Gastrointestinal and Liver Diseases Research Center,Iran University of Medical Sciences , mohammadian.az@iums.ac.ir
Abstract: (40 Views)
Abstract
Background & Objectives: Dietary interventions are increasingly recognized as a fundamental aspect of managing inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis. These chronic, often debilitating conditions arise from a complex interplay of genetic predisposition, environmental triggers, and immune system dysregulation, with diet playing a crucial role in influencing disease activity and progression. Emerging evidence indicates that specific dietary patterns can alleviate symptoms, reduce inflammation, and potentially modify the disease course in IBD patients. This review explores how diet impacts IBD, including the modulation of gut microbiota, immune responses, and intestinal permeability. It also examines the benefits and potential drawbacks of various dietary strategies, such as exclusive enteral nutrition, the low FODMAP diet, and the anti-inflammatory Mediterranean diet, emphasizing variability in individual responses.
Additionally, the review highlights the importance of personalized nutritional plans tailored to each patient’s unique needs, considering factors like disease type, disease stage, comorbidities, and lifestyle. Since IBD is a heterogeneous condition, what works for one patient may not be effective for another. Therefore, a customized approach to nutrition is essential for optimizing patient outcomes and enhancing the quality of life for individuals living with IBD.
Methods: The present study is a scoping review. Relevant articles published in Persian and English from 1985 onward were examined using reputable scientific databases, including Scopus, PubMed, Web of Knowledge, Google Scholar, IranMedex, and SID. For English resources, the keywords “Inflammatory Bowel Diseases,” “Crohn's disease,” or “ulcerative colitis” alone or in combination with “diet” or “food” were used, all aligned with MESH terminology. For Persian resources, articles containing one or more of the keywords "inflammatory bowel diseases," "Crohn's disease," or "ulcerative colitis," either alone or combined with terms such as "dietary regimen," "food components," "nutritional patterns," or "diet therapy," were searched in internal scientific databases. Finally, 25 articles, including 21 clinical trials and 4 systematic reviews and meta-analyses were subjected to content analysis.
Findings: The study search yielded a total of 17,758 records from various databases, and 16,749 studies remained after further exclusion. After the abstract and title screening process, a total of 16,683 articles were excluded due to non-compliance with the research hypothesis or inclusion criteria. Subsequently, 66 potentially relevant articles were extensively reviewed. Ultimately, 21 clinical trials involving 2,050 participants and 4 systematic reviews and meta-analyses were included. Various dietary patterns have been studied for their ability to reduce flare-ups, manage symptoms, and potentially even induce remission. Based on available evidence, we explored several dietary patterns and their mechanisms in treating and preventing Crohn's disease and ulcerative colitis relapse.
Crohn's Disease and Dietary Approaches
One of the most frequently recommended changes for individuals with Crohn’s disease is reducing red meat and processed meat intake. The evidence supports limiting red meat consumption to less than one serving per month and emphasizes white meat (like chicken and fish) and plant-based proteins, such as legumes. The mechanism is rooted in the inflammatory responses triggered by the high consumption of red meat and processed meats. These foods may alter gut microbiota composition, activating the immune system and promoting intestinal inflammation, thus leading to disease relapse.
The Specific Carbohydrate Diet (SCD) restricts complex carbohydrates, particularly disaccharides and polysaccharides while allowing the consumption of monosaccharides. This diet is based on the premise that individuals with IBD may not digest certain carbohydrates properly, leading to microbial imbalances and inflammation in the gut. The SCD aims to reduce gut bacterial fermentation and inflammatory responses by focusing on easily digestible foods.
This diet focuses on eliminating foods that exacerbate symptoms and selecting foods that do not trigger inflammation. It often involves avoiding processed foods, refined sugars, and additives. The diet’s primary mechanism is to reduce gut irritation by removing foods that increase inflammation or trigger flare-ups, such as artificial additives and preservatives.
