Diet, Nutrition, and 
   Inflammatory 
   Bowel Disease
              a
           What’s Inside
           About Crohn’s & colitis ........................................... 2                                           Diet research ............................................................32
             The digestive system ................................................2                                        Final words about diet, nutrition, and IBD ......34
             The effect of IBD on digestion ..............................3
           IBD symptoms, complications,                                                                                    Make your own custom smoothie ....................35
           medications, and nutrition .................................... 3                                                 References: ................................................................. 36
             IBD symptoms ..............................................................3
             IBD complications  ......................................................4
             Growth delays .............................................................. 5
             Low bone mass ............................................................6
             Strictures ........................................................................ 6
             IBD medications .......................................................... 7
           Tips for maintaining a healthy diet with IBD .....7
             Drink plenty of fluids  ................................................9
             Eat a variety of vegetables and fruits..............10
             Select the right grains ............................................10
             Include protein-rich foods ..................................... 11
             Get enough calcium ................................................. 12                                       Figuring out what to eat when you have an 
             Maintain adequate caloric intake  .....................13
             Making a plan that works for you ......................13                                                     inflammatory bowel disease (IBD), like Crohn’s 
           Possible trigger foods and                                                                                      disease or ulcerative colitis, can be complicated.  
           food intolerances .....................................................15                                       These diseases affect your diet and nutrition in 
             Food allergies and intolerances ......................... 15                                                  a variety of ways: 
             Fiber ................................................................................ 16                     • Certain foods or food groups may worsen 
             Lactose ...........................................................................17                            symptoms. These foods can be different for 
             Suggestions for eating in a flare ........................18                                                     everyone and may change over time.
             High-fat foods ...........................................................20                                  • You may be able to eat most foods when 
             Gluten and fructan intolerance .........................20                                                       feeling well, but need to avoid certain foods 
             Non-absorbable sugars/FODMAP                                                                                     when you are flaring (active symptoms)
             (Fermentable Oligo Di-Monosaccharides  
             and Polyols) ................................................................. 21                             • A balanced, nutrient-rich diet is important 
             Is there a place for fast or junk food? ............22                                                           to avoid nutrient deficiencies
             Developing an individual diet ............................. 22                                                • Hydration (water) is key to feeling well
             Is there an IBD diet? ............................................... 23
           Vitamin and mineral supplementation ...........24                                                               • Many of our social activities involve food 
                                                                                                                              and drink. With some additional planning, 
           Probiotics ...................................................................28                                   there’s no reason why you can’t enjoy those 
           Nutritional support therapy................................29                                                      social gatherings.
             Enteral nutrition  ...................................................... 29                                  This brochure explains the impact of IBD on diet 
             Parenteral nutrition ................................................30                                       and nutrition and provides practical information 
           Questions to ask your healthcare provider .....31                                                               to help you eat well and stay healthy.
                                                                                                                                                                        1
      About Crohn’s & colitis                                     The roles of the GI system are:
                                                                  • Digestion—the breakdown and processing  
      Crohn’s disease and ulcerative colitis belong                 of food
      to a group of conditions known as IBD. These                • Absorption of nutrients, water,  
      diseases cause chronic inflammation in the                    and medication
      gastrointestinal (GI) tract, the area of the body 
      where digestion and absorption of nutrients                 • Elimination of waste
      take place. Normally, the immune system helps               The effect of IBD on digestion
      to protect the body from harmful infections 
      and irritants. In IBD, the immune system reacts             Crohn’s disease can affect any part of the GI 
      inappropriately, causing inflammation. This may             tract, from the mouth to the anus. Ulcerative 
      lead to symptoms such as abdominal pain and                 colitis affects the large intestine (colon and 
      cramping, diarrhea, bleeding, weight loss, and/             rectum). Because of the location of Crohn’s 
      or fatigue.                                                 and colitis, they can impact digestion in a  
      For more information about Crohn’s disease                  number of ways:
      or ulcerative colitis, view the Foundation’s                • Inflammation in the small intestine can inter-
      Living with Crohn’s Disease and Living with                   fere with digestion and prevent absorption 
      Ulcerative Colitis brochures by visiting                      of vitamins, nutrients, water, carbohydrates, 
      www.crohnscolitisfoundation.org/brochures                     fats, proteins, and minerals. 
