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Nutrition Management of Inflammatory Bowel Disease

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At Ignite Nutrition we specialize not only in Irritable Bowel Syndrome (IBS), but we also work with clients with Inflammatory Bowel Disease (IBD) and other gut disorders. If you’re wondering what the difference is between IBS and IBD, or if you have IBD and are trying to find out if there is a nutrition solution, read on as we are going to explore that today.

What is the difference between Irritable Bowel Syndrome and Inflammatory Bowel Disease?

Irritable Bowel Syndrome and Inflammatory Bowel Disease have similar names and their symptoms often overlap. However, it’s very important to get a proper diagnosis and distinguish between the two. As the treatment, management of symptoms, and complications are very different.

Irritable Bowel Syndrome is a collection of symptoms that impact the function of the gastrointestinal tract, but not the structure. IBS is called a functional gut disorder because on examination of the gut, everything appears normal despite ongoing symptoms. In contrast, Inflammatory Bowel Disease is an autoimmune disorder, causing inflammation and structural damage. Inflammatory Bowel Disease is a group of inflammatory conditions, the two most common being Ulcerative Colitis and Crohn’s Disease. Crohn’s can attack any part of the GI tract and any layer. Whereas Ulcerative Colitis only impacts the colon and the innermost layer.

What are the Symptoms of Inflammatory Bowel Disease?

The symptoms of IBD can vary from person to person and change within the person over time. Many people experience periods of remission. Where little to no symptoms are present. People also experience periods of flare-ups – where multiple and/or debilitating symptoms are present. Inflammation in the gut can cause ulcers and decrease absorption of water and food within the bowel. This can lead to symptoms such as:

  • Frequent and urgent bowel movements
  • Loose stools
  • Blood in stool
  • Weight loss
  • Abdominal pain and cramping
  • Lack of appetite
  • Fatigue
  • Fever

How is Inflammatory Bowel Disease diagnosed?

There is no single test to diagnose IBD. The doctor will look at the results of a series of different tests as a whole to make a diagnosis. Blood and stool tests help in ruling out other potential causes of symptoms and guide a physician’s decision to proceed with further testing. Endoscopic tests, biopsies, and radiology confirm inflammation (including location and severity) in the gastrointestinal tract and the presence of any structural damage.

Management of Inflammatory Bowel Disease

There is no cure for IBD at this time, it is a chronic lifelong condition. The goal of management strategies is to achieve and maintain remission of symptoms. The first line management strategy of IBD is medication. Surgical treatment is also sometimes required to manage the disease or complications of the disease. These strategies will be managed by your team of physicians involved in your care. At Ignite Nutrition we take a holistic approach to management. We consider the impact of diet and lifestyle on improving symptoms and increasing quality of life.

Medication Management:

Inflammatory Bowel Disease has some serious complications when not controlled. These include ulcers, malnutrition, fistulas, bowel obstruction and increased colon cancer risk. Working closely with a gastroenterologist and following guidance on medication management is especially important.

The top 5 classes of medications used for IBD are:

  • Aminosalicylates – Used to reduce inflammation in the lining of the intestine
  • Corticosteroids – Act to suppress the immune inflammatory response. Usually used on a short-term basis.
  • Immunomodulators – Act to suppress the immune inflammatory response. Used on a long-term basis.
  • Biologic therapies – Antibodies grown in the lab to prevent proteins from creating inflammation.
  • Antibiotics – Used to treat infections that may occur from disease or surgical interventions.

If you’re wondering what the difference is between IBS and IBD, or if you have IBD and are trying to find out if there is a nutrition solution the registered dietitians at Ignite Nutrition in Calgary, Alberta can help you.

Surgical Treatment:

Medication management isn’t always enough to control IBD. Often times complications from the disease may also result in the need for surgical intervention. Up to 70% of people with Crohn’s disease and approximately 30% of people with Colitis will need surgical treatment.

Nutrition Therapy:

There is no current evidence that specific foods or diets cause, prevent, or cure IBD. While there is no diet specific for IBD, individualized dietary strategies can help manage the symptoms of the disease.

