I Wasn’t Trying to Write a Case for Dietitians. But Here We Are.
A new(ish) review in Clinical Nutrition ESPEN looked at something IBD nutrition research doesn’t talk about enough:
Not just what people with IBD should eat…
…but the barriers, beliefs, and behaviors that shape how people actually eat in real life.
I appreciated seeing a paper focus on this side of nutrition care.
Because if you spend any time working in IBD or living with IBD, you know:
Motivation usually isn’t the problem.
Most people with Crohn’s disease and ulcerative colitis believe diet matters (many in the review considered it as important as their medication) and most had changed the way they eat since diagnosis.
The review highlighted a few main barriers they’re navigating at the same time:
- Unpredictability of symptoms and conflicting information
- Cost, time, and workplace limitations
- Social isolation and family dynamics
Somewhere around page four, I realized this paper was basically a case for why people with IBD need IBD-trained dietitians.
A few examples from the paper that stood out to me:
→ Trial and error becomes exhausting
When symptoms are unpredictable and guidance is often inconsistent, people rely on trial and error. And doing that alone, over months or years, is exhausting and can lead to unnecessary dietary restrictions.
🙌 This is where GI dietitians can help — bringing clinical experience and knowledge of the science to make trial and error more strategic, and a lot less frustrating.
→ The restriction starts… but no one tells patients when it’s safe to stop
The review highlighted something I see all the time: food restrictions that start during a flare often continue long into remission.
Someone is told to avoid certain foods during a flare or after surgery — but that temporary restriction becomes permanent because many patients are never told when (or how!) to expand their diet, even as malnutrition and micronutrient deficiencies remain real concerns.
🙌 This is where GI dietitians can help — helping patients meet their nutrition needs when their bodies need the most support and making a reintroduction plan before restriction becomes the new normal.
→ The social side of restrictive diets matters too
One patient I worked with had her UC beautifully controlled on the specific carbohydrate diet.
But eating out with friends had become so difficult that she’d stopped going out altogether.
This is the kind of pattern the review highlighted — many patients reported withdrawing from social outings and avoiding restaurants because eating out had become too stressful.
🙌 Dietitians help patients work through the challenges associated with eating in the real world — restaurants, family gatherings, travel, food costs, and all the situations where dietary changes can start to feel overwhelming or isolating.
Nutrition care in IBD is rarely (arguably never) just about handing someone a list of foods.
It’s helping people navigate a variety of barriers: conflicting advice, symptom unpredictability, food fear, social situations, and the very real gap between “knowing” and actually being able to follow through.
That’s my case for working with a knowledgeable IBD dietitian 🙂
