What is the connection between diet and Crohn’s disease?
There is no cure for Crohn’s disease. However, medical treatments and diet changes can help you achieve remission.
Crohn’s is an autoimmune disorder that causes inflammation that damages the digestive tract. There appears to be a genetic component to Crohn’s disease. This means that people with a family history are more likely to develop it. It’s unclear why the body attacks its own tissues.
What is known is that Crohn’s disease is a complex disease with many factors that may lead to onset and flare-ups. These factors include changes in gut bacteria, Western-style diets high in sugar and fat but low in fruits and vegetables, genetics, illness, and environmental triggers.
What is the low-residue diet?
Residue refers to material left in your digestive tract after the initial stages of digestion are finished. These materials often contain a lot of fiber because the body can’t fully digest fiber. A low-residue diet is meant 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 can stimulate bowel contractions.
A low-residue diet increases the time food spends traveling through the digestive tract. A slower digestion process decreases the amount of stool your body produces. This is believed to increase the chance that your body will absorb nutrients. It also may reduce the incidence of diarrhea.
How does the low-residue diet work?
The low-residue diet has you consume no more than 10 to 15 grams of fiber every day. People without inflammatory bowel disease should ideally consume about 25 to 38 grams of fiber daily. You should also avoid dairy products and certain types of carbohydrates. They may provoke abdominal cramping and diarrhea.
A doctor or dietitian should supervise you if you decide to follow a low-residue diet. People who follow this diet for too long may develop vitamin C and folic acid deficiencies. It can also change the gut bacteria. The amounts and types of food, as well as how long you follow the diet, should be dictated by your individual needs.
Which foods should I eat?
There are guidelines for a low-residue diet. They can be changed based on how your body reacts to the diet.
|• refined carbohydrates including white bread, white rice, pasta, and refined cereal (such as Corn Flakes, Rice Krispies, and Cream of Wheat)||• legumes, nuts, and seeds|
|• clear juices||• most raw fruits and vegetables|
|• clear broth and strained soups||• popcorn|
|• raw lettuce, cucumber, onion, and zucchini||• unprocessed coconut|
|• well-cooked or canned vegetables, no skins or seeds, including yellow squash, spinach, pumpkin, eggplant, green beans, asparagus, beets, carrots, and potatoes||• most whole grains, including breads or pastas|
|• some raw fruits, including ripe apricots, bananas, cantaloupe, honeydew melon, watermelon, nectarines, papayas, peaches, and plums||• dried fruits|
|• limited cooked fruits as long as they have no seeds or skins||• figs, prunes, berries|
|• finely ground, well-cooked meat||• deli meats|
|• fish, eggs, and poultry||• spicy foods and dressings|
|• butter, vegetable oils, margarine||• caffeine|
|• up to 2 cups per day of "smooth milk products," such as yogurt, cottage cheese, and ricotta cheese||• prune juice or juice with pulp|
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:
It may be necessary to drink additional fluids, especially water, to avoid constipation when reducing the volume of your stools with a low-residue diet. After you’ve been in remission for a good amount of time, your doctor may suggest gradually reintroducing higher fiber foods into your diet.
Does research support low-residue diets?
There is not a lot of recent research to support using a solid low-residue diet. There is more evidence to support using a short-term liquid, semi-elemental, and low-residue diet to manage symptoms of Crohn’s disease. This diet consists only of nutritional shakes you can get from your doctor. Some doctors may recommend a solid low-residue diet to help manage acute symptoms.
A semi-elemental diet can effectively:
- improve absorption of nutrients
- increase weight and growth in malnourished children
- induce remission of symptoms
This diet can also function as an elimination diet. After you have been on the semi-elemental diet for a while, you may try slowly reintroducing foods. This will help you identify and exclude problematic foods. The LOFFLEX diet, or low fat/fiber limited exclusion diet, is similar and may also be recommended by your doctor.
Crohn’s is a condition that affects everyone differently. This makes it difficult to prescribe one type of diet plan. In fact, your symptoms may vary over time. However, there is a significant amount of gut bacteria research that supports a high-fiber, plant-based diet for the prevention of inflammatory bowel disease and other digestive conditions.
Things to keep in mind
Fruits, vegetables, grains, and legumes supply important antioxidants, phytonutrients, vitamins, minerals, and other nutrients. Try to consume a balanced diet, as the low-residue diet may not provide enough vitamin C, folic acid, calcium, or antioxidants, or nutrients for gut bacteria, for example. All of these nutrients are essential for good health. Supplements may be necessary to correct dietary deficiencies.
Multiple diets are being studied for their potential benefit for inflammatory bowel diseases. These include the low-FODMAP diet, plant-based diets, exclusion diets, and the LOFFLEX diet. Doctors don’t recommend any one diet for everyone with Crohn’s disease because the condition affects everyone differently. Consider consulting with a dietitian if you have any questions or concerns, or to help you individualize your nutrition approach.