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What To Eat When You Have Inflammatory Bowel Disease?
What to eat during a flare-up
In the active period of the disease, it is recommended to consume a high calorie, high protein, low fiber, low residue diet. Aim to eat five to six smaller meals per day, and consume smoothies as needed to increase caloric and protein intake. Avoid skipping meals, since that can make the small intestine more active and increase gas and liquid stools.
It is possible to develop a temporary lactose intolerance. In this case, choose lactose free dairy products. It is also recommended to avoid high-fat foods, spicy foods, foods high in sugar, coffee, and alcohol- all of which can potentially be more difficult to tolerate.
During a flare-up, it may be more difficult to tolerate roughage such as raw fruits and vegetables, salads, fruit and vegetable peels, nuts, seeds, and popcorn. In this case, preference may be given to foods that are high in fiber and that have a softer or more liquid texture, such as smoothies, soups, cooked and peeled vegetables, fruit and vegetable purees, and creamy nut butters. Once the symptoms are improved, you can try to gradually increase your fiber intake and the variety of your diet in order to optimize gut health. It is advisable to reintroduce only one food at a time in small amounts, to monitor symptoms by keeping a food diary, and to stop eating the new foods if you develop abdominal pain or diarrhea.
The low-FODMAP diet
FODMAPs are fermentable carbohydrates that are not well digested by the digestive system, and are then found in significant amounts in the large intestine (colon), where they are fermented. This fermentation can lead to digestive symptoms in people who are sensitive. This diet is effective in reducing the symptoms of people with irritable bowel syndrome (IBS). Studies suggest that a low- FODMAP diet may also help reduce gastrointestinal symptoms in people with IBD. The low-FODMAP diet is designed to be followed for a short period of time. It is important to reintroduce the different foods afterwards by following a very specific protocol in order to identify trigger foods and thresholds.
SOSCuisine’s low-FODMAP meal plans can be useful for people who want to try the low FODMAP approach.
The Mediterranean diet
The Mediterranean diet has long been recognized for its protective effects against various chronic diseases. It is characterized by a high intake of plant based foods, regular consumption of fish and poultry, moderate consumption of red wine, low fat dairy products and eggs, and low intake of processed foods, sweets, red meat, and processed meats. It is represented by a pyramid.
Several studies show that the Mediterranean diet can be effective in reducing inflammation, improving the gut microbiota and promoting remission of symptoms in people with IBD.
The Crohn’s disease and Ulcerative Colitis meal plans of SOSCuisine are based on the Mediterranean diet and designed for people suffering from IBD.
The Specific Carbohydrate Diet (SCD)
The specific carbohydrate diet (SCD) was developed by Dr. Sidney Hass in 1930 for children with celiac disease. It was later popularized by Elaine Gottschall via the book Breaking the vicious cycle. This diet eliminates cereal products, starchy vegetables (potato, sweet potato, corn, turnips, some legumes), dairy products (except fermented yogurt), added sugars (except honey), soybeans, processed foods, additives and emulsifiers, as well as canned fruits, vegetables, and fish. Only monosaccharides that require a minimum level of digestion are allowed. Thus, the foods allowed are mainly fresh fruits and vegetables (except starchy vegetables), meat, poultry, seafood, eggs, nuts, seeds (except flax, chia and hemp seeds), peanuts, oils, some legumes as well as homemade fermented yogurt. There is also a modified SCD diet, which allows rice, oats, maple syrup, sweet potatoes, and unsweetened cocoa to be added.
According to several clinical studies, the SCD diet can allow people with IBD to achieve remission. A new study compared the effectiveness of the SCD diet with the Mediterranean diet in 194 adult patients with Crohn’s disease with mild to moderate symptoms. They were randomly assigned to consume the Mediterranean diet or the SCD diet for 12 weeks. There were no significant differences between the two diets in terms of improving symptoms and reducing inflammatory markers. This study indicates that both diets may be equally effective in promoting remission of symptoms in adults with Crohn’s disease. The Mediterranean diet has the advantage of being less restrictive, more varied, and easier to follow in the long term when compared to the SCD diet. It therefore seems to be a preferred choice for most patients with IBD.
Sources
Chicco et coll. (2021) Multidimensional Impact of Mediterranean Diet on IBD Patients. Inflamm Bowel Dis;27(1):1-9.
Cohen et coll. (2014). Clinical and mucosal improvement with specific carbohydrate diet in pediatric Crohn disease. J Pediatr Gastroenterol Nutr; 59(4):516-21.
Crohn et Colite Canada, Régimes et nutrition, accessed August 17 2021
Fritsch et coll. (2000) Low-Fat, High-Fiber Diet Reduces Markers of Inflammation and Dysbiosis and Improves Quality of Life in Patients With Ulcerative Colitis. Clin Gastroenterol Hepatol; S1542-3565(20)30685-6.
Gearry et coll. (2009) Reduction of dietary poorly absorbed short-chain carbohydrates (FODMAPs) improves abdominal symptoms in patients with inflammatory bowel disease-a pilot study. Crohns Colitis;3(1):8-14.
Godny (2020) Adherence to the Mediterranean diet is associated with decreased fecal calprotectin in patients with ulcerative colitis after pouch surgery. Eur J Nutr;59(7):3183-3190.
Gosh et coll. (2020) Mediterranean diet intervention alters the gut microbiome in older people reducing frailty and improving health status: the NU-AGE 1-year dietary intervention across five European countries. Gut;69(7):1218-1228.
Kakodkar et Mutlu (2017) Diet as a Therapeutic Option for Adult Inflammatory Bowel Disease. Gastroenterol Clin North Am; 46(4):745-767.
Levine et coll. (2000) Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol; 18(6):1381-1392.
Lewis et coll. (2021) A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults With Crohn’s Disease. Gastroenterology (sous presse).
Suskind et coll. (2020) The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn’s Disease: A Randomized Diet Controlled Trial. Nutrients;12(12):3749.
Suskind et coll. (2016) Patients Perceive Clinical Benefit with the Specific Carbohydrate Diet for Inflammatory Bowel Disease. Dig Dis Sci;61(11):3255-3260.
Author
Kathryn holds a Bachelor Degree in Nutrition as well as a Bachelor and a Master Degree in Kinesiology, all from Laval University. She is a Registered Dietitian and active member of the Ordre professionnel des Diététistes Nutritionnistes du Québec (ODNQ) and of the American Academy of Nutrition and Dietetics. She holds the Monash University's certification for the FODMAP diet and IBS, and has considerable clinical experience in that area. She is also an accomplished athlete, having ran track and cross-country at a national level. Kathryn specializes in sports nutrition, weight loss, diabetes, as well as heart and gastrointestinal health.
Thanks for this information. I’m always looking for IBS articles and it has been driving me nuts because I don’t see the way that diet is a very big factor. It’s really hard to find the correct information especially where I am living currently. The doctors are so focused on the use of biological medicine when I was treated that I was so sick from that the whole time. Thanks to the way I was treated I have lost my teeth and I got an infection where I lost my finger. It’s really been an awfully tough battle. And then I have to deal with the doctors that don’t believe it is a real thing! Yeah that’s fine if you want to believe that it’s just an excuse to get out of work have not been in my shoes. So I thank you for your information on the subject and I really appreciate it.
Jessica you’re welcome, I’m glad that you found my article helpful.
They haven’t figured my issue out bowel movement is fine 63 years old I am just cutting sugar. I’d love to eat red meat but since this even the taste isn’t working any longer fish sounds great I will try to eat lots more