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Nutrition Management

Inflammatory Bowel
Disease
Evelyn Tribole, MS, RD
Author, Ultimate Omega-3 Diet

August 19, 2009
Orange County CCFA
www.EvelynTribole.com
Beyond Symptom
Management
• New Research
• Implications
• So What Do I Eat?


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Attunement
Internal External

http://www.gse.buffalo.edu/cap/satsanga/healthyself.asp

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Linoleic Acid Doubles Risk for 
Ulcerative Colitis
Why
• Dramatic rise in dietary omega­6 fats “heart healthy”
• First­line medications block omega­6 fat compounds
•  Tissue levels of omega­6 inflammatory compounds 
rise with the amount of intestine damage.
WHO & Where
• 200,000 people
• 10 Countries
• Prospective study
Hart AR. Linoleic Acid, a Dietary N­6 Polyunsaturated Fatty Acid, and the Aetiology of Ulcerative Colitis ­ A European 
Prospective Cohort Study.Gut 2009. Gut. Published Online First: 23 July 2009. doi:10.1136/gut.2008.169078


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Omega-6
Polyunsaturated Fats
• Most Commonly Eaten Fat
• Soybean oil
• Cottonseed oil
• Corn oil
• Margarines, spreads,
dressing


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Anti-Inflammation Medications
Block
Effects of Omega-6 Fat
• NSAIDS
• COX-2 Inhibitors
• Statins
• Inhalers
• Acne medication
• Mood Stabilizers


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First­Line Colitis Medications
Block Omega­6 Effects

Dose­Dependent
5­aminosalicylic acid 
(Mesalamine)


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5-ASA Trade Names
Apriso, Asacol, Canasa
Lialda, Pentasa, Rowasa


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Linoleic Acid Doubles Risk for 
Ulcerative Colitis
Findings
• Dietary Omega­6 Fat Ups Risk 2­fold
• Accounted for 30% of cases

Diet Details
• Risk for Women: > 6.1 grams linoleic acid
• Risk for Men: > 7.8 grams linoleic acid
Perspective
• USA Diet averages 13.0 grams linoleic acid
• Top Sources: soybean oil, corn oil, cottonseed oil
• 1 Tb soybean oil=6.9 grams 
1 Tb soybean oil= grams linoleic acid
Hart AR. Linoleic Acid, a Dietary N­6 Polyunsaturated Fatty Acid, and the Aetiology of Ulcerative Colitis ­ A European 
Prospective Cohort Study.Gut 2009. Gut. Published Online First: 23 July 2009. doi:10.1136/gut.2008.169078


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Dietary Omega­6 Fat Ups Risk 
for Colorectal Cancer
Why
• Omega­6 compound (PGE2), is associated with a high risk of 
colorectal cancer.
• Balance of dietary omega­6 and omega­3 effect eicosanoids

WHO & Where
• 75,000 Women
• China
Murff HJ et al.A Prospective Study of Dietary Polyunsaturated Fatty Acids and Colorectal Cancer Risk in Chinese Women. Cancer Biomarkers Prev. 2009 18:
2283-2291.

Chan AT et al.Aspirin Use and Survival After Diagnosis of Colorectal Cancer.JAMA. 2009;302(6):649-658.


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Dietary Omega­6 Fat Ups Risk 
for Colorectal Cancer
Findings
 Omega­6 compound (PGE2), with low dietary omega­6:3
 Cancer risk
 Cancer risk:
• Dietary arachidonic acid 
• High dietary ratio of omega­6 to omega­3 fats

Murff HJ et al.A Prospective Study of Dietary Polyunsaturated Fatty Acids and Colorectal Cancer Risk in Chinese Women. Cancer Biomarkers Prev. 2009 18:
2283-2291.

Chan AT et al.Aspirin Use and Survival After Diagnosis of Colorectal Cancer.JAMA. 2009;302(6):649-658.


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Arachidonic Acid

Found in meats, poultry, eggs
Higher in farmed fish
Lower in pasture­raised (grass­fed) cattle

Murff HJ et al.A Prospective Study of Dietary Polyunsaturated Fatty Acids and Colorectal Cancer Risk in Chinese Women.
Cancer Biomarkers Prev. 2009 18: 2283-2291.

Chan AT et al.Aspirin Use and Survival After Diagnosis of Colorectal Cancer.JAMA. 2009;302(6):649-658.


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Omega-Fats

Omega-3 Omega-6 Omega-9

Olive oil
Avocado
Nuts

algae oil


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Fats in Olive Oil
Monunsaturated RATIO
73% VS
CONTENT
Saturated 14%

Polyunsaturated 11%


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Fats in Soybean Oil
Monunsaturated 23%

Saturated 16%

Polyunsaturated 58%


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Different Omega-
3s

Marine Plant
Foods
Foods
EPA
ALA
DHA

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Omega-3 Fat: Basics
Originally classified as a
vitamin

Required in every cell

Different types with


different jobs

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Recommended
Omega-3 Intake
Omega-3 Fatty Acid Milligrams/day

ALA [1] (from plants) 2220 *

DHA + EPA [1]


650 *
(marine)
Rx: IBD Fish Oil [2] 2700-5600
*based on 2,000 kcal/day
[1] Simopoulos, AP et al.. Workshop on the Essentiality of and Recommended Dietary Intakes for Omega­6 and Omega­3 Fatty Acids. J Am Coll Nutr (1999) 18: 487.
[1] Simopoulos, AP et al.. Workshop on the Essentiality of and Recommended Dietary Intakes for Omega­6 and Omega­3 Fatty Acids. J Am Coll Nutr (1999) 18: 487.

[2] Calder P. Recommendations for Therapeutics and Prevention: n-3 Polyunsaturated fatty acids, inflammation, and inflammatory diseases.
Am. J Clinical Nutr. 2006;
2006; 83(6):S1505-1519S.


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USA Diet Compared to
Recommendations
Milligrams/da USA Diet=
Fatty Acid y
Deficient

1300
ALA 2200
(60%)

DHA +
650 85 (13%)
EPA

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2­Fish Servings/Week
Fish (6-oz
EPA + DHA (mg)
cooked)
Anchovies 3500
Wild Salmon 2960
Halibut 2000
Rainbow
1960
Trout
Sardines 1660
Sea Bass 1300

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What if You Won’t Eat
Fish?

EPA
&DHA
•Fish
•Algae oils
•Fortified

Foods
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Fortified Foods
Read the Label
• Which omega-
3?

• What Amount?
– DHA 32 mg/serving
(Horizon milk)


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Supplements
How to Choose
No standard
formula
Amount of:
DHA
EPA
No need for
added:
Omega-6

Omega-9
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Special Concerns:
Omega-6 Fats
Excess Interferes with Omega-3s

Top Omega-6 Sources=Vegetable oils


Soybean oil Corn oil
Cottonseed oil  Margarines

Lowest Omega-6 Vegetable oils


Olive oil  Canola oil  Flax oil

Brenna JT, et al. Prostaglandins, Leukotrienes & Essential Fatty Acids.2009;80: 285-91.

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Mediterranean Diet


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Silo Effect
• Pharmaceutical:
Blocking the excessive omega-6
eicosanoid signals

• Cardiology
• Oncology
• IBD


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Conclusion
Type of Omega-
3 DHA + EPA
Right Amount
650
milligrams/day
Limit Omega-6

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