Inflammatory Bowel Disease (IBD), encompassing both Crohn’s disease and ulcerative colitis (UC), can significantly impact various aspects of health, including the liver. As a dietitian, understanding and addressing the intricate relationship between liver health and IBD is crucial for managing and improving patient outcomes.
Nourishing the liver is especially important in IBD because a healthy liver helps in metabolizing medications, managing inflammation, and preventing additional complications that can arise from liver disease.
Here’s an in-depth look at how IBD affects liver health and dietary strategies to support liver function.
Understanding Liver Health in IBD
Prevalence of Liver Issues in IBD:
- Approximately 30% of individuals with IBD can have abnormal liver tests, and about 5% may develop liver disease (PMID: 35070000).
Fatty Liver Disease:
- Fatty liver disease, or hepatic steatosis, affects both UC and Crohn’s disease patients equally. It occurs when excess fat is stored in the liver, which can also happen with conditions such as diabetes, pregnancy, and obesity. Steroid use, common in IBD treatment, is also a contributing factor.
Hepatitis:
- Hepatitis, or inflammation of the liver, can be caused by certain IBD medications like methotrexate, azathioprine, and 6-mercaptopurine (6MP). Although rare, anti-TNF agents may also cause hepatitis. Uncontrolled inflammation due to IBD can exacerbate this condition.
Primary Sclerosing Cholangitis (PSC):
- PSC is another liver condition associated with IBD. This disease affects the bile ducts, which carry bile from the liver to the small intestine. Inflammation leads to scarring and narrowing of the bile ducts. While only 5% of those with UC will develop PSC, about 70% of patients with PSC have underlying UC (Crohn’s and Colitis Canada).
Screening and Monitoring:
- It is essential for IBD patients to be screened for PSC annually with liver function tests, regardless of the presence of symptoms.
Dietary Strategies for Liver Health
Increase Leafy Greens:
- Aim to include leafy greens like spinach in your diet 3-5 times per week. Compounds found in these greens may lower the risk of fatty liver.
- PRO TIP:To reduce symptoms, especially with raw spinach, start by incorporating them into smoothies.
Beans and Soy Products:
- Consuming legumes such as lentils, navy beans, black beans, chickpeas, soybeans, and peas 5-7 times per week can lower the likelihood of non-alcoholic fatty liver disease (NAFLD). Soy protein, particularly ß-conglycinin, can help reduce triglyceride levels and protect against visceral fat buildup.
Increase Omega-3 Rich Fish:
- Include fatty fish like salmon, sardines, mackerel, herring, and halibut in your diet, aiming for three servings per week. These fish are high in omega-3 fatty acids, which can reduce liver fat, boost protective HDL cholesterol, and lower triglyceride levels.
Add in Walnuts:
- Consuming a handful of walnuts a few times per week is associated with a lower risk of NAFLD and improved liver function tests.
- PRO TIP: if you are currently unable to tolerate walnuts, consider making/purchasing a walnut butter and drizzle over oatmeal or bananas for improved tolerance
Turmeric Tea:
- There is some research suggesting that turmeric, whether used in cooking or as turmeric tea, may help decrease levels of serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which are often elevated in those with fatty liver.
Overall Dietary Recommendations:
- Increase Unsaturated Fats: Include more sources of unsaturated fats like avocados, olive oil, nut butter, and fatty fish (salmon, mackerel, trout, sardines)
- Decrease Saturated Fats: Reduce intake of saturated fats from sources like butter, coconut oils/creams, red meats, and cured meats.
- Include Soluble Fibers: Incorporate soluble fibers from foods such as oatmeal and flax regularly.
By focusing on these dietary strategies, people with IBD can support their liver health and potentially mitigate some of the liver-related complications associated with their condition. As always, it’s essential to work with a healthcare provider or dietitian to tailor these recommendations to individual needs and health status.
If you’re interested in learning more about liver health and IBD stay tuned for a new podcast episode where we chat with ‘Andy The RD’ on all things liver health!