Table of Contents:
- IBD and Malnutrition
- What to eat during flare-ups
- Types of IBD Diets
- IBD specific diet
- Low FODMAP
- Paleo
- Mediterranean
- AID diet
- What to do in remission
- Healing IBD with Food
IBD, or Irritable Bowel Disease, is classified as a cluster of recurrent symptoms impacting the health and function of the gastrointestinal tract and bowels. The specific symptoms vary from patient to patient but generally contain some combination of inflammation of the digestive tract, abnormal or painful bowel movements, cramping, bloating, abdominal pain, fatigue, joint pain, or other symptoms. Treatment revolves around managing the level of interference of these issues on a day-to-day basis until they do not occur or do not interfere, which is called remission.
Many patients with IBD struggle with malnutrition and nutritional deficit. Due to the dysfunction of the GI tract, digestion of food may not be completed before movement to the bowels, or nutrients may not be absorbed. This can result in weight loss, fatigue, and other medical complications following a lack of specific nutrients and vitamins. Therefore, IBD patients should exercise caution with both the types of food and frequency of nutritious food in their diet to receive the appropriate nutrients and avoid malnutrition.
IBD and Malnutrition
How can IBD cause malnutrition? While it largely depends on the specific symptoms of the patient and the type of IBD, there are some common trends.
Many IBD patients, for example, experience abnormal bowel movements such as diarrhea. Diarrhea, or loose stools, result from excessively quick peristalsis, or waves pushing the food through the intestines. This pushes food through the GI tract at a rate where the nutrients cannot be absorbed in quantities high enough to properly supply the body with raw materials necessary for maintenance and strength.
When the proper materials are not received, the body must rely on reserves to supply these needs. However, when these reserves, stored in adipose tissue and skeletal muscle, are not replenished, this leads to fatigue and a starvation response. These further suppress the immune system’s function, leading to longer recovery periods from inflammation and illness, as well as general weight loss from the depletion of natural reserves.
Another impact of improper nutrition in IBD patients is the decrease in the uptake of vitamins and amino acids. There are certain physiological building blocks that, aside from the larger groups of carbs, fats, and proteins, cannot be naturally synthesized in the body. As a result, other physiological systems, involving hormonal regulation, thyroid function, and cardiopulmonary function in extreme cases, can be impacted.
What to eat during flare-ups
The aforementioned mechanisms describe the impact of malnutrition on IBD patients and the importance of checking in with your body to ensure it is receiving the necessary resources to keep you healthy. With this, there is no time more poignant for this reflection than during a flare-up.
A flare-up is exactly what it sounds like; a sudden worsening of symptoms occurring over days or weeks. The intensification of the symptoms makes it difficult and unappealing to eat, but IBD patients must stick to a nutritious diet during these periods.
That said, there are specific foods that are better to eat than others during a flare-up. For example, easy-to-digest foods, such as low FODMAP (as discussed below) or anti-inflammatory foods can help stabilize the digestive tract and improve symptoms. Whole grains (as opposed to white grains), coconut or non-dairy-based yogurt, chicken broth, and non-starchy vegetables help rest your digestive tract while providing a wealth of nutrients. We will discuss this more in-depth in the next section.
Types of Diets in IBD
The importance of maintaining one’s nutritional uptake, especially when dealing with the additional complication of IBD, is integral to managing a healthy lifestyle. Luckily, dieticians and nutritionists have created a variety of diets designed to stabilize and preserve health for IBD patients to avoid causing a flare-up. As always, it is important to consult a medical professional to understand which diet is right for you and the management of your symptoms.
Low FODMAP
One of the most common diets for patients experiencing IBD symptoms is the low FODMAP diet. FODMAP, or fermented oligosaccharides, disaccharides, monosaccharides, and polyols, represents a food group high in difficult-to-digest sugars and deficient in nutrients. Avoiding these foods can improve digestion and reduce the frequency of symptom recurrence. One of the features of this diet is that it begins with a highly restrictive diet, and as symptoms come under control, foods are gradually reintroduced to identify possible triggers or foods that cause flare-ups.
