Can Changing My Diet Help Diarrhoea?

You may find that you have diarrhoea whatever you eat or drink, but some people find altering their diet helps to reduce diarrhoea. Everyone is different and what works for others may not work for you. However, the following suggestions may be of some assistance.

Eating

• Eat small, frequent meals.
• Keep a food diary and note down any foods that seem to upset you, so you can avoid them. It is important not to cut out too many food groups, however, and if you find you are avoiding lots of different types of food it may be helpful to consult a dietitian to help you balance your diet. Some sensitivities may be only temporary and you may be able to re-introduce that food at a later date. 
• For many people foods rich in fibre tend to make diarrhoea worse. Don’t give up all fruit and vegetables, but try cutting down on high fibre foods such as bran cereal, pulses (peas and beans) and the type of fruits or vegetables usually eaten with the skins, pips and seeds. Onions can be particularly troublesome. 
• Avoid very hot or spicy foods if they don’t agree with you.
• If milk makes your diarrhoea worse, try using a lactose free milk and avoiding foods made with milk such as custards and sauces. Some medicines also contain lactose, but do not stop taking any prescribed medication without checking with your IBD team. 
• Chicken and rice soup is a traditional remedy for diarrhoea, which some people have found useful. Carrot soup is also said to be soothing for the gut, and is rich in beta-carotene which may promote healing. 
• The BRAT diet, (bananas, rice, applesauce and toast – or tea) is also traditionally recommended as a way of reducing acute diarrhoea, but does not contain enough nutrients to be a healthy long term option.

Other ‘special diets’ may also reduce diarrhoea. However, in order to make sure that you are still getting a balanced and nutritious intake, these are best used only with the advice of a qualified dietitian. 

Drinking

• Many people are sensitive to caffeine, so try opting for decaffeinated coffee, tea, and cola drinks.
• Avoid alcohol, as this is known to have a laxative effect.
• Drinks made with artificial sweeteners can also cause diarrhoea.

For more information on healthy eating with IBD see our booklet, Food and IBD Check out our information leaflet for more guidance on Managing Diarrhoea.

IBD Surgery and Diet

Surgery should not make a major difference to what you eat – but there are some points to bear in mind, depending on the type of surgery involved.

• Removal of the ileum

If you have Crohn’s and have had all or most of your ileum removed, you may not be absorbing all the nutrients, such as vitamin B12, which your body needs. Vitamin B12 deficiency can be harmful, and may result in anaemia. Your doctor should be checking whether you are deficient, and may suggest that you receive a vitamin B12 supplement by injection.

The ileum also absorbs bile salts. These salts (which come from your liver) are used to transport and absorb fat. If you do not have enough ileum left to absorb them, they may spill over into your colon and cause watery diarrhoea. Your doctor can prescribe medication for this. For more information, see our information sheet Managing Diarrhoea.

• Short bowel syndrome
Anyone with less than 200cm of small intestine as a consequence of surgery is said to have a short bowel. On average, the length of a normal adult small intestine is approximately 600cm. This means that there is a reduced area available to absorb nutrients and you may have to go on a specialist diet in order to maintain a healthy weight.

Some people with a short bowel are at an increased risk of kidney stones and may need to go on a low oxalate diet. Your doctor or dietitian will be able to advise you about this. A few people will have an extremely short bowel and in these circumstances, long term parenteral nutrition (nutrients passed intravenously into the bloodstream) may be recommended. It may be possible to have this done at home, and people can remain well on this treatment for a long time.


• Ileostomy and internal pouch
Having an ileostomy (where the colon has been removed and the small intestine ends in an artificial opening through the abdominal wall) should not mean you have to make drastic changes to your diet. This may seem unlikely in the weeks following your operation, but things should settle down over time. You may find that it helps to add foods to your diet one at a time in order to judge their effect on your digestive system.

More salt and water is lost via an ileostomy than in someone with a colon, because the colon absorbs water and minerals. This may mean that you will need extra fluid and salt to avoid dehydration, especially in hot weather. 

With an ileostomy, there is generally no need for a special diet unless advised by a doctor. However, there are certain foods that you may find helpful to avoid. For example:

• Nuts, fruit skins, and some vegetables which may cause blockages.
• Fizzy drinks and ‘windy’ vegetables such as cabbages and beans which may cause gas,
• Beer, chocolate, and some fruit which may cause diarrhoea.
• Eggs and some types of fish as these can cause strong odours.


People with an internal pouch (known as an ileo-anal pouch), may also find it helpful to avoid the foods listed above. It may also be worth bearing in mind the following: 

• Anal irritation can be caused by coconut, spicy food, nuts, some fruit and food with pips. They may also cause colicky pain (abdominal cramps), which is usually only temporary.
• Alcohol may cause dehydration (if taken in excess) and you may find beer and red wine increase pouch output.

The stoma nurse or a dietitian can provide dietary advice if you have a pouch or an ileostomy.

Diet and IBD - Does Food Cause IBD?

Considerable research has been undertaken to look for any possible link between diet and IBD. Scientists have investigated a wide range of food and nutrients to see if they play a role in the development of the disease. Researchers have suggested that there could be links between IBD and a diet high in fats and sugars. In the past, IBD rates have been lower in non-Western countries, such as Japan, than in Western Europe and North America. However, in the past few decades the number of people with IBD in Japan has been rapidly increasing. 

Researchers have also noted that many Japanese people now eat a more westernised diet – a diet typically high in fats and sugars. So the suggestion is that it could be this change in diet which has led to the increase in IBD. There have also been other studies, including a large European study, which fit in with this theory. These have found a possible link between UC and linoleic acid (a fatty acid found in red meat, margarine and cooking oils such as corn and sunflower oils). It has also been suggested that a diet high in the types of sugars found in sweets and confectionery may have a link with IBD. However, research about food and IBD is conflicting and not all studies agree, so scientists are still discussing whether and how food may play a part in causing IBD.

You can find out more about Diet and IBD in our information booklet Food and IBD.

You can ask your GP, IBD Nurse or IBD specialist to refer you to a dietitian on the NHS. You may also be able to find a private dietitian in your area via the Freelance Dietitians Group (www.dietitiansunlimited.co.uk). All dietitians are registered with the Health Professions Council (www.hpc-uk.org). If you choose to see a nutritionist, make sure they are appropriately qualified. More information is available from The Nutrition Society (www.nutritionsociety.org).

Alternative and complementary medicines

Crohn's and Colitis Treatments

When there is no obvious cause or cure for an illness it’s natural to think about other approaches. There are a whole variety available – homeopathy, acupuncture, aromatherapy, hypnotism, herbal remedies, special diets, relaxation techniques – to name but a few. Some are presented as alternatives to orthodox treatment; others say they are ‘complementary’, which means they may help you in addition to the treatment you are already receiving.

Although there is no hard evidence that any of these actually work, many people have felt they have benefited. For instance, while relaxation exercises may only sometimes alleviate symptoms, they may help someone cope better with the everyday stresses of living with IBD. However, if you do decide to try any of these approaches we strongly advise that you discuss it with your doctor first.

In particular, don’t give up the medication you are on, take any new remedies (including ‘herbal’ remedies), go on an extreme diet, or have procedures like colonic irrigation, without talking to your consultant.