Nutrition and IBD
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Nutrition Guidelines for Crohn's Disease
Ensuring good nutrition is an important part of managing Crohn’s disease.
People with Crohn’s disease are at risk for developing malnutrition and
nutrient deficiencies, which makes it more difficult for the body to heal
and fight infection. Malnutrition may also cause people to feel more fatigued
and some medications may not be as effective when nutritional status is
depleted. With proper monitoring and attention to nutrition, these complications can often be avoided.
There are several reasons that people with Crohn’s disease may be at
nutritional risk. These include the following:
Decreased food intake due to decreased appetite, pain, diarrhea, or other symptoms (or fear of these symptoms)
Increased needs for calories, protein, and some Vitamins and minerals like Antioxidants
Diarrhea or other fluid losses can lead to dehydration if not replaced
Crohn’s disease most often affects the small intestine, the part of the bowel
where nutrients are absorbed. Whether or not absorption is affected (and to
what degree) depends on the severity and location of the disease.
Eating to help the gut heal itself is one of the new concepts in IBD treatment,
and numerous experimental studies are being conducted in this area. Essential Fatty Acids from fish or
flaxseed oils, in the diet or as supplements, have been used to help fight
the inflammation in IBD. The complex carbohydrates that are not digested by
the small bowel...such as psyllium...stimulate the bacteria in the colon to
produce short-chain fatty acids. These Essential Fatty Acids help the mucosa
(the lining) of the colon to heal itself. L-glutamate may be helpful in
healing some of the small bowel abnormalities of early Crohn's, since that
compound nourishes the lining of the small intestine.
Another approach is the use of probiotics, which are just beginning to be
appreciated as a therapeutic aid in IBD. Probiotics are "good" bacteria that
restore balance to the enteric microflora-bacteria that live in everybody's
intestine. Lactobacillus preparations and live-culture yogurt can be very
helpful in aiding recovery of the intestine. There is much work being done in
the use of diet, Vitamins and supplements to aid in the healing of IBD and much more to
be learned.
Many patients find it helps to switch to a low-fiber diet. With your doctor's
guidance, you may also benefit from supplements of iron, vitamin B-12,
folic acid, or other Vitamins and minerals to replace those lost to diarrhea
or not adequately absorbed due to the disease. Many people with ulcerative
colitis or Crohn's disease are also lactose intolerant; for them, avoiding
dairy products may make sense. It is important to follow your doctor's
instructions. If your symptoms persist or if you develop new symptoms,
tell your doctor.
THE FACTS ABOUT FLAX.....CLICK HERE
Some medications prescribed for Crohn’s disease may affect appetite, taste
sensation, or nutrient absorption
Diet restrictions (which may or may not be necessary)
Diet
Although special formulas, or even feeding through an intravenous line,
are sometimes used to help treat Crohn’s disease, there is no specialized oral
diet for people with Crohn’s disease. Rather, the recommended diet for
Crohn’s disease is a balanced diet focusing on adequate calories, protein,
Vitamins, minerals, and fluid. No specific foods are known to trigger Crohn’s
disease or make the disease worse. Therefore, there are no specific foods
that must be avoided by all patients with Crohn’s disease. Some individuals
may have their own food intolerances or notice that certain foods cause
discomfort. In such cases, those foods should be avoided. Nutrition needs
may vary from person to person depending on the status of their disease,
thus it is best to meet with a dietitian who can help you individualize
your diet to best meet your needs.
Calories and Protein
It is important to take in enough calories each day to maintain a healthy
weight. Your calorie needs may be increased when you are acutely ill. Rapid,
unintentional weight loss places you at risk for malnutrition.
The inflammation caused by Crohn’s disease leads to increased protein needs.
Inadequate protein intake may negatively affect healing and lead to muscle
loss.
A dietitian can provide more specific guidelines for your individual calorie
and protein needs, as well as provide you with more information on increasing
calories and protein in the diet, if needed.
Fiber
Dietary fiber is an important component of a balanced, healthy diet. Fiber is
broken down in the colon into short chain Essential Fatty Acids. The colon uses these
short chain fatty acids as an energy source. In people with Crohn’s disease,
there is no need to limit the intake of dietary fiber. Likewise, it is not
necessary to increase fiber intake above the recommended levels for the
general population. Recommended daily dietary fiber intake is 15-25 grams.
Trial and error is the best way to figure out what amount of fiber you are
able to tolerate in your diet. The amount of fiber tolerated varies between
individuals and may also vary with an individual during a Crohn’s flare.
Vitamins and Minerals
Antioxidants
Vitamin B12 is a nutrient important for normal body function. Vitamin B12 is
absorbed in the ileum, a part of the small bowel often affected by Crohn’s
disease. Vitamin B12 levels can be monitored by a blood test and supplements
may be recommended if levels are low.
Calcium and Vitamin D are nutrients important for healthy bones. Many adults
do not take in enough of these nutrients. People with Crohn’s disease are
especially at risk because dairy products (which are the main source of
Calcium and vitamin D) are often avoided. Such avoidance may or may not be
necessary; see the section below on Lactose Intolerance for more information.
Other Vitamins and minerals of special concern include:
Folic acid (especially for people on the medication sulfasalizine)
Magnesium, potassium, zinc may be lost in diarrhea or other intestinal fluid
Iron (especially if blood loss from the intestine occurs)
Your physician or dietitian may recommend additional vitamin and/or mineral
supplements based on laboratory values or other information.
Special Situations
Lactose intolerance
Lactose is a sugar found in dairy products. Some people with Crohn’s disease
may have difficulty digesting lactose and dairy products due to low levels
of the enzyme (lactase) needed to break down lactose in the small bowel.
Symptoms include cramping, bloating, gas, and/or diarrhea after consuming
dairy products.
Not all people with Crohn’s disease will experience lactose intolerance (I am NOT lactose intolerant) and
routine avoidance of dairy products is not needed. If tolerated, dairy
products can be a good source of calories, protein, Vitamins and minerals for
people with Crohn’s disease.
If dairy products do cause discomfort, they should be avoided or consumed in
small amounts as tolerated. In such cases, discuss your Calcium and vitamin D
intake with your dietitian.
More information on lactose intolerance is available from the Digestive Health Center; ask your physician or nutritionist for additional handouts if needed.
Strictures, partial obstruction, or narrowed areas of bowel.
If your doctor has informed you that you have strictures, a partial bowel
obstruction, or that you have areas in the bowel which are narrowed, a low
fiber or low residue diet may be recommended.
On a low fiber diet, the following foods should be avoided:
raw fruits and vegetables (especially those with pulp, edible skins or seeds)
corn
beans and legumes (including peanuts)
nuts (you might be able to tolerate cashews and macadamias, but I would be careful and only try a few at a time to see if you can tolerate them, chew them well)
seeds
popcorn
raisins
whole grain products
bran products and
fiber supplements
It is also important to chew all foods well.
On behalf of learning, and use as teaching tools for those of us who need to
know about our disease, I have tried to supply you with as much information as
I could find on all of the drugs, treatments and disorders associated with
Inflammatory Bowel Diseases. I have tried to blend all facts supported by research
and also from personal experiences of other IBD sufferers into one readable webpage, and any and all information presented here is not entirely
from one source. Most information contained within these pages is found in the public domain.
At times you may find information used from another site, and as with all copyrighted materials you may find on these pages, I claim fair use under sections 107 through 118 of the Copyright Act (title 17, U.S. Code). Click here for more info
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