Crohn’s Disease Diet | Dieting Tips To Help Control Crohn’s Disease
Dealing with gastrointestinal pain and symptoms is not a pleasant experience. Following a Crohn’s disease diet can help limit symptoms, reduce inflammation, and make you feel better overall. Ranging from GI specific symptoms, such as diarrhea, vomiting, abdominal cramping or pain, constipation, or more generalized symptoms, it is safe to assume that you have dealt with this at least once in your lifetime. However, living with a gastrointestinal condition is all the more difficult as these symptoms may become more chronic and severe in nature.
Amongst the spectrum of GI conditions, there is a group called inflammatory bowel diseases (IBD). Crohn’s disease lies within the IBD group of GI conditions. The disease is named after the physician who first discovered the disease in 1932, Dr. Burrill B. Crohn. People often get the disease confused with other gastrointestinal conditions, including ulcerative colitis, which is another type of IBD. Although these two diseases result in similar symptomatology, they actually differ in the pathology and the areas in the gastrointestinal tract that are affected.
Differences Between Crohn’s and Ulcerative Colitis
Before following a Crohn’s disease diet it’s important to know the differences between Crohn’s and ulcerative colitis.
So, which parts of the gastrointestinal tract are affected by Crohn’s disease? Crohn’s disease most commonly affects the ileum, the end of the small bowel, and the beginning of the colon. Despite these areas being affected most statistically, any portion of the GI tract can be affected, including any part from the mouth all the way to the anus.
As mentioned before, ulcerative colitis is often confused with Crohn’s, but ulcerative colitis can only affect the colon. Additionally, Crohn’s disease can affect the entire thickness of the bowel wall, and interestingly enough, the inflammation that it causes can skip portions of the diseased intestine, resulting in patches of non-affected, normal GI tract.
General Information on Crohn’s
It is reported that Crohn’s disease may affect around 780,000 Americans. It is not gender-related, affecting men and women in near-equal proportions, and additionally, it can affect people of any age. It has been found that Crohn’s disease is more prevalent in younger populations, from adolescents and young adults between the ages of 15 and 35. It is important to note that for those affected who are younger in age, the disease may delay growth and development.
Crohn’s tends to have a familial link, as it was found in different studies that 5% to 20% of affected individuals have a first-degree relative (parent, child, or sibling) who also has the disease. Additionally, it was found that Crohn’s is most common in people of eastern European backgrounds. As with other diseases, these hereditary factors are only one portion of the likelihood that one will develop the disease, and environmental factors also play a key role. Hence, how a Crohn’s disease diet can help because it influences environmental factors to some degree.
Impact on the GI Tract
So how does Crohn’s actually affect the GI tract and lead to the subsequent symptoms you experience? As previously mentioned, Crohn’s disease belongs to a group of conditions called IBDs. In those unaffected by IBDs, the GI tract functions normally, allowing for proper digestion and absorption of nutrients. Additionally, inflammation is the body’s natural response to tissue injury, infection, or other potential causes of harm. This response normally helps protect the body, but in IBD, inflammation occurs inappropriately, as the immune system reacts. This inflammation leads to subsequent impairment of the GI organs to properly function, leading to the various symptoms. Following a Crohn’s disease diet is important because many common foods make inflammation worse.
The GI tract consists of multiple organs, most of which are hollow, and it starts from the mouth, followed by the esophagus, then the stomach, small intestine, colon, rectum, and last the anus. It plays three important roles: digestion, which is the breakdown of food, absorption of nutrients and water, and the elimination of waste products.
So, how does Crohn’s affect these processes? The inflammation caused by Crohn’s can result in food not being properly digested, and this incompletely digested food travels through the colon which can cause diarrhea and abdominal pain. This diarrhea can then cause dehydration, as you are losing important fluids and electrolytes as a result. Similarly, the abdominal pain and other symptoms can cause a subsequent loss of appetite, making it difficult for some people to consume an adequate number of calories. This in turn can result in weight loss.
If Crohn’s affects the small intestine, it can lead to malabsorption of nutrients. The degree to which this occurs depends on how much of the small intestine is affected by Crohn’s disease and other factors, including whether the disease is active, and if any portion of the intestine has been surgically removed. The larger the proportion of the small intestine that is affected, the greater the degree of malabsorption. We will continue our discussion below regarding the symptoms surrounding Crohn’s disease.
Given that Crohn’s disease can affect any part of the GI tract, there are some common symptoms that most people affected will experience, but there is some variance in the symptomatology. Some of the symptoms that relate to general inflammation of the GI tract are listed below. These symptoms are called local complications, as they are localized to the intestinal tract.
- Persistent diarrhea
- Rectal bleeding
- Urgent need for bowel movements
- Abdominal cramping
- Abdominal pain
- Abdominal bloating
- Sensation of incomplete bowel movements
- Constipation (this can lead to bowel obstruction)
To further expand on some of the localized complications one may experience with Crohn’s, one may also have other symptoms. These include abscesses, which are pockets of pus that result from bacterial infection. These abscesses can form on your intestinal wall or near the anus. One will notice subsequent swelling, tenderness, pain, and potentially fever. These resulting symptoms will subside once the abscess is drained, and antibiotics can help clear the infection.
One may also experience bile salt diarrhea, which occurs as the body is unable to properly process fats and bile acids due to the dysfunction of the ileum. Fissures may also occur, which are painful tears in the lining of the anus. These tears can cause bleeding during bowel movements. Fistulas, which are sores or ulcers that turn into openings that connect two parts of the intestine, may also occur. These fistulas can tunnel into surrounding tissues, including the bladder, vagina, and skin. Similarly, to abscesses, antibiotics can treat smaller fistulas. If they are larger, they may require surgical intervention.
Some of the previously mentioned symptoms, including abdominal pain and bloating, can be resultant of strictures. These are narrowed and thickened portions of the GI tract that occur secondary to the inflammation. Similarly to large fistulas, if the obstruction is large enough, it may require surgical intervention. Obviously with complications of the GI tract, Crohn’s can result in malabsorption and malnutrition, as the GI tract’s ability to properly utilize the food and absorb nutrients from it is affected.
There are also some generalized symptoms that can also be associated with IBDs. These types of symptoms are called systemic complications, as they affect the entire body.
- Loss of appetite
- Generalized fatigue
- Weight Loss
- Night sweats
Interestingly, arthritis, a condition characterized by joint inflammation, which leads to subsequent pain, swelling, and decrease in flexibility, is the most common systemic complication of Crohn’s. There are three types of arthritis can be resultant from Crohn’s.
- Peripheral: Peripheral arthritis affects the periphery of the body, including large joints, such as those in your arms and legs. These joints include elbows, wrists, knees, and ankles. The inflammation of your joints will be associated with the acute episodes of Crohn’s pain, but it generally doesn’t result in lasting damage.
- Axial: This type of arthritis affects your spine and lower back. Unlike peripheral arthritis, this can result in permanent damage, if the bones of your spine fuse together. It can be referred to as spondylitis or spondyloarthropathy.
- Ankylosing spondylitis: This is a rarer and more serious type of spinal arthritis, particularly rarer among people with Crohn’s. This type of arthritis can lead to inflammation of the eyes, lungs, and heart valves.
There is no definitive way to diagnose Crohn’s based on symptoms alone, and it requires various testing performed by your physician to properly diagnose the condition. Because Crohn’s disease is chronic, those affected often experience acute periods in which symptoms flare up along with periods of remission, during which they do not experience any symptoms.
To properly diagnose the condition, it requires data from multiple tests and sources, including lab work, and imaging studies. This lab work may include various blood tests. Imaging studies may include CT scans, colonoscopies, sigmoidoscopies, MRIs, or other imaging modalities.
We will briefly discuss the reasoning behind these various tests before moving on to information about a Crohn’s disease diet. An endoscopy utilizes medical instruments to visually examine the colon through the use of a small camera that is mounted to the end of a thin lighted tube. For the purpose of diagnosing Crohn’s disease, there are two types of endoscopic examinations that your physician may suggest: a colonoscopy or an upper endoscopy.
Colonoscopy – utilizes the insertion of a flexible tube through the anus which allows for examination of the colon, which is the lowest part of the large intestine.
Upper endoscopy – utilizes the insertion of a flexible tube through the mouth, down the esophagus and into the stomach. This method can go down as far as the duodenum, which is the first part of the small intestine.
How to Avoid Acute Flares With A Crohn’s Disease Diet
Now, if you have been diagnosed with Crohn’s disease, what can you do about it? We will begin our discussion on Crohn’s disease diet below, but before we dive into that content, there are other factors that you can control to avoid acute episodes of symptoms.
Physicians are currently unsure what triggers these acute episodes, but they know that lifestyle factors, including diet, smoking, and stress can play a large role in preventing or causing these episodes. Obviously, if your physician provides you with prescriptions to help with treatment, you should continue taking these medications even if you are not currently experiencing symptoms.
Drugs may have various side effects, but even if these side effects are affecting you, you should discuss changes with your physician before making the decision to stop taking your medications. Smoking not only affects your lung, but also negatively impacts your body’s ability to fight infections, inflammation, and general ability to recover, hence making your body more prone to potential flares. Although it may be difficult, if you are a smoker, consider asking your physician for resources to help you quit if you desire to stop and need assistance. It is interesting to note that if you have Crohn’s, you should also avoid NSAID drugs. NSAIDs are non-steroidal anti-inflammatory drugs, which include aspirin, Ibuprofen, and Naproxen. These drugs can trigger symptoms, so speak with your primary care provider about alternatives to help with pain.
Now we will spend the rest of our discussion on Crohn’s focusing on a Crohn’s disease diet and how you can change what you eat so that you start to feel better. Food can act as a preventative measure of acute episodes and relapses. Interestingly enough, it is not as simple to say eliminating one specific food group will relieve all of your symptoms, and there is limited evidence to even suggest that your diet actually causes Crohn’s- although, it can make it much worse or much better. Two people may eat exactly the same diet, with one person feeling healthy and the other experiencing intense Crohn’s flare ups.
The inflammation is believed to be a multifactorial model, and individual variance makes it extremely difficult and unreliable to make overgeneralized, blanket statements. However, we can provide some suggestions and based on your individual response to these changes, it might help you identify factors that are specialized for you and unique trigger foods that you should avoid.
- Limit dairy products: Many people dealing with inflammatory bowel diseases, including Crohn’s, find that some of the symptoms, including abdominal pain, bloating, gas, and diarrhea, improve once the consumption of dairy products is limited or eliminated completely. It is important to note that you should identify whether or not you are lactose intolerant. This means that your body cannot properly digest lactose, a sugar found in dairy products.
- Low-fat foods: As previously mentioned in the discussion of bile salt diarrhea, if you have Crohn’s disease that affects the small intestine, your ability to properly digest and absorb fat may be affected. Because of this, fat passes through the intestine and worsens diarrhea. In this instance, avoid high-fat foods like butter, margarine, cream sauces, and fried foods.
- Try low fiber: Although consuming an adequate amount of fiber is an important way to maintain proper GI health in the general public, for those with Crohn’s disease, consuming too much fiber can make symptoms worse. High-fiber foods, including green leafy vegetables, whole grains, fresh fruit, and others can aggravate your GI tract. This does not mean you should completely eliminate these foods as they are packed with important vitamins and micronutrients. They are still important to a healthy Crohn’s disease diet. Therefore, you can try cooking these foods in different ways. For example, you can try steaming, baking, or stewing raw vegetables if you find that they bother you.
- Avoid other problematic foods: These include spicy foods, alcohol, and possibly even caffeine.