      The digestive system                                        • Water is reabsorbed in the colon. Inflamma-
                                                                    tion in the colon prevents water from being 
      The GI tract consists of a series of mostly hollow            reabsorbed from the stool. This may lead to 
      organs beginning at the mouth and followed by                 diarrhea and urgent bowel movements. 
      the esophagus, stomach, small intestine, colon, 
      rectum, and anus (see Figure 1).                            IBD symptoms,  
                                THE GASTROINTESTINAL              complications,  
                                (GI) TRACT                        medications, and  
             1                   1 Oral cavity (mouth)            nutrition
                  2              2 Esophagus (throat)
                                 3 Liver                          Maintaining healthy nutrition with IBD can  
                                4 Stomach                         be a struggle due to active disease symptoms, 
               3     4           5 Large intestine/colon          disease complications, and medication  
                                 6                                side effects.
                                   Small intestine
             5      6            7 Rectum                         IBD symptoms
                                8 Anus                            When your disease is active, symptoms like 
                  7                                               diarrhea, urgency to have a bowel movement 
                  8                                               (rushing to the bathroom), abdominal pain, 
                                                 Figure 1         nausea, vomiting, blood in the stool, constipation,  
                              2                                                            3
      loss of appetite, fatigue, and weight loss can               Bile acids or bile salts help your body to absorb 
      negatively impact nutrition.                                 fats. These bile salts are normally reabsorbed 
                                                                   in your ileum. When your ileum is inflamed 
      Severe diarrhea can cause dehydration, which                 or removed by surgery, bile salts cannot be 
      means that your body may not have enough                     reabsorbed in the small intestine. Instead, they 
      fluids, nutrients, and/or electrolytes (especially           travel to the colon where they cause watery 
      sodium, potassium, magnesium, phosphorus,                    diarrhea. If a larger section of the ileum is  
      and zinc). If you are struggling with abdominal              affected, malabsorption of fatty acids can be a 
      pain and nausea, you may not have an appetite,               problem, causing abdominal cramping, diarrhea, 
      making it difficult to eat enough calories and               loss of fat-soluble vitamins, and weight loss. 
      take in adequate nutrients. When you are  
      having numerous bowel movements daily, you                   Patients with ulcerative colitis may have less 
      may avoid eating to try to control diarrhea or               significant nutrient deficiencies because the 
      avoid abdominal pain. This puts you at risk for              small intestine is not involved. However, weight 
      malnutrition and weight loss.                                loss and anemia may still be a problem due to 
                                                                   poor appetite, food aversions, severe diarrhea, 
      Another possible symptom of IBD is rectal                    and blood loss.
      bleeding resulting from sores (ulceration)  
      that form in the intestines, leading to blood                Growth delays
      loss. Chronic blood loss can eventually lead                 Growth delays may occur in some children with 
      to anemia (low red blood cell count), which,                 IBD due to long-term use of corticosteroid 
      if left unchecked, may cause fatigue.                        medications (which inhibit bone growth), intes-
      IBD complications                                            tinal inflammation, and general poor nutrition.
      Malabsorption of nutrients                                   To minimize the negative effects of IBD on 
      Malabsorption (difficulty absorbing nutrients)               growth, good eating habits, adequate calorie 
      may occur due to inflammation in the intestines.             intake, and control of intestinal inflammation 
      Proteins, fats, carbohydrates, vitamins, and                 are essential for children. If your child is not 
      minerals are absorbed primarily in the small                 staying on their typical growth curve, it may  
      intestine. If you have Crohn’s disease that                  be necessary to consult your physician or a 
      involves the small intestine (duodenum,                      registered dietitian for help with evaluating 
      jejunum, and ileum), inflammation can interfere              caloric and nutrient intake.
      with absorption of many nutrients, leading to 
      malnutrition and weight loss. 
      The degree of malabsorption depends on 
      how much of the small intestine is affected by 
      Crohn’s disease. Generally, the malabsorption 
      and nutrient deficiencies tend to be more  
      significant if larger sections of the small  
      intestine are inflamed or removed. If a significant 
      portion of the ileum (end of the small intestine) 
      is inflamed or removed, the absorption of 
      fat-soluble vitamins (A, D, E, and K) and vitamin 
      B12 may be affected. 
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