Laura Manning, a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai.

Inflammatory Bowel Diseases (IBD) such as Crohn’s disease and ulcerative colitis are believed to be caused by a combination of your genetic predisposition and changes in the microorganisms in your gut.

These disorders are on the rise in industrialized regions like North America and Western Europe, forcing scientists to reconsider the role of modern diets in the development and management of these diseases. Indeed, our gut bacteria look quite a bit different from our ancestors’ as we eat more and more processed foods to help us keep up with our busy lives and to allow us to prepare foods quicker and easier.

In this Q&A, Laura Manning, a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai, offers some advice on what you should eat if you have IBD and the possible connection to a related condition, Irritable Bowel Syndrome (IBS).

The good news is that in academic medical centers around the world, including the Mount Sinai Health System, studies are examining the link between IBD and a variety of diets, including low FODMAP, which can help, she says.

 Can food choice decrease your risk for IBD?

Studies show that certain dietary patterns may put people at greater risk for IBD. For example, a low-fiber, high-fat diet may increase inflammation and cause disease relapses. This is typical of a diet with a lot of processed foods.  In contrast, a diet high in soluble fibers, fruits, and vegetables and  low in saturated fat may be beneficial to our microbiome and have anti-inflammatory properties.

How can eating the right foods help treat IBD?

In addition to conventional medication focused on modifying the immune-inflammatory pathways in the gastrointestinal (GI) tract, diet can play an essential role in the management of IBD, especially for patients with a lot of unpleasant GI symptoms such as diarrhea, bowel urgency, and abdominal cramps.  Unfortunately, there is not enough scientific evidence to suggest that there is a “silver bullet” diet for IBD or a single diet approach that can take someone with IBD from a very severe flare-up all the way down to remission (i.e. no signs of inflammation at all).

What are FODMAPS?

FODMAP is an acronym for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. Foods that are high in FODMAPs include fruits, honey, high fructose corn syrup, lactose from dairy products, and some vegetables and cereals. These are hard to digest sugars that pass through the small intestine without being properly broken down by enzymes. Once these sugars reach the colon, they cause more water to enter the intestine, which leads to potential unpleasant side effects such as pain, bloating, and diarrhea.  Also, bacteria ferment (think of brewing beer), and the residual FODMAPs give off gas. You can learn more from this video.

How can a low FODMAP diet help?

There is very strong evidence showing the benefits of the low FODMAP diet for managing symptoms in patients with Irritable Bowel Syndrome (IBS), a much more common disorder of gut-brain dysregulation with many of the same symptoms as IBD.  We are now seeing that the diet can help manage symptoms in patients with IBD as well, especially when patients are in remission.

A person with IBD often can be technically in remission (a healed intestinal tract) but continue to experience symptoms that mimic an IBD flare-up. This is known as IBD with IBS overlay and it is extremely common, affecting 40-60 percent of IBD patients. High FODMAP foods can trigger IBS symptoms in people with IBD and make them feel like they are experiencing a flare-up. In fact, in a recent study, the low FODMAP diet was shown to lower symptoms like gas, bloating, diarrhea, nausea, and fatigue in patients with IBD.

What can I eat to help manage my symptoms?

The most common question patients with IBD ask me is “what can I eat?” My goal is to help patients find ways to eat that will allow them to manage symptoms and feel like they are in control. That’s where the low FODMAP diet becomes so useful. A FODMAP elimination and reintroduction process can be a life-changing tool for IBD patients to identify the triggers that add to their daily stress.

We know food alone does not cause IBD, but many patients will begin to notice “trigger foods” that increase their symptoms of gas, bloating, and diarrhea. The best way to identify your trigger foods is to simply keep a journal of what you eat. Note if there are changes that occur in our bowel function when certain foods are eaten more than others.

Are there resources to help me follow this diet?

The low FODMAP diet is complicated, and it can be tough to stick with it. We’ve found that Epicured, a meal delivery service that I work closely with, is an easy, go-to option for many of my patients. There are lots of other resources out there too, from mobile apps to support services. You’re not alone in this.

Any other advice?

Don’t get frustrated. What works for one person with IBD may not work for another. This is one of the many challenges I face as a dietitian working with patients at the Feinstein IBD Center at Mount Sinai. Having worked with patients with IBD for more than 15 years, I have seen many different diet therapies work and fail, and I must tailor suggestions to each individual. You can also get more information from the Crohn’s & Colitis Foundation.

Food is a very important topic because it evokes a lot of emotion in people.  People with IBD must carefully think about what to eat and the timing of their meals. If I can offer suggestions that help ease this stress, then I can successfully improve their nutrition, allow people to eat comfortably at work and at gatherings and lessen anxiety that commonly accompanies mealtime.  Food is a large part of our culture as well as a basic human need, and patients with IBD welcome guidance to help manage their disease and lead the healthiest life they can.

Laura Manning is a Clinical Dietitian at The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai. You can make an appointment at the Feinstein IBD Clinical Center or contact the office at 212. 241. 8100. For exceptional low FODMAP, IBD-friendly prepared meals delivered right to your door, check Epicured’s menu.

 

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