How does IBD affect diet?
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Crohn’s disease and colitis interfere with the body’s ability to digest food, absorb nutrients, and eliminate waste in a healthy way. When you eat and drink, food travels through your gastrointestinal (GI) tract, also known as the digestive system.
With Crohn’s disease, inflammation can occur anywhere in the GI tract. It can usually present anywhere from mouth to anus, preventing proper absorption of nutrients in the food you have eaten. With colitis, inflammation is typically only in the colon, ranging from the whole colon to limited disease of the rectum and anus. The colon’s job is to absorb water from the food you have digested, but when the colon is inflamed, the stool that passes through the anus is left watery, causing diarrhea.
You will want to eat a well-balanced diet to ensure you are getting a range of nutrients to help your body grow and be healthy. Since IBD is a chronic disease, it can become active, a period called a “flare-up”, or it can be dormant, a period called “remission”.
Your diet during a flare-up could be different from your diet during remission. Certain choices of meat, fats, sugars, and processed foods that are typical in a Western Diet are associated with increased risk for the development of IBD.
Trigger and safe foods
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Trigger and safe foods are different for everyone. As you live with this disease, you will learn to identify what they are.
During a flare, foods high in fibre can trigger obstructive symptoms – particularly if the bowel is narrowed due to inflammation – and should only be consumed after consultation with your healthcare provider. Scroll down to the next section for more information about Fibre and IBD.
Other trigger foods and drink may include the following:
Corn and snack foods made with corn like nacho chips
Whole nuts and seeds such as sunflower and pumpkin
Raw vegetables including tomatoes and bell peppers
Oranges and orange juice
Fried and fatty foods including high animal protein (red and processed meats)
Sports drinks and sweetened beverages
Alcohol and coffee
Research studies have tried to identify food tolerances and intolerances in people with Crohn’s and colitis. Here is a list of some of their key findings:
Foods such as yogurt, rice, and bananas have been reported to improve symptoms.
Many people with IBD believe that eating spicy foods, vegetables, fruit, soda, fibre, dairy and/or coffee could lead to relapse or loss of remission.
Food avoidance among people with IBD is also common for alcohol, popcorn, raw vegetables, legumes, nuts, seeds, deep-fried food, and processed deli meat, especially among those with active IBD.
Vegetables, spicy foods, fruit, nuts, fried and fatty foods, milk, red meat, soda, popcorn, dairy, alcohol, foods high in fibre, corn, seeds, coffee, and beans have been reported to worsen symptoms.
People with active IBD consumed significantly more portions of sports drinks and sweetened beverages compared with those with inactive disease. High animal protein and processed meats intake are also associated with increased risk of IBD, particularly Crohn’s disease.
With careful supervision by a dietitian, it is not recommended to start avoiding specific foods or food groups for long periods. When you are in a flare-up and your gut is sensitive, you may choose to avoid eating certain foods for the time being and return to a more balanced diet when you feel better.
Tracking your food will help you to identify other trigger foods. Download the Crohn’s and Colitis Canada MyGut app to help you track how you feel after eating certain foods. This can help you and your health care provider to start to identifying the foods that cause discomfort.
Choose nutrient dense foods
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If you are eating very little, you will want to get more bang for each bite. Eat small, frequent meals consisting of nutrient-rich fruits and vegetables – especially leafy greens that help regulate bacteria in the gut – and limit refined sugars, sweets, and processed foods. Fruits and vegetables are sources of fibre, vitamins, and minerals.
Fibre and IBD
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If you do not have a stricture, which is narrowing of your bowel, do not be afraid to increase fibre sources.
There are two types of fibre: soluble and insoluble. Soluble fibre attracts water into the intestines creating more watery stool. Insoluble fibre is not absorbed by the body, and works as a bulking agent. This type of fibre can have hard bits within it and comes out as part of your stool, which can irritate the intestines.
In flare-ups, health care providers often used to suggest a “low residue” or “low insoluble fibre” diet. “Residue” is undigested food that makes up stool, including fibre. A low-residue diet simply means a diet of foods that are easy to digest. This means, limiting high-fibre foods so that you may have fewer and smaller bowel movements.
