Low-Residue Diet

Crohn’s disease may not be curable, but with medical therapy and the right diet, it’s possible to achieve and maintain remission. Although diet can play an important role in the management of symptoms, it’s not the complete solution. Crohn’s isn’t that simple of a condition. 

Crohn’s is an auto-immune disorder that causes inflammation, which damages the digestive tract. Although there appears to be a genetic component to Crohn’s, meaning that people with a family history are more likely to develop the disease, it’s still unclear why the body attacks its own tissues. What is known is that food doesn’t play a role in provoking this inflammation.

The Low-Residue Diet

The low-residue diet was designed to put as few demands on the digestive tract as possible. It’s similar to a low-fiber diet, but also excludes some foods that are believed to stimulate bowel contractions. The idea is to increase the time food spends traveling through the digestive tract, increasing the chance that nutrients will be absorbed, and reducing incidences of diarrhea.

For decades, doctors have known that following a low-residue diet can significantly improve patients’ remission rates. In the early 1990s, researchers showed that Crohn’s patients with the highest intake of daily calories from a low-residue diet were most likely to maintain remission of their symptoms, compared to patients who consumed fewer daily calories in the form of low-residue foods.

Dietary approaches to symptom control must be tailored to the individual, however, because Crohn’s disease manifests differently in each sufferer—in fact, even the individual’s symptoms may vary over time.

Patients with inflammation in the small intestine may have difficulty extracting sufficient nutrients from food, putting them at risk of malnourishment. Therefore, medications to reduce contractions in the lower bowel may be required to help reduce spasms, or your doctor may prescribe corticosteroids to reduce inflammation in the small intestine and improve its normal functioning. Antispasmodics or anti-diarrhea medications may also be required.

The Rationale for the Low-Residue Diet

Foods like milk and dairy products, and foods high in fiber or certain types of carbohydrates, may provoke abdominal cramping and diarrhea. The idea of the low-residue diet is to avoid high-fiber foods, thus minimizing cramping. Residue refers to the undigested portion of food. Lower fiber intake means less residue and smaller amounts of stool.

The low-residue diet aims for no more than seven to ten grams of fiber daily. In contrast, people without inflammatory bowel disease should ideally consume about 25 to 38 grams of fiber daily, depending on age and sex. The low-residue diet should be undertaken with a doctor’s supervision. The amounts and types of food you consume—and how long you follow the diet—should be tailored to your needs. Guidelines for a low-residue diet (individual results will vary) include:

Foods to Avoid:

  • legumes
  • nuts
  • seeds
  • most raw fruits and vegetables
  • potato skins
  • popcorn
  • whole coconut
  • most whole grains, including whole-grain products such as breads or pastas
  • dried fruits and berries
  • milk  and milk products (in some cases you may have up to 2 cups per day of "smooth milk products" like yogurt, cottage cheese, and ricotta cheese)
  • deli meats
  • vegetable sauces with seeds (i.e., tomato sauce)
  • spice foods and dressings
  • caffeine

Foods to Include:

Low-residue foods should be well-cooked. Avoid cooking methods—such as roasting, broiling, or grilling—which may make food tough or dry. Good cooking methods include steaming, braising, poaching, simmering, and microwaving.

It may be necessary to drink additional fluids—especially water—to avoid constipation when reducing the volume of your stools with a low-reside diet. After remission has been attained for a good amount of time, your doctor may suggest gradually reintroducing higher-fiber foods into your diet.

Here are some specific foods you may want to include:

  • refined carbohydrates; including white bread, white rice, pasta, and refined cereal (such as corn flakes, Rice Krispies, and Cream of Wheat)
  • clear juices
  • clear broth and strained soups
  • raw lettuce, cucumber, onion, and zucchini
  • well-cooked or canned vegetables, no skins or seeds, including yellow squash, spinach, pumpkin, eggplant, green beans, asparagus, beets, carrots, and potatos (be sure to not eat any of these vegetables raw—they are only okay to eat when cooked)
  • some raw fruits, including ripe apricots, bananas, cantaloupe, honeydew melon, watermelon, necatarines, papayas, peaches, and plums
  • limited cooked fruits as long as they have no seeds or skins
  • finely ground, well-cooked meat
  • fish, eggs, and poultry
  • butter, vegetable oils, margarine

It should be noted that fruits, vegetables, grains, and legumes supply important antioxidants, phytonutrients, vitamins, minerals, and other nutrients. Try to consume a balanced diet, as the low-reside diet may not provide enough vitamin C, folic acid, calcium, or antioxidants, for example. All of these nutrients are essential for good health. Supplements may be necessary to correct dietary deficiencies. Consider consulting with a dietary specialist if you have any concerns.