On the first day of AIBD 2020, one of the breakout sessions I attended was “Talking Nutrition with Your IBD Patients.” Led by Dr. Maria Abreau from the University of Miami Miller School of Medicine, she was joined by Ashwin Ananthakrishnanan, MD, MPH (Massachusetts General Hospital and Harvard Medical School); Kelly Issokson, MS,RD, CNSC (Cedars-Sinai); Andrew Grossman, MD (Children’s Hospital of Philadelphia); and Mark Mattar, MD, FACG (MedStar Georgetown University Hospital).
I want to start out by saying that this session and what was discussed made me extremely hopeful for the future of patient care when it comes to incorporating and implementing complementary therapies. The word complimentary was used to highlight the fact that dietary therapies are not necessarily alternative therapies, but can play a role in and be an integral part of treating mild to moderate IBD.
As Dr. Abreau mentioned, too often patients are told by doctors that food doesn’t matter, and that they’ll come to her and say, “My last doctor said it doesn’t matter what I eat.”
Having personally experienced this exact situation firsthand, when a doctor once told me that no food will affect me except for popcorn and Chinese food, to hear an expert in the field finally say that, “You lose the patient’s trust when you tell that diet doesn’t have anything to do with it,” is in itself a step in the right direction. Her hope is that those who joined this session, which was specifically centered around approaching and having discussions about nutrition with patients, will have at least learned not to say that it doesn’t matter what you eat. I share that same hope. And no, this does not mean that food causes IBD, and it certainly doesn’t mean that food can cure IBD - this just means that food, something that is a part of our everyday lives, does play a role when it comes to your body. It means that both the progression and management of the disease, as well as the process of bringing one closer to remission, need to be seen with a multi-faceted lense.
The presentation consisted of addressing a variety of patient scenarios, from the management of stricturing of Crohn’s disease to a teenager with growth stunting. By going through each case and discussing their individual situations and needs, this inherently showcases how incredibly individualized both IBD and nutrition are.
When discussing the presence of strictures in patients, as seen in one of the patient cases discussed, the panel brought up an important point. While this is a scenario where low fiber needs to and should be emphasized, low fiber is brought up much more often than it should be. It ends up being the default suggestion to everyone, which is not beneficial, and can actually be harmful. Instead, patient individuality needs to be at the forefront.
There were a few distinct common threads that were woven through each of the cases that I want to especially highlight below.
1: The importance of Mental Health/Mindset Surrounding Food
As a patient, it gives me hope that doctors and dieticians are working together and having discussions about helping patients with the very real food avoidance/ food fear that can come with IBD by focusing on not only mindset reframing, but also their own verbiage. It is critical to help patients establish a better relationship with food as part of their healing, and this is something that requires support, which I’ll dive into soon when addressing the importance of working with a dietitian who is well-versed in IBD.
Too often, it creates great duress in patients when they are presented solely with a seemingly-never ending list of foods that are off limits to them; the thought of food elimination alone can be triggering on top of an already overwhelming situation. Instead of solely focusing on, “What do I need to avoid?” it’s imperative to help shift it to “What CAN I eat?” (like proven anti-inflammatory foods). In doing so, it’s also important that more doctors begin to make it clear to patients that in a setting of active inflammation, food intolerances may be different than they are in remission.
The fact that these conversations are being had and these changes are being made on a professional level is going to be of immense benefit to both the physical and mental health of IBD patients.
2: The Importance of Nutritional Status
Assessing and addressing nutritional status in IBD patients is a must, both in general and in those on dietary therapies when any kind of elimination is involved. This includes vitamin b12, d, iron, etc.
As I learned in another session, “Infectious Complications in IBD and How to Manage the Patient with Ongoing Infection,” malnutrition increases the risk of infections in IBD patients. Intervening early and being vigilant in respect to nutritional status is imperative to mitigating additional repercussions.
3: The Importance of Working with a GI-trained Dietitian
To sum it all up, one of the most prominent threads woven throughout this session was the need for quality, accessible dietitian support. All of the above points come back to this one; because there is wide variability in which foods can trigger symptoms in an individual, because food fear is a very real thing, and because malnutrition can lead to even more complications, all experts on the panel recommend seeing a GI/IBD focused dietician.
It’s imperative to know that nutritionists are NOT registered dieticians. Yet, as patients, it can often be difficult and challenging to identify and find true GI or IBD focused dietitians. To help with this, as Kelly Issokon suggested, these following sites have searchable databases to locate one:
I hope that with resources and insights like the ones above, and with conversions like these, access to dietary therapies, information about dietary therapies, and the ability to succeed with dietary therapies (again, as complementary therapies, not necessarily alternative therapies), will become more attainable and feasible for all IBD patients.