Diet and nutrition are important aspects of overall health. While nutritional status and food triggers can directly affect patients diagnosed with inflammatory bowel disease (IBD), medical science lacks the evidence to support specific diet recommendations or restrictions. Nutritional intake should focus on an overall healthy diet with individual avoidance of known trigger foods. A dietician can help with healthy eating and identifying trigger foods.
IBD symptoms can result in the loss of appetite, reduction of oral intake and avoidance of certain foods which can lead to nutritional deficiencies, malnutrition and weight loss. It is important for patients to monitor their nutritional intake and focus on healthy foods choices as tolerated. Patients should consult their provider if they are unable to maintain a stable weight.
Inactive IBD disease (clinical remission)
There exists no supporting evidence for diet recommendations or restrictions to maintain clinical remission and prevent inflammation or flare symptoms. Individual patients with known food triggers may benefit from avoiding such foods.
Active IBD disease
There is no single food or food category that has been identified to cause inflammation or inflammatory symptoms. Individual patients experiencing active inflammation or flare symptoms may have symptom relief with avoidance of lactose. Lactose intolerance symptoms include bloating, abdominal pain, and/or diarrhea, following the intake of lactose (ie dairy products). Patients may also benefit from a low fermentable oligo-, di-, and monosaccharide and polyolIna (FODMAP) diet. The FODMAP diet involves the avoidance of short-chain carbohydrates which are not absorbed well in the small intestines. Avoiding these foods may help improve GI symptoms.
Surgical Treatment for IBD
Nutritional recommendations following surgical removal of the intestines vary from patient to patient. Those patients who require surgery for treatment of their IBD should consult a gastroenterologist or surgeon regarding nutritional requirements following surgery.
Elimination Diet
The elimination diet involves monitoring GI symptoms over time, while eliminating specific foods from the diet. If symptoms improve during the trial period, the eliminated food may be the cause of GI symptoms. Additionally, introducing one new food to the diet while monitoring GI symptoms may aid in identification of trigger foods.
Enteral Therapy
Enteral therapy is the use of specialized liquid nutrition given by mouth or through tube feedings. This form of nutrition is reserved for patients who are unable to maintain daily nutrition intake due to ongoing active disease (active inflammation/flare).
Parenteral Nutrition
Parenteral Nutrition provides necessary calories, amino acids, electrolytes, vitamins, minerals, trace elements and fluids through intravenous (IV) route. Patients experiencing short bowel syndrome, bowel obstruction or are unable to eat may benefit from IV-administered nutrition.
Vitamin Supplements
Vitamin D, vitamin B 12, iron, magnesium, calcium and zinc are recommended for patients with known deficiencies. A healthcare provider can order lab testing to assess nutritional deficiencies. Vitamin supplements are not recommended without known deficiencies, as some supplements can be toxic if taken in excess.
Fiber supplement
Patients with IBD should not restrict fiber from their diet. Current recommendations are for 14 grams of dietary fiber per 1000 calories per day. Patients who have a stricture (bowel blockage) are recommended to follow a low fiber diet to decrease the risk of further complications.
Probiotics
Research regarding supplementing GI health with probiotics has reported conflicting results as to the overall health benefits including those with IBD. If patients experience improvement in their GI symptoms, there is no harm in continuing with the supplement. Research has not shown any risk with taking probiotics.
Omega-3 Fatty Acids (fish oils) and Low Carbohydrate diets
Omega-3 fatty acids and low carbohydrate diets are popular for many diseases including IBD. Research has not shown any benefit for the treatment of IBD.
Other Nutritional Supplements
Fiber curcumin, aloe vera, wormwood, frankincense and wheatgrass have been studied to treat inflammatory bowel disease with mixed results. There is not enough information currently for us to recommend any of these supplements to treat ulcerative colitis or Crohn’s disease. If you choose to try these supplements, you need to inform your doctor as some supplements have been associated with side effects and laboratory abnormalities.
Reference
www.uptodate.com/content/nutrition-and-dietary-management-for-adults-with-inflammatory-bowel-disease (Accessed on October 13, 2023).
