Lifestyle Medicine and Inflammatory Bowel Disease in Viet Nam: Dietary Therapy, Malnutrition Risk, and Immunomodulatory Treatment Safety

Lifestyle Medicine and Inflammatory Bowel Disease in Viet Nam: Dietary Therapy, Malnutrition Risk, and Immunomodulatory Treatment Safety

Last reviewed: October 30, 2026

A person living with Crohn’s disease may begin avoiding certain foods because they seem to worsen abdominal pain or diarrhea. Over time, the list of foods they consider safe becomes shorter. They stop eating vegetables, limit fruit, avoid dairy products and gradually reduce the size of their meals. Their digestive symptoms may become less troublesome, but they also begin losing weight and feeling unusually tired.

At a follow-up appointment, it may be tempting to ask whether the dietary changes are working. A more important question is whether the person is receiving adequate nutrition and whether intestinal inflammation is actually under control.

This distinction matters because inflammatory bowel disease is not simply a condition in which certain foods cause digestive discomfort. Crohn’s disease and ulcerative colitis are chronic immune-mediated inflammatory disorders that can damage the gastrointestinal tract and cause serious complications.

Dietary interventions can serve different purposes. Some help prevent or correct malnutrition. Others relieve gastrointestinal symptoms without necessarily changing inflammatory activity. In selected patients with Crohn’s disease, structured nutritional therapy can also be used to induce remission.

These approaches are not interchangeable, and their use must be considered alongside the need for disease-directed medical treatment.

For healthcare professionals in Viet Nam, evidence-based Lifestyle Medicine offers an opportunity to improve nutrition, physical health and daily functioning while supporting accurate diagnosis, objective disease monitoring and safe long-term treatment.

Understanding Inflammatory Bowel Disease and Its Clinical Risks

Inflammatory bowel disease generally refers to Crohn’s disease and ulcerative colitis. Both involve chronic intestinal inflammation, but their distribution, complications and treatment requirements differ.

Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to the anus. Inflammation may extend through the full thickness of the bowel wall and lead to intestinal narrowing, fistulas, abscesses or other complications. Ulcerative colitis primarily affects the colon and rectum, with inflammation involving the colonic mucosa. Its extent and severity vary, from disease limited to the rectum to more extensive colonic involvement.

Patients may experience diarrhea, abdominal pain, rectal bleeding, urgency, fatigue and weight loss. Some also develop inflammatory manifestations involving the joints, skin, eyes or other organs. These symptoms can substantially affect daily life, but they are not sufficient to establish a diagnosis.

Chronic diarrhea may result from intestinal infections, celiac disease, medication-related problems or other gastrointestinal conditions. Abdominal pain, bloating and altered bowel habits also occur in irritable bowel syndrome, a disorder of gut–brain interaction that does not involve the characteristic intestinal inflammation and tissue damage seen in inflammatory bowel disease.

Distinguishing these conditions is particularly important when treatment may involve corticosteroids, biological medicines or other therapies that modify immune responses.

Diagnosis usually requires clinical assessment supported by relevant laboratory investigations, stool testing, endoscopy with biopsies and appropriate imaging. The investigations selected depend on the suspected disease, its location and the patient's circumstances.

No single symptom, dietary response or inflammatory marker is sufficient in every case.

A person should not be diagnosed with inflammatory bowel disease simply because they experience chronic digestive symptoms or temporarily improve after following a restrictive diet. Equally, persistent symptoms in someone with established inflammatory bowel disease should not automatically be assumed to represent active inflammation.

Accurate diagnosis and assessment provide the foundation for selecting appropriate lifestyle and medical interventions.

Symptom Improvement Does Not Always Mean Inflammation Is Controlled

A patient may report fewer bowel movements after changing their diet while significant intestinal inflammation remains active. Another person may continue experiencing abdominal discomfort despite objective evidence that their disease is in remission.

These situations require different clinical responses.

Contemporary inflammatory bowel disease management increasingly follows a treat-to-target approach. Rather than relying only on symptom improvement, treatment aims to achieve appropriate clinical and objective measures of disease control.

The International Organization for the Study of Inflammatory Bowel Diseases outlined this approach in its STRIDE-II recommendations, emphasizing the importance of distinguishing short-term symptom improvement from longer-term goals such as endoscopic healing. [9]

Depending on the condition and clinical circumstances, assessment may include C-reactive protein, fecal calprotectin, endoscopic findings and imaging, alongside symptoms and quality of life.

Fecal calprotectin provides useful noninvasive information about intestinal inflammation, but an elevated result is not specific to inflammatory bowel disease. Intestinal infections and other conditions may also affect the measurement.

Normal or relatively low inflammatory markers do not exclude active disease in every circumstance, particularly when inflammation affects sections of the small intestine or disease activity is otherwise difficult to assess.

Clinical remission, biochemical improvement and endoscopic healing are related but distinct outcomes. In selected patients with Crohn’s disease, assessment of inflammation extending through the bowel wall may also provide useful information.

These distinctions are particularly important when evaluating dietary interventions. A diet that reduces diarrhea or abdominal discomfort may be beneficial, but symptom improvement should not be described as control or healing of intestinal inflammation unless appropriate clinical evidence supports that conclusion.

A responsible treatment plan should establish what an intervention is intended to achieve and how its effects will be evaluated.

Dietary Therapy Has Different Roles in Crohn’s Disease and Ulcerative Colitis

The European Crohn’s and Colitis Organisation published its first comprehensive consensus on dietary management of inflammatory bowel disease in 2025.

This was an important development because it recognized that diet can sometimes function as a disease-directed therapeutic intervention rather than serving only to maintain nutritional adequacy or reduce symptoms. [1]

However, the strength and applicability of the evidence differ substantially between Crohn’s disease and ulcerative colitis.

For Crohn’s disease, certain structured nutritional interventions have demonstrated benefits for inducing remission in appropriately selected patients. For ulcerative colitis, the 2025 consensus does not recommend a specific diet as an established method for inducing remission in active disease.

