Plant-Based Iron Sources, Absorption, Deficiency | Plant Nutrition Wellness

Getting enough plant-based iron on a vegan or vegetarian diet can take some planning and practice, but it is possible. This article breaks down why iron requirements are higher for people following a plant-based diet, strategies to increase iron intake and absorption, and how to spot red flags for iron deficiency. 

 

What is iron and why do we need it?

Iron is an essential mineral with several important functions in the body (1). Some of these include:

  • Forming part of haemoglobin which helps carry oxygen from the lungs to the rest of the body.
  • Forming part of myoglobin, which is a protein that helps transport oxygen to muscles during exercise and daily movement.
  • DNA synthesis and energy production in cells.
  • Immune support

There are two different types of iron in the diet. These are haem and non-haem iron. Haem iron is only found in animal products such as meat and fish, whereas non-haem iron is found in both animal products and plant foods (2).

The main difference between the two types of iron is how well we absorb them. Unfortunately for plant-based eaters, haem iron is much better absorbed by the body than non-haem iron. Approximately 15-35% of haem iron is absorbed during digestion compared to only 2-20% of non-haem iron.

The absorption of non-haem iron is also affected by other components in foods consumed at the same time (3). This is one of the reasons that animal products such as red meat are promoted as better sources of iron than plant foods.

However, a well-planned vegan or vegetarian diet absolutely can provide adequate iron. In fact, in Australia, even for non-vegetarians, most dietary iron comes from plant foods rather than meat (2).

 

iron on a plant-based diet - legumes

 

Iron requirements on a plant-based diet

When consuming a vegetarian or vegan diet, some nutrients must be consumed in larger quantities than what is specified for the general healthy population, iron being one of them. This is because, as mentioned previously, plant-based sources of iron are much less readily absorbed by the body.

It is recommended that all individuals consuming a predominantly plant-based diet consume 180% of the recommended daily intake specified for the general population to make sure that requirements are met (2).

Iron requirements differ greatly between genders and across different stages of life. Below is a summary of the daily requirements for vegetarians or vegans based on the values provided in the Nutrient Reference Values for Australians and New Zealanders (4).

 

Age Group Recommended Daily Intake (RDI)
Males Females
Infants
7-12 months 19.8mg 19.8mg
Children & Adolescents
1-3 years 16.2mg 16.2mg
4-8 years 18mg 18mg
9-13 14.4mg 14.4mg
14-18 19.8mg 27mg
Adults
19-50 years 14.4mg 32.4mg
51+ years 14.4mg 14.4mg

 

Best plant-based iron sources

To ensure requirements are met, it is recommended to include a variety of plant-based sources of iron in the diet and ensure that each meal contains iron-rich foods.

There are a wide variety of plant-based iron sources you can choose from. These include legumes, whole grains, nuts and seeds, leafy green vegetables and dried fruit. Fortified products such as some cereals and meat alternatives also act as great sources of iron for vegans and vegetarians (2).

The following table lists the amounts of iron found in different plant foods and fortified products (5):

 

Legumes

Food Serve Size Iron Content (mg)
Tofu 150g firm 4.4
Tempeh 150g 4.4
Edamame ½ cup (70g) cooked 2.5
Baked Beans 200g can 2
Red Kidney Beans ½ cup (90g) cooked 1.9
Chickpeas ½ cup (100g) cooked 1.6
Lentils ½ cup (100g) cooked 1.8
Butter Beans ½ cup (40g) cooked 0.5
Green Split Peas ½ cup (50g) cooked 0.5


Wholegrains

Food Serve Size Iron Content (mg)
Amaranth ½ cup uncooked (100g) 7
Wholegrain Bread 2 slices (80g) 1.8
Rolled Oats ½ cup uncooked (50g) 1.8
Brown Rice ½ cup cooked (125g) 0.7
Quinoa ½ cup cooked (65g) 1.1
Barley ½ cup cooked (100g) 0.9
Buckwheat ½ cup cooked (100g) 0.6


Nuts & Seeds

Food Serve Size Iron Content (mg)
Pumpkin Seeds ¼ cup (30g) raw, unsalted 3
Hemp Seeds ¼ cup (30g) raw, unsalted 3
Sesame Seeds ¼ cup (30g) raw, unsalted 2.7
Tahini 2tbsp (30g) 2.7
Chia Seeds ¼ cup (30g) raw, unsalted 2.3
Flax Seeds ¼ cup (30g) raw, unsalted 1.7
Cashews ¼ cup (30g) raw, unsalted 1.5
Pine Nuts ¼ cup (30g) raw, unsalted 1.2
Pistachios ¼ cup (30g) raw, unsalted 1.2
Almonds ¼ cup (30g) raw, unsalted 1.1
Walnuts ¼ cup (30g) raw, unsalted 0.8
Brazil Nuts ¼ cup (30g) raw, unsalted 0.7
Peanuts ¼ cup (30g) raw, unsalted 0.7
Pecans ¼ cup (30g) raw, unsalted 0.7


