Chronic Inflammatory Bowel Diseases: Most Effective Dietary Supplements

IBD encompasses two main conditions: Crohn's disease and ulcerative colitis (UC). These disorders are characterized by chronic inflammation of the intestinal wall, caused by an immune system dysregulation. Approximately 200,000 people are affected in France, with an increasing incidence in industrializing countries. IBD progresses through inflammatory flare-ups, alternating with remission phases. Symptoms include frequent, sometimes bloody diarrhea, abdominal pain, and generalized fatigue. Extraintestinal manifestations are common: arthritis, erythema nodosum, uveitis, and sclerosing cholangitis. Complications include strictures, fistulas, and an increased risk of colorectal cancer.

Etiology

IBD results from a combination of genetic, immunological, and environmental factors:  Genetic: Genetic research on inflammatory bowel diseases (IBD) has identified specific genes associated with a higher risk of developing these diseases. NOD2, a gene involved in bacterial recognition, presents variations that reduce the ability to eliminate microbes and alter interactions between the intestinal mucosa and the microbiota. ATG16L1, involved in autophagy, plays a role in cell stress management and the regulation of inflammatory responses. Finally, IL23R codes for the interleukin 23 (IL-23) receptor, a key molecule in immune regulation. Genetic variations in IL23R can trigger hyperactivation of TH17 lymphocytes, which release pro-inflammatory cytokines and cause chronic inflammation of the intestinal mucosa.  Immunological: Dysregulation of the immune system resulting in the production of inflammatory cytokines, dysfunction of regulatory cells that control inflammation, and weakening of the intestinal epithelial barrier, allowing bacteria and antigens to invade the mucosa.  Microbiota: IBD is often associated with an imbalance in the intestinal microbiota or dysbiosis. This imbalance is characterized by a decrease in beneficial bacteria such as Faecalibacterium prausnitzii and an increase in pathogenic bacteria, notably Escherichia coli.
2  Environmental: Smoking, processed foods, and pollution are aggravating factors.

Medication Treatments

Treatments for inflammatory bowel diseases (IBD) include various options tailored to the severity and location of inflammation. Therapeutic approaches combine anti-inflammatory, immunomodulatory, and sometimes surgical treatments.  5-Aminosalicylates (5-ASA): First-line drugs for mild to moderate forms of UC. Administered orally or rectally, they reduce colonic inflammation and maintain remission. Mesalazine is commonly used.  Corticosteroids: Recommended for moderate to severe forms during inflammatory flare-ups. However, their use is limited to the short-term due to side effects.  Immunomodulators: Azathioprine and 6-mercaptopurine are used as maintenance therapy to prevent relapses after remission. These drugs affect the immune response but require regular monitoring due to side effects.  Biotherapies: Anti-TNFb1 (such as infliximab) are particularly effective for severe or refractory forms of UC. Other options include vedolizumab, targeting molecules responsible for intestinal inflammation.

Complementary Approaches

Complementary approaches, based on herbal medicine and nutrition, offer supplements to alleviate inflammation and enhance intestinal health. Certain plants have demonstrated anti-inflammatory and protective effects on the intestinal mucosa. Among them, Aloe vera, rich in compounds like aloin, reduces inflammatory markers and promotes the regeneration of damaged tissues. Curcumin, extracted from turmeric, inhibits inflammatory pathways such as NF-aB and decreases pro-inflammatory cytokines like IL-1b2 and TNF-ba. Moreover, extracts of Boswellia serrata, through boswellic acid, reduce the activity of cyclooxygenase-2 (COX-2) and the transcription factor NF-aB, helping to soothe IBD symptoms. Finally, ginger, with its active component shogaol, has shown benefits in reducing tissue damage and inflammatory markers. An adapted diet is essential to limit inflammatory flare-ups. Recommendations include reducing insoluble fibers during acute phases and the introduction of probiotics such as Lactobacillus acidophilus and Bifidobacterium bifidum to rebalance the intestinal microbiota. Dietary antioxidants like polyphenols, found in green tea and certain fruits, also offer protection against oxidative damage. Lastly, adopting a lactose-free and gluten-free diet may be beneficial for some patients. Supplementation with magnesium, zinc, and copper contributes to cell regeneration and modulation of immune responses. Magnesium bisglycinate, in particular, improves neurological functions and reduces fatigue associated with IBD. Furthermore, vitamin D and calcium are essential in preventing bone fragility frequently associated with these diseases.