These differences need to be clear in professional education.

It would be inaccurate to suggest that everyone with inflammatory bowel disease can achieve remission by eliminating particular foods or using nutritional supplements. It would be equally inaccurate to dismiss all disease-directed nutritional therapies as ineffective.

The appropriate intervention depends on the diagnosis, disease activity, complications, prognosis, nutritional status and individual treatment goals.

For people who do not require a specific therapeutic diet, healthy eating principles consistent with general dietary recommendations remain appropriate, adapted to nutritional needs and individual tolerance.

Specialized dietary treatment requires clear indications, professional supervision and appropriate clinical monitoring. Its role should be determined by the evidence and the patient's circumstances rather than a general preference for avoiding medication.

Exclusive Enteral Nutrition Can Be a Therapeutic Option in Crohn’s Disease

Exclusive enteral nutrition involves temporarily replacing ordinary food with nutritionally complete enteral formulas.

The intervention is generally delivered over a defined treatment period, commonly six to eight weeks, under professional supervision.

Unlike ordinary nutritional supplementation, commercial meal replacement products or restrictive wellness diets, exclusive enteral nutrition is a structured medical nutritional treatment designed to provide adequate nutrients while supporting disease control.

The 2025 European Crohn’s and Colitis Organisation consensus strongly recommends exclusive enteral nutrition for inducing clinical and endoscopic remission in Crohn’s disease, with evidence supporting its use in both children and adults. [1]

Its role is particularly well established in pediatric Crohn’s disease, where it can induce remission while avoiding some of the adverse effects associated with systemic corticosteroids.

Adults may also benefit, although treatment acceptance, tolerance, practicality and the availability of professional support are important considerations.

Successful implementation requires selection of a nutritionally appropriate formula, provision of sufficient energy and nutrients, patient education and monitoring of both nutritional status and inflammatory disease activity.

The treatment can be demanding. Patients may find it difficult to consume only formula products for several weeks because of taste fatigue, social inconvenience, cost or the psychological burden of avoiding ordinary meals.

These challenges should be discussed before treatment begins.

A commercially available protein drink or meal replacement product should not automatically be considered equivalent to a medically prescribed enteral formula. Nor should a patient independently stop eating ordinary food and begin exclusive liquid feeding without appropriate clinical assessment.

The intervention may be unsuitable as the sole treatment strategy for patients with particular high-risk disease characteristics, serious complications or circumstances requiring urgent medical or surgical intervention.

For some patients, exclusive enteral nutrition offers a valuable therapeutic option. For others, medication, surgery or a different nutritional approach may be more appropriate.

Its success should be assessed through relevant clinical and objective inflammatory outcomes, together with nutritional adequacy and treatment tolerance.

The Crohn’s Disease Exclusion Diet Is Not an Ordinary Elimination Diet

Another approach receiving increasing attention is the Crohn’s Disease Exclusion Diet combined with partial enteral nutrition.

This is not simply advice to avoid processed foods or identify personal dietary triggers. It is a structured therapeutic intervention with specified food choices, staged dietary progression and a defined contribution from nutritionally complete formulas.

The 2025 European Crohn’s and Colitis Organisation consensus recognizes this combination as an alternative induction approach for selected patients, supported by important evidence in children and more limited evidence in adults with mild-to-moderate Crohn’s disease. [1]

The updated 2026 European Crohn’s and Colitis Organisation–European Society for Paediatric Gastroenterology, Hepatology and Nutrition guideline recommends exclusive enteral nutrition as a first-line nutritional induction therapy for children with low-risk luminal Crohn’s disease. The Crohn’s Disease Exclusion Diet combined with partial enteral nutrition is also recommended as an alternative in this group. [3]

For children with high-risk disease characteristics, early anti-tumor necrosis factor therapy is generally recommended rather than relying on nutritional induction alone. Nutritional treatment may still have a supportive or bridging role when appropriate.

This distinction matters because treatment selection must consider disease prognosis, not simply whether the patient or family prefers dietary therapy over medication.

The pediatric guideline emphasizes that specialized dietary interventions should be initiated, monitored and adjusted by an appropriately qualified dietitian to maintain nutritional adequacy, support treatment adherence and reduce the risk of disordered eating.

Evidence remains insufficient to assume that the Crohn’s Disease Exclusion Diet without partial enteral nutrition produces equivalent induction benefits. Emerging evidence suggests that dietary maintenance approaches may be useful in highly selected patients with low-risk disease, but they require careful monitoring and cannot be assumed to provide reliable long-term control for everyone.

An intervention that successfully induces remission should not automatically be expected to maintain remission indefinitely.

For healthcare professionals, the appropriate message is that structured dietary therapy can be an evidence-based treatment option in selected patients with Crohn’s disease, but it requires careful indication, monitoring and reassessment.

Dietary Support in Ulcerative Colitis Has Different Goals

The role of dietary intervention in ulcerative colitis requires a different interpretation of the evidence.

The 2025 European Crohn’s and Colitis Organisation consensus does not recommend a specific diet as an established method for inducing remission in active ulcerative colitis. [1]

This does not mean nutrition is unimportant.

Dietary care can help maintain nutritional adequacy, address deficiencies, improve food tolerance and support general health. During remission, a Mediterranean-style eating pattern may be considered as an adjunct to medical therapy in appropriate patients.

However, the evidence does not justify claiming that such a diet reliably prevents relapse or replaces effective maintenance treatment.

The distinction between improving overall health, relieving gastrointestinal symptoms and treating active intestinal inflammation is essential.

A person with active ulcerative colitis who experiences frequent bloody diarrhea, urgency or other signs of significant inflammation requires appropriate clinical assessment and treatment.

