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Pradeep Yarra   Citation: Milajerdi A, Ebrahimi-Daryani N, Dieleman LA, Larijani B, Esmaillzadeh A. Association of Dietary Fiber, Fruit, and Vegetable Consumption with Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis [published online ahead of print, 2020 Nov 13]. Adv Nutr. 2020;nmaa145. doi:10.1093/advances/nmaa145                                            Question 1:   Why is this study important? In IBD patients, intake of dietary fiber, vegetables and fruits had been center of multiple studies to quantify effect of diet on IBD patients. Differences in explanation or effect was related to multiple pathophysiological mechanisms of IBD disease. This study summarizes findings from published cohort studies on the association between dietary fiber, fruit, and vegetable consumption and risk of IBD. It only included prospective studies, completely controlling bias associated with case-control or cross-sectional studies.Identify one key finding of this study and describe how it relates to nutritional sciencesA significant inverse association between fruit and vegetable consumption and risk of UC (Ulcerative Colitis), CD (Crohn Disease), and IBD. In addition, a significant inverse association was found between dietary fiber intake and risk of CD and IBD. However, there was no significant association between dietary fiber intake and risk of UC in the current metanalysis.What are the clinical implications of this study? Clinical implication is it addresses most common questions asked when we interact with IBD patients, either UC or CD. Eating vegetables and fruits is excellent. Dietary fiber intake is preferred in CD to reduce risk but not in UC. 

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Pradeep Yarra   Citation: Milajerdi A, Ebrahimi-Daryani N, Dieleman LA, Larijani B, Esmaillzadeh A. Association of Dietary Fiber, Fruit, and Vegetable Consumption with Risk of Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis [published online ahead of print, 2020 Nov 13]. Adv Nutr. 2020;nmaa145. doi:10.1093/advances/nmaa145                                            Question 1:   Why is this study important? In IBD patients, intake of dietary fiber, vegetables and fruits had been center of multiple studies to quantify effect of diet on IBD patients. Differences in explanation or effect was related to multiple pathophysiological mechanisms of IBD disease. This study summarizes findings from published cohort studies on the association between dietary fiber, fruit, and vegetable consumption and risk of IBD. It only included prospective studies, completely controlling bias associated with case-control or cross-sectional studies.Identify one key finding of this study and describe how it relates to nutritional sciencesA significant inverse association between fruit and vegetable consumption and risk of UC (Ulcerative Colitis), CD (Crohn Disease), and IBD. In addition, a significant inverse association was found between dietary fiber intake and risk of CD and IBD. However, there was no significant association between dietary fiber intake and risk of UC in the current metanalysis.What are the clinical implications of this study? Clinical implication is it addresses most common questions asked when we interact with IBD patients, either UC or CD. Eating vegetables and fruits is excellent. Dietary fiber intake is preferred in CD to reduce risk but not in UC. 

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Valentini, Luzia, Schaper, Lennart, M.D, Buning, Carsten, M.D, Hengstermann, Susanne, Koernicke, Thomas, M.D, Tillinger, Wolfgang, M.D, . . . Lochs, Herbert, M.D. (2008). Malnutrition and impaired muscle strength in patients with Crohn's disease and ulcerative colitis in remission. Nutrition
(Burbank, Los Angeles County, Calif.),24(7), 694-702.

This is an important study because it assesses the nutrition status of patients with Crohn’s disease (CD) and ulcerative colitis (UC) in remission by a variety of methods, such as body mass index, handgrip strength, and body composition analysis. Interestingly, the patients fell in a well-nourished category by using some methods and in a malnourished category by using other methods.

A key finding was that it is critical to apply several nutrition assessment methods when conducting a malnutrition screening in patients with CD and UC in remission. The rationale behind the importance of applying several nutrition assessment methods in those patients is that some methods may place those patients under a well-nourished category, such as body mass index while others place those patients under a malnourished category, such as handgrip strength.

