The underlying cause of inflammatory bowel disease (IBD) is not known at present. While food choice doesn’t induce IBD, it can affect some disease symptoms, so it does matter what you eat. If you’re affected by IBD, aim to become knowledgeable and ‘nutritionally’ fit. Since food tolerance is a very individual experience, we’ve outlined some dietary guidelines and suggestions, rather than rules, below. These may or may not work for you. So how do you figure out what’s going to work for you? Experiment! Try introducing or removing foods from your diet for about a week and watch for good or bad results. Dietitians call this process “DAT,” for diet as tolerated. By using this process, you become the expert on your own diet.
You may also want to try keeping a food diary to help you identify particular food sensitivities. It’s easy to do. Use a small notebook or binder to keep track of your meals, listing specific ingredients, portions, time of day, and the condition under which the meal or snack was eaten (e.g. ‘on the go,’ at home at the table, in a restaurant). Also, keep track of any bowel symptoms you might have. Women may also want to note where they are in their menstrual cycle.
Things to look out for that may be causing you problems
Generally, when your disease is in an active state, high fibre foods are not recommended since they may scratch or irritate your bowels as they move through them. Sometimes, bulky, fibrous foods could contribute to an intestinal blockage, especially if you are prone to strictures. When not experiencing active disease, you may be able to gradually increase the fibre in your diet.
High fibre foods you may want to avoid:
- Nuts and seeds, including berries with seeds such as strawberries and raspberries
- Sesame seeds – if you’re eating a burger at a restaurant and the buns have sesame seeds, ask for yours to be served with two bun bottoms
- Say goodbye to irritating popcorn and corn
- Eliminate the tough outer skins on vegetables such as potato, squash, eggplant, tomato, or cucumber
More about fibre:
- Learn about fibre as you may need a fibre-reduced diet while in a disease flare up state – some low-fibre food choices include peeled apples, plain bagels, and peeled potatoes
- Alternatively, the addition of a commercial fibre supplement may be just what you need to ensure your bowel stays healthy, even with IBD – ask your physician what your particular situation requires
To reduce intestinal gas and its associated bloating and discomfort, try the following:
- Avoid gas-producing foods such as beans, cabbage, and broccoli, but only if they are a problem for you – you don’t want to eliminate too many foods or you will not have a balanced diet
- Avoid sipping hot drinks, sucking on candies, smoking, or gum chewing, in order to reduce ingested or swallowed air
Tips to ensure you get adequate nutrition:
- If you’re on a very restricted diet, then talk to your doctor about supplementation with a daily multi-vitamin
- Make sure you’re getting adequate protein, as your body needs this to heal
- If you are taking immunosuppressants, such as azathioprine (Imuran®), cyclosporine, mercaptopurine (6-MP) (Purinethol®), and methotrexate sodium (Rheumatrex™), then consider bottled water to eliminate any possible germs you don’t need, keeping in mind that bottled water can contain high levels of bacteria if it’s been opened, even when refrigerated
- Say hello to omega-3 fatty acids, which our bodies need daily and have been shown to reduce inflammation
- Some people experience pain because they have been avoiding food and are just simply hungry or thirsty, so be sure to keep eating and drinking, even if you dread the possible consequences
- Drink water or non-caffeinated, non-alcoholic beverages such as skim milk, 100% fruit juice, and soups to make sure you stay hydrated. Some early signs of dehydration are fatigue, headache, dry mouth, and dark urine with a strong odour. Water is used by every cell in the body and it aids in the absorption, digestion and transportation of nutrients. Consequences of dehydration include cognitive impairment, constipation, urinary tract infections, and poor wound healing
If diarrhea is a problem, then these hints might be particularly useful:
- Liquid supplements, such as Boost® and Ensure®, offer great nutritional benefit but may elicit diarrhea, although to help with this some versions contain added fibre. Sipping these drinks slowly over a period of time might ward off diarrhea
- Learn about probiotics, the good intestinal bacteria, and prebiotics, the food you eat that stimulate these beneficial bacteria
- Diarrhea can quicken dehydration, especially in the hot summer months, and this may lead to electrolyte loss. Sports drinks, such as Gatorade® (containing carbohydrates, minerals, sodium, potassium, and chloride) and Powerade® (containing carbohydrates, potassium, sodium, and vitamins B3, B6, and B12 – which play a role in energy metabolism) might help.
- For a homemade glucose-electrolyte replacement mixture, try this recipe:Prepare Glass 1 and 2 as indicated below
Mix together Glass 1:
1 cup of fruit juice
½ tsp sugar or honey
Pinch of table salt
Mix together Glass 2:
1 cup of boiled or
¼ tsp baking soda
Drink some from Glass 1, and then some from Glass 2, and repeat this until you aren’t thirsty
If there is any associated pain, blood, or distension; see your healthcare provider
Other dietary suggestions to ensure ‘nutritional fitness’ while living with IBD:
- Eat slowly and chew your food well
- Have frequent small meals during the day, in a relaxed environment
- Cooking foods well will make them softer and diminish contamination
- Salad a problem for you? Try eating it at the end of the meal, like the French!
- Avoid alcohol
- Avoid caffeine (e.g. coffee, tea, soft drinks, energy drinks, chocolate)
- Hot & spicy foods are irritating to some, yet others tolerate them well and some spicy foods can even reduce inflammation
Be sure to wash your hands before eating or preparing food and especially after using the toilet as hand washing is the single most important means of preventing the spread of infection from viruses and bacteria – even the flu.
A consultation with a registered dietitian specializing in inflammatory bowel disease may also provide some benefit. Most hospitals have nutrition counselling services, and your family doctor can also provide a referral. The national Dietitians of Canada website, www.dietitians.ca, is also very helpful.
Experiment and find several small improvements that, when taken together, will add up to make a big difference. Good Luck!
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