Nutrition and Microbiome in IBD

Highlights from the Crohn’s and Colitis Congress 2019

The “Nutritional Therapy for IBD” exhibit concluded another successful mission at the Crohn’s and Colitis Congress 2019 in Las Vegas. The unique exhibit was created by Kim Beall, Pharm.D., Sheri Pilley, CHC, Gisele Woodward MSW, and David Suskind, MD and is sponsored by the Woodward Crohn’s and Colitis Foundation, with the goal to promote awareness for the role of nutrition in management of IBD. It was first introduced at the NASPGHAN 2018 conference (North American Society of Pediatric Gastroenterology, Hepatology and Nutrition), and was extremely well received, with hundreds of clinicians stopping by to learn about dietary therapy and pick up resources like flash drives loaded with data on nutrition in IBD, patient handouts on diet, and copies of the Nutrition in Immune Balance book, while sampling SCD food.

Kim Beall, a Doctor of Pharmacy, who is also an experienced user of SCD, shares selected conference highlights below related to diet and microbiome. 

Nutritional Therapy for IBD: From Theory to Your Practice.

This nutritional workshop was moderated by James Lewis, and the panel of speakers included Kelley Issokson MS RD, Dale Lee MD, Lindsey Albenberg MD , Eric Vasiliauskas MD , and Jeremiah Faith Ph.D . The speakers presented the full spectrum of information from Jeremiah Faith’s basic science work on diet and microbiome to enteral nutrition, and Crohn’s disease exclusion diets including SCD and practical applications of implementation. An emphasis was placed on the importance of the pitch given to these options when presenting them to patients. For example, Dr. V showed junk food on one slide and the delicious array of SCD foods on the next slide, and promoted it not as an exclusion diet but rather as wholesome delicious diet. His disclosure for the talk was humorous yet telling when he smiled and said he himself eats SCD/Paleo style diet.

Dr. Dale Lee addressed a noticeable point of concern by many doctors who resistance dietary therapies. These doctors worry that diet will delay a timely treatment with biologics. Dr. Lee addressed this by expressing his understanding to the concern and commented that he feels if the patient is being monitored with endpoints in mind, he feels comfortable waiting a few weeks, checking the progress and re-evaluating as needed for further intervention.

An integrated personalized microbiome approach to treatment

The keynote address, Host Microbiome Interactions in Health and Disease, 
was presented by Eran Elinav MD, PhD, Professor in the department of immunology at the Weizmann Institute in Israel. He spoke of the interactions and communications between the microbiome and the host and its involvement in the pathogenesis of disease with the potential to modify these effects via personalized diet which may lead to the promotion of health and wellness. To emphasize the individuality of the microbiome, he discussed his data from the personalized nutrition project whereby individuals eating the same food were found to have profoundly different glycemic responses thought to result from microbiome differences.

He explained the bacteriophages, viruses that target and consume specific bacteria, and the potential to cultivate these to specifically target bacteria that are recognized to be overgrown or out of balance in IBD. He shared part of his research investigating some of the microbiome associated pathways to effect gut barrier function, including NLRP6 pathway, and inflammasome modulating metabolites of LPS and histamine, and leaving us with the direction of the research to work toward an integrated personalized microbiome approach to treatment.

The instability of the microbiome in IBD vs healthy controls

Janet Jansson, chief biologist at Pacific Northwest National Lab  , an internationally recognized human microbiome researcher who is involved with the Human Microbiome Project, presented on the microbiome with an emphasis on IBD. The Human Microbiome Project Phase II data evaluating a subset of IBD patients over time while analyzing microbiome changes is still underway with collection of a very large amount of data that will be available to analyze. She showed clustering of types of IBD according to microbiome – ileal CD, colonic CD and UC. Furthermore, she showed the very interesting finding of the instability of the microbiome in IBD vs healthy controls, with ileal Crohn’s disease and resected ileal CD being the most volatile. This paper was published in 2017 and the data can be visualized in motion here.  She emphasized the large task of evaluating the metagenomics, metaproteomics, and metabolomics and the complex pathways of metabolism and its byproducts which effect the microbiome as an ecosystem, ending with a message of importance to care for and restore homeostasis to this system.

Environmental risk factors for IBD

Gillaad Kaplan MD, MPH, FRCPC a gastroenterologist and epidemiologist from the University of Calgary spoke on the environmental risk factors for IBD and posing the question whether or not it may be preventable. After covering the information of global incidence and prevalence and the recognized associated environmental risk factors, he concluded with a check list for prevention: don’t smoke, minimize NSAIDS and antibiotics, avoid vitamin D deficiency, eat fruit vegetables fiber and fish oil, maintain high level of physical activity, low stress and quality regular sleep. He also noted breastfeeding as a potential preventive option.

A new tool for helping to assess risk in IBD

The new PROSPECT tool is expected to be available to all practitioners in the next 6 months. It may be helpful as predictive model of complicated disease. However, both this tool and the surge of upcoming new drugs that aim to affect the immune system creates additional pressure for starting pharmacological therapy early. In conversations, most agree it is logical to offer information for both dietary and pharmacological methods to patients, as they are acting on two different pathways. In that regard, The “Nutritional Therapy for IBD” exhibit proved very helpful. It helps address the need to encourage doctors to get comfortable with dietary therapies as a legitimate option.

The basic science sessions at the conference covered more information on the microbiome which included material to utilize diet to alter the microbiome and alter the function of the immune system. All of the above helped to magnify interest in the diet exhibit and the use of nutritional therapy to alter the microbiome.

It was truly a rewarding experience to see the growing interest in the microbiome and the role of dietary therapy! Kim S. Beall, Pharm.D.