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Inflammatory Bowel Disease and Diet-Question and Answers By Nicola Attwood Gastro Dietitian-Colchester Hospital Crohn’s and Colitis Meeting May 2013.

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Presentation on theme: "Inflammatory Bowel Disease and Diet-Question and Answers By Nicola Attwood Gastro Dietitian-Colchester Hospital Crohn’s and Colitis Meeting May 2013."— Presentation transcript:

1 Inflammatory Bowel Disease and Diet-Question and Answers By Nicola Attwood Gastro Dietitian-Colchester Hospital Crohn’s and Colitis Meeting May 2013

2 What is Inflammatory Bowel Disease? Ulcerative ColitisCrohn’s Disease Chronic No medical cure Chronic No cure Inflammatory Bowel Disease Indeterminate Colitis 10%

3 What is Difference between UC and CD? Ulcerative Colitis Starts in the rectum Extends to beginning of large bowel (caecum) Inflammation limited to lining of the colon Crohn’s Disease Can effect any part of the bowel Can be patchy Can extend through the bowel wall


5 Why is malnutrition common in IBD? EffectCause Reduced food intake Malabsorption Increased intestinal losses Drugs Poor appetite,pain, nausea, dietary restriction Reduced absorption caused by damaged from inflammation and surgery Altered absorption and utilisation.

6 What vitamin and mineral deficiencies need to be treated? Deficiencies in vitamins and minerals in IBD is common Supplement with Folic acid, vitamin D, vitamin B complex and vitamin C may be good idea if you are symptomatic. May need calcium if on steroids Supplement with iron if anaemic Supplement with zinc if there is long-term diarrhoea.

7 How is malnutrition treated? Provide extra energy and protein in diet by fortifying foods Aim for small frequent meals May need prescription supplements such as Fresubin Energy®, Fortisip ®, Ensure Plus ®, Modulen ® or Elemental 028 ®

8 Is There a special diet for those with IBD? Diet for IBD needs to be individualised Depends of type of disease and part of bowel affected Depends on previous surgery An elimination diet can help identify food intolerances A low residue diet may be needed if there is a stricture or in a flare-up Dietitian is the best guide in selection of most appropriate diet

9 What to eat if IBD is active? Best diet should include foods from all the food groups Choose low fibre starchy foods, fruit and vegetables Avoid some foods if intolerance is identified Smaller meals are better tolerated

10 What is a low fibre or low residue diet? These diets help to reduce the amount of “roughage” or residue in the stool Restriction of raw fruits and vegetables, their skins Restriction of seeds, nuts and sweet corn Restrict high fibre carbohydrates such as bran, wholemeal, and potato skins These diets are used when there is significant diarrhoea, high output stomas or strictures.

11 High fibre foods to avoid

12 Recommended foods and those to avoid Food GroupsRecommendAvoid GrainsBread and cereals made from refined flours:Wholegrain/meal bread and cereals: (four or more white bread, Cornflakes, Rice krispies, wholewheat/meal bread, granary bread, servings daily)Cheerios, Puffed wheat, Special K, porridgeseeded bread, cereals containing bran, Weetabix, Shredded Wheat, muesli or other cereas/snack bars containing bran, dried fruit/coconut or nuts white ricewholegrain/brown rice, fried rice white pastawholegrain/wheat pasta wholegrain/wheat biscuits/crackers white flour and foods made with this flourwholemeal/wheat flour PulsesNone Dried beans including baked beans, lentils, dried peas Nuts and seedsNone All nuts and seeds and foods containing them including nut butters, coconut Potatoes Potatoes boiled, mashed, baked withoutPotato skin, fried potatoes including chips (2 medicum size/day)skinroasted, crisps, potato salad VegetablesWell cooked vegetables as follows:Salads and other raw vegetables (2 cups/day) green beans, spinach, pumpkin

