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Lesley Stanford, MS, RD, CSP

Pediatric Nutritionist, Duke University Medical Center

Q: My 14 was just diagnosed with Crohns and it was pretty bad. He is on remicaid but has also suggested a diet in which half of his calories come from a “formula” such as boost or ensure. We are very concerned that boost and ensure have added ingredients and sugars that might not be so healthy. I have recently been looking at organic protein based powders. I sampled one today from a company called Orgain and I very much enjoyed it but wanted to be sure it met all of the requirements we needed.

A: Partial enteral nutrition is a treatment for IBD. Formula provides 30 – 50% of a patient’s estimated calorie needs. It can be used with medication to inducing remission. Patients consume formula and take solids generally while taking medication. Studies have shown that the formula used does not have to be elemental or peptide-based. The protein source from the recommended formula can be intact. Orgain and Kate’s Farms have intact protein and could be used. hide answer

Q: Is the Specific Carbohydrate Diet one that is helpful in controlling ulcerative colitis symptoms?

A: A Specific Carbohydrate Diet(SCD) is a grain-free diet that is low in sugar and lactose. It is considered an exclusion diet in which foods are eliminated from a patient's diet. It takes discipline to maintain; it requires more meal-planning and preparation. Studies with adults and pediatric patients with IBD have shown that a SCD is often more useful to manage symptoms for Crohn's than UC. hide answer

Q: My partner has had Crohn's for 10 years. Two years ago, he had surgery (resection). He loves food and has been focused on regaining weight lost. Now, he has put on weight and has been sedentary because of COVID-19. I worry about his diet which includes fried foods, rich sauces, take-aways, fizzy drinks, lots of snacks (crisps, sweets); odd eating times. I think he would benefit from professional help, although he is resistant. What can I do?

A: A registered dietitian is a helpful member of a patient's health care team. Consider a nutrition consult if he is interested in improving his diet. www.eatright.org is a useful way to find a dietitian in your area if your health care team does not have a dietitian. If he is interested in making a few changes, consider ordering healthier foods from restaurants for take-out or curbside. Add more fruits and vegetables. Many people have struggled with erratic mealtimes since mid-March due to pandemic. hide answer

Q: I have ulcerative colitis that is in remission most of the time. Is coffee bad for IBD patients or just the caffeine component? Would decaf coffee be ok when I am in remission?

A: Caffeine is often considered an ingredient to avoid during a flare. Caffeine can have a laxative effect for some patients. A study looking a patients' perception of the effect of caffeine on symptoms (Barthal, 2015) showed that patients felt caffeine made GI symptoms worse. However, many adults continued to drink coffee. Decaffeinated coffee may be the safer choice. It is important to remember that caffeine is not associated with inflammation. hide answer

Q: I am looking for a protein powder supplement. I do not eat meat, though I will eat eggs. When in a flare-up, I limit my bean intake. I also avoid gluten as much as possible. Is there a certain type of protein that could be suggested for UC patients (pea, cranberry, whey, etc.)?

A: It is important to determine the amount of protein recommended. Talk to your health care team and set a goal. There are some many protein powders and drinks on the market. First, look at the protein source. Try a small amount of a dairy-based or plant-based protein powder to determine if you tolerate. Plant-based protein powder can be made from grains, nuts, soy, or seeds. Some protein powders are blends of a variety of plants. When comparing protein powders and drinks, look at the sugar content. Many supplements are high in sugar. When comparing protein powders and drinks, be aware a 2018 study showed some powders and drinks contain heavy metals like arsenic, cadmium and lead. Do your research before purchasing. hide answer

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