Diet and Fermented Foods in Inflammatory Bowel Disease Management
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“Dysbiosis in IBD, characterized by a relative depletion of beneficial bacteria, disrupts gut homeostasis and contributes to inflammation.”
Inflammatory Bowel Diseases (IBD), including Crohn’s Disease (CD) and Ulcerative Colitis (UC), have a complex pathophysiology influenced by genetic, immunological, and environmental factors. A key environmental factor is the gut microbiome. Dysbiosis in IBD, characterized by a relative depletion of beneficial bacteria, disrupts gut homeostasis and contributes to inflammation.
The traditional approach to IBD management, focusing on medication, often comes with side effects and variable efficacy. This has led to a growing interest in the role of the exposome, environmental and lifestyle factors in the disease. One of these lifestyle factors is diet, which can rapidly change the microbiome, offering a safer, more embraced alternative.
Published in 2022 by B. Olendzki et al. from the Department of Microbiology and Physiological Systems and Program of Microbiome Dynamics at the University of Massachusetts Medical School, Worcester, the study in the journal Gut Microbes aimed to evaluate the impact of the IBD-Anti-Inflammatory Diet (IBD-AID) on the gut microbiome in IBD patients. This research was a single-arm pre-post intervention trial involving 25 participants, with 22 completing the baseline period and 19 completing the intervention. Throughout the study, a total of 340 stool samples and 553 dietary records were collected, employing advanced computational approaches to analyze the interactions between diet and the microbiome. The participants, averaging 40.5 years in age and having a BMI of 27.9, underwent significant dietary changes during the intervention. They reported a notable 1.8-fold increase in the consumption of prebiotics, a 1.5-fold increase in probiotics, a 1.6-fold increase in beneficial foods such as extra virgin olive oil, salmon, sardines, walnuts, beans, lentils, lean animal proteins like poultry, and eggs, and a 3.7-fold reduction in adverse foods including wheat, corn, lactose, high-fat animal and vegetable proteins, processed fried foods, artificial sweeteners, and beverages high in sugar, high-fat processed foods. These dietary modifications occurred rapidly, within the initial weeks of the intervention, suggesting a swift and effective adaptation to the diet.
“The abundance of Roseburia hominis, an SCFA-producing bacterium, increased significantly, indicating a positive shift in the gut microbiome.”
Compared to baseline, specific bacterial species showed either reduced or increased abundances during the intervention. Notably, the abundance of Roseburia hominis, a microbe generating short chain fatty acid (SCFA) from complex carbohydrates, such as fiber, increased significantly, indicating a positive shift in the gut microbiome. The intervention enhanced the microbiome’s capacity for the biosynthesis of vital amino acids and degradation of mannan, a dietary fiber. This shift suggests an increased potential for producing anti-inflammatory SCFAs, essential for maintaining gut health and suppressing inflammation.
“Increased consumption of prebiotics, probiotics, and beneficial foods, like lean animal proteins, omega-3 fatty acids, and fermented dairy products, positively correlated with an increase in beneficial Clostridia and Bacteroides species.”
The study identified specific foods that correlated with changes in the microbiome. Increased consumption of prebiotics, probiotics, and beneficial foods, like lean animal proteins, omega-3 fatty acids, and fermented dairy products, positively correlated with an increase in beneficial Clostridia and Bacteroides species. Conversely, the consumption of adverse foods was associated with an increase in bacteria such as Collinsella stercoris and Parabacteroides distasonis, which are typically enriched in IBD patients, indicating the crucial role of diet in shaping the gut microbiome.
The study also assessed the impact of diet on circulating cytokines, critical players in inflammation. Participants with higher intake of prebiotics and beneficial foods exhibited lower levels of inflammatory cytokines (IL-6 and IL-8) and higher levels of GM-CSF, a protective cytokine against colitis. In contrast, higher consumption of adverse foods correlated with higher levels of pro-inflammatory cytokines (IL-8 and TNF-alpha).
In my personal journey with Ulcerative Colitis, incorporating fermented foods, especially Kefir milk, into my diet has been immensely beneficial. To improve its palatability, I blend Kefir milk with protein shakes and various fruits. This dietary addition aligns with the growing understanding of the importance of probiotics for gut health. Additionally, I have eliminated ultra-processed foods and added sugars, known for their potential to exacerbate inflammatory conditions, from my diet. This conscious effort helps me avoid dietary triggers that could aggravate my condition.
“This variety in plant-based foods is not just about nutritional enrichment; it’s a strategic approach to encouraging the growth of beneficial gut bacteria, crucial for managing gut-related health issues like ulcerative colitis.”
Alongside these changes, I have significantly increased my intake of organic vegetables and fruits with every meal, aiming to cultivate a diverse and healthy gut microbiome that reduces immune activation. This variety in plant-based foods is not just about nutritional enrichment; it’s a strategic approach to encouraging the growth of beneficial and anti-inflammatory gut bacteria, crucial for managing gut-related health issues like ulcerative colitis. These dietary strategies collectively have not only aided in managing my condition but also contributed to my overall sense of well-being, emphasizing the benefits of a holistic approach to health.
Even though this pilot study doesn’t prove causation, it reveals the profound impact of diet on the gut microbiome and immune responses in IBD patients. The inclusion of fermented foods and a balanced diet can play a crucial role in managing IBD. These findings highlight the potential of a dietary approach in addition to pharmacologic management in altering the gut microbiome and modulating the immune system for better management of IBD.
For those living with IBD or interested in prevention strategies, subscribing to Dr. Emeran Mayer’s premium newsletter can be a valuable resource. (Click here for more information!) Subscribers receive Gut-Healthy Recipes and learn from the expert through access to Dr. Mayer’s Premium Newsletter Articles. Additionally, subscribers can get their own questions answered in a monthly AMA (Ask Me Anything) session with Dr. Mayer. Moreover, the traditional Mediterranean diet, renowned for its benefits in managing conditions like IBD due to its rich variety of anti-inflammatory foods, is a key focus of Dr. Mayer’s new recipe book ‘Interconnected Plates.’ It artfully combines tradition, science, and the enjoyment of food, offering over 55+ simple daily meal ideas to incorporate into your diet for better gut health. For more details, check out Interconnected Plates here!