The exact cause of Inflammatory Bowel Disease (IBD) is greatly debated since at the moment we don’t know. Many theories are out there, but one that always seems to come up first is diet. There is no denying that over the last few decades obesity and IBD have been on the rise globally. In fact, globally speaking obesity has tripled since 1975. The way in which we eat has greatly changed too. With more and more convenience, prepackaged, and ultra processed foods over the last several decades, we have added chemicals, additives, and colorings that we are finding can’t fully be digested. Do many people then ask if this change in obesity and eating causes the onset or early onset of Crohn’s or Ulcerative Colitis? One study in Ontario, Canada at McMaster University aimed to answer just that. The study is called PURE (Prospective Urban Rural Epidemiology) and is the first large-scale multinational study on the subject.
PURE followed 116,087 participants aged 30-70 from 2003-2016 in 21 nations. A total of 467 patients developed IBS, 337 developed UC, and 90 developed CD. Each participant kept records of food intake with a baseline questionnaire including the frequency of processed food consumed. Not surprisingly North America, Europe, and South America saw the highest processed food intake with many participants consuming processed foods up to five times a day, which included soft drink consumption as well. South America saw the highest soft drink consumption, and China saw the highest sodium consumption. For sugar consumption, it was found that the highest risk of IBD was at 100 grams a day or more. However, the largest increase in the risk of developing IBD was found to be consuming one or more servings of fried food daily.
This study, although the first large scale of its kind, does have some limitations. The first being that the participants were in charge of recording their information as well as submitting new diagnoses to the researchers. This adds margin for error, as some may have not accurately updated information. Another limitation is that this is a ‘diet study’. More often than not such studies are hard to complete or complete with full accuracy. Lastly, most people were above the age of 35 which is a drawback as most IBD patients will be diagnosed in adolescence or early adulthood. All in all, the PURE study did make a connection between ultra-processed food and IBD development.
Another recent study aimed to connect obesity and Crohn’s disease after finding a 34% increased risk of developing Crohn’s with obesity in adulthood. Interestingly enough this link was not seen in Ulcerative Colitis. Specifically, those with a BMI of 30 or above increased their risk for older-onset Crohn’s. This suggests a link to the rise in older patients developing IBD in the last decade. Additionally, across the entire population study, each 5 BMI increase was associated with a 16% higher risk of being diagnosed with Crohn’s. This increased in the younger population with a 22% increased risk for those aged 18-20. It was also found that childhood obesity increased the risk of a Crohn’s diagnosis before the age of 30. Previous epidemiology studies have not been able to connect obesity and IBD, but it is believed this was due to the limited population size as well as the retrospective design of the studies.
Future research will need to be done in both of these areas, but an undeniable link seems to be associated with increased risk of IBD and obesity as well as ultra-processed foods. We know that gut wall permeability can lead to a ‘leaky gut’ which is associated with IBD and other chronic illnesses. The more processed food that is eaten, the weaker the gut wall can become. This makes way for overbreeding of harmful bacteria and even fermenting of this bacterium which can lead to leaky gut as well. There is no denying that obesity and processed food consumption are at an all-time high. I believe that these things are connected, and while more evidence is needed from the scientific community, if you listen your body will tell you what foods bother it. I have personally found any processed foods bother me after my UC diagnosis, and I hope more studies will be done in the near future on these ever-pressing topics.
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