The NHS estimates that one in every 250 people suffers from Inflammatory Bowel Disease (IBD), the generic term used to describe the conditions Ulcerative Colitis (UC), and Crohn’s disease. In the Spring 2016 edition of #ion_nutrition Optimum Nutrition Magazine Lisa Patient looks at the perspectives on these chronic conditions.

Altering the Microbiome

Both UC and Crohn’s disease are long-term conditions that involve inflammation of the gastrointestinal tract. By far the most popular area of research in recent years has centred on the microbiome, the population of bacteria that lines the gut.

Research tells us that there is a link between DNA and the microbiome. IBD sufferers have certain genes “switched on” that are associated with changes in the microbiome, namely a less diverse population of bacteria and more potential harmful bacteria. Dietary changes can help with diversity, particularly restricted feeding times 2 and eating a diet high in plant fibre from fruits and vegetables. 3

Taking probiotics is popular therapy for populating the microbiome with good bacteria . A particular probiotic strain called E.Coli Nissle has been found to prevent infection and reduce inflammation in Crohn’s sufferers.  4

In severe cases of IBD, doctors are increasing turning to faecal transplants, where stool is taken from a healthy person and transplanted into the patient. In 2015 the success rate of faecal transplantation was estimated at 90%, highlighting the role of the microbiome in this disease. 5

Viruses and Bacteria

Viruses are also an area of investigation, with a study showing that a type of virus called enterovirus is found in the gut of IBD sufferers but not unaffected guts. This virus is stored in the gut nerve cells and spread by nerve fibres, which could explain why the disease comes and goes and why it affects multiple parts of the intestines. 6

Of particularly dietary interest is a study that linked a bacterium in cow’s milk to Crohn’s disease, which suggests a dairy-free diet may be beneficial 7

Intestinal Barrier

The intestinal barrier is the name given to the mucosal lining of the gut. This should allow nutrients to pass through, but protect the body from harmful particles passing through the gut wall. Maintaining a good intestinal barrier is challenging for IBD sufferers but two nutrients have been shown to help: vitamin D and glutamine.8 9 Both of these nutrients are typically obtained in supplement form, but should only be taken under medical supervision.

Fats

Several studies show that omega 3 fats, as found in oily fish, nuts and seeds, can reduce the inflammation associated with IBD. But one recent animal study highlighted how a saturated fat called palmitic acid, found in butter, olive oil, cheese, milk and meat, significantly worsened inflammation. It was also noted that Crohn’s Disease sufferers have lower levels of omega-6 fats in their blood. A fat that helps with reducing inflammation, omega-6 is found in seeds and their oil. 10

Vitamin A

Patients of IBD have been found to have low vitamin A levels. 11 Vitamin A, found as beta-carotene in vegetables and fruits such as carrots, kale, mango, and as retinol in liver and fish, has been shown to prevent inflammation in the colon .12

Herbs

Gingko Biloba, turmeric, berberine, aloe vera and the Chinese herb mix qing-dai 13,14,15,16,17 have each been the subject of one or more clinical trials in the past 5 years, and each was found to have an anti- inflammatory effect and provide some relief, although it should be noted that the number of trials is very limited.

Foods to Avoid

Many people with IBD avoid eating brassica vegetables such as cabbage and broccoli18, but there is no strong supporting evidence that these exacerbate the condition. Similarly there is very little research into whether or not gluten has an impact, although one study did report an improvement in symptoms amongst sufferers on a gluten-free diet.19. More information on the effect of alcohol would be interesting, although it is known that alcohol intake has a detrimental effect on the diversity of bacteria in the gut microbiome. 20

The Way Forward

Inflammatory Bowel Disease is a serious condition for which there is currently no cure. However, research tells us that making the right dietary choices can help relieve the symptoms and that a highly varied plant-based, dairy-free diet may be effective for some.

 

References

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