Vegetables

Food Serve Size Iron Content (mg)
White Potato 1 medium baked with skin 1.4
Green Peas ½ cup cooked (80g) 1.3
Silverbeet  1 cup raw (50g) 1.2
Kale 1 cup raw (65g) 1
Sweet Potato ½ cup baked with skin 0.9
Beetroot (fresh) ½ cup baked (80g) 0.9
Beetroot (tinned) ½ cup drained 0.6
Broccoli ½ cup cooked (80g) 0.5
Spinach 1 cup raw (30g) 0.5


Other

Food Serve Size Iron Content (mg)
Blackstrap Molasses 1 tbsp 3.6
Dark Chocolate 30g 1.3
Soy Milk 1 cup (250mL) 1.2
Dried Apricots 30g (~4 apricots) 0.9
Tomato Paste 1 tbsp 0.7
Hummus 2 tbsp 0.7
Raisins 2 tbsp (30g) 0.4
Dried Figs 30g (~2 figs) 0.4

 

Fortified Products

Food Serve Size Iron Content (mg)
Coles Perform Plant Protein Powder 35g 6.6
Milo (Plant Based Energy) 20g 4.4
Vegie Delights Chicken Burger 1 patty (75g) 3.5
Vegie Delights Vege Mince 100g 3.5
Vegie Delights Vegetable Roast 120g 3.5
Vegie Delights Vege Sausages 2 sausages (100g) 3.5
Sanitarium Light ‘n’ Tasty Berry 40g 3
Kellogg’s Special K Original 40g 3
Kellogg’s All Bran Original 45g (½ cup) 3
Sanitarium Weet-Bix 2 bricks (30g) 3
Vegie Delights Lentil Patties 1 patty (75g) 2.6

 

Iron-rich day on a plate

Breakfast: ~7mg
2 Weet-Bix + ½ cup soy milk + ½ cup strawberries + 30g hemp seeds

Lunch: ~10mg
Tofu nourish bowl: 150g tofu + 1 cup spinach + 1 cup roast veg (beetroot, pumpkin, sweet potato, carrot broccoli) + ½ cup quinoa + tahini dressing (1 tbsp tahini, lemon juice, maple syrup)

Dinner: ~6mg
Bean barley and vegetable stew (1 cup kale, ½ cup red kidney beans, ½ cup barley + 1 cup mixed veg) + 1 baked potato  

Snacks: ~10mg
Veggie sticks with 3 tbsp hummus
Four dried apricots + 30g dark chocolate
30g almonds
20g Milo + 1 cup soy milk

TOTAL:  ~33mg

 

plant-based iron sources, vegan dietitian

 

Optimising iron absorption

Many dietary factors that can either increase (enhancers) or decrease (inhibitors) our body’s ability to absorb iron from plant-based foods.

 

Inhibitors

The main inhibitor is phytates or phytic acid, which is often referred to as an ‘anti-nutrient’ because it binds to minerals such as iron preventing their absorption.

Unfortunately, phytates are abundant in many iron-rich plant foods such as legumes, whole grains and nuts. The phytate content in whole grains can be reduced during processing, however, nutrients such as iron and zinc are often reduced as well. Additional ways to decrease phytates include leavening bread and soaking and sprouting legumes, grains and seeds (2, 6).

Other inhibitors include polyphenols which are found in tea, coffee, cocoa and red wine and some other minerals such as calcium and zinc which compete for absorption (2).

 

Enhancers

Many dietary factors can enhance iron absorption, the most helpful being vitamin C. Adding vitamin C-rich foods such as citrus fruits, kiwi fruit, strawberry, broccoli, red capsicum and white potato to your meals can increase iron absorption by up to 3 to 6-fold (2).

Some other dietary factors that can enhance iron absorption include other organic acid additives such as citric, malic and lactic acids as well as vitamin A and beta-carotene. These are high in dark leafy greens, and many orange fruits and vegetables such as carrots, sweet potatoes and apricots. (2)

Some simple tips to improve iron absorption include:

  • Drink tea and coffee 30 mins before or after meals
  • Soak and rinse legumes before cooking
  • Add vitamin C-rich foods to your meals
  • If supplementing with zinc or calcium, consume these away from iron-rich meals or snacks

 

plant-based iron absorption enhancers - vitamin C

 

Iron deficiency on a plant-based diet

Iron deficiency is the most common nutritional deficiency in the world affecting over 30% of the population across both developing and developed countries (7).

There are multiple reasons why you may develop an iron deficiency. These include (8):

  • Increased blood loss:
    • Bleeding in your digestive tract: ulcer, colon cancer, regular use of medicines such as aspirin or nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen and naproxen
    • Frequent blood donation
    • Frequent blood tests – especially in infants and small children
    • Heavy menstrual periods
    • Injury or surgery
    • Urinary tract bleeding
  • Inadequate intake or increased requirements
  • Problems absorbing iron:
    • Intestinal and digestive conditions: coeliac disease, inflammatory bowel diseases (ulcerative colitis and Crohn’s disease), Helicobacter pylori infection
    • History of gastrointestinal surgery such as weight-loss surgeries (especially gastric bypass or gastrectomy)

 

online dietitians help with gut health for iron absorption on a plant-based diet

 

As such, high-risk groups for developing an iron deficiency include (2,3,8):

  • Those on a restricted diet such as a vegan or vegetarian diet or restricted calorie diet (weight loss)
  • Women of reproductive age – increased losses through menstruation
  • Pregnant and breastfeeding women – increased needs for foetal growth
  • Endurance athletes – increased losses
  • Medical conditions leading to intestine inflammation or chronic blood: ulcers, Crohn’s Disease, Ulcerative Colitis, undiagnosed Coeliac disease

Iron deficiency can be categorised into three levels based on the severity of the deficiency (2).

  1. Depleted iron stores – no limitations to iron supply around the body
  2. Early functional iron deficiency – suboptimal iron supply to tissues but no substantial impairment to red blood cell formation
  3. Iron deficiency anaemia – decreased red blood cell count, substantial functional impairment

 

Signs you may have an iron deficiency

Symptoms often start mild and worsen as the deficiency becomes more severe. Feeling more tired than usual is often the first tell-tale sign you may have an iron deficiency.

Common symptoms include (2, 8):

  • Weakness and fatigue
  • Dizziness
  • Decreased immunity
  • Shortness of breath
  • Impaired cognition
  • Increased sensitivity to cold
  • Heart palpitations
  • Decreased athletic performance
  • Hair loss or brittle nails
  • Irritation or bleeding at corners of the mouth or around the lips

If iron-deficiency anaemia goes untreated, more severe and potentially life-threatening complications can arise. These include:  

  • Depression
  • Heart problems
  • Increased risk of infections
  • Pregnant women: premature delivery, low birth weight
  • Infants: higher infant mortality, delayed psychomotor development impaired cognition

If you think you may have an iron deficiency it is important to discuss any concerns with your GP.

 

Are you more at risk of iron deficiency being vegan or vegetarian?

It is commonly thought that individuals following a vegan or vegetarian diet are more at risk of developing an iron deficiency due to the lower bioavailability of iron in plant-based sources.

Whilst it is important to pay more attention to your iron intake if you are following a primarily plant-based diet, eating a well-planned vegan or vegetarian diet provides no increased risk for developing an iron deficiency compared to non-vegetarians (2,3). Feel free to contact our vegan nutritionists and online dietitians in Australia for more information and personalised recommendations.

 

taking an iron supplement on a plant-based diet - advice from online dietitians

 

Should you take an iron supplement? 

It is absolutely possible to meet your iron requirements solely from food sources when following a plant-based or vegan diet, and supplements should never be used to replace a healthy diet. However, a supplement may be necessary in some instances to resolve or avoid deficiency (3).

Due to the body’s ability to tightly regulate iron absorption from food sources, there is no evidence of adverse effects from consuming high amounts of iron from plant-based food sources. However, over-supplementation is a different story. This is because excess iron in supplements can accumulate in the body, which can be very harmful. Possible side effects include constipation, diarrhoea, vomiting, nausea, liver dysfunction, and increased inflammation in the body (3). 

There are, however, a few common side effects associated with iron supplementation that you may experience such as nausea, abdominal pain, gas, diarrhoea, constipation and black or tarry stools (3).

To avoid unnecessarily supplementing, we recommend to ‘test not guess’ and get a blood test done first through your GP before starting on any supplements. Your GP or dietitian will then be able to best guide you on whether or not supplementation would benefit you.

 

Thriving on plant-based iron

Following a well-planned and balanced plant-based diet can ensure that you meet your dietary iron requirements. However, in some circumstances, supplementation may be necessary to avoid or correct iron deficiency, working with your doctor and dietitian for a tailored approach. 

