Maitreyi Raman, MD
It is absolutely not your fault that you have been diagnosed with IBD + Diet is ready for prime time in IBD management.
Nutritional Therapy for IBD promotes a patient-centric approach to nutrition: An Option for Every Patient™.
This approach puts patients at the center of the shared decision-making process in order to select the option that is the best fit for them. At the heart of the approach is the very first option: nutritional education. With education and awareness of evidence-based options, patients decide with their medical team what is right for them.
Nutritional therapy can come in the form of a balanced diet that consists primarily of solid whole foods (solid food approaches) or it can come in the form of enteral nutrition, which incorporates a mandatory liquid diet component.
Solid Food Approaches
There are a wide variety of solid food approaches to nutritional therapy. While they each have their own set of rules and guidelines, it is also important to work with your care team to select and customize the diet to meet your specific medical needs. There are different types of IBD that present in different locations with varying levels of complexity. For example in the presence of strictures or ostomies, a more specialized approach to diet is needed. Your care team can help evaluate an optimal nutritional approach based on all of the factors specific to you.
There are three categories of solid food approaches: therapeutic diets, healthy eating options, and options for symptoms.
- The Specific Carbohydrate Diet (SCD)
- The Modified Specific Carbohydrate Diet (mSCD)
- The Anti-Inflammatory Diet for IBD (IBD-AID)
- The Auto-Immune Protocol (AIP)
- The Crohn's Disease Exclusion Diet (CDED)
Therapeutic diets are whole-food diets designed to address IBD or auto-immune disease. They have the potential to improve clinical symptoms and reduce inflammation by limiting foods thought to contribute to them. They are most often combined with traditional medications as adjunctive therapy, but in some circumstances, they may be considered for primary therapy. They may require significant lifestyle change.
Healthy Eating Options for IBD
These options were not designed to address disease/symptoms/inflammation, but instead are considered generally healthy ways of eating. These dietary approaches may lower inflammation, lessen symptoms, and improve overall health. Healthy eating options are more flexible than therapeutic diets and easier to implement. They are not considered suitable for primary therapy but are beneficial when used in combination with pharmaceutical options (adjunctively).
Options for Symptoms
- The Low-FODMAP Diet
- Lactose-free/dairy-free/gluten-free diets
- Identifying and avoiding trigger foods.
These options include dietary changes intended to address lingering symptoms that remain when your treatment plan is otherwise working. They can improve quality of life by addressing those unresolved symptoms, but they have not been shown to lower inflammation in IBD.
Enteral nutrition involves the use of a nutritionally complete liquid diet to induce or maintain remission and includes the following:
- Exclusive enteral nutrition (EEN): all calories come from liquid diet
- Partial enteral nutrition (PEN): a specific percentage of calories come from liquid diet.
Blurring the Lines
Over time, the lines between solid food approaches and enteral nutrition have blurred. This blurring of lines allows one approach to take advantage of the benefits of another approach.
- Smooth textures and blenderized foods are often incorporated into solid food diets when disease is active or when strictures are present.
- The Crohn's Disease Exclusion Diet includes a formula component
- The future of EEN may eventually include the option to use homemade smoothies (a small pilot study evaluating this method will soon be published).