The study’s clinical nutrition implication is that it is crucial to consider biochemical parameters, body composition, food intake, muscle strength and other methods when assessing the nutritional status of patients with CD and UC remission phase.

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Lucendo AJ, De Rezende LC. Importance of nutrition in inflammatory bowel disease. World J Gastroenterol. 2009 May 7;15(17):2081-8. doi: 10.3748/wjg.15.2081. PMID: 19418580; PMCID: PMC2678578.

This study is important because it focuses on the specific management of IBD with dietary measures, and discusses how diet has an impact on IBD. A key finding relating to nutrition is the concept that unless the location of the damage is not amenable or there is perforation, enteral feeding is highly preferred to parenteral feeding. Older studies referenced have shown that enteral feedings with basic formulas can assist in achieving remission rates similar to steroid bursts, and assist in postponing surgeries.
The clinical implications of this study surround the concept that maintaining adequate nutrition in patients who are in remission or in an active flare is paramount to promote healing and improving gut health. Feeding through oral or enteral intake (the number one means of nutrition in children with CD and active flares) is thought to help restore or maintain gut flora and prevent further dysbiosis or overgrowth

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Roncoroni L, Bascuñán KA, Doneda L, Scricciolo A, Lombardo V, Branchi F, Ferretti F, Dell'Osso B, Montanari V, Bardella MT, Elli L. A Low FODMAP Gluten-Free Diet Improves Functional Gastrointestinal Disorders and Overall Mental Health of Celiac Disease Patients: A Randomized Controlled Trial. Nutrients. 2018 Aug 4;10(8):1023. doi: 10.3390/nu10081023. Erratum in: Nutrients. 2019 Mar 06;11(3): PMID: 30081576; PMCID: PMC6115770.


This study evaluated the effects of a low FODMAP diet (LFD) on gastrointestinal and psychological symptomatology in celiac disease patients. FODMAP stands for foods that contain fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. FODMAP foods are carbohydrates that can be trigger foods because they are not well absorbed as they pass through the intestines. The bacteria in the intestines ferments FODMAP foods creating gas and other products leading to intestinal distension that can be uncomfortable especially for someone that has celiac disease. The study consisted of a total of 50 celiac disease patients on a gluten free diet that has persistent gastrointestinal symptoms were included.  Patients were allocated to two dietary groups—one on a low FODMAP gluten free diet and the other on a regular gluten free diet. They consumed these diets for 21 days straight. Gastrointestinal symptomatology and general well-being were evaluated using visual analog scale scores. For abdominal pain, the visual analog score was much lower in the low FODMAP gluten free diet treatment group as well as fecal consistency. In both groups, the general well-being increased but a higher improvement in the low FODMAP diet. Although the long term effects have not been researched, the short term effects show that a low FODMAP gluten free diet regimen helps to improve the gastrointestinal symptomology and gut improvement in celiac disease patients. Patients with celiac disease that are experiencing IBS-like symptoms should consider a low FODMAP diet in order to relieve their symptoms. 

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Citation: Qiao H, Fang D, Chen J, Sun Y, Kang C, Di L, Li J, Chen Z, Chen J, Gao Y. Orally delivered polycurcumin responsive to bacterial reduction for targeted therapy of inflammatory bowel disease. Drug Deliv. 2017 Nov;24(1):233-242. doi: 10.1080/10717544.2016.1245367. PMID: 28156160.
The study investigates how polycurcumin to enhances an oral drug efficacy in inflammatory bowel disease (IBD). The patients utilize anti-inflammatory drugs, immunosuppressants, and TNF blockers to cure their IBD. However, those medicine costs a high fee and have untoward reactions. Scientists discovered curcumin is a valuable alternative in IBD, but it limits bioavailability in the guts. Hence, Dr. Qiao's team would synthesize curcumin and hydrophilic polyethylene glycol (PGE) to improve the clinic's drug effect. They have several purposes: sufficient solubility, nano-scaled size, robustness, low cytotoxicity, transmembrane permeability, oral bioavailability, and preferential accumulation in the guts.