If you are struggling to get enough iron on a plant-based diet, or trying to correct iron deficiency but feel unsure about where to start, you can book an appointment with one of our online dietitians at The PNW Clinic today. 

 

Article written by: PNW Clinic Dietitian Georgia D’Andrea.

Are Artificial Sweeteners During Pregnancy Safe? | Plant Nutrition Wellness

The frenzy over using artificial sweeteners as a low-calorie alternative to sugar has been around for decades. Despite these years of use and research, whether or not they are safe or ‘healthy’ is still hotly debated. Determining the safety of artificial sweeteners during pregnancy only adds an extra layer of confusion into the mix.

If you’re confused about whether or not it is safe to use artificial sweeteners during pregnancy,  I don’t blame you. The current evidence pool is a topic of debate amongst health professionals and non-health professionals alike.

To ease your mind, we have sorted through the most recent evidence base from pregnancy nutritionists, pregnancy dietitians, and other expert sources. Here is what we found regarding whether you can add some artificial sweeteners into your pregnancy diet.

 

What are artificial sweeteners?

First, it’s essential to define what an artificial sweetener is, as this term doesn’t relate to all of our no-calorie sweeteners.

Despite often all being thrown together in the artificial sweetener bag, there are 3 types of no-calorie sweeteners currently used in our foods.

These include:

  • Artificial sweeteners e.g. sucralose, saccharin and aspartame
  • Sugar alcohols e.g. mannitol, sorbitol and xylitol
  • Novel sweeteners (often labelled as a more natural alternative) e.g. stevia and monk fruit

To focus on artificial sweeteners more specifically, these are ingredients made in labs out of chemicals. They are very sweet to taste yet very low in calories. In fact, they can be up to 600x sweeter than regular table sugar. This means that you need a much smaller amount to get the same level of sweetness.

Although made from chemicals, their use in food products is heavily regulated by all national food governing bodies, including Australia’s, to ensure that only those deemed safe are put on our shelves.

Here are a few specific artificial sweeteners you may come across when looking in the supermarket:

  • Aspartame (e.g. Equal)
  • Saccharin
  • Sucralose (e.g. Splenda)
  • Cyclamate
  • Acesulphame potassium or ‘Ace K’

 

are artificial sweeteners safe during pregnancy from a pregnancy dietitian

 

How do they compare to sugar alcohols?

Sugar alcohols are found in products such as sugar-free mints, gum and lollies. You can also find them down the ‘health food’ aisle in low-carb or sugar-free products such as protein bars.

You can easily spot them in the ingredients section by looking for an ‘ol’ at the end of the word. For example, sorbitol, mannitol, maltitol and xylitol as well as isomalt, which is the one exception to the rule.

Sugar alcohols are low in calories and not well absorbed by the body.

You may notice statements on the packaging of products they are found in such as, “high consumption may also have a laxative effect”.  Sugar alcohols can cause some unpleasant digestive side effects such as bloating, gas, diarrhoea and abdominal pain in some individuals.

 

What about stevia and monk fruit?

Novel sweeteners, such as stevia and monk fruit as well as the lesser-known tagatose, allulose and inulin, are often referred to as ‘natural sweeteners.’ They are typically derived from plant sources (e.g. the stevia plant) and are less processed than their alternatives such as artificial sweeteners and sugar alcohols.

 

Is it safe to use artificial sweeteners during pregnancy?

Most (but not all) artificial sweeteners have been deemed safe to use during pregnancy by Australia and New Zealand’s food safety governing body FSANZ (1).

Although they are marked as safe to consume, there is a growing body of evidence to suggest they may have some problematic side effects during pregnancy.

Most importantly, research has found that artificial sweeteners, such as saccharin, aspartame and potentially Ace K, cross the placenta (2, 3, 4). Just as your baby is exposed to the nutrients you consume that cross the placenta, they are likely also going to be exposed to these chemicals.

While research has been done to determine a safe level of these chemicals for adult consumption, there is nowhere near enough research currently to say that this is also safe for a foetus (5).

 

pregnancy dietitian and nutritionist, fertility dietitian

 

Additionally, a 2018 review from Cambridge University on the effect of sugar and alternative sweeteners during pregnancy on maternal and child health found that there is some evidence to suggest a negative impact of alternative sweeteners (such as artificial sweeteners) on infant outcomes.

This included increased risk of preterm birth, higher than average birth weight, and increased preference for sweet foods. So far, there is no information on the potential long-term risks of infant exposure to these chemicals. Ultimately, the study concluded that much more research is needed in the area (5).

