An Overview of IBD Diet and Nutrition

Ask ten people with inflammatory bowel disease (IBD, consisting of Crohn's disease and ulcerative colitis) about their diet and you will get ten different answers about nutrition, recipes, and how symptoms are affected. This is because there is not one single answer about diet and nutrition when it comes to IBD.

As it is with so many other topics related to IBD, there are a lot of opinions and not very much in the way of data. However, there are some guidelines that people with IBD can use to find their way to a healthy diet that nourishes their body.

IBD Diet Studies

Diet is a difficult topic to study. People involved in diet studies must actually stick to the diet they are given. If they do not follow guidelines, this can result in any number of problems. That isn't to say that studies on diet are impossible. In fact, as more aspects of IBD are being understood, studies on diet are now being designed. While the IBD community waits for the results of such studies, the best idea is to rely on what we already know.

Compounding the difficulties of diet is an apparent communication problem. There are studies showing that people with IBD and their physicians have different views on diet. One study shows that more patients than physicians think that diet affects IBD. Patients also report that they've not received advice on diet, yet almost all physicians say they've given guidelines on it. And only half of patients say they've followed physician advice on diet.

Latest IBD Diet Research

Researchers at the University of Southern California recently discovered that a "fasting-mimicking" diet may actually relieve inflammation and repair the gut. During their study, they repeated cycles of a low-calorie, plan-based diet on a mouse model of IBD.

Featured in Cell Reports, the scientists describe how periodic 4-day cycles of a fasting-mimicking diet partially reversed the hallmarks of IBD in mice. In fact, they noted that the diet reduced inflammation and increased stem cells in the mice's intestines. Stem cells are needed for tissue repair and regeneration. Additionally, the animals' small intestines grew longer after several cycles on the diet.

Consequently, the researchers conclude that the fasting prepares the tissue for improvement. Meanwhile, the replenishing and repairing of the tissue occurs during the "refeeding" phase. As a result, the researchers compare the process to tearing down and rebuilding a house. The calorie restriction is the tearing down process while the refeeding is the rebuilding phase.

How Diet Affects IBD

Diet is neither a cause of IBD nor a cure for IBD. However, it is vital for patients with IBD to fuel their bodies with nourishing food. During a flare-up, it is especially important to focus on nutrition in order to better help the body cope with the inflammation.

Many people with IBD restrict food during a flare-up in order to cut back on symptoms such as pain and diarrhea. But restrictive diets can lead to vitamin deficiencies and also affect quality of life—which is another reason why effective treatment for IBD and getting back to a regular diet is important.

Lack of appetite is common in people with IBD, especially during a flare-up. This can make maintaining a healthy weight even more difficult; it's common for people with IBD to struggle with putting on weight. Eating nutrient-dense foods, more frequent small meals, and getting creative with foods, such as trying foods at different temperatures, are strategies that may help.

IBD Diet Options

There is no one diet that has been shown to help people with IBD. Some people do report that changing their diet helps their symptoms. But there's no diet that's been shown to help all people with IBD.

Working with a registered dietitian will provide the best chance of success in finding a diet that helps with symptoms and isn't restricting vitamins and nutrients. Here are some of the diets that are commonly talked about in connection to IBD:

