DIETARY ADVICE FOR CROHNS DISEASE AND ULCERATIVE COLITIS

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1 DIETARY ADVICE FOR CROHNS DISEASE AND ULCERATIVE COLITIS Information Leaflet Your Health. Our Priority.

2 Page 2 of 7 What is Crohn s disease/ Ulcerative Colitis? Crohn s disease and Ulcerative Colitis, known as Inflammatory Bowel Disease, are disorders affecting the gastrointestinal tract (gut). Crohn s disease can affect any part from the mouth to the anus, whereas Ulcerative Colitis affects only the large bowel. Symptoms can include: Diarrhoea Abdominal pain Tiredness Nausea (feeling sick) and vomiting Weight loss Anaemia Both conditions can have periods of relapse (when symptoms are present) and remission (when symptoms are reduced and you are feeling well). The nutritional treatment of inflammatory bowel disease therefore changes, according to what stage you are in, i.e. active stage or in remission. Dietary Advice for Active Stage of Crohn s Disease/Ulcerative Colitis You may find that limiting foods that are high in fibre helps to relieve your symptoms, as they can irritate the bowel. Examples of low fibre foods are shown in the following table. However, in times of remission aim to slowly increase the number of high fibre foods consumed Avoid highly spiced foods which may also irritate the bowel Fatty foods may increase symptoms. Try to have a smaller portion of fatty foods e.g. fish and chips and spread fats evenly through the day rather than have in one meal When reintroducing foods it is important to do this slowly, introducing one new food at a time Aim to still eat a wide variety of foods from all the different food groups shown in the low fibre dietary advice table It is important to remember that everyone is individual. Foods that cause problems with one person may not necessarily have the same effect on somebody else

3 Page 3 of 7 Low Fibre Dietary Advice Breads and Cereals Fruit Vegetables and Salad Meat, fish, eggs, and cheese FOODS TO CHOOSE White bread White pasta and rice Cornflakes, Rice Krispies Biscuits and cakes made from white flour (e.g. cream crackers, rich tea, sponge and madeira cake) Small quantities of stewed fruit (max of 2 portions per day) Tinned soft fruits (without skins) Fresh fruit juice (no bits) Boiled (no skins) and mashed potatoes Soft cooked carrots, cauliflower, butternut squash, swede, sieved tomatoes (without pips/skins) Any lean meat Any fish Cheese, eggs FOODS TO AVOID Wholemeal, granary or seeded bread Wholemeal pasta and brown rice Digestive and fruit biscuits Fruit cake High fibre cereals e.g. Allbran, Weetabix, bran flakes and muesli All fresh and dried fruits Avoid pips, seeds, skins and stringy fruit e.g. rhubarb Fruit juice with bits All other vegetables and salads Tough fibrous meats with gristle Dairy Produce Fats 2-3 servings per day choose lower fat varieties if better tolerated Fat spreads/oils - in moderation Avoid yoghurt with fruit pieces Only limit these if you cannot tolerate fats Miscellaneous Bovril, Oxo, Marmite Tea, coffee Squash, fizzy drinks Boiled sweets, mints Jam jelly, clear marmalade Honey, syrups Nuts, chocolates, jams with seeds, marmalade with rind, crisps

4 Page 4 of 7 Sample Low Fibre menu Breakfast Cornflakes or Rice Krispies with milk, sugar if desired White bread or roll (can be toasted) Thin spread margarine/butter Marmite, seedless jam, jelly marmalade or honey Tea or coffee Tea/coffee or fruit juice Plain cake or biscuits/crackers Lunch Clear soup White bread, barm cake or bread rolls Lean meat, fish, chicken, egg, cheese Spreads (e.g.: mayonnaise, margarine) Smooth fruit yoghurt Fruit juice Tea/coffee or fruit juice Plain cake or biscuits/crackers Stewed fruit or tinned fruit (without skins) Dinner Lean meat, fish, chicken, cheese or eggs Boiled/mashed potato, white pasta/rice or white bread Soft-cooked carrot or cauliflower florets Gravy/sauce Ice-cream/jelly or Plain sponge or Milk pudding/custard Supper Horlicks or Ovaltine or tea/coffee Plain biscuit or white toast/spread What If My Appetite or Intake is Poor and I am Losing Weight? If your appetite is poor, this can affect your food intake and you may lose weight. During this time, healthy eating is not a priority. Here are some points to help you some extra nourishment.

5 Page 5 of 7 Choose higher fat and/or sugar foods, for example, full cream milk; thick and creamy yoghurts; creamy/condensed soup etc. Avoid diet versions of foods High fibre foods are bulky and can be very filling chose low fibre alternatives (for example, white bread/pasta/rice; cornflakes/rice krispies), and restrict your intake of salad, fruit and vegetables refer to low fibre food list Try to follow a little and often eating pattern and include 5-6 small meals rather than three large meals. If you still feel hungry- you can always have second helpings Encourage yourself to have a nutritious drink between meals e.g. full-cream milk, milk shakes, hot milky drinks (Malted drinks, hot chocolate or milky coffee) Sample Meal Plan for a High Protein, High Calorie and Low Fibre Diet Breakfast Fruit juice Cereal, e.g. corn flakes, rice krispies or porridge with full fat milk. Egg/bacon/fish White bread, pancakes, English muffins with butter or margarine and/ or honey, jelly jam or marmalade (shreddless) Milky tea or coffee or full fat milk Glass of full fat milk and tea biscuits, e.g. rich tea/ morning coffee or a thick and creamy yogurt Lunch Meat/fish/eggs/cheese with white bread and butter/margarine Ham and/ or cheese omelette Glass of full fat milk or milky coffee and plain or chocolate biscuit/ piece of sponge cake Dinner Meat/fish/eggs/cheese White bread or potatoes boiled (no skin/mashed) or chips Carrots, swede, parsnip or turnip well cooked Milk pudding/ice cream/jelly and cream/mousse/sponge pudding/jam tart and custard/meringues, double cream/toffee /chocolate sauce Supper Cream crackers/crispbread and cheese Toast with butter and jam or honey Pancakes with butter/jam Plain crisps or breadsticks with dips (taramasalata, sour cream, prawn marie rose, cheese dips)

6 Page 6 of 7 Dietary Advice for Remission Stage of Crohn s Disease/Ulcerative Colitis Only follow this advice when you have achieved a normal weight and are not continuing to lose weight. Do not follow this advice if you are still having symptoms of Crohn s disease or ulcerative colitis. During times of remission (i.e., when you are well) you should try to follow a healthy diet that includes a higher fibre, lower fat intake with a variety of foods. This will provide you with all the calories (energy) and nutrients (protein, carbohydrates, fat, vitamins and minerals) you need. The following will give you advice on how to do this. Protein foods: Examples include: Lean red meat, poultry, eggs, fish, nuts and pulses. Aim to have at least two servings daily Dairy products: Examples include: cheese, milk and yogurts. Aim to have three servings daily. One serving is 1 pot yoghurt (125g), one-third pint/190 ml milk (low fat versions) or 25g cheese. Starchy Carbohydrates: Examples include: Bread, potatoes, cereal, pasta, rice, noodles (preferably wholemeal versions) Try to have one serving at each main meal. Fruit and vegetables (as tolerated) This can include fresh, tinned or frozen. Aim for five servings daily Fats and Oils: Examples include: Butter, margarine, sunflower oil, olive oil. Use in moderation in cooking and meal preparation Others: Examples include: Cakes, biscuits, chocolate, sweets. Small amounts can be taken as part of a balanced, varied diet. Useful Contacts: Crohn's and Colitis UK 4 Beaumont House Sutton Road St Albans AL1 5HH Contact us Acute Dietitians Inpatient Therapies Department Stepping Hill Hospital Tel:

7 Page 7 of 7 If you would like this leaflet in a different format, for example, in large print, or on audiotape, or for people with learning disabilities, please contact: Patient and Customer Services, Poplar Suite, Stepping Hill Hospital. Tel: Information Leaflet. PCS@stockport.nhs.uk. Our smoke free policy Smoking is not allowed anywhere on our sites. Please read our leaflet 'Policy on Smoke Free NHS Premises' to find out more. Leaflet number MED115 Publication date June 2015 Review date June 2017 Department Nutrition and Dietetics, Inpatient Integrated Therapies Location Stepping Hill Hospital