An Overview of IBD Diet and Nutrition

Ask 10 people with inflammatory bowel disease (IBD) about their diet and you will get 10 different answers about how certain foods affect their condition. There is no one recommended approach to diet and nutrition for IBD because, as with a lot related to this gastrointestinal disorder (which encompasses Crohn's disease and ulcerative colitis), there is not very much in the way of related data.

However, there are some guidelines that people with IBD can use to find their way to a healthy diet that both nourishes their body and helps manage their symptoms.

How Diet Affects IBD

Diet is neither a cause of IBD nor a cure for it. 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 your quality of life. With IBD, you already have inflammation in the small and large intestine that can inhibit the absorption of vitamins and minerals. Plus, some treatment medication can also inhibit absorption. This makes getting back to a regular diet especially 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.

Some foods may be triggers for you (such as milk if you have lactose intolerance), while others (such as alcohol, fatty foods, gassy foods, and carbonated beverages) commonly exacerbate intestinal problems. They may not cause the flare-up, but they can make it even more unpleasant.

Maintain clear communications with your doctor on your observations of how diet affects your symptoms. In return, listen to the advice and guidelines given. Only half of patients say they've followed physician advice on diet.

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 health care 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.

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. Diet studies themselves are difficult to design, as the test subjects may stray from the guidelines and cloud the results.

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, but they may be used after surgery or when there is a stricture (a narrowed part in the intestine) present. This diet 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.

Fasting-Mimicking Diet

The fasting-mimicking diet repeats cycles of low-calorie, plan-based diet. A University of Southern California study showed these 4-day cycles partially reversed the hallmarks of IBD in mice. They concluded the fasting prepared the gut tissue for improvement, which then occurs in the refeeding phase. 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.

Identifying Problematic 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.

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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