Inflammatory Bowel Disease and Diets
As promised in my last article on inflammatory bowel diseases (IBD, Crohn’s disease and ulcerative colitis), I’m going to compare the different diets you may have been recommended if you suffer from IBD: the low-FODMAP* diet, the specific carbohydrate diet, the anti-inflammatory diet for IBD, the paleo diet and the hypotoxic diet.
One thing to note before we begin: no single specific diet works for everyone with ulcerative colitis or Crohn’s disease. However, this might soon change, as studies on the subject are currently ongoing.
The most important thing is to tailor your diet to your specific needs. Your needs depend on several factors: your diagnosis, the part of your digestive system affected by your illness, and the illness’ status. A diet that is adapted to your needs and your intolerances (as transient as these may be) will enable you to be as comfortable as possible, while ensuring you meet all your nutritional needs. Before embarking on a specific or more restrictive diet, speak to your healthcare team.
Without further ado, let’s take a look at the different diets that you may have been recommended: the low-FODMAP diet, the specific carbohydrate diet, the IBD anti-inflammatory diet, the paleo diet and the hypotoxic diet. For each of these, I’ll give you more information and indicate whether scientific research has demonstrated the efficiency of these diets in managing the symptoms associated with Crohn’s disease and ulcerative colitis.
1. Low-FODMAP Diet
FODMAPs are carbohydrates that are not well digested by the gastro-intestinal system. Because they’re not properly digested, they end up in the large intestine (colon) in high quantities, where they then ferment. This fermentation causes, in those who are sensitive to it, functional symptoms. These include dyspepsia, bloating, diarrhea, constipation and intestinal gas.
The majority of studies looking at FODMAPs focus around irritable bowel syndrome. However, a recent review of this literature has concluded that a low-FODMAP diet can be helpful for people suffering from an inflammatory bowel disease to better manage functional symptoms, especially during remission.
The low-FODMAP diet is designed to be followed for 4-6 weeks. During this period, the amount of FODMAPs in the diet is reduced as much as possible. This way, symptoms are lessened. Each of the six families of FODMAPs is then reintroduced individually in order to identify which one (or ones) is (or are) problematic.
To give the low-FODMAP diet a go, follow our low-FODMAP meal plans, which will ensure you have adequate amounts of foods to limit (those who have moderate FODMAP content) and no foods with high content.
For more information on how to put the low-FODMAP diet into practice in your day-to-day, why not take a look at our book “The Low-FODMAP Solution: Put an End to IBS and Abdominal Pain“?
2. Specific Carbohydrate Diet (SCD)
The specific carbohydrate diet is an extreme version of low carb diets. Sugar (sucrose), lactose, all cereal products and starches are removed from the diet.
Unlike the low-FODMAP diet, no scientific study supports this type of diet. The fundamental principles of the specific carbohydrate diet are based on the belief that carbohydrate-rich foods are not well digested and quickly find themselves in the colon. Once there, the carbohydrates create toxins and gases, which cause diarrhea and other symptoms. By eliminating most of the sources of carbohydrate from the diet, you also eliminate the energy source of the colon’s bad bacterial, thereby eliminating the symptoms.
While these principles are in part based on facts, we now know it isn’t necessary to remove all carbohydrates from the diet to obtain a reduction in symptoms. It is enough to avoid the types of carbohydrates that cause problems…. Which is exactly what the low-FODMAP diet does!
3. Anti-Inflammatory Diet for IBD (IBD-AID)
This new diet comes from the Department of Medicine of the University of Massachusetts in the United States. A team of researchers and dietitians took inspiration from the carbohydrate specific diet, and made several changes to it. Only added sugars, cereal products containing gluten (rye, wheat, barley and triticale) and some starches are removed from the diet.
These foods can encourage the growth of pro-inflammatory bacteria in the digestive system when they are present in large quantities in the diet. By removing them, it’s believed these pro-inflammatory bacteria can be eliminated, and balance can be regained. What’s more, in order to boost the number of good bacteria in the intestinal flora, the consumption of probiotics and prebiotics is encouraged.
Despite interesting preliminary results, larger studies are needed before this diet can be recommended.
4. Other Trendy Diets
You’ve probably also heard of the paleo diet and the hypotoxic diet? Unfortunately, these diets have not yet been proven effective in the treatment of inflammatory bowel diseases. Despite some anecdotal cases of remission, there are no scientific studies that enable us to recommend them.
It’s important to remember that the more foods or food groups are removed from the diet, the bigger the risk of nutritional deficiencies. A diet as wide and varied as possible is recommended, especially during remission. Consult a dietitian if you need help to adapt your diet based on your needs and restrictions.
*FODMAPs are fermentable carbohydrates that are partly responsible for causing symptoms in people with irritable bowel syndrome (IBS). For more info, read this article.
- Charlebois, A., Rosenfeld, G., & Bressler, B. (2016). The impact of dietary interventions on the symptoms of inflammatory bowel disease: a systematic review. Critical reviews in food science and nutrition, 56(8), 1370-1378.
- Marsh, A., Eslick, E. M., & Eslick, G. D. (2016). Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. European journal of nutrition, 55(3), 897-906.
- Olendzki, B. C., Silverstein, T. D., Persuitte, G. M., Ma, Y., Baldwin, K. R., & Cave, D. (2014). An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report. Nutrition journal, 13(1), 1.