Tag Archives: Health & Nutrition

Video: What can I eat if I have IBS?

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Video: What can I eat if I have IBS?

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Video Transcript

For a lot of people who receive a diagnosis of irritable bowel syndrome, or IBS, the first thing they want to know is “What can I eat?” From simple changes to specialized diet plans, everyone has an opinion.

Maybe you have a friend who said avoiding dairy and wheat eliminated all her symptoms, or a colleague who swears that a vegan diet cured his IBS. Maybe you’ve joined an online group where everyone is saying you must eat a low FODMAP diet. The truth is, each person has a unique experience with IBS, so, what works for one person might not work for another. There is no one diet guaranteed to treat IBS, but some have more success than others, and there are guidelines that can help you figure out what will work best for you.

IBS is a functional gastrointestinal condition defined by abdominal pain, bloating, constipation, and/or diarrhea. If you want to learn more about IBS, find links to our other IBS videos in the description. Most people with IBS find that they can’t just eat whatever they would like to eat, because certain foods can worsen their symptoms.

If you decide to make changes to your diet, start by thinking about how and when you eat. Do you sit down for a meal and take your time, or do you grab bites of food while focusing on other activities? Bad eating habits can be especially detrimental if you have IBS.

Some good habits include sitting down at the table for each meal, keeping portions moderate or small, eating at regular intervals, chewing well, and eating slowly. Eating large meals sporadically can increase digestive symptoms, as can eating while stressed, anxious, angry, or distracted.

How you prepare your food matters too. If you find that eating a salad gives you intense abdominal pain and bloating, try steaming some vegetables until they are soft instead. Cooked food is often easier to digest.

While fat is a vital nutrient, large amounts of it can upset the digestive tract. Focus on eating fat from food sources such as fish, nuts, and avocado. Try lower-fat cooking methods, such as baking, roasting, steaming, boiling, and sautéing, and limit deep frying or adding too much oil when cooking your food.

Protein is important for gut health and overall health. When choosing a protein option, some are easier to digest, such as eggs, chicken, tofu, and lactose-free Greek yogurt, rather than beans, lentils, or steak.

Another key ingredient for a healthy gut is dietary fibre. However, fibre can be a tricky subject for people with IBS. On one hand, fibre can help regulate digestive health, feed good bacteria in the gut, and, depending on the type of fibre, can reduce constipation or diarrhea. On the other hand, fibre can irritate a sensitive gut and lead to pain and bloating, especially in large doses. Don’t go from a low-fibre diet to one high in fibre over night, as this can cause very painful digestive symptoms.

If you want to increase the fibre in your diet, you need to make gradual changes, increasing your daily intake by a few grams and maintaining the new level for a week or two before adding more, and increase your fluid intake.

Even if you aren’t eating lots of fibre, you should still make sure you are drinking enough water. This is a good tip for everyone, as hydration is super important for overall health. It can be especially crucial for those with IBS.

Frequent diarrhea can lead to dehydration, so it is important to drink plenty of fluids whenever you experience this symptom. Water can also help if you have constipation, because liquids help soften stools. And, while water is ideal, you can also stay hydrated by drinking herbal tea, broth, juice, milk, and most non-alcoholic liquids.

Another option that could improve your gut health is probiotics. Fermented foods such as yogurt, kombucha, kimchi, and kefir are easy to access options, but you don’t really know what you are getting with these products. While it won’t hurt to try incorporating these foods in your diet, it is best to take probiotic supplements that have research backing their efficacy. However, there are many products available, a lack of regulation in the industry, and no guarantee that these will help. Since they can also be quite expensive, a one-month trial can help you figure out if this approach is helpful for you. Speak with your healthcare team about which product is best for your needs.

Now that we’ve gone over ways you can improve your diet, we need to focus on the most difficult changes to make: eliminating problem foods. Not every person with IBS has the same trigger foods, but some are more common than others. For many, the first step is to check for any major intolerances or allergies.

Lactose intolerance is very common overall, and the symptoms can be more pronounced in individuals with IBS. Gluten intolerance is another possibility, but it isn’t as common as you might think. Some individuals who think they are gluten intolerant actually have trouble digesting certain carbohydrates in bread, not gluten, which is a protein. If dairy and bread don’t give you problems, you don’t need to avoid them.

