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‘Hype vs. Science’: Identifying, Disseminating Nutrition Data that Matters
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In this guest commentary, Kate Scarlata, MPH, RDN, a Boston-based registered dietitian, addresses the results of a recent case report published in an open-access journal that indicated that a plant-based diet induced remission in a patient with Crohn’s disease. The results received a significant amount of social media attention and touted a plant-based diet as a ‘cure’, however as Scarlata notes, that’s not necessarily the case.
Case reports in the literature, like we saw with Sandefur and colleagues, may provide insights about a person’s experience with diet alterations but they are not a controlled experimental study design, which means that cause and effect cannot be established. Additionally, these types of reports cannot be generalized to the entire IBD population. There were a lot of moving parts involved with this case report in which the patient underwent not just the suggested dietary change, but also modified other lifestyle habits. Moreover, the participant was taking a medication that could have played a significant role in the remission of his disease.
Social media provides a place for a plethora of pseudoscience, and evidence-based clinicians should respond to social media threads that promise unsubstantiated science.
People diagnosed with inflammatory bowel disease are looking for something to help control their disease, and diet is usually something these patients gravitate toward. Putting out this message via social media that a plant-based diet is a ‘cure’ is giving people false promises based on the data on diet and IBD that we understand to date.
Self-imposed elimination diet
Living with IBD can be a challenge. Imagine if eating triggered pain and frequent trips to the bathroom. It makes sense that individuals would consider making nutritional changes as a way to manage these symptoms. Further complicating this scenario, individuals with food-related symptoms may be at risk for escalating food fears and/or maladaptive eating, which can compound nutritional deficiency risks and reduce emotional well-being. It is very possible patients with IBD will read this type of messaging on social media and consider a self-imposed elimination diet, which may compromise their GI function and nutritional status, if nutritionally inadequate.
More than just a diet
In this case study, the patient was not just on a diet. He was on a biologic, and integrated diet changes along with yoga and weightlifting.
Another limitation to this case study is that no food records were assessed to review the individual’s diet. Relying on the patient’s recall of his diet adds another layer of bias and ambiguity to this case report.
Although there is a growing interest in the role of diet and IBD, there are limited scientific data regarding IBD and diet at this time. Moreover, due to various clinical presentations of IBD, it is unlikely, that there will be a one-size-fits all diet for this condition. Illustrating this point, an IBD patient with strictures at risk for an obstruction may require dietary modification in insoluble fiber, while other individuals may be more tolerant to various dietary fibers. A general recommendation of eating a “plant-based diet” depending on the plant selections may potentially place some patients at risk for obstruction. Further, some IBD patients experience intolerance to FODMAP carbohydrates, which are found in many plant-based foods. There are many factors one should consider when thinking about the nutritional needs of individuals with IBD from structuring disease, to food fears and anxiety around diet, as well as food specific symptoms. From my experience working with IBD patients, diet interventions require an individualized approach.
A step ahead
Patients with GI disorders can be quite educated on the science of their disorder. Health care providers should be somewhat privy to what is being touted for IBD management on the Internet. There is no doubt that our patients are on social media and as practitioners we need to be there with them to provide the science and discount the hype. Regarding this case, I was very happy to see tweets from GI doctors and registered dietitians providing science-based counterpoints to tweets suggesting diet is a cure for IBD. With today’s technology, we need to continually combat misinformation in social media settings, to provide an evidence-based and trusted voice for our patients.
Reference:
Sandefur K, et al. Nutrients. 2019;doi:10.3390/nu11061385.
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Kate Scarlata, MPH, RDN, is a Boston-based registered dietitian and New York Times best-selling author known worldwide for her expertise. She can be reached on Twitter at @katescarlata_RD.
Disclosure: Scarlata reports no relevant financial disclosures.
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