Emerging evidence underscores the significant impact of diet on IBD development and treatment.
Inflammatory Bowel Disease (IBD) represents a group of chronic immune-mediated intestinal disorders with a complex interplay between the host immune system and the intestinal microbiome. Emerging evidence underscores the significant impact of diet on IBD development and treatment, according to research published online in Nutrients. The literature review by Elizabeth A. Reznikov, DO, PhD, and colleagues aimed to explain the role of dietary interventions in IBD. They focused on Crohn’s disease (CD) and ulcerative colitis (UC), with a particular emphasis on exclusive enteral nutrition (EEN), exclusionary whole food diets, and the Mediterranean diet.
“While the etiopathogenesis of IBD is not completely understood, it is thought to be interrelated to the complex interaction between the host immune system and the intestinal microbiome,” Dr. Reznikov wrote. “Given the increased prevalence of IBD in countries that adopt a Western lifestyle, prevailing theories propose a significant contribution of the Western diet to the development of IBD.”
Popular Diets and Nutrition Plans in IBD
EEN is a cornerstone in inducing remission, particularly in pediatric CD, with approximately 80% efficacy rates. EEN impacts the intestinal microbiome, leading to mucosal healing and systemic anti-inflammatory effects, although the exact mechanisms remain under investigation. However, its long-term sustainability is challenged by “formula fatigue.”
Partial enteral nutrition (PEN) with Crohn’s disease exclusion diet (CDED) presents a promising alternative, combining specific dietary exclusions with partial formula intake, according to the review. Studies demonstrate comparable efficacy to EEN in inducing remission, with better tolerability and potential for long-term maintenance. Notably, the researchers found that CDED induces significant alterations in the intestinal microbiome and metabolome, supporting its mechanistic role in IBD management.
Exclusionary whole food diets, such as the specific carbohydrate diet (SCD); low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP) diet; and Mediterranean diet, offer additional dietary strategies. SCD shows promise in inducing and maintaining remission in CD and UC, with notable improvements in symptoms, laboratory markers, and mucosal healing. However, according to the findings, challenges in adherence and sustainability remain prevalent.
FODMAP and Mediterranean diets demonstrate symptom improvement and enhanced QOL in patients with IBD with functional gastrointestinal symptoms, although evidence regarding their impact on inflammation is limited. Nonetheless, the Mediterranean diet exhibits broader health benefits and may serve as a preferred dietary approach for mild-to-moderate CD.
The Future of Dietary Therapies
Ongoing research highlights the need for personalized dietary interventions tailored to individual patient needs and preferences. Integrating dietary therapies into clinical practice requires multidisciplinary collaboration involving physicians, dieticians, and patients to establish clear goals and expectations. Furthermore, future studies should delve deeper into the mechanistic underpinnings of dietary interventions, exploring immunologic, microbiologic, and genetic factors to optimize therapeutic outcomes.
“With further research and integration of diet into clinical practice, dietary interventions have the potential to change the IBD paradigm,” they wrote.
Overall, dietary interventions play a crucial role in IBD management, offering effective strategies for inducing remission and improving long-term outcomes. By advancing the understanding of the complex interplay between diet, the microbiome, and host immune responses, we can pave the way for personalized dietary approaches that revolutionize the management of IBD.
“While research in diet and IBD has expanded greatly in the last decade, much is still unknown,” Dr. Reznikov concluded. “Future studies need to expand on the clinical application of diet in IBD as well as give a better understanding of the mechanism by which diet works. Pairing immunology and microbiology by assessing specific immunologic cell and cytokine and chemokine profiles, growth and nutrition mediators, metagenomics, and nutrigenomics would give further insight into the mechanisms by which diet impacts IBD.”
