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Inflammatory Bowel Disease Resource

Inflammatory Bowel Disease and Breastfeeding

laura lomax

To say I was one of those moms who was set on exclusively breastfeeding was an understatement. There were many adventures surrounding being a new mom I tried to prepare myself for, but it never crossed my mind breastfeeding would be more complicated than choosing to breastfeed.

I was diagnosed with ulcerative colitis shortly after giving birth to my first child. I experienced worsening symptoms throughout my pregnancy, but postpartum my symptoms quickly spiraled out of control. Less than a month postpartum I could barely care for my newborn. I was constantly running to the restroom (often interrupting feeds), eating and drinking minimally, drastically losing weight, and sleeping minimally.   As a result of my inadequate nutrition and hydration I was not making significant milk. My son was putting out as many hints as possible for a baby including wanting to continuously feed, sleeping minimally, and was extremely fussy.  My husband and family were very supportive and wanted to take the burden off of me by feeding bottles of formula, but I refused. While the lack of milk was a problem, the even bigger problem was my refusal to except my illness and the fact that no matter how hard I tried or wanted to breastfeed it did not change the fact I was not making adequate milk.  As a dietitian I helped many moms navigate through difficult breastfeeding scenarios, encouraged friends to breastfeed, and advocated breastfeeding benefits to everyone. How was it going to look when I didn’t even breastfeed my own baby??? I felt like I couldn’t just give up…  Honesty I felt if I stopped breastfeeding I would be failing as a mom, failing my son, and even failing as a dietitian.  Beside all the pressures I put on myself I also LOVED breastfeeding and the unique bond created.

A few weeks later I was finally able to be seen by a gastroenterologist and get scheduled for a colonoscopy. Knowing during the prep I would not be able to breastfeed, I began trying to pump milk. Trying being the key word. I was not able to pump more than an ounce over multiple days before the colonoscopy and reluctantly agreed to give my son formula. At this point I had no choice and honestly agreed because I felt it would just be temporary.

Before I knew it I was abruptly awaken from the colonoscopy and given the diagnosis of ulcerative colitis, told I required lifelong medications, and had to stop breastfeeding completely.  The next day my son had a pediatrician visit and he was now falling off the growth curve. So there it was solid evidence I could no longer ignore. In that moment as we all do as parents I quickly realized that what I “wanted” was no longer the priority. I had to start thinking as a parent and prioritizing what was best for my son. He started formula and almost immediately his fussiness and desire to feed improved and he started gaining weight appropriately.  While exclusively breastfeeding was out of the picture for me, along with my son’s pediatrician I worked with an AMAZING lactation consultant.  My lactation consultant helped me feel confident in formula feeding, as well as provided guidance to me on how to incorporate breastfeeding into my feeding plan. Together with my lactation consultant, my son’s pediatrician, my gastroenterlogist, and my husband we developed a plan to help incorporate breast feeding as my health allowed and based on the medications prescribed for my ulcerative colitis.

Whether you choose to breastfeed, choose not to breastfeed, or are unable to breastfeed for whatever reason I hope my story reminds you that your feeding choice makes you no less caring or loving of a mother. My struggles with breastfeeding opened my eyes to the unique experiences we all face as mothers and how important it is that we support each other.  

While my first experience with breastfeeding was far from what I ever expected with my second child my ulcerative colitis was well controlled and was able to breastfeed almost exclusively. My daughter loved breastfeeding and we got to share so many of those experiences I longed for with my first child. Below I have summarized my top 5 tips for breastfeeding and Inflammatory bowel disease.  

Tips:

  1. Stay Hydrated- Breastfeeding women have increased fluid needs to help maintain adequate supply. For women with IBD especially during times of flares or increased diarrhea fluid needs will be greater. Keep a water bottle with you throughout the day. To help encourage intake try a simple fruit infused water. Simply add fresh berries, oranges, watermelon to a pitcher then fill with water and allow to refrigerate for several hours.

  2. Consume Adequate Calories and Protein. To help achieve this goal eat small frequent meals. While calorie needs vary for each individual breastfeeding mothers can require an additional 300-500 calories per day. To help ensure calorie needs are met set a goal to eat a small snack while breastfeeding or pumping. Choose a nutrient rich snack such as a banana and string cheese, yogurt, an avocado, a boiled egg and fruit, or whole grain crackers with peanut butter.

  3. Speak with a lactation consultant- Lactation consultants are the breastfeeding specialist. Lactation consults help parents navigate feeding a new baby including feeding schedules, latching, adequate intake, and so much more. Specific to IBD they are also a great resource for medication and breast feeding safety, different positions to breastfeed that might be more comfortable with IBD, tips to increase milk supply, and provide support and reassurance.

  4. Have a supportive Team – Along with a lactation consultant be sure to discuss your feeding plans with your child’s pediatrician, your gastroenterologist, and spouse/partner. Choose a medical providers that will sit down and discuss the safety of drugs prescribed for IBD while breastfeeding, their potential transfer to breast milk, and examine the overall risk vs benefit of breastfeeding in your individual situation.  Being surrounded by a supportive team and being informed will help you make the best decisions regarding breastfeeding.

  5. Prioritize your health. As a new mom if you are not healthy you will not be able to care for your baby. One of the most important tips for all new moms and especially a mom with IBD is to rest when your baby is resting. Infants particularly having very demanding feeding schedules making adequate rest difficult. It is tempting to want to accomplish task around the house when the baby is sleeping, but it is imperative to use this time to rest.  

*Disclaimer: Thoughts shared are based on my personal experience. Always speak to your physician and healthcare team when making decisions regarding your health or the health of your baby. * 

Common Nutrient Deficiencies in IBD

laura lomax

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Vitamin and mineral deficiencies can be seen with inflammatory bowel disease for a variety of reasons: 

  • Inflammation in the GI tract, especially of the intestines and colon can interfere with vitamin, mineral, and nutrient absorption
  • Dietary modifications – Common dietary restrictions can lead to elimination of food groups putting patients at risk for nutritional deficiencies. Along with avoidance of foods, common symptoms often lead to loss of appetite and decreased intake especially during times of flares.
  • Medications and Surgical Interventions – Including resection or removal or portions of the small intestine or large intestine.

Calcium

Absorption occurs in duodenum

Food Sources: Cows milk, fortified milks (soy, almond), yogurt, cheese, canned fish, leafy greens, and fortified foods (orange juice, cereal, etc)

Supplements: Supplements commonly prescribed as dairy products on commonly avoided with lactose intolerance and leafy greens are not always tolerated. Supplement dose range based on age and deficiency. It is important to also address Vit D deficiency as they work together to maintain bone health.

Functions: Calcium has a variety of roles including muscle function, cell and hormonal signaling, and bone formation.

Risk: Corticosteroids decrease Calcium absorption. Physical inactivity is also a risk factor for osteoporosis

Vitamin D

Absorbed in ileum

Food sources: Vitamin D is found in minimal amounts naturally in the diet (salmon, tuna, and egg yolks). Fortified food sources of Vitamin D include milk and milk alternatives, yogurt, and some orange juice.

Supplements: Available as both Vitamin D2 and Vitamin D3.

Functions: Helps the body absorb calcium and promote bone health, plays a role in cell growth, as well as immune function (source 3).

Risk: Vitamin D deficiency is common in many individuals with IBD affecting 60-70% of IBD patients (source 2). While addition research is still need studies continue to explore how low Vitamin D levels influence IBD with results showing effects on disease activity, immune function, and even susceptibility to c. diff infections (source 2). It is a good practice to have your Vitamin D levels examined annually to assess and treat deficiency.

Vitamin A

Absorption in the ileum

Food Sources: Fortified milk and milk alternatives, eggs, cheese

Supplements: Often included in a daily multivitamin.

Functions: Vitamin A is needed for a variety of functions in the body including vision and immune function.

