Kim Braly Nutrition

Celebrating this collaborative effort today 🎉.

Have you ever asked “why cant we use foods from our refrigerator at home for EEN?” Well, you are not alone. This question is commonplace among families and patients with IBD. but EEN as a treatment for CD has involved only commercial formulations (until now).

This pilot study aimed to evaluate the therapeutic potential of a whole-foods smoothie that mimicked commercial oral supplement formulations in newly diagnosed pediatric mild-moderate Crohn’s Disease with an inflammatory phenotype.

This pilot study opens the door for future research evaluating mucosal healing.

Creating a nutrition intervention that a patient can stick with is far from easy and takes a village (kind’ve like raising a child :D). Huge high five to this amazing study team with physicians who realize the importance of nutrition research as a part of IBD care and make it happen. A special thank you to Dr. Dale Lee for spearheading this effort.

Happy Thanksgiving ❤️

I am forever grateful for the community- the patients, caretakers and families I have had the privilege to walk with, the incredible providers, researchers, advocates…

The hard in IBD can bring joyful moments and make the burden less heavy through the support of community.

If you are feeling alone in your IBD journey, please reach out. I will share resources and would love to connect.

I’m thankful for you!

Boy can the discussion around cow’s milk dairy ruffle feathers. This is why it’s so important to talk about!
Did you know that the experts who made the IOIBD (International Organization for the Study of IBD) nutrition guidelines published in 2020 achieved consensus for ALL food types analyzed EXCEPT pasteurized dairy? This is significant as IBD nutrition experts could not agree. It is understandable that we are all confused!

I am not saying everyone should consume cow’s milk dairy, and many do for important reasons, but please do not exclude it unnecessarily.

Those with IBD are at risk for low bone mineral density and dairy can be one of the most palatable, well-tolerated options providing calcium and vitamin D. And, for many with IBD, plant based sources of calcium may not be tolerated or enjoyable at quantities needed to meet daily needs.

The ESPEN (European Society for Parenteral and Enteral Nutrition) Guidelines recommend people with IBD should not be told to eliminate dairy; but instead choose low-lactose if lactose deficiency/intolerance is suspected. THese guidelines provide some helpful insights.

For the complete list of references and to read the full article:

→ https://kimbralyrd.com/dairy-and-inflammatory-bowel-disease/

https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

🥛Cow’s milk dairy has been with us for at least 6,000 years. In fact, our ancestors were consuming it even before they developed the ability to digest lactose past infancy, likely in fermented forms.

Fast forward to today and dairy still isn’t digestible for all, and dairy has its vocal skeptics. This may be why as many as 58% of people with IBD avoid dairy, seeking symptom relief.

🔍But here’s the pressing question:

Is steering clear of dairy always the best approach? Especially considering that dairy is:

✅ Highly nutritious
✅ One of the biggest U.S. fermented food sources
✅ A well-loved U.S. dietary staple

In my latest blog article, "Is All Dairy Created Equal?", I dive deep into the IBD-dairy dilemma, analyzing the pros and cons, and offering evidence-based, as well as applied recommendations.

If you’re an IBD RD, doctor, or healthcare professional looking to offer informed advice, I invite you to give it a read.

👉 https://kimbralyrd.com/dairy-and-inflammatory-bowel-disease

Please Share your thoughts below! How do you approach dairy in your IBD practice?

colitis #

Last week I had the privilege of joining GI practitioners from all over the world at the kickoff Advanced Dietary IBD Education and Training (DIET) Program as part of the faculty for the 10-month virtual course.

I connected with old colleagues, and finally met others in person.
I promised to share in a post, so here it is. My biggest highlight was meeting all of the GI providers who want to know more about IBD nutrition and are LEARNING for their patients.

💩New News:
Providers ARE talking combination therapy - diet + medications as well as PERSONALIZED nutrition interventions (Dr. Vasiliauskas inspired all of us)

🦠Microbiome experts still don’t have a clue about the microbiome (not really, but we still have SO much to learn about the microbiome, IBD, nutrition drivers)
CD tailored diet recommendations may be different than UC in the future.