An earlier Canadian review in 2014 had similar findings. They concluded that more research is needed to fully understand the effects of artificial sugar exposure to infants whilst in the womb. However, they did ultimately recommend that sugar substitutes can be consumed in “moderate amounts” as so far, no research has found strong evidence to suggest adverse effects (6).

 

Which artificial sweeteners during pregnancy are safe?

Most, but not all artificial sweeteners have been deemed safe during pregnancy.

Currently, the safe ones include:

 

Aspartame

Acceptable daily limit (ADI) – 40mg aspartame per kg body weight (7)

Although aspartame does cross the placenta during pregnancy, research has found that doses of up to 200mg per kg body weight (which is 5x the ADI) don’t lead to negative effects in offspring.

Based on these findings, having aspartame is not expected to be unsafe during pregnancy so long as intake is kept within the ADI (6).

However, women who suffer from phenylketonuria (a rare medical condition where the body can’t break down phenylalanine) should avoid aspartame. This is because phenylalanine is a digestive byproduct of aspartame which can become toxic when it accumulates in large amounts (8).

 

Sucralose

Acceptable daily limit (ADI) – 5mg sucralose per kg body weight (9)

So far to date, research has found no increased risk of any adverse effects to infants with high-dose sucralose exposure during pregnancy. However, these are only animal studies, which are not 100% comparable to humans.

It is recommended to keep intake below the ADI (6).

 

Acesulphame potassium or ‘Ace K’:

Acceptable daily limit (ADI) – 0-15mg Ace K per kg body weight (10)

There is currently very little research available on the safety of Acesulphame potassium, also known as Ace K, during pregnancy. Similarly to aspartame, there is research that suggests it crosses the placenta, meaning it is likely a growing baby will be exposed to it when eaten (11).

Animal studies have also found that foetuses exposed to the sweetener had an increased preference for sweet foods later in life compared to those who were not exposed. However, the mice in this study were fed Ace K in amounts far greater than the ADI (12)

Currently, having Ace K is considered safe during pregnancy so long as it is within the ADI (6). However, you will see above that in Australia the ADI ranges between zero to 15mg per kg body weight, making things a bit more confusing.

The safest bet is to keep intake of this one to an absolute minimum.

 

pregnancy dietitian on artificial sweteeners during pregnancy

 

Which artificial sweeteners are NOT safe during pregnancy?

In terms of the artificial sweeteners deemed UNSAFE during pregnancy, these include saccharin and cyclamate. These sweeteners should be avoided by all pregnant and lactating women.

 

Saccharin

Saccharin is well-known by researchers to cross the placenta during pregnancy (13).

One study even found that repeated intake by pregnant women can lead to a considerable amount of accumulation of the chemical in foetuses (14). As such, current guidelines recommend avoiding intake of saccharin during pregnancy to keep on the safe side (6).

 

Cyclamate

There is currently little research available regarding cyclamate use during pregnancy. It is currently recommended to be avoided during pregnancy as it is known to cross the placenta and accumulate in foetuses (15, 16).

NOTE: Both saccharin and cyclamate are deemed safe for use by the general public.

 

What about using sugar alcohols and novel sweeteners during pregnancy?

Similarly to artificial sweeteners, there is also little information available regarding the safety of sugar alcohols during pregnancy.

The current consensus is they are safe ‘when consumed in moderation’ (6). They fail to mention exactly how much ‘moderation’ refers to. This is another one we’d recommend keeping to a minimum. We also recommend discussing this with your pregnancy dietitian for individualised advice.

The same goes for novel sweeteners such as Stevia and monk fruit. Currently, there have only been rat studies testing the safety of Stevia during pregnancy. So far they have found no negative effects with consumption.

But again, rats are not humans, so this information does need to be taken with caution (6).

When it comes to monk fruit, even less research has been done regarding pregnancy. If you go by current government guidelines, both Stevia and monk fruit are considered to be safe during pregnancy. We recommend not to go too overboard, using it only in small amounts and only if needed (again it is recommended to speak to a dietitian for more individualised advice).

 

artificial sweeteners during pregnancy, adding artificial sweetener to coffee or tea

 

So, what’s the general consensus?

Ultimately, with the limited amount of research available to say whether artificial sweeteners during pregnancy are safe for you and your growing bub,  we believe that the best option is to avoid them as much as possible to air on the side of caution.

Instead, we recommend opting for a small amount of the real deal whether that be regular table sugar, maple syrup, agave or honey to help give your foods that added sweetness.

