Nutritional Therapy for IBD

By Sarah Marie Jackson, MS, RDN

Inflammatory Bowel Disease (IBD) includes Ulcerative Colitis (UC) and Crohn’s Disease (CD), both of which affect 3.1 million people in the United States and are increasing in numbers worldwide. Unfortunately, the cause of IBD is not completely understood but experts believe it involves the gastrointestinal immunologic system along with genetic and environmental factors. The treatment for IBD sufferers often includes a slew of medications, such as steroids, antibiotics and immunosuppressing drugs but should also include nutritional interventions. A Registered Dietitian can provide medical nutrition therapy to decrease symptoms associated with the diseases, such as, diarrhea, fever, weight loss, anemia, food intolerances, malnutrition, growth failure. See table 1. For the defining differences among the two IBD conditions

Foods/Drinks to Limit in order to Relive IBS Symptoms

Table 1.
  • Ulcerative Colitis

  • Crohn’s Disease

  • Chronic inflammation and ulcers on the lining of the colon and rectum
  • Perianal disease causes abdominal pain and is not continuous (skips areas in the GI tract).
  • Presenting symptom is usually bloody diarrhea
  • Shallow ulcers, cobblestone appearance.
  • Weight loss/malnutrition
  • Malabsorption of nutrients/weight loss

As an RD who has worked with IBD sufferers, I know that nutritional management can often be subjective to each individual client. Typically, symptoms vary based on which area of the gastrointestinal tract is affected and which condition of IBD an individual has. During times of severe inflammation or “flare ups”, individuals with IBD may experience partial bowel obstructions, nausea, diarrhea and/or bloating. These symptoms may also be exacerbated by certain foods, however the foods that are not well tolerated are often unique to each individual. For example, some people may tolerate raw vegetables while others may be able to only have low fiber containing, well-cooked options. It can often be frustrating for IBD sufferers to pinpoint the foods that do cause physical discomfort, which is why I recommend that client’s use a food journal. Tracking food intake and corresponding symptoms that may occur after ingestion, can help you and your dietitian identify the foods that should be consumed in moderation while symptoms are active and the best way to re-incorporate them when appropriate. Although specific dietary recommendations should be based on individual tolerance, here are some general nutritional tips that may benefit certain IBD sufferers going through a flare up:

  • Limit Lactose containing foods (i.e. dairy). The sugar in dairy products, known as lactose, is frequently not tolerated among those with IBD. In an early clinical trial, researchers demonstrated that one in five patients with UC benefited from the removal of lactose containing milk and cheese from their diets. It is important to note that the reduction or elimination of dairy can lead to an inadequate intake of calcium. Assess for your tolerance of dairy products before eliminating them completely and discuss supplementation risk/benefits with your physician.
  • Probiotics! When antibiotics must be taken per medical recommendation, they can cause a dysbiosis, or an imbalance in gut microflora, which can cause bowel irregularities like diarrhea. Certain strains of bacteria have been studied for their potential benefits in ulcerative colitis. The most positive research has been conducted in treating pouchitis, often seen in those with UC. For IBD patients, probiotic supplements may be considered since they have low risk of adverse effects and promising potential in patients with UC.
  • Dietary supplementation with curcumin. Curcumin is a phenol found in turmeric and has been used as a holistic herbal remedy for centuries. A clinical trial of curcumin 2 grams per day for six months showed a trend towards a reduced relapse rate. This clinical significance shows promise for the use of curcumin for UC maintenance.
  • Reduce refined carbohydrates & increase fiber (as tolerated): Strong statistical associations exist between CD and a high intake of refined carbohydrates. A single controlled trial demonstrated good results for maintenance of remission in CD with temporary exclusion diet of wheat, dairy and yeasts. Increasing fiber containing fruits, vegetables and whole grains is recommended but should be incorporated based on individual tolerance.
  • Examine your tolerance to FODMAP’s. Some evidence has demonstrated that a reduction in fermentable, oligo-di-mono-saccharides (FODMAP’s) may benefit IBD sufferers who suffer from ‘IBS-type’ symptoms. This elimination then re-introduction of certain fermentable carbohydrates should be done under the supervision of a dietitian to prevent long-term microbiome changes.
  • Reduce excessively greasy foods: High fat foods such as fatty meats, butter, fast-foods and fried foods can cause diarrhea and gas if absorption is incomplete. This occurs when there is inflammation in the small intestine or if part of the bowel has been resected.
The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician with any questions you may have regarding a medical condition.

References

  • 1. Haskey N, Gibson D. An Examination of Diet for the Maintenance of Remission in Inflammatory Bowel Disease. Nutrients. 2017;9(3):259.
    doi:10.3390/nu9030259
  • 2. Mahan LK, Escott-Stump S, Raymond JL. Krauses Food & the Nutrition Care Process. Place of publication not identified: Saunders; 2016.
  • 3. Richman E, Rhodes JM. Review article: evidence-based dietary advice for patients with inflammatory bowel disease. Alimentary Pharmacology & Therapeutics. 2013;38(10):1156-1171.
    doi:10.1111/apt.12500.

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