Inflammatory Bowel Diseases and Nutrition: How do they relate?

Tempo de Leitura: 3 minutos

Inflammatory bowel diseases are a set of disorders that affect the intestines chronically. Although its etiology is not fully elucidated, studies relate its development with the interaction between the immune system and the intestinal microbiota. Thus, for effective treatment, nutritional interventions need to be assertive. We have compiled here some strategies that can be used in patients with IDI. Read more about Inflammatory Bowel Diseases (IDI) and nutrition: how do they relate?

The gastrointestinal tract and IDI

The prevalence of IDI in Western-style countries is increasing worldwide. The spectrum of Inflammatory Bowel Diseases (IBD) encompasses Crohn’s Disease (CD) and Ulcerative Colitis (UC), which usually cause intestinal barrier dysfunction as well, affect the composition of the intestinal microbiota occurring release of pro-inflammatory metabolites.

Moreover, in CD the diversity of the microbiota is reduced and this has a high presence
of Erysipelotrichales, Bacteroidales and Clostridiales
. In addition to a reduction of Enterobacteriaceae, Pasteurellacaea, Veillonellaceae and Fusobacteriaceae,

which contributes to the inflammatory process of the gastrointestinal tract. In UC, the diversity of coebitive bacteria decreases, and the number of Enterobacteriaceae, Enterococcus, Ruminococcus and Bacteroides

increases, from an overproduction process, which aggravates the dysbiotic picture of the patient.

What to avoid in IDs?

Regarding, the diet may improve or worsen the inflammatory condition of the patient. Data suggest that Diets rich in sugars and fats, affect the mucous barrier of the intestine, corrupting it. In addition, this dietary pattern increases permeability between cells by establishing a leaky gut.

Associated with this, the intake of food additives such as polysorcarcity 80, commonly used by the food industry as an emulsifier, acts by increasing bacterial translocation and
adherence of E coli
. in the intestinal M cells and also in peyer’s plates, which results in an even greater process of inflammation.

In addition to this additive, some data suggest that dietary polysaccharides such as maltodextrin increase the production of bacterial biofilm. In this way, the consumption of foods containing emulsifiers, thickeners and additives should be discouraged by healthcare professionals for the general population.

Nutritional Treatment in IDi

Laboratory evaluation

In CD, laboratory evaluation by digestive endoscopy is very common, as this is a basic examination that allows the finding of the degree of inflammation of the patient’s digestive tract. However, the symptoms that the patient reports are not always directly related to the degree of inflammation presented on the examination. In this way, the request for fecal calprotectin and C-reactive protein (CRP) may aid in the evaluation of the actual inflammatory state of the patient.

Conversely, in UC symptoms such as frequent bowel movements and the presence of bleeding in the stool correlate well with the histological findings of endoscopy, both in the adult population and in pediatrics, which helps in the elucidation of the case.

The Best Nutritional Therapies for Inflammatory Bowel Diseases

Nutritional management in pediatric cases is essential. Data indicate that the gold standard is the exclusive enteral nutrition offering from the use of complete nutritional formula for a period of 6 to 10 weeks, which results in up to 80% regression of Crohn’s disease.

Another possibility of nutritional therapy is partial enteral nutrition, associated with a diet excluding whole foods where 50 to 90% of the caloric supply comes from formulas and the rest of the calories from foods such as meat, rice and some vegetables. In addition, the adoption of the low FODMAP diet, a gluten-restricted specific carbohydrate diet for celiacs, in addition to the adoption of a Mediterranean diet, seem to favor the remission of the disease.

Clinical practice

Therefore, it is clear the relevance of nutritional management in inflammatory bowel diseases, and the best strategy depends on each case. That is, the nutritionist is the professional responsible for evaluating and determining his/her conduct in relation to IDI. Thus, in general, guidelines such as reduction of consumption of saturated fat, food additives, fats from dairy sources and trans fat, showed benefits in both CD and UC. In addition, sweeteners that present in their composition sucralose and saccharin are also not recommended for patients with IDI. Finally, the need for the use of nutritional formulas and/or food exclusion should be evaluated individually by the nutritionist.


Reading suggestion:
do all diseases start in leaky gut?

Watch The Lecture Microbiota CLUB 2022 with Cristiano Rudge:
Differential Diagnosis in Irritable Bowel Syndrome

Current Nutritional Therapies in Inflammatory Bowel Disease:

REZNIKOV, Elizabeth A.; SUSKIND, L. David. Current Nutritional Therapies in Inflammatory Bowel Disease: improving clinical remission rates and sustainability of long-term dietary therapies. Nutrients, [S .L.], v. 15, n. 3, p. 668, Jan. 28. 2023. MDPI AG.

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