Healthy Diet Plan for Inflammatory Bowel Disease (Ulcerative Colitis and Crohn’s Disease)

 

WHAT IS INFLAMMATORY BOWEL DISEASE (IBD):

IBD is a term used to describe a set of chronic inflammatory disorders that mostly affect the digestive tract. Crohn's disease and ulcerative colitis are the two most common kinds of IBD. These disorders cause inflammation in various regions of the gastrointestinal tract, resulting in a variety of symptoms and problems.

Crohn's Disease

Crohn's Disease affects any area of the digestive tract, from the mouth to the anus. Abdominal pain, diarrhea, weight loss and fatigue. Inflammation can spread all the way through the intestinal wall, causing diarrhea, strictures (narrowing), fistulas (abnormal openings), malabsorption, and the necessity for surgical resections of parts of the digestive tract.

Ulcerative Colitis

Ulcerative Colitis is a disease that mostly affects the colon (large intestine) and the rectum. The redness and swelling in ulcerative colitis usually begins in the rectum and can progress throughout the colon. Symptoms include bloody diarrhea, abdominal pain, eagerness to urinate, and, in some cases, weight loss and exhaustion. Because the inflammation does not spread along the entire gut wall, no fistulas form. However, severe inflammation may necessitate surgery to remove the affected part.

CAUSES OF IBD:

The specific origins of IBD are unknown; however, it is thought to be a combination of genetic predisposition, immune system breakdown, and factors from the environment. A medical history, physical examination, blood tests, imaging studies (such as endoscopy and colonoscopy), and sometimes biopsies are used to make a diagnosis.

TREATMENT OF IBD:

The goal of IBD treatment is toreduce inflammation, relieve symptoms, induce remission, and enhance the patient's overall quality of life. Treatment strategies are customized based on the individual's illness, severity, and responsiveness to therapies. Medication, dietary adjustments, lifestyle changes, and, in certain cases, surgery to remove affected regions of the intestine or correct problems such as fistulas are also options. Individuals with IBD must collaborate closely with healthcare providers to build a specific treatment plan and effectively manage the condition.

1.       Medications are the most commonly used treatment modality.

Anti-inflammatory medications:

such as aminosalicylates, corticosteroids, and immunomodulators, are used to treat inflammation and symptoms.

Biologics

are targeted medicines that suppress specific inflammatory chemicals, such as tumor necrosis factor (TNF) inhibitors and integrin receptor antagonists.

JAK Inhibitors:

 Janus kinase inhibitors which help in the regulation of immune response and inflammation.

Antibiotics:

Used to treat bacterial overgrowth and infections in some circumstances.

2.       Dietary Therapy:

Exclusive Enteral Nutrition (EEN): Consuming a liquid formula as the primary source of nutrition can enhance remission in some situations, especially in children.

3.       Surgery:

Complications such as strictures, abscesses, perforations, or serious disease that does not respond to standard treatments may necessitate surgical intervention. Surgery may involve the removal of damaged intestinal segments or the creation of temporary or permanent stomas.

4.       Lifestyle Changes:

Stress management, regular exercise, and a good diet can all contribute to general well-being and perhaps lower symptom severity.

5.       Therapeutic Interventions:

Psychological care and counseling can assist patients in dealing with the emotional effects of having a chronic disease.

6.       Individualized Strategy:

Treatment for IBD is not one-size-fits-all. Gastroenterologists and other healthcare professionals collaborate with patients to create a customized treatment plan that takes into account the disease type, location, severity, patient preferences, and response to medicines. To ensure best outcomes and control potential adverse effects, regular monitoring and modifications to the treatment plan are routine.

RESEARCH and DEVELOPMENT:

Ongoing research uncovers fresh insights into the underlying causes of IBD, which leads to the development of new unique treatments. This field is evolving, with novel and emerging therapies directed at specific components of inflammation and immune response.

Individuals with IBD should collaborate closely with their healthcare team to develop the optimal treatment plan for their illness and attain the highest potential quality of life.

DIET PLAN FOR IBD PATIENTS:

What you eat neither causes nor treats inflammatory bowel disease (IBD). However, doctors and nutritionists believe that food may play a role in the primary inflammation process that causes IBD symptoms.

