How Can Nutrition Therapy Help Kids with IBD?

Inflammatory bowel disease (IBD) affects approximately 100-200 in every 100,000 children in the United States. As a matter of fact, IBD is so common in children that most physicians will treat patients with inflammatory bowel disease at some point in their practice. While symptoms of IBD can begin at any time, many cases of IBD are diagnosed in children before age 10.

In this blog post, we’re going to talk about a treatment plan for inflammatory bowel disease called nutrition therapy. But, first, let’s start at the beginning.

What is IBD?

Inflammatory bowel disease (IBD) is a term used for a group of conditions that cause chronic inflammation of the gastrointestinal (GI) tract-Crohn's disease, Ulcerative Colitis, and Indeterminate Colitis. These are chronic, relapsing autoimmune inflammatory bowel diseases that can flare at any time.

What are the symptoms of IBD?

While IBD needs to be diagnosed by a doctor, symptoms of IBD that should not be ignored include:

• Loose, watery and even bloody diarrhea
• Severe stomach cramping
• Fatigue
• Loss of appetite and weight loss
• Fever
• Skin rashes
• Rectal bleeding
• Joint pain
• Primary amenorrhea

Can IBD be treated?

While IBD cannot be cured, patients with IBD can go on to live a typical life by following doctor-prescribed treatment plans. With the proper medication and support, symptoms can lessen over time and patients with IBD can go into remission, which is when symptoms are minimal or non-existent.

Most patients begin their IBD treatment with anti-inflammatory medication and even immune system suppressors. Antibiotics and other supplements may also be used. One method of treatment, and the treatment plan we’ll be exploring most today, is nutritional support, or nutrition therapy.

What is nutrition therapy?

Nutrition therapy is a method of healing the stomach and intestines with nutrition, or food. Nutrition therapy begins with either including and removing certain foods from your child’s diet to better understand their sensitivities and intolerances.

Nutrition therapy has been proven to help kids with IBD and has been so successful that sometimes it is even recommended before the use of steroids and other medications to treat inflammation. There are two popular and well-received forms of nutrition therapy:

1. Specific Carbohydrate Diet
2. Enteral Nutrition Therapy

What is the Specific Carbohydrate Diet?

The Specific Carbohydrate Diet is a way of eating nutrient-dense foods that have been linked to drastically improved IBD symptoms, and, in some cases, remission. This diet focuses on whole foods that are unprocessed and free of additives that will heal the gut, as well as removing foods that will further inflame the gut. This diet was first introduced to the world of medicine in the early 1900s and was used primarily to treat celiac disease, an autoimmune disease that causes inflammation in the gut after eating gluten. The specific carbohydrate diet gained popularity with IBD patients after some found success. Since then, researchers have continued to explore the diet and how it can give patients with IBD relief.

What can I eat on the Specific Carbohydrate Diet?

The goal of the Specific Carbohydrate Diet is to focus on eating more whole foods and less processed foods. Below, you’ll find some whole food examples that are encouraged while following the diet.

Protein:

• DO eat fresh poultry, eggs, fish, canned fish, shellfish, meat, pork and collagen
• DON’T eat cured meats, tofu, soy products or meat substitutes

Grains and flours:

• DO eat nut flours, lentil or bean flour and coconut flour
• DON’T eat all grains and grain flours (wheat, barley, buckwheat, corn), rice, tapioca, potato or cornstarch

Dairy:

• DO eat homemade yogurt cultured for 24 hours and cheese aged for more than 30 days
• DON’T eat soft non-aged cheeses such as mozzarella, milk and store-bought yogurt

Veggies:

• DO eat most vegetables, except starchy vegetables and some nightshades, like eggplant, tomatoes and bell peppers.
• DON’T eat starchy vegetables like potatoes, turnips, parsnips and jicama, and avoid okra, seaweed, kelp and algae

Fruits:

• DO eat most whole fruits, but make sure they’re ripe! Bananas, for example, are easier to digest when they have spots on the peel
• DON’T eat green bananas, young/green coconut, plantain, tamarind or concentrated, sugary fruit juices

Oils and fats:

• DO eat avocado and olive oil, but limit processed oils like canola, butter, coconut and clarified butter, also known as ghee
• DON’T eat soy, refined vegetable oils or butter substitutes

Sweeteners:

• DO eat honey and fruit sweetener made from dates
• DON’T eat any other sweeteners, such as Stevia, Splenda, etc.

Legumes:

• DO eat nuts, most seeds, nut butters (peanut, almond, hazelnut), dried lentils, dried beans and nut milks
• DON’T eat pinto beans, cannellini beans, chickpeas or mung beans

Fermented foods:

• DO eat sauerkraut, homemade yogurt, kimchi and fermented vegetables. These are encouraged, due to the natural probiotics, which support a healthy gut microbiome, or environment
• DON’T eat any fermented food with added sugar

The Specific Carbohydrate Diet is a nutritionally complete diet, and your child will be nourished and will receive essential fats, protein, carbohydrates and fiber that they need to grow big and strong. The diet is meant to add in gut-friendly foods and remove foods that cause – and prolong – inflammation. While adhering to a diet protocol might not last forever, keeping inflammation in your child’s gut down through diet and/or medication will last a lifetime.

It’s important to remember that this diet is not for every child or every family, but it does work for many. Choosing to follow the diet will depend on the severity of your child’s diagnosis, as well as food preferences and food access. Although the diet has worked for some, it does not work for others. Medications or other diets could be the best treatment plan for your child. Please contact your child’s pediatric gastroenterologist for a more thorough look into potential dietary plans and treatment options for your child.

What is Enteral Nutrition Therapy?

Enteral Nutrition Therapy is a nutrition option for children and teens with the inflammatory bowel disease called Crohn’s disease. This eating plan is also known as the “liquid diet” or Exclusive Enteral Nutrition.

If your child is prescribed Enteral Nutrition Therapy, your physician will supply you with liquid nutrients that contain all necessary vitamins, minerals and nutrition for your child. This diet should be taken at regularly scheduled intervals, which will be prescribed, and given at these times similarly to medication. It’s recommended that no other solid food be consumed during this time, unless otherwise stated by your child’s doctor, as to allow the liquid nutrition to work effectively and not disrupt the gut while its healing. If your child is unable to drink the formula, physicians will recommend a temporary feeding tube.

Enteral Nutrition Therapy is recommended for children with severe Crohn’s disease who are having difficulty eating, gaining weight or whose symptoms have become unmanageable. For more information on this diet, please see our toolkit.

The Specific Carbohydrate Diet and Enteral Nutrition Therapy are both highly acclaimed and widely recommended forms of nutritional therapy for children with inflammatory bowel disease. In many countries, including the United States, these nutritional therapies are viewed as the “standard of care” for induction therapy. While not all children will benefit from nutritional therapy without medication, some will. Improving your nutrition and avoiding foods that cause inflammation and stomach upset while also receiving medication for IBD is also recommended if medication is what works best for your child.

Other Diets for IBD

• Crohn’s Disease Exclusion Diet (CDED) is a diet that focuses on excluding foods that irritate the gut and/or intestines and takes place in three phases. CDED always includes Partial Enteral Nutrition (PEN) and is a good option for patients with Crohn’s who are unwilling to try Exclusive Enteral Nutrition and has also shown to cause remission.
• Partial Enteral Nutrition (PEN) is a diet which slowly incorporates solid foods along with a liquid diet. Over time, and with positive results, more solid food is introduced, and liquid nutrition is reduced.