Maintaining a healthy body weight can be a challenge when you have Crohn’s disease.
Although food doesn’t cause the inflammation and tissue damage at the root of Crohn’s disease, people associate eating with flare-ups and often avoid food to prevent further discomfort.
Skipping meals may provide some relief, but the need for nourishment, especially adequate calories, can’t be ignored. Malnutrition and unexplained weight loss are very common in many people with Crohn’s.
For these and other reasons, you should always try to work with a dietitian to create 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 experiencing any nutritional deficiencies.
Every person’s needs are different, which is why it’s important to work closely with your healthcare team to create an individualized dietary plan.
When you’re living with Crohn’s, weight loss is common. There are many factors that can cause weight loss. Finding out why is key to finding a solution.
Once you determine why you’re losing weight, chances are good that your healthcare provider or dietitian will be able to assist you in making changes to help keep your weight at a healthy level.
Read on to see if any of these factors may be contributing to your weight loss.
You may also lose weight because your body doesn’t properly absorb nutrients like proteins, fats, sugars, vitamins, and minerals. This is called malabsorption.
In a person with Crohn’s, malabsorption is usually caused by inflammation in the small intestine, according to the Crohn’s and Colitis Foundation.
The degree of malabsorption depends on how many sections of your small intestine are inflamed or have been surgically removed and how large those sections are.
Lower food intake
Lower food intake is a leading cause of weight loss in people with Crohn’s. Loss of appetite, which can stem from Crohn’s symptoms such as stomach aches, bloating, and nausea, is often the reason for eating less.
These symptoms can make it difficult to eat enough food to get sufficient calories and nutrition, especially when you’re tempted to eat less, or not eat at all, to avoid discomfort and flare-ups.
Increased use of energy stores
Even with sufficient caloric intake, weight loss can happen because of the inflammatory process in Crohn’s disease.
Inflammation can lead to increased consumption of the body’s stored energy and a breakdown of body tissues, both of which can lead to weight loss.
Some Crohn’s symptoms, such as diarrhea, vomiting, and intestinal bleeding, can divert nutrients from the body.
If these nutrients are not replenished by sufficient food intake, nutrient loss can be a cause of weight loss over time.
Side effects of some medications prescribed to treat Crohn’s include diarrhea and vomiting. If these side effects become frequent, they can lead to weight loss over time.
This is especially possible with medications in the aminosalicylates and immunomodulators categories.
You may require extra calories in your diet to counteract the body’s malabsorption or loss of nutrients.
You may need to lessen or even eliminate specific components from your diet that may trigger flare-ups. These might include:
- excess fiber
Be sure to consider any changes or restrictions you make in your diet with your dietitian to make sure you get sufficient nutrition.
Sometimes, people with Crohn’s try to eat too restrictive a diet, which can lead to weight loss and malnutrition.
Poor appetite has long been associated with Crohn’s disease. But once you and your healthcare team discover what’s causing your diminished appetite, much can be done to jump-start it again.
Read on to see what may be causing your low appetite.
People with Crohn’s disease sometimes experience decreased appetite when flare-ups produce symptoms of nausea, bloating, abdominal pain, and diarrhea. Symptoms like these can make you feel less like eating.
Overly restrictive diet
Also, some people with Crohn’s wind up with too limited a diet by attempting to avoid foods that trigger symptoms.
Restricting a diet too much can lead to making eating itself seem like a chore, and appetite dwindles.
Appetite loss may also stem from a hormone imbalance in people with Crohn’s, according to a clinical trial published in the U.S. National Library of Medicine.
This imbalance is thought to involve the enteroendocrine (EEC) cells in the bowel, which act as sensors to relay nutrient information to the brain, which then determines appetite.
People with active Crohn’s disease have an increased number of EEC cells, and more cells means more hormones are released.
Though more information is needed to understand exactly how the process works, research shows that this may increase the gut signals to the brain to decrease appetite.
Mental health conditions
Some mental health conditions such as depression, anxiety, and stress can also decrease appetite. These conditions are more common among those with Crohn’s and inflammatory bowel diseases (IBD) than in the general population.
Be sure to contact your healthcare provider if you think your loss of appetite may be related to an emotional or mental health condition.
Choosing the right foods to maintain a healthy weight can seem like walking a tightrope. Having Crohn’s often means you don’t want to eat foods that trigger symptoms, but on the other hand, you don’t want to risk malnutrition.
Together with your healthcare team, you can develop a plan for you to achieve and maintain a healthy weight. Strategies vary, and there are many tools you can use.
Keep a food journal
Probably the first suggestion will be for you to keep a food journal. Here’s where you record what you eat and any symptoms you experience. It lets you and your dietitian see over time what works and what doesn’t.
Your dietitian can help you use your journal to develop an optimal diet that may alleviate symptoms, help you maintain a healthy body weight, and help prolong disease remission.
Consider the variables
There is no one-size-fits-all diet for Crohn’s. You should consider many variables when developing a diet plan.
For example, you’ll want to take into consideration your current symptoms and whether you’re in the midst of a flare or a remission.
The location of your Crohn’s, whether or not you have strictures, and any prior surgeries are all important, too.
