Evidence-based dietary strategies critical component of IBD care
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When it comes to dietary management of inflammatory bowel disease, it is important to make the distinction between diet and nutrition.
Essentially, diet is the food we eat, but nutrition is how our bodies use that food to support health. Diet and nutrition are an integral part of care for patients with IBD and can really make a difference in how people feel and respond to their medications.
General Recommendations for IBD
Despite being an important factor in disease management and being one of the most common questions people with IBD have (“what can I eat?”), nutrition is often overlooked. It is important to recognize that there is no one-size-fits-all approach to diet in IBD and diet recommendations must be tailored to the individual.
The International Organization for the Study of Inflammatory Bowel Disease recently published diet guidelines, which outline foods shown to improve symptoms and reduce risk for flares. The guidelines encourage consumption of fruits, vegetables and foods rich in omega-3 fatty acids and also included a list of foods to limit (red meat, processed meats, dairy fat, coconut, palm oil and certain food additives).
Remember, these are just guidelines and must be adapted to each person’s cultural, social, health and financial needs.
Dietary Therapies for Crohn’s Disease
Currently, the most well-studied and effective dietary therapy for CD is Exclusive Enteral Nutrition (EEN), which involves replacing all solid food with a completely balanced formula for 6 to 12 weeks, depending on what EEN is being used for. EEN works like steroids to reduce inflammation and improve gut healing, while also providing nourishment. EEN can also be used in patients who plan to have surgery as a way to optimize nutrition, decrease inflammation and risk for complications, and accelerate recovery.
Other dietary strategies are based on the consumption of whole foods, like the Crohn’s Disease Exclusion Diet, which is a defined diet coupled with a formula component. Using this diet, patients get their nutrition from foods meant to induce remission (chicken, eggs, potatoes, apples, bananas and other minimally processed foods) and limit foods that may promote inflammation such as red meat, wheat, dairy, added sugar, processed foods and food additives.
Another diet that has been shown to reduce symptoms and inflammation is the Specific Carbohydrate Diet (SCD), which is free of grains, sugar (except for honey), soy and dairy (except for aged cheeses and homemade yogurt). The SCD is rich in whole foods like unadulterated meats, fresh fruits, non-starchy vegetables, certain legumes, nuts and some seeds. This diet can be challenging, however, because it removes a lot of foods that are easily accessible and typically consumed. It also can increase time needs for meal prep and food sourcing, and make it more difficult to travel or nourish outside of the home.
Researchers conducting the DINE CD trial recently compared the SCD to the Mediterranean diet in people with CD and found that both diets helped people feel better and led to similar responses in inflammatory markers, such as fecal calprotectin and CRP (Lewis JD, et al). This study suggests a more liberal approach to diet may be appropriate for some.
Some studies also suggest SCD can help improve symptoms and disease activity in patients with UC. More recent data from Maria T. Abreu, MD, professor of medicine and director of the Crohn’s and Colitis Center at the University of Miami, and colleagues demonstrated that a low-fat, high-fiber diet helped improve patients’ symptoms, which is contrary to the message given to many people with UC or IBD in general.
Counter Myths With Evidence-Based Care
Diet matters in IBD and should be complementary to a patient’s medical care. Everybody has a different goal — whether it is to improve symptoms, find “safe” foods, run a marathon, get into remission or prepare for surgery — and an IBD-focused dietitian can help with understanding how to best achieve nutrition goals.
Fiber is good for IBD. We are learning that when people eat more fiber, specifically from fruits and vegetables, they tend to feel better. Conversations with dietitians are crucial to determine how patients who are actively flaring or who have strictures can incorporate these fibers without worsening their symptoms.
A great resource for recipes for IBD is the newly launched GutFriendlyRecipes.org from the Crohn’s and Colitis Foundation. The recipes have been reviewed by IBD-focused dietitians, and search results can be customized to meet individualized needs like “flare-friendly,” “stricture friendly,” “no dairy” and more.
Many people with IBD have guilt around food and are often told something they ate caused a flare of their disease, even when there is not enough information to make that connection. There are many factors that contribute to a flare of IBD, and we never want to make patients feel guilty about what they are eating. We know that extremely strict diets can negatively affect mental and physical health, so we should encourage patients to eat foods that agree with their condition and that they enjoy.
There are many myths about diet and IBD, and it is critical that we as nutrition professionals promote evidence-based care and help our patients facilitate healthy changes to improve their quality of life. The Crohn’s and Colitis Foundation has recently updated their Nutrition Resources for providers and patients, making it easy to stay up-to-date and navigate these conversations with patients.
- References:
- Fritsch J, et al. Clin Gastroenterol Hepatol. 2021;doi:10.1016/j.cgh.2020.05.026.
- Lewis JD, et al. Gastroenterology. 2021;doi:10.1053/j.gastro.2021.05.047.
- For more information:
- Kelly Issokson, MS, RD, is an IBD-focused registered dietitian and director of the Advanced Dietary IBD Education and Training Program at Cedars-Sinai in Los Angeles and can be contacted at kelly.issokson@cshs.org.
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