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Inflammatory Bowel Disease: Diet Changes May Ease Symptoms

Updated on December 22, 2022

  • The gut microbiome plays a critical role in IBD, for which the development of specialty diets have been designed to manipulate the microbiome.
  • According to a 2013 review that examined the efficacy of popular therapeutic diets, the low FODMAP diet is the most effective specialty diet for alleviating the symptoms of IBD, although questions remain regarding its impact.
  • Nutritional supplementation using butyric acid can offer a more simple and effective way of supporting microbiome health and can be used alone or in concert with specialty diets.

Inflammatory bowel diseases (IBDs) like Crohn’s disease and ulcerative colitis are debilitating diseases that occur when gut microbiota cause inflammation of the epithelial cells in the GI tract. Although the exact causes of IBDs remain unknown, researchers believe that dietary and genetic factors play a role.

Although IBDs are typically treated via surgery or antibiotics, these options are often less than ideal. Surgery can be painful and requires extensive recovery time, whereas antibiotics can cause digestion difficulties due to their destruction of essential gut bacteria. As such, less invasive options are under active investigation, many of which focus on dietary manipulation of the gut microbiome to alleviate IBD symptoms. Unfortunately, the majority of such studies have primarily examined older specialty diets rather than attempting to investigate and develop new, more effective therapeutic diets. But in recent years, compelling evidence is emerging that supports more modern dietary interventions for individuals who seek to alleviate IBD symptoms noninvasively.

Scrutinizing Therapeutic Diets for IBD

For decades, researchers have proposed and evaluated a variety of diets to find one that would alleviate IBD symptoms. The majority of these diets focus on modulating the amount of fiber, carbohydrates, and protein consumed by the patient. In a 2013 review, Drs. Jason K. Hou, Dale Less, and James Lewis examined the efficacy of these diets to gain greater insight into the possibilities of dietary manipulation of the gut microbiome in IBD patients.

Most IBD diets fall into one of two categories: low fiber diets or high protein diets. There is significant overlap between the two, and both are premised in the belief that IBD patients should avoid providing their compromised gut microbiomes with carbohydrates that could be fermented to cause IBD symptoms. Low fiber diets are thought to accomplish this by denying fibrous stool-forming scaffolding to which bacteria can adhere and ferment, causing pain and bloating. High protein diets, in contrast, are believed to work by exploiting the difficulty that gut microbiota of IBD patients have in digesting soluble proteins. Because these soluble proteins require too much energy to break down normally, proponents of high protein diets claim they are not able to produce enough fermented byproducts to cause the symptoms of IBD.

As noted by Drs. Hou, Less, and Lewis, the support for these diets are often based on obsolete or disproven science. For example, an oft-cited study in favor of a low fiber specialty diet was published in 1955 and examined celiac disease rather than IBD. In fact, when analyzing existing literature, the research group concluded that low fiber diets might do more harm than good in patients with IBD, leading to augmentation of IBD symptoms, as well as nutritional deficiencies. This could be because fiber is necessary for healthy digestion, and its absence can cause problems independent of IBD symptomatology. High protein diets might also aggravate IBD; while unlikely to cause malnutrition, high protein diets also are unlikely to contain enough fiber and carbohydrates to be processed by the GI tract without causing the symptoms of IBD.

The Potential of Low FODMAP Diets

Unlike many others, Drs. Hou, Less, and Lewis didn’t confine their research to older, widely used specialty diets; they also investigated the recently developed low FODMAP diet. FODMAP refers to Fermentable Oligo/Di/Mono-Saccharides And Polyols, which have long been suspected of aggravating IBD symptoms because their molecules are easy for gut microbiota to ferment. In a seminal 2005 paper, the researchers Peter Gibson and Susan Shepherd lent credence to this theory by linking the high quantity of FODMAPs—including fructoses, lactoses, polyols, and oligosaccharides—in the Western diet with the development and aggravation of Crohn’s disease.

FODMAPs are plentiful in the Western diet and particularly prevalent in foods such as fruits, milk, and beans. As a result, the average person consumes more FODMAPs per day than the small intestines’ enzymes are capable of breaking down. The remaining FODMAPs readily pass through to the large intestines, where they act as “fast food” for bacteria; fermentation of FODMAPs then causes bacterial populations to drastically expand, leading to inflammation and tissue damage in the process. This inflammation occurs in the small intestine, large intestine, and the colon, all of which are characteristic of IBD.