Genetics do not change quickly, but environment DOES and is a key driver in IBD etiology (Dr. Braun, MD PhD).

Diet studies are hard to design, what is the control group?
Supplements may be a part of therapy recommendations in the future.

Not all white Priuses in L.A. are Uber Drivers 😀.

📰Old News
It is very hard to do a nutrition study evaluating CAUSATION vs. ASSOCIATION.

We need FUNDING for nutrition research but that is not an excuse to provide patients with nutrition guidance and offer our expert opinion.

❤️Needs
Research in the elderly IBD population.

More research in ostomies/pouch.

High powered nutrition RCTs.

Culturally competent nutrition research.

Research in IBD disparities (Dr. Sandra Quezada).

What are your thoughts or questions 👇


colitis

Linda reached out with the goal “to be able to eat a wide variety of mostly plant based foods”- her preferred means of eating. I added:

✅Optimize diet to provide energy, satisfaction, and pleasure with eating again.
✅Ensure nutrition adequacy (energy, vitamins, minerals), working towards usual/comfortable body weight.
✅Find an eating plan that is well tolerated and as diverse as possible.

I provided education, guidance and an individualized approach and Linda did the rest!

We know the body of research in nutrition and IBD continues to be “small” or “limited” some might say. But nutrition interventions for microscopic colitis specifically are lacking. So, we used the evidence that we have in IBD to serve as a guide to expand her diet and improve food-related quality of life❤️.

Sources:
1) https://www.crohnscolitisfoundation.org/what-is-microscopic-colitis
2) Nielsen et al. https://doi.org/10.7554/eLife.79397
colitis

It has been a fun and busy month helping families and patients transition back to school.

A common message I hear every year is “I want to do or eat what my friends eat”.

This comes from such a normal, healthy place that every kid feels - the desire to fit in and have control when IBD can feel so out of control. We do a lot of brainstorming on ways to find normalcy and control while acknowledging the hard, frustration (all the feelings to say the least) that IBD brings.

Two of my favorite transitions:

📚Teenage years! Hello independence and excellent questions.

🏫College. Wow. The transition to college and “adulting” is hard in itself. The nuances of IBD, managing one’s healthcare, social pressures and food facilitates new complexities that are essential to plan for and to talk through with those that have experience.
Here are some tips and a few favorite resources to get you started!

For those that are paving the way, what are some tips to offer families that may be new to IBD or transitions?
Do you need help navigating IBD, school and a personalized nutrition approach? Head to 🔗 in bio.

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What do three pediatric IBD dietitians have in common? A passion for learning, nutrition research, and sharing knowledge!
In the latest NASPGHAN Council for Pediatric Nutrition Professionals (CPNP) podcast, Jen Smith, Bailey Koch, and I dive into some of the complexities of nutrition therapy such as-
🫛Best fit patients.
🙌Our approaches.
❓Answers to common questions.
We also share RESOURCES that are available to you. This episode offers pearls for both patients and providers working with the IBD population.
Tune in and share your thoughts and questions:
https://www.buzzsprout.com/2136263/13193417-episode-4-kim-braly-nutrition-and-ibd-specific-carbohydrate-diet-scd-and-beyond?t=0

One of my favorite parts of mentoring other healthcare professionals in IBD nutrition is the shared knowledge. We learn from each other to better support the patients we see and improve care. These sessions are tailored to the individual’s goals and needs.
I am committed to expanding the community of dietitians trained in IBD nutrition. There is a huge need for access to trained IBD dietitians globally.
It was an absolute joy to support Maysa as she begins her IBD practice in Saudi Arabia. She reached out to me for coaching on nutrition therapy as well as insights on building a private practice. We dug into the nitty gritty details, the evidence (and lack there of) of IBD nutrition and complex IBD nutrition cases. Maysa is a wealth of knowledge in IBD nutrition and recently launched her instagram page! She is an incredible asset to the IBD nutrition community and the clients she sees. Make sure to follow her journey at .
If you are an IBD provider or program looking to expand your nutrition offerings, my program integration could be a good fit! Reach out and I would love to hop on a call to learn more about your needs and dreams.

