Eating Right for Crohn's Disease

Crohn’s disease is a chronic inflammatory bowel disease (IBD). It causes inflammation in the body’s digestive or gastrointestinal (GI) tract. The small intestine and colon are most often affected, but it may be present anywhere along the GI tract, which runs from the mouth to the anus.

While the cause of Crohn’s disease is not fully understood, doctors do know that multiple factors cause an abnormal immune-system response in the body, resulting in the destruction of the GI tract. Research suggests that the immune system of someone with Crohn’s disease mistakes normal bacteria, foods, and other substances in the intestine for foreign invaders such as bacteria or a virus. The immune system’s response is to attack and send out white blood cells to kill those invaders. The problem is that these white blood cells then attack healthy tissue, accumulate in the lining of the intestine, and cause it to swell and become inflamed.

Crohn’s and Digestion

When the small intestine is inflamed, it has a difficult time digesting food and absorbing nutrients, which can cause diarrhea. The same is true when the colon or large intestine becomes inflamed, but the diarrhea is often more severe because the majority of the water in the stool is supposed to be absorbed in the colon.

Chronic diarrhea can cause malnutrition, a condition where the body isn’t getting enough vitamins and nutrients. Over time, malnutrition or undernourishment can affect the body negatively. For example, children with Crohn’s disease may have delayed development and/or stunted growth. Decreased hormone levels in women and girls may cause irregular menstrual cycles or even cessation of menstruation.

Fighting Crohn’s With Food

Food is both friend and foe for someone battling Crohn’s disease. Certain foods can trigger flare-ups or exacerbate symptoms. However, food consumption is absolutely necessary to make up for the loss of nutrients during active periods of the disease. This means keeping the body fueled and providing adequate nutrients during flare-ups. It also means helping the body heal and, during times when the disease is less active, preparing the body for subsequent flare-ups.

The tips here are meant to serve as a starting point for patients with Crohn’s disease. Your doctor or a registered dietitian (RD) will be able to provide you with more specific information targeted to your age, sex, lifestyle, and disease.

Everyone is Different

“Foods that trigger symptoms differ for each person,” says Jeannie Gazzaniga-Moloo, a registered dietitian and spokesperson for the American Dietetic Association. “But we do know there are a few types of foods that tend to cause problems for many people,” she says.

Foods that commonly aggravate the symptoms of Crohn’s disease:

• Alcohol (mixed drinks, beer, wine, liquor)
• Oils, mayonnaise, butter, and margarine
• Carbonated or caffeinated beverages such as soda, coffee, or tea
• Chocolate
• Dairy products (if you’re lactose intolerant)
• Fried foods
• Whole grains, bran, and foods high in fiber
• Gas-producing foods such as lentils, beans, onions, broccoli, cabbage, and legumes
• Nuts and seeds
• Raw fruits and vegetables
• Fatty meats such as some red meat and pork

Keep a Food Diary

Because food triggers are different for each person, it helps to keep a daily food journal. This will help you identify possible food triggers that make symptoms worse or foods that seem to bring on flare-ups. Your doctor or dietician will review your food diary with you, decide which foods to eliminate from your diet, and ensure you’re still eating a balanced, healthy diet.

Learn simple tips on starting and keeping a food diary.

High-calorie, High-protein Diet

Once you’ve identified foods that trigger digestion problems, it’s important to work “safe” foods into a diet plan that is high in both calories and protein. Inflammation in the intestines may make absorption of vitamins and nutrients difficult, so it’s important to increase the amount of nutrients (especially protein) that you consume. You increase your chances of absorbing more vitamins and nutrients in the process.

Pick Healthier Proteins

If you have to take in more proteins, you should focus on healthier options. With this disease, not all proteins are equal. Lean proteins are best, says Tracie Dallessandro, a registered dietitian and author of What to Eat with IBD. “Look for high quality proteins like chicken, fish, and turkey,” she says. “You should eat fish two to three times a week and limit red meat to once per week.” Other healthy protein options include smooth nut butters, soy protein, and eggs.

Be Careful with Fruits and Veggies

Raw fruits and vegetables may be too difficult to digest; the skins and high-fiber content can wreak havoc on your intestines. Cooked fruits and vegetables that have their skins and seeds removed may be tolerated more easily. Including vegetables in pureed soups or stews is a great way to increase your intake, Tracie says.

Snack Wisely, Snack Often

It’s important for people with Crohn’s to eat throughout the day—three moderate meals plus three or four snacks, says Jeannie. This decreases the amount of stress your intestine experiences with three large meals only, and it increases the opportunities for your body to absorb more vitamins and nutrients.

Supplement Your Food Choices

A multivitamin is a great way to make up for any nutritional deficiencies. You might also need additional supplements, such as vitamin D. A blood test, administered or ordered by your doctor, is the best way to reveal any deficiencies. If you’re low in any particular vitamin or nutrient, you can adjust your diet plan and decide which supplement, if any, are necessary. Because product efficacy varies, it’s important to talk to your doctor before taking any supplements.

Stay Hydrated

Fluids lost as a result of diarrhea may lead to dehydration. Drinking at least eight glasses (64 ounces) of water each day will help replenish any fluids lost to diarrhea or improper digestion. Vitamin-enhanced waters are okay—just pick one that is low in calories or make your cup half regular water, half enhanced water, says Tracie. The enhanced waters do have some useful vitamins and nutrients—another opportunity to absorb more into your body—but they need to be diluted because of sugar and calorie content.

Eat a Low-residue Diet

Certain foods add residue, or bulk, to the stool that can exacerbate symptoms of Crohn’s disease. These foods include seeds, raw fruits and vegetables, and nuts. A low-residue diet may help decrease abdominal pain, cramping, and diarrhea.