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Ulcerative colitis / Crohn's disease

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Treatment of ulcerative colitis and Crohn's disease is largely the same and consists of two components: diet change and drug therapy. The aim of the change in diet is to improve the nutritional and general condition of those affected, to positively influence the symptoms and the course of the disease and to achieve symptom-free periods for as long as possible. Different diets are recommended depending on the stage of the disease.

What is ulcerative colitis?

Ulcerative colitis is a chronic inflammatory disease of the large intestine that accompanies the person throughout life. This leads to inflammation of the lining of the colon, on which ulcers form. It can affect the entire colon or only certain sections, but the rectum is always affected. If only the rectum is affected, this is known as proctitis. If the large intestine is affected up to the left curve, it is called left side colitis. Total colitis / pancolitis affects the entire large intestine. In the initial stage, the inflamed mucous membrane is reddened and bleeds on contact with the chyme. With the formation of ulcers, the mucous membrane is destroyed over time. The main symptoms of ulcerative colitis are bloody and slimy diarrhea, stomach pain (left side), constant need to defecate, fever and general weakness. The bowel movements are frequent, but the intestinal transit time can still be normal. The symptoms appear in bouts, so that there are also symptom-free phases. Other typical disorders associated with ulcerative colitis are anemia, iron deficiency, reduced protein content in the blood (hypoproteinemia) and a disturbed electrolyte balance. The risk of developing cancer is increased with this disease.

What is Crohn's Disease?

Crohn's disease is also a chronic inflammatory bowel disease that occurs in relapses. However, it can affect the entire digestive tract from mouth to anus. It occurs primarily in the lower small intestine (ileum) and upper large intestine (colon). Healthy and diseased sections can alternate. In contrast to ulcerative colitis, not only the superficial mucous membrane cells, but also the underlying layers of the intestinal wall are inflamed. This leads to adhesions, constrictions (stenoses) and fistula formation in the intestine. The disease usually begins insidiously, with the first symptoms also being abdominal pain, diarrhea, weight loss and attacks of fever. Those affected often show signs of an insufficient supply of essential nutrients. The reason for this is, on the one hand, an impaired absorption of the nutrients in the body, on the other hand, an insufficient intake with food.

The differentiation of the two diseases is sometimes very difficult in the course of a diagnosis. A detailed medical history, clinical examinations and findings from biopsies and laboratory tests are therefore very important. Rectal bleeding and symptoms in active smokers are more indicative of Crohn's disease than ulcerative colitis and can be indicative as early as the anamnesis.

Causes of ulcerative colitis and Crohn's disease

The causes of the two diseases are still unknown. Genetic factors as well as allergens, autoimmune diseases, infections with bacteria or viruses or a combination of these causes are discussed. Psychosomatic factors such as stress or tension and diet may also play a role as triggers.

Proper nutrition as an effective help

Treatment of ulcerative colitis and Crohn's disease is largely the same and consists of two components: diet change and drug therapy. The aim of the change in diet is to improve the nutritional and general condition of those affected, to positively influence the symptoms and the course of the disease and to achieve symptom-free periods for as long as possible. Malnutrition in particular should be prevented. Therefore, a substitution of nutrients may be necessary.
Different diets are recommended depending on the stage of the disease. In the event of an acute episode, adequate supply of the body can usually only be ensured through enteral or parenteral nutrition. While enteral nutrition provides the patient with liquid food through a tube in the stomach or intestines, parenteral nutrition bypasses the digestive tract completely and nutrient solutions are administered via the bloodstream. If oral feeding is possible during an acute phase, a low-fiber diet should also be observed.
After an attack, the gastrointestinal tract must slowly be accustomed to normal food intake again by increasing the diet. It starts with easily digestible, predominantly carbohydrate-rich (fiber-rich) foods. The amount is slowly increased and then finally supplemented with protein and finally fatty foods. The intake of mostly medium-length fatty acids can alleviate gastrointestinal complaints.
In the symptom-free times or phases with only slight complaints, food is consumed in the normal way. There is no known standard diet for patients with inflammatory bowel disease. However, it has been shown that the symptoms improve when those affected do without certain foods. Which foods cause symptoms can vary greatly from person to person. If the intestine shows constrictions (stenoses) in Crohn's disease, a rather low-fiber diet should be adhered to.