Okay, we have all heard this one. What are your thoughts or experiences? No judgment here!
This summer, I’m continuing my series on IBD nutrition myths, starting with Myth #1 🧪.

This week’s FAQ during patient calls- Fats and IBD- so I am referring back to a blog.
We all get mixed messages about fats. We're told they're harmful and should be limited. But then we hear there can be "good" fats and "bad" fats. With IBD, it gets even more confusing. Have you had a well-intentioned doctor tell you to limit or avoid fats for your Crohn’s or Ulcerative colitis?
It turns out the body of research on dietary fats and IBD is growing… but there are a LOT of gaps as well. So, I have dug into the research in hopes of breaking it down and providing practical application on dietary fats & IBD.

Don’t eat meat? Terrific, this blog is for you too! Don’t forget to leave your thoughts, comments and questions.
check out the full blog article here:
https://kimbralyrd.com/dietary-fat-and-colitis/
Be the first to learn of new evidence-based blog posts and nutrition resources by signing up for my Newsletter. Part two of IBD myth busting is coming soon and I will share first with subscribers!

Today is one of my favorite professional days - World IBD Day. Community is one of my core values and World IBD Day bands together a team of parents, patients, advocates and healthcare workers.
I am joining in the to raise awareness not just about inflammatory bowel diseases, but also about Exclusive Enteral Nutrition. I have had the privilege of using EEN in practice for the past 11 years. It continues to be an underutilized therapy for many reasons. By raising awareness, I hope to help bridge the discomfort and gap between research and clinical application.
Follow my stories today as I join the and share some of my learnings from over the years using EEN in practice.
Here are the resources I noted in the post.
Articles.
Doi:10.1016.
DOI:10.1097.
https://practicalgastro.com/2023/04/07/exclusive-enteral-nutrition-in-inflammatory-bowel-disease-an-under-appreciated-therapeutic-gem/.
Websites.
Kimbralyrd.com
ntforibd.com

The answer to this question is not straightforward and depends on many factors. What is your disease type, location and severity? Are there other complications? Are you or your child in the hospital? Some of the answers to these questions may indicate that diet could be an excellent next step, other answers might indicate that one needs to start medication or needs a more immediate intervention, such as surgery.
In addition to disease type and severity, it is important to evaluate other, more subjective aspects such as ones food preferences, experience with food, and a family’s/patient's goals of care. We find that selective eaters who LOVE their traditional diet may struggle with a diet like the specific carbohydrate diet (SCD) and thrive with a therapy such as exclusive enteral nutrition (EEN) for example.
And last, but not least, guidance from an IBD RD versed in nutrition therapy is key to an approach that is best for you and your family.
Reach out for your Free Discovery Call to learn more about nutrition for your IBD and take a look at other FAQs regarding nutrition therapy via link here:
https://kimbralyrd.com/what-is-dietary-therapy/

Have you had someone tell you or your patients:
IBD is caused by eating a poor diet?
You shouldn't eat fiber with Crohn's or Colitis?
If you modify your diet to treat your symptoms your eating could become disordered?
Some myths you hear about diet are internet memes with nothing to back them up.
But other IBD nutrition myths, like those above, are not so straightforward.
These ideas may be based on older research or outdated practices. There may be a partial truth that's being overgeneralized. Or there may be some truth for some people in some circumstances.
That's why I wanted to cover the top 5 misconceptions I see about IBD and diet — especially those that affect practitioners and individuals making decisions about dietary approaches. If you want to get to the bottom of some of these persistent myths, you've got to dig.
So read on! I've done the digging for you in my latest post:
https://kimbralyrd.com/ibd_nutrition_myths/
Please share your experience and insights and don’t forget to sign up for the mailing list to be the first to know about new IBD nutrition resources!

