🎙 Overview
In this session, we invited Dr. Ali Arjomand to talk about how you one can expand your their diet as an IBD ( Inflammatory Bowel Disease(IBD) patient. Food
If you are an IBD patient, food and diet is are where you feel our IBD mostly on a day-to-day basis. itIt's also probably where your standard GI clinics don't really have the time or resources to support you. In this session, Dr. Arjomand talked about the important nutrients for IBD patients, and how you can expand your foods gradually step-by-step to get to a more diverse diet and a healthier gut ecology.
At the end of this page, you can find the materials Dr. Arjomand shared with the session participants in Shared Materials.
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Dr. Ali Arjomand is a certified nutritionist and a Crohn’s disease patient for 20 years. He is the founder of Modulla Health, an IBD-focused nutrition clinic where he delivers personalized nutrition interventions to IBD patients. Dr. Ali’s science-based nutritional interventions have transformed the disease course of for many IBD and IBS patients.
🍏 What are the important nutrients missing and how
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do I get them as an IBD
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patient?
The US Dietary Guidelines are the official guidelines from the US government and health authorities have guidelines for food intake - the US Dietary Guidelines. However, the guidelines aren't really highly adhered to in by the average population. In the average population, there is a general lack of intake of vegetables , and fruits, while foods such as refined grains are being overly consumed.
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As a way to sneak much-needed nutrients into an average diet, the standard food supply is enriched with fortified nutrients. In the case of enriched flour, it contains nutrients such as thiamine, niacin, folic acid, riboflavin, and iron. As IBD patients, because of your Because of various food restrictions, you IBD patients are not only missing out on the natural foods that provide these nutrients, you are but also missing out these on the nutrients that would come from foods like enriched flour.
Furthermore, the dietary habits of the general public promote foods that are triggering to IBD while nutrients that are much needed for a healthy gut environment are lacking. As IBD patients, it is important for you are trying to work with that landscape and even do better - you do not just use food to manage our condition, but even go further and use food to help to mindfully navigate dietary environment, carefully plan yourfood intake to help manage your condition, move forward and hopefully put yourselves into remission. Therefore, it is important to understand the relationship between nutrients and what you eat in your diet.
In Dr. Arjomand’s definition,a nutrient is a substance or ingredient that promotes growth, provides energy, and maintains life. Essential nutrients are nutrients that cannot be produced by the body (or cannot be produced in sufficient amounts) and must be obtained through other means. A Diet is where you one obtain your their essential nutrients.
There are 6 5 major macro-nutrients that the human body needs to function properly. Dr. Arjomand introduced them and talked about how IBD patients can work to acquire these nutrients:
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Oxygen: Many people probably don’t think of oxygen as a macro-nutrient. Technically it’s not. You don’t get it from diet, but it’s an essential element for survival, and you cannot store it.
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Water: IBD patients may eliminate consumption of non-nutritive beverages such as soda, sports drinks, beer, and fruit juice. Instead, you one should rely on consuming pure water , and beverages like tea or coffee if you they can tolerate themthese foods. It is important to remember that food is also a substantial source of water.
Protein: You also One cannot store it protein in the their body. If you eat too much protein , you end up peeing it out and if you eat too little you is consumed, the excess protein will come out of the body via urine. If one consumes too little protein, they will end up sacrificing other parts of your their body to meet your their needs. You need It is important to ensure a sufficient intake of protein each day. Otherwise, it leads to weakness, sarcopenia, and other dysfunctions. For IBD patients, it protein is the most important macro-nutrient to focus on because the disease increases the protein requirement, and most of the patients struggle finding the sources of protein to be included in their diet. Normally, people need about 0.8 grams of protein per kilogram of body weight to keep from getting sick. Dr. Arjomand suggests that IBD patients should aim for 1.2 ~ 1.4 grams per kilogram of body weight to suffice your their daily protein intake (For example, if your weight is 120 lbs or 55 kg, you will need to consume 65 ~ 76 g protein per day). Most patients struggle to find sources of protein to be included in their diet. Here are some foods that are high in protein, listed from high to low:
Fat: You can store fat, and that is not necessarily a bad thing.
Fat: Fat is essential for the healthy functioning of the human body as long as you find it comes from healthy sources. If you are working on Fat is a great source of calories for problems like weight loss or growth faltering from your IBD, fat is a great source of calorie for those problems. However, you one should take caution if you they have gallbladder surgery (where your ability to absorb fat is limited) or you they have rapid diarrhea. Here are some example sources of fat:.
