As the old adage goes, “an apple a day…”
Does an apple a day keep IBD under bay? Let’s delve into what we know about inflammatory bowel disease when it comes to nutrition and lifestyle.
IBD (inflammatory bowel disease) and Nutrition:
The main thing to remember is that there is no single common diet suitable for all patients with inflammatory bowel disease. The general consensus from the International Organization for the Study of IBD advises patients with inflammatory bowel disease (Crohn’s disease and ulcerative colitis) who are in remission (meaning that their disease is under control with medications) to consume a diet composed of healthy carbohydrates, fats, and protein. Patients should consume fiber-rich food, should limit processed foods and artificial sweeteners, and should avoid trans-unsaturated fats. Excessive consumption of animal fat or sugar (including artificial sweeteners) is considered a risk factor for IBD development whereas diets high in fiber, Vitamin D, and citrus fruits may be protective.
We also know that IBD can lead to nutritional deficiencies if it is not in remission. The micronutrients that we are usually referring to include iron, calcium, Vitamin D, Vitamin B12 and, to a lesser degree, folic acid, zinc, magnesium and Vitamin A. A healthy diet composed of a variety of vegetables, fruits, dietary fibers, and polyunsaturated fatty acid should be sufficient to get all the necessary micronutrients once the disease is in remission.
IBD and Diets:
Some of you may have heard about restrictive diets such as low FODMAP and specific carbohydrate diets. Data on the low FODMAP diet with IBD has been conflicting. We do know that a low FODMAP diet helps to decrease symptoms of gas and bloating for patients with irritable bowel syndrome. As such, a low FODMAP can potentially mitigate gas and bloating symptoms in patients with inflammatory bowel disease, but it does not change underlying inflammation within the disease process.
The specific carbohydrate diet is a rather restrictive diet that is postulated to have beneficial effects on inflammation from inflammatory bowel disease. It involves the elimination of all grains, refined/processed sugars/foods, and many dairy products. Due to the restrictive nature of this diet, there is a risk of compromising nutritional status which would need to be seriously considered, especially as malnutrition can be common in IBD, and restrictive diets should be supervised by a dietician and your physician.
IBD and BMI (body mass index):
As we know, obesity is a complex disease with an excessive amount of body fat, and it leads to an increased risk of diseases, including heart disease, stroke, diabetes, and high blood pressure among many other things. Obesity is defined as body mass index (BMI) greater than 30, whereas a BMI between 25-29 is considered overweight.
The prevalence of obesity in the United States among adults older than 20 years of age was noted to be 42.4% in 2017-2018, according to the CDC. Between the years 2015-2016, the prevalence of both obese and overweight individuals was noted to be 71%. The bottom line is that this is a very common problem.
So what role does it play when it comes to IBD? Obesity increases the risk of IBD relapse or flare and is associated with higher anxiety, depression, fatigue, and pain, which can further exacerbate IBD symptoms. Obesity also changes how your body processes medications and can make your medicine less effective, including many of the medicines used to treat IBD. This can lead to unfavorable results and treatment failure.
IBD and overall lifestyle:
A recent article published in March 2020 in Clinical Gastroenterology and Hepatology looked at 3 large cohort studies showing an association between a healthy lifestyle and reduced mortality in patients with inflammatory bowel disease. A healthy lifestyle includes never smoking, having a normal BMI (that pesky BMI pops up again), performing at least moderate physical activity, and consuming a Mediterranean diet with light consumption of alcohol. There is an about a 4-fold increase in the risk of mortality for active smokers, particularly those with heavier tobacco use. It is never too late to quit or start trying to quit with all the known benefits of tobacco cessation.
The Mediterranean diet is a hot topic, especially in regard to heart health, and has now been shown to have some benefit in IBD. The foundation of the diet includes vegetables, fruits, herbs, nuts, beans, and whole grains. Meats, which are included in moderate quantity, primarily consist of poultry, eggs, and seafood. Red meats are consumed infrequently.
What are some examples of moderate physical activity?
- Walking briskly (about 3-4 miles per hour)
- Bicycling (about 10 mph)
- Golf (walking and carrying clubs)
- Water aerobics
- Just a few examples.
Moderate physical activity for 30 minutes a day, 5 days a week, is recommended.
IBD during times of Corona…
And finally, with our current viral pandemic, where the United States is the epicenter, it is all the more reason to keep the above in mind. We have an opportunity to take this time to help ourselves by eating healthy and increasing our physical activity, which, in addition to helping manage your IBD as explained above, also releases endogenous endorphins that are greatly needed during these times of stress. Many of our patients with IBD have asked some great questions during the coronavirus outbreak. Should they come off of their immunosuppressive therapies? Are they more susceptible to getting COVID 19? If they do get COVID 19, will they have a more serious illness?
First and foremost, it is important that you do not stop taking your medicine. There was a GI journal article published on April 20, 2020, saying exactly that. There is no clear data that people on immunosuppressants are increasingly acquiring Coronavirus or having worse outcomes. Additionally, stopping your medicine can lead to IBD flares, often requiring you to end up in the hospital on steroids, where the chance of catching COVID-19 is higher. It is best to continue taking your immunosuppressive agents and to continue following the CDC recommendations, including staying at home/limiting exposures, wearing masks, rigorous handwashing, and maintaining 6 feet of distance.
If you have any questions, please give us a call at 336-768-6211 and we would be happy to answer!
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Digestive Health Specialists, PA is here to help if you, or someone you know, would like more information, or if you are experiencing any digestive health symptoms and would like further evaluation. Feel free to give us a call at 336-768-6211 or fill the form below.