Nutrition for IBD

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Please consult your doctor and dietitian before using information on this page. These are medically supervised diets that should be done in conjunction with your healthcare team to ensure adequate nutrition for health and healing. Never attempt these diets without the support of your medical team.

Following a healthy diet is important for everyone, especially those with inflammatory bowel diseases (IBD) such as Crohn’s disease (CD) and Ulcerative Colitis (UC). Although there is no known cure (yet) for IBD, altering the diet can help restore health, improve symptoms, and help medications work better.

In general, a healthy diet should include lean protein (tofu, eggs, chicken breast, lean beef, yogurt, legumes), 5-9 servings of fruits and vegetables, whole grains, nuts and seeds, limited added sugars (soda, cookies, cakes, candies, etc.), and plenty of water. During periods of inflammation, it may be helpful to replace lactose containing foods (milk, yogurt, fresh cheese) with low lactose or lactose free foods (lactose free milk and yogurt, aged cheese), reduce excess fructose (juice, soda, products with high fructose corn syrup), limit caffeine and spicy foods, and eat soft/well-cooked vegetables and fruits to help reduce symptoms. A low fiber diet will be needed if there is intestinal narrowing. Hydration is important for replacing fluids lost and maintaining fluid balance. Taking a multiple vitamin/mineral supplement is important to ensure adequate micronutrient balance. You may need to take a daily vitamin D and/or calcium supplement (ask your MD or dietitian about dose), especially if taking steroids or avoiding dairy products. Extra folic acid may be needed if you’re taking certain medications, such as methotrexate or sulfasalazine. Extra B12 may be needed if you’ve had a surgical resection of the terminal ileum, if following a vegetarian diet, or if you’ve had J-Pouch/IPAA surgery.

Many of my clients choose to use nutrition as a means to control inflammation. There is data1,2,3 supporting the use of a formula diet, known as Exclusive Enteral Nutrition or EEN (click here for my EEN blog), in helping to induce remission in Crohn’s disease. EEN would be drinking formula instead of eating food. The formula would provide 100% of calorie and protein needs, as well as other macronutrient and micronutrient needs. This treatment regimen is as effective as steroids in reducing inflammation3, but has the added benefit of supporting nutritional needs, healing the mucosa, and no negative side effects. There is also preliminary data4,5 suggesting a diet known as the Specific Carbohydrate diet, or SCD (click here for my SCD blog), can help with reducing clinical symptoms and improving the gut mucosa. The CCFA (Crohn’s and Colitis Foundation of America) just received funding to study the effect of the SCD and the Mediterranean diet in Crohn’s disease. So more data is soon to come.

Once remission is achieved, studies6,7,8,9 show that a partial formula diet (Partial Enteral Nutrition, or PEN) can help maintain CD remission just as well as some medications (mercaptopurines and 5-ASAs)8. PEN would be drinking formula to meet ~50% of calorie and protein needs, and the remainder of nutrition would come from foods. A small study from Japan10 found that those with CD who followed a semi-vegetarian diet (meat once every two weeks, fish weekly, and vegetarian foods (eggs, milk, vegetables, fruits, potatoes, yogurt, fermented foods) daily were able to maintain remission for up to two years at a higher rate than those who followed an unrestricted diet.

To learn more about how altering your diet can help improve IBD quality of life and outcomes, which diet is best for you, and how to implement diet changes in a balanced way, contact me for an appointment.

Click here to donate to the Crohn’s & Colitis Foundation to help fund research and education efforts for IBD

 

References:

  1. Fell JM, Paintin M, Arnaud-Battandier F, Beattie RM, Hollis A, Kitching P, Donnet-Hughes A, MacDonald TT, Walker-Smith JA. Mucosal healing and a fall in mucosal pro-inflammatory cytokine mRNA induced by a specific oral polymeric diet in paediatric Crohn’s disease. Aliment Pharmacol Ther. 2000;14(3):281-9.

    http://www.ncbi.nlm.nih.gov/pubmed/10735920

  2. Yamamoto T, Nakahigashi M, Umegae S, Kitagawa T, Matsumoto K. Impact of elemental diet on mucosal inflammation in patients with active Crohn’s disease: cytokine production and endoscopic and histological findings. Inflamm Bowel Dis. 2005;11(6):580-8. http://www.ncbi.nlm.nih.gov/pubmed/15905706
  3. Wall CL, Day AS, Gearry RB. Use of exclusive enteral nutrition in adults with Crohn’s disease: A review. World J Gastroenterol. 2013; 19(43): 7652–7660. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3837264/
  4. Suskind DL, Wahbeh G, Gregory N, Vendettuoli H, Christie D. Nutritional Therapy in Pediatric Crohn disease; the specific carbohydrate diet. J Pedicatr Gastroenterol Nutr. 2014;58(1):87-91. http://www.ncbi.nlm.nih.gov/pubmed/24048168
  5. Cohen SA, Gold BD, Oliva S, et al. Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr. 2014;59(4):516-521. http://www.ncbi.nlm.nih.gov/pubmed/24897165
  6. Takagi S, Utsunomiya K, Kuriyama S, Yokoyama H, Takahashi S, Iwabuchi M, Takahashi H, Takahashi S, Kinouchi Y, Hiwatashi N, Funayama Y, Sasaki I, Tsuji I, Shimosegawa T. Effectiveness of an ‘half elemental diet’ as maintenance therapy for Crohn’s disease: a randomized-controlled trial. Alimentary Pharmacology & Therapeutics. 2006;24(9): 1333–1340. http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2006.03120.x/references;jsessionid=F084BFA3F2D30E80BA2D010A59C408CF.f02t03?globalMessage=0
  7. Yamamoto T, Nakahigashi M, Saniabadi AR, Iwata T, Maruyama Y, Umegae S, Matsumoto K. Impacts of long-term enteral nutrition on clinical and endoscopic disease activities and mucosal cytokines during remission in patients with Crohn’s disease: A prospective study. Inflammatory Bowel Diseases. 2007;13(12): 1493–1501. http://onlinelibrary.wiley.com/doi/10.1002/ibd.20238/abstract
  8. El-Matary W, Otley A, Critch J, Abou-Setta AM. Enteral Feeding Therapy for Maintaining Remission in Crohn’s Disease: A Systematic Review. JPEN J Parenter Enteral Nutr. 2015 http://www.ncbi.nlm.nih.gov/pubmed/26645668
  9. Duncan H, Buchanan E, Cardigan T, Garrick V, Curtis L, McGrogan P, Barclay A, Russell RK. A retrospective study showing maintenance treatment options for paediatric CD in the first year following diagnosis after induction of remission with EEN: supplemental enteral nutrition is better than nothing! BMC Gastroenterology. 2014; 14(50). http://www.ncbi.nlm.nih.gov/pubmed/24645851
  10. Chiba M, Abe T, Tsuda H, et al. Lifestyle-related disease in Crohn’s disease: relapse prevention by a semi-vegetarian diet. World J Gastroenterol. 2010;16(20):2484-2495. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2877178/