ULCERATIVE COLITIS


 

ULCERATIVE COLITIS

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Dietary Management of Inflammatory Bowel Disease

Crohn’s disease and chronic ulcerative colitis are two diseases that are together classified as inflammatory bowel disease (IBD) and result in an inflammation of the intestines.

Symptoms

During an attack, symptoms may include:

  • Abdominal pain
  • Nausea and vomiting
  • Frequent bowel movements
  • Diarrhea
  • Weight loss
  • Dehydration
  • Anemia
  • Fever

These factors contribute to a loss of appetite in many individuals. In addition, IBD, particularly Crohn’s disease, often is associated with poor digestion and poor absorption of dietary protein, fat, carbohydrates, water, and a wide variety of vitamins and minerals. Thus, much of what a person eats may never really get into the body. Therefore, while dietary habits do not cause the disease, they do play a crucial role in managing it.

Eating plan

The same IBD diet does not necessarily work for everyone, but you can work with your registered dietitian to:

  • Develop an eating plan that will help manage symptoms during the acute phases of a flare-up
  • Help determine what types of foods may exacerbate symptoms
  • Learn how to resume a healthy eating plan that will promote recovery during remissions

In addition, the following dietary tips can help you manage IBD.

Meals

Use this advice when you eat:

  • Eat small, frequent meals and snacks, instead of just a few large meals
  • Choose adequate high-protein foods, even during a flare up, which may help relieve IBD symptoms—lean meats, fish, poultry, and eggs or egg substitutes
  • Do not skip meals, which may cause pain and bloating when you finally do eat
  • Slow down when you eat
  • Chew food well and take small bites

Meal planning

Plan your meals with these tips in mind:

  • Choose adequate high-protein foods, even during a flare-up, which may help relieve IBD symptoms:
    • Lean meats
    • Fish
    • Poultry
    • Eggs or egg substitutes
  • See if cooked vegetables are more easily tolerated than raw vegetables
  • Limit gas-producing foods, such as:
    • Cruciferous vegetables (broccoli, cabbage, cauliflower, and Brussels sprouts)
    • Dried peas, beans, legumes, and lentils
    • Onions
    • Chives
    • Peppers
    • Carbonated beverages
  • Avoid caffeine and foods that contain sorbitol (sweetener used in foods), which may cause diarrhea
  • Limit these foods in your diet, if you develop gas and diarrhea after eating fatty or greasy foods:
    • Butter
    • Margarine
    • Mayonnaise
    • Salad dressing
    • Oil
    • High-fat meats and dairy products
    • Skin of poultry
    • Fried foods
    • Etc

Fiber

Know when to use and limit high-fiber foods:

  • Try foods that are high in fiber, when IBD is under control:
    • Whole-grain breads, bagels, buns, and pasta
    • Bran cereals
    • Whole grains, such as barley, corn, brown rice, and quinoa
    • Dried fruits
    • Berries, oranges, apples, and pears (with skins)
    • Green, leafy vegetables
    • Limit high-fiber foods to help minimize symptoms during a flare-up

Lactose intolerance

If you are lactose intolerant:

  • Avoid lactose-containing (dairy) foods
  • Try soy-based alternatives, lactase enzymes, and lactase-pretreated foods

Beverages

Include liquids in your diet:

  • Drink plenty of fluids, especially water, to prevent constipation and to keep your body hydrated, which sometimes is a challenge during vomiting and diarrhea episodes
  • Use predigested nutritional drinks (elemental diet), as recommended by your registered dietitian, to give your bowels a rest and replenish lost nutrients
  • Avoid alcohol and caffeine, because these stimulate the intestines and may exacerbate IBD symptoms

Vitamins and minerals

Follow your doctor’s recommendation:

  • Take vitamin and/or mineral supplements, according to your doctor’s instructions

New nutritional therapies

The following are new nutritional therapies under consideration:

  • Fish and flaxseed oils—in the diet or as supplements
  • Prebiotics—such as psyllium (a complex carbohydrate)
  • Probiotics—lactobacillus preparations and live-culture yogurt 

References and recommended readings

Crohn’s & Colitis Foundation of America. Diet and nutrition. Available at: http://www.ccfa.org. Accessed January 24, 2011.

National Digestive Diseases Information Clearinghouse (NDDIC). Crohn’s disease. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease. Accessed January 24, 2011.

National Digestive Diseases Information Clearinghouse (NDDIC). Inflammatory bowel disease (IBD). Available at:  https://www.niddk.nih.gov/health-information/digestive-diseases. Accessed January 24, 2011.

Tsang G. Inflammatory bowel disease IBD diet (Crohn’s diet). Available at: http://www.healthcastle.com/ibd-diet.shtml. Accessed January 24, 2011.

Review Date 3/11

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Irritable Bowel Syndrome:

Potentially Bothersome Foods

The majority of research on specific foods and their effects on symptoms of irritable bowel syndrome (IBS) is not conclusive. However, some foods are more often implicated as potentially bothersome to people suffering from IBS. The following list is not a recommendation of foods that all people with IBS should avoid. It is a brief listing of foods that some people with IBS find exacerbates their condition. A careful look at diet history and continual recording of food and symptoms is recommended.

