Although diet alone does not cause or treat IBD, there are foods that commonly exacerbate symptoms—and there are foods that may actually help reduce inflammation, heal the intestinal lining, and more.
The majority of people who have been diagnosed with Inflammatory Bowel Disease (IBD) have tried modifying their diet to lessen the symptoms of IBD or maintain remission.
This article takes a look at several key functional foods that researchers have examined in the study of managing IBD through diet. In many cases, success stories about treating IBD through diet are anecdotal. Here, we examine the body of scientific evidence for (and against) the use of functional foods like turmeric, fish oil, and probiotics for IBD symptom management.
1. Curcumin for IBD
At times, a gastroenterologist (GI) will prescribe curcumin supplements along with conventional IBD medications (corticosteriods, anti-TNF therapies, etc).
Curcumin is the active ingredient found in turmeric. Turmeric has been used in Ayurvedic medicine for thousands of years in managing inflammatory conditions. Although we commonly find turmeric in loose, powder form, as a supplement, curcumin generally takes the form of powder-filled capsules.
Can curcumin treat IBD? There’s evidence to suggest that curcumin can help patients manage IBD symptoms by helping them maintain remission. A 2018 scientific review on nutraceutical supplements for Crohn’s and colitis pointed to a study in which 82 participants with ulcerative colitis took 2 grams of curcumin per day. The study found that, when accompanying the patients’ standard IBD therapy (such as sulfasalazine and mesalamine), curcumin supplements significantly reduced relapse rates.
The authors of the review also pointed to several other reviews with similar conclusions: that curcumin may be an effective, safe therapy for maintaining remission, alongside standard therapy.
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2. Probiotics for IBD
Because some bodies of research suggest that IBD may be caused or aggravated by alterations in the intestinal microbiota, many patients and physicians have looked to probiotics for treating IBD symptoms. Most people are familiar with probiotics, with Greek yogurt being a widely recognized source of living bacteria cultures. In the medical use of probiotics for IBD, however, most studies examine the effects of one strain or a formula of probiotic strains delivered in capsule form.
There’s mounting evidence showing that probiotics, defined as live microorganisms that confer a benefit on their host, can treat or prevent conditions ranging from cancer to infections and even allergies. Hundreds of studies have examined the complex interactions between microorganisms (probiotics, prebiotics, synbiotics, etc) and human health, and a complete breakdown of all of these microbiota is beyond the scope of this article.
When using probiotics to treat IBD, the aim is to alter the microflora of the intestines to a more favorable composition of organisms with anti-inflammatory and gut healing properties. Research indicates that probiotics may also decrease intestinal permeability, regulate proinflammatory mechanisms, and dampen autoimmune responses—all of which are desirable outcomes in the treatment of IBD.
Even so, determining the actual effects of probiotic supplements in IBD has proven difficult. Although several clinical trials have examined the use of probiotics in the maintenance of remission in IBD, results have been inconsistent.
One of the main reasons why it’s difficult to generalize about the benefits of probiotics for treating IBD is that the subject includes numerous strains, all of which have a different effect on the gut microbiota. For example, some studies have found the strains E. coli Nissle 1917, E. coli, Lactobacillus GG and Probio-Tec AB-25 to be effective in maintaining UC remission. In fact, several studies have observed E coli Nissle 1917 to be equally as effective as mesalamine in inducing UC remission. At the same time, a Cochrane study found no difference between probiotics and the conventional mesalazine for UC remission and further concluded that probiotics for maintaining remission in Crohn’s disease was unfavorable.
Likewise, while two analyses determined that strains Lactobacillus GG and Lactobacillus johnsonii LA1 couldn’t prevent relapse in Crohn’s patients, studies on the probiotic formula VSL#3 (containing various strains of Lactobacilli, Bifidobacteria, and Streptococcus) showed an 85% decrease in UC relapse rates.
Although the evidence isn’t conclusive, in the majority of cases probiotic supplementation is not found to be harmful, and it appears that certain strains may confer anti-inflammatory and intestinal healing benefits.
3. Fish Oil for IBD
Fish oil is a source of omega-3 polyunsaturated fatty acids. Humans do not produce essential fatty acids in our bodies. Therefore, they must be acquired through diet. As a source of omega-3, fish oil and has been shown to suppressing T cell signaling, which sets off a chain reaction that reduces the production of proinflammatory cytokines and, overall, decreases inflammation.
Studies on fish oil and IBD in general have demonstrated that fish oil can be helpful in maintaining remission, but it’s not considered a stand-alone treatment.
A handful of smaller studies showed positive results in the treatment of UC with fish oil, with one study noting that patients taking a fish oil supplement could reduce their prednisone dose more quickly than participants not taking fish oil. A recent meta-analysis from the Cochrane Collaboration looked at the various studies on fish oil supplements Crohn’s disease remission. Examining data from over 1000 participants, the researchers concluded that the group taking omega-3 supplements experienced a marginal benefit when compared to the placebo group. They also noted that the efficacy of fish oil was enhanced when combined with mesalamine therapy.
It’s important to note that fish oil likely holds the greatest benefit for IBD patients who already experience a fatty acid deficiency due to nutrient loss, in which case a fish oil supplement is might be recommended as part of a generally nutritious IBD diet. However, before buying a bottle of a fish oil supplements, speak to a GI or nutritionist as fish oil formulations vary.
Healing Your Intestinal Lining
Aside from nutraceuticals and functional foods, researchers are also examining the effects of specially designed formulas for healing the gut lining. Currently, researchers are studying the effects of a protein-rich beverage called CROWN, which is designed to treat IBD symptoms by healing the intestinal lining. Click here for more information on joining the CROWN clinical trial.
Haskey, N., & Gibson, D. L. (2017). An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease. Nutrients, 9(3), 259. http://doi.org/10.3390/nu9030259
Sigall-Boneh R, Levine A, Lomer M, Wierdsma N, Allan P, Fiorino G, Gatti S, Jonkers D, Kierkuś J, Katsanos K, Melgar S, Yuksel E, Whelan K, Wine E, Gerasimidis K. (2017) Research Gaps in Diet and Nutrition in Inflammatory Bowel Disease. Journal of Crohn's and Colitis, 11(12), 1407–1419, https://doi.org/10.1093/ecco-jcc/jjx109
Parian A, Limketkai B, Shah N, Mullin G. (2018) Nutraceutical Supplements for Inflammatory Bowel Disease. Nutrition in Clinical Practice. 30(4); 551-558. DOI: 10.1177/0884533615586598
Reid, G., Jass, J., Sebulsky, M. T., & McCormick, J. K. (2003). Potential Uses of Probiotics in Clinical Practice. Clinical Microbiology Reviews, 16(4), 658–672. http://doi.org/10.1128/CMR.16.4.658-672.2003