Nutrition, Food, and IBD: Community Questions Answered

Editors note:
We recently asked the community to submit questions about IBD. We received a range of great questions that Dr. Nandi is now answering! This post answers questions related to nutrition and IBD. Questions asked included:

"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 one 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 regards to IBD, I recommend thinking of food in two states of health: Flare and Remission. No doubt, when one is in a flare, different foods can be met with disparate tolerance.

In a flare, fibrous foods such as vegetables can produce intolerable cramps, bloat, and abdominal discomfort. In particular, those foods with greater non-soluble fiber content such as carrots, broccoli, and even legumes are common culprits of abdominal discomfort and bloat in any type of IBD. Indeed, when consumed in significant 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 individuals with IBD may best benefit from aggressive hydration with water or oral electrolyte rehydration solutions (eg, 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 (eg, chicken, turkey). Red meat has been suggested to be pro-inflammatory in Crohn’s disease but not Ulcerative colitis at the time of this article.1

Something to avoid ‘eating’ or rather consuming especially in times of flare is excess aspirin or NSAID’s (Non-steroid anti-inflammatory drugs, eg, ibuprofen, naproxen) for pain.

In patients without IBD, aspirin and NSAID’s can cause intestinal ulcerations. In IBD, we have ulcerations in the intestine during times of active disease. Thus, aspirin and NSAID’s can cause new ulcers or the existing ones to become worse as well.

Foods to eat while in remission

Of course, the time to eat healthily is when one is in remission. Unfortunately, some patients may choose to consume an unhealthy diet once they are in remission with fast foods or processed foods. 2

These types of foods have been suggested to be associated independently with greater risk of IBD. Indeed, fast foods and processed foods are less nutrient-rich and do not have the potential to fortify the body with as many essential nutrients, vitamins, minerals, and healthy proteins and fats as a diet that is non-processed.

Processed foods involve stripping of these vital nutrients and are then later ‘enriched’ with vital vitamins to restore some nutrient benefit. When we eat healthy foods during remission, we re-stock those nutrient stores that were depleted during times of flare when we became malnourished.

If we eat nutrient-deficient foods (fast food, processed) during times of health, we contribute to more malnutrition rather than re-stocking our lost supplies. Nutrient deficiencies in IBD include Calcium, Vitamin A, Vitamin D, Zinc, Selenium, Potassium, Iron, B12, Folic acid.

Review with your clinician if 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 meta-analyses suggest that the consumption of vegetables may be more protective in ulcerative colitis than Crohn’s. Notably, consumption of fruit appears to be protective in both ulcerative colitis and Crohn’s disease.3

Diets that are higher in fiber may be beneficial to microbial diversity as well. In fact, increased fiber intake is transformed by gut bacteria into short-chain fatty acids (SCFA’s) which increase beneficial gut bacteria known as Firmicutes in turn and have been associated with greater gut diversity.

Diverse microbiomes are theorized to confer greater intestinal resilience and potentiate immune health. Further research is currently underway to explore the role of nutrition and IBD.

Benefits of a plant-based diet

In 2019, we have studies that suggest there may be environmental influence from nutrition 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 wording of ‘suggest’ is used as the data is also full of confounders that we cannot compensate for yet such as the unique nature of everyone’s genetics, immunology, microbial profiles, and IBD phenotype to name a few.

Thus, until more definitive data is established, I recommend my own patients to pursue a diet that is more natural and devoid 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 and I hope that we can share new research updates in the future soon!

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