Dietary advice for inflammatory bowel disease

Poor nutritional health and IBD

There is no evidence to support that diet or food allergies can cause, prevent or cure inflammatory bowel disease (IBD) such as Crohn's disease or ulcerative colitis. However, diet is an important consideration for individuals with IBD – especially those with Crohn's disease – as they are more at risk of poor nutritional health due to:

• Loss of appetite due to abdominal pain, nausea, fear of eating and worsening symptoms.
• Poor digestion and malabsorption due to the disease itself or medications.
• An increased need of nutrients for the body – chronic diseases such as Crohn's disease increase the energy needs of the body, particularly during flare ups.

Nutritional deficiencies are common in IBD, particularly Crohn's disease and can cause added complications such as anaemia, weight loss and impaired growth and development (in children). Therefore, in some cases nutritional supplements may be advised.

How IBD will affect my diet

Generally, most people with IBD should eat a varied, well-balanced diet, however it is advised that you consult with your GP or dietician to develop an individual diet plan based on:

• Which disease you have (Crohn's or ulcerative colitis).
• For Crohn's patients: Whether you have an intestinal stricture (narrowed section of the bowel).
• What part of your intestine is affected and to what severity.
• Whether your disease is active or inactive.

For inactive disease it is generally advised that you have a well-balanced, nutritious diet, however during active disease additional considerations may be required.

Although there are plenty of diets advertised for especially managing IBD it is important to remember that the success rate of alleviating symptoms depends on the individual, there is no scientific evidence to support these diets. The best method to find a diet that works for you is to keep a food journal to track what you eat and your body's reaction and discuss this with your GP or dietician to develop a customised diet plan for you.

General dietary considerations for IBD

Certain aspects of your normal diet may not be tolerated well during IBD flare ups and may need altered following a discussion with your doctor/dietician.

Trigger foods

A benefit of a food journal is that you can keep track of which food act as triggers and worsen your symptoms as they will not be the same for all IBD sufferers. You may then be able to eliminate these certain foods from your diet, however it is essential this is done with the supervision of your doctor or dietician to ensure it doesn't result in nutritional deficiencies.

Fibre

For general health a high fibre diet is advised, however for many people with IBD may find that consuming fibre during active disease or if they have strictures may cause abdominal cramps, bloating and worsening diarrhoea. Insoluble fibre (doesn't dissolve in water) in particular is a harder, more coarse fibre that is more difficult to digest and can exacerbate IBD symptoms and even cause intestinal blockages in severe disease or when strictures are present. Soluble fibre (does dissolve in water) on the other hand absorbs water and makes food move more slowly through the intestine and can reduce diarrhoea. Most foods contain a combination of soluble and insoluble fibres.

Cooking, peeling and removing seeds from fruit and vegetables, and avoiding wholegrain carbohydrates are important ways for IBD patients to reduce their intake of insoluble fibre when required.

Lactose

Some people with IBD are also lactose-intolerant which can be diagnosed with a simple test. Some Crohn's disease patients may lack the enzyme 'lactase' found in the small intestine which breaks down lactose and therefore may need to avoid milk and other dairy products. Dairy products are an important source of calcium so supplements may need to be taken to avoid deficiencies.

High-fat foods

People with IBD may struggle with fat absorption and eating high-fat foods such as butter, margarine or cream may lead to increased diarrhoea or gas.

Fluids

It is essential to keep hydrated, and it is recommended that you drink 8-10 glasses of water a day. Fruit juices diluted in water can also be good to drink. Alcohol and drinks containing caffeine dehydrate the body and should be avoided.

In general, the dietary guidelines for managing IBD include:

• Eat smaller meals to reduce the load on the digestive tract.
• Eat more regularly to maintain calorie/energy needs.
• Avoid trigger foods.
• Eat more simply or blandly, avoiding spices.
• Limit foods containing insoluble fibre (seeds, nuts, beans, leafy vegetables, fruit).
• Reduce the amount of fried, greasy and high-fat foods.
• Keep hydrated and avoid alcohol and caffeine.

Examples of recommended foods and foods to avoid include:

Resources

The Crohn's and Colitis Foundation of America (CCFA) has a very useful booklet describing the impact of IBD on maintaining healthy nutrition, how diet can impact your disease, tips for managing IBD with a healthy diet, and other resources including sample meal plans, recipes and a food journal template and is available here.

Other useful websites include:

Crohn's and Colitis Foundation - I'll Be Determined
https://www.ibdetermined.org/ibd-information/ibd-diet.aspx

Guts4life
http://www.guts4life.com/living-with-ibd/lifestyle-matters/living-healthily