Exploring Diet with IBD

Diet advice for Crohns and ulcerative colitis patients

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

Some people eat food with little thought to its journey through their system. But for patients with inflammatory bowel disease, the process of digestion may get a lot more consideration.

When a body has digestive troubles, certain foods can either help ease symptoms or trigger them.

The subject of proper diet and nutrition for these conditions is not a universal one, but rather an individualized practice, often discovered through trial and error, with patience and persistence.

IBD Explained

In inflammatory bowel disease (IBD), the gastrointestinal tract is inflamed due to a chronic and abnormal immune system response. The two most common of these conditions are Crohn's disease and ulcerative colitis.

According to the Centers for Disease Control and Prevention (CDC), in IBD, the immune system mistakes materials in the intestine, like food and bacteria, as substances that should not be there, leading to an attack on the intestine's cells, and eventually, chronic inflammation.

Common symptoms of Crohn's disease include diarrhea, abdominal pain, fatigue, fever, rectal bleeding, weight loss and sometimes issues with other parts of the body, like the joints and skin.

Common symptoms of ulcerative colitis include bloody stool, abdominal pain, the sensation of urgency to use the bathroom, fatigue and weight loss. Issues with other parts of the body can also occur, including skin lesions and joint pain, says CDC.

Can Dietary Changes Help?

According to the Crohn's and Colitis Foundation of America (CCFA), there is not one diet or way of eating that will help all IBD patients, but rather individual patients have to find what works for them and their condition.

"Furthermore, these diseases are not static; they change over time, and eating patterns should reflect those changes," noted CCFA. "The key point is to strive for a well-balanced, healthy diet."

According to Edward Loftus Jr., MD, gastroenterologist at the Mayo Clinic in Rochester, Minnesota, because of this variation from person-to-person, using diet and nutrition to treat IBD can be a controversial topic.

However, through working with patients with Crohn's and ulcerative colitis over the years, Dr. Loftus has observed several themes in terms of diet and IBD that seem to help some patients.

"My recommendations for changing your diet aren't firm recommendations, but they are suggestions for things you could try to see if they'd be helpful," stressed Dr. Loftus.

Daily Dairy, Sugar and Red Meat

Dr. Loftus has seen a lactose-free diet help a lot of patients, especially during a flare-up of IBD. No milk, ice cream or hard cheeses, said Dr. Loftus.

"During flares, you should eliminate dairy and you should really be strict about it," Dr. Loftus recommended. "... [A]nd then as your symptoms settle down you could gradually reintroduce those to see if you can tolerate them."

Dr. Loftus also said that some IBD patients can benefit from reducing sugar.

"Multiple studies suggest that too much sugar in your diet can actually worsen the symptoms of inflammatory bowel disease. ... [S]ugar tends to cause an overgrowth of bacteria in the intestine and bacteria overgrowth can lead to symptoms of increased gassiness and bloating," he said.

In addition, red meat might be a food that IBD patients should limit.

"There's a suggestion that too much animal fat might worsen your symptoms of either Crohn's disease or ulcerative colitis, so cutting back on red meat, especially higher fat-containing red meat, might be a good idea," said Dr. Loftus.

Fighting Flare-Ups

As mentioned previously, IBD can worsen for a period of time (called a flare or a flare-up), then significantly improve or disappear for a period (called remission).

According to CCFA, during flare-ups, eating may lead to pain and cramping. To reduce this, the foundation suggests a number of steps that might help, including eating smaller meals more frequently throughout the day — perhaps five small meals with fist-sized portions versus three larger, infrequent meals.

CCFA, like Dr. Loftus, also recommended avoiding dairy during a flare-up, as well as greasy or fried foods and foods like butter, margarine, cream sauces and pork products.

"Restrict your intake of certain high-fiber foods such as nuts, seeds, corn, popcorn, and various Chinese vegetables," explained CCFA. "If there is narrowing of the bowel, these foods may cause cramping."

A Dietary Exploration

Again, it is important to remember that these suggestions are not universal, but rather common themes that seem to work for some patients. A food diary can be a helpful tool for a patient when exploring his or her individual diet needs.

"[I]n one column, write down all the foods you ate that day, and in the second column, write down your symptoms," said Dr. Loftus. "And if you keep track of this diligently over weeks or months, you might be able to start seeing some themes and consider eliminating certain diets."

And according to CCFA, this practice might have more benefits beyond just spotting irritating foods; it also may help patients (especially if working with professionals) get a big-picture look at their nutrition.

"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," explained CCFA. "If not, the dietitian can suggest ways to adjust your diet so that your intake of nutrients is improved."

CCFA noted that working with a dietitian can also help patients identify deficiencies, problem spots and patterns in their diet.

Regardless, it can be helpful for IBD patients to approach the topic of diet with a curious and optimistic approach.

"It's an exploration, think about making some changes in your diet," said Dr. Loftus. "Not one diet works for everybody, but it's definitely worth exploring."

Review Date: 
February 19, 2014