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Popular Diet Trends for Inflammatory Bowel Diseases: Claims and Evidence

Abstract

Purpose of review

Patients with inflammatory bowel disease (IBD) frequently look to diet to improve symptoms. Although regularly asked for dietary guidance, gastroenterologists are often unprepared to provide evidence-based recommendations. This review will summarize popular diets claiming benefits in IBD, as well as current data evaluating their efficacies.

Recent findings

The Specific Carbohydrate Diet has demonstrated symptom improvement and even mucosal healing; however, large trials and prospective data are lacking. The low FODMAP diet has shown benefit for functional symptoms in IBD, yet efficacy regarding inflammation is lacking. Large studies for the gluten-free diet yielded mixed results in IBD outcomes, while suggesting a negative impact on psychological well-being. Data on an “anti-inflammatory” diet were positive but remain severely limited. A currently planned large trial for the Mediterranean diet in IBD may provide much needed clinical data.

Summary

We provide an overview of frequently utilized diets in IBD. The body of evidence does not currently support clear dietary recommendations in IBD, as larger, prospective studies are needed.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, et al. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2018;390(10114):2769–78. https://doi.org/10.1016/S0140-6736(17)32448-0.

    Article  Google Scholar 

  2. Loftus EV Jr. Clinical epidemiology of inflammatory bowel disease: incidence, prevalence, and environmental influences. Gastroenterology. 2004;126(6):1504–17.

    PubMed  Article  Google Scholar 

  3. Molodecky NA, Soon IS, Rabi DM, Ghali WA, Ferris M, Chernoff G, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology. 2012;142(1):46–54 e42; quiz e30. https://doi.org/10.1053/j.gastro.2011.10.001.

    Article  Google Scholar 

  4. de Vries JHM, Dijkhuizen M, Tap P, Witteman BJM. Patient’s dietary beliefs and behaviours in inflammatory bowel disease. Dig Dis. 2019;37(2):131–9. https://doi.org/10.1159/000494022.

    PubMed  Article  Google Scholar 

  5. Lichtenstein GR, Loftus EV, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG Clinical guideline: management of Crohn’s disease in adults. Am J Gastroenterol. 2018;113(4):481–517. https://doi.org/10.1038/ajg.2018.27.

    PubMed  Article  Google Scholar 

  6. Rubin DT, Ananthakrishnan AN, Siegel CA, Sauer BG, Long MD. ACG Clinical Guideline: ulcerative colitis in adults. Am J Gastroenterol. 2019;114(3):384–413. https://doi.org/10.14309/ajg.0000000000000152.

    PubMed  Article  Google Scholar 

  7. Haas SV, Haas MP. The treatment of celiac disease with the specific carbohydrate diet; report on 191 additional cases. Am J Gastroenterol. 1955;23(4):344–60.

    CAS  PubMed  Google Scholar 

  8. Gottschall EG. Breaking the vicious cycle: intestinal health through diet. Ontario: Kirkton Press; 1994.

    Google Scholar 

  9. Knight-Sepulveda K, Kais S, Santaolalla R, Abreu MT. Diet and inflammatory bowel disease. Gastroenterol Hepatol (N Y). 2015;11(8):511–20.

    Google Scholar 

  10. Limketkai BN, Wolf A, Parian AM. Nutritional interventions in the patient with inflammatory bowel disease. Gastroenterol Clin N Am. 2018;47(1):155–77. https://doi.org/10.1016/j.gtc.2017.09.007.

    Article  Google Scholar 

  11. Kakodkar S, Farooqui AJ, Mikolaitis SL, Mutlu EA. The specific carbohydrate diet for inflammatory bowel disease: A Case Series. J Acad Nutr Diet. 2015;115(8):1226–32. https://doi.org/10.1016/j.jand.2015.04.016.

