The role of nutrition is essential in various aspects of treating inflammatory bowel diseases. The food we consume directly affects the intestinal lining, the local immune system, and the harmonious microorganisms (bacteria, viruses, and fungi) that reside in the healthy gut. In pediatric centers focused on treating inflammatory bowel diseases in children, emphasis is placed on nutritional therapy as well as regular assessments to evaluate nutritional status, vitamin and mineral levels, protein and fat intake, and meticulous monitoring of growth. Deficiencies in nutrition are common among children with inflammatory bowel diseases.
The nutritional emphasis in inflammatory bowel diseases can be divided into four parts:
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Nutrition that addresses inflammation: Nutrition plays a critical role in managing inflammation, especially in children, where growth and development are dependent on a consistent and balanced food supply. Reduced food intake might result from loss of appetite, nausea, fear of diarrhea, and abdominal pain. Poor nutritional status can lead to compromised immune function, delayed wound healing, and overall reduced daily functioning. Nutritional follow-up aims to increase caloric intake and protein content. Intensive involvement of an experienced dietitian is key in constructing personalized nutrition plans based on the nutritional status and severity of inflammation.
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Correction of specific deficiencies: Deficiencies in iron, vitamin D, calcium, and protein can arise due to reduced absorption and inflammation-induced hindrance of nutrient uptake. These deficiencies might not only result from the disease's impact on intestinal absorption but also due to inflammation-related factors that hinder the absorption of specific nutrients.
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Nutrition to alleviate symptoms: Certain diets can help alleviate symptoms such as abdominal pain, bloating, and diarrhea, seen in both Crohn's disease and ulcerative colitis. These diets can also aid in conditions with overactive bowel movements.
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Nutrition as an alternative to steroid treatment: Nutritional approaches can serve as alternatives to steroid treatments in managing inflammation in Crohn's disease. This is a complex topic, warranting further elaboration.
It's important to note that extreme dietary restrictions should be approached with caution, especially in children, as they might lead to decreased food and calorie intake, potentially affecting growth and quality of life.
During active disease phases with symptoms like abdominal pain, bloating, and diarrhea, a low-residue diet is recommended. This approach aims to reduce the stress on digestion. However, in periods of remission, transitioning back to a regular diet is advised. A low-residue diet involves reducing insoluble dietary fibers, and in specific cases (based on disease nature), also reducing fat, fried food, and lactose. It's crucial to monitor nutritional intake, especially during disease periods, and to reintroduce a balanced diet during remission.
In conclusion, nutrition plays a significant role in managing inflammatory bowel diseases in children. Tailoring dietary strategies to individual patients, correcting deficiencies, alleviating symptoms, and exploring nutritional alternatives to steroid treatments are all important considerations in a comprehensive approach to these conditions.
Nutrition Treatment for Crohn's Disease in Children - It Works!
Crohn's disease of the small intestine is primarily characterized by nutritional problems and diarrhea, while colitis (inflammation of the large intestine) is characterized by stool leakage. During an acute attack of the disease, various medications can be used to provide relief, with steroids being the most common choice. Steroids are highly effective in improving symptoms, but their treatment comes with many side effects, especially in children.
Numerous clinical studies in the last thirty years have established the effectiveness of nutrition therapy as a calming regimen. Initially, it seemed that an extensively hydrolyzed formula, easy to absorb, was needed, but it is now clear that regular formulas are equally effective and more palatable. The specific formula used is less important than providing only one formula for a fixed period of 6-8 weeks. In addition to the formula, the child can only drink water and chew gum or suck on candy. The response to this treatment is remarkably efficient, with clinical improvement and a reduction in inflammation markers within just a few days. In 75% of cases, complete remission of intestinal inflammation can be expected within two months, compared to only 25% with steroids.
When starting this treatment, it is essential to ensure the support of a multidisciplinary team, including a specialist in inflammatory bowel diseases experienced in nutritional therapy and a dietitian, as well as family support. The decision to proceed with the treatment should always consider the expected improvement compared to the temporary impact on the quality of life during the absence of solid food, and it should be made together with the child and parents. Some places in the world (like England and France) may insist on this treatment, even to the extent of using tube feeding. However, the Pediatric Inflammatory Bowel Disease Center at Shaare Zedek does not endorse such extreme measures routinely, and the treatment relies on the consent of the patient to consume the required amount. Providing non-hydrolyzed formulas has significantly improved compliance since they taste better compared to extensively hydrolyzed formulas. It's important to note that this treatment does not cure the disease but rather induces remission. The disease may return after the treatment, so it should always be combined with medications designed to maintain remission after stopping the special diet. Continued partial use of formulas (as an addition to regular food) may strengthen the body's ability to maintain remission. This treatment approach offers numerous advantages, including encouraging growth and weight gain, strengthening bones, rapid response to treatment, and restoring common nutritional deficiencies in Crohn's disease. It empowers the patient to initiate treatment on their own when they feel an attack is starting, reducing their dependence on the medical system and enhancing their self-confidence while alleviating anxieties associated with this chronic condition.
It is important to emphasize that nutrition therapy, especially in cases of small intestinal (rather than large intestinal) Crohn's disease, is particularly suitable, especially when initiated early. The efficacy may be somewhat reduced in adults but is still significant.
Joab from Jerusalem was diagnosed with Crohn's disease of the small intestine at the age of 11. He was recommended to undergo treatment through nutrition. For two consecutive months, Joab was exclusively fed through modulen packets (liquid diet). Joab managed to calm the inflammation, and the acute inflammation subsided, leading to a significant improvement in his condition, and he even began to gain weight.
Also, meet Aharon, Ynon, and Yuval, who have also achieved remission of inflammation through nutrition!
Ynon successfully achieved remission of his Crohn's disease through exclusive nutrition therapy.
Aharon, suffering from severe Crohn's disease of the small intestine and having undergone partial intestinal resection, continued to experience frequent hospitalizations due to disease flare-ups and bowel obstructions. After two months of nutrition therapy with a formula (Exclusive Enteral Nutrition), the disease entered complete remission (remission). Additionally, his inflammatory markers in the blood returned to normal levels, and he experienced an increase in appetite, weight, energy levels, and overall well-being. Currently, Aharon continues with partial enteral nutrition as part of his treatment.
Yuval also achieved remission of his Crohn's disease through nutrition therapy.
