychobiotics, and vitamin D supplementation can modulate microbial composition, reduce luminal irritants, support barrier integrity, and attenuate immune system activation. Similarly, pharmacologic therapies including serotonergic receptor modulators, bile acid sequestrants and neuroimmune agents act on specific mechanistic pathways, reflecting a shift from symptom-based to mechanism-driven management. Collectively, these findings highlight that integrating dietary, microbial, neuroimmune, and serotonergic modulation within a unified therapeutic framework can support a more rational and individualized approach to IBS management and long term symptom control. Full article

Background/Objectives: Irritable bowel syndrome (IBS) is presented with both gastrointestinal and extraintestinal symptoms. In addition, overweight/obesity and metabolic syndrome is prevalent in IBS. Dietary interventions with a low content of fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) or a starch- and sucrose-reduced diet (SSRD) efficiently reduce symptoms and weight. Our hypothesis was that not only nutrition composition but also weight reduction is of importance for symptom relief. The aim was to merge two randomized trials and examine symptoms, weight, nutrition intake, and lipid levels at baseline and during nutritional intervention. Methods: One study with 105 IBS patients randomized to either an SSRD (n = 80) or control diet (n = 25) and one study with 155 IBS patients randomized to an SSRD (n = 77) or low FODMAP (n = 78) were merged. Symptom and food questionnaires were analyzed together with weight/body mass index (BMI) and lipid levels. Results: Patients had moderate or severe IBS at baseline, and half of them were overweight/obese. Energy intake was reduced by both diets, with the most pronounced carbohydrate reduction after the SSRD. The cholesterol levels were highest in the second cohort, possibly due to the higher fat and lower starch intake. About 25% had high-density lipoprotein below reference levels. Gastrointestinal and extraintestinal symptoms, as well as weight/BMI, were reduced by the SSRD and low FODMAP, but not in the control group. The SSRD in the second cohort and low FODMAP rendered lower levels of total cholesterol, low-density lipoprotein, and non-high-density lipoprotein levels. Weight/BMI were more often associated with lipid levels and symptoms than nutrient composition at baseline, and weight/BMI reductions correlated with carbohydrate reduction and were associated with a reduction in gastrointestinal and extraintestinal symptoms. Conclusions: Not only food components, but also overweight/obesity may be of importance for the development and severity of IBS and related symptoms. Full article

Irritable Bowel Syndrome (IBS) is a functional disorder of the digestive system. Its global prevalence varies widely, estimated at up to 10%, due to differences in diagnostic criteria, cultural factors, and dietary patterns. Dietary interventions have emerged as first-line strategies for symptom management, with the low-FODMAP (fermentable oligo-, di-, and monosaccharide and polyol) diet demonstrating robust efficacy in reducing gastrointestinal symptoms by minimizing poorly absorbed, fermentable carbohydrates. However, concerns regarding the long-term nutritional adequacy, potential alterations in gut microbiota composition, and sustainability of the low-FODMAP diet have prompted the need for more integrative and nutritionally balanced dietary models. In contrast, the Mediterranean Diet (MD), rich in fruits, vegetables, legumes, whole grains, nuts, olive oil, and omega-3 fatty acids from fish, is widely recognized for its anti-inflammatory, cardiometabolic, and potential anticarcinogenic effects. Notably, adherence to the MD has been associated with favorable gut microbial profiles and reduced risk of colorectal and other gastrointestinal cancers. However, the high FODMAP content of many MD components limits its immediate compatibility with IBS dietary protocols. This review explores the evidence supporting the integration of MD principles into a low-FODMAP framework for the dietary management of IBS. Rather than proposing a new model, we synthesize existing literature, including recent clinical findings, and offer practical, evidence-informed guidance for tailoring a Mediterranean-style low-FODMAP diet that supports both symptom management and long-term nutritional health. Integrating MD principles into the low-FODMAP approach offers a promising strategy to enhance the nutritional quality, sustainability, and long-term efficacy of dietary management in IBS. Full article

Background/Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental condition associated with behavioral and cognitive impairments. Increasing evidence also links ASD with systemic immune dysregulation, including abnormal cytokine profiles and chronic low-grade inflammation. Emerging evidence suggests that targeted dietary strategies and probiotic supplementation may modulate immune responses and gut–brain interactions in patients with ASD. This study aimed to evaluate the immunomodulatory effects of a structured anti-inflammatory diet (NeuroGutPlus) compared to multi-strain probiotics in children with ASD. NeuroGutPlus is a nutritionally complete anti-inflammatory dietary protocol that targets gut integrity, inflammation, and mitochondrial function. It includes a diet low in gluten, FODMAPs, casein, and artificial additives, and a high intake of omega-3 fatty acids, polyphenols, and fermentable fibers. Methods: A total of 30 children with ASD and 12 neurotypical controls were enrolled in a 12-week randomized controlled nutritional trial. Participants received either a NeuroGutPlus anti-inflammatory diet, probiotic supplementation (16 strains of Lactobacillus and Bifidobacterium), or no intervention. Plasma levels of 20 cytokines and chemokines were measured pre- and post-intervention using multiplex Luminex immunoassays. Principal component analysis (PCA) was used to explore shifts in the immune profile. Results: Patients treated with the NeuroGutPlus diet significantly reduced IFN-γ levels (p = 0.0090) and showed a stabilizing effect on immune profiles, as evidenced by PCA clustering. Probiotic supplementation led to a significant increase in IL-8 (+66.6 pg/mL; p = 0.0350) and MIP-1β (+74.5 pg/mL; p = 0.0100), along with a decrease in IFN-γ (p = 0.0070), suggesting reconfiguration of innate immune responses. Eight out of eleven biomarkers showed significant post-intervention differences between groups, indicating distinct immunological effects. Conclusions: This study provides evidence that anti-inflammatory diets exert broader and more consistent immunoregulatory effects than probiotics alone in children with ASD. These findings support the inclusion of precision dietary strategies as non-pharmacological interventions to mitigate immune-related dysfunction in patients with ASD. Full article

