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. 1 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
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.
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
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
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.
- Knights D1, Silverberg MS2, Weersma RK3, Gevers D4, Dijkstra G3, Huang H5, Tyler AD2, van Sommeren S6, Imhann F6, Stempak JM2, Huang H7, Vangay P7, Al-Ghalith GA7, Russell C8, Sauk J9, Knight J10, Daly MJ11, Huttenhower C12, Xavier RJ13 (2014). Complex host genetics influence the microbiome in inflammatory bowel disease Genome Med. Dec 2;6(12):107. doi: 10.1186/s13073-014-0107-1. eCollection (2014).
- Zarrinpar A1, Chaix A2, Yooseph S3, Panda S4 (2014). Diet and feeding pattern affect the diurnal dynamics of the gut microbiome. Cell Metab. Dec 2;20(6):1006-17. doi: 10.1016/j.cmet.2014.11.008.
- De Filippo C1, Cavalieri D, Di Paola M, Ramazzotti M, Poullet JB, Massart S, Collini S, Pieraccini G, Lionetti P (2010). Impact of diet in shaping gut microbiota revealed by a comparative study in children from Europe and rural Africa. Proc Natl Acad Sci U S A, Aug 17;107(33):14691-6. doi: 10.1073/pnas.1005963107. Epub 2010 Aug 2.
- Huebner C1, Ding Y, Petermann I, Knapp C, Ferguson LR (2011). The probiotic Escherichia coli Nissle 1917 reduces pathogen invasion and modulates cytokine expression in Caco-2 cells infected with Crohn’s disease-associated E. coli LF82. Appl Environ Microbiol. Apr;77(7):2541-4. doi: 10.1128/AEM.01601-10. Epub 2011 Feb 11.
- Konturek PC1, Haziri D2, Brzozowski T3, Hess T2, Heyman S2, Kwiecien S3, Konturek SJ3, Koziel J4 (2015). Emerging role of fecal microbiota therapy in the treatment of gastrointestinal and extra-gastrointestinal diseases J Physiol Pharmacol. Aug;66(4):483-91.
- Nyström N1, Berg T, Lundin E, Skog O, Hansson I, Frisk G, Juko-Pecirep I, Nilsson M, Gyllensten U, Finkel Y, Fuxe J, Wanders A. (2013). Human enterovirus species B in ileocecal Crohn’s disease. Clin Transl Gastroenterol Jun 27;4:e38. 2013. doi: 10.1038/ctg.2013.7.
- Scanu AM1, Bull TJ, Cannas S, Sanderson JD, Sechi LA, Dettori G, Zanetti S, Hermon-Taylor J (2007) Mycobacterium avium subspecies paratuberculosis infection in cases of irritable bowel syndrome and comparison with Crohn’s disease and Johne’s disease: common neural and immune pathogenicities. J Clin Microbiol. 2007 Dec;45(12):3883-90. Epub 2007 Oct 3.
- T. Raftery, A. R. Martineau, C. L. Greiller, S. Ghosh, D. McNamara, K. Bennett, J. Meddings, M. O’Sullivan (2015). Effects of vitamin D supplementation on intestinal permeability, cathelicidin and disease markers in Crohn’s disease: Results from a randomised double-blind placebo-controlled study. United European Gastroenterology Journal, 3 (3): 294 DOI: 10.1177/2050640615572176
- Benjamin J1, Makharia G, Ahuja V, Anand Rajan KD, Kalaivani M, Gupta SD, Joshi YK (2011). Glutamine and whey protein improve intestinal permeability and morphology in patients with Crohn’s disease: a randomized controlled trial. Dig Dis Sci. Apr;57(4):1000-12. doi: 10.1007/s10620-011-1947-9. Epub 2011 Oct 26.