Dietary approaches during periods of remission and flare-ups will differ. During remission, the goal is to eat a well-balanced diet that provides adequate nutrition. During flare-ups, there are some dietary strategies that can help decrease symptoms, reducing malnutrition risk, and improve quality of life which include:

Eat Small Frequent Meals:

Malabsorption of food is common with IBD and can lead to increased symptoms. Eating smaller meals more often will give your body more opportunities to absorb nutrients. Which is beneficial for healing and can help reduce some symptoms.

Drink Plenty of Fluids:

A side effect of IBD for many people is diarrhea. It’s recommended to decrease intake of caffeine and alcohol during a flare-up. As these can stimulate the bowels and worsen symptoms. Very cold fluids and fluids high in sugar (such as pop or juice) may also increase stool output. Maintaining adequate hydration is always important but especially during a flareup to reduce risk of dehydration. Aim for 2-3L of fluid daily.

Moderate Fibre Intake:

Fibre, found in all plant-based foods (vegetables, fruit, whole grains, nuts/seeds, and legumes), is an important component of our diet. However, during a flare, certain types of fibre can worsen symptoms. Increasing soluble fibre and decreasing insoluble fiber will reduce gut transit time and improve stool consistency.

During a flare, choose softer cooked vegetables and remove skins and seeds of vegetables and fruit when possible. The outer bran layer of whole grains can aggravate the bowels during a flare. Therefore choosing refined grains (such as white rice or white bread) is a strategy that can provide symptom relief. Beans with skin and whole nuts and seeds can also be problematic. Stick to options like hummus, nut butter and lentils. During periods of remission, reintroduce these sources of fibre for optimal health.

In our practice, we find a huge variety in what patients can and can’t tolerate. So, when feeling well, we always encourage patients to try foods you may typically avoid due to symptoms. In order to see if your tolerance has changed. Your dietitian can help you come up with a personalized fibre plan for when you’re feeling well, and when your disease is active & symptoms are worse.

Reduce High-Fat Foods

High fat and greasy foods can prolong symptoms or make them worse. During an IBD flare, it’s advised to avoid or limit deep-fried foods, fatty cuts of meat, processed meats, and large amounts of cheese, butter, and cream.

The Mediterranean Diet

The Mediterranean Diet is an eating pattern that focuses on eating more plant-based foods, less processed and red meat, and adding in healthy fats from fish, nuts & seeds, and olive oil. This dietary pattern can be used as a guiding principle for dietary choices that reduce inflammation. It is frequently recommended by gastroenterologists. Your GI Dietitian can help you transition your typical diet to a more Mediterranean style diet.

Elimination Diets

Dietary tolerances for Inflammatory Bowel Disease are highly individual. Some people may find they develop intolerance to certain foods, such as lactose, during a flare or that certain foods make their symptoms worse. Symptoms of IBD are often debilitating. So, it’s understandable that people may assume eliminating foods from the diet or seeking out an elimination diet will be beneficial. There is some research supporting the use of elimination diets such as the low FODMAP diet for IBD symptom management. Specifically when an IBS diagnosis overlaps with the patients IBD. However, the risk of malnutrition with IBD is high and eliminating foods or food groups can make the risk higher so we do advise caution. If you are interested in exploring if you have any dietary intolerance or if strategic elimination of food is beneficial, it’s best to work with a Registered Dietitian who can provide a strategic plan for elimination and assess for nutritional inadequacies.

Exclusive Enteral Nutrition

Exclusive Enteral Nutrition (EEN) is a method of receiving all your caloric and nutrient needs from a specially formulated liquid supplement. This supplement is taken either by mouth or tube feed. EEN is a nutrition therapy used for many people with IBD when experiencing disease complications, malnutrition, medication intolerance, or if unable to adequately control the disease with pharmacological strategies. A gastroenterologist and dietitian will prescribe and manage this for you should you require it.

Bottom Line

Inflammatory Bowel Disease symptoms and management can greatly vary depending on where your disease is at. Diet can play a role in symptom management, wellbeing, and overall health – and can vary from person to person.

Working with a Registered Dietitian is important to ensure that you are meeting your dietary requirements and that your food choices are not impacting your symptoms. Book an appointment with one of our Calgary based Dietitians today.

If you’re wondering what the difference is between IBS and IBD, or if you have IBD and are trying to find out if there is a nutrition solution the registered dietitians at Ignite Nutrition in Calgary, Alberta can help you.

Categorized: Gut Health & IBS

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