Abstract
Diet plays a pivotal role in the onset and course of inflammatory bowel disease (IBD). Patients are keen to know what to eat to reduce symptoms and flares, but dietary guidelines are lacking. To advice patients, an overview of the current evidence on food (group) level is needed. This narrative review studies the effects of food (groups) on the onset and course of IBD and if not available the effects in healthy subjects or animal and in vitro IBD models. Based on this evidence the Groningen anti-inflammatory diet (GrAID) was designed and compared on food (group) level to other existing IBD diets. Although on several foods conflicting results were found, this review provides patients a good overview. Based on this evidence, the GrAID consists of lean meat, eggs, fish, plain dairy (such as milk, yoghurt, kefir and hard cheeses), fruit, vegetables, legumes, wheat, coffee, tea and honey. Red meat, other dairy products and sugar should be limited. Canned and processed foods, alcohol and sweetened beverages should be avoided. This comprehensive review focuses on anti-inflammatory properties of foods providing IBD patients with the best evidence on which foods they should eat or avoid to reduce flares. This was used to design the GrAID.
Highlights
Diet is one of the environmental factors that is associated with the onset and course of inflammatory bowel diseases (IBD) comprising Crohn’s disease (CD) and ulcerative colitis (UC)
A prospective study including 412 patients with quiescent UC treated with an aminosalicylate, reported that dietary intake of myristic acid, a saturated fatty acid was associated with increased risk of a flare (Odds Ratio (OR)
A prospective study including 412 patients with quiescent UC treated with an aminosalicylate, reported that dietary intake of myristic acid, a SFA commonly found in palm oil, coconut oil and dairy fats was associated with increased risk of a flare [30]
Summary
Diet is one of the environmental factors that is associated with the onset and course of inflammatory bowel diseases (IBD) comprising Crohn’s disease (CD) and ulcerative colitis (UC). Accumulating evidence points to a gut dysbiosis combined with an aberrant immune response in genetically predisposed individuals; a process probably triggered and maintained by changes in environmental factors, including diet [1]. Since the prevalence of IBD is highest in the Western world, affecting up to 0.5% of the general population in 2015 [2], it is thought that the Western diet, high in fats and sugars and low in vegetables and fruits, contributes to the development of IBD [3]. It is established that the Western diet reduces the diversity of the gut microbiome [4]. The strongest proof for the role of nutrition in the aetiology of CD is found in children with IBD, where strict exclusive enteral nutrition (E.E.N.) can induce remission in CD
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