Certain meals may worsensymptoms, while others can help to relieve them and encourage healing. As a result, paying attention to what you eat and how your body reacts to different foods is a crucial component of an overall IBD treatment strategy.

A food plan for IBD may support but never replace medical treatment. Always take your meds exactly as your doctor has suggested.

WHAT TO EAT:

Working closely with a healthcare practitioner or a qualified dietitian who specializes in gastrointestinal diseases is essential if you have Inflammatory Bowel Disease (IBD), as dietary recommendations might vary depending on the precise kind and severity of your ailment. However, the following general rules may be useful:

Low-Fiber Diet:

 A low-residue diet may be indicated during active flare-ups. This means consuming meals that are low in fiber and simple to digest. Well-cooked vegetables without skins, white bread, refined cereals, lean protein sources like poultry and fish, and cooked fruits without seeds are all examples.

Low FODMAP Diet:

FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols, which are short-chain carbohydrates (sugars) that are poorly absorbed by the small intestine. Some people have intestinal distress issues after consuming them.

Low FODMAP Diet includes:

Almond Milk

Grapes, oranges, strawberries, blueberries, and pineapple are examples of fruits.

Eggplant, potatoes, tomatoes, cucumbers, and zucchini are examples of vegetables.

Grains such as rice, quinoa, and oats

Brie, Camembert, cheddar, and feta are examples of cheeses.

Meat and eggs

Some people with IBD may benefit from a low-FODMAP diet, which avoids particular types of carbohydrates that might trigger digestive discomfort. This diet should be followed under the supervision of a healthcare practitioner because it might be restrictive and difficult to maintain without it.

Foods high in omega-3 fatty acids:

such as fatty fish (salmon,mackerel, sardines), flaxseeds, and walnuts, may have anti-inflammatory qualities and may be effective for regulating inflammation in IBD.

Protein:

Include lean protein sources such poultry, fish, eggs, tofu, and low-fat dairy items in your diet. Protein is required for tissue repair and upkeep.

Cooked Vegetables:

Peeled and deseeded, may be simpler to digest than raw or fibrous vegetables. Carrots, zucchini, spinach, and green beans can all be added.

Refined Grains:

During flare-ups, choose refined grains such as white rice, bland spaghetti, and white bread. These are often easier on the stomach.

Probiotic-Rich Foods: 

Live active cultures yogurt, kefir, and fermented foods like sauerkraut and kimchi can all help build a healthy gut microbiome.

Hydration:

It is critical to stay hydrated. Drink plenty of water throughout the day to stay hydrated and to promote digestion. 8-10 Glasses of Water are generally recommended for IBD Patients. Limit caffeinated, sugary drinks and beverages containing sugar derivatives.

Nutritional Supplements:

In some circumstances, your healthcare professional may offer nutritional supplements to ensure you obtain enough nutrients, especially if you have a hard time eating a balanced diet.

Individualized Approach:

Keep in mind that IBD affects everyone differently. What works for one person may not work for the next. Maintaining a food diary to track your symptoms can assist you in identifying trigger foods and patterns.

It's crucial to remember that the guidelines may differ depending on whether you're in active flare-up, remission, or managing symptoms. Before making any major modifications to your diet, always with your healthcare provider, and consider getting help from a certified dietitian who specializes in gastrointestinal problems for an individualized approach.

WHAT NOT TO EAT:

While there is no one-size-fits-all diet for IBD, certain foods and dietary habits might aggravate symptoms and should be avoided or reduced in general. Remember that individual sensitivities to foods might vary, so working with a healthcare practitioner or registered dietitian to develop a personalized diet plan is essential. Here are some broad tips for what to avoid eating if you have IBD:

Foods High in Fiber:

While fiber is generally thought to be healthful, it can be troublesome for people with IBD during flare-ups. Insoluble fiber-rich foods, such as whole grains, nuts, seeds, and raw fruits and vegetables, can be difficult to digest and may aggravate symptoms. During flare-ups, choose cooked and peeled fruits and vegetables and low-fiber alternatives.

Dairy Products:

Dairy products can be difficult for some people with IBD to digest, particularly if they are lactose intolerant. It's best to avoid or restrict dairy consumption during flare-ups. Lactose-free alternatives or lactase enzyme supplements may be tolerated better.

