The Modification of the Gut Microbiota via Selected Specific Diets in Patients with Crohn's Disease

Abstract

Gastrointestinal symptoms in Crohn's disease (CD) are common and affect the quality of life of patients; consequently, a growing number of studies have been published on diet interventions in this group. The role of the gut microbiota in the pathogenesis and the progression of inflammatory bowel diseases (IBD), including CD, has been widely discussed. Mainly, a decreased abundance of Firmicutes, species of the Bifidobacterium genus, and the Faecalibacterium prausnitzii species as well as a reduced general diversity have been described. In this review article, we summarize available data on the influence of reduction diets on the microbiome of patients with CD. One of the most frequently used elimination diets in CD patients is the low-FODMAP (Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols) diet. Although many papers show it may reduce abdominal pain, diarrhea, or bloating, it also reduces the intake of prebiotic substances, which can negatively affect the gut microbiota composition, decreasing the abundance of Bifidobacterium species and Faecalibacterium prausnitzii. Other elimination diets used by IBD patients, such as lactose-free or gluten-free diets, have also been shown to disturb the microbial diversity. On the other hand, CDED (Crohn's disease exclusion diet) with partial enteral nutrition not only induces the remission of CD but also has a positive influence on the microbiota. The impact of diet interventions on the microbiota and, potentially, on the future course of the disease should be considered when nutritional guidelines for IBD patients are designed. Dietetic recommendations should be based not only on the regulation of the symptoms but also on the long-term development of the disease.

Keywords: Crohn’s disease; elimination diets; microbiome.

Figure 1

Gut microbial imbalance and development of CD.

Figure 2

Relationship between diet and microbiome, its function, and intestinal barrier condition. Each of the indicated types of nutrition interacts with the microbiota in a characteristic way. IL-10—interleukin 10, CDED—Crohn disease exclusion diet, TNF-α–tumor necrosis factor. SCFA: Short-chain fatty acids; FODMAP: Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols.