Role of nutrition and probiotics in the management of inflammatory bowel disease and irritable bowel syndrome

During the annual conference of the Dutch Dairy Association, 28 March 2019, a number of experts discussed gut health. One of the speakers, Ben Witteman, a gastroenterologist at the ‘Gelderse Vallei’ hospital in Ede, the Netherlands, considered the role of nutrition and probiotics in the management of inflammatory bowel disease (Crohn’s disease and ulcerative colitis) and irritable bowel syndrome. This article summarizes the highlights of his presentation.

Inflammatory bowel disease (IBD) is characterized by inflammation that occurs throughout the entire digestive tract (Crohn’s disease) or only in the large intestine in the case of ulcerative colitis (1). By contrast in irritable bowel syndrome (IBS), inflammation is not present and it is characterized by dysfunction of the gut. The nerves in the gut are more sensitive, resulting in too many or too few bowel movements leading to abdominal and bowel discomfort (1).

Role of nutrition according to patients

A study conducted at the Gelderse Vallei hospital investigated the perceptions of approximately 300 patients with IBD on the role of nutrition in the management of their symptoms (2). Results showed that patients viewed the diet as an important way to control symptoms. 62% of the patients were successful in controlling abdominal complaints by changing their diet, and 59% found adaptations to their diet as effective as medication (2). Most patients preferred to avoid certain foods (77%) rather than eating more of the beneficial foods (57%) or following a specific diet plan (48%). Supplements were used by 68% of patients with IBD. Finally, the study showed that for the majority of patients (81%) the main source of their nutrition knowledge was based on their own information and experiences instead of via a dietitian (2).

Nutrition and lifestyle advice for patients with IBD

The general advice for patients with IBD is to eat a healthy diet based on national nutritional guidelines. In addition to this, Ben Witteman provided some further tips for patients to try out:

• Replace processed foods or fast food with healthy, minimally processed foods and vegetables
• Eat less red meat, replace this with vegetarian alternatives and fish
• Replace butter with oil
• If the diet is low in fibre try a fibre-rich diet
• Using the low-FODMAP diet (under the supervision of an appropriately trained dietitian)
• Replace fruit juice with green tea or tomato juice
• Instead of confectionary eat more fruit, nuts or dried fruit
• Replace milk products with fermented milk products
• Quit smoking, try to be more physically active and spend time outdoors

Use of probiotics

Probiotics may have a positive effect on the gut microbiome which is mostly present in the large intestine, and to a lesser extent in the small intestine and stomach. The composition of this microbiome differs strongly from person to person, and is influenced by different factors such as nutrition, physical activity, aging and disease. Additionally, antibiotics, birth method (cesarean section or natural birth) and breastfeeding also influence the gut microbiome.

A systematic review from 2014 showed a positive effect for the use of probiotics in the management of ulcerative colitis (3). Furthermore, the review showed no evidence for the use of probiotics in Crohn’s disease although the results of studies were contradictory (3).

However, an earlier systematic review (2013) which assessed the effect of probiotics in IBS found evidence that in some patients, probiotics resulted in a reduction of general symptoms and abdominal pain (4). The conclusion that specific probiotics can be beneficial was confirmed in an updated review in 2018 (5).

According to Ben Witteman, the effects of probiotics differ from person to person and their use is not harmful. Probiotics are usually not necessary if the disease is already in remission.   

Referenties

1. Maag Lever Darm Stichting, 2019. Retrieved from: www.mlds.nl
2. De Vries, J. H., Dijkhuizen, M., Tap, P., & Witteman, B. J. (2019). Patient’s Dietary Beliefs and Behaviours in Inflammatory Bowel Disease. Digestive Diseases, 37(2), 131-139.
3. Ghouri, Y. A., Richards, D. M., Rahimi, E. F., Krill, J. T., Jelinek, K. A., & DuPont, A. W. (2014). Systematic review of randomized controlled trials of probiotics, prebiotics, and synbiotics in inflammatory bowel disease. Clinical and experimental gastroenterology, 7, 473.
4. Hungin, A. P. S., Mulligan, C., Pot, B., Whorwell, P., Agréus, L., Fracasso, P., … & Winchester, C. (2013). Systematic review: probiotics in the management of lower gastrointestinal symptoms in clinical practice–an evidence‐based international guide. Alimentary pharmacology & therapeutics, 38(8), 864-886.
5. Hungin, A. P. S., Mitchell, C. R., Whorwell, P., Mulligan, C., Cole, O., Agréus, L., … & Seifert, B. (2018). Systematic review: probiotics in the management of lower gastrointestinal symptoms–an updated evidence‐based international consensus. Alimentary pharmacology & therapeutics, 47(8), 1054-1070.