Association between IBD and greater amounts of microplastics in stool

What is your opinion regarding the hypotheses of researchers, suggesting that microplastic exposure may be related to IBD process or that IBD exacerbates the retention of MPs?

Up to 71% of patients with inflammatory bowel disease (IBD) believe diet affects symptomatology and 81% follow elimination diets while in remission. However, current dietary recommendations are confusing and contradictory. In this study by Dr Yan et al. [1], authors raised the provocative hypothesis that microplastics (MP) may contribute to the development of IBD. MP are small plastic particles (<5 mm diameter) and considered a major environmental problem due to the overuse of plastics nowadays. MP are widely distributed, easily ingested with our diet, or even inhaled, and may accumulate in various organs due to their small sizes and low rate of degradation. Although preclinical studies have suggested the adverse events of MP on metabolic disorders and inflammation, their impact on human health hasn’t been fully investigated yet. Here, authors collected feces of healthy and IBD patients and analysed the concentration of MP. Authors showed a higher concentration of fecal MP in IBD than healthy. Intriguingly, the concentration of MP positively correlated with the disease severity, suggesting MP as potential triggers of clinical activation in IBD while providing a potential link between diet and inflammation. Indeed, authors reported that patients with a higher abundance of fecal MP consumed more plastic-packaged products. Although it has been suggested that MP could pass through the intestinal barrier into the circulatory system and potentially impact health, the results are very preliminary and more information is needed before taking premature conclusions affecting patients. Independently of the impact on gastroenterology, this study highlights the global concerns regarding the large use of plastics nowadays, the implications it may have for human health through the food chain but also through commodities and agricultural products, and the pressing need of reducing plastic use.

What would be your advice to patients suffering IBD regarding the microplastic exposure?

Results need to be taken with caution and more research is required to understand the reported increase of faecal MP in IBD and the implications for clinical severity. Although dietary consumption seems to be the most plausible hypothesis, multiple demographic, methodological or clinical factors could be explaining this increase. It would be of interest to see whether these observations apply to countries other than China, where IBD is on the raise. IBD patients also present with an altered gut microbiome, absorption, permeability and motility, as well as different stool consistency, all factors that can influence MP excretion. Indeed, the gut microbiome is a complex and diverse ecosystem presenting microbes with the capacity to digest different components including MP, and IBD patients present an impaired microbiome. In addition, patients frequently consume different drugs or bioproducts (vitamins, probiotic, etc) to manage their symptoms and this could also indirectly affect faecal MP.
Finally, diet affects symptomatology in IBD and there is the wrong impression that ultraclean foods which are frequently plastic-packaged or bottled (e.g. the increase use of bottled water in the last decades), are beneficial. Thus, dietary choices by patients could potentially include more plastic-packaged food. My advice to patients is adhering to traditional and well-tolerated diets, preferring home-prepared and natural foods, and avoiding both ultra-processed and plastic- packaged foods. Reduction of plastic is also good for taking care of our planet!