Implementing Personalized Dietary Interventions for Immune-Mediated Inflammatory Diseases

The epidemiological association between various dietary patterns and the risk for chronic diseases is reasonably well established, including those for autoimmune and immune-mediated inflammatory diseases (IMIDs). However, when population data used to develop these associations for particular groups are used to predict risk in specific individuals, other complicating factors often affect the risk assessment. Additionally, understanding which components of any given dietary pattern are responsible for or protect against the risk of a specific health/disease outcome is complicated and hotly debated. This is especially true for autoimmune disorders and IMIDs. Furthermore, when these dietary associations are tested as preventative or interventional therapies in clinical trials, the results are often equivocal or difficult to interpret. Predictably, guideline recommendations for dietary intervention (for IMIDs and other chronic diseases) are limited and are often ignored in clinical practice, an oversight that prevents patients with IMIDs from realizing lasting remission and tissue healing. Emerging data on the mechanisms connecting dietary intake with changes in the gut microbiome, intestinal permeability, and dysfunctional immune reactivity have shed light on the role of dietary intervention as adjunctive therapies for IMIDs. However, leveraging this emerging data involves personalized dietary assessments and recommendations, often requiring the services of a nutritional specialist trained to understand the complexity of food-driven systemic inflammation. This paper summarizes the published data connecting diet patterns, individual dietary assessment, and dietary interventions for specific IMIDs. When personalized and implemented with other lifestyle interventions (e.g., stress reduction, movement, etc.), nutritional interventions should be considered foundational therapy for chronic immune-mediated inflammation.