Below is a list of foods you might need to avoid for a Crohn’s disease diet:
- Alcohol (mixed drinks, beer, wine)
- Butter, mayonnaise, margarine, various oils
- Carbonated beverages
- Coffee, tea, chocolate
- Dairy products
- Fatty foods (particularly fried foods)
- High-fiber foods
- Lentils, beans, cabbage, broccoli, onions
- Various nuts and seeds (including the nut butters)
- Raw fruits and vegetables
- Red meat and pork
- Spicy foods
- Whole grains
Again, as previously mentioned, the above suggestions are generalized and may not be specific to you. It is difficult to create generalized recommendations as everyone’s reaction to different foods will vary, particularly in those affected by Crohn’s.
You might notice that you can eat bananas without any problems whereas another individual’s symptoms may worsen because of the same food. In order to better identify your trigger foods, we suggest you keep a food diary to keep track of what you’re eating and how your symptoms are doing based on your diet. If you’re in the process of trying to identify trigger foods, eliminate them one at a time for a few days at a time to give yourself enough time to adequately assess whether the food you’ve taken out is actually a trigger food.
You might not even have to completely avoid these trigger foods, as cooking them in different ways may actually allow you to keep consuming them while avoiding flares. Additionally, if your diet is too varied and you feel that this method may not best identify different trigger foods, try starting with a bland diet. Then, slowly advance your diet as tolerated to mirror your previous daily eating habits. It might also be helpful to consult with a physician in order to get food allergy testing done. This is another way to identify foods that you should generally avoid, particularly if they not only tend to trigger Crohn’s symptoms but cause other symptoms or conditions, including anaphylaxis.
Popular Diets – Gluten-free, Keto, Paleo – are these good for Crohn’s disease diet?
A lot of you may be wondering, what if I have Crohn’s and I want to try a specific type of diet? Well, unfortunately, there is nearly no scientific evidence to suggest that there is a cookie cutter diet for those dealing with Crohn’s. As previously mentioned, you need to find an individual and personalized plan that works for YOU. It will take some time and a lot of testing out different food groups, but you will need to find the foods that your body best responds to and avoid the potential trigger foods.
This section will briefly cover a few popular diets and whether or not you should try them in regard to Crohn’s.
There has been a lot of media coverage surrounding gluten-free diets and how many people are actually gluten intolerant vs. gluten sensitive. Unfortunately, a lot of people have skewed the understanding of this term and misunderstand its true meaning.
Gluten intolerance is only true in a medical sense for those affected by Celiac disease. This disease, similarly to Crohn’s, results in an inappropriate immune response, following the consumption of gluten products. Now, this is not to say that gluten is automatically not a trigger food for your Crohn’s. It might be, and you might be gluten sensitive, but these two terms greatly differ in their clinical presentation.
The keto diet is also gaining popularity due to its marketing exposure and ability to help people lose weight. It is a diet that essentially removes all carbs, focusing on meeting basic protein requirements and filling the rest of your calories with fat. This has been suggested as Crohn’s disease diet alternative that potentially debunks the idea that diet does not play a role in Crohn’s. If you are considering this diet or are looking to lose weight, speak with your physician to determine whether or not this is a safe method for you to do so.
Paleo is also popular, and although it tends to stress a healthy diet through the consumption of non-processed foods, these foods may irritate and trigger Crohn’s flare ups. As previously mentioned, you can try to eat fruits and vegetables, but find a cooking method that allows you to eat them without experiencing symptoms to ensure you are eating the right Crohn’s disease diet for you.
Crohn’s Disease Diet: Generalized Diet and Lifestyle Tips
Now that we’ve debunked the idea that there is nothing you can do to decrease your symptoms, here are some more tips to improve your health. For one, try eating more frequent and smaller meals. This may help your GI tract better absorb the food with the smaller quantities and increased frequency. Sometimes when and how you eat is an important part of your Crohn’s disease diet.
