Facing Challenges with Specialized IBD Diets: Cultural Considerations

Working with Latino, Hispanic, and Haitian communities within the pediatric inflammatory bowel disease (IBD) population comes with several important considerations. When planning diets for these underrepresented populations, considerations can include language differences, contrast between cultural food preferences and nutrition guidelines, as well as socioeconomic factors. Understanding these cultural and practical factors is essential when providing nutrition counseling for therapeutic diets in the management of IBD.

There are several diet therapies that can be utilized for the management and treatment of IBD. The Crohn’s Disease Exclusion Diet (CDED) is a dietary therapy that may be utilized to help manage some forms of Crohn’s disease. It is 3-phase diet that combines enteral nutrition therapy and whole foods. Learn more about the diet here: Crohn’s Disease Exclusion Diet: An Overview.

Through my 40+ years of experience as a Registered Dietitian caring for Latino, Hispanic, and Haitian IBD patients in South Florida, I have become well acquainted with the culinary traditions within these communities. Adhering to a therapeutic diet, like the CDED, and honoring cultural food traditions can be challenging in the following ways:

• Challenge: Foods that are strongly encouraged on the CDED, such as apples and mashed potatoes, are not typical of the Latin American diet
  • Recommendation: Assess typical dietary intake, food preferences, and recipes that the patient and family prefer. Provide new recipes and creative ways to try to incorporate CDED allowed foods that are not typical of the Latin American diet.
• Challenge: Foods like red meat, pork, plantains, and malanga (a starchy root vegetable) are common in Latin American and Haitian cuisine but are excluded from the CDED. Common Latin American and Haitian food preparation styles, such as frying and seasoning with high amounts of sodium, conflict with the CDED recommendations.
  • Recommendation: Provide recommendations for CDED allowed alternatives to these food preferences. Ask curious questions as to the taste/flavor of the food and seasonings used to prepare these foods so that comparable alternatives can be provided. Provide guidance on alternative preparation methods such as baking, sautéing, and boiling.
• Challenge: Families may be hesitant to modify traditional recipes as they are often generational
  • Recommendation: Focus on culturally sensitive menu planning that works within cultural traditions, rather than replacing them

In my current practice, I have seen improved adherence to the CDED with practical adjustments to food preparation (such as baking instead of frying), adjusting portion sizes, and exchanging fresh spices and herbs for higher sodium seasoning. I have found that when decision-making around dietary therapy is in collaboration with families, and in the family’s native language, patients and caregivers are more likely to be compliant.

I believe there is an opportunity for future research to evaluate the impact of cultural cuisines on IBD. With more research surrounding this topic, information learned has the potential to help shape more culturally informed menus that honor tradition and also adhere to IBD diet therapy guidelines.

📌 Sources

1. https://www.eatright.org/food/cultural-cuisines-and-traditions 
2. Barbara Gordon, RDN, LD and Suzanne Jiménez Sánchez, MS, RDN, LND. (n.d.). Explore flavorful Puerto Rican cuisine. Retrieved from https://www.eatright.org/food/cultural-cuisines-and-traditions/central-and-south-american/puerto-rican-favorites-made-healthy
3. Cultural cuisines and traditions. (n.d.). Retrieved from https://www.eatright.org/food/cultural-cuisines-and-traditions
4. Khare-Ranade P, Myers EF, El Shikieri AB. Development of Quick Guides for Assessing Food/Nutrition and Culture to Enhance Assessment of Food and Nutrition-Related History in Cross-Cultural Clients of Nutrition and Dietetics Practitioners around the World. J Acad Nutr Diet. 2022 Jul;122(7):1233-1238. doi: 10.1016/j.jand.2022.03.011. Epub 2022 Mar 23. PMID: 35339720

Mirta Rios, RD is a registered dietitian working with IBD patients in South Florida.

Please note:

The information in this post is of a general nature. This advice will not apply to every single patient with IBD. The nutritional needs of people living with IBD vary greatly. Nutrition needs may change over time. It is the hope of the ICN Registered Dietitian group that all patients with IBD will have access to nutritional support as part of comprehensive IBD care. If you are seeking support from a registered dietitian, ask your care team what resources are available at your center. If necessary, you may receive a referral. If you are looking to find an RD to work with on your own, the Academy of Nutrition & Dietetics has a “Find a Nutrition Expert” option on their website (eatright.org/find-a-nutrition-expert).

Get #InTheLOOP with more posts by Registered Dietitians on the ICN blog >>

Everything we do in ImproveCareNow is magnified by the efforts of thousands of improvers! No action is too small; here are some ways to get started:

💚 Join the Patient Advisory Council (pediatric patients with IBD who are 14+)

💙 Join the Parent/Family Advisory Council (parents/caregivers of young people with IBD)

💚 Participate in our Current Research Opportunities (subject to eligibility)

💙 RSVP to join us at one of our upcoming ICN events

💚 Subscribe to blog updates to stay #InTheLOOP with our IBD stories

💙 Download, use & share our free, co-produced IBD resources

💚 Connect with our welcoming & supportive pediatric IBD community and receive IBD resources, community stories, and ICN updates & opportunities

💙 Donate to ImproveCareNow – we are proud to use every dollar donated to advance our mission!

Our mission is to transform the health, care and costs for all children and adolescents with Crohn’s disease and ulcerative colitis (Inflammatory Bowel Disease or IBD) by building a sustainable collaborative chronic care network.