Inflammatory Bowel Disease and Customized Nutritional Intervention Focusing on Gut Microbiome Balance

Abstract

Inflammatory bowel disease (IBD) represents a chronic relapsing-remitting condition affecting the gastrointestinal system. The specific triggering IBD elements remain unknown: genetic variability, environmental factors, and alterations in the host immune system seem to be involved. An unbalanced diet and subsequent gut dysbiosis are risk factors, too. This review focuses on the description of the impact of pro- and anti-inflammatory food components on IBD, the role of different selected regimes (such as Crohn's Disease Exclusion Diet, Immunoglobulin Exclusion Diet, Specific Carbohydrate Diet, LOFFLEX Diet, Low FODMAPs Diet, Mediterranean Diet) in the IBD management, and their effects on the gut microbiota (GM) composition and balance. The purpose is to investigate the potential positive action on IBD inflammation, which is associated with the exclusion or addition of certain foods or nutrients, to more consciously customize the nutritional intervention, taking also into account GM fluctuations during both disease flare-up and remission.

Keywords: diet; food; inflammation; inflammatory bowel disease; microbiome; microbiota; nutrition.

Figure 1

Diet plays a critical role in intestinal homeostasis, which is defined by the gut microbiota, intestinal mucosal barrier, and mucosal immune system. Diet directly modulates the mucosal barrier and immunity, whereas diet–microbiota interaction also regulates intestinal homeostasis. The up arrow indicates an increase while the down arrow indicates a decrease.

Figure 2

Potential therapeutic indications for specific diets based on disease severity. NP: parenteral nutrition; NE: enteral nutrition; CDED: Crohn’s Disease Exclusion Diet, IGED: Immunoglobulin Exclusion Diet; SCD: Specific Carbohydrate Diet; LOFFLEX: Low-Fat Fiber Limited Exclusion; MD: Mediterranean Diet.