Diet and IBD
As we discussed in our previous article on nutrition and IBD, nutrition concerns of patients with living Inflammatory Bowel Disease (IBD) are extremely common. Once you develop IBD, paying special attention to what you eat may go a long way toward reducing symptoms and promoting healing. In Part II of this article, we answer some common questions patients living with IBD may have regarding your diet.
Is IBD caused by allergy to food?
No. Although some people do have allergic reactions to certain foods, neither Crohn's disease and ulcerative colitis is related to food allergy. People with IBD may think they are allergic to foods because they associate the symptoms of IBD with eating.
Do any specific foods worsen the inflammation of IBD?
No. Although certain foods may aggravate symptoms of these diseases, there is no evidence that the inflammation of the intestine is directly affected. Obviously, any contaminated food that leads to food poisoning or dysentery will aggravate IBD.
Is there a special diet for people with IBD?
There is no one single diet or eating plan that will do the trick for everyone with IBD. Dietary recommendations must be individualized. They should be tailored just for you -- depending on which disease you have and what part of your intestine is affected. Furthermore, these diseases are not static; they change over time, and eating patterns should reflect those changes. The key point is to strive for a well-balanced, healthy diet. Healthy eating habits, of course, are desirable for everyone but they're especially important for people with IBD.
Which foods should be avoided?
Again, there are no blanket rules or recommendations. If a particular kind of food causes digestive problems try to avoid it. But it's important to distinguish between an actual allergy to one kind of food and an intolerance. Many people have food intolerances—far more than really have true food allergies. Elimination tests are better at diagnosing which foods must be avoided or modified than the standard allergy skin or blood testing. Many good books discuss the proper way to follow such an "elimination diet," which involves keeping a food and symptom diary over several weeks.
In fact, a food diary can help pinpoint which foods are troublesome for you, but it can also reveal whether or not your diet is providing an adequate supply of nutrients. By reviewing your food diary, your dietitian can see if you are getting the recommended daily allowances (RDAs) for a person of your age, sex, and size. If not, the dietitian can suggest ways to ajust your diet so that your intake of nutrients is improved. That may mean increasing the amount of food you eat, changing what you eat, or adding supplements to your diet.
It's important to remember that it's not just the amount of food you consume that guarantees a healthy diet. Your daily intake needs to include an adequate amount of calories, proteins, and nutrients. A balanced diet should contain a variety of foods from all food groups:
- Meat, fish, poultry, and dairy products, if tolerated, are sources of protein;
- Bread, cereal, starches, fruits, and vegetables are sources of carbohydrates;
- Margarine and oils are sources of fat.
Should people with IBD be concerned about fluid intake?
Yes. In a condition with chronic diarrhea, the risk of dehydration always exists. If fluid intake does not keep up with diarrhea, kidney function may be affected. Patients with Crohn's disease and other diarrheal diseases have an increased incidence of kidney stones, which is related to this problem. Furthermore, dehydration and salt loss create a feeling of weakness.
For these reasons, people living with IBD should consume ample fluids-especially in warm weather when loss of salt and water through the skin may be high. A good rule of thumb is to drink one half ounce per day for every pound of body weight. That means that if you weight 140 pounds, you should drink at least 70 ounces a day, or eight and three-quarters glasses. Sip your beverages, rather than gulp them. By introducing air into the digestive system, gulping can cause discomfort.
What's the best way to decrease intestinal cramping after eating?
During periods of disease flares, eating may prompt abdominal discomfort and cramping. Here are some ways to reduce these symptoms:
- Eat smaller meals at more frequent intervals: five small meals (think in terms of "fist-sized" portions) every three or four hours, for example, rather than the traditional three large meals a day.
- Reduce the amount of greasy or fried foods in your diet. Butter, margarine, cream sauces, and pork products may all cause diarrhea and gas if fat absorption is incomplete. These symptoms tend to occur more in people who have had large amounts of small bowel (particularly ileum) removed.
- Limit consumption of milk or milk products if you are lactose intolerant. Some people cannot properly digest lactose, the sugar present in milk and many milk products, regardless of whether they have IBD. This may occur because the inner surface of the small intestine lacks a digestive enzyme, called lactase. Poor lactose digestion may lead to cramping, abdominal pain, gas, diarrhea, and bloating. Because symptoms of lactose intolerance may mimic those of IBD, it may be difficult to recognize lactose intolerance. A simple "lactose tolerance test" can be performed to identify the problem. If there is any question, milk consumption may be limited. Alternatively, lactase supplements may be added to many dairy products so that they no longer cause symptoms. Your dietitian may assist you and/or your child with this. However, it's desirable to maintain intake of at least some dairy products because they represent such a good source of nutrition, particularly calcium and protein.