The updated 2026 European Crohn’s and Colitis Organisation guidelines on medical treatment of ulcerative colitis reinforce the importance of selecting evidence-based medication according to disease severity and treatment goals. They address established therapies such as 5-aminosalicylates, corticosteroids and immunomodulators, together with newer biological and targeted treatments. [10]

Simply eliminating dairy products, increasing fiber or taking supplements is not an adequate alternative to evaluating disease activity and providing indicated medical treatment.

Similarly, improvement in stool frequency does not necessarily establish mucosal healing.

Some nutritional products or compounds have been studied as adjunctive therapies in ulcerative colitis, but evidence for a particular product should not be generalized to commercial supplements or interpreted as a reason to avoid established treatment. The suitability and safety of any adjunctive intervention require professional assessment.

Dietary counseling should support nutrition and individual tolerability without creating unrealistic expectations about disease control.

Malnutrition Risk Can Be Missed When Attention Focuses Only on Weight

Malnutrition is an important concern in inflammatory bowel disease, particularly when active inflammation, reduced food intake or intestinal complications are present.

Some patients lose weight because eating becomes associated with pain, diarrhea or fear of worsening symptoms. Others develop deficiencies because of impaired absorption, previous intestinal resection, ongoing blood loss or increased nutritional requirements.

The risk is not limited to visibly underweight patients.

A person with overweight or obesity may still have inadequate protein intake, micronutrient deficiencies or clinically important loss of skeletal muscle. Body weight alone therefore provides an incomplete picture of nutritional health.

Assessment should consider recent weight changes, food intake, muscle mass and function, disease activity, previous surgery, medication history and relevant laboratory findings.

Iron deficiency is common and may be associated with blood loss, inflammation or impaired absorption. Vitamin B12 deficiency deserves particular attention in patients with ileal Crohn’s disease or previous ileal resection.

Folate, vitamin D, calcium, zinc and other nutritional concerns may also arise depending on disease characteristics and treatment history.

Testing and supplementation should be guided by clinical indications rather than assuming that every patient needs an extensive panel of investigations or a broad supplement regimen.

Inflammation can affect the interpretation of certain laboratory markers. For example, serum albumin may be influenced by inflammatory activity and other clinical factors and should not be treated as a stand-alone measure of nutritional status.

The 2025 European Crohn’s and Colitis Organisation consensus emphasizes nutritional screening and assessment as routine components of inflammatory bowel disease care, including attention to body composition and muscle function rather than relying on body mass index alone. [1]

Patients with severe malnutrition may also require careful assessment when nutritional intake is increased, including consideration of refeeding-related complications in those at risk.

The goal is to identify clinically significant nutritional problems early and correct them through appropriate dietary intervention, supplementation or specialized nutritional support.

An effective Lifestyle Medicine approach should not focus only on whether a patient is eating foods commonly considered healthy. It must also consider whether that person is receiving enough energy, protein and essential nutrients to maintain health and function.

Restrictive Eating Can Become Part of the Problem

People living with inflammatory bowel disease often identify foods that appear to worsen their symptoms.

These experiences deserve attention, but a food that causes discomfort does not necessarily increase intestinal inflammation.

For example, someone with lactose intolerance may experience bloating or diarrhea after drinking milk. Reducing lactose may improve these symptoms without changing the underlying inflammatory activity of Crohn’s disease or ulcerative colitis.

Similarly, some foods may be more difficult to tolerate during an active flare or after intestinal surgery.

The response should reflect the clinical problem rather than assume that the same restrictions are necessary for every patient.

Repeated elimination of entire food groups can reduce dietary variety and increase the risk of inadequate energy, protein and micronutrient intake.

Food-related anxiety may also interfere with social life. Some people become reluctant to eat outside the home or participate in family meals because they fear triggering symptoms.

In more severe cases, fear of eating may contribute to clinically significant restrictive or disordered eating patterns.

Healthcare professionals should ask not only which foods patients avoid, but why those restrictions were introduced, whether they remain necessary and what nutritional consequences may have developed.

A dietary intervention should have a clear purpose, a reasonable evidence base and a plan for reassessment.

Long-term restriction should not become the default simply because someone has inflammatory bowel disease.

Low-FODMAP Diets May Improve Symptoms Without Treating Inflammation

Some patients with inflammatory bowel disease continue to experience bloating, abdominal discomfort or altered bowel habits despite objective evidence that intestinal inflammation is controlled.

These symptoms may overlap with those associated with irritable bowel syndrome.

A diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols, commonly called a low-FODMAP diet, may help selected patients with persistent functional gastrointestinal symptoms.

The 2025 European Crohn’s and Colitis Organisation consensus strongly recommends this approach for irritable bowel syndrome-like symptoms in patients whose inflammatory bowel disease is in remission. [1]

However, it is not an established treatment for active intestinal inflammation and should not be used as evidence that disease-directed medication is unnecessary.

This distinction is particularly important when a person experiences improvement after removing fermentable carbohydrates. Reduced bloating or diarrhea does not demonstrate remission of Crohn’s disease or ulcerative colitis.

A low-FODMAP intervention should generally follow appropriate clinical assessment and include a time-limited restriction phase, structured food reintroduction and subsequent personalization.

Prolonged avoidance of multiple carbohydrate-containing foods may unnecessarily reduce dietary diversity.

Special caution is needed when someone already has malnutrition, significant weight loss or extensive dietary restrictions. In such circumstances, introducing another restrictive eating pattern may create more harm than benefit without specialist nutritional support.

The purpose is to manage selected symptoms while preserving adequate nutrition and continuing appropriate inflammatory bowel disease care.

Intestinal Strictures Require Specific Dietary and Clinical Assessment

Crohn’s disease can cause intestinal narrowing through inflammation, fibrosis or a combination of both.

People with symptomatic strictures may experience abdominal pain, bloating, vomiting or features of partial bowel obstruction.

Dietary advice that is reasonable for someone with uncomplicated disease may be inappropriate when significant narrowing is present.

