Nutrition in inflammatory bowel disease (Crohn's disease, ulcerative colitis)
Although there is still no way to cure both diseases, a combination of drug therapy and a healthy and adapted diet can help to significantly increase your quality of life. The focus is on extending the time between relapses and alleviate the intensity of inflammation. Because many symptoms such as abdominal pain, colic, flatulence and diarrhoea often occur after eating, these can be reduced with the diet.
Frequently, patients who are affected avoid eating and adequate fluid intake. However, this can lead to essential nutrient (vitamin/mineral) deficiencies and weight loss, which in turn can cause a worsening of the disease. With a healthy and balanced diet, many essential nutrient deficiencies can be prevented to achieve a better quality of life with less pain.
However, there are no clear and valid diet recommendations for all patients!
We recommend undergoing further examination to exclude additional food intolerances that may be present. In particular, it should be ascertained whether celiac disease (gluten intolerance) and/or lactose intolerance are present. These tests are carried out in our practice. Especially for Crohn's disease, severe diarrhoea and inflamed intestinal mucosa may cause the decreased uptake of many nutrients, especially of vitamin B12. In particular, after surgery of the small intestine, regular injections of vitamin B12 may be necessary. Furthermore, Crohn’s patients may also suffer from a lack of the following substances:
potassium, magnesium and zinc (with recurring diarrhoea)
iron, zinc, albumin, immunoglobulins (during acute inflammatory surges)
vitamins A, D, E, and K (with fatty stools)
folate (when taking sulfasalazine)
calcium, magnesium (when taking cortisone)
Calcium and vitamin D deficiencies can occur because of the long duration of the disease and especially due to the repeated intake of cortisone. This can lead to a reduction in bone density (i.e. osteopenia, osteoporosis). In this case, the determination of bone density (Dexascan) throughout the disease’s progression is often recommended. In our practice at regular intervals, we test whether a deficiency exists and recommend (as required) taking additional supplements or the intravenous administration of, for example, iron.Nevertheless, you should try to supplement your daily requirements through a balanced diet. The following table provides some general information regarding the range of foods and their nutrient content:
Whole grain products, potatoes, bananas, apricots, spinach
Bananas, whole grain products, milk products, meat, fish (as an additional tablet supplement up to 360 mg daily with caution, since higher doses cause diarrhoea)
Fish, meat, poultry, nuts (or possible intravenous administration of
iron such as Ferrinject)
Tuna, liver, butter, carrots, tomatoes
Oily fish, butter, margarine, eggs, exposure to sunlight
Coagulation, fruit, dairy products, eggs, cereals
Milk products, fish (or as an injectable substitute)
Tomatoes, spinach, cabbage, potatoes, bread, oranges, milk products, meat, eggs (or in tablet form [1000 µg/day])
Milk products, mineral water, broccoli, sesame seeds (or in tablet
form [1000-1500 mg/day])
Several small meals are essentially easier to digest than a single large meal. Furthermore, cold or hot foods should be avoided.
Although the influence of diet has been discussed for many years - in particular, the increased consumption of refined carbohydrates and chemically processed fats (trans fatty acids) and the decrease in the consumption of dietary fibre – this could not be clearly demonstrated as the cause for the development of Crohn's disease or ulcerative colitis. During a severe attack of the disease, it may be helpful to switch to a "low-stimulus" diet.
If you suffer from Crohn's disease, abstinence from nicotine is a decisive element of therapy. Stopping smoking should definitely be considered as a step towards improving the symptoms because it has been shown in numerous studies that nicotine clearly exacerbated the severity of the disease. If you suffer from colitis, it is not compulsory to stop smoking but nicotine can influence the course of illness. Nevertheless, we recommend stopping smoking for your overall health.
Strong coffee and tea should be enjoyed in moderate amounts as higher volumes may aggravate symptoms.
Alcohol should be enjoyed in small amounts.
Probiotics such as Mutaflor, lactobacilli and so on may be particularly useful in maintaining remission.