One primary experiment is pharmacodynamics in IBDs' animal model. First, they make use of DSS-induced (dextran sulfate sodium) mice to analog IBD. Next, they observed mice weight, colon length, histological examination, and pro-inflammatory cytokines (IL-6 and TNF-α). The results show that polycurcumin can help IBD and decrease cytokine releasing. When the patients intake curcumin-related food, they may promote the immune system in the gut. On the contrary, concentrations of curcumin cannot reach treatment. I realize that other food can corporate with curcumin to achieve maximum efficacy.

The study uses animal subjects to consider drug delivery, so other researchers consult to do human subjects to develop the medicine.

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Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn's disease and ulcerative colitis. Gastroenterology. 2013;145(5):970-977. doi:10.1053/j.gastro.2013.07.050

This is an important paper because while therapeutic options after diagnosis of IBD is an important area of research, dietary and lifestyle modifications that could decrease the risk of developing IBD could significant decrease the disease prevalence. Especially in patients with a family history of AI diseases, while genetics can’t necessarily be changed, dietary modifications that can result in a reduced risk of developing IBD can and should be recommended for high risk patients.

I think the main key finding of the study is that in patients who consumed a high fiber diet (top quintile of patient’s with an average of 24 grams a day), they were 40% less likely (HR 0.59, CI 0.39-0.90) to develop CD.  The strongest association was for fiber obtained from fruits, with an average of 6.4 grams (around 2 pieces of fruit) in the patient’s with the highest quintile of fiber intake.

The mechanisms that the authors proposed include fiber’s effect on the gut microbiome as well as the aryl hydrocarbon receptor pathway, whereby fiber in fruits and cruciferous vegetables binds to the AhR in intestinal intraepitherlial lymphocytes, protecting against environmental antigens. Prospective data can be particularly useful clinically, to help patients with risk factor modification, and two pieces of fruit a day is a very reasonable dietary modification.

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Citation: Cava, E., Collo, A., Capello, E., Mazza, F., & Riso, S. (2020, May 19). Nutritional management of celiac crisis in an elderly adult: A case report of the rare presentation of celiac disease in a 75-y-old woman. Nutrition

Volumes 79–80, November–December 2020, 110858

https://doi.org/10.1016/j.nut.2020.110858

This study relates directly to the topics of learning for this week, as it covers celiac disease. This particular article covers a rare form of celiac disease that presents in the form of a celiac crisis. It goes into depth about other symptoms and problems that can result from CD. Celiac crisis can develop from a person who has CD and has severe metabolic disturbances and diarrhea. The study relates back to how critical nutrition support is for the patient to recover from the crisis. The study directly relates to nutrition as the cure for this patient was a change in diet that had to be followed by parenteral nutrition, a form of intravenous nutrition to revive the patient of vitamins, proteins, fats, carbohydrates, etc. to recover the patient from unexpected celiac crisis. Some clinical improvements included changes diet, dietitian counseling, nutritional support adjustments, and laboratory evaluation. Improved health status, improved food tolerance, and better gastrointestinal symptoms were also noted.

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Svolos V., Hansen R., Nichols B., Quince C., Ijaz U.Z., Papadopoulou R.T., Edwards
C.A., (...), Gerasimidis K. (2019) Treatment of Active Crohn's Disease With an Ordinary Food- based Diet That Replicates Exclusive Enteral Nutrition. Gastroenterology, 156(5), 1354-1367. https://doi.org/10.1053/j.gastro.2018.12.002

1. This study is important because currently, exclusive enteral nutrition (EEN) is the established treatment for Crohn’s disease and this treatment option is not widely tolerated. Due to the fact that IBD is becoming more common, it is necessary that an alternative management plan be discovered to allow patients more freedom from their diagnosis.