Also, you may want to be tested for nutritional deficiencies and take steps to remedy these, if any, in your diet plan.
Develop your optimal diet plan
Talk to your doctor if you’re concerned about your weight or if you feel like your diet is too limited. They can recommend a nutritionist who will help you create a personalized diet plan.
Here are some general guidelines for an optimal diet plan:
- Drink plenty of water throughout the day (in relatively small portions).
- Eat small portions regularly throughout the day.
- Minimize or eliminate 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.
- People who are lactose intolerant should avoid dairy or choose products that have relatively little lactose, such as hard cheeses.
- Take supplements your healthcare provider recommends to store up key nutrients, such as calcium, vitamin D, vitamin B12, and folic acid.
- 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.
Consider enteral nutrition therapy
One approach your healthcare provider may recommend for treating Crohn’s disease, which may help restore your weight as well, is enteral nutrition.
This involves introducing a liquid nutrient formula directly into the stomach or intestines using a tube that’s threaded through a nostril.
There are other routes of ingestion including a surgically placed gastrostomy tube that enters directly into the stomach or a jejunostomy tube that enters directly into the stomach and then into the intestines.
Medications may help
Doctors have numerous weapons in their arsenal to fight Crohn’s disease that may help you achieve and remain at a healthy weight.
Powerful drugs to decrease inflammation may allow some people to go into remission. Examples include aminosalicylates and corticosteroids.
Others may benefit from drugs such as immunomodulators, antibiotics, or the newest class of drugs called biologic therapies.
Weight loss is common among people with Crohn’s from the time of diagnosis through the course of the disease.
According to a study in the journal Gastroenterology Study and Practice,
Weight loss often continues with active Crohn’s. You might find yourself facing the challenge of maintaining a healthy weight in the midst of symptoms like:
- poor appetite
- food intolerances
- nutrient loss through diarrhea or bleeding
- nausea and abdominal pain
One recent review of research shows that between 75 and 85 percent of people with Crohn’s experience significant weight loss, especially during the condition’s active phases.
Weight loss in Crohn’s is often accompanied by malnutrition, especially in children, according to guidelines from the European Society for Clinical Nutrition and Metabolism. This has been known to delay growth and the onset of puberty.
Can you be overweight with Crohn’s?
Low body weight is a common feature of Crohn’s disease, and people with the condition often struggle to maintain a healthy body weight.
However, research shows that there are also many people with Crohn’s disease who are overweight or have obesity.
People with Crohn’s are not necessarily excluded from the increase in the number of people who have obesity in the United States.
One research review found that about 72 percent of people with IBD were overweight and approximately 32 percent had obesity. Crohn’s figures were slightly less, with 63 percent being overweight, and 27 percent having obesity.
The study points out that previously held beliefs about people with IBD being underweight may no longer be accurate.
People with Crohn’s may now be overweight, underweight, or at their healthy weight, which makes diagnosis and treatment more complex.
Even if you’re overweight or have obesity, you can still experience malnutrition associated with significant weight loss. This is why healthcare providers generally advise seeing your medical team about any significant or continual weight loss.
When you’re dealing with an unpredictable and fluctuating condition like Crohn’s, your healthcare team can serve as a stable anchor.
You’ll want to stay in close touch with them and never hesitate to reach out if symptoms are worrisome or you need advice.
Read on to find out when during the course of your Crohn’s you’ll want to contact a healthcare provider.
If you think you have symptoms of Crohn’s disease, it’s important that you see a doctor as soon as possible for a diagnosis and treatment plan.
There’s no single test for Crohn’s. Your healthcare provider will probably diagnose Crohn’s only after ruling out other possible causes for your symptoms.
Your diagnosis of Crohn’s will probably involve a general physical, plus some of the following tests:
- blood tests
- imaging scans, such as MRIs and CT scans
- scoping procedures, such as endoscopy and colonoscopy
Sudden or severe symptoms
During the course of your Crohn’s diagnosis, sudden or severe symptoms may arise that you don’t think are emergencies, but you’re concerned. A phone call or email to your healthcare team will probably be sufficient.
These types of symptoms, especially if sudden or severe, might include:
- body rash
- reaction to medication
Then there are medical emergencies when you should contact your doctor immediately or go to an emergency treatment center. Symptoms might include:
- high temperature
- severe pain in your abdomen (lasting more than 1 hour)
- rectal bleeding, either significant or new
- persistent vomiting (especially with stoppage of bowel movements)
- significant changes in bowel movements (especially without any passing of gas)
Maintaining a healthy weight with Crohn’s can be challenging. Whether you’re underweight, at your healthy weight, or overweight, any sudden, significant, or sustained unexplained weight loss is a signal to contact your healthcare provider.
Medical professionals and dietitians are your allies in developing treatment and dietary plans to help you achieve and maintain a healthy weight. There are a wide variety of treatments and eating plans to try.
You can also eat different foods at different times.
During a flare-up, you might not be able to eat everything you know you should. But there may be good substitute foods to eat at the time, like a nutritional drink. Check with your healthcare provider about your options.
It’s important to keep the big picture in view when living with Crohn’s. You know the flare-up you’re experiencing will subside, and you’ll be able to eat regularly again. You know there are many options to try to treat your symptoms.