Implementing
Evidence-Based Nutritional Therapy
Diet is a powerful tool when used as part of a comprehensive medical management plan.
What is Nutritional Therapy
Diet is Essential to the Management of IBD
The role of nutrition in IBD is moving beyond its utilization to treat malnourished patients, although malnutrition remains a common IBD complication. Dietary intake is now recognized for its central role in defining the gut microbiome, which directly influences the underlying immune system and the integrity of the gastrointestinal lining. Metabolomics research is further uncovering complex metabolic pathways in digestion and important byproducts produced, like short-chain fatty acids (SCFAs),1 which are integral in reducing inflammation and achieving balanced immune function. Current research is placing nutrition on the cutting edge of medicine, making nutritional therapy a novel and exciting new adjunctive approach to managing IBD.
The Microbiome and IBD
The microbiome is becoming increasingly recognized for its importance in human health and disease and is one of the hottest topics in medicine right now, with IBD being the most extensively studied among disease states.2 ,3 Microbiome disturbances are commonly found in IBD and are increasingly implicated in the onset and development of IBD.4,5 As diet has the greatest impact on the microbiome, it may offer the most manipulatable lever to modulate it for therapeutic benefit.6,7
Targeting the microbiome with diet upstream in combination with medications targeting the immune system downstream, may offer a two-pronged approach with a potential advantage for improved outcomes.8,9
How Dietary Therapy Can Improve Mental Health
Patients with IBD suffer disproportionally higher rates of depression and anxiety, which are associated with a lower quality of life10,11 and correlated with active disease.12 Furthermore, anxiety, depression, and fatigue, common comorbidities in IBD, are rated by patients to have the highest symptom severity scores in a recent international survey.13
The concept of the gut-brain axis has recently emerged, and it is increasingly accepted that the gut microbiota play an important role in communicating with our brain and regulating mood, including anxiety and depression.14 Disruptions in the gut microbiota, along with important interrelated dynamics of dysregulated stress and immunity, may be converging to influence the development of depression.15
Can diet impact the gut microbiota to influence the gut-brain axis and subsequently our mental health? Increasing data suggest that indeed it does, with diet playing a central role in our brain function, mood, and mental well-being.16 The recognized role of diet in shaping the gut microbiota is changing the available approaches that can be taken to improve a number of health conditions,17 including depression18 and anxiety,19 as pro-inflammatory diets are associated with poor mental health.20 Although more research is needed to fully evaluate the effects of nutrition on mental health, the emerging field of nutritional psychiatry is taking the lead in utilizing dietary interventions to improve mental health. Nutritional therapy may offer an attractive additional therapeutic option for IBD given the potential dual benefit of improving both the underlying condition of IBD and mental health.
Patients Embrace Diet as a Tool
Nutritional therapy is likely one of the clinicians' most powerful tools to alter disease outcomes. Patients recognize the influence of diet on symptoms and are already making efforts to improve their symptoms with perceptive eating.21 They are seeking to utilize diet as a therapeutic tool under the guidance of medical professionals.22 Initiating dietary therapy with their healthcare team allows the greatest benefit to patients by providing a safe and effective approach.
References
- Deleu S, Machiels K, Raes J, Verbeke K, Vermeire S. Short chain fatty acids and its producing organisms: An overlooked therapy for IBD?. EBioMedicine. 2021;66:103293. doi:10.1016/j.ebiom.2021.103293
Diet and the microbiome - Lloyd-Price J, Arze C, Ananthakrishnan AN, et al. Multi-omics of the gut microbial ecosystem in inflammatory bowel diseases. Nature. 2019;569(7758):655-662. doi:10.1038/s41586-019-1237-9
- Integrative HMP (iHMP) Research Network Consortium. The Integrative Human Microbiome Project: dynamic analysis of microbiome-host omics profiles during periods of human health and disease. Cell Host Microbe. 2014;16(3):276-289. doi:10.1016/j.chom.2014.08.014
- Khan I, Ullah N, Zha L, et al. Alteration of Gut Microbiota in Inflammatory Bowel Disease (IBD): Cause or Consequence? IBD Treatment Targeting the Gut Microbiome. Pathogens. 2019;8(3):126. Published 2019 Aug 13. doi:10.3390/pathogens8030126
- Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology. 2014;146(6):1489-1499. doi:10.1053/j.gastro.2014.02.009
- Sonnenburg ED, Sonnenburg JL. Starving our microbial self: the deleterious consequences of a diet deficient in microbiota-accessible carbohydrates. Cell Metab. 2014;20(5):779-786. doi:10.1016/j.cmet.2014.07.003
- Serban DE. Microbiota in Inflammatory Bowel Disease Pathogenesis and Therapy: Is It All About Diet?. Nutr Clin Pract. 2015;30(6):760-779. doi:10.1177/0884533615606898
