Welcome to the Gut Feelings Podcast, where we break down IBD nutrition and make it more digestible and fun.

We talk real life with IBD, evidence -backed nutrition, and no story about poop is off limits.

We are the Crohn's and Colitis Dietitians.

Let's go.

So this week is malnutrition week, and we thought we'd dive into one, what malnutrition is, but two, talk about why it's so important.

The number one thing that comes to mind is that malnutrition can actually impact how well your medications work, which is huge.

So when people are more malnourished, they're less likely to be as responsive to medications.

And there's a number of reasons for that.

And having a dietician by your side can really help to reduce the risk and can help you with treating malnutrition if you're already there.

So let's talk about how we define malnutrition.

A good thing to start off with, Ashley.

So when I think malnutrition.

In simple terms, it is an imbalance in between what nutrients your body needs and the nutrients your body actually get.

And of course, in IBD, that can really be impacted because there's so many things going on that can impact how your body receives and utilizes those nutrients.

Yeah.

And that can come about a number of ways.

Number one, your appetite's lower.

So you're typically eating less than a flare up sometimes, but also inflammation actually raises your caloric need, especially if you have like a fever or if you've got infection or other things going on.

your caloric demand goes up a lot.

So it becomes easier to be malnourished.

So not only that, then when you talk about nutrients, so when we talk about nutrients being low, we're talking about that could be micronutrients, like your vitamin D, your B vitamins, any of those things.

It could also be macronutrients, which should be protein, carbohydrate, fat.

Those also can get low when you have IBD.

That could be because you're not absorbing things as easily, like fat malabsorption, for example, or it could be increased demands.

Maybe you're in a flare -up and your protein needs go up and your appetite goes down.

And so it's hard to make ends meet in terms of getting your needs met.

Yeah.

Like other things to consider too is, you know, certain medications may contribute to that.

added expense on how your body utilizes nutrition or utilizes nutrients.

So for example, prednisone is a good old prednisone.

Yes, I know the love hate relationship.

But prednisone is a steroid that we all know of.

And of course, with it, a nutrient consideration is that it has the ability to decrease calcium absorption.

So that is something that we are always mindful of as dieticians.

to take a peek at when we are working with our patients to ensure that we're meeting the body's demand, not only during a flare, but, you know, prednisone is present.

We're mindful of that as well.

Methotrexate also.

Methotrexate can lower folate.

So, yeah, that's another aspect.

There's a lot of different things we think about with medications.

So there's a lot of different angles that you can experience malnutrition with.

And it's so important, you know, for health care providers to be screening for it.

You know, there are some things that, you know, there's malnutrition screening tools like must, for example, is one of them.

Sometimes they're only looking at one side, though.

They're looking at maybe the weight loss side.

You know, if your BMI decreases over time or you lose, you know, three to six over the course of three to six months, you lose, you know, five to 10 percent of body weight.

Those would kind of put you in that category for malnutrition.

However, there's something we know as dietitians is malnutrition isn't.

only about weight loss.

It's also, you know, meeting all of these different needs that are present.

So sometimes, I mean, a lot of times, even if your provider is screening for malnutrition in that way, sometimes people are missed that, you know, are avoiding foods to, you know, avoid symptoms, for example, or in their diet becomes smaller and smaller, and they're struggling to get enough.

And There are a lot of people that fall into that category or maybe have multiple nutrient deficiencies that I think still get missed.

And there's a missed opportunity there for them to have better reduced symptoms if they're working with a dietitian and to actually treat the malnutrition earlier on rather than when it gets to more severe malnutrition.

Yeah.

Ashley, I know you touched a little bit on maybe some signs of malnutrition, weight loss, of course, being one of them.

Decreased appetite is also another.

But if you also notice that you are someone who is often feeling cold, especially in your hands and feet, that could be something that may be an indicator of malnutrition.

Let's say concentration or getting sick often too.

There's lots that come into play that are those.

signs of malnutrition that dietitians are mindful of, but more severe things to be mindful of is when you start to see that visible wasting in your muscles.

So you may notice like, um, there's more definition around here, around your clavicles, around your knees.

That is when we want to, of course, involve your healthcare provider to see like, okay, what are some things that we can start?

implementing to help the body out and yourself.

Those are big ones to be mindful of.

Yeah.

And we have a post coming out today.

If you're watching this, this is, you know, already have been up, but you put some stats in there about just how common it is.

And I think it's really interesting.

I think people are going to be surprised.

So maybe share a little bit about that too.

Okay.

So for everybody watching or listening, What some studies suggest is that 65 to 75 % of people with Crohn's and 18 to 62 % of people with colitis experience malnutrition.

That's big.

Yeah.

That's why we're talking about it today because it is so prevalent, right?

Yeah.

Yeah.

In IBD, much like Ashley, you said, like we see.

decrease food intake because maybe everything bothers your guts at one point.

But then we also may see more restrictive diets, which of course impact.

Are we getting all the nutrients that we need from these restrictive diets?

