Diet in Inflammatory Bowel Disease
To some extent advice will vary depending on whether you have Crohn's disease or ulcerative colitis, the site of the disease and past and current treatments. However, it is generally agreed that in most cases of IBD, the normal guidelines for a healthy balanced diet should be followed.
What is a balanced diet?
However, having an illness of the digestive tract will have an effect on the way in which your body handles food. For some people this may mean they have difficulty in eating such a wide variety of foods or that they have increased requirements for certain foods.
How does inflammation affect dietary requirements?
You may also find you are losing weight because your digestive tract is not absorbing food as efficiently as a normal gut. In Crohn's disease, damage to the lining of the small intestine may reduce its capacity to absorb nutrients. This can cause the body to become short of energy or deficient in certain minerals and vitamins, which may make you feel tired. If you have a fever this will increase the body's need for energy. The increased energy requirement is to some extent offset by a reduction in the amount of physical activity taken so it is best to take it easy when suffering with active disease.
Food residue that is not absorbed in the small intestine will enter the large intestine (or colon). An inflamed large intestine may not be able to reabsorb sufficient water or salt from the residue which will result in the passing of a large volume of diarrhoea or semi-solid stool. You may also lose some protein from leakage of the damaged intestinal lining. If this lining bleeds there is a risk of becoming deficient in iron which can lead to anaemia.
When a relapse has been treated you should then begin to feel much better with a return of your appetite. A nutritious diet, high in calories and protein, is then needed to replace lost energy and nutrients.
If your appetite remains poor for a while, you may find small, frequent meals and snacks easier to manage than a few large ones. Extra energy can be obtained from simple carbohydrates or sugars such as sweet drinks, biscuits and sugary desserts, but try to have these in addition to other foods rather than instead of them, as they supply little if any extra vitamins or minerals. Special high energy and nutritious drinks can be obtained on prescription from your doctor. Medical advice should be sought if you are losing weight or struggling to regain it.
Fluids need to be replaced during bouts of diarrhoea and vomiting to prevent dehydration. Usually this can be achieved by drinking more liquid but in severe cases, a solution of salt and glucose in water may be prescribed to improve absorption. In hospital, fluid losses are sometimes replaced by giving fluids into a vein.
Should the inflamed gut be rested?
circumstances, for example if the gut has become completely obstructed,
it may be
necessary to stop eating and receive nutrition
via a vein into the blood. This is known as Total Parenteral Nutrition
(TPN). In Crohn’s disease TPN 'dampens' down inflammation in most
cases and is sometimes used as a treatment or as preparation for surgery.
This is not the case in ulcerative colitis although TPN is still used
sometimes to provide nutrition when the gut is not working. Special artificial
diets known as 'enteral diets' are also effective in Crohn's disease
at reducing inflammation, but they are not helpful in ulcerative colitis.