By Clara Caslin
Aoife McDonald is a dietician, who has set up her own clinic called The Digestive Health Clinic. It is located in Cork, Ireland and is launching in the Summer of 2019. Aoife studied BSc. Nutritional Science at University College Cork (UCC) and then went on to do a Postgraduate Diploma in Nutrition and Dietetics at the University of Chester, UK. She has three years experience working in the NHS and has a special interest in gastroenterology. A digestive health programme has been designed by Aoife to help people with Inflammatory Bowel Disease and Irritable Bowel Syndrome to manage their symptoms through diet and lifestyle changes.
What types of food do you recommend for people with Inflammatory Bowel Disease (IBD)?
There are no foods that are specifically recommended for those with IBD, therefore it is advised that people with this condition aim to follow the dietary guidelines for the general public. These guidelines are based on the principles of a Mediterranean diet, which is largely based on high-fibre plant-based foods such as wholegrains, nuts and seeds, fruits and vegetables, legumes, and olive oil. It also encompasses plenty of seafood such as oily fish, moderate amounts of eggs, moderate intakes of poultry and dairy products (cheese and yoghurt) and low quantities of red meat.
What types of food do you not recommend?
There is no one particular food that all those with IBD should avoid completely, as sensitivities can vary from person to person. If you have IBD and suffer from digestive discomfort when in remission, I would recommend keeping a strict food and symptom diary to help you to identify any problematic foods.
Studies have shown that the incidence of IBD is higher in countries where a 'Western Diet' is consumed. This dietary pattern is characterised by refined carbohydrates, high intakes of red meat and regular consumption of processed foods, which often contain additives such as emulsifiers and sweeteners. Adhering to a Mediterranean diet as outlined above may be beneficial to those with IBD, as it inherently limits intake of these types of foods.
What portion sizes should people with IBD eat?
People with IBD should eat 'normal' portions, but 'normal' can mean different things to different people! A good rule of thumb is to fill half your dinner plate with vegetables or salad, one quarter with a wholegrain such as brown rice or quinoa, and the other quarter with a protein source such as lean meat, fish, eggs or legumes. Take a look at the Healthy Ireland guidelines for further advice on portion sizes http://www.healthyireland.ie/
You may wish to have smaller portions when in a flare-up, or if you experience IBS-like symptoms when in remission, reducing your portion sizes can help with symptom management.
Should IBD patients stay away from fibre?
In general, patients with IBD do not need to avoid fibre, and should aim to have at least 30 grams per day. However, tolerance to fibre can vary significantly from person to person. If you are planning on increasing your fibre intake, always do so slowly, and ensure you are drinking plenty of water too.
Many people with IBD consume low fibre foods when in a flare-up as these are easier to digest, and can reduce the frequency of bowel movements. Once symptoms have improved, patients can slowly begin to reintroduce fibre to their diet, up to their personal level of tolerance. The one exception is in those with stricturing Crohn's Disease, where a low fibre diet may be recommended long term to reduce the risk of bowel obstruction.
Apparently, dairy is bad for IBD. Is that true?
No, dairy is not bad for IBD. Some people may experience transient lactose intolerance if their IBD affects the small bowel, as this is where the enzyme needed to break down lactose is found. When their IBD is back under control and their bowel has had time to heal, these patients are normally able to reintroduce dairy foods back into their diet.
However, if you find that dairy does not suit you, always ensure that you are replacing these foods with non-dairy alternatives such as fortified soya or almond milk, and soya or coconut yoghurt. Other foods such as tinned fish, green leafy vegetables, beans, soya products, figs, oranges, seeds and some nuts are also good dietary sources of calcium. IBD patients have an increased risk of developing osteoporosis, therefore adequate calcium and vitamin D intake is particularly important.
Would IBD patients benefit from a gluten free diet?
A gluten free diet is generally only recommended for people with Coeliac disease, which affects about 1% of the population. In saying this, many people with IBD find that removing gluten-containing foods from their diet makes them feel better.
If you find that gluten does not suit you, consider the types foods you are eating. For example, pizza and cake contain gluten, but these foods are also highly processed and high in fat, so it may be these components of the foods that are causing discomfort rather than the gluten.
In the 30% of people with IBD who also suffer from Irritable Bowel Syndrome (IBS), removing gluten containing foods from the diet may help to improve digestive discomfort. Foods such as bread and pasta are high in FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) which can cause symptoms in those with a sensitive gut. In this case, the reduction in FODMAPs rather than gluten can lead to symptom improvement. Your dietitian may take you through the Low FODMAP Diet process if you also have IBS.
Should IBD patients avoid alcohol and caffeine?
Patients with IBD do not need to avoid alcohol and caffeine, unless an individual finds that it triggers symptoms for them. Reducing caffeine intake can be useful if you have persistent loose stools as caffeine acts as a stimulant.
Overall, there are no specific guidelines for caffeine and alcohol consumption among IBD patients, therefore I would recommend adjusting caffeine and alcohol intake on a individual basis. The alcohol guidelines for the general population can be found at www.alcoholireland.ie
What are common problems that you see coming up with your IBD clients?
In clinic, one of the common problems that comes up is Irritable Bowel Syndrome (IBS). I help patients to manage their functional gut symptoms through diet and lifestyle changes, as well as therapeutic diets such as the Low FODMAP Diet. This diet involves reducing intake of FODMAPs (poorly absorbed carbohydrates) for 4-6 weeks, followed by a systematic reintroduction process. About 60% of IBD patients with IBS achieve clinically significant symptom improvements on a Low FODMAP Diet. For accurate results, this therapeutic diet should only be carried out with patients who are in remission, and under the guidance of their dietitian.
Other patients I see in clinic may not be able to manage solid foods when in a flare-up. These patients sometimes require exclusive enteral nutrition (liquid diets) followed by a slow reintroduction process called the LOFFLEX diet (Low Fat/Fibre Limited Exclusion diet), which is used when patients are transitioning from a liquid diet back to solid foods. This diet helps patients to identify foods they are sensitive to, and therefore may need to avoid long-term.
On the wards, I see patients who require parenteral nutrition, which is a type of nutrition that is given intravenously. This is normally only needed short-term until the patient can safely eat and drink again. I also provide dietary advice to patients following surgery who have a new colostomy or ileostomy.
You can contact Aoife by email:
Instagram: @digestivehealthclinic
Website: www.thedigestivehealthclinic.com
Disclaimer: The information provided is not intended to replace medical advice or diagnosis from a physician or other medical provider. Please speak with your IBD team/dietitian if you are planning on making changes to your diet.
