Diet and Inflammatory Bowel Disease

Review of Patient-Targeted Recommendations

Jason K. Hou; Dale Lee; James Lewisk

Disclosures

Clin Gastroenterol Hepatol. 2014;12(10):1592-1600. 

In This Article

Putting It All Together: What to Tell Patients?

Patients with IBD have a strong interest in dietary modifications as part of a holistic approach to manage their disease. There is scientific evidence that dietary factors may influence both the risk of developing IBD and intestinal mucosal inflammation. However, there is a lack of large prospective controlled trials to provide the dietary recommendations patients desire. Taken together, studies of exclusive enteral nutrition, exclusion diets, and semivegetarian diets suggest that minimizing exposure of the intestinal lumen to selected food items may prolong the remission state of patients with IBD.[35] Even less evidence exists for the efficacy of the SCD, FODMAP, or Paleo diets. Furthermore, the practicality of maintaining these interventions over long periods of time is doubtful. At a practical level, adherence to defined diets may result in an unnecessary financial burden or reduction in overall caloric intake in patients who are already at risk for protein–calorie malnutrition.

Many patient-targeted dietary recommendations from the Internet and defined diets parallel those of irritable bowel syndrome and functional gastrointestinal disorders. Although the existing data do not support these recommendations as a means of reduction of intestinal mucosal inflammation, the anecdotal response reported by patients to these dietary restrictions may highlight a functional component of gastrointestinal symptoms among patients with IBD. There is a growing body of evidence of nonceliac gluten intolerance, which may also be addressed with these dietary restrictions. Avoidance of these foods is likely of little danger and could potentially improve gastrointestinal symptoms. Patients with IBD describe the ability to identify foods that can exacerbate their symptoms.[66] However, essentially all food groups (fruits, vegetables, meats, and grains) have been noted by patient self-report to exacerbate symptoms and do not provide generalizable information for other patients with IBD. Rather, patients may be instructed to be aware of their diet through food diaries and their symptoms and make modifications specific to the individual patient. This personalized approach may identify specific triggers to their symptoms and also empower patients with a sense of control over their symptoms. Further controlled studies are necessary to make stronger recommendations on the role of diet and IBD course.

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