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What Is the Best Diet for IBD?

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Nearly every patient with inflammatory bowel disease (IBD) has the same query—which has a not-so-simple answer.

“’Doctor, what should I eat when living with IBD?’ is likely the most frequently asked question following diagnosis,” says Dr. Maitreyi Raman, an associate professor of medicine at the University of Calgary.

Raman, who’s a gastroenterologist, physician nutrition specialist, and researcher, has closely studied the topic and reviewed the available evidence for dietary patterns that may be of benefit (or not) to patients.

IBD includes Crohn’s disease, which can cause inflammation in any part of the digestive tract and commonly affects the small intestine; ulcerative colitis, limited to the large intestine, or colon, and rectum; and indeterminate colitis, which has features of both Crohn’s and colitis. Symptoms for all forms of IBD include diarrhea, abdominal cramping and pain, fatigue, and unintended weight loss.

Given the life-disrupting nature of the chronic condition, patients are often highly motivated to try different therapies that might bring relief, including making changes to their diet.

“The role of diet as a risk factor and therapy for IBD has been of great interest to patients,” says Raman, who co-authored a review of diets for IBD published in Clinical Gastroenterology and Hepatology in March 2021. Those findings indicate that exclusive enteral nutrition is the most well-supported approach, but isn’t realistic for everyone. Other plans, such as the specific carbohydrate diet, can also be helpful.

Unfortunately, there’s a relative dearth of research on the best diet for IBD. Still, evidence is growing. Over the past decade, the science and understanding of the gut microbiome, which comprises trillions of bacteria (helpful and harmful), have evolved, Raman notes. An imbalance of bacteria in the gut can cause a host of health problems, and may contribute to IBD. And diet can make a big difference.

Recent high-quality randomized controlled trials have found that changes in diet improved IBD symptoms, reduced gut inflammation, and enhanced patient outcomes, Raman explains.

Before diving into options for what you might put on your plate and in your body if you have IBD, know that experts emphasize that dietary changes aren’t a wholesale substitute for medical treatment.

“Diet is one of many therapies,” says Dr. James Lewis, associate director of the Inflammatory Bowel Diseases Program at the University of Pennsylvania Perelman School of Medicine. “While a diet-based strategy may be preferred and practical for some patients, it may be much harder to implement for other patients.” Certain diets for IBD are quite restrictive, and any significant changes in eating patterns can be challenging to sustain. Still, many patients—especially those with mild to moderate disease—look to diet as one therapy option for IBD.

Experts recommend patients seek professional help in order to develop a personalized eating plan. Therezia Alchoufete, lead dietitian for UPMC Total Care at the University of Pittsburgh, stresses that dietary choices need to be tailored to the individual.

Consider your goals not only related to IBD but also for your overall health. And make sure the focus is on what you can eat, not just what you’re eliminating. Alchoufete talks to patients about making thoughtful choices while looking to increase variety and nutrients. “My goals for each patient would be to begin building this positive relationship with food—really understanding which foods can help them feel good.”

Exclusive enteral nutrition

The most widely studied and data-supported diet for IBD—and Crohn’s in particular—is an all-liquid, formula-based meal-replacement diet. It’s called exclusive enteral nutrition, and it’s typically prescribed and overseen by doctors. Most commonly recommended for children, this can be consumed by drinking a specialty formula prepared by a doctor, or administered via a feeding tube inserted through the patient’s nose and into the stomach.

There’s strong evidence to show it leads to reduced inflammation and improved healing, and it’s comparable to treatment with steroids in helping patients achieve remission from Crohn’s, which means the disease is no longer active. It also works relatively quickly. Short-term exclusive enteral nutrition programs are designed to induce remission in six to 12 weeks.

However, it’s primarily been studied in children, not adults. And there’s an even more obvious con: it’s challenging to stick with the diet “from a quality-of-life standpoint, since it requires entirely eliminating normal food,” says Dr. Ashwin Ananthakrishnan, a gastroenterologist in the Digestive Healthcare Center at Massachusetts General Hospital.

