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Inflammatory Bowel Diseases

By Meredith Beil

DIETARY MANAGEMENT OF INFLAMMATORY BOWEL DISEASES: CROHN’S DISEASE and ULCERATIVE COLITIS

In conjunction with prescribed medications, dietary modification and nutritionalsupplementation for individuals with inflammatory bowel diseases addresses nutritional deficiencies and can alleviate symptoms.  The two main inflammatory bowel diseases (IBD): Crohn’s Disease and Ulcerative Colitis, can cause a wide range of symptoms, but most commonly result in diarrhoea, weight loss &/or growth failure, malnutrition, anaemia, food intolerances and bowel obstructions. 

COMMONSYMPTOMS AND CONSEQUENCES

  • DIARRHOEA– results in malabsorption and loss of nutrients and fluids.  Long lasting and/or severe diarrhoea is likely to be accompanied by electrolyte depletion and dehydration. Diarrhoea should be treated appropriately to prevent these complications, for example, with a rehydration solution from your pharmacist.  Dietary sugars (including lactose in milk and fructose in fruits) may exacerbate diarrhoea when inflammation is present so it is wise to limit the intake of dietary sugars at these times.  Soluble fibre (eg in psyllium husk) is beneficial, due to its fluid holding properties that help to provide stool consistency.  Soluble fibre also enhances the health of the cells lining the large intestine.
     
  • WEIGHT LOSS / GROWTH FAILURE– symptoms such as abdominal pain, bloating, nausea, vomiting, diarrhoea and loss of appetite will likely compromise nutritional intake. Prevention of weight loss and in particular, prevention of lean muscle loss, will allow optimal health and healing.  The onset of IBD may occur in children and adolescents and any indication of growth failure must be addressed.  Appropriate nutritional supplementation may be warranted to provide the extra nutrition required to promote growth, weight gain or weight maintenance.
     
  • MALNUTRITION– potentially a serious consequence due to damage of the absorptive layer of the gastrointestinal tract.  Malabsorption of vitamins, minerals, proteins and fats may result in nutritional deficiencies which will compromise healing and may result in further exacerbation of the disease state. Replacement of these nutrients is essential for health and individual advice from an accredited practicing dietitian (APD) is recommended.
     
  • ANAEMIA– resulting from poor oral intake and/or compromised absorption of iron, and other nutrients essential for iron uptake; including vitamins such as B12, C and folic acid. An inflamed or damaged intestinal tract results in compromised absorption.  Intestinal bleeding may also result in significant iron losses.  Please refer to http://www.capitalchemist.com.au/resource/339 for further information on iron deficiency and anaemia and it’s treatment.
     
  • FOOD INTOLERANCES- occur more often in individuals with IBD than in the general population.  Lactose and gluten intolerances are not uncommon in individuals with IBD although should not be unnecessarily eliminated from the diet.  Lactose intolerance may be temporary during the inflammatory stage, due to the damaged intestinal lining, and resolve upon disease remission.  It is often other foods or food chemicals causing the symptoms, not necessarily lactose and/or gluten, so it is always wise to consult with an APD if you wish to investigate food intolerances.
     
  • BOWEL OBSTRUCTIONS -may occur due to inflammation, strictures and swellings of the gastrointestinal tract, resulting in compromised movement of food through the intestines.  To minimise the risk of bowel obstructions food should always be chewed thoroughly into small particles. Foods most likely to be implicated in bowel obstructions are highly fibrous plant foods such as potato skins, stringy vegetables, broccoli and cauliflower stalks, oranges and grapefruits.  These foods are best avoided if bowel obstruction is a possibility. 

DRUG-NUTRIENT INTERACTIONSfor medications commonly used in IBD:

  • Corticosteroid medications warrant a reduction in salt/sodium intake along with an increase in protein, calcium, iodine and potassium intake. 
  • Sulfasalazine decreases folate levels and generally warrants folic acid supplementation, as does Methotrexate therapy.
  • Alcohol in drinks, medications, supplements and foodstuffs, is to be avoided if taking Metronidazole (for the duration of treatment and 24hrs after).

Dietary factors thatmay trigger a relapse of IBD in an individual include particular foods or nutrients such as alcohol or excessive sugar. In addition, consuming a diet low in fruits, vegetables, fibre and omega 3s fatty acids may be a causative factor.  

Nutrients that modulate the inflammatory and immune responsesof the body include omega 3 fatty acids and vitamin D. Prebiotics and probiotics may be of benefit, along with dietary antioxidants found naturally in our food supply.  Consuming a diet rich in vegetables, fruits, nuts, seeds and whole-grains; along with seafoods high in omega 3 fatty acids (such as tuna, salmon and mackerel) is highly recommended; in conjunction with adequate Vitamin D from sensible exposure to the sun.

The balance of healthy and unhealthy bacteria in the gutcan be compromised by malnutrition and it is recognised that this microflora may play a major role in IBD. Prebiotics and probiotics may have a beneficial effect on both the gut microflora and the gut immune system.  Prebiotics favour the multiplication of “good” bacteria in the gut and help to prevent the overgrowth of other bacteria.  Probiotics (such as Lactobacillus and Bifidobacterium) are bacteria which are used to re-establish beneficial gut flora and are continuing to be studied for their potential benefits in IBD.

Small, frequent mealsmay be better tolerated than three large meals, along with thorough chewing of food and avoidance of swallowing air.

Improving nutritional status is a major goal of IBD and optimal individualised nutrition can assist in inducing remission and promoting overall general good health. So be sure to include a wide variety of nutritious foods in your diet, avoid foods that have been shown to not be tolerated by you, and supplement your dietary intake as professionally prescribed.
 

References: Shanahan F (2000), Probiotics and inflammatory bowel disease: Is there a scientific rationale? ,Donohoo E et al (2006) June 2006 mims annual ;Escott-Stump S Nutrition and Diagnosis-Related Care. Ed 6.;Escott-Stump S, Mahan L K . Krauses’s Food & Nutrition Therapy. Ed 12.

 

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