Dietary Manipulation of the Gut Microbiome in Inflammatory Bowel Disease Patients: Proof of Concept

Abstract

Diet is a modifiable, non-invasive, inexpensive behavior that is crucial in shaping the intestinal microbiome. A microbiome imbalance or dysbiosis in inflammatory bowel disease (IBD) is linked to inflammation. Here, we aim to define the impact of specific foods on bacterial species commonly depleted in patients with IBD to better inform dietary treatment. We performed a single-arm, pre-post intervention trial. After a baseline period, a dietary intervention with the IBD-Anti-Inflammatory Diet (IBD-AID) was initiated. We collected stool and blood samples and assessed dietary intake throughout the study. We applied advanced computational approaches to define and model complex interactions between the foods reported and the microbiome. A dense dataset comprising 553 dietary records and 340 stool samples was obtained from 22 participants. Consumption of prebiotics, probiotics, and beneficial foods correlated with increased abundance of Clostridia and Bacteroides, commonly depleted in IBD cohorts. We further show that the IBD-AID intervention affects the immune tone by lowering IL-8 and increasing GM-CSF with certain foods correlating with levels of those cytokines. By using robust predictive analytics, this study represents the first steps to detangle diet-microbiome interactions to inform personalized nutrition for patients suffering from dysbiosis-related IBD.

Individualized diet conversation in primary care

“…Having a systematic process for integrating diet assessment and discussion into the routine visit should increase the likelihood that the diet conversation will occur. This is important given that less than 50% of PCPs currently broach this conversation, despite the recommendations of public health and professional nutrition organizations 11,13-15. The comments made by staff support the feasibility of seamlessly integrating a brief diet assessment and discussion into routine primary care visits.…”

“…Despite these recommendations, most PCPs do not routinely address diet or only discuss it in the context of obesity 13. The National Health and Nutrition Examination Survey, 2011-2018 found that fewer than one-third of providers advised their patients on diet, with persons identified as obese or overweight targeted for diet advice 13. The need for diet advice is most often determined by body weight, body mass index, or lab tests, rather than actual food intake.…”

“…PCPs are often a patient's first point of contact of care and have a designated role in health promotion and disease prevention, as they are considered trusted resources for health information 7,12. Despite these recommendations, most PCPs do not routinely address diet or only discuss it in the context of obesity 13. The National Health and Nutrition Examination Survey, 2011-2018 found that fewer than one-third of providers advised their patients on diet, with persons identified as obese or overweight targeted for diet advice 13.…”

“…When diet is assessed, the questions tend to be subjective (for example, “Do you eat healthy food?” or “How is your diet?”). Few providers assess specific food intake, which provides a more complete picture of dietary patterns and enables more effective, individualized nutrition conversations 8,13-15…”