For example, encouraging unrestricted consumption of bulky, difficult-to-digest foods without assessing an established symptomatic stricture may worsen obstructive symptoms.

However, it would also be inappropriate to recommend that every person with Crohn’s disease avoid fiber indefinitely.

The 2025 European Crohn’s and Colitis Organisation dietary consensus supports a cautious, individualized approach. Limited reduction of bulky fiber may be considered in patients with stricturing Crohn’s disease who experience obstructive symptoms, but the supporting evidence is limited. [1]

The presence, location and severity of narrowing require appropriate clinical assessment.

Some inflammatory strictures may respond to medical therapy, while predominantly fibrotic strictures may require endoscopic or surgical management.

Nutritional modifications may help manage symptoms or maintain nutrition, but they do not reliably reverse established fibrotic narrowing.

Persistent vomiting, severe abdominal pain, marked abdominal distension or inability to pass stool or gas may indicate significant obstruction and require urgent medical evaluation.

Dietary adjustment should never replace the assessment of a possible intestinal complication.

Physical Activity, Sleep and Psychological Health Remain Relevant

Inflammatory bowel disease can affect physical and psychological well-being far beyond the gastrointestinal tract.

Fatigue, anemia, disrupted sleep, abdominal pain, urgency and repeated medical appointments may reduce a person's ability to work, exercise, travel or participate in ordinary social activities.

Regular physical activity can support cardiovascular fitness, muscle strength, mood and quality of life when appropriately adapted to the person's condition.

However, evidence that exercise directly reduces intestinal inflammation or prevents relapse is less established.

For someone with stable disease, walking, resistance training or other suitable activities may be reasonable. A person experiencing severe anemia, dehydration, active bleeding, substantial malnutrition or a major disease flare may need to modify activity until the clinical problem has been assessed and treated.

Patients recovering from abdominal surgery may also require individualized rehabilitation.

Sleep disturbance and psychological distress deserve attention because they can affect daily functioning, coping and the experience of symptoms.

Some patients experience anxiety about unpredictable bowel urgency or fear of symptoms occurring in public. Others may find it difficult to maintain relationships, attend work regularly or participate in social activities.

Psychological support may help people manage these burdens, but it should not be presented as a cure for immune-mediated intestinal inflammation.

Stress may influence symptoms and coping, yet inflammatory bowel disease should not be attributed simply to stress, personality or an inability to maintain healthy habits.

Lifestyle-related interventions are most useful when they support the person's overall well-being without replacing treatment of active disease.

Immunomodulatory Treatment Remains Necessary for Many Patients

Treatment options for inflammatory bowel disease have expanded substantially over recent decades.

Conventional therapies include 5-aminosalicylates in appropriate ulcerative colitis settings, corticosteroids for selected induction purposes and immunomodulatory medicines used according to disease characteristics.

Advanced treatment options include biological medicines targeting specific inflammatory pathways and oral targeted therapies.

These treatments differ in their mechanisms, indications and safety profiles. They are not interchangeable between Crohn’s disease and ulcerative colitis or between patients with different disease severity and prognostic risk.

The choice of treatment depends on factors such as disease location, inflammatory activity, complications, previous treatment response, comorbidities and patient preferences.

An important objective is to achieve durable disease control while minimizing unnecessary exposure to systemic corticosteroids.

Corticosteroids can be effective for short-term control of inflammatory activity in appropriate circumstances, but they are generally unsuitable for long-term maintenance because of their adverse effects.

These may include infections, bone loss, hyperglycemia, hypertension, psychological effects and other complications.

Advanced therapies can improve inflammatory control and reduce reliance on corticosteroids in appropriately selected patients. However, they also require attention to medication-specific risks, laboratory monitoring and infection prevention.

For some individuals, surgery remains essential, particularly when serious complications develop or medical treatment is insufficient.

Lifestyle Medicine should not frame biological therapy, immunosuppressive medication or surgery as evidence that a patient has failed to make appropriate lifestyle changes.

Effective care may require several approaches working together.

Infection Safety Depends on the Treatment and the Patient

The European Crohn’s and Colitis Organisation published updated guidelines on the prevention, diagnosis and management of infections in inflammatory bowel disease in July 2026. [2]

These guidelines reflect the growing range of conventional immunosuppressants, biological therapies and targeted oral medicines.

Different treatments act on different components of immune function and carry different infection-related risks.

It would therefore be inaccurate to assume that every biological medicine produces the same degree or type of immunosuppression. Some treatments have relatively selective effects on intestinal inflammatory pathways, while others have broader systemic effects.

The patient's infection risk also depends on factors beyond the selected medicine.

Age, nutritional status, disease activity, corticosteroid exposure, combination treatment, existing infections and other medical conditions may influence susceptibility.

The updated European guidance emphasizes individualized infection assessment before and during treatment. The aim is to achieve adequate inflammatory disease control while preventing avoidable treatment-related harm.

For healthcare professionals in Viet Nam, this approach is particularly relevant because certain infectious diseases must be considered both during diagnostic evaluation and when planning immune-modifying treatment.

Tuberculosis Is Both a Diagnostic and Treatment-Safety Concern

Tuberculosis has particular relevance to inflammatory bowel disease care in Viet Nam.

Intestinal tuberculosis can resemble Crohn’s disease in clinical presentation and, in some circumstances, endoscopic and imaging findings. Both conditions may cause abdominal pain, weight loss, diarrhea and inflammatory abnormalities.

The distinction can be difficult when clinical findings are not typical.

The European Crohn’s and Colitis Organisation consensus on managing inflammatory bowel disease in low- and middle-income countries, published in the January 2026 issue of the Journal of Crohn’s and Colitis, emphasizes the importance of considering intestinal infections, including tuberculosis, during diagnostic evaluation. [4]

Misclassifying intestinal tuberculosis as Crohn’s disease and initiating inappropriate immunosuppressive treatment may have serious consequences.

Tuberculosis also creates risks after inflammatory bowel disease has been diagnosed.

