Nutrition in Inflammatory Bowel Disease. Maryanne Comrie Registered Dietician Inkosi Albert Luthuli Central Hospital

Transcription

1 Nutrition in Inflammatory Bowel Disease Maryanne Comrie Registered Dietician Inkosi Albert Luthuli Central Hospital

2 Does diet cause IBD? Can diet cure IBD? Do I need to cut gluten/milk/wheat out of my diet? How do I make sure I am getting the proper nutrition?

3 Aims of Todays presentation Highlight the importance of good nutrition in IBD and the risks of malnutrition. Give a guideline for how to eat during the active phase/flare up and in remissive phase Cover common trigger foods that may not be tolerated. Dispel diet myths about IBD

4 IBD and Nutrition Although diet is not a cause of IBD, it is still very important in the management of IBD and preventing malnutrition. Malnutrition can worsen the extent of the disease and lower the immune system.

5 Causes of malnutrition in IBD Loss of Appetite Increased nutrient losses Poor absorption in gut Weight loss Protein/muscle Loss Vitamin & Mineral Deficiencies Bone disease Anaemia Increased needs due to inflammation Drug-nutrient interactions

6 Poor absorption of nutrients in inflamed GUT lining Protein, vitamin and minerals, blood loss

7 Benefits of Good Nutrition Build up protein stores Heal the gut mucosal lining Replace vitamin and mineral deficiencies Reduce inflammation process Better outcomes in surgeries Maintain a healthy weight

8 How can I tell if I am a healthy weight for my height? Weight / (height x height) Between 20 25: healthy weight. BMI Borderline underweight Normal weight Overweight Obese

9 Nutritional Aims Depends on: Location & extent of the inflammation Active (flare up) or remissive (no flare up) phase

10 Important to remember *No specific food or special diet can cause or cure IBD *Some foods may trigger IBD and some may ease symptoms * Diet is individualized, not all foods affect every person with IBD in the same way.

11 Active Phase Aim is to rest the bowel, choose gentle foods that gut can easily digest, cause least discomfort. If food cannot be tolerated: Clear liquids such as apple/grape juice, jelly, non-fizzy drinks, hot bovril can be taken. Rehydrate and replace lost electrolytes eg: sugar salt solution, O.R.S, energade, game Nutritional supplement drinks can help for extra protein.

12 Active Phase Avoid foods that make symptoms worse. wheat, corn, tomatoes, citrus fruit and eggs are common problem foods.

13 Active Phase Also avoid milk and milk products

14 Active Phase Slowly introduce food into your diet, starting by adding: softly cooked vegetables eg: carrots, butternut, marrows, gem squash cooked fruit eg: apple sauce, canned fruit

15 Active Phase As inflammation and ulceration subsides, a light diet can be followed. What is a light diet? Not having high fibre foods, fatty and fried foods or spices/chilli.

16 Remissive Phase Aim is to eat a variety of foods leave out the foods that you have a specific problem with. Eat balanced mixed meals 3 times daily with healthy snacks in between. Small, more frequent meals are easier to digest.

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18 Starchy Foods Include starchy foods. These include foods like rice, phutu, potatoes, butternut and bread. Starchy foods should be limited to ¼ of the plate, or a fistful on the plate. Try choose brown, unrefined or high fibre options

19 Fibre What is fibre? Fibre forms part of plant products such as cereal grains, fruit and vegetables & legumes, nuts and seeds. Does not get digested and broken down by our bodies but rather forms part of our stools. There are 2 types: insoluble or roughage, and soluble or soft fibre

20 Fibre Insoluble fibre or roughage: Doesn t dissolve in water passes through the GIT relatively intact/undigested. Adds bulk to the diet Helps feed the good bacteria in the gut for immune function

21 Fibre Soluble or Soft fibre: Gentle fibre that attracts water forming a gel. Can help can improve diarrhoea Helps regulate blood sugar levels Can lower bad (LDL) cholesterol It may help to have less insoluble / rough fibre in the diet and include more soluble fibre in the diet

22 Fibre Roughage Wheat bran (bran flakes, bran muffins, digestive bran) Wholewheat bread Brown rice Stringy or fibrous vegetables and fruit eg: celery, spinach Pips, seeds, peels of vegetables Soluble or soft fibre Oats, oat bran Brown bread White rice Peeled fruits and vegetables Dried fruit (not raisons/prunes) Beans, lentils with skins Popcorn kernels Flax seeds Beans, peas and lentils without husks, barley, tiger soup mix, chickpea flour, split peas

23 Fibre No evidence showing benefits in following a completely fibre-free diet in IBD unless in a flare up or when you have a stricture/ blockage in the bowel

24 Protein Foods Chicken, fish, low fat dairy or eggs may be eaten every day: good source of iron & protein and help with wound healing. Always choose low fat/lean. Red meat < 3 / week, fish and chicken more often. Beans/lentils/soya healthy alternative to animal protein

25 Protein Foods Oily fish eg: mackerel, tuna, salmon, sardines contain omega 3 fatty acids, good for reducing inflammation and blood pressure. Vegetarian sources of omega 3 Dairy products also good source of protein and calcium. No need to cut out dairy although some patients with IBD do not tolerate them well [Shah et al 2015].

