Should you try an IBD diet?

If you’re living with Inflammatory Bowel Disease (IBD), you’ve likely spent time researching potential ways to manage your symptoms and achieve remission. Many people consider dietary changes as one potential solution, but is that always the best approach to take? Let's explore the Pro’s and Con’s of using a diet to manage your IBD symptoms and inflammation.

Why you may be interested in a therapeutic diet

There are many reasons people with Crohn’s disease or ulcerative colitis may want to start a therapeutic diet. Some reasons may include wanting to avoid medications, avoid long-term risks associated with medications, use diet as an adjunctive therapy, among others. ^

Research on therapeutic diets in IBD

According to the most recent dietary guidelines for IBD, Exclusive Enteral Nutrition and the Crohn’s Disease Exclusion Diet are the only diets that patients with Crohn’s disease should consider as therapeutic options for induction of remission. ^{ } No specific diet has been recommended for induction of remission for ulcerative colitis, however, the American Gastroenterological Association (AGA) guidelines recommend limiting red and processed meat in these individuals. ^  

The Mediterranean diet is widely recommended by the AGA for all patients with IBD to maintain remission and reduce symptoms, unless otherwise advised by their doctor. ^ This diet is rich in fruits, vegetables, whole grains, and healthy fats, and has been associated with reduced inflammation and better overall health outcomes.

Other diets, such as the Specific Carbohydrate Diet (SCD), the Autoimmune Protocol Diet, and the Anti-Inflammatory Diet for IBD, have lower-quality data supporting their use for induction or maintenance of remission. ^  The Low Fodmap diet is recommended only in individuals with IBD in remission who are still experiencing symptoms. As a result, these diets are not currently recommended by scientific dietary guidelines, although some individuals may still find them beneficial under medical supervision.

Pro’s of Therapeutic Diets

If you’re dealing with symptoms of IBD, the promise of symptom relief through dietary management is a powerful motivator. Implementing a therapeutic diet for Inflammatory Bowel Disease (IBD) can offer several potential benefits, depending on your specific condition. Here are some of the potential benefits:

• Induction of Remission: Certain therapeutic diets, such as Exclusive Enteral Nutrition (EEN) and the Crohn’s Disease Exclusion Diet (CDED), have been shown to induce remission in some patients with Crohn’s disease.
• Symptom Reduction: Therapeutic diets can help reduce the frequency and severity of IBD symptoms, such as abdominal pain, diarrhea, and bloating.
• Improved Nutritional Status: When implemented with a dietitian, a well-planned therapeutic diet can help correct or prevent nutrient deficiencies that are common in IBD patients, leading to better overall health and energy levels.
• Support for Gut Health: Certain diets can promote a healthier gut microbiome by including more whole foods, resistant starches, probiotics, and prebiotics which may help manage IBD symptoms.
• Complementary to Medication: For some patients, a therapeutic diet can complement their medication regimen, potentially enhancing the effectiveness of their treatment. Therapeutic diets can also be used as a bridge between two medications as insurance is in the approval process of the new medication. 
• Potential for Medication Reduction: Some patients may be able to reduce their reliance on medications by successfully managing their IBD with diet, potentially lowering the risk of medication-related side effects.
• Avoidance of Surgery: In some cases, implementing a therapeutic diet may help avoid the need for surgical interventions by controlling symptoms and preventing disease progression.
• Empowerment and Control: Adopting a therapeutic diet can give patients a sense of control over their condition, as they actively participate in managing their health through dietary choices.
• Enhanced Quality of Life: By managing symptoms more effectively, a therapeutic diet can improve a patient’s quality of life, allowing them to engage more fully in daily activities without being hindered by IBD-related discomfort.

Con’s of Therapeutic Diets

However, it's crucial to remember that diets aren't benign. While it's natural for you to want  to restrict foods or follow specific diets in an attempt to manage your IBD symptoms and inflammation, diets can have potential side effects, much like medications. Here are some of the downsides of following a diet for IBD:

