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Role of Nutrition in IBD

Diet and IBD

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

Therapeutic Diet Review Articles

A Systematic Review of the Role of Diet in Ulcerative Colitis

Diets Discussed: MED, Low-FODMAP, Other Diets - UC, SCD, WFPB, AIP, IBD-AID
Summary Excerpt: "atients with UC may be able to improve their symptoms and overall quality of life through dietary interventions. While FODMAP-restricted diets, the Mediterranean diet, and anti-inflammatory diets have shown promise in reducing intestinal inflammation and improving UC patient outcomes, other types of diets mentioned in previous studies should also be considered. "

A Systematic Review of the Role of Diet in Ulcerative Colitis. Cureus 15(5): e39350. doi:10.7759/cureus.39350
Abbas N, et al.

Incorporation of Plant-Based Diet Surpasses Current Standards in Therapeutic Outcomes in Inflammatory Bowel Disease

Diets Discussed: WFPB
Summary Excerpt: The authors describe their experience using a modality at their center in Japan since 2003 incorporating a plant-based diet (PBD), (a lacto-ovo-vegetarian diet, allowing fish consumption once a week and meat every other week) with Infliximab as a first-line (IPF) therapy administered for all patients with newly diagnosed Crohn’s disease and severe ulcerative colitis.

Metabolites 2023, 13, 332. https://doi.org/10.3390/metabo13030332
Chiba, M. and Morita, N.

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

Diets Discussed: SCD, MED, Low-FODMAP, WFPB, IBD-AID
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

Diet as treatment for inflammatory bowel disease: is it ready for prime time?

Diets Discussed: CDED, SCD, mSCD, MED, IBD-AID, EEN, PEN, AIP
Summary Excerpt: In this review, we summarize the literature on diet as treatment for IBD. We highlight the latest clinical dietary studies, randomized clinical trials, as well as new and emerging diets for the treatment of IBD.

Current opinion in gastroenterology, 38(4), 358–372.
Cusimano F., Damas O.

Diet in Treatment of Inflammatory Bowel Diseases

Diets Discussed: EEN, PEN, SCD, IBD-AID, AIP, CDED, WFPB, CD-TREAT
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

A Case-Based Approach to New Directions in Dietary Therapy of Crohn's Disease: Food for Thought

Diets Discussed: CDED
Summary Excerpt: This case-based narrative review will discuss the Crohn's disease exclusion diet (CDED) as monotherapy, combination therapy with drugs, as a rescue therapy in refractory patients and for de-escalation from medical therapy.

Nutrients . 2020 Mar 24;12(3):880. doi: 10.3390/nu12030880.
Levine A et al

Diet in Treatment of Inflammatory Bowel Diseases

Diets Discussed: EEN, PEN, SCD, IBD-AID, AIP, CDED, CD-TREAT, WFPB
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 . 2019 Dec 5;S1542-3565(19)31394-1.
Sasson AN

Dietary Management of Pediatric Inflammatory Bowel Disease

Diets Discussed: EEN, SCD, IBD-AID, CDED
Summary Excerpt: In particular, nutritional therapies for IBD have garnered significant interest due to their limited side effect profile, bowel-sparing nature, and naturalistic approach. This review will examine the role of diet in the pathogenesis and malnutrition in IBD, and will discuss dietary approaches to management of IBD, including exclusive enteral nutrition, specific carbohydrate diet, anti-inflammatory diet, and food supplements (specifically curcumin and long-chain n-3 polyunsaturated fatty acids).

J Med Food. 2019 Nov;22(11):1092-1099. doi: 10.1089/jmf.2019.0063. Epub 2019 Jul 18.
Kaenkumchorn T and Kesavan A

A Review of Dietary Therapy for IBD and a Vision for the Future

Diets Discussed: EEN, SCD, IBD-AID, CDED, WFPB, CD-TREAT
Summary Excerpt: Dietary interventions, with known ability to modulate the intestinal microbiome, are a unique opportunity to improve outcomes in IBD. Dietary intervention trials are challenging, and capturing both broad dietary patterns as well as exposure to individual food compounds is important. With increasing patient interest and preliminary research in dietary therapy indicating efficacy, it is imperative to further advance the science of utilizing diet in IBD, as well as to support patients by proactively addressing diet within their care plan.

