Nutrition and IBD

If your IBD is under control and you are relatively symptom free, follow Canada's Food Guide, as it emphasizes a wide variety of foods that provide all the nutrients the body needs. There is no need to restrict foods or to follow a special diet as this could deprive your body of important nutrients it relies on. Isolated nutrients in supplements may also be unnecessary. Eating "real food" is tastier, filling, and provides more nutrient variety. A well-balanced diet including a variety of foods is best for good health.

If you are experiencing acute disease activity, you may find it helpful to modify your regular diet, for example by eating a low-fibre diet This helps to minimize gastrointestinal symptoms, but does not play a role in preventing the progression of the disease. It is vital that you try to maintain good nutritional status during this time.

It is important to remember that dietary changes should not compromise your well-being. This means maintaining moderate weight and energy levels, continued enjoyment from eating, and participation in social situations involving food. Food is an important aspect of your quality of life, and your health care providers, including a clinical dietitian, can help you learn about your own food tolerances to find the diet that works for you.

People who have IBD are at a risk of malnutrition. Factors that contribute to malnutrition include:

• malabsorption (altered digestion and absorption with inflamed gut mucosa)
• increased gastrointestinal losses (bleeding, diarrhea)
• increased requirements
• decreased dietary intake (associating symptoms with eating) due to:
  • bloating, cramping
  • nausea, vomiting, diarrhea
  • loss of appetite
  • fear of eating due to pain
  • elimination diets
  • therapy: medical (drug-nutrient interactions)
  • surgical (resections/shorter bowel with less absorptive surface)

Diet therapy is individualized as it considers all of the above factors. It usually focuses on hydration, electrolyte balance, ensuring adequate intake of nutrients, modifying foods to manage gastrointestinal symptoms, and replacement of deficient nutrients if needed. All of this is considered in the context of an individual's severity of symptoms, food preferences, tolerances, finances, and lifestyle.

Symptom management often includes:

• reducing the frequency of bowel movements
• increasing consistency of loose stool
• minimizing obstruction risk (post-op or for individuals with bowel structures)

Strategies to achieve this involve:

• decreasing insoluble fibre in the diet (e.g. skins and seeds of fruit and vegetables, whole wheat and whole grain breads and cereals)
• gradually increasing soluble fibre (oats, oat bran, pulp of fruits and vegetables, legumes, and barley)

Insoluble fibre increases the amount of stool and stimulates bowel movements. Soluble fibre contributes less to fecal bulk, and helps form loose bowel movements. Other strategies may include modifying dietary intake of lactose, fat, simple sugars, or caffeine. Changes to meal size, composition (e.g. nutrient density), and timing (e.g. small frequent meals) can also be evaluated.