IBD diet: reasons and practical advice for everyday life

The diagnosis of inflammatory bowel disease (IBD), which includes Crohn's disease and ulcerative colitis, raises many questions for those affected. Lifestyle, and particularly diet, plays a central role in managing the condition and maintaining symptom-free periods. Many people are unsure about what they can eat, what foods to avoid and how to put together a diet that supports their wellbeing without giving up delicious food.

This article provides comprehensive guidance on the basic principles of the IBD diet. It explains in detail how diet affects inflammation and practical steps you can take to alleviate symptoms. Our aim is to provide you with reliable, evidence-based information to help you manage your condition more consciously and reduce uncertainty about your condition. Developing the right dietary strategy is key to living with inflammatory bowel disease.

The relationship between inflammatory bowel disease and nutrition

Inflammatory bowel disease (IBD) is a chronic, autoimmune condition involving chronic inflammation of the intestinal tract of unknown origin. The two main types are Crohn's disease, which can affect any part of the digestive tract, and ulcerative colitis, which affects the colon and rectum. Although the exact cause of the disease is not known, genetic predisposition, environmental factors and abnormal immune function all play a role.

The relationship between diet and IBD is extremely complex. While diet alone is not the cause of the disease, certain foods and eating habits can worsen symptoms, trigger inflammation or, on the contrary, contribute to maintaining a symptom-free state (remission). Inflammation of the intestinal tract can also impair the absorption of nutrients, which can lead to deficiencies, so conscious dietary management is of paramount importance.

The aim of dietary therapy is twofold: to alleviate symptoms (diarrhoea, abdominal pain, bloating) during flare-ups and to ensure adequate nutrient intake to prevent deficiencies and support the overall health of the body. As each patient is unique, there is no one IBD diet that works for everyone. Close collaboration with the treating physician and dietitian is essential to develop a personalised diet.

Nutritional strategies to relieve symptoms

The diet for IBD treatment varies depending on the severity of symptoms. Different dietary principles should be followed during the active, inflammatory phase of the disease and during the asymptomatic, resting phase.

Diet during the active (flare-up) phase of the disease

During flare-ups, the intestinal tract is extremely sensitive, so the primary aim of the diet is to relieve the intestinal tract and reduce symptoms such as abdominal pain and diarrhoea. An easily digestible diet low in fibre and fat is recommended during this period.

Suggested foods:

• Cooked, steamed vegetables: For example carrots, potatoes, courgettes (without peel), pumpkin. Cooking softens the fibres, making them easier to digest.
• Low-fibre fruits: Banana, peeled peaches, melon. Avoid high fibre, small seeded fruits (e.g. raspberries, strawberries).
• Lean protein sources: Boiled or stewed chicken breast, turkey breast, fish. Red meat is harder to digest because of its higher fat content.
• Refined cereals: White rice, white bread, pasta. Although whole grains are generally healthier, in the active phase, the lower fibre varieties are gentler.
• Fluid replacement: Special attention should be paid to replenishing fluid and electrolyte losses due to diarrhoea. The consumption of mineral water without carbonic acid and weak herbal teas (e.g. chamomile) is recommended.

Foods to avoid:

• High fibre foods: Raw vegetables, salads, whole grains, pulses (beans, lentils), oilseeds.
• Fatty, spicy, hot foods: These can irritate the intestinal lining and increase symptoms.
• Dairy products: Many IBD patients develop secondary lactose intolerance, which can cause bloating and diarrhoea. In such cases, lactose-free or plant-based alternatives are recommended.
• Sugary drinks, alcohol, coffee: These can also be irritating.

Diet in the resting (remission) phase

During the symptom-free period, the aim is to maintain a nutrient-rich, balanced diet to help maintain remission and prevent nutrient deficiencies. During this phase, the diet can be gradually expanded, taking into account the individual responses of the body.