    PubMed  Article  Google Scholar 

  12. Suskind DL, Wahbeh G, Cohen SA, Damman CJ, Klein J, Braly K, et al. Patients perceive clinical benefit with the specific carbohydrate diet for inflammatory bowel disease. Dig Dis Sci. 2016;61(11):3255–60. https://doi.org/10.1007/s10620-016-4307-y.

    CAS  PubMed  Article  Google Scholar 

  13. Obih C, Wahbeh G, Lee D, Braly K, Giefer M, Shaffer ML, et al. Specific carbohydrate diet for pediatric inflammatory bowel disease in clinical practice within an academic IBD center. Nutrition. 2016;32(4):418–25. https://doi.org/10.1016/j.nut.2015.08.025.

    PubMed  Article  Google Scholar 

  14. Burgis JC, Nguyen K, Park KT, Cox K. Response to strict and liberalized specific carbohydrate diet in pediatric Crohn’s disease. World J Gastroenterol. 2016;22(6):2111–7. https://doi.org/10.3748/wjg.v22.i6.2111.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  15. Cohen SA, Gold BD, Oliva S, Lewis J, Stallworth A, Koch B, et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2014;59(4):516–21. https://doi.org/10.1097/MPG.0000000000000449.

    CAS  PubMed  Article  Google Scholar 

  16. Gibson PR, Shepherd SJ. Personal view: food for thought--western lifestyle and susceptibility to Crohn’s disease. FODMAP hypothesis Aliment Pharmacol Ther. 2005;21(12):1399–409. https://doi.org/10.1111/j.1365-2036.2005.02506.x.

    CAS  PubMed  Article  Google Scholar 

  17. Barrett JS, Gearry RB, Muir JG, Irving PM, Rose R, Rosella O, et al. Dietary poorly absorbed, short-chain carbohydrates increase delivery of water and fermentable substrates to the proximal colon. Aliment Pharmacol Ther. 2010;31(8):874–82. https://doi.org/10.1111/j.1365-2036.2010.04237.x.

    CAS  PubMed  Google Scholar 

  18. Ong DK, Mitchell SB, Barrett JS, Shepherd SJ, Irving PM, Biesiekierski JR, et al. Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010;25(8):1366–73. https://doi.org/10.1111/j.1440-1746.2010.06370.x.

    CAS  PubMed  Article  Google Scholar 

  19. Moshfegh AJ, Friday JE, Goldman JP, Ahuja JK. Presence of inulin and oligofructose in the diets of Americans. J Nutr. 1999;129(7 Suppl):1407S–11S. https://doi.org/10.1093/jn/129.7.1407S.

    CAS  PubMed  Article  Google Scholar 

  20. Barrett JS. How to institute the low-FODMAP diet. J Gastroenterol Hepatol. 2017;32(Suppl 1):8–10. https://doi.org/10.1111/jgh.13686.

    PubMed  Article  Google Scholar 

  21. Kamal A, Pimentel M. Influence of dietary restriction on irritable bowel syndrome. Am J Gastroenterol. 2019;114(2):212–20. https://doi.org/10.1038/s41395-018-0241-2.

    PubMed  Article  Google Scholar 

  22. Halpin SJ, Ford AC. Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis. Am J Gastroenterol. 2012;107(10):1474–82. https://doi.org/10.1038/ajg.2012.260.

    PubMed  Article  Google Scholar 

  23. Farrokhyar F, Marshall JK, Easterbrook B, Irvine EJ. Functional gastrointestinal disorders and mood disorders in patients with inactive inflammatory bowel disease: prevalence and impact on health. Inflamm Bowel Dis. 2006;12(1):38–46.

    PubMed  Article  Google Scholar 

  24. • Pedersen N, Ankersen DV, Felding M, Wachmann H, Vegh Z, Molzen L, et al. Low-FODMAP diet reduces irritable bowel symptoms in patients with inflammatory bowel disease. World J Gastroenterol. 2017;23(18):3356–66. https://doi.org/10.3748/wjg.v23.i18.3356This prospective trial compared low FODMAP diet to regular diet in patients with IBD. The low FODMAP diet resulted in improved functional gastrointestinal symptoms and quality of life.