- Liuyang Wang, Stefan H. Oehlers, Scott T. Espenschied, John F. Rawls, David M. Tobin, Dennis C. Ko. (2015). CPAG: software for leveraging pleiotropy in GWAS to reveal similarity between human traits links plasma fatty acids and intestinal inflammation. Genome Biology, 16 (1) DOI: 10.1186/s13059-015-0722-1
- Soares-Mota M1, Silva TA1, Gomes LM1, Pinto MA1, Mendonça LM1, Farias ML1, Nunes T1, Ramalho A1, Zaltman C1 (2015). High prevalence of vitamin A deficiency in Crohn’s disease patients according to serum retinol levels and the relative dose-response test. World J Gastroenterol. Feb 7;21(5):1614-20. doi: 10.3748/wjg.v21.i5.1614.
- Reifen R1, Levy E2, Berkovich Z2, Tirosh O2 (2015). Vitamin A exerts its antiinflammatory activities in colitis through preservation of mitochondrial activity. Nutrition. 2015 Nov-Dec;31(11-12):1402-7. doi: 10.1016/j.nut.2015.05.011. Epub 2015 Jun 6.
- Sun Y1, Lin LJ1, Lin Y1, Sang LX2, Jiang M2, Zheng CQ1 (2015). Gingko biloba extract (Ginaton) ameliorates dextran sulfate sodium (DSS)-induced acute experimental colitis in mice via reducing IL-6/STAT3 and IL-23/IL-17. Int J Clin Exp Med. 2015 Oct 15;8(10):17235-47. eCollection 2015.
- Liu L1, Liu YL, Liu GX, Chen X, Yang K, Yang YX, Xie Q, Gan HK, Huang XL, Gan HT. (2013). Curcumin ameliorates dextran sulfate sodium-induced experimental colitis by blocking STAT3 signaling pathway. Int Immunopharmacol. 2013 Oct;17(2):314-20. doi: 10.1016/j.intimp.2013.06.020. Epub 2013 Jul 12.
- Yan F1, Wang L, Shi Y, Cao H, Liu L, Washington MK, Chaturvedi R, Israel DA, Cao H, Wang B, Peek RM Jr, Wilson KT, Polk DB (2012). Berberine promotes recovery of colitis and inhibits inflammatory responses in colonic macrophages and epithelial cells in DSS-treated mice. Am J Physiol Gastrointest Liver Physiol. Mar 1;302(5):G504-14. doi: 10.1152/ajpgi.00312.2011. Epub 2011 Dec 15.
- Park MY1, Kwon HJ, Sung MK (2011). Dietary aloin, aloesin, or aloe-gel exerts anti-inflammatory activity in a rat colitis model. Life Sci. Mar 14;88(11-12):486-92. doi: 10.1016/j.lfs.2011.01.010. Epub 2011 Jan 26.
- Xiao HT1, Peng J2, Hu DD3, Lin CY4, Du B4, Tsang SW4, Lin ZS5, Zhang XJ6, Lueng FP4, Han QB4, Bian ZX4. (2015). Qing-dai powder promotes recovery of colitis by inhibiting inflammatory responses of colonic macrophages in dextran sulfate sodium-treated mice. Chin Med. 2015 Oct 13;10:29. doi: 10.1186/s13020-015-0061-x. eCollection 201
- Ballegaard M1, Bjergstrøm A, Brøndum S, Hylander E, Jensen L, Ladefoged K. (1997). Self-reported food intolerance in chronic inflammatory bowel disease. Scand J Gastroenterol. Jun;32(6):569-71.
- Herfarth HH1, Martin CF, Sandler RS, Kappelman MD, Long MD (2014). Prevalence of a gluten-free diet and improvement of clinical symptoms in patients with inflammatory bowel diseases. Inflamm Bowel Dis. Jul;20(7):1194-7. doi: 10.1097/MIB.0000000000000077.
- Vassallo G1, Mirijello A, Ferrulli A, Antonelli M, Landolfi R, Gasbarrini A, Addolorato G (2015) Review article: Alcohol and gut microbiota – the possible role of gut microbiota modulation in the treatment of alcoholic liver disease. Aliment Pharmacol Ther. May;41(10):917-27. doi: 10.1111/apt.13164. Epub 2015 Mar 23.