Nutrients , 11 (5) 2019 Apr 26
Green N et al

Implementing Dietary Modifications and Assessing Nutritional Adequacy of Diets for Inflammatory Bowel Disease

Diets Discussed: SCD, AIP, CDED, IBD-AID, CD-TREAT
Summary Excerpt: This article reviews dietary risk factors for IBD and common beliefs about diet among patients with IBD, and how these aspects may inform general dietary recommendations for this patient population. Additionally, this article reviews dietary interventions used in the management of active IBD, with a focus on whole food diet–based therapies rather than enteral or parenteral nutrition, as well as their nutritional adequacy.

Gastroenterol Hepatol (N Y) , 15 (3), 133-144 Mar 2019
Nazarenkov N et al

Evolving Role of Diet in the Pathogenesis and Treatment of Inflammatory Bowel Diseases

Diets Discussed: EEN, PEN, CDED, SCD, mSCD
Summary Excerpt: Uncontrolled clinical studies have demonstrated that various dietary therapies such as exclusive enteral nutrition and newly developed exclusion diets might be potent tools for induction of remission at disease onset, for patients failing biologic therapy, as a treatment for disease complications and in reducing the need for surgery. We review these advances from bench to bedside, along with the need for better clinical trials to support these interventions.

Gut , 67 (9), 1726-1738 Sep 2018
Levine A et al

Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease

Diets Discussed: SCD, EEN
Summary Excerpt: The literature on diet and IBD is reviewed with a particular focus on EEN, SCD, and low FODMAP diets. Lessons learned from the existing observations and strengths and shortcomings of existing data are presented.

Gastroenterol Clin North Am. 2017 Dec;46(4):745-767. doi: 10.1016/j.gtc.2017.08.016
Kakodkar S and Mutlu EA

Dietary Therapies in Pediatric Inflammatory Bowel Disease: An Evolving Inflammatory Bowel Disease Paradigm

Diets Discussed: EEN, PEN, SCD, CDED, IBD-AID
Summary Excerpt: Recently, there has been growing interest and study of dietary interventions for induction and maintenance of remission. In addition to exclusive enteral nutrition, successes have been achieved with specific exclusion diets. This article evaluates current literature regarding the role of diet and nutrition in pathogenesis of disease, as well as the role of diet as primary therapy for pediatric IBD.

Gastroenterol Clin North Am , 46 (4), 731-744 Dec 2017
Lane ER et al

Specific Carbohydrate Diet for Inflammatory Bowel Disease — Learn About the SCD to Support Clients With IBD and How It Compares With Other Evidence-Based Nutritional Therapies

Diets Discussed: SCD, EEN, PEN, IBD-AID
Summary Excerpt: Based on studies done thus far, the SCD appears to be an effective way to both establish and maintain remission for people with UC or CD. Both prospective and retrospective studies at different institutions with slightly different protocols have demonstrated benefits, and improvements have been observed in people of different ages and genders and with different locations and disease severity. Variants on the SCD, such as IBD-AID or "SCD-like" diets also may prove to be viable strategies—in fact, Seattle Children's Hospital is investigating the effectiveness of the SCD compared with a modified SCD with added foods, such as rice and oats, vs a more whole-foods based diet to see which strategy yields the best clinical results.

Today's Dietitian Vol. 19, No. 6, P. 42
Harris C

Diet and Inflammatory Bowel Disease

Diets Discussed: SCD, IBD-AID
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

Enteral Nutrition Review Articles

Systematic Review with Meta-analysis of Partial Enteral Nutrition for the Maintenance of Remission in Crohn's Disease

Summary Excerpt: The rate of clinical relapse at 0.5 to 2 years was significantly lower in patients receiving PEN (420-1800 kcal/d) than in those not receiving nutrition therapy (RR: 0.67, 95% CI: 0.54-0.82, P < .01; number needed to treat = 5, P < .01). Patients receiving PEN exhibited a higher frequency of clinical remission maintenance at 0.5 to 1 year (67%) than did those not receiving nutrition therapy (48%; RR: 1.32, 95% CI: 1.07-1.64, P = .01).

Nutr Res. 2020 Sep;81:7-18. doi: 10.1016/j.nutres.2020.06.006. Epub 2020 Jun 9.
Yang H 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

An Overview of the Role of Exclusive Enteral Nutrition for Complicated Crohn's Disease

Summary Excerpt: Published literature focusing upon the use of nutritional therapy as part of medical therapy in the management of complicated CD were identified and reviewed. Although there continue to be various interventions utilized for complicated CD, the currently available literature demonstrates that nutritional therapies, especially EEN, have important roles in the management of these complex scenarios.