Foods low in residue are easy for your body to break down so it helps prevent blockage in your bowel. During a flare-up, avoid breads, cereals, and granola bars with large amounts of bran and whole grains (and nuts if they bother you), and most raw fruits and vegetables.
Many people with IBD are afraid of foods high in fibre, but these types of food are important for your bowel health. Unless you are in a flare-up, include sources of fibre into your diet to get a range of other nutrients, and pair it with lots of water to promote healthy bowel movements. A low residue diet or low fibre diet is not very nutritious in the long-term. Once your symptoms improve, you will want to slowly add this back into your diet.
Fats and IBD
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Fats are an important part of our diet, and choosing the right types of fats can help increase calories when appetite is low or during a flare of IBD.
Fats do not need to be avoided and fat free foods may contain emulsifiers that can worsen inflammation. Good choices for fat intake include monounsaturated fats such as:
- some cooking oils including olive, canola, vegetable, peanut, and faxseed oils (avoid corn, sunflower, and safflower oils as they are high in omega-6 fatty acids)
- cold-water fish like salmon and tuna
- most nuts including walnuts
Foods rich in omega-3 fatty acids (like docosahexaenoic acid) are known for their anti-inflammatory properties that help decrease inflammation in the body. Sources of food with omega-3 fatty acids include:
- fish including salmon, sardines, and anchovies
- ground flaxseed (tip: add to smoothies, yogurt, or cereals)
Foods like red meat, lard, margarine, and some cooking oils, contain the hard-to-digest “bad fat” known as linoleic acid. Avoid trans fat typically found in highly processed, fatty or greasy foods, that can cause diarrhea or increase inflammation. Some saturated fat, such as foods that provide other helpful nutrients and calories, may be okay and do not need to be strictly avoided but consumed in moderation.
Drinks and IBD
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Limit alcohol and caffeine intake as both can contribute to IBD symptoms. Sports drinks and sweetened beverages may also be associated with IBD.
You may want to consider nutritional supplements and drinks to add more nutrients to your body. As always, drink lots of water.
Protein and IBD
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Include a protein source, such as meat, fish, eggs, beans or lentils, with each meal or snack. Protein helps add calories to your intake to maintain good nutrition. Smooth nut butter is a good option to help thicken stool.
Limit red, processed, or fried meat. Keep red meat to 1-2 servings per week, and choose fish more often. Certain types of fish contain omega-3 fatty acids, which have anti-inflammatory properties.
Lactose and IBD
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Lactose is a type of sugar in milk products. Our bodies need a special enzyme called lactase to help digest these foods. Some people do not have enough of these enzymes, and so they have a condition called lactose intolerance.
Milk products should be okay to consume in moderation, unless you have trouble processing dairy foods and are lactose intolerant. Milk is a source of calcium, which is an important nutrient for maintaining bone health.
Some people find they cannot tolerate lactose, depending on where the disease site is.
Try it in small amounts when you are not experiencing a flare-up. During a flare-up when your intestine is irritated, your body may become more sensitive to foods with lactose. This can cause bloating, gas, discomfort, and cramping.
If you enjoy foods with lactose, hard cheeses and yogurts are generally received better than liquid lactose. There are also lactase enzyme pills you can take before eating foods with lactose. You can also try foods lower in lactose, such as:
Lactose free milk
Lactose free ice cream
Lactose reduced yogurt
Cheeses such as cottage cheese, cream cheese, gouda, cheddar, parmesan, mozzarella, blue, and swiss
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Dietary Therapies and IBD: The Role of Fats and the Mediterranean Diet, Presented by Dr. Deanna Gibson (PhD) and Natasha Haskey (RD), Gutsy Learning Series: Crohn's and Colitis Canada, 2020.
IBD Kitchen: Recipes and Food Ideas for People with IBD (Part 1), Communication EBMed, 2021. Published with permission by Crohn's and Colitis Canada.
The Role of Diet and Nutrition, Presented by Robyn Nagel (RD, MHSc), Gutsy Learning Series: Crohn's and Colitis Canada, 2021