That being said, consuming the occasional artificial sweetener (except for saccharin and cyclamate) is likely nothing to stress about and has been deemed ‘safe’.  Plus, artificial sweeteners can play a helpful role in certain circumstances such as gestational diabetes where limiting sugar intake is crucial for your baby’s health.

If you want to optimise your diet during pregnancy, our pregnancy dietitian nutritionist Georgia D’Andrea is an expert in all things plant-based fertility, pregnancy and post-natal nutrition. You can book an appointment today.

 

References

  1. https://www.foodstandards.gov.au/consumer/additives/Pages/Sweeteners.aspx
  2. https://pubmed.ncbi.nlm.nih.gov/3756841/
  3. https://pubmed.ncbi.nlm.nih.gov/2862125/
  4. https://www.scielo.cl/pdf/ijmorphol/v28n3/art25.pdf
  5. https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/effects-of-consuming-sugars-and-alternative-sweeteners-during-pregnancy-on-maternal-and-child-health-evidence-for-a-secondhand-sugar-effect/2F31AE3E8099B7989ABB69F4E1EB97F5#ref55
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229159/
  7. https://www.foodstandards.gov.au/consumer/additives/aspartame/Pages/default.aspx
  8. http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/food-aliment/sugar_sub_sucre-eng.php
  9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982014/#:~:text=The%20acceptable%20daily%20intake%20(ADI,%2Fkg%20body%20weight%2Fday
  10. https://www.foodstandards.gov.au/code/applications/Documents/A1100%20Ace-K%20in%20Chewing%20Gum%20CFS.pdf
  11. https://www.scielo.cl/pdf/ijmorphol/v28n3/art25.pdf
  12. https://pubmed.ncbi.nlm.nih.gov/21653241/
  13. https://pubmed.ncbi.nlm.nih.gov/3756841/
  14. https://pubmed.ncbi.nlm.nih.gov/4999747/
  15. https://pubmed.ncbi.nlm.nih.gov/31358725/
  16. https://www.ajog.org/article/0002-9378(70)90449-7/pdf

Nutrition for Inflammatory Bowel Disease (IBD) on a Plant-Based Diet

Are you wondering whether you can manage inflammatory bowel disease (IBD) on a plant-based diet? You’re not alone. Plant-based diets for IBD have been gaining traction and attention amongst some of the 80,000 Australians diagnosed with IBD (1).

This article will discuss what IBD is and how it is affected on a plant-based diet. IBD is regularly mistaken for irritable bowel syndrome (IBS) as they share some common symptoms, but these are very different conditions. For more information, we have a blog post discussing IBS in more detail.

 

What is IBD? (Crohn’s Disease and Ulcerative Colitis)  

Inflammatory bowel disease refers to ongoing (chronic) inflammation within all or part of the digestive tract (1). There are two conditions that fall under the IBD category. These are:

 

Crohn’s Disease

Crohn’s affects the lining within any part of the digestive tract (mouth to anus) however it is predominantly found in the ileum which is located at the end of the small intestine (3). Crohn’s causes swelling and inflammation in the affected area and increases the risk of colorectal cancer (1,2).

Symptoms of Crohn’s disease include:

  • Abdominal pain (2)
  • Diarrhoea (2)
  • Reduced appetite (2)
  • Weight loss (2)
  • Fatigue
  • Blood in stool (2)

 

Ulcerative Colitis (UC)

Ulcerative colitis affects the surface layers of the large intestine (bowel) and/or rectum. UC results in small ulcers forming on the lining of the intestine (3, 9). UC also increases risk of developing colon cancer (9).

Symptoms of ulcerative colitis include:

  • Abdominal pain and cramps (9)
  • Diarrhoea (9)
  • Fatigue (9)
  • Reduced appetite (9)
  • Rectal bleeding (9)
  • Blood and/or mucus in stool (9)

While IBD is a life-long disease, people are either in an active state/flare-up or in remission. When in an active state, this condition affects your energy levels, appetite, and bowel movements (1).

There are medications to help lower symptoms in these conditions. The most common types of medications are steroids, antibiotics, and medicines that suppress the immune system (1, 2). However, as there is no cure, it is important to also use dietary strategies to help minimise symptoms, especially when experiencing flare-ups.

 

bloating and nutrition for ibd on a plant-based diet

 

Who is at risk of developing IBD?

While the root cause of inflammatory bowel disease is unknown, we do know that anyone can develop IBD, with most people diagnosed between the ages of 15-30 (1, 2). However there are risk factors that are thought to increase the likelihood of acquiring these conditions. Some of these include:

Family history – Some studies have an shown increased likelihood for those to develop Crohn’s or UC if there is a close relative with the condition (2).

