Eating Well Despite Bowel Disease

Maintaining good nutrition is challenging for anyone dealing with a hectic schedule and the availability of cheap fast food, but it is particularly challenging for people living with bowel disease.

Inflammatory bowel disease, which includes Crohn's disease and ulcerative colitis, affects the intestines. While Crohn's disease can inflame any part of the gastrointestinal tract, ulcerative colitis affects only the colon.

And since an inflamed small intestine and colon can affect absorption of fluids and nutrients, many people with this condition may not get the nutrition they need.

Contrary to popular belief, foods and food allergies don't contribute to the development or worsening of inflammatory bowel disease. But diet can affect one's symptoms, which can include diarrhea, abdominal pain and decreased appetite. Discovering troublesome foods is key.

Below, Leslie Bonci, a nutritionist at the University of Pittsburgh, offers advice about how to eat healthfully without exacerbating symptoms.

Can dietary habits cause inflammatory bowel disease (IBD)?
There aren't any foods that cause inflammatory bowel disease but sometimes the foods that people eat, or the eating habits that people have, can make symptoms worse. If people eat too quickly or eat too much, or if they just eat certain types of foods and not others, it can cause them to not feel well.

What effect do dairy products have on IBD symptoms?
A lot of times when people are diagnosed with IBD, they're told that they can't have any dairy foods at all. And dairy products can be a problem if someone with IBD has lactose intolerance. Lactose is the sugar that's found in dairy foods, and it's added to other foods. If it doesn't digest well, if it doesn't break down well, people can have a lot of symptoms with it.

If people want to consume dairy products, they should cut back on the amount. Not having a full glass of milk or not eating a whole block of cheese can really help. Instead, people should have about a quarter of a glass of milk, or a slice of cheese that is about an 1/8-inch thick.

Some people use lactase tablets, which contain the enzyme that helps break down lactose. You can get this in a tablet form, and you have to take it before you eat the food because otherwise it doesn't work.

The good news is there are also good substitutes for dairy products. For instance, somebody might opt to use milk that's been pre-treated with lactase. So instead of having regular milk, you could have Lactaid milk. Or some people might opt to use soy milk. Soy milk is sometimes even a little higher than cow's milk in terms of nutritional value.

People with IBD should be aware of getting enough calcium because dairy foods are such an excellent source of calcium. Other options are calcium-fortified foods. For instance, there are cereals and orange juice that have calcium added to them. The body doesn't care if it was in there to begin with or added to the product. We can still get the benefit out of it.

How well are fruits and vegetables tolerated?
This is a big issue, because a lot of people that have IBD totally eliminate fruits and vegetables because they think that they're going to bother them. Fresh fruits and vegetables can be hard to digest, and a lot of people assume that the only way to get the benefit of a fruit and vegetable is to have it fresh, which isn't true. If you have canned, frozen, or dried fruits and vegetables, that works just as well from a nutritional standpoint.

The biggest issue with fruits and vegetables is the amount. For somebody who has inflammatory bowel disease, the serving of a fruit might be a sliver. They should start with a very small amount, and get the body used to eating it.

The other thing is that people sometimes worry about, particularly with fruits, is the peel on the fruit, which consists of insoluble fiber and may irritate the lining of the intestines. You can take the peel off and have the fruit itself, or there's the advantage of a canned fruit, or something dried.

The other thing about fruits that I think is very important to realize is that there are certain fruits that might be a little bit more problematic than others. For instance, prunes do have a laxative effect, and for people that have inflammatory bowel disease, it's probably good to try and stay away from them.

Sometimes things with seeds, and raspberries, strawberries and blueberries, can be a little bit aggravating, but it is more about the volume. Instead of starting with a cup of berries, start with a very small amount.

Even when it comes to using other types of fruits, if people buy things that are canned, such as juice packs, buy ones without the sugar, because the extra sugar can actually make the symptoms a little bit worse.

The same rules apply to vegetables. Whether somebody's buying them fresh, frozen or canned, the nutritional value is there. But again, we might want to rethink the serving size, starting with a very little bit, and then gradually increasing the amount.

