Should All Patients With IBD See a Dietitian?

Navigating diet with Crohn's or ulcerative colitis can be a real minefield. There's only so much we can learn from food diaries, the internet, and chatting with other patients. Sometimes we need to speak to an expert to help it all make sense and for us to understand the best diet for us.

The role of diet and IBD is a tricky one: new research from the Crohn's & Colitis Foundation found the specific carbohydrate diet can improve Crohn's disease symptoms.¹ Yet, this diet – which focuses on veggies, nuts, fish, and whole grains – is naturally high in fibre which some patients may struggle with and, in cases of active flares, instead a low-residue diet is recommended.

Many nonprofit healthcare organizations, such as the Crohn's & Colitis Foundation, recommend that patients see a dietitian for more specialist support. Seeing a dietician can have quite a few benefits. Let's take a look at them.

Can a dietician help with ulcerative colitis or Crohn's?

There are many benefits of seeing a dietitian with IBD. Practically, a dietitian is able to prescribe short-term nutritional treatments, such as enteral nutrition which is often given through liquid drinks like Ensure, when a patient is flaring. 

Longer-term, a dietitian may be able to work with IBD patients on a food diary to help look at potential triggers. I've talked before about food diaries and how they can be quite daunting when you've got no idea where to begin, so working with a dietitian could be the solution here. They may be able to help with starting a low-residue diet then able to support you in reintroducing food, especially adding more fibre when you are well and in remission.

They may also be beneficial if you are at risk of certain nutritional deficiencies, especially if you already follow a restricted diet, such as being a vegetarian. Dietitians are also essential for patients who are new to life with an ostomy bag, as they will need to be taught diet changes – especially ones that help ensure the body has enough electrolytes like potassium and sodium – to adapt to life with a bag.

Finally, many IBD patients experience IBS when in remission, so they may be supported by a dietitian to deal with these symptoms even when they don't have any disease activity.

The problems of accessing dietitian support with IBD

Overall, there are many reasons why those of us with IBD should see a dietitian. However, whilst accessing dietitian support is really important, not everyone is able to access it. A British Dietetic Association report found that in the UK only 7% of IBD services had enough dietitians to support their patients.²

As well as simply not having enough dietitians, another reason might be that many Crohn's or UC patients aren't made aware dietitian services are available or that working on their diet could potentially help symptoms. Others don't know how to access them, their doctors don't make them part of patient support, or patients can't afford to see them privately.

While there are many barriers to accessing dietitian support, there's no doubt they can be really valuable for those of us with IBD. Therefore, I think this is something that should be offered to patients as soon as they're diagnosed.