If you have Crohn's disease, you probably have found that certain foods trigger your intestinal symptoms, especially when the disease flares. Learning to avoid these food triggers may allow you to better self-manage your Crohn's disease, reduce gastrointestinal symptoms, and promote intestinal healing.
What Is Crohn's Disease?
It’s one of the two main types of inflammatory bowel disease (IBD) along with ulcerative colitis. Both involve an immune reaction against the intestinal tract.
Crohn's often inflames the small intestine, which can cause diarrhea and belly pain. You may have less appetite, and the inflammation makes it harder for your body to absorb nutrients from the food you do eat.
Surgery for Crohn's that removes part of your intestines can add to the absorption problem.
It can be hard to get enough nutrition and maintain a healthy body weight with Crohn’s disease.
What Is a Crohn's Disease Diet Plan?
You've probably read about different types of diets for Crohn's disease. But the fact is, there is no scientifically proven diet for inflammatory bowel disease. Most experts believe, though, that some patients can identify specific foods that trigger their gastrointestinal symptoms, particularly during disease flares. By avoiding your "trigger foods," you may find that your GI symptoms of gas, bloating, abdominal pain, cramping, and diarrhea are more manageable. At the same time, you will give your inflamed intestines time to heal.
This is even more important when you have a flare-up of your Crohn’s symptoms. Spicy or greasy foods, whole grains, high-fiber fruits and vegetables, nuts and seeds, caffeine, and alcohol can all be harder on your body during a flare-up.
If you have had problems absorbing nutrients due to Crohn's disease, it's important to follow a high-calorie, high-protein diet, even when you don't feel like eating. In this setting, an effective Crohn's disease diet plan, based on recommendations from experts, would emphasize eating regular meals -- plus an additional two or three snacks -- each day. That will help ensure you get ample protein, calories, and nutrients. In addition, you will need to take any doctor-recommended vitamin and mineral supplements. By doing so, you will be able to replenish the necessary nutrients in your body.
Which Foods Should I Avoid With a Crohn's Disease Diet Plan?
The foods that trigger symptoms differ for each person with Crohn's disease. To know which foods to leave out of your diet plan, you'll need to determine which foods, if any, trigger yours. Many people with Crohn's disease find that one or more of the foods on the following list aggravate symptoms during disease flares. It's possible that at least some of these listed foods will trigger your symptoms:
- Alcohol (mixed drinks, beer, wine)
- Butter, mayonnaise, margarine, oils
- Carbonated beverages
- Coffee, tea, chocolate
- Dairy products (if lactose intolerant)
- Fatty foods (fried foods)
- Foods high in fiber
- Gas-producing foods (lentils, beans, legumes, cabbage, broccoli, onions)
- Nuts and seeds (peanut butter, other nut butters)
- Raw fruits
- Raw vegetables
- Red meat and pork
- Spicy foods
- Whole grains and bran
Once you've identified foods that cause your symptoms to flare, you can choose either to avoid them or to learn new ways of preparing them that will make them tolerable. To do that, you'll need to experiment with various foods and methods of preparation to see what works best for you. For instance, if certain raw vegetables trigger a flare, you don't necessarily need to give them up. You may find that steaming them, boiling them, or stewing will allow you to eat them without increased GI symptoms. If red meat increases fat in the stools, you could try eating ground sirloin or ground round to see if you can tolerate a leaner cut of beef. Or you might decide to rely on fish or low-fat poultry without skin as your main sources of protein.
Is a Low-Residue Diet a Crohn's Treatment Diet?
A low-residue diet is one that's low in specific foods that add residue to the stool. Many individuals with small-bowel Crohn's disease have a narrowing or stricture of the lower small intestine (the ileum). For them, a low-fiber with low-residue diet can help lessen abdominal pain, cramping, and diarrhea. And while scientific proof is lacking, this diet may also help decrease frequency of bowel movements for some people. Foods to avoid on a low-residue diet may include:
- Corn hulls
- Raw fruits
- Raw vegetables
What’s the Role of Fiber in Crohn’s?
Dietary fiber is important for your overall health. It can help you keep your cholesterol, blood pressure, and weight at healthy levels. And getting about 23 grams of fiber a day can cut your risk of a Crohn’s flare by as much as 40%. But while you’re having a flare, high-fiber foods can aggravate your symptoms.