Can people with IBD tolerate fiber?
Fiber is a very important issue for people with inflammatory bowel disease. Most of the time people say, "I can't have fiber at all," or they've been given that recommendation. The issue is that we need to understand there are different types of fiber and some fibers may be more bothersome than others.

For instance, the fiber that's on the skin of fruits and the peel of vegetables is insoluble fiber. This is fiber that's in bran cereal, and it can sometimes make stools a little bulkier and can sometimes lead to diarrhea. However, the soluble fiber — what's on the inside of the fruits and vegetables, and potatoes and barley — actually slows down the movement through the gastrointestinal tract. So particularly for people who have problems with diarrhea, soluble fiber can be a very good thing to have.

Just like anything else, people should start with small amounts of fiber-rich food at a time, and also make sure that they drink enough fluid when they're having fiber.

The other fiber foods that people will question are nuts and seeds and beans. Sometimes when people have inflammation in their lower intestine, things that have sharp edges like nut are probably not a good idea because they can be a little bit abrasive. So people might want to have peanut butter instead of the nut or even chop the nuts finely and chew them well. Even if people eat beans, lentils, split peas or kidney beans, how much one is eating can be an issue.

Eating small amounts can also help manage some of the gas and bloating associated with beans. If somebody is having bean soup for lunch, it's not a good time to have cabbage. Sometimes canned beans are a little bit easier to tolerate. Broccoli, Brussels sprouts, cauliflower can also contribute to gas. These are really healthy vegetables, so, again, we recommend starting with small amounts.

What else can cause gas and bloating?
The other thing that affects gas and bloating is people's eating habits. We need to sit down and take time to eat. We need to eat slowly because otherwise we take in too much air.

Because they're full of bubbles, carbonated beverages can cause gas. Sometimes using a straw, chewing gum, or eating mints can cause gas because you end up taking in air. And the sweeteners that are in the gums and the mints can actually cause a lot of gas and bloating. They're good for your teeth; they're not great for your gut.

Do people with IBD have a lot of trouble with fatty foods?
The other major group of food that can create problems for people with inflammatory bowel disease are foods that are high in fat. And the reason for that is that they can be very upsetting to the gastrointestinal tract. We are not only talking about things that we might add to food such as margarine, butter, mayonnaise, salad dressing. There are also hidden fats, such as the fat that is in cookies, lunch meats, hot dogs, doughnuts. If you have too much of it, it can make symptoms worse.

That doesn't mean that people should switch to entirely fat-free food, but you need to be careful about the amount, especially people who have Crohn's disease and might not be able to absorb fat. They really need to keep fat intake low. There are low-fat options, so we have ways of getting in less fat and still have the taste of foods.

How can people ensure they're getting enough protein?
Protein is absolutely essential for all of us. People with inflammatory bowel disease want to make sure they're having enough protein because protein is one of the major ways of supporting a healthy immune system, and for kids with these diseases, protein helps their bodies to grow well.

There are lots of different types of protein. It's found in red meat, poultry, fish, eggs, dairy products, tofu, beans, nuts and seeds. Protein needs to be part of the diet each and every day. The good news is we can choose different types of ways to get those proteins needs met.

Do people with IBD have to avoid the desserts and sweets?
The fact of the matter is we all enjoy eating things that are sweet. People with IBD can also partake of those foods. I don't think it's a great idea for people to be eating sweets to the exclusion of all else, and that is really the major issue.

There are certain types of sweets that might be a little bit more bothersome. For instance, chocolate can have somewhat of a laxative effect, so people might find it bothersome to eat a chocolate bar. If it is part of a cookie, that might be a little bit better. There are a lot of recipes for sweets that are high in fat, so people should gear toward the lower fat versions or finding some substitutes.

The bottom line is that eating should be as broad-based as possible. We want to have a variety of foods every day, and we want to sit down, relax and enjoy them.

Excerpted from Healthology Press.

Reference Source 104

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