    PubMed  PubMed Central  Article  Google Scholar 

  25. Cox SR, Prince AC, Myers CE, Irving PM, Lindsay JO, Lomer MC, et al. Fermentable carbohydrates [FODMAPs] Exacerbate functional gastrointestinal symptoms in patients with inflammatory bowel disease: a randomised, double-blind, placebo-controlled, cross-over, re-challenge trial. J Crohns Colitis. 2017;11(12):1420–9. https://doi.org/10.1093/ecco-jcc/jjx073.

    PubMed  Article  Google Scholar 

  26. Halmos EP, Christophersen CT, Bird AR, Shepherd SJ, Muir JG, Gibson PR. Consistent prebiotic effect on gut microbiota with altered FODMAP intake in patients with Crohn’s disease: a randomised, controlled cross-over trial of well-defined diets. Clin Transl Gastroenterol. 2016;7:e164. https://doi.org/10.1038/ctg.2016.22.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  27. Colombel JF, Shin A, Gibson PR. AGA Clinical Practice update on functional gastrointestinal symptoms in patients with inflammatory bowel disease: expert review. Clin Gastroenterol Hepatol. 2019;17(3):380–90 e1. https://doi.org/10.1016/j.cgh.2018.08.001.

    PubMed  Google Scholar 

  28. Elli L, Tomba C, Branchi F, Roncoroni L, Lombardo V, Bardella MT, et al. Evidence for the presence of non-celiac gluten sensitivity in patients with functional gastrointestinal symptoms: results from a multicenter randomized double-blind placebo-controlled gluten challenge. Nutrients. 2016;8(2):84. https://doi.org/10.3390/nu8020084.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  29. Niland B, Cash BD. Health benefits and adverse effects of a gluten-free diet in non-celiac disease patients. Gastroenterol Hepatol (N Y). 2018;14(2):82–91.

    Google Scholar 

  30. Fasano A, Sapone A, Zevallos V, Schuppan D. Nonceliac gluten sensitivity. Gastroenterology. 2015;148(6):1195–204. https://doi.org/10.1053/j.gastro.2014.12.049.

    CAS  PubMed  Article  Google Scholar 

  31. Dalla Pellegrina C, Perbellini O, Scupoli MT, Tomelleri C, Zanetti C, Zoccatelli G, et al. Effects of wheat germ agglutinin on human gastrointestinal epithelium: insights from an experimental model of immune/epithelial cell interaction. Toxicol Appl Pharmacol. 2009;237(2):146–53. https://doi.org/10.1016/j.taap.2009.03.012.

    CAS  PubMed  Article  Google Scholar 

  32. Drago S, El Asmar R, Di Pierro M, Grazia Clemente M, Tripathi A, Sapone A, et al. Gliadin, zonulin and gut permeability: effects on celiac and non-celiac intestinal mucosa and intestinal cell lines. Scand J Gastroenterol. 2006;41(4):408–19. https://doi.org/10.1080/00365520500235334.

    CAS  PubMed  Article  Google Scholar 

  33. Herfarth HH, Martin CF, Sandler RS, Kappelman MD, Long MD. Prevalence of a gluten-free diet and improvement of clinical symptoms in patients with inflammatory bowel diseases. Inflamm Bowel Dis. 2014;20(7):1194–7. https://doi.org/10.1097/MIB.0000000000000077.

    PubMed  Article  Google Scholar 

  34. • Schreiner P, Yilmaz B, Rossel J-B, Franc Y, Misselwitz B, Schari M, et al. Vegetarian or gluten-free diets in patients with inflammatory bowel disease are associated with lower psychological well-being and a different gut microbiota, but no beneficial effects on the course of the disease. United Eur Gastroenterol J. 2019. https://doi.org/10.1177/2050640619841249This large national cohort study analyzed the impact of gluten-free diet on patiens with IBD. The gluten-free diet diet not demonstrate significant improvement in activity scores, hospitalization, surgery, or complications. Additionally, patients that followed the gluten-free diet had higher anxiety and depression scores, as well as scores indicating worse psychological well-being.