In most cases, the symptoms will occur within 3 days of eating the suspected food. In addition, you should not conclude that a food is likely to have caused symptoms unless the symptoms occur on three separate occasions following ingestion of the specific food. If you want to remove a suspected food from your diet, you should eliminate it for 2 weeks and then try to reintroduce it to your normal diet. If it is not obvious that the food is harmful when included in the diet, and if improvement is not seen when it is excluded, it is not necessary to continue to eliminate the food.

If a food does indeed seem to cause bothersome symptoms, perhaps this is not a permanent problem. You may, after 3-6 months, want to add the food back into their diet to see if symptoms still occur.

Potentially bothersome foods

The following foods are potentially bothersome for some people with IBS:

  • Fried foods
  • High-fat foods
  • Caffeine:
    • Coffee
    • Tea
    • Chocolate
    • Cola
  • Carbonated beverages
  • Alcohol
  • Gas-producing foods:
    • Beans
    • Brussels sprouts
    • Onions
    • Celery
    • Carrots
    • Raisins
    • Bananas
    • Prune juice
    • Apricots
    • Wheat germ
    • Bagels
  • Sugar alcohols such as sorbitol:
    • Sugarless food products
    • Some varieties of fruit*
  • Fructose:
    • Honey
    • Fruits
    • Fruit juices
    • Table sugar
    • High-fructose corn syrup*
  • Fructans:
    • Wheat
    • Onions
  • Lactose:
    • Milk
    • Dairy foods
  • Insoluble fiber:
    • Whole-wheat flour
    • Bran
    • Wheat
    • Edible seeds
    • Mature vegetables
  • High-protein foods:
    • Meat
    • Poultry
  • Corn
  • Peas
  • Bananas
  • Potatoes
  • Eggs
  • Wheat

*Note: Fruits containing both fructose and sorbitol are especially likely to cause symptoms in sensitive individuals. Examples of fruits containing both fructose and sorbitol include cherries, apples, and pears.

References and recommended readings

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204-1214.

Palmer S. Soothing the symptoms of IBS with diet therapy. Available at:

http://www.todaysdietitian.com/newarchives/060109p34.shtml. Accessed August 4, 2009.

Review Date 10/09

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Irritable Bowel Syndrome: Potentially Bothersome Foods

What are the symptoms?

  • Cramping
  • Abdominal pain
  • Bloating
  • Constipation
  • Diarrhea

What aggravates it?

  • Stress
  • Diet
  • Medication
  • Hormones

How is it diagnosed?

No one knows for sure what causes irritable bowel syndrome (IBS) to develop. We do not have an easy way to diagnose it. Some tests rule out other possibilities. IBS is diagnosed if symptoms and frequency seem right.

What should I eat?

Follow these diet tips:

  • Follow a well-balanced diet
  • Eat regularly
  • Drink plenty of fluid

What foods should I avoid?

Avoiding the following gas-causing foods:

  • Fatty meats
  • Fried foods
  • Whole milk
  • Whole-milk cheeses
  • Fatty desserts
  • Broccoli
  • Brussels sprouts
  • Cabbage
  • Cauliflower
  • Corn
  • Onions
  • Beans
  • Celery
  • Carrots
  • Raisins
  • Bananas
  • Prune juice
  • Apricots
  • Wheat germ
  • Bagels

Some people have found that the following foods cause symptoms. Try these foods and see if they change your symptoms:

  • Sweeteners, such as fructose or sorbitol
  • Poultry
  • Fish
  • Alcohol
  • Caffeine
  • Carbonated beverages
  • Wheat
  • Bran
  • Seeds
  • Eggs
  • Potatoes
  • Peas
  • Cherries
  • Apples
  • Pears

What else can I do?

It is a good idea to keep a diary of the foods that you eat and your symptoms. This will help you to see patterns. Meet with a registered dietitian, who is trained to help you find associations between food and symptoms.

What about probiotics?

Probiotics (healthful bacteria) in yogurt and other fermented products also might help.

What treatment is available?

Besides dietary changes, treatment for IBS can include:

  • Relaxation training and therapy
  • Counseling and support
  • Regular exercise
  • Sleep (getting enough is important)
  • Some medications

References and recommended readings

American Dietetic Association. ADA Nutrition Care Manual. Available to subscribers at: www.nutritioncaremanual.org. Accessed October 29, 2010.

Heizer WD, Southern S, McGovern S. The role of diet in symptoms of irritable bowel syndrome in adults: a narrative review. J Am Diet Assoc. 2009;109:1204-1214.

Merck Manuals Online Medical LibraryIrritable bowel syndrome (IBS) (spastic colon). Available at: http://www.merck.com/mmpe/sec02/ch021666/ch021666a.html?qt=diagnosing%20malnutrition&alt=sh. Accessed October 29, 2010.

National Center for Complementary and Alternative Medicine. An introduction to probiotics. Available at: http://nccam.nih.gov/health/probiotics/index.htm. October 29, 2010.

National Digestive Diseases Information Clearinghouse (NDDIC). Irritable bowel syndrome. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/ibs/. Accessed October 29, 2010.

Palmer S. Soothing the symptoms of IBS with diet therapy. Available at:
http://www.todaysdietitian.com/newarchives/060109p34.shtml. Accessed October 29, 2010.

Review Date 10/10

G-1414

Location
Gastroenterology Associates of Beverly Hills
9033 Wilshire Blvd, 200
Beverly Hills, CA 90211
Phone: 310-858-2224
Fax: 310-858-2225
Office Hours

Get in touch

310-858-2224