Understanding the "Nutrinomics" of Nutritional Therapy in IBD
There is still a great deal that we don’t understand about Crohn’s Ddisease (CD) and IBD. For example it is still unclear if a person gets Crohn’s Disease and that leads to a shift in the gut microbiota or vise-versa.
One of the main treatments for Crohn’s disease is exclusive enteral nutrition (EEN), such as modulen, using a nutritional product that acts as a drug. To make progress we need to change our way of thinking and apply concepts we would use in implementing drug therapy to modulen. It has been shown that there was superior remissions of EEN vs steroids, faster mucosal healing rates, improve systemic inflammatory markers etc.
People with CD have a different microbiota compared to healthy individuals; they have a greater number of bacteria. However, the variety of bacteria is limited, which means people with CD have a smaller set of bacteria to begin with.
The microbiome studies gives useful info for example on biological pathways for a small interested group to study but not to apply and understand as a clinical concept. We are still not familiar with how modulen works. The aim is to understand the science and mechanism of it in order to get over 80% remission rates. There has been a lot of confusion on how modulen works as we can see that during therapy if we look at the metabolomics we can see broadly that it goes further away from the normal. However, after the modulen therapy we bring back the metabolomes back to a close to normal.
In the future, we need to focus on improving modulen, and understanding why it doesn’t work in some individuals, create new dietary strategies, improve EEN clinical induction and maintenance rate.