    PubMed  PubMed Central  Article  Google Scholar 

  35. Zylberberg HM, Demmer RT, Murray JA, Green PHR, Lebwohl B. Depression and insomnia among individuals with celiac disease or on a gluten-free diet in the USA: results from a national survey. Eur J Gastroenterol Hepatol. 2017;29(9):1091–6. https://doi.org/10.1097/MEG.0000000000000932.

    PubMed  PubMed Central  Article  Google Scholar 

  36. Simsek S, Baysoy G, Gencoglan S, Uluca U. Effects of gluten-free diet on quality of life and depression in children with celiac disease. J Pediatr Gastroenterol Nutr. 2015;61(3):303–6. https://doi.org/10.1097/MPG.0000000000000799.

    CAS  PubMed  Article  Google Scholar 

  37. Theethira TG, Dennis M, Leffler DA. Nutritional consequences of celiac disease and the gluten-free diet. Expert Rev Gastroenterol Hepatol. 2014;8(2):123–9. https://doi.org/10.1586/17474124.2014.876360.

    CAS  PubMed  Article  Google Scholar 

  38. Sears B, Lawren B. The Zone: A dietary road map. 1st ed. Regan Book: New York, NY; 1995.

    Google Scholar 

  39. Ricker MA, Haas WC. Anti-inflammatory diet in clinical practice: a review. Nutr Clin Pract. 2017;32(3):318–25. https://doi.org/10.1177/0884533617700353.

    PubMed  Article  Google Scholar 

  40. Olendzki BC, Silverstein TD, Persuitte GM, Ma Y, Baldwin KR, Cave D. An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutr J. 2014;13:5. https://doi.org/10.1186/1475-2891-13-5.

    PubMed  PubMed Central  Article  Google Scholar 

  41. Albenberg L, Brensinger CM, Wu Q, Gilroy E, Kappelman MD, Sandler RS, et al. A diet low in red and processed meat does not reduce rate of Crohn’s disease flares. Gastroenterology. 2019;157(1):128–36 e5. https://doi.org/10.1053/j.gastro.2019.03.015.

    PubMed  Article  Google Scholar 

  42. Koga H, Iida M, Aoyagi K, Matsui T, Fujishima M. Long-term efficacy of low residue diet for the maintenance of remission in patients with Crohn’s disease. Nihon Shokakibyo Gakkai Zasshi. 1993;90(11):2882–8.

    CAS  PubMed  Google Scholar 

  43. Ananthakrishnan AN, Khalili H, Konijeti GG, Higuchi LM, de Silva P, Korzenik JR, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology. 2013;145(5):970–7. https://doi.org/10.1053/j.gastro.2013.07.050.

    CAS  PubMed  Article  Google Scholar 

  44. Willett WC, Sacks F, Trichopoulou A, Drescher G, Ferro-Luzzi A, Helsing E, et al. Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995;61(6 Suppl):1402S–6S. https://doi.org/10.1093/ajcn/61.6.1402S.

    CAS  PubMed  Article  Google Scholar 

  45. Widmer RJ, Flammer AJ, Lerman LO, Lerman A. The Mediterranean diet, its components, and cardiovascular disease. Am J Med. 2015;128(3):229–38. https://doi.org/10.1016/j.amjmed.2014.10.014.

    PubMed  Article  Google Scholar 

  46. Estruch R, Ros E, Salas-Salvado J, Covas MI, Corella D, Aros F, et al. Primary prevention of cardiovascular disease with a Mediterranean diet supplemented with extra-virgin olive oil or nuts. N Engl J Med. 2018;378(25):e34. https://doi.org/10.1056/NEJMoa1800389.

