Inflammatory Bowel Disease Nutrition Tips
(Crohn’s Disease and Ulcerative Colitis)
Nutrition Recommendations During Remission (Inactive Disease)
- Aim to eat balanced meals and snacks with a combination of protein, fat, and complex carbohydrates. Check out the plate method in Canada’s Food Guide to see what this could look like.
- Choose a variety of healthy whole foods (e.g., vegetables, fruits, nuts, seeds, whole grains) and limit the intake of ultra-processed foods, artificial sweeteners, and trans fats.
- Do not limit your intake of foods high in fibre unless they trigger symptoms for you and/or if you have stricturing Crohn’s disease. Most people have no trouble digesting fibre while in remission, while some people may still find certain foods high in insoluble (tough) fibre, such as raw vegetables, hard to digest. Fibre is incredibly important for promoting mucosal healing, stimulating sodium and water intake in the colon, and the growth of beneficial bacteria.
- Take vitamin D3 supplements (2000 IU/day). Vitamin D3 has anti-inflammatory properties and having low levels of Vitamin D (25-OH D) might increase your risk of a flare.
- Avoid low carbohydrate diets, such as the specific carbohydrate (SCD) diet, with the goal of preventing relapse, as they are not effective and major healthcare societies do not recommend them. They can be very restrictive and lead to nutrient deficiencies.
Nutrition Recommendations During a Flare (Active Disease)
- Eat smaller, frequent meals (5-6/day). Smaller volumes of food are easier to digest and process and this gives your body more time to absorb essential nutrients, while also helping to minimize gut symptoms after a meal.
- Modify the texture of foods to make them softer and easier to digest. This could include blended soups and smoothies, cooked and/or mashed vegetables and fruit without the skin, and ground meat.
- Choose foods with soluble (soft) fibre and temporarily restrict your intake of insoluble (tough) fibre to promote mucosal healing and prevent irritation and symptoms that occur with an inflamed gut lining. Foods rich in prebiotic fibres (e.g., bananas, oatmeal) may also help to reduce inflammation.
- Choose energy-dense foods that are high in protein and calories and try to make every bite count. This could include a smoothie, blended soup, smooth peanut butter with rice crackers, scrambled eggs on toast, or store-bought oral nutrition drinks (e.g., Rumble®). Easier-to-digest proteins include eggs, lean chicken, turkey, fish (e.g., tuna), plain yogurt, tofu, smooth peanut butter, and aged cheddar cheese.
- You may or may not need to restrict lactose during this time. If you experience symptoms of lactose intolerance, such as bloating, abdominal pain, and/or diarrhea after consuming a food high in lactose (e.g., 1 cup of regular milk), then a short-term restriction can help to manage and prevent these symptoms.
- Limit caffeine, alcohol, spicy foods, sugary drinks, tough red meat with lots of connective tissue (e.g., steak), and deep fried, greasy foods.
- Take a daily multivitamin in a form that is easier for your body to absorb and digest (e.g., liquid, crushed, chewable).
- Take vitamin D3 supplementation in liquid form (e.g., drops). Vitamin D3 drops packaged with oil helps to increase and optimize the absorption of this fat-soluble vitamin.
- Consider calcium supplementation. It can be hard to eat enough food during a flare, including calcium-rich foods. Calcium deficiency may increase your risk of bone loss and osteoporosis, especially when taking certain medications (e.g., corticosteroids). Check out the online calcium calculator at osteoporosis.ca/calcium-calculator to get a general idea of how much calcium you’re getting, and talk to your doctor, pharmacist, and/or registered dietitian to see if additional foods or supplementation may be a good idea for you.
- Consider short-term zinc supplementation if you are having more than eight watery and loose bowel movements per day. Talk to your doctor, pharmacist, and/or registered dietitian to learn more.
- Consider an electrolyte drink (oral rehydration solution) to replace fluid and electrolyte losses if you are having diarrhea and are having trouble staying hydrated.
- Consider short-term L-glutamine supplementation to help meet the body’s increased needs during a flare and to help promote healing of the inflamed gut lining.
- You might need nutrition support in cases of severe and active disease to allow your body to properly heal and repair itself, meet the increased nutritional needs during a flare, prevent nutrient deficiencies, and correct signs and symptoms of malnutrition. This could include enteral nutrition (tube feeding or oral nutritional supplements) or parenteral nutrition (TPN) where you receive nutrition intravenously.
Unique considerations for Crohn’s disease
- Consider vitamin B12 supplementation if the inflammation is affecting the terminal ileum where most of this vitamin is absorbed.
- Consider folic acid supplementation if you are taking certain medications such as sulfasalazine and/or methotrexate and if you have a decrease in intake of folate-rich foods such as spinach.
- Current research does not show fish oil supplementation to be effective at inducing or maintaining remission in Crohn’s disease.
- If you are considering probiotic supplements, please consult your doctor, pharmacist, or registered dietitian. Research does not currently support probiotic supplementation to be effective at inducing or maintaining remission.
Unique considerations for ulcerative colitis
- Eat foods rich in iron (as tolerated) and/or take additional supplementation if your iron levels are low. Foods rich in iron include eggs, liver, meat, fortified oatmeal, pumpkin seed butter, and blackstrap molasses. Some forms of supplemental iron are easier to digest than others, and you may need to take iron through an IV depending on the severity of the flare. Talk to your doctor, pharmacist, and/or dietitian to learn more about which form would be best for you.
- Consider taking some forms of probiotic supplementation ( coli Nissle 1917, VSL #3) as they have shown promise for ulcerative colitis and may help to prevent acute pouchitis.
Please consult your doctor, pharmacist, or registered dietitian for more information.