Inflammatory bowel disease (IBD), the collective term for Crohn's disease and ulcerative colitis, is an inflammatory disease that affects roughly 1 in 200 people in the US. Crohn's disease and ulcerative colitis are similar because they are both inflammatory diseases that affect the colon and are chronically relapsing illnesses. Crohn's disease can occur anywhere along the digestive tract from the mouth to the anus and can affect the entire lumen or all layers of the digestive tract and even other parts of the body. Ulcerative colitis remains restricted to the colon and confined to the colon's mucosa layer or innermost layer. Sometimes making the diagnosis of Crohn's disease versus ulcerative colitis can be difficult for physicians, especially in severe cases of ulcerative colitis where the entire colon is inflamed (pancolitis). Common symptoms of IBD are bloating, abdominal pain, diarrhea, urgency, bleeding, and fatigue. The goals for the treatment of IBD are bringing IBD into remission, keeping IBD in remission, decreasing the need for long-term corticosteroids, and improved quality of life. Alteration of the intestinal microbiome (intestinal-bacteria) is believed to be a significant cause of IBD.
Both Crohn's disease and ulcerative colitis are affected by the foods that we eat. Modifying the diet to include foods that promote a healthy digestive tract microbiome has been proven to reduce IBD inflammation. Given that diet can rapidly shape the gut microbiome, dietary interventions represent an ideal strategy to produce beneficial microbiome shifts that could rebalance gut bacterial imbalance or dysbiosis. In general, increasing fluid intake and eating fruits and vegetables helps IBD because it reduces gastrointestinal inflammation. The strategy of increasing dietary fiber is therapeutic during an IBD flare. We just need to change the form of the fiber by putting using more cooked foods, and blenderizing, so it is not irritating, provides nutrients and easily digested.
In contrast, refined sugars, wheat, corn, lactose and certain emulsifiers, along with foods high in saturated fat should be avoided by patients with IBD because they can irritate the IBD digestive system. Sugars and saturated fat have different adverse effects on the microbiota. Sugars have been found to cause dysfunction of the immune system, while saturated fat has been found to irritate the digestive lumen and increase inflammation. Cultured dairy products should be encouraged unless the patient is intolerant of casein, a milk protein, since these products have low or no lactose.
The IBD Anti-Inflammatory Diet (IBD-AID) is focused on modifying the immune system with anti-inflammatory foods that are beneficial for IBD. This is the same principle that medication therapies rely on for treating IBD – to alter the immune system with anti-inflammatory medications. Foods that are high in soluble fiber are protective in IBD because soluble fiber reduces inflammation and maintains an intact gastrointestinal endothelial barrier. A critical aspect of soluble fiber is that it binds with fluids, mitigating loose stools and urgency and motility disorders. Soluble fiber is a prebiotic and can shift the microbiota towards a healthy balance, thereby improving the digestive system function and reducing uncomfortable symptoms.
There is a great need to develop long-term dietary guidelines that address nutritional deficiencies common to patients with IBD and promote a microbiome that assists with IBD remission. By-and-large the American diet is low in dietary soluble fiber and other beneficial foods for IBD, which is why establishing an adequate and nutritious diet that promotes an anti-inflammatory microbiome is so important. The IBD-AID has been shown to improve the lives of people struggling with IBD profoundly. Patients who adopted the IBD Anti-Inflammatory Diet show improvement of disease symptoms after four weeks of adherence to the diet and can often reduce their medications.
The IBD-AID was designed to promote short-chain fatty acid (SCFA) producing good bacteria and gut health by incorporating naturally prebiotic and probiotic foods – instead of manufactured supplements. The IBD-AID focuses on substitution (not only exclusion) of foods that favor bacteria with pro-inflammatory potential. SCFA are produced in the digestive tract by bacterial fermentation of dietary fiber and are responsible for maintaining a balanced digestive system.
The IBD-AID is based on four key parameters:
- Prebiotic and probiotic foods (emphasis on volume and variety)
- Beneficial foods necessary for nutrition
- Substitution of foods harmful to patients with IBD
Most physicians don't provide IBD patients with a specific diet. Their recommendations are generally for a regular diet with the philosophy "if it hurts, don't do it."
"What should I eat?" is a common question asked by patients with IBD. The IBD-AID primarily consists of fruits, non-starchy vegetables, prebiotics (e.g., soluble fiber, leeks, onions, and bananas), and probiotics (e.g., fresh cultured yogurt, kefir, and miso). Beneficial grains (such as oats and barley), lean protein from chicken, fish, omega-3 eggs, legumes, and healthy fats (such as nuts, seeds, olive oil, and avocado) are also components of IBD-AID. The IBD-AID focuses on approaching dietary change by ADDING needed nutrients, beneficial fatty acids, and changing foods' textures to suit the patient needs by having three phases to easily digest and absorb nutrients. It is also essential to avoid certain foods such as those foods higher in saturated fat, trans-fat, and processed foods that are empty calories.
The IBD-AID is enjoyable and flavorful to not only the patient but the whole family. It is also vital for patients to understand that diet adherence requires changes in behavior, which takes time and training. For some patients, more than ten weeks on the IBD-AID might be needed for desired improvements in health and digestion to occur. The IBD-AID can be difficult, but patient motivation, support from a knowledgeable dietitian, family and friends, and skills in the kitchen and the marketplace are a recipe for success.
