Intermittent Fasting as a Potential Therapeutic Approach for Irritable Bowel Syndrome: A Mechanistic Perspective

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Abstract
Irritable bowel syndrome (IBS) is a gastrointestinal disorder that is highly prevalent, often accompanied by considerable comorbidities and that places a substantial burden both on individuals and healthcare systems. Treatments are usually aimed at addressing symptoms but often fall short of long-term relief. Current dietary strategies primarily focus on what patients should avoid eating, while the potential physiological importance of when food is consumed has received little attention in IBS research. We hypothesize that gastrointestinal symptoms may, at least partially, be affected by a cumulative burden of epithelial injury as well as insufficient time for mucosal maintenance and repair. This paper explores the hypothesis that intermittent fasting regimens could represent underexplored therapeutic strategies for reducing IBS symptoms by promoting gut renewal and restoring homeostasis. We review the multifactorial pathophysiology of IBS and explore how fasting may impact relevant biological mechanisms. Several lines of evidence, from both preclinical and clinical studies, indicate that intermittent fasting may reduce inflammation, regulate gut motility and reshape the microbiota, thereby strengthening the gut barrier and dampening immune responses. Fasting also induces autophagy, a key cellular recycling process essential for intestinal barrier maintenance and microbial defense, which may be impaired in IBS. Hence, intermittent fasting may reduce cumulative epithelial injury and allow time for repair to alleviate symptoms in IBS. Although no randomized controlled trials on fasting regimens and IBS are available, evidence from related populations and mechanistic research supports further exploration of this accessible, low-cost approach.

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