What lifestyle interventions are effective for alleviating symptoms and preventing flare-ups in patients with Crohn's disease or ulcerative colitis?

From the Guidelines

Patients with Crohn's disease or ulcerative colitis should be advised to follow a Mediterranean diet rich in a variety of fresh fruits and vegetables, monounsaturated fats, complex carbohydrates, and lean proteins, and low in ultraprocessed foods, added sugar, and salt to alleviate symptoms and prevent flare-ups. This recommendation is based on the most recent and highest quality study available, which suggests that a Mediterranean diet may reduce inflammation and improve overall health in patients with inflammatory bowel disease (IBD) 1.

Key Lifestyle Interventions

• Dietary modifications: identifying and avoiding personal food triggers through food diaries or elimination diets, with common trigger foods including high-fiber foods during flares, lactose, alcohol, caffeine, spicy foods, and fatty foods
• Stress management techniques: mindfulness meditation, yoga, and regular exercise to control symptoms and reduce stress, a known trigger for IBD flares
• Adequate sleep: 7-9 hours nightly to support immune function and reduce inflammation
• Smoking cessation: crucial, especially for Crohn's disease patients, as smoking worsens symptoms and treatment outcomes
• Regular physical activity: walking, swimming, or cycling for 30 minutes most days to improve overall health and reduce inflammation
• Proper hydration: 8-10 glasses of water daily to prevent complications, particularly during active flares with diarrhea

Rationale

These interventions work by reducing inflammatory processes, supporting gut microbiome health, strengthening immune function, and minimizing triggers that can activate inflammatory pathways in the intestinal tract. A healthy Mediterranean diet, in particular, has been shown to have numerous health benefits, including reduced cardiovascular disease incidence, and may be beneficial for patients with IBD, although it may require accommodations for food texture in the setting of intestinal strictures or obstructions 1.

Additional Considerations

• Exclusive enteral nutrition using liquid nutrition formulations may be an effective therapy for induction of clinical remission and endoscopic response in Crohn’s disease, particularly in children 1
• Parenteral nutrition may be necessary for patients with IBD facing acute and/or chronic intestinal failure, and should be transitioned to customized hydration management and oral intake whenever possible to decrease the risk of developing long-term complications 1

From the Research

Lifestyle Interventions for Crohn's Disease and Ulcerative Colitis

• Lifestyle interventions can play a crucial role in managing Crohn's disease and ulcerative colitis, with the goal of alleviating symptoms and preventing flare-ups 2.
• A systematic review found that smoking cessation is an effective lifestyle intervention for maintaining remission in adults with Crohn's disease 2.
• Enteral nutrition has also been shown to be effective in inducing remission in Crohn's disease, particularly in children and young adults 2, 3.
• Fish oil and probiotics have been studied as potential lifestyle interventions for Crohn's disease, but more research is needed to confirm their effectiveness 2.

Medical Management of Crohn's Disease and Ulcerative Colitis

• The medical management of Crohn's disease and ulcerative colitis typically involves a combination of aminosalicylates, corticosteroids, and immunomodulators 4, 3, 5, 6.
• Aminosalicylates, such as 5-ASA, are commonly used to treat mild ulcerative colitis and may also be effective in mild Crohn's disease 5, 6.
• Corticosteroids, such as budesonide, may be used to treat mild Crohn's disease and ulcerative colitis, but their use is often limited due to potential side effects 5, 6.
• Immunomodulators, such as azathioprine and mercaptopurine, may be used to maintain remission in patients with Crohn's disease and ulcerative colitis 4, 6.

Future Directions

• Newer therapies, such as biologics and small molecules, are being developed for the treatment of Crohn's disease and ulcerative colitis 4, 5.
• The goal of treatment is shifting from solely inducing clinical remission to also achieving mucosal healing, which may help to prevent long-term complications 4, 6.
• Further research is needed to determine the optimal treatment approach for patients with Crohn's disease and ulcerative colitis, including the use of lifestyle interventions and medical therapies 2, 4, 3, 5, 6.