Inflammatory Bowel Disease

Inflammatory bowel diseases (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are autoimmune-based chronic inflammatory diseases that follow a relapsing and remitting course. The pathogenesis of IBD has yet to be fully elucidated; however, studies suggest a multifactorial process involving genetics, environmental exposures, the gut microbiome, and immune dysregulation among others. One accepted theory is that IBD develops due to an exaggerated, uncontrolled immune response to an environmental trigger in the gut microbiota. There has been a rising incidence of IBD worldwide, and experts believe a “westernized diet” is at least partially to blame. A diet high in refined sugars, animal fat, and complex carbohydrates is associated with higher rates of IBD, whereas diets rich in omega-3 fatty acids and fiber protect against development of IBD.1

The gut serves as the body’s principle interface between the outside world and immune system. Disruptions in gut integrity and overall function are distorted in autoimmune diseases such as IBD. Orally ingested medications and or nutrients may play a number of roles in propelling or improving symptoms and the course of disease by influencing gut health and mucosal immunity.

Diet is the primary modality we have available to help modify symptoms. Surveys reveal that a large percentage of IBD patients not only alter their diets but also ask clinicians for dietary advice.2 Researchers reported that 90% of CD and 71% of UC patients changed their diets following diagnosis.3 Among patients altering their diets, 73% experienced improved symptoms of abdominal pain, flatulence, and diarrhea. Despite patient demand for dietary guidance, no diet is currently recommended for IBD in clinical practice guidelines and the online Nutrition Care Manual, which is used by many hospitals.

A systematic review concluded that IBD rates have increased with the spread of the Western diet, specifically a higher intake of total fats, omega-6 fatty acids, and meat. High-fiber and fruit intakes were shown to be associated with a decreased risk of CD, while high-vegetable intakes were found to be protective against UC.4 Coconut-derived medium-chain triglycerides (MCT) oil has been shown to improve bowel damage in animal models and modulate immunity.5

The suggested diet for IBD has a bimodal approach: (1) an elimination diet for symptom control and (2) an anti-inflammatory diet for long-term disease control and optimum health. During bouts of diarrhea and abdominal pain, a softer diet and sufficient fluids are recommended, whereas high sugar drinks, juices, caffeine, alcohol, and sugar alcohols should be avoided. Obstruction may require a liquid diet or nothing by mouth.

There are two major types of essential fatty acids (EFAs): omega-3 and omega-6 polyunsaturated fatty acids (PUFA). These are considered essential because the body is unable to synthesize them, thereby necessitating dietary intake. Omega-3 has been shown to have beneficial health effects, including anti-inflammatory properties, whereas excess omega-6 has been associated with proinflammatory and prothrombotic states. The ratio of omega-6 to omega-3 consumed should be approximately 4:1, but a Western diet has a ratio closer to 10:1 and some experts believe this imbalance contributes, in part, to the development of IBD and or its recalcitrance to medical therapy.6 Omega-3 supplementation decreases inflammatory cytokines, including TNF-α, IL-1β, and NF-κB, as well as improves the functioning of the immune system.7 Fish oil is an excellent source of omega-3 fats.

Glutathione is considered one of the most important antioxidant defenses in the body. N-acetylcysteine (NAC) replenishes glutathione rendered inactive by oxidation within the liver and has been shown to have antiinflammatory effects.8 Probiotics such as VSL#3 and Lactobacillus GG have also shown promise in addressing symptoms of IBD.

Reach out to us at RMRM if you’d like us to review your particular case and see what other treatment modalities we have to offer beyond that discussed above.

  1. A. Tragnone, et al.: Dietary habits as risk factors for inflammatory bowel disease. Eur J Gastroenterol Hepatol. 7 (1):47-51 1995
  2. S. Kane: What physicians don’t know about patient dietary beliefs and behavior can make a difference. Expert Rev Gastroenterol Hepatol. 6 (5):545-547 2012
  3. T.J. Green, R.M. Issenman, K. Jacobson: Patients’ diets and preferences in a pediatric population with inflammatory bowel disease. Can J Gastroenterol. 12 (8):544-549 1998
  4. J.K. Hou, B. Abraham, H. El-Serag: Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol. 106 (4):563-573 2011
  5. T. Tsujikawa, et al.: Medium-chain triglycerides modulate ileitis induced by trinitrobenzene sulfonic acid. J Gastroenterol Hepatol. 14 (12):1166-1172 1999
  6. A.P. Simopoulos: The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother. 56 (8):365-379 2002
  7. M. Fisher, et al.: Dietary n-3 fatty acid supplementation reduces superoxide production and chemiluminescence in a monocyte-enriched preparation of leukocytes. Am J Clin Nutr. 51 (5):804-808 1990
  8. Y. Hou, et al.: N-acetylcysteine and intestinal health: a focus on its mechanism of action. Front Biosci (Landmark Ed). 20:872-891 2015