How to feed patients with Crohn’s disease and other inflammatory bowel diseases

Proven content

One of the diseases that carry a risk of malnutrition is Crohn’s disease and ulcerative colitis (UC), which are a group of diseases defined as inflammatory bowel diseases of unknown etiology. The reasons indicated are genetic, environmental and immunological factors.

The material was created in cooperation with Nutramil Complex

Inflammatory bowel disease causes that patients require careful and constant nutritional control due to frequent protein and energy deficiencies. Statistics show that about 75% of patients hospitalized with Crohn’s disease are malnourished. This is most often caused by a diet that eliminates groups of foods that can cause acute attacks of the disease, although there is no scientific evidence to support the effectiveness of a restrictive diet in preventing disease attacks. Therefore, it is very important to make patients aware of the importance of a well-balanced diet.

How are bowel diseases treated

Drug treatment of inflammatory bowel disease is symptomatic. The most recently used drugs are mesalazine and sulfasalazine – derivatives of 5-aminosalicylic acid (5ASA). The effectiveness of sulfasalazine in the treatment of UC is good, however, in Crohn’s disease, some effectiveness is shown only in those who have large intestine involved, and in the case of lesions in the small intestine, mesalazine is used.

Another group of drugs used in the treatment of inflammatory bowel diseases are: glucocorticosteroids. Their action is visible quite quickly – after just 48 hours. Unfortunately, treatment with steroids carries the risk of side effects, so they are not used as first-line drugs.

It happens that the disease is refractory to treatment with stroids, or when discontinuation of their use causes rapid relapse, immunosuppressants such as 6-mercaptopurine and azathioprine are implemented.

Today, the most common treatment for Cron’s disease is Infliximab, a drug called biological therapy, which allows direct interference with inflammation.

The period of exacerbation of the disease

Protein and energy malnutrition in patients with Crohn’s disease is caused by loss of appetite, vomiting, nausea, chronic bleeding, loss of protein into the gastrointestinal tract. In addition, there are disorders of digestion and absorption, often persistent diarrhea, increased metabolism. In addition, patients starving themselves to avoid exacerbation of the disease aggravate the state of malnutrition. It is estimated that in the acute stage of the disease, depending on the extent of inflammatory changes, 25-80% of patients may be malnourished, and acute kwashiorkor malnutrition – requiring parenteral nutrition, occurs in about every fifth patient.

In the exacerbation phase of the disease, mainly elemental diets are used, which allow to achieve remission in approximately 60% of patients. In people with moderate symptoms of the disease, enteral nutrition with industrial diets (eg Nutramil Complex®) may be as effective as steroids, and additionally does not cause side effects, prevents nutrient deficiencies and improves nutritional status.

It is assumed that the diet during this period should provide 25-30 kcal / kg bw / d. and 1,2-1,5 g protein / kg bw / d. The supply of fat should not exceed 30-35% of the total energy supply, and half of it should be covered by MCT fatty acids.

Nutrition after the exacerbation of the disease

The diet should be easily digestible, protein-rich and low-residue.

It is recommended to limit the supply of fiber in order not to additionally irritate the intestinal mucosa. Therefore, products such as:

– coarse-grained groats,

– wholemeal bread,

– wholemeal pasta,

– fatty dairy products: cheese, cream, milk, fried eggs,

– fatty meats, fish,

– candy

– legumes, cruciferous vegetables, onions – and all the others that have a bloating effect.

What to eat?

– light, stale wheat bread,

– wheat flour products,

– semolina,

– soft-boiled eggs,

– lean meat and cold cuts,

– lean fish meat,

– fats of vegetable origin,

– cooked vegetables, carrots, spinach, green lettuce,

– apples, bananas, blueberries, apricots, fruit purees, mousses.

It should be remembered that due to inflammatory processes and increased catabolism, patients require an increased supply of protein, so you should gradually include additional protein products. If during this period it becomes impossible to supplement the deficiencies with the use of a diet, you can use food for special medical purposes, such as Nutramil® Complex or Nutramil Complex Protein. It is an industrial diet that does not contain fiber and lactose, but contains MCT fatty acids, a readily available source of energy.

Nutrition in remission of the disease

The diet in the period of Crohn’s disease remission should be as close to normal as possible, excluding those products after which the patient noticed symptoms. The greatest challenge for patients is maintaining a healthy weight and preventing malnutrition. The patient should eat what he likes while trying to nourish himself like any healthy person, ie a varied diet rich in nutrients, minerals, vitamins and antioxidants. The most common nutritional deficiencies in the disease are folic acid, iron and zinc.

Bibliography:

1. Szczygieł B., Disease-related malnutrition, Warsaw 2012, PZWL, pp. 191-194

2. Włodarek D., Dietoterapia 1, Warsaw 2009, SGGW, pp. 38-40

The material was created in cooperation with Nutramil Complex