Inflammatory Bowel Disease (IBD) is a chronic condition that causes inflammation of the gastrointestinal (GI) tract. This inflammation can lead to symptoms of diarrhea, rectal bleeding, unexplained weight loss, fever, abdominal pain and cramping, a feeling of tiredness, reduced appetite and/or bowel urgency.
The two main types of IBD are Crohn’s disease and ulcerative colitis.
Crohn’s disease usually affects the lower part of the small intestine but can involve any part of the GI tract, from the mouth to the anus. It involves some or all layers of the lining of the GI tract. The areas of inflammation are often patchy, with sections of normal gut in between.
Ulcerative colitis affects the large intestine (colon and rectum) and only involves the inner-most lining. The inflammation begins in the rectum and lower colon and may extend up the colon in a continuous pattern.
The main treatment for IBD usually involves drug therapy and in some cases, surgery. Diet and nutrition also play an important role in IBD disease management. There is currently not enough evidence to show that there is one specific trigger, food, diet or lifestyle that causes, prevents, treats or cures IBD.
Since IBD reduces the body’s ability to digest and absorb nutrients and fluid, it is important to stay nourished, hydrated and prevent weight loss. Individuals with IBD who are feeling well or are in remission should follow a healthy, balanced diet as tolerated, and drink adequate fluids.
Some people have found that certain foods trigger their symptoms or make them worse. All people with IBD are not affected by the same foods, therefore you should not routinely avoid specific foods unless they are triggers for you. The best way to identify trigger foods that contribute to your symptoms is to keep a bowel symptom journal.
During a “flare-up” or when you are experiencing symptoms, the following tips may be helpful to manage symptoms and replace lost nutrients:
Eat small, frequent meals
Depending on your symptoms, the following foods may be problematic for some people:
Foods high in "insoluble" fibre such as whole grains, bran, raw fruits and vegetables, nuts, seeds, corn and popcorn (especially if you have a stricture)
Sweets and sugary beverages
Foods with sugar alcohols i.e. mannitol, sorbitol etc.
“Hot” spices and spicy foods
Alcohol and caffeine
Gassy foods such as cruciferous vegetables (cabbage, Brussels sprouts, broccoli and cauliflower), legumes and carbonated beverages
Lower fibre breads, cereals and grains (i.e. white rice), cooked/canned fruit and cooked vegetables (skins, membranes and seeds removed), may be better tolerated during this time.
Include food sources of "soluble" fibre such as psyllium, oats, barley, ground flax seed, avocado and sweet potatoes, especially if you are experiencing diarrhea.
Substitute lactose-free milk products, if you think you may have trouble digesting lactose (milk sugar).
Choose high protein/energy food and drinks to prevent weight loss and/or malnutrition.
Add a meal replacement drink (i.e. Ensure® or Boost ®), if your intake is inadequate or you are losing weight.
Prevent dehydration by consuming adequate fluids. If you have ongoing diarrhea, you may need to replace electrolytes such as potassium, sodium and chloride using a sports drink or electrolyte replacement solution.
Check with your physician or dietitian to see if you are at risk of deficiency of any of these vitamins and minerals: iron, calcium, fat soluble vitamins A, D, E and K, folate, vitamin B12, potassium, magnesium and zinc, and find out about food sources of these nutrients and whether you need a supplement.
Once you are feeling well again or are in remission, you should resume a healthy, balanced diet as tolerated.
Certain types of probiotic supplements have been found to be beneficial for ulcerative colitis and pouchitis, but not necessarily Crohn’s disease (1,2). You should speak to your physician or dietitian regarding the type of probiotic supplement that will be right for you.
Despite the known anti-inflammatory effects of omega 3 fats, more research is needed to determine if they may be helpful for people with IBD. (3) Food sources of omega-3 fats such as fatty fish (i.e. salmon, mackerel, herring, trout and sardines), canola, flaxseed and soybean oils and flaxseeds, chia seeds, walnuts and soy products, have many other health benefits and should be included as part of a healthy diet.
Studies have shown that in some people with Crohn’s disease, a temporary period of exclusive enteral nutrition (EEN) may help give the bowel a chance to heal and lead to remission. (4) During this time, all calories/nutrients are provided through a complete, balanced nutrition formula and regular food is not consumed. This must be done only as advised and monitored by your physician and registered dietitian.
Other lifestyle changes that might also be helpful for managing flares include increasing physical activity, quitting smoking, reducing stress and getting plenty of sleep.
Understandably so, individuals suffering with IBD are often looking at ways to modify their diet to better manage their symptoms and prevent flares. This often results in experimenting with various diets such as the such as the Specific Carbohydrate Diet (SCD), FODMAP, Anti-inflammatory or Semi-vegetarian diets, to name a few. Studies have shown that in some people, these diets may be helpful for either inducing/maintaining remission or managing IBD symptoms, however there is not enough scientific evidence to justify recommending them for everyone at this point in time. (5)
If you are avoiding specific “trigger” foods to decrease your chances of a flare or minimize symptoms or following a restrictive diet, it is recommended that you seek the advice of a Registered Dietitian to tailor a diet that is specific for your needs and to ensure that you are getting all of the vitamins, minerals and nutrients you need to keep you healthy.
Eat Well, Live Well
Sood, A., V. Midha, G.K. Makharia, V. Ahuja, D. Singal, P. Goswami, and R.K. Tandon. "The probiotic preparation, VSL# 3 induces remission in patients with mild-to-moderately active ulcerative colitis." Clinical Gastroenterology and Hepatology 7.11 (2009): 1202-1209.
Mimura, T., F. Rizzello, U. Helwig, G. Poggioli, S. Schreiber, I. C. Talbot, R. J. Nicholls, P. Gionchetti, M. Campieri, and M. A. Kamm. "Once daily high dose probiotic therapy (VSL# 3) for maintaining remission in recurrent or refractory pouchitis." Gut 53.1 (2004): 108-114.
Cabré E, Mañosa M, Gassull MA.“Omega-3 fatty acids and inflammatory bowel diseases - a systematic review” Br J Nutr. 2012 Jun;107 Suppl 2:S240-52
Sigall-Boneh, R., Levine, A., Lomer, M., Wierdsma, N., Allan, P., Fiorino, G., Gatti, S., Jonkers, D., Kierkuś, J., Katsanos, K.H., Melgar, S., Yuksel, E. S., Whelan, K., Wine, E., Gerasimidiso, K., “Research Gaps in Diet and Nutrition in In ammatory Bowel Disease. A Topical Review by D-ECCO Working Group [Dietitians of ECCO]” Journal of Crohn's and Colitis, 2017, 1407–1419
Owczarek, D., Rodacki, T., Domagała-Rodacka, R., Cibor, D., Mach, T., “Diet and nutritional factors in inflammatory bowel diseases” World J Gastroenterol 2016 January 21; 22(3): 895-905