Living healthily

Diet

Maintaining a healthy lifestyle – eating well, getting enough exercise, and keeping bad habits to a minimum – has benefits for everyone. When you have IBD leading a healthy lifestyle can also help manage your symptoms and keep you feeling well.

People with IBD will often have:

• Loss of appetite: As a result of feeling unwell, pain and nausea as well as diarrhoea
• Weight loss: As a result of diarrhoea and poor appetite
• Altered fluids, nutrients, and electrolytes (‘salts’) absorption due to inflammation in small intestine and/or colon
• Diet-related flare-ups (in some people)

A well-balanced diet can help to prevent nutritional deficiency, particularly in patients with Crohn’s disease.

Diet is not the cause of IBD, but certain foods may trigger a flare-up or make symptoms worse. Those triggers can vary widely from person to person and no one type of food or beverage aggravates symptoms for all people with ulcerative colitis or Crohn’s disease.

Although there is no ‘magic’ diet that works for everyone with IBD, a healthy diet generally will help you manage your IBD and reduce the effects of flare-ups.

A healthy diet is more about what you keep in your diet, rather than what you cut out. If you exclude foods but find no real difference in your symptoms then you can try to reintroduce them back into your diet.

To determine which foods tend to provoke symptoms and flare-ups, it can be useful to keep a food diary. This can help you to see how your diet relates to your symptoms.

In general, people who have either ulcerative colitis or Crohn’s disease should:

• Eat smaller portions regularly. Divide the daily intake into 5-6 smaller portions and eat every 2-3 hours. This is better than eating less frequently but larger portions. Smaller portions will help to reduce the load on the digestive tract, helping it to digest the food better
• Reduce intake of fat. Fats can increase instestinal peristalsis and so crampy pains. Reducing oils, butters, hardened fats and margarines, cream but also desserts and filled biscuits can help to reduce fat intake
• Reduce intake of simple sugars. These are found in honey, desserts, cakes and concentrated fruit juices. They may cause or increase the chance of diarrhoea
• Reduce or avoid intake of milk and dairy products. Milk and dairy products (milk, cream and processed cheeses, less in yogurts both full-fat or low-fat) can aggravate symptoms of IBD. They should be avoided during flare-ups and then gradually re-included in the diet according to your personal tolerance for dairy products
• Avoid preserved meals and semi-finished products
• Avoid savoury and spicy meals
• Avoid artificial sweeteners – in particular sorbitol – that may cause or increase the chance of diarrhoea
• Avoid nuts and seeds
• Avoid greasy and fried foods, which can cause gas and diarrhoea
• Restrict foods high in fibre, such as fresh fruits and vegetables and wholegrains, as these can aggravate symptoms (especially when the intestines are inflamed). During a flare-up it is necessary to avoid oat flakes and corn flakes as well as legumes, vegetables and fruit with high fibre content (in particular cabbage, sprout, citrus fruit, plums, grapes and apricots). Served fruit and vegetables need to be peeled, cleared of seeds and heat-treated (e.g. stewed apples are suitable)
• Cook high fibre foods before eating: Rather than eliminating these necessary foods from your diet, thoroughly cook fruits and vegetables, and avoid eating them raw
• Avoid foods that can cause gas such as beans, cabbage, broccoli, caffeine, and carbonated drinks

If a particular food causes problems, talk to your healthcare provider or dietician before permanently eliminating it from your diet. You may need to add a vitamin or mineral supplement to replace necessary nutrients.

Next steps:

• Speak to your IBD specialist to see whether you would benefit from discussing your own situation with a dietician or nutritionist
• Read up on healthy eating guidelines
• Create a shopping list incorporating foods you have learnt about and think you may enjoy
• Discuss with your family or housemates what changes you may be making to your diet

Do I need to eat differently during a flare-up?

During a flare-up, you may want to give your intestine a “rest” and restrict your food intake. However, as a result, you may miss out on important nutrients, in particular, proteins that help the body to cope with the inflammatory process. Moreover, some medicines (mainly steroids) may interfere with protein metabolism. You may find it easier to digest food if it is mashed up or pureed.

Once your flare-up has been resolved, it is important to reintroduce any food you avoided in the space of 3-5 days one at a time.

Is there a special way to cook my food?

To help to reduce pressure on your digestive system, foods should be heat-treated and easily digestible. Stewing, steaming, braising or moderate grilling are all good ways to cook food. You should avoid frying where possible.

What is a healthy, varied diet?

