When a person is diagnosed with a Crohn’s disease or one ulcerative colitis, The first thing you usually ask your doctor is what diet you should follow and what foods you should eliminate. In fact, dietary restrictions Are frequent among those who suffer from this pathology: some patients decide to do without milk and dairy, others spicy, fiber… The question is whether these guidelines have a solid foundation and, above all, whether they serve to prevent outbreaks or episodes of diarrhea. Two doctors specializing in the digestive system explain it to us.
Crohn’s disease is, along with ulcerative colitis, an inflammatory bowel disease (IBD). “They are chronic disorders whose cause is partially known and in which there is excessive activation of the immune system that produces intestinal lesions of different considerations ”, explains Antonio M. Moreno García, specialist of the Spanish Digestive System Foundation (FEAD) and the Digestive System Service of the Puerta del Mar University Hospital in Cádiz. “The most accepted current theory is that it is developed in genetically predisposed people, in which environmental factors interact with the microbiota and the immune system, whose activation causes intestinal lesions ”.
The incidence of IBD is 16 new cases per 100,000 inhabitants per year, and the prevalence is estimated at 0.5% of the population. This is how Javier Gisbert, group leader of the Center for Biomedical Research Network for Liver and Digestive Diseases (Ciberehd) and head of the Inflammatory Bowel Disease Unit of the Hospital Universitario de La Princesa (Madrid), who outlines the main differences between Crohn’s disease and ulcerative colitis: colon), while Crohn’s disease can affect the large intestine only, but also any part of the digestive tract, mainly the small intestine ”.
Another notable divergence is that ulcerative colitis is superficial, while Crohn’s disease has a deeper involvement of the digestive system. Regarding the symptoms, the most characteristic of Crohn’s disease is diarrhea and abdominal pain; and ulcerative colitis, diarrhea, and the appearance of blood in the stools (rectal bleeding).
Both ailments have a very significant effect on the quality of life of those who suffer them, who are usually young people, and in the prime of their life. “Logically, it is tremendous what can alter the life of a young person who is active having, for example, 10 bowel movements a day”, emphasizes Gisbert.
Do dietary restrictions make sense?
The main concern of those affected by Crohn’s disease and ulcerative colitis is to control the activity of their disease, which translates into avoiding outbreaks of diarrhea and abdominal pain. To do this, they often restrict the intake of various foods in the belief that, in this way, they will remain free of these episodes, that is, in remission. What happens is that Those self-imposed dietary prohibitions are unfounded.
The Ciberehd specialist is blunt: “These patients should and can eat whatever they want and there is no study that shows that there is a direct relationship between a certain diet and IBD ”. This expert regrets that false beliefs about harmful foods are promoted, on many occasions, by health professionals and web pages with uncontested content. Moreno García confirms that there are “no good or bad foods. That is to say, no foods are going to cause an outbreak”.
What’s more, an excessively restrictive diet can deteriorate nutritional status. In this sense, a study directed by Gisbert and recently published in the journal Journal of Crohn’s and Colitis revealed a high prevalence of malnutrition in these patients, largely motivated by dietary restrictions. Specifically, the products that those affected most avoided both to avoid outbreaks and during them were, among others, spicy foods, alcohol, fats, carbonated beverages, convenience foods, fiber, legumes, dairy, and sugar.
In Gisbert’s words, when asked what can I eat ?, the answer is: “Whatever you want, what feels good to you. And what we usually say to patients is that they should only restrict from the diet those foods that repeatedly or systematically cause them discomfort”.
Therefore, depriving yourself of having an aperitif from time to time with friends does not help prevent outbreaks, but it does suppose a new frustration that affects the already reduced quality of life of these people. What can prevent the disease from becoming active and new episodes of diarrhea and abdominal pain arise is to scrupulously follow treatment prescribed by the doctor.
Nutritional recommendations from the experts
Moreno García offers the following general dietary indications for patients with IBD, which are practically a copy of the recommendations for the general population:
The diet should be complete, varied, and balanced.
When you enter new food It should be done one at a time, using it with others that you already know will suit you. This way you can see which ones it tolerates and which ones it does not.
There are no good or bad foods. You have to avoid food that causes us inconvenience.
Eat slowly, chewing well the food.
They should not be removed milk and its derivatives from the diet if you do not have an intolerance. These foods are an important source of calcium Y vitamin D.
You can have vegetable fiber in normal amounts. Only when you are suffering an outbreak of diarrhea should you restrict the amount of fiber, whole grain products, wheat bran, etc.
The hydration must be adequate. If we are facing an outbreak of diarrhea, we will adjust the number of fluids we drink to the amount of the ones we lose with bowel movements.