Self‐reported flares among people living with inflammatory bowel disease are associated with stress and worry but not associated with recent diet changes: The Manitoba Living with IBD Study

Abstract

Background In this matched case‐control longitudinal study among people living with inflammatory bowel disease (IBD), we investigated beliefs about what triggers a flare. Methods Adults with confirmed IBD and active disease within 2 years were enrolled in the Manitoba Living with IBD Study and followed biweekly with online surveys for 1 year. The 7‐point IBD Symptom Change Indicator was used for participant identification of a flare. Flare cases were matched to non‐flare controls by sex and disease type. Members of each matched pair completed supplementary information on diet changes and psychological functioning in the previous 2 weeks and provided stool samples to assess fecal calprotectin (FCAL). Results Of 128 enrolled participants, 95 matched flare/non‐flare pairs were created. Those reporting a flare were more likely to have elevated FCAL (51% vs 34% among non‐flares, P = 0.043). Although 61% of study participants believed at baseline that a food may trigger flares, and 25% of those in a flare believed that a food may have triggered their current flare, there was no difference in consumption of assessed foods between flares and non‐flares in the previous 2 weeks. Patients with flares were more likely to be having difficulties in emotional state than controls (40% vs 18%, P = 0.001) and more likely to be stressed or worried (64% vs 33%, P = 0.001). Conclusion Although a majority of individuals with IBD believe that specific foods trigger their disease flares, this was not supported by the current findings. Recent psychological functioning was associated with self‐reported IBD flare.

Habitual Dietary Intake and Adherence to Dietary Guidelines of Patients with Inflammatory Bowel Diseases

“…In the following section, we examined the compliance of IBD patients' dietary preferences with the recommendations of the Mediterranean diet. According to the ESPEN guidelines, the Mediterranean diet model, which includes consumption of fruit, vegetables, whole-grain cereal products, legumes and nuts, and a reduction in saturated fatty acids of animal origin and sugars, is recommended for IBD patients, particularly those in remission [27]. For this reason, our study assessed the patients' dietary compliance with the recommendations of the Mediterranean diet, particularly since this is also the dietary model promoted by international guidelines for the general population as well [47,61].…”

“…Due to the lack of strict guidelines, IBD patients, based on their own experience and fear of relapse, self-impose restrictive elimination diets, as confirmed in many studies [25][26][27]. This behavior promotes nutritional deficiencies and malnutrition, which is often diagnosed in these patients and which hinders the achievement of therapeutic goals [28][29][30].…”

Hormonal Contraceptives Reduce Active Symptomatic Disease but May Increase Intestinal Inflammation in IBD

“…The primary use of HC is to prevent pregnancy; however, some women use HC to regulate their cycle and to reduce severe abdominal pain or cramping 19 . Both of these symptoms also often occur during times of active disease 20 or flare-ups 21 . Many women living with IBD experience greater symptom exacerbation during times of menses, 22,23 suggesting that menstruating women with IBD who are not experiencing greater symptom severity could be benefitting from the potentially protective effects of HC.…”

The Role of Dietary Fibers in the Management of IBD Symptoms

“…All of these nutritional problems also have a serious psychosocial repercussion and worsen patients' quality of life [128]. In fact, a majority of individuals with IBD believe that specific foods trigger their disease flares, although this belief is not supported by any study [129].…”