Experiment with this similar to identifying trigger foods. This may seem like a silly and obvious suggestion but ensure that you are drinking plenty of fluids. Obviously, water is the best solution, and as previously mentioned, coffee, carbonated beverages, and alcohol may be linked with symptoms.
Consider taking a multivitamin supplement to help cover any potential gaps in your vitamin and micronutrient consumption, particularly as you may not be getting all these important components due to your GI tract’s inability to properly absorb all the food you consume. Lastly, speak with a dietician, as they can provide more definitive advice, particularly if you have Crohn’s and would like to lose weight or notice that your Crohn’s disease diet has become extremely limited.
You might also be asking at this point; can I go out with my friends and family and eat? The quick answer is yes, of course you can. Simply take the previous mentioned tips into play and find something on the menu that you know won’t worsen symptoms or cause an acute flare. Don’t be afraid to ask the server if the restaurant can change the cooking method of a particular item in order to better accommodate your needs.
When in doubt, keep your choices simple. Go for a boiled, grilled, steam, or poached options and ensure that your choice is not overly drenched in sauces or spices. On a similar note, what about fast food – can I eat McDonalds and other popular quick options? Can I have a cheat day once a week?
Oddly enough, you can eat fast food and it might not be a bad option. Of course, keep all of the previously mentioned information in mind, but because fast food is generally a dense source of calories with blander foods, it can help alleviate malnutrition and reduce the risk that you do not get adequate calories.
For general health purposes and to also help deal with your Crohn’s, having a cheat day every day is probably not the best idea; however, if you can maintain a proper diet for most of the week, giving yourself the mental freedom to eat what you want once or twice a week can be beneficial. Although, there’s always the risk that it will negatively impact your symptoms for longer than just the 1 day you are eating cheat foods that are not on your regular Crohn’s disease diet.
Another important lifestyle change you can make is engaging in more physical activity. Whether this is something as simple as walking more every day or participating in various sports, exercise can be a great way to counter the symptoms of Crohn’s. Consistent aerobic and/or anaerobic exercise has numerous benefits, including improvements in cardiovascular health, but in the context of Crohn’s, it can help increase insulin sensitivity and improve your GI tract’s ability to function more efficiently. Additionally, it can also reduce stress, another lifestyle factor that is often related to Crohn’s flares.
Sample Meal Plan for Crohn’s Disease Diet
Before we wrap up this article on Crohn’s, we thought it might be helpful to provide you with a sample meal plan to provide you with a better idea. We are emphasizing once more that there is no miracle or universal diet, so even this sample meal plan might not be the best or work for you.
- ¼ cup egg substitute (or egg whites) scrambled with some low-fat cheddar cheese
- Optional: mix in some vegetables into the scramble e.g. spinach, small broccoli, onions, tomatoes
- 2 slices of bread (wheat, potato, or whatever type of bread that works well for you)
- 1 cup of fruit (berries, watermelon, etc.)
- 1 cup of plain Greek yogurt with ½ cup of fruit mixed in
- 3-6 ounces of protein (lean ground turkey, deli meats, ground beef, chicken) with source of fat (cheese, avocado) on flour tortillas with lettuce and other condiments (mustard, salsa)
- 1 banana topped with 1 tbsp of nut butter
- Pasta or rice with limited oil, vegetables, and source of protein
As with all articles, use the information discussed here as a foundation of your understanding, but understand that this is merely a small summary of the available information on Crohn’s. If you are concerned that you may have Crohn’s, speak with your primary care provider to discuss testing, and if you are already diagnosed with the condition and need help with dealing with the symptoms, seek consultation with them regarding potential treatment methods or lifestyle changes you can safely make.
Although the symptoms of Crohn’s can be difficult and the condition is chronic, you can make educated and healthy decisions to reduce flares and live a symptom-free life. This includes creating a Chron’s disease diet that works for you. Similarly, if you have other medical conditions, it is important to have these discussions as your other medications may negatively affect symptoms of Chron’s.