Why IBD patients avoid some foods – and advice from their gastroenterologist

IBD

By Michael Woodhead

9 May 2019

Almost all patients with IBD avoid certain foods such as lactose-containing products in an attempt to avoid IBS-type symptoms, Australian research shows.

A survey of 117 outpatients with Crohn’s disease or ulcerative colitis found that 90% of them reported avoiding foods, with food avoidance more common during flare ups than in remission.

Lactose-containing products, spicy foods, deep fried and fatty foods were the most commonly avoided foods, reported by about 40% of patients in active disease and 30% of patients in remission, according to the survey carried out by researchers from the Royal Brisbane and Women’s Hospital.

Wheat products, legumes, nuts, seeds and green (brassica) vegetables  were also commonly avoided foods.

The rationale given by IBD patients for avoiding foods was a belief that they exacerbated symptoms such as bowel pain/cramps, diarrhoea and bloating. Patients rarely stated that they had received dietary advice from health professionals to avoid common foods, but many said they relied on information from the internet or social media to make their decisions.

Patients in remission said they had the highest confidence in advice on diet received from gastroenterologists (score 4.1/5) compared to GPs (4.0), dieticians (3.5) or the internet (3.3).

But patients with active disease had less confidence in advice from health professionals and more frequently sought advice from websites (53%) and online forums (17%).

Although none of the patients showed signs of malnutrition, the researchers said their findings aligned with previous research showing that many patients with IBD avoid nutritious foods such as vegetables and high fibre foods, particularly during flare ups.

They said it was notable that Australian patients did not avoid food  because of fears they would trigger a flare, but mostly because they exacerbated certain symptoms.

“In remission, these symptoms are consistent with symptoms of IBS, supporting previous research indicating that IBS symptoms are commonly … experienced in IBD patients in remission, as a response to the ingestions of certain foods,” they wrote in Clinical Nutrition.

And while the food avoided tended to be in the FODMAPs category, only one in ten patients had a confirmed diagnosis of IBS, “suggesting that diagnosing concurrent IBS in people with IBD is challenging, particularly where they may also be ongoing but subclinical IBD activity,” they added.

This suggested a need for tests such as fecal calprotectin in IBD patients to monitor disease control and to differentiate between active disease, co-existent IBS and symptoms related to other causes such as previous surgery or post-inflammatory damage, they suggested.

The study findings also showed the need to steer patients with IBD towards online and social media sources on diet that are evidence based, they added.

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