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By Colleen D. Webb, MS, RDN, CLT

As IBD rates climb worldwide, more patients with Crohn’s disease and ulcerative colitis are seeking nutritional advice from registered dietitians nutritionists (RDNs).

Proper nutrition is an important part of IBD management. RDNs play a key role in teaching patients how to eat well for this complicated disease.

I’ve counseled thousands of people with Crohn’s disease and ulcerative colitis, and I’m eager to share what I’ve learned! That’s why I’m launching an online course later this year to help RDNs learn more about counseling IBD patients. Sign up to be the first to know when the course is live!

In the meantime, here are 8 tips to help RDNs counsel IBD patients with confidence:

  1. Recognize there is no one diet for everyone with IBD. As much as we might wish it existed, there is no one-size-fits-all diet for IBD just as there is no one medication for everyone with IBD. Some people have treated or healed themselves using popular diets, such as the Autoimmune Protocol or the Specific Carbohydrate Diet, whereas others have used Mediator Release Testing, the low FODMAP or a plant-based diet. The best dietary approach is one that you personalize to meet the needs of your patients.

  2. Educate your patients on nutrition’s role in managing IBD. Get ready to cringe… Here are two of the most common pieces of advice patients receive about what to eat with IBD: 1) Food doesn’t impact IBD. 2) Don’t eat fruits or vegetables.

As RDNs it is our responsibility to teach our patients about the importance of proper nutrition for IBD.

In the Wellness By Food eBook, Eating with IBD: The Essentials, we summarize some key ways food impacts IBD:

  • A healthy gut requires proper nutrition.
  • Gut microbes directly affect the immune system and inflammation, and what we eat directly affects our gut microbes.
  • People with IBD are more likely to develop nutrient deficiencies, which we can prevent or correct through proper nutrition.
  • Some foods worsen chronic inflammation whereas others help fight it, and IBD is a chronic inflammatory condition.
  • Certain foods trigger unwanted IBD symptoms, such as gas, bloating, diarrhea and abdominal pain.
  • When one eats well for their IBD, they’re eating well for their whole body.
  • Research plus clinical and personal experience have shown us that people with IBD who eat and live well have fewer and shorter flares.

  1. Ask your patients about their eating behavior. How your patients eat their food is as important as what they eat. Ask them about their eating environment, posture during meals, eating speed, and chewing habits. If your patient is a fast and mindless eater, then they’re more likely to feel sick after meals. Not only can this eating behavior lead to GI discomfort, but it can cause bowel obstructions in at-risk individuals.

  2. Focus on what TO eat. Food intolerances, nutrient deficiencies, fear of food and disordered eating behaviors are common among patients with Crohn’s and ulcerative colitis. Unnecessary and/or long-term dietary restrictions can be dangerous. Many “IBD” diets focus on what foods our patients “can’t” eat. Elimination diets can help to identify food triggers and promote gut healing, but we must focus on what foods to eat. Work with your patients to develop a “Safe Foods” list.

  3. Acknowledge that your patient is the boss. I always tell my patients they know their bodies better than anyone. Even though we’re the nutrition experts, we have to listen to what our patients tell us. Their observations might not align with what we know about nutrition science or research, but it doesn’t matter. We’re unique individuals. I let my patients know that I will share with them the rationale for why something should or shouldn’t work, but how they use that information is up to them. Whatever they decide, I’m here to help. Keep an open mind and be flexible.

  4. All the supplements in the world won’t take the place of a healthy diet. If only there was a magic pill for IBD remission! Alas, we know there isn’t. Your patients will read and hear lots of misleading and untrue claims about supplements and IBD. As RDNs, we have to guide them to the right ones, steer them away from the wrong ones, and let them know that supplements are only useful when combined with a healthy diet and lifestyle. The definition of “supplement” is “something that completes or enhances something else when added to it.” Your patients need to know that diet and lifestyle are the basis for good health.

  5. Show and tell. Most people with IBD tolerate home-cooked meals better than restaurant dishes. But, cooking for IBD can require time and creativity in the kitchen. Besides telling our patients what to do, we must show them how to do it. Here are some things I do to help my patients follow through with our plan:
  • Connect them with a personal chef who can cook for them and/or teach them to cook
  • Provide hand-picked recipes based on their “Safe Foods” list
  • Host a cooking class and/or cooking demonstration

  1. Make sure your patient knows you are not blaming them. None of us would intentionally blame an IBD patient for their disease. However, our advice can come off that way. We never want to make our patients feel guilty about their food or lifestyle choices. Be sure to let your patients know that they did not cause their IBD.

What are some of your favorite tips for working with IBD patients? We’d love to hear from you!

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