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Implementing
Evidence-Based Nutritional Therapy
Diet is a powerful tool when used as part of a comprehensive medical management plan.
Diet is Essential to the Management
of Many GI Conditions
Nutrition is increasingly recognized as a critical component in the management of IBD, IBS, celiac disease and EoE. Across inflammatory, immune-mediated, and gut–brain interaction disorders, dietary intake influences symptoms, disease activity, and overall patient outcomes.
For example, research in IBD demonstrates how nutrition extends beyond the prevention of malnutrition, though malnutrition remains a common complication, and plays a central role in shaping the gut microbiome, regulating immune function, and supporting intestinal integrity. Metabolomics research is further uncovering complex metabolic pathways in digestion and important byproducts produced, like short-chain fatty acids (SCFAs),1 which are integral in reducing inflammation and achieving balanced immune function.
As a result, nutrition is emerging at the forefront of modern GI care, positioning nutritional therapy as an important adjunctive approach in disease management. Explore the topics below to review key research in this area.
The Microbiome and IBD
The microbiome is becoming increasingly recognized for its importance in human health and disease and is one of the hottest topics in medicine right now, with IBD being the most extensively studied among disease states.2 ,3 Microbiome disturbances are commonly found in IBD and are increasingly implicated in the onset and development of IBD.4,5 As diet has the greatest impact on the microbiome, it may offer the most manipulatable lever to modulate it for therapeutic benefit.6,7
Targeting the microbiome with diet upstream in combination with medications targeting the immune system downstream, may offer a two-pronged approach with a potential advantage for improved outcomes.8,9
How Dietary Therapy Supports Mental Health in IBD Patients
Patients with IBD suffer disproportionally higher rates of depression and anxiety, which are associated with a lower quality of life10,11 and correlated with active disease.12 Furthermore, anxiety, depression, and fatigue, common comorbidities in IBD, are rated by patients to have the highest symptom severity scores in a recent international survey.13
The concept of the gut-brain axis has recently emerged, and it is increasingly accepted that the gut microbiota play an important role in communicating with our brain and regulating mood, including anxiety and depression.14 Disruptions in the gut microbiota, along with important interrelated dynamics of dysregulated stress and immunity, may be converging to influence the development of depression.15
Can diet impact the gut microbiota to influence the gut-brain axis and subsequently our mental health? Increasing data suggest that indeed it does, with diet playing a central role in our brain function, mood, and mental well-being.16 The recognized role of diet in shaping the gut microbiota is changing the available approaches that can be taken to improve a number of health conditions,17 including depression18 and anxiety,19 as pro-inflammatory diets are associated with poor mental health.20 Although more research is needed to fully evaluate the effects of nutrition on mental health, the emerging field of nutritional psychiatry is taking the lead in utilizing dietary interventions to improve mental health. Nutritional therapy may offer an attractive additional therapeutic option for IBD given the potential dual benefit of improving both the underlying condition of IBD and mental health.
References
- Deleu S, Machiels K, Raes J, Verbeke K, Vermeire S. Short chain fatty acids and its producing organisms: An overlooked therapy for IBD?. EBioMedicine. 2021;66:103293. doi:10.1016/j.ebiom.2021.103293
Diet and the microbiome - Lloyd-Price J, Arze C, Ananthakrishnan AN, et al. Multi-omics of the gut microbial ecosystem in inflammatory bowel diseases. Nature. 2019;569(7758):655-662. doi:10.1038/s41586-019-1237-9
- Integrative HMP (iHMP) Research Network Consortium. The Integrative Human Microbiome Project: dynamic analysis of microbiome-host omics profiles during periods of human health and disease. Cell Host Microbe. 2014;16(3):276-289. doi:10.1016/j.chom.2014.08.014
- Khan I, Ullah N, Zha L, et al. Alteration of Gut Microbiota in Inflammatory Bowel Disease (IBD): Cause or Consequence? IBD Treatment Targeting the Gut Microbiome. Pathogens. 2019;8(3):126. Published 2019 Aug 13. doi:10.3390/pathogens8030126
- Kostic AD, Xavier RJ, Gevers D. The microbiome in inflammatory bowel disease: current status and the future ahead. Gastroenterology. 2014;146(6):1489-1499. doi:10.1053/j.gastro.2014.02.009
- Sonnenburg ED, Sonnenburg JL. Starving our microbial self: the deleterious consequences of a diet deficient in microbiota-accessible carbohydrates. Cell Metab. 2014;20(5):779-786. doi:10.1016/j.cmet.2014.07.003
- Serban DE. Microbiota in Inflammatory Bowel Disease Pathogenesis and Therapy: Is It All About Diet?. Nutr Clin Pract. 2015;30(6):760-779. doi:10.1177/0884533615606898