Cruciferous vegetables, such as broccoli, cauliflower, cabbage, and Brussels sprouts, as well as legumes such as chickpeas, lentils, and beans, contain high amounts of fermentable carbohydrates, which can cause gas and bloating that can be especially pronounced in those with IBS, so it is best to limit these.

Fruits contain sugars that can irritate the gut, so don’t have more than one portion per meal or snack and wait a few hours before having more. Sugar alcohols such as sorbitol, mannitol, xylitol, and erythritol, which can be found in some sweetened foods, can also lead to severe bloating and diarrhea.

You might have noticed that most of the foods that can cause trouble for those with IBS are types of carbohydrates. This is where the low FODMAP diet comes in. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. These are carbohydrates that don’t digest well in the small intestine and instead pass into the large intestine where they ferment and cause symptoms.

A short-term low FODMAP diet might help you identify trigger foods. We’ve written a lot about the low FODMAP diet at badgut.org, and you can find links in the description. It typically involves three stages. First, you remove all high FODMAP foods from your diet. Then, you slowly reintroduce the foods, noting which cause problems for you. The final step is creating a personalized diet based on this information.

Other foods and drinks to potentially limit include alcohol, beverages that contain caffeine, carbonated beverages, spicy foods, and deep fried or heavily processed fatty foods.

Sometimes, the easiest way to figure out what food intolerances you have is to try an elimination diet, with the help of a dietitian. This involves temporarily avoiding certain foods and seeing if that improves your symptoms. This can be a lot to sort out. You might want to try using our three-month digestive health journal to record your food journey. Click the link in the description to buy a copy.

Food is so important. What and how we eat can make such a difference in our physical and mental health and impact our social and professional lives, as so many events revolve around food.

If you plan on making drastic changes to your diet, speak with a registered dietitian who can help you find an eating plan that improves your symptoms without sacrificing your ability to maintain a healthy diet and enjoy eating.

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Pancreatitis: What’s fibre got to do with it?

Pancreatitis: What’s fibre got to do with it?

Pancreatitis is inflammation of the pancreas. There are two main types of pancreatitis: acute (abrupt onset) and chronic (long-standing disease). The inflammation can damage pancreatic tissue and cause symptoms such as abdominal pain, nausea, weight loss, diabetes, and malabsorption.

You may have already heard about the role of fat in the management of pancreatitis, but what about the role of fibre? Is there one? Newer research is showing that fibre may very well play an important role in the management of pancreatic disorders, including acute and chronic pancreatitis. The latest evidence in this area remains controversial, and more studies are needed to confirm these findings, but it is still interesting to check out what they are discovering. Keep reading to learn more about what science has shown so far about the nutrition management of pancreatitis, and how to apply these findings to your everyday life and practice.

Acute Pancreatitis

In the hospital setting, when an individual is admitted with acute pancreatitis, the doctor will write a nil per os (NPO) diet order, which is Latin for “nothing by mouth”. The person will get plenty of intravenous (IV) fluids to stay hydrated, as they will often have symptoms of nausea, vomiting, and abdominal pain that prevent them from eating or wanting to eat. Eating when the pancreas is inflamed will stimulate the pancreas and trigger these undesirable symptoms. If the case is mild, then the diet will be gradually advanced from liquids to solids (low-fat with or without a low-fibre restriction, or regular diet as tolerated) over the next few days, and in very mild cases, within 24 hours.1 The ultimate goal is to return to a regular diet over time. In cases of severe acute pancreatitis, nutrition support (e.g., tube feeding) is necessary for those who are not able to, or not expected to, tolerate oral intake anytime soon.2 This is because these individuals will have increased energy and protein needs that can only be met through nutrition support. Nutrition is also key for preserving gut barrier function. When the gut barrier function is compromised, it can lead to the translocation of bacteria across the gut barrier, which can cause infection of the pancreas and, worst case scenario, systemic inflammatory response syndrome (SIRS).1

