IBD Awareness: A Guide to Nutrition and Gut Support
The first week of December is designated as Crohn’s and Colitis Awareness Week, which focuses on the main forms of inflammatory bowel disease (IBD). This umbrella term describes the chronic inflammation of the digestive or gastrointestinal (GI) tract. The two most common forms of IBD are Crohn’s disease and ulcerative colitis. At Summerfield, we support patients managing a wide range of health conditions, and we know the importance of nutrition patterns and lifestyle practices when living with chronic conditions, such as IBD.
What is IBD?
These conditions are defined and differentiated by the areas of the GI tract that are affected. Crohn’s disease causes inflammation that can affect any part of the GI tract, from the mouth to the anus. Most commonly, it affects the end of the small intestine and the beginning of the large intestine (colon). Symptoms include abdominal pain, severe diarrhea, fatigue, unexplained weight loss, and malnutrition. Ulcerative colitis causes inflammation of the rectum and colon, with symptoms including anemia, severe fatigue, bleeding, skin sores, joint pain, and loss of appetite.
Navigating an inflammatory condition of the digestive tract is of the utmost importance and complexity. Something most of us don’t need to think about daily is that everything we eat comes in contact with our GI tract. This means that if this area is inflamed, eating may be a source of extreme discomfort. The experience can be thought of similarly to rubbing sand on a sunburn. Quite painful to imagine, as food moving through an inflamed GI tract leads to increased discomfort. While there is no “best” diet for IBD, there is supportive data on eating patterns that can optimize nutritional status and minimize digestive discomfort, such as an anti-inflammatory diet.
Dietary Guidance for IBD
At the foundation, an anti-inflammatory diet emphasizes whole, fresh foods. Generally, this includes fruits, vegetables, healthy fats from nuts, seeds, olive oil, avocados, whole grains, and lean proteins, while minimizing ultra-processed foods, fried and high-fat foods, as well as high-sugar foods. Key considerations for this way of eating are the high nutrient content of whole, fresh foods, and the way these benefit total body health as well as digestion (such as in providing fiber as a fuel source for healthy bacteria in the gut).
The International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) has outlined dietary guidelines for patients with IBD, depending on the condition. For ulcerative colitis, it is advised to reduce the consumption of foods containing carrageenan, emulsifiers, and thickeners (such as carboxymethylcellulose and polysorbate-80), processed foods containing titanium dioxide, maltodextrins, and artificial sweeteners, dietary fat from palm, coconut, dairy, red, and processed meats (and to increase intake of omega-3 fatty acids from fish). For Crohn’s disease, it is advised to reduce the intake of insoluble fiber from fruits and vegetables when strictures are present, to reduce exposure to saturated fats, maltodextrins, artificial sweeteners, carboxymethylcellulose, polysorbate-80, carrageenan, and processed foods containing titanium dioxide.
Additional Dietary Considerations
Adjustments to the diet may be required when someone is experiencing symptoms due to IBD, often referred to as being in a “flare”. This is a period when symptoms reappear or worsen after having been stable for some time. This indicates active inflammation and can last from a few days to several months. While food is not the only tool for managing a flare, it can be beneficial for reducing and managing symptoms. During these phases, a focus on lean, easily digested proteins such as chicken, fish, and eggs is ideal. Cooked vegetables and low-fiber fruits are often better tolerated than raw or high-fiber selections. Adequate water intake is a common struggle for many individuals, and hydration cannot be overlooked. There is an increased risk for dehydration during a symptom flare, especially for individuals with Crohn’s disease. Having more frequent bowel movements means more water and electrolytes are leaving the body than is optimal, so this is a crucial time to focus on hydration. Eating smaller, more frequent meals can help to reduce the effort required from the digestive tract, as can products like coconut water, broth, soups, smoothies, and other electrolyte or rehydration beverages (especially when managing diarrhea). It’s advised to avoid common triggers such as caffeine, alcohol, dairy (if intolerant), and spicy/fatty foods. Individual triggers and tolerance can vary from person to person, so tracking food and symptoms may be a helpful strategy, as well as working with a dietitian to develop a dietary pattern that best meets individual nutrition needs and health goals.
Other dietary approaches that may offer benefit include:
- IBD-AID stands for inflammatory bowel disease anti-inflammatory diet. This approach builds on the anti-inflammatory diet by adding fermented foods with live bacteria to support the microbiome. It limits certain carbohydrates, which may be pro-inflammatory for some, such as lactose, wheat, refined sugar, and corn.
