Keywords
Mediterranean diet
Intestinal inflammation
Dietary supplements
Inflammatory bowel disease
Dysbiosis
Intestinal inflammation
Dietary supplements
Inflammatory bowel disease
Dysbiosis
Abstract
Intestinal inflammation leads to various chronic diseases, collectively known as inflammatory bowel disease (IBD). IBD mainly affects the large intestine, but it can also affect the gastrointestinal tract as a whole. Its major symptoms are pain, diarrhea, and weight loss, and it is usually associated with deficiencies of both macro- and micronutrients. Unluckily, after some time the body develops resistance against the already available drugs: thus, many patients fail to maintain remission, which is achieved in less than 50% of cases. Diet is a major determinant of gut inflammation. An unbalanced diet can affect the gut microbiota and cause dysbiosis, which is related to a dysregulated host immune response. The Mediterranean Diet its renowned for its anti-inflammatory effects and for preventing dysbiosis. In order to improve management and treatment of intestinal inflammatory diseases, it should become common practice to integrate the patient’s diet with dietary supplements with anti-inflammatory effects (probiotics, butyrate, phosphatidylcholine, lactoferrin, palmitoylethanolamide, silymarin, and omega 3), which maintain the stability of the intestinal microbial cohort and strengthen the mucosal barrier, thus preventing or soothing IBD symptoms. Dietary supplements may help fight the high costs, the adverse side effects, and the recurrent relapses typical of drug use.
References
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[2] Rossi RE, Whyand T, Murray CD, Hamilton MI, Conte D, Caplin ME. The role of dietary supplements in inflammatory bowel disease: a systematic review. Eur J Gastroenterol Hepatol 2016;28:1357-64. https://doi.org/10.1097/MEG.0000000000000728
[3] Ghishan FK, Kiela PR. Vitamins and minerals in inflammatory bowel disease. Gastroenterol Clin North Am 2017;46:797-808. https://doi.org/10.1016/j.gtc.2017.08.011
[4] Chicco F, Magrì S, Cingolani A, Paduano D, Pesenti M, Zara F, Tumbarello F, Urru E, Melis A, Casula L, Fantini MC, Usai P. Multidimensional Impact of Mediterranean Diet on IBD Patients. Inflamm Bowel Dis 2021;27:1-9. https://doi.org/10.1093/ibd/izaa097
[5] Jadhav P, Jiang Y, Jarr K, Layton C, Ashouri JF, Sinha SR. Efficacy of Dietary Supplements in Inflammatory Bowel Disease and Related Autoimmune Diseases. Nutrients 2020;12:2156. https://doi.org/10.3390/nu12072156
[6] Romani A, Ieri F, Urciuoli S, Noce A, Marrone G, Nediani C, Bernini R. Health Effects of Phenolic Compounds Found in Extra-Virgin Olive Oil, By-Products, and Leaf of Olea europaea L. Nutrients 2019;11:1776. https://doi.org/10.3390/nu11081776
[7] Vitetta L, Vitetta G, HallS. Immunological tolerance and function: associations between intestinal bacteria, probiotics, prebiotics, and phages. Front Immunol 2018:2240. https://doi.org/10.3389/fimmu.2018.02240
[8] Abraham BP, Quigley EM. Probiotics in inflammatory bowel disease. Gastroenterol Clin North Am 2017;46:769-82. https://doi.org/10.1016/j.gtc.2017.08.003
[9] Kim DH, Kim S, Lee JH, Kim JH, Che X, Ma HW, Seo DH, Kim TI, Kim WH, Kim SW, Cheon JH. Lactobacillus acidophilus suppresses intestinal inflammation by inhibiting endoplasmic reticulum stress. J Gastroenterol Hepatol 2019;34:178-85. https://doi.org/10.1111/jgh.14362
[10] Vanderpool C, Yan F, Polk BD. Mechanisms of probiotic action: implications for therapeutic applications in inflammatory bowel diseases. Inflamm Bowel Dis 2008;14:1585-96. https://doi.org/10.1002/ibd.20525
[11] Marasco G, Cirota GG, Rossini B, Lungaro L, Di Biase AR, Colecchia A, Volta U, De Giorgio R, Festi D, Caio G. Probiotics, Prebiotics and Other Dietary Supplements for Gut Microbiota Modulation in Celiac Disease Patients. Nutrients 2020;12:2674. https://doi.org/10.3390/nu12092674