• Mental Health Impact: Studies have linked restrictive diets with higher levels of post-traumatic stress symptoms, anxiety, and depression. ^{ } The constant focus on what you can and cannot eat can also lead to a greater fear of gastrointestinal symptoms, increasing fear of foods, reducing interest in food and affecting social interactions.
• Nutrient Deficiencies: Restrictive diets that remove entire food groups from the diet can lead to nutrient deficiencies. This is particularly concerning for IBD patients who already have increased nutritional needs due to their condition. Certain nutrient deficiencies are associated with worse disease outcomes. ^{ }
• Malnutrition: Therapeutic diets, due to their potentially restrictive nature, could also encourage weight loss due to decreased enjoyment of eating or not knowing what is “safe” to eat on the diet. Additionally, if a diet is not working but an individual really wants to keep trying it, the person could have worsening inflammation and increased malabsorption leading to malnutrition. Malnutrition has been associated with worse disease outcomes. ^
• Social and Lifestyle Challenges: Following a strict diet can be socially isolating. It can also lead to increased GI symptoms, economic burden, and false hope or expectations.
• Risk of Disordered Eating: Focusing too much on diet can increase the risk of developing disordered eating. Disordered eating includes behaviors such as restrictive eating, skipping meals, binge eating, emotional eating, purging, strict food rituals, eating with guilt, avoiding social eating, and an obsession with only eating foods one deems as healthy.  
• Risk of Eating Disorders: Up to 29% of individuals with IBD may also have an eating disorder. ^ Conditions like anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder (ARFID) are particularly concerning. Patients with a history of exclusion diets were found to be 3 times more likely to have ARFID symptoms. ^
• Financial Hardship: A lot of IBD diets include making meals from scratch and using mostly whole foods which can be more expensive. Food insecurity is already a problem in individuals with IBD, impacting approximately 12% of individuals with IBD. ^
• Cultural Considerations: Food is deeply tied to cultural identity, and many therapeutic diets for IBD may exclude traditional cultural staples. Although it’s still possible to implement, this can make it challenging to follow the diet and find enjoyment in eating.
• Impact on Children: Restrictive diets can also have lasting effects on children. Parental feeding practices, such as restricting food for health reasons, can influence children’s eating behaviors and emotional relationship with food. Research suggests that children subjected to these practices may have an increased risk for developing disordered eating behaviors, emotional eating, and a reliance on palatable foods to cope with negative emotions. ^{ }‍

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If You Want to Try a Diet, What Should You Do?

If you’re considering trying a diet for IBD, it’s essential to approach it carefully and with professional guidance:

• Work with an IBD-Focused Registered Dietitian (like us!): Partnering with a dietitian who specializes in IBD is crucial. They can help you tailor a diet plan that meets your nutritional needs while also addressing your symptoms. A dietitian can monitor your progress, adjust your diet as needed, and ensure that you’re not at risk for nutrient deficiencies or other complications.
• Consult Your Gastroenterologist: Before making any significant changes to your diet, it’s essential to consult with your gastroenterologist. They can provide insight into how dietary changes might interact with your current treatment plan and order inflammatory markers to check on its success.
• Create a follow up plan: Prior to starting the therapeutic diet, talk to your (or your child’s) gastroenterologist and IBD care team about whether it’s safe for you or your child to follow the diet. It could be helpful to develop goals of the diet, such as symptom remission, and when you will assess whether the diet is working. Regularly looking at your progress and goals of the diet will help you and your care team decide whether it makes sense to continue the diet. 
• Ease into the diet: Instead of diving into a restrictive diet, consider making one new therapeutic diet approved meal a week until you have a list of a few enjoyable breakfasts, lunches, dinners, & snacks to get you started.
• Consider timing: is right before winter holidays or before your vacation the best time to implement the diet, or would there be a better time to try the diet out? 

If You Don’t Want to Try a Therapeutic Diet, Are There Other Alternative Options?

Absolutely! If you're hesitant about trying a therapeutic diet, there are still things you can do to help manage your IBD symptoms:

• Work with an IBD-Focused Registered Dietitian (like us!): Working with an IBD focused dietitian can actually help you expand your diet to include more foods while decreasing your symptoms.
• Choose Variety Over Restriction: Instead of cutting out entire food groups, consider adding in more variety into that category. For instance, if you want to reduce your red meat intake but love red meat, don’t cut it out. Instead, try adding in other types of protein you also enjoy such as chicken, tofu, salmon, cod, and ground turkey. 
• Try Mindfulness-Based Therapies: Mindfulness and stress-reduction techniques have been shown to help manage IBD symptoms. Practices such as meditation, yoga, or cognitive-behavioral therapy can reduce stress and its impact on your digestive system.
• IBD Medications: Various medications are available to manage IBD including one’s to manage inflammation and others that can help manage symptoms. Your doctor can help you find the right combination of treatments that work for you.
• Other Medications, Supplements, and Digestive Enzymes: Over-the-counter medications, supplements like fiber supplements, anti-diarrheals, or digestive enzymes can sometimes be good tools to have in your toolbox to help manage symptoms. 

Conclusion

Deciding whether to go on a diet for IBD is a personal choice that should be made with careful consideration and your IBD medical team’s input. While some diets may offer symptom relief and/or reduced inflammation, they come with potential risks that shouldn't be overlooked. Balancing the benefits and drawbacks, along with exploring other management options, will help you make the best decision for your overall health and well-being.