Successful Elimination Diet Management in IBD Patients
Many patients with inflammatory bowel disease (IBD) require nutritional management to control clinical signs, provide adequate nutrients, and compensate for ongoing nutrient losses. An elimination diet containing a hydrolyzed protein source or a diet containing a single novel protein are commonly recommended for IBD patients.1
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A Thorough History
Before beginning an elimination diet, ask the client to provide a complete diet history that includes input from all family members and any others who may be feeding the patient (eg, a house cleaner, a nurse visiting a family member). Diet history forms that can be completed at home are available at www.wsava.org/educational/global-nutrition-committee.
The veterinarian or veterinary nurse should review the history forms with the client upon the patient’s arrival to the practice. Ask the client open-ended questions to help ensure that the veterinary team is aware of everything the patient eats. Identifying every food source (eg, treats given with medication, food dropped on the floor) increases the chances of success.
Clear Communication
Next, take the following steps to clearly communicate the diet plan and improve client compliance.
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Step 1: Transition gradually
Gradually switch the patient from the regular diet to the elimination diet. The general guideline is:
Feed three quarters of the regular diet with one quarter of the new diet for 3 to 5 days.
Change to half portions of each diet for 3 to 5 days.
Feed one quarter of the regular diet and three quarters of the new diet for another 3 to 5 days.
Completely transition to the recommended elimination diet.
Step 2: Give only the recommended diet
Educate clients on the importance of feeding patients only the recommended diet during the elimination trial period (ie, no flavorings, sauces, gravy, chewable medications, treats).
Step 3: Be patient
Patients may improve in as little as 3 weeks; however, elimination trials for gastrointestinal issues such as IBD may take as long as 12 to 16 weeks before improvement is seen following the complete transition from the regular diet.2 Clients should be aware there is no fast track for elimination trials.
Step 4: Follow-up
Follow-up is always important, but it is critical for IBD patients undergoing an elimination trial. A veterinary team member should call or email the client 2 days after the patient transitions to the new diet and then check in weekly to ask about the transition and any challenges and concerns, and to answer any questions. Such follow-up demonstrates support and concern, which increases client compliance and the chances for successful dietary management of IBD.
Step 5: Dieting long-term
Once the patient’s clinical signs have resolved, other foods may be reintroduced, giving only one new protein at a time. If the signs return, any new foods should immediately be eliminated from the diet until all the clinical signs have again been resolved.2
It may be prudent to remind the client that a permanent balanced elimination diet likely benefits the patient because the disease is managed over the long-term.
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Conclusion
Client compliance is essential to the success of dietary management of IBD; the key to client compliance is education.
Editor’s note: Ed Carlson, CVT, VTS (Nutrition), is employed by IVG Hospitals and VetBloom, where he has worked in internal medicine, emergency and critical care medicine, and general practice as a technician supervisor, and hospital manager. He is currently in the learning and development department. He is active in multiple state and national veterinary nurse organizations and received the VTS (Nutrition) credentials in 2014. He also lectures on nutrition at multiple local, regional, and national veterinary conferences.