Does Diet Matter in IBD?

Diet is essential in the first line of treatment to heal from IBD

Many of us may have had a doctor tell us that what you eat doesn’t matter in Inflammatory Bowel Disease (IBD). Or just to eat a low residue diet. To put it mildly:, this is not true.

If you have IBD, your diet can make-or-break your healing.

And it isn’t just about low residue. 

To help motivate you to consider dietary changes for IBD, here is an explanation of why diet matters AND how to find the right diet for you.

DIET MATTERS IN IBD

Many of us have gotten frustrated because we haven’t been able to figure out the foods or diet that doesn’t make us sick. Especially when you are in a flare, everything you eat can feel bad. Or, what you eat one day works, but the same food seems to make you sick another day.

Why is this? Because either:

a) You either haven’t found the right diet (yet)

-or, (usually):

b) There are other things causing inflammation in your gut besides what you eat. They may need to be addressed before you can see the impact of diet in resolving your inflammation

To use a metaphor by MSIDS doctor, Richard Horowitz, if you have 16 nails in your foot, and you remove 10 of them, your foot will still hurt quite a lot. That obviously doesn’t mean you shouldn’t have removed those 10 nails. You just need to look for, and remove, the other 6 causes of pain.

This is also true for what we eat when we have IBD. Diet is foundational to healing the inflammation from IBD, but is not the only factor. We need to figure out the other “nails” that are causing inflammation. However, starting with changing your diet is fundamental and also the most self-empowered thing you can do for yourself right now.

HOW DOES DIET AFFECT INFLAMMATION IN IBD?

This all has to do with the complex and wonderful interactions between our gut microbiome and immune system. 

Gut microbiome: the 100 trillion microbes that live in your intestines. That is TEN TIMES more cells than there are of you in your body (there are ‘only’ 10 trillion cells that are your DNA). The volume alone is mind-boggling. Consider, also, that these 100 trillion bugs are living in a complex, interdependent ecosystem in your intestines, and it is truly awe-inspiring.  

Immune system: the system in our body that is charged with balancing tolerating and working with friendly microbes and defending against the unfriendly ones (that’s right, microbes are essential to a healthy human). 

Finally, take into account that ~75% of your immune system, both function and volume, is in your intestines, communicating intricately with these microbes and vice versa.

Generally speaking, your immune system creates inflammation when it senses that this microbe-immune system is out of balance. Inflammation is how it restores this balance. IBD is a complex condition involving both microbe imbalances as well as a dysregulated immune/inflammation response.

What else is in your gut, interacting with these 100 trillion microbes and complex immune system? FOOD., of course. What we eat is what feeds our microbes, which in turn program our ~75% of our immune system.

So, Inflammation in your gut can be caused or exacerbated by: 

• What you feed your microbes. What we eat changes the gut microbe population, and hence our immune system’s reaction to it.

• Your immune system can also react to directly to the food itself. This happens when we develop intestinal permeability, or leaky gut.

HERE’S WHERE TO START

When it comes to diet: there is no one-size-fits-all in answering this question. Finding the right IBD for you is trial and error. And when things are severely inflamed, an elemental diet or other bowel rest diet may be the place to start. But the majority of people with mild to active IBD can find relief starting on a basic Paleo-template or even Autoimmune Paleo Protocol (AIPP).

Finding the right IBD diet for you is based on these basic principles:

• Eliminate any foods that could be feeding microbes in your gut that trigger inflammation.

• Eliminate any foods that may themselves be triggering the inflammation (eg: food intolerances and food allergies).

The following are basic starting points for developing an IBD-healing diet:

Eliminate all processed foods
Did it exist before 1900? Does it come in a box, bag or can or from an aisle in a grocery store? Does it contain ingredients your great grandma wouldn’t recognize? These are processed foods. There are exceptions with the wealth of organic, Paleo and allergen friendly foods. But remember the underlining principles. Read the labels and follow the principles below.

Eliminate all major food allergens
The top allergens are gluten, corn, soy, eggs and dairy. At least for now. You may be able to introduce some of these to test tolerance when you are well.

Eliminate all sugar, especially and absolutely all processed sugar
“Can I eat fruit?” Maybe. Remember: trial and error. Start with as strict a version of elimination as you can tolerate. You can reintroduce foods once you feel stable and better one by one by sampling them for 4 days to test your tolerance.

Eliminate all grains
Yes this is gluten free. Other grains include rice, quinoa, barley, oats, spelt, rye and this also includes corn. Again, you may be able to introduce some of these later.

Don’t just pay attention to what you don’t eat. Pay attention to eating nutrient-dense food
What foods are nutrient dense?

Plants (especially vegetables): If you are flared, especially diarrhea, you’ll want these well-cooked. Try to incorporate variety and various colored vegetables. These include winter and summer squash, greens, cruciferous vegetables such as broccoli, cauliflower and cabbage. Also carrots, parsnips, beets etc.

Animals: Consider eating “nose-to-tail.” This means adventuring away from the sterile white, skinless, boneless chicken breast of our modern era. Humans have always eaten all the parts of the animal. This is where all the nutrients are. The collagen and minerals in the skin and bones and cartilage are especially healing for most of our guts. Organ meats (organic please) supply the richest food sources of essential nutrients such as vitamin E, A and iron, in which most people with IBD are deficient.

Consider starches
Good sources of starch, on the Paleo template diet include sweet potatoes, plantains, taro root (also known as cassava, cassava flour and tapioca flour). You may do well on white potatoes, which are also a great source of potassium, but eliminate these at first until you feel well and can properly identify if they are a trigger.

Go low-residue
Yup, that’s true. If you are flared it is important to eat food that is easy to digest and does not ‘scrape’ your inflamed intestines. Once your inflammation is better, long term, eating fiber-rich food will be an important part of fostering a healthy gut microbiome and preventing IBD flares. 

If you don’t respond to this basic diet, there could be other issues going on, including different food intolerances and diets to treat other aspects of gut inflammation. These diets include low-histamine, low-FODMAP, low oxalate, low salicylates, fructose malabsorption and less obvious food intolerances and allergies, to name a few.

Work with a skilled Functional medicine practitioner to identify both the dietary strategies and other causes of autoimmunity and inflammation (the other ‘nails’) leading to your IBD.