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Nutrition Support in Inflammatory Bowel Disease

What is Inflammatory Bowel Disease (IBD)?

About 1 million people in the US suffer from IBD (which is different than the more common irritable bowel syndrome). Most new cases of IBD develop in people 15 to 25 years of age, but it can occur in older adults too. There are two different forms of IBD: Crohn's disease and ulcerative colitis. Both cause inflammation in the bowel, but they often affect different parts of the bowel and to a different degree.

Many experts believe that IBD is an autoimmune disease, with genetic, immune and environmental factors all likely to be involved.

In terms of dietary supplements, a daily multi-nutrient is often recommended because IBD patients can have difficulty absorbing nutrients from their diet. Also, ‘multis’ usually contain folic acid, and one of the medications (sulfasalazine) used to treat IBD, can reduce absorption of this B-vitamin in the intestine. Other dietary supplements have been investigated in IBD, and several have shown some initial promise.

Vitamin D May Help Stave Off Relapse

In those with IBD, symptoms (diarrhea, abdominal pain and weight loss) come and go in a pattern of relapse and remission. Patients with IBD often experience long periods without symptoms, but then get acute attacks that can last from several weeks to months. The anti-inflammatory activity of vitamin D led researchers to examine its effect on the rate of remission in IBD patients.

In this study, patients with Crohn’s who were in remission received 1200 IU vitamin D or placebo daily for 12 months (1). Those taking vitamin D had a lower rate of relapse: Only 13% of those in the vitamin D group relapsed compared with the 29% in the placebo group. According to the researchers, a larger trial is needed to confirm that vitamin D can make a significant difference in holding off relapse.

Can Omega-3s Help Calm Inflammation?

Fish oils have been studied for IBD in clinical trials, but results haven’t always been consistent. One trial reported that taking 2.7 grams of omega-3s for 12 months can reduce rate of relapse in Crohn's disease patients who are in remission (2), while another clinical study failed to show a difference in relapse rate (3).

In ulcerative colitis patients, preliminary clinical research suggests that taking fish oil along with soluble fiber and antioxidant vitamins C and E might reduce the need for corticosteroids (4), a medication that is sometimes given in moderate and severe disease.

Probiotics May Be an Adjunct to Medications

Supplements of “friendly” bacteria are often used to help re-colonize the GI tract in patients who are given certain antibiotics. But in addition to helping restore normal bacteria, probiotics might also work to modulate the immune system.

A probiotic mixture of several species of Bifidobacteria, Lactobacillus, and Streptococcus, has been studied in people with IBD. One trial reports this probiotic combination helped keep pathogenic bacteria in check and reduced relapse in ulcerative colitis patients intolerant to 5-aminosalicylic acid (5-ASA) (5) – a drug often used to treat mild disease. Other clinical evidence suggests adding a probiotic may help some patients with active mild-to-moderate ulcerative colitis who don't respond adequately to conventional treatment alone (6).

Finally, if you have IBD, it’s always best to work with your physician in deciding whether and when to try a dietary supplement for nutritional support.

References

1. Jorgensen SP, et al. Clinical trial: Vitamin D3 treatment in Crohn’s disease – a randomized double-blind placebo-controlled study. Aliment Pharmacol Ther 32:377-83, 2010.
2. Belluzzi A, Brignola C, Campieri M, et al. Effect of an enteric-coated fish-oil preparation on relapses in Crohn's disease. N Engl J Med 334:1557-60, 1996.
3. Feagan BG, et al. Omega-3 free fatty acids for the maintenance of remission in Crohn disease: the EPIC Randomized Controlled Trials. JAMA 299:1690-7, 2008.
4. Seidner DL, et al. An oral supplement enriched with fish oil, soluble fiber, and antioxidants for corticosteroid sparing in ulcerative colitis: a randomized, controlled trial.Clin Gastroenerol Hepatol 3:358-69, 2005.
5. Venturi A, et al. Impact on the composition of the faecal flora by a new probiotic preparation: preliminary data on maintenance treatment of patients with ulcerative colitis. Aliment Pharmacol Ther 13:1103-8, 1999.
6. Bibiloni R, et al. VSL#3 probiotic-mixture induces remission in patients with active ulcerative colitis. Am J Gastroenterol 100:1539-46, 2005.