Nutrition is an important aspect in the treatment of irritable bowel disease (IBD). IBDs are sometimes accompanied by malnutrition, weight loss, low albumin levels in the blood, anemia, vitamin and mineral deficiencies.Nutrition and diets as a complementary treatment method:
Malnutrition among people who suffer from IBD is caused by loss of appetite, nausea, dietary restrictions, diarrhea, and stomach pains. There is an increase in the amount of proteins in the intestines, causing a decrease in the amount of proteins in the blood. Diarrhea causes a loss of sodium. Malnutrition can cause a decrease in the function of the immune system, difficulty recovering from wounds and illnesses and a decrease in the function of the entire digestive system.
Tracking a patient’s nutritional condition is vital. While tracking, it is important to emphasize an increase in calorie intake and protein intake. Recommendations for food supplements are only given in a framework of personal consultations with a dietician. The dietician will take each unique case into consideration and base recommendations on each patient’s personal case. The dietician will also try to include food that the patient prefers.
- Growth retardation among children
- Short bowel syndrome (less than 50% of the small intestine is functional)
- Low quality of life
There are a number of nutritional therapies for IBD, each one has its supporters and detractors.
Elemental and Semi-Elemental Diets
These diets are based on a synthetic product, comprised of broken down food elements which are easy to ingest and absorb. This eases the process of digestion. An elemental diet is an effective first step in nutritional therapy and as a complementary step during an inflammation of Crohn’s disease. When not inflamed, there is no need to use the elemental diet, as the digestive system can handle the dissolution and absorption of complex foods.
The elemental diet has a number of advantages:
- It allows the intestines to relax, as all the nutrients are absorbed in the front section of the small intestine.
- It causes a decrease in the permeability of the intestine, and therefore stops the movement of proteins into the intestinal cavity.
- It is lowers the inflammation of the intestine. There are a number of studies which connect this improvement to the absence of whole proteins which can penetrate the wall of the intestine and cause an autoimmune reaction. Additionally, the low fat content lowers the production of inflammatory substances.
- The elemental diet allows a rebuilding of the damaged intestinal lining.
- The elemental diet is not an accepted form of therapy for ulcerative infections.
This diet is based on a liquid diet which includes all nutrients in dissoluble forms. Today there are a number of available polymeric formulas. The actual effectiveness of the polymeric diet is considered controversial.
If a person is suffering from an inflammation of Crohn’s disease, the first step of treatment is to start with a low-lactose, low-fiber, and low-fat diet. A low-fiber diet will prevent any mechanical stimulation of the damaged intestinal lining. A low-lactose diet will prevent osmatic diarrhea. Low-fat prevents fatty stools following the mal-absorption of fats and to lower the production of inflammatory agents. A low-residue diet does not include fresh fruit and vegetables or dietary fibers. It also only allows the consumption of low-lactose milk products. The amount of fat is limited, but includes a minimal serving of fat in order to supply the body with the necessary fatty acids that the body cannot produce on its own.
The second stage of the diet occurs when the patient shows signs of improvement in his clinical condition. Gradually, milk products are added to the diet, as well as more fatty foods. Limiting cellulose intake is recommended for an extended period of time, but this limitation is lowered over time.
There are a number of studies that recommend a fiber-rich, as the fibers help the intestinal bacteria, leading to the production of short fatty acid chains, which help the damaged lining of the colon heal itself.
The Elimination Diet
This diet requires close cooperation between the physician and patient. The side effects are minimal and the diet lowers the outbreaks of Crohn’s disease.
This diet begins with a limited number of hypoallergenic foods such as chicken soup, potatoes, white bread and sugar. Every few days, another food is added to the patient’s menu, while foods that make the patient sick are removed.
IBDs and Dietary Fibers
Dietary fibers are resistant to the digestive enzymes of a person. They do not digest and enter the intestines where they are dissolved by bacteria. The dietary fibers have no nutritional value and no caloric value. They can be divided into two main groups: soluble and dissoluble.
This group includes cellulose. The dissoluble fibers can retain large amounts of water, increasing the volume of a person’s stool, accelerating its removal. By doing so, they increase the activities of the intestine and shorten the amount of time the food spends in the intestines, and put pressure on the intestinal walls. Due to these characteristics, the intestines of patients with Crohn’s disease cannot tolerate fibers.
Foods Rich with Dissoluble Fibers
- Grains: whole wheat, brown rice, corn
- Vegetables; cabbage, cauliflower, broccoli, celery, kohlrabi
Soluble fibers slow the process of emptying the stomach cavity, prolonging the feeling of fullness. They are able to absorb poisons, bile salts, cholesterol and cancerous agents and remove them from the body. They slow the absorption rate of sugar into the blood.
Foods Rich with Soluble Fibers
- Fruit: Apples, bananas and pears
- Vegetables: zucchini, carrots and pumpkin
- Legumes: chickpeas, lentils, beans, peas, soy beans
Foods contain both soluble and insoluble fibers with different ratios, therefore, when the disease acts up, it is recommended to avoid all foods containing fiber.
Omega 3, Fish Oil and Crohn’s Disease
In recent years, the effect of fish oil on IBDs has been studied. Research is still being conducted and there are no conclusive results. Some laboratories have begun developing devices that use fish oil to treat IBDs. Fish oil contains omega 3 fatty acids, which are attributed to the recovery of conditions such as atherosclerosis, high blood fat profile, hypertension and IBDs. If a person ingests foods which contain omega 3, the production of inflammatory agents is drastically reduced and a quicker recovery is possible.
On the other hand, vegetable oil contains omega. Omega 6 produces many inflammatory agents. Omega 3 production overtakes omega 6 production, decreasing the production of inflammatory agents.