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A quick disclaimer: Vitamin supplementation should only occur to correct lab patterns of deficiencies/insufficiencies and be dosed by your doctor or registered dietitian nutritionist according to your individualized needs. Supplementing too much could cause negative health effects. This article is not meant to be prescriptive or replace the advice of your licensed healthcare professional.
In people with Crohn’s disease or ulcerative colitis, the relationship between diet, symptoms, and disease activity is complex and our understanding of these interactions is ever-evolving. While some providers still defer to the “diet doesn’t matter” line of thinking, there is significant scientific evidence to support the use of nutrition as a tool to be used alongside a physician’s care plan. Below, we’ll share some research highlighting why nutrition matters and how it can potentially improve the experience of people living with various forms of IBD in different scenarios.
1. Nutrition can help certain medications work better
A study published in 2021 showed that Vitamin D supplementation could improve the effectiveness of Remicade (infliximab) in patients with moderate-to-severe Crohn’s disease. In 73 patients receiving Remicade who were also supplementing with vitamin D, this study found that the clinical remission rate at 54 weeks of supplementation was higher compared to the patients who were not supplementing with vitamin D. Vitamin D supplementation, especially in patients who were identified as deficient, increased cells with anti-inflammatory properties (IL-10). The bottom line is that Vitamin D3 supplementation, especially in patients who are deficient, could improve the effectiveness of Remicade in people with moderate-to-severe Crohn’s disease and possibly induce clinical remission (1). More clinical trials in other classes of medications used to treat IBD are warranted to further evaluate nutrition’s role on drug efficacy.
2. Nutrition can help reduce inflammation
In the general population, research is clear that consuming more polyunsaturated omega-3 fatty acids (found in foods like salmon, anchovies, canola oil, cod liver oil, walnuts, and flaxseeds) can decrease inflammatory markers (2). Specific to IBD, no diet is superior to any other for controlling inflammation. However, there is research that suggests that improvement of a patient’s nutritional status and alteration of gut flora by foods is thought to lead to decreased mucosal inflammation (3). Omega-9, found in foods like olive oil, almond oil, and avocado oil, has been shown in mice studies to potentially play a role in prevention for ulcerative colitis (4). For more details on the research supporting the role of nutrition in reducing inflammation, check out this post which summarizes the 2020 diet guidelines set out by the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) (5).
3. Nutrition can help symptoms
Research has shown that symptoms such as fatigue, pain, GI distress, and sleep disturbances can be correlated with disease activity, but not always. This means that symptoms can persist even in the absence of disease activity, which can result from subclinical or low-level inflammation, or other concurrent conditions (like Rheumatoid arthritis or IBS) (6). A retrospective study from New Zealand in 2020 found that patients with IBD reported that symptoms were influenced by their food choices. However, the responses from the study were too variable to draw generalizable conclusions and instead further supported the need for individualized nutrition interventions (7).
4. Nutrition can help prevent and manage malnutrition
A study in 2014 found that hospitalized patients with IBD had the highest incidence of malnutrition (8). People who have active disease might have difficulty eating enough food due to decreased appetite or restriction, fatigue from GI symptoms, or malabsorption. Additionally, the inflammatory process usually requires that more calories be consumed. Eating enough and preventing malnutrition can reduce the chances of experiencing complications associated with malnutrition, such as poor clinical outcomes, response to therapy, and quality of life (9).
While research into the connection between nutrition, disease activity, and symptom severity is ever-evolving, there is solid evidence supporting the use of nutrition in a variety of situations across the IBD patient journey. In certain circumstances and patient populations, nutrition can be used as a tool to potentially help with inflammation, symptom management, surgery and when using certain biologics. Nutrition therapy is important for patients with IBD and is recommended to be included in your clinical care plan.
Working one-on-one with a registered dietitian nutritionist with special interest and experience in IBD is a safe and effective way to be sure that you are eating enough calories and protein to support your body’s needs, regardless of where you are in your IBD disease journey. If you don't have a dietitian or are curious to learn how working with one could help you achieve your health goals, we’d love to help, and we welcome you to sign up for complimentary consultation.
- Xia, S. L., Min, Q. J., Shao, X. X., Lin, D. P., Ma, G. L., Wu, H., Cao, S. G., & Jiang, Y. (2021). Influence of Vitamin D3 Supplementation on Infliximab Effectiveness in Chinese Patients With Crohn's Disease: A Retrospective Cohort Study. Frontiers in nutrition, 8, 739285.
- Ferrucci L, Cherubini A, Bandinelli S, Bartali B, Corsi A, Lauretani F, Martin A, Andres-Lacueva C, Senin U, Guralnik JM. Relationship of plasma polyunsaturated fatty acids to circulating inflammatory markers. J Clin Endocrinol Metab. 2006 Feb; 91(2):439-46.
- Hardy H, Harris J, Lyon E, Beal J, Foey AD. Probiotics, prebiotics and immunomodulation of gut mucosal defenses: homeostasis and immunopathology. Nutrients. 2013 May 29; 5(6):1869-912.
- Fernández, J., de la Fuente, V.G., García, M.T.F. et al. A diet based on cured acorn-fed ham with oleic acid content promotes anti-inflammatory gut microbiota and prevents ulcerative colitis in an animal model.Lipids Health Dis19, 28 (2020).
- Levine, A., Rhodes, J. M., Lindsay, J. O., Abreu, M. T., Kamm, M. A., Gibson, P. R., Gasche, C., Silverberg, M. S., Mahadevan, U., Boneh, R. S., Wine, E., Damas, O. M., Syme, G., Trakman, G. L., Yao, C. K., Stockhamer, S., Hammami, M. B., Garces, L. C., Rogler, G., Koutroubakis, I. E., … Lewis, J. D. (2020). Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 18(6), 1381–1392.
- Conley, S., Proctor, D. D., Jeon, S., Sandler, R. S., & Redeker, N. S. (2017). Symptom clusters in adults with inflammatory bowel disease. Research in nursing & health, 40(5), 424–434. https://doi.org/10.1002/nur.21813
- Morton, H., Pedley, K. C., Stewart, R., & Coad, J. (2020). Inflammatory Bowel Disease: Are Symptoms and Diet Linked?. Nutrients, 12(10), 2975.
- Matarese et al. “The Healthcare Professional’s Guide to Gastrointestinal Nutrition” (2014) Scaldaferri, F., Pizzoferrato, M., Lopetuso, L. R., Musca, T., Ingravalle, F., Sicignano, L. L., Mentella, M., Miggiano, G., Mele, M. C., Gaetani, E., Graziani, C., Petito, V., Cammarota, G., Marzetti, E., Martone, A., Landi, F., & Gasbarrini, A. (2017). Nutrition and IBD: Malnutrition and/or Sarcopenia? A Practical Guide. Gastroenterology research and practice, 2017, 8646495. https://doi.org/10.1155/2017/8646495Download .nbib