The Low-Carbohydrate Diet (LCD) restricts carbohydrate intake to under 84 grams daily, promoting the consumption of proteins, healthy fats, and low-carb vegetables. This approach aims to reduce inflammation by limiting the fermentation of undigested carbohydrates in the gut, which can produce inflammatory byproducts.
An anti-IBD diet focuses on consuming whole, non-processed, nutrient-dense foods, including fruits, vegetables, and lean proteins. This diet emphasizes reducing processed foods, refined carbohydrates, and allergens. The anti-IBD diet aims to decrease gut inflammation and improve overall nutrition by eliminating potential dietary triggers.
The Low-FODMAP Diet is particularly beneficial for individuals sensitive to fermentable carbohydrates. By avoiding foods high in FODMAPs (such as certain fruits, vegetables, and dairy), this diet helps prevent bloating, gas, and abdominal discomfort, which are common in IBD patients. The reduced intake of fermentable carbohydrates minimizes gut bacterial fermentation and decreases the risk of flare-ups.
The Crohn's Disease Exclusion Diet (CDED) involves a structured liquid formula providing 1000 calories per day for six weeks, followed by a reduced-calorie phase with added calcium supplements. This approach combines nutritional support and the exclusion of specific foods to reduce immune responses and inflammation in the gut, promoting disease remission.
The High Restricted Organic Diet (HROD) focuses on consuming organic, minimally processed foods such as fruits, vegetables, and grains while avoiding pesticides, additives, and artificial substances. The aim is to limit exposure to compounds that could trigger inflammation, particularly in individuals sensitive to food additives.
A semi-vegetarian diet promotes plant-based foods while limiting animal products, especially red meat. Reducing animal protein and processed meats reduces inflammation and improves gut health.
Ulcerative Colitis and Dietary Strategies
Carrageenan-Free diet- Like Crohn’s disease, individuals with ulcerative colitis benefit from eliminating processed foods containing carrageenan, a common food additive linked to intestinal inflammation. By avoiding this additive, the diet seeks to reduce symptoms and promote a healthier gut environment.
The Mediterranean diet, rich in plant-based foods, whole grains, fruits, vegetables, and fish, has been shown to reduce the gut inflammation risk. It encourages the consumption of healthy fats (like olive oil) and minimizes red meat and processed foods. This diet’s anti-inflammatory properties are attributed to its high content of antioxidants, omega-3 fatty acids, and fiber, all of which support gut health.
The Alberta Anti-Inflammatory Diet (AB-AID) emphasizes consuming omega-3-rich fish, fruits, vegetables, and whole grains while avoiding processed, fried foods and additives. The mechanism of action is by reducing inflammatory markers in the gut, which can help manage flare-ups and promote remission.
As with Crohn’s disease, ulcerative colitis patients may also benefit from the Low FODMAP Diet, particularly for those with symptoms like bloating and abdominal discomfort. The diet minimizes gut irritation and gas production by reducing the intake of high-FODMAP foods.
Cow’s Milk Protein Exclusion diet (CMP)-This diet excludes all dairy products, including milk and cheese, while allowing butter. This approach is based on the hypothesis that cow’s milk proteins can trigger immune responses in certain individuals, exacerbating symptoms of ulcerative colitis.
A gluten-free and dairy-free diet is often recommended for individuals with sensitivities to these proteins. Eliminating gluten and dairy may reduce immune system activation, relieve symptoms, and decrease inflammation in susceptible individuals.
Conclusion: In summary, dietary interventions play a significant role in the management and treatment of inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, and can serve as a valuable complement to pharmaceutical therapies. Further robust studies with better designs and long-term follow-ups are essential to develop more effective therapeutic approaches. These investigations should focus on the interaction between dietary regimens and the gut microbiome and the long-term impacts of nutritional interventions to establish more comprehensive clinical guidelines. Collaboration among physicians, nutritionists, and patients, considering individual and environmental factors, will play a critical role in managing IBD and improving treatment outcomes.
Background & Objectives: Dietary interventions are increasingly recognized as a fundamental aspect of managing inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis. These chronic, often debilitating conditions arise from a complex interplay of genetic predisposition, environmental triggers, and immune system dysregulation, with diet playing a crucial role in influencing disease activity and progression. Emerging evidence indicates that specific dietary patterns can alleviate symptoms, reduce inflammation, and potentially modify the disease course in IBD patients. This review explores how diet impacts IBD, including the modulation of gut microbiota, immune responses, and intestinal permeability. It also examines the benefits and potential drawbacks of various dietary strategies, such as exclusive enteral nutrition, the low FODMAP diet, and the anti-inflammatory Mediterranean diet, emphasizing variability in individual responses.
Additionally, the review highlights the importance of personalized nutritional plans tailored to each patient’s unique needs, considering factors like disease type, disease stage, comorbidities, and lifestyle. Since IBD is a heterogeneous condition, what works for one patient may not be effective for another. Therefore, a customized approach to nutrition is essential for optimizing patient outcomes and enhancing the quality of life for individuals living with IBD.
Methods: The present study is a scoping review. Relevant articles published in Persian and English from 1985 onward were examined using reputable scientific databases, including Scopus, PubMed, Web of Knowledge, Google Scholar, IranMedex, and SID. For English resources, the keywords “Inflammatory Bowel Diseases,” “Crohn's disease,” or “ulcerative colitis” alone or in combination with “diet” or “food” were used, all aligned with MESH terminology. For Persian resources, articles containing one or more of the keywords "inflammatory bowel diseases," "Crohn's disease," or "ulcerative colitis," either alone or combined with terms such as "dietary regimen," "food components," "nutritional patterns," or "diet therapy," were searched in internal scientific databases. Finally, 25 articles, including 21 clinical trials and 4 systematic reviews and meta-analyses were subjected to content analysis.
Findings: The study search yielded a total of 17,758 records from various databases, and 16,749 studies remained after further exclusion. After the abstract and title screening process, a total of 16,683 articles were excluded due to non-compliance with the research hypothesis or inclusion criteria. Subsequently, 66 potentially relevant articles were extensively reviewed. Ultimately, 21 clinical trials involving 2,050 participants and 4 systematic reviews and meta-analyses were included. Various dietary patterns have been studied for their ability to reduce flare-ups, manage symptoms, and potentially even induce remission. Based on available evidence, we explored several dietary patterns and their mechanisms in treating and preventing Crohn's disease and ulcerative colitis relapse.
Crohn's Disease and Dietary Approaches
One of the most frequently recommended changes for individuals with Crohn’s disease is reducing red meat and processed meat intake. The evidence supports limiting red meat consumption to less than one serving per month and emphasizes white meat (like chicken and fish) and plant-based proteins, such as legumes. The mechanism is rooted in the inflammatory responses triggered by the high consumption of red meat and processed meats. These foods may alter gut microbiota composition, activating the immune system and promoting intestinal inflammation, thus leading to disease relapse.
The Specific Carbohydrate Diet (SCD) restricts complex carbohydrates, particularly disaccharides and polysaccharides while allowing the consumption of monosaccharides. This diet is based on the premise that individuals with IBD may not digest certain carbohydrates properly, leading to microbial imbalances and inflammation in the gut. The SCD aims to reduce gut bacterial fermentation and inflammatory responses by focusing on easily digestible foods.
This diet focuses on eliminating foods that exacerbate symptoms and selecting foods that do not trigger inflammation. It often involves avoiding processed foods, refined sugars, and additives. The diet’s primary mechanism is to reduce gut irritation by removing foods that increase inflammation or trigger flare-ups, such as artificial additives and preservatives.
The Low-Carbohydrate Diet (LCD) restricts carbohydrate intake to under 84 grams daily, promoting the consumption of proteins, healthy fats, and low-carb vegetables. This approach aims to reduce inflammation by limiting the fermentation of undigested carbohydrates in the gut, which can produce inflammatory byproducts.