Risk: Deficiency common when ileum is removed or diseased

Vitamin E

Absorption in the ileum

Food sources: Almonds, sunflower seeds, avocado, wheat germ, leafy greens, egg yolk

Supplements: Often included as part of a multivitamin.

Functions: Several functions include acting as an antioxidant as well as plays a role in immune function.

Risk: Vitamin E is a fat soluble vitamin and should be evaluated if fat malabsorption is present. Deficiency can also be a concern if ileum is removed or diseased

Vitamin K

Absorption in the ileum

Food sources: Leafy greens, green vegetables (broccoli, Brussel sprouts, et)

Supplements: Often included as part of a multivitamin

Functions: Works as a cofactor and has roles in bone maintenance, central nervous system, and vision.

Risk: Increased risk of deficiency if ileum is removed or diseased.

B12 (cobalamin)

Absorption in the ileum

Food sources: Meat, fish, poultry, cheese, milk, eggs. B12 is naturally found in animal foods. It is important for vegetarians and vegans to look for fortified foods such as fortified cereals or fortified milk alternatives (soy or almond milk).

Supplements: Is available in oral supplements, but with deficiency B12 injections can be prescribed to bypass barriers to absorption (Source 3).

Functions: B12 is a water soluble vitamin. Several functions include maintaining nerve cell health, DNA synthesis, helps maintain heart health (decreasing homocysteine levels), helps maintain a healthy level of red blood cells (prevents megaloblastic anemia).

Risk: Increased risk of deficiency if ileum is removed or a significant portion diseased.

Folic Acid (B9)

Absorption in the small intestines.

Food sources: Liver, leafy greens, oranges, seeds, and fortified foods (such as breads and cereals).

Supplements: Supplementation is often prescribed for those taking medications that interfere with folate absorption (such as sulfasalazine or methotrexate. Deficiency is of special concern for women of child bearing age as folate deficiency can lead to increased risk of neural tube defects in babies.

Functions: Folate is a water soluble vitamin that functions as a coenzyme for a variety of process. Several main roles include prevention of megaloblastic anemia, DNA metabolism and cell division, and amino acid metabolism.

Risk: Deficiency can occur with avoidance of folate rich foods, medication interference, and malabsorption.

Zinc

Absorbed throughout the small intestine.

Food sources: Seafood, beef, beans. Noted: phytates and fibers inhibit zinc absorption while animal sources of zinc increase absorption (4)

Supplements: Supplements can be prescribed with prolonged diarrhea or poor wound healing.

Functions: Acts as a cofactor for a variety of enzyme processes including growth and immune function.

Risk: Deficiency can result in poor growth, weakened immune system, increased susceptibility to infection, and poor wound healing.

Iron

Absorption in duodenum

Food sources: Two types of iron include heme iron from animals such as beef, chicken, pork, salmon. Non heme iron is from plant sources such as fortified cereals, dark green vegetables, beans, and pumpkin seeds. Pairing iron rich foods with Vitamin C rich foods will increase absorption.

Supplements: Supplemented can be purchased over the counter or prescribed. Over the counter oral iron supplements can cause GI side effects such as abdominal pain and diarrhea.

Functions: Red blood cells need adequate iron to make hemoglobin. Hemoglobin is a protein in the red blood cells that carries oxygen throughout the body.

Risk: Inadequate intake, blood loss, and poor absorption all contribute to deficiency. Individuals with excessive blood loss such as ulcers or bloody diarrhea are at increased risk as well as with duodenal inflammation.

*As always information provided is general and you should always speak to your physician and medical team before making any adjustments to your health regimen*

Sources:

1.       Pediatric Nutrition Handbook. 6th edition. Ronald Kleinman. 2009.

2.       Vitamin D and inflammatory Bowel Disease. Ashwin N Ananthakrishnan. Gastroenterol Hepatol (NY) 2016 Aug; 12 (8): 513-515.