  • Exclusive enteral nutrition (EEN). The only diet that has been studied enough that there is good scientific evidence to use it is EEN. EEN has been shown to help in Crohn's disease in children, but there is less proof that it works well in adults. This diet is a liquid one and is typically given through a tube that goes down the nose to the stomach, usually overnight. The key point to this diet is not only that it helps improve symptoms, but it can also help improve inflammation in the intestine.
  • Liquid diets. Liquid diets aren't typically recommended, in general. But there are times when they might be used. Two times when liquid diets may be recommended include after surgery or when there is a stricture (a narrowed part in the intestine) present. This is a diet that, understandably, shouldn't be followed for long because it limits nutrient intake.
  • Low-fiber diet. A low-fiber diet might be used for some time after surgery or during a flare-up. Restricting the amount of fiber can lead to fewer stools. It can also help in cutting down on bloating or pain since there's less undigested food moving through the intestines. This diet isn't meant to be followed long-term and people with IBD should get back to a more comprehensive diet that includes all sorts of foods as soon as possible.
  • Lactose-free diet. Some people with IBD may find that milk sugar (lactose) causes bloating, diarrhea, or discomfort. The symptoms can range from being mild to severe. Cutting all milk products containing lactose out of the diet is the best way to avoid symptoms.
  • Specific carbohydrate diet (SCD). The SCD is a diet that removes grains, lactose, and sugar from the diet. The main drawback of this diet is that most patients find it restrictive and difficult to follow. It has not been studied extensively for use in people with IBD and therefore its effectiveness is unknown. However, it's not thought to be harmful.
  • Low FODMAP diet. "FODMAP" is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. The premise of this diet is to restrict any foods that have FODMAPs in them. Most people don't instinctively know what foods are high-FODMAP or low-FODMAP, so it's best to try this diet while working closely with a dietitian who understands IBD. There have been some small studies on low-FODMAP diet and IBD which have shown good results. Clinical trials are needed before this diet can be recommended for a wider patient group with IBD.
  • Gluten-free diet. This diet removes gluten, a protein found in wheat, barley and rye, from the diet. Some IBD patients have said that removing gluten from their diet relieves their symptoms; but researchers have not determined yet if it also reduces IBD inflammation. Additionally, it may be a good idea to be tested for celiac disease before beginning a gluten-free diet.

Identify Problem Foods

Figuring out which foods may cause symptoms of diarrhea or bloating can take time and organization. Keeping a detailed food diary that includes symptoms and reactions to certain foods may help in finding problem cases. The most important part of keeping a food diary is to be consistent with it and include as much information as possible.

Trying a food elimination diet is another technique that can help. To use this method, it is important to get the advice of a qualified healthcare professional—preferably a registered dietitian—since such a diet can be time-intensive and confusing. Eliminating foods should only be done short term until any potential food intolerances are identified. If foods or food groups need to be avoided on an ongoing basis, a dietitian can create a plan that ensures adequate vitamin and mineral intake.

General Diet Guidelines

People with IBD need a healthy diet that nourishes the body. Every person with IBD will find their own personal diet that works for them. It's a good idea to find some recipes that contain foods that are tasty and well tolerated and learn how to cook them. This will help in avoiding convenience foods or fast foods when coping with fatigue or other symptoms of a flare-up.

There are some general guidelines that give a head start on understanding how to eat for IBD:

  • Alcoholic beverages. Drinking is another area that is different for every person with IBD. Some may find that beer can lead to gas and bloating. Certain medications used to treat IBD or IBD complications may interact with alcohol, so it's best to check with a physician or pharmacist before drinking. Alcohol does have an effect on the digestive system, especially the liver, and these aspects should be considered and discussed with the help of a healthcare provider.
  • Carbonated beverages. Extra carbonation can lead to bloating and gas, which are not wanted, especially during a flare-up.
  • Fried foods. Fried foods are often high in fat and empty calories and may lead to diarrhea in some people.
  • High fiber foods. Fiber is an important part of a balanced diet, but foods that are high in fiber—such as nuts, corn, seeds, and popcorn—might need to be restricted. This is especially true after abdominal surgery (ostomy or j-pouch surgery) and for anyone who has a stricture.
  • Lactose. Lactose intolerance is common. Eliminating milk products will help in avoiding any symptoms that are caused by milk sugar.

    A Word From Verywell

    Many people with IBD have a complicated relationship with food and struggle in knowing what to eat. Trial and error is time-consuming and frustrating, but it is currently the best way in navigating a diet that works to avoid symptoms and that is also healthy.

    The goal of IBD flare-up treatment is to control symptoms and inflammation and get back to a healthy diet as soon as possible. And the best way to get to a healthful diet is to seek help from and work closely with experienced healthcare professionals.

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