Latent tuberculosis infection can become clinically active during certain forms of immune-modifying treatment. Anti-tumor necrosis factor therapies, in particular, have a well-established association with tuberculosis reactivation.

The updated 2026 European Crohn’s and Colitis Organisation infection guideline recommends screening for latent tuberculosis before starting anti-tumor necrosis factor agents or Janus kinase inhibitors. For lower-risk treatment groups, screening decisions should also consider additional risk factors, local tuberculosis burden and the patient's clinical circumstances. [2]

More broadly, tuberculosis assessment before significant immunosuppression remains important, with the approach adapted to the planned treatment and epidemiological setting.

Assessment may involve clinical history, epidemiological risk, relevant testing and chest imaging when indicated.

No single test can exclude tuberculosis in every situation. A negative screening result does not eliminate all subsequent infection risk, particularly when immunosuppression or new exposure occurs.

In settings with substantial tuberculosis exposure, ongoing risk assessment may be needed during treatment. Repeat testing should follow clinical risk and applicable guidance rather than an automatic assumption that the same schedule is appropriate for everyone.

When active or latent tuberculosis is identified, specialist assessment and coordination are necessary to determine appropriate management and the timing of immune-modifying treatment.

For patients in Viet Nam, attention to tuberculosis should be integrated into both diagnostic reasoning and medication safety planning.

Hepatitis B Screening and Reactivation Prevention Matter in Viet Nam

Hepatitis B is another important infection-safety consideration for patients who may require immunomodulatory treatment.

The updated 2026 European Crohn’s and Colitis Organisation infection guideline recommends hepatitis B serological assessment before immunosuppressive therapy, including hepatitis B surface antigen, surface antibody and core antibody testing. [2]

These investigations help distinguish current infection, previous exposure and susceptibility. Additional investigations, including hepatitis B viral DNA testing, may be necessary according to the findings and planned treatment.

The results inform decisions about vaccination, antiviral prophylaxis, monitoring and specialist referral.

Not every patient with evidence of previous hepatitis B exposure requires the same intervention. Reactivation risk depends on infection status, viral markers and the type and intensity of immunosuppression.

Viet Nam's Ministry of Health issued Decision No. 1740/QĐ-BYT on June 16, 2026, updating national guidance on the diagnosis and treatment of hepatitis B virus infection. [7]

The document includes recommendations concerning hepatitis B reactivation in people receiving immunosuppressive treatment, chemotherapy and other relevant therapies.

For patients with inflammatory bowel disease who require biological or other immune-modifying medication, coordination between gastroenterology and clinicians with appropriate expertise in hepatitis management may be necessary.

The objective is to reduce preventable hepatitis B reactivation while avoiding unnecessary delays in effective inflammatory bowel disease treatment.

Lifestyle measures such as avoiding alcohol and maintaining adequate nutrition may support general liver health, but they do not substitute for appropriate screening, antiviral prevention or treatment when these are clinically indicated.

Vaccination and Infection Monitoring Should Be Planned Early

Vaccination status should be reviewed as part of inflammatory bowel disease care, preferably before initiating treatment that significantly modifies immune function.

The 2026 European Crohn’s and Colitis Organisation infection guideline addresses vaccination and screening for relevant infections according to treatment status and individual risk.

Vaccination against hepatitis B, influenza and other preventable infections may be important depending on the patient's age, prior vaccination history, immunity and planned medication.

However, vaccine timing and suitability are not identical for every patient.

Live vaccines may be contraindicated during certain forms of significant immunosuppression. Other vaccines may produce reduced immune responses, depending on the treatment and clinical circumstances.

These decisions require appropriate professional assessment.

Patients also need to understand when symptoms suggesting infection should prompt medical review.

Fever, persistent respiratory symptoms, worsening diarrhea or significant abdominal deterioration may reflect infection, active inflammatory bowel disease, medication-related complications or more than one process occurring together.

For example, diarrhea in a patient receiving immunomodulatory treatment is not always an inflammatory bowel disease flare. Infectious causes, including Clostridioides difficile, may require investigation.

Automatically increasing corticosteroid treatment in response to worsening diarrhea without considering infection can create additional risks.

Safe care depends on timely assessment and appropriate differentiation between inflammatory disease activity and infectious complications.

Children and Adolescents Require Developmentally Appropriate Care

Pediatric inflammatory bowel disease involves additional concerns related to growth, puberty, nutrition, education and psychological development.

A child with Crohn’s disease may experience impaired growth even when substantial weight loss is not immediately apparent.

Nutritional treatment therefore needs to consider normal development as well as control of intestinal inflammation.

The updated 2026 European Crohn’s and Colitis Organisation–European Society for Paediatric Gastroenterology, Hepatology and Nutrition guideline recommends exclusive enteral nutrition as a first-line induction option for appropriate children with low-risk luminal Crohn’s disease. [3]

The Crohn’s Disease Exclusion Diet combined with partial enteral nutrition is also recommended as an alternative.

For children with disease characteristics associated with a high risk of poor outcomes, early anti-tumor necrosis factor treatment is recommended rather than relying on nutritional induction alone.

These recommendations reinforce the importance of risk stratification.

The guideline also emphasizes objective disease monitoring, growth, quality of life and prevention of long-term bowel damage.

Restrictive eating patterns that reduce energy intake or interfere with growth can be particularly harmful in children and adolescents.

Age-appropriate care should involve pediatric gastroenterology and appropriately qualified nutrition professionals, with support from families and schools as necessary.

School attendance, sports participation, body image, peer relationships and the burden of treatment can influence how successfully a child manages the condition.

Recommendations developed for adults should not automatically be applied to younger patients.

What Recent Evidence Tells Us About Inflammatory Bowel Disease in Viet Nam

Inflammatory bowel disease is receiving increasing clinical attention in Viet Nam, although nationally representative epidemiological data remain limited.