Fibre, specifically prebiotic fibre, has been shown to help preserve gut barrier function and integrity. This helps prevent the translocation of bacteria across the gut barrier that can lead to the increased infection rates seen in acute pancreatitis.1 A prebiotic-rich diet is associated with lower rates of pancreatic infection, hospital stay, SIRS and multiorgan failure.1 One randomized, double-blind study of 30 participants with severe acute pancreatitis found that those given nutrition support (tube feeding) with a prebiotic formula had a shorter hospital stay and fewer complications than those given standard nutrition support without prebiotics.3 Prebiotics act as food for our healthy gut bacteria. They feed and stimulate the growth of the friendly bacteria that live in the gut, helping to keep the immune system strong and healthy. Prebiotic-rich foods include asparagus, artichokes, beans, bananas, garlic, green peas, oats, and onions. A banana topped oatmeal, banana oat smoothie, or banana oat bars, could be easier prebiotic-rich foods to tolerate during recovery. You can also find prebiotics in supplement form, which is okay, but, if you can tolerate prebiotics in food form, why not start with food first? That way, you get all the beneficial nutrients found in the food, instead of just the isolated prebiotic in supplement form.

Chronic Pancreatitis

There is a greater risk of malnutrition in chronic pancreatitis. This is due to malabsorption caused by a decreased level and/or activity of pancreatic enzymes, which are needed to digest food for optimal absorption.1 However, pancreatic enzyme supplementation can help. Individuals with pancreatic insufficiency take these enzymes with meals to optimize nutrient absorption. While some foods do contain natural digestive enzymes (e.g., pineapple), they are not in amounts high enough to prevent malabsorption in chronic pancreatitis. Also, we need a mix of enzymes to break down all the macronutrients (protein, carbohydrates, and fat), and this mix cannot be found in one single food. Chewing foods really well, taking the time to eat, and enjoying smaller, frequent meals (e.g., eat half a sandwich and then eat the other half a few hours later) can also help optimize absorption, because the body will have more time to process and properly digest these foods.

Fat can stimulate the pancreas and trigger abdominal pain; however, health experts still recommend that you try to eat some fat. Avoiding fat completely can make it even more difficult to tolerate when you do add it to your diet because the enzyme that breaks down fat (lipase) needs to have some fat in order to stay active and working well.4 In addition, fat is crucial to good health and is needed to absorb the fat-soluble vitamins A, D, E, and K. The recommended macronutrient range for fat is 20-35% of total daily calories, and a 30% range is reasonable for someone with chronic pancreatitis. It is important to know that since a keto diet is up to 80% of total calories from fat, it would not be a good dietary option for individuals who have pancreatitis.

Fibre may decrease the activity of pancreatic enzymes in people who have pancreatic enzyme insufficiency. This association of a high-fibre diet on decreased pancreatic enzyme activity has been shown mostly through laboratory (in vitro) studies, and human (in vivo) studies are needed to confirm these findings.1 A high-fibre diet in people with pancreatic exocrine insufficiency can also increase fat excretion in the stool, meaning that less fat will be absorbed and used by the body. Fibre may also stimulate the pancreas through an undefined neurohormonal mechanism, which could trigger symptoms.1 Again, these findings are associations, and more research is needed before making any drastic changes. That being said, a very-high-fibre diet (> 50 g/day) may not be a good idea, especially if more symptoms are triggered.

Ten Nutrition Goals for Pancreatitis

  1. ensure nutritional adequacy of meals
  2. correct nutrient deficiencies (e.g., vitamins A, D, E, K)
  3. limit malabsorption (e.g., pancreatic enzymes)
  4. prevent weight loss
  5. eat smaller, frequent meals to optimize digestion and absorption
  6. manage symptoms (abdominal pain, bloating, nausea, vomiting, diarrhea, steatorrhea) by choosing well tolerated foods
  7. preserve gut barrier function and integrity (e.g., prebiotics)
  8. avoid unnecessary food restrictions (e.g., very low-fat diet)
  9. control blood sugars as needed (higher risk of diabetes with chronic pancreatitis)
  10. avoid alcohol


Pancreatitis is a complex disease and nutrition management depends on whether it is acute or chronic. Although there is still a lot to learn about fibre in pancreatitis, a low-fibre diet is initially recommended in the early stages of acute pancreatitis until symptoms subside. Afterward, prebiotic fibre could be encouraged in acute pancreatitis to help preserve the integrity of the gut barrier and help reduce the risk of infection and other complications. It may be prudent to avoid a very-high-fibre diet in cases of chronic pancreatitis because fibre may reduce pancreatic enzyme function, increase fat malabsorption, and trigger symptoms. Ultimately, it will be interesting to see what the future research will show and if the use of prebiotic fibre may become a standard in the treatment of acute pancreatitis.