- Green N, Miller T, Suskind D, Lee D. A Review of Dietary Therapy for IBD and a Vision for the Future. Nutrients. 2019;11(5):947. Published 2019 Apr 26. doi:10.3390/nu11050947
- Lee D, Albenberg L, Compher C, et al. Diet in the pathogenesis and treatment of inflammatory bowel diseases. Gastroenterology. 2015;148(6):1087-1106. doi:10.1053/j.gastro.2015.01.007
How dietary therapy can improve mental health - Bernstein CN. Addressing Mental Health in Persons with IBD. J Can Assoc Gastroenterol. 2018;1(3):97-98. doi:10.1093/jcag/gwy038
- Byrne G, Rosenfeld G, Leung Y, et al. Prevalence of Anxiety and Depression in Patients with Inflammatory Bowel Disease. Can J Gastroenterol Hepatol. 2017;2017:6496727. doi:10.1155/2017/6496727
- Marrie RA, Graff LA, Fisk JD, Patten SB, Bernstein CN. The Relationship Between Symptoms of Depression and Anxiety and Disease Activity in IBD Over Time. Inflamm Bowel Dis. 2021;27(8):1285-1293. doi:10.1093/ibd/izaa349
- Rubin DT, Sninsky C, Siegmund B, et al. International Perspectives on Management of Inflammatory Bowel Disease: Opinion Differences and Similarities Between Patients and Physicians From the IBD GAPPS Survey. Inflamm Bowel Dis. 2021;27(12):1942-1953. doi:10.1093/ibd/izab006
- Cryan JF, O'Riordan KJ, Cowan CSM, et al. The Microbiota-Gut-Brain Axis. Physiol Rev. 2019;99(4):1877-2013. doi:10.1152/physrev.00018.2018
- Cruz-Pereira JS, Rea K, Nolan YM, O'Leary OF, Dinan TG, Cryan JF. Depression's Unholy Trinity: Dysregulated Stress, Immunity, and the Microbiome. Annu Rev Psychol. 2020;71:49-78. doi:10.1146/annurev-psych-122216-011613
- Adan RAH, van der Beek EM, Buitelaar JK, et al. Nutritional psychiatry: Towards improving mental health by what you eat. Eur Neuropsychopharmacol. 2019;29(12):1321-1332. doi:10.1016/j.euroneuro.2019.10.011
- Hills RD Jr, Pontefract BA, Mishcon HR, Black CA, Sutton SC, Theberge CR. Gut Microbiome: Profound Implications for Diet and Disease. Nutrients. 2019;11(7):1613. Published 2019 Jul 16. doi:10.3390/nu11071613
- Duarte-Silva E, Clarke G, Dinan TG, Peixoto CA. Personalized Nutrition for Depression: Impact on the Unholy Trinity. Neuroimmunomodulation. 2021;28(2):47-51. doi:10.1159/000514094
- Norwitz NG, Naidoo U. Nutrition as Metabolic Treatment for Anxiety. Front Psychiatry. 2021 Feb 12;12:598119. doi: 10.3389/fpsyt.2021.598119. PMID: 33643090; PMCID: PMC7907178.
- Chen GQ, Peng CL, Lian Y, Wang BW, Chen PY and Wang GP (2021) Association Between Dietary Inflammatory Index and Mental Health: A Systematic Review and Dose–Response Meta-Analysis. Front. Nutr. 8:662357. doi: 10.3389/fnut.2021.66235
Patients Embrace Diet as a Tool - Nowlin S, Manning L, Keefer L, Gorbenko K. Perceptive eating as part of the journey in inflammatory bowel disease: Lessons learned from lived experience. Clin Nutr ESPEN. 2021;41:299-304. doi:10.1016/j.clnesp.2020.11.017
- Megan T Zangara, Natalie Bhesania, Wei Liu, Gail A M Cresci, Jacob A Kurowski, Christine McDonald, Impact of Diet on Inflammatory Bowel Disease Symptoms: An Adolescent Viewpoint, Crohn's & Colitis 360, Volume 2, Issue 4, October 2020, otaa084, https://doi.org/10.1093/crocol/otaa084
Patients Embrace Diet as a Tool
Introducing the IBD Nutrition Navigator™
Nutritional therapy is likely one of the clinicians' most powerful tools to improve disease outcomes. Patients recognize the influence of diet on symptoms and are already making efforts to improve their symptoms with perceptive eating.21 They are seeking to utilize diet as a therapeutic tool under the guidance of medical professionals.22 Initiating dietary therapy with their healthcare team allows the greatest benefit to patients by providing a safe and effective approach.
Our IBD Nutrition Navigator™ helps integrate evidence-based nutritional guidance into every stage of IBD care, from the initial diagnosis to long-term management.
It has been developed by providers for providers with practicality in mind. With only six short steps, providers and patients can choose the right nutritional therapy together within the sometimes tight time constraints of a follow-up appointment.
Tools and Resources
Patient Tools and Resources
At GI Nutrition Foundation, we recognize that nutrition is often underutilized due to the difficulties in implementing it. We strive to provide the highest level of resources to support healthcare professionals in integrating evidence-based nutrition.
These practical, evidence-based tools reinforce nutritional guidance, encourage engagement, and help patients feel confident managing their conditions between visits.
Over 1000 delicious dishes that fit the dietary needs of your patients
Flyer and brochure about Nutrition and GI conditions
Tips and strategies to support patients in managing nutrition and chronic GI conditions in daily life
Websites, videos, support groups and more to help your patient learn and connect
Clinical Tools and Resources
From evidence-based nutrition updates to program development guidance and curated clinical tools our resources are designed to keep healthcare professionals informed and equipped for practical application.
Explore the links to the right to access these resources.
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