When I was diagnosed with Crohn’s disease 3 months ago, some of my friends and family said, “You’re a dietitian, so it’ll be easy for you to fix this through food.” While these comments were always meant with the best intention, many people don’t realize that there is no cure for Inflammatory Bowel Disease (IBD), diet included. Food is often a huge source of anxiety for people with IBD, especially in social situations, as it can often trigger unpleasant symptoms, such as bloating, gas, diarrhea, nausea, and vomiting. Over time, many people with IBD experience malnutrition and unintended weight loss due to the body’s inability to retain nutrients. However, changing the way that food is prepared, cooked, and eaten may greatly help reduce the frequency and severity of symptoms and improve overall health.
A low-residue (also called low-fiber) diet is one of the most widely-prescribed diet therapies for people with Crohn’s disease and other forms of IBD. While most adults are instructed to increase their fiber intake, many gastroenterologists recommend limiting high-fiber foods to people with IBD in an attempt to minimize gut irritation. This includes limiting foods like whole grains, fruits, vegetables, nuts, and seeds. For those who make eating healthy a priority, it can be very challenging to find foods that are both nutrient-dense and low-residue. Here are 10 practical nutrition tips to help make food an effective tool in symptom management.
1. There is no “one size fits all”
Just as there are a variety of medications and surgeries that can be used to manage IBD, there are many different eating styles and techniques that can be helpful as well. When approaching nutrition as a symptom-management tool, it’s important to remember that it can take quite a bit of trial and error to find what works best. A little patience and persistence can go a long way in finding symptom relief.
2. Keep a food journal
One of the best ways to stay organized when making diet changes is to keep track of the results in a food journal. Make one small diet change at a time and track any changes in symptoms for the next day or two. This helps to identify a food that may be triggering symptoms (a “trigger” food) that should be avoided. It can also help identify which foods are safe to include and thereby reduce anxiety around mealtime.
3. Test for trigger foods
Instead of blindly guessing at which foods may cause unpleasant symptoms, try following a short-term elimination diet. There are many types of elimination diets out there that have been found to be effective for IBD management. The low-FODMAP diet and the Specific Carbohydrate diet have both been found to be effective elimination plands that can help guide the trial and error process. In fact, some research shows that these plans may be more effective in symptom management than a low-residue diet alone.
4. Make protein a priority
It’s not just important to ditch trigger foods. Including the foods that provide nourishment and support health is just as important. When anyone with a chronic condition begins to unintentionally lose weight, the body will go first for the lean protein source- muscle. Muscle breakdown related to illness has been linked with higher changes of complications and hospitalization in those with IBD. For that reason, it is crucial to provide the body with protein it needs from an external source (food) so that it doesn’t start breaking down the internal source (muscle). It’s also important to spread protein sources out throughout the day to allow the body to absorb and use it best. If poor appetite is an issue, try including protein in 5-6 small snacks, such as 1 hard-boiled egg, ½ cup of cottage cheese, or a scoop of protein powder with milk. Remember that protein is also found in plant sources, like nut butters, beans, quinoa, and tofu.
5. Ditch the skins
Whether it is from a plant or animal, be sure to remove any skin before eating. Animal skin, such as that found on chicken, is high in fat and can cause often trigger IBD symptoms. Plant skins, like that found on potatoes, apples, pears, and plums, are high in insoluble fiber that can be difficult to digest.
6. Choose cooked over raw plants
There’s nothing like a raw kale salad to send someone with IBD running for the nearest restroom! While raw vegetables are full of nutrients, they are packed with difficult-to-digest insoluble fiber that can further irritate an inflamed digestive tract. Sautéing, roasting, or steaming fruits and vegetables can help to break down some of the insoluble fiber and make these foods easier to digest. Avoid boiling vegetables directly in water, as this causes some of the nutrients to leech out during cooking. Using a steaming basket helps to preserve vital nutrients the body needs to support health.
7. Go for purees
During my most recent flare, purees were my go-to for nutrition support. Smoothies, nut butters, and fruit purees like applesauce are a simple way to break down fiber without cooking. Also remember to use the blender you were born with- your mouth! Chewing is the first step of digestion, as it helps to break down larger fibers and allows the enzymes in saliva to begin the digestive process.
8. Consider nutrition supplements
When calorie intake is very low or when unintended weight loss becomes chronic, consider taking a nutrition supplement, such as a health shake or protein bar. These supplements can increase calorie, protein, and nutrient intake in a small volume of food or liquid. Also consider investing in a juicer to juice fruits and vegetables. This simple technique removes almost all the fiber, allowing for nutrients to be absorbed while minimizing gut irritation.
9. Get tested for deficiencies
Many people with IBD have vitamin and mineral deficiencies, such as iron and vitamin B12. These two vitamins in particular can contribute to anemia, which may worsen IBD-related fatigue. Talk to your gastroenterologist about getting tested for anemia and other deficiencies so that treatment can begin. Always talk to your doctor before beginning any vitamin, mineral, or herbal supplement.
10. Meet with a dietitian that specialises in digestive diseases.
The Registered Dietitian (RD) is the professional expert on all things food and nutrition. Consider setting up an appointment with a RD to gain more knowledge and tools to help make your diet work for you instead of against you.