2. One key finding from this article is that the food-based diet induced similar effects in comparison to EEN regarding the severity of inflammation in the ileum of the small intestine of patients. This was measured through a mean histopathology score which decreased the ileitis severity by 1.25 for EEN and 1.0 for the food-based diet. This outcome shows that not only is a food-based diet more generally accepted by patients, but it has comparable effects on inflammation caused by the disease. This is revolutionary for patients suffering from Crohn’s disease as it offers them an opportunity to begin treatment and feel more confident that they can adhere to it and maintain a nutritionally healthy lifestyle while lessening their symptoms of Crohn’s disease.

3. Exclusive enteral nutrition is a daunting treatment option, but with the ability to replicate its positive effects such as changes in microbiome and decreased gut inflammation through food-based diets, patients can easily comply and significantly reduce the symptoms of Crohn’s disease that negatively affect their every day lives.

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Hu S, Vich Vila A, Gacesa R, et al

Whole exome sequencing analyses reveal gene–microbiota interactions in the context of IBD

Gut 2021;70:285-296.

https://gut-bmj-com.ezproxy.uky.edu/content/70/2/285

This study explored the interaction between the gut microbiome and host's genetics in the pathogenesis of IBD.  Specifically they evaluated the impact of the host's genetics on the microbiome of those with IBD. To execute this study the research team combined whole exome sequencing of the host genome and whole genome shotgun sequencing of fecal samples from patients with IBD verses population-based controls. This concept is important to study because it has the possibly to lead to better treatments of the disease.

For example, one key finding of the study was that a variant in the MYRF gene found in IBD was associated with the decrease of acetyl-coenzyme A biosynthesis pathway. This pathway is important in short chain fatty acid production. This is definitely in the nutrition sciences realm.

A common and important diet recommendation for most irritable bowel diseases is a low fat diet. This makes me think "how will this influence treatment in the future?" Do we know if long-chain fatty acids are more likely to induce a IBD flare? This is a area I would love to read more about.

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Chiba M, Nakane K, Komatsu M. Westernized Diet is the Most Ubiquitous Environmental Factor in Inflammatory Bowel Disease. Perm J. 2019;23:18-107. doi:10.7812/TPP/18-107

Since IBD is not curable, patients have to live with it while maintaining remission stage as much as possible.  This study was conducted to find the key factor because clinicians need to identify the causes for right treatment.

This study describes that so many factors—smoking, animal protein, fiber, tea/coffee, vitamin D, breastfeeding, NSAID, antibiotics, oral contraceptives, vaccination, appendectomy, air pollution and hygiene—are  believed as causes of IBD, but most are not proven.  Even though genetics is the main factor, environment is the trigger which should be controlled to prevent the development of IBD.  It seems this study started with assumption of western diets as the main cause: Focusing on gut microbiota, this study simply suggest that low fiber nutrition is the cause of IBD and high fiber nutrition is the treatment of it rather than medication.

The study’s clinical implication in short is that nutrition intervention with a plant-based diet will be beneficial to UC patients if they are in mild condition.  The study concludes the westernized diets induce genetic sensitivity, so that it recommend not only to treat patients with a diet control, but also to advocate the plant-based diet to the public before people with susceptible loci are affected by dysbiosis.

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Comeche JM, Gutierrez-Hervás A, Tuells J, Altavilla C, Caballero P. Predefined Diets in Patients with Inflammatory Bowel Disease: Systematic Review and Meta-Analysis. Nutrients. 2020;13(1):52. Published 2020 Dec 26. doi:10.3390/nu13010052

Imprtance: Since there are many diet changes promoted to improve the disease activity of inflamatory bowel diseases, this article is a systematic review of diet studies to help clinicians which studies are actually worth considering as appropriate guides in advising patients.

Out of 4195 diet related scientific articles found, only 60 met 1st level criteria, and only 31 met 2nd level criteria to be included in this review. The total population studied was 5331 individuals with some form of diagnosed inflammatory bowel disease.

