Nutritional Therapies

Nutritional supplements

Nutritional supplements and drinks can help increase your intake and limit further weight loss. Since your body may not be able to absorb sufficient amounts of vitamins and minerals, your healthcare provider may also recommend taking a daily multi-vitamin or supplements such as:

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Probiotics and prebiotics

Probiotics and prebiotics sound the same, but they are quite different, and have different implications for the gut.

What are probiotics?

Probiotics are living microorganisms, often bacterial, that live in our bodies. They are similar to the bacteria that naturally occur in the human body – particularly the intestine, and even more particularly the intestine of a healthy, breastfed baby. These microorganisms have been shown to provide health benefits when ingested, and are reported to be especially helpful for those with intestinal and inflammatory disorders, specifically ulcerative colitis. 

What are prebiotics?

Prebiotics, on the other hand, are “food” for certain groups of bacteria. They are not living bacteria, but are carbohydrates not normally digested, such as fibre, that are contained in many natural food items like fruits, legumes, and whole grains. When you ingest prebiotics, you selectively increase certain populations of bacteria that consume that prebiotic. In this way, you increase your own probiotic bacteria. 

Food items that contain a more comprehensive mix of prebiotics include fruits, legumes, whole grains, artichokes, and dandelion greens. Prebiotics also help the body absorb calcium to prevent osteoporosis.

Probiotics may help restore and maintain the “good” bacteria in our guts, but the evidence for this is lacking. Animal studies have shown some single-item prebiotics worsen inflammation. By consuming prebiotics, you may increase the number of probiotics in your body. 

Do probiotics help those living with IBD?

Caution should be used with dramatic claims that specific products containing probiotics can reduce active intestinal inflammation, and not all probiotic bacteria strains are the same. However, study results from animal models on prevention of disease are encouraging.

Clinical studies in animals suggest probiotics may help reduce flares and prevent complications of Crohn's or colitis, such as pouchitis. Probiotics are typically considered safe to use as very few adverse effects have been reported, with increased gas being the main complaint.

However, variability across clinical studies, such as doses and types of probiotics used, make it difficult for experts to draw conclusions about the efficacy of probiotic use in the management of IBD. Further studies are needed to determine how effective probiotics may be in bringing about remission or maintaining remission in Crohn's or colitis. 

People with Crohn's or colitis should be aware of what probiotics supplements they are taking. Make sure the product you choose has a drug information number (DIN), natural product number (NPN), or homeopathic number (DIN-HM), and talk to your doctor before starting the product. Decisions about the use of probiotics in your disease management should be communicated with your health care providers. 

Many people take probiotic supplements, but most probiotics on the market which have been recommended for IBD are still being studied. More extensive research is needed to understand how effective probiotics are at maintaining remission in people with IBD. For now, some studies suggest certain strains of probiotics may help reduce flare-ups in IBD populations. 

The Clinical Guide to Probiotic Products Available in Canada is a tool that healthcare providers use to select the appropriate probiotic for their patients. This database contains a list of commercially available probiotics as well as the level of evidence used to rate their effectiveness. The levels of recommendation for each product have been classified across three levels of evidence, with Level I being the highest. Navigating this database can help you learn about the probiotics available on the market and guide conversations with your healthcare provider and dietitian. Please note that probiotics should be taken as a supplement, and not a substitute, to your prescribed treatment plan. Consult your healthcare provider before starting or stopping any dietary supplement.

Natural sources of probiotics

Yogurt and supplements deliver probiotics, but there are a number of other natural food sources, such as:

  • Buttermilk is similar to yogurt, and can be the basis of a great smoothie. It is available in the dairy aisle of most grocery stores.

  • Kefir is a drink made of cow, goat or sheep milk fermented with kefir grains. Available in natural food stores, it is bitter on its own but can be mixed with fruit or other sweeteners.

  • Tempeh is a fermented soy product similar to tofu, except that it is chewier. It is also a high-quality protein and one of the few vegetarian sources of vitamin B12.

  • Miso is a Japanese seasoning produced by fermenting various beans or grains. It is used in soups, sauces, and spreads.

  • Sauerkraut is fermented or pickled cabbage. Probiotic bacteria is formed when fresh cabbage ferments in brine.

  • Kim Chi is somewhat like sauerkraut, but much more pungent and spicy. In Korea, kim chi is served as a side dish or a relish.

  • Brewer’s yeast, a by-product of beer making, thought to contain probiotic bacteria.

Natural sources of prebiotics

  • Raw chicory root

  • Raw jerusalem artichoke

  • Raw dandelion greens

  • Raw garlic

  • Raw leek

  • Raw and cooked onion

  • Raw asparagus

  • Raw wheat bran

  • Cooked whole wheat flour

  • Raw banana

Speak with your healthcare provider if you are interested in taking probiotic supplements. 

Watch the video below to learn more from an expert gastroenterologist about probiotic and prebiotics, and the use of other nutritional supplements such as vitamin D and fibre to help manage Crohn’s or colitis.

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Enteral Nutrition

What Exclusive Enteral Nutrition (EEN)?

Exclusive enteral nutrition is a type of treatment that includes a nutritional formula taken by mouth or by placing a tube in the nose or in the gut. Exclusive enteral feeding delivers daily nutrients to the body in liquid form and helps get your disease under control.

It helps with catch-up weight gain and optimizing growth potential. It also helps to heal the lining of the intestines, reduce swelling, and improve symptoms, with very little side effects. While uncommon, side effects may include nausea, bloating, loose stool, skin irritation around the tube, and clogging of the tube. 

How is EEN administered?

A soft tube called a nasogastric (NG) tube goes from your nose to your stomach to deliver the nutrients. Inserted at a hospital, your healthcare provider will explain how to continue feeds at home using the feeding pump, tubing, and any other equipment you need. Your healthcare provider can recommend the desired duration to induce remission. 

Dietary changes

This is a liquid diet only, so you will not have to eat regular foods. If you would like, you can continue to drink clear fluids. Foods and liquids that you can have include water, clear juices (no pulp or fruit pieces), Gatorade or sports drinks, clear pop, iced tea, herbal tea, strained soup broth, popsicles, freezies, jello, and gum.

You should feel full, your energy should start to increase, and your IBD symptoms should lessen. Once the length of your tube feed is complete – discuss this with your provider – you can slowly begin to add food back into your diet. 

Children with Crohn's disease

The European Crohn’s and Colitis Organization, the European Society of Pediatric Gastroenterology, Hepatology and Nutrition, and a recent consensus statement of the Canadian Association of Gastroenterology Pediatric Gastroenterologists recommend enteral nutrition as a first-line therapy in pediatric Crohn’s disease patients.

This treatment should be used to promote growth and address undernutrition. While enteral nutrition may prolong remission, its maintenance of remission has yet to be proven.

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