[12] Lindfors K, Blomqvist T, Juuti-Uusitalo K, Stenman S, Venäläinen J, Mäki M, Kaukinen K. Live probiotic Bifidobacterium lactis bacteria inhibit the toxic effects induced by wheat gliadin in epithelial cell culture. Clin Exp Immunol 2008;152:552-8. https://doi.org/10.1111/j.1365-2249.2008.03635.x
[13] Laparra JM, Sanz Y. Bifidobacteria inhibit the inflammatory response induced by gliadins in intestinal epithelial cells via modifications of toxic peptide generation during digestion. J Cell Biochem 2010;109:801-7. https://doi.org/10.1002/jcb.22459
[14] Laparra JM, Olivares M, Gallina O, Sanz Y. Bifidobacterium longum CECT 7347 modulates immune responses in a gliadin-induced enteropathy animal model. PloS One 2012;7:e30744. https://doi.org/10.1371/journal.pone.0030744
[15] D’Arienzo R, Stefanile R, Maurano F, Mazzarella G, Ricca E, Troncone R, Auricchio S, Rossi M. Immunomodulatory effects of Lactobacillus casei administration in a mouse model of gliadin-sensitive enteropathy. Scand J Immunol 2011;74:335-41. https://doi.org/10.1111/j.1365-3083.2011.02582.x
[16] Roda A, Simoni P, Magliulo M, Nanni P, Baraldini M, Roda G, Roda E. A new oral formulation for the release of sodium butyrate in the ileo-cecal region and colon. World J Gastroenterol 2007;13:1079-84. https://doi.org/10.3748/wjg.v13.i7.1079
[17] Säemann MD, Böhmig GA, Osterreicher CH, Burtscher H, Parolini O, Diakos C, Stöckl J, Hörl WH, Zlabinger GJ. Anti-inflammatory effects of sodium butyrate on human monocytes: potent inhibition of IL-12 and up-regulation of IL-10 production. FASEB J 2000;14:2380-2. https://doi.org/10.1096/fj.00-0359fje
[18] Coradini D, Pellizzaro C, Marimpietri D, Abolafio G, Daidone MG. Sodium butyrate modulates cell cycle-related proteins in HT29 human colonic adenocarcinoma cells. Cell Prolif 2000;33:139-46. https://doi.org/10.1046/j.1365-2184.2000.00173.x
[19] Vernia P, Fracasso PL, Casale V, Villotti G, Marcheggiano A, Stigliano V, Pinnaro P, Bagnardi V, Caprilli R. Topical butyrate for acute radiation proctitis: randomised, crossover trial. Lancet 2000;356:1232-5. https://doi.org/10.1016/s0140-6736(00)02787-2
[20] Facchin S, Vitulo N, Calgaro M, Buda A, Romualdi C, Pohl D, Perini B, Lorenzon G, Marinelli C, D’Incà R, Sturniolo GC, Savarino EV. Microbiota changes induced by microencapsulated sodium butyrate in patients with inflammatory bowel disease. Neurogastroenterol Motil 2020;32:e13914. https://doi.org/10.1111/nmo.13914
[21] Di Sabatino A, Morera R, Ciccocioppo R, Cazzola P, Gotti S, Tinozzi FP, Tinozzi S, Corazza GR. Oral butyrate for mildly to moderately active Crohn’s disease. Aliment Pharmacol Ther 2005;22:789-94. https://doi.org/10.1111/j.1365-2036.2005.02639.x
[22] Scheppach W, Sommer H, Kirchner T, Paganelli GM, Bartram P, Christl S, Richter F, Dusel G, Kasper H. Effect of butyrate enemas on the colonic mucosa in distal ulcerative colitis. Gastroenterology 1992;103:51-6. https://doi.org/10.1016/0016-5085(92)91094-k
[23] Lorenzon M. Process for the production of an n-butyric acid compound in micro encapsulated form, for animal or human consumption. Google Patents 2013
[24] Krokowicz L, Stojcev Z, Kaczmarek BF, Kociemba W, Kaczmarek E, Walkowiak J, Krokowicz P, Drews M, Banasiewicz T. Microencapsulated sodium butyrate administered to patients with diverticulosis decreases incidence of diverticulitis--a prospective randomized study. Int J Colorectal Dis 2014;29:387- 93. https://doi.org/10.1007/s00384-013-1807-5
[25] Banasiewicz T, Krokowicz Ł, Stojcev Z, Kaczmarek BF, Kaczmarek E, Maik J, Marciniak R, Krokowicz P, Walkowiak J, Drews M. Microencapsulated sodium butyrate reduces the frequency of abdominal pain in patients with irritable bowel syndrome. Colorectal Dis 2013;15:204-9. https://doi.org/10.1111/j.1463-1318.2012.03152.x
