This topic was requested by one of our library members. It’s understandably an important topic – and what’s interesting is that it varies so much from person to person!
Flares can vary because there are different types of flares:
- Symptom flares – symptoms are high, but inflammation isn’t
- Inflammation flares – inflammation is showing up in lab work or on a colonoscopy and symptoms may or may not be present
- Complicated flares – flare ups might also be related to strictures, obstructions or other things that require medical attention
- Outside the gut symptoms – sometimes inflammation is fine, gut symptoms are low but there are still lingering symptoms like joint pain
While nutrition advice is best in the context of someone that can get to know your individual needs before advising, I’ll do my best to give some general tips and ways we approach flare ups in our practice. Of course if you ever need further guidance – please reach out!
When symptoms are present but inflammation is not, we often like to focus on modifying foods and expanding the diet over time. With symptom flares- it can be tempting to want to decrease all the foods you feel are triggers but this can backfire long term and lead to poor recovery and increased symptoms. If you aren’t sure where to start- check out our START here document in the library.
Remember- what’s a trigger now may not always be a trigger. As you expand your diet overtime, your microbiome can improve and you may be able to tolerate foods you didn’t before.
How you know you are in a symptom flare:
- Things like bloating, diarrhea, constipation or gas increase
- Urgency and not making it might also be present
- Although less common in a symptom flare up only, nausea and abdominal pain occasionally show up
- You aren’t tolerating foods well
What we focus on during this time:
- Verifying the flare – just to be sure this would be a good time to look at lab and stool markers like fecal calprotectin, CRP etc to make sure you aren’t also inflamed.
- Checking in with your GI – checking in with your GI is always a good idea if you’ve noticed a change in symptoms, even if lab markers are fine your GI may want to even do a scope.
- We focus on bringing in nutrition tools to improve symptoms – we might use a food based tool like cardamom to help with nausea, we might use bitter foods or bumping up carminative herbs to help with gas
This section is hard to be thorough on because there are so many nutrition tools you can use to help with symptom reduction. In fact we have a whole 3 month course on this topic. It’s also often incredibly individualized! For example, we might suggest something totally different for someone wanting to reduce diarrhea and urgency than we would for someone experiencing bloating and constipation.
If you are stuck dealing with uncomfortable symptoms – nutrition support can be exceptionally helpful! In our programs– we see 86% reduction in symptoms like diarrhea, abdominal pain, bloating and urgency. That means going from 10x/day down to 2 – which is a huge bump in quality of life! We also have been able to see 93% improvements in energy.
When inflammation is high – our calorie needs, protein needs and nutrient needs often go up. Inflammation requires a lot of our bodies – this means you are more likely to experience significant fatigue and long term the risk of nutrient deficiencies and malnutrition go up.
Our priority when inflammation is elevated is to decrease it and make sure you have extra nourishment in place for recovery. We might decrease it through recommending a treatment plan that’s customized to you and includes both dietary and supplemental strategies. We may also ask your healthcare provider to run labs to check for things commonly low in IBD.
How you know it’s an inflammation flare:
- Fecal calprotectin, C-Reactive Protein, Sedimentation Rate or Lactoferrin are elevated
- A recent scope showed inflammation is present
What we focus on during this time:
- Labs we commonly check for: Vitamin D, Ferratin, Hemoglobin, Hematocrit, Zinc, Folate, Vitamin B12
- Bringing in an anti-inflammatory diet approach (however possible) that includes more plants & omega 3’s
- We might bring in a prebiotic often to help with regulating stool pattern. Our favorite is GutLove Back to Balance.
- We like to incorporate smoothies if tolerated on a regular basis with berries and leafy greens to bump up antioxidant support.
- We often look for ways to bring in anti-inflammatory herbs into the diet like Curcumin – but this depends on what medications people are on also so we would want to check this first before recommending any specific dose.
- Modifying textures to help with tolerance – aiming for smoothies, soups, purees etc to improve tolerance
- Bringing in liquid nutrition supplementation to help with intake and protein intake like kate farms, orgain, owyn etc.
- Layering in extra rest & relaxation – a nap, going to bed an hour earlier, saying no to draining activities and yes to things that support you
- Adding in mindfulness and meditation – taking 1-3 minutes of deep belly breathing before meals and rest, mindful walks, foam rolling, visualization etc
Things like stricturing, obstructions etc can make eating a challenge. Nutritional needs vary so much depending on severity and where you are at in the process. Some will not have to adjust diet hardly at all with stricturing, while others might need temporary fiber adjustments or even liquid only diets for a time.
If you’ve got a complicated case, make sure you have an IBD trained dietitian by your side to help guide you!
Outside the Gut Flares
Sometimes your labs look good, colonoscopies look good and even your symptoms are lower… but you might still be experiencing “outside the gut” symptoms like skin issues, mouth ulcers, joint pain, brain fog or low energy. If this is the case for you – make sure to tell your GI and IBD dietitian so they can brainstorm ways to support you best.
I hope this was helpful for you!