Intest Res. 2019 Apr; 17(2): 171–176.
Adamji M and Day AS

Exclusive Enteral Nutrition in Pediatric Inflammatory Bowel Disease

Summary Excerpt: EEN has been shown to improve growth and correct micronutrient deficiencies as well as improve comorbid conditions like osteopenia and anemia. EEN has also been shown to be equally as efficacious as steroids in inducing remission with better mucosal healing.

Curr Opin Pediatr , 30 (5), 671-676 Oct 2018
Miller T and Suskind DL

Enteral Nutrition in the Management of Pediatric and Adult Crohn's Disease

Summary Excerpt: In adults, EEN appears to be moderately beneficial for the induction of remission of CD; however, its use is understudied and underutilized. Stronger evidence is in place to support the use of EEN in pediatric CD with the added benefit of nutrition support and steroid-sparing therapy during the growth phase. Overall, EEN is an established therapy in inducing CD remission in the pediatric population while its role as primary therapy of adult Crohn's disease remains to be defined.

Nutrients , 10 (5) 2018 Apr 26
Hansen T and Duerksen DR

Reasoning Beyond the Potential Use of Exclusive Enteral Nutrition and Other Specified Diets in Children With Ulcerative Colitis

Summary Excerpt: Although there is not yet definitive data illustrating a role for EEN in the management of active ulcerative colitis (UC), there are several lines of evidence that illustrate that dietary interventions may be helpful. In particular, the key mechanisms of the activity of EEN (namely, changes in the intestinal microflora in Crohn disease) are likely also relevant to UC. Furthermore, the use of EEN in pediatric UC patients may add to a better bone health. Prospective studies are now required to evaluate the role of EEN in UC in children.

J Pediatr Gastroenterol Nutr , 66 (3), 378-382 Mar 2018
Shaoul R et al

The Impact of Exclusive Enteral Nutrition (EEN) on the Gut Microbiome in Crohn’s Disease: A Review

Summary Excerpt: While the mechanism of action of EEN is not clear, EEN is known to cause profound changes in the gut microbiome. Understanding how EEN modifies the gut microbiome to induce remission could provide insight into CD etiopathogenesis and aid the development of microbiome-targeted interventions to guide ongoing dietary therapy to sustain remission. This review includes current literature on changes in composition and function of the gut microbiome associated with EEN treatment in CD patients.

Nutrients , 9 (5) 2017 May 1
MacLellan A et al

Potential Impact of Diet on Treatment Effect from Anti-TNF Drugs in Inflammatory Bowel Disease

Summary Excerpt: One small prospective study on diet and anti-TNF treatment in 56 patients with CD found similar remission rates after 56 weeks among 32 patients with good compliance that received concomitant enteral nutrition and 24 with poor compliance that had no dietary restrictions (78% versus 67%, p = 0.51). A meta-analysis of 295 patients found higher odds of achieving clinical remission and remaining in clinical remission among patients on combination therapy with specialised enteral nutrition and Infliximab (IFX) compared with IFX monotherapy (OR 2.73; 95% CI: 1.73-4.31, p < 0.01, OR 2.93; 95% CI: 1.66-5.17, p < 0.01, respectively)

Nutrients , 9 (3) 2017 Mar 15
Andersen V et al

Exclusive Enteral Nutrition in Children with Crohn’s Disease

Summary Excerpt: Exclusive enteral nutrition involves the use of a complete liquid diet, with the exclusion of normal dietary components for a defined period of time, as a therapeutic measure to induce remission in active Crohn's disease (CD). This very efficacious approach leads to high rates of remission, especially in children and adolescents newly diagnosed with CD. This intervention also results in mucosal healing, nutritional improvements and enhanced bone health.

World J Gastroenterol , 21 (22), 6809-16 2015 Jun 14
Day AS and Lopez RN

Consensus Guidelines of ECCO/ESPGHAN on the Medical Management of Pediatric Crohn's Disease

Summary Excerpt: The aim was to base on a thorough review of existing evidence a state of the art guidance on the medical treatment and long term management of children and adolescents with CD, with individualized treatment algorithms based on a benefit-risk analysis according to different clinical scenarios. In children and adolescents who did not have finished their growth, exclusive enteral nutrition (EEN) is the induction therapy of first choice due to its excellent safety profile, preferable over corticosteroids, which are equipotential to induce remission.

J Crohns Colitis , 8 (10), 1179-207 Oct 2014
Ruemmele FM 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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