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Nutrition in IBD

The role of nutrition in IBD is moving beyond the simplicity of its utilization to treat malnourished patients, although malnutrition remains a common IBD complication. Dietary intake is now recognized for its central role in defining the gut microbiome which directly influences the underlying immune system and the integrity of the gastrointestinal lining. Metabolomics research is further uncovering complex metabolic pathways in digestion and important byproducts produced, like short-chain fatty acids (SCFAs), which are integral in reducing inflammation and achieving balanced immune function. Current research is placing nutrition on the cutting edge of medicine, making nutritional therapy a novel and exciting new approach for the management of IBD.

Patients recognize the influence of diet on symptoms and are seeking to utilize diet as a therapeutic tool under the guidance of medical professionals. The publications below establish the critical connection between diet and IBD and describe the rationale for integration of nutritional therapy into clinical practice.

Publications

Dietary Exposures and Interventions in Inflammatory Bowel Disease: Current Evidence and Emerging Concepts

Summary Excerpt: Specific dietary interventions have been shown to reduce symptoms, improve inflammatory biomarkers, and quality of life metrics to varying degrees, but these studies are limited by study design, underpowering, heterogeneity, and confounding. While no definitive recommendations regarding specific dietary interventions as therapy in IBD can be made at this clinicians together with a dedicated nutritionist should discuss types of dietary interventions previously investigated, possible benefits and risks, and quality of evidence with patients who may be interested in incorporating dietary changes to their standard therapies.

Nutrients 2023, 15, 579. https://doi.org/10.3390/nu15030579
Gubatan, J. et al

Food as Treatment of Inflammatory Bowel Diseases

Photo Credit: LiliGraphie/Shutterstock 

Summary Excerpt: The latest research on diet as treatment in inflammatory bowel disease is summarized with evidence for mechanisms behind diet as treatment.

Infect Immun. 2022 May 19;90(5):e0058321. doi: 10.1128/iai.00583-21
Maldonado-Contreras, A

Therapeutic Implications of Diet in Inflammatory Bowel Disease and Related Immune-Mediated Inflammatory Diseases

Summary Excerpt: Authors summarize the current evidence on various diets used in the treatment of IBD and explore applications from related immune mediated inflammatory diseases (IMID)

Nutrients. 2021;13(3):890. Published 2021 Mar 10. doi:10.3390/nu13030890
Jiang Y et al

Diet in Treatment of Inflammatory Bowel Diseases

Summary Excerpt: We review findings from studies of the effects of dietary patterns, single micronutrients, and food additives in inducing and maintaining remission in patients with IBD. We discuss future directions for research and propose a framework for studies of dietary interventions in the treatment of IBD.

Clin Gastroenterol Hepatol . 2021 Mar;19(3):425-435.e3. doi: 10.1016/j.cgh.2019.11.054. Epub 2019 Dec 5.
Sasson AN et al

Nutritional Approach as Therapeutic Manipulation in Inflammatory Bowel Disease

Summary Excerpt: Nutritional interventions not only correct nutritional deficiencies but also improve symptoms and clinical courses of the disease. Hence, nutritional approaches need to be developed to significantly evaluate the effectiveness of dietary interventions used to treat IBD.

Intest Res , 17 (4), 463-475 Oct 2019
Yoon JY

Importance of Nutritional Therapy in the Management of Intestinal Diseases: Beyond Energy and Nutrient Supply

Summary Excerpt: In this article, we review various dietary nutrients and their contribution to the pathogenesis and treatment of various intestinal diseases including inflammatory bowel disease, irritable bowel syndrome, colorectal cancer, and diverticulitis, among other such disorders. A better understanding of diet-host-gut microbiome interactions is essential to provide beneficial nutrients for gut health and to limit nutritional hazards to ensure successful nutritional management of gastrointestinal conditions in clinical practice.

