Take-Home Messages from 20 Years of Progress in Dietary Therapy of Inflammatory Bowel Disease

Abstract

<b><i>Background:</i></b> A significant body of literature has interrogated the critical role of diet in the development and management of inflammatory bowel disease (IBD). <b><i>Summary:</i></b> This review provides a summary and critical appraisal of the literature in this area, focussing on four distinct themes: nutritional epidemiology, animal and in vitro experiments, enteral nutrition, and food-based dietary therapies. <b><i>Key Messages:</i></b> Nutritional epidemiology and data from experiments in animals indicate that a western-type diet pattern is associated with increased risk of IBD onset. However, these findings have not been consistently replicated in the dietary management of IBD. Exclusive enteral nutrition (EEN) is the only dietary therapy with reproducible evidence of efficacy in the management of active Crohn’s disease (CD). Use of EEN may also be useful for improving perioperative outcomes in CD, and as an adjuvant therapy to biologic therapy. Several dietary therapies for CD and ulcerative colitis have been proposed in the literature, but replication in well-controlled studies is needed before their routine use enters the clinical setting. Precision nutritional therapy might be an attractive therapeutic paradigm in a heterogenous disease like IBD. However, no recommendations for personalised dietary therapy can currently be made, and it is imperative we unravel the complex interplay between diet and gut inflammation before we are able to do so. Undoubtedly, diet is of critical importance in the development and management of IBD. However, the exact mechanism by which diet causes gut inflammation is still elusive, and dietary guidance is difficult to formulate.

Letter: The multifaceted role of Escherichia coli in influencing disorders of the industrial populations—Authors' reply

“…3 A pertinent example is the role of food additives in the initiation and propagation of gut inflammation in inflammatory bowel disease through their interaction with E. coli. In our review article, and elsewhere, 4 we discussed pivotal evidence from animal and in vitro experiments proposing a potential mechanism implicating food additives and their interaction with E. coli in disease pathogenesis. However, our discussion also incorporated contrary findings from recent clinical trials, revealing that the removal of food additives from the diet did not yield improvements in inflammatory markers.…”

Postprandial Dysmetabolism and Its Medical Implications

“…Certain dietary components, such as a high intake of processed foods, saturated fats and sugar and a low intake of fiber-rich foods, have been associated with an increased risk of developing or exacerbating IBD symptoms, potentially influencing disease severity and progression. Diets rich in fiber from fruits, vegetables and whole grains have been associated with a lower risk of IBD and may help manage symptoms [74].…”