Navigating Nutritional Therapy

For a long time, it was thought that diet does not matter when it comes to managing Crohn's disease and ulcerative colitis, two conditions that are collectively known as inflammatory bowel disease (IBD). Growing evidence suggests that food does indeed matter, as diet is both a risk factor (Lo CH et al) and a therapeutic option. Increasing evidence associates Western diet and ultra-processed foods with the development of IBD (Narula N et al), while growing evidence points to the therapeutic potential of manipulating diet (Sasson AN et al). Nutritional therapy includes dietary options emphasizing anti-inflammatory foods to modulate the microbiome and its metabolic byproducts (Tilg H and Moschen AR) (Thorburn AN et al) (Lavelle A and Sokol H), a proposed mechanism to explain their benefits of improving symptoms, reducing inflammation, and aiding in mucosal healing.

The term microbiome is used to collectively describe all of the microorganisms living in a specific environment or community. The gut microbiome encompasses the bacteria, viruses, and fungi, as well as their genes, that reside within the lining of the gastrointestinal tract.

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 (Lloyd-Price J et al) (Integrative HMP [iHMP] Research Network Consortium). Microbiome disturbances are commonly found in IBD and are increasingly implicated in the onset and development of IBD (Khan I et al) (Kostic AD et al). As diet has the greatest impact on the microbiome, it may offer the most manipulatable lever to modulate it for therapeutic benefit (Sonnenburg ED and Sonnenburg JL) (Serban DE).

Nutritional therapy offers the ability to affect the microbiome upstream at a potential source of inflammation, while medications target the immune system downstream. When using the therapies in combination, this two-pronged approach may offer a potential advantage for improved outcomes (Green N et al) (Lee D et al).

The role of nutrition in IBD is moving beyond the simplicity of 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) (Deleu S et al), 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 approach for the management of IBD.

Patients recognize the influence of diet on symptoms and are already making efforts to improve their symptoms with perceptive eating (Nowlin S et al). They are seeking to utilize diet as a therapeutic tool under the guidance of medical professionals (Zangara et al). Initiating dietary therapy in this manner would allow the greatest benefit to patients by providing a safe and effective approach. Many professional publications establish the critical connection between diet and IBD and describe the rationale for integrating nutritional therapy into clinical practice.