Nutrition, Food, and IBD: Community Questions Answered

When we asked the community to submit questions about inflammatory bowel disease (IBD), we received a range of great questions related to nutrition and IBD. Dr. Nandi answers several here, including:

"Are there any foods that are really good for IBD?"

"What foods can I eat that could help with my UC, and what could make it worse?"

"I have had UC since 2009. I want to know what I can’t eat."

Food matters and is vital to good health

Let's get 1 thing straight. Food matters. To be more precise, food is nutrition. Food is medicine. Food influences the growth, development, and diversity of our intestinal microbiome and, in turn, we believe influences our immune system's overall function. In other words, food is vital to your health.

Foods while in a Crohn's or colitis flare

When we think of nutrition in regard to IBD, I recommend thinking of food in 2 states of health: flare and remission. No doubt, when one is in a flare, different foods can be met with different tolerance.

In a flare, fibrous foods such as vegetables can produce intolerable cramps, bloat, and abdominal pain. In particular, foods with greater non-soluble fiber content such as carrots, broccoli, and even legumes (beans) are common culprits of abdominal discomfort and bloat in any type of IBD. Indeed, when eaten in large quantity they can even produce partial small bowel obstructions in some Crohn's patients with some degree of intestinal stricture.

To make matters more complicated, consumption of any food in the midst of a flare can stimulate intestinal contractions, leading to severe urgency, diarrhea, and even incontinence. Hence, the flare diet for most people with IBD may best benefit from aggressive hydration with water or oral electrolyte rehydration solutions (e.g., electrolyte powders, coconut water).

Also, emphasis on protein as a major component of calories is made in the form of plant-based protein: tofu or seitan, seafood (any type of fish such as tuna, salmon, mackerel), and healthy lean cuts of animal protein (chicken, turkey). We think red meat is pro-inflammatory in Crohn's disease but not ulcerative colitis (at the time of this article).

Something to avoid consuming, especially in times of flare, is excess aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen.

In people without IBD, aspirin and NSAIDs can cause intestinal ulcers. Those with IBD have ulcerations in the intestine during times of active disease. Thus, aspirin and NSAIDs can cause new ulcers or make the existing ones worse.

Foods to eat while in remission

Of course, the time to eat healthily is when you are in remission. Unfortunately, some people may choose to eat an unhealthy diet of fast foods or processed foods once they are in remission.

These types of foods may be linked with greater risk of IBD. Indeed, fast foods and processed foods are less nutrient-rich and do not fortify the body with as many essential nutrients, vitamins, minerals, and healthy proteins and fats.

Processed foods are stripped of these vital nutrients and then later "enriched" with vital vitamins to restore some nutrient benefit. When we eat healthy foods during remission, we restock nutrient stores that were depleted during times of flare when we became malnourished.

If we eat nutrient-deficient foods (fast food and processed foods) during times of health, we contribute to more malnutrition rather than restocking our lost supplies. Nutrient deficiencies in IBD include calcium, vitamin A, vitamin D, zinc, selenium, potassium, iron, B12, and folic acid.

Review with your doctor whether your levels should be checked and whether there is benefit or harm to supplementing any of these nutrients.

Fruits and vegetables for Crohn's and ulcerative colitis

When it comes to specifics, some research suggests that eating vegetables may be more protective in ulcerative colitis than Crohn's. But, notably, we think eating fruit is protective in both ulcerative colitis and Crohn's disease.

Diets that are higher in fiber may be good for microbial diversity as well. In fact, fiber is transformed by gut bacteria into short-chain fatty acids (SCFAs), which increase good gut bacteria known as firmicutes. These have been associated with greater gut diversity.

Diverse microbiomes are thought to improve intestinal resilience and immune health. Further research is currently underway to explore the role of nutrition and IBD.

Benefits of a plant-based diet

Some studies suggest there may be environmental influence from food that is processed or contains preservatives. We also have studies that suggest a plant-based diet may be more beneficial than a diet with red meat.

The word "suggest" is used because the data is also full of complicating factors. These include the unique nature of everyone's genetics, immunology, microbial profiles, and IBD phenotype, to name a few.

Until more definitive data is established, I recommend that my own patients pursue a diet that is more natural and free of processed ingredients, emulsifiers, and preservatives. A plant-based diet is healthier than one vested in meat. And I recommend avoidance or moderation of red meat in favor of healthy-fat protein such as seafood and fish.

This is an exciting and ever-evolving topic. I hope that we can share new research updates in the future soon!