By Anne-Marie Stelluti, RD
Anne-Marie Stelluti is a registered dietitian and business owner of Modern Gut Health, a private practice with special focus in digestive health nutrition.
First published in the Inside Tract® newsletter issue 215 – 2020
1. Ribichini E et al. Role of Fibre in Nutritional Management of Pancreatic Diseases. Nutrients. 2019;11(2):2219.
2. PEN The Global Resource for Nutrition Practice. Gastrointestinal System – Pancreatitis Key Practice Points. Available at https://www-pennutrition-com. Accessed 2020-08-01.
3. Karakan, T et al. Comparison of early enteral nutrition in severe acute pancreatitis with prebiotic fibre supplementation versus standard enteral nutrition: A prospective randomized double-blind study. World J. Gastroenterol. 2007;13:2733-2737.
4. Holtmann G et al. Survival of human pancreatic enzymes during small bowel transit: Effect of nutrients, bile acids, and enzymes. Am. J. Physiol. 1997(1):553-558.
Photo: © bit24 | bigstockphoto.com

Advances in Diverticular Disease and Diet

Advances in Diverticular Disease and Diet

New evidence is shedding light on the ways diet influences diverticular disease and is reinforcing some of the Gastrointestinal Society’s long-held positions, such as how nuts and seeds are safe to eat. This article will focus on the latest research and how that influences recommendations on what you can do to help reduce the risks of diverticular disease through food and lifestyle changes.

Diverticular disease and diverticulosis are interchangeable terms meaning the presence of small out-pouches (diverticula) in the large intestine (colon). It occurs in about 5% of the Western adult population who are younger than forty years of age, but it rises sharply to occur in at least 50% of those who are older than 60 years of age. It’s a disease most prevalent in the elderly, with the prevalence approaching 65% in those 85 years of age and older, and the majority not experiencing any symptoms or complications.1 Diverticulitis occurs when these pouches become inflamed or infected, which causes symptoms such as nausea, vomiting, abdominal pain, and bleeding. Why does this happen? Scientists suggest that it is likely due to several factors, including genetics, the environment, and more recently, inflammation and the intestinal microbiome.2,3

The traditionally accepted theory that a low fibre diet causes diverticulosis comes from a paper published in 1971 by Painter and Burkitt in the British Medical Journal.4 They hypothesized that the reason why diverticulosis was so common in the West was that the typical Western diet was much lower in fibre when compared to countries in Africa, where diverticulosis was rare. However, the researchers did not actually measure diet nor diverticulosis; it was just a hypothesis. Research in this area then stagnated for some time, but has picked up during the last two decades.2


When a patient with acute diverticulitis comes to the hospital, their diet will consist of liquids (e.g., juice, broth, jello) to give the colon a rest. Gradually, the person can expand to a low fibre diet as symptoms improve and they start to feel better. Before hospital discharge, a registered dietitian will advise the patient to increase their fibre intake gradually, toward a high fibre diet at home, with the hope of reducing the risk of recurrent diverticulitis.

Current guidelines still recommend a high fibre diet to prevent diverticular disease, despite being based on low quality evidence from observational studies.5,6,7 A review of several studies (meta-analysis) published last year in the European Journal of Nutrition8 concluded that a high fibre diet may reduce the risk of diverticular disease. They found that people who consumed 40 g of fibre per day had a 58% reduction in risk of diverticular disease when compared to those who consumed only 7.5 g of fibre per day. They also noted that people who eat higher fibre diets tend to have healthier lifestyles in general.