During National Eating Disorders Awareness week I wanted to highlight some differences between eating disorders and disordered eating.

This blog article dives into some of the complexities around eating for those living with IBD. It’s a couple years old now, but oh so relevant!
Check it out. P.S. I will discuss this topic a bit more in my upcoming article on IBD Myths… which has some hot topics. Stay tuned! Are you signed up for my Newsletter? I share new resources and announcements related to IBD, gut health, and more first here!

Have you felt like your heart was racing or had a “pit” in your stomach for months on end?
We know IBD is both a marathon and a sprint. There are seasons where it is all consuming and there is no space for YOU as a parent caring for your young one who is hurting. So, it is all the more important to find ways to rest and recover during periods of reprieve.
For all of the parents out there, what have you found to be helpful for you during seasons of stability or during the sprints?
Cheering you on!
❤️Your IBD RD, Kim

Drug-nutrient interactions are common in IBD.

For Methotrexate and Sulfsalazine, 1 mg/d is common practice, but not always the case. Ask your team if you have questions about your particular therapy.

We cover drug-nutrient interactions and so much more during our sessions together.

For a FREE Discovery Call and to share your journey, ask questions, and learn more about my 3D-Dietary Approach™ to IBD nutrition to see if you/we feel it meets your needs-
head to my bio and click “work with kim.”

Your IBD RD, Kim
1) Pronsky ZM, Crowe SR JP. Food Medication Interactions™ . 16th ed. Food-Medication Interactions; 2010.
2) Miele E, Shamir R, Aloi M, et al. Nutrition in Pediatric Inflammatory Bowel Disease: A Position Paper on Behalf of the Porto Inflammatory Bowel Disease Group of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition. JPGN. 2018;66:687-708.
3) UpToDate: Uptodate.com.

🌸 AFFIRMATIONS for parents of IBD warriors🌸
1) It will be okay, we will get through this.

Find your support system and hold them tightly.

2) Take one day at a time.

The big picture can be overwhelming. Stay in the present as much as able.

3) I am doing my best.

Keep showing up for your young one.

4) I can do hard things.

YES YOU CAN!

4) I will hold space for the rollercoaster of feelings that come today.

Days can hold extreme highs and extreme lows. This is normal.

5) It is normal and okay to rest.

IBD is a marathon (with sprints at times). Rest for you and your IBD warrior is essential and OKAY.

❤️your IBD RD, Kim

For a detailed handout with detailed ideas access “Flare Foods for Kids” at kimbralyrd.com.

OR click “work with Kim” in bio for a free Discovery Call ❤️.

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The journey is less lonely when shared with others.

I know many of you can relate to this family - multiple medications, diet misinformation and overwhelm. This 16 yo felt that the CDED was the best fit for their preferences and situation, and I agreed.

We need all of the tools in our toolkit to best support those living with IBD. I’m a big fan of a multidisciplinary team 🙌.

Send a ❤️ if you can relate to this

📣First exciting resource in 2023 🎉
Meet my incredible partner Maddie, and our new resource- EATS for IBD. Some of you may already know Maddie as she is an IBD thriver, phenomenal cook and patient advocate.
Maddie and I began working together in 2016 after she was diagnosed with Crohn’s Disease. Maddie had achieved clinical remission using Exclusive Enteral Nutrition (EEN) and was looking for guidance on next steps. I helped Maddie transition to the and from there our friendship grew from a shared love of delicious food and a passion for making life better for people with IBD.
We have spent years creating evidence-based nutrition tools that empower those with IBD to reach a better quality of life through food. We cannot WAIT to share with you all! Don’t miss it.
Hop on over to our IG page for practical, nourishing and delicious kitchen resources.
Tag a friend or share with someone who could benefit.

❤️Your IBD RD, Kim

From our family to yours, wishing you a happy New Year. May there be rest, adventure, good food, and lots of laughs 🥂

Today I present a ghost: A ghost of medicine past.