Environment – Crohn’s and UC have been shown to be more common for those living in western countries such as Australia, the United States and Western Europe compared to Asia and Africa (2). It is suggested that the modern, ‘Western’ lifestyle may play a role in this.

Smoking – Studies have shown that smoking can increase the likelihood of developing Crohn’s (2, 7).

 

How does plant-based eating affect IBD?

Studies have shown many benefits of plant-based eating on overall health. Plant-based eating promotes high intakes of grains, fruits, vegetables, legumes, nuts, and seeds. These are full of nutrients that generally help our body and gastrointestinal (GI) tract to function and thrive (3).

Research has supported that the best diet for those with IBD is one that nourishes your gut bacteria (3). Our gut microbiome is made up of trillions of organisms that play many roles in the body. Some of these include reducing inflammation while also contributing to digestion.

There are many foods that feed our gut bacteria, with the majority originating from plant-based sources. Foods such as leafy green vegetables, whole grains, and high-fibre meals all contribute positively to creating a healthy gut microbiome.

 

This should mean that following a plant-based diet is the most efficient in minimising symptoms, right?

 

It’s true these foods have a positive impact on the gut microbiome, but there are some challenges for IBD on a plant-based diet too.

Plant-based diets can be a double-edged sword for those with IBD as the foods listed are also culprits that can worsen symptoms during flare-ups or times of active inflammation. We will discuss this in more detail further on.

Additionally, as plant-based diets restrict foods originating from animal sources, there is a risk of developing deficiencies in various nutrients that further increases when implementing a plant-based diet for IBD.

 

leafy greens nutrition for IBD on a plant-based diet

 

Benefits and risks of a plant-based diet for IBD

 

Benefits

Fibre – This feeds the gut bacteria and promotes a healthy gut microbiome. Soluble fibre is a type of fibre that assists with slowing digestion, softening stools and preventing constipation (7). Soluble fibre is found in foods such as oats, beans, carrots, citrus fruits, and psyllium.

Polyphenols – These are a type of natural plant compound that are beneficial as they reduce inflammation (3,4). Polyphenols can be found in foods such as berries, plums, beans, nuts, spinach, onion, green tea, and dark chocolate (4, 8).

Excludes animal products – Foods such as red meat and dairy have been found to cause negative impacts on gut health and are known to aggravate symptoms. For those with IBD, regardless of dietary choice, it is recommended to minimise dairy and meat consumption (3,6).

 

Risks

Fibre – Wait a minute, I thought fibre was a pro? For someone with this condition, fibre is both a pro and a con. As mentioned, fibre is extremely important for gut health. However, fibre can also worsen symptoms during a flare-up (11). This is due to fibre not being digested and at the wrong time (during a flare) this can cause diarrhoea, constipation, bloating, gas and/or cramping as it moves through the digestive tract.

Risk of nutrient deficiencies – A major concern for anyone diagnosed with IBD can be malnutrition (lack of essential nutrition) due to poor absorption (4). This may mean higher requirements for certain nutrients (5). When following a plant-based diet and experiencing flare-ups, certain nutrient-dense foods may be avoided in the diet such as vegetables or whole grains (11). This can lead to further risks of becoming malnourished.

Volume eating – A lot of plant-based foods are naturally lower in calories/energy in comparison to animal-based products. This means that meals may be bigger to compensate to ensure fullness. Examples of this can be a salad or stir fry full of vegetables that are lower in energy/calories. Consuming large amounts of food in one sitting can put strain on the digestive system which can contribute to uncomfortable symptoms such as bloating or diarrhoea.

 

salad with strawberries and avocado for IBD nutrition on plant-based diet

 

Whole foods vs. plant-based alternatives to discretionary foods

Current advice for those with inflammatory bowel disease is to eat a well-balanced diet while limiting processed foods and avoiding foods identified to worsen symptoms (7).

Whole foods are identified as unprocessed and free of any additives. They are also typically nutrient-dense and have positive outcomes for health. Many whole foods are shown to have anti-inflammatory properties to help create a healthy gut microbiome to help minimise symptoms and reduce inflammation (8).

Whole foods include:

  • Fruits
  • Vegetables
  • Legumes
  • Whole grains
  • Nuts and seeds

A lot of processed foods may also be referred to as discretionary foods. Discretionary foods refer to foods that don’t fit into the five food groups – fruit, vegetables, dairy or alternatives, meat or alternatives, and grains.

Many discretionary foods often lack essential nutrients and contain added sugars and salt. They also contain food additives such as thickeners and emulsifiers. Some research has found that these compounds may increase inflammation and the risk of flare-ups for people with IBD (8).