Intest Res , 17 (4), 443-454 Oct 2019
Kim SE

Towards a Food Pharmacy: Immunologic Modulation Through Diet

Summary Excerpt: In patients consuming predominantly a Western diet high in n-6 poly-unsaturated fatty acids (PUFAs), sugars, and meat, and low in fruits and vegetables, an impaired gut epithelial barrier and disturbances in the intestinal microbiota have been observed, resulting in a chronic mucosal inflammation. An anti-inflammatory diet may restore this disbalance. In this review, we discuss the effects of diet on the composition of the microbiota, the gut epithelial barrier function, and the mucosal immune system.

Nutrients , 11 (6) 2019 May 31
Molendijk I et al

Diet, Gut Microbiome and Epigenetics: Emerging Links with Inflammatory Bowel Diseases and Prospects for Management and Prevention

Summary Excerpt: Other nutritional interventions or specific diets including the Specific Carbohydrate Diet (SCD), the low fermentable oligosaccharides, disaccharides, monosaccharides, and polyol (FODMAP) diet and, most recently, the Mediterranean diet have shown strong anti-inflammatory properties and show promise for improving disease symptoms. More work is required to evaluate the role of individual food compounds and complex nutritional interventions with the potential to decrease inflammation as a means of prevention and management of IBD.

Nutrients. 2017 Aug 30;9(9). pii: E962. doi: 10.3390/nu9090962
Aleksandrova K et al

Diet as a Trigger or Therapy for Inflammatory Bowel Diseases

Summary Excerpt: We discuss current knowledge about popular diets, including the specific carbohydrate diet and diet low in fermentable oligo-, di-, and monosaccharides and polyols. We present findings from clinical and basic science studies to help gastroenterologists navigate diet as it relates to the management of IBD.

Gastroenterology. 2017 Feb;152(2):398-414.e6. doi: 10.1053/j.gastro.2016.10.019. Epub 2016 Oct 25.
Lewis JD and Abreu MT

The Role of Diet in Inflammatory Bowel Disease

Summary Excerpt: When looking at medical therapy, there are some patients who are adequately managed with one medication, while others require multiple medications. In the future, there will likely be a subpopulation of patients with Crohn’s disease or ulcerative colitis whose inflammation can be controlled with a therapeutic diet. For other patients, dietary manipulation may be an ancillary therapy that can allow them to use less immunosuppression and still remain in remission. Finally, as with all medical therapies, there will almost certainly be a subset of the population in which dietary therapy is completely ineffective.

Gastroenterol Hepatol (N Y). 2016 Jan; 12(1): 51–53.
Lewis JD

Diet and Inflammatory Bowel Disease

Summary Excerpt: The role of diet has become very important in the prevention and treatment of IBD. Although there is a general lack of rigorous scientific evidence that demonstrates which diet is best for certain patients, several diets-such as the low-fermentable oligosaccharide, disaccharide, monosaccharide, and polyol diet; the specific carbohydrate diet; the anti-inflammatory diet; and the Paleolithic diet-have become popular. This article discusses the diets commonly recommended to IBD patients and reviews the supporting data.

Gastroenterol Hepatol (N Y). 2015 Aug;11(8):511-20.
Knight-Sepulveda K et al

Diet in the Pathogenesis and Treatment of Inflammatory Bowel Diseases

Summary Excerpt: We review the roles of diet in the etiology and management of IBD, based on plausible mechanisms and clinical evidence. Researchers have learned much about the effects of diet on the mucosal immune system, epithelial function, and the intestinal microbiome; these findings could have significant practical implications. Controlled studies of patients receiving enteral nutrition and observations made from patients on exclusion diets have shown that components of whole foods can have deleterious effects for patients with IBD. Additionally, studies in animal models suggested that certain nutrients can reduce intestinal inflammation.

Gastroenterology , 148 (6), 1087-106 May 2015
Lee D et al

Nutritional Therapy for IBD

Improving the Care of Patients with Crohn’s Disease and Ulcerative Colitis through Nutrition

Disclaimer: Nutritional Therapy for IBD does not provide medical advice. References are for informational purposes only. Resources from the web are aggregated here; however, links to sites should not be construed as endorsements of those sites, their opinions, or their content. Only medical professionals are qualified to provide medical advice. Patients should consult with their medical team when making decisions about their medical management plan.

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