Current Nutritional Therapies in Inflammatory Bowel Disease: Improving Clinical Remission Rates and Sustainability of Long-Term Dietary Therapies

Abstract

Inflammatory Bowel Disease (IBD) includes a spectrum of chronic immune-mediated intestinal diseases thought to be related to the complex interaction between the host immune system and the intestinal microbiome. Research supports the use of nutritional therapy in IBD; however, it is not routinely used in clinical practice. This literature review seeks to advance the understanding of diet and its effect in IBD with a focus on both Crohn’s Disease (CD) and Ulcerative Colitis (UC). The contribution of diet to the development and treatment of IBD cannot be overstated. In both pediatric as well as adult IBD, nutritional interventions have been shown to improve clinical symptoms as well as inflammatory burden. The impact of dietary intervention is best exemplified through the use of Exclusive Enteral Nutrition (EEN) in CD. EEN and clinical research on exclusionary whole food diets—Crohn’s Disease Exclusion Diet (CDED), Specific Carbohydrate Diet (SCD), low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet, and Mediterranean Diet—are discussed within this review. Current clinical literature supports the elimination of detrimental components and the incorporation of low processed whole foods in the diet. Additional prospective and longitudinal dietary studies on sustainable and long-term dietary options, along with a deeper understanding of the mechanism, are needed to further advance the role of nutritional interventions in IBD.

Weighing the scales: Taking a balanced approach to diet therapies in pediatric inflammatory bowel disease

“…1 EEN has demonstrated similar efficacy to steroid therapy for induction. 1 The SCD and CDED have demonstrated increasing promise as both mono-and adjunct therapies in certain diet-responsive patients, potentially related to beneficial shifts in the gut microbiome.…”

“…Research increasingly supports the efficacy of DTs for IBD, such as exclusive enteral nutrition (EEN) and partial enteral nutrition (PEN), the Specific Carbohydrate Diet (SCD), and the Crohn's Disease Exclusion Diet (CDED) in certain patients with IBD 1 . EEN has demonstrated similar efficacy to steroid therapy for induction 1 . The SCD and CDED have demonstrated increasing promise as both mono‐ and adjunct therapies in certain diet‐responsive patients, potentially related to beneficial shifts in the gut microbiome.…”

“…Research increasingly supports the efficacy of DTs for IBD, such as exclusive enteral nutrition (EEN) and partial enteral nutrition (PEN), the Specific Carbohydrate Diet (SCD), and the Crohn's Disease Exclusion Diet (CDED) in certain patients with IBD 1 . EEN has demonstrated similar efficacy to steroid therapy for induction 1 .…”

“…Diet therapies (DTs) have had increased evidence for efficacy and improvement of symptoms and inflammatory markers for patients with inflammatory bowel disease (IBD) 1 . DTs offer benefits in a clinician's armamentarium to expand therapeutic options while providing patients with greater autonomy and a potentially effective treatment option that targets lifestyle, gut microbiome, and/or immune‐related disease mechanisms 1 . However, in the general pediatric population, disordered eating behaviors (DEBs) are increasingly a concern, affecting 22% of children, in addition to eating disorders (EDs) 2 .…”

“…1 DTs offer benefits in a clinician's armamentarium to expand therapeutic options while providing patients with greater autonomy and a potentially effective treatment option that targets lifestyle, gut microbiome, and/or immune-related disease mechanisms. 1 However, in the general pediatric population, disordered eating behaviors (DEBs) are increasingly a concern, affecting 22% of children, in addition to eating disorders (EDs). 2 Research also indicates the increased incidence of DEBs in pediatric patients with IBD.…”