• Fibres recirculation: Slowly and carefully introduce back higher fibre foods. Start with soluble fibres (e.g. oatmeal, apples) as these are generally better tolerated than insoluble fibres (e.g. wheat bran).
• Diverse protein sources: In addition to lean meats, eggs and well-tolerated dairy products can be included.
• Healthy fats: Foods rich in omega-3 fatty acids, such as marine fish (salmon, mackerel), can have anti-inflammatory effects.
• Probiotics: Fermented foods, such as yoghurt or kefir (if lactose is not a problem), can support gut flora health.

It's important to keep a food diary to record the food you eat and any symptoms you experience. This will help you identify foods that cause you personal complaints.

Common nutrient deficiencies in IBD and how to make up for them

Specific nutrient deficiencies often develop in patients with IBD due to intestinal inflammation and reduced absorption. Recognising and treating these is essential for long-term health.

Iron deficiency and anaemia

One of the most common problems is iron deficiency anaemia, which is caused by intestinal blood loss and insufficient absorption of iron. Symptoms include fatigue, weakness and pallor. Replacement of iron can be done by oral medication or, in more severe cases, by infusion therapy. The consumption of iron-rich foods (e.g. lean red meat, liver) is also recommended if tolerated by the patient.

Vitamin B12 deficiency

Vitamin B12 is absorbed in the ileum, the last part of the small intestine. Because Crohn's disease often affects this section of the intestine or may require surgical removal, vitamin B12 deficiency is common. This can lead to anaemia and nervous system symptoms. Replacement usually takes the form of an injection.

Vitamin D and calcium deficiency

Vitamin D deficiency is common among IBD patients, partly as a side effect of fat malabsorption and partly as a side effect of corticosteroid treatment. Vitamin D is essential for the absorption of calcium, so a deficiency can lead to osteoporosis. Adequate intake of vitamin D and calcium is critical to maintain bone health. If necessary, dietary supplements are recommended, preceded by a medical examination.

Zinc and magnesium deficiency

Chronic diarrhoea can lead to significant loss of zinc and magnesium. Zinc deficiency can affect immune function and slow wound healing, while magnesium deficiency can cause muscle cramps and fatigue.

Regular laboratory tests are needed to prevent and treat nutrient deficiencies. Do not start taking high doses of supplements on your own; always consult your doctor or a specialist in a gastroenterology centre.

Expert help for a personalised diet

Although there is a wealth of dietary advice available online, IBD is a complex disease that requires a personalised approach. Self-diagnosis and following one-sided, extreme diets can be dangerous, exacerbate nutrient deficiencies and worsen overall health.

The safest and most effective way is to follow a diet designed in close collaboration with a gastroenterologist and a dietician. An experienced specialist can help:

• Identify individual intolerances: It helps to identify which foods cause complaints.
• Plan a balanced diet: It ensures that you get all the nutrients you need, despite the restrictions.
• To address nutrient deficiencies: Suggests appropriate dietary supplements.
• To provide support: It helps you navigate the diet maze and keep motivated.

From Endomedix Gastroenterology Centre team of experts is committed to providing the highest level of personalised care for patients with inflammatory bowel disease. Our gastroenterologists and dietitians will work together to help you develop a lifestyle and diet that contributes to long-term symptom relief and improved quality of life. Do not hesitate to seek expert help if you feel you cannot cope on your own.

Find the right path for you

Living with inflammatory bowel disease can be challenging, but mindful eating is one of the most effective tools you can have in your hands to control symptoms and improve quality of life. It's important to understand that there is no one-size-fits-all IBD diet; the goal is to find a personalised diet that is tailored to your individual needs and tolerance.

Listen to your body, keep a food diary and be patient with yourself. Gradual changes to your diet, careful introduction of new foods and close medical supervision are all key to success. Remember, you don't have to go it alone. Seek the help of a gastroenterologist and dietitian who can offer their expertise to help you develop a balanced and enjoyable diet. Visit Endomedix Gastroenterology Centre professionals are ready to help you manage your illness and achieve better well-being.