Characterised by persistent inflammation of the intestinal tract, IBD can be debilitating. Symptoms, including abdominal pain, diarrhea, loss of appetite and fatigue, can linger for weeks to years yet even disappear for periods of time. The two different conditions that fall under the category of IBD—Crohn’s disease and ulcerative colitis—affect the gut in different ways. With Crohn’s disease, inflammation in all layers of the intestinal wall prevents the small intestine from properly absorbing nutrients and disturbs the fine balance of water needed to usher foods along the intestine. That can lead to relentless diarrhea. Add appetite loss to the equation, and vitamin and mineral deficiencies become a real problem. With ulcerative colitis, the inner lining of only the large intestine becomes inflamed, preventing the normal absorption of water from the colon, the last 150 cm of bowel, causing diarrhea and extreme discomfort.
More than half of people who develop IBD eventually have surgery to remove part of their intestine or correct intestinal abnormalities, which can leave the gut less robust and more sensitive to swings in dietary and other irritants.
Food won’t prevent or cure IBD, but the right diet may diminish symptoms. The strategy is to focus on foods that reduce inflammation, to reestablish healthy bacteria in the gut and to pamper your intestinal tract. Keeping a food diary helps determine which foods trigger flare-ups and which seem to help. Work with your doctor to determine whether you have sensitivities to specific foods and establish whether you need supplements to replenish some of the nutrients lost during bouts of IBD.
Your food prescription
Small, frequent meals rich in calories
Six small meals a day are often more easily digested than the traditional three and make it easier to get enough calories to maintain weight. People with IBD often lose significant weight, making it difficult for them to get sufficient nutrients. This is particularly true for people who have narrowed areas of the intestine as a result of IBD.
Aim for: Choose calorie-rich, nutrient-dense foods like whole grains, legumes, and nuts when your gut feels calm.
Potatoes, White Rice, Refined Pasta, and Other Low-Fibre Foods
The digestive tracts of people with active IBD are often inflamed and sensitive to irritation. Smooth bland foods tend to be easier on the gut during this time. Because these foods often lack essential nutrients that we need for robust health, it’s best to consult your doctor or a registered dietitian and to take a multivitamin to ensure that you’re getting the nutrients you need.
This green banana, common in South America, may have a soothing effect on the lining of the intestine. A study from England showed that soluble fiber from plantain creates an environment that resists inflammatory bacteria. If more studies follow suit, the plantain may find a regular place on the global menu of people with IBD.
Aim for: No one knows how much plantain may be the ticket to a healthy intestine, but boiled green plantain or sautéed yellow plantain is a lovely addition to any evening meal and may help soothe some of the irritation that comes with IBD.
Olive oil is rich in anti-oxidants called flavonoids, which protect the body’s cells from daily wear and tear. Flavonoids may help reduce inflammation by neutralizing free radicals that contribute to it. One recent study showed that a combination of olive oil and fish oil reduced inflammation in the colons of rats with IBD.
Try to buy extra virgin olive oil, which has the most flavonoids. For the highest quality and the most nutrient-dense oils, seek out estate oils that are produced in one region (this doesn’t mean you have to choose the most expensive; the choice is incredibly varied). Avoid ‘light’ and ‘extra light’ olive oil, which has usually been further refined or filtered to reduce its ‘olive’ taste – this means more flavonoids have been removed.
Aim for: Try to use extra virgin olive oil as a replacement for the other oils you consume.
Yogurt with active cultures and other fermented milk products
Although the cause of IBD remains a mystery, scientists are now exploring whether an overgrowth of bacteria in the intestine may contribute to the disease. Probiotics are beneficial bacteria found in fermented milk products such as yogurt, cultured buttermilk, probiotics and kefir. Getting more of them helps keep the unhealthy gut bacteria in check.
Aim for: People with IBD respond differently to different diets, so there’s no blanket recommendation here. You might start by having ½ cup of yogurt or fermented milk with live active cultures daily (look on the label for Lactobacillus acidophilus, Streptococcus thermophilus and bifidus, among other active cultures) and gradually increase the amount you eat, up to 1 ½ cups a day. Keeping a food and symptom diary during this trial period should help you establish your optimal amount.
Salmon, mackerel, walnuts and other sources of omega-3 fatty acids
With inflammation at the root of the problems caused by IBD, it makes sense to seek out foods rich in omega-3 fatty acids, which battle inflammation. Salmon and other fatty fish are the very best sources. In one study, patients with Crohn’s disease who ate 100 g or more of fish per day for two years lowered their chances of relapse from 58 per cent to 20 per cent. Linseeds, linseed oil and walnuts also contain essential fatty acids, but they aren’t converted efficiently by the body to the kinds of omega-3s that fight inflammation (the kinds found in fish). But for those people who have trouble eating fish, they’re most certainly better than nothing.
Aim for: Three fish meals per week.
Water and other fluids
The risk of dehydration is ever present with IBD because of chronic diarrhea. Kidney problems can also result when the amount of fluids entering the body doesn’t keep up with the amount leaving it. Even when you don’t have symptoms, it’s a good idea to prioritize water.
Aim for: At least eight 250-ml glasses of water or other fluid every day. Some acidic juices, such as pineapple or tomato, may irritate your digestive tract, so stick to clear fluids whenever possible and avoid carbonated beverages, which can contribute to bloating. The polyphenols in green tea may help to reduce diarrhea.