Nutrition - Overview

Individuals living with Inflammatory Bowel Disease (IBD) are often interested in how their diet can affect disease management. Nutrition plays an important role in maintaining health during times of disease activity and remission. Diet can also help with symptom management during disease flare ups. It is important to remember that diet does not cause or cure IBD. There are two key ways that nutrition care impacts IBD:

1. Maintaining good nutritional habits and preventing malnutrition helps with healing, immunity and increasing energy. This means eating a varied and healthy diet that is an excellent source for all nutrients. Nutritional deficiencies result from inadequate macronutrients (carbohydrate, protein, fat) and micronutrients (vitamins, minerals, trace elements).
2. Preventing or minimizing gastrointestinal (GI) symptoms and normalizing bowel function.

Foods to Eat or Avoid: The "Million Dollar" Question

Photo: plate of nutritious foodFood intake is frequently associated with GI symptoms and by changing what or how food is consumed, individuals gain a sense of control over an unpredictable disease.

When making such decisions, it is difficult to sort out myths from facts. Messages from books, television or the Internet often claim that exclusionary diets (where a food or food group is eliminated) will cure or prevent relapse of IBD. There is no reliable evidence to support these claims and there is no standard diet for IBD.

If your IBD is under control and relatively symptom free, follow Canada's Food Guide as it emphasizes a wide variety of foods that provide all the nutrients your body needs. There is no need to restrict foods or to follow a special diet.

If you are experiencing acute disease activity, you may find it helpful to modify your regular diet (e.g. low fibre diet). This helps to minimize GI symptoms, but does not play a role in preventing the progression of the disease. It is of utmost importance that you try to maintain your nutritional status during this time.

Healthy Eating

Excluded certain foods is not necessary and restricts important nutrients the body relies on. Isolated nutrients in supplements may also be unnecessary. Eating "real food " is more tasty, filling, and provides more nutrient variety. A well-balanced diet including a variety of foods is best for good health.

It is important to remember that dietary changes should not compromise your well-being. This means maintaining weight and energy levels, continued enjoyment from eating, and participation in social situations involving food. Food is an important aspect of your quality of life, and your health care providers (including a Registered Dietitian) can help you to learn about your own food tolerances to find the diet that works for you.

Dietary Choices

Dietary choices and food tolerances vary from person to person. For individuals with IBD there are many factors which may affect food tolerance such as current disease state and the portion of the GI tract that is affected. Additional factors that contribute to increased risk for malnutrition include:

• malabsorption (altered digestion and absorption with inflamed gut mucosa)
• increased GI losses (bleeding, diarrhea)
• increased requirements
• decreased dietary intake (associating symptoms with eating) due to:
  • bloating, cramping
  • nausea, vomiting, diarrhea
  • loss of appetite
  • fear of eating due to pain
• elimination diets
  • therapy: medical (drug-nutrient interactions)
  • surgical (resections/shorter bowel with less absorptive surface)

Diet therapy is individualized as it considers all of the above factors. It usually focuses on hydration, electrolyte balance, ensuring adequate intake of nutrients, modifying foods to manage GI symptoms, and replacement of deficient nutrients if needed. This is all considered in the context of an individual's severity of symptoms, food preferences, tolerances, finances, and lifestyle.

Symptom Management

Symptom management often includes:

• reducing the frequency of bowel movements
• increasing consistency of loose stool
• minimizing obstruction risk (post-op or for individuals with bowel strictures)

Strategies to achieve this involve:

• decreasing insoluble fibre in the diet (e.g. skins and seeds of fruit and vegetables, whole wheat and whole grain breads and cereals)
• gradually increasing soluble fibre (oats, oat bran, pulp of fruits and vegetables, legumes, and barley)

Insoluble fibre increases the amount of stool and stimulates bowel movements. Soluble fibre contributes less to fecal bulk, and helps form loose bowel movements. Other strategies may include modifying dietary intake of lactose, fat, simple sugars, or caffeine. Changes to meal size, composition (e.g. nutrient density), and timing (e.g. small frequent meals) can also be evaluated.