- Green N, Miller T, Suskind D, Lee D. A Review of Dietary Therapy for IBD and a Vision for the Future. Nutrients. 2019;11(5):947. Published 2019 Apr 26. doi:10.3390/nu11050947
- Lee D, Albenberg L, Compher C, et al. Diet in the pathogenesis and treatment of inflammatory bowel diseases. Gastroenterology. 2015;148(6):1087-1106. doi:10.1053/j.gastro.2015.01.007
How dietary therapy can improve mental health - Bernstein CN. Addressing Mental Health in Persons with IBD. J Can Assoc Gastroenterol. 2018;1(3):97-98. doi:10.1093/jcag/gwy038
- Byrne G, Rosenfeld G, Leung Y, et al. Prevalence of Anxiety and Depression in Patients with Inflammatory Bowel Disease. Can J Gastroenterol Hepatol. 2017;2017:6496727. doi:10.1155/2017/6496727
- Marrie RA, Graff LA, Fisk JD, Patten SB, Bernstein CN. The Relationship Between Symptoms of Depression and Anxiety and Disease Activity in IBD Over Time. Inflamm Bowel Dis. 2021;27(8):1285-1293. doi:10.1093/ibd/izaa349
- Rubin DT, Sninsky C, Siegmund B, et al. International Perspectives on Management of Inflammatory Bowel Disease: Opinion Differences and Similarities Between Patients and Physicians From the IBD GAPPS Survey. Inflamm Bowel Dis. 2021;27(12):1942-1953. doi:10.1093/ibd/izab006
- Cryan JF, O'Riordan KJ, Cowan CSM, et al. The Microbiota-Gut-Brain Axis. Physiol Rev. 2019;99(4):1877-2013. doi:10.1152/physrev.00018.2018
- Cruz-Pereira JS, Rea K, Nolan YM, O'Leary OF, Dinan TG, Cryan JF. Depression's Unholy Trinity: Dysregulated Stress, Immunity, and the Microbiome. Annu Rev Psychol. 2020;71:49-78. doi:10.1146/annurev-psych-122216-011613
- Adan RAH, van der Beek EM, Buitelaar JK, et al. Nutritional psychiatry: Towards improving mental health by what you eat. Eur Neuropsychopharmacol. 2019;29(12):1321-1332. doi:10.1016/j.euroneuro.2019.10.011
- Hills RD Jr, Pontefract BA, Mishcon HR, Black CA, Sutton SC, Theberge CR. Gut Microbiome: Profound Implications for Diet and Disease. Nutrients. 2019;11(7):1613. Published 2019 Jul 16. doi:10.3390/nu11071613
- Duarte-Silva E, Clarke G, Dinan TG, Peixoto CA. Personalized Nutrition for Depression: Impact on the Unholy Trinity. Neuroimmunomodulation. 2021;28(2):47-51. doi:10.1159/000514094
- Norwitz NG, Naidoo U. Nutrition as Metabolic Treatment for Anxiety. Front Psychiatry. 2021 Feb 12;12:598119. doi: 10.3389/fpsyt.2021.598119. PMID: 33643090; PMCID: PMC7907178.
- Chen GQ, Peng CL, Lian Y, Wang BW, Chen PY and Wang GP (2021) Association Between Dietary Inflammatory Index and Mental Health: A Systematic Review and Dose–Response Meta-Analysis. Front. Nutr. 8:662357. doi: 10.3389/fnut.2021.66235
Patients Embrace Diet as a Tool - Nowlin S, Manning L, Keefer L, Gorbenko K. Perceptive eating as part of the journey in inflammatory bowel disease: Lessons learned from lived experience. Clin Nutr ESPEN. 2021;41:299-304. doi:10.1016/j.clnesp.2020.11.017
- Megan T Zangara, Natalie Bhesania, Wei Liu, Gail A M Cresci, Jacob A Kurowski, Christine McDonald, Impact of Diet on Inflammatory Bowel Disease Symptoms: An Adolescent Viewpoint, Crohn's & Colitis 360, Volume 2, Issue 4, October 2020, otaa084, https://doi.org/10.1093/crocol/otaa084
Knowledge and Tools
At Nutritional Therapy for IBD, we recognize that nutrition is often underutilized due to the difficulties in implementing it. We strive to provide the highest level of resources for healthcare professionals to aid your work in implementing evidence-based nutrition.
Tools for your Patients
Use our Patients & Families section as an educational time-saving tool for your practice. It offers essential information for your patients to learn about evidence-based nutritional options. Patients can find recipes to follow the dietary plans you develop together in our extensive recipe section. They can stay motivated and current in their knowledge via our patient newsletter and patient resource database. We offer downloadable materials that you can hand out to your patients to learn the basics about Nutritional Therapy and find the information and tools on our website.
Support for Patients & Families
Our educational information for patients and families.
Recipes
Delicious and Nutritious IBD Recipes that Fit the Dietary Needs of Your Patients.
Materials for your Patients
Flyer and Brochure about Nutritional Therapy for IBD.
Patient Resources
Database of patient resources to help your patient learn more and connect.
Stay up to Date
Stay current by reading nutritional highlights from recent international conferences and subscribing to the newsletter focused on recent publications. Find information to develop your own nutritional program and browse our additional clinician resources for still more.
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An Option for Every PatientTM
Given the full array of options, it can be challenging for clinicians and patients to match the individuality of each patient and their disease presentation with the most appropriate dietary fit. Nutritional Therapy for IBD has developed a new patient-centric approach, including an algorithm to help guide clinicians and patients in selecting a dietary approach.
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