May 19 is Inflammatory Bowel Disease (IBD) Day. A chronic and lifelong illness, IBD includes both Crohn’s disease and ulcerative colitis, and it affects 1.6 million Americans, including myself. Nutrition plays an important role for those with IBD; there is no single food that should be avoided or consumed. Likewise, because different foods and diets affect people differently, it is important to find an individualized diet that works best for each person.
I reached out to the Crohn’s and Colitis Foundation of America (CCFA) to discuss how the diet and nutritional needs of those affected with IBD differ from the general population.
What is Inflammatory Bowel Disease?
Known collectively as inflammatory bowel diseases (IBD), Crohn’s disease and ulcerative colitis affect 1.6 million Americans. They are debilitating digestive diseases that cause chronic inflammation and damage in the gastrointestinal (GI) tract.
Crohn’s disease can affect any part of the GI tract, from the mouth to the anus. It most commonly affects the end of the small intestine (the ileum) where it joins the beginning of the colon. In ulcerative colitis, inflammation is limited to the large intestine (colon) and the rectum. It usually begins in the rectum and lower colon but may also spread continuously to involve the entire colon.
Symptoms of IBD may include abdominal pain, persistent diarrhea, rectal bleeding, fever, and weight loss. Many IBD patients require numerous hospitalizations and surgery. Most people develop the diseases between the ages of 15 and 35, although the disease can occur at any age.
While the exact cause of IBD is not entirely understood, it is known to involve an interaction between genes, the immune system, the microbiome, and environmental factors. IBD may be controlled with treatment, but not cured.
Is there a special diet for people with IBD?
For patients living with IBD, diet can be a difficult area to navigate. IBD is not caused by eating any one particular food, but certain foods may aggravate symptoms in some patients. Because of the individual nature of these diseases, what works for one patient may not work for another. Because of this, there is no one special diet for people with IBD.
That being said, there are some general dietary recommendations that doctors often suggest for patients living with these diseases. Foods that may trigger symptoms include high fiber foods, lactose, high-fat foods, gluten, partially absorbed sugar alcohols like sorbitol and mannitol, and FODMAP (Fermentable Oligo-Di-Monosaccharides and Polyols).
Even with these general guidelines it is important for people with IBD to develop an individual diet. These diets are based on:
- Symptoms (diarrhea, constipation, abdominal pain, etc.)
- Whether the person is in remission or experiencing a flare
- Location of disease
- Presence of narrowing of the small intestine (strictures)
- Any prior surgeries
- Whether there are any specific nutritional deficiencies (such as iron deficiency)
Additionally, meeting your body’s caloric and protein demands is essential to prevent tissue wasting and weight loss. However, getting adequate calories can be challenging when appetite loss is a symptom of IBD. Caloric needs may increase during times of stress, including inflammation, fever, and diarrhea. Your doctor or registered dietitian can provide specific guidelines during these times.
Unfortunately, there have been few well-designed clinical trials aimed at guiding dietary modifications to help manage symptoms and inflammation in patients with IBD. To bring greater understanding to the role that diet plays in IBD, CCFA recently received $2.5 million from the Patient-Centered Outcomes Research Institute to study the effectiveness of the Specific Carbohydrate Diet and Mediterranean-style diet to manage symptoms and induce remission in patients with Crohn’s disease.
To learn more about specific dietary recommendations, check out CCFA’s Diet & Nutrition brochure.
Does a flare-up affect a person’s diet, and in what way?
It absolutely can. When flares are present, what you eat can impact your symptoms. No one type of food or beverage aggravates symptoms for all people with Crohn’s and ulcerative colitis. Each person living with IBD will need to determine which foods may trigger or worsen symptoms. Keeping a food journal may help you track how your diet relates to your symptoms.
In general, when experiencing a flare, it is best to avoid greasy and fried foods, which can cause gas and diarrhea. Some people find that foods high in fiber, such as fruits, vegetables and whole grains, can be problematic. Rather than eliminating these necessary foods from your diet altogether, it may be helpful to avoid these foods for the limited time during the flare-up. Also, for those who are sensitive to fruits and vegetables that are high in fiber, it may be helpful to eat them when they are thoroughly cooked.
Patients may also want to avoid foods that are likely to cause gas, such as beans, cabbage, broccoli, carbonated drinks, and caffeine in coffee, tea, and other beverages. Eating smaller, more frequent meals may be helpful, as well. Alcohol intake, whether moderate or in excess, may also make symptoms worse. Alcohol abstinence may not be required, but moderation is advised.
If you find that particular foods affect your IBD symptoms, talk to your doctor or dietitian. A registered dietitian can help you to plan a diet that works for you.
You mentioned that people with IBD can have nutritional deficiencies. How can nutritional deficiencies affect their health, and what do they do to prevent this?
People with IBD may have difficulty meeting nutrient requirements for a variety of reasons, including disease symptoms, complications, and medication. Diarrhea, urgency, abdominal pain, nausea, blood in the stool, constipation, loss of appetite, fatigue, and weight loss can negatively impact one’s nutrition. These symptoms can cause dehydration, malnourishment, anemia, malabsorption, growth delay in pediatric patients, and much more.
Many people with IBD take supplements to make up for a deficiency or to prevent a deficiency from occurring. This is because IBD, as previously discussed, can prevent a person from maintaining adequate nutrition. Supplements that may be needed include calcium, vitamin D, folic acid, vitamin B12, iron, zinc, omega-3 fatty acids, and vitamins A, D, E, and K. Always consult with your doctor before adding any supplements into your daily routine. They can recommend what is best for your individual needs.
What are some ways that someone with IBD can better manage their disease with diet?
Keeping a food journal can be incredibly helpful to track what foods may trigger your symptoms. You can do this in a traditional journal or by using our GI Buddy app.
You should always consult with your doctor when considering making changes to your diet. Your doctor can provide you with the best advice regarding what nutritional deficiencies you may have or may be at risk for and how you should be supplementing your diet to address them. They can also refer you to a registered dietitian or a nutritionist who can provide you with more information, meal plans, and other critical resources.
Living with Crohn’s disease has taught me that healthy doesn’t mean the same thing to everyone. I eat a balanced diet consuming a lot of fruits and vegetables, lactose-free dairy, and enriched and fortified whole grains. But I do have to avoid eating whole nuts, which in the past have caused health problems. But for some living with IBD, they find that some fruits and vegetables trigger flare-ups. For others, they can’t consume any dairy. And there are those who have no problem chowing down on some whole nuts.
A healthy diet is different for everyone. Whether you have Crohn’s disease or Celiac disease, you’re a vegetarian or pescatarian, you’ve never liked broccoli or you absolutely love pineapples, “healthy” isn’t one size fits all. It’s balance, moderation, and variety.
For more information about diet, nutrition, and IBD, contact the IBD Help Center at firstname.lastname@example.org or 888-MY-GUT-PAIN (888-694-8872).