Not always.

So there's just two big things that we want to be mindful of.

And that could be some of those things that contribute to those large percentages.

Yeah.

And I think, I think sometimes people are surprised or it's news to them that, you know, some, some nutrients they'll have to like actively treat, like getting it through the diet is not going to be enough.

Like when they're deficient.

And the reason for that is you have all these things going on in the back end.

Like if you're talking about vitamin D, for example, when you're inflamed, your body's utilizing more of the vitamin D.

So it's one of those inflammation sensitive nutrients that as inflammation goes up, it will tend to come down.

But yet we need it to help with, you know, control of inflammation and recovery and all that.

So it's kind of one of those.

tricky situations.

The same with iron.

You know, when you think about iron, it can get low when you have bleeding, like with ulcerative colitis, for example.

But also with any type of IBD, if you've got active inflammation, and the reason for that is you've got your liver that's producing something called hepcidin, which can actively...

It does two things.

It helps regulate inflammation, but it also helps regulate iron homeostasis, which like keeping your iron levels in a good spot.

So we don't want iron to go too high or too low because that would be toxic if it's too high.

But the downside of that is as inflammation goes up, iron goes down too.

So we have a lot of inflammation sensitive nutrients like that, that, you know, you know, with IBD.

people that get low will have to do some sort of supplementation generally.

And the reason why we're talking about it today is not only because the stats are so high in the IBD population, but because one, it can have an impact on your medications and how well they work.

Two, it can also decrease your quality of life.

Because if you're feeling fatigued all the time because your intake is not where we would like it to be.

That makes it very hard to do all the fun things you want to do in life.

But then the third reason is Ashley.

Number one, a lot of people don't realize that I think we get to malnutrition in part sometimes to help with reduction of symptoms.

We might be restrictive.

I've done this.

I've done this even recently.

You're feeling not great.

And so you struggle to get.

enough, right?

So that can happen sometimes with IBD.

And the side effect of that is you start going down that path to malnutrition and less diversity in the gut, the longer that you do that.

And, you know, and that can happen in a flare or not in a flare where you, we can have these things happen or uncomfortable symptoms that, you know, derail us a little bit.

And I think there's a thought that if we reduce, then we'll have less symptoms in the short term.

That can be true.

In the long term, what we see is decreased diversity in the gut, which actually leads to more symptoms.

And it can also lead to motility challenges.

So you might see changes in motility.

So ultimately, a lot of restriction and malnutrition does actually add to symptoms too.

And we definitely want to reduce that because reducing your symptoms is going to make a huge difference in how you're feeling and how you're able to move through day to day.

So if someone was feeling like, oh, I am cold all the time, I've noticed some weight loss or I feel fatigued all the time, what would be one of your first steps you would say to them?

If you can, seeing a dietician that specializes in IBD is the best, quickest way to get your answers and get treatment.

That's number one, always.

I mean, I think there's no replacing that because...

we can dial it in to custom to you and where you're at, where your IDB is located.

It can be more effective.

It's kind of like, you know, I've learned this through having business coaches, for example, that you can get where you want to go on your own and it can take 10 years or you can get where you want to go and get your questions answered in 15 minutes.

And, you know.

save you yourself a lot of time and frustration.

And it's even more important when we talk about our own health, right?

So we want to get answers and also get a plan to, you know, treat our IBD effectively, make sure we're doing all the things that is going to help with that.

So that's thing number one, if that's not accessible to you right now, I would say our Flair ebook is a great place to start too.

It's kind of the next best thing.

We tried to make it as thorough as possible and it's, The ebook that we continue to get lots of comments about.

It's our most purchased ebook.

And we've had so many great, so much great feedback from it so far.

So that's another thing you can definitely check out.

But yeah, it is important to have this conversation with your doctor too.

Always important to express like, hey, I'm struggling to eat enough.

What can I, what can we...

What can we do about it?

That's another place that I would definitely bring that up to.

Yeah.

So if you need any support around malnutrition or you think that you may be struggling with it, we do have a malnutrition checklist if you're curious and you want to kind of see if you check off any of the boxes of criteria for that and then bring that to your provider and have a conversation about it.

And we even have a resource for providers as well that you can check out.

and share with your provider.

So, and if you're looking for one -on -one support, feel free to reach out.

We'd love to chat about working with you and help you get on the right track.

All right.

Take care, everybody.

Are you looking for clarity on your food symptom triggers for your IBD?

Do you experience things like bloating, urgency, fatigue, maybe even diarrhea, abdominal pain, or constipation?

We know someone who can help with that.

We know three people.

Yeah, if you're looking for getting clarity on your triggers and even using nutrition as a tool to reduce symptoms and also reduce your risk of flare up long term, if you're looking for that kind of clarity and you want a plan customized to you, we are accepting patients again.

And we just added our third dietitian while she came back from maternity leave.

So we are excited to work with you.

So if you are interested, feel free to reach out, send us a email or set up a call and we can have a chat.

it.