Common foods belonging to this group are potatoes, whole wheat or alternative grains, white meat, dairy-free milk and yogurt, nuts and seeds, bananas, and blueberries. Likewise, common foods to avoid are overly processed foods or foods high in sugars, such as apples, rye, and wheat grains (though some types of IBD can have whole wheat grains in moderation), citrus fruits, and dairy.
Paleo
Unlike the low-FODMAP diet, the paleo diet is a more restrictive diet focused on consuming natural, unprocessed foods. In short, the focus is on excluding anything that may have been processed, and instead consuming the foods humans consumed in the Paleolithic era. All grains, dairy, sugar additives, vegetable oils, beans and legumes, factory-farmed eggs, and potatoes are avoided in favor of what can be pulled from the ground. Many patients do not adhere to this diet all the time, but as needed to control their symptoms, making it difficult to research the efficacy of this diet in the long term. While there is evidence that foods rich in fiber and low in processed sugar can aid in the dietary maintenance of IBD, the specific use of the paleo diet has limited results in scientific literature.
Mediterranean Diet
The Mediterranean diet uses a different mechanism to target gut-healthy nutrition. Instead of avoiding foods that are potential triggers and inflammatory, it reorients attention to foods that enhance gut microbiota and improve digestion. Through consuming plant-based foods with limited quantities of vegetable oils high in saturated fats, dairy products, and vegetables, the emphasis is on moderation rather than restriction. Much like the low FODMAP diet, there is an elimination phase, where foods are phased out and then gradually reincorporated into the diet by gut tolerance. Again, it is hard to measure the overall success of this diet, as many that use this diet do not use it long-term, but as needed to manage IBD symptoms and restore remission. However, it is generally more popular than the paleo diet due to being less restrictive.
Anti-Inflammatory Diet (AID diet)
Scientific literature documents that IBD patients experience high levels of inflammation, much of which is due to the lack of properly balanced gut microbiota. Therefore, the focus of the AID diet is to relieve inflammation through promoting micro biotic health. This means incorporating more prebiotic and probiotic foods that have undergone fermentation (such as seaweed, plain yogurt, chia seeds, hemp seeds, bananas, and garlic) to further build up these communities and reduce inflammation. There are some foods to avoid, such as some processed foods high in sugar, but this diet is considered less restrictive than, say, the paleo diet.
What to do in remission
One of the age-old questions in medicine is how long to take a treatment. For certain chronic diseases, there are medications and treatments prescribed for the intensification of symptoms, such as in a flare-up. Likewise, there are some medications and treatments that must be continued for life. For patients with IBD, it largely depends on the severity of their symptoms, the frequency of recurrence, and how stable their remission remains.
Much of this is related to diet. There are some foods that all IBD patients, regardless of being in remission or not, should avoid, such as excess amounts of processed and packaged junk foods, caffeine, and pro-inflammatory foods, since they may send the patient back into a flare-up. However, many of the diets mentioned above (apart from low FODMAP), are not typically continued long-term, or at least to the same structures as they would during a flare-up. In fact, there is evidence that long-term restrictive diets in IBD patients contribute to malnutrition. Nonetheless, it is important to maintain a dietary routine such that proper nutrition is supported. Therefore, finding a healthy balance between strict adherence to a diet and moderation in types of food can make remission remain and remain more enjoyable!
Healing IBD with food
It is necessary to note that while we cannot cure IBD altogether, we can manage symptoms and maintain remission through a proper diet. Tracking what we eat and ensuring we consume the appropriate amount of nutrients, such as keeping a food diary, allows us to reflect on our diet and make appropriate changes.
Avoiding nutritionally deficient foods, such as overly processed foods or those classified as trigger foods reduces the frequency of flare-ups while increasing available calories from nutrient-dense foods.
It is important to exercise at regular intervals to an extent that is appropriate to the symptoms of IBD (see our article, IBD and Exercise, for more information) to increase digestive efficiency and ease.
Finally, sleep is integral to proper digestion and nutritional uptake. Therefore, it is even more important for IBD patients to receive the proper amount of sleep to improve their digestive process and reduce symptoms.
Summer Pitocchelli-Schwartzman