Another study, published in 2019,9 looked at the association between fibre intake and risk of diverticulitis in 50,019 women, 43-70 years of age, from the Nurse’s Health Study that took place from 1990 to 2014. They found that a higher fibre intake was associated with a reduced risk of diverticulitis in women, especially when they consumed more whole grains and whole fruits, particularly apples, pears, and prunes.

Fibre might help reduce the risk of diverticular disease through its anti-inflammatory effects and by how it alters the intestinal microbiome versus how it helps reduce constipation and promote bowel regularity.5,7,9,10 Clearly, to confirm this, we need more high-quality research, and it will be interesting to see what is discovered.

Table 1 – High Fibre Diet (40 g) Example

  Food Fibre
Breakfast ¾ cup cooked oatmeal (using quick oats)

½ cup raspberries (from frozen)

1 tbsp. whole flaxseeds

3.5 g

4.8 g

2.9 g

Lunch two slices rye bread, toasted

two slices of aged cheddar cheese

one medium apple, with skin

2.2 g

0 g

3.5 g

Dinner ½ cup roasted chickpeas

1 cup cooked quinoa

½ cup canned tomatoes

1 cup raw spinach

9.6 g

5.5 g

1.0 g

0.7 g

Snack one medium pear, with skin

¼ cup walnuts

5.3 g

1.7 g

Total 40.7 g

*Source = Canadian Nutrient File

Nuts, Seeds, and Popcorn

My grandmother had diverticulosis and she ended up avoiding nuts and seeds for years, including the fresh blueberries and strawberries that she loved so much. A large groundbreaking study published in 200810 set out to test the theory that nuts, seeds, and popcorn cause diverticulitis. They followed 47,228 men from the Health Professional’s Follow-up Study from 1986 to 2004 and found that these foods were not associated with a risk of diverticulitis or diverticular bleeding.

They also specifically did not find any association between eating blueberries and strawberries and diverticular complications. What they found instead, was that men who ate more of these foods actually had fewer cases of diverticulitis than those who didn’t. They concluded that nuts and seeds may actually be protective against diverticulitis, perhaps due to their anti-inflammatory effects. 2,6,10,11 The NICE guidelines from the UK, and the PEN Guidelines from Dietitians of Canada, state that there is no need to avoid nuts, seeds, popcorn, or fruit skins for diverticulosis.12 It turns out that my grandmother could have enjoyed those berries that she loved so much after all!

Red Meat, Poultry, and Fish

Some studies have shown that red meat intake increases the risk of diverticular disease, whereas others have found no association.2,5 A large prospective cohort study, published in 2018, looked at 51,529 men from the Health Professional’s Follow-up Study from 1986 to 2012. The researchers observed an association with red meat intake and an increased risk of acute diverticulitis but observed no association with a higher consumption of poultry or fish.13 Overall, whether red meat increases the risk remains controversial. However, given the many other health benefits of limiting red meat intake, I would suggest decreasing consumption anyway.

Caffeine, Alcohol, and Smoking

Consuming caffeine or alcohol does not affect your risk of diverticular disease.2,6,7 Smoking might increase the risk of diverticulitis, and current guidelines recommend that people stop smoking, even though no significant association has been found.6,7,12

Vitamin D

A risk factor for diverticular disease that might play a role in the development of diverticulitis is low levels of serum vitamin D (25-OH D).2 A similar connection exists with low vitamin D levels playing a role in other inflammatory conditions, such as Crohn’s disease.3 The PEN guidelines from Dietitians of Canada currently recommend ensuring adequate vitamin D levels in those who have diverticular disease.6


There is insufficient evidence for the use of probiotics in acute diverticulitis. The 2015 American Gastroenterology Association guidelines actually recommend against the use of probiotics for uncomplicated diverticulitis.3,6 A systematic review looking at eleven studies with various probiotics in the treatment of diverticular disease showed a positive trend in the reduction of abdominal symptoms; however, given the various strains and doses of probiotics used, the study authors could not make any recommendations.3

Physical activity

Physical activity is associated with a reduced risk of diverticulitis and diverticular bleeding, 2,5,7 and the NICE guidelines from the UK recommend exercise to reduce the risk of symptomatic diverticular disease.12 The American Gastroenterology Association recommends vigorous physical activity, such as running, for people who have experienced diverticulitis.3 It is important to note that these associations and guidelines are based on low quality evidence,7 but given the numerous health benefits of being physically active, if you’re not already active and can be, why not give it a try?


