Medically reviewed by Jenny Blair, MD
One of the questions patients most often ask me in the clinic is, ‘What can I do about my diet?’ says Anne Tuskey, MD, a gastroenterologist and associate professor at University of Virginia Health System in Charlottesville. “I tell them there is not a particular food category or single food that’s been associated with triggering a disease flare. It’s both liberating for patients and frustrating at the same time.”
While any relationships between diet and the development of IBD remain unclear, here are a few diet and nutrition considerations to keep in mind with IBD.
You Are the Expert of You
“There is no certain diet we recommend for IBD patients,” says Tasneem Ahmed, DO, assistant professor of internal medicine at UT Southwestern Medical Center in Dallas, Texas. “There’s no need to avoid dairy or gluten or fiber. We tell patients to eat what works best for you. You’re the best judge of what you can tolerate and what works in your body. That said, I do recommend a balanced diet.”
In general, a diet for someone in remission is similar to that of someone who does not have IBD, says Robin Rothstein, MD, professor of clinical medicine at the Lewis Katz School of Medicine at Temple University (LKSOM) and co-medical director of the Inflammatory Bowel Disease Program at LKSOM in Philadelphia, Pennsylvania.
A healthy diet is primarily plant-based (fruits, vegetables, whole grains) with minimally processed foods, says Dr. Rothstein. The Crohn’s and Colitis Foundation recommends consuming a variety of foods that provide the healthy fats, protein, carbohydrates, vitamins, and minerals you need while ensuring you’re getting the right amount of calories.
Should You Try a Restricted Diet?
“I don’t often recommend a restricted diet for someone in remission,” Dr. Tuskey says. That said, sometimes her patients want to try a popular diet, such as the low-carb or paleo diet, to see if it helps. There’s little data to support the effectiveness of these diets, Dr. Tuskey says. Reports that certain diets work for IBD (or don’t work) are mostly anecdotal. However, if her patients really want to try a restricted diet, she encourages them to meet with a registered dietitian to make sure they don’t compromise their nutritional health.
Because certain foods trigger IBD symptoms in some patients, it pays to identify and eliminate, or reduce your trigger foods, especially when you’re having a flare.
Certain Eating Plans Do Help Some Patients
“The only diet that has actually been studied and shown to be of some clinical potential benefit in IBD is the Specific Carbohydrate Diet (SCD), which limits certain carbohydrates, processed foods, starches,” Dr. Ahmed says. The low FODMAP diet, a diet low in fermentable oligosaccharides, disaccharides, monosaccharide and polyols, has also been shown to help manage IBD symptoms. Ask your doctor if either of these eating plans might be right for you.
Should You Take a Probiotic? It Depends
Probiotics, healthy microorganisms in certain foods and supplements, may be helpful for some people, says Dr. Rothstein. However, there are few scientific data to support using them in IBD, with one exception: patients at risk for pouchitis. If you have ulcerative colitis, you may need to have your colon removed (proctocolectomy). During the procedure, your surgeon will create a pouch from your small intestine. This pouch may become inflamed (pouchitis).
Dr. Rothstein says there are small studies that suggest a probiotic called VSL#3 may prevent pouchitis in new pouches and preventing recurrent pouchitis in UC patients. Otherwise, she says, there are so many probiotics on the market (and they’re expensive), it’s difficult to figure out which one is right for you given that the bacteria in each person’s gut is different.
IBD Treatments Can Cause Nutritional Deficiencies
Two of the commonly used medications for IBD, methotrexate and sulfasalazine, can impair your body’s ability to absorb folic acid, which may lead to anemia. “If patients are on one, or both, medications, I will recommend folate supplementation,” says Dr. Rothstein.
Another group of patients at risk for nutritional deficiencies are those with Crohn’s disease who’ve had their terminal ileum surgically removed. “The terminal ileum is where your body absorbs vitamin B12. I monitor these patients periodically and prescribe prescription or over-the-counter supplements as needed,” Dr. Rothstein says.
Overall, people with IBD might benefit from adding a nutrition health professional to their IBD care team. Drs. Rothstein, Ahmed, and Tuskey encourage IBD patients to consult with a nutrition professional who has expertise specifically in IBD and can help you manage symptoms as well as make healthy food choices.
Jenny Blair is a writer and journalist covering science, medicine, and the humanities. She earned her MD at Yale University, then completed a residency in emergency medicine at the University of Chicago. After several years in practice, she transitioned to working with words and ideas full-time. Jenny has contributed to Discover, New Scientist, Washington Spectator, and Medtech Insight, among other publications. She lives in New York City.
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