- The Autoimmune Protocol (AIP) omits grains, legumes, dairy, nightshade vegetables, nuts and seeds, and all processed foods (including sugar, alcohol, and refined oils). This approach is meant to be strict at the start, with the most foods being eliminated, before a reintroduction phase to identify triggers vs tolerated foods. At the foundation, AIP is aimed at supporting the immune system. The Paleo Diet is similar to AIP in that it omits grains, legumes, dairy, processed foods, refined sugars, and salt. This approach is less strict and intended as a long-term strategy for focusing on whole foods to reduce inflammation.
- The Mediterranean Diet is similar to an anti-inflammatory diet, emphasizing fruits, vegetables, whole grains, legumes, fish, nuts, olive oil, herbs, and spices. This diet limits red meat and includes small amounts of poultry, eggs, cheese, and dairy.
- The low-FODMAP diet was originally developed for the management of irritable bowel syndrome (IBS) but has been shown to improve similar symptoms for patients with IBD, such as reducing gas, distention, and pain when the GI tract is stable and not in a flare. This dietary approach reduces fermentable carbohydrates, including oligosaccharides, disaccharides, monosaccharides, and polyols found in foods such as milk, yogurt, wheat, apples, pears, onions, garlic, beans, and lentils. This diet is meant only for short-term use and does not reduce inflammation, but it can aid in symptom management by minimizing the fermentable carbohydrates that bacteria in the intestinal tract would otherwise feed on, which are the source of gas production that can lead to GI discomfort.
- An elemental diet consists of powdered meal-replacement products that are antibacterial, anti-inflammatory, and hypoallergenic. This diet has shown great benefit for patients with Crohn’s disease during a flare, as it allows the gut to rest and heal instead of having to digest whole foods.
This list is not exhaustive, as there are other diets individuals may try that have the potential to offer benefits. Individual tolerance to certain foods may vary, which is why some diets exclude foods that others include. Whenever embarking on a new or restrictive dietary approach, please consult a dietitian to help you establish a plan that meets all macronutrient and micronutrient needs.
Understanding IBD and the gut
Inflammatory bowel disease isn’t caused by a single factor, but the result of a complex immune response triggered by a combination of genetics, an imbalanced gut microbiome, and environmental factors. IBD is classified as an immune-mediated inflammatory condition, as the dysfunctional immune response to gut bacteria and resulting attack on the GI tract is a central feature in IBD. There is a reduction in the overall number and types of beneficial bacteria, and there are greater amounts of harmful bacteria, such as Escherichia coli (E. coli). There is also a notable reduction in bacteria that produce anti-inflammatory short-chain fatty acids (SCFAs) through the fermentation of dietary fiber. These SCFAs have been described as providing energy to intestinal cells and protecting the intestinal lining.
Probiotics and IBD
This all leads us to ask, what is the role of supplemental bacteria, aka probiotics, in the management of IBD? Unfortunately, there is little consensus. When it comes to Crohn’s disease, many sources don’t have a recommendation. Others highlight what we know about certain strains from a broader perspective and advise trialing those that aid in a reduction of inflammation and symptom management. For ulcerative colitis, multi-strain probiotics have shown some benefit for symptom management. These include products with a blend of Lactobacillus and Bifidobacterium strains. Visbiome Advanced Care probiotic is a high-potency product that contains eight different probiotic strains that have been reported as being effective at inducing and maintaining remission for ulcerative colitis. This product is not meant to replace medication and must be used under the guidance of a physician.
Broadly speaking, here are some important notes about very well-studied bacteria and yeast strains that may offer benefit (even if not inducing remission):
- Lactobacillus rhamnosus GG (LGG): Has been shown to help regulate immune responses, reduce inflammation, decrease symptoms of pain and diarrhea, as well as support the gut barrier/improve gut integrity.
- Saccharomyces boulardii, a beneficial yeast, has shown benefit in symptom improvement (primarily a reduction in bowel movement frequency) and in the composition of the gut microbiome in some patients.
While probiotics aren’t a stand-alone remedy, they may be a useful addition to a symptom management plan.
Lifestyle Management
Stress management is another useful addition to the management of IBD. The connection between the gut and brain has been a topic of increased interest and research, with more data highlighting that GI health is connected to mental health and stress. So much so that there are now apps (such as Nerva) and devices that assist in managing brain-gut signals through various means. If stress is a persistent concern for someone with IBD, it cannot be overlooked as a potential contributor to symptoms.
Formulating the best approach for managing IBD is an individualized experience. Partnering with medical providers who are knowledgeable about the various diets and other tools for treatment and symptom management will empower individuals living with IBD to identify the best approach for their body and lifestyle. There is considerable evidence to support the role of diet in lowering inflammation, reducing symptoms, and supporting optimal health. If working with a dietitian could benefit you on your wellness journey, reach out to us today!
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