There is an increased risk of diverticular disease in obesity, especially abdominal obesity, including complications such as diverticular bleeding and diverticulitis.2,3,5,7,8 Obesity is considered to be an inflammatory state, so eating foods rich in fibre, some of which have anti-inflammatory effects, might help reduce obesity-induced chronic inflammation.9


It’s time to say goodbye to popular but unproven theories about diet and diverticular disease. If you have diverticulosis, there is no need to restrict yourself by avoiding nuts, seeds, and berries, which are nutrient dense and have anti-inflammatory effects that may actually help prevent diverticulitis from occurring in the first place. I am looking forward to new research that will delve deeper into the role diet plays in inflammation and altering the intestinal microbiome, and what this will mean for preventing and treating diverticular disease in the future. In the meantime, there are many healthy lifestyle strategies that may help reduce our risk of diverticular disease, and they are worth giving a try.

Ten lifestyle strategies that might help reduce the risk of diverticulitis

  1. Eat a high fibre diet (35-40 g/day).
  2. Eat more insoluble fibre (e.g., whole flaxseeds, nuts, berries, raw vegetables, skins of fruits and vegetables).
  3. Eat whole fruits regularly, especially apples, pears, and prunes.
  4. Add nuts and seeds to the foods that you love (e.g., walnuts on oatmeal, sesame seeds on top of asparagus, toasted pumpkin seeds on top of a spinach salad).
  5. Eat chicken and fish more often than red meat.
  6. Do you have constipation? Consider a fibre supplement (e.g., psyllium) and drink more water.
  7. Maintain adequate vitamin D levels and consider supplementation if blood levels are low.
  8. Be physically active (e.g., jogging, running).
  9. Lose weight if greater than normal/ideal.
  10. Stop smoking.

By Anne-Marie Stelluti, RD
Anne-Marie Stelluti is a registered dietitian and business owner of Modern Gut Health, a private practice with special focus in digestive health nutrition.
First published in the Inside Tract® newsletter issue 214 – 2020
1. Weizman AV et al. Diverticular disease: Epidemiology and management. Can J Gastroenterol. 2011; 25(7): 385 389.
2. Strate LL, et al. Epidemiology, Pathophysiology, and Treatment of Diverticulitis. Gastroenterology. 2019; 156(5): 1282-1298.
3. Rezapour M et al. Diverticular Disease: An Update on Pathogenesis and Management. Gut and Liver. 2018; 12(2): 125-132.
4. Painter NS, Burkitt DP. Diverticular Disease of the Colon: A Deficiency Disease of Western Civilization. British Medical Journal. 1971; 2: 450-454.
5. Tursi A, Elisei W. Diet in colonic diverticulosis: is it useful? Pol Arch Intern Med. 2020; 130:232-239.
6. PEN The Global Resource for Nutrition Practice. Gastrointestinal System – Diverticular Disease page. Available at https://www.pennutrition.com. Accessed 2020-04-20.
7. UpToDate. Diverticular Disease page. Available at https://www.uptodate.com. Accessed 2020-04-20.
8. Aune D et al. Dietary fibre intake and the risk of diverticular disease: a systematic review and meta-analysis of prospective studies. Eur J Nutr. 2020; 59(2): 421-432. 
9. Ma W et al. Intake of Dietary Fiber, Fruits, and Vegetables and Risk of Diverticulitis. Am J Gastroenterol. 2019; 114: 1531-1538.
10. Strate LL, et al. Nut, corn and popcorn consumption and the incidence of diverticular disease. JAMA. 2008; 300(8): 907-914.
11. Peery AF, Sandler RS. Diverticular disease: Reconsidering Conventional Wisdom. Clin Gastroenterol Hepatol. 2013; 11(12): 1532-7.
12. NICE. Diverticular Disease: diagnosis and management page. Available at https://www.nice.org.uk/guidance/ng147. Accessed 2020-04-24.
13. Cao Y et al. Meat intake and risk of diverticulosis among men. Gut. 2018; 67(3): 466-472.
Photo: © Nadezhda Nesterova | bigstockphoto.com

Health & Nutrition

Health & Nutrition

On this page you will find links to many articles about good health and proper nutrition. Many of our nutrition pages are written by registered dietitians. Click the links below to see the articles we have available.


