Diet and IBD: The Relationship

Diet and IBD

Many people with IBD will have been told over the years that diet plays no part in their IBD management. While it is true that diet can’t cure IBD, the idea that is has no role in it’s management is fortunately becoming outdated. When I speak to my patients with IBD, I always say that I can’t cure their IBD but I can help with pain management and frequency as well as potentially improve their stool form and fatigue. Usually this is plenty of motivation for them to consider making dietary changes. This means we can improve the quality of life with people with IBD through diet and more and more research is going into understanding how diet may help with maintaining remission and supporting long term health. 

There is a lot of research going on at the moment to understand how processed foods and the additives they contain, such as emulsifiers, may impact IBD but as yet, this research isn’t of good enough quality to be incorporated into IBD dietary guidelines. That said, as with the general population, being aware of which foods in your diet are processed and ultra processed, is a good idea when you live with IBD. 

While there isn’t an accepted definition of ultra processed foods to date, a way to identify ultra processed foods is to consider the ingredients list, looking for emulsifiers, sweeteners, preservatives or colourings and consider how different the food is now to it’s original form. For example, processed meats, biscuits, cake products and processed meat alternatives, as well as crisps and instant noodles are all considered ultra processed. We don’t need to worry about canned or frozen whole foods where the original ingredients are still recognisable however, as long as there aren’t unnecessary additives. 

Many people with IBD will cut things out of their diet to help them to manage symptoms. This can however, lead to people eating a highly processed “beige” diet which isn’t ideal for long term health. 

Research has shown that a Mediterranean style diet with plenty of plants, fish, lean protein, dairy and limited processed food has been shown to improve health markers including inflammation in IBD. If your disease is in remission, it is a good idea to start working towards a Mediterranean dietary pattern. 

For some people with IBD, increasing fibre as per the Mediterranean diet can be difficult because it can cause symptoms like pain and bloating as well as an increase in stool frequency. This is where modifying the fibre you include can be really helpful. For example, whole chickpeas and pulses can be difficult digest, but when you blend them into hummus or soups or cook split peas into dhal, people generally tolerate them better. Similarly, raw vegetables can be uncomfortable to digest but cooked veggies are much easier and nuts are easier when they’re made into nut butter. If you live with IBD and want to increase your plant intake but are struggling with symptoms when you do, start with smooth soups and smoothies rather than salads and seeds. This is especially relevant if you have narrowings in your bowel from old inflammation, known as strictures, if you have scar tissue in your bowel known as adhesions or if you have an ileostomy. 

Some people with IBD also live with irritable bowel syndrome (IBS) which can be confusing as your inflammation levels might be normal but your symptoms are still bad. This can also cause distress to those who live with both conditions as the symptoms of the IBS can be mistaken for a flare. If you think you might have IBS as well as IBD, speak to a registered dietitian about whether the low FODMAP diet might be right for you. 

Many people with IBD may have found that they have fewer symptoms without dairy in their diet but this isn’t the case for everyone. The risk of removing dairy, is that your bone health will suffer and bone health is often already compromised in people living with IBD by steroid use. If you notice you’re more comfortable without dairy in your diet, is is most commonly the lactose in dairy that people struggle to digest. This means that low lactose dairy products such as lactose free milk, cheeses like cheddar, parmesan, mozzarella and feta and kefir might still suit you because they are very low in lactose. If you can include these, your bone health will be less compromised.

Overall, it’s important to remember that diet in IBD is very individual and working with an specialist IBD dietitian is important to make sure your diet is managing your symptoms, not compromising your health and is supporting your IBD management.