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Friday, April 19, 2013

Guest Post: Navigating the World of IBD Diets

10:47 AM Posted by Tiffany Taft , , ,
We're thrilled to have a guest post by Beth Doerfler, MS, RD, LDN who writes about specialized diets and Inflammatory Bowel Disease (IBD).  I've known Beth for almost a decade now, and she is truly a great dietitian with leading expertise on the role of diet in chronic digestive conditions.  She's also just an all around awesome human being.  Beth and I worked together at Northwestern in the Center for Psychosocial Research in GI, where she sees patients in the gastroenterology division and helps them adjust to eating with a less than stellar digestive system.  Thank you, Beth, for this great article!

Is there a specialized diet for IBD? Yes and no. Contradictory as it may sound, you have likely met with health professionals and family who have said “diet has nothing to do with your Crohns or colitis…eat whatever you can tolerate”. On the other hand, you can’t help but find great testimonials about people who have tried specialized diets like gluten free or the specific carbohydrate diet and are feeling better than ever. Often patients will ask: What should I do? Should I be on a specialized diet?

I would like to use this space to highlight some questions that I typically discuss with my patients as well as my 2 cents on how they can be helpful or harmful. At least they can be discussion topics for your next doctor or nutritionist visit.

Should I try the Specific carbohydrate diet?

This diet was developed by biochemist Elaine Gottschall and the premise is to limit complex carbohydrates and raw items (to start) as a way to decrease diarrhea and inflammation in the bowel.

There are currently no controlled clinical trials studying the efficacy of this diet in adults with inflammatory bowel disease. Despite promising testimonials it is hard to be a guinea pig. However, 2 GI centers are studying this diet in kids and adults but currently we don’t know if this diet is a good idea or not in IBD. What if you want to try it, what should you know?

• There are 5 stages to the book and try not to stay in the early stages too long (stage 1 for example is designed for 3-5 days of bowel rest and consists of soups, pressed juices )

• Cooked veggies vs. raw are a good idea in any stage of this diet or any other diet as the fibers are hard to break down in our gut. Peeling skin on certain fruits is a good idea as well

• Do the best you can. While the SCD advocates home-made highly fermented yogurt you can certainly try store bought Greek yogurt with no added sugars. Adding some fresh fruit can sweeten it up nicely. We have no evidence to suggest this is inferior.

• If you notice the diet is interfering with your quality of life or you are losing unwanted weight abandon the diet, loosen the restriction or seek more individualized help from your doctor or dietitian.

Should I be juicing?

Yes if you feel like it but it is not superior to eating vegetables and fruits! Juicing is a great way to get vegetables in through a format that is generally pretty GI friendly. However, it can be time consuming and costly. Purchasing a pre-prepared juice cleanse can run people ~ $60.00/day.

Here are some pointers on this topic:

• Eating cooked veggies, vegetable juice and fresh fruits (peel skin if you have a sensitive stomach or issues with diarrhea) are a great approach.

• Research focusing on benefits of fruits and vegetables looks more at total consumption rather than the form (i.e raw vs. cooked). Bottom line: get them in how you can whether it is from juicing or cooked veggies.

• If you are juicing, don’t forget to add dietary protein to your day to keep those muscles thriving. You can do any type of lean protein that works well for including poultry, fish, tofu, eggs, beef, Greek yogurt or protein powders made from whey, soy or pea protein.

How do I put this all together? 

In general you have read that diet needs to be individualized and that is true. There are some key factors that work well for most people including moderate fiber, low lactose and lean proteins. Feel free to experiment with the amount and type of carbohydrate and sugars in your diet to get the best balance. If you need help putting a diet plan together or if you want to make sure that you are achieving nutritional balance while on a specialized diet do seek the help of a registered dietitian to compliment your efforts. Look to www.eatright.org to find a specialist in GI nutrition.

Wishing you good health and happy eating!

Bethany Doerfler MS, RD, LDN is a clinical research specialist who provides medical nutrition therapy to improve weight, overall health and digestion. She is currently participating in clinical research in the Division of Gastroenterology at Northwestern Memorial Hospital and serves as adjunct faculty at Loyola University Chicago. Ms. Doerfler earned a bachelor’s of science in nutrition from Michigan State University and a masters of science in nutritional epidemiology from the University of Illinois at Chicago. Ms Doerfler has co-authored several book chapters and journal articles on diet and lifestyle modification in disease management. She has presented to corporate, medical and academic audiences throughout Chicago.