Allay Nutrition Group Session - Expanding your Foods: Why, When and How to Broaden your Food Range, Safely and Effectively
🎙 Overview
In this session, we invited Dr. Ali Arjomand to talk about how one can expand their diet as an Inflammatory Bowel Disease(IBD) patient.
If you are an IBD patient, food and diet are where you feel IBD mostly on a day-to-day basis. It's also probably where your standard GI clinics don't have the time or resources to support you. In this session, Dr. Arjomand talked about important nutrients for IBD patients, and how you can expand your foods step-by-step to get to a more diverse diet and healthier gut ecology.
At the end of this page, you can find the materials Dr. Arjomand shared with the session participants in Shared Materials.
This page captures the key ideas and highlights from the session. You can also watch the full session recording here: Full Session Recording
👤 Who is the host?
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 for many IBD and IBS patients.
🍏 What are the important nutrients missing and how do I get them as an IBD patient?
The US Dietary Guidelines are the official guidelines from the US government and health authorities However, the guidelines aren't highly adhered to 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.
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. Because of various food restrictions, IBD patients are not only missing out on the natural foods that provide these nutrients, but also missing out 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 to mindfully navigate dietary environment, carefully plan your food 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 one obtain their essential nutrients.
There are 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:
Water: IBD patients may eliminate consumption of non-nutritive beverages such as soda, sports drinks, beer, and fruit juice. Instead, one should rely on consuming pure water and beverages like tea or coffee if they can tolerate these foods. It is important to remember that food is also a substantial source of water.
Protein: One cannot store protein in their body. If too much protein 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 their body to meet their needs. It is important to ensure a sufficient intake of protein each day. Otherwise, it leads to weakness, sarcopenia, and other dysfunctions. For IBD patients, protein is the most important macro-nutrient to focus on because the disease increases the protein requirement. 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 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: Fat is essential for the healthy functioning of the human body as long as it comes from healthy sources. Fat is a great source of calories for problems like weight loss or growth faltering from IBD. However, one should take caution if they have gallbladder surgery (where ability to absorb fat is limited) or they have rapid diarrhea. Here are some example sources of fat.
Carbohydrates: People’s ability to store carbohydrates is very limited and anything in excess is converted to fat. Technically, there is no dietary requirement 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 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 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 the bloodstream but it feeds the gut microbes. Most people don’t get the vegetables they need, 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. After 15 years, it took a heavy toll on his health. In his opinion, IBD patients should instead get as much fiber as they safely and quickly can. 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. To increase the diversity of fiber intake, you can try to increase the kinds of plants in your diet. You can start by eating five different kinds of plants in your diet and 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 do I gradually expand my food diversity?
After 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 worksheet and strategy on how to gradually expand the diversity of your food.
The table lists foods by stages, from stage 1 to stage 4. Stage 1 contains the easiest and most basic foods many patients feel comfortable with. As the stage number goes up, the foods become more advanced, and might be harder 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 resilient. Once you are comfortable with foods in your current stage, introduce some foods from the next stage and make sure to prepare 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 subside and you are comfortable with expanding your foods again, try to reintroduce them. Gradually you will have a large set of ingredients available to you that supports your gut health.
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
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 from the root of the turmeric plant and has been proven to have real benefits. It’s an anti-inflammatory ingredient, which is important for IBD. Dr. Arjomand 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 fiber. By consuming things like curcumin capsules, you are missing an opportunity to introduce them as fiber sources into your diet.
Q: Do you have any insights on almond milk?
A: Almond milk is a great nutrient source for IBD patients. However, you need to be careful as store-bought almond milk or coconut milk typically contain emulsifiers. Emulsifiers are used to help blend the fatty and watery components so that they do not separate in the store. You should avoid emulsifiers in your almond milk since there are evidences that emulsifiers promote intestinal inflammation. There are a couple of brands that are out there without emulsifiers such as “Malk“. They sell pure almond milk. Another option is to make almond milk yourself. This is an even better option because you are in charge of what goes into it.
Q: How important are probiotics 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 have had antibiotics or eliminated fiber for a long time. The intake of probiotics will help you re-establish your gut ecology. Probiotics are living organisms in food. Anything fermented (for example - cheese, yogurt, kimchi, sauerkraut and etc.) has probiotics in them. To consume probiotics, you don’t necessarily need to buy their capsule form. A better way is to expand and introduce fermented foods into your diet. If you are not tolerating any of those foods, you can then choose to take probiotic capsules. This will help you get through the tough spot where your gut environment is fragile and re-establish gut ecology. It is 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 two probiotics and every week switch between one and the other. You can also add more diverse 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 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, a middle, and an end. It is up to you to define where to end. One way of defining the end is when you are fully in remission for two years and off all medications. At that time you should move off of SCD gradually. When you introduce some non-SCD ingredients, you may 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 that may negatively impact your weight and nutrient intake, so it is perfectly acceptable, or even recommended for you to venture out 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 vegetables generally friendlier, cooking them is the way to go. You may want to try over-cooking your vegetables - cooking to the point where it’s 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 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 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 incredibly hard to remember. Furthermore, a journal helps you to have your shopping list already in place so that you can reorder the same ingredients, making it easy for you to keep your pantry and fridge stocked with foods that are compliant with your disease.
Q: How can expanding foods potentially reduce my fatigue?
A: Unfortunately, feeling fatigued is typical with IBD as your body is fighting this condition. But as your disease is managed, 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 your sleep is disrupted and you are not getting a full rest. Finding 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. Lack of iron, or anemia, is commonly related to fatigue. Anemia is very common in IBD patients. 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 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 eating different things on different days at a different place it is hard to look back and remember everything you ate. That is one of the 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 foods that you are confident are safe to eat (for example, you can refer to foods in stage 1 in Expanding Foods by Stage form). You can always keep these foods in your pantry or refrigerator so that at a moment’s notice, you can dial back to an easier set of foods instead of needing to go to the grocery store in a pinch.
Shared Materials
Dr. Arjomand suggested some easy-to-read research papers to the session participants. You can read these papers to understand more about nutrition and dietary intervention for IBD:
The slides Dr. Arjomand used in the session:
