Current Nutrition Research And Crohn's Disease

Many people are hopeful that nutrition may play a role not only in treating but also in preventing IBD. There are several areas of research that hold this promise.

 

 

Synbiotics refers to both prebiotics and probiotics, which contribute to maintaining the health of the intestinal bacteria and keep a sufficient number of 'good' bacteria in the intestine.

 

Bacteria in the intestinal tract are important factors in maintaining an appropriate balance within the body's immune system. The inflammatory response is actually a natural protective mechanism, but can be damaging if it is overactive or uncontrolled. It is thought that some of the 'good' bacteria normally present in the intestine contribute to maintaining the appropriate balance of the immune response.

 

There are food sources of both prebiotics and probiotics, but how much and how often you should eat these foods to experience benefits is not known.

 

 

Prebiotics are non-digestible carbohydrates that are fermented by colonic bacteria. The process of fermentation provides energy for the growth of 'good' bacteria, which, in turn, produce short-chain fatty acids, which are a fuel source for the cells lining the large intestine. Prebiotics also promote water and electrolyte reabsorption.

 

Prebiotics known as fructo-oligosaccharides (FOS) can be found in everyday foods, such as onions, bananas, tomatoes, honey, garlic, barley, and wheat. Some nutrition companies are adding these prebiotics to their food supplements in drinks and puddings.

 

 

Probiotics are any number of different 'good' bacteria that are administered by mouth, in a capsule or in a drink or food. The bacteria then establish themselves and grow within the intestine, a process called colonization. They are thought to provide immune system balance by down-regulating inflammation.

 

Probiotics are most easily found in yogurts, where active or live bacterial cultures have been added. Unfortunately, there is no standardization regarding the bacterial strains or amount of bacterial colony forming units (CFUs) added. Similarly, the amount of remaining live bacteria when you consume the product will be affected by the processing, transport, and storage conditions. Live bacteria need to be kept in a refrigerated environment. Probiotics must also arrive alive in the gut, so they must be acid- and bile-resistant.

 

Examples of probiotic species include Lactobacillus acidophilus and Bifidobacterium. When buying yogurt, look for those that "contain" active cultures as compared with those that are "made with" active cultures to be sure you're getting as much of the live bacteria as possible.

 

 

This rapidly expanding area of nutrition is of interest wherever there is an inflammatory component to disease (for example, arthritis, cardiovascular disease, IBD). Immunonutrition involves modulating the inflammatory response through diet. The type of fat we eat is directly related to the fat that makes up our cells, which influences a cell's ability to produce eicosanoids and cytokines. These are hormone-like compounds that affect the body's immune response to injury and infection. By eating more anti-inflammatory fats, we can directly influence production of these anti-inflammatory mediators.

 

There are a few different kinds of dietary fats, including trans fats, saturated fats, monounsaturated fats, and the essential polyunsaturated fats (omega-3 and omega-6). Two important omega-3 fatty acids are eicosapentanoic acid (EPA) and docosahexaenoic acid (DHA).

 

 

The optimal amount of omega-3 in the diet has not been defined in IBD. In cardiovascular disease, the optimal intake has been defined at 1000 mg EPA plus DHA per day. For the general public, some recommendations in the medical literature suggest an intake of 400 to 500 mg per day as being optimal.

 

To put this in perspective, one omega-3 egg has roughly 5 mg EPA and 75 mg DHA. Omega-3 milk has roughly 15 mg DHA per 250 ml (one cup). Some of these products have added costs, so be sure to read the label to determine if the additional omega-3 is significant enough to add to your daily totals.

 

 

The area of antioxidants and IBD looks promising, but studies are still at a biochemical level and cannot yet be translated to specific recommendations for people. Antioxidants include vitamin E, vitamin C, carotenoids, glutathione, and selenium.

 

 

There is also a so-called low microparticle diet being studied for relief of symptoms in Crohn's disease. This diet involves avoiding inert inorganic non-nutrient microparticles. There are natural contaminants, such as soil and dust, as well as food additives, such as aluminosilicates and titanium dioxide used as brightening agents or anti-caking agents. The diet also focuses on avoiding processed foods, such as processed meats and processed cheese, or anything that could have soil residue. There is not yet strong evidence to support its use in clinical practice.

 

 

Trophic (growth or anabolic) factors, such as glutamine, have also generated interest. Glutamine is an amino acid (building block of protein), which the body can make on its own. During times of stress, it is considered 'conditionally essential' because the body cannot produce enough for the demand. Because it is a fuel source for intestinal mucosa and immune cells, glutamine has been proposed to help with Crohn's disease and short bowel syndrome, but research has not demonstrated any benefit to date. There are limited human studies, and stability is an issue with some supplement forms of glutamine.