Gut Health Restoration and Microbiome Repopulation in Individuals With Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a multifactorial, debilitating, complex, chronic disorder of gut-brain interaction (DGBI). Gut microbiota and its metabolites play an important role in the aetiology, pathogenesis, and pathophysiology of IBS. Diet is one of the key modulators of gut microbiota composition, function, and structure. Therefore, dietary modulation of the gut microbiome to correct gut microbiota dysbiosis and restore host-microbe eubiosis is purported to be an effective IBS-management strategy. The most evidence-supported dietary treatment for IBS is the fermentable oligo, di, and monosaccharides, and polyols (FODMAP) diet. Research has demonstrated that the efficacy of the FODMAP-diet may be partly mediated by alterations in the gut microbiome. The objectives of this narrative review are to (1) elucidate the pathophysiological central and peripheral gut-related mechanisms through which FODMAPs induce IBS-symptoms, (2) explicate the mechanisms of action of the FODMAP-diet to reduce IBS-symptoms through actions on the gut microbiome, (3) expound the implementation of the FODMAP-diet, and (4) to present an armamentarium of nutraceutical therapeutic approaches to restore the gut microbiome and maintain a healthy gut microbial balance and equilibrium in IBS-patients. This article advances the field of IBS research by providing an understanding of the mechanisms of FODMAPs and their elimination from the diet to repair the gut microbiome, as well as the implementation of nutraceuticals to restore diversity and functionality of gut microbiota. This article offers IBS-patients and clinicians a roadmap for implementing the FODMAP-diet as precision nutrition in conjunction with gut-centric therapeutic interventions to restore gut microbiota equilibrium.