Self-Reported Food Intolerance in Chronic Inflammatory Bowel Disease

Ballegaard, Martin; Bjergstrøm, A.; Brøndum, S.; Hylander, E.; Jensen, Lisbeth; Ladefoged, Karin

doi:10.3109/00365529709025101

Cited by 97 publications

(60 citation statements)

References 9 publications

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“…Indeed, intolerance of cereals, fibrous fruits and vegetables is commonly reported (Ballegaard et al 1997). Hence, in the present study, potential differences in dietary habits leading to lower Fe intakes in cases were investigated.…”

Section: Discussionmentioning

confidence: 96%

“…However, sub-optimal dietary Fe intake has not been widely considered as a potential contributor to ID in CD, and yet deserves attention because food aversions and self-reported food intolerance are common in this patient group (Ballegaard et al 1997;Mishkin, 1997). Thus patients often alter their diet to reduce abdominal symptoms, such as pain and diarrhoea (Ballegaard et al 1997).…”

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confidence: 99%

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Intake of dietary iron is low in patients with Crohn's disease: a case–control study

et al. 2004

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Patients with Crohn's disease (CD) often experience Fe deficiency (ID) and frequently alter their diet to relieve abdominal symptoms. The present study set out to assess whether patients with CD have dietary habits that lead to low Fe intakes and/or reduced bioavailable Fe compared with control subjects. Patients with asymptomatic CD were matched to controls (n91/group). Dietary intakes of Fe and contributions from different food groups were compared using a 7 d food diary. Promoters and inhibitors of non-haem Fe absorption were investigated and a recently published algorithm was applied to assess bioavailable Fe. Fewer patients than controls met the reference nutrient intake for Fe (32 % CD patientsv. 42 % controls). Overall, patients had significantly lower mean Fe intakes (by 2·3 mg/d) and Fe density (by 0·26 mg/MJ (1·1 mg/1000 kcal)) compared with controls (bothP<0·001). Differences were mainly due to a preference among CD patients for low-fibre non-Fe fortified cereals, particularly breakfast cereals. In particular, control subjects had higher Fe intakes than matched CD subjects for men (P<0·001) and women less than 50 years (P=0·03). Intakes of both ascorbic acid (P<0·001) and phytic acid (P<0·01), but not animal tissue (P=1·0), were lower in patients with CD, but these had no overall effect on the predicted percentage of bioavailable Fe. Thus total bioavailable Fe was reduced in patients with CD due to lower intakes (P<0·01). Dietary Fe intakes are low in CD patients, which may contribute to an increased risk of ID and anaemia. Changing dietary advice may compromise perceived symptoms of the disease so the need for Fe supplementation should be carefully considered.

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

Intake of dietary iron is low in patients with Crohn's disease: a case–control study

et al. 2004

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“…Supplementary enteral nutrition providing 35-50 % of energy requirements using either an elemental or polymeric formula has been shown to help in the maintenance of disease remission if provided for up to 12 months (68) . In UC, patients often consider specific foods induce symptoms and self-restrict their diet (69) . There is no evidence to support enteral nutrition in the maintenance of disease remission in UC.…”

Section: Maintenance Of Disease Remissionmentioning

confidence: 99%

Dietary and nutritional considerations for inflammatory bowel disease

Lomer

2011

Proc. Nutr. Soc.

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Nutritional assessment and dietary advice are fundamental to inflammatory bowel disease (IBD) patient management and all patients should have access to a dietitian. Newly diagnosed patients often think that their pre-illness diet has contributed to the development of their IBD. However, epidemiological evidence to support diet as a risk factor is lacking. How the diet contributes to the gastrointestinal microbiota is interesting, although the role is not yet clearly defined. Nutritional problems in IBD are common. Malnutrition occurs in up to 85% of patients and weight loss affects up to 80% of patients with Crohn's disease and 18–62% of patients with ulcerative colitis. Nutritional deficiencies are prevalent, particularly in relation to anaemia and osteoporosis. Intestinal strictures can be problematic in Crohn's disease and limiting fibrous foods that may cause a mechanical obstruction in the gastrointestinal tract is helpful. Patients often explore dietary exclusion to alleviate symptoms but such changes may be self-directed or inappropriately advised and can lead to further nutritional deficiencies. Some patients experience concurrent functional symptoms (e.g. abdominal bloating, abdominal pain, flatulence and diarrhoea) that can significantly affect quality of life. Recently, a group of poorly absorbed carbohydrates that occur naturally in the diet called fermentable oligo-, di-, mono-saccharides and polyols have been associated with functional symptoms by intestinal bacterial fermentation leading to rapid gas production, and an osmotic effect increasing fluid delivery to the colon. Emerging evidence indicates that a diet low in fermentable oligo-, di-, mono-saccharides and polyols can alleviate functional symptoms in IBD.

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“…The unrestricted microparticle diet (control group) were advised on how to meet their dietary reference values for all nutrients (Department of Health, 1991). Both groups were recommended to avoid fibrous fruit and vegetables, as indicated for patients with structuring disease (Ballegaard et al 1997), and equal time was spent in advising all patients. Fig.…”

Section: Dietary Exclusion Of Microparticles In Crohn's Diseasementioning

confidence: 99%

Fine and ultrafine particles of the diet: influence on the mucosal immune response and association with Crohn’s disease

2002

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Crohn’s disease is a modern Western disease characterised by transmural inflammation of the gastrointestinal tract. It is of unknown aetiology, but evidence suggests that it results from a combination of genetic predisposition and environmental factors. Bacterial-sized microparticles (0·1–1·0 µm) are potent adjuvants in model antigen-mediated immune responses and are increasingly associated with disease. Microparticles of TiO2 and aluminosilicate accumulate in macrophages of human gut-associated lymphoid tissue where the earliest signs of lesions in Crohn’s disease are observed. Dietary microparticles are of endogenous or exogenous origin. Endogenous microparticles dominate and are calcium phosphate (most probably hydroxyapatite), which precipitates in the lumen of the mid-distal gastrointestinal tract due to secretion of Ca and phosphate in the succus entericus. Exogenous dietary microparticles are contaminants (soil and/or dust) and food additives. TiO2, for example, is a food colourant, and aluminosilicates are anti-caking agents, although some aluminosilicates occur as natural contaminants. Food additives alone account for ingestion of approximately 1012 particles/person per d. Possible mechanisms for the role of exogenous and endogenous dietary microparticles in promoting toleragenic or immune responses of gastrointestinal mucosal phagocytosis are discussed. In a double-blind randomised pilot study we have shown that a diet low in Ca and exogenous microparticles appears to alleviate the symptoms of ileal Crohn’s disease, with a significant (P = 0·002) improvement in the Crohn’s disease activity index. A multi-centre trial and further mechanistic studies at the cellular level are underway.

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Self-Reported Food Intolerance in Chronic Inflammatory Bowel Disease

Cited by 97 publications

References 9 publications

Intake of dietary iron is low in patients with Crohn's disease: a case–control study

Intake of dietary iron is low in patients with Crohn's disease: a case–control study

Dietary and nutritional considerations for inflammatory bowel disease

Fine and ultrafine particles of the diet: influence on the mucosal immune response and association with Crohn’s disease

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