As a result of their findings, Gibson and Shepherd published a preliminary low FODMAP cookbook. In a 2009 pilot study, they subsequently developed a low FODMAP diet designed specifically to reduce the symptoms of Crohn’s disease, although it was broadly applicable to other inflammatory bowel diseases. The study found that most participants who adhere to the low FODMAP diet strictly for three months experience improvement in IBD symptoms, whereas those who did not follow the diet strictly saw few improvements. In total, 56 percent of patients who adhered to the diet saw an overall reduction of symptoms, including diminished bloating, pain, gas, and diarrhea. Although many of these improvements were reported to be moderate in magnitude, study participants were not asked whether they thought the diet was worth continuing. However, participants generally found the diet to be palatable, easy to prepare, and thus easy to adhere to. Most critically, the success of the FODMAP pilot study proved that dietary interventions can offer much-needed relief for IBD patients.

Drs. Hou, Less, and Lewis’ investigation of the low FODMAP diet supports these promising results; in fact, the low FODMAP diet was found to be more effective for alleviating IBD symptoms than any other dietary intervention they looked at. More recent reviews of the low FODMAP diet have confirmed the therapeutic benefits of the diet in the treatment of IBD. Support for this intervention provides greater insight into the potential causes of and solutions for IBD symptoms that can help researchers refine future treatment methods.

The Future of Diet-Based Therapies for IBD

Although the low FODMAP diet presents exciting possibilities for non-invasive treatment of IBD, there are still unanswered questions regarding its long-term nutritional impact. For example, although it is far more nutritionally sustainable than many other specialty diets, unrecognized deficiencies might cause pathologies over extended periods of time. Additionally, the diet might change the gut microbiome in ways not yet fully understood and complicate subsequent IBD treatment. As such, longer-term studies are needed to gain more insight into the potential of the low FODMAP diet. In the meantime, support is emerging for a different kind of dietary intervention: nutritional supplementation.

Recent studies suggest that a number of new nutritional supplements might help reduce the symptoms of IBD by restoring a healthy gut microbiota in patients with IBD.  Butyric acid supplements are considered particularly promising according to a 2014 paper. Butyric acid is a necessary component of the gut microbiome and is utilized for cell signaling in the intestinal lumen. Researchers have found that individuals with IBD have lower levels of butyric acid-producing microbiota than in healthy controls, which is believed to be the result of healthy butyric acid-producing bacteria being outcompeted by bacteria farther upstream in the GI tract. As a result, these upstream bacteria are allowed access to an easy food source—potentially FODMAPs—that exacerbates IBD symptoms. Meanwhile, the healthy microbiome organisms further downstream are starved. This leads to the GI tract being deprived of critical butyric acid, thus compromising gastrointestinal function.

The findings of this study indicate that butyric supplements have a vital role to play in the nutritional support of IBD. When used alongside specialty diets that carefully regulate the gut microbiome, IBD patients might receive greater symptom relief than they would with diet alone. As more advanced nutritional supplements become available it might also be possible to use such supplements as standalone therapies. While further research is needed to refine treatment protocols, it is clear that dietary interventions offer exciting possibilities for alleviating IBD symptoms.

The power of Tesseract supplements lies in enhancing palatability, maximizing bioavailability and absorption, and micro-dosing of multiple nutrients in a single, highly effective capsule. Visit our website for more information about how Tesseract’s products can help support your gastrointestinal health and immune health.*

Works Cited

Andersen V, Olsen A, Carbonnel F, Tanneland A, Vogel U. 2012. Digestive and Liver Disease. 44:185–194.

Charlebois A, Rosenfeld G, Bressler B. 2015. Critical Reviews in Food Science and Nutrition. 56:1370–1378.

Gearry RB, Irving PM, Barrett JS, Nathan DM, Shepherd SJ, et al. 2009. Journal of Crohn’s and Colitis. 3:8–14.

Gibson PR, Shepherd SJ. 2005. Alimentary Pharmacology and Therapeutics. 21:1399–1409.

Hou JK, Lee D, Lewis J. 2014. Clinical Gastroenterology and Hepatology. 12:1592–1600.

Wang W, Chen L, Zhou R, Wang X, Song L, et al. 2013. Journal of Clinical Microbiology. 52:398–406.

Al Czap, Founder | Tesseract

Al Czap has more than four decades of professional experience in preventative medicine. He founded Thorne Research in 1984 (sold in 2010) and he published Alternative Medicine Review for 17 years beginning in 1996. AMR was a highly acclaimed, peer-reviewed, and indexed medical journal. Al was the first to recognize the need for hypoallergenic ingredients and to devise methods of manufacture for and delivery of hypoallergenic products to underserved patient populations. His work has greatly impacted those with impaired immune and digestive systems and compromised health due to environmental exposures.

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