Diet for People With Inflammatory Bowel Diseases

28th February 2020
Recurrent diarrhea, weight loss or even constipation can be symptoms of inflammatory bowel diseases. What can we do to fight them?

Within inflammatory bowel diseases, we can differentiate two types with separate symptoms and treatments: ulcerative colitis and Crohn’s disease. Diet plays a very important role to fight the symptoms of inflammatory bowel diseases.

The importance of diet for inflammatory bowel diseases

It’s fundamental to know that there’s no specific diet for these pathologies; it’s something that must fit the stage of the disease that the patient is currently experiencing. With this in mind, we can pinpoint three different situations:

Remission stage

During this stage, the inflammatory activity is minimal. Because of this, there’s no need to modify your diet, although you must make sure that you’re eating balanced and healthily. It’s convenient to avoid unnecessary restrictions, except for those who suffer from allergies or some kind of intolerance.

Mild acute outbreak

During this stage, it’s very important to adapt your diet and use it as a way to control the symptoms. The ideal option in most cases is to follow a diet that’s easy to digest and with astringent properties. Avoid fats as much as possible.

A moderate or severe outbreak

In this stage, there are a lot more symptoms. Affected patients are usually admitted to the hospital. As long as the digestive tract allows it, eating should be maintained.

Patients with ulcerative colitis usually retain their digestive tract functions, but eating can increase the inflammation for children who suffer from Crohn’s disease. In these cases, doctors usually resort to enteral feeding.

Enteral feeding consists of administering nutrients through a tube. This means that instead of giving the patient solid foods, they usually get their nutrients in the shape of commercial formulas that go through a tube that connects their mouth with the digestive system.

A person suffering from abdominal pain due to inflammatory bowel diseases

When the complications are even more severe -toxic megacolon, abscesses or severe fistulas- specialists turn to parenteral feedings. This feeding system consists of administering nutrients through an IV line. It’s the last resort when the digestive tract isn’t working correctly.

General recommendations during an inflammatory bowel disease outbreak

The collaboration between the patient and nutritionist is fundamental since the symptoms of inflammatory bowel diseases can have a very close relationship with certain types of food. In this context, it’s very important for the patient to keep a record of every single thing they eat during each day.

  • The diet plan must follow a balanced and healthy pattern as much as possible.
  • Splitting the diet is usually a good strategy whenever a part of the digestive tract is suffering. This means, eating the same amount of food, but dividing it into small portions in order to not increase the digestive tract’s workload.
  • Eating slowly and chewing properly, in a calm environment to avoid becoming afraid of food.
  • Resting after each meal.
  • Separating liquid intake from solid food intake, and even then, consume liquids in small amounts. This is also a common strategy when dealing with diarrhea, in order to not overload your body. Oral rehydration solutions -isotonic beverages- promote the absorption of water and solutes.
  • Eat your food at medium temperatures. Foods that are too hot or cold can stimulate intestinal transit.
  • Eat simple preparations that contain salt to compensate for the loss of ions due to diarrhea. For hypertensive patients, the continuous loss of water and salts can cause drops in their blood pressure.
  • Avoid drinking coffee, stimulants and carbonated drinks.

Diet particularities

Lactose for people with inflammatory bowel diseases

During an inflammatory bowel disease outbreak, we must eliminate lactose from our diet. This is the same for any other condition that causes diarrhea. During an outbreak, it’s common for people to develop some sort of lactose intolerance due to a temporary lactase deficit; lactase is the enzyme that decomposes lactose.

Woman saying no to a glass of milk because she is lactose intolerant

Outside of an outbreak, it’s not recommended to eliminate lactose unless the patient is already intolerant. People with ulcerative colitis are more susceptible to suffer from lactose intolerance -primarily acquired- in general terms, not just during an outbreak.

Fats

If the patient is experiencing diarrhea or abdominal pain, they must limit their fat consumption, especially of lower quality fat. On some occasions, the patients who suffer from Crohn’s disease are taking enteral nutrition in the form of a shake that contains a lot of omega-3 polyunsaturated fats, and they shouldn’t restrict them. These drinks have an anti-inflammatory effect, and they improve the inflammation state of the intestinal mucus.

Fiber

Experts recommend limiting fiber intake, especially insoluble fiber. Patients with ulcerative colitis can include insoluble fiber to slow down their intestinal transit, but this is a big consideration to avoid for people with Crohn’s disease. Instead, they must try to eat as little fiber as possible.

As their condition improves, Crohn’s patients can start to incorporate fiber gradually back into their diet until their diet is normal again. However, it’s important to start with soluble fiber first.

Analytical control

People with inflammatory bowel diseases are susceptible to micronutrient deficits. A proper control of their micronutrients is essential, since on some occasions, these patients have a very restrictive diet.

The analytical parameters they should look out for are vitamin B12, folic acid, vitamins D, E and A and some minerals such as calcium, magnesium, and phosphorus.

Functional foods

The use of prebiotics -living microorganisms that promote the improvement of intestinal flora- is a controversial topic for Crohn’s patients. It’s not very clear if they have a positive effect or not.

On the other hand, prebiotics can be beneficial to improve the inflammation of the reservoir for people with ulcerative colitis. When a patient with this disease has his colon removed, they usually get a connection between the small intestine and whatever is left from their rectum. The doctors will create a reservoir using a part of the small intestine.

Sardines and other foods with a high Omega 3 content

Omega-3

There isn’t enough data for people with inflammatory bowel diseases to systematically supplement this nutrient. Foods that have a high content in Omega-3 are fine to consume as long as the patient can tolerate fat.

Antioxidants and inflammatory bowel diseases

They’re not actually needed, and specialists don’t recommend their systematic supplementation. However, patients can orient their diet plan to increase the consumption of natural antioxidants with foods that contain them.

It’s clear that these recommendations can vary depending on the characteristics of each case. If you suffer from inflammatory bowel disease, you should definitely follow the precise instructions from your doctor.

  • Salas-Salvadó J, i Sanjaume AB et al. 2019. Nutrición y dietética clínica. Elsevier Health Sciences.