Irritable bowel syndrome (IBS) is a gut–brain axis chronic disorder, characterized by recurrent abdominal pain and altered bowel habits in the absence of organic pathology. Nutrition plays a central role in symptom management, yet no single dietary strategy has demonstrated universal effectiveness. This narrative review critically evaluates current nutritional approaches to IBS. The low-Fermentable Oligo-, Di-, Mono-saccharides and Polyols (FODMAP) diet is the most extensively studied and provides short-term symptom relief, but its long-term effects on microbiota diversity remain concerning. The Mediterranean diet, due to its anti-inflammatory and prebiotic properties, offers a sustainable, microbiota-friendly option; however, it has specific limitations in the context of IBS, particularly due to the adverse effects of certain FODMAP-rich foods. A gluten-free diet may benefit individuals with suspected non-celiac gluten sensitivity, although improvements are often attributed to fructan restriction and placebo and nocebo effects. Lactose-free diets are effective in patients with documented lactose intolerance, while a high-soluble-fiber diet is beneficial for constipation-predominant IBS. IgG-based elimination diets are emerging but remain controversial and require further validation. In this review, we present the 10 dietary commandments for IBS, pragmatic and easily retained recommendations. It advocates a personalized, flexible, and multidisciplinary management approach, avoiding rigidity and standardized protocols, with the aim of optimizing adherence, symptom mitigation, and health-related quality of life. Future research should aim to evaluate, in real-world clinical settings, the impact and applicability of the 10 dietary commandments for IBS in terms of symptom improvement and quality of life Full article

Background: A low-FODMAP diet is considered as a potential supportive treatment approach in some gastrointestinal disorders. The aim of this study was to systematically review the literature for randomized controlled trials assessing the efficacy of the low-FODMAP diet on the severity of gastrointestinal symptoms and quality of life in patients with gastrointestinal disorders. Methods: This review was conducted in accordance with CASP tool and PRISMA guidelines. A comprehensive search of the PubMed, Scopus, and Web of Science databases resulted in the identification of fourteen randomized controlled trials. Results: Ten studies examined the effect of the low-FODMAP diet in patients with irritable bowel syndrome (IBS), three with inflammatory bowel disease (IBD), and one with symptomatic proton pump inhibitor (PPI) refractory gastroesophageal reflux disease (GERD). All interventions compared the low-FODMAP diet with another diet and lasted from 3 to 12 weeks. Most studies on IBS showed significant improvements in abdominal pain, bloating, and quality of life compared to control diets. In IBD, improvements were mainly observed in functional gastrointestinal symptoms, while no clear benefit was demonstrated in GERD. Heterogeneity in study designs, intervention durations, comparator diets, and outcome measures limited the ability to conduct a meta-analysis. Conclusions: Although a low-FODMAP diet may reduce symptoms in selected individuals, it is not universally necessary. Importantly, the diet’s restrictive nature and potential long-term effects—such as nutritional deficiencies and alterations in gut microbiota—highlight the need for clinical supervision by dietitians with expertise in gastrointestinal disorders. Furthermore, in some cases, symptom improvement may be achievable through less restrictive changes, such as improving food hygiene and reducing intake of processed or high-sugar foods. Further high-quality randomized controlled trials with standardized endpoints and longer follow-up are needed to clarify the efficacy and safety of the low-FODMAP diet across various gastrointestinal conditions. Full article

Background: Nutritional management has become an integral part of Inflammatory Bowel Disease (IBD) care, with growing evidence supporting specific dietary interventions alongside pharmacologic therapy. However, clinical guidance remains fragmented due to heterogeneous study designs and variable endpoints. Objectives: This review critically examines the current evidence on dietary strategies and oral nutritional supplementation (ONS) in both Crohn’s Disease (CD) and Ulcerative Colitis (UC), highlighting their clinical applications, mechanisms of action, and limitations. Methods: A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases, analyzing studies on various dietary approaches and ONS in IBD. Results: Exclusive Enteral Nutrition (EEN) is a first-line therapy in pediatric CD, while partial enteral nutrition (PEN) and the Crohn’s Disease Exclusion Diet (CDED) show promising efficacy and better adherence in both children and adults. Whole-food-based interventions, including the Mediterranean Diet, Specific Carbohydrate Diet, plant-based diets, and emerging strategies such as CD-TREAT and the Tasty & Healthy diet, have demonstrated varying levels of benefit in disease maintenance and symptom control. Targeted exclusion diets—such as low-FODMAP, low-emulsifier, and low-sulfur diets—may relieve functional symptoms and influence inflammatory activity, although evidence remains preliminary. ONS plays a pivotal role in addressing malnutrition and improving outcomes in perioperative and hospitalized patients. Conclusions: Dietary interventions and ONS represent valuable therapeutic tools in IBD management. Future research should prioritize standardized, well-powered clinical trials and personalized nutritional approaches to better define their role within integrated care pathways. Full article

