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Nutritional Therapies For Inflammatory Bowel Disease

November 21, 2021 at 4:00 a.m.

About 1.3% of US adults currently live with a diagnosis of inflammatory bowel disease. The most common forms of IBD include ulcerative colitis and Crohn's disease. Ulcerative colitis is characterized by inflammation and sores (ulcers) along the superficial lining of the large intestine and rectum. Crohn's disease involves inflammation of the lining in any part of the digestive tract, including the deeper layers. However, it most commonly affects the last part of the small intestine (the ileum) and the large intestine.

The symptoms of IBD can vary considerably from one person to the next, but the most commonly experienced symptoms include:

• Diarrhea.

• Fatigue.

• Abdominal pain and cramping.

• Bloody bowel movements.

• Reduced appetite.

• Unintended weight loss.

These symptoms can vary from mild to severe. The complications of IBD can be life-threatening and include malnutrition, dehydration, bowel obstruction, fistulas, anal fissures, or a perforated colon.

There's still no consensus on the actual cause of IBD, though it is generally believed to be an autoimmune condition that can be triggered by excessive use of NSAIDS, smoking, or chronic stress. Like other autoimmune conditions, it's also believed to be a lifelong condition characterized by periods of remission (when there are no symptoms) and flares (when symptoms reappear).

The currently accepted conventional methods of addressing symptoms include anti-inflammatory drugs like corticosteroids and aminosalicylates, immune system suppressing drugs such as methotrexate, immunomodulatory drugs such as azathioprine and 6-mercaptopurine, biologics such as Humira, antibiotics such as Cipro and Flagyl, a feeding tube (enteral nutrition) or nutrients injected into a vein (parenteral nutrition), and surgery.

About 25% of people living with ulcerative colitis and 80% of people living with Crohn's disease require surgery during their lifetime. Of those requiring surgery, about half require another surgery within 10 years. Having the first surgery under emergency circumstances or smoking cigarettes are two risk factors known to increase the chances of needing a second surgery within 10 years of the first.

These statistics can sound grim to anyone affected by a diagnosis of IBD. However, there is compelling evidence that non-pharmacological therapies can effectively lead to remission of IBD and prevent recurrence rates and reduce the need for repeated surgical interventions.

In the early 1900s, doctors prescribed dietary therapy for Crohn's and ulcerative colitis that involved the total elimination of complex carbohydrates and all refined sweeteners except for honey. Although the diet was believed to be effective, it was largely forgotten by the medical community with the introduction of pharmacological therapies.

After all, the diet typically must be followed for life in order to stay in remission, and there was hope that new pharmaceutical drugs could work just as well and allow those living with Crohn's and colitis to no longer have to follow a restrictive diet.

And for many people living with a diagnosis of IBD, the right combination of pharmaceutical products can keep the disease in remission for many years and with minimal side effects. But for many, conventional treatments are not enough to keep the disease from progressing, or the side effects of the medications outweigh the perceived benefits.

As more recent scientific research has shed light on the role of the gut microbiome in IBD, there has been a resurgence of interest in dietary strategies that could favorably alter the gut microbiome to produce disease remission.

One study conducted through the Seattle Children's Hospital and the Children's Center for Digestive Health Care in Atlanta looked at the effects of a diet that eliminates processed foods, additives, iron supplements, milk, starchy foods, fruit juice, and all added sweeteners except for honey. The diet consisted mostly of non-starchy vegetables, fresh fruits, homemade yogurt, unprocessed meats, poultry, fish, eggs, and nuts. After 12 weeks, most patients showed a decrease in C-reactive protein (an inflammatory marker) and an improvement in their gut microbial profile.

Other research has shown that people living with Crohn's disease, in particular, tend to have genetic differences in their vitamin D receptor that make them more likely to become vitamin D deficient. Vitamin D is an important regulator of the adaptive and innate immune system, and low vitamin D status has been associated with autoimmune disease. A higher vitamin D level, on the other hand, is associated with improved outcomes in IBD.

Food additives have repeatedly been shown to cause relapses in the symptoms of IBD, but they are ubiquitous in the modern food supply. Dairy products, nondairy milks, ice creams, deli meats, rotisserie chicken, and non-gelatin capsules used in dietary supplements and medicines, often contain carrageenan, a seaweed derivative that has been shown in animal studies to induce colitis. Maltodextrin from cornstarch, which promotes the growth of e-coli and other pathogenic bacteria in the ileum, is frequently added to candy, beer, baby formula, breakfast cereal, nutrition bars, chips, crackers, most packaged snack foods, and as a binder in some medications and supplements. Polysorbate 80, sodium caprate, and carboxymethyl cellulose, often added to breads, sauces, pickles, and medications, can cause e.coli bacteria to move into the lymphoid follicles in the ileum.

Numerous studies have demonstrated clinical efficacy of a total elemental (amino acid-based) diet. Elemental diet formulas are hypoallergenic because the amino acids are not long enough for antigen recognition, so are unlikely to cause adverse side effects.

Recent studies that looked at people with Crohn's disease who had undergone intestinal resection found that those who consumed an elemental diet consisting of 900-1200 calories per day (in addition to solid food) for two years were significantly less likely to have a recurrence of symptoms or need a repeat surgery than those who did not consume a post-surgical elemental diet.

There's also evidence that an elemental diet can bring about remission of disease in people with mild to moderate IBD. A study conducted in Japan saw a 91.7% disease remission rate in people with Crohn's disease and a 85.7% disease remission rate in people with ulcerative colitis after starting an elemental diet. The majority of these people stayed in remission for at least three years.

These are just a few of the peer-reviewed research studies demonstrating that nutritional therapies can improve clinical outcomes and quality of life in people living with a diagnosis of IBD. Moreover, a nutritional approach doesn't have to be used instead of conventional treatments. While people with mild symptoms may be able to manage their condition with diet alone, many may find that a combination of nutritional strategies, medications, and surgery works best for them.

For more information about the elemental diet or the grain-free diet mentioned in this article, please send an email to [email protected]


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Ohara, Nobuyoshi et al. "Adherence to an elemental diet for preventing postoperative recurrence of Crohn's disease." Surgery today vol. 47,12 (2017): 1519-1525. doi:10.1007/s00595-017-1543-5

Shinozaki, Masaru et al. "Elemental diet therapy plays a significant role in preventing surgical recurrence of Crohn's disease in the era of biologics." Surgery today vol. 51,2 (2021): 250-257. doi:10.1007/s00595-020-02112-5

Sharma, Sanchit et al. "Efficacy and tolerability of exclusive enteral nutrition in adult patients with complicated Crohn's disease." Intestinal research vol. 19,3 (2021): 291-300. doi:10.5217/ir.2019.09172

Kudo, Takahiro et al. "A Multicenter Prospective Survey on Early-Onset Inflammatory Bowel Disease in Japan." Digestion vol. 102,3 (2021): 368-376. doi:10.1159/000507570

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