Inflammatory Bowel Disease Nutrition Program
While there’s no cure for inflammatory bowel disease (IBD), diet can play an important role in managing your symptoms during flares-ups and periods of remission. Our nutrition specialists at the Orlando Health Digestive Health Institute Center for Inflammatory Bowel Disease can help you find a diet tailored to your unique needs.
Maintaining proper nutrition – eating enough calories, protein and nutrients – is a challenge for anyone with Crohn’s disease or ulcerative colitis. And since every patient’s disease follows a different course, there’s no such thing as a one-size-fits-all diet.
You require a nutritional plan built around your experience with the disease. Your needs will vary based on a range of factors, including what part of your intestine is affected, current symptoms, whether you are in remission or having a flare, and whether your body is lacking certain nutrients, vitamins or minerals.
Our specialty dietitian is trained to provide comprehensive nutrition assessments, prescribe nutrition support and help you make better diet choices at home. These services are provided to patients with IBD, adult celiac disease and other gastrointestinal conditions. You can see the dietitian in the office, through telehealth and at community teaching programs and classes.
Diet and Nutrition as a Treatment Option
Your diet needs will vary significantly, based on what’s happening with your disease at any point in time:
Eating During a Flare
A low-fiber diet can be especially helpful when you have a stricture or bowel obstruction, are experiencing looser stools or after surgery when your gut needs time to recover. This diet can reduce cramping and bowel movements by decreasing fiber intake. That means avoiding high fiber foods such as green leafy vegetables, nuts, seeds, popcorn, whole grains, raw fruits and vegetables with peels.
Generally, it’s important to identify foods that will make your symptoms worse. Consider keeping a food log to track what you eat and any symptoms that follow.
Among the most tolerated foods:
- White rice
- Blended smoothies
- Pureed vegetable soups
- Plain chicken
- Cooked eggs
- Mashed potatoes
Among the more common trigger foods:
- Raw fruits and vegetables
- Spicy foods
- Fried and fatty foods
- Red meat
You may also see improvement by eating smaller, more frequent portions throughout the day, sticking with blander, softer foods and using oral nutrition supplements.
Remission Through Diet
There are several diets that be used as therapy to help manage your disease and keep it in remission:
- Specific Carbohydrate Diet (SCD): This is a “single sugar” focused diet that eliminates refined and processed foods, along with soy, lactose, sucrose and grains. Some vegetables, including potatoes, okra and corn, also are avoided. The diet is based on the idea that malabsorption of complex carbohydrates, lactose and sucrose causes bacterial overgrowth and intestinal injury. Small studies have shown improvement in symptoms and endoscopic findings.
- Mediterranean Diet: This diet, known for its anti-inflammatory and beneficial cardiovascular effects, is rich in fiber and plant-based foods, including olive oil, low-fat dairy, fresh herbs and spices. There is little or no red meat, while poultry, eggs, cheese and yogurt are allowed in small portions. In a recent study, this diet shows promise for Crohn’s disease patients with mild to moderate symptoms.
- Crohn’s Disease Exclusion Diet (CDED): This is a whole food-based diet sometimes used in combination with supplemental enteral nutrition therapy (a nutrient-rich formula often consumed via drinking). It focuses on fruits, vegetables, meats and carbohydrates. Foods to avoid include gluten, gluten-free baked goods, dairy, animal fats and processed meats. The goal is to improve your microbiome, alter the mucous layer in the gut and potentially change intestinal permeability by cutting out foods thought to cause intestinal inflammation. Research has shown improvement in clinical symptoms and inflammatory markers.
- Exclusive Enteral Nutrition (EEN): With this diet, 100% of your nutrition – including calories, vitamins, minerals and protein -- are consumed in liquid form. It can be taken by mouth or by a tube inserted through the nose or stomach. Studies indicate the diet can induce remission, particularly in children with Crohn’s disease. It is a popular pediatric therapy in Western Europe.
Managing Symptoms Through Diet
This dietary approach attempts to reduce symptoms – rather than the inflammation.
- Low-FODMAP Diet: This diet reduces the intake of a group of sugars that can be poorly absorbed by the gastrointestinal (GI) tract. For some, this poor absorption may contribute to diarrhea, gas and bloating. The FODMAP (Fermentable, Oligo-, Di-, Monosaccharides and Polyols) diet restricts foods containing fructose, lactose, sugar polyols (sorbitol and mannitol), fructans (found in garlic, leeks, artichokes and wheat) and galacto-oligosaccharides (found in lentils, chickpeas and green peas). While it can help with certain IBD symptoms, it hasn’t been proven to reduce the underlying inflammation.
- Gluten-Free Diet: The goal is the elimination of gluten, a type of protein found in wheat, rye and barley. You may find that it reduces symptoms, but as with the Low-FODMAP Diet, it doesn’t halt the IBD inflammation. Before transitioning to this diet, it may be helpful to get tested for gluten sensitivity, allergy or celiac disease.
Nutrition Support Therapy
Inflammatory bowel disease often makes it difficult for you to get enough calories and nutrition from food and supplements alone. You could be hampered by weight loss, uncontrolled symptoms, surgery, obstruction and severe inflammation. If that’s the case, your healthcare provider may recommend nutrition support therapy.
This could include enteral nutrition (tube feeding) or parenteral nutrition (intravenous feeding) – if the gut is not working properly and is unable to absorb nutrients.
Resources & Events
There is no universal approach to nutrition and IBD. The optimal diet plan is one that meets your individual nutritional, medical and lifestyle needs and helps you manage symptoms and inflammation. Because many of these diets involve restriction of certain food groups, this could put you at further risk for nutritional deficiencies. It is advised to discuss any dietary changes with your doctor or registered dietitian to make sure you find a plan that is nutritionally balanced and healthy.