With half a million people in the UK living with inflammatory bowel disease, this painful, debilitating condition affects around one in 123 people. Navigating the ins and out of the condition can be difficult, and finding the right foods to eat is stressful, but here, writer Jenna Farmer, who has Crohn’s disease herself, helps you navigate how to find the right diet when living with IBD
Inflammatory bowel disease (or IBD for short) is an umbrella term used to describe Crohn’s disease and ulcerative colitis, which can cause both painful and distressing symptoms, including fatigue, stomach pain, diarrhoea, bleeding and mouth ulcers, to name but a few.
When diagnosed, what they eat can cause a lot of confusion for patients. Some may notice a direct correlation of worsening symptoms after eating certain foods, while others will feel clueless and unwell whatever they eat.
It’s important to note that diet cannot cure or necessarily control IBD symptoms, but many patients do find it a helpful strategy to figure out potential trigger foods, alongside taking medication. Studies have shown most patients with IBD do recognise that diet plays a part in their condition, with one published in the journal Digestive Diseases finding that 59% thought diet was more or of equal importance to the medication they took in controlling their condition, and 77% restricted certain foods.
While most say diet plays a part, that doesn’t mean they have it all figured out: research in BMC Gastroenterology suggested that patients found this a struggle and stressful, and part of that is because they’re not necessarily receiving the right support. Like any chronic condition, support from a dietitian should be available, but not everyone is able to access them.
“Every single person with IBD deserves high-quality, personalised, joined-up care, allowing them to live a full life, but a recent review of IBD services found that only 7% of services had enough dietitians to meet IBD standards,” says chief executive of Crohn’s & Colitis UK, Sarah Sleet.
Understanding your trigger foods
Trigger foods are items you consume that can appear to make your symptoms worse, although this doesn’t necessarily mean they impact your condition directly.
“It’s really important to clarify that just because a food triggers symptoms, it doesn’t mean it’s triggering inflammation,” explains Clemmie Oliver, IBD specialist nutritionist and founder of the NALM Clinic. “Different foods have mechanisms by which they may trigger symptoms in people with Crohn’s, for example, when they eat milk/cream they get symptoms like bloating and diarrhoea – this isn’t because its triggering inflammation (but the symptoms can sometimes feel similar to a Crohn’s flare up), but instead its an issue with their ability to digest the naturally occurring sugar in dairy called lactose. Lactose intolerance is more common in people with Crohn’s disease, particularly in those with Crohn’s affecting the small intestine.”
Triggers are different for everyone, but there are some common ones that many people with IBD have, which may be a useful starting point to explore.
“Data from research studies on patient-reported symptom trigger foods in IBD found 12 foods were most commonly reported: milk/cream; dairy products; spicy foods; raw nuts and seeds; red and processed meats; corn and popcorn; raw fruit; vegetables; beans and lentils; sweets and added sugars; high fibre foods; and citrus fruits,” explains Clemmie. “Not every person with Crohn’s will have issues with all of these, but they can be a useful place to start.”
Some prefer to keep a food diary over a period of a few weeks to see if they can figure out which of these foods could be an issue for them, but it is important not to eliminate lots of foods from your diet – especially since patients with IBD are at risk of malnutrition. “No restrictive diet should ever be used without the guidance and support of a specialist IBD dietitian or nutritionist, as restriction can increase the risk of nutrient deficiency, and have a negative impact on Crohn’s disease,” adds Clemie.
While many patients focus on excluding foods, it is important to recognise the role of the diet as a whole, too.
When you’re flaring, you may feel as if you can’t eat anything at all. In some cases, you may be prescribed a 100% liquid diet (sometimes referred to as enteral nutrition). This is when your doctor prescribes you specially created liquid drinks (common brands include Ensure and Fortisip) to meet all of your nutritional needs. Of course, this isn’t usually a long-term measure, but can be a very useful short-term strategy that allows patients to rest their digestive tract.
While the low FODMAP diet isn’t specifically for IBD, we do know that it is very helpful with irritable bowel syndrome (IBS) symptoms. This is important as many IBD patients may also experience IBS symptoms too when in remission, around 40% in fact, according to a study in Gastroenterology & Hepatology. The low FODMAP diet centres around limiting short-chain carbohydrates – such as those found in apples, wheat, and milk – as they can ferment in the gut and cause digestive symptoms.
The Mediterranean diet hit the headlines last year when it was shown specifically to improve symptoms of patients with Crohn’s, with 43.5% of those who followed it for six weeks achieving clinical remission in a study funded by the Crohn’s & Colitis Foundation and the Patient-Centered Outcomes Research Institute. The Mediterranean diet is centred around fruit, vegetables, wholegrains, and fish, and avoids red meat and processed foods.
“Generally, research is pointing towards a Mediterranean diet as a way of eating that may be beneficial not only for Crohn’s disease, but for overall health and reduced risk of diseases like cardiovascular disease, and type 2 diabetes, so this is a good place to start,” says Clemmie.
Accessing the right support
Although there’s some evidence that the diets mentioned here could be useful, it’s still important to figure out what works for you and your body. If you’re overhauling your diet, you shouldn’t have to do it alone.
“Patients can get dietary support through a specialist IBD dietitian who may be part of their IBD team. If this service is not available, there are specialist IBD dietitians and nutritionists that work privately. It’s important to ensure that anyone you work with has the right qualifications and experience with Crohn’s disease, so you get the right care and advice,” says Clemmie Oliver.
While diet is only one part of IBD, it is an important one. As always, if you are thinking of making any changes to your diet (especially when restricting trigger foods), it’s always important to speak to your doctor first.