3.       National institute of Health. https://ods.od.nih.gov/factsheets

4.       Linus Pauling Institute. http://lpi.oregonstate.edu/search/osu/zinc

 

ANTI INFLAMMATORY DIET: FOODS TO CHOOSE AND AVOID

laura lomax

MY GOAL IS TO HELP CLIENTS USE NUTRITION IN COMBINATION WITH THEIR OTHER MEDICAL THERAPIES TO HELP REMOVE THE FEAR OF EATING, TAKE CONTROL OF THEIR DISEASE, AND FUEL AN ACTIVE LIFESTYLE – LAURA LOMAX, MS, RD, LD OWNER OF GREENS & GRAINS NUTRITION

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FOODS TO CHOOSE - ANTI INFLAMMATORY FOODS

FRUITS AND VEGETABLES: Eating anti-inflammatory rich fruits and vegetables doesn’t have to be fancy or expensive. It can be simple foods. Choose the produce that is in season and if you have problems with tolerance try the fruits or vegetables in different forms. For example, if you don’t tolerate raw fruits & veggies try incorporating them into a smoothie, well cooked, or pureed.

SPICES AND HERBS: Ginger, garlic, cumin, cinnamon, oregano, thyme, sage, cloves, allspice

OMEGA 3 FATTY ACID RICH FOODS: salmon, sardines, herring, mackerel, flaxseed oil, chia seeds

NUTS AND SEEDS: Walnuts, pecans, pistachios, almonds, macadamia, brazil nuts

WHOLE GRAINS: Brown rice, oats, popcorn, buckwheat, wild rice

BEANS, LENTILS, SOYBEANS, AND EDAMAME  

DARK CHOCOLATE OR COCOA

PROBIOTIC RICH FOODS: yogurts without added sugar, fermented foods (such as sauerkraut)

TEA: green tea, matcha tea, black tea

FOODS TO LIMIT OR AVOID

PROCESSED MEATS: bologna, hot dogs, sausage, cold cuts 

TRANS FAT OR HYDROGENTATED OILS: Food label laws allow a product to be labeled zero grams if it has less than 0.5 grams per serving. To be sure your food is trans fat free check the food ingredients list and double check you don’t see the word “hydrogenated oils or partially hydrogenated”. Some common foods to double check include peanut butter, snack bars, and biscuits. 

SUGARY BEVERAGES AND OTHER FOODS WITH ADDED SUGARS: In a few years food labels will be mandated to identify grams of added sugar on the food label. Until then be sure to look at your ingredient list if you are unsure if a food contains natural vs added sugar. Look for sugar in the ingredient list (ingredients are listed from most to least in the product). Sometimes labels can be tricky so remember sugar, honey, high fructose corn syrup, organic cane sugar, fructose, evaporated cane juice, corn syrup solid are all just other ways of saying added sugar.

REFINED GRAINS: Opt for the whole grain options as mentioned above. While all whole grains are your best bet, aim to make at least half your grains whole.

FOODS HIGH IN SATURATED FATS: Such as fried foods, fatty meats, and many processed baked goods.

As always tips provided are general anti- inflammatory foods. Dietary recommendations vary by individual based on disease location, severity, and overall health. Always discuss changes with your medical team prior to making changes in your diet.

 

For more tips and healthy recipes follow me on Instagram @greensandgrainsrd and on Facebook at Greens & Grains Nutrition.

Introduction

laura lomax

7/13/17

WELCOME:

Thank you for visiting my Inflammatory bowel resource page. The goal of this page is to build a resource and community for those of us with inflammatory bowel disease. My name is Laura Lomax and I am a mom, dietitian, and I have ulcerative colitis. I believe there is an undeniable correlation between the foods we put in our body and how we feel. This is true for everyone, BUT I feel even more so for those of us living with inflammatory bowel disease (IBD). As a dietitian with ulcerative colitis to say I have tried all kinds of dietary approaches to help my ulcerative colitis is an understatement!  I strive to help people with IBD use diet in combination with their individualized  medical therapies to regain control of their life and remove the fear of eating so they can live an active lifestyle.