Systematic reviewindependent cross-checkabstract checked I-ORG-132 standard review

Diet for bile acid diarrhoea

Effectiveness of diet, psychological, and exercise therapies for the management of bile acid diarrhoea in adults: A systematic review.

Overview

McKenzie YA et al.. J Hum Nutr Diet 2022 · PMID 35274385 · DOI 10.1111/jhn.13005

Eating less fat seemed to ease bile acid diarrhoea, but the studies were small and of very low certainty.

Does the study support the specific claim? No · Methodological quality: low

Study explained simply

What did the researchers want to find out?: Review non-drug treatments for bile acid diarrhoea
How was the study done?: Systematic review
How many people, animals or samples were studied?: 8 small studies, 192 patients
What was actually found?: Low-fat diets tended to help
How large was the observed effect?: Not pooled
What do the results mean in everyday life?: If diarrhoea follows gallbladder removal, more fat is unlikely to help
What are the study's limitations?: Very low certainty, indirect
What does it say about Elawady's specific claim?: Runs against the advice to eat more fat
Do the results apply to Germany and Europe?: Applicable
What can explicitly not be concluded from this study?: Cannot prove benefit or harm of fat changes after cholecystectomy

Authors: McKenzie YA et al.
Journal: J Hum Nutr Diet
Year: 2022
Identifier: PMID 35274385 DOI 10.1111/jhn.13005
Verification: verified – PubMed efetch 2026-10-26; Crossref works API 2026-10-26
Retracted: no
Corrections: none
Extent checked: abstract only
Conflicts of interest and funding: Full text: authors declare no conflicts.

Effectiveness of diet, psychological and exercise therapies in adults with bile acid diarrhoea.

Study design: Systematic review – Systematic review (SWiM narrative synthesis, ROBINS-I, GRADE)
Population: Adults with bile acid diarrhoea (BAD)
Country: Mostly European studies
Period: 1975 - 13 July 2021
Sample size: 8 prospective cohort studies, 192 patients
Inclusion and exclusion criteria: Studies meeting diagnostic criteria for BAD

Exposure / intervention: Diet therapies (fat reduction, carbohydrate modification, elemental diet)
Comparator: Before/after or controls
Endpoints: Diarrhoea, abdominal pain, flatulence
Statistical methods: Narrative; GRADE

Results: Dietary fat reduction (5 studies, n = 181) in secondary BAD showed beneficial directions of effect on diarrhoea, pain and flatulence; risk of bias serious; certainty very low. Full text: in one included study (Bosaeus 1979, low-fat 40 g/day), watery diarrhoea normalised in 8/9 patients and returned in all 9 when fat intake was temporarily increased; one non-responder was cholecystectomised. Most included secondary BAD followed ileal resection or cancer treatment; post-cholecystectomy patients were under-represented.
Absolute risks: Not reported
Authors' conclusion: No conclusions could be drawn on effectiveness; high-quality RCTs needed.

No pooled estimates; very low certainty.

Only systematic evidence on dietary fat and bile-acid-related diarrhoea, a known complication after cholecystectomy.

n/a

European studies.

Direction of evidence (less fat, fewer symptoms) runs against advice to double fat intake; very low certainty.

Multidimensional assessment
Multidimensional assessment
Authenticity of the source	verified
Methodological quality	low
Risk of bias	high
Precision of results	low
Directness	indirect
Reproducibility	unknown
Consistency with the overall evidence	consistent
Regional transferability	high
Adequacy of the interpretation (by the archive)	not applicable

RCTs in post-cholecystectomy diarrhoea.