Letter to Editor

Response to “Inflammatory Bowel Disease Treated with a Plant-Based Diet – An Update”

Sakarie Mustafe Hidig*

Department of Surgery, Division of Hepatobiliary and Pancreatic Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, China

Submission:January 08, 2025;Published:January 20, 2025

*Corresponding author:Sakarie Mustafe Hidig, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, China

How to cite this article:Sakarie M H. Response to “Inflammatory Bowel Disease Treated with a Plant-Based Diet – An Update”. Adv Res Gastroentero Hepatol, 2025; 21(2): 556059.DOI: 10.19080/ARGH.2025.21.556059.

Abstract

Dear Editor,

The evidence presented in “Inflammatory Bowel Disease Treated with a Plant-Based Diet – An Update” underscores the potential role of plant-based diets (PBDs) in the management of inflammatory bowel disease (IBD). However, while the outlined case studies and research findings are promising, additional considerations regarding scientific rigor, patient heterogeneity, and disease-specific factors are necessary. This response provides a critical evaluation of the claims and suggests areas for further research, emphasizing the integration of PBDs within evidence-based multimodal treatment strategies.

Keywords:Inflammatory bowel disease; Plant-based diet; Crohn’s disease; Ulcerative colitis; Personalized nutrition

Abbreviations:IBD: Inflammatory Bowel Disease; PBDs: Plant-Based Diets; CD: Crohn’s Disease; UC: Ulcerative Colitis; CDED: Crohn’s Disease Exclusion Diet

Introduction

Inflammatory Bowel Disease (IBD), encompassing Crohn’s Disease (CD) and Ulcerative Colitis (UC), represents a significant clinical challenge due to its chronic relapsing nature and multifactorial ethology. The growing interest in plant-based diets (PBDs) as a therapeutic intervention is supported by their potential to modify the gut microbiome, reduce systemic inflammation, and address comorbid conditions. The original article effectively highlighted the potential benefits of PBDs in IBD management, citing case studies and small cohort studies. However, a broader discussion of scientific rigor, patient diversity, and the limitation of current evidence is warranted. This reply evaluates the scientific validity of the presented data, offers additional context from recent studies, and outlines avenues for further research [1].

The article’s discussion on the impact of Western dietary patterns aligns with established evidence that high-fat, high-sugar diets adversely affect gut microbiota composition, exacerbating IBD symptoms. PBDs rich in fiber, phytonutrients, and antioxidants are hypothesized to counteract these effects by promoting beneficial bacterial populations. However, the assertion that PBDs alone can achieve and maintain remission requires caution. Gut microbiota dynamics are influenced by genetic predispositions, environmental exposures, and other dietary factors. Studies like those by Chiba et al. (2023) underscore the importance of personalized nutrition approaches in IBD management [2]. A more robust exploration of how PBDs interact with established therapies, such as biologics, is essential. The cited studies demonstrate positive clinical outcomes, such as reduced relapse rates and improved quality of life. Nevertheless, significant limitations include small sample sizes, lack of control groups, and short follow-up periods. For example, the 8-week Australian trial involved only 14 participants, making generalizability difficult. In contrast, larger randomized controlled trials (RCTs) are required to validate these findings. Recent RCTs have shown that while PBDs can improve inflammatory markers, their efficacy as a standalone treatment remains uncertain. Moreover, patient compliance over extended periods, particularly outside controlled settings, is a challenge that necessitates further investigation. On Case Studies and Anecdotal Evidence While the individual case studies of UC and CD patients transitioning to PBDs provide valuable insights, they are inherently limited by their anecdotal nature. The reported improvements, such as decreased CRP levels and endoscopic remission, are encouraging but may not represent typical outcomes. Inclusion of objective measures like histological healing and validated symptom scoring systems would strengthen these findings [3].

I recommend multimodal treatment strategies aligned with the current guidelines for IBD management, which emphasize a combination of pharmacological interventions, lifestyle modifications, and dietary adjustments. While plant-based diets (PBDs) can serve as adjunctive therapies, abandoning standard treatments, such as biologics or immunomodulators, in Favor of dietary interventions alone could pose risks. For instance, research by Levine et al. (2019) introduced the Crohn’s Disease Exclusion Diet (CDED), which integrates specific plant-based components with traditional therapies, showing promising results in paediatric populations. Similar integrative models may provide a balanced approach to leveraging PBDs [4].

One concern with PBDs is the risk of deficiencies in key nutrients like vitamin B12, iron, and omega-3 fatty acids, which are crucial for maintaining remission in IBD. Careful dietary planning, potentially including supplementation, is necessary to mitigate these risks. The article’s emphasis on the role of PBDs in addressing comorbidities, such as type 2 diabetes and cardiovascular disease, is well-founded. The anti-inflammatory and metabolic benefits of PBDs have been corroborated by largescale epidemiological studies. However, tailored interventions addressing both IBD-specific and systemic health needs are vital. Encouraging adherence to PBDs requires culturally sensitive dietary recommendations. Patients’ preferences, socioeconomic factors, and access to diverse plant-based foods must be considered to ensure sustainable adoption [5]. For future directions, I recommend Firstly, conducting well-designed RCTs with diverse patient populations to determine the long-term efficacy of PBDs. These studies should include biomarkers of inflammation, microbiome analyses, and detailed dietary adherence assessments. Secondly, Investigating the molecular mechanisms by which PBDs influence gut immunity and microbiota. Advanced techniques like metagenomics and metabolomics could elucidate pathways through which dietary components exert their therapeutic effects. Addressing the variability in IBD presentation and response to treatment through personalized dietary interventions. Combining genetic, microbiome, and dietary data could help identify patient subgroups most likely to benefit from PBDs [6].

In conclusion, the authors’ letter presents an optimistic view of PBDs as a treatment for IBD. While the evidence suggests potential benefits, the current body of research is, in my opinion, limited by methodological constraints and small sample sizes. PBDs should be considered part of a holistic, evidence-based approach to IBD management, integrating standard therapies, patient-specific considerations, and nutritional adequacy. Further research is needed to establish the precise role of PBDs in IBD care and optimize their implementation in diverse clinical contexts..

References

1. Rose S, Strombom A (2024) Inflammatory Bowel Disease Treated with a Plant-Based Diet - An Update. Adv Res Gastroentero Hepatol 20(5): 556049.
2. Chiba M, Tsuji T, Komatsu M (2023) Therapeutic advancement in inflammatory bowel disease by incorporating plant-based diet. Transl Gastroenterol Hepatol 8: 38.
3. Rose S, Strombom A (2020) Ulcerative Colitis - prevention and treatment with a plant-based diet. Adv Res Gastroentero Hepatol 15(2): 555908.
4. Levine A, Wine E, Assa A, Sigall Boneh R, et al. (2019) Crohn's Disease Exclusion Diet Plus Partial Enteral Nutrition Induces Sustained Remission in a Randomized Controlled Trial. Gastroenterology 157(2): 440-450.
5. Jess T, Jensen B, Andersson M, Villumsen M, Allin K (2020) Inflammatory Bowel Diseases increase risk of Type 2 diabetes in a nationwide cohort study. Clin Gastroenterol Hepatol 18(4): 881-888.
6. Rose S, Strombom A (2018) Crohn’s disease prevention and treatment with a plant-based diet. Adv Res Gastroentero Hepatol 9(1).