Abstract and Introduction
Abstract
Patients have strong beliefs about the role of diet in the cause of inflammatory bowel disease (IBD) and in exacerbating or alleviating ongoing symptoms from IBD. The rapid increase in the incidence and prevalence of IBD in recent decades strongly suggests an environmental trigger for IBD, one of which may be dietary patterns. There are several pathways where diet may influence intestinal inflammation, such as direct dietary antigens, altering the gut microbiome, and affecting gastrointestinal permeability. However, data that altering diet can change the natural history of IBD are scarce, and evidence-based dietary guidelines for patients with IBD are lacking. Patients, therefore, seek nonmedical resources for dietary guidance, such as patient support groups and unverified sources on the Internet. The aim of this review is to identify patient-targeted dietary recommendations for IBD and to critically appraise the nutritional value of these recommendations. We review patient-targeted dietary information for IBD from structured Internet searches and popular defined diets. Patient-targeted dietary recommendations focus on food restrictions and are highly conflicting. High-quality dietary intervention studies are needed to facilitate creation of evidence-based dietary guidelines for patients with IBD.
Introduction
Inflammatory bowel disease (IBD) is hypothesized to result from an environmental trigger in a genetically susceptible person. The incidence of Crohn's disease (CD) and ulcerative colitis (UC) are rising in Europe and North America, and in countries where IBD was previously thought to be uncommon (eg, China, South Korea, Puerto Rico).[1–3] Rapid shifts in the epidemiology of IBD point to an environmental trigger to IBD. The spread of the "Western" diet, high in fat and protein but low in fruits and vegetables, has been proposed as a possible explanation of the increase in IBD incidence.[4] The bowel lumen is continually exposed to numerous antigens, including the food that we consume and the enormous population of organisms that compose the gut microbiome. There are numerous proposed mechanisms through which diet could influence the incidence of IBD, including direct dietary antigens, altering the gut microbiome, and affecting gastrointestinal permeability.[5]
Patients frequently ask physicians for recommendations about food and diet, seeking ways to improve, or even cure their IBD. However, there are very limited data regarding the impact of diet on IBD. The combination of the paucity of quality data with strong patient interest may drive patients to seek nonmedical sources of diet recommendations, such as the Internet and the lay literature. In this review, we discuss patient-targeted dietary recommendations from the Internet and defined diets for IBD and evaluate the scientific evidence behind them.
Clin Gastroenterol Hepatol. 2014;12(10):1592-1600. © 2014 AGA Institute
