Advances in Nutrition The review concluded that “not including dietary advice as part of the management of inflammatory bowel disease is a missed opportunity.”
According to the 2017 Global Burden of Disease Study, “Inflammatory bowel disease is on the rise worldwide, with approximately seven million people currently diagnosed with the disease, resulting in poor health outcomes for patients as well as an increasing economic burden for society.” For some people, inflammatory bowel disease is a mild and manageable illness. But for others, it can be debilitating and lead to life-threatening complications.
Inflammatory bowel disease is an umbrella term that includes several disorders characterized by chronic inflammation of tissues in the digestive tract, often going through cycles of remission and relapse. The two most common forms of inflammatory bowel disease are Crohn’s disease and ulcerative colitis, although there are also less common forms such as microscopic colitis.
Over the past decade, researchers have made great strides in understanding the underlying causes of the development and progression of IBD. IBD is now understood to be rooted in the interplay of genetic, microbial, and environmental factors, and many researchers believe the recent increase in cases may be linked to modern Western lifestyles and diets.
Inflammatory bowel disease is usually treated with medications, including immunosuppressants, anti-inflammatory drugs, biologics, and immunomodulators, over the long term. Although these treatments help many patients manage their symptoms, not all patients respond well to them. Furthermore, there are currently no medications that can prevent the onset of inflammatory bowel disease.
Although research has improved drug therapy, little is known about how diet influences the onset and progression of inflammatory bowel disease. In response, the authors of “Diet, Foods, and Nutrient Exposures and Inflammatory Bowel Disease or Disease Progression: A Comprehensive Review” analyzed the evidence to gain a better understanding of the interplay between dietary factors and inflammatory bowel disease, with the goal of aiding in the development of effective dietary strategies to prevent disease onset and alleviate symptoms. The review: Advances in Nutrition: An International Review JournalA publication of the American Society for Nutrition.
To conduct their research, the authors conducted a comprehensive search for relevant systematic reviews and meta-analyses that investigated the association between diet and the onset, progression, and remission of inflammatory bowel disease. They found 47 systematic reviews and meta-analyses that met their inclusion criteria.
Following their analysis, the authors concluded that “higher intakes of fruits and vegetables are strongly associated with lower incidence of ulcerative colitis and Crohn’s disease.” Additionally, they noted that “Mediterranean, vegetarian, and semi-vegetarian diets are associated with reduced incidence and progression of inflammatory bowel disease.” In contrast, the evidence led the authors to conclude that “dietary patterns high in meat, ultra-processed foods, dietary fat, and refined sugars are associated with increased incidence of inflammatory bowel disease, ulcerative colitis, and Crohn’s disease.”
Interestingly, the associations between diet and ulcerative colitis were somewhat different than those between diet and Crohn’s disease. For example, the authors found that increased dietary fiber intake was associated with a lower risk of Crohn’s disease, but no clear association with ulcerative colitis was seen.
Many of the associations found between diet and inflammatory bowel disease are mirrored by studies of inflammatory markers, the microbiome, and other disease mechanisms, increasing confidence that the authors’ findings are causal and not just associational. Given that “several dietary factors have strong associations with both disease onset and progression,” the authors conclude that “not offering dietary advice as part of the management of inflammatory bowel disease would be a missed opportunity.”
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