Irritable bowel disease in the 1,000 days

AndieM.Ed., RD, LDN, CLC, RYT-200

What to Know

  • Learn how IBD and IBS may impact pregnancy
  • Tips for keeping the severity of your symptoms at bay
  • Dietary considerations when dealing with IBD or IBS

Sufferers of Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS) may experience similar symptoms but follow different treatments. IBS is a functional gastrointestinal disorder rather than a disease. IBD is a disease that also may include Crohn’s and Ulcerative Colitis. Crohn’s disease is a chronic inflammation of the gastrointestinal tract from the mouth to the anus, while Ulcerative Colitis is a chronic inflammatory condition limited to the colon, otherwise known as the large intestine.

Both IBD and IBS may cause a range of gastrointestinal symptoms such as abdominal pain, nausea, bloating, distension, change in bowel habits (diarrhea, constipation, or a combination of both), and flatulence.

Women in all stages of life – including preconception, pregnancy and postpartum – may experience IBD and IBS. In most cases, neither affects fertility. However it’s best to do all you can to get yourself in remission prior to pregnancy (if you’re able to), because there are some potential risks.

The severity and extent of IBD when a woman becomes pregnant seems to influence the degree to which she’ll experience symptoms during pregnancy. So if she’s in remission prior to pregnancy, she’ll likely stay in remission, and if she’s actively symptomatic when she becomes pregnant, she’ll likely remain so during pregnancy. Severe IBD also may increase the likelihood of miscarriage, preterm labor, preterm delivery and low birth weight.

In the immediate postpartum period, IBD may flare up due to hormonal fluctuation and changes in medication. But there is no evidence that IBS or IBD interferes with breastfeeding or that breastfeeding women become more symptomatic.

Most women with IBD or IBS can have a healthy pregnancy, a healthy baby and healthy lactation. To stay on track of IBD or IBS in pregnancy, it’s important to have the supervision of both a gastroenterologist and obstetrician.

What to Do

Choose nutrient dense foods that will nourish your body in the best way possible

Whether you are preconception, pregnant or postpartum choose fresh, whole foods like vegetables, fruits, beans, fish, lean meats and whole grains.

Because of the apparent connection between specific foods that people eat and the cause of their IBD or IBS symptoms, dietary and lifestyle changes may help alleviate gastrointestinal symptoms and manage IBD or IBS and thus reduce reliance on pharmacological interventions.

Keep a food diary

Keeping track of your food (and drink!) intake for at least 7 days will help both you and your gastrointestinal specialist or other care provider to evaluate any possible dietary connections with your gastrointestinal symptoms.

Consider an elimination diet

In consultation with your obstetrician and gastroenterologist, eliminating certain foods for a period of time, usually 3-4 weeks, then gradually reintroducing them and monitoring your gastrointestinal system for possible reactions, may be helpful.

The foods most commonly eliminated and then re-introduced to good effect are dairy, gluten, soy, eggs, corn, pork, beef, chicken, beans and lentils, coffee, citrus fruits, nuts, nightshade vegetables and FODMAPs (a collection of short chain carbohydrates and sugar alcohols found in foods naturally or as food additives).

Consider a low FODMAP diet

A notable dietary treatment for IBD and IBS is called the low FODMAP diet, a complex title describing a collection of molecules found in foods naturally or as food additives that are poorly absorbed in some people. FODMAP is an abbreviation for those molecules: fermentable, oligosaccharides (like fructans and galacto-oligosaccharides (GOS)), disaccharides (like lactose), monosaccharides (eg. excess fructose) and polyols (like sorbitol, mannitol, maltitol, xylitol and isomalt).

Following a low FODMAP diet may help reduce the severity of IBS and IDB symptoms.

FODMAPS to avoid include:

  • Excess Fructose: honey, apples, mango, pear, watermelon, high fructose corn syrup
  • Fructans: artichokes, garlic in large amounts, leek, onion, spring onion (white part), shallots, wheat in large amounts, rye in large amounts, barley in large amounts, inulin, fructo-oligosaccharides
  • Lactose: milk, ice cream, custard, dairy desserts, condensed and evaporated milk, milk powder, yoghurt, soft unripened cheeses (like ricotta, cottage, cream, marscarpone)
  • Galacto-Oligosaccharides (GOS): Legume beans (like baked beans, kidney beans, bortolotti beans), lentils, chickpeas
  • Polyols: apples, apricots, avocado, cherries, nectarines, pears, plums, prunes, mushrooms, sorbitol, mannitol, xylitol maltitol and isomalt

During pregnancy, if you are going to try the FODMAP diet, be sure to consult with your OBGyn or midwife. In consultation with your obstetrician and gastroenterologist, the low FODMAP diet has two phases. Phase one of the diet involves a strict restriction of the FODMAP foods listed above for 6-8 weeks. In the second phase, an expert dietitian would determine the type and amount of FODMAPs you can reintroduce and tolerate for a long-term diet.

Since both phases are highly individualized, it’s recommended to work with an expert dietitian throughout.

Consider a simplified dietary approach

If the low FODMAPs diet seems too burdensome or strict, try following a simplified dietary approach for IBS by avoiding:

  • Your food allergies and intolerances
  • Milk, dairy products and lactose (especially if lactose intolerant)
  • Rich, fatty foods especially fried foods
  • Beverages containing caffeine, beer and alcohol
  • Foods high in fructose
  • Sugar substitutes (such as sorbitol, xylitol and mannitol)
  • Gas-forming foods such as onions, celery, carrots, brussels sprouts, cucumber, cabbage, cauliflower, radishes. beans and legumes, raisins, bananas, apricots, prunes, dried fruit, bagels, wheat germ, pretzels, peas, bran cereal and other foods high in bran, brown rise, leeks and parsnips

Choose foods with probiotics

Cultured dairy products (such as yogurt with live active cultures and kefir), fermented vegetables (such as kimchee and sauerkraut) or, consider taking a probiotic supplement.

Speak to your healthcare provider if you’re taking any prescription medications for IBD or IBS