Inflammatory
Bowel Disease
and Diet-Question
and Answers
By Nicola Attwood
Gastro Dietitian-Colchester Hospital
Crohn’s and Colitis Meeting May 2013
What is Inflammatory Bowel Disease?
Inflammatory Bowel Disease
Crohn’s Disease
Ulcerative Colitis
Indeterminate
Colitis 10%
Chronic
No medical cure
Chronic
No cure
What is Difference between UC and CD?
Ulcerative Colitis
Crohn’s Disease
•Starts in the rectum
•Extends to beginning
of large bowel (caecum)
•Inflammation limited to
lining of the colon
•Can effect any part of
the bowel
•Can be patchy
•Can extend through the
bowel wall
Why is malnutrition common in IBD?
Effect
Cause
Reduced food intake
Malabsorption
Increased intestinal
losses
Poor appetite ,pain,
nausea, dietary
restriction
Reduced absorption
caused by damaged
from inflammation and
surgery
Drugs
Altered absorption and
utilisation.
What vitamin and mineral
deficiencies need to be treated?
• Deficiencies in vitamins and minerals in IBD is
common
• Supplement with Folic acid, vitamin D, vitamin B
complex and vitamin C may be good idea if you
are symptomatic.
• May need calcium if on steroids
• Supplement with iron if anaemic
• Supplement with zinc if there is long-term diarrhoea.
How is malnutrition
treated?
• Provide extra energy and protein in diet by fortifying
foods
• Aim for small frequent meals
• May need prescription supplements such as
Fresubin Energy®, Fortisip ®, Ensure Plus ®, Modulen
® or Elemental 028 ®
Is There a special diet for
those with IBD?
• Diet for IBD needs to be individualised
• Depends of type of disease and part of bowel
affected
• Depends on previous surgery
• An elimination diet can help identify food
intolerances
• A low residue diet may be needed if there is a
stricture or in a flare-up
• Dietitian is the best guide in selection of most
appropriate diet
What to eat if IBD is
active?
• Best diet should include foods from all the food
groups
• Choose low fibre starchy foods, fruit and vegetables
• Avoid some foods if intolerance is identified
• Smaller meals are better tolerated
What is a low fibre or low
residue diet?
• These diets help to reduce the amount of
“roughage” or residue in the stool
• Restriction of raw fruits and vegetables, their skins
• Restriction of seeds, nuts and sweet corn
• Restrict high fibre carbohydrates such as bran,
wholemeal, and potato skins
• These diets are used when there is significant
diarrhoea, high output stomas or strictures.
High fibre foods to avoid
Recommended foods and those to avoid
Food Groups
Recommend
Avoid
Grains
(four or more
servings daily)
Bread and cereals made from refined flours:
white bread, Cornflakes, Rice krispies,
Cheerios, Puffed wheat, Special K, porridge
Wholegrain/meal bread and cereals:
wholewheat/meal bread, granary bread,
seeded bread, cereals containing bran,
Weetabix, Shredded Wheat, muesli or
other cereas/snack bars containing bran,
dried fruit/coconut or nuts
wholegrain/brown rice, fried rice
wholegrain/wheat pasta
wholegrain/wheat biscuits/crackers
wholemeal/wheat flour
white rice
white pasta
white flour and foods made with this flour
Pulses
None
Dried beans including baked beans,
lentils, dried peas
Nuts and seeds
None
All nuts and seeds and foods containing
them including nut butters, coconut
Potatoes
Potatoes boiled, mashed, baked without
(2 medicum size/day) skin
Potato skin, fried potatoes including chips
roasted, crisps, potato salad
Vegetables
(2 cups/day)
Salads and other raw vegetables
Well cooked vegetables as follows:
green beans, spinach, pumpkin
Food Groups
Recommend
Avoid
Vegetables
asparagus tips, beetroot, carrots, seedless
strained vegetable soup/vegetable juices,
Vegetables can be pureed if necessary
brussel sprouts no pips, seeds, husks,
skins or stalks, sweetcorn, cabbage,
sauerkraut, mushrooms, turnip, onions,
leeks, peppers
Fruit
( 2 medium size
squash, tinned fruit,
ripe banana, melon, tomato no skin or seeds,
pieces/day)ripe avocado. Jelly jam,
shredless preserves,lemon curd.
