Primary Health Care: Open Access

Significance of Nutritional Therapy for Treating Intestinal Disorders

Patricia Laughlin^{* *}Correspondence: Patricia Laughlin, Editorial Board, Primary Health Care: Open Access, United Kingdom, Email:

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Introduction

The gastrointestinal system represents a complex amalgamation of elements involving immunity, the microbiome, and the epithelium [1]. The interactions between the gut microbiome and the host have profound and extensive implications in biology, surpassing the traditional roles of food digestion and nutrient absorption. Dietary components wield significant influence over this intricate system, assuming a critical role in establishing and maintaining the delicate balance within the gut. This equilibrium is crucial for the overall well-being of the host. Within this article, we undertake an in-depth exploration of a wide array of dietary constituents and their consequences for the development and management of various intestinal disorders [2]. These encompass conditions such as inflammatory bowel disease, irritable bowel syndrome, colorectal cancer, diverticulitis, and related ailments. A heightened understanding of the interplay between diet, the host's physiology, and the gut microbiome is essential. It enables the provision of advantageous nutrients to enhance gut health, all while minimizing potential nutritional hazards. Ultimately, this knowledge ensures effective nutritional management of gastrointestinal conditions in the context of clinical practice.

Correlation between distinct dietary patterns and intestinal disorders

High species diversity represents a fundamental characteristic of a healthy gut microbiome in individuals. However, certain external factors, such as the use of antibiotics, infections, or alterations in dietary habits, have the potential to disrupt the microbiome's composition, creating an environment that deviates from its natural equilibrium [3]. Typically, in healthy individuals with a robustly diverse gut microbiome, these alterations are reversible. Nonetheless, when external factors exert overwhelming influence beyond the microbiome's capacity for self-regulation, it can lead to a significant disturbance in the ecosystem. This disturbance often results in a decrease in microbiota diversity and resilience, ultimately causing tissue damage. Patients with Inflammatory Bowel Disease (IBD), a prevalent form of gutrelated illness, exhibit functional microbial dysbiosis, as evidenced by metagenomic studies, including those conducted by the European MetaHIT Project [4]. Additionally, metabolomic analyses of samples such as breath or feces have shown reduced levels of butyrate, acetate, and trimethylamine, along with elevated levels of amino acids in IBD patients. The insufficient production of Short Chain Fatty Acids (SCFAs) is a characteristic observed in individuals with IBD.Dietary factors have garnered substantial attention as significant contributors to the etiology and pathogenesis of IBD, given the notable rise in the incidence and prevalence of this condition. Genetic susceptibility, as described in existing literature, can only partially account for the dramatic upswing in disease prevalence observed in epidemiological studies .The surge in global IBD cases seems closely linked to the adoption of a Western lifestyle. Reportedly, various dietary components have been identified as factors that can negatively impact the composition of the gut microbiome and either cause or exacerbate inflammation, particularly in animal models of IBD. These substances encompass high-fat/high-sugar diets, gluten, maltodextrin, emulsifiers, titanium dioxide nanoparticles, luminal iron, aluminum (a food chain contaminant), artificial sweeteners, and dietary phosphate. Importantly, these components are commonly found in the Western diet .

Role of nutritional therapy in the treatment of intestinal disease

Nutritional Therapy for Ensuring Optimal Nutrient Intake: Malnutrition is often regarded as a medical and social concern primarily in a few lessdeveloped countries, typically characterized by insufficient access to food (undernutrition).

