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Optimal Nutrition for IBD: What's Needed
Dr. Stan Cohen is one of our founders and our CEO as well as the Chairman of our Medical Advisory Board. Dr.
Article in collaboration with:
Dr. Stan (Stan Cohen MD)
Diets That Can Lessen Inflammation in Inflammatory Bowel Disease
Our understanding of how nutrition impacts Inflammatory Bowel Disease (IBD) has evolved significantly. Traditionally, the focus was on providing extra protein, adequate calories, iron, and vitamins to meet the increased metabolic needs caused by inflammation and compensate for decreased nutrient absorption and waste. However, flares in IBD often reduce appetite, making it difficult to meet these increased nutritional demands.
Now, we understand that:
- Microbes (bacteria and other organisms) play a key role in intestinal health.
- Certain foods and factors can potentially reduce or prevent inflammation.
- Other foods and factors may worsen or trigger inflammation.
- Specific diets can include beneficial foods while eliminating problematic ones.
- Modifications must be tailored to the individual's condition.
In essence, healthy intestinal microbes protect the gut. When they're compromised, inflammation can occur. Supporting the growth and stability of these microbes through nutrition, alongside prescribed medications, is essential.
What's Needed
In addition to the traditional focus on protein, calories, iron, and vitamins, the following nutrients and strategies are essential:
- Minerals: Calcium and zinc are particularly important.
- Vitamins: B12, folate, C, and D.
- Omega-3 Oils: These can help reduce inflammation in IBD.
- Fluids: Staying hydrated is critical.
- Fiber: High-fiber foods can promote the growth of beneficial intestinal bacteria during remission Curcumin (Turmeric): Effective for preventing or controlling inflammation, especially in ulcerative colitis.
What to Avoid
While it's important to focus on beneficial nutrients, certain foods and additives can harm the protective layer of bacteria and intestinal mucus or cause discomfort in those with Crohn's disease or ulcerative colitis:
- Harmful Additives:
- Emulsifiers in processed foods can disrupt protective intestinal factors.
- Maltodextrin can decrease protective mucus in the intestine.
- High-Fat Foods and High Sugar foods: These can promote an unhealthy bacterial population (dysbiosis).
During flares, certain foods may worsen symptoms like nausea, gas, or cramping. While their direct impact on intestinal tissues is unclear, keeping a food diary can help identify triggers. Common culprits include:
- High-fiber foods: Beans, nuts, seeds, popcorn.
- High-fat foods: Red meats, dairy.
- Lactose.
- Caffeine and Alcohol.
- Spicy Foods.
- Raw fruits and vegetables high in fiber.
- Gluten, especially for those with gluten intolerance or celiac disease.
Diets for Crohn's Disease
Nutritional therapy for Crohn's disease has focused on addressing malnutrition and underweight issues. Historically, 25% of children with Crohn's experienced stunted growth. In some IBD centers, newly diagnosed children are placed on short-term liquid diets, known as exclusive enteral nutrition, as their primary treatment. This approach, sometimes requiring tube feeding, has been as effective as traditional medications with significantly better intestinal healing.
The success of nutrition-based treatments has paved the way for additional dietary approaches, including:
- Specific Carbohydrate Diet (SCD): Eliminates grains, lactose, and certain sugars.
- Crohn's Disease Elimination Diet (CDED): Gradual reintroduction of foods.
- Autoimmune Diet: Focused on reducing inflammation.
- Mediterranean Diet: Rich in anti-inflammatory foods such as fruits, vegetables, and omega-3s.
Diets for Ulcerative Colitis
While there is no specific diet developed exclusively for ulcerative colitis, further research is being done in this area. Currently the Mediterranean Diet, the SCD and Autoimmune Diet are often recommended. These diets emphasize anti-inflammatory and gut-friendly principles, with adjustments made during flares to reduce irritation.
Points to Remember
- Supplementation: Restrictive diets can lead to vitamin and mineral deficiencies. Supplements may be necessary to ensure balanced nutrition.
- Professional Guidance: A registered dietitian familiar with IBD can provide tailored advice and practical strategies to make dietary changes easier.
- Holistic Approach: Diet alone is not a complete solution. Effective treatment involves a combination of nutrition, medication, exercise, and mental health care.
- Track Triggers: Maintaining a food diary can help identify specific foods that cause discomfort or worsen symptoms.
Final Thought
While nutrition plays a vital role in managing IBD, it complements but does not replace medical treatment. Regular monitoring, personalized care, and adherence to a comprehensive treatment plan are essential to managing this chronic condition effectively.
References
SM Barbalho, R deAlvaresGoulart, K Quesada, MD Bechara,A deCássioAlvesdeCarvalhoe. Inflammatory bowel disease: can omega-3 fatty acids really help? Ann Gastroenterol. 2016. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700845/
MT Zangara, AK Ponti, ND Miller, MJ Engelhart, PP Ahern, and others. Maltodextrin Consumption Impairs the Intestinal Mucus Barrier and Accelerates Colitis Through Direct Actions on the Epithelium. Front Immunol. 2022. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8963984/
S Jiang, Z Miao. High-fat diet induces intestinal mucosal barrier dysfunction in ulcerative colitis: emerging mechanisms and dietary intervention perspective. Am J Translational Res. 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10006746/
I Correia, P Almeida Oliveira,1M Luz Antunes, M da Graça Raimundo, A Catarina Moreira. Is There Evidence of Crohn's Disease Exclusion Diet (CDED) in Remission of Active Disease in Children and Adults? A Systematic Review. Nutrients. 2024. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11013840/
This article, as well as all others, was reviewed and edited by a member of our Medical Advisory Board.
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