NUTRITION DURING A FLARE
Lorraine Cooney, Specialist Gastroenterology Dietitian
Lorraine, a gut health dietitian at Blackrock Clinic, shares insights about managing diet during and IBD flare, and getting back to eating well in remission. With IBD it is always recommended to get personalized guidance from a dietitian, as individual responses to food and the course of the disease can vary significantly between individuals.
Diet during Active Disease (Flare):
Focus on Meeting Nutritional Requirements:
During active stages of IBD, it's important to prioritize meeting your nutritional requirements rather than focusing on restrictive aspects of your diet. Consuming smaller, frequent meals can help optimize overall nutrition intake. Choosing foods that are soft, well cooked and moist can be easier to digest. If you find yourself eating less than your normal intake, you will be at increased risk of malnutrition, as your nutrition requirements are generally higher during a flare. If you start to lose weight, talk to your dietitian or doctor, who can consider supplementing your diet with oral nutrition supplements.
Avoid Foods that Increase Bowel Frequency:
Steer clear of foods that may increase bowel frequency, such as high-fat foods (like fatty, greasy or fried foods, creamy sauces and processed foods), fruit juices and juice-based smoothies, prunes and other dried fruits, some vegetables like mushrooms and cauliflower, as well as sugar free products like chewing gum. Coffee and alcohol are best avoided too.
Adequate fluid intake, ideally up to 2 litres of water per day, is essential to prevent dehydration. Herbal teas can also hydrate and feel soothing. If struggling to drink water isotonic drinks can be helpful or your medical team can advise on additional hydrating drinks. It’s usually not helpful to drink fizzy drinks.
For some people, dairy products like milk or yogurt may worsen symptoms when the bowel is inflamed. This is usually temporary and often resolves once inflammation settles. You can switch to lactose-free products (e.g. milk, yoghurt) or plant-based alternatives (e.g. soya, coconut yoghurts) if you find it difficult to tolerate dairy during a flare.
In some cases, a low-fibre diet may be beneficial, especially when experiencing severe symptoms or in the presence of a fistula or stricture, but a low fibre diet is not always necessary. A dietitian can help you find the best balance of fibre in your diet, as they can consider your individual needs and tolerance levels.
If your appetite is poor and foods are not well-tolerated, consider taking a multivitamin and mineral supplement to support adequate nutrient intake. Specific nutrient supplements may be necessary if you're deficient in iron, folic acid, calcium or vitamin B12. Nutrient deficiency doesn't always align with dietary intake, so regular blood test monitoring by your GP or consultant is advised.
Diet Progression during Remission:
Gradual Reintroduction of Foods:
When the inflammation starts to calm down, you should slowly reintroduce any foods you may have avoided to diversify your diet and start to eat normally again. You can start to do this by introducing one or two foods every few days, to help you expand your diet again. If a particular food worsens symptoms, cut it out for a few weeks and retry later with a smaller portion.
Increase Fibre Intake:
If you have been following a low fibre diet, it’s time to gradually increase fibre in your diet when in remission. Fibre-rich foods include wholegrains (such as wheat, oats and rice), vegetables and fruits, beans and lentils, nuts and seeds. A dietitian can guide you in finding the optimal balance of fibre for your individual needs.
If unintentional weight loss occurred during a flare or you are underweight, focus on trying to increase your total calorie and protein intake to regain to a healthier weight. Aim to include a wide variety of tolerated foods. Continuing to eat small frequent meals and snacks can help you achieve a higher weight, as well as positively impacting your overall nutrition status and enhancing gut health, if your appetite remains poor.
Diet plays a vital role in managing IBD during flares and remission. While individual responses to food and medication can vary, following expert advice can help manage symptoms and promote better overall wellbeing. Remember that it’s helpful to receive personalized guidance tailored to your specific needs and circumstances. By carefully managing your diet and maintaining a diverse and nutritious eating plan, you can nurture your gut and lead a healthier life with IBD.