New paper alert: Dietary Guidance for Patients with Inflammatory Bowel Disease (IBD)

Author: Bianca Maree Harrington, APD

9 April 2020

 

Microba’s Lead Microbiome Coach and Accredited Practising Dietitian, Bianca Maree Harrington summarises this study which explores the connection between IBD and diet (article abstract can be seen here).

Overview

In February, PubMed published a new paper on IBD, titled Dietary Guidance for Patients with Inflammatory Bowel Disease (IBD) from the International Organisation for the Study of Inflammatory Bowel Disease (IOIBD). The paper reviewed available evidence regarding diet and IBD, to provide dietary guidance for practitioners to support their patients with IBD.

Study objective


The objective was to review the available evidence regarding diet and IBD, to provide dietary guidance for practitioners to support their patients with IBD.

Specifically, IOIBD aimed to provide expert opinion regarding the specific dietary components, foods groups and food additives that may be prudent to either increase or decrease in the diet to prevent a flare up.

The  food groups and dietary components reviewed included fruit and vegetables, red meat, processed meats, pasteurised and unpasteurised dairy, wheat/gluten, fatty acids, FODMAPs, artificial sweeteners, thickeners and emulsifiers.

The study

Members of the IOIBD board (the board) came together to review the available evidence. Animal studies were factored when human data was absent, or the study was considered reproducible in humans.

The board considered the recommendations for Ulcerative Colitis and Crohn’s disease separately.

Each food group, food component or additive was assigned 1 of 4 categories:

  1. Prudent to increase.
  2. Decrease or avoid consumption.
  3. Safe to consume.
  4. Insufficient evidence to make a claim.

An evidence level was also assigned to support the recommendation:

  • RCTs providing high level evidence.
  • Observational studies low level evidence.
  • All remaining studies (i.e. Cross sectional and Prospective studies) were assigned very low-level evidence.

Where possible, the review focused on the effect of diet on inflammation and symptoms. Although in some cases information was only available on symptom control.

Key findings

 

  • The paper found that it was prudent to increase the consumption of fruits and vegetables in Crohn’s disease. However, for those patient’s with strictures, it was recommended they reduce to the intake of insoluble fibre, such as wholegrains and vegetables, to reduce the risk of relapse.
  • Omega-3’s appear to play an important role in reducing the risk of relapse in patients with Ulcerative Colitis. Specifically, in those patients who consumed an omega-3 to omega-6 ratio closer to 1.
  • Interestingly, evidence shows that an increased intake of Omega-3’s from marine fish, rather than supplementation provided better outcomes in IBD.
  • The low FODMAP diet does not appear to modulate the inflammatory activity of IBD. However, in patients with concomitant IBS, the low FODMAP diet may assist with reducing symptoms, particularly in those with resolution of inflammation and strictures.

To access the full paper, you must have a subscription. View the abstract here.

 

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About the Author

Bianca Maree is a specialist Accredited Practising Dietitian and the Lead Microbiome Coach at Microba, with an expertise in managing food intolerances associated with Irritable Bowel Syndrome (IBS). She is passionate about furthering our understanding of how the microbiome and other lifestyle factors can impact IBS sufferers, and how an integrative approach is required to better manage this condition.