A retrospective study published in Gastroenterology Research and Practice on February 28, 2026, described patients admitted to the Gastroenterology and Hepatology Center of Bach Mai Hospital, Hanoi, between January 2022 and December 2024. [5]

The study included 242 patients with confirmed inflammatory bowel disease. Of these, 143 had Crohn’s disease and 99 had ulcerative colitis.

The researchers reported substantial disease manifestations and factors associated with poorer prognosis among many hospitalized patients.

Approximately 81.8% were initially managed using a step-up treatment strategy, while 18.2% received a top-down approach.

During 12 months of follow-up, 20.2% of patients required treatment escalation.

The authors also identified limited access to advanced therapies as an important challenge affecting treatment strategies.

These findings provide useful insight into inpatient specialist care at a major Vietnamese hospital, but they should be interpreted within the study's limitations.

The data do not establish the national prevalence of inflammatory bowel disease, the proportion of Vietnamese patients who need biological therapy or the outcomes of every patient receiving care in Viet Nam.

Patients admitted to a specialist hospital are likely to differ from those with mild or uncomplicated disease managed entirely in outpatient settings.

The findings should therefore be treated as single-center clinical evidence rather than a nationally representative picture.

One important aspect of the study was the consideration of alternative diagnoses, including intestinal tuberculosis and malignancy, during diagnostic assessment.

This reinforces the importance of accurate diagnosis in a setting where intestinal infections remain clinically relevant.

The study also highlights why improving access to specialist assessment, disease monitoring and appropriate treatment may be as important as providing additional general lifestyle education.

Vietnamese Professional Guidance Provides a Foundation for Nutrition Care

Viet Nam has a national professional resource addressing the nutritional management of gastrointestinal diseases.

On November 26, 2024, the Ministry of Health issued Decision No. 3558/QĐ-BYT, introducing the Guidelines on Dietary Management for Gastrointestinal Diseases. [6]

The document includes specific guidance on nutritional care for inflammatory bowel disease, covering nutritional assessment, energy and protein requirements, micronutrient deficiencies, oral and enteral nutrition, and monitoring.

It also contains pediatric Crohn’s disease nutrition guidance that discusses specialized approaches such as exclusive enteral nutrition and the Crohn’s Disease Exclusion Diet.

This is important because international dietary recommendations should not be presented as though no relevant Vietnamese professional guidance exists.

At the same time, the 2025 European Crohn’s and Colitis Organisation consensus provides more recent disease-specific evidence, particularly concerning the role of specialized dietary interventions in inducing remission in selected patients with Crohn’s disease.

These documents should be interpreted according to their respective purposes, populations and clinical contexts.

Guidance aimed at preventing and treating malnutrition is not necessarily equivalent to recommendations evaluating dietary therapy as an intervention for controlling intestinal inflammation.

International evidence may inform professional review and clinical education, but it does not automatically establish that every treatment formula, nutritional program or medication is approved, affordable, available or routinely implemented in Viet Nam.

Healthcare professionals must consider Vietnamese regulatory requirements, professional guidance, institutional capacity and the needs of individual patients.

For VLMA, the appropriate educational contribution is to explain the evidence and the conditions necessary for safe implementation rather than presenting a specialized intervention as universally accessible or suitable.

Dietary Care Must Reflect Vietnamese Food and Family Life

People living with inflammatory bowel disease in Viet Nam commonly eat meals based on rice, noodles, vegetables, fish, meat, tofu, fruit and other familiar foods.

A clinical nutrition plan should consider these foods in relation to disease activity, bowel function, nutritional needs and individual tolerance.

Traditional Vietnamese meals should not automatically be classified as harmful.

For someone with stable disease and adequate bowel function, preserving dietary variety may be an important goal. For a person with symptomatic intestinal narrowing, recent surgery or active disease affecting food tolerance, temporary modifications may be necessary.

Eating at workplace canteens, restaurants or school cafeterias may create additional challenges when portions and ingredients are difficult to predict.

Family meals also have social importance. A restrictive diet that prevents someone from participating in ordinary meals or requires expensive specialty foods may become difficult to maintain.

Healthcare professionals should ask which restrictions are clinically necessary, which reflect the patient's personal experiences and which could potentially be reconsidered.

When specialized nutritional formulas are required, cost and availability may influence treatment feasibility.

A treatment cannot achieve its expected benefits if the patient cannot obtain adequate quantities of the prescribed formula or maintain appropriate clinical follow-up.

The objective is to translate scientific evidence into care that is both clinically justified and realistic.

Coordinated Care Is More Useful Than a Separate Lifestyle Program

Inflammatory bowel disease often requires contributions from several professional disciplines.

The treating gastroenterologist or other responsible specialist evaluates inflammatory activity, complications and disease-directed treatment. Clinical nutrition professionals assess nutritional status, develop appropriate dietary plans and monitor treatment adequacy and tolerance.

Nurses and pharmacists may contribute to medication education, monitoring and treatment continuity within their professional responsibilities. Surgeons, radiologists, rehabilitation professionals and mental health professionals may become involved when specific needs arise.

The care pathway should be organized around the patient's clinical problems rather than requiring everyone to receive every possible intervention.

For example, a patient with Crohn’s disease and substantial weight loss may need timely nutritional assessment and objective evaluation of intestinal inflammation. Another person with ulcerative colitis in remission but persistent bloating may require assessment of functional gastrointestinal symptoms and dietary tolerance.

A patient preparing to begin biological therapy may need infection screening, vaccination review and a clear medication-monitoring plan.

These interventions have different purposes and should not be treated as interchangeable.

The value of Lifestyle Medicine lies in integrating appropriate nutrition, physical activity, psychological support and behavior-change strategies into established clinical care.

It should not create a parallel treatment system that operates separately from specialist assessment and medically indicated therapy.

For healthcare organizations in Viet Nam, improving coordination and follow-up may provide greater value than introducing additional lifestyle counseling sessions without clear clinical objectives.

