Expert Q&A

A: Most recent scientific research has focused on the semi-vegetarian diet in mostly Crohn’s disease. A small study out of Japan suggested that patients who followed a semi-vegetarian diet were less likely to experience disease relapse than those who were eating a more meat-heavy diet. There has been lesser research done on semi-vegetarian or plant-based diets in UC. There is limited data suggesting that there might be benefits to following a plant-based diet in combination with medical therapy in cases of mild UC. It is important to note that plant-based diets are traditionally higher fiber. Since fiber is a primary fuel source for colon cells and in turn the gut microbiome, eating a fiber rich diet can have a number of health benefits. A plant-based diet can normalize bowel movements especially in constipated patients and help normalize stool in patients with diarrhea. However, tolerance to fiber sources may vary from patient to patient especially in cases of active disease. Those following a strict plant-based diet, especially vegans, may be at risk for additional nutritional deficiencies such as vitamin B12, vitamin D, calcium, and iron. hide answer

A: While there is no one size fits all approach to IBD nutrition and vitamin/mineral supplementation, having UC does put patients at risk for certain nutrition deficiencies. Some of the more common nutrient deficiencies include folate, magnesium, zinc, iron, potassium, Vitamin D, and calcium. It is very important that before taking any vitamin or dietary supplements, that you first discuss it with your doctor or your dietitian. While most patients may benefit from taking a daily multivitamin/mineral supplement, supplementation needs vary person to person depending on medical and surgical histories, medications, and nutritional status. Identifying the best brand of vitamins and supplements is challenging because the Food and Drug Administration (FDA) does not regulate the vitamin and supplement industry, so I generally recommend products that have been USP verified and discussed with your medical team. There are numerous live micro-organisms that may improve the balance of good versus bad bacteria in IBD including E. Coli strain Nissle 1917, Lactobacillus, Bifidobacterium longum, and VSL#3. However, it’s important to talk to your doctor before starting probiotics, especially if you are a young child, older adult, or have a compromised immune system. Dietary sources of probiotics include yogurt, kefir, miso, and tempeh. hide answer

A: It’s important to drink plenty of fluids to prevent dehydration such as broths/bouillon, fruit juices (diluted as needed), diluted Gatorade or G2, Pedialyte (or other oral rehydration solutions), ginger ale, and water/coconut water. Try limiting caffeinated and/or carbonated beverages, if gas or cramps occur. Try avoiding sugar alcohol (mannitol, sorbitol) containing beverages or foods if symptoms worsen or continue. Certain soluble fibers can help with diarrhea by absorbing excess water in the gut. This can be found in both soluble fiber supplements (such as psyllium) and via dietary sources. These starchy foods include items such as bananas, rice, applesauce, potatoes, white toast, noodles, and oatmeal. Avoiding insoluble fibers such as the skins, seeds, and stringy fibers of unpeeled, raw fruits and vegetables and gradually resuming consumption of higher fiber foods, once the diarrhea subsides may prove helpful. Some patients may have other underlying intolerances (such as to gluten or dairy) that could also contribute to looser stooling. It may be helpful to keep a food log to pinpoint trigger foods and eating smaller, more frequent portions throughout the day. For more tailored nutritional recommendations, ask your healthcare team about getting connected with a registered dietitian. hide answer

A: After six weeks the DINE-CD study showed that 43.5% of patients following a Mediterranean style diet and 46.5% of patients following the Specific Carbohydrate Diet™ achieved symptomatic remission in Crohn’s disease patients with prior mild-to-moderate symptoms on stable doses of medications. Given these similar results, it’s important to note the differences between the Mediterranean diet and Specific Carbohydrate diet. While the Specific Carbohydrate Diet has typically been popular among IBD patients due to prior research (and the book Breaking the Viscous Cycle) as well as its structured approach, public health experts often recommend a Mediterranean style diet because it has a variety of other health benefits. Researchers from the DINE-CD study also note that the Mediterranean diet is easier to follow for most and less restrictive than the Specific Carbohydrate Diet which may make it preferred for patients with CD with mild to moderate symptoms. However, there is no universal guide that will work for everyone with IBD as individual tolerance to items such as fruits, vegetables, and other fiber sources may vary and specifics like surgical/medical history, access to food, and nutritional/functional status should be accounted for. While there is no specific instruction set on how to get started, working with a trained professional such as a registered dietitian can help you put these specific dietary changes into place as well as make tailored nutritional recommendations. As of now, the DINE-CD study recommends these diets as a long-term approach to manage symptoms of IBD. hide answer

A: Some patients with IBD may also have underlying lactose intolerance. Lactose is the type of sugar in milk and dairy foods.
To digest lactose, people need a specific enzyme in the small intestine called lactase which can be impacted by inflammatory bowel disease. If you have trouble digesting lactose, you may experience diarrhea, bloating, stomach pain, and gas symptoms. Limiting or avoiding milk and dairy products can help ease these symptoms.
Taking lactase supplements before having milk and dairy products may also help. Milk and dairy containing foods are a primary source of calcium, so making sure to include other sources of calcium in the diet or speaking with your healthcare provider about a multivitamin would be beneficial. Dairy/lactose free alternatives include lactose-free milk,
nondairy creamers, nondairy whipped toppings, soy based sour cream, and other almond, cashew, oat, pea protein, rice, or soy based dairy alternatives. Some people with lactose intolerance can safely eat dairy foods that contain a little lactose (less than 1 gram lactose per serving) such as aged cheese. Be sure to check product ingredients. Avoid foods made with butter, cream, milk, or milk solids. Also avoid products when the ingredients list states, “may contain milk.” hide answer