Diet as Adjunctive Treatment for Inflammatory Bowel Disease: Review and Update of the Latest Literature

Abstract

Purpose of review Diet plays an integral role in development of inflammatory bowel disease (IBD) and continues to act as a mediator of intestinal inflammation once disease sets in. Most clinicians provide little dietary guidance to IBD patients, in part due to lack of knowledge in nutrition and lack of available nutritional resources. The purpose of this review is to provide clinicians with a brief summary of the latest evidence behind diets popular among IBD patients; to highlight diets with known efficacy; and to provide guidance that may help busy practitioners. Recent findings The latest studies show that exclusive enteral nutrition (EEN) remains the most effective diet for induction of remission in Crohn’s disease (CD); either in the form of elemental, semi-elemental or polymeric formulas. Recent studies also show that EEN can be useful in complicated CD including in enterocutaneous fistulas closure and to optimize nutrition in the pre-operative setting. Although new studies suggest that partial enteral nutrition supplemented with elimination diets may be beneficial in ulcerative colitis (UC) and CD, larger controlled studies are needed to support their use. The autoimmune diet also shows promise but lacks larger studies. Recent uncontrolled clinical studies evaluating the specific carbohydrate diet (SCD) suggest that this diet may improve biochemical markers of inflammation and induce mucosal healing, although larger studies are needed to support its use; especially because the SCD is very restrictive. Short term use of the low FODMAP diet is appropriate when in the setting of an acute flare up and/or in stricturing disease, but long term restriction of FODMAPs is not recommended given long term changes observed in the microbiome. Recent studies suggest that avoidance of processed foods, packaged with preservatives and emulsifiers, may be important in decreasing intestinal inflammation; many of the recent popular diets share a common concept, avoidance of processed foods. Summary In this review of the latest literature, we highlight that dietary studies are still in a rudimentary stage. Large prospective randomized control studies are underway evaluating head to head comparisons on the efficacy of some of these diets. We offer general guiding principles that may help gastroenterologists in the meantime.

Low FODMAP Diet: Evidence, Doubts, and Hopes

“…A recent meta-analysis concluded that an LFD is effective in reducing GI symptoms in patients with quiescent IBD. However, this does not seem to be due to a further improvement in intestinal inflammation, because no differences in fecal calprotectin were found between IBD patients on a LFD in comparison with those on a standard diet [56,57].…”

“…Finally, given the proven efficacy of the LFD diet within the context of functional gastrointestinal symptoms, it is still necessary to broaden the field of study to other diseases that often have some symptoms in common with IBS and which could probably benefit from an LFD. These include IBD, functional esophageal and duodenal disorders, exercise-related gastrointestinal symptoms, radiation-induced enteropathy and nonceliac gluten sensitivity [55,57,[96][97][98][99][100].…”

Czynniki środowiskowe zwiększające ryzyko aktywacji i rozwoju chorób zapalnych jelit

“…Najnowsze badania wykazały, że wyłączne żywienie dojelitowe pozostaje najskuteczniejszą metodą wywołania remisji w aktywnej chorobie Crohna. Badania pokazują, że może być ono skuteczne nawet w zamykaniu przetok jelitowo-skórnych w ciężkiej postaci ChLC [24]. Ponadto wykazano zależność między modyfikacją diety polegającą na kilkutygodniowej fazie eliminacji niektórych pokarmów, po której następowała faza podtrzymująca, a poprawą jakości życia związaną z większą częstością remisji w NChZJ.…”

Microbial orchestra in juvenile idiopathic arthritis: Sounds of disarray?

“…Among patients with IBD, a dietary approach that has gained traction is the specific carbohydrate diet (SCD), which consists of consuming monosaccharides at the exclusion of polysaccharides and disaccharides (excluding sucrose and certain starches). In general, grains, table sugar, and food preservatives are disallowed, while fruits, some vegetables, nuts, meats, and eggs are mostly permitted . The rationale for the SCD is that fermentation of complex carbohydrates in the colon results in malabsorption, diarrhea, and bacterial overgrowth .…”

“…In general, grains, table sugar, and food preservatives are disallowed, while fruits, some vegetables, nuts, meats, and eggs are mostly permitted. 154 The rationale for the SCD is that fermentation of complex carbohydrates in the colon results in malabsorption, diarrhea, and bacterial overgrowth. 155 Interestingly, this is mutually exclusive to the dietary approach proposed above that involved complex carbohydrates to stimulate the growth of bacteria responsible for SCFA production.…”