26 Vegetables and Fruit Eat plenty of vegetables and fruit, good source of vitamins, minerals and antioxidants. Vitamin C containing fruit and vegetable helps absorption of iron. Choose variety of colours Red Orange/yellow Green

27 Fluids, Physical Activity Drink plenty of fluid, especially water (at least 6-8 glasses daily), works with fibre in the body, prevents dehydration. Physical Activity 30 minutes daily ~ builds muscle and bone strength, good for overall immune system

28 Foods and beverages that may worsen symptoms Excess fruit and fruit juices Sorbitol (artificial sweetener) containing foods eg: diet cooldrinks and gums Fizzy drinks Skins and pips of vegetables Gas forming vegetables eg broccoli, brussels sprouts, cauliflower, cabbage, cucumber, corn, leeks, onions, peas, green peppers, radishes & turnips High roughage foods eg: popcorn, wheat bran.

29 Foods and beverages that may worsen symptoms Concentrated carbohydrates eg sugar, chocolates, sweets, cakes and desserts. Fatty foods. Limit oil when cooking. Limit fatty foods eg: vet koeks, processed meats (sausages, polony), organ meat, full cream dairy products, mayonnaise, pies. Limit fatty takeaways eg: chinese, fried chicken/chips Empty calories!

30 Foods and beverages that may worsen symptoms Spices, chilli, seasoning and spicy food Caffeine eg tea, coffee, coke, diet coke, pepsi etc Smoking and drinking alcohol increases inflammation These all irritate the gut!

31 Food allergies and intolerances Lactose intolerance: similar symptoms to IBD. Bloating, stomach cramps or diarrhea min after taking a dairy containing food eg: milk. Cheese, yoghurts & maas better tolerated. Fat malabsorption: called steatthorea: pale, grey, foul smelling stools avoid fatty foods.

32 Food allergies and intolerances Gluten or wheat intolerance eg: coeliac disease ~ not common, needs to be tested. Speak to your doctor if you suspect Limited data on glutenfree diets being beneficial for IBD [Shah et al 2015]

33 Supplements Vitamin and mineral supplements Iron, Vitamin B12, Folic acid (anaemia) Zinc (wound healing) Calcium & vitamin D (bone health) Vits ADEK, if malabsorption of fat Antioxidants (vit A,C,E) & omega 3 may reduce inflammation. Always separate iron and calcium supplementation

34 Supplements Probiotics Live friendly bacteria, which are beneficial to the gut and immune system. The balance of good and bad bacteria can be disrupted with antibiotic use, or during frequent diarrhoea. Probiotics are found naturally in certain fermented foods, eg: live yoghurt and maas, or taken in tablet form. Have shown to be beneficial in patients with UC, with pouchitis. No evidence in Crohns [Shah et al 2015]

35 Supplements Nutritional Supplements In active phase For poor appetite To help with weight and muscle gain High protein and added nutrients (eg: prebiotics, vits&minerals) If not tolerating milk, choose one you can mix with water Specialized supplements on the market Modulen IBD & Peptamen

36 Conclusion Healthy eating is important in preventing malnutrition as well as vitamin and mineral deficiencies. Focus on a balanced diet it is one of the building blocks to health along with medication and following a healthy lifestyle.

37 Conclusion Try not to eliminate any food groups unnecessarily and take a nutritional supplement if you are struggling to gain weight. Always consult a doctor before starting any alternative therapy as it could interact with medication.

38 Conclusion Don t be shy to see a dietician as she can give you a diet plan for your individual needs

39 Useful Websites Crohns and Collitis Foundation of America HealingWell Crohn s Disease Resource Center National Association for Colitis and Crohn s Disease References Mahan L & Escott-Stump S (2008). Krause s Food and Nutrition therapy (pg: ) ESPEN Guidelines on Enteral Nutrition: Gastroenterology (2006) 25, Nutritional Therapy for Active Crohn s Disease: World J. Gastroenterology 2008 July 21; 14(27): Paul A Smith Oral Diets and Nutrition Support for Inflammatory Bowel Disease: What is the Evidence? 2015 Shah ND, Parian AM, Mullin GE, Limketkai BN. Nutrition in Clinical Practice Food and IBD, Information Booklet - Crohns and Colitis UK

40 Questions?