However, even individuals in developed nations face potential risks, especially among hospitalized patients. Importantly, the definition of malnutrition has evolved to encompass not only deficiencies but also excesses or imbalances in an individual's energy and nutrient intake. In this article, our focus on malnutrition is limited to deficiencies.One of the most prevalent gut-related conditions necessitating nutritional therapy is intestinal failure. It arises as a secondary consequence of various inflammatory intestinal conditions, such as Crohn's Disease (CD) or ischemic bowel disease [5]. The nature and extent of nutritional therapy required for patients with intestinal failure are contingent upon the location and severity of the affected intestinal segments, primarily within the small intestine, where absorptive capacity is compromised. In cases where the clinical presentation of intestinal failure is severe, as in short bowel syndrome, a significant component of the treatment strategy involves intravenous supplementation for fluids, electrolytes, and various nutrients. While there may be limited evidence and guidelines regarding the optimal timing and methods for initiating and discontinuing enteral nutrition (EN) or parenteral nutrition (PN), it is typically recommended to reintroduce EN as soon as patients begin to recover from severe intestinal diseases. When EN alone does not meet the energy requirements, supplemental PN is employed.he multifaceted causes of undernutrition in intestinal diseases encompass factors such as reduced nutritional intake due to gastrointestinal (GI) symptoms, malabsorption within the diseased gut segments, heightened GI losses due to conditions like diarrhea or fistulas, and the impact of medications like steroids and sulfasalazine. Additionally, less common factors contributing to nutritional challenges include dental issues, orofacial pain conditions, salivary dysfunction, oral complications during cancer treatment, and specific GI disorders. These conditions may have a relatively tenuous connection to the intestinal diseases themselves.

Utilizing dietary intervention as a therapeutic strategy

Dietary intervention encompasses deliberate modifications or treatments made to an individual's diet with a predetermined objective, typically aimed at enhancing the individual's overall well-being. There are three primary models for dietary intervention, which include the supplementation of specific dietary components, the exclusion of certain dietary elements, or the utilization of dietary formulas as substitutes for a regular diet [5].Another facet of dietary intervention is grounded in the recognition that diet has a significant impact on the gut microbiome, leading to subsequent alterations in the gut environment, as previously mentioned. In the context of intestinal inflammation, the metabolism of both the host's immune and nonimmune cells, as well as that of the gut microbiome, undergoes changes. Consequently, the nutritional requirements of the host and/or the microbiome may be modified in the presence of gastrointestinal diseases. When considering treatment strategies, it is crucial to have a precise understanding of the appropriate dietary modifications that can help restore gut microbial diversity, thereby optimizing therapeutic dietary interventions [6].Extensive research into the influence of diet on the development and exacerbation of gastrointestinal diseases has spurred interest in the potential of dietary adjustments as a viable treatment option. However, as of now, there is a paucity of well-designed clinical trials and large-scale, randomized prospective studies that can definitively establish the most effective dietary regimen for treating specific diseases or inducing/maintaining remission. The meta-analyses available in the literature have predominantly incorporated data from smaller-scale studies.

The function of probiotics and prebiotics in specialized microbe-centric nutritional therapy: Probiotics and prebiotics represent natural dietary constituents that have the capacity to enhance the intestinal environment. They are increasingly being utilized as biotherapeutic agents for microbialbased therapy, akin to procedures such as fecal microbiota transplantation. Probiotics, in particular, find common use in preventing dysbiosis among individuals undergoing extended antibiotic or immunosuppressive treatments. The effectiveness of probiotics is contingent upon the specific microbial strains employed. In terms of their immunological functions, probiotic strains generate growth factors that fortify the integrity of the gut epithelium and gut barrier. Additionally, they produce antimicrobial substances such as Short Chain Fatty Acids (SCFAs), bacteriocins, hydroperoxides, bile acids, and lactic acid, which play a pivotal role in eradicating pathogens[7]. Furthermore, probiotics stimulate host immune responses by releasing cellular components from the strains, thereby enhancing the activity of macrophages and lymphocytes .Regarding their non-immunological functions, probiotics and prebiotics contribute to improved digestion and nutrient absorption. They also engage in competition with potential pathogens for nutrients and binding sites in the intestine, regulate pH fluctuations, and facilitate the clumping of pathogens while sequestering metabolic toxins. These agents have been identified to inhibit apoptosis, participate in mucin synthesis, and contribute to tissue repair, thereby fortifying the protective function of the gut barrier.