A diet low in fermentable oligo-, di-, and monosaccharides and polyols (FODMAP) is an established treatment for irritable bowel syndrome (IBS). The starch- and sucrose-reduced diet (SSRD) is a newer, promising diet. Nutrients influence the production of gut hormones, which affect gastrointestinal motility. This study aimed to investigate the changes in copeptin, leptin, PAI-1, C-peptide, and insulin in patients with IBS following a 4-week dietary intervention and to explore whether these hormonal levels correlated with symptom improvements. A total of 142 participants with IBS were randomized to either a 4-week intervention with the SSRD (n = 70) or a low-FODMAP diet (n = 72). Participants completed the study questionnaire, food diary, ROME IV questionnaire, irritable bowel syndrome severity scoring system (IBS-SSS), and visual analog scale for irritable bowel syndrome (VAS-IBS) at baseline and after 4 weeks and 6 months; blood samples were collected at each of these time points. Leptin levels decreased from baseline to 4 weeks in the SSRD group (p = 0.002) but not in the low-FODMAP group (p = 0.153). In the overall study population, leptin (p = 0.001) and PAI-1 (p = 0.019) levels decreased from baseline to 4 weeks. Leptin changes were mainly associated with alterations in carbohydrate intake but not with symptom changes. These findings suggest that the SSRD reduces the levels of leptin in patients with IBS, while PAI-1 levels decrease independently of the dietary intervention, without a corresponding impact on symptoms. Full article

Background/Objectives: Disorders of gut–brain interaction (DGBI), characterized by chronic abdominal pain and significant disability, affect 15–20% of children and adults and continue into adulthood in ~60% of cases. Costs for adults reach USD 30 billion per year, yet effective management strategies are elusive. Studies support using cognitive behavioral therapy (CBT), but abdominal pain only improves in ~40% of patients. Dietary management (low FODMAP diet; LFD) has also shown promise but it is effective in only a similar percentage of patients. Studies suggest that biologic factors (biomarkers) contribute to CBT response. Similarly, gut microbiome composition appears to influence abdominal pain response to the LFD. However, no previous CBT trials in children or adults have measured these biomarkers, and it is unclear which patients respond best to CBT vs. LFD. Methods: Children aged 7–12 years with DGBIs (n = 200) will be categorized as having/not having Autonomic Nervous System imbalance and/or abnormalities in gut physiology. We will randomize these children to either CBT or a LFD to compare the effectiveness of these treatments in those with/without abnormal physiologic biomarkers. We hypothesize that CBT will be more effective in those without abnormal physiology and LFD will be more effective in children with abnormal physiology. Primary outcome measures include the following: (1) Symptom improvement (abdominal pain frequency/severity) and (2) improvement in health-related quality of life. Conclusions: This innovative multidisciplinary study is the first to identify physiological characteristics that may moderate the response to two different management strategies. Identification of these characteristics may reduce the burden of these disorders through timely application of the intervention most likely to benefit an individual patient. Full article

Inflammatory Bowel Disease (IBD), encompassing Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic inflammatory condition of the gastrointestinal tract that significantly impacts nutritional status. Malnutrition is a frequent complication, resulting from reduced nutrient intake, malabsorption, and increased metabolic demands due to chronic inflammation. A comprehensive nutritional assessment encompassing anthropometric, biochemical, and dietary evaluations is crucial for informing personalized interventions. Several nutritional approaches have been explored to modulate inflammation and the gut microbiota, yielding promising results. The Mediterranean, anti-inflammatory, and low-FODMAP diets have shown potential benefits in symptom control. In contrast, diets high in ultra-processed foods and saturated fats are associated with worsened disease activity. Additionally, stool consistency, assessed using the Bristol Stool Scale, serves as a practical indicator for dietary adjustments, helping to regulate fiber intake and hydration strategies. When dietary modifications alone are insufficient, nutritional support becomes a critical component of IBD management. Enteral nutrition (EN) is preferred whenever possible because it maintains gut integrity and modulates immune responses. It has demonstrated efficacy in reducing postoperative complications and improving disease control. In cases where EN is not feasible, such as in intestinal obstruction, severe malabsorption, or high-output fistulas, parenteral nutrition (PN) is required. The choice between peripheral and central administration depends on treatment duration and osmolarity considerations. Despite growing evidence supporting nutritional interventions, further research is needed to establish standardized guidelines that optimize dietary and nutritional support strategies in managing IBD. Full article