Measuring Better Care Requires More Than Counting Dietary Changes

Healthcare organizations may report how many patients received dietary counseling, attended an education session or followed a recommended eating plan.

These measures describe activities, but they do not establish whether inflammatory bowel disease outcomes improved.

Evaluation should consider the purpose of each intervention.

For specialized dietary induction therapy, relevant outcomes may include clinical remission, changes in inflammatory biomarkers and endoscopic healing when appropriate.

For patients at risk of malnutrition, evaluation may include dietary intake, weight trajectory, nutritional deficiencies, muscle function and recovery from nutritional complications.

For medical treatment, important outcomes include sustained disease control, corticosteroid exposure, hospitalization, surgery, adverse effects and treatment continuity.

Patient-reported outcomes also matter.

A person may value being able to share meals with family members, attend work consistently, sleep without repeated bowel urgency or participate in social activities without fear of symptoms.

These are meaningful aspects of quality of life, but they should complement rather than replace objective assessment of intestinal inflammation and complications.

A patient may feel better while important inflammation persists. Another may have objective remission but continue to experience symptoms requiring further investigation.

A responsible evaluation should therefore distinguish symptom relief, nutritional improvement, inflammatory disease control and treatment safety.

Healthcare organizations should also examine whether referrals lead to completed assessments and whether identified risks receive appropriate responses.

The goal is not simply to increase the number of consultations or dietary recommendations. It is to provide interventions that address the actual clinical problems, evaluate their effectiveness and minimize avoidable harm.

Professional Responsibilities and Legal Boundaries in Viet Nam

Lifestyle Medicine can contribute to inflammatory bowel disease care through evidence-based professional education, nutritional support, appropriate physical activity, behavior-change interventions and attention to the social circumstances affecting health.

However, diagnosing Crohn’s disease or ulcerative colitis, interpreting endoscopic and biopsy findings, prescribing specialized medical nutrition, selecting immunomodulatory therapy and managing serious complications are regulated clinical activities.

In Viet Nam, the Law on Medical Examination and Treatment No. 15/2023/QH15 and its applicable amendments and implementing regulations provide the relevant legal framework for medical practice.

The consolidated legal text is reflected in Document No. 26/VBHN-VPQH, issued by the Office of the National Assembly on February 26, 2026. [12,13]

Healthcare professionals must act within their qualifications, competence, legally authorized professional scope and applicable institutional responsibilities.

Education or certification in Lifestyle Medicine does not independently authorize someone to diagnose inflammatory bowel disease, initiate exclusive enteral nutrition as a clinical treatment, prescribe immunosuppressive medication or modify an individualized medical treatment plan.

Clinical nutrition delivered as part of medical examination and treatment must also comply with applicable professional and institutional requirements. Clinical treatment decisions should be distinguished from general health education or nonclinical lifestyle information.

Relevant Ministry of Health guidance, including Decision No. 3558/QĐ-BYT on gastrointestinal nutrition and Decision No. 1740/QĐ-BYT on hepatitis B management, should be considered when applicable.

International recommendations from the European Crohn’s and Colitis Organisation and other professional bodies can inform evidence appraisal and professional education. However, they do not automatically become Vietnamese regulatory requirements or establish the approval, availability or reimbursement of particular medicines, diagnostic tests or nutritional products.

Confidentiality and personal data protection are also important.

Clinical histories, endoscopy findings, laboratory investigations, medication records and identifiable patient experiences must be managed according to applicable Vietnamese legal requirements.

The Law on Personal Data Protection No. 91/2025/QH15 and Decree No. 356/2025/NĐ-CP, both effective January 1, 2026, are relevant to organizations processing identifiable personal health information. [14,15]

Healthcare organizations and other parties processing such information need appropriate lawful processing arrangements, security safeguards and clearly defined responsibilities.

For the Vietnam Lifestyle Medicine Alliance, the appropriate role is professional education, scientific knowledge sharing, evidence appraisal and responsible communication about applying research in healthcare.

Educational content should not be presented as an official clinical treatment guideline issued by VLMA or as individualized medical advice.

Effective Dietary Care Must Be Connected to Disease Control and Safety

Inflammatory bowel disease demonstrates why the relationship between Lifestyle Medicine and medical treatment cannot be reduced to a simple choice between diet and medication.

In selected patients with Crohn’s disease, specialized nutritional therapy can play a direct therapeutic role and contribute to remission. For patients with ulcerative colitis, dietary support remains important, but no specific whole-diet intervention is established as a stand-alone induction treatment.

For both conditions, adequate nutrition is essential to preventing and correcting malnutrition, supporting physical health and improving quality of life.

However, symptom improvement does not necessarily demonstrate that intestinal inflammation has been controlled. Likewise, effective medication does not remove the need to assess nutritional status, physical functioning or the social and psychological consequences of chronic illness.

The 2025 European Crohn’s and Colitis Organisation dietary consensus and the 2026 updates on infection prevention, pediatric Crohn’s disease and medical treatment of ulcerative colitis reinforce the importance of selecting interventions according to the evidence, disease characteristics and individual clinical risk.

For Viet Nam, responsible implementation also requires attention to intestinal tuberculosis, hepatitis B, availability of specialized nutritional therapy, access to appropriate medical treatment and the consequences of delayed diagnosis or treatment.

The contribution of Lifestyle Medicine is not to promote restrictive diets as alternatives to gastroenterology care. It is to support clinically appropriate nutrition and healthier living within coordinated care that recognizes the importance of objective disease monitoring and safe treatment.

Better care should help people achieve and maintain disease control, avoid preventable nutritional complications, receive appropriate treatment and participate more fully in everyday life.

That is where evidence-based Lifestyle Medicine can make a meaningful and responsible contribution to inflammatory bowel disease care in Viet Nam.