[26] Emmi G, Bettiol A, Niccolai E, Ramazzotti M, Amedei A, Pagliai G, Taddei N, Sofi F, Fiorillo C, Prisco D, Becatti M. Butyrate-rich diets improve redox status and fibrin lysis in Behçet’s Syndrome. Circ Res 2021;128:278-80. https://doi.org/10.1161/CIRCRESAHA.120.317789
[27] Garland EL, Gaylord SA, Palsson O, Faurot K, Douglas Mann J, Whitehead WE. Therapeutic mechanisms of a mindfulness-based treatment for IBS: effects on visceral sensitivity, catastrophizing, and affective processing of pain sensations. J Behav Med 2012;35:591-602. https://doi.org/10.1007/s10865-011-9391-z
[28] Bengtsson M, Hammar O, Mandl T, Ohlsson B. Evaluation of gastrointestinal symptoms in different patient groups using the visual analogue scale for irritable bowel syndrome (VAS-IBS). BMC Gastroenterol 2011;11:122. https://doi.org/10.1186/1471-230X-11-122
[29] Stremmel W, Merle U, Zahn A, Autschbach F, Hinz U, Ehehalt R. Retarded release phosphatidylcholine benefits patients with chronic active ulcerative colitis. Gut 2005;54:966-71. https://doi.org/10.1136/gut.2004.052316
[30] Stremmel W, Braun A, Hanemann A, Ehehalt R, Autschbach, F, Karner M. Delayed release phosphatidylcholine in chronic-active ulcerative colitis: a randomized, double-blinded, dose finding study. J Clin Gastroenterol 2010;44:e101–e107. https://doi.org/10.1097/MCG.0b013e3181c29860
[31] Ehehalt R, Wagenblast J, Erben G, Lehmann WD, Hinz U, Merle U, Stremmel W. Phosphatidylcholine and lysophosphatidylcholine in intestinal mucus of ulcerative colitis patients. A quantitative approach by nanoElectrospray-tandem mass spectrometry. Scand J Gastroenterol 2004;39:737-42. https://doi.org/10.1080/00365520410006233
[32] Anes E, Kühnel MP, Bos E, Moniz-Pereira J, Habermann A, Griffiths G. Selected lipids activate phagosome actin assembly and maturation resulting in killing of pathogenic mycobacteria. Nat Cell Biol 2003;5:793-802. https://doi.org/10.1038/ncb1036
[33] Stremmel W, Ehehalt R, Autschbach F, Karner M. Phosphatidylcholine for steroid-refractory chronic ulcerative colitis: a randomized trial. Ann Intern Med 2007;147:603-10. https://doi.org/10.7326/0003-4819-147-9-200711060-00004
[34] Stremmel W, Merle U, Zahn A, Autschbach F, Hinz U, Ehehalt R. Retarded release phosphatidylcholine benefits patients with chronic active ulcerative colitis. Gut 2005;54:966-71. https://doi.org/10.1136/gut.2004.052316
[35] Cheng WD, Wold KJ, Benzoni NS, Thakwalakwa C, Maleta KM, Manary MJ, Trehan I. Lactoferrin and lysozyme to reduce environmental enteric dysfunction and stunting in Malawian children: study protocol for a randomized controlled trial. Trials 2017;18:523. https://doi.org/10.1186/s13063-017-2278-8
[36] Garas LC, Feltrin C, Hamilton MK, Hagey JV, Murray JD, Bertolini LR, Bertolini M, Raybould HE, Maga EA. Milk with and without lactoferrin can influence intestinal damage in a pig model of malnutrition. Food Funct 2016;7:665-78. https://doi.org/10.1039/c5fo01217a
[37] Kuwata H, Yamauchi K, Teraguchi S, Ushida Y, Shimokawa Y, Toida T, Hayasawa H. Functional fragments of ingested lactoferrin are resistant to proteolytic degradation in the gastrointestinal tract of adult rats. J Nutr 2001;131:2121-7. https://doi.org/10.1093/jn/131.8.2121
[38] Zavaleta N, Figueroa D, Rivera J, Sánchez J, Alfaro S, Lönnerdal B. Efficacy of rice-based oral rehydration solution containing recombinant human lactoferrin and lysozyme in Peruvian children with acute diarrhea. J Pediatr Gastroenterol Nutr 2007;44:258-64. https://doi.org/10.1097/MPG.0b013e31802c41b7
[39] Cremon C, Stanghellini V, Barbaro MR, Cogliandro RF, Bellacosa L, Santos J, Vicario M, Pigrau M, Alonso Cotoner C, Lobo B, Azpiroz F, Bruley des Varannes S, Neunlist M, DeFilippis D, Iuvone T, Petrosino S, Di Marzo V, Barbara G. Randomised clinical trial: the analgesic properties of dietary supplementation with palmitoylethanolamide and polydatin in irritable bowel syndrome. Aliment Pharmacol Ther 2017;45:909-22. https://doi.org/10.1111/apt.13958
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