Fruit and IBD
With the increasing popularity of low sugar diets, fruit has received a bad rap in recent years. It is true that eating or drinking large quantities of fruit or fruit juice is going to increase your sugar intake but, like most things in nutritional science, eating a lot of any one type of food, or avoiding whole food groups, is not usually good for us!
is fruit sugar different to other types of sugar?
Sugar is a type of carbohydrate. The type of sugar, and other carbohydrates, in fruit varies by fruit, their ripeness and some fruit may contain more than one type of sugar. Unripe fruit contain more starch and as the fruit ripens that starch is converted to sugars which give fruit their sweet taste. Some of the types of sugar found in fruit are:
equal amounts of glucose or fructose (monosaccharides) (e.g. kiwifruit)
more fructose than glucose (e.g. mango)
sugar alcohols or polyols such as sorbitol (e.g. stone fruit)
fructo-oligosaccharides (FOS), also called fructans. This is a glucose and a fructose unit joined together (commonly known as sucrose (e.g. white sugar) with extra units of fructose attached. (e.g. ripe bananas)
The types of sugar that occur naturally in fruit can also be produced in factories and added to manufactured/processed foods. The difference between sugar in whole fruit and sugar in manufactured/processed sweetened foods is that sugar in fruit is paired with other nutrients and natural chemicals that have lots of helpful functions in our bodies.
There is more to fruit than sugar
Fruit not only include sugar but also fibres and many plant chemicals or phytonutrients that give fruit their distinctive colour and flavour. Many of these phytonutrients (e.g. anthocyanin, restervatrol, flavonols to name just a few) have been shown to have anti-inflammatory and antioxidant roles in the body. Recent research suggests that phytonutrients, in addition to the fibre, can affect the type and variety of microbes in your gut. See previous blog for more about fibre and your gut microbes. Different coloured fruit have different types of phytonutrients and fibre. If you eat many different coloured fruit your gut and gut microbes will benefit from being exposed a variety of different plant fibres and phytonutrients.
Research has shown that people who eat more than 30 different plant foods (fruit, vegetables, grains, nuts, seeds, legumes) per week have a more varied microbiome. We think that having a more varied or diverse microbiome makes your immune system stronger and therefore more equipped to fight against attack and recover faster after an illness or bout of inflammation.
Fruit in dietary treatments for IBD
The Crohn’s disease exclusion diet (CDED) is a dietary treatment for active Crohn’s disease. A 2019 study showed the CDED to be as effective as exclusive enteral nutrition (EEN) at treating Crohn’s disease inflammation. The CDED s a 12 week dietary treatment that for the first 6 weeks includes 50% of nutrition from partial enteral nutrition with a nutritional complete commercial formula (such as Module IBD, Ensure Plus, fortisip) and a specific exclusion diet that includes mandatory foods such as banana, apple, chicken, eggs. These mandatory foods were chosen based on scientific research that has that they, or compound in the foods, reduce gut inflammation. The second 6 weeks includes a greater variety of solid foods along with 25% of energy from the nutritional formula.
Why does the CDED specifically include banana and peeled apple? Apples and bananas both contain pectin, along with other fibres. Pectin is a fibre which attracts water in the gut and can help to make stool more formed. For this reason stewed apple has long been used as a remedy for diarrhoea and constipation. In animal and laboratory studies, pectin has been shown to positively influence the immune system and have antioxidant and anti-inflammatory roles. The old saying an apple a day keeps the doctor away is certainly sounding promising!
Fruit may have a role in the prevention of inflammation after ileal-anal anastomosis pouch surgery (a surgical treatment for ulcerative colitis). A study published in 2019 looked at the diets and microbes present in the stool of 172 people after pouch surgery. They found that people who eat more fruit and a greater diversity of microbes in their stool and that those who eat less fruit. They also observed that if people in the study reduced their intake of fruit over time that they were more likely to develop inflammation in the pouch (pouchitis). Eating more than 1.5 servings (a small handful) of fruit every day was linked with a reduced likelihood of developing pouch inflammation in the next 12 months.
take home messages
Aim to eat 2 servings of fruit everyday. Try in minimise eating highly processed fruit because processed fruit will contain less of the beneficial bits that you find in whole fresh or frozen fruit.
Eat a rainbow of colorirse fruit. Eating seasonally is a great way to ensure you eat a range of different fruit across the year.
Bulk buy seasonal fruit when it is cheap. Cook any excess fruit and freezing it into smaller portions to use later when there is less fresh fruit available. I love stewed fruit! Stewed fruit with crumble……. stewed fruit on breakfast……. stewed fruit mixed through plain yoghurt for a snack or dessert….. so many options!
If your bananas go black sitting in the fruit bowl chuck them in the freezer! You can either freeze them whole with the skin on, or, peel them and put them in a sealed container or bag in the freezer. Frozen bananas are a great addition to smoothies and baking (see recipe below).
Recipe - Pancakes
Traditional pancakes recipes are low in fibre but, by adding fruit and changing the type of flour, pancakes can become a nutritious and delicious breakfast option. The Crohn’s disease exclusion diet or CDED requires you to eat bananas and eggs daily! Pancakes are a great way of combining bananas and eggs in one dish. This is my favourite nutritious pancake recipe and is from the Kuwi’s Kitchen Kiwi Kids Cookbook by Kat (Merewether) Quin https://www.illustrated.co.nz Kat has ulcerative colitis and a lot of her recipes are inspired by her diet/health journey with colitis.
Ingredients
1 banana mashed (frozen banana works well)
2 eggs whisked
1/4 tsp ground cinammon
1/2 cup of rolled oats (note: the CDED allows 1/2 cup of oats per week during Phase 2)
1/2 tsp baking powder
Pop the rolled oats, baking powder and cinnamon in a food processor. Whizz on high for 2 minutes, or until it reaches a flour-like consistency.
Mash banana with a fork. (Note: if using frozen banana with skin on, pour boiling water over skin, then slice off the skin with a sharp knife, cut into small chunks and then mash)
Whisk the eggs.
Mix everything together.
Preheat the pan over a medium heat.
Add a little olive or canola oil and pour on roughly 2 tablespoons of the mix per pancake
Cook one side until bubbles appear and pop on the top of the pancake.
Flip the pancakes. Cook for another minute or until the other side is nicely browned.
Serve with sliced fruit e.g. banana, strawberries, blueberries, kiwifruit and a drizzle of honey and tahini. Another favourite combination in our house is lemon juice and a sprinkle of sugar.