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Nutrition //

It is well known that diet plays an important role in IBD and that nutritional deficiencies, including malnutrition, as well as food avoidance is common.  At the IBD Clinical and Research Centre we have been investigating the role of nutrition in IBD in various research studies since 2002.

In our earliest study our goal was to determine the nutritional status adults with IBD.

What did we do? We recruited 126 subjects who provided blood samples to measure hemoglobin, ferritin, albumin, protein, vitamin B12, vitamin D, zinc, calcium, carotene, vitamin A, vitamin B6 and folate levels. We also analyzed their diet in addition to the calories their bodies were expending at rest.

What did we find? We reported that our patients were actually “healthy” when we looked at just their weights and body mass index. However, when we analyzed the blood, there were several nutritional deficiencies that we identified including a high prevalence of iron, vitamin B6 and vitamin D deficiency, which was compounded with dietary deficiencies as well, regardless of disease activity.  We recommend that all persons with IBD take a multivitamin supplement.

Publication: Vagianos K, Bector S, McConnell J, Bernstein C. Nutrition assessment of patient with inflammatory bowel disease. Journal of Parenteral and Enteral Nutrition 2007; 31:311-319.

 

One of the findings in our 2007 publication was the prevalence of vitamin B6 deficiency among IBD. In our follow up study our goal was to explore the association of vitamin B deficiency and homocysteinemia levels. Homocysteine is a sulfur amino acid whereby high levels of homocysteine are a risk factor for arterial and venous thromboembolism, both of which are increased in IBD. Our goal was to determine if homocysteine changed depending on disease activity (inflammation) and vitamin B levels.

What did we do? A total of 100 adults with IBD were recruited and provided blood samples and dietary information 3 times over the course of one year. We compared homocysteine and B vitamin levels between active disease and those in remission.

What did we find? We reported that homocysteine was mostly normal in patients and changed minimally over time. Only a small minority of patients had high levels. There was no association between a flare up of IBD and high homocysteine. We also showed that serum vitamin B6 deficiency was found in 30% of the whole group but it was unclear why this deficiency existed.

Publication: Vagianos K, Bernstein C. Homocysteinemia and B vitamin status among adult patients with inflammatory bowel disease: a one year prospective follow up study. Inflammatory Bowel Disease 2012; 18:718-724.

In 2016 we published a paper that described the dietary habits of IBD adults who were enrolled in the Manitoba IBD Cohort study. What we knew about diet before this study is that patients with IBD often change their dietary habits as a means of controlling their symptoms, that IBD patients report that certain foods make their symptoms worse and that there may be a role of sugar in inducing a flare up of IBD.

What did we do? Patients enrolled in the Manitoba IBD cohort study completed food avoidance questionnaires, were asked to identify how often they ate high sugar foods and the dietary intake of the IBD group was compared to the diets of a control matched Canadian sample of people without IBD.

What did we find? We showed that persons with IBD will avoid certain foods to control their symptoms and these are often nutrient rich foods. Food avoidance is primarily based on personal preference and not on professional advice. We showed that the overall diet of the IBD patients differed from those Canadians without IBD but the reality was that deficiencies existed in both groups.

Publication: Vagianos K, Clara I, Carr R, Graff L, Walker J, Targownik L, Lix L, Rogala L, Miller N, Bernstein C. What are adults with inflammatory bowel disease (IBD) eating? A closer look at the dietary habits of a population-based Canadian IBD cohort. Journal of Parenteral and Enteral Nutrition 2016; 40:405-411.