Discretionary foods are often found to be high in fat which has been found to worsen symptoms.

Plant-based discretionary foods include:

  • Sugar-sweetened beverages – soft drinks and bottled iced tea
  • Mock meats
  • Plant-based baked goods and pastries
  • Plant-based fast-food – veggie burgers and fries
  • Chips, savoury biscuits, pretzels

While we don’t advocate for cutting these foods out completely (as this would likely be unsustainable), it may be wise to base the majority of your diet around whole foods when managing IBD.

 

plant-based discretionary foods and IBD

 

How to get started with eating more plant-based for IBD

It’s important to start small when implementing any new dietary changes with IBD. While you may want to jump in headfirst, the gut can be quite sensitive. A slow and steady change to your diet may be the best approach. Here are some tips to help get you started with IBD on a plant-based diet.

 

Slowly increasing fibre intake

As discussed, fibre can be beneficial for a healthy digestive tract. However, if you are experiencing an active flare-up or are new to a high-fibre diet, the drastic change can worsen symptoms. When there is no active inflammation, try slowly introducing more soluble (‘soft’) fibre sources (e.g. oats, beans, carrots, citrus fruits, and psyllium) to help create a healthy gut microbiome (10).

 

Choosing lower fibre options when necessary

Contrary to the last point, when experiencing a flare-up, a high-fibre diet may not be beneficial. This means sometimes it is necessary to choose lower-fibre options. Additionally, it may mean cutting the skin off fruit and vegetables as they are high in insoluble fibre (otherwise known as ‘rough’ fibre). As a reminder, this is not advised long-term and only when experiencing symptoms or recommended by a health professional (10).

 

Cooking vegetables

When experiencing a flare-up, raw vegetables may further aggravate symptoms. Cooking vegetables can help improve digestion and lower the insoluble fibre content.

 

Eating enough protein

As the risk of malnutrition is higher in those diagnosed with Crohn’s or UC, ensuring you get enough protein is important. This can include tofu and other soy products (11). We have an article dedicated to getting enough protein on a plant-based diet.

 

calcium-fortified tofu on a vegan diet - bowl with broccoli, rice, herbs

 

Recognising trigger foods

Understanding foods that trigger symptoms is important and can help you eliminate foods that worsen flare-ups. This may be done with a food diary or a temporary elimination diet (5). It is highly recommended to work with a health professional such as a dietitian to ensure this is personalised and avoid any deficiencies.

 

What other dietary strategies can help IBD?

While there is no cure for IBD, there are other dietary strategies that may help minimise symptoms. Some of these include:

  • Frequent mealtimes – eating in smaller volumes, more often, creates less stress on the GI tract which can help minimise feelings of abdominal pain. This may look like smaller main meals and regular snacks eaten every 3-4 hours.
  • Avoiding foods that cause flare-ups – each person may have different foods that trigger symptoms, however some common foods that have been identified to worsen symptoms include fried foods and spicy foods.
  • Limiting alcohol – minimising alcohol consumption has shown to have positive effects on minimising symptoms (8).
  • Increasing omega-3-rich foods – omega-3-rich foods such as chia seeds, olive oil, and nuts can help with reducing inflammation in the body.
  • Chew your food – take smaller bites and chew your food well before swallowing
  • Limit sugar alcohols (mannitol, sorbitol, erythritol, xylitol, isomalt)
  • Drink enough water – most people need around 2L per day, aim for straw-coloured urine

 

Summary

Managing IBD on a plant-based diet can be an overwhelming topic to explore, and there are a lot of individual considerations.

Some people may be experiencing a flare-up of their disease, while others may be symptom-free.

Regardless, it is important to work with a health professional when navigating the endless supply of information.

If you think you need support, book in with one of our PNW dietitians to understand trigger foods and create a personalised plan to help minimise symptoms. You can book a free discovery call here.

 

References

  1. https://hudson.org.au/latest-news/crohns-disease-in-australia-the-latest-research/
  2. https://www.healthdirect.gov.au/crohns-disease
  3. https://www.frontiersin.org/articles/10.3389/fnut.2021.733433/full
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1856830/
  5. https://www.monashfodmap.com/blog/low-fodmap-diet-inflammatory-bowel-disease-ibd-update/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382506/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6326567/
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064481/
  9. https://www.healthdirect.gov.au/ulcerative-colitis
  10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4607699/
  11. https://www.ucsfhealth.org/education/nutrition-tips-for-inflammatory-bowel-disease

 

Article written by: Leanna Fyffe, Student Dietitian

Reviewed by: Megan Boswell, PNW Clinic Dietitian