Diet Stacking - An Expanding Challenge for Gastroenterologists and Dietitians in
Managing Chronic Gastrointestinal Disorders
#MMPMID41384274
Melton SL
; Knowles SR
; Gwee KA
; Gibson PR
; Tuck CJ
; Day AS
JGH Open
2025[Dec]; 9
(12
): e70314
PMID41384274
show ga
Dietary therapy has an established role in managing gastrointestinal disorders,
as a short-term induction therapy (e.g., exclusive enteral nutrition for Crohn's
disease), a long-term monotherapy (e.g., gluten-free diet for coeliac disease and
a personalized FODMAP diet) or adjunct therapy (e.g., Mediterranean diet). As use
of dietary therapies rises, it is becoming increasingly common for
gastroenterologists and dietitians to encounter patients who are simultaneously
following two or more dietary therapies to achieve optimal symptom control, to
manage multiple concurrent medical issues, or for social or religious reasons.
This practice is termed 'diet stacking'. The aim of this review is to clarify the
principles behind the safe and effective combination of dietary interventions
with specific attention to potential risks, mitigation of risk and practical
application. For gastroenterologists, awareness of current dietary practices of
their patients prior to advising dietary therapy is warranted and, in those who
are diet stacking, risk assessment is essential. Validated screening tools to
evaluate risks, particularly of disordered eating, are limited. The management of
those who currently or are at risk of diet stacking is best directed toward
gastrointestinal dietitians who offer time, appropriate skills for assessment,
and the delivery of pragmatic patient education to safely implement appropriate
dietary interventions, and assess for the need for engaging psychological primary
management or co-management. In conclusion, diet stacking is common, and requires
awareness and often multi-disciplinary management to ensure it is implemented
safely.
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