Carbohydrates: You can store only a little bit of carbohydrate, but not much People’s ability to store carbohydrates is very limited and anything in excess gets is converted to fat. Technically, there is no dietary requirement from the diet. In practice, you likely for carbohydrate. Most people consume 100 to 400 grams of carbohydrates per day. Carbohydrates induce insulin release, which is important for anabolic growth(the process where your body uses nutrition and energy to build muscles). It may be hard to gain weight on low carbon due to low insulin inductioncarbon due to low insulin induction. It is also important to select the right set of foods where IBD patients get carbohydrates. Refined carbs like bread, rice, potatoes, pasta, and sugar are a pretty large portion of people’s diet. However, these refined carbs can aggravate IBD symptoms. In some cases eliminating them all together altogether is super beneficial. Instead of depending on refined carbs for calories, one can instead add more whole grains to their diet. Calories are important to maintain your current weight. You can scan the following QR code for a calorie calculator to get a rough estimate of daily calories needed:
Fiber: Fiber doesn’t get absorbed into your bloodstream. Either it comes out of you or, more importantly, the bloodstream but it feeds the gut microbes and this is the one that you want to focus on. Most people don’t get the vegetables they need, and it means meaning they don’t get the fiber they need in their body. Fiber is a key missing part of IBD patient intake. From Dr. Arjomand’s experience, he was told by every IBD doctor that he had to go on a low residue and low fiber diet. He did it for After 15 years and , it took a heavy toll on his health. In his opinion, what IBD patients should do is to instead get to as much fiber as you can they safely and as fast as you quickly can. Depends As IBD patients, depending on your disease, you may differ in how fast you can increase your fiber intake. You may be able to consume more fibers faster if you have ulcerative colitis and slower if you have Crohn’s Disease. It is also important to expand the diversity of fiber. A challenge that To increase the diversity of fiber intake, you can try is to increase the kinds of plants in your diet. You can start with getting by eating five different kinds of plants in your diet . Or if that’s already happening, get to 10 kinds of fiber sourcesand then gradually move on and increase this number to ten. When it comes to fiber, even spices count – you can sprinkle a little bit of cinnamon on your yogurt and that counts as one kind of fiber source.
🥗 How
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do I gradually expand
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my food diversity?
For IBD patients, some foods are easier. As you are expanding the diversity of your foodsAfter understanding each essential nutrient, the next step is to learn about how to incorporate these nutrients into one’s daily diet. One of the best ways is to expand the diversity of food. As IBD patients, it is important for you to take gradual steps, starting from the foods that are friendlier and easier to tolerate, to foods that are more advanced. Dr. Arjomand shared a table worksheet and strategy of on how you can use this table to gradually expand the diversity of your food.
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The table lists foods by stages, from stage 1 to stage 4. Stage 1 contains the easiest and most basic foods most many patients feel comfortable with. As the stage number goes up, the food becomes foods become more advanced, and might be harder for you to tolerate if you are in flare or your disease is in a bad place. But as you gradually advance to the next stages, you will be exposed to a much diverse diet and in turn, your gut ecology becomes more diverse and more resilient. Once you are comfortable with foods in your current stage, to advance to the next stage, the best way is to introduce some of the foods from the next stage and make sure to prepare and cook them in a way that is more tolerable to your gut. When you notice that a newly introduced food is triggering symptoms, you can dial back to foods from your last stage so that you know that your basic nutritional needs are always covered. Once your symptoms subsidized subside and you are comfortable with expanding your food foods again, you can try introduce those food againtry to reintroduce them. Gradually you will have a large set of ingredients available to you that supports your gut health.
Listen For more information, listen to Dr. Ali Arjomand as he explains how to use the table to gradually expand your food diversity: https://vimeo.com/733016166/cf1a1febc5
🙋♀️🙋♂️ Q & A
Q//vimeo.com/733016166/cf1a1febc5
🙋♀️🙋♂️ Q & A
During the session, Dr. Ali Arjomand answered questions from participants live. The following are the transcripts of the questions and answers.
Q: Do you have any Insights on turmeric or ginger?
A: Turmeric is a spice . It’s ground up from the root of the turmeric plant and has been shown proven to have real benefits. It’s an anti-inflammatory ingredient, which is exactly what you want for IBD. Most of the supplements you see at supplement shops try and get the turmeric in a pure form - curcumin capsulesimportant for IBD. Dr. Arjomand advised against that. Because besides advises against taking curcumin capsules (curcumin is the active compound , in turmeric) instead of turmeric the spice. Because a lot of these spices, including turmeric or ginger, contain a lot of fiber. By consuming things like curcumin capsules, you are missing out an opportunity to introduce them as fiber sources into your diet.
Q: Do you have any Insights insights on almond milk?
A: Almond milk is a great nutrient source for IBD patients. You However, you need to just be careful that as store-bought almond milk or coconut milk typically has what’s called an emulsifier. It is contain emulsifiers. Emulsifiers are used to help blend the fatty and watery component components so that it doesn’t they do not separate out in the store. You should avoid emulsifiers in your almond milkmilk since there are evidences that emulsifiers promote intestinal inflammation. There are a couple of brands that are out there without emulsifier. One of them is emulsifiers such as “Malk“. They sell pure almond milk. If you are making Another option is to make almond milk yourself, that . This is an even better option because you are in charge of what goes into it.
Q: How important are probiotics to add to in my diet?
