Relationship Between Inflammatory Bowel Disease And Diet

Introduction

The term "inflammatory bowel disease" (IBD) refers to a group of two disorders that cause recurring inflammation of the gastrointestinal tract.¹ The main subtypes of inflammatory bowel disease are Crohn's disease and ulcerative colitis.¹ While environmental exposures and genetic composition are thought to be the main factors causing inflammatory bowel disease, research has indicated correlations between diet and the likelihood of developing IBD.² 

Although diet is neither the cause nor the solution for inflammatory bowel disease, it has an impact on the underlying inflammatory process that results in IBD symptoms.³ For example, while certain foods like fruits, vegetables, and fish may ease symptoms and aid in recovery, foods like red meat or foods that are rich in sugar and fat may exacerbate them, thus, an integral part of an overall treatment strategy for IBD is monitoring your diet and how your body reacts to certain foods.^3,4

In this article, we explore the relationship between IBD and diet and provide a comprehensive guide to help individuals navigate their dietary choices effectively.

Understanding Inflammatory Bowel Disease

Types and causes of IBD

Both ulcerative colitis and Crohn's disease impede the body's capacity to properly digest food, absorb nutrients, and get rid of waste.⁵

Ulcerative colitis

Ulcerative colitis is a disease that causes inflammation in the colon, and it might affect the entire colon or only a portion of the rectum and anus, often leading to bloody diarrhoea.⁶ The purpose of the colon is to absorb water from the food that has broken down; however, diarrhoea is caused when the colon becomes inflamed and the stool that goes through the anus becomes diluted.⁵ Ulcerative colitis is an autoimmune disease, meaning that the immune system, (the body's defence against infection), is attacking healthy tissue.⁶ The most widely accepted explanation is that the immune system misinterprets harmless bacteria present in the colon as a danger and targets the colon's tissues, inflaming them.⁶ Even though the exact cause is unknown, it is believed that environmental and genetic factors combine to cause it.⁶

Crohn's disease

Any part of the gastrointestinal tract can become inflamed when someone has Crohn's disease. This condition often manifests from the mouth to the anus, impeding the body's ability to properly absorb and digest the nutrients included in meals.⁵ Food that hasn't been fully digested and passed through the colon might result in diarrhoea and pain in the abdomen.⁷ Crohn's disease is also an autoimmune disease, meaning that the immune system attacks the digestive system. Some other factors which contribute to the manifestation of Crohn’s disease are genetics and an unusual gut bacterial balance.⁸ Smoking can worsen Crohn’s disease symptoms.

Symptoms of IBD

Common symptoms include:

• Diarrhoea 
• Cramps and pains in the stomach 
• The presence of blood, mucus or pus in your stool
• Fatigue 
• Weight loss¹

Role of Diet in Inflammatory Bowel Disease Management

Research on the effects of various diets on inflammatory bowel disease has yielded valuable insights about the potential influence of dietary changes on disease outcomes.²

Mechanisms by which Diet can Influence IBD

Several hypotheses have proposed a direct connection between IBD and food. For example, it has been suggested that food directly affects IBD by altering the gut microbiome's composition. Food affects how metabolites (small compounds produced by gut microbes), which have the potential to start or worsen inflammatory bowel disease, are produced. Another hypothesis is that immunological response to food antigens can influence IBD. Moreover, the mucous layer, which shields the epithelium from the contents of the stomach, can also be influenced by diet. Many other hypotheses have proposed that diet may impact IBD indirectly by altering bile acid profiles or by affecting immune function.²

General Dietary Guidelines for Individuals with IBD

Foods to limit or avoid

• Trigger foods that have already produced issues⁹
• Raw vegetables like tomatoes and bell peppers, prunes, and caffeinated beverages that might cause an increase in stool frequency⁹,⁵
• Concentrated sweets like juices, candies, sports drinks and soda, since this can aid in lowering the quantity of water drawn into your intestines and cause watery stools⁹
• Alcohol and caffeine³
• High-fibre meals like beans³
• Spicy foods³
• Oranges or orange juice³
• Corn and corn-based snack foods like popcorn, nacho chips³,⁵
• Foods high in animal protein, such as fried and fatty meals (red and processed meats)⁵
• It is crucial to stay away from nuts, seeds, beans, and kernels if you have any strictures⁹
• It is important to reduce meals high in Fermentable Oligo-Di-Monosaccharides and Polyols (FODMAPS), which are fermentable sugars present in certain carbohydrates and sugar alcohols that can aggravate symptoms such as excessive gas, bloating, diarrhoea, and cramps in those with intolerances⁷