Global Developments and Future Perspectives

To date, substantial research efforts have been directed towards gaining a deeper understanding of the genetic and microbial aspects related to Gastrointestinal (GI) diseases. Extensive studies have also been conducted to develop effective and safe pharmacological treatments for GI diseases. However, limited research data have been available concerning the influence of nutrition or diet in this context. Currently, there is a growing recognition of the pivotal role that diet and nutrition play in the etiology and management of GI diseases [8]. Consequently, several developed countries are actively involved in the development and commercialization of novel nutritional therapies, alongside planning and coordination to expedite research progress. Despite the considerable knowledge acquired thus far regarding the connection between nutrition/diet and gut health, numerous gaps persist in research and understanding within this field [9]. The relationship between nutrition and gut health is exceedingly intricate, necessitating future multidisciplinary collaborative research efforts. For instance, modifying the long-term dietary behaviors of patients requires not only scientific and medical strategies but also psychosocial and sociocultural approaches[10]. Since October 2016, the National Institutes of Health (NIH) Nutrition Research Task Force has been instrumental in shaping the Strategic Plan for NIH Nutrition Research, which outlines a 10year agenda to accelerate basic, translational, and clinical research while enhancing training in the realm of nutrition research. This initiative aims to enhance overall health and address conditions induced by nutrition and diet. In the context of Inflammatory Bowel Disease (IBD), the Dietitians' Committee of the European Crohn's and Colitis Organisation, in collaboration with experts in microbiology, physiology, and medicine, has conducted a comprehensive review of the evidence pertaining to the role of diet and nutritional therapy in the development and management of IBD. The outcomes of this review are anticipated to serve as a valuable resource for future researchers investigating the role of diet and nutrition in IBD.

Conclusion

Nutritional therapy extends beyond its traditional roles as a means of energy and protein supplementation or as a strategy for preventing and managing malnutrition induced by diseases. Dietary patterns exert a profound influence on the gut microbiome, and the alterations in microbial composition triggered by dietary choices can significantly impact the gut environment. Consequently, nutritional therapy can be regarded as a costeffective approach for both therapeutically addressing and preventing intestinal health issues. There is a clear need for further research to delve into the intricate interplay among different dietary nutrients, host immune responses, and the gut microbiome. This expanded understanding will ultimately enhance the efficacy of dietary interventions in the treatment of intestinal diseases.

References

1. Wlodarska, Marta, et al. "An integrative view of microbiome-host interactions in inflammatory bowel diseases." Cell host & microbe 17.5 (2015): 577-591.

   [Google Scholar] [Cross Ref]

2. Simrén, Magnus, et al. "Intestinal microbiota in functional bowel disorders: a Rome foundation report." Gut 62.1 (2013): 159-176.

   [Google Scholar] [Cross Ref]

3. Thorburn, et al. "Diet, metabolites, and â??western-lifestyleâ? inflammatory diseases." Immunity 40.6 (2014): 833-842.

   [Google Scholar] [Cross Ref]

4. Tilg, Herbert, and Alexander R. Moschen. "Food, immunity, and the microbiome." Gastroenterology 148.6 (2015): 1107-1119.

   [Google Scholar] [Cross Ref]

5. Sugihara,et al. "The role of dietary nutrients in inflammatory bowel disease." Front. immunol. 9 (2019): 3183.

   [Google Scholar] [Cross Ref]

6. Fournier BM, Parkos CA. The role of neutrophils during intestinal inflammation. Mucosal Immunol. 2012;5:354â??366.

   [Google Scholar]

7. Arumugam, Manimozhiyan, et al. "Erratum: Enterotypes of the human gut microbiome (Nature (2011) 473 (174-180))." Nature 474.7353 (2011): 666.

   [Google Scholar] [Cross Ref]

8. Wu, Gary D., et al. "Linking long-term dietary patterns with gut microbial enterotypes." Science 334.6052 (2011): 105-108.

   [Google Scholar] [Cross Ref]

9. Ou, Junhai, et al. "Diet, microbiota, and microbial metabolites in colon cancer risk in rural Africans and African Americans." Am. j. clin. nutr. 98.1 (2013): 111-120.

   [Google Scholar] [Cross Ref]

10. Griffin, Nicholas W., et al. "Prior dietary practices and connections to a human gut microbial metacommunity alter responses to diet interventions." Cell host  microbe 21.1 (2017): 84-96.

    [Google Scholar]