Diet Can Provide Symptom Management for Patients with IBD

Millie D. Long, MD, reported on the latest studies on specific foods and diets that can help patients manage IBD-related symptoms at the at the Advances in Inflammatory Bowel Diseases 2021 virtual meeting on Saturday, March 6, 2021.

Dr Long explained that acknowledging patients’ observations about how food makes them feel is an invaluable tool in treating the individual patient—which is the best point of action in easing symptoms. She also described available literature that suggests diet can impact the gut microbiome and intestinal barrier, making patients susceptible to inflammatory bowel disease (IBD.) However, because there is no single cause for IBD, foods may not necessarily increase inflammation,  but they can certainly exacerbate gastrointestinal (GI) symptoms, she said.

A number of dietary factors contribute to malnutrition in IBD, including inadequate intake due to lack of appetite or food aversions; vomiting and diarrhea; medications such as prednisone and sulfasalazine; and malabsorption due to active disease or bowel resection, Dr Long said.

With a self-reported, internet-based cohort, IBD Partners utilized a validated food frequency questionnaire on dietary patterns in patients with IBD and found foods that tended to improve symptoms included yogurt, rice, and bananas, Foods that appeared to worsen symptoms included nonleafy vegetables, spicy foods, fruits, nuts, leafy vegetables, fried foods, milk, red meat, soda, popcorn, dairy, alcohol, high-fiber foods, corn, fatty foods, seeds, coffee, and beans.

“One important take-home is that different foods can trigger symptoms in different patients, so patients need to be considered individually,” noted Dr Long. “From my perspective, I do think there are important clues out of this, though; fiber is quite healthy, fruits and vegetables, encouraging those types of diets makes some sense. But really, it’s likely this western diet that’s contributing to IBD—the red meat, the dietary fat, the emulsifiers, and fiber seems to be pretty severely lacking in the typically western diet. Fiber is hypothesized to have an inflammatory effect— it may play a role even in maintaining the intestinal barrier function. Really, we need to be staying away from this western diet.”

Other treatments include enteral diets, which offer the highest evidence base and success in pediatric patients, but meets with mixed acceptance and results in adults.

Dr Long went on to discuss two popular diets, specific carbohydrate diet and the Mediterranean diet, in controlling IBD symptoms. Both diets are considered “do-able” from a patient’s perspective, but vary in practice. The specific carbohydrate diet allows all noncanned meats, fruits, vegetables, oils, nuts, and honey, and prohibits all grains, including corn, wheat, and rice, as well as soy, dairy, canned meats, canned vegetables, and more. The Mediterranean diet allows a high intake of olive oil, fresh vegetables, leafy greens, fresh fruits served as snacks and desserts, whole-grain cereals, nuts, legumes, and moderate intakes of fish, seafood, and poultry. This diet also permits dairy, such as yogurt and cheese, and red wine, while limiting intake of eggs, red meat, processed meat, and sweets.

In the recent DINE study, researchers compared both the specific carbohydrate diet and the Mediterranean Diet in a 12-week randomized clinical trial of 194 participants. Food from the specified diet was catered and delivered to patients to improve adherence. Patients experienced symptomatic remission without the initiation or increase of any CD medications. After 6 and 12 weeks, patients scored <150 on the Crohn Disease Activity Index.

Overall, there was no statistically significant difference between the results of the two diets. Each proved to be tolerated, despite significant fiber in both, and each resulted in improved symptoms for patients with IBD. Symptomatic remission was common in both diets, with or without confirmed inflammation prior to randomization.

It’s also important to note, Dr Long commented, that neither diet was associated with normalization of C-reactive protein concentration or other biological markers of remission.

“Healthy diet is important. Diet can be a tool to improve symptoms, but in a complementary fashion to other management of IBD,” Dr Long concluded. “It’s important to not mistake symptom control with disease control.”

-Angelique Platas

References:

Long M. Diet as therapy for IBD. Presented at: Advances in Inflammatory Bowel Diseases regional meeting. March 6, 2021. Virtual