A: For the most part, I recommend “diet as tolerated” for those with IBD. Everyone is different in their ability to tolerate different foods, and sometimes it depends on whether the disease is flaring or in remission. Your body will tell you what diet you can tolerate.
When you are well, we recommend following Canada’s Food Guide to Healthy Eating as much as possible. This helps to promote good health and ensure that you get a good base of vitamins and minerals in case you develop a flare at some point. Some people find that even when they are well, they have certain ‘trigger’ foods that may cause diarrhea, gas or cramping. It is fine to avoid these foods if it makes you feel more comfortable. The most common trigger foods reported by patients include: lactose containing foods (dairy products), caffeine, leafy green vegetables, high-fat foods, very high-fibre foods and spicy foods.
Everyone is different, so it is important to try all foods for yourself and see how your body reacts. The more foods you can include in your diet the better, as it means you are getting more variety in taste, texture, vitamins and minerals on a regular basis.
During a flare, we again recommend diet as tolerated. Some people find it helpful to follow a low-fibre diet: this type of diet reduces the amount of insoluble fibre (roughage) in the diet, which helps to lessen gas production and cramping, and potentially reduce the number of bowel movements in a day. Ultimately, it can help you feel more comfortable during a flare.
A low-residue diet (similar to a low-fibre diet, but with restrictions on foods that increase bowel activity) is recommended for those who have strictures to decrease the risk of obstruction and to reduce pain and abdominal cramping. This diet is sometimes suggested for those with fistulas and is generally recommended as a temporary diet (4-8 weeks) after most IBD-related surgeries. For more information on the
low-residue diet, see the resources list at right.
Enteral feeding (tube feeding) has been shown to be successful in bringing about remission in Crohn’s disease and is mostly used in paediatric patients to minimize the use of steroids. Enteral feeding uses formulas or liquids that provide all of the carbohydrates, fats, proteins, vitamins and minerals needed for a balanced diet, while allowing the gut to rest and heal during a flare.
Sometimes total parenteral nutrition (TPN) is required, if patients are experiencing significant weight loss, bowel obstruction, fistulas, short bowel or other IBD complications. TPN is intravenous (IV) nutrition that is administered into the blood. It also contains all of the nutrients needed to help maintain weight and nutritional status.
Other diets have been created and suggested by various authors. Be careful of diets that claim they can cure IBD or prevent future flares. If it sounds too good to be true, it likely is. At this point, there is no research to support any specific diet or food that might improve or worsen the disease.
If you are avoiding a number of foods or food groups, you may want to consider speaking to a registered dietitian about how to increase the variety in your diet, or how to ensure you are getting a balance of vitamins and minerals so you can maintain your weight and reduce your risk of developing nutrient deficiencies.
A: The most common nutrient deficiencies in people with IBD include: iron, B12, calcium, vitamin D and folic acid. Less common deficiencies include the fat-soluble vitamins (A,D,E,K), zinc and magnesium.
You may be at risk for nutrient deficiencies if:
- You are following a low-residue diet for more than four weeks, and avoid a large number of foods or a whole food group(s);
- You have had surgery to remove parts of your small bowel;
- You have chronic inflammation in your small bowel, especially your terminal ileum;
- You have an ileostomy or fistula that drains large amounts of stool or fluid daily (volumes greater that one litre per day);
- You are taking certain medications, particularly prednisone, methotrexate, azathioprine, cholestyramine;
- You have blood in your stools for an extended period of time;
- You are lactose intolerant and are not including sufficient calcium and vitamin D-rich alternatives.
If you are concerned, talk to your doctor or dietitian about whether you are at risk for deficiencies. They may order blood
work before suggesting supplements.
Remember that while vitamins and minerals are natural and healthy, more is not always better. Taking large amounts of supplements unnecessarily can also be dangerous, so it is important to discuss your supplements with a health care professional.
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