Diet and IBD: Why “One Size Fits All” Doesn’t Apply

Q & A with Dietitian Kelly Issokson

Kelly Issokson, MS, RD, is a clinical dietitian at Cedars-Sinai in Los Angeles. She is a nutrition expert and IBD-focused dietitian. Ms. Issokson also helps patients with other GI conditions, such as IBS, SIBO, celiac disease, and diverticulosis. She recently worked with the Foundation to create Gut Friendly Recipes, a free online recipe finder tool for people with digestive issues, IBD and for general nutritious eating.

Can you tell us a little bit about your background and how you became interested in working as a dietitian, especially in the field of gastrointestinal health?

Kelly Issokson, MS, RD

I have a background both in dietetics and in culinary arts. As a young student, I enrolled in a culinary program, but shifted my focus to nutrition and received my degree in culinary nutrition. I became interested in GI nutrition when, as a chef, I began noticing the impact of diet on health. My focus shifted from just making good food, to making food that was not only delicious, but also good for our bodies. That’s when I began pursuing a career in dietetics.

In my early training, I was very lucky to work with dietitians at a teaching hospital (Cedars-Sinai) and see all the ways in which dietitians can help people. I became particularly interested in liver health and IBD, thanks to two very smart registered dietitians (RDs) who showed me how nutrition care impacts these populations. In 2013, I began working with the IBD team at Cedars-Sinai, and I’ve been fortunate to grow in my role with this wonderful team.

What inspired you to get involved with the Crohn’s & Colitis Foundation and the Gut Friendly Recipes project, and what do you hope to accomplish through this initiative?

There are very few evidence-based resources available for people with IBD. Many people search online or get info from sources that aren’t always reliable and sometimes lead to over-restricted diets that may worsen health and quality of life. The Crohn’s & Colitis Foundation’s Gut Friendly Recipes project is unique in that all the recipes have been reviewed by a dietitian and sorted into specific categories to meet everyone’s needs. Whether you are in a flare, or remission, or if you need to limit certain foods due to strictures, or if you’re looking to increase your vegetable intake—there are recipes available for everyone. I am confident that this resource will not only help people find recipes that are delicious, easy, and gut friendly, but will also help remove some anxiety from meal planning and foster better relationships with food.

What are some of the biggest challenges that people with Crohn’s disease and ulcerative colitis face when it comes to managing their diet, and how do you work with them to address these challenges?

Just knowing what to eat with IBD can be very challenging, as there is no “one size fits all” approach to diet and IBD. Talking to a provider about diet is crucial to learning what approach is best. And the answer depends mostly on the goal of the individual, as certain foods or diets may help with managing symptoms or can work in conjunction with medications to help decrease inflammation, improve response to medications, or keep people in remission for longer periods of time. I work with people and focus on making small, incremental changes, to help them achieve their nutrition goals. With IBD, nutrition goals can evolve, so it’s important to check in with a dietitian when changes occur to see how or if your diet needs to be adjusted.

How do you approach creating gut-friendly recipes that are both tasty and nutritious, and what are some of your go-to ingredients and cooking techniques?

When creating gut-friendly recipes, I like to start with simple ingredients and preparation methods. People often feel best when eating home-cooked meals, but this can take a lot of time and energy. Personally, I love sheet pan meals where you toss everything in oil and herbs or spices (oregano, thyme, rosemary, and smoked paprika are some of my favorites), put it all on a single sheet pan and roast it.

Using herbs is a great way to add flavor to meals without worsening symptoms (sometimes hot spices like cayenne can worsen symptoms). I also love my smoothies! Smoothies are a great way to incorporate easy-to-digest fiber in your diet. The Crohn’s & Colitis Foundation has a smoothie recipe on the back of their nutrition pamphlet. One of my favorite recipes is: 1 frozen banana or berries, ½ cup kale or spinach, 1-2 tablespoons nuts or seeds (I like walnuts or chia), ½ cup water, ice, and blend!

How important is it for people with IBD to work with a registered dietitian or nutritionist, and what kinds of services do you typically provide to your clients?

An IBD-focused registered dietitian should be part of everyone’s treatment team, but they are not always easily accessible. Some places don’t have IBD-focused RDs, and visits with an RD may be unaffordable for some people. At Cedars-Sinai, patients see me as part of their visit with their IBD doctor or nurse practitioner. Patients can also schedule separate visits with me for longer, more in-depth sessions.

Each visit begins with me learning all about my patient and what their goals are. At the first visit, I do a comprehensive nutrition assessment, which involves reviewing their medical and surgical history, labs, medications, supplements, performing a nutrition-focused physical exam, and learning about their eating practices and behaviors, their relationship with food, and their food access. I then take all this information and develop a nutrition plan together with my patient. I often discuss cooking methods as part of my counseling, as this is an important skill needed to achieve their nutrition goals.

What are some common misconceptions about diet and IBD, and how do you work to dispel these myths?

A common misconception is that you can’t eat fiber if you have IBD! Recent research is helping us learn just how important fiber is for the gut microbiome (the community of bacteria, viruses, fungi, and archaea in your intestines). Fiber also helps to control the movement of food through our gut, improves symptoms, and helps to prevent IBD flares. A good way to incorporate fiber during flares or if strictures are present is to change the texture of the food to a smooth, creamy consistency—think of creamy peanut butter versus whole nuts, or hummus instead of garbanzo beans, or a green smoothie instead of a big salad. The more processed and broken down the food is, the better it will be tolerated during acute flares or if strictures are present.

Another myth is that if a food triggers symptoms it must be avoided for life. I spend a lot of time helping people identify possible trigger foods and working with them to find the best time and way to reintroduce that food. A good example is lactose intolerance. Lactose is a sugar found in fresh dairy (milk, cream, ice cream, sour cream, cream cheese), and people can develop lactose intolerance as they get older or if they are experiencing a flare. Instead of removing dairy from their diet altogether, many people find relief is they choose lactose-free dairy (lactose-free milk, plain yogurt, aged cheeses like cheddar) or use a lactase digestive enzyme when they consume dairy products.

What advice would you give to someone who has recently been diagnosed with Crohn’s disease or ulcerative colitis and is struggling to navigate their dietary needs?

Talk about it—you may or may not have access to a dietitian, but your IBD provider is the main person you should initially discuss your diet struggles with. Your IBD provider can connect you with an IBD-focused RD who can help you. You can also join a support group or check out the Crohn’s & Colitis Foundation’s nutrition resources. There are also regional and local conferences that the Foundation hosts and these usually include a talk on diet/nutrition. You can also search for a GI dietitian through the Foundation’s provider search tool, or through the Academy of Nutrition and Dietetics’ search tool at eatright.org.  

Can you share a favorite gut-friendly recipe with our readers, and explain why it’s a good choice for people with IBD?

I love the All-in-One Veggie Breakfast—this is a great example of a delicious meal that can be made easily in one pan with quick preparation and minimal dishes. Eating healthy doesn’t always have to be so time consuming and complicated, and this recipe is a great example of that. This meal is great for people with IBD because it is well balanced—it contains proteins, vegetables, and fruit (yes, tomato is a fruit!), and is a great source of fiber and vitamin C. It is also easily customized, if needed. For example, if a patient wants to eat this but doesn’t eat potatoes, a dietitian may suggest butternut squash as a substitute. Or if someone is limiting insoluble fiber due to strictures or a flare, a dietitian may recommend using peeled potatoes and canned tomatoes (or peeled tomatoes).