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Defined or Restrictive Diets for IBD

Inflammatory Bowel Disease (IBD) is a complex condition that affects individuals differently, making dietary choices a crucial aspect of disease management. In this edition of IBD Insights: Living with the Disease, our Patient and Public Involvement (PPI) panel shares their experiences with restrictive diets and how they navigate food choices during disease flares and remission.

Patient-to-Patient Tips on Dietary Restrictions
  • Temporary Restriction During Flares: Some patients may need to follow a restricted diet under the guidance of a healthcare professional during a flare-up to allow the bowel to recover. However, this restriction should be temporary.
  • Addressing Food Sensitivities: Certain foods may trigger symptoms during a flare. Eating simple, nutritious meals can help manage symptoms while ensuring proper nutrition.
  • Returning to a Normal Diet: Once symptoms subside and the flare is under control, patients should aim to return to a varied and balanced diet unless otherwise advised by a healthcare provider.
  • Avoiding Negative Food Associations: Many IBD patients encounter societal assumptions about their diet. It is essential to avoid internalizing restrictive food beliefs that may not apply to individual cases.
  • Medical Guidance is Key: Only follow a restrictive diet upon the recommendation of a doctor or registered dietitian, as self-imposed restrictions can lead to nutritional deficiencies.
  • Experimenting with New Foods: Trying different foods and monitoring tolerance can help broaden dietary options and reduce unnecessary restrictions. Trusting your body’s response to food is key.
  • Seek Professional Advice for Reintroduction: After a period of restriction, it is advisable to reintroduce foods slowly, consulting a dietitian or doctor for guidance.
  

 

The Science Behind
Defined Diets for IBD Guidelines on Dietary Interventions Reintroducing Foods after a Flare
While dietary needs vary among individuals with IBD, several factors influence what foods may be tolerated:
  • No Universal IBD Diet: Clinical guidelines do not recommend a specific oral diet to promote remission in active IBD.
  • Gradual Approach: Slowly reintroduce foods one at a time to assess tolerance.
  • Disease Type: Includes Crohn’s disease, ulcerative colitis, and indeterminate IBD.
  • Short-Term Restrictive Diets: A restrictive diet may be advised by a registered dietitian based on individual needs, but only for a short period.
  • Individualised Restrictions: If certain foods need to be avoided due to specific disease characteristics, healthcare guidance is necessary.
  • Disease Location: Colitis affects only the colon, whereas Crohn’s can impact any part of the gastrointestinal tract.
  • Example: Low FODMAP Diet: The low FODMAP diet involves a short-term exclusion phase (4-8 weeks) followed by a gradual reintroduction of foods.
  • Mechanical Adaptations: Some individuals may struggle with certain food textures. Options like blending foods into soups or smoothies (e.g., the IBD-AID diet) may help improve tolerance.
  • Disease Characteristics: Conditions such as fistulizing disease, strictures, ostomy, pouchitis, or bowel obstructions can affect dietary choices.
  • Supervision is Essential: Exclusion diets should always be supervised, as prolonged restrictions can lead to malnutrition and deficiencies.
  • Focus on Nutrient Intake: Malnutrition is a significant concern in IBD and can impact immune function, treatment response, and overall well-being.
  • Disease State: Diet may need to be adjusted depending on whether the disease is in an active flare or remission.
  • Post-Remission Diet: Once remission is achieved, food restrictions should end, and the goal should be a balanced, nutritious diet.
  • Balanced Eating in Remission: No specific diet is required in remission, but maintaining a healthy, nutrient-dense diet is essential for optimal health.

Expert Panel Contributions

This resource was developed in collaboration with experts in the fields of microbiome research, immunology, and clinical nutrition:

  • Silvia Melgar – Investigator at APC Microbiome Ireland, expertise in immunology, inflammation, and host-diet interactions.
  • Majella O'Keeffe – Registered Dietitian, researcher, and senior lecturer specializing in nutrition and dietary management of IBD.
  • Ana Velikonja – Research scientist at Arla Foods Ingredients, formerly a postdoctoral researcher in gut microbiome and IBD.

Final Thoughts

Managing IBD through diet is a personalised process that should always be guided by healthcare professionals. While short-term dietary restrictions may be necessary, a long-term approach should focus on inclusivity, balance, and meeting nutritional needs to support overall health and well-being.

Host Institution

Host Logos - UCC and Teagasc

Partner Institutions

APC Microbiome Ireland

Biosciences Building, University College Cork, Ireland,

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