    CAS  PubMed  Article  Google Scholar 

  47. de Lorgeril M, Salen P, Martin JL, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation. 1999;99(6):779–85.

    PubMed  Article  Google Scholar 

  48. Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, et al. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004;292(12):1440–6. https://doi.org/10.1001/jama.292.12.1440.

    CAS  PubMed  Article  Google Scholar 

  49. Koloverou E, Esposito K, Giugliano D, Panagiotakos D. The effect of Mediterranean diet on the development of type 2 diabetes mellitus: a meta-analysis of 10 prospective studies and 136,846 participants. Metabolism. 2014;63(7):903–11. https://doi.org/10.1016/j.metabol.2014.04.010.

    CAS  PubMed  Article  Google Scholar 

  50. Sureda A, Bibiloni MDM, Julibert A, Bouzas C, Argelich E, Llompart I, et al. Adherence to the Mediterranean diet and inflammatory markers. Nutrients. 2018;10(1):E62. https://doi.org/10.3390/nu10010062.

    PubMed  Article  CAS  Google Scholar 

  51. Dinu M, Pagliai G, Casini A, Sofi F. Mediterranean diet and multiple health outcomes: an umbrella review of meta-analyses of observational studies and randomised trials. Eur J Clin Nutr. 2018;72(1):30–43. https://doi.org/10.1038/ejcn.2017.58.

    CAS  PubMed  Article  Google Scholar 

  52. Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol. 2011;106(4):563–73. https://doi.org/10.1038/ajg.2011.44.

    CAS  PubMed  Article  Google Scholar 

  53. Marlow G, Ellett S, Ferguson IR, Zhu S, Karunasinghe N, Jesuthasan AC, et al. Transcriptomics to study the effect of a Mediterranean-inspired diet on inflammation in Crohn’s disease patients. Hum Genomics. 2013;7:24. https://doi.org/10.1186/1479-7364-7-24.

    PubMed  PubMed Central  Article  CAS  Google Scholar 

  54. Taylor L, Almutairdi A, Shommu N, Fedorak R, Ghosh S, Reimer RA, et al. Cross-sectional analysis of overall dietary intake and mediterranean dietary pattern in patients with Crohn’s disease. Nutrients. 2018;10(11):E1761. https://doi.org/10.3390/nu10111761.

    PubMed  Article  CAS  Google Scholar 

  55. Peyrin-Biroulet L, Sandborn W, Sands BE, Reinisch W, Bemelman W, Bryant RV, et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol. 2015;110(9):1324–38. https://doi.org/10.1038/ajg.2015.233.

    CAS  PubMed  Article  Google Scholar 

  56. • Limketkai BN, Iheozor-Ejiofor Z, Gjuladin-Hellon T, Parian A, Matarese LE, Bracewell K, et al. Dietary interventions for induction and maintenance of remission in inflammatory bowel disease. Cochrane Database Syst Rev. 2019;2:CD012839. https://doi.org/10.1002/14651858.CD012839.pub2This recent systematic review evaluating the safety and efficacy of dietary intervention in IBD included 18 randomized controlled trials with greater than 1800 participants. The study concluded that the data were lacking for drawing definitive conclusions for dietary recommendations, as benefits and harms remain unclear. This systematic review is the most comprehensive evaluation of dietary intervention in IBD to date.

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Andrew T. Weber, Neha D. Shah, Jenny Sauk, and Berkeley N. Limketkai declare no conflict of interest.

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Weber, A.T., Shah, N.D., Sauk, J. et al. Popular Diet Trends for Inflammatory Bowel Diseases: Claims and Evidence. Curr Treat Options Gastro 17, 564–576 (2019). https://doi.org/10.1007/s11938-019-00248-z

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Keywords

  • Inflammatory bowel disease
  • Diet
  • Nutrition
  • Crohn’s disease
  • Ulcerative colitis