The term inflammatory bowel disease (hereinafter IBD) gives name to a group of diseases that occur with inflammation of the digestive tract, these being ulcerative colitis and Crohn’s disease . The main distinction between the two is that, in the first, the inflammatory process exclusively affects the colon being confined only to the mucous and submucosal layer. In contrast, in Crohn’s disease , any part of the digestive tract may be affected and the entire process of the digestive wall can be covered by the inflammatory process.
Symptoms and treatment of inflammatory bowel disease
The prevalence of protein-energy malnutrition in patients with IBD ranges between 20 and 85% depending on the degree and type of inflammation, the specific location of the disease, etc. The mechanisms responsible for this malnutrition are deficit in intake, increased metabolism due to inflammation and losses due to malabsorption, among others.
Conventional diet therapy is the first therapeutic front to prevent and treat nutritional deficits in IBD, providing as varied a diet as possible. In this regard, it is worth mentioning those nutrients that have been shown to have primary therapeutic capacity , especially to prevent recurrences, these being omega-3 fatty acids (especially in Crohn’s disease) and fermentable fiber (especially in ulcerative colitis) .
The importance of Omega-3 polyunsaturated fatty acids
Especially important are ecosapentaenoic acid (from now on EPA) and docosahexaenoic acid (hereinafter DHA), present in fish oil. Both acids have beneficial anti-inflammatory properties for IBD, especially for Crohn’s disease.
This is because the EPA competes with arachidonic acid for the enzymes involved in the synthesis of eicosanoids (lipoxygenase and cyclooxygenase), molecules involved in inflammation. Thus, prostaglandins, thromboxanes and leukotrienes derived from EPA, have attenuated proinflammatory effects compared to those derived from arachidonic acid. In addition, studies show that both EPA and DHA inhibit the production of inflammatory cytokines.
Fermentable dietary fiber and short chain fatty acids
Fermentation in the colon of dietary fiber is what gives rise to short chain fatty acids: acetate, propionate and butyrate. The protagonist of these and in which they focus most of the studies is the butyrate.
Butyrate is the preferred energy substrate of colon cells and it has been observed that there is a decrease in fecal levels of this substrate in patients with ulcerative colitis depending on the degree of disease. This implies that, an increase in the intake of short-chain fatty acids would mean an increase in butyrate , which, as recent studies show, could take advantage of its anti-inflammatory effect, since it is attributed with inhibitory properties in the production of some cytokines
Theoretically, the intake of fermentable dietary fiber , which slowly degrades throughout the entire colon ensuring sufficient butyrate production, could be beneficial in the treatment of ulcerative colitis . However, although this theory already has several studies that overwhelm it, research on it continues.
Probiotics and prebiotics
The probiotics are defined as any living organism that, after ingestion in adequate amounts, a beneficial effect on health that goes beyond the mere nutritional effect.
The prebiotics are nonabsorbable ingredients of foods which benefit the health of the individual who ingests a selectively favoring growth and / or activity of probiotic species resident in the colon, for example, the intestinal microbiota.