The “Food as Medicine” special issue acknowledges the intense interest in diet by patients, providers and researchers alike. In fact, just in the past year, over 30,000 publications are listed on PubMed with the keyword “diet.” For patients with chronic gastrointestinal diseases, questions surrounding the role of diet in etiology and treatment are common but often understudied. For example, in patients with inflammatory bowel disease (IBD), diet and alternative therapy are consistently named the most important unmet needs in IBD research in a patient-prioritized research agenda (1).
Diet plays an active role in development and propagation of chronic disease and has a therapeutic role in many disease processes. The theme of our “Food as Medicine” special issue is multidisciplinary, representing a true intersection between health care disciplines such as gastroenterology, nutrition, and complementary medicine, while avoiding the pitfalls of “pseudoscience” that often plague this field. In our efforts to solicit submissions for this special issue of American Journal of Gastroenterology, we reviewed over 100 diverse observational and interventional studies on a variety of topics and selected 17 for inclusion. The topics range from complications of alcohol, to food insecurity, to dietary interventions for chronic disease, to food-based interventions in primary prevention of malignancy. We also present a series of narrative reviews focusing on the role of food in the management of disorders of gut-brain interaction. This series of articles from the ROME Foundation Working Group provides practical applications on the role of diet in irritable bowel syndrome, functional constipation, and small bowel disorders.
Our interventional studies are of the highest quality, including a number of randomized controlled trials (RCTs). Many patients with liver disease struggle with uncontrolled cramping, in this issue Tapper et al. provide data from a RCT of pickle juice for reduction of cramps (PICCLES) (2). Read on for data on this simple, sweet and salty way to improve our patients' symptoms. Ever wonder whether a supplement such as green tea extract can prevent future colorectal adenomas? Ettrich et al. present data to inform our recommendations for primary prevention of adenomas (3). For children with IBD, patients and families are intensely interested in the role of diet as therapy. In the PRODUCE trial by Kaplan et al., we learn important lessons on the effectiveness and sustainability of dietary therapy in pediatric IBD (4).
As we discuss diet, we should recognize that not all households have access to a healthy diet. Therefore, a realistic approach to prescribing food as medicine is needed. The COVID-19 pandemic further affected household finances and supply chains that provide daily access to nutritional support. Du et al. studied food insecurity in children prescribed a gluten-free diet during this time, demonstrating a number of challenges we can learn from (5).
This special edition contains diverse, innovative and yes, sometimes delicious articles that are relevant to clinicians and researchers of all levels of experience. We hope that these articles provide food for thought in both clinical management and future research. Come dine with us in the “Food as Medicine” special issue!
CONFLICTS OF INTEREST
Guarantor of the article: Millie D. Long MD, MPH, FACG.
Specific author contributions: Both authors contributed to the writing and editing of this article.
Financial support: None to report.
Potential competing interests: None to report.
2. Tapper EB, Salim N, Baki J, et al. Pickle juice intervention for cirrhotic cramps reduction: The PICCLES randomized controlled trial. Am J Gastroenterol 2022;117(6):895-901.
3. Seufferlein T, Ettrich TJ, Menzler S, et al. Green tea extract to prevent colorectal adenomas, results of a randomized, placebo-controlled clinical trial. Am J Gastroenterol 2022;117(6):884-94.
4. Kaplan HC, Opipari-Arrigan L, Yang J, et al. Personalized research on diet in ulcerative colitis and Crohn’s disease 1 (PRODUCE): A series of N-of-1 diet trials. Am J Gastroenterol 2022;117(6):902-17.
5. Du N, Mehrota I, Weisbrod V, et al. Survey based study on food insecurity during COVID-19 for households with children on a prescribed gluten-free diet. Am J Gastroenterol 2022;117(6);931-4.