Diet and Inflammatory Bowel Disease
By: Ruth Kander, Dietitian Bsc (Hons) SRD
IBD affects everyone in a different way – there is no one rule for all and everyone will have different dietary requirements. In medicine, and in this case nutrition, we practise evidence based medicine which means that healthcare professionals usually only make recommendations based on the best medical research available at that time. The evidence for nutrition in IBD is variable and there is still much research to be done.
Everyone is aware of the importance of a healthy balanced diet for good health, but some people who have IBD may not be able to tolerate a normal diet, especially the 5 a day rule of fruits and vegetables. Often people with IBD are unable to tolerate fruits and vegetables for a variety of medical reasons such as strictures/narrowings, fear of blockages, surgical intervention or simply intolerance. I always suggest to people to be rational about this and think about which fruits and vegetables agree with them. People often find that the lower fibre varieties of cereals, fruits and vegetables suit them best.
Tips for having fruits and vegetables:
- Always peel fruits and avoid those with pith
- Eat boiled/cooked vegetables and make sure they are peeled
- Avoid small vegetables like peas, beans and corn which can get caught in the bowel
- Chew fruits and vegetables very well
- Eat lower fibre fruit such as tinned fruits, melons, peeled apple, pears, mango, Sharon fruit, peeled plum, lychee, pineapple
Everyone will have different views on whether it is beneficial to go gluten/wheat free. There is no research to suggest it is. Some avoid brown/wholegrain varieties or fear of seeds getting stuck or causing a blockage, which is reasonable.
- Try to include carbs at each meal; bread, potatoes, rice, pasta, couscous, noodles, cereals.
- If you prefer the white varieties that is absolutely acceptable.
- If you are trying to gain weight, then have a larger portion at meals and have some high carb snacks.
- If you are trying to lose weight, then control your portion sizes.
Usually people who are in remission and are well tolerate protein foods without a problem. It is recommended to have two portions daily. This means:
- Meat/chicken the size of palm of your hand
- Eggs 1-2
- Beans/lentils 4 tablespoons
If you are vegetarian or vegan you may consider having more soya/tofu/quorn products rather than beans and lentils which the body can find harder to digest, and which may cause a blockage.
Some people find they are intolerant to dairy foods which could be due to either lactose or milk protein. If you exclude dairy foods, discuss this with your doctor as you will be missing out on calcium in your diet.
It is recommended to have 3-4 portions of dairy foods daily to ensure adequate calcium intake.
- Try to have a healthy balanced diet each day
- If you have multiple food intolerances, ask to be referred to a specialist gastroenterology dietitian
- If you feel more comfortable with low fibre fruits, vegetables and carbohydrates, then have those
- Eat 2 portions of protein daily
- Ensure you have an adequate fluid intake each day
- Be as active as possible each day