Common Diets in Inflammatory Bowel Disease
A diagnosis of inflammatory bowel disease (IBD) can bring up numerous questions, including “what am I supposed to eat?”
While food and nutrition are a major part of living with IBD, it can be difficult to follow some recommendations, especially when your child is not feeling well. It is important that your child gets all of the calories and nutrients needed to grow and thrive.
Crohn’s and ulcerative colitis can affect the way your child’s body breaks down and absorbs food and nutrients. Depending on the location and severity of IBD, the poor absorption of nutrients can lead to certain nutritional deficiencies. We recommend working with your GI dietitian or medical team to help monitor for these deficiencies.
Basic Nutrition in IBD
One of the fundamental tools for managing nutrition with IBD is to try and identify foods that trigger symptoms. These “trigger foods” often worsen symptoms such as severe stomach pain or diarrhea. Often, these foods are high in fat or certain types of fiber. They may also contain sugars, sugar alcohols, or spicy foods that can be difficult to tolerate with a compromised gastrointestinal tract.
Your child’s dietitian or GI doctor may recommend keeping a journal to help track foods and symptoms and make it easier to visualize a pattern. While restricting certain foods may help to alleviate certain symptoms, it may also impact weight or lead to an imbalance of key nutrients needed in your child’s diet.
It is a common misconception that all fruits, vegetables, and grains need to be avoided to prevent aggravating symptoms; but the truth is, your child needs these foods to continue to grow and thrive.
While fruits and vegetables are naturally high in fiber, there are certain forms of fiber that may be tolerated better and there are also ways to continue to provide these same nutrients in a different form.
For example, it may be difficult to tolerate a raw fruit or fruit with the skin; however, removing the skin of the fruit or eating fruit that has had time to ripen or has been processed, like a ripe banana or applesauce, may be easier to tolerate.
Cooking, pureeing, or juicing fruits and vegetables can also be helpful in promoting tolerance. It is recommended to avoid whole grains high in insoluble fiber during a flare; however, these are important to reintroduce once your child’s IBD is in remission. While your child is in remission, it is important to encourage a diverse diet of nutrient dense foods.
During a flare, restricted diets can lead to poor nutrient intake, and it is essential to gradually introduce these nutrient-rich foods while your child is feeling better during remission. Foods that are high in fiber and calcium are often the foods to reintroduce as they are often restricted or limited during a flare.
Due to common struggles with weight gain and growth in children with IBD, adequate intake of healthy protein is also important. Avoiding even mild cases of malnutrition is essential as this can impact your child’s ability to recover from illness.
It is common to see decreased bone strength in children with IBD. This can be related to a deficiency in specific fat-soluble vitamins such as vitamin D or poor absorption of a nutrient like calcium. It can also be related to inflammation, decreased physical activity, or even use of certain medications.
At Cambrooke, we recognize the importance of providing nutrition to support bone health and that is why we have uniquely designed our Essential Care Jr. with ingredients to promote healthy bones.
Therapeutic Diets for IBD
Nutrition therapy provides an alternative option to medication therapy. There are a few specific diets that have been studied and found to be effective in decreasing inflammation and promoting mucosal healing.
Some things to consider when choosing diet therapy for IBD are the severity and location of the disease, the time commitment related to food preparation, the cost of specialty foods and/or formula, the impact on quality of life, and also whether or not your child would rely on diet alone or combined therapy with diet and medication.
Exclusive Enteral Nutrition (EEN)
This is the gold standard for diet therapy in this population. EEN is a nutrition therapy primarily used to induce remission in Crohn’s disease. This diet consists of the child taking 100% of his or her nutrition intake from a complete nutrition formula for 6-12 weeks. During this time, there is no solid food intake. EEN can be the primary therapy, induce remission, and promote intestinal healing. We recommend working with your child’s medical team to determine which formula to use and goal volumes to meet your child’s nutritional needs.
Specific Carbohydrate Diet (SCD)
SCD was initially established to treat celiac disease; however, it has since been shown to be effective in the treatment of IBD. The diet includes avoiding high starch vegetables, grains, lactose (the sugar found in milk), food additives, artificial ingredients, and sweeteners (except honey). The SCD encourages a diverse intake of fruits, vegetables, nuts, meat, poultry, fish, homemade yogurt, and hard cheeses.
This diet has been well studied and even shown to be effective in a modified version known as the Modified Specific Carbohydrate Diet (MSCD). While this diet has been shown to be effective, it is important remember that following this diet can result in an increased time commitment to food preparation, and specialty foods may be more costly.
Crohn’s Disease Exclusion Diet (CDED)
This diet focuses on nutrition that affects the bacteria in the gut. It was created to avoid or reduce the foods that may negatively impact the bacteria in the GI tract. The diet consists of three phases and includes Partial Enteral Nutrition (PEN) with a nutritionally complete formula to satisfy a portion of the child’s nutrition needs.
The diet provides an alternative option for those who do not wish to fully commit to the 100% formula diet required with EEN. The foods encouraged in the diet are high in fiber, pectin and resistant starch and are limited or completely void of foods with artificial ingredients, low/no animal fats, lactose, or gluten. It is important to note that while this diet is more expansive than EEN, it is a highly restrictive diet much like the SCD, so time commitment and cost need to be considered.
Anti-inflammatory Diet for IBD (IBD-AID)
This diet was modeled after the SCD; however, it was also designed to encourage more probiotic and prebiotic foods to help support the healthy bacteria in the GI tract.
This diet is broken into three phases and emphasizes the importance of starting at the proper phase. It also focuses on diet compliance, because without diet compliance it cannot be effective.
Because these restrictive diets are so difficult and there are always going to be “really hard” days to stick with it, IBD-AID strives for 80% compliance with a 20% buffer for those “off” times. The diet not only encourages prebiotics and probiotics, but it also encourages foods rich in omega-3 fatty acids due to the research behind these fats and how they work against inflammation. Again, much like all of the other restricted diets, there is going to be a strong time and cost component to consider.
How Cambrooke Can Support Your Child
Whether your child may benefit from a nutrition supplement to help boost nutrient intake or a complete nutrition formula for diet therapy, Cambrooke offers two amino acid-based formulas for children over the age of one-years-old, designed to support the needs of children with IBD.
Essential Care Jr. is loaded with premium ingredients to support your child, such as low fermentable carbohydrates that may be easier to tolerate in the compromised GI tract, vitamin K2 that has been shown to support bone health, a proprietary blend of essential amino acids with 40% leucine to help build muscles, and higher amounts of omega 3 fatty acids to help fight inflammation. Essential Care Jr. is also free of artificial ingredients that are often avoided in many of the therapeutic IBD diets.
EquaCare Jr. is similar in nutrition and taste to other junior amino acid-based formulas; however, it is designed to provide you with a more affordable price than these other formulas when cost is a concern. Learn more about each of these beneficial products by visiting us online today or calling 1-833-377-2773.
Sources:
https://www.crohnscolitisfoundation.org/diet-and-nutrition
