6 Reasons to Work With a Dietitian When You Have IBD

About once a month, someone reaches out to our team and then never makes it to a first session. They decided to wait until things felt more stable. We understand why, but it is always hard to hear, because unstable and chaotic times are often when support can help most.

If you have Crohn's disease or ulcerative colitis and you are wondering whether it is time to get help, here are six reasons to work with a registered dietitian who focuses on IBD. A dietitian can support your medical treatment, look for nutrition gaps like malnutrition, and build a game plan to help you feel better overall.

1. You are stressing about what to eat all day, every day

Food noise is real. It is the constant thinking, second guessing, and googling that happens around every meal. If you are also cooking for a family, you are balancing everyone else's needs with what your body can handle.

That mental load adds up, and it can shape your whole life. Fear around food can keep you from going out to eat, seeing friends, or enjoying the moments that matter. Many people tell us they feel lighter once they have a plan. Having someone listen to your fears and build a way forward can help you feel safer in your body again, and stress can play a role in how we feel (and have potential to increase gut symptoms too!).

2. Your list of "safe" foods is down to just a few

If you are eating only a handful of foods, it is worth taking a closer look at why. Food triggers are more complicated than many people realize. Some foods may be tied to inflammation, some may trigger symptoms, and some fear based or trauma based triggers can also drive symptoms. These are not always the same thing.

A dietitian can help you sort out which foods truly need attention and which are on your list because of perception or fear. That way your options can grow instead of shrink. Again, such a sigh of relief when we can focus on adding foods in instead of being stuck at a handful of “safe” foods. 

3. Nutrient deficiencies are common in IBD and often missed

Low vitamin D, vitamin B12, and iron are among the most common nutrient concerns in IBD, and together they can contribute to fatigue. Yet these levels are not always tested. When they are, they are not always followed up in a way that helps you reach a healthy range.

If you are suffering with ongoing fatigue, the above nutrients can be a helpful step in addressing the most prevalent symptoms among people with IBD. It does not have to be part of your “normal”.

A few things a dietitian can help with:

Bringing labs into the conversation. Sometimes a nutrient was checked once, but other concerns like bleeding, strictures, or surgery took priority. Nutrition markers can slip through the cracks.

Looking at the full picture. For iron, that may mean asking your care team about additional labs, such as ferritin, so your iron stores can be evaluated.

Checking over time. "It was fine two years ago" does not tell you where you are today. Regular checks give a clearer view.

Keeping low results in context. In IBD, a low result is often real. Needs can be higher, especially with active inflammation, so it deserves attention rather than being brushed off.

A dietitian is another member of your team who can help you ask the right questions and prepare for conversations with your medical providers.

4. Your plan does not include ways to reduce your risk of flares

When you are in a flare, it is natural to focus on getting to the other side. But a good plan also looks ahead. Calming things down this month is important, and so is thinking about how to lower your risk of future flares.

This is especially important if you were told to follow a low residue or low FODMAP diet. These approaches are meant for the short term, not forever. And neither one of these diets have evidence to support them being a way to optimize nutrition or support inflammation reduction in IBD.

Expanding your diet again can take strategy, and many people stay stuck in a restrictive pattern because they do not know how to move forward or feel afraid to try. A dietitian can help you ease into a plan that works for the long haul.

5. Your nutrition strategy does not include tools to reduce symptoms

Many people do not realize that dietitians can help with symptoms. Working together, we can look for patterns across your symptoms, your daily routine, and your foods, and connect dots that are hard to see on your own.

Symptoms do not always show up right after a food, so the "eat it, react to it" way of thinking does not tell the whole story. It is also not always about what to take out. Sometimes adding foods and building more variety is what helps most over time.

Symptoms can also be connected in unexpected ways. For example, some people with IBD experience constipation along with reflux, and looking at both together can open up new strategies. 

Energy is another big one. Fatigue has many possible causes, and getting to the root of it can make a real difference in your day to day life.

6. You think IBD nutrition is only about testing foods to see if they trigger you

Tracking every food and every bathroom trip is almost a rite of passage with IBD. Most of us have done it. It is worth asking how well it worked for you? Are you down to five safe foods? Did your symptoms come back anyway?

Food tracking can be useful in some situations, but it is usually not where we start (if we use it at all).

A dietitian can also look at things you might not think to connect, such as when you work out, when you eat your first meal, are you eating too much fiber all at once, and whether you are getting enough food overall. Skipping meals or not eating enough can play into symptoms too. It is a bit like putting puzzle pieces together. We could truly go on and on!

Is it time to reach out?

If any of these reasons sound familiar, you do not have to wait until things settle down. Working with an IBD focused dietitian can help lower the stress around food, address nutrient gaps, and give you a long term plan that fits your life and your medical care.

Work with our team of dietitians in our Nutrition Collective group where we take the guesswork out of IBD nutrition. Start with clarity around all your IBD nutrition questions here!