Controlling your IBD

Diet and Nutrition - Introduction

Top tips

• Make it a 'Mediterranean style' diet' - wherever you live - to help your body defend and repair itself

• Eat regularly throughout the day - this improves your dietary intake and eases the effect on your bowels

• Spicy foods, high-fat foods and fizzy drinks are commonly problematic with IBD and can easily be cut from your diet, making your diet much healthier overall

• Keeping a food and symptom diary may help identify any less obvious dietary triggers. If desired, a typical 'diary' can be accessed from here.

• Everyone is different, and there is no 'Wonder Diet' for people with IBD. So, consult your healthcare professional before undertaking any dietary change, or experimenting with a new diet

• If you're cutting out major food groups such as wheat or dairy, make sure you're not at risk of nutritional deficiencies - ask your doctor to refer you to a dietician for advice

• Keep ahead of your fluid requirements - especially if you have diarrhoea; choose suitable drinks to manage your symptoms

• Vitamin and mineral supplements are commonly recommended; check with your doctor, dietician or pharmacist regarding suitability - your condition is complex and you will need specialist advice

• Request an appropriate referral to a dietician who specialises in IBD

When you have IBD it is common to be concerned that particular foods may 'trigger' the condition or make symptoms worse. Diet is not the cause of IBD, but dietary choices can help to manage your symptoms. Other lifestyle factors can affect your health in IBD, such as exercise; a modest 30-minute walk three times a week has been shown not only to improve mental outlook, but also to improve bone mineral density, an important predictor of osteoporosis risk in later years.

The more varied your diet, the healthier it will be. A healthy diet is more about what you keep in your diet, rather than what you cut out. If you exclude foods but find no real difference in your symptoms then you should reintroduce them back into your diet.

Eating healthly                                                                             

Healthy eating keeps the body well, helps it repair any damage, resist inflammation and to heal more quickly if symptoms flare up.

So what is a healthy diet?                                                                                       back to top

The Food Standards Agency has defined the 'Eatwell plate' to show how much of each food group you should eat to have a healthy balanced diet (Figure 1).

Figure 1. The Food Standards Agency 'Eatwell Plate' showing food proportions in a healthy diet

(© Crown copyright material is reproduced with the permission of the Controller of HMSO and Queen's Printer for Scotland).

Starchy foods contain soluble fibre - a gel-like fibre digested by bowel bacteria. This type of fibre is sometimes called 'prebiotic' as it helps healthy 'probiotic' bacteria to survive and multiply. Soluble fibre is gentle on the bowel wall; it can absorb water and so reduce diarrhoea and produce a softer stool. Soluble fibre is found in all types of carbohydrate foods, including white bread, porridge oats and some vegetables and beans.

Protein foods include meat (beef, lamb, chicken, pork), fish, dairy foods (milk, yoghurt, cheeses), soya milk and tofu. All these are fibre free. Protein from peas, beans, lentils and soybean also provides soluble fibre.

Proteins are needed daily because we don't store protein to call on when our bodies need more. Protein maintains a healthy bowel and boosts your immune system - both essential for good health. If you have inflammatory bowel disease you may need additional protein to help repair your bowel. Try to include protein foods at every meal.

Dairy foods are high in protein, fibre-free and rich in calcium and phosphate - essential for healthy bones. Bone strength is related to its density, which peaks in your early 30s. Prolonged use of steroids can weaken bones, so calcium-rich foods, such as dairy products, are important to help bones recover. However, dairy foods may be poorly tolerated. This can be due to fat content, protein type, or sugar content. If you find dairy products (particularly cheese) 'hard to digest', try lower fat options first. Choose semi-skimmed and skimmed milks, low fat yoghurts, reduced fat cheeses (such as half-fat cheddar or Edam) or low fat cheeses (such as cottage cheese) to reduce fat but keep essential protein. You may need to reduce the amount of other fats in your diet as well.

Milk protein is made of casein and whey. Whey protein empties from the stomach more quickly and so lessens feelings of 'fullness'. Goat's milk and cheeses have a higher whey content which may be preferred.

Dairy foods contain milk sugar (lactose) which is found in milk, yoghurt and soft cheeses: windy, explosive diarrhoea is commonly associated with lactose intolerance. If these symptoms seem familiar try a lactose-free diet.

Fruits and vegetables are rich in vitamins, minerals, anti-oxidant plant substances and many contain soluble fibre and insoluble fibre, all useful to boost our health. Research shows that people with IBD don't eat enough fruits and vegetables. When your IBD is under control include fruits and vegetables throughout the day. If you're worried about symptoms, start with a small portion and gradually increase over time. You may tolerate cooked or canned versions better than raw.

Fats and oils provide calories, essential fats we can't make ourselves, and fat-soluble vitamins A, D, E and K. Vitamin D seems to have an important role in Crohn's disease. Fat also helps the body absorb important plant anti-oxidants such as beta-carotene and lycopene.

Olive oil and rapeseed oil, both rich in mono-unsaturated fats, are the healthiest oils to use. Omega-3 fats, found in oily fish and rapeseed oil, may help to reduce inflammation, but not during active phases. For an average adult diet, 70-90g of fat daily is an acceptable amount. Some people find a high-fat diet worsens their symptoms and that reducing fat intake helps.