Dietitians ‘a valuable resource’ in multidisciplinary IBD care team
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DENVER — A varied and well-balanced diet plays “a significant role” in the management of patients with inflammatory bowel disease and can be guided with support from a dietitian, a presenter reported at the Crohn’s and Colitis Congress.
“IBD has long been thought to arise from inappropriate and maladaptive stimulation of the immune system, although emerging data has actually shown that diet plays an important role in the pathogenesis and inflammation," Keisa M. Lynch, DNPAPRN, FNP, associate professor in the College of Nursing at the University of Utah, said. “This highlights the abundant need for guidance. The International Organization for Inflammatory Bowel Disease formed a working group and put together recommendations and guidance for future considerations.”
Lynch reported that general dietary recommendations for patients with IBD include consuming six small meals a day, foods high in insoluble and soluble fibers, and high protein shakes or smoothies when needed. Further, guidance recommends limiting foods and beverages that contain lactose and avoiding greasy or fried foods.
Patients with active UC should reduce their intake of insoluble fiber, concentrated sweets, high fat foods, caffeine and alcohol, and sugar alcohols that may increase symptoms, while increasing fluid intake.
“It’s also important to increase omega-3s in the diet of ulcerative colitis patients, mainly from marine fish and not from supplementation,” Lynch noted, adding that those in remission should adhere to a well-balanced, high-fiber diet as tolerated and “not limit anything.”
A subset of patients within this UC group are those who undergo ileal pouch-anal anastomosis (IPAA), and goals for management include optimizing pouch function, providing tailored advice on a healthy diet and lifestyle, screening for and addressing metabolic complications, pouch surveillance, risk stratification for pouchitis or failure, and health maintenance.
“One of the most frequently asked questions we all get in the office prior to doing an IPAA or after an IPAA takedown is, ‘What am I going to eat?’” Lynch said. “ Soon after surgery, food is actually encouraged and shown to improve outcomes.”
Additional dietary recommendations after ileostomy takedown include:
- consuming small frequent meals per day;
- including soluble fiber, protein and moderate fat;
- limiting insoluble fiber initially;
- avoiding caffeine and alcohol;
- increasing fluid intake;
- avoiding late eating or overeating; and
- using antidiarrheal medication at bedtime.
Food-related intolerances are common among patients with IBD, and they may persist after IPAA. For patients experiencing increased stool output or frequency, Lynch recommended avoiding milk, spicy foods, alcohol and high-fat foods. Similarly, increased flatulence has been linked to spicy foods, onions, leeks, cabbage and milk, while increased stool consistency has been associated with bananas and high quantities of digestible starches.
It is also important to limit sugar alcohols such as sorbitol, xylitol and mannitol, Lynch said, as they can “increase bloating, gas and diarrhea.”
“Dietary factors do play a significant role in IBD with a pouch function,” she said. “We should encourage our patients to consume a varied and well-balanced diet. Lastly, but most importantly, we should collaborate with their dietitians — they are a valuable resource in the multidisciplinary team."
Perspective
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David Gardinier, RD, LD
There is a growing need for nutritional guidance for patients with IBD. Patients are interested in diet, and there is increasing evidence that dietary changes can help manage the symptoms — and, in some cases, the inflammation — associated with IBD.
This presentation from Crohn’s and Colitis Congress discusses general nutrition recommendations for patients with IBD. It also covers dietary recommendations for patients with a new IPAA and highlights the important role of a dietitian as a part of the IBD multidisciplinary team.
While general nutrition advice is a good starting point for patients, the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines on clinical nutrition in IBD highlight the need for all IBD patients to receive an individualized nutritional approach based on their personal situation, preferably with the input of a specialized dietitian.
Including dietitians as part of an IBD multidisciplinary team allows for a comprehensive and personalized approach that reflects the value of nutrition care in improving outcomes for IBD patients.
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Lynch K. Presentation Sp48: What your patients want to know: Dietary considerations for ulcerative colitis & the J-pouch. Presented at: Crohn’s and Colitis Congress; Jan. 19-21, 2023; Denver.
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