IBD+Diet:Has anything been proven to work?

Last month a really interesting overview study of IBD was published. Unlike most of the studies we tend to find about IBD, this was strictly an overview of non-medicated therapies and IBD-such as restricting certain foods, specific diets, exercise and things like therapy. I blog a lot about diet and IBD, but still get asked this question all the time; so thought I’d go into ‘teacher mode’ and examine the evidence! 

Diet and IBD: Is anything proven to work?

I’ve already written an overview of some of the possible diets and IBD-but have never really discussed much of the evidence! However, I’m concerned that the way some ‘advocates’ are writing about it lately; it’s as if diet has already been unequivocally proven to solve IBD, so I wanted to delve into it deeper!

I am passionate that diet plays a big part for me, but the evidence is still very much ongoing (and of course, I’ve recently just started Humira too). I just wanted to mention that King’s College London is currently looking for those with IBD to take part in a new diet study so please do get involved if you can. Those interested, need to be able to visit London and be stable with their IBD (e.g. not just started any new medicines like me!) you can email alicia.sandall@kcl.ac.uk or call 0207 848 4552

Low Residue Diet

I have previously blogged about my concerns on the low residue diet. In my opinion, it doesn’t teach patients about the difference between insoluble and soluble fibre; and many assume all vegetables are off the menu! They’re not. The low residue diet makes people gravitate towards things like white bread and pasta constantly-but things like stewed apple and cooked veg like sweet potato can be used too. The research study notes there isn’t any evidence that low residue diet helps in the long-run (although it’s still used in the short-term for people with strictures and blockages of course).

“Despite this, evidence for the efficacy of low-residue diets in IBD is lacking. Seventy patients with CD were randomized to a low-residue diet (~3 g/d of fiber) or regular diet (13 g/d) . There was no difference in outcome between the two groups, including symptoms, need for hospitalization, need for surgery, new complications, nutritional status, or postoperative disease recurrence.”

This confirms that long-term, low residue is not beneficial for the majority of people. And in fact, we NEED FIBRE! Patients with Crohn’s whose average intake of fibre was 23.7 g per day were ~40% less likely to experience a flare at six months as compared with those whose median consumption was 10.4 g of fibre per day. 

I’ve always known fibre is important and I have largely stuck to soluble fibre from things like oats, squash, apple, sweet potato, carrots and parsnips but I’ve also tried to increase my insoluble fibre too. If you’re new to this, you could try…

• Blending fruit into smoothies (unlike juicing, this keeps the fibre). Try my turmeric protein smoothie or ginger rehydration smoothie.
• Adding well-cooked veggies to easy to digest meals (with low fibre options like potato and rice). Try my Turmeric Thai curry-which uses soft sweet potato as a base and you can add more veggies in slowly.
• Consider using nut butters or blending nuts-e.g. my cashew nut butter dip. Blending them makes them much smoother!

                                 Introduce fibre gradually with recipes like this one!

Meat or No Meat?

In my post ‘can going vegan help IBD?’ I explained the reasons for and against eating meat in IBD patients. It seems to be universally accepted that red meat is not ideal for IBD patients.

“A prospective cohort study of 183 patients with UC found high intake of meat and meat products (processed meats) predicted an increased likelihood of relapse.”

A semi-vegetarian diet  was evaluated prospectively for two years in patients with CD and seemed to demonstrate very high remission rates. The definition of this was weekly fish, twice weekly meat, unlimited egg and dairy with plenty of grains, fruit and veg. It also eliminated sweets, bread, cheese and fast food.

Interestingly, the CRP was normal at the final visit in more than half of the patients in remission on this diet. 

I think it’s not rocket science why this might be a good diet- although I’m not sure why chicken and fish weren’t allowed more frequently. It prioritises natural food and limits junk foods.

Mediterranean Diet

The SVD outlined above is quite similar to a Mediterranean diet (although they consume more fish I believe) and indeed a study showed that those who followed this type of diet showed a trend in reducing CRP and normalising gut bacteria Again what this seems to have in common is that it eliminates red meat and increases vegetables and plants.

Low Fodmap

I have also expressed concern about the low FODMAP diet too. It is now being used in those who have perhaps achieved clinical remission but are still having symptoms. Indeed, a study showed 42% of those with IBD experienced improvements of bloating and pain and 66% reported normalised stools on the low FODMAP diet. However, this study doesn’t actually show if any inflammation markers improved. I do think it’s important to consider that perhaps some of those individuals might have experienced relief just by eliminating lactose or gluten as the low FODMAP diet eliminates so much; I wonder if it could also be the case that an individual feels better because of one or two of the the things cut out. However, it could be worth considering.

Gluten Free

There is not much evidence at all about gluten-free and IBD. I have blogged before about why gluten might be a problem for some of us (and me!) but the overview noticed evidence is lacking. However, one survey of patients with IBD found that 65.5% of patients that followed a gluten-free diet showed improvement in at least one clinical symptom and 38.3% indicated fewer or less severe flares. Not enough to suggest it works for everyone but perhaps enough to show there could be a link.

SCD

And finally, we see a lot of posts about SCD lately but it seems to be more anecdotal. The overview explains that most success is shown with children-perhaps because they’re more likely to stick with it? Of a small study of 50 individual, 1/3 felt the diet helped them achieve remission whilst 66% found symptoms resolved.

Exercise

Finally, a note on exercise. Although we all tend to struggle to do it, since we’re so tired all the time-it was shown that exercise did help with fatigue in IBD patients and even disease activity-since lower levels of physical activity are associated with higher levels of inflammation.

What can we learn?

The main conclusions we can draw from this are…

• Diet certainly has helped many individuals with IBD and it’s something we should be exploring.
• Everything points to the fact that excessive quantities of red meat do not seem to fit well with the IBD diet (this might contradict those who do well on paleo and perhaps this is because that diet focuses on grass-fed, organic versions of red meat?)
• There’s little value on being on a low residue diet for a long time.
• Low-FODMAP could help symptoms.
• We all need fibre.

If you’re interested, you can read the overview from the World Journal of Gastroenterology yourself here. I hope my blog post on it has helped-does it match what you currently have figured out about your own diet? Or is it completely different?