In our recent conversation with ISCC members the questions of a specific diet for IBD was raised. Simply put, there is no specific diet that people with inactive IBD should follow*. However, there is evidence that a Western style diet, which is typified by higher intakes of processed meats, fast food, high fat intake, and conversely lower intakes of fruits, vegetables, and fibre, is implicated in the development of IBD as well as other conditions including heart disease and cancer. What we do know from the evidence is that a healthy balanced diet is important for those with and without IBD and a healthy, balanced diet is associated with better health outcomes overall. Emerging scientific evidence has indicated a Mediterranean diet, which is associated with lots of positive health effects, could be beneficial for people with IBD. There is emerging evidence for a low FODMAP diet in some patients with IBD. More details on these diets are given below.
*People with an active episode of IBD may be advised by their healthcare professional to follow a particular diet. The above information is specific to inactive IBD.
A Mediterranean Diet
A Mediterranean diet is a diet defined as a high intake of plant-based foods, unrefined cereals, fruit, vegetables, legumes, olive oil a moderate to high consumption of fish and dairy products along with a lower consumption a red meats, processed meats and saturated fatty foods such as pastries and foods containing large quantities of sugar. Some research has suggested that a Mediterranean style diet is associated with an improved quality of life and reduced disease activity in Crohn’s Disease and there is lots of evidence to suggest a Mediterranean diet is associated with good health overall.
Low FODMAP diet
A Low FODMAP diet is a therapeutic diet typically used in the treatment of irritable bowel syndrome (IBS). Although a low FODMAP diet is not an established treatment option for IBD, emerging evidence has shown some promising findings that a low FODMAP diet may help to reduce gut symptoms in people with both IBD and IBS. A low FODMAP diet is a very restrictive diet which should be done in collaboration with a registered dietitian to ensure that your diet is healthy and as varied as possible throughout the process. This restrictive diet is not recommended without dietetic guidance and has the potential to increase the risk of malnutrition and or nutritional inadequacies if undertaken without dietetic support. For more information, seek advice from a registered dietitian. It is not recommended that people implement this diet without support from a registered dietitian or healthcare professional.
Vegetarian or plant-based diets
There is currently no compelling evidence in support of a vegetarian diet in IBD. If you choose to become vegetarian it is important to understand food and identify areas of concern. In IBD nutrients such as iron, calcium, vitamin D among others can be low. These nutrients can also be low in vegetarian and particularly vegan diets so it is important to carefully consider the adequacy of a vegetarian or vegan diet. If you are considering removing meat from your diet consider substituting meat or meat products with plant-based protein alternatives such as beans, lentils, chickpeas, tofu, soya alternatives and nuts.
Iron rich sources should also be included and can include lentils beans, peas, dark green leafy vegetables such as spinach, cabbage and broccoli, dried fruits such as figs, apricots, raisins eggs, and cereals fortified with iron .
The amount of calcium and vitamin D in plant sources is not as readily available when compared to animal sources, so choosing fortified milk and calcium set tofu to increase the calcium content of your diet and fortified cereals containing vitamin D can help rich the calcium and vitamin D targets. If you think your diet may be lacking in these nutrients, a multi-vitamin can be considered to supplement.
Meal Patterns and Portions
Large meals can cause gut symptoms in many people, both with and without IBD. A practical strategy to minimise symptoms can be tracking your meal patterns and portion sizes. People with IBD may find that reducing the size of meals and having smaller but more frequent meals can be helpful in terms of managing symptoms.
Exploring the relationship between the timing of meals and symptoms can also be worth considering. Whilst there is a lack of research on the impact of meal timings and IBD symptoms some patients find it helpful to change the timing of their meals. For instance, some individuals may find their symptoms are worse in the mornings, whereas others may find symptoms are worse in the evenings. A food and symptom diary can help you keep track of your symptoms, food and drink intake and identify the best timing of meals for you. If the mornings are more problematic for you, try having a lighter breakfast in the morning and more substantial meals as the day goes on. Another benefit of keeping a food and drink diary is you may be able to identify certain foods that could be causing more symptoms for you. Remember that each individual may vary, what works for one person may not be what works for you.
Emerging Evidence: Diet and IBD
The area of diet and IBD is a very active area of research and while no formal recommendations yet exist there are several active areas of research that are being explored. For example, the role of emulsifiers in IBD. Emulsifiers are food additives which are added to a food to stabilise the consistency of food items; they prevent the separation of oil and water helping to prolong the shelf life, improve the appearance and mouth feel of a food when eaten. Studies so far, although very small in size, suggest that emulsifiers may contribute to an increase in inflammation along the GI tract which could trigger symptoms and so it has been suggest that some individuals with IBD may find it beneficial to reduce foods containing dietary emulsifiers6 . These studies have focused predominantly on emulsifiers which do not occur naturally in foods such as lecithin commonly found in chocolate, xanthan gum found in mayonnaise and carrageenan found in flavoured milks, iced coffee and dairy based ice cream. But before you drop the tub of mayo, remember this is a new area of research and no definitively conclusions can be drawn.
Probiotics have been defined by the World Health Organisation as “live microorganisms which, when administered in adequate quantities, confer health benefits to the host”. In more simple terms an organism which is really any living structure such as a plant bacteria fungus or animal that is either consumed through a capsule or naturally through certain foods such as Greek yoghurt, kefir or kombucha when eaten these foods may have beneficial effects on the digestive system.
Can Probiotics Help Maintain Inactive IBD?
Naturally occurring probiotics found in fermented foods have been part of the human diet for centuries and were initially produced to preserve foods, improve flavor, and eliminate toxins, now many people are incorporating fermented foods in their diets because they contain probiotics which have a positive effect on heart and digestive health. Kefir is a fermented dairy product which has been shown to have a positive effect on bloating and overall general digestive symptoms period 7. There is currently no evidence to support the use of probiotics in the remission or maintenance of inactive Crohn’s disease. In mild to moderate Ulcerative colitis some early-stage evidence suggests that some specific probiotics may help prolong remission. These probiotics that have shown a small benefit include Escheria Coli Nissle 1917 or VSL #3 which are available over the counter in a capsule form.
Prebiotics are carbohydrates which promote the growth of good bacteria in the gut. They occur naturally in many foods such as oats, garlic, onions, leek, asparagus, bananas, apples and bran and can be consumed as part of a healthy balanced diet. Scientific research has found no link between prebiotics and a reduction in active episodes of IBD but research is ongoing within this area so watch this space!