Reviewing randomized clinical data on 2 dietary strategies for patients with IBD, James D. Lewis, MD, stated that the goals of the patient and their ability to adhere to the diet are just as important as the efficacy of the method.

Dr Lewis is a professor of medicine and epidemiology at the Perelman School of Medicine of University of Pennsylvania.

Currently, there is limited guidance from national organizations when it comes to dietary strategies. Adding to provider uncertainty, Dr Lewis said, is the fact that “historically, studies of whole food diets for IBD were of low quality and quite heterogenous.” However, he added, “a number of studies in the last 5 to 10 years are of better quality and are beginning to provide evidence that diet can be an important part of managing IBD. Still, we don’t have proof of the definitive diet that is right for everybody.”

While there are impressive results with exclusive enteric nutrition (EEN) formula-based diets, Dr Lewis commented, “nobody wants to sustain themselves on these oral formulas over the long term.”

In contrast, patients find it easier to adhere to whole food diets, but it can be difficult to find the correct combination of nutrients and foods. More comprehensive diets, like the Crohn’s Disease Exclusion Diet (CDED), have shown more of a benefit than simple restrictions. However, it can still be challenging to identify which aspects of the diet are the most important.

Through all the uncertainty, Dr Lewis stated that patient goals and ability to adhere to the diet are as important as the efficacy of the approach. “When talking to your patients about their dietary patterns, your recommendations may vary depending on their goals,” Dr Lewis stated. A patient may be looking to use a diet to improve their health, as a bridge to a new therapy, or as a primary therapy. Each goal would necessitate a different recommendation.

—Allison Casey

Reference:
Dietary Interventions in Inflammatory Bowel Disease. DDW Meeting News. May 21, 2022.