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Therapeutic Diets
What are Therapeutic Diets
Therapeutic diets are whole-food based, nutritionally balanced dietary plans that improve symptoms, reduce inflammation, and aid in mucosal healing. Like a standard healthy diet, therapeutic diets focus on nutrient-dense whole foods thought to be beneficial like vegetables and fruits. They differ in that they limit components thought to be problematic in Crohn's disease and ulcerative colitis, like processed foods, additives, sugar, gluten, and dairy.
To be effective, a therapeutic diet must be followed more strictly than a general healthy diet, and a long-term commitment is required to achieve and sustain results. After a prolonged period of remission with healing, many find they can broaden the diet to incorporate a wider range of healthy foods.
Nutritional therapy is essentially adding foods that will help to heal and substituting for foods in the way of healing.
Diet and the Microbiome
Therapeutic diets have a beneficial effect on the microbiome. The gut microbiome is a community of bacteria, viruses, and fungi living within the lining of the gastrointestinal tract. A balanced community of organisms in the microbiome may be essential to good health.
In Inflammatory Bowel Disease (IBD), the composition of the gut microbiome is altered, a condition known as dysbiosis, which is associated with inflammation. Diet influences the gut microbiome and may be the most effective means to modify it in a favorable way.
Therapeutic diets provide an opportunity to improve microbial diversity and shift dysbiosis towards a more balanced state.
Therapeutic diets also avoid components thought to be harmful to the gut barrier (the lining of the intestinal tract). Restoring or maintaining the condition of the intestinal lining can prevent the abnormal activation of the immune system, which can result in inflammation.
While nutritional therapy has the potential to reduce inflammation by altering the microbiome, medications target the abnormal activation of the immune system. In combination, these two therapies work to resolve inflammation from different vantage points. This combined approach may have the potential to produce better results than either method alone.
Click on the box below to learn more about the microbiome.
The Impact of Dietary Therapy on the Microbiome
The term microbiome is used to collectively describe all of the microorganisms living in a specific environment or community. The gut microbiome encompasses the bacteria, viruses, and fungi, as well as their genes, that reside within the lining of the gastrointestinal tract.
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.1,2 Microbiome disturbances are commonly found in IBD and are increasingly implicated in the onset and development of IBD3,4 As diet has the greatest impact on the microbiome, it may offer the most manipulatable lever to modulate it for therapeutic benefit.5,6
Nutritional therapy offers the ability to affect the microbiome upstream at a potential source of inflammation, while medications target the immune system downstream. When using the therapies in combination, this two-pronged approach may offer a potential advantage for improved outcomes.7,8
References
- 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
Considerations
If you are the caregiver, the following considerations apply to you and the patient.
When to Consider a Therapeutic Diet
- When you want to implement a diet that has been specifically designed to target IBD or auto-immune conditions.
- When you have a strong positive desire to improve your diet and include more healthy diversity.
- When you feel empowered by the idea of making your own food and exploring the addition of the healthy variety of fruits and vegetables available to you.
- When you have enough time, support, energy, and financial stability to make these changes comfortably.
When a Therapeutic Diet May Not Be Right for You
- When you (or the patient) has an eating disorder, a history of or is at high risk of developing an eating disorder, or a history of an eating disorder in the immediate family.
- When it is not something you (or the patient) are interested in or committed to. Therapeutic diets should only be considered if it is something the patient wants. This is particularly important when the patient is a child. Imposing unwanted dietary change on an unwilling child may further burden a child already carrying a heavy load and may foster an unhealthy relationship with food.
- When implementing a therapeutic diet will cause too much hardship due to lack of time, energy, interest, support, or financial stability.
- When your quality of life decreases after implementing a therapeutic diet. Successful implementation of a therapeutic diet should improve your quality of life by allowing you to enjoy things that were difficult when your disease was active. When the demands of a therapeutic diet cause more hardship than benefits, a therapeutic diet is not the right fit.
- When you find you cannot expand the diet to include a healthy diversity of foods.
Focus on Variety within Therapeutic Diets
Therapeutic diets are often referred to as restrictive and sometimes called exclusion diets because they are built on the premise of excluding specific foods that are thought to be detrimental in patients with IBD. However, the secret to successfully implementing a therapeutic diet is focusing on the inclusion and diversity of beneficial foods.
When Disease Is Active
When disease is active, it is common to struggle with adding in foods, and you may need to limit your diet in order to function. However, once healing has begun, you should be able to start expanding the diversity of your diet within the array of included foods. All therapeutic diets have guidelines for phases/stages that can be used to assist with expanding the diet. If you cannot expand your diet to include a healthy diversity of foods, something is not working and you should consult with your care team to discuss options.
Replace Restricted Foods with Diverse Alternatives
Your dietary plan should be implemented in such a way that for every healthy food that is limited, it is replaced with a variety of healthy alternatives. When a food like potatoes is removed from the diet, it is optimally replaced with healthy alternatives like cauliflower, squash, rutabaga, and celeriac. When wheat pasta is restricted, patients find a role for spaghetti squash, spiralized zucchini and butternut squash, and pasta made from legumes like beans and lentils. For every food that is restricted, a door opens for trialing new healthy alternatives. The end result should be a diet that is much healthier than the standard American diet, limiting processed foods and sugar consumption; increasing diversity and quantity of fruits and vegetables; and focusing on consuming a nutritionally complete, balanced diet. Consult a registered dietitian to ensure your diet is balanced and to help you continue to expand and diversify your diet in healthy ways.
Picky Eaters
Some worry about children on a therapeutic diet who are already known to be picky eaters. There is a concern that a therapeutic diet will only further limit the diet. Many parents of picky eaters have found the opposite to be true: once healing has begun and the foods eaten do not exacerbate the symptoms of IBD, children eat much better and are accepting of a wider diversity of foods.
Takeaway
The important takeaway from this is to understand that if you continue to be stuck consuming a limited selection of foods beyond the first few months, even if you feel well, your treatment plan is not working. It is not healthy to continue on such a path. It may be that a different dietary approach will better suit you, or adding/adjusting medications is required. The healthy path is one that is always looking to add healthy diversity and not the one that is constantly forced to restrict.
Detailed information on each dietary therapy can be found on our Dietary Options Page:
