IBD and the importance of nutrition

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.