What to Eat with IBD

by Rory Hornstein
(from Ostomy Canada Magazine – Winter 2013: Volume 21, Number 2)

What to Eat with IBD Photo 01Now that you have an ostomy, you may be able to eat a larger variety of foods than you did before the surgery. Once you’ve recovered from surgery, it’s recommended that you eat a variety of foods. These guidelines will help you manage your diet while you recover from surgery. They will also provide suggestions for managing symptoms such as gas and odour as you continue to live with your ostomy.

Anti-Inflammatory food may alter pro-inflammatory food constituents by decreasing antigens and microparticles through exclusion diets. Bacterial load may be reduced in the small intestine through elemental diets and prebiotics/probiotics can alter the balance of microbiota. Specifically, small molecule production in the colon may be altered and cell structure changed. Lipids (n-3 LCFAs) – fish/fish oil play a role as well.

Symptomatic food can include obstructing food (in small intestinal stenosis) through skins, fibre, nuts, seeds and fatty food (in fat malabsorption). Functional gut ‘trigger’ foods include poorly absorbed short-chain CHO (FODMAPs), chemicals (amines, glutamates, salicylates) and allergens.

Many patients struggling with an ostomy feel that they are told to, ‘eat what you can’. Most consider dietary factors important in controlling symptoms/aiding recovery. A systemic, organized approach is warranted as the value of a food should be determined in the context of the total diet.

Diets such as FODMAP identify mal- absorption of Fructose, Lactose, Oligosac- charides, Polyols (FODMAPs) that may contribute to symptoms of pain, bloating and wind. The principle focuses on the reduction of FODMAP intake, which may improve abdominal symptoms in patients with IBD and functional gut symptoms. This can be effective for those with an ostomy as well.

No food is all ‘bad’ or all ‘good’. Dietary change should be in the context of the whole diet, clinical scenario, and specific issue that needs to be addressed. Dietitians should be an integral part of the patient’s management team. Effectiveness of dietary counselling in controlling symptoms is no longer in doubt (low FODMAP diet). Food choice will hopefully also emerge as an efficacious and
practical tool to reduce inflammation, and to prevent issues from developing from disease.

Once you have recovered from surgery, no special diet is required. Continue trying a variety of foods to see which are best tolerated. Adequate fluid intake is important to replace fluids lost in the output. Follow a low fiber diet to prevent blockages. You may become lactose intolerant for a short time after surgery. Re-introduce higher fibre foods slowly. Do not restrict your fluids to control high output. This could lead to dehydration or worsen existing dehydration. If your output is greater than 1L/day, you may need a special drink to help reduce your fluids. Speak to your GI Specialist about this.

Become aware of your own illness… what aids your recovery process and what hinders it. Nutrition can empower your body and mind to be strong. Diet can enable you to control at least one aspect of your disease, re-nourishing your body and allowing your intestines to heal. Embrace all modalities toward healing and care for yourself physically and emotionally. Seek support and reduce stress – be strong and determined. Diet and nutrition is an integral part of the healing process…food is medicine. The course of your disease can be changed by how you manage your life and what you eat.

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Rory Hornstein, RD / Specialty in Inflammatory Bowel Disease and IBS / www.roryrd.com

“What to Eat with IBD” first appeared in the Winter 2013 edition of Ostomy Canada. You can become a subscriber to our glossy, full-colour publication of Ostomy Canada by joining Ostomy Canada Society. Find out more here.

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