The best fiber choices when you have Crohn’s are foods that contain soluble fiber. Soluble fiber soaks up extra fluid in your gut. Foods rich in soluble fiber can help you slow down your digestion and ease diarrhea. The other kind of fiber, insoluble fiber, can boost the amount of water in your gut. You’ll digest foods quickly. That can lead to watery diarrhea, stomach cramps, or gas. At worst, too much insoluble fiber can cause a blockage.
Foods that come from plants are the best source of fiber. This includes fruits, vegetables, grains, beans, and nuts. Most plant-based foods contain both soluble and insoluble fiber. Remove peels, skin, and seeds of fruits or veggies to cut down on insoluble fiber. And check labels for added fiber in foods you wouldn’t expect, like dairy products.
During times when you don’t have active Crohn’s symptoms, choose whole grains and a variety of fresh fruits and vegetables.
Can Keeping a Daily Food Diary Help Me Manage My Crohn's Disease?
Yes. Keeping track of the foods you eat each day can help you identify the "offenders" -- foods that may trigger symptoms. Avoiding these foods, especially when your disease is active, may give you better control of the symptoms.
You can also use a daily food diary to help you and your doctor determine if you're getting a properly balanced diet. It can show whether you are getting enough protein, carbohydrates, fats, and water. It can also show whether you are getting enough calories to maintain your weight and energy.
To start your diary, record the foods you eat each day and the serving sizes in a small notebook. Enter the date, food, and any symptoms you might feel after eating this food in the notebook.
After a month or two, set up a time to review your food diary with a registered dietitian. The dietitian can determine if you're getting essential nutrients in a well-balanced meal plan or if you might need supplements. Proper nutrition helps the body heal itself and keeps you well. So having a nutrition discussion with a registered dietitian is important to your overall health and to the management of Crohn's disease.
What Else Is Important in a Crohn's Disease Diet Plan?
Limiting some food triggers may help control your symptoms during disease flares. But don't restrict yourself so much that you make malnutrition, which often accompanies Crohn's disease, worse. You'll need to find other sources to replace calories, protein, carbohydrates, and fats that are in the foods you eliminate. To do that, you'll need to focus on adding nutrient-dense foods in your diet plan.
While fast foods should normally be avoided in a healthy diet plan, sometimes they can give your diet a needed boost when used sparingly. Some fast foods can offer a valuable supply of key nutrients and calories. For instance, pizza offers calories, protein, and nutrients such as calcium and vitamins A, B, C, and D. A milkshake is high in calories and calcium. Of course, if you are lactose-intolerant, you need to remember to take the proper medication before drinking a milk product.
Ask your doctor or dietitian about vitamin and mineral supplementation. For example, many people with Crohn's disease have a vitamin D deficiency. A study published in the American Journal of Preventive Medicine reported that higher doses of vitamin D (1,000 to 2,000 IU each day) may be good for you, particularly in reducing the risk of colorectal cancer, which may be higher in people with IBD. The National Academy of Sciences has established that a dose of 2,000 IU/day of vitamin D is safe. But it's still important that you check with your doctor to see what dosage is ideal for you.
Can a Liquid Diet Help Me Control Crohn's Disease Symptoms?
Some research suggests that liquid diets might help people with certain health conditions, and there is evidence that some people with Crohn's disease may benefit from a high-calorie liquid diet, particularly during a flare. By giving the intestines a much-needed rest, the liquid diet can help suppress symptoms of Crohn's disease. In addition, the liquid diet or special high-calorie liquid formulas can help people with Crohn's who need extra nutrition short-term or those whose intestines cannot absorb proper nutrition from whole foods.
Your doctor may recommend one of two forms of nutritional support:
- Enteral nutrition: You may drink liquid supplements such as Ensure Plus or Boost Plus either in addition to or instead of regular food. Liquid supplements can also be delivered through a feeding tube. Enteral nutrition is often helpful for children who may have stalled growth or late puberty because of Crohn's.
- Parenteral nutrition: If you have a severe flare, are very malnourished, or have lost much of your small intestine to surgery, your doctor may recommend bypassing your gut entirely. Liquid nutrients pass through a tube, or catheter, directly into your bloodstream. This gives your intestines a break, which can help ease symptoms. Your doctor might call it bowel rest.
Are There Benefits to Gain From Omega-3 Fatty Acids and Probiotics?
Numerous studies using fish oil and flaxseed oil suggest an important role for good fats in the inflammation that happens with IBD. The studies, though, are inconsistent on whether or not omega-3 fatty acids have a specific anti-inflammatory effect with IBD. If you want to add omega-3 fatty acid supplements to your diet, talk with your doctor first.
Other studies are just beginning to examine whether