Maintaing healthy body weight is one of the bigger challenges of life with Crohn’s disease.
Although food doesn’t cause the inflammation and tissue damage at the root of Crohn’s disease, patients associate eating with flare-ups, and often avoid food to prevent further discomfort. This is especially true when Crohn’s strikes infants and children. While abstinence may provide some relief, the need for nourishment—especially adequate calories—can’t be ignored.
Studies show that up to 85 percent of Crohn’s patients will suffer some form of malnutrition, and up to 80 percent will struggle with unwanted weight loss. For these and other reasons, you should always work with a dietician to devise a diet plan that works for you. Treatment should also include regular monitoring of body weight and other tests as needed to determine if you’re suffering from any nutritional deficiencies.
Even when your Crohn’s is in remission, you may suffer from low body weight due to malabsorption of nutrients. You may require extra calories in your diet to counteract the body’s inefficient absorption of calories from food. You also may require a diet that’s free of specific components, for instance: gluten, lactose, fructose, or excess fiber. Every patient’s needs are different, which is why it’s important to work closely with health care professionals to devise an individualized dietary plan.
General Guidelines for Weight Maintenance
The following guidelines, suggested by the National Institutes of Health and the Crohn’s and Colitis Foundation of America, may alleviate symptoms and help you maintain a healthy body weight, and/or help prolong disease remission.
- Drink plenty of water throughout the day (in relatively small portions).
- Eat small portions regularly throughout the day.
- Skip foods that are high in fiber, including beans, nuts, seeds, raw vegetables, and popcorn.
- Avoid fatty foods, including fried foods, and heavy cream or butter-laden sauces.
- Lactose-intolerant people should avoid dairy or choose products, such as hard cheeses, which have relatively little lactose.
- Take supplements as directed to shore up key nutrients, such as calcium, vitamin D, vitamin B12, and folic acid. A recent study showed that up to 70 percent of Crohn’s patients suffer from low vitamin D levels, for example.
- If you know from experience that certain foods are likely to cause gas, put them on your “Foods to Avoid” list. Likely culprits include spicy foods, cabbage, broccoli, cauliflower, beans, and fruit juices. Citrus fruits may be especially problematic.
The Other End of the Spectrum
Low body weight is a common feature of Crohn’s disease and sufferers often struggle to maintain a healthy body weight. However, Crohn’s patients who are overweight and even obese are not uncommon. In fact, a recent study concluded that up to 16 percent of Crohn’s patients are obese and two percent are morbidly obese.
Being obese puts Crohn’s patients at increased risk for complications if they should need to undergo surgery to correct intestinal problems. Studies have shown that surgeries on obese patients took longer and they were more likely to heal poorly, compared to normal weight individuals. Surgical complications rose in tandem with rising body mass index (BMI) among study participants.
Furthermore, another recent study suggested that obesity itself may represent an independent risk factor for developing Crohn’s disease. In other words, people who were obese were more likely to be diagnosed with new Crohn’s disease than “control” subjects of a similar age or gender and a normal weight. Investigators speculated that obesity, which promotes an inflammatory state, may have played a role in triggering the intestinal inflammation associated with their diagnosis.
Enteral Nutrition Therapy
Doctors have numerous weapons in their arsenal to fight Crohn’s disease. Powerful drugs to decrease inflammation may allow some patients’ disease to go into remission. Examples include the aminosalicylates and corticosteroids. Others may benefit from drugs such as immunomodulators, antibiotics, or the newest class of drugs called biologic therapies.
Another approach is to induce remission of the disease using enteral nutrition. Enteral nutrition involves introducing a liquid nutrient formula directly into the stomach or intestines using a tube that is threaded through a nostril. Some studies have shown that patients respond as well to enteral nutrition therapy as they do to drug therapy with corticosteroids. This is especially true among children with Crohn’s.
One recent study found that exclusive enteral feeding induced remission in 80 percent of newly diagnosed children. Many were able to maintain remission of symptoms with no further treatment other than supplemental feedings with a liquid nutritional formula, taken by mouth. A recent French study showed that enteral feeding resulted in slightly bigger gains in body weight, but oral or enteral feeding was associated with significant remission of disease.