Introduction
Inflammatory bowel disease is one of the chronic conditions that affects our gastrointestinal system from mouth to anus. It is classified into two categories: Crohn’s disease and ulcerative colitis. IBD is mainly considered as a spectrum of chronic immune mediated intestinal diseases characterized by episodes of flare-ups and remission. According to researches done on IBD, it is primarily believed to be related to a complex interaction between the immune system of the individual and the intestinal microbiome. Additionally, diet and nutrition are identified a vital factor in the development of IBD. In this blog we will shade light on the general and specific dietary plans and emerging nutritional therapies for individuals with IBD.
General dietary interventions by YourFides Dietitian
Mediterranean Diet: Recent researches point out that all patients with inflammatory bowel disease should be encouraged to follow a Mediterranean diet. This is due to the fact that it is rich in a variety of fresh fruits and vegetables, monounsaturated fats, complex carbohydrate and proteins and it is associated with relatively lower risk of IBD. On the contrary, it is low in ultra processed foods, sugar and salt which makes it ideal for patients with IBD. In spite of its advantages, emerging studies show that patients with IBD have relatively low compliance with the Mediterranean diet as compared to the general population.
Specific dietary therapies
Exclusive enteral nutrition(EEN): This nutrition plan uses liquid nutrition formulations and effectively induces remission and endoscopic response in Crohn’s disease with stronger evidence in children than adults. EEN may be considered as a steroid sparing bridge management for individuals with IBD. Moreover, EEN can be an effective treatment for Crohn’s disease patients who are malnourished prior to an elective surgery.
Crohn’s disease Exclusion Diet (CDED): It uses partial enteral nutrition therapy and it is an effective therapy for inducing clinical remission in mild to moderate Crohn’s disease. It showed good outcome and better adherence in both children and adults as compared to EEN.
Parenteral Nutrition(PN): This plays a crucial role in patients with IBD experiencing intestinal failure both acute and chronic.
- Short term parenteral nutrition may be used for individuals with an intra-abdominal abscess and/or phlegmonous inflammation especially in the preoperative phase. It enhances their capacity to achieve optimal nutrition via the digestive tract and provides bowel rest, decrease infection and inflammation thereby acting as a bridge to definitive surgical outcomes.
- Studies suggest that PN can be of great help in patients with IBD who have high output gastrointestinal fistula, ileus, short bowel syndrome or severe malnutrition in situations where oral and enteral nutrition are not feasible or contraindicated. It is recommended to transition long term PN to customized hydration management (e.g. intravenous electrolyte support and/or oral rehydration solutions) and oral intake whenever possible to decrease the risk of long-term complications. Medications like glucagon-like peptide-2 agonists can aid this transition.
- Individuals with symptomatic intestinal strictures and IBD need dietary modifications because they might not tolerate fibrous, plant-based foods such as raw fruits and vegetables owing to their texture. Careful chewing and cooking together with processing of fruits and vegetables to a less fibrinous and soft texture might help these patients to take advantage of a wider variety of plant-based foods and fiber.
Other exclusion Diets
- Low FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides and polyols): Even though evidences are preliminary, low FODMAP diet has been suggested to relieve functional symptoms and influence inflammatory process in IBD patients.
- Other exclusion diets like specific carbohydrate diet (SCD), CD-TREAT and the Tasty and Healthy diet are also being investigated for their benefits in disease maintenance and symptom control.
Points not to be overlooked
- Malnutrition is one of the common and undertreated conditions in patients with IBD. They are usually associated with dietary restrictions and clinical complications of IBD itself. These patients need regular screening by their healthcare provider and assessment of clinical signs and symptoms like unintentional weight loss, generalized body swelling especially in the extremities and loss of muscle mass. If these are observed, a more thorough evaluation of the patient by a registered dietitian like YourFides is indicated.
- Patients with IBD should be evaluated for vitamin D and iron deficiency. IBD patients with extensive ileal disease or prior ileal surgery should be monitored for vitamin B12 deficiency.
Conclusion
Inflammatory bowel disease is a spectrum of chronic immune mediated diseases characterized by remissions and flare-ups. It presents unique nutritional challenges that require tailored dietary approaches to tackle the condition. While we have general dietary approaches like mediterranean diet, emerging studies also suggest specific nutritional therapies such as exclusive enteral nutrition and Crohn’s disease exclusion diet that provide targeted strategies. Importantly, routine nutritional assessment and management of deficiencies, including vitamin D, iron, and vitamin B12, are critical components of comprehensive IBD care. Collaborating with healthcare professionals and registered dietitians like YourFides ensures that individuals with IBD receive personalized and evidence-based nutritional support to optimize their health outcomes.
If you are having any comments or inquiries, please leave us your invaluable comments. YourFides, our registered dietitian, is available to help you with your concerns.