inflammatorisk tarmsykdom

Sjekk kildene: Inflammatorisk tarmsykdom (Crohns sykdom og ulserøs kolitt) og kosthold

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Kosthold kan påvirke forløpet av inflammatorisk tarmsykdom. Hva er evidens, og hvorfor forskes det ikke mer på det?

En oversiktsartikkel har sett på bruken av ulike kostholdsmønstre ved inflammatorisk tarmsykdom. Det er beskrevet positiv virkning ved ulserøs kolitt, men, dessverre, «To date, there have been no other studies evaluating the use of vegetarian or semi-vegetarian diets for treatment of UC».

Hwang C, Ross V, Mahadevan U. Popular exclusionary diets for inflammatory bowel disease: the search for a dietary culprit. Inflamm Bowel Dis. 2014
Apr;20(4):732-41. doi: 10.1097/01.MIB.0000438427.48726.b0. Review. PubMed PMID: 24562173.
Lenke til oversikten er her

VEGETARIAN OR SEMI-VEGETARIAN DIET

(REDUCED ANIMAL FAT) Perhaps the strongest evidence for the potential role that animal fat may have on IBD risk comes from Japan, a country with a relatively homogenous genetic background, which has recently seen major dietary shifts in the population. The Ministry of Health in Japan has maintained national data on dietary intake since the 1960s. These data demonstrate that between 1966 and 1985, the proportion of animal sources increased dramatically, although overall total daily caloric or protein intake did not. These dietary changes also correlated with a rise in CD over this same time period.

As a result, several academic hospitals in Japan have instituted semi-vegetarian diets for patients with CD (small portions of meat once every 2 weeks and of fish biweekly). In a small study of 22 patients with CD who had recently achieved remission after medical or surgical treatment, the authors found that the group that adhered to the semi-vegetarian diet in the 2 years after initiation had a lower rate of relapse than those who chose to discontinue the diet (93% versus 33%, P¼ 0.0003). It should be noted, however, that relapse was defined by reappearance of symptoms, and none of the patients had assessment for mucosal healing as part of the study. In addition, the patients were also encouraged to decrease their intake of bread, sweets, margarine, cheese, and fast foods, so it is not known if any of these restrictions had greater impact on relapse rates. To date, there have been no other studies evaluating the use of vegetarian or semi-vegetarian diets for treatment of UC. There does not seem to be sufficient evidence at this time to recommend eliminating meat to patients with IBD as a means to control their disease.»

Den omtalte studien viste gode resultater ved behandling av inflammatorisk tarmsykdom med med vegetarkost. Lenke til den japanske studien er her

Chiba M, Abe T, Tsuda H, Sugawara T, Tsuda S, Tozawa H, Fujiwara K, Imai H. Lifestyle-related disease in Crohn’s disease: relapse prevention by a  semi-vegetarian diet. World J Gastroenterol. 2010 May 28;16(20):2484-95. PubMed PMID: 20503448; PubMed Central PMCID: PMC2877178.

 «RESULTS: SVD was continued by 16 patients (compliance 73%). Remission was maintained in 15 of 16 patients (94%) in the SVD group vs two of six (33%) in the omnivorous group. Remission rate with SVD was 100% at 1 year and 92% at 2 years. SVD showed significant prevention in the time to relapse compared to that in the omnivorous group (P = 0.0003, log rank test). The concentration of C-reactive protein was normal at the final visit in more than half of the patients in remission who were taking an SVD, who maintained remission during the study (9/15; 60%), who terminated follow-up (8/12; 67%), and who completed 2 years follow-up (7/10; 70%). There was no untoward effect of SVD. CONCLUSION: SVD was highly effective in preventing relapse in CD.»

Forfatterne av den japanske studien kommenterte også en artikkel der plantebasert kosthold anbefales til alle pasienter ved Kaiser Permanente, lenke til kommentaren er her

«Diet reviews recommend plant-based diets to treat and prevent a variety of common diseases. Inflammatory bowel disease (IBD) is not an exception. However, evidence level of our study is not enough to make gastroenterologists appreciate the efficacy of a plant-based diet in IBD. Clinical studies providing high levels of evidence showing the efficacy of a plant-based diet in IBD is eagerly awaited.»