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Good nutrition is key for people with IBD.

If you have inflammatory bowel disease (IBD), it can be difficult to get adequate nutrition due to diarrhea (a common symptom), and/or reduced or improper absorption of nutrients. It's important for people with IBD to understand how their condition works, and to ensure that they are getting enough of the proper nutrients from their diets.

"Inflammatory bowel disease (IBD) most commonly refers to Crohn's disease and ulcerative colitis, both of which are lifelong inflammatory diseases that affect the digestive tract," says Colleen D. Webb, MS, RD, a registered dietitian and certified nutritionist at the Jill Roberts Center for Inflammatory Bowel Disease at Weill Cornell Medical Center. "Crohn's disease can affect any part of the gastrointestinal tract, whereas ulcerative colitis is limited to the large intestine."

How IBD affects nutrition. IBD can cause inflammation of the large and small intestines and colon. This inflammation results in the body's inability to properly absorb nutrients from food.

Iron deficiency, one of the most common complications of IBD, can result from blood loss, chronic inflammation, poor dietary intake, and the use of certain medications like proton pump inhibitors.

"Both animals and plants contain iron, but the iron from animals (heme iron) is better absorbed," says Webb. "Good sources of heme iron include meat, poultry, liver, fish, and shellfish. Non-heme iron is found in beans, whole grains, fortified cereals, and spinach. Pairing plant sources with acidic foods, such as tomatoes or orange juice, increases iron availability. Cooking in a cast-iron pan also will boost your iron intake."

Calcium is another essential nutrient that may be significantly impacted by IBD. People with IBD have been shown to have an increased risk of bone loss, which may result from use of certain medications (for example, steroids such as prednisone), reduced absorption, and/or low calcium intake. "Good sources of calcium include milk, yogurt, and cheese. For those with lactose intolerance or sensitivity, there are non-dairy sources too, including fortified foods (almond milk, rice milk, and orange juice), dark leafy greens, broccoli, and canned salmon and sardines with the bones," Webb says.

People with IBD also are at increased risk of vitamin D deficiency, another nutrient that is vital to bone health. The best way to obtain vitamin D is through sun exposure. Sources of vitamin D are limited, and include fatty fish, some mushrooms (see article on page 1), and fortified foods, such as dairy and non-dairy milks, cereal, and orange juice. "I encourage everyone with IBD to discuss their vitamin D status with their healthcare provider to find out if they would benefit from vitamin D supplementation," Webb adds.

Smart eating strategies. "Consuming a well-balanced diet is an essential part of the overall treatment of IBD, so I encourage everyone with IBD to eat a healthy diet with lots of anti-inflammatory foods like fruits and vegetables, as well as fatty fish, such as salmon, tuna, and herring," Webb says. "Good nutrition helps medications work better, corrects and prevents nutrient deficiencies, fights inflammation, and gives people the energy they need to get through the day."

To prevent or minimize symptoms, IBD patients are advised to chew their food well, eat slowly, sit in an upright position before and after eating, and eat small portions frequently throughout the day.

Foods that trigger symptoms vary from patient to patient, so there is no set list of foods to eat and foods to avoid. However, recording daily food and beverage intake and symptoms in a food diary is an excellent tool for identifying individual food triggers.


Some foods may exacerbate IBD symptoms, especially during flareups. Examples include:

* High-fiber foods, such as raw vegetables, nuts and seeds, whole grains, and popcorn

* Fatty foods, including creamy sauces, fried foods, and red meat

* Foods and beverages high in added sugar, like sports drinks, soft drinks, candy, and desserts.
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Publication:Women's Nutrition Connection
Date:Nov 1, 2013
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