Image Credit: © marctran | 123rf.com

IBD and Malnutrition

IBD and Malnutrition

Inflammatory bowel disease (IBD) is an umbrella term that refers to diseases that involve chronic inflammation of the digestive tract. Crohn’s disease and ulcerative colitis are the two major types of IBD. In Crohn’s disease, inflammation affects any part of the digestive system, often involving the lowest portion of the small intestine where the gut absorbs most of the nutrients from the food we eat. In ulcerative colitis, inflammation occurs in the large intestine. Diarrhea, intense abdominal pain, fever, nausea, and loss of appetite are some of the symptoms of IBD, but there are several treatments and management strategies available.

Since IBD affects the digestive system, which is where we process food and absorb nutrients, there are many factors that can lead to malnutrition. While it is difficult to pinpoint how common it is, research shows that somewhere between 20-85% of individuals with IBD experience malnutrition.1 Medication side effects, diminished ability to absorb nutrients (malabsorption), surgical resections, flares, and restrictive diets necessary for imaging and diagnostic tests are some of the ways malnutrition can develop in individuals with IBD. Also, those in hospital are at a higher risk for malnutrition due to lack of subsequent home care support, potential anorexia from illness, or procedure requirements preventing oral intake of food and drinks such as a nothing by mouth (NPO) order. In turn, this complication is a risk factor for repeated or longer hospital stays, increased risk of infections, mortality, and more. Malnutrition can also increase the risk of infection for those on immunosuppressive agents (e.g., azathioprine, methotrexate).

Researchers from the University of Calgary1 observed that there were significant gaps in knowledge and clinical practice guidelines on malnutrition in IBD. The study authors conducted a narrative review of the prevalence of malnutrition and its current care guidelines. They searched for English publications on IBD and nutrition interventions in Ovid Medline and PubMed. Based on their findings and analysis, they produced an expert opinion summary to inform clinicians on timely intervention and diagnosis of malnutrition in IBD that is not based on the requirement of weight loss or body mass index (BMI). This is because malnutrition occurs regardless of changes in body weight. It develops from a lack of adequate consumption or absorption of necessary nutrients that leads to changes in body composition, altered physical and mental function, and other impairments.

Concerningly, the study authors found that there is no gold standard definition of malnutrition in IBD for hospitalized individuals and community populations as well as validated tools for nutritional screening and assessment. There is also a lack of data on the use of parenteral nutrition in IBD populations and evidence gaps on the effectiveness of nutrition intervention on hospitalized IBD patients. Parenteral nutrition is intravenous delivery of nutrients, and it is an option when the gastrointestinal tract is not working. The nutrients given include protein, carbohydrate, fat, vitamins and minerals, electrolytes, and water. As a model of care, they highlight the University of Calgary’s High Risk Malnutrition Clinic as an example of a multidisciplinary facility that includes physician nutrition specialists and registered dietitians who have an expertise in nutrition for liver diseases.

The researchers recommend that there needs to be more awareness and recognition on the impact and prevalence of malnutrition among individuals living with IBD, especially for those in hospital. As a preventative step, healthcare professionals should screen all hospitalized patients with IBD for malnutrition. Those living with IBD should also receive appropriate nutrition interventions and the study authors proposed algorithms for consideration, which include screening, diagnosis, and treatment for IBD patients in hospital. They suggest that future research should focus on finding the best treatment options for malnutrition in IBD.

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Learn more about nutrition and IBD by watching our video, featuring Anne-Marie Stelluti, registered dietitian.

First published in the Inside Tract® newsletter issue 221 – 2022
1. Chiu E et al. Optimizing Inpatient Nutrition Care of Adult Patients with Inflammatory Bowel Disease in the 21st Century. Nutrients. 2021;13(5):1581.

Microbiome: From Research and Innovation to Market