Medically Reviewed by Jenny Blair, MD
Diet is an important part of managing IBD symptoms and staying healthy, but it can also be confusing and fraught with misinformation. Furthermore, only 41 percent of gastroenterologists and 16 percent of nurses feel they have “very good” knowledge of IBD nutrition, according to a 2016 survey published in Inflammatory Bowel Diseases. That’s where a registered dietitian (RD) can help.
A registered dietitian is a degreed nutrition professional who’s completed a supervised practice program, passed a national certifying exam, and takes continuing education credits to maintain their competencies. They are sometimes called registered dietitian nutritionists.
What to Expect when Working with RDs
Every patient’s needs are different, says Kelly Issokson, MS, RD, CNSC, a registered dietitian in the Nutrition and Integrative IBD Program at Cedars-Sinai in Los Angeles, California. Many patients meet with her just once or twice, while others have an ongoing relationship.
Issokson says she spends much of the initial session learning about a patient’s history with IBD. “I ask them about their disease activity, what kind of diets they’ve tried, what foods trigger their symptoms. It’s important for me to understand if they’re on any medications or if they’ve had a surgical procedure that might decrease absorption of certain nutrients.”
With that information, Issokson and her patient develop an individualized nutrition plan. “It’s important to understand that no one diet works for everyone with IBD,” she says.
During subsequent meetings, patients can ask additional questions, address challenges, and assess the effect of diet, medication, or supplement changes, says Issokson.
Some patients may then have all the information they need. “For those who are eating an unrestricted diet, maintaining their weight, and are in remission, one visit may be all they need to help them understand where their nutritional deficits are (if they have any), and how to correct them,” Issokson says.
On the other hand, patients who choose to incorporate nutrition therapy as part of their IBD management may need to follow up more often to assess their tolerance and response to prescribed diets, as well as to ensure proper nutrition intake, says Issokson.
RDs Are an Underutilized Resource
In the previously mentioned survey, 58 percent of IBD patients felt nutrition was very important to help manage their condition, but only 11 percent said they had met with a dietitian.
To date, there’s a lack of research on the benefits of working with a nutritional professional specifically for IBD. However, says Issokson, “We do know that malnutrition prevalence is high in IBD and malnutrition increases morbidity and mortality, reduces response to medications, delays wound healing, and worsens quality of life.”
When Should You Work with a RD?
When you’re newly diagnosed. RDs can answer your questions, dispel misconceptions about food, and may help prevent nutritional deficiencies, especially if you’re taking medications, such as methotrexate or sulfasalazine.
When you need surgery. “Many IBD patients will need surgery during the course of their disease,” Issokson says. Unfortunately, about 75 percent of Crohn’s patients who are hospitalized are malnourished. Optimizing nutrition before and after surgery may help reduce surgical complications and length of stay in the hospital, she adds.
When you’re considering a restricted diet. Anne Tuskey, MD, assistant professor at University of Virginia Health System in Charlottesville, says many of her patients want to try a restricted diet. Although, the Specific Carbohydrate Diet and low-FODMAP diet show some benefit in people with IBD, there’s no scientific evidence to support other restrictive diets. Dr. Tuskey recommends patients work with a RD with IBD experience to ensure adequate nutrition if they choose to do a restrictive diet.
How to Find a Qualified Dietitian
Visit the Academy of Nutrition and Diet’s online database and search for an RD by zip code or specialty.
Look for an RD with specific expertise in IBD. Alternatively, ask your physician for recommendations. Many IBD centers have RDs as part of a multidisciplinary care team.
“RDs can address the full spectrum of IBD nutritional needs,” says Dr. Tuskey. “They are an invaluable resource in our clinical practice.”
Not all insurance plans cover the services of a registered dietitian, so be sure to check your plan.
“Food can have a powerful impact on symptoms and help reduce inflammation,” Issokson says. “Meeting with a dietitian can help you identify your personal triggers and safe foods, as well as provide you with guidance on how to eat a balanced diet that will help you heal, recover, and stay healthy.”