Fatty and fried foods:

These foods might aggravate inflammation and cause pain. These meals can also cause diarrhea and stomachache. Reduce your consumption of fried foods, fatty meats, and heavy sauces.

Spices and spicy foods:

 Foods laden with spices may cause irritation of the gastrointestinal tract, causing symptoms to worsen. If spicy foods make your symptoms worse, it's better to avoid or limit your intake.

Coffee and Alcohol:

Both caffeine and alcohol cancause dehydration and digestive system discomfort. They may also cause symptoms such as diarrhea or stomach distress. It's best to minimize or avoid certain drinks, especially during flare-ups.

Artificial sweeteners:

Artificial Sweeteners such as Sorbitol and Mannitol, can have a laxative effect and aggravate diarrhea. Look for these sweeteners on food labels and try to avoid them.

Carbonated Beverages:

Carbonated Beverages can cause gas and bloating, which can be uncomfortable for persons who have IBD. Furthermore, carbonation may aggravate symptoms in some people.

Processed Foods:

Processed Meals frequently contain chemicals, preservatives, and artificial components that can cause inflammation and exacerbate IBD symptoms. When possible, use whole, minimally processed foods.

Various Raw Fruits and Vegetables:

Raw fruits and vegetables, especially during flare-ups, might be difficult to digest. Fruits and vegetables can be made more tolerable by peeling, boiling, and removing seeds.

Large Meals:

 Eating large meals might put additional strain on the digestive system, perhaps worsening symptoms. Try eating smaller, more frequent meals throughout the day instead.

Individual tolerances vary, so keep track of your personal reactions to different foods and make modifications as needed.

TREATMENT OF NUTRIENT DEFICIENCIES IN IBD:

People with Crohn's disease

may be more prone to nutrient deficits in the following areas. A number of factors, including drugs used, sections of the digestive tract removed, the degree of inflammation, and the patient's capacity to consume appropriate nutrition, influence the risk of nutritional insufficiency. If you are concerned about a deficiency, speak with your doctor or a nutritionist. Supplements and nutrient-rich meals are used to alleviate nutritional deficiencies.

Folic Acid :

Sulfasalazine use increases the risk of significant inflammation in the jejunum (middle region of the small intestine) or removal of the jejunum.

Zinc: 

Extensive inflammation and/or removal of the jejunum, diarrhea, fistula losses, prednisone use, or very low blood zinc levels all increase the risk.

Vitamin A:

 is associated with an increased risk of fat malabsorption, as well as disease involvement of the duodenum (upper small intestine) and/or upper jejunum.

Magnesium :

Extensive inflammation and/or excision of substantial parts of the jejunum and ileum, fistula losses, and prolonged diarrhea all increase the risk.

Vitamin B12:

Extensive inflammation in the ileum (lower small intestine) or  removal of the ileum increase the risk.

Vitamin D, E, and K:

 Fat Malabsorption increases the risk, as does inflammation of substantial parts of the jejunum and/or ileum or excision of segments of the jejunum and ileum.

Potassium:

 Chronic vomiting and diarrhea, as well as the usage of prednisone, increase the risk.

Calcium:

 Lactose intolerance, fat malabsorption, prednisone use, significant inflammation, or surgery along the entire small intestine are all increased risks when dairy foods are avoided.

Ulcerative Colitis:

People suffering with ulcerative colitis may have greater requirements for the nutrients listed below. Deficiencies are determined by the drugs utilized as well as the extent of bleeding and diarrhea. If you are concerned about a deficiency, speak with your doctor or a nutritionist. Correct with nutrient-dense diets and supplements.

Calcium:

Prednisone use increases the risk of calcium.

Magnesium:

 Chronic diarrhea puts you at a higher risk.

Folate:

Increased risk with use of Sulfasalazine usage.

Iron:

 Blood loss through colon ulceration and/or clinical signs and symptoms of deficiency (anemia) increase the risk.

Potassium:

 Chronic vomiting and diarrhea, prednisone use, and low potassium levels in the blood all increase the risk.

SPECIAL IBD DIETS:

Specialized IBD diets are frequently disputed in the medical field because they aren't always effective and might be restrictive, resulting in weight loss or malnutrition. The optimal diet is one that fits your specific nutritional demands while also assisting you in managing your IBD symptoms. Do not try any of these diets until you have discussed it with your doctor or a licensed nutritionist.