An anti-IBD diet focuses on consuming whole, non-processed, nutrient-dense foods, including fruits, vegetables, and lean proteins. This diet emphasizes reducing processed foods, refined carbohydrates, and allergens. The anti-IBD diet aims to decrease gut inflammation and improve overall nutrition by eliminating potential dietary triggers.
The Low-FODMAP Diet is particularly beneficial for individuals sensitive to fermentable carbohydrates. By avoiding foods high in FODMAPs (such as certain fruits, vegetables, and dairy), this diet helps prevent bloating, gas, and abdominal discomfort, which are common in IBD patients. The reduced intake of fermentable carbohydrates minimizes gut bacterial fermentation and decreases the risk of flare-ups.
The Crohn's Disease Exclusion Diet (CDED) involves a structured liquid formula providing 1000 calories per day for six weeks, followed by a reduced-calorie phase with added calcium supplements. This approach combines nutritional support and the exclusion of specific foods to reduce immune responses and inflammation in the gut, promoting disease remission.
The High Restricted Organic Diet (HROD) focuses on consuming organic, minimally processed foods such as fruits, vegetables, and grains while avoiding pesticides, additives, and artificial substances. The aim is to limit exposure to compounds that could trigger inflammation, particularly in individuals sensitive to food additives.
A semi-vegetarian diet promotes plant-based foods while limiting animal products, especially red meat. Reducing animal protein and processed meats reduces inflammation and improves gut health.
Ulcerative Colitis and Dietary Strategies
Carrageenan-Free diet- Like Crohn’s disease, individuals with ulcerative colitis benefit from eliminating processed foods containing carrageenan, a common food additive linked to intestinal inflammation. By avoiding this additive, the diet seeks to reduce symptoms and promote a healthier gut environment.
The Mediterranean diet, rich in plant-based foods, whole grains, fruits, vegetables, and fish, has been shown to reduce the gut inflammation risk. It encourages the consumption of healthy fats (like olive oil) and minimizes red meat and processed foods. This diet’s anti-inflammatory properties are attributed to its high content of antioxidants, omega-3 fatty acids, and fiber, all of which support gut health.
The Alberta Anti-Inflammatory Diet (AB-AID) emphasizes consuming omega-3-rich fish, fruits, vegetables, and whole grains while avoiding processed, fried foods and additives. The mechanism of action is by reducing inflammatory markers in the gut, which can help manage flare-ups and promote remission.
As with Crohn’s disease, ulcerative colitis patients may also benefit from the Low FODMAP Diet, particularly for those with symptoms like bloating and abdominal discomfort. The diet minimizes gut irritation and gas production by reducing the intake of high-FODMAP foods.
Cow’s Milk Protein Exclusion diet (CMP)-This diet excludes all dairy products, including milk and cheese, while allowing butter. This approach is based on the hypothesis that cow’s milk proteins can trigger immune responses in certain individuals, exacerbating symptoms of ulcerative colitis.
A gluten-free and dairy-free diet is often recommended for individuals with sensitivities to these proteins. Eliminating gluten and dairy may reduce immune system activation, relieve symptoms, and decrease inflammation in susceptible individuals.
Conclusion: In summary, dietary interventions play a significant role in the management and treatment of inflammatory bowel diseases (IBD), including Crohn’s disease and ulcerative colitis, and can serve as a valuable complement to pharmaceutical therapies. Further robust studies with better designs and long-term follow-ups are essential to develop more effective therapeutic approaches. These investigations should focus on the interaction between dietary regimens and the gut microbiome and the long-term impacts of nutritional interventions to establish more comprehensive clinical guidelines. Collaboration among physicians, nutritionists, and patients, considering individual and environmental factors, will play a critical role in managing IBD and improving treatment outcomes.
Type of Study: review article |
Subject:
Gastroentrology
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