CD TREAT

There have been some attempts to replicate the success of exclusive enteral nutrition with solid foods. A small 2019 study published in Gastroenterology found consuming an individualized “ordinary food-based” diet with a similar composition to exclusive enteral nutrition, dubbed CD-TREAT, led to changes in the microbiome that mirrored those found with exclusive enteral nutrition. The diet was also associated with decreased gut inflammation and well tolerated by children and adults in the study.

CD-TREAT is prescribed and personalized by a doctor or dietitian, and it excludes certain dietary components like gluten (so no wheat), lactose, and alcohol. It incorporates all the macro-nutrients (with more protein and fat and fewer carbs) and reduces fiber. So a person might eat, for example, a rice cereal with nondairy full-fat milk for breakfast, a grilled cheese on gluten-free bread with an apple for lunch, and grilled salmon with potatoes and a sliced ​​cucumber for dinner.

Although more study is needed, the findings provide a framework for treating active Crohn’s without relying on a liquid diet.

Crohn’s disease exclusion diet

Successful IBD diets eschew the traditional red-meat-heavy, sugary, processed Western diet that wreaks havoc on good health. Research suggests the shift toward that way of eating bears much blame for increases in IBD rates—even in the East, like Japan, where the Western diet has been adopted as well.

To counter that, the Crohn’s disease exclusion diet seeks to cut out Western diet staples, such as processed meat, artificial sweeteners, and alcohol, which may affect gut health. Evidence from high-quality comparative trials demonstrates the diet’s effectiveness in relieving symptoms and reducing inflammation—and it could start to work within three to six weeks.

A study published in 2019 in Gastroenterology demonstrated that for children with mild to moderate Crohn’s disease, the Crohn’s disease exclusion diet can induce and sustain remission. A subsequent study published in November 2021 in the Lancet Gastroenterology & Hepatology found it was effective for inducing and maintaining remission in adults with mild to moderate Crohn’s.

But as its name indicates, the Crohn’s disease exclusion diet is highly restrictive. In the 2021 study examining the approach, participants were only allowed to have chicken breast, eggs, and partial enteral nutrition—or liquid formula for a portion of their calories—as sources of animal protein, and limited to certain fruits and vegetables, for the first six weeks. The second six-week phase involved the gradual introduction of almost all fruits and vegetables, while restricting beef and legumes, and allowing one slice of whole-grain bread daily.

This 12-week period, called the induction phase, is most important for achieving remission. The third six-week period, the maintenance phase, adds back more foods to make the diet more sustainable while maintaining results.

Even with those adjustments, the diet may be a challenge to adhere to in the long term, and requires in-depth planning plus home cooking, said Dr. Henit Yanai, head of the IBD Center at the Rabin Medical Center in Petah Tikva, Israel.

Specific carbohydrate diet

The specific carbohydrate diet, which is a grain-free elimination diet, is based on the idea that consuming certain complex carbs feeds unhealthy bacteria, causing an overgrowth of these “bad” bacteria in the small intestine. That in turn could contribute to inflammation.

Based on that concept, the diet avoids everything from table sugar to grains—including wheat and corn—starchy foods like potatoes, and other exclusions. Adherents can, however, have meats, fish, and poultry without additives, veggies (fresh or frozen but not canned with any additives), and most nuts and oils. They can also use honey as a sweetener.

However, experts express concern about patients’ ability to sustain the diet and advise that the eating plan should be monitored by a dietitian.

Mediterranean diet

The Mediterranean diet is another recommended approach to some IBD patients. It’s been well studied and is highly touted for its overall benefits, including for heart and brain health. Best of all, it’s an eating style recommended for nearly everyone and is easier to follow than more restrictive diets. If you follow this plan, you’ll load up on fruits and vegetables, whole grains, nuts, and lean protein such as fish.

