Chronic inflammatory bowel diseases: the most effective dietary supplements

Inflammatory bowel diseases (IBD) encompass two main conditions: Crohn's disease and ulcerative colitis (UC). These disorders are characterized by chronic inflammation of the intestinal wall, caused by dysregulation of the immune system. About 200,000 people are affected in France, with a rising incidence in industrializing countries. IBD follow an inflammatory flare-remission pattern, alternating with periods of remission. Symptoms include frequent diarrhea, sometimes bloody, abdominal pain, and generalized fatigue. Extra-intestinal manifestations are common: arthritis, erythema nodosum, uveitis, and primary sclerosing cholangitis. Complications include strictures, fistulas, and an increased risk of colorectal cancer.

Etiology

IBD result from a combination of genetic, immunological, and environmental factors: • Genetic: Genetic research on inflammatory bowel diseases (IBD) has identified specific genes associated with an increased risk of developing these conditions. NOD2, a gene involved in bacterial recognition, has variants that reduce the ability to clear microbes and alter the interactions between the intestinal mucosa and the microbiota. ATG16L1, involved in autophagy, plays a role in managing cellular stress and regulating inflammatory responses. Finally, IL23R encodes the receptor for interleukin 23 (IL-23), a key molecule in immune regulation. Genetic variants of IL23R can lead to 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 penetrate the mucosa. • Microbiota: IBD are often associated with an imbalance of the gut microbiota, or dysbiosis. This imbalance manifests as a decrease in beneficial bacteria such as Faecalibacterium prausnitzii and an increase in pathogenic bacteria, notably Escherichia coli.  • Environmental: Smoking, processed foods, and pollution are aggravating factors.

Drug treatments

The treatments for inflammatory bowel diseases (IBD) include various options tailored to the severity and location of the inflammation. Therapeutic approaches combine anti-inflammatory drugs, immunomodulators, and sometimes surgical interventions. • 5-Aminosalicylates (5-ASA): First-line medications for mild to moderate forms of UC. Administered orally or rectally, they help reduce colonic inflammation and maintain remission. Mesalamine is commonly used. • Corticosteroids: Recommended for moderate to severe forms during inflammatory flares. 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 act on the immune response but require regular monitoring due to their adverse effects. • Biologic therapies: Anti-TNFα agents (such as infliximab) are particularly effective in severe or refractory forms of UC. Other options include vedolizumab, which targets molecules involved in intestinal inflammation.

Complementary approaches

Complementary approaches, based on herbal medicine and nutrition, provide adjuncts to reduce inflammation and strengthen intestinal health. Some plants have demonstrated anti-inflammatory and mucosal-protective effects. Among them, Aloe vera, rich in compounds such as aloin, reduces inflammatory markers and promotes regeneration of damaged tissues. Curcumin, extracted from turmeric, inhibits inflammatory pathways such as NF-κB and decreases pro-inflammatory cytokines like IL-1β and TNF-α. In addition, extracts of Boswellia serrata, thanks to boswellic acid, reduce the activity of cyclooxygenase-2 (COX-2) and the transcription factor NF-κB, helping to relieve IBD symptoms. Finally, ginger, through its active component shogaol, has shown benefits in reducing tissue damage and inflammatory markers. An appropriate diet remains essential to limit inflammatory flares. Recommendations include reducing insoluble fiber during acute phases and introducing probiotics such as Lactobacillus acidophilus and Bifidobacterium bifidum to rebalance the gut microbiota. Dietary antioxidants such as polyphenols, found in green tea and certain fruits, also offer protection against oxidative damage. Finally, adopting a low-lactose and gluten-free diet may be beneficial for some patients. Supplementation with magnesium, zinc, and copper contributes to cellular regeneration and modulation of immune responses. Magnesium bisglycinate, in particular, improves neurological functions and reduces fatigue related to IBD. In addition, vitamin D and calcium are essential to prevent bone fragility frequently associated with these diseases.