Case Study: Reintroducing Fibre for Crohn’s Disease Management

In my experience, clients with inflammatory bowel disease have a difficult time knowing what they should and shouldn’t eat following a flare up of their disease. Often when I meet them, they are following a very restrictive eating pattern that can compromise their health and well-being in other ways. This was the case when I met Jack…….

Patient Background

Jack, a 25-year-old male, was diagnosed with Crohn’s disease at the age of 19. He had experienced multiple flare-ups over the years, characterized by abdominal pain, diarrhoea, fatigue, and weight loss. Despite medication management, including corticosteroids and immunosuppressants, Jack’s symptoms persisted, affecting his quality of life and ability to maintain a regular job.

During his most recent flare-up, Jack was admitted to the hospital due to severe abdominal pain and bloody diarrhoea. Following a series of tests, including colonoscopy and imaging, he was diagnosed with a moderate to severe flare of Crohn’s disease. To manage his symptoms and promote gut rest, Jack was placed on a low-fibre diet during his hospital stay and advised to limit his lactose intake.

Given the severity of his symptoms, the primary focus was on symptom control and nutritional support. The initial dietary approach involved restricting high-fibre foods such as whole grains, raw fruits and vegetables, nuts, and seeds to minimize bowel irritation and promote healing.

Jack’s inpatient dietitian played a crucial role in educating him about the importance of following a low-fibre diet during the acute phase of his flare-up. They provided detailed guidance on suitable food choices, meal planning, and cooking methods to ensure Jack received adequate nutrition while minimising gastrointestinal discomfort. 

Transition to Community Care 

As Jack’s symptoms began to improve with medical treatment, Jack was discharged from hospital.  As the weeks went by he was left confused about what he should be eating now and decided, understandably, that given he was feeling better on his current diet, he would continue to follow the low fibre, low lactose eating pattern recommended in hospital. He quickly noticed that he was now experiencing constipation – the exact opposite of the issue he presented to hospital with! Along with the constipation came other uncomfortable symptoms such as bloating and abdominal pain which is what led Jack to make an appointment with me – a community based dietitian with specialist knowledge in gastrointestinal nutrition.

Inflammatory Bowel DiseaseDuring our initial consultation together, Jack expressed concerns about reintroducing fibre-rich foods, fearing that they might trigger a relapse of his symptoms. I reassured him that reintroducing fibre would be a gradual process tailored to his individual tolerance level and symptoms. I also spent time educating Jack on the importance of dietary fibre for optimising gut microbiome health, reducing inflammation and normalising bowel function. We discussed the different types and functions of dietary fibres and other factors that would assist with normalising bowel function such as hydration and physical activity. We also discussed the importance of trialling a reintroduction of dairy foods in time due to their array of beneficial nutrients that support bone and muscle health. 

Together, Jack and I developed a personalised dietary plan focused on incorporating fibre-rich foods in a systematic manner. Jack was encouraged to start with well-cooked, easily digestible sources of fibre, such as steamed vegetables, cooked fruits, oats and canned legumes. He was advised to increase his fibre intake gradually while monitoring his symptoms closely for any signs of discomfort or exacerbation of his Crohn’s disease.

Outcome and Follow-Up

Over the following weeks, Jack and I worked closely together to gradually increase his fibre and lactose intake while monitoring his symptoms. Through regular follow-up appointments and ongoing support, Jack successfully reintroduced a variety of fibre-rich and lactose containing foods into his diet and enjoyed the increased variety! As Jack’s dietary variety increased, he noticed improvements in his overall well-being, including reduced abdominal pain, normalised bowel movements, and increased energy levels. Jack also learned how to make nutritious food choices that supported his digestive and overall health and contributed to the management of his Crohn’s disease.

Through tailored dietary support, Jack was able to achieve better symptom control and quality of life. The successful reintroduction of fibre and lactose into his diet highlights the importance of individualised nutritional interventions in the management of Crohn’s disease and underscores the valuable role of dietitians in supporting patients through the transition from hospital to community care.