IBD and the importance of nutrition

Written in association with: Dr Shameer Mehta
Published:
Edited by: Nicholas Howley

How important is nutrition in managing inflammatory bowel disease (IBD), and what exactly should you be eating? We spoke with Dr Shameer Mehta, a highly-skilled consultant gastroenterologist based in London:

How important is it to treat IBD with nutrition?

There are many aspects of good IBD management including lifestyle changes (such as stopping smoking if you have Crohn’s disease), medications and nutritional therapy.

The use of nutritional therapy can be as important as other factors for a variety of reasons:

  • Firstly, nutrition in the form of liquid feeds can be a treatment for inflammation itself, thereby helping the bowel recover during disease flares.
  • Secondly, it can prevent or alleviate malnutrition which itself puts patients at higher risk of complications with a greater chance of being admitted to hospital and with worse overall quality of life. This can be in the form of high-calorie nutritional supplements or the replacement of specific nutrients using tablets or injections, such as iron or vitamin B12.
  • Thirdly, nutritional therapy can treat symptoms that patients with IBD experience, beyond simply the effect of the therapy on the bowel itself.

Importantly, nutritional therapy has the advantage of leading to fewer complications in general than medications, and can be a vital tool when used appropriately.

What IBD symptoms can nutritional changes help to control?

Common symptoms suffered by patients with IBD include diarrhoea, abdominal pain and fatigue. In the right situation, nutritional therapy can help to control all of these in one of two ways.

The first is by reducing the level of inflammation within the gut by, for example, the delivery of pre-digested food.

Secondly, in patients with little or no inflammation, they may experience bad symptoms arising from bowel dysfunction unrelated to inflammation – indeed we know that many patients with IBD also suffer with irritable bowel syndrome (IBS) or food intolerances. In these situations, certain exclusion diets such as the FODMAPs diet can help improve a variety of symptoms including bloating and excessive gas.

What dietary recommendations do you have for a flare of ulcerative colitis?

In general, I would recommend a healthy balanced diet for patients suffering with ulcerative colitis. During a flare, it is important to include sufficient calories in your diet to give your body the extra fuel it needs to combat active inflammation within the gut. This can be difficult because patients often lose their appetite when they’re suffering with a flare.

In addition, it can be useful to avoid foods you know make your symptoms worse: common things include food high in fibre during periods of diarrhoea or food groups known to make IBS symptoms worse such as spicy foods, excessive alcohol or caffeine. A proportion of patients with ulcerative colitis also suffer with lactose intolerance so a trial of avoiding lactose can also be helpful.

It is important to say that whilst some diets can help symptoms, there is no good evidence that any diet treats the disease during flares.

What dietary recommendations do you have for a flare of Crohn’s disease?

Once again, much like ulcerative colitis, it is important to maintain a healthy balanced diet if you have Crohn’s disease. Similarly, avoiding food groups that you know can make IBS symptoms worse is also a useful tactic.

However, some patients with Crohn’s also develop narrowings within their bowel which can lead to additional problems such as abdominal pain, weight loss or even blockages. To minimise these problems, I would recommend a low residue diet which includes limiting high-fibre foods like nuts, seeds, cereals or certain fruits and vegetables. These food groups can be hard to digest and can worsen symptoms such as abdominal cramping, bloating and nausea.

By Dr Shameer Mehta
Gastroenterology

Dr Shameer Mehta is a highly skilled and experienced gastroenterologist, based in London and specialising in pelvic radiation disease, inflammatory bowel disease (IBD) and nutritional disorders, among others.

He is one of only a few consultants who has been appointed to two London teaching hospitals: University College London Hospital and, currently, The Royal London Hospital (Barts Health NHS Trust) where he is the clinical lead for nutrition. His private practice is based at The London Digestive Centre and The Princess Grace Hospital, as well as Cleveland Clinic London where is also the clinical lead for nutrition. He maintains a strong interest in research and education, both nationally and internationally and is an honorary associate professor at University College London. He is also a passionate advocate for shared decision making between patient and physician and believes a healthy gut is vital for overall well-being. 

He began his medical training at Guy’s and St Thomas’s Hospitals, before starting his higher specialist training in North East London in gastroenterology. Following this, he then went on to complete a fellowship at Queen Mary’s and the Blizard Institute in medical education and basic science research. He was designated a fellow of the Higher Education Academy in recognition of his work. His research degree (MD) in basic science examined the role that microRNAs have in the control of the epithelial to mesenchymal transition and the development of intestinal fibrosis in Chron’s disease. 

Dr Mehta’s main role is as the Lead for the Intestinal Failure Service at The Royal London Hospital, one of the largest such services in the UK. He works in a multi-disciplinary fashion providing a comprehensive treatment plan to patients with complex nutritional care and intestinal failure. He also works with patients experiencing inflammatory bowel disease (IBD), irritable bowel disease and those with gastrointestinal disorders as a consequence of their cancer treatment. He currently holds the position of clinical lead for the trust’s Nutrition and Hydration Strategy Group, which attempts to improve nutritional provisions for patients, visitors and staff. 

He has a track record of delivering high-quality research in areas including the role malnutrition in IBD, intestinal-failure associated liver disease, and pelvic radiation disease. He is invited regularly to present his findings at conferences and seminars globally and continues to publish in high-impact  medical journals.   

Dr Mehta contributes to medical education as an accredited trainer for the ESPEN Clinical Nutrition Diploma, co-chairing the UCL Master’s degree in Clinical Nutrition and Public Health, and sits on the organising committee for the UCL postgraduate course in Clinical Nutrition.  

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