Improve IBD Care: Add a Dietitian and Psychologist

Inflammatory bowel disease (IBD) can be complicated and may require a team effort to help you achieve the best health. It is important to think about health from a holistic perspective that considers physical, nutritional, and mental health. When approaching Crohn's or ulcerative colitis from this perspective, you will likely need multiple specialists to meet your needs.

Treating Crohn's and ulcerative colitis holistically

Your gastroenterologist may have mentioned that you would benefit from working with a dietitian or mental health provider. If they have given you recommendations for such providers, that is wonderful! The goal is to find providers skilled in working with patients with IBD.

If your provider has only mentioned these options but not provided recommendations, keep reading.

Finding your IBD nutrition expert

To begin, choose a registered dietitian (RD) or registered dietitian nutritionist (RDN) with training and expertise working with individuals with IBD. RDs/RDNs are food and nutrition experts who have met strict training standards to earn their credentials. It is worth noting that one can call themselves a "nutritionist" without having the same training and expertise as an RD/RDN – so be cautious!¹

Diets for UC and Crohn's

Diet recommendations may change based on whether you are flaring or in remission. The Crohn's and Colitis Foundation provides the following list of specialized diets that may be helpful for some patients with IBD.²

• Carbohydrate exclusion diets
• Low FODMAP diet
• Mediterranean diet
• Semi-vegetarian diet

It is important to highlight that these diets are best followed under the care of an RD/RDN with expertise in IBD and would be individualized to your specific nutritional needs.²

Additional resources about nutrition and IBD can be found on the Crohn's & Colitis Foundation website.

Locating a nutrition provider by state

• IFFGD list of Dietitians
• Kate Scarlata's list of Dietitians trained in the low FODMAP diet
• The Academy of Nutrition and Dietetics "Find a Nutrition Expert": You can narrow the search by checking the box "Gluten Intolerance-Digestive Health-GI disorders" under the "Speciality+" dropdown.

Finding your GI mental health provider

First, choose a mental health specialist with training and expertise in working with people with IBD or other GI conditions. They may be a PhD (doctorate), PsyD (doctorate), LPC/LCPC (licensed professional counselor/licensed clinical professional counselor, master's level), or LCSW (licensed clinical social worker, master's level). Next, ask the following questions before establishing care:

• Have you worked with people who have IBD?
• Are you familiar with the complexities of IBD?
• What treatment approaches do you think would be best for my current state of health?

The answers a provider gives can provide insight into whether you would like to pursue treatment. Even if they are not very familiar with IBD, a compassionate specialist may be able to help you find a treatment plan that is a good fit!

A mental health provider skilled in cognitive behavioral therapy, mindfulness-based therapy, and/or gut-directed hypnotherapy may be especially helpful. Additional resources about mental and emotional health and IBD can be found on the Crohn's & Colitis Foundation website.³

Locating a GI mental health provider

A list of GI mental health providers can be found in the Rome GI Psych Directory.

If a GI specialist is not in your area, you can locate a mental health provider using PsychologyToday and filter your search for the following:

• Issues: anxiety, chronic illness, chronic pain, depression, stress
• Type of therapy: cognitive behavioral therapy (CBT), mindfulness-based (MBCT), hypnotherapy, acceptance and commitment (ACT)

Building your Crohn's or UC care team

Assembling a team to manage your IBD will take time. You want to feel comfortable, feel supported, and have the experts you need to meet your health goals. While both experts can be helpful, don't feel pressured to get everyone in place at once. Talk with your doctor to determine where to spend your energy first.