Anyone who has been working in GI or nutrition for Inflammatory Bowel Disease will be familiar with the low-residue diet.
Once commonly prescribed for those with Crohn's and ulcerative colitis, the idea was to reduce intestinal irritation.

Those working in the field today may also be aware that the evidence hasn't really supported a low fiber/residue diet to improve IBD long-term. And today there's growing evidence in favor of Nutrition Therapies (SCD, IBD-AID, AIP, CDED) that include fiber-containing foods in various textures and types.

The problem is that those with IBD don't always hear this message. They may come to me having restricted many beneficial high-fiber foods long-term.
If you've ever heard individuals expressing concern about consuming legumes, nuts or seeds, or you have IBD and you've struggled to tolerate these foods, you may find my latest post helpful:
🫘 Are you nuts to eat them? Legumes, nuts & seeds in Inflammatory Bowel Disease.
⇒ Check it out: https://kimbralyrd.com/ibd-legumes-nuts-seeds

(By the way, this is a friendly ghost. Low-fiber/low-residue can still be useful in some cases, such as post surgery, or in stricturing disease, for example).

Enjoy this busy season ensuring self care and rest. Here are some ideas:

🍲 Home cooked meals shared with loved ones around a table fuels connection. Try to think of a new question to ask something else each day and turn off distractions.

🥬Fermented foods increase diversity of the microbiome and offer protective benefits.

💧Hydration keeps us alert as our body excretes waste through urine. Water loss and hydration are important for those with IBD as losses can be higher, especially in the case of ostomy or increased stool ouput.

🏊Enjoyable movement gives us endorphins, improves mood and energy. This can be walking around the block for a work break or stretching. Listen to your body and what feels good.

👩‍👦Your support team is essential - family, friends, and care team. Ideally, a care team would involve your IBD/GI provider, mental health provider and IBD dietitian but access can be difficult.

How are you nourishing yourself this holiday season?

It’s 2022. Patients, caretakers, providers, friends join together to make .

Frequently, it is patients and families that bring change. Nearly 10 years ago when I started collaborating in research with the IBD team at Seattle Children’s, it was because families continued to ask and push for nutrition research. We needed to ensure nutrition therapy could be done safely, could be sustainable, and we did not have the data!

To all of the IBD Patients, parents, caretakers and providers - continue to ask the hard questions. Challenge the status quo and consider giving to nutrition research as funding can be harder to come by.

Research and asking questions leads to a cure!

The holidays can stir up a mixture of emotions like excitement, sadness, worry. Here are some tips that I find helpful for individuals with IBD to try during the holiday season.

🎉Create new traditions.
Ideas such as crafting together, decorating, movie watching and taste testing new recipes are some of my family’s favorite holiday traditions. What are yours?

♥️♦️Games.
Games are a great way to take the focus off of food. Plan a fun group game that your family and friends will enjoy. It can involve a fun non-food gift exchange or prize at the end. Bunco is always a fun favorite.

🧘‍♂️Find ways to decrease stress.
Walks outside (even in the cold invigorating air) or any type of movement significantly impact our mental health. Relaxation techniques and other self care strategies can be found in my guide to “soothing a flare” on my homepage.

😴Sleep hygiene.
It may be tempting to have late night movie binges. Who wouldn’t? These are the best! If you decide to enjoy some later nights, try to balance with relaxation and getting back into a routine when able. Rest will support you through the hustle and bustle of holiday gathering.

👕Wear comfortable clothes.
Gatherings can be anxiety provoking in themselves. Make sure you dress for comfort. Expandable waist lines, loose fitting clothes can all help you feel more comfortable, especially if you are trying foods you usually do not eat. They can also be stylish!

📚Share books and Resources.
Sharing favorite resources such as a favorite cookbook, or educational resources with friends and family so they can support you and your family, especially if IBD is a new and foreign term for them.

🍽This includes sharing your favorite holiday dish!

What are you most excited about this holiday season?