Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai.

Inflammatory Bowel Diseases (IBD) such as Crohn’s disease and ulcerative colitis are believed to be caused by a combination of genetic predisposition and alterations in the gut microbiota. These disorders are on the rise in industrialized areas like North America and Western Europe [1], forcing scientists to reconsider the role of modern diets in the development and management of these diseases. Indeed, our gut bacteria look quite a bit different from our ancestors’ as we eat more and more processed foods to help us keep up with our busy lives and to allow us to prepare foods quicker and easier.

IBD 101 

Here are the basics: IBD (including Crohn’s Disease and Ulcerative Colitis) is an autoimmune condition where the digestive tract becomes inflamed and forms ulcerations that can cause a wide range of symptoms including frequent bowel movements, weight loss, and vitamin deficiencies. The gastrointestinal (GI) tract contains harmless bacteria that aids in digestion and the metabolism of vitamins. In people with IBD, the body mistakes the bacteria as foreign invaders and cells travel from the blood system to the GI tract, creating an inflammatory response and causing a variety of GI symptoms [9]. IBD can also affect your eyes, skin and joints and can have a profound impact on daily life.

Can Food Choices Decrease Your IBD Risk?

Studies show that certain dietary patterns may put people at greater risk for IBD [2]. For example, having a low-fiber, high-fat diet may increase inflammation and cause disease relapses. This is typical of a diet with a lot of processed foods. In contrast, a diet high in soluble fibers, fruits and vegetables and low in saturated fat may be beneficial to our microbiome and have anti-inflammatory properties. [3,4]

 

FOOD AS IBD TREATMENT

In addition to conventional medication focused on modifying the immune-inflammatory pathways in the gastrointestinal (GI) tract, diet can also play an essential role in the management of IBD, especially for patients with a lot of unpleasant GI symptoms such as diarrhea, urgency and abdominal cramps. Unfortunately, there is not enough scientific evidence to suggest that there is a “silver bullet” diet for IBD, or, for that matter a single diet approach that can take someone with IBD from a very severe flare-up all the way down to remission (i.e. no signs of inflammation at all).

The good news is that in academic medical centers across the world (including at Mount Sinai where I practice), there are studies underway to look at the link between IBD and a variety of diets, including, of course, low FODMAP.

Low FODMAP & IBD: What We Know Today

There is very strong evidence showing the benefits of the Low FODMAP diet for managing symptoms in patients with Irritable Bowel Syndrome (IBS), a much more common disorder of gut-brain dysregulation with many of the same symptoms as IBD [5].  We are now seeing that the diet can help manage symptoms in patients with IBD as well, especially when they’re in remission. Here’s why:

Often times, a person with IBD can be technically in remission (a healed intestinal tract) but continue to experience symptoms that mimic an IBD flare-up. This is known as IBD with IBS overlay and it is extremely common, affecting 40-60% of IBD patients. High FODMAP foods can trigger IBS symptoms in people with IBD and make them feel like they are experiencing a flare-up [6]. In fact, in a recent study, the Low FODMAP diet was shown to lower symptoms like gas, bloating, diarrhea, nausea and fatigue [7,8] in patients with IBD.

FODMAPs (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) are hard to digest sugars which pass through the small intestine without being properly broken down by enzymes. Once these sugars reach the colon, they cause an osmotic shift bringing more water into the lumen which causes all the potential unpleasant side effects of pain, bloating and diarrhea. Additionally, the bacteria ferment (think of brewing beer), and the residual FODMAPs give off gas, as if there wasn’t enough to manage!

"OK... SO WHAT CAN I EAT?"

The most common question patients with IBD ask me is “what can I eat?” My goal is to help patients find ways to eat that will allow them to manage symptoms and feel like they are in control. That’s where the low FODMAP diet becomes so useful. A FODMAP elimination and reintroduction process can be a life-changing tool for IBD patients to identify the triggers that add to their daily stress. We know food alone does not cause IBD but many patients will begin to notice “trigger foods” that increase their symptoms of gas, bloating, and diarrhea. The best way to identify your trigger foods is to simply keep a journal of what you eat. Note if there are changes that occur in our bowel function when certain foods are eaten more than others.

IT'S NOT: 'ONE SIZE FITS ALL'

Don’t get frustrated. What works for one person with IBD may not work for another. This is one of the many challenges that I have as a dietitian working with patients at the Feinstein IBD Center at Mount Sinai. Having worked with patients with IBD for over 15 years, I have seen many different diet therapies work and not work, and I must tailor suggestions to each individual person.

Food is a very important topic because it evokes a lot of emotion in people. People with IBD must carefully think about what to eat and the timing of their meals and if I can offer suggestions that help ease this stress, then I can successfully increase their nutrition, allow people to eat comfortably at work and at gatherings and lessen anxiety that commonly accompanies mealtime. Food is a large part of our culture as well as a basic human need and patients with IBD welcome guidance to help manage their disease and lead the healthiest life they can.

Resources that can help you:

Mount Sinai Make an appointment at the Feinstein IBD Clinical Center here or contact the office at 212.241.8100.

Epicured For exceptional low FODMAP, IBD-friendly prepared meals delivered right to your door, visit our menu.

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DISCLAIMER: Mount Sinai is an investor in Epicured. This material is for informational purposes only, and Mount Sinai makes no representation or guarantee as to any results or experience with Epicured. You should consult with your physician before using a dietary program such as Epicured. Mount Sinai employees do not receive material benefit from endorsing or recommending Epicured. 

Laura Manning is not employed by Epicured. Laura is a full-time employee of the Mount Sinai Health System and receives no compensation, monetary or otherwise, from Epicured. 

REFERENCES: 

[1] Molodecky, N.A.; Soon, I.S.; Rabi, D.M.; Ghali, W.A.; Ferris, M.; Chernoff, G.; Benchimol, E.I.; Panaccione, R.; Ghosh, S.; Barkema, H.W.; et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012, 142, 46–54.

[2] Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory Bowel disease: a systematic review of the literature. Am J Gastroenterol 2011;106:563–73.

[3] Brown, K.; DeCoffe, D.; Molcan, E.; Gibson, D.L. Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients 2012, 4, 1095–1119.

[4] Ananthakrishnan AN, Khalili H, Konijeti GG, et al. A prospective study of long-term intake of dietary fiber and risk of Crohn’s disease and ulcerative colitis. Gastroenterology 2013; 145:970–977.

[5] Schumann D, Klose P, Lauche R, Dobos G, Langhorst J, Cramer H. Low fermentable, oligo-, di-, mono-saccharides and polyol diet in the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Nutrition, Jan 2018;45:24-31.

[6] Selina R Cox Alexis C Prince Clio E Myers Peter M Irving James O Lindsay Miranda C Lomer Kevin Whelan Fermentable Carbohydrates [FODMAPs] Exacerbate Functional Gastrointestinal Symptoms in Patients With Inflammatory Bowel Disease: A Randomised, Double-blind, Placebo-controlled, Cross-over, Re-challenge Trial Journal of Crohn's and Colitis. Dec 2017; 11

[7] Zhan, Y.L.; Zhan, Y.A.; Dai, S.X. Is a low FODMAP diet beneficial for patients with inflammatory bowel disease? A meta-analysis and systematic review. Clin. Nutr. 2017.

[8] Prince AC, Myers CE, Joyce T, et al. Fermentable carbohydrate restriction (low FODMAP diet) in clinical practice improves functional gastrointestinal symptoms in patients with inflammatory bowel disease. Inflamm Bowel Dis 2016;22:1129–1136.

[9] What are Crohn’s and Colitis. http://www.crohnscolitisfoundation.org/what-are-crohns-and-colitis/what-is-crohns-disease/. Accessed from the web May 12, 2018.

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