Key finding: All diet studies addressed some level of reduction of pro-inflammatory foods and addition of anti-inflammatory foods. Despite the facts that not all of the studies showed improvement in all measurements of disease activity and there was high variability in the diets and the tools used for measurement, this review does show support for vegetarian being beneficial for these patients.

Clinical implication: I would use this document as a good starting point for initiating diet change conversations with my patients diagnosed with inflammatory bowel diseases. We could look at the options together and, based on a patient's preferences and dedication and accepted level of change, narrow the options. It would be much easier to look at 31 studies in one document instead of over 4000 studies that would be available in a overall search.

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Li, X., You, Q., Song, Y., Shi, L., & Hu, W. (2020). Enteral nutrition for severe malnutrition Crohn's disease patient: Case report. Medicine, 99(25).

The study takes a look at nutrition and Crohn's Disease through the lens of a case study. This study is important because it uses much of the current clinical/nutritional guidelines to treat a patient undergoing a severe relapse of her Crohn's disease. Her flare-up causes severe malnutrition and significant weight loss. By combining a combination of high protein diet and high caloric food in a combination of forms - powder, regular food, supplements, and feeding tube, this case study determined that, even with frequent hospitalization and strict monitoring, meeting the significant nutritional deficits that occur with severe IBD flare-ups may not be possible and other solutions may be required as a result.

For the field of nutrition, one key finding is that jejunal tubes were the best course of action for this patient (and other patients experiencing life-threatening malnutrition as a result of IBD) as it increased protein digestion and amino acid resorption. This is a vast improvement to the copious amounts of high concentration of protein powder and nutritional supplements that are the current first guideline.

This case study brings back an incredibly important human look at medicine with a comparison of nutritional avenues used to combat malnutrition in IBD and how even the current nutritional guidelines and therapeutic standards aren't always the best first course of action.

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Citation:

Angela Effinger, Caitriona M O'Driscoll, Mark McAllister, Nikoletta Fotaki, Gastrointestinal diseases and their impact on drug solubility: Celiac disease, European Journal of Pharmaceutical Sciences, Volume 152,2020, 105460, ISSN 0928-0987, https://doi.org/10.1016/j.ejps.2020.105460.

This study is important because while it is known that individuals with gastrointestinal disease can suffer from vitamin malabsorption, not much is addressed about the impact on drug absorption. This study set out to investigate if individuals that suffer from celiac disease also have a decreased drug absorption capacity.

One key finding from the study was that solubility of drugs were impacted based upon the hydrophobicity and lipophilicity of the drug, though only minimally. This finding can relate to nutritional sciences as patients may want to monitor what types of foods that they consume around the time of taking medication. Perhaps nutrition can exacerbate the effect of drug solubility, especially in patients with IBD or Celiac Disease.

The data from this study suggests that drug dosing may be a little more complex for patients with gastrointestinal diseases. It is important to consider the solubility of the drug, especially when slight changes in the dose may have drastic pharmacological impacts on the individual. This makes fine-tuning a drug dose for the individual an important field of study. The goal would be to maximize the therapeutic effects of drugs while minimizing the adverse effects.

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Sandall AM, Wall CL, Lomer MCE. Nutrition Assessment in Crohn's Disease using Anthropometric, Biochemical, and Dietary Indexes: A Narrative Review. J Acad Nutr Diet. 2020 Apr;120(4):624-640. doi:10.1016/j.jand.2019.04.013.

This study is important because it attempts to identify the specific components to be included in the nutrition assessment of patients with Crohn’s disease with regards to anthropometric, biochemical and dietary intake.  Per the researchers, the review is the first of its kind that attempts to appraise the methods of nutrition assessment in patients with Crohn’s disease.