13 Food GroupsRecommendAvoid Vegetablesasparagus tips, beetroot, carrots, seedlessbrussel sprouts no pips, seeds, husks, strained vegetable soup/vegetable juices, skins or stalks, sweetcorn, cabbage, Vegetables can be pureed if necessarysauerkraut, mushrooms, turnip, onions, leeks, peppers Fruitsquash, tinned fruit, Fruit juices with pulp, prune juice, fizzy ( 2 medium sizeripe banana, melon, tomato no skin or seeds,drinks, tinned pineapple, fresh fruit pieces/day)ripe avocado. Jelly jam, shredless preserves,lemon curd.dried fruit, cakes/biscuits containing dried Fruit can be pureed if necessaryfruit, jam, marmalade with seeds, skins, pips. Mincemeat. Fruit pie/tart/flan. Skin, stalks, seeds, stones Milk and milkWhole milk up to 300ml (1/2 pint)/day, semi-Full fat cheese, milk puddings made productsskimmed up to 450ml (3/4 pint), skimmedwith wholegrain ingredients milk up to 600ml (1pt), low fat products quiche, pizza eg plain yogurt or with allowed fruit fromage frais or milk puddings or custard or cream or icecream without nuts or pieces of fruit, creamy soup with sieved vegetables, plain cottage cheese or low fat cheese, milk substitudes eg soya milk and plain soya desserts Fats and oilsOil (1 tablespoon/person), low fat margarine, Full fat margarine, coconut cream, lard, butter (scraping), low fat cream saucessuet

14 Food GroupsRecommendAvoid Meat and poultryTender lean meat and poultry, lean Tough/course meats with gristle, (100g/4oz)processed meats eg ham/chicken/turkeyluncheon meats, sausages, hotdogs, or baconcold cuts, meat pies, pasties, pates, fried meat/poultry, meat prepared with wholegrain ingredients/seeds/nuts meat burgers Fish (up to 160g orFish (white/oily) steamed, poached, boiled, Fried fish and shellfish 6oz)tinned in water or oil (discard) Eggs (up to 4/wk)Boiled, poached, scrambled, omeletteFried MiscellaneousSugar, honey, syrup, boiled sweets, mintsPopcorn, pickles, horseradish, relish, caramel, marshmallow, jelly, pepper, salt, herbs, spices, curries, chilli, alcohol, gravy made with water, tomato sauce, soy,mustard, lemon juice, vinegar, garlic sauce, low fat white sauce, chocolates, carbonated drinks. Scones, pastries

15 What to eat when IBD is in Remission? Important to eat foods from all the main foods groups Can slowly introduce fibre rich foods Add one new food at a time and start with small portions-gradually increasing Keep a food and symptom diary to identify food intolerances Gradually build up to a normal diet.

16 Can food make IBD inflammation worse? No certain foods in any individual may aggravate symptoms of these diseases no evidence that the inflammation of the bowel is directly affected. Avoid food out of date or contaminated as food poisoning will aggravate IBD

17 Identifying “problem foods” Keeping a food and symptom diary is very important Common foods less well tolerated are: o alcohol (mixed drinks, beer, wine), Fizzy drinks, caffeine drinks and fruit juice o Skins, husk and stalks of fruit and vegetables o dairy products (if lactose intolerant) o fatty foods (fried foods) o foods high in fibre such as whole grains and bran o gas-producing foods (lentils, beans, legumes, cabbage, broccoli, onions) o nuts and seeds (peanut butter, other nut butters) o raw fruits and raw vegetables o spicy foods

18 Should someone with active IBD drink more fluid? Yes! chronic diarrhoea increases the risk of dehydration dehydration and salt loss create a feeling of weakness. people with IBD should drink plenty of fluids, especially in warm weather when skin losses of salt and water may be high

19 Diet tips for IBD- summary Keep a food and symptom diary to identify problem foods that may aggravate symptoms Follow a low residue diet or low fibre diet if having a flare up Small frequent meals are often better tolerated If losing weight let us know-you may need supplements No special diet for IBD – everyone is difference. Aim for a balance of all the main foods groups Thank You

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