The Mediterranean diet was featured in a rare and prominent head-to-head comparison of diets for IBD, led by Lewis, called the DINE-CD trial. The study, which was published in May 2021 in the journal Gastroenterology, pitted it against the specific carbohydrate diet. More than 190 patients with mild to moderate Crohn’s were involved in the research.

The study found that both diets similarly helped patients achieve symptomatic remission and improved their quality of life. Neither option had a significant impact on a biomarker used to measure inflammation, something the Crohn’s disease exclusion diet has been documented to help improve.

But since the Mediterranean approach allows a wide variety of foods and is better studied for its overall health benefits, Lewis and other doctors tend to recommend it over the specific carbohydrate diet.

Low FODMAP diet

Patients whose Crohn’s disease is well controlled in regards to inflammation but who are still suffering from irritable bowel symptoms may benefit from the low-FODMAP diet. (That stands for fermentable oligo-, di-, monosaccharides, and -polyols.) Primarily promoted for IBS, this diet aims to exclude short-chain carbohydrates, or sugars, that are poorly absorbed by the small intestine. Foods that are restricted, or avoided, on this diet initially include wheat, dairy, certain fruits like apples, and veggies such as artichokes and asparagus.

“If people have significant pain and bloating, and nothing else is working, then perhaps I might try the FODMAP elimination diet,” says Dr. Jean Fox, gastroenterologist at Mayo Clinic in Rochester, Minn. But generally she has patients follow the approach under the supervision of a dietitian, so they don’t continue the restrictive phase for more than six weeks.

Following that, in the reintroduction phase, foods are slowly reintroduced over six to eight weeks, to see which might be causing trouble. After identifying which might cause symptoms, those foods can be avoided or restricted. The downside, says Fox, is that patients who don’t see any symptom relief following this diet may be unnecessarily restricting a wide range of foods.

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Whole Grain Benefits

For the 55-and-over crowd, March 27-April 3, 2022 | Local News

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For information about services available to older adults, contact Pam Jacobsen, director of the Retired and Senior Volunteer Program and Helen Mary Stevick Senior Citizens Center, 2102 Windsor Place, C, at 217-359-6500.

RSVP and the Stevick Center are administered by Family Service of Champaign County.

ANNOUNCEMENTS

  • Active Senior Republicans in Champaign County’s monthly meeting will be held at 9:30 am on April 4 in the Robeson Pavilion Room A & B at the Champaign Public Library. This month’s speakers will be Jesse Reising, Regan Deering and Matt Hausman, Republican primary candidates for the newly redrawn 13th Congressional District.
  • Parkland Theater House needs four ushers each night for “The SpongeBob Musical,” opening April 14. There will be nine shows in total — April 14-16, April 22-24 and April 29-May 1. For details, call or email Michael Atherton, Parkland Theater House Manager, theatre@parkland.edu or 217-373-3874.
  • Parkland College also needs four volunteers for commencement. The commencement ceremony will be in person at Krannert Center for the Performing Arts at 8 pm May 12. Volunteers needed from 6:30 to 8 pm For details, contact Tracy Kleparski, Director of Student Life, at TKleparski@parkland.edu or 217- 351-2206.
  • The Milford High School National Honor Society and Student Council is hosting a Senior Citizens Banquet at 6 pm April 22. The event will be held in the MAPS #124 Gymnasium (park at south doors at Milford High School. To RSVP, call Sandy Potter at 815-471-4213.

STEVICK CENTER ACTIVITIES

Knit or crochet for those in need:

Meditative Movement with Yoga:

  • 9 to 10:15 am Tuesdays and Thursdays.

Bingo:

  • 11 am to noon, second and fourth Tuesdays. Call 217-359-6500.

Bridge:

  • Noon to 3 pm Thursdays.

Euchar:

Card game 13:

  • To sign up to play, call 217-359-6500 and ask for Debbie.

Men’s group:

  • 9 am Monday-Friday. Join us for a cup of coffee and great conversation.

HOT LUNCH PROGRAM

The Peace Meal Nutrition Program provides daily hot lunches at 11:30 am for a small donation and a one-day advance reservation at sites in Champaign, Urbana, Rantoul, Sidney (home delivery only), Mahomet (home delivery only) and Homer.

For reservations, call 800-543-1770. Reservations for Monday need to be made by noon Friday.

NOTE: There is no change for home deliveries, but at congregate sites, you can get a carry-out meal.

Sunday:

  • BBQ pork sandwich, mini potato bakers, corn, creamy cole slaw, bun.

Tuesday:

  • Turkey pot roast with carrots and celery, Italian green beans, pineapple, whole grain roll.

Tuesday:

  • Savory sausage stew, broccoli, chunky apple sauce, biscuit, surprise dessert.

Tuesday:

  • Meatloaf, mashed potatoes and brown gravy, tomatoes and zucchini, apricots, whole-grain roll.

Friday:

  • Chef’s choice — regional favorites will be served.

VOLUNTEER OPPORTUNITIES

If you are 55 and older and want to volunteer in your community, RSVP (funded by AmeriCorps Seniors and the Illinois Department on Aging) provides a unique link to local nonprofits needing help. We offer support, benefits and a safe connection to partner sites.

Contact Pam Jacobsen at rsvpchampaign@gmail.com or 217-359-6500.

CURRENT NEEDS

Senior Volunteers.

  • RSVP of Champaign, Douglas and Piatt counties/AmeriCorps Senior Volunteers is your link to over 100 nonprofit organizations. Please contact Pam Jacobsen at rsvpchampaign@gmail.com or call 217-359-6500 for volunteer information.

Food for seniors. Handlers needed to unload boxes of food for repackaging at 7 am on the second and fourth Tuesdays of the month. We are looking for backup delivery drivers to deliver food to seniors. Contact Robbie Edwards at 217-359-6500 for info.

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The future of nutrition advice

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By Lisa Drayer, CNN

(CNN) — Most of us know we should eat more fruits, vegetables and whole grains.

So why would the National Institutes of Health spend $150 million to answer questions such as “What and when should we eat?” and “How can we improve the use of food as medicine?”

The answer may be precision nutrition, which aims to understand the health effects of the complex interplay among genetics, our microbiome (the bacteria living in our gut), our diet and level of physical activity, and other social and behavioral characteristics.

That means that everyone could have their own unique set of nutritional requirements.

How is that possible? I asked three experts who conduct precision nutrition research: Dr. Frank Hu, professor of nutrition and epidemiology and chair of the Department of Nutrition at the Harvard TH Chan School of Public Health, and Martha Field and Angela Poole, both assistant professors in the division of nutritional sciences at Cornell University’s College of Human Ecology.

Below is an edited version of our conversation.

CNN: How is precision nutrition different from current nutrition advice?

dr Frank Hu: The idea of ​​precision nutrition is to have the right food, at the right amount, for the right person. Instead of providing general dietary recommendations for everyone, this precision approach tailors nutrition recommendations to individual characteristics, including one’s genetic background, microbiome, social and environmental factors, and more. This can help achieve better health outcomes.

CNN: Why is there no one-size-fits-all prescription when it comes to what we should be eating?

Huh: Not everyone responds to the same diet in the same way. For example, given the same weight-loss diet, some people can lose a lot of weight; other people may gain weight. A recent study in JAMA randomized a few hundred overweight individuals to a healthy low-carb or low-fat diet. After a year, there was almost an identical amount of weight loss for the two groups, but there was a huge variation between individuals within each group — some lost 20 pounds. Others gained 10 pounds.

Martha Field: Individuals have unique responses to diet, and the “fine adjust” of precision nutrition is understanding those responses. This means understanding interactions among genetics, individual differences in metabolism, and responses to exercise.

CNN: How do we eat based on precision nutrition principles now?

Huh: There are some examples of personalized diets for disease management, like a gluten-free diet for the management of celiac disease, or a lactose-free diet if you are lactose intolerant. For individuals with a condition known as PKU (phenylketonuria), they should consume (a) phenylalanine-free diet. It’s a rare condition but a classic example of how your genes can influence what type of diets you should consume.

Angela Poole: If I had a family history of high cholesterol, diabetes or colon cancer, I would increase my dietary fiber intake, eating a lot of different sources, including a variety of vegetables.

fields: If you have high blood pressure, you should be more conscious of sodium intake. Anyone with a malabsorption issue might have a need for higher levels of micronutrients such as B vitamins and some minerals.

CNN: There is research showing that people metabolize coffee differently. What are the implications here?

Huh: Some people carry fast caffeine-metabolizing genes; others carry slow genes. If you carry fast (metabolizing) genotypes, you can drink a lot of caffeinated coffee because caffeine is broken down quickly. If you are a slow metabolizer, you get jittery and may not be able to sleep if you drink coffee in the afternoon. If that’s the case, you can drink decaf coffee and still get the benefits of coffee’s polyphenols, which are associated with decreased risk of heart disease and diabetes without the effects of caffeine.

CNN: How much of a role do our individual genes play in our risk of disease? And can our behavior mitigate our disease risk?

Huh: Our health is affected by both genes and diets, which constantly interact with each other because certain dietary factors can turn on or off some disease-related genes. We published research showing that reducing consumption of sugary beverages can offset the negative effects of obesity genes. That’s really good news. Our genes are not our destiny.

Another area of ​​precision nutrition is to measure blood or urine metabolites, small molecules produced during the breakdown and ingestion of food. For example, having a higher concentration of branched-chain amino acids (BCAAs) strongly predicts one’s future risk of diabetes and cardiovascular disease. The blood levels of BCAAs depend on individuals’ diet, genes and gut microbiome. We found that eating a healthy (Mediterranean-style) diet can mitigate harmful effects of BCAAs on cardiovascular disease. So measuring BCAAs in your blood may help to evaluate your risk of developing diabetes and cardiovascular disease and encourage dietary changes that can lower the risk of chronic diseases down the road.

fields: The environmental effects can sometimes be on the same magnitude as the genetic effects with respect to risk for disease.

CNN: Our individual microbiomes may be able to dictate what type of diet we should be consuming. Can you tell us about this emerging research? And what do you think of microbiome tests?

Poole: Research has shown that in some people, their blood sugar will spike higher from eating bananas than from eating cookies, and this has been associated with microbiome composition. Scientists have used microbiome data to build algorithms that can predict an individual’s glucose response, and this is a major advance. But that’s not an excuse for me to shovel down cookies instead of bananas. Likewise, if the algorithm suggests eating white bread instead of whole-wheat bread due to blood glucose responses, I wouldn’t just eat white bread all the time.

At the moment, I’m not ready to spend a lot of money to see what’s in my gut microbiome… and the microbiome changes over time.

Huh: Microbiome tests are not cheap, and the promise that this test can help develop a personalized meal plan that can improve blood sugar and blood cholesterol … at this point, the data are not conclusive.

CNN: How will nutrition advice be different 10 years from now?

Poole: I think you will receive a custom-tailored grocery list on an app — foods that you want to buy and foods that you want to avoid, based on your blood sugar responses to foods, your level of physical activity and more.

Huh: We will have more and better biomarkers and more affordable and accurate nutrigenomics and microbiome tests as well as better computer algorithms that predict your response to food intakes.

But these technologies cannot substitute general nutrition principles such as limiting sodium and added sugar and eating more healthy plant foods. In a few years, you may be able to get a more useful response from Alexa if you ask her what you should eat — but like other answers from Alexa, you’ll have to take it with a grain of salt.

The CNN Wire
™ & © 2022 Cable News Network, Inc., a WarnerMedia Company. All rights reserved.

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Are Peanut Butter and Jelly Sandwiches Healthy?

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In order to assess its nutritional value, first we must discuss the breakdown of this sandwich.

Typically, there are three main ingredients — bread, peanut butter, and jelly — each with different nutritional values.

Nutritional value of bread

Bread can be a part of a balanced diet. The nutritional value of bread depends on the type chosen.

For starters, whole-grain bread is the best option because it provides a higher amount of nutrients. Whole grain kernels have three parts: the bran, endosperm, and germ (1).

Because whole grain bread retains all three parts, it’s higher in protein and fiber compared with other breads. These nutrients slow the absorption of sugar into your blood stream and keep you full longer (2, 3).

Whole grain bread is also richer in key nutrients, like B vitamins, iron, folate, and magnesium. Look for the word “whole” as part of the first ingredient in bread’s nutritional label (2).

Choosing sprouted grain bread, like Ezekiel bread, is also an excellent choice. The sprouting process increases digestibility and bioavailability of nutrients. Studies show sprouted bread has more fiber, vitamin E, and vitamin C, and beta-glucan (4).

Sourdough bread is fine, too. Although it’s not as high in fiber and protein, it has a lower glycemic index than white bread.

Glycemic index measures how quickly food increases blood sugars. In general, foods with a lower glycemic index better support your overall health.

But keep in mind that glycemic index doesn’t tell the whole story. We must look at the meal as a whole — for example, what we add to the bread. Nutrients, like protein and fats, can help lower the overall glycemic load of a meal, and serving sizes also play a role (5).

As a guideline, look for whole grain breads that offer at least 2 grams of fiber per slice. We also suggest using bread that contains 3 grams of protein or more per slice.

If that’s not available, sourdough bread may be your next best option.

Summary

Choose breads that are higher in fiber and protein, like whole grain bread or sprouted grain bread. These varieties help slow absorption of sugars and keep you full longer.

Nutritional value of peanut butter

Many people find peanut butter delicious.

Nutritionally, it also delivers. Peanut butter is a good source of protein and healthy fats, important for all stages of life, especially growing children. Plus, it’s a good source of fiber.

Two tablespoons (32 grams) of smooth peanut butter contain 7 grams of protein, 16 grams of fats, and 2 grams of fiber (6).

Importantly, the majority of fats in peanut butter are unsaturated fats. Research consistently indicates that replacing saturated fats found in animal products with more unsaturated fats (like those in peanut butter) may lower cholesterol and improve heart health (7, 8).

For growing kids, healthy fats are vital for healthy development. Plus, fats help absorb the vitamins A, D, E, and K, all of which play a synergistic role in supporting immune and brain health (9, 10).

Contrary to popular belief, conventional peanut butter doesn’t usually have more sugar than 100% natural peanut butter. However, it may have more salt (6).

When shopping, check the nutrition labels to ensure it doesn’t contain additional ingredients other than peanuts.

When enjoying natural peanut butter, the oil will separate from the peanut butter. Not to fret — just give it a good stir! This helps mix the oils with the solids.

Pro tip: You can store peanut butter upside down in the fridge to keep it from separating again!

Summary

When available, choose 100% natural peanut butter, as it’s lower in salt. Remember to stir the peanut butter before eating to mix the oils with the solids.

Nutritional value of jelly

The PB&J sandwich isn’t complete without jelly or jam. What’s the difference, anyway?

Well, while jellies and jams have similar nutritional value and taste, there’s a slight difference: Jellies are made with fruit juice, while jam is made with the fruit juice and pulp (7).

Both jellies and jams contain pectin (artificially added to jelly), which has prebiotic effects that may improve gut health (8).

However, both are naturally high in sugar, so enjoy them in moderation. To have more say in the ingredients used, you can try making your jelly at home.

If you’re buying from a store, look for jellies with no added sugar in the ingredients list. Alternative names for added sugars include glucose, sucrose, dextrose, and fructose.

Summary

Jellies are high in natural sugars and contain pectins that may have a beneficial effect in promoting good health. Try to choose jellies with no added sugars.

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