What is Nutritional Therapy?
What is Nutritional Therapy?
Nutritional therapy in IBD focuses on using diet and nutrition alongside medications to manage symptoms, aid healing, and reduce inflammation. It can be used short-term, for example, to induce remission or optimize nutrition prior to surgery or to treat malnutrition, or long-term to manage symptoms and impact levels of inflammation.
Navigating Nutritional Therapy
Diet is a powerful tool when used as part of a comprehensive medical management plan. However, navigating nutrition within IBD is often more complex than other medical conditions. Those with Crohn’s or colitis often experience symptoms in relation to the foods they consume1,2,3, and there is no single recommended dietary therapy to guide them. Expanding research shows a range of dietary IBD therapies to be effective 4, and while many have commonalities, some also have subtle to significant differences. Considering all of these factors, dietary therapy can prove challenging to navigate. We provide a framework for a closer investigation to become familiar with the evidence-based options available in nutritional therapy for IBD. Although ongoing research will continue to modify the approach, patients can benefit greatly by applying the information and options available today.
Given the unique interplay of microbial and genetic diversity, IBD phenotypes, and individual health conditions, the optimal therapeutic approach is often contingent on the individual and, as a result, best achieved through a process of personalization. Patients and clinicians, including gastroenterologists, dietitians, nurses, advanced practice providers, psychologists, and pharmacists, should work together in shared decision-making to find the right evidence-based nutritional option to include as part of a comprehensive medical treatment plan.
Some forms of nutritional therapy that can help patients with IBD include liquid nutrition, whole foods-based therapeutic diets, and methods to modify diet to improve symptoms or manage a flare. Below is a short overview of these approaches. Detailed information on each dietary therapy can be found on our Dietary Options Page.
References
- Whelan K, Murrells T, Morgan M, et al. Food-related quality of life is impaired in inflammatory bowel disease and associated with reduced intake of key nutrients. Am J Clin Nutr. 2021;113(4):832-844. doi:10.1093/ajcn/nqaa395
- Holt DQ, Strauss BJ, Moore GT. Patients with inflammatory bowel disease and their treating clinicians have different views regarding diet. J Hum Nutr Diet. 2017;30(1):66-72. doi:10.1111/jhn.12400
- Gu P, Feagins LA. Dining With Inflammatory Bowel Disease: A Review of the Literature on Diet in the Pathogenesis and Management of IBD. Inflamm Bowel Dis. 2020;26(2):181-191. doi:10.1093/ibd/izz268
- Nutritional Therapy for IBD research
Whole Food approaches
There are three categories of whole food approaches:
Therapeutic Diets
Therapeutic diets are whole-food diets designed to address IBD or auto-immune disease. They have the potential to improve clinical symptoms and reduce inflammation by limiting foods thought to contribute to them. They are most often combined with traditional medications as adjunctive therapy, but in some circumstances, they may be considered for primary therapy. They may require significant lifestyle changes.
Healthy Eating Options
These options were not designed specifically to address disease, symptoms, or inflammation, but instead are considered generally healthy ways of eating. These dietary approaches may lower inflammation, lessen symptoms, and improve overall health. Healthy eating options are more flexible than therapeutic diets and easier to implement. They are not considered suitable for primary therapy but are beneficial when used in combination with medications (adjunctively).
Options for Persistent Symptoms
These options include dietary changes intended to address lingering symptoms that remain when inflammation levels are low, and your treatment plan is otherwise working. They can improve quality of life by addressing those unresolved symptoms, but they have not been shown to lower inflammation in IBD.
Enteral Nutrition
A nutritionally complete liquid diet where all (Exclusive Enteral Nutrition) or some (Partial Enteral Nutrition) of the daily calories come from a drinkable formula.
Blurring the Lines
Over time, the lines between whole-food approaches and enteral nutrition have blurred. This blurring of lines allows one approach to take advantage of the benefits of another approach.
- Smooth textures and blenderized foods are often incorporated into wholefood diets when disease is active, or strictures are present.
- The Crohn's Disease Exclusion Diet, for example, includes a formula component
- The future of EEN may eventually include the option to use homemade smoothies (a small pilot study has just been published).
Detailed information on each dietary therapy can be found on our Dietary Options Page.
Stay Tuned!
Given the full array of options, it can be challenging for clinicians and patients to match the individuality of each patient and their disease presentation with the most appropriate dietary fit. Nutritional Therapy for IBD has developed a new patient-centric tool, including an algorithm, to help guide clinicians and patients in selecting a dietary approach.
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Curious? Listen to the podcast of Gastro Broadcast with Dr. Ananthakrishnan, who is leading the development of this tool, and our founder Kim Beall.
