Inflammatory Bowel Disease                      Return to the Beginning

Inflammatory bowel disease (IBD) is a chronic condition known by two main disease states: Crohn’s Disease and ulcerative colitis. Often when a patient is asymptomatic or in remission, a special diet is not needed except for known triggers identified by the patient, which may vary case by case. Diet education comes into play when a patient presents to the hospital with an exacerbation of Crohn’s Disease or ulcerative colitis and is ready to be discharged on an oral diet. The role of the healthcare practitioner is to provide diet education specifying foods to temporarily restrict to avoid further exacerbation of symptoms. Patients should not be overly restrictive or on the diet long-term. Excessive restrictions without the supervision of a healthcare provider may set the stage for suboptimal macro and micronutrient ingestion that may inadvertently create deficiencies.

 

It is important first to understand the differences and similarities in Crohn’s Disease and ulcerative colitis. Each one is site-specific in the gastrointestinal tract. Crohn’s Disease usually affects the terminal ileum, a combination of the terminal ileum and the colon, or, less often, the colon only or proximal small intestine only. On the other hand, ulcerative colitis is confined to the colon. This difference in location may indicate susceptibility to certain vitamin or mineral deficiencies as determined by absorption site. Fat malabsorption as well as Vitamin B12 deficiency is more prevalent in Crohn’s Disease due to location. 

 

 

 

 

Both diseases represent an inflammatory process that creates symptoms of nausea, vomiting, diarrhea, abdominal cramping, and loss of appetite. Unfortunately, no specific dietary toxin or antigen has been determined as the causative factor for the disease or exacerbation of the disease (1). Active inflammation may cause not only enteric loss of proteins, electrolytes, minerals, and blood, but the complication of weight loss and under nutrition. This is most often caused by a decrease in nutrition intake versus gastrointestinal losses or increased caloric needs unless in the presence of fever or sepsis that by itself would increase caloric needs (1).

The relationship between dietary treatment and IBD is based on four main principles.

1. Incorporate guidelines to avoid exacerbating symptoms such as diarrhea.
2. Correct and prevent nutritional deficits, including calorie and protein deficits, that have caused a decline in weight.
3. Establish a balance between diet restriction and liberalization to avoid restricting food options and thus restricting total caloric intake.
4. Incorporate all of these to work with the medical care to promote the healing of intestinal mucosa.

The path the diet will likely take while the patient is hospitalized is from a nothing by mouth diet order, to clear liquids only, and then advance to a low fat, low fiber (low residue), and low lactose diet. Reducing fat will help control steatorrhea if fat digestion is compromised. Reducing fiber will decrease mechanical irritation and decrease the chance of obstruction if a narrowed bowel is present. This also will assist in decreasing stool frequency. Restricting lactose intake may be indicated due to temporary lactose intolerance caused by a decrease in lactase activity in the inflamed bowel.

Initial diet education survival skills are mainly provided to continue symptom control until the patient returns to his/her healthcare provider for further diet instructions. If other complications such as significant weight loss or vitamin/mineral deficiencies are present, the patient should be referred to a registered dietitian for further diet adjustment and counseling.

 

Inflammatory Bowel Disease Survival Skills

• Eat small meals/snacks often throughout the day (6 small meals).
• Increase fluid intake to a minimum of eight 8 ounce glasses per day if loose stools persist.
• Incorporate a general multivitamin and mineral supplement.
• Avoid milk/dairy products. Add them back slowly to monitor tolerance when bowel movements normalize and when the patient is feeling better. Usually yogurts and cheeses are tolerated initially better than milk.
• Avoid fried and high fat meats, highly marbled or tough meats. Try lean meat such as skinless poultry, baked or broiled fish.
• Limit high fiber grains such as whole grain breads/cereals/pasta with greater than two grams of dietary fiber per serving.
• Avoid raw vegetables, try well-cooked, skinless choices.
• Avoid raisins and raw fruit with peels or skins. Try juice, bananas, and canned fruits.
• Limit fats and oils.
• Avoid caffeine (2).
• Stress to the patient that the goal is to ultimately liberalize his or her diet as much as possible after symptoms have subsided under the guidance of a healthcare provider.