Do you experience unpredictable diarrhoea, abdominal pain, bloody stools, fever, and fatigue? Have you ever spoken to your doctor about these symptoms? Perhaps you may have undiagnosed Inflammatory Bowel Disease.
Inflammatory Bowel Disease (IBD) includes both Crohn’s Disease (CD) and Ulcerative Colitis (UC). It is a life-long relapsing and remitting condition characterised by chronic inflammation along the gastrointestinal tract.
UC affects the large intestine (colon) and CD can occur anywhere along the gastrointestinal system (from the mouth to the anus). Both present as unpredictable ‘flares’ that result in gastro-like symptoms e.g. diarrhoea, abdominal pain, bloody stools, fever, and fatigue. Severity, timing and location of flares are individual to each person with IBD.
How is it diagnosed?:
Due to the non-specific symptoms of IBD, you will likely undergo a variety of tests to exclude other conditions such as coeliac disease, gastroenteritis, or others with similar symptoms.
There is no one test that reliably diagnoses all IBD cases.
For people with suspected IBD, either or all of the following might be done: blood tests, visual inspections (colonoscopy or endoscopy), biopsies, X-Rays or CT scans, and/or faecal testing.
What treatment is available?:
Treatment options vary to the individual and can include medications, surgery and dietary interventions.
Common medications include: Aminosalicylates; corticosteroids; immunomodulators; biological agents and antibiotics. These medications can be used alone or in combinations and are working to reduce inflammation of the intestine. Side effects vary, so follow up regularly with your GP or specialist to monitor effectiveness, need and any adverse effects.
Some may require surgical removal of damaged portions of the bowel or to drain abscesses.
A note on complimentary or alternative medicines: there is minimal evidence to support alternative treatments. Some treatments may worsen symptoms or even interfere with medications, they can also be expensive. If you have been directed towards any alternative treatments, check with your healthcare team first and monitor your symptoms.
What are flares?:
People with UC and CD can fluctuate in unpredictable bouts of inflammation. These are referred to as ‘flares’ or a ‘flare up’. They will likely resemble the symptoms mentioned above. You may be requested to have additional investigations and therapies may be adjusted.
Can I achieve remission?:
There are different definitions of remission:
- Symptom control/clinical remission is the resolution of active IBD symptoms.
- Mucosal healing is the absence of active disease seen by a colonoscopy (no ulcers, bleeding etc.)
- Histologic remission is when there is no active inflammation when a biopsy is taken.
Different people will have different remission goals and different treatments will help achieve these.
How can Dietitian’s help:
The dietitians at Optimum Intake are equip to assist during all stages of suspected and diagnosed IBD.
Before diagnosis or with suspected IBD, your dietitian can assess your dietary intake, recommend diet changes and help identify possible dietary causes of symptoms such as intolerances, allergies or poor nutrition.
As diagnosis can be delayed, individuals are at risk of becoming malnourished and can have significant nutritional deficiencies.
Common reasons why:
- Difficulties absorbing nutrients,
- Increased nutrient requirements during inflammation,
- Reduced oral intake due to a poor appetite and feeling unwell
Micronutrient deficiencies depend on the location and severity of inflammation, and the individual’s overall diet. Therefore there is no set vitamin/mineral supplement recommended for all with IBD. Common micronutrient deficiencies include vitamins B12, A, D, E and K, calcium, iron, zinc, folate, selenium, magnesium, potassium, sodium and copper. Blood tests during inflammation don’t always show your true nutritional status. Therefore, a dietitian is best equip to assess your individual needs.
Unfortunately, there is no diet that can be used to induce or maintain remission in all people with IBD. This is not to say that diet doesn’t have an important role in IBD and other inflammatory diseases. Many people have success with a wide variety of diets and supplements.
Your Doctor/dietitian may recommend ‘bowel rest’ to reduce stress on an inflamed bowel. This is usually a fluid only diet called ‘exclusive enteral feeding’, which may help induce remission. Your dietitian will prescribe nutritional supplements to meet your energy, protein and total nutritional requirements and can help suggest and monitor preferred drinks based on symptoms, flavour and texture. In some cases this might need to be administered via a tube.
What about fibre? Fibre is undigested plant foods that help keep regularity and bulk in the stool. The internet can be full of confusing advice about fibre intake and IBD. During a flare or with a narrow bowel, some people may experience worsened symptoms with high fibre foods. A low fibre or modified fibre diet might be recommended as a temporary measure, and some may benefit from long term dietary fibre modifications if they are prone to bowel obstructions. In remission, usually meeting the dietary guidelines (25-30g per day) for fibre is a good goal.
Weight gain is a common side effect when using steroids to reduce inflammation. This is due to some water retention, change in metabolism and an increased appetite. Healthy eating and activity during times of well-being are key.
Final tips and things to remember:
- Your medical, physical, and mental health goals may change throughout the stages of disease.
- Your dietitian play’s an important role throughout all stages of IBD.
- Make a good relationship with your care team: GP, gastroenterologist, dietitian and any other specialists involved.
- If doing your own research, go to reputable sources such as the Crohn’s and Colitis Foundation.
- When seeing a dietitian for the first time:
- Bring your referral from your Doctor.
- Bring or have your Doctor send your blood tests and/or reports from the gastroenterologist.
- A food diary and symptom diary may be beneficial. Usually 3-5 days is sufficient, include some weekdays and a weekend.
- List any foods you believe make your symptoms worse.
If you are feeling overwhelmed and stuck, Optimum Intake Dietitians are here to provide support and guide you through the range of possible solutions. We will personalise each recommendation to your specific needs, symptoms and experiences. We are best contacted directly via phone 0499 008 451 or email firstname.lastname@example.org.