AURORA, COLO. – Inflammatory bowel disease doesn’t respect international borders, and
Dr. Neha D. Shah
“Many patients are in an environment that they’re not used to, an environment where most people speak English and their customs and their language may differ from the individual providing care to them. They’re often told, in addition, to eat foods that they may not even have heard of. It can really be a scary situation for many of these patients,” said Neha D. Shah, MPH, RD, CNSC, a dietitian at University of California San Francisco Health.
“Put yourself in their shoes. [Consider] what would make you feel more comfortable in that environment, and then apply that perspective to the care of your patient,” she advised colleagues at the annual Crohn’s & Colitis Congress®, a partnership of the Crohn’s & Colitis Foundation and the American Gastroenterological Association.
Ms. Shah explained that by incorporating understanding of cultural differences and food culture into the care of persons with IBD, clinicians can help patients from different ethnic backgrounds accept diets that both contain familiar foods and also help to ameliorate their gastrointestinal symptoms.
Food culture and acculturation
As of 2016, the estimated prevalence of IBD among pediatric patients in the United States was 77 per 100,000, and the prevalence in adults was estimated at 478.4 per 100,000. In a 2021 study of the effects of race and ethnicity on the diagnosis and management of IBD, the authors estimated that the prevalence of IBD in the United States was about 3.1 million persons, or 1.3% of the population, with an increase in prevalence in non-White persons and ethnicities, she noted.
Some of the increasing prevalence among minority populations may be attributable to diet acculturation, when members of a particular group partially or completely adopt the eating patterns and/or food choices of the host country.
Culturally appropriate foods
The term “food culture” refers to “the sociocultural aspect of eating, and include[s] the beliefs, values, and attitudes a community may accept around food,” she said.
Ms. Shah provided examples of culturally appropriate foods that may be tolerated by patients with IBD, such as beans, tortillas, chicken with rice, guacamole, mangos, and tomatoes in persons from South America, or lentils, breads, rice, oats, spinach, and tea among patients from the Indian subcontinent.
By understanding and respecting cultural differences, learning how to best communicate with persons of other cultures, and by being aware of one’s own biases, clinicians can better help patients create diet plans that fit within their expectations and lifestyles, she said.
For example, patients can be encouraged to incorporate more culturally familiar plant-based foods such as legumes to manage active disease and maintain remissions.
Patients with active disease should have at least one-half cup of one form of culturally appropriate fiber at each meal. The dietitian should consider recommending blending fiber into other foods or serving it cooked, mashed, or minced, depending upon the patient’s level of tolerance.
During the transition phase, patients can reintroduce an additional half cup of fiber at one meal, then at two meals, and finally at three daily meals. Patients can see whether they can tolerate more raw or whole high-fiber foods at this stage.
During remissions, patients should be advised to add two to three foods containing culturally appropriate fiber at each meal, she said.