‘One last thing doc, I’ve been reading online about the Paleo diet and that it’s been beneficial to other patients with colitis, what do you think?’

We have all been here. Most of us feel that we really should have the answer to questions regarding diet and inflammatory bowel disease (IBD) but what advice to give is far from straight forward.

The development of IBD is due to a complex interaction between genetic predisposition, environment, gut microbiota and the intestinal immune system [1]. Diet, as an environmental factor, clearly affects outcome in IBD with good data supporting the use of enteral nutrition in paediatric Crohn’s disease [2]. However, life with enteral nutrition is a challenge with many adult patients finding long-term exclusive enteral nutrition difficult to tolerate. Whilst our understanding of dietary influences on IBD is growing[3], high quality evidence for a more palatable dietary approach in IBD is lacking.

The study by Crooks and colleagues highlights a lack of concordance in dietary advice between healthcare professionals managing patients with IBD, with approximately half perceiving diet as a factor implicated in the development of IBD [4]. In a world driven by evidence-based medicine, the variation in opinion here may be surprising but is likely to reflect the challenges faced in performing rigorous studies of dietary intervention. It would be interesting to know how different healthcare professionals have formed their beliefs. Undoubtedly there are influences from irritable bowel syndrome management strategies, with many IBD patients experiencing functional symptoms during periods of remission, but the differences observed between gastroenterologists and other healthcare professionals are difficult to explain.

As we understand the interaction between environment and microbiome better, we will be able to give patients better advice regarding what they eat and their IBD. Until then, we have to acknowledge that there is no one-size fits all approach and advocate patients take a common-sense approach to what they eat. Although many physicians may not feel equipped to offer specific dietary advice to individual patients, those with IBD are often able to identify perceived triggers and with a degree of concordance between patients in terms of which food items are avoided [5]. There are numerous patient-led resources providing recipe recommendations including https://www.ibdrelief.com/ – whilst we cannot vouch that these recipes reduce the likelihood of a flare, the food certainly looks tasty!

REFERENCES

1. Segal JP et al, The application of omics techniques to understand the role of the gut microbiota in inflammatory bowel disease. Therap Adv Gastroenterol, 2019. 12: p. 1756284818822250.
2. Swaminath A et al, Systematic review with meta-analysis: enteral nutrition therapy for the induction of remission in paediatric Crohn’s disease. Aliment Pharmacol Ther, 2017. 46(7): p. 645-656.
3. Rapozo DC, Bernardazzi C and De Souza HS, Diet and microbiota in inflammatory bowel disease: The gut in disharmony. World J Gastroenterol, 2017. 23(12): p. 2124-2140.
4. Crooks B, McLaughlin J and Limdi J, Dietary beliefs and recommendations in inflammatory bowel disease: a national survey of healthcare professionals in the UK. Frontline Gastroenterology, 2020: p. flgastro-2020-101723.
5. Crooks B et al, The dietary practices and beliefs of people living with inactive ulcerative colitis. European Journal of Gastroenterology & Hepatology, 2020. p. MEG.0000000000001911