Expert Q&A

A: UC primarily affects the colon, which has the primary responsibility of removing water, some nutrients, and electrolytes from partially digested food. Concentrated beverages high in excess sugars draw water and electrolytes into the gut, making stools loose and unformed, and without the colon fully functional in the case of UC, this can lead to further electrolyte and fluid losses. Your body absorbs fluid best when there is a certain ratio of sugar to salt to water. Oral rehydration solutions take full advantage of that ratio and could help keep you hydrated while biking. Ready to use products include Liquid IV, Drip Drop, and Pedialyte. A homemade recipe includes using 4 cups of G2 or Powerade Zero with ½ teaspoon of salt. I would suggest discussing what medical limitations may or may not exist given your active disease status in terms of physical activity intensity and duration with your medical provider. hide answer

A: Nutrition therapy for people living with inflammatory bowel disease is not a “one size fits all” approach. What might work well for one individual might not work for another which is what can be quite frustrating for patients searching for a diet plan. Due to your underlying gluten sensitivity, IBS, and lactose intolerance, it might be helpful to focus on whole foods. Some Crohn’s disease patients have had success with whole food-based diets such as the Crohn’s disease exclusion diet. It models some of the components of the autoimmune protocol but is not as restrictive up front and serves as a maintenance versus elimination- based diet. The whole foods approach aims to reduce exposure to foods thought to cause intestinal inflammation, change the microbiome, alter the mucous layer in the gut, or change intestinal permeability. This diet includes fruits, vegetables, meats, complex and simple carbohydrates. If animal- based protein is difficult for you to tolerate, plant-based protein sources could serve as an alternative. This diet plan avoids gluten, gluten free baked goods, dairy, animal fats, processed meats, products containing emulsifiers, canned goods, and packaged products with an expiration date. To promote bowel regularity in the setting of IBS-C, it might be beneficial to discuss adding in fiber, additional hydration strategies, or probiotic supplementation with your medical team. Finding an outpatient dietitian specializing in IBD care could also serve as a helpful resource for tolerance follow up. hide answer

A: Some general recommendations to help include seeing a dietitian with expertise in IBD, getting tested for vitamin/mineral deficiencies and discussing ways to supplement with your healthcare team, drinking plenty of fluids, keeping a food journal to pinpoint problem food items, and trying to slowly increase dietary variety. While everyone’s IBD is different, these are some of the most commonly reported “problem” foods for individuals with active IBD: foods high in insoluble fiber, foods with sugar, artificial sweetener, and sugar alcohols, lactose rich foods, “gassy” cruciferous vegetables and uncooked vegetables/fruit, high fat/greasy/fried foods, caffeine, and alcoholic and carbonated beverages. Some potential foods to include during a flare include: diluted juices, smoothies, pureed vegetable soups, applesauce, canned fruit without added sugar, banana, pumpkin, oatmeal, cream of wheat, plain chicken, turkey, or fish, cooked eggs or egg substitute, mashed potatoes, rice, or noodles, white bread, and oral nutrition supplements. In general, eating smaller, more frequent meals may also be helpful. hide answer

A: Deciding what to eat and recommending what to eat can be challenging for those with IBD. Since everyone’s IBD is different, there is no one single diet or eating plan that will work for everyone with Crohn’s disease or ulcerative colitis. Dietary recommendations must be tailored just for you – depending on what part of your intestine is affected, what symptoms you have (such as, diarrhea or constipation), the status of your disease, whether you are in remission or having a flare, as well as the presence of any nutrient, vitamin, or mineral deficiencies which your team can assess. Seeing a dietitian with expertise in IBD can also help with this assessment. While everyone’s IBD is different, these are some of the most commonly reported “problem” foods for individuals with active IBD: foods high in insoluble fiber, foods with sugar, artificial sweetener, and sugar alcohols, lactose rich foods, “gassy” cruciferous vegetables and uncooked, raw vegetables/fruit (especially those with tough outer skins or seeds), high fat/greasy/fried foods, caffeine, and alcoholic and carbonated beverages. Try slowly introducing new food items, even one at a time and eating small, frequent portions (i.e. 5-6 smaller portions if 3 big meals per day is difficult). Keeping a food log like you describe of what you eat and how you feel can be a helpful way to figure out what diet might work best for you as the best diet is one that meets your nutritional needs, while helping you better manage your IBD symptoms. hide answer

A: The low FODMAP focuses on reducing FODMAP carbohydrates which can be poorly absorbed in the small intestine and thus may be broken down and fermented by your microbiome producing excess fluid and gas. This is actually a diet that has been primarily studied in IBS – irritable bowel – which is different than IBD. The Specific Carbohydrate Diet has been popular among IBD patients due to growing research following the book “Breaking the Viscous Cycle” as well as its structured approach. Researchers from the DINE-CD study compared the effectiveness of the SCD against the Mediterranean diet and found statistically similar rates of symptomatic remission in Crohn’s Disease patients. The Mediterranean diet may be easier to follow for some and can be less restrictive than the Specific Carbohydrate Diet which may make it preferred for patients. The post-operative bariatric maintenance diet (phase IV) aligns with most of the Mediterranean diet principles such as recommendations of lean meat, poultry, pork, and fish, low fat dairy products, low fat starches and whole grains, and cooked vegetables and fruits. If you can't tolerate 3 meals daily, 5-6 smaller meals daily may be better tolerated as well as separating liquid and solid food intake. Because following a therapeutic diet, experiencing active IBD, and having a surgical history of RYGB puts you at increased risk for vitamin/mineral deficiencies, it’s important to stay in close contact with your healthcare team to make sure you remain nutritionally healthy. The Crohn’s and Colitis Foundation has a Diet & Nutrition Page that can be a helpful resource for patients to stay up to date. A registered, licensed dietitian preferably with experience in bariatric surgery and inflammatory bowel disease should be able to tailor nutritional recommendations specifically for you and your needs. hide answer