A key finding of the review is that standard nutrition assessment anthropometric measures have traditionally only included weight and BMI and thus the risk of malnutrition in patients with Crohn’s disease can easily go undetected by only using these two measurements.  The authors bring to light the common misconception of practitioners that patient’s with Crohn’s always present with underweight and dietary protein-energy deficits. Based on the authors’ findings there was actually an insignificant difference in protein and energy consumption and increased intra-abdominal fat was observed in the studies included in the review.

Nutrition assessment of patients with Crohn’s disease should include more than weight and BMI and as a result of the review an evidenced-based comprehensive nutrition assessment tool has been developed by the authors.  In addition to micronutrient assessment and dietary intake assessment the comprehensive nutrition assessment tool includes an expansion of anthropometric data to include hand-grip strength, mid-upper arm circumference, triceps skinfold, mid-arm muscle circumference and bioelectrical impedance.

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Citation:
Shivi Siva, MD, David T. Rubin, MD, George Gulotta, BA, Kristin Wroblewski, PhD, Joel Pekow, MD, Zinc Deficiency is Associated with Poor Clinical Outcomes in Patients with Inflammatory Bowel Disease, Inflammatory Bowel Diseases, Volume 23, Issue 1, 1 January 2017, Pages 152–157, https://doi.org/10.1097/MIB.0000000000000989

This study took a look into the trace element zinc and the effect it had on patient morbidity in patients with Inflammatory Bowel Disease. Zinc plays a very important role in tissue repair, wound healing and the regulation of the immune response and as is evident in this study, can help mediate symptoms of IBD. This study was important because it linked patients with deficient zinc serum levels to hospitalizations as complications from IBD. Patients with a zinc deficiency had negative disease outcomes (hospitalizations and pain) and when returning zinc serum levels to normal these outcomes improved. In order to bring zinc serum levels back to normal level in patients who are deficient, it is recommended to adjust one’s diet to foods that are high in zinc, red meat and poultry are good options. Another option for patients that are experiencing IBD symptoms is oral supplementation. Nutrition and vitamins shops offer just about anything imaginable to consumers and finding a zinc supplement that works could help improve adverse effects of IBD in these patients. Patients who experience adverse disease outcomes should monitor zinc serum levels closely to improve symptoms and quality of life.

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Fajstova, A., Galanova, N., Coufal, S., Malkova, J., Kostovcik, M., Cermakova, M., Pelantova, H., Kuzma, M., Sediva, B., Hudcovic, T., Hrncir, T., Tlaskalova-Hogenova, H., Kverka, M., & Kostovcikova, K. (2020). Diet Rich in Simple Sugars Promotes Pro-Inflammatory Response via Gut Microbiota Alteration and TLR4 Signaling. Cells, 9(12), 2701. https://doi.org/10.3390/cells9122701

This study is important because it looks at the role a high sugar diet plays on immune response. Some studies have suggested that diet has a significant effect on the initiation and diagnosis of IBDs.

A key finding in this study was that a high sugar diet promotes inflammation, impairs gut barrier function, and makes colitis more severe in mice. There was also a significant increase in fatty acid concentration in the mice with high-sugar diets. Fatty acids can trigger a pro-inflammatory response with a TLR4 (Toll-Like Receptor 4) cascade. Mice who were deficient in TLR4 had less severe cases of inflammation and colitis compared to the mice with active TLR4.

Diet plays an important role on gut microbiota and the gut mucosal environment and these factors impact the GI tract. Some diets (such as western diets) can promote inflammation and lead to IBDs and other auto-immune diseases, especially if the diet is unhealthy. Clinically, it is important to recommend low-sugar diets to patients who have IBDs or have a familial risk of developing one.

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Citation:
Ryan JJ, Hanes DA, Bradley RD, Contractor N. Effect of a Nutrition Support Formula in Adults With Inflammatory Bowel Disease: A Pilot Study. Glob Adv Health Med. 2019 Jul 29;8:2164956119867251. doi: 10.1177/2164956119867251. PMID: 31384513; PMCID: PMC6664624.

