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Diet as a Trigger or Therapy for Inflammatory Bowel Diseases.

Abstract

The most common question asked by patients with inflammatory bowel disease (IBD) is, "Doctor, what should I eat?" Findings from epidemiology studies have indicated that diets high in animal fat and low in fruits and vegetables are the most common pattern associated with an increased risk of IBD. Low levels of vitamin D also appear to be a risk factor for IBD. In murine models, diets high in fat, especially saturated animal fats, also increase inflammation, whereas supplementation with omega 3 long-chain fatty acids protect against intestinal inflammation. Unfortunately, omega 3 supplements have not been shown to decrease the risk of relapse in patients with Crohn's disease. Dietary intervention studies have shown that enteral therapy, with defined formula diets, helps children with Crohn's disease and reduces inflammation and dysbiosis. Although fiber supplements have not been shown definitively to benefit patients with IBD, soluble fiber is the best way to generate short-chain fatty acids such as butyrate, which has anti-inflammatory effects. Addition of vitamin D and curcumin has been shown to increase the efficacy of IBD therapy. There is compelling evidence from animal models that emulsifiers in processed foods increase risk for IBD. We discuss current knowledge about popular diets, including the specific carbohydrate diet and diet low in fermentable oligo-, di-, and monosaccharides and polyols. We present findings from clinical and basic science studies to help gastroenterologists navigate diet as it relates to the management of IBD.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: lewisjd@mail.med.upenn.edu.

    Crohn's and Colitis Center, Department of Medicine, Department of Microbiology and Immunology, University of Miami Miller School of Medicine, Miami, Florida. Electronic address: Mabreu1@med.miami.edu.

    Source

    Gastroenterology 152:2 2017 02 pg 398-414.e6

    MeSH

    Anti-Inflammatory Agents, Non-Steroidal
    Crohn Disease
    Curcumin
    Diet
    Diet Therapy
    Dietary Fats
    Dietary Fiber
    Dietary Supplements
    Dysbiosis
    Emulsifying Agents
    Fatty Acids, Omega-6
    Fatty Acids, Volatile
    Fermentation
    Fruit
    Gastrointestinal Microbiome
    Humans
    Inflammation
    Inflammatory Bowel Diseases
    Risk Factors
    Vegetables
    Vitamin D Deficiency

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    27793606

    Citation

    Lewis, James D., and Maria T. Abreu. "Diet as a Trigger or Therapy for Inflammatory Bowel Diseases." Gastroenterology, vol. 152, no. 2, 2017, pp. 398-414.e6.
    Lewis JD, Abreu MT. Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology. 2017;152(2):398-414.e6.
    Lewis, J. D., & Abreu, M. T. (2017). Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology, 152(2), pp. 398-414.e6. doi:10.1053/j.gastro.2016.10.019.
    Lewis JD, Abreu MT. Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. Gastroenterology. 2017;152(2):398-414.e6. PubMed PMID: 27793606.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Diet as a Trigger or Therapy for Inflammatory Bowel Diseases. AU - Lewis,James D, AU - Abreu,Maria T, Y1 - 2016/10/25/ PY - 2016/07/26/received PY - 2016/10/15/revised PY - 2016/10/19/accepted PY - 2016/10/30/pubmed PY - 2017/6/6/medline PY - 2016/10/30/entrez KW - Diet KW - Inflammatory Bowel Disease KW - Microbiome KW - Short-Chain Fatty Acids SP - 398 EP - 414.e6 JF - Gastroenterology JO - Gastroenterology VL - 152 IS - 2 N2 - The most common question asked by patients with inflammatory bowel disease (IBD) is, "Doctor, what should I eat?" Findings from epidemiology studies have indicated that diets high in animal fat and low in fruits and vegetables are the most common pattern associated with an increased risk of IBD. Low levels of vitamin D also appear to be a risk factor for IBD. In murine models, diets high in fat, especially saturated animal fats, also increase inflammation, whereas supplementation with omega 3 long-chain fatty acids protect against intestinal inflammation. Unfortunately, omega 3 supplements have not been shown to decrease the risk of relapse in patients with Crohn's disease. Dietary intervention studies have shown that enteral therapy, with defined formula diets, helps children with Crohn's disease and reduces inflammation and dysbiosis. Although fiber supplements have not been shown definitively to benefit patients with IBD, soluble fiber is the best way to generate short-chain fatty acids such as butyrate, which has anti-inflammatory effects. Addition of vitamin D and curcumin has been shown to increase the efficacy of IBD therapy. There is compelling evidence from animal models that emulsifiers in processed foods increase risk for IBD. We discuss current knowledge about popular diets, including the specific carbohydrate diet and diet low in fermentable oligo-, di-, and monosaccharides and polyols. We present findings from clinical and basic science studies to help gastroenterologists navigate diet as it relates to the management of IBD. SN - 1528-0012 UR - https://www.unboundmedicine.com/medline/citation/27793606/Diet_as_a_Trigger_or_Therapy_for_Inflammatory_Bowel_Diseases_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0016-5085(16)35266-0 DB - PRIME DP - Unbound Medicine ER -