Inflammatory Bowel Disease and Nutrition
Patients with inflammatory bowel disease typically have great and warranted concerns about what they should eat. While diet is most likely not a major factor in the inflammatory disorder in these patients, it may play some role, and certainly can affect their symptoms. Ulcerative colitis and Crohn's disease typically effect different parts of the gastrointestinal tract, and therefore have different implication on nutrition. In Crohn's disease, when the small bowel can be involved with inflammation, patients have difficulty absorbing nutrients such as vitamins, minerals, carbohydrates and fat. Ulcerative colitis on the other hand, only involves the colon, which is where significant water absorption takes place. That is the reason why patients with Crohn's disease typically have more malnutrition than those with Ulcerative colitis.
While certain foods will worsen symptoms in these conditions, specifically lactose and high fiber diets, there is no evidence that this is a food allergy. While the symptoms are worse, there is no documented increase in inflammation of the gastrointestinal tract. That being said, patients with inflammatory bowel disease are always asking what they should eat. It is important to note that there is no single regimented diet in inflammatory bowel disease. Each patient should use their experiences to see what they should and should not eat. Unlike a disease like celiac sprue for example, where there is an allergy to gluten that causes destruction of the small intestinal villi, diet in inflammatory bowel disease will not affect the disease process, only hopefully affect the symptoms.
There has been a lot of buzz with regard to The Specific Carbohydrate Diet; the focal point of the book Breaking the Viscious Cycle, by Elaine Gottschall, M.S. Essentially, the diet involves decreasing poorly digestible carbohydrates, which may decrease symptoms of gas, bloat, cramps and diarrhea. Some may find the diet difficult to adhere to. It consists mainly of: meats, limited fruits, vegetables, oils, honey and nuts. Sugar, wheat and every other grain are not allowed. Another popular diet is the elimination diet. Clinical studies using an elimination diet (diet of foods that have a lower tendency to produce allergic reactions) have provided significant IBD improvements with no side effects. The theory behind these diets is generally to limit carbohydrates in an effort to kill microbes that might contribute to symptoms. It is important to note, that in no way should dietary treatment alone be used instead of medical therapy as it does not affect the underlying inflammatory process. That being said, it certainly might be worth a try. Probiotics (pills containing high doses of "good" bacteria) has of late been felt to aid in the treatment of inflammatory bowel disease. Some of the symptoms of inflammatory bowel disease are felt to be related to excess "bad" bacteria. By increasing the amount of "good" bacteria in the gastrointestinal tract with probiotics, the amount of "bad" bacteria is decreased, restoring balance to the flora that live in everybody's gastrointestinal tract. Lactobacillus and live-culture yogurt can be helpful as well.
Finally, vitamin supplementation is important in inflammatory bowel disease. Both Ulcerative colitis and Crohn's disease can cause blood loss from the gastrointestinal tract that can lead to anemia. In Crohn's disease, the blood loss will typically be occult, while in Ulcerative colitis there may be evidence of gross rectal bleeding. Most patients, even if they are not anemic, will benefit from iron supplementation. Additionally, in Crohn's disease, there may be malabsorption of iron, B12 and calcium, so supplementation with vitamins containing these vitamins and minerals is warranted.
In summary, diet and nutrition are very important in the treatment of inflammatory bowel disease. You should discuss this with your gastroenterologist and perhaps even a nutritionist to come up with the best plan tailored to your disease.