DIETARY MANAGEMENT OF INFLAMMATORY BOWEL DISEASES: CROHN’S DISEASE and ULCERATIVE COLITIS
combination with prescribed medications, dietary modification and
nutritional supplementation for individuals with inflammatory
bowel diseases addresses nutritional deficiencies and can improve 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.
Symptoms and Consequences
can result 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 to prevent complications, seek advice from your pharmacist
for an appropriate option. Soluble fibre such as psyllium husk can be
beneficial, due to its fluid holding properties that will help to bulk stools.
/ Growth Failure
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 muscle loss, will allow optimal health and healing.
IBD may occur in children and adolescents, therefore 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. Seek advice from
your accredited practising dietitian (APD) regarding supplements and an
appropriate nutrition interventions.
is a potentially serious consequence of damage to 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.
from poor oral intake and/or compromised absorption of iron, and other
nutrients essential for iron uptake; 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
our Fact Sheet on Iron Deficiency and Anaemia further information.
occurs 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. Consult an accredited
practising dietitian (APD) if you wish to investigate food intolerances.
Bowel obstruction may occur due to inflammation,
strictures and swelling of the gastrointestinal tract, resulting in compromised
movement of food through the intestines.
To minimise the risk of bowel obstruction food should be chewed
thoroughly and highly fibrous plant foods such as potato skins, cauliflower
stalks, and grapefruits should be
limited if bowel obstruction is a possibility.
medications commonly used in IBD:
medications require a reduction in sodium and increase in protein, calcium, iodine and
decreases folate levels and may need folic acid supplementation, as does
is to be avoided if taking Metronidazole
treatment and 24hrs after)
Please discuss any concerns with you
Dietary factors that may trigger a relapse of IBD in an
individual include alcohol or excessive sugar. Nutrients that modulate
the inflammatory and immune responses of the body include omega 3 fatty
acids and vitamin D. Consuming a diet rich in omega 3 fatty acids is highly
recommended, in conjunction with adequate Vitamin D from sensible exposure to
the sun or a supplement as needed. The balance of healthy/unhealthy
bacteria in the gut can play a major role in IBD. Prebiotics assist with
the multiplication of healthy bacteria in the gut and help to prevent the
overgrowth of other bacteria. Probiotics
are used to re-establish beneficial healthy gut flora, and are be studied for
their potential benefits in IBD among other conditions. Small, frequent
meals may be better tolerated than three large meals, along with
thorough chewing of food.
Improving nutritional status is a major goal of IBD. Optimal
nutrition can assist in inducing remission and promoting overall good health. Be
sure to include a wide variety of nutritious foods in your diet, avoid foods
that are poorly tolerated by you, and supplement your dietary intake as
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. Krause’s Food & Nutrition Therapy. Ed 12.