The basic principles for diet in IBD are the same as those for the rest of the general population. This means that the diet should include a mixture of carbohydrate-containing foods (potatoes, pasta, rice, bread, oats, corn), protein-rich foods (meat, fish, milk, eggs and cheese) and lower amounts of fat, particularly animal fat. Together with fruit, vegetables and fluids, these provide the energy, vitamins and trace elements that are necessary to ensure good health.

Should I avoid milk?

Some people cannot properly digest lactose, the sugar present in milk and many milk products, regardless of whether they have IBD. This is because they do not make enough of a digestive enzyme, called lactase.

Poor lactose digestion may lead to cramps, abdominal pain, gas, diarrhoea, and bloating. If you are unsure about whether you have lactose intolerance, ask for a “lactose tolerance test” to identify the problem.

If you have ulcerative colitis or Crohn’s disease, you can also try limiting dairy products and seeing if that makes a difference. If you think you are lactose intolerant, you can try adding lactase supplements to help your body digest this type of food.

Dairy foods are a good source of nutrition, in particular calcium and protein, so you should, where possible maintain intake of this food group.

Do I need to take extra vitamins?

People with Crohn’s disease in particular may need to take vitamin supplements  since the condition affects the small intestine, the area responsible for absorbing vitamins from food.

Vitamin B12 is absorbed in the lower ileum. If you have ileitis (Crohn’s disease that affects the ileum), you may need to take injections of vitamin B12, because your body cannot absorb enough from your food.

If you are on a low-fibre diet, you may not be getting enough of certain vitamins common in fruits, such as vitamin C and may need to take a supplement.

In general, it is probably worthwhile for most people with IBD to take a multivitamin preparation regularly.

If you suffer from maldigestion or have undergone intestinal surgery, other vitamins, particularly vitamin D, may be required especially in non-sunny countries, and calcium intake may be necessary. Steroid use and Crohn’s disease itself are linked to bone thinning and osteoporosis, so adequate calcium and vitamin D are very important.

In general, people with IBD do not suffer from mineral deficiency. However, calcium, phosphorus, and magnesium supplements may prove necessary in people who have extensive small intestinal disease or who have had substantial lengths of intestine removed through surgery. Iron therapy is helpful to correct anaemia. Oral iron turns the stools black, which can sometimes simulate intestinal bleeding.

How much fluid should I be drinking?

Since people with inflammatory bowel disease often experience diarrhoea, there may be a risk of dehydration and eventually kidney problems. Initially, dehydration and salt loss create a feeling of weakness. If your fluid intake does not keep up with diarrhoea, your kidney function may be affected. Patients with Crohn’s disease can have an increased incidence of kidney stones. For these reasons, people with IBD should consume ample fluids, especially in warm weather when skin losses of salt and water may be high.

Are there supplements that I can take?

At present, there are numerous experimental studies to see if supplements have a benefit in inflammatory bowel disease. Examples include:

• Fish or flaxseed oils, in the diet or as supplements, have helped fight the inflammation in IBD
• Complex carbohydrates (e.g. psyllium) that are not digested by the small bowel, may stimulate the bacteria in the colon to produce short-chain fatty acids, which help the mucosa (the lining) of the colon to heal itself
• L-glutamate is believed to nourish the lining of the small intestine and may be helpful in healing in early Crohn’s disease
• Probiotics (e.g. Lactobacillus preparations and live-culture yoghurt). “Good” bacteria may help to restore balance to the intestinal bacterial (microflora). Live yogurt can be very helpful in aiding recovery of the intestine

There is still a lot of research needed to see how such supplements may help in both ulcerative colitis and Crohn’s disease.

Treatment with certain minerals (selenium, calcium), vitamins (folic acid) and medications (the 5-ASA drugs seem to fulfil this role for many with IBD) to prevent colorectal cancer is  still a developing field, and there will be more about this as new research studies are published.

Exercise

If you are experiencing a flare-up of your ulcerative colitis and Crohn’s disease, you may not feel like exercising, but you should not use your symptoms as an excuse not to exercise.

Staying active is good for you psychologically as well as physically. Osteoporosis, a condition where bones become weak and brittle, is a possible complication of IBD. There is evidence to show that exercise builds up bone and helps to prevent osteoporosis. If you are able to exercise, you will not be at risk of ‘over-doing it’ just because you have IBD. You will have a pretty good idea of what types of exercise you can and cannot do.

Remember:

• You don’t have to engage in intense activities to gain benefits
• Less intense activities (many of which can be done near toilet facilities) can include stretching and toning, walking, swimming, cycling and golf
• Engaging in more strenuous activities regularly when you are feeling well is perfectly OK – there are a number of elite athletes with IBD whose condition doesn’t prevent them from competing at the highest level