- Restrict your intake of certain high-fiber foods such as nuts, seeds, corn, popcorn, and various Chinese vegetables. If there is narrowing of the bowel, these foods may cause cramping. High-fiber foods also provoke contractions once they enter the large intestine. Because they are not completely digested by the small intestine, these foods may also cause diarrhea. That is why a low-fiber, low-residue diet (see below) is often recommended.
However, some people who follow these guidelines may still continue to experience abdominal cramping following eating. In these cases, medication may be helpful. Prednisone and other corticosteroids, for example, may reduce intestinal inflammation-allowing the bowel to work more normally. Speak with your doctor to see if taking antispasmodics or antidiarrheal medications 15 to 20 minutes before eating may be helpful for you. Antispasmodics or antidiarrheal medications may be helpful in reducing symptoms and maintaining good nutrition, particularly when the disease is mild; they should be avoided with more severe disease.
What is a low-fiber with low-residue diet?
About two thirds of people with small bowel Crohn's disease develop a marked narrowing (or stricture) of the lower small intestine, the ileum. For these patients, a low-fiber with low-residue diet or a special liquid diet may be beneficial in minimizing abdominal pain and other symptoms. This diet minimizes the consumption of foods that add "scrapy" residue to the stool. These include raw fruits, vegetables, and seeds, as well as nuts and corn hulls. The registered dietitian associated with your IBD treatment program can assist you in devising such a diet when appropriate. Often, these dietary adjustments are temporary; the patient follows them until the inflammation that caused the narrowing responds either to medical treatment or to a corrective surgical procedure.
It is important, however, to watch out that you do not impose too many food restrictions on yourself or your child. These limit variety in the diet and make a balanced intake of foods more difficult to achieve.
Is there a place for fast or "junk" food?
Children with IBD face special challenges, and eating nutritiously is high up on the list. Parents would like to think that there's no place in a healthy diet for fast food, but this may not be true. Some of these food provide a valuable supply of nutrients as well as calories. Take pizza, for instance. The cheese offers calcium, protein, and vitamin D; the tomato sauce provides vitamins A and C; and the crust supplies B vitamins. The same is true for other popular favorites such as hamburgers or cheeseburgers, although all of these foods also contain more fat and salt than should be consumed on a regular basis. Milk shakes and ice cream also offer a good source of calcium, proteins, and calories. If lactose intolerance is a problem, that can be overcome by taking commercially available lactase in tablet form before consuming any dairy products.
Key Take Away Diet Tips
There is not one set diet that is applicable to everyone with IBD—it is an individualized plan. Modifications in diet depend on the symptoms you experience, the extent of your disease and many other factors determined by the doctor.
Two of the common symptoms of IBD include diarrhea and cramping. Here are a few tips to keep in mind when experiencing these symptoms:
- Try: Bananas, white bread, white rice, and cheese (if you're not lactose intolerant), Gatorade and Crystal Light diluted with water, fruit juices, applesauce, smooth peanut butter, bland soft foods, crackers made with white flour, plain cereals, refined pastas, broth, canned varieties of fruit, cooked vegetables, potatoes without skin,eating broiled or steamed fish (e.g. herring, salmon, halibut, flounder, swordfish or pollack), using canola and olive oils, small & frequent meals, nutritional supplements if there is weight loss and if your doctor approves vitamins and mineral supplements.
- Avoid: Caffeine in coffee, tea and other beverages, fresh fruits and uncooked vegetables, high-fiber foods (such as fiber-rich breads, cereals, nuts and leafy greens), high sugar foods, skins, seeds, popcorn, high fat foods, spicy foods, raw foods, prunes, beans, large food portions, in some cases dairy products, ice-cold liquids (even water), and too much of any type of liquid.
It is always important to keep a food journal to help you understand the foods you are able to tolerate and not tolerate during the time of a flare. To find an example of a food journal please review the section below entitled " Helpful Diet Links." Finally, if possible, it is helpful to consult with a dietician. They can help you formulate a specific dietary plan for your case. The dietician can also review your food journal to see if there are any patterns in your diet in relation to your symptoms.
For further information, call CCFA at our Information Resource Center: 888.MY.GUT.PAIN (888.694.8872).
The Crohn’s & Colitis Foundation of America provides information for educational purposes only. We encourage you to review this educational material with your health care professional. The Foundation does not provide medical or other health care opinions or services. The inclusion of another organization’s resources or referral to another organization does not represent an endorsement of a particular individual, group, company or product.
About this resource
Published: May 30, 2012