Focus on “more options, less restrictive diets” in Crohn’s management.

DENVER — Nutritional therapy for Crohn’s disease patients should focus on increased and varied consumption rather than restrictive diets, according to a presenter at the Crohn’s and Colitis Congress.

Among the priorities of therapeutic nutritional therapy in patients with inflammatory bowel disease are optimization of nutritional status, alleviation of digestive symptoms, reduction of inflammation and evaluation of quality of life, Theresia AlChoufete, MWITHRD, LDN, chief dietitian in the Division of Gastroenterology, Hepatology and Nutrition at the University of Pittsburgh Medical Center, told attendees. And while medical nutritional therapy can improve a patient’s quality of life regardless of the stage of their disease, this is especially true for patients in remission.

“In remission is a really great time to talk about diet because it helps to improve the patient’s relationship with food, but also to work on symptoms that they may have that are not just inflammation,” AlChoufete said.

She advised providers to review individual nutritional goals with their patients when they are in remission and encourage texture unless they have stricture or obstructive disease. Other considerations include promoting a “nutritionally balanced plate,” incorporating more plant-based foods, and recognizing and identifying gut irritants and food intolerances.

Conversely, in patients with active disease, the main goal of nutrition should be an increased intake of calories and protein, despite their potential aversion to food perceived as worsening symptoms.

“We can do this by increasing the frequency of their meals, but making them smaller,” AlChoufete said. “In this case, again, a texture adjustment would be very helpful.”

A simple solution to minimize over-restriction of these foods is to “make it soft,” she said, by increasing soluble fiber and decreasing insoluble fiber. Reducing common flare-ups by recognizing and eliminating triggers and exploring the use of over-the-counter supplements to meet daily vitamin needs is also important.

With regard to established dietary strategies for the treatment of CD, AlChoufete noted that the Mediterranean diet highlights the positive effect of increased consumption of whole foods, lean proteins and healthy fats to help patients improve digestion and achieve symptomatic and clinical remission.

“The research definitely expands our options for nutritional therapy for Crohn’s disease. We want to focus on more options, less restrictive diets and make sure we’re promoting a plant-based diet,” she concluded. “Making sure we’re talking about nutritionists is an important part of treatment.”

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Crohns & Colitis Congress