A: It is important to add probiotics in your diet. Your gut ecology may have been stripped over the years because you’ve you have had antibiotics or you have eliminated fiber for a long time. Intake The intake of probiotics will help you re-establish the your gut ecology. Probiotics are living organisms in the food. Anything fermented (for example : - cheese, yogurt, kimchi, sauerkraut and etc.) have has probiotics in them. To consume probiotics, you don’t necessarily need to buy probiotics in their capsule form. The A better way is to expand and introduce fermented foods in into your diet. If you are not tolerating any of those foods, the next best thing is to take probiotics in capsule form and that you can then choose to take probiotic capsules. This will help you get through a the tough spot where your gut environment is fragile and re-establish the gut ecology. It is also important to ensure the diversity of your gut ecology. So, if you are taking probiotic capsules, don’t stick with one brand for too long. You can buy 2 two probiotics and every week switch between one and the other. You can also add more diverse source sources of fiber into your diet to feed different strains of probiotics to add to the diversity in your gut ecology.
Q: If I am on a Specific Carbohydrate Diet(SCD) and I want to expand my food, should I introduce new food that is considered illegal in the diet?
A: SCD is probably likely the most studied and implemented diet for IBD. An important thing to note is that SCD should not be thought of as a life-long endeavor. You should think of it as an intervention that has a start, has a middle, and an end. It is up to you to define where to end. Some people want to be One way of defining the end is when you are fully in remission for two years and off all medications, then it is time for them to move on from . At that time you should move off of SCD gradually. When you introduce some non-SCD ingredients, you may also start seeing some symptoms come back. In that case, you can always dial back and go back to full SCD and try again. SCD is a restrictive diet and that it may negatively impact your weight and your nutrient intake, so it is perfectly acceptable, or even recommended for you to venture out the from SCD when your disease is in a good shape.
Q: Do you recommend cooking vegetables to make them easier to digest? Are there some vegetables that are easier for IBD patients to digest?
A: In Dr. Arjomand’s opinion, vegetables are your exit out of IBD. If there was an off-ramp to IBD, it’s the combination of probiotic fermented foods and vegetables. There are some vegetables that are more friendly , and easier to tolerate. And there are some that are more advanced and you may not want to try them now. To make vegetable vegetables generally friendlier, cooking them is definitely the way to go. Even You may want to try over-cooking your vegetables - cooking to the point where it’s super so soft that you can give it to a baby who has no teeth.
Q: How to expand food with the help of food journaling?
A: There are a lot of things to track in your head. So having a food journal is really important. It helps healthcare providers to watch over the patients to see where the gaps are. It also helps the patients themselves to better understand their foods and the correlation with their symptoms. When you are journaling, you don’t have to find the actual ingredient ingredients item by item, but a rough journal is much better than nothing. When you start to keep a journal, you will be able to pair your journal with your symptoms and notice patterns over time. With a journal, when you are symptomatic, you can even retrospectively go back and remember what you had a month ago when your symptoms were under control and structure your diet so that you can get your symptoms back down. Without a journal, it would be really incredibly hard to remember that. Furthermore, a journal helps you to have your shopping list already in place so that you can reorder the same things over and over againingredients, making it easy for you to keep your pantry and fridge stocked with food foods that are compliant with your disease.
Q: How can expanding food foods potentially reduce my fatigue?
A: Feeling fatigue is pretty typical with IBD and some of it is just by virtue of having a disease and Unfortunately, feeling fatigued is typical with IBD as your body is fighting this condition. You don’t have too feel too bad about your fatigue. When your But as your disease is managed better and your body isn’t so tied up fighting IBD and actually has more energy, you , your symptoms will be as well. Therefore you will have more energy and will naturally feel better.
The fatigue can also come when your symptoms are bad enough that you wake up at night or enough that your sleep is disrupted that and you are not getting a full rest. The next day you are going to be tired. You should see if you can enhance your sleep and get more restful sleepFinding methods to enhance your sleep will lessen your fatigue.
The other reason could be that if you are short of energy because your body does not have enough calories or the nutrients to function. Iron is a big one of such nutrients. Being short of Lack of iron, also or anemia, is commonly related to fatigue. Anemia is very common in IBD patients which makes you exhausted. Without iron, you cannot deliver oxygen and other nutrients that your body needs to function. In that case, you may want to think about taking multi-vitamin supplements.
Q: My sensitive food seems to change all the time, how do I know if what I can tolerate today I can tolerate is tolerable today is also tolerable next month?
A: The landscape is always changing on you, what used to be very tolerable one day may not be tolerable in the future, so you always have to keep an eye on things. Knowing what you are eating is the first step. If you are randomly eating different things on different days , at a different places, place it is hard to look back for the last five days and remember everything you ate. That is one of the reason reasons keeping a journal is good for you. When you don’t feel well you can always backtrack the last 48 hours and remember new food or new changes in your diet. Once you identify them, you can avoid them until the symptoms settle. You can also keep a list of food foods that you are confident that they are safe to eat (For for example, you can refer to foods in stage 1 in Expanding Foods by Stage form.). You can always keep those these foods in your pantry or refrigerator so that on at a moment’s notice, you can dial back to a an easier set of easier food to ride out the next couple of days foods instead of needing to go to the grocery store in a pinch.
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Dr. Arjomand suggested some easy-to-read research paper papers to the session participants. You can read these paper papers to understand more about nutrition and dietary intervention for IBD:
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