Specific Dietary Considerations for IBD

For IBD, smaller, more frequent meals are frequently found to be better tolerated by patients.¹⁰

• Include more omega-3 fatty acids in your diet. There could be an anti-inflammatory impact from these lipids. Fish such as salmon, mackerel, herring, and sardines contain them⁹
• Cold foods might aid in lowering diarrhea⁹
• Adhere to a lactose-free diet if you are intolerant of lactose⁹
• If stool is oily and foul-smelling, it may indicate fat malabsorption, necessitating a low-fat diet⁹
• Yoghurt, rice, and bananas are among the foods that have been shown to alleviate symptoms⁵
• In the event of a flare-up or constipation, soluble fibre could be easier to handle. You may find soluble fibre in oats (oat cakes, porridge oats), pulses and beans, fruit and vegetables with peels, including parsnips, carrots, turnips, and swedes¹¹
• If you don't have a good appetite and have trouble consuming solid foods, think about taking nutritional supplements⁹

Inflammatory bowel disease is often associated with malnutrition due to digestive issues, malabsorption, loss of appetite, and increased caloric needs during flares.³

Hence, eating a varied, well-balanced diet is crucial, even if your symptoms are not acting up. Try including the following foods in your diet on a daily basis since well-nourished people tend to respond better to IBD medications.³

• 8-10 glasses of water
• Bland, soft meals e.g. white rice, refined pastas, and simple cereals and carbohydrates high in fibre (oat bran, legumes, barley)
• Lean meats, fish, eggs, nuts, poultry, and soy as sources of proteins. 
• Omega-3 fatty acids and additional healthy fats like canola and olive oil
• Fully cooked veggies, dark-coloured, seedless, skinless fruits and vegetables 
• Fruit juices, applesauce and bananas
• Low-fat dairy products, or dairy alternatives if you are lactose intolerant³

Patients should see a physician or nutritionist to develop a personalised, well-balanced food plan depending on the type of inflammatory bowel disease they have, its location and severity, and whether it is active or in remission.³

As there is no one dietary plan that is suitable for all individuals with IBD, it Is best to work with a qualified nutritionist or your physician on a continuing basis.³

Additional Dietary Interventions

Formula-based diets

Formula-based diets, particularly exclusive enteral nutrition, have shown promise as therapeutic modalities, especially for Crohn's disease.² Exclusive enteral nutrition can meet all of a person's daily nutritional needs by consuming only liquid formulas without meals for six to eight weeks.¹² Hypothesis indicates its potential to provide specific nutrients for mucosal healing to alter the gut microbiome and metabolome.²

Elimination diet

The elimination diet involves systematically removing potential trigger foods under medical and dietitian supervision to identify and manage symptoms effectively. It's crucial to substitute eliminated foods with nutrient-equivalent alternatives to maintain proper nutrition.⁷ Keeping a food journal may be a useful tool for many people to monitor how their bodies react to different meals.

Several diets are promoted for treating IBD, such as the Specific Carbohydrate Diet and the  maker’s diet.

Specific Carbohydrate Diet

To minimise symptoms of gas, cramps, and diarrhoea, this diet restricts carbohydrates that are difficult to digest. The diet is free of most grains and dairy items and is mostly composed of meats, veggies, oils, and honey.⁷

The Maker's Diet

This diet emphasises the physical, mental, spiritual, and emotional aspects of overall wellness. Suggested foods are not refined, processed, hormone- or pesticide-treated.

Although a diet plan can supplement, it should never replace medical treatment for IBD. Always take your medications according to the advice from your physician. A personalised nutrition treatment plan created by a qualified dietitian aims to improve quality of life, reduce disease activity and symptoms, and avoid malnutrition by addressing nutritional deficiencies.

Summary

Inflammatory bowel disease and diet have a complex relationship, with dietary factors influencing disease progression and symptom management. Common symptoms of inflammatory bowel disease, such as diarrhoea, abdominal pain, and fatigue, can be influenced by dietary factors, hence it is better for individuals with this condition to adopt tailored dietary approaches. While specific dietary recommendations vary, general guidelines suggest avoiding trigger foods and incorporating nutrient-rich alternative options. However, it is crucial to approach dietary changes under medical and dietitian supervision to ensure nutritional adequacy and symptom management. Although diet plays a big part in managing inflammatory bowel disease, personalised nutrition regimens that seek to lower disease activity and enhance quality of life should be used in addition to medical treatment, not as a substitute for it.