Fruit can be pureed if necessary
Fruit juices with pulp, prune juice, fizzy
drinks, tinned pineapple, fresh fruit
dried fruit, cakes/biscuits containing dried
fruit, jam, marmalade with seeds, skins,
pips. Mincemeat. Fruit pie/tart/flan.
Skin, stalks, seeds, stones
Milk and milk
products
Whole milk up to 300ml (1/2 pint)/day, semi- Full fat cheese, milk puddings made
skimmed up to 450ml (3/4 pint), skimmed
with wholegrain ingredients
milk up to 600ml (1pt), low fat products
quiche, pizza
eg plain yogurt or with allowed fruit fromage
frais or milk puddings or custard or cream or
icecream without nuts or pieces of fruit,
creamy soup with sieved vegetables, plain
cottage cheese or low fat cheese, milk
substitudes eg soya milk and plain soya
desserts
Fats and oils
Oil (1 tablespoon/person), low fat margarine, Full fat margarine, coconut cream, lard,
butter (scraping), low fat cream sauces
suet
Food Groups
Recommend
Avoid
Meat and poultry
(100g/4oz)
Tender lean meat and poultry, lean
processed meats eg ham/chicken/turkey
or bacon
Tough/course meats with gristle,
luncheon meats, sausages, hotdogs,
cold cuts, meat pies, pasties, pates,
fried meat/poultry, meat prepared with
wholegrain ingredients/seeds/nuts
meat burgers
Fish (up to 160g or
6oz)
Fish (white/oily) steamed, poached, boiled,
tinned in water or oil (discard)
Fried fish and shellfish
Eggs (up to 4/wk)
Boiled, poached, scrambled, omelette
Fried
Miscellaneous
Sugar, honey, syrup, boiled sweets, mints
caramel, marshmallow, jelly, pepper, salt,
gravy made with water, tomato sauce, soy,
sauce, low fat white sauce,
Popcorn, pickles, horseradish, relish,
herbs, spices, curries, chilli, alcohol,
mustard, lemon juice, vinegar, garlic
chocolates, carbonated drinks. Scones,
pastries
What to eat when IBD is
in Remission?
• Important to eat foods from all the main foods
groups
• Can slowly introduce fibre rich foods
• Add one new food at a time and start with small
portions-gradually increasing
• Keep a food and symptom diary to identify food
intolerances
• Gradually build up to a
normal diet.
Can food make IBD
inflammation worse?
• No
• certain foods in any individual may aggravate
symptoms of these diseases
• no evidence that the inflammation of the bowel is
directly affected.
• Avoid food out of date or contaminated as food
poisoning will aggravate IBD
Identifying “problem
foods”
• Keeping a food and symptom diary is very
important
• Common foods less well tolerated are:
o alcohol (mixed drinks, beer, wine) , Fizzy drinks, caffeine drinks
and fruit juice
o Skins, husk and stalks of fruit and vegetables
o dairy products (if lactose intolerant)
o fatty foods (fried foods)
o foods high in fibre such as whole grains and bran
o gas-producing foods (lentils, beans, legumes, cabbage, broccoli,
onions)
o nuts and seeds (peanut butter, other nut butters)
o raw fruits and raw vegetables
o spicy foods
Should someone with active
IBD drink more fluid?
• Yes!
• chronic diarrhoea increases the risk of dehydration
• dehydration and salt loss create a feeling of
weakness.
• people with IBD should drink plenty of fluids,
especially in warm weather when skin losses of salt
and water may be high
Diet tips for IBDsummary
• Keep a food and symptom diary to identify
problem foods that may aggravate symptoms
• Follow a low residue diet or low fibre diet if having a
flare up
• Small frequent meals are often better tolerated
• If losing weight let us know-you may need
supplements
• No special diet for IBD – everyone is difference. Aim
for a balance of all the main foods groups
Thank You