Autoimmune Protocol Diet:

The AIP diet gradually eliminates grains, legumes, vegetables (tomatoes, eggplants, potatoes, peppers), sugar (refined sugars), dairy, eggs, nuts, seeds, and processed foods in stages. The diet is based on nutrient-rich meals, lean protein, fruits and vegetables, and is modified as needed. The goal is to eliminate dietary elements that cause dysbiosis (microbiota imbalance in the gut), inflammation, and intolerance to foods. The regimen also emphasizes improving other aspects of one's lifestyle, such as , stress, sleep, physical activity, and relationships.

Anti-inflammatory Diet:

IBD patients have an imbalance of gut bacteria, which contributes to inflammation, according to research.  The IBD-AID was created to restore the balance of both good and bad bacteria while also supporting proper eating. It integrates aspects of the Specific Carbohydrate Diet by avoiding specific carbs and increasing prebiotic and probiotic (contains microorganisms) meals to boost the gut microbiome. It is intended to be deployed in stages, with the progression of food consistency.

Exclusive Enteral Nutrition (EEN):

Exclusive enteral nutrition, or EEN, is when you get all of your calories through an exclusive nutrition formula rather than eating conventional meals.  The term "enteral" refers to liquids that flow through the intestines and contain all of the proteins, carbs, fats, minerals, and vitamins required to sustain you. EEN is a common pediatric medication in Western Europe since it has been shown to promote recovery in children with Crohn's disease. EEN may also help IBD patients who are already on biologic therapy and increase their response rates.

CD-TREAT Diet:

The CD-TREAT diet is an anti-inflammatory whole foods-based diet that uses whole foods to mimic the benefits of exclusive enteral nutrition (EEN). This diet eliminates complex carbs (gluten, lactose, and alcohol) while adding particular proteins, fruits and vegetables.

Low-FODMAP diet:

It is a diet that restricts a set of fibers and sugars that are poorly absorbed by the digestive tract. Foods which contain fructose, lactose, sugar polyols (sorbitol and mannitol), galacto-oligosaccharides (found in lentils, chickpeas, and green peas) and fructans (found in garlic, leeks, artichokes, and wheat), fall into this category.

Mediterranean Diet:

This diet has a lot of fiber and food that is plant-based including olive oil, low-fat dairy, herbs, and spices. This diet contains little to no red meat, although it does include poultry, eggs, cheese, and yogurt in moderate amounts.

A recent research study of Ulcerative Colitis and Crohn's disease patients discovered that the Mediterranean diet improved nutritional status, IBD activity, inflammatory markers, and quality of life during a six-month period.

SCD stands for Specific Carbohydrate Diet:

Fruits, vegetables, fish, meat, homemade yogurt, and aged cheeses are allowed on the Specific Carbohydrate Diet TM (SCD), but grains, processed foods, soy, and certain vegetables such as potatoes and corn are not. The SCD has been proposed to help persons with mild to moderate Crohn's disease reduce their symptoms.

Semi-Vegetarian Diet:

Eggs, yogurt, fruit, vegetables, legumes, brown rice, miso, and pickled vegetables are all part of the Semi-Vegetarian diet, along with the odd glass of milk and green tea. This diet calls for only one serving of animal protein each week-meat every two weeks and fish once every week.

Web Resources About IBD Diet Plans and Information:

Lifestyle, diet in inflammatory bowel disease

https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/lifestyle-and-diet-in-inflammatory-bowel-disease

Inflammatory Bowel Disease Diet

https://www.uhhospitals.org/services/Digestive-health-services/Conditions-and-treatments/small-and-large-intestine/inflammatory-bowel-disease/diet-guide

Creating a Crohn's Disease Diet Plan

https://www.webmd.com/ibd-crohns-disease/crohns-disease/creating-a-crohns-disease-diet-plan

How Your Diet Can Help Reduce IBD Symptoms

https://time.com/6158021/ibd-ulcerative-colitis-best-diet/

Dietary Guidance for Patients With Inflammatory Bowel Disease

https://www.uspharmacist.com/article/dietary-guidance-for-patients-with-inflammatory-bowel-disease

Diet & Lifestyle Changes for Inflammatory Bowel Disease (IBD)

https://cdhf.ca/en/diet-and-lifestyle-changes-for-inflammatory-bowel-disease/

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