This was a small pilot study looking at effect of a  twice daily nutritional supplement in patients
with IBD.  The concept is so important  due to the prevalence of nutrient deficiencies associated with IBD and that there are currently no specific dietary guidelines.
The study looked at various parameters after 12 weeks of supplementation via serum analysis and found an improvement in serum folate 48.7%.   B12 was also increased by 17% (although this was not statistically significant).   The conclusion was the need for further randomized controlled study.
There is enormous potential clinical significance of such study in both determining best method of micronutrient supplementation (i.e., oral vs IM, etc) and also in gaining valuable insight as to what role improving nutritional status plays in improving quality of life for these patients.

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Citation: Freire, R., Ingano, L., Serena, G. et al. Human gut derived-organoids provide model to study gluten response and effects of microbiota-derived molecules in celiac disease. Sci Rep 9, 7029 (2019). https://doi.org/10.1038/s41598-019-43426-w

In this study, intestinal organoids were grown in-vitro to research the gut epithelium in celiac patients versus non-celiac patients, prior to the introduction of gliadin as well as post gliadin introduction, to determine if organoids would express signature characteristics of Celiac disease in a consistent manner, proving that patient organoids can be used as means of studying CD in the future. It also studied three (3) microbiome byproducts (butyrate, lactate, and polysaccharide A) to determine if the microbiome can be used to regulate the epithelial response to gluten.

The study outcomes had a number of important findings, but there are two that struck me as more significant: 1) the validation of an organoid model creates a new tool, possibly easier to utilize, to conduct Celiac disease research, and 2) confirmation of the impact of the microbiome involvement in the pathogenesis of Celiac disease.  Noted in this study, many past studies showed correlation, but not “mechanistic causation”.

For purposes of nutritional sciences, the findings of the microbiota byproduct impact could have implications for evolving nutritional treatment of Celiac patients.  For example, butyric acid is created when gut bacteria breakdown fiber and lactate has probiotic properties with Lactobacillus having protective effects on epithelial cells. The study found that all three bacterial byproducts “improved the barrier functionality of Celiac disease epithelia.

Only three bacterial byproducts were tested in this study; however, the validation of additional microbiota byproducts could continue to support new nutritional means to help the body protect itself from an immune response before the illness presents and could have many clinical implications including reduced patient morbidity.

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Citation: Laffin, M., Fedorak, R., Zalasky, A. et al. A high-sugar diet rapidly enhances susceptibility to colitis via depletion of luminal short-chain fatty acids in mice. Sci Rep 9, 12294 (2019). https://doi.org/10.1038/s41598-019-48749-2

This study is important because it focuses on dietary component of the multifactorial nature of IBD and demonstrates the effect of Western-style diets, which are typically high in fat and sugar content, on the incidence of IBD flares. Isolated effects of refined sugars are studied in comparing enteric microbial composition, luminal milieu, and susceptibility to colitis. Researchers also focus on protective mechanism of dietary fiber, which metabolizes into SCFAs (including acetate) by specific bacterial populations, on IBD status.

One key finding of this study is that short term exposure (two days) to high sugar diet increases susceptibility to colitis by reducing short-chain fatty acids (SCFA) and increasing gut permeability.  It's found that mice fed on high-sugar diet, comparing to group with chow diet, has decreased microbiota diversity, SCFA-producing microbial groups linking to loss of barrier function. They are also found to have altered innate immune function with enhanced tissue levels of inflammatory cytokines (TNAa and IL-1b) and monocytes response to inflammatory stimuli. Additionally, it's shown that acetate alone substantially alleviates the deleterious effects of high-sugar diet supporting that SCFAs play a crucial role in the response of gut to insults and tissue repair. This d

The dramatic effect of just two days of a high-sugar diet on microbial function and populations emphasizes role of diet as risk factors for IBD activity. This study provides mechanistic insight into clinical implication of diet avoidance with elimination of high sugar content in the prevention of IBD flares and colonic insults. This also suggests the protective role of dietary fiber, which contains SCFAs, in tissue repair and alleviation of the gut insults.

