Mediterranean Diet

Image Credit: Creativa Images/Shutterstock
Image Credit: Creativa Images/Shutterstock 

The Mediterranean Diet (MED) is characterized by a high intake of vegetables (2 servings per meal) and fruits (1-2 servings per meal), extra virgin olive oil (3 tablespoons per day), breads and cereals (1-2 servings per day), legumes (2 or more servings per week), seafood (more than 2 servings per week), eggs (2-4 servings per week), poultry (2 servings per week), limited dairy (1-2 servings per day), low intake of red meat (less than two servings per week), and limited sweets (less than two servings per week) (Bach-Faig, et al., Chicco et al).

In addition to improving symptoms in IBD, data support its health benefits in other disease states such as cardiovascular disease, cancer, and diabetes, with much of its benefit attributed to reductions in inflammation from higher consumption of vegetables, fruits, nuts, and healthful fats from avocados, fish, and olive oil (Martina D) (Tosti V et al). The Mediterranean diet may further serve as a preventive strategy against colon cancer (Ilescas, et al.) and later-onset of Crohn's Disease (Khalili H et al).

Mediterranean Diet and IBD

Photo Credit: stockcreations/Shutterstock
Photo Credit: stockcreations/Shutterstock 

Increasing research supports the role of the MED to improve the condition of IBD. For patients with IBD who prefer a choice that may be easier to follow, the MED is a good choice for improving the condition of IBD and overall health. One mechanism to explain the benefit may be via the anti-inflammatory properties afforded by favorably affecting the microbiome (Reddavide R et al) (Tomasello G et al) (Ghosh TS et al).

The MED has been shown to significantly reduce symptoms in patients with either Crohn’s disease or ulcerative colitis (Chicco et alLewis JD et al). A significantly larger portion of patients with either CD or UC following the MED experienced lower CRP and fecal calprotectin levels  (<250 ug/g) as well as significantly improved quality of life scores (Chicco et al). An important finding from the DINE CD trial (Lewis JD et al) was that patients with CD on either the SCD or MED had significant improvements in patient reported outcomes, including fatigue. Following pouch surgery for UC, patients with higher adherence to the MED were associated with decreased fecal calprotectin levels (Godny L et al). A list of supporting research for the MED in IBD can be found here (MED Research).

The benefits of MED also extend to pediatric patients. In a prospective, randomized study of 100 patients (aged 12-18) with mild to moderate disease IBD, half were given MED for 12 weeks (El Amrousy, D. et al). After this dietary change, the MED group "showed a significant decrease in both clinical scores (PCDAI and PUCAI) and most inflammatory markers (CRP, calprotectin, TNF-α, IL17., IL 12 and IL13) compared to patients in their normal group" (El Amrousy, D. et al).

Following the MED can be a challenge for some patients with IBD, especially if they have been following a low-fiber diet or they have strictures present. Some recommendations include to juice or puree fruits and well-cooked vegetables when beginning the diet. As symptoms improve or inflammation goes down, patients can start incorporating whole fruits and vegetables. Cereals in the diet refer to ancient grains (farro, wild rice, spelt, etc.). Rice is a good carbohydrate choice for this diet. Nuts and seeds for the MED can be consumed cooked and pureed (peanut butter and hummus), or even as homemade almond milk.

Nutritional Therapy for IBD

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

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