What to Eat After an IBD/IBS Flare
Inflammatory bowel disease (IBD) is a term that includes a group of diseases that cause chronic inflammation of the gastrointestinal (GI, digestive) tract. The two common forms of IBD are Crohn's disease and ulcerative colitis (UC). In Crohn's disease, the inflammation appears in patches anywhere in the GI tract from the mouth to the anus. In ulcerative colitis, there is chronic inflammation and sores (ulcers) that are continuous along the small intestine and colon.
IBS, stands for "irritable bowel syndrome" and essentially refers to digestive issues that do NOT stem from visual inflammation, ulcers or sores. The symptoms of IBS can vary from person to person as well. Some have IBS-D (prone to diarrhea) and some have IBS-C (prone to constipation) while others have a combination of both.
Both IBS and IBD have no cure, and while neither can be controlled through diet, diet can play a crucial role in symptom management and disease remission.
But regardless of what you do diet wise, flare-ups are bound to happen from time to time, and when they do, how you care for yourself and what you eat afterwards is integral in the healing and recovery of your digestive system.
Suggestions for first foods after a flare include:
1) Applesauce- While apples are high FODMAP and can be problematic, appleSAUCE is not. Apple flesh is made of soluble fiber. This bulks up in the intestines to create nice regular contractions instead of painful spasms and cramps. Apple SKIN has insoluble fiber which is the part of them you CANNOT digest and this is the part of an apple which makes it hard for the sensitive system of IBS or IBD to deal with. But applesauce is JUST the flesh and it's pureed and broken down making it easy on the stomach. Make sure it's unsweetened. Applesauce also has plenty of nutrients, like potassium and vitamin C which is CRUCIAL after a flare.
2) Oatmeal- opt for INSTANT (as it's broken down and LOWER in fiber) and make sure you prepare using PLENTY of water. If you need to be gluten free get gluten free oats.
3) Cream of Rice- It's a great source of plain carbohydrate, and it's so easily digestible it's fed t infants. Enough said.
4) Plain rice cakes or rice crackers- These are a great bland source of carbohydrate to help get some calories back into you after a flare.
5) Plain chicken- Mild and versatile, chicken has protein, B vitamins, and zinc, a mineral that helps your immune system work well. It’s a good choice for the first days after a flare-up, but make sure it isn’t marinated or dipped in anything too adventurous. Spicy foods make symptoms worse.
6) Broiled or steamed salmon- Again, keep seasonings minimal if at all. But fish like sardines, salmon, and even mackerel are great choices if you broil or steam them. They are rich in omega-3 fatty acids, which fight inflammation and also help you get protein and vitamin D.
7) Cooked egg whites- Egg whites are a great source of protein and HIGHLY digestible. They are also full of filling protein, iron, and vitamin D. Try them hardboiled or scrambled.
8) Steamed carrots and green beans- It’s a smart strategy to AVOID vegetables at first as the fiber can be a major contributor to stomach pain and bloating. When you DO add veggies back in however, make sure they are steamed, NOT raw and not harshly roasted. Veggies that don’t have seeds, like carrots and green beans, are a good place to begin.
9) Mashed potatoes (sweet or white)- You’ll need to take the fiber-filled skins off first. I suggest PEELING potatoes and then boiling and mashing, or foil wrapping them and baking them until nice and tender. Once the skins are removed they’re a good first food to have after a flare. Sweet potatoes are great but white potatoes are fine too- they're healthier than you might think: They have plenty of potassium, magnesium, and vitamin C.
My additional advice for my clients following any sort of digestive flare up:
1) Follow a low residue diet (limiting high-fiber foods, like whole-grain breads and cereals, nuts, seeds, raw or dried fruits, and vegetables ) to minimize abdominal pain and diarrhea. and slowly add back a variety of foods, one at a time, assessing for symptom recurrence.
2) Begin with well-tolerated liquids and soft solids, then solids
3) Introduce one or two items every few days and avoid any foods that cause symptoms.
4) Add fiber to diet as tolerated. Well-tolerated fiber sources include tender cooked vegetables, canned or cooked fruits, and easily digestible starches like cooked cereals (cream of rice and oatmeal) and mashed or boiled potatoes.
5) Increase your calorie and protein intake following a flare. Abdominal pain, diarrhea and decreased appetite may have caused poor food intake.
6) Eat SMALL frequent meals (5-6 per day) versus larger meals. This is MUCH easier on the stomach.
7) Replenish lost fluids and electrolytes — It is important to hydrate well following a flare and drink adequate amounts of fluid. Fluid requirements increase during or after episodes of diarrhea. Also make sure you replenish losses of electrolytes from diarrhea. Sodium, chloride and potassium can be replenished with an electrolyte supplement
8) Bolster with vitamins and minerals — A standard multivitamin with minerals should be taken each day. I like NutraKey ENVIE as its' powdered and can be consumed in water as a liquid.
The following are foods to limit and avoid following a digestive flare:
1) Caffeine: Although there is not a lot of data on the affect of caffeine on ulcerative colitis symptoms, a 2013 survey of 442 people found that 20% of individuals with the condition reported caffeine made symptoms worse. Caffeine is found in coffee, tea, soda, and chocolate.
2) Dairy products: While not bad for all people with ulcerative colitis, dairy products can trigger symptoms in some and dairy is usually recommended to be minimized in people who have IBS. And if you are lactose intolerant you should make SURE to avoid all dairy.
3) Alcohol: This may trigger diarrhea in some people.
4) Carbonated drinks: Some sodas and beers contain carbonation that can irritate the digestive track and cause gas. Many carbonated beverages also contain sugar, caffeine, or artificial sweeteners, which can be IBD and IBS triggers.
5) High fiber foods: These include dried beans, fruits, whole grains, berries, peas, and legumes. They may increase the number of bowel movements, amount of gas, and abdominal cramping.
6) Popcorn: Similarly to other seeds and nuts, this can be difficult to digest.
7) Foods that contain sulfur or sulfites: This mineral can cause excess gas production. Some of these foods include beer, wine, almonds, cider, soy, wheat pasta, breads, peanuts, raisins, and cured meats.
8) Nuts and seeds: Included are those in nut butters. Smooth nut butters are usually fine, but avoid "chunky" ones.They may cause abdominal cramping, bloating, and diarrhea. When a person experiences a flare, even small seeds may trigger symptoms.
9) Sugar alcohols: These can cause bloating, diarrhea, and gas. Sugar alcohol is in many sugar free gums and candies, protein bars, protein powders, low calorie products, ice creams and more. Check labels!
10) Fructose sugar: This can be poorly absorbed causing increased gas, cramping, and diarrhea. Check the label for things like high-fructose corn syrup, fruit juice, honey, and molasses, as these all contain fructose.
11) Many vegetables: These are often high in fiber, which can be hard to digest, causing bloating, gas, and abdominal cramps. The major gas-producing vegetables include cabbage, Brussels sprouts, cauliflower and broccoli. Cooked vegetables are better tolerated than raw.
12) Spicy foods: These include buffalo sauces and seasonings, hot sauces, and hot peppers. They may cause diarrhea in many people. For people with IBD and IBS, hot and spicy foods usually trigger or worsen a flare.
13) Gluten: This is found in wheat, rye and barley and can sometimes trigger symptoms in IBD and IBS. Although oats do not contain gluten, they have a similar protein that can cross-react in individuals sensitive to gluten. Oats are also often processed in the same factory space as wheat. So if you DO consume oats go for gluten free.