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Citation: Itzlinger A, Branchi F, Elli L, Schumann M. Gluten-Free Diet in Celiac Disease—Forever and for All? Nutrients. 2018; 10(11):1796. https://doi.org/10.3390/nu10111796

This study was important because a part of it focused on whether gluten can be re-introduced in asymptomatic patients who were diagnosed with celiac disease based on screening.

Strict gluten restriction is the main-stay of treatment in celiac disease, however it can be extremely difficult to adhere to, especially in asymptomatic patients.

One of the key finding in this study is that after a median age of 18.5 years after diagnosis, the screening-detected subgroup reported more anxiety with poorer quality of life than those who were symptomatic. Another finding was that in patients with poor or no adherence to the GFD in patients with a long history of CD, there was no excess in mortality, also reported a proportion of almost 30% with no histological relapse despite chronic voluntary gluten ingestion.

With 20-30% of CD patients developing gluten tolerance overtime, and the limited risk of developing osteoporosis and other complications, this study extends the idea that under careful monitoring, including histological surveillance, gluten-challenge could be a possibility. This would be especially beneficial in asymptomatic cases by not just aiming at maintaining a good histological recovery but also a good quality of life for our patients.

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Citation: Ishikawa H, Akedo I, Umesaki Y, Tanaka R, Imaoka A, Otani T. Randomized controlled trial of the effect of bifidobacteria-fermented milk on ulcerative colitis. J Am Coll Nutr. 2003 Feb;22(1):56-63. doi: 10.1080/07315724.2003.10719276. PMID: 12569115.

This study is important because investigated and showed evidence of the uses of a bifidobacteria-fermented milk (BFM) as a treatment to maintaining remission of UC. It also showed possible preventative evidence to relapsing UC. This could serve as a valuable way to treat UC!

A key finding of this study is that the use of 100mL/ day for one year showed result of 3/11 in the BFM, as compared to 9/10 in the control group, saw exacerbation of symptoms. While the size of this study’s sample is a limitation, it can be deemed significant for nutritional science purposes. Fermented milk has been used in other studies with probiotics and probiotics to alter intestinal microbiota and immune response in the GI (Wang et al., 2012). The utilization of BFM is directed toward UC and could be further valuable for people suffering with IBD and other GI issues.

As is well understood, the gut is incredibly complex and individualized based on a variety of genetic and environmental factors. Even smaller scale studies such as this push us into a direction of finding out what could make certain treatments better for some people, but not for others (Ishikawa H, et al., 2003).

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Citation: Natah SS, Mouihate A, Pittman QJ, Sharkey KA. Disruption of the blood-brain barrier during TNBS colitis. Neurogastroenterol Motil. 2005 Jun;17(3):433-46. PMID: 15916631.

This study is important because, while central nervous system changes during colitis suggest possible blood-brain barrier (BBB) permeability, the BBB has not been fully evaluated in regard to colitis. The researchers used a chronic ulcerative colitis rat model to investigate if BBB permeability occurred, and, if so, to what extent using one large molecule (IgG; 156 kDa) and one smaller molecule (sodium fluorescein; 376 Da).

Compared to control animals, the chronic colitis rat model demonstrated permeability to sodium fluorescein, but not to IgG, suggesting disruption to the BBB is mild. This finding relates to nutritional sciences because it contributes to understanding the “extraintestinal manifestations” of inflammatory bowel diseases and might be key to uncovering the mechanisms behind IBD’s role in depression, fatigue, and anhedonia.

Even though this study was conducted in rats, evidence shows that the human BBB is also disrupted by systemic inflammation. This suggests that treating this condition in the clinic will also prevent opening of the BBB and limit the central nervous system effects due to colitis.

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