19 October 2022

By Adele Sayers

Adele is a colorectal surgeon working in Exeter. She has kindly volunteered to add her fantastic experience and knowledge to our social media feeds and will also be part of our regular blogging team. This is Adele’s first blog for us.

Whilst I was disappointed to read the results of the Bowel Research UK (BRUK) survey released during Love Your Gut Week, I can’t say I was surprised. The BRUK survey found that many patients felt they were given insufficient information immediately after their initial diagnosis of bowel disease or following their bowel surgery.

As a colorectal surgeon, I’m regularly asked by patients for dietary advice for various bowel conditions. It is clear from talking to patients with IBD (inflammatory bowel disease) that there is a lack of readily available information and what can be found on the internet can be confusing or even misleading, with websites often giving conflicting advice.

Over the years, there have been many theories suggesting a direct link between diet and IBD. These theories have included a connection between diet and developing IBD, diet and triggering IBD flares, and diet regimes to treat IBD.

A comprehensive summary on this topic was written by Phillip Gu and Linda Feagins which was published in the journal “Inflammatory Bowel Diseases” in 2020. This paper explains what we currently know about diet and the role it plays in IBD, as well as highlighting the still existent knowledge gaps.

Whilst there is good evidence that the “Exclusive Enteral Nutrition” diet – a liquid diet consisting of specially prescribed, formula-based nutritional drinks – can help to kick-start remission in Crohn’s disease, most of the research to date has been focused on Crohn’s in children. There has been evidence investigating its use in adult patients, but we need more research to help us identify ways in which we can improve its success rate.

One reason why exclusive enteral nutrition isn’t as successful in adults could be related to it being a purely liquid diet, and therefore it can be difficult to follow.  However, this isn’t a diet you should just start yourself. This diet should only be started following the advice of an IBD team and a specialist IBD dietician, to ensure that all nutritional requirements are met.

Personally, I work in a unit that has seen great success in the use of exclusive enteral nutrition. This success is all thanks to the fantastic dieticians within the team, who provide the much-needed expertise and support for patients.

The paper by Gu and Feagins also highlighted that some of the many recommended diets may help a proportion of IBD patients, but not all. For example, the low FODMAP diet (which stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols – just rolls off the tongue!), helps patients with IBD who also have irritable bowel syndrome (IBS). However, it will have little positive effect on those patients without IBS. Therefore, the blanket advice that can sometimes be found online isn’t suitable for every IBD patient. Often, more tailored dietary advice is required.

The BRUK survey highlights just how important it is to ensure that IBD units have the necessary expertise from all relevant allied health professionals, such as specialist dieticians. Patients should be able to have access to tailored dietary advice, without the need to be scouring the internet for answers. Answers that may not always be correct.

When reading the Love Your Gut Week press release, I was delighted to see the list of recommended websites at the bottom of the article. Being able to signpost patients to validated internet resources, such as the Crohns & Colitis UK site, is something I do regularly. Having a resource that can be accessed when convenient and re-read at any time (for example when doing the weekly shop), is invaluable.

However, there is no question – when it comes to how diet and IBD interact, there is still a lot more to learn.

It sounds like more research is needed.

If only I knew of a charity that offered funding for bowel research…