Lifestyle Issues: What Do I Tell My Patients? Smoking and Diet

During the past decade, smoking has been recognized as a riskfactor in inflammatory bowel disease (IBD). Smoking is associated with Crohn'sdisease, and nonsmoking with ulcerative colitis. The biological rationale behindthese findings is not known. Because of the negative effects of smoking, adviceto patients with IBD cannot differ from advice given to any patient. In familieswith IBD, young healthy members should be advised never to start smoking. InCrohn's disease, a fat-reduced diet will be necessary when bile salt metabolism isdisturbed. Prospective trials with unrefined carbohydrate fibre-rich diets orlow-residue diets versus normal diets show no difference in the clinical course ofCrohn's disease. Thus the patient should have a well balanced diet with unrestrictedfibre intake, supplemented in case of malabsorption with vitamins andminerals. Diet counselling itself has proved beneficial, probably because ofoptimization of nutritional status. In ulcerative colitis, patients may be lactoseintolerant without lactase deficiency. Low dietary fibre intake doses does notseem to be of importance. The ulcerative colitis patient should be advised to eata normal to high fibre diet. Recent studies have suggested a possible beneficialeffect of dietary supplementation with fish oil