When Crohn's disease or ulcerative colitis becomes active, symptoms such as diarrhea, abdominal pain, urgency, reduced appetite, and fatigue can make eating more difficult.
There is not one menu that everyone with IBD should follow during a flare. Nutritional needs and food tolerance depend on the individual, the location and severity of disease, symptoms, complications, and other health factors.
Nutrition Still Matters During a Flare
It can be tempting to dramatically restrict food when eating seems to make symptoms worse.
But active IBD can increase nutritional challenges at the same time that symptoms make eating more difficult. Maintaining adequate nutrition is therefore particularly important.
Work With What You Tolerate
During periods of active symptoms, some people find that changing food preparation, portion sizes, or textures makes eating more manageable.
For example, some fiber-containing foods may be better tolerated when their texture is modified during a flare rather than automatically eliminating them altogether.
What works will vary from person to person.
Smaller Meals May Feel More Manageable
When appetite is reduced or larger meals worsen symptoms, some people may find smaller meals eaten more frequently easier to tolerate.
The objective is not to eat as little as possible. It is to find practical ways to maintain nutrition while symptoms are being treated.
Pay Attention to Hydration
Diarrhea can increase fluid losses.
If frequent diarrhea is occurring, staying hydrated becomes particularly important. A healthcare team can advise if there are questions about fluid or electrolyte needs.
Avoid Unsupervised Restrictive Diets
A flare can make people understandably eager to find something they can control.
But eliminating multiple foods without professional guidance can lead to inadequate calorie intake, nutrient deficiencies, unintended weight loss, and malnutrition.
Restrictive diets should not be started without appropriate medical or dietitian support.
Know When to Contact Your Healthcare Team
Changes in diet do not replace treatment for active intestinal inflammation.
If symptoms are new, worsening, severe, or different from the usual pattern, contact the healthcare team rather than assuming food is the cause.
A clinician may need to determine whether symptoms represent active inflammation, infection, a complication, or something else.
Consider Nutrition Support
Tell the healthcare team if there is:
- Unintended weight loss
- Difficulty eating enough
- Frequent vomiting
- Persistent diarrhea
- Avoidance of many foods
- Concern about dehydration
- Concern about vitamin or mineral deficiencies
A gastroenterologist and registered dietitian can help determine whether additional nutritional support is appropriate.