Selected References

1. Svolos V, Gordon H, Lomer MCE, et al. European Crohn’s and Colitis Organisation Consensus on Dietary Management of Inflammatory Bowel Disease. Journal of Crohn’s and Colitis. 2025;19(9). doi:10.1093/ecco-jcc/jjaf122.

2. Yanai H, Ellul P, Verstockt B, et al. ECCO Guidelines on the Prevention, Diagnosis, and Management of Infections in Inflammatory Bowel Disease. Journal of Crohn’s and Colitis. 2026;20(7). doi:10.1093/ecco-jcc/jjag071.

3. Shouval DS, Hojsak I, Miele E, et al. Management of Pediatric Crohn’s Disease: An ECCO–ESPGHAN Guideline Update. Journal of Crohn’s and Colitis. 2026;20(8). doi:10.1093/ecco-jcc/jjag084.

4. El-Hussuna A, Hauer AC, Karakan T, et al. ECCO Consensus on Management of Inflammatory Bowel Disease in Low- and Middle-Income Countries. Journal of Crohn’s and Colitis. 2026;20(1). doi:10.1093/ecco-jcc/jjaf125.

5. Nguyen NH, Nguyen HTT, Khuc TT, et al. Inflammatory Bowel Disease in Vietnam: Insights From a Retrospective Study at Bach Mai Hospital. Gastroenterology Research and Practice. 2026;2026:1618547. Published February 28, 2026. doi:10.1155/grp/1618547.

6. Ministry of Health of Viet Nam. Decision No. 3558/QĐ-BYT, dated November 26, 2024. Guidelines on Dietary Management for Gastrointestinal Diseases.

7. Ministry of Health of Viet Nam. Decision No. 1740/QĐ-BYT, dated June 16, 2026. Guidelines for Diagnosis and Treatment of Hepatitis B Virus Infection.

8. Hashash JG, Elkins J, Lewis JD, Binion DG. AGA Clinical Practice Update on Diet and Nutritional Therapies in Patients With Inflammatory Bowel Disease: Expert Review. Gastroenterology. 2024;166(3):521–532. doi:10.1053/j.gastro.2023.11.303.

9. Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: An Update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease Initiative of the International Organization for the Study of IBD: Determining Therapeutic Goals for Treat-to-Target Strategies in IBD. Gastroenterology. 2021;160(5):1570–1583. doi:10.1053/j.gastro.2020.12.031.

10. Gisbert JP, Chaparro M, Verstockt B, et al. ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment. Journal of Crohn’s and Colitis. 2026;20(7). Published July 7, 2026. doi:10.1093/ecco-jcc/jjag066.

11. Rea BL, Cheema S, Lanza S, et al. Lifestyle Medicine Core Competencies: 2025 Update. American Journal of Lifestyle Medicine. 2026;20(3):443–451. First published online October 28, 2025. doi:10.1177/15598276251379821.

12. National Assembly of Viet Nam. Law No. 15/2023/QH15, dated January 9, 2023. Law on Medical Examination and Treatment. Effective January 1, 2024.

13. Office of the National Assembly of Viet Nam. Consolidated Document No. 26/VBHN-VPQH, dated February 26, 2026. Law on Medical Examination and Treatment.

14. National Assembly of Viet Nam. Law No. 91/2025/QH15, dated June 26, 2025. Law on Personal Data Protection. Effective January 1, 2026.

15. Government of Viet Nam. Decree No. 356/2025/NĐ-CP, dated December 31, 2025. Detailing Certain Articles and Measures for the Implementation of the Law on Personal Data Protection. Effective January 1, 2026.

Editorial, Clinical and Legal Disclaimer

This article is published by Vietnam Lifestyle Medicine Alliance (VLMA) for general information and professional education. VLMA is a physician-led professional education and knowledge-sharing initiative operated by Vietnam Lifestyle Medicine Alliance Company Limited. The article presents an evidence-informed discussion of Lifestyle Medicine in inflammatory bowel disease care and does not constitute an official clinical practice guideline, individualized medical advice, a diagnosis, a prescribed diet, an enteral nutrition treatment protocol, a medication recommendation or a treatment plan.

Dietary interventions may support nutritional adequacy and symptom management. Specific structured nutritional therapies may also be used to treat selected patients with Crohn’s disease under appropriate professional supervision. These interventions must not be assumed effective for every form of inflammatory bowel disease or used to replace medically indicated treatment without individualized clinical assessment.

The information must not be used to diagnose Crohn’s disease or ulcerative colitis, independently interpret inflammatory markers or endoscopic findings, initiate exclusive enteral nutrition, prescribe or discontinue corticosteroids, biological medicines or other immunomodulatory treatments, or determine individualized infection screening, prophylaxis or treatment without appropriate professional assessment.

People experiencing severe abdominal pain, persistent vomiting, significant gastrointestinal bleeding, marked dehydration, suspected bowel obstruction, fever with clinical deterioration or other concerning symptoms require prompt medical evaluation. Serious complications may require emergency treatment.

For patients receiving immune-modifying medication, potential infections, including tuberculosis, hepatitis B reactivation and gastrointestinal infections, must be assessed and managed according to individual clinical circumstances and applicable professional guidance.

International recommendations discussed in this article do not automatically constitute Vietnamese clinical standards or establish the regulatory approval, availability, reimbursement or suitability of particular medicines, diagnostic tests, nutritional formulas or treatment programs in Viet Nam.

All regulated clinical activities must be undertaken by appropriately qualified healthcare professionals acting within their legally authorized scope of practice and applicable requirements governing healthcare facilities in Viet Nam.

This article does not endorse any commercial elimination diet, supplement, nutritional formula, microbiome product, biological medicine, medication brand or healthcare provider. Identifiable personal health information must be handled in accordance with applicable confidentiality and personal data protection requirements.

The content reflects the scientific evidence, professional recommendations and legal sources reviewed as of October 30, 2026, and may require updating as further research, clinical guidance and Vietnamese regulatory requirements evolve.