In regards to diet in inflammatory bowel disease (IBD), the focus is often on how to eat to avoid pain, and optimize macronutrient and vitamin intake while limiting physical side effects. This is important, but another important factor to consider in the nutrition matrix in IBD is fluid and the issue of fluid balance. 

Individuals with IBD run the risk of developing electrolyte imbalances secondary to the fluid changes that occur during flare-ups, especially from diarrhea as well as malabsorption deficiencies. Symptoms of electrolyte imbalances include muscle pain and weakness, headaches, confusion, depression, seizures, and irregular heartbeat. 

There are certain minerals in the body that must be maintained in appropriate balance, including calcium, chloride, magnesium, phosphate, potassium, and sodium. The harmony of these minerals in the body are what regulates the most important bodily functions, including fluid acid-base balance, cardiac and brain function, and the delivery of oxygen to the cells. 

Crohn’s disease (CD) and ulcerative colitis (UC) present different electrolyte challenges. UC is confined to the colon, whereas CD is found in the small and large intestines. A number of studies reviewed in a 2013 article suggested that electrolyte deficiencies in UC patients may even be life-threatening, with the main transport abnormality being the decrease in net sodium and chloride absorption, resulting in impaired water absorption and secretion. 

This review also reported a study that found that, of 63 patients with CD who were assessed for electrolyte disorders, 33% had low levels of sodium, potassium, calcium, and magnesium in their blood, either alone or in combination. In addition, hypocalcemia, or low calcium, may be observed, due to both limited calcium absorption in the intestine and irregular metabolism of vitamin D. 

Acid-base imbalances are also seen in IBD. Metabolic acidosis — when the body produces too much acid — is the most common acid-base disorder and is found in CD patients. The main mineral associated with this imbalance is chloride, as it maintains fluid levels on the outside cells of the body. When too much is lost, it can lead to renal bicarbonate retention. 

Below are a few dietary suggestions to ensure electrolytes are included in your daily menu:

• Sprinkle some salt in moderation on your food and sip some bone broth for sodium. 
• Potassium-rich foods include potatoes, bananas, avocados, melons, grapefruit, and coconut water.
• Include more chloride into your diet by adding rye, seaweed, and tomatoes as tolerated. Salt also helps to provide chloride. 
• The best sources of phosphorus for patients with IBD are organ meats, poultry, ancient grains such as amaranth, and sprouted lentils blended. 
• Magnesium depletion is common in IBD and can affect energy levels and immunity. Symptoms such as cramps and bone pain are also common. Foods to include in the diet are leafy greens ( spinach), broccoli, squash, whole grains, legumes, seeds, and nuts as tolerated. Oral supplementation up to 700 mg/day may be indicated as monitored by a medical professional. 

The maintenance of proper electrolyte balance is critical in IBD. Patients with IBD should be aware of the impact these minerals have on the overall function and equilibrium of the organ system. Over time, chronic electrolyte imbalances can wreak havoc on bone density, and kidney and cardiovascular function, disrupting the delicate line the body must walk to heal and maintain wellness. 

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Alana Kessler, MS, RD, CDN, E-RYT, is a registered dietitian, nutritionist, weight management expert, and an accredited member of the CDR (Commission on Dietetic Registration) and the American Dietetic Association. She is also a yoga and meditation teacher, Ayurveda specialist, and the founder of the New York City-based fully integrated mind, body, and spirit urban sanctuary, BE WELL. Alana’s BE WELL ARC System and Method Mapping technique is a holistic multidisciplinary approach to health and wellness that blends Eastern and clinical Western diet and lifestyle support to effect long-lasting behavior change.

A graduate of NYU with a BA and MS in clinical nutrition, Alana is dedicated to helping others learn how to nourish themselves, create balance, and understand their true nature through nutrition, yoga, and inner wellness. She leads Yin Yoga workshops and trainings as well as wellness retreats at international locations. Her health, fitness, and lifestyle expertise has been featured in Aaptiv.com, Droz.com, EatThis.com, RD.com, Redbook, WomensHealthmag.com, and Vogue. For more information, visit her website at bewellbyak.com.