Have you ever asked your gastroenterologist, “What can I eat?”

You are in good company.

Maybe you’ve even tried seeking support from social media and were left feeling like you needed to restrict your diet even more.

Fortunately, you may not need to restrict your diet. In 2020 the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD) published recommendations specifically for nutrition in Crohn’s disease and ulcerative colitis (1). This is the first time an expert consensus has been able to provide recommendations for IBD nutrition.

Here are some important takeaways: 

• Eating patterns were emphasized over individual ingredients. An example of a dietary pattern is the Mediterranean diet, which emphasizes choosing more vegetables, fruits, whole grains, nuts, legumes and seeds, with decreased red and processed meats. A study in 2019 showed that adherence to this pattern of eating was associated with decreased inflammation in patients with UC following j-pouch surgery (2).
• Fiber does not cause flares! In fact, a study in 2016 found this to be true, too. Patients with Crohn’s disease who did not avoid fiber were 40% LESS LIKELY to flare than those who did avoid fiber (3). 
• Texture modifications for fiber in patients with active/severely active disease or who are at risk for strictures or obstructions may be necessary.
• Fats, especially saturated and trans fats for Crohn’s; dairy fats, coconut oil, and palm oil  for ulcerative colitis were recommended to be consumed sparingly. 
• Meats, specifically red and processed meats, were recommended to be decreased. A British study showed that patients with UC who ate red meat daily were 5 times more likely to flare than those who consumed it once weekly or less (4). Fatty fish (e.g. salmon) intake was recommended in lieu of supplements for patients with UC. 
• Added sugars and the use of artificial sweeteners were both recommended to be decreased in Crohn’s and UC. Studies have suggested that added sugars have been suggested to increase gut bacteria that can lead to inflammation (5). Artificial sweeteners have been shown to alter gut bacteria, mostly in mice models (6). 
• Most importantly, a personalized approach for nutrition IBD was recommended. There is no one-size-fits-all answer for managing IBD. 

If you are in an active disease flare and do not feel like you can tolerate fruits and vegetables, try adding them to a blender for a tasty smoothie. Substitute nuts and seeds for creamy nut and seed butters, or try applesauce without added sugar instead of raw apples. Warm up some tasty oats, a creamy, effective way to incorporate more grains into your eating pattern.

Lastly, if you are feeling a little hesitant about incorporating more variety into your eating pattern right now, here are some non-nutrition related efforts that may indirectly support your digestion:

• Drink plenty of water
• Prioritize sleep and incorporate a bedtime ritual
• Practice stress-management techniques that work best for you
• Go for a walk while listening to a good podcast or favorite album

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If you feel you may benefit from one-on-one support, feel free to reach out for a complimentary consult call.

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References:

1. Levine, A., Rhodes, J. M., Lindsay, J. O., Abreu, M. T., Kamm, M. A., Gibson, P. R., Gasche, C., Silverberg, M. S., Mahadevan, U., Boneh, R. S., Wine, E., Damas, O. M., Syme, G., Trakman, G. L., Yao, C. K., Stockhamer, S., Hammami, M. B., Garces, L. C., Rogler, G., Koutroubakis, I. E., … Lewis, J. D. (2020). Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 18(6), 1381–1392. https://doi.org/10.1016/j.cgh.2020.01.046
2. Godny, L., Reshef, L., Pfeffer-Gik, T., Goren, I., Yanai, H., Tulchinsky, H., Gophna, U., & Dotan, I. (2020). Adherence to the Mediterranean diet is associated with decreased fecal calprotectin in patients with ulcerative colitis after pouch surgery. European journal of nutrition, 59(7), 3183–3190. 

https://doi.org/10.1007/s00394-019-02158-3

3. Brotherton, C. S., Martin, C. A., Long, M. D., Kappelman, M. D., & Sandler, R. S. (2016). Avoidance of Fiber Is Associated With Greater Risk of Crohn's Disease Flare in a 6-Month Period. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 14(8), 1130–1136. https://doi.org/10.1016/j.cgh.2015.12.029
4. Jowett SL, Seal CJ, Pearce MS, et al. Influence of dietary factors on the clinical course of ulcerative colitis: a prospective cohort study. Gut2004;53:1479–84.
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1774231/
5. Fajstova, A., Galanova, N., Coufal, S., Malkova, J., Kostovcik, M., Cermakova, M., … Kostovcikova, K. (2020). Diet Rich in Simple Sugars Promotes Pro-Inflammatory Response via Gut Microbiota Alteration and TLR4 Signaling. Cells, 9(12), 2701. doi:10.3390/cells9122701
6. Tamura, M., Hoshi, C., & Hori, S. (2013). Xylitol Affects the Intestinal Microbiota and Metabolism of Daidzein in Adult Male Mice. International Journal of Molecular Sciences, 14(12), 23993–24007. doi:10.3390/ijms141223993