Вы находитесь на странице: 1из 12

Crohn’s and Colitis Foundation of Canada

NATIONAL OFFICE

600 - 60 St. Clair Avenue East


Toronto, Ontario M4T 1N5
Telephone: (416) 920-5035 or 1-800-387-1479
Fax: (416) 929-0364
Web site: www.ccfc.ca E-mail Address: ccfc@ccfc.ca

REGIONAL OFFICES

British Columbia/Yukon
Telephone: (604) 685-1844
Alberta/Northwest Territories/Nunavut
Telephone: (403) 569-8477
Nutrition, diet
Manitoba/Saskatchewan
Telephone: (204) 231-2115
Ontario
Telephone: (416) 920-5055 and
Québec Maritime
Telephone: (514) 342-0666 Telephone: (902) 422-8137
INFLAMMATORY
Newfoundland/Labrador
Telephone: (709) 579-3700

BOWEL
LOCAL INFORMATION

DISEASE

SPONSORS
PLATINUM

SILVER

Copyright © 2001 by Crohn’s and Colitis Foundation of Canada. Reprint 10/01


What is Inflammatory Bowel Disease? Together, We Can Find the Cure
Inflammatory bowel disease (IBD) is a term used to describe two similar, yet distinct
conditions: Crohn’s disease and ulcerative colitis. IBD is also known by other names
The Crohn’s and Colitis Foundation of Canada (CCFC) is a not-for-profit voluntary
including: Crohn’s colitis, ileitis, distal colitis and pancolitis. These diseases affect the
digestive system and cause the intestines to become inflamed, form sores (ulcers), medical research foundation. Our mission: To find the cure for Crohn’s disease and
bleed easily, scar and lose the normal smoothness of their inner lining. Symptoms of ulcerative colitis. To realize this, the CCFC is committed, first and foremost, to raising
IBD include abdominal pain, cramping, fatigue, diarrhea, fever and joint pain. funds for medical research. The CCFC also believes it is important to make all people
Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to with inflammatory bowel disease aware of the Foundation, and to educate these
the anus. Patches of inflammation occur, with healthy tissue between diseased areas; individuals, their families, health professionals and the public about these diseases.
these are called “skip lesions”. The inflammation can extend through every layer of
affected bowel tissue. Crohn’s disease cannot be cured by drugs or surgery, although
either or both can relieve the symptoms.
YES! I support the search for the cure for IBD.
Here is my tax-deductible donation right now for:
Ulcerative colitis affects only the colon (large bowel), and only a single layer of
bowel tissue: the inner lining. The disease almost always starts in the portion of the ❏ $35 ❏ $50 ❏ $100 ❏ Other: $
colon called the rectum, and may extend as a continuous (not patchy) inflammation
from there into the rest of the colon. Usually, ulcerative colitis can be controlled with I prefer to contribute by: ❏ Cheque ❏ MasterCard
medication. The disease can be completely eliminated by surgically removing the
colon, but afterward, waste material (stool) may have to be stored and expelled ❏ VISA ❏ AMEX
through an external appliance (bag).
Card Number: Expiry Date:
No one knows what causes IBD. It affects people regardless of race, gender or age. People
are most frequently diagnosed between the ages of 15 to 25 years, or 45 to 55 years.
My Signature:
IBD is unpredictable. Many people experience “flare-ups” (attacks) and then the
disease seemingly goes away. The quiet periods are called “remission” and can vary in
Name:
length from weeks to years. Most people will “relapse” and have multiple attacks. IBD
symptoms may also vary in severity. Some people have mild symptoms and can be
treated with a combination of drugs and nutritional therapy, while others experience Address:
debilitating symptoms and need to take potent drugs, visit hospital frequently, and/
or have surgery. Postal Code: Telephone:
See the CCFC brochure “The Facts about Inflammatory Bowel Disease” for more information.
Please send me details about:
Which Parts of the Body are Involved? ❏ contributing monthly to the search for the cure
The Digestive System: Food passes from the mouth (the Dedicated Research Donor program)
down the esophagus (swallowing tube) into the
stomach, which dilutes and mixes the food and Esophagus
❏ volunteering my time and skills to the Foundation
passes it on to the small bowel (small intestine).
The small intestine breaks down the food. Each Stomach ❏ including the CCFC in my will
part of the small intestine (which is some six
metres long and includes the duodenum, Duodenum Large
❏ membership in the CCFC
jejunum and ileum) absorbs different nutrients. intestine
(colon)
Leftover material passes into the large Small (large ❏ Je désire recevoir la documentation en français.
intestine (also called the colon and is about intestine bowel)
(small
1.5 metres long), which absorbs water and bowel) Jejunum
forms stool. Solid stool is passed to the rectum
Ileum Please make cheques payable to: The Crohn’s and Colitis Foundation of Canada.
and eliminated through the anus. (lower
part Send your cheque and this form to the CCFC National Office, 600 - 60 St. Clair
This brochure is provided for information only. Cecum
of small Avenue East, Toronto, Ontario M4T 1N5. For more information on activities in
A doctor should always be consulted for advice intestine)
Appendix Rectum your area, contact your Regional Office listed on the next page.
and medical treatment. Anus
Registered Charity # 11883 1486 RR0001
OUR MISSION: FIND THE CURE. YOU CAN HELP. CALL US.
CROHN’S AND COLITIS FOUNDATION OF CANADA
416-920-5035 or 1-800-387-1479
A Nutrition Checklist Nutrition and Inflammatory Bowel Disease
Here is a checklist of the factors that affect nutritional requirements. While good nutrition is universally important, it’s even more so for people
Answering “yes” to any question could indicate a need to improve or with IBD. That’s because the better-nourished they are, the better their
supplement one’s diet. A doctor or dietitian should be consulted. bodies will respond to the treatment of IBD.
Food is the ‘fuel’ of the body. The digestive system processes that fuel.
People with IBD tend to eat less during periods of pain. Additionally when
MEDICAL CHECKLIST YES NO
IBD is active, the digestive process is interrupted and nutrients are not
Has there been a loss of more than 10 per cent of absorbed effectively. Malnutrition may result.
usual weight within the past six months? ❏ ❏ People with IBD must be on guard for malnutrition which can happen very
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

easily. People who are malnourished lose weight, lack energy, can become
For children and adolescents: deficient in proteins and essential vitamins and minerals, and are more
Is growth slower than others of the same age? ❏ ❏ susceptible to other illnesses.
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Have I had multiple intestinal resections? ❏ ❏ Malnutrition can also be caused by malabsorption; the digestive tract’s
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
reduced ability to absorb all the nutrients offered to it.
Do I vomit frequently? ❏ ❏ Malabsorption may happen in IBD when:
• nutrients are lost through bleeding and diarrhea
DIET CHECKLIST • medications taken for IBD interact adversely with nutrients
Is the diet being limited in any way that may result in • part of the intestine is surgically removed (that is, there is less absorptive
missing nutrients and energy? ❏ ❏ tissue to process the nutrients in food).
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Is fibre being avoided? ❏ ❏ A healthy diet is a key component in the treatment of IBD. It’s important
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
that people with IBD consult their health-care team (doctor, dietitian,
Are milk or milk products being avoided? ❏ ❏ gastroenterologist, and others) about the treatment program that is most
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
appropriate for their circumstances. Treatment of IBD may include diet,
Is a non-prescribed diet being followed? ❏ ❏ nutritional supplements, medication and possibly surgery. The health-care
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
team’s recommendations will be based on the severity of the disease.
Are meals or snacks being skipped, or is food consumption
When symptoms are mild, a normal healthy diet and regular visits to the
less than usual? ❏ ❏ health-care team may be advised. When symptoms are moderate, the person
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

may be advised to change the diet slightly, and to eat certain foods while
Are caffeine, alcohol, sugar or fat being substituted
avoiding others. Nutritional supplements may be recommended to reduce
for more balanced foods? ❏ ❏ symptoms or compensate for weight loss. When symptoms are severe, the
person may be advised to consider taking additional nutritional formulas —
again, in combination with other therapies — to restore the balance of
nutrients, help prevent weight loss, give the bowel a chance to rest, and
possibly relieve pain.
In extreme cases, some people are unable to eat at all. When this happens,
nutrition can be given using a nasogastric tube passed through the nostril
and into the stomach, or a feeding tube that is connected directly to the
stomach through a fitting in the abdomen. An alternative is total parenteral
nutrition (TPN), in which nutrition is administered intravenously.

8 1
The Nutrients You Need: Vitamin B12 injections may be prescribed for people with Crohn’s disease
who have had surgery to remove the ileum, which is the lower part of the
Carbohydrates, Proteins and Fat small intestine. Since the ileum absorbs Vitamin B12 and bile salts, removal
of more than one metre of ileum results in the need to give Vitamin B12 by
The health-care team will recommend a balanced diet of foods from all food
injection in order to avoid a deficiency. A test can determine if there is
groups (grains, dairy, fruits and vegetables, meat and alternatives) to ensure
malabsorption of Vitamin B12.
an adequate supply of carbohydrates, proteins and fats. Together, they
provide the nutrients the body needs each day to grow, generate sufficient Total parenteral nutrition (TPN) means nutrients are delivered through
energy, repair damage and fight illness. intravenous injection for people who are too ill to eat. This could be due to
extensive surgical removal of the small intestines, intestinal blockage
Carbohydrates should supply half of the day’s energy. The two forms of
(usually correctible by surgery) or inability to tolerate oral or tube feedings.
carbohydrates are complex carbohydrates (starch and fibre) and simple
TPN is administered in a hospital but if the problem is irreversible or lasts a
sugars. Complex carbohydrates come from whole-grain breads, cereals,
long time, patients are taught to self-administer TPN at home.
pasta, rice, legumes (dried beans, peas, lentils), fruits and vegetables.
Simple sugars come from sugar, honey, syrup, jam or jelly, candies, soft
drinks, pastries and pies, cakes and cookies, and the natural sugars in milk
and fruits or fruit juices.
Simple sugars pose particular problems for those with IBD. Too much simple
sugar can cause (or increase) diarrhea. That’s because simple sugars cause
more fluid to be drawn into the intestine, so food passes
People with IBD through quickly. Diarrhea can be somewhat controlled by
are prone to limiting the consumption of concentrated sweets and
losing protein desserts, soft drinks and undiluted fruit juices, and dried
from severe fruits or high-sugar fruits such as grapes, pineapple and
diarrhea. Some watermelon. About 30 per cent of the general population
signs of protein can not tolerate sorbitol - a sugar found in fruits such as
deficiency plums, pears, peaches and grapes. These individuals may
include fatigue, find these fruits especially likely to cause diarrhea.
brittle nails and
dull, dry hair. Proteins build and repair every cell in the body, and are
especially important to growing children and to people
who are ill or have had surgery. Proteins help wounds heal
faster, repair the lining of the digestive tract, and help the tract produce the
enzymes that digest food and absorb nutrients. Foods that supply proteins
include meat, poultry, fish, eggs, milk products, legumes (dried beans, peas,
lentils) and tofu.
People with IBD are prone to losing protein from severe diarrhea. Some
signs of protein deficiency include fatigue, brittle nails and dull, dry hair.
Fat, the most concentrated source of energy, insulates the body and protects
vital organs. People who are underweight may be advised to include more
high-fat foods in a healthy, balanced diet. Fish (in particular, cold-water
fish, such as tuna, salmon, bluefish, mackerel and shellfish), is high in both
fat and protein, and is easy to digest.

2 7
Drinking alcohol may not be advisable for people with IBD. It may combine Other foods that supply fat include butter, margarine, vegetable oils, sauces
with some medications to cause adverse side effects, and alcohol on its own and gravies, meat and poultry, dairy products, baked and fried foods and
may trigger diarrhea and indigestion. Alcohol may also promote the loss of some processed snack foods.
important nutrients, such as folic acid and calcium. Alcohol is less likely to
Fat can be problematic for people who have had diseased portions of the
be a problem if it is taken with meals. The health-care team can advise if
small bowel removed (resected). They have less fat-absorbing tissue as a
alcohol poses any problems in specific circumstances.
result of surgery, and are susceptible to diarrhea and fat malabsorption. To
The caffeine found in coffee, tea, chocolate and soft drinks may irritate the control this, the health-care team may recommend a low-fat diet. This
digestive tract. It seems to be less a problem when part of a larger meal. means cooking meals using little or no fat, and avoiding fried and battered
foods. Other high-fat foods to avoid include commercially-baked products,
convenience foods (such as cookies and crackers) and fast foods.
Dietary Supplements
Vitamin and mineral supplements are no substitute for the energy generated
by real food. However, a person with IBD may be advised by their doctor to How a Poor Diet Affects the Body
take vitamin supplements and other nutritional products. This may compen-
sate for an inadequate diet; give the bowel a “rest;” or replace lost nutrients
using natural means. Rather than concentrating on any one vitamin, it’s IF THIS HAPPENS... IT COULD BE CAUSED BY LACK OF
best to take a multi-vitamin supplement. This should be taken only under THESE NUTRIENTS/ELEMENTS.....
medical supervision.
Anemia
Elemental diets are liquid formulations which are most often prescribed for (shortage of red blood cells) Iron, vitamin B12 , folic acid
children (though adults may take them too) to encourage growth and ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

development. They are elemental because the proteins, fats and carbohy-
Bleeding, bruising Vitamin K
drates are pre-digested. That gives the bowel a chance to “rest” and heal,
helping to reduce disease activity and the need for drug therapy. Elemental ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

diets can be prescribed for people with Crohn’s disease for several weeks at Bloating, diarrhea, gas Maldigestion of carbohydrates
a time, while their disease is active. The diets are not prescribed for ulcera- and fat
tive colitis because that disease affects only the colon, not the nutrient- ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

absorbing small bowel.


Bone fracture and pain Protein, vitamin D, calcium
Elemental diets are not very appetizing, so they have to be administered ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

through a feeding tube. The tube is passed through the nostril and into the
mouth, or it may be inserted through an opening in the abdomen directly Delayed growth Calories, malabsorbed proteins,
into the stomach. The diet is pumped into the stomach while the person fats, carbohydrates
rests, and the pump is disconnected when the person is active with work or ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

school. Tube feeding may sound frightening but can be very effective in Interruption of menstrual periods Calories, protein, iron
restoring and maintaining a good level of nutrition. It is commonly pre-
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

scribed for pre-teenage children to encourage growth.


Lip and mouth sores Iron, B-vitamins
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Muscle spasms Electrolytes (especially calcium/


magnesium)
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Muscle wasting Calories and malabsorption of


proteins, fats, carbohydrates
6 3
Fibre in the Diet Can Prevent Diarrhea It’s Not Okay to Just Stop Eating
Fibre keeps the lining of the digestive tract healthy. Fibre is found in cereals, People with IBD sometimes think they need a change in diet. They may feel
fruits and vegetables, legumes (dried beans, peas and lentils), nuts and seeds, too sick to eat, or are interested in trying a special diet plan, or believe their
and whole grain breads. bowel “needs a rest”. Whatever the reason for changing eating habits, it’s
important to get advice from the health-care team. The team is well
Water-soluble fibre helps lower blood cholesterol and maintains healthy
acquainted with their patient’s individual circumstances and can help make
blood sugar. Some types of water-soluble fibre control diarrhea by giving
the decisions that are right for each person’s unique needs.
more formation to stool. Water-soluble fibre is derived from fruit such as
apples, grapefruit, oranges, and plums; from vegetables and legumes such as
carrots, kidney beans, lentils, potatoes, soy beans, split peas and squash; and
from grains such as barley, oat bran, oatmeal and psyllium seed. Common Problems
Insoluble fibre, or roughage, stimulates bowel movements and makes a Some people with IBD feel “full” easily, or have pain or inflammation. They
bigger, bulkier stool. Insoluble fibre comes from cereals including bran may find it helpful to eat more frequent, but smaller-portioned meals.
cereals, unprocessed bran, whole-grain bread or whole-grain cereal; brown Between meals, nutritional supplements can improve low energy levels and
rice, baked potatoes (including the skin); and fruits such as apples (with supply needed nutrients. Meals should not be missed.
skin), blueberries, raisins, raspberries, and strawberries.
People with Crohn’s disease of the small bowel may develop strictures. A
stricture is a narrowing of the small intestine which makes it difficult for
food – particularly fibrous food such as nuts, seeds and some fruits and
vegetables — to pass through. Patients may experience cramps as a result
and may need to avoid these foods. Patients should speak with their doctors
Medication for IBD Can Affect Nutrition and dietitians before undertaking any dietary changes or restrictions.
Gas and bloating, common symptoms in IBD, can be embarrassing. One
DRUG WHAT MIGHT HAPPEN
solution is to simply reduce the intake of foods that encourage gas to form.
Some of them might be: cabbage, cooked dried beans, peas and lentils,
Pain killers, Constipation due to slowing of the onions, high-fibre fruits and vegetables, sweets, and certain whole grains,
tranquillizers digestive process milk products and yeast products. Tips that may help include: eating slowly;
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

avoiding stress; cutting down on fats if they seem to encourage bloating.


Sulfasalazine Interferes with absorption of folic acid Ingesting air (by gulping food, drinking through a straw, or consuming
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

carbonated beverages) should also be avoided. Commercial products that


Cholestyramine Interferes with absorption of vitamins A, D, E, K contain an enzyme to reduce gas are also available. In some people, bloating
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
may be due to constipation. Cleaning out the bowel and avoiding constipa-
Corticosteroids Interferes with absorption of calcium, protein tion may reduce the passage of gas.
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Lactose intolerance is the inability to digest the sugar lactose, which is


Antibiotics Interferes with absorption of vitamin K, biotin found in milk products. Milk products are important in any diet, because
they contain minerals such as calcium, and vitamins such as A, D and folic
acid. People with lactose intolerance lack the specific enzyme called lactase
which digests lactose. However, many people who are lactose-intolerant
See the CCFC brochure “Medication for Inflammatory Bowel Disease” for
may digest milk products low in lactose: yoghurt with active cultures,
further description of these drugs.
cottage cheese and aged cheeses. Other solutions: take lactase tablets or milk
which has had the enzyme added; choose lactose-free products; take
calcium supplements or other alternate sources of calcium.

4 5
Fibre in the Diet Can Prevent Diarrhea It’s Not Okay to Just Stop Eating
Fibre keeps the lining of the digestive tract healthy. Fibre is found in cereals, People with IBD sometimes think they need a change in diet. They may feel
fruits and vegetables, legumes (dried beans, peas and lentils), nuts and seeds, too sick to eat, or are interested in trying a special diet plan, or believe their
and whole grain breads. bowel “needs a rest”. Whatever the reason for changing eating habits, it’s
important to get advice from the health-care team. The team is well
Water-soluble fibre helps lower blood cholesterol and maintains healthy
acquainted with their patient’s individual circumstances and can help make
blood sugar. Some types of water-soluble fibre control diarrhea by giving
the decisions that are right for each person’s unique needs.
more formation to stool. Water-soluble fibre is derived from fruit such as
apples, grapefruit, oranges, and plums; from vegetables and legumes such as
carrots, kidney beans, lentils, potatoes, soy beans, split peas and squash; and
from grains such as barley, oat bran, oatmeal and psyllium seed. Common Problems
Insoluble fibre, or roughage, stimulates bowel movements and makes a Some people with IBD feel “full” easily, or have pain or inflammation. They
bigger, bulkier stool. Insoluble fibre comes from cereals including bran may find it helpful to eat more frequent, but smaller-portioned meals.
cereals, unprocessed bran, whole-grain bread or whole-grain cereal; brown Between meals, nutritional supplements can improve low energy levels and
rice, baked potatoes (including the skin); and fruits such as apples (with supply needed nutrients. Meals should not be missed.
skin), blueberries, raisins, raspberries, and strawberries.
People with Crohn’s disease of the small bowel may develop strictures. A
stricture is a narrowing of the small intestine which makes it difficult for
food – particularly fibrous food such as nuts, seeds and some fruits and
vegetables — to pass through. Patients may experience cramps as a result
and may need to avoid these foods. Patients should speak with their doctors
Medication for IBD Can Affect Nutrition and dietitians before undertaking any dietary changes or restrictions.
Gas and bloating, common symptoms in IBD, can be embarrassing. One
DRUG WHAT MIGHT HAPPEN
solution is to simply reduce the intake of foods that encourage gas to form.
Some of them might be: cabbage, cooked dried beans, peas and lentils,
Pain killers, Constipation due to slowing of the onions, high-fibre fruits and vegetables, sweets, and certain whole grains,
tranquillizers digestive process milk products and yeast products. Tips that may help include: eating slowly;
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

avoiding stress; cutting down on fats if they seem to encourage bloating.


Sulfasalazine Interferes with absorption of folic acid Ingesting air (by gulping food, drinking through a straw, or consuming
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

carbonated beverages) should also be avoided. Commercial products that


Cholestyramine Interferes with absorption of vitamins A, D, E, K contain an enzyme to reduce gas are also available. In some people, bloating
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
may be due to constipation. Cleaning out the bowel and avoiding constipa-
Corticosteroids Interferes with absorption of calcium, protein tion may reduce the passage of gas.
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Lactose intolerance is the inability to digest the sugar lactose, which is


Antibiotics Interferes with absorption of vitamin K, biotin found in milk products. Milk products are important in any diet, because
they contain minerals such as calcium, and vitamins such as A, D and folic
acid. People with lactose intolerance lack the specific enzyme called lactase
which digests lactose. However, many people who are lactose-intolerant
See the CCFC brochure “Medication for Inflammatory Bowel Disease” for
may digest milk products low in lactose: yoghurt with active cultures,
further description of these drugs.
cottage cheese and aged cheeses. Other solutions: take lactase tablets or milk
which has had the enzyme added; choose lactose-free products; take
calcium supplements or other alternate sources of calcium.

4 5
Drinking alcohol may not be advisable for people with IBD. It may combine Other foods that supply fat include butter, margarine, vegetable oils, sauces
with some medications to cause adverse side effects, and alcohol on its own and gravies, meat and poultry, dairy products, baked and fried foods and
may trigger diarrhea and indigestion. Alcohol may also promote the loss of some processed snack foods.
important nutrients, such as folic acid and calcium. Alcohol is less likely to
Fat can be problematic for people who have had diseased portions of the
be a problem if it is taken with meals. The health-care team can advise if
small bowel removed (resected). They have less fat-absorbing tissue as a
alcohol poses any problems in specific circumstances.
result of surgery, and are susceptible to diarrhea and fat malabsorption. To
The caffeine found in coffee, tea, chocolate and soft drinks may irritate the control this, the health-care team may recommend a low-fat diet. This
digestive tract. It seems to be less a problem when part of a larger meal. means cooking meals using little or no fat, and avoiding fried and battered
foods. Other high-fat foods to avoid include commercially-baked products,
convenience foods (such as cookies and crackers) and fast foods.
Dietary Supplements
Vitamin and mineral supplements are no substitute for the energy generated
by real food. However, a person with IBD may be advised by their doctor to How a Poor Diet Affects the Body
take vitamin supplements and other nutritional products. This may compen-
sate for an inadequate diet; give the bowel a “rest;” or replace lost nutrients
using natural means. Rather than concentrating on any one vitamin, it’s IF THIS HAPPENS... IT COULD BE CAUSED BY LACK OF
best to take a multi-vitamin supplement. This should be taken only under THESE NUTRIENTS/ELEMENTS.....
medical supervision.
Anemia
Elemental diets are liquid formulations which are most often prescribed for (shortage of red blood cells) Iron, vitamin B12 , folic acid
children (though adults may take them too) to encourage growth and ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

development. They are elemental because the proteins, fats and carbohy-
Bleeding, bruising Vitamin K
drates are pre-digested. That gives the bowel a chance to “rest” and heal,
helping to reduce disease activity and the need for drug therapy. Elemental ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

diets can be prescribed for people with Crohn’s disease for several weeks at Bloating, diarrhea, gas Maldigestion of carbohydrates
a time, while their disease is active. The diets are not prescribed for ulcera- and fat
tive colitis because that disease affects only the colon, not the nutrient- ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

absorbing small bowel.


Bone fracture and pain Protein, vitamin D, calcium
Elemental diets are not very appetizing, so they have to be administered ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

through a feeding tube. The tube is passed through the nostril and into the
mouth, or it may be inserted through an opening in the abdomen directly Delayed growth Calories, malabsorbed proteins,
into the stomach. The diet is pumped into the stomach while the person fats, carbohydrates
rests, and the pump is disconnected when the person is active with work or ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

school. Tube feeding may sound frightening but can be very effective in Interruption of menstrual periods Calories, protein, iron
restoring and maintaining a good level of nutrition. It is commonly pre-
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

scribed for pre-teenage children to encourage growth.


Lip and mouth sores Iron, B-vitamins
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Muscle spasms Electrolytes (especially calcium/


magnesium)
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Muscle wasting Calories and malabsorption of


proteins, fats, carbohydrates
6 3
The Nutrients You Need: Vitamin B12 injections may be prescribed for people with Crohn’s disease
who have had surgery to remove the ileum, which is the lower part of the
Carbohydrates, Proteins and Fat small intestine. Since the ileum absorbs Vitamin B12 and bile salts, removal
of more than one metre of ileum results in the need to give Vitamin B12 by
The health-care team will recommend a balanced diet of foods from all food
injection in order to avoid a deficiency. A test can determine if there is
groups (grains, dairy, fruits and vegetables, meat and alternatives) to ensure
malabsorption of Vitamin B12.
an adequate supply of carbohydrates, proteins and fats. Together, they
provide the nutrients the body needs each day to grow, generate sufficient Total parenteral nutrition (TPN) means nutrients are delivered through
energy, repair damage and fight illness. intravenous injection for people who are too ill to eat. This could be due to
extensive surgical removal of the small intestines, intestinal blockage
Carbohydrates should supply half of the day’s energy. The two forms of
(usually correctible by surgery) or inability to tolerate oral or tube feedings.
carbohydrates are complex carbohydrates (starch and fibre) and simple
TPN is administered in a hospital but if the problem is irreversible or lasts a
sugars. Complex carbohydrates come from whole-grain breads, cereals,
long time, patients are taught to self-administer TPN at home.
pasta, rice, legumes (dried beans, peas, lentils), fruits and vegetables.
Simple sugars come from sugar, honey, syrup, jam or jelly, candies, soft
drinks, pastries and pies, cakes and cookies, and the natural sugars in milk
and fruits or fruit juices.
Simple sugars pose particular problems for those with IBD. Too much simple
sugar can cause (or increase) diarrhea. That’s because simple sugars cause
more fluid to be drawn into the intestine, so food passes
People with IBD through quickly. Diarrhea can be somewhat controlled by
are prone to limiting the consumption of concentrated sweets and
losing protein desserts, soft drinks and undiluted fruit juices, and dried
from severe fruits or high-sugar fruits such as grapes, pineapple and
diarrhea. Some watermelon. About 30 per cent of the general population
signs of protein can not tolerate sorbitol - a sugar found in fruits such as
deficiency plums, pears, peaches and grapes. These individuals may
include fatigue, find these fruits especially likely to cause diarrhea.
brittle nails and
dull, dry hair. Proteins build and repair every cell in the body, and are
especially important to growing children and to people
who are ill or have had surgery. Proteins help wounds heal
faster, repair the lining of the digestive tract, and help the tract produce the
enzymes that digest food and absorb nutrients. Foods that supply proteins
include meat, poultry, fish, eggs, milk products, legumes (dried beans, peas,
lentils) and tofu.
People with IBD are prone to losing protein from severe diarrhea. Some
signs of protein deficiency include fatigue, brittle nails and dull, dry hair.
Fat, the most concentrated source of energy, insulates the body and protects
vital organs. People who are underweight may be advised to include more
high-fat foods in a healthy, balanced diet. Fish (in particular, cold-water
fish, such as tuna, salmon, bluefish, mackerel and shellfish), is high in both
fat and protein, and is easy to digest.

2 7
A Nutrition Checklist Nutrition and Inflammatory Bowel Disease
Here is a checklist of the factors that affect nutritional requirements. While good nutrition is universally important, it’s even more so for people
Answering “yes” to any question could indicate a need to improve or with IBD. That’s because the better-nourished they are, the better their
supplement one’s diet. A doctor or dietitian should be consulted. bodies will respond to the treatment of IBD.
Food is the ‘fuel’ of the body. The digestive system processes that fuel.
People with IBD tend to eat less during periods of pain. Additionally when
MEDICAL CHECKLIST YES NO
IBD is active, the digestive process is interrupted and nutrients are not
Has there been a loss of more than 10 per cent of absorbed effectively. Malnutrition may result.
usual weight within the past six months? ❏ ❏ People with IBD must be on guard for malnutrition which can happen very
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

easily. People who are malnourished lose weight, lack energy, can become
For children and adolescents: deficient in proteins and essential vitamins and minerals, and are more
Is growth slower than others of the same age? ❏ ❏ susceptible to other illnesses.
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Have I had multiple intestinal resections? ❏ ❏ Malnutrition can also be caused by malabsorption; the digestive tract’s
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
reduced ability to absorb all the nutrients offered to it.
Do I vomit frequently? ❏ ❏ Malabsorption may happen in IBD when:
• nutrients are lost through bleeding and diarrhea
DIET CHECKLIST • medications taken for IBD interact adversely with nutrients
Is the diet being limited in any way that may result in • part of the intestine is surgically removed (that is, there is less absorptive
missing nutrients and energy? ❏ ❏ tissue to process the nutrients in food).
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

Is fibre being avoided? ❏ ❏ A healthy diet is a key component in the treatment of IBD. It’s important
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
that people with IBD consult their health-care team (doctor, dietitian,
Are milk or milk products being avoided? ❏ ❏ gastroenterologist, and others) about the treatment program that is most
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
appropriate for their circumstances. Treatment of IBD may include diet,
Is a non-prescribed diet being followed? ❏ ❏ nutritional supplements, medication and possibly surgery. The health-care
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○
team’s recommendations will be based on the severity of the disease.
Are meals or snacks being skipped, or is food consumption
When symptoms are mild, a normal healthy diet and regular visits to the
less than usual? ❏ ❏ health-care team may be advised. When symptoms are moderate, the person
○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○ ○

may be advised to change the diet slightly, and to eat certain foods while
Are caffeine, alcohol, sugar or fat being substituted
avoiding others. Nutritional supplements may be recommended to reduce
for more balanced foods? ❏ ❏ symptoms or compensate for weight loss. When symptoms are severe, the
person may be advised to consider taking additional nutritional formulas —
again, in combination with other therapies — to restore the balance of
nutrients, help prevent weight loss, give the bowel a chance to rest, and
possibly relieve pain.
In extreme cases, some people are unable to eat at all. When this happens,
nutrition can be given using a nasogastric tube passed through the nostril
and into the stomach, or a feeding tube that is connected directly to the
stomach through a fitting in the abdomen. An alternative is total parenteral
nutrition (TPN), in which nutrition is administered intravenously.

8 1
What is Inflammatory Bowel Disease? Together, We Can Find the Cure
Inflammatory bowel disease (IBD) is a term used to describe two similar, yet distinct
conditions: Crohn’s disease and ulcerative colitis. IBD is also known by other names
The Crohn’s and Colitis Foundation of Canada (CCFC) is a not-for-profit voluntary
including: Crohn’s colitis, ileitis, distal colitis and pancolitis. These diseases affect the
digestive system and cause the intestines to become inflamed, form sores (ulcers), medical research foundation. Our mission: To find the cure for Crohn’s disease and
bleed easily, scar and lose the normal smoothness of their inner lining. Symptoms of ulcerative colitis. To realize this, the CCFC is committed, first and foremost, to raising
IBD include abdominal pain, cramping, fatigue, diarrhea, fever and joint pain. funds for medical research. The CCFC also believes it is important to make all people
Crohn’s disease can affect any part of the gastrointestinal tract, from the mouth to with inflammatory bowel disease aware of the Foundation, and to educate these
the anus. Patches of inflammation occur, with healthy tissue between diseased areas; individuals, their families, health professionals and the public about these diseases.
these are called “skip lesions”. The inflammation can extend through every layer of
affected bowel tissue. Crohn’s disease cannot be cured by drugs or surgery, although
either or both can relieve the symptoms.
YES! I support the search for the cure for IBD.
Here is my tax-deductible donation right now for:
Ulcerative colitis affects only the colon (large bowel), and only a single layer of
bowel tissue: the inner lining. The disease almost always starts in the portion of the ❏ $35 ❏ $50 ❏ $100 ❏ Other: $
colon called the rectum, and may extend as a continuous (not patchy) inflammation
from there into the rest of the colon. Usually, ulcerative colitis can be controlled with I prefer to contribute by: ❏ Cheque ❏ MasterCard
medication. The disease can be completely eliminated by surgically removing the
colon, but afterward, waste material (stool) may have to be stored and expelled ❏ VISA ❏ AMEX
through an external appliance (bag).
Card Number: Expiry Date:
No one knows what causes IBD. It affects people regardless of race, gender or age. People
are most frequently diagnosed between the ages of 15 to 25 years, or 45 to 55 years.
My Signature:
IBD is unpredictable. Many people experience “flare-ups” (attacks) and then the
disease seemingly goes away. The quiet periods are called “remission” and can vary in
Name:
length from weeks to years. Most people will “relapse” and have multiple attacks. IBD
symptoms may also vary in severity. Some people have mild symptoms and can be
treated with a combination of drugs and nutritional therapy, while others experience Address:
debilitating symptoms and need to take potent drugs, visit hospital frequently, and/
or have surgery. Postal Code: Telephone:
See the CCFC brochure “The Facts about Inflammatory Bowel Disease” for more information.
Please send me details about:
Which Parts of the Body are Involved? ❏ contributing monthly to the search for the cure
The Digestive System: Food passes from the mouth (the Dedicated Research Donor program)
down the esophagus (swallowing tube) into the
stomach, which dilutes and mixes the food and Esophagus
❏ volunteering my time and skills to the Foundation
passes it on to the small bowel (small intestine).
The small intestine breaks down the food. Each Stomach ❏ including the CCFC in my will
part of the small intestine (which is some six
metres long and includes the duodenum, Duodenum Large
❏ membership in the CCFC
jejunum and ileum) absorbs different nutrients. intestine
(colon)
Leftover material passes into the large Small (large ❏ Je désire recevoir la documentation en français.
intestine (also called the colon and is about intestine bowel)
(small
1.5 metres long), which absorbs water and bowel) Jejunum
forms stool. Solid stool is passed to the rectum
Ileum Please make cheques payable to: The Crohn’s and Colitis Foundation of Canada.
and eliminated through the anus. (lower
part Send your cheque and this form to the CCFC National Office, 600 - 60 St. Clair
This brochure is provided for information only. Cecum
of small Avenue East, Toronto, Ontario M4T 1N5. For more information on activities in
A doctor should always be consulted for advice intestine)
Appendix Rectum your area, contact your Regional Office listed on the next page.
and medical treatment. Anus
Registered Charity # 11883 1486 RR0001
OUR MISSION: FIND THE CURE. YOU CAN HELP. CALL US.
CROHN’S AND COLITIS FOUNDATION OF CANADA
416-920-5035 or 1-800-387-1479
Crohn’s and Colitis Foundation of Canada
NATIONAL OFFICE

600 - 60 St. Clair Avenue East


Toronto, Ontario M4T 1N5
Telephone: (416) 920-5035 or 1-800-387-1479
Fax: (416) 929-0364
Web site: www.ccfc.ca E-mail Address: ccfc@ccfc.ca

REGIONAL OFFICES

British Columbia/Yukon
Telephone: (604) 685-1844
Alberta/Northwest Territories/Nunavut
Telephone: (403) 569-8477
Nutrition, diet
Manitoba/Saskatchewan
Telephone: (204) 231-2115
Ontario
Telephone: (416) 920-5055 and
Québec Maritime
Telephone: (514) 342-0666 Telephone: (902) 422-8137
INFLAMMATORY
Newfoundland/Labrador
Telephone: (709) 579-3700

BOWEL
LOCAL INFORMATION

DISEASE

SPONSORS
PLATINUM

SILVER

Copyright © 2001 by Crohn’s and Colitis Foundation of Canada. Reprint 10/01