Inflammatory Bowel Diseases - Diet. Dietary recommendations at NChZJ

IBD requires a proper diet, which is an important part of treatment. What can people suffering from inflammatory bowel diseases eat, and what products are prohibited? There are some general rules governing the diet for inflammatory bowel disease, but specific recommendations vary depending, among other things, on whether the disease is in remission or exacerbation. Check what are the nutritional recommendations at NCHZJ.

Diet for inflammatory bowel diseases , as a clear dietary recommendation, does not exist. Why? Because despite many studies and significant progress in understanding the formation and course of inflammatory bowel diseases, it has not been possible to establish uniform guidelines for all patients with the same degree. In the case of inflammatory bowel diseases, the diet should be determined individually by a specialist.

IBD diet: main goals

• restoring or maintaining the proper nutritional status of the sick person
• alleviating the activity of inflammation and symptoms
• regulating the functioning of the body's immune system
• reduction of conditions predisposing to surgical procedures
• prevention of postoperative complications

In the case of children, there is one more goal: achieving and maintaining a he althy body weight and ensuring proper physical development.

Diet for inflammatory bowel disease: starting point

When planning an appropriate diet for people with NCHD, you should take into account:

• nutritional status of a sick person and the role of nutritional therapy in preventing nutritional deficiencies
• influence of nutrients on the development or alleviation of intestinal inflammation
• influence of nutrients on regulating the immune system
• drug treatment applied
• disease stage (exacerbation or remission state)

Diet for patients with NCD - general recommendations

The diet should be wholesome, individually selected for each person, in terms of energy and nutritional value, taking into account the nutritional status and possible nutritional deficiencies.

• Nutritional recommendations should follow the phasediseases.

In severe exacerbations, parenteral nutrition should be used.

In the period of milder exacerbations, eat 5-6 meals a day, small in volume, provide more wholesome protein derived from good-quality fish and meat. The recommended amount of protein in the diet is about 150% higher than the standard amount in the diet of he althy people.

Foods should be crushed, cooked or baked in aluminum foil or parchment paper (meatballs, pastes, finely chopped pieces, soups, creams, vegetable and fruit purees, vegetable purée, jelly, etc.).

You should limit the consumption of foods rich in dietary fiber and irritating the gastrointestinal tract (raw vegetables, fruit with the skin, thick groats, nuts, whole grain products).

Sweet milk and milk-based drinks are also being restricted. Milk should be replaced with fermented milk drinks.

• Nutritional assumptions should take into account the nutritional status of the patient.

If you find nutritional deficiencies, you should introduce products rich in specific ingredients, and if the malnutrition is significant or the course of the disease makes it impossible to fill the deficiencies in the traditional way, supplementation should be introduced. The most common deficiencies are protein malnutrition, fat-soluble vitamins (A, D, E, K), vitamins C, B12, folic acid, iron (anemia), calcium (osteopenia, osteoporosis), other ingredients (magnesium, zinc, selenium) .

• If there is a suspicion of allergy, appropriate tests should be performed and an elimination diet should be applied.

• Fresh, seasonal, natural, good-quality, little processed products should be used.
• Products containing refined sugars should be excluded from the diet - their consumption may exacerbate the symptoms of the disease.
• The source of carbohydrates in the diet should be small groats (semolina, millet, kus-kus, small barley groats, etc.), light bread, graham bread, small pasta, rice, vegetables that are a good source of starch: potatoes, sweet potatoes, carrots.

• Products containing long-chain fatty acids(coconut oil, palm oil, cocoa butter, peanut butter, butter, lard) should be restricted. The fats consumed during the diet should be good quality vegetable oils.
• Food irritating to the gastrointestinal tract should be reduced

- hard meals, in large pieces, fried
- vegetables containing hard food fiber (brassica,legumes, unripe, hard)
- flatulent products (cruciferous vegetables, onions, leek, garlic)
- fruit containing small seeds (raspberries, strawberries, blueberries)
Dietary fiber in the diet it should come from vegetables, ripe, soft fruits, wheat or graham bread. Berries (containing small seeds) should not be completely excluded from the diet, but served in the form of purees, juices, jelly purees. These fruits are an excellent source of vitamins and antioxidants, which is of great importance in supporting the nutritional support of the sick.

• Food should be

- cooked (traditionally, steamed)
- baked (in aluminum foil or parchment)
- frying and traditional baking is not recommended.

• The diet should exclude meat and raw fish dishes (steak tartare, sushi, fish tartare).
• Avoid hot spices.
• You should take care of the proper amount of fluids, especially in people suffering from chronic diarrhea. The best to drink are: good quality water, including mineral waters, isotonic drinks, fruit teas, it is advisable to drink herbs.
• The diet should exclude highly processed fast-food, ready-made powdered meals, sweets, carbonated drinks.

• It is worth considering the use of appropriate dietary supplements, including probiotics, vitamins, minerals and preparations that increase the body's resistance.

Malnutrition in NCHZJ

One of the most serious problems faced by people with both IBD is malnutrition.

Due to concerns about the possible exacerbation of symptoms (abdominal pain, diarrhea, etc.), the occurrence of chronic constipation, intestinal ulcers, fistulas, many patients limit their food intake, which in the long term leads to serious energy and nutrient deficiencies nutrients such as protein, fats, vitamins and minerals.

Surgical procedures, e.g. resection of the terminal ileum, can also lead to a reduction in the absorption of fat-soluble vitamins and fat-soluble vitamins,

Patients often suffer from vitamin deficiencies (A, B, D, E, K, C), minerals (including calcium, selenium, magnesium, zinc), and a reduction in enzyme activity.

• vitamin A, the source of which are offal (liver), fish fat (fish oil) and vegetables rich in beta - carotene: e.g. carrots, parsley, beet leaves, pumpkin and others
• vitamin D - its deficiency will be supplemented by fish oil, sea fish and fish preserves, and above all exposure to sunlight
• vitamin E - found in sunflower seeds, pumpkin seeds (in ground form), vegetable oils
• vitamin K - its source is green vegetables and sprouts, vegetable oils, sea algae (e.g. spirulina, chlorella)

In the areas of inflammation and scarring, protein absorption also deteriorates. To supplement the deficiency of this ingredient, it is worth reaching for lean meat and poultry, fish, seafood, eggs, fermented milk products, and cereal products. It is the best source of protein for people with NCD.

Some nutritional deficiencies may be caused (or made worse) by drugs used in the treatment of NCD - corticosteroids limit calcium absorption, sulfasalazine - folate, and cholestyramine reduces vitamin absorption. In turn, prednisone can lead to a deficiency of calcium, potassium and zinc. Certain medications can also cause indigestion, taste disturbances, nausea and vomiting.

Iron deficiency, folate deficiencies, impaired production and absorption of vitamin B12, chronic inflammation, bowel resection and tissue blood loss very often lead to anemia (anemia). It is worth emphasizing that malnutrition and anemia are a common problem among children with inflammatory bowel diseases.

Mineral element	The best food sources for people with NCHZJ
Folic acid	green leafy vegetables, yeast, parsley, eggs, chicken liver
Iron	offal, meat, eggs, parsley, pumpkin seeds
Calcium	fermented milk products, whey, plant-based milks (e.g. almonds), parsley, ground sesame seeds, sardines, calcium-enriched products, mineral water
Zinc	meat, eggs, bread, rice, fruit
Selen	offal (kidney), seafood, meat, nuts (especially Brazilian)

All factors related to malnutrition have a huge impact, among others on cellular immunity of the organism, development, growth and sexual maturation in children, wound healing, nitrogen balance and the condition of the skeletal system. They can also lead to increased postoperative morbidity and slower treatment.

Important

If malnutrition is found in patients, the priority of nutritional therapy is to supplement nutritional deficiencies and, in the long term, to prevent their recurrence. However, it should be remembered that in chronic diseases it is not easy to identify deficiencies. It is usually difficult to distinguish between changes due to the diseasefrom symptoms related to malnutrition.

In nutritional therapy in inflammatory bowel diseases, patients should be encouraged to follow an almost normal, high-nutritional diet, taking into account the necessary restrictions resulting from individual intolerances and ailments.

NChZJ - nutrition in states of exacerbation or remission

The diet proposed in the case of exacerbations of the disease should be modified in such a way as to relieve the intestines and protect them from unfavorable factors. The nutritional intervention in this case depends on the severity of the symptoms.

In acute, severe and recurrent symptoms, preoperative preparation in malnourished patients, fistulas, and other inflammatory bowel diseases, parenteral nutrition is often recommended to enable remission (inhibition and relief of disease symptoms). People whose he alth condition has improved or symptoms are only slightly exacerbated should follow an easily digestible, high-energy and highly nutritious diet with limited consumption of products that irritate the gastrointestinal tract.

In the period of he alth improvement (remission), the diet of patients should be based on the general principles of a wholesome and easily digestible diet and take into account individual caloric needs. It should also contain nutrients that reduce inflammation in the digestive tract, improve the functioning of the immune system, and prebiotics. A number of unfavorable foods should be excluded and the use of appropriate supplementation should be considered.

Diet at NCHZJ - products not recommended and allowed

NCHZJ are classified as chronic, non-infectious inflammatory diseases, the formation of which is often related to the consumption of specific food ingredients. Inflammation is the body's (immune system) response to things that are harmful to a person. Among the nutritional factors, gluten, cow's milk proteins and processed products have the strongest effect. Therefore, they should be excluded. The method of preparing the dishes is also important. It is forbidden to fry, traditional baking, browning before stewing or grilling. Traditional cooking, steaming, under pressure, baking in foil and parchment, cooking in a small amount of water without first frying is allowed.

Product group	not recommended	acceptable
vegetables	peas, beans, broad beans, soybeans, other legumes cabbage, cauliflower, brussels sprouts, red cabbage, sauerkraut onion, leek, garlic, chives peppers, cucumbers,radish	carrots, beets, parsley (root and parsley), celery, pumpkin, tomatoes (peeled), spinach, lettuce, chicory, zucchini, eggplant, other (according to individual tolerance)
fruit	pears, plums, cherries, gooseberries, watermelon unripe fruit, whole fruit containing small seeds (e.g. raspberries, strawberries, blueberries) dried fruit, canned fruit	peeled, boiled, puree, seedless bananas, peaches, apples, apricots, oranges strawberries, raspberries, currants, blackberries, blueberries, wild strawberries (puree)
dairy products	sweet milk fruit milk drinks, sweetened, with the addition of glucose-fructose syrup fatty cheeses, blue cheeses, processed cheeses, feta cheese, mozzarella cream and high-fat cream condensed milk, powdered milk	fermented milk drinks yogurt, kefir, whey lean curd cheese, - according to individual tolerance
Grain products	wholemeal, coarse, rye bread thick groats: buckwheat, wheat and barley groats wholemeal pasta	small groats (semolina, millet, kus-kus) rice oatmeal, corn flakes rice noodles light bread, graham bread (limited amount) small pasta
Meat and meat products, fish	pork mutton fat poultry (duck, goose) pates, sausage, brawn, cured meats, black pudding, sausages, salami canned meat oily fish, including smoked fish (mackerel, salmon, halibut, eel, other fatty fish) spicy canned fish	lean meat: beef, veal, rabbit meat lean poultry: turkey meat, chicken lean meats lean fish: cod, trout, pike perch, pike, sole
Drinks	alcohol coffee strong tea sweetened, colored, carbonated drinks with sweeteners (sorbitol, mannitol, xylitol)	vegetable juices mineral and spring water weak tea fruit and herbal infusions
Sweets	significant amounts of sugar honey chocolate cookies and highly processed bars, whole grain bars containing cocoa, nuts, halva	small amounts of sugar low-sugar drinks pitted low-sugar jams
Other	mayonnaise spicy ketchup mustard vinegar pickled vegetables (in vinegar) spicy spices: hot pepper, pepper, cayenne pepper, chilli	s alt lemon juice dill, marjoram, thyme, lovage, rosemary, turmeric, ginger (a small amount) cinnamon, vanilla

Diet at NCHZJ - additional recommendations

IBD is characterized by an abnormal response of the person's immune system to food in the gut. In this situation, the immune cells become overactive - they concentrate in the intestinal mucosa, causing tissue damage, inflammation and, consequently, further intestinal damage.

An inappropriate immune system response can affect the gut or cells throughout the digestive system. Moreover, the chronic inflammatory process in the gut causes increased oxidative stress and the formation of free radicals. The cells of the immune system are particularly sensitive to the action of reactive oxygen species. The antioxidant effect in food is exerted by antioxidants found in some vegetables and fruits. In addition, many plant compounds also have a strong ability to inhibit the inflammatory response.

Among the compounds with anti-inflammatory and / or antioxidant properties there are :

• curcumin (it is a yellow dye used in spice mixes)
• polyphenols (e.g. green tea)
• anthocyanins (cherries, cranberries, raspberries, strawberries, blueberries)
• carotenoids (carrots, pumpkin, apricots, parsley)
• lycopene (tomatoes, other red fruits and vegetables)
• vitamin C (rosehips, sea buckthorn, black currant, parsley, pepper, berries)
• vitamin E (pumpkin seeds, sunflower seeds, sprouts, vegetable oils)

Special properties in supporting the treatment of IBD are attributed to omega 3 fatty acids (α-linolenic acid -ALA, arachidonic acid - AA, EPA and DHA) and omega 6 (linoleic acid (LA) and γ-linolenic acid (GLA), belonging to the large group of Polyunsaturated Fatty Acids (PUFA).

These acids have proven, strong anti-inflammatory properties and regulate the functioning of the systemthe immune organism. They exhibit the effect of accelerating the remission of the disease in the acute phase of the disease. In addition, EPA fatty acids improve appetite, which is of great importance when there is a risk of malnutrition in patients. It is worth emphasizing that too much omega 6 fatty acids in relation to omega 3 may accelerate, not slow down, the formation of the inflammatory process.
Products rich in omega-3 and omega 6 fatty acids recommended in the diet of people with NCHZJ is primarily:

• sea fish (salmon, mackerel, herring, sardines)
• oilseeds (linseed, hemp seeds, pumpkin seeds, rape seeds, black seeds - to be eaten ground).

Sources of PUFAs in the diet are also vegetable oils - safflower, low-erucic rapeseed oil, linseed, sunflower, soybean, corn, grape seed oil. Another, rich source of these acids are sea algae ( Crypthecodinium CohnieiandSchizochytrium sp ), which are used to enrich breakfast cereals, food preserves with omega 3 acids. dairy products and products for special nutritional uses.

Other food ingredients necessary to improve he alth are:

• Short-chain fatty acids (SCFA - acetic, propionic and butyric acids)

They are produced by microorganisms that live naturally in the large intestine. These compounds are the basic source of energy for intestinal endothelial cells and are an important element in the broadly understood, proper functioning of the human intestinal microflora.

Most contemporary studies emphasize the great importance of the appropriate composition of microbes in the intestinal ecosystem for human he alth, including the functioning of the intestines and the proper functioning of the immune system in humans. Proper bacterial flora is of great importance in maintaining a he althy structure and function of the intestines and in protecting the body against the excessive growth of pathogenic microorganisms.
Butyric acid, in addition to being an energy material for the cells of the intestinal membranes, reduces the severity of diarrhea, restores the regeneration of the intestinal epithelium, supports the functions of the intestines and their normal motor function. Research also confirms the anti-inflammatory effect of SCFA. Butyric acid is present in small amounts in dairy products and fermented plant products, but these amounts are not important in helping to improve he alth in sick people.

• Probiotics and prebiotics

Naturally occurring microorganisms in the digestive tract (probiotic intestinal bacteria) take part in thefermentation, processing and obtaining energy from food, production of vitamin K, B12, affect the functioning of the immune system.

People with NCD often have intolerance to their intestinal flora. The risk of infection resulting from irregularities in the proportions of the intestinal flora is often associated with, for example, the use of immunosuppressants, glucocorticosteroids and others.

Regulating the microflora of the gastrointestinal tract can be of great importance in supporting treatment, and one of the methods here is to provide products that are a good medium for probiotic bacteria.

Prebiotics are substances that are not digested in the small intestine and provide nutrients for the normal bacterial flora in the large intestine. Thus, they have a positive effect on the balance between the desired and pathogenic microorganisms. During the fermentation of the prebiotics, the abovementioned short chain fatty acids are produced. In addition, they help maintain the proper pH in the intestines, accelerate the regeneration processes of the intestinal epithelium and mucus production, and improve and increase the absorption of calcium and other nutrients.

Among the prebiotics there are compounds classified as the soluble fiber fractions, incl. inulin and fructo-oligosaccharides. Their best, natural nutritional source are, among others asparagus, chicory, artichokes, wheat, bananas, potatoes and honey.
Since the gut microflora is so important in the course of IBD, it is often recommended to take supplements containing probiotic bacteria during illness.
Vitamin A- in the context of NCHN, it takes part in the proper functioning of the immune system through its participation in the maturation of immune cells. In addition, β-carotene (vitamin A provitamin) has a strong protective effect on the immune system. Products rich in vitamin A are mainly animal products: offal - especially liver, cheese, some species of fish. The best sources of carotene are red, orange, yellow and green vegetables: e.g. carrots, parsley, kale, beet leaves, pumpkin and others.

Vitamin E- the mechanism of its action on immune cells is to protect against oxidation of fatty acids included in biological membranes. It also has the ability to support cells and reduce the effects of free radicals. Good sources of vitamin E are sunflower seeds, pumpkin seeds, vegetable oils, almonds, hazelnuts.

Vitamin D- has a regulating effect on the immune system, a protective effect, it is also important inalleviating ailments and significantly improving the he alth of sick people. Most of the vitamin D in the body is produced by the skin's changes when exposed to sunlight (UV-B). Nutritional sources are sea fish (salmon, mackerel, herring), fish oil and fortified foods. It is worth remembering that the presence of fat is essential for the effective absorption of vitamin D3 in the intestines.

Selenium- is an important component of many enzymes, including those that protect cell membranes against oxidation, it also promotes increased activity of immune system cells. A rich source of selenium are products with a high protein content, e.g. in offal (especially kidneys), seafood, meat, dairy products and nuts.

Zinc- affects all basic life processes, including the correct amount of zinc in the diet restores the proper immune response of the body. The most important source of zinc in the diet is meat and meat products, cheese, eggs, bread, rice, fruit.

Iron- is a component of enzymes involved in the oxidation process, it also affects the proper functioning of the immune system cells. Iron deficiency promotes anemia in sick people and increases the risk of infection. Good dietary sources of iron include offal, meat, eggs, parsley, pumpkin seeds, bread, and fortified foods. Iron-rich foods should be eaten together with vitamin C containing significant amounts (parsley, pepper, black currant, other vegetables and fruits), which improves iron absorption.

Glutamine (GLN)- is an endogenous amino acid (produced by the body). One of the functions of this compound is to increase immunity by producing antioxidants and glutathione, a substance that determines the rate of cell formation of the immune system. Glutamine also influences the tightness of the intestinal barrier lowered by the inflammatory process in the intestines and affects the absorption of nutrients and bacterial balance.

In the case of glutamine deficiency in the body, it is recommended to supply it externally. Supplementation may improve the condition of the intestines and their functioning.

NZChJ and nutrition in accordance with the FODMAP protocol

The FODMAP elimination diet refers to a temporary feeding regimen that contains a small amount of the compounds specified FODMAPs. These compounds are easily fermentable carbohydrates, incl. fructose, lactose, fructans, which are quite poorly absorbed and ferment easily in the lower part of the large intestine. During fermentation, carbon dioxide, hydrogen or methane gas is produced, which causes the intestine to stretch and widen.This, in turn, contributes to the aggravation of symptoms in inflammatory bowel diseases.

The diet requires the division of products into those containing significant amounts of easily fermentable carbohydrates and those with a low content. FODMAPs are mainly found in dairy products, legumes, some fruits and vegetables. When following a diet, foods rich in FOODMAP are significantly reduced, but those with a low content are introduced.

Products Not Recommended in the FODMAP Diet

• legumes: beans, chickpeas, soybeans, lentils
• dairy products: milk, cream, condensed milk, powdered milk, cottage cheese, cheese - mascarpone, ricotta
• vegetables: broccoli, cauliflower, Brussels sprouts, cabbage, asparagus, artichokes, patisons, green peas, onion, garlic, leek, beetroot, mushrooms, fennel
• fruit: apples, pears, watermelon, mangoes, nectarines, peaches, apricots, plums, dried fruit, tinned fruit
• wheat and rye grain products
• other: glucose-fructose syrup, sweeteners (sorbitol, mannitol, m altitol, xylitol) agave syrup, honey

Products recommended in the FODMAP diet include :

• vegetables: cucumbers, tomatoes, zucchini, eggplant, carrots, corn, lettuce
• plant-based milk: almond, coconut, rice, lactose-free milk
• fish
• meat
• gluten-free bread and pasta
• flakes: oat and corn
• potato flour
• quinoa
• crystal sugar
• stevia and others

Research confirms that the use of a diet containing small amounts of FODMAP is effective in supporting treatment in people with IBD and comorbid functional bowel disorders. Compliance with the recommendations will alleviate or subside.
More about the FODMAP diet
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