Managing Inflammatory Bowel Disease (IBD)

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If you have Inflammatory Bowel Disease (IBD), you may have questions about your symptoms and the foods you eat. Read on to learn more about IBD, how to manage symptoms, and when you should see your healthcare provider. 

What is Inflammatory Bowel Disease (IBD)?

IBD refers to two conditions: ulcerative colitis and Crohn’s disease.

  • Ulcerative colitis causes inflammation and sores in the large intestine (colon) and rectum.
  • Crohn’s disease causes inflammation and sores in any part of the digestive tract including the mouth, esophagus, stomach, intestines and anus. 

What causes IBD? 

There is no known cause of IBD.  Some research suggests IBD occurs when the body’s immune system attacks healthy cells in the digestive system by mistake.  Diet and stress do not cause IBD, but may make it worse.

What are the symptoms of IBD?

IBD symptoms can range from mild to severe.  This depends on the amount and location of inflammation in the digestive tract and where it occurs. Living with IBD can mean that you sometimes feel healthy with no symptoms. Other times, you can experience flare-ups (or symptoms) and feel unwell.  Common symptoms of IBD flare-ups include:

  • Diarrhea
  • Nausea
  • Pain and cramping in the abdomen, including gas and bloating
  • Fever
  • Fatigue
  • Blood in your stool
  • Loss of appetite
  • Unplanned weight loss

Over time, these symptoms can result in:

  • Not being able to absorb vitamins and minerals, including iron, folic acid and calcium
  • Reduced bone mineral density, which increases the risk of broken bones

When should I see my health care provider?

It’s important to speak with your health care provider if you are experiencing any of the following symptoms:

  • Diarrhea or vomiting with fever
  • Pain in the lower abdomen
  • Blood in stool, and/or
  • Unplanned weight loss

How can I manage my symptoms of IBD?

While there is no cure for IBD, you can help manage your symptoms and lower the risk of complications. Try these tips:

  • Add soluble fibre gradually to your meals. Vegetables and fruit, legumes (peas, beans, lentils), and grains (barley, oat or psyllium) can help prevent or manage symptoms of diarrhea. Add fibre slowly to limit gas and bloating.
  • Avoid sugary drinks and limit alcohol and caffeine. These beverages can make diarrhea worse.
  • Eat small meals and snacks during the day, and drink plenty of fluids. Water, weak tea, and broth can help manage diarrhea.
  • Eat slowly and chew your food well.
  • Keep a diary of foods that make you feel unwell and limit these foods. When possible, follow Canada’s Food Guide to plan meals using a variety of foods that you tolerate.
  • Avoid drinking through a straw or drinking carbonated beverages, which may lead to swallowing extra air causing gas and bloating.

Here are other ways to manage symptoms:

  • Manage stress levels.
  • Move more and sit less. Aim to be active for at least 150 minutes per week and break up long periods of sitting. Try brisk walking, biking and swimming.
  • Get enough sleep so that you feel rested - aim for 7 to 9 hours per day.
  • Consider quitting smoking.  If you’re looking for help quitting, find free help in your area here.

Should I avoid fibre during an IBD “flare-up”?

Research shows that there is no need to avoid fibre when you have symptoms or a “flare-up” of IBD. Only avoid the specific foods that make your symptoms worse. A dietitian can help you identify these foods and work with you to make substitutions. 

How can I get the nutrients I need when I have IBD?

IBD may affect the nutrients being absorbed in your digestive system. To help you get the nutrients you need, eat:

  • Iron rich foods like meat, poultry, iron fortified cereals, and dark green leafy vegetables.
  • Folate rich foods like dark green vegetables.
  • Vitamin D and calcium rich foods like milk, fortified plant-based beverages, fish, almonds and dark green vegetables. You can include cheese and yogurt if they don’t make your symptoms worse.
  • Protein rich foods like beans, tofu, eggs, meat, poultry and fish.
  • Enough calories to maintain your weight and keep your energy levels up. Avoid skipping meals. 

What about medications?

There has been some research to show that specific strains and doses of probiotics may help with remission in people with Ulcerative Colitis but more research is needed. There isn’t enough research to say whether probiotics help with Crohn's disease. If you’re interested in trying probiotics, speak to a dietitian. They can guide you on which strains have been studied for your specific symptoms and condition. 

Before starting any supplements, check with your dietitian or health care provider. 

Do probiotics help?

There is not enough research to say that probiotics are helpful with symptoms of IBD. More research is needed to determine the type and dosage of probiotics to manage symptoms. However, using probiotics has not been shown to cause harm in managing IBD. 

How can a dietitian help?

It is important to work with a dietitian when you have IBD. A dietitian can help you:
●      Identify foods that might make your symptoms worse
●      Make changes to your diet to help manage symptoms like diarrhea, gas and bloating
●      Make sure you are getting enough vitamins and minerals 
●      Recommend any dietary supplements you may need
●      Eat a balanced diet to maintain your energy 

Connect with a dietitian today!

Bottom line

Living with IBD means managing your symptoms through medication, diet and lifestyle choices.  Some people with IBD have trouble getting enough nutrients and would benefit from working with a dietitian. 

You may also be interested in:

Irritable Bowel Syndrome
Facts on Soluble Fibre
How to Get More Iron
What Can I Expect When I Go and See a Dietitian?
This article was written and reviewed by dietitians from Dietitians of Canada. The advice in this article is intended as general information and should not replace advice given by your dietitian or healthcare provider. 

Last Update – May 6, 2022

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