New IBD Research Summary

A case-control study of nutrient, fibre and FODMAP intakes of people with IBD and their food-related quality of life, depending on disease status

BACKGROUND - What we know already?

  • Having IBD has a psycho-social impact on our relationship with food, which includes seeing food as enjoyment. People with IBD are also known to be at risk of micronutrient deficiencies and can be malnourished

  • Certain foods are thought to trigger symptoms in around 60% of people with IBD. Around 1/3 of people with IBD still experience gut symptoms in the absence of any inflammation (also known as IBS)

  • FODMAPS (highly fermentable carbohydrates) which include onion, garlic, lactose and wheat have been linked to some IBS symptoms due to their rapid fermentation in the upper gut, causing water to be drawn into the gut, distending the bowel and causing pain in some people

  • 2 small previous studies showed a lower level of nutrient and FODMAP intake in people with IBD, but did not differentiate between disease state or take into account that this could be due to a lower overall food intake.

THIS STUDY - What did they do?

  • 232 people with IBD were asked to complete a 7 day food diary and a food-quality of life survey. The participants were split into the following 4 groups depending on their disease status:

    • Active IBD

    • Non-active IBD but with GI symptoms

    • Non-active IBD

    • Healthy controls

  • The participants food diaries were analysed for nutrient and FODMAP intake and then adjusted for energy intake, to make sure that any lower nutrient levels were not caused by people with IBD eating less food. The results of the different groups were then compared to each other.

THIS STUDY - What did they find?

  • People with active IBD consumed significantly less fibre, FODMAPS and fructans than the healthy controls.

  • People with active IBD also had a significantly lower intake of nutrients including iron, folate, vitamin C and magnesium than the healthy control group.

  • People with in-active IBD but with GI symptoms also had a significantly lower intake of iron, folate, vitamin C and magnesium than the healthy control group.

  • All people with IBD irrelevant of symptoms and disease status consumed significantly less fibre (around 4.5 - 5.8g /day) than the healthy control group and had a significantly lower food-quality of life score.

  • People with non-active IBD only had significantly lower intake of magnesium than the control group.

What does this mean?

  • People with active IBD and in-active IBD with GI symptoms are restricting their diets, which is resulting in a lower consumption of fibre, FODMAPS and micronutrients such as Iron and Vitamin C.

  • Further research would need to be done to understand why IBD patients are making these changes, but it may that they are eliminating ingredients that they believe are causing GI issues.

  • Some studies have linked lower levels of fibre intake with worse disease outcomes in IBD, and lower levels of nutrients are linked to many adverse health conditions and reduced wellbeing.

  • This study highlights the importance of working with a nutritionist or dietician when implementing diet changes, as they can support you to ensure you are still getting all the nutrients you require.

If you would like help and support with your IBD and what dietary and lifestyle changes would be appropriate for you, please get in touch with me. You can book a free call, where I can get to know you, your journey, your struggles, your life, and we can chat about the best route forward for you. You can also ask any questions you have about working with me.

Reference

Selina R Cox, Hazel Clarke, Majella O’Keeffe, Patrick Dubois, Peter M Irving, James O Lindsay, Kevin Whelan, Nutrient, Fibre, and FODMAP Intakes and Food-related Quality of Life in Patients with Inflammatory Bowel Disease, and Their Relationship with Gastrointestinal Symptoms of Differing Aetiologies, Journal of Crohn's and Colitis, Volume 15, Issue 12, December 2021, Pages 2041–2053, https://doi.org/10.1093/ecco-jcc/jjab116

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We are all wonderfully unique and what works for one person may not work for another so please seek help and advice before changing your diet to work out the right way forward for you.

Clemmie Macpherson