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 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. More on this later.
We also know that IBD can lead to nutritional deficiencies if it is not in remission. The micronutrients 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 acids 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 physician.
Foods that trigger symptoms vs foods that are associated with inflammation: broad concepts.
There are some foods (trigger foods) that cause unpleasant symptoms that one would want to minimize in the diet. These trigger food do not necessarily cause harm but does make symptoms (gas/bloat, abdominal discomfort, cramping, diarrhea, etc.) worse. Much of the low FODMAP diet is concentrated on these concepts. Some common trigger foods/beverages:
High insoluble fiber (does not dissolve in water) such as raw kale, apple with skin, sunflower seeds
High-fiber foods such as cabbage, cauliflower, asparagus, Brussels sprouts, and other cruciferous vegetables
High lactose-containing foods
Sugar alcohols and added sugary foods
Alcohol, caffeinated beverages, and energy drinks (dehydrates your system)
There are also foods that are associated with an increased risk of inflammation if eaten too frequently. Some of these include:
Processed foods containing certain additives (more research is needed)
What to eat during an IBD flare?
Soft, bland foods (rice, white bread, pasta)
Low-fiber foods (banana, cantaloupe)
White meal poultry
Soy, eggs, tofu
Skinless, fully-cooked vegetables
Hydrate well (at least 8 tall glasses of water)
Eating smaller meals with the combination of the above, 4-6x/day may be more beneficial to decrease symptoms during a flare
Again, there is no “one size fits all” and while in a flare, it is still important to get adequate hydration and nutrition.
Once you are no longer in flare and start getting into remission, then you can start reintroducing varied foods so that your diet is diverse.
Working with a dietician can also be beneficial.
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 a 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:
An 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 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 regarding heart health, and has now been shown to have some benefits for IBD. The foundation of the diet includes vegetables, fruits, herbs, nuts, beans, and whole grains. Meats, which are included in moderate quantities, 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)
Just a few examples.
Moderate physical activity for 30 minutes a day, 5 days a week, is recommended.
If you have any questions, please call us at 336-768-6211; we would be happy to answer!
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 out the form below.