Nutraceuticals and Diet Supplements in Crohn’s Disease: A General Overview of the Most Promising Approaches in the Clinic

Abstract

Crohn’s disease (CD) is a chronic inflammatory gastrointestinal disorder requiring lifelong medications. The currently approved drugs for CD are associated with relevant side effects and several studies suggest an increased use of nutraceuticals among CD patients, seeking for what is perceived as a more “natural” approach in controlling this highly morbid condition. Nutraceuticals are foods or foods’ components with beneficial health properties that could aid in CD treatment for their anti-inflammatory, analgesic and immunoregulatory activities that come along with safety, high tolerability, easy availability and affordability. Depending on their biological effect, nutraceuticals’ support could be employed in different subsets of CD patients, both those with active disease, as adjunctive immunomodulatory therapies, and/or in quiescent disease to provide symptomatic relief in patients with residual functional symptoms. Despite the increasing interest of the general public, both limited research and lack of education from healthcare professionals regarding their real clinical effectiveness account for the increasing number of patients turning to unconventional sources. Professionals should recognize their widespread use and the evidence base for or against their efficacy to properly counsel IBD patients. Overall, nutraceuticals appear to be safe complements to conventional therapies; nonetheless, little quality evidence supports a positive impact on underlying inflammatory activity.

Gut microbiome and human health: Exploring how the probiotic genus Lactobacillus modulate immune responses

“… Compare et al, 2017 reported L. casei DG lower pro-inflammatory IL-6, IL-8, TLR-4 and IL-1a and increase IL-10 cytokinelevels in the colonic mucosa of post-infectious IBD subjects. Additionally, L. casei and L. bulgaricus significantly lowered the pro-inflammatory cytokine TNF-α in colonic mucosal samples from CD patients ( De Conno et al, 2022 ). The Treg cells are another immunological player involved in immune-modulation and tolerance.…”

Crohn’s Disease, Host–Microbiota Interactions, and Immunonutrition: Dietary Strategies Targeting Gut Microbiome as Novel Therapeutic Approaches

“…Thus, it is not surprising that over the last decades, alternative strategies based on the use of pre-/probiotics, have been developed to complement or even replace pharmacological therapy for the treatment of IBD [ 112 ]. The role of prebiotics and probiotics in CD management has been extensively discussed and reviewed in detail elsewhere [ 113 , 114 , 115 , 116 , 117 ]. Several probiotic strains known to have beneficial effects on health have been tested in human clinical studies including Bifidobacterium spp., Lactobacillus spp., E. coli Nissle 1917, and Saccharomyces boulardii [ 19 ].…”

“…Noteworthy, while the efficacy of probiotics such as VSL#3, containing a mixture of eight bacterial strains including four Lactobacillus spp., three strains of Bifidobacterium spp., and Streptococcus salivarius subsp. Thermophilus, has been well established for UC management, but attempts to prove their usefulness in CD have produced controversial results [ 113 ]. These incongruences might be in part explained by differences in study design, methodology, the variety of pre- or probiotics used, and/or patients’ compliance.…”

The potential role of Bifidobacterium spp. as a preventive and therapeutic agent in controlling inflammation via affecting inflammatory signalling pathways

“…Several studies have shown that, although sometimes using probiotics could not be helpful and effective in treating Crohn's disease (CD), as a subtype of IBD (De Conno et al . 2022), various probiotic strains, including Bifidobacterium spp, play a beneficial role in controlling IBD through enhancement of epithelial barrier function, causing homeostasis and modulation of the immune system (Magrone and Jirillo 2013; Moratalla et al . 2016).…”

“…Taking probiotics could be a beneficial way to control inflammation, irritable bowel syndrome (IBS) and IBD (Moayyedi et al 2019). Several studies have shown that, although sometimes using probiotics could not be helpful and effective in treating Crohn's disease (CD), as a subtype of IBD (De Conno et al 2022), various probiotic strains, including Bifidobacterium spp, play a beneficial role in controlling IBD through enhancement of epithelial barrier function, causing homeostasis and modulation of the immune system (Magrone and Jirillo 2013;Moratalla et al 2016). Studies explained that Bifidobacterium longum 536 (BB536), for example, can induce remission in patients with ulcerative colitis (UC), a subtype of IBD (Matsuoka et al 2018).…”