In recent years we are aware of the increasing incidence of many chronic diseases, which some may call the ‘new era diseases’. Our world is evolving with more technologies and options which have led us to immense changes in our lifestyles.
We are working more hours, experiencing episodes of stress on a daily basis, moving less, and consuming highly processed fast foods. We are now in a situation in which we do not know how our food is grown, where it comes from, what it consists of, and how processed it actually is. We’ve forgotten the main role of our food, which is to provide us with nutrients to support our bodies.
The Role of Diet in Inflammation
Inflammatory bowel diseases (IBD) are a large component of the ‘new era’ chronic diseases spreading throughout the world. There are several potential factors involved in the pathogenesis of IBD, including genetics, the immune system, the microbiome, and our environment. Of the many environmental triggers under research, diet has come under the most investigation.
Diet plays a crucial role in IBD, from pathogenesis to the management of the disease, especially Crohn’s Disease (CD). More and more studies support the role of diet in IBD, including epidemiological studies which show the association between these conditions and red meat, animal fat, soft drinks, and processed food in general. In addition, studies with animal models have investigated the role of specific ingredients and the mechanism through which they increase inflammation.
Exclusive Enteral Nutrition Diet for Crohn’s Disease
The strongest evidence is found in human studies showing that diet can treat and reduce inflammation in CD. The first line therapy for children with CD according to most guidelines is a dietary therapy called Exclusive Enteral Nutrition (EEN). This treatment includes drinking liquid medical formulas as the sole source of food for a period of 6-12 weeks. The formulas are like a milkshake and there are several options available. This treatment results in 60-85% of remission just by changing the diet!
We can see the effect on the mucus layer with significant endoscopic improvement after this treatment as well, together with improvement in growth in children.
The Crohn’s Disease Exclusion Diet
EEN treatment works wonders but can be difficult to follow, especially in the long term. Therefore we are attempting to understand the main mechanism by which this treatment works.
There isn’t one clear answer and there are several groups working to find out if we can make dietary treatments more feasible. One of the suggested mechanisms is the exclusion of dietary components that are potentially pro-inflammatory, as we saw in animal models, and might increase inflammation by affecting the intestinal barrier and microbiome. Based on this notion, a dietary therapy called the Crohn’s Disease Exclusion Diet (CDED) was developed.
The idea behind CDED is the exclusion of these potentially pro-inflammatory ingredients and the inclusion of wholefood diets with neutral and beneficial foods that might improve the microbiome as well. Several promising studies for children and adults have been published, showing high remission rates (60%-80%), as well as improvement in the mucus layer.
Diet & IBD Going Forward
In light of this new research, we should make a concerted effort to avoid processed foods as much as possible and be more aware of where our food is coming from and what it is made of. Pay extra attention to food labels, and check whether any unfamiliar ingredients listed may exacerbate your condition. Food labels reveal much more than the nutrition panel and calories. We need to gain an understanding of the source of the calories, and what we are consuming in addition to them.
As in other environmental diseases, we should note and control the trigger – our diet. Take lung diseases, for example. A doctor won’t recommend medications while enabling the patient to continue smoking, as we are now aware of the role smoking plays in the development of that disease. The same goes for diabetes. Diet is a contributing factor, so we recommend a change in diet to manage the disease.
And now, in 2022, we are headed towards more personalization in dietary treatment. Diet should be adjusted for the individual patient and based on the condition, preferences, and disease status so we can better control the inflammation and symptoms. If you or a loved one suffers from Crohn’s disease or ulcerative colitis, the best way to tackle your diet is to visit a specialized dietitian so they can support your specific needs and adjust your diet accordingly.
Rotem Sigall-Boneh
