By Ginger Bailey, RDN CD
Inflammatory Bowel Disease
Getting a diagnosis of an inflammatory bowel disease can be overwhelming. Not only do you not feel well, but you may also feel unsure about what – and what not – to eat to avoid making your situation worse. But I have good news. While dietary guidelines can change a bit from person to person, there are some very helpful tips that apply to just about everyone. All you need to do is choose the correct recommendation for you, typically based on what phase of the disease you are in. Are you in an active flare? Or are you in a remission phase and trying to prevent a relapse? Let’s talk about both.
Inflammatory Stage (Flare)
This is the stage most people are in when they first get diagnosed. People typically struggle with eating in this phase because their gastrointestinal (GI) tract is very inflamed causing a myriad of uncomfortable symptoms. The key to remember in this phase is that your system needs time, and possibly, treatment to calm down until the inflammation subsides. This isn’t always a fast process, but during this phase, it is important to not further irritate your inflamed gut. The same way you wouldn’t want to drive 100 mph on the freeway with a compromised tire, you also don’t want to put things into your gut that are difficult to digest, worsening your symptoms. So, let’s go over some guidelines for starting easy to gradually build your way back to more normal eating.
- Step 1: Start with bland, starchy foods first. These are the easiest to digest. Some examples would be: white rice, saltine crackers, white toast, white pasta, tortillas, potatoes without the skin, rice-based cereals, and bananas.
- Step 2: Begin including lean proteins. Examples of these are: white fish, chicken without skin, turkey, ham, and egg whites. You could also try including some rice milk, almond milk, coconut milk, etc. Avoid using soy milk. Soy tends to be a common allergen, and if consumed in large amounts, can affect hormone levels. That’s the last thing your gut needs!
- Step 3: Slowly introduce healthy fats. Ideally, you mainly want to include anti-inflammatory fats such as salmon, tuna, nut butters, avocado, and vegetable oils. You could also attempt egg yolks at this point. I recommended using organic eggs as they are less likely to trigger an inflammatory response.
- Step 4: Reintroduce low-fiber fruits and veggies. Try starting with canned fruits and vegetables since the canning process helps break down the fiber content. Avoid consuming raw veggies, as they have too much fiber for your system to handle. Applesauce or blended fruits can be helpful as blending also helps break up the fiber. Initially, don’t include too many servings per day. Gradually work your way back into these foods. If you have a juicer, you could try juicing some of the higher-fibers fruits that would be difficult to handle otherwise. Beware that some fruit juices can cause diarrhea. If you purchase juice, make sure that it is 100% fruit juice.
- Step 5: Reintroduce the rest of the foods you have been avoiding. Do this gradually, and one at a time, so you can determine if there is a specific food that causes problems for you. Some people with inflammatory bowel diseases have a hard time with dairy. Also, avoid eating large amounts of refined sugars, red meats, and animal fats, which can cause more inflammation. Generally, focusing more on whole foods, and less on processed foods is a good rule of thumb. Many of the ingredients added during processing are not good for your immune system and may lead to more inflammation.
Once the inflammation has calmed down, the goal is to keep it that way! At this point, fiber is an important factor in keeping the gut healthy. When the gut is inflamed, fiber tends to irritate it. But once the gut has healed, fiber is critical to maintaining gut health. The fiber we can’t digest is actually important for feeding healthy bacteria in our system. When too many of these healthy bacteria die off, that is often what can lead to many GI illnesses.
In this phase, getting plenty of fruits and vegetables is very important. These foods also contain substances called phytochemicals which have great health benefits, including keeping inflammation at an acceptable level. Keep in mind that those with inflammatory bowel disease may never be able to handle eating a lot of raw vegetables. If so, that is okay. There are plenty of delicious ways to prepare and enjoy cooked vegetables that are well-tolerated.
On the other hand, most people are able to tolerate raw fruits again. In this phase, it is also helpful to start switching to more whole grains rather than refined ones. Again, make this transition slowly so your gut can get used to handling more fiber again. Whole grains also contain a lot of important nutrients that are frequently lost in the processing. It is always recommended to avoid bleached flours. The bleaching agents used in flours are bad for the immune system, in general. In fact, bleaching agents have been banned in many countries because of their negative health effects.
These are the most important things you can do to help heal your gut and get back to feeling healthy again. It may take more individualized dietary management if your situation doesn’t improve by following these guidelines. If so, it is highly recommended that you seek out a registered dietitian who is well-versed in inflammatory bowel diseases to help you. I have worked with many patients struggling with inflammatory bowel conditions, and while they can be challenging to live with, there is much you can do to heal your body. Whether you’re recently diagnosed or have lived with inflammatory bowel disease for a long time, remember that it is always possible to get back to a good quality of life.
Good luck and eat healthy!