Otherwise, you are best provided with a light, wholesome diet in the symptom-free times, in which you simply leave out the foods that lead to symptoms. Nothing is forbidden. You can eat whatever you can tolerate. But there are foods, beverages and meals that experience has shown are often difficult to digest. These include, for example, fatty foods, milk, cereals, yeast and tomatoes. So try to save on the visible fats such as butter and oil and prefer less high-fat foods, i.e. low-fat milk instead of whole milk or jacket potatoes instead of French fries. Choose mild cheeses that contain less than 45 percent fat in the dry matter (45 percent fat in dry matter). You should avoid mold cheeses such as Gorgonzola, Roquefort or overripe Camembert entirely. Prepare your meals in an easily digestible way. You can do this by using types of preparation such as stewing, steaming or grilling without fat. The right utensils such as coated pans, Roman pot and roasting tube will help you and make saving fat easier. Fried, roasted or deep-fried foods should be consumed with caution.

Be careful with:

  • Fatty, spicy, fried and deep-fried foods
  • Smoked, cured foods
  • Flatulent vegetables like cabbage, leek, or onions
  • tomatoes
  • Unripe fruit, raw stone fruit
  • Nuts, almonds, pistachios
  • Grain
  • milk
  • Spices such as pepper, curry, mustard, horseradish, garlic
  • Confectionery such as chocolate, nougat, and cream candies
  • Alcohol, carbonated drinks, ice-cold foods
  • nicotine

Prefer plant-based foods such as whole grains in your diet. B. Whole wheat pasta or fine wholemeal bread, brown rice, potatoes, vegetables, fruit and legumes, provided you can tolerate these foods. They are usually lower in fat than animal products such as sausage, fatty meat or fatty cheese. In addition, you consume more fiber with a plant-based diet. However, caution is advised with difficult to digest and bloating vegetables such as cabbage, leek, onions, mushrooms, peppers, cucumbers, olives or radishes. Unripe fruit, raw stone fruit such as cherries, plums, mirabelle plums, peaches or nectarines, nuts, almonds and pistachios as well as avocados are known to cause symptoms. If you want something meaty, you prefer lower-fat variants such as lean beef, veal, poultry or game. It is better not to expose your digestive tract to cured and seared meat as well as fat-infused meat. The same applies to fatty sausage products and fatty fish such as eel, herring or salmon, as well as everything smoked. Eat several small meals throughout the day, take your time to eat, and chew enough.
It is better to avoid alcohol, carbonated drinks such as lemonade or cola, as well as ice-cold foods, sweets and nicotine. Because these irritate the gastrointestinal tract and can therefore worsen your well-being.

Take action

Try to avoid stressful and hectic situations. When stress has a negative impact varies from person to person. What is the right requirement for one person is already overwhelming for another. The situations that stress the individual also vary from person to person. The best thing to do is to write down the things that are causing you stress. This enables you to identify the situations in which you are under pressure and to develop strategies to deal with stress more easily. Set priorities and delegate activities once in a while. Go out into the fresh air a lot and use your days off to relax. Relaxation techniques such as autogenic training, yoga or breathing exercises help you to escape the hectic everyday life for a short time. Regular exercise also helps to reduce stress. You should also treat yourself to plenty of rest, vacation and free time. Also pay attention to regular working hours and lunch breaks. If you smoke, try to quit, or at least try to limit it severely.

For more information, please contact the German Crohn's Disease / Ulcerative Colitis Association (DCCV),
Inselstraße 1, 10179 Berlin, Tel. 030 2000392 - 11, www.dccv.de.

As of 6/2020

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