Making Decisions about Dietary Therapy in Inflammatory Bowel Disease

Abstract

Treatment for inflammatory bowel disease (IBD) deserves an informed shared decision-making process between patient and doctor. IBD spans a spectrum of phenotypes that impact each patient uniquely. While treatment has primarily consisted of medical or surgical therapy, dietary approaches have become increasingly relevant. A majority of patients with IBD use some form of dietary modification, and it is common for patients to do this without their physicians’ knowledge. Lack of medical supervision can lead to nutritional deficiencies and a worsening disease state. Some patients work with their medical team to pursue a well-defined exclusion diet as a primary therapy, such as the specific carbohydrate diet, exclusive enteral nutrition, or the Crohn’s disease exclusion diet. The motivations to use dietary therapy for IBD remain unclear and the effectiveness has not been definitively established for many approaches. It is necessary for medical providers to be knowledgeable and to foster open communication with their patients in order to ensure the highest likelihood of remission. This review provides an overview of dietary treatment options, the current knowledge about patient motivations for pursuing dietary therapy, and the roles of patient empowerment and patient activation. We outline areas of improvement for the decision-making process.

Aspects of the Pathogenesis and Management of Inflammatory Bowel Diseases

“…Although many of the interventions to induce or maintain remission involve drugs, dietary interventions are increasingly being considered. In particular, exclusive enteral nutrition (EEN), involving a period of a completely liquid formula and exclusion of normal table foods, is recommended internationally as the primary therapy to induce remission in children [11] and is also used commonly in adults in some locations [12]. Solomon et al [13] reviewed aspects of dietary therapies in IBD, highlighting several of the options available in addition to EEN.…”