Fiber, family history, and your gut bacteria- the perfect storm for Inflammatory Bowel Disease
Symptoms of Inflammatory Bowel Disease (IBD) including abdominal pain, diarrhea, and weight loss are more profound than those with Irritable Bowel Syndrome (IBS). They can be debilitating and disruptive to those dealing with it and their caregivers. There’s a genetic component to IBD but the condition doesn’t necessarily develop in everyone that has it. Crohn’s disease and ulcerative colitis are collectively known as IBD and their environmental triggers are yet to be discovered.
A recent study conducted at the University of Michigan has discovered a complex association between diet, family history, and the gut microbiota that may shed light on the development of IBD.
The study was led by the labs of Eric Martens, Ph.D. and Mahesh Desai, Ph.D. and first authors Gabriel Pereira, Ph.D., Marie Boudaud, Ph.D. and their colleagues and follows past research that indicates that a diet low in fiber led to the development of mucin degrading bacteria- the type which survive by destroying the mucosal lining of the intestine.
Genes and IBD
As mentioned above, IBD has a genetic component. A loss of a protein that impacts the immune system, known as cytokine interleukin-10 (IL-10) or its receptor may result in early-onset IBD in infants and children. The new research was to evaluate the genetic association using mice with the same immune alteration.
Some of the mice developed intestinal inflammation on their own, although the severity level varied and seemed to worsen due to certain bacteria and a low-fiber diet. Mice bred to lack bacteria did not show signs or symptoms of disease.
The team discovered that inflammation could be turned up or down by changing the absence or presence of a human model of the gut microbiome and fiber content of their mouse models. Inflammation spurred by a low-fiber diet seemed to increase due to the higher level of mucin-degrading bacteria Akkermansia mucinphila and Bacteroides caccae.
According to Martens, professor of microbiology and immunology at U-M Medical School. "These bacteria start foraging on the mucus layer for nutrients, reducing its thickness and barrier function and brings microbes just 10-100 microns closer to the host tissue. That was enough in the context of the mice with IBD genetics to make them sick,".
Diet Impact
Providing the mice with a high-fiber diet prevented the development of inflammation. Returning mice given a low-fiber to high-fiber diet resulted in a spike in inflammation and then a decrease. This suggests that fiber may reverse the negative impact of mucus erosion on inflammation. However, children with IBD are often fed exclusively with enteral nutrition, which has no fiber. This type of diet does aid in reducing inflammation despite the lack of fiber.
Exclusive enteral nutrition (EEN) was dried out and given to the mice with IBD genetics to test inflammation. Mice experienced different inflammation levels after the diet administration with some showing less inflammation than mice given the fiber-free diet. EEN reduced mucus thickness.
Increased levels of isobutyrate, a single branched-chain fatty acid were higher in EEN-fed mice and could reduce inflammation. Fermentation of some bacteria in the gut produces isobutyrate. Martens notes, "It seems one of the ways these exclusive enteral nutrition diets could work in people is by triggering certain bacteria to make beneficial metabolites."
Pereira states, “Our findings suggest a potential new path for treating IBD. By tailoring specific dietary interventions to influence gut microbiome function, we may be able to manipulate these bacterial communities to alleviate inflammation.". The team will further investigate how diet and bacteria influence each other to improve therapies for pediatric IBD and how to possibly prevent or reverse the start of these conditions by altering environmental triggers.
Below are tips for your clients with IBD:
· Treat IBD patients individually. What works for one won’t work for all.
· Keep a food diary to discover which foods trigger symptoms.
· Cut back on ultra-processed foods such as snacks and desserts. These are linked with higher chances of developing IBD. 2
· Reduce intake of high-fat, greasy foods which are harder to digest.
· Limit processed red meat, which may be detrimental to the health of your large bowel.3
· Include easy-to-digest grains and starches such as rice, potatoes, and pasta.
· Choose cooked vegetables over raw during an IBD flare. Gassy vegetables from the cabbage family including broccoli, cauliflower, cabbage, and kale may worsen symptoms.
· Take medications as prescribed.
· Consider the use of probiotics. Research supports those that contain Bifidobacterium spp 4
· Work with a registered dietitian to gradually add high-fiber foods back to your diet after a flare.
Lisa Andrews, MEd, RD, LD
References:
Gabriel Vasconcelos Pereira, Marie Boudaud, Mathis Wolter, Celeste Alexander, Alessandro De Sciscio, Erica T. Grant, Bruno Caetano Trindade, Nicholas A. Pudlo, Shaleni Singh, Austin Campbell, Mengrou Shan, Li Zhang, Qinnan Yang, Stéphanie Willieme, Kwi Kim, Trisha Denike-Duval, Jaime Fuentes, André Bleich, Thomas M. Schmidt, Lucy Kennedy, Costas A. Lyssiotis, Grace Y. Chen, Kathryn A. Eaton, Mahesh S. Desai, Eric C. Martens. Opposing diet, microbiome, and metabolite mechanisms regulate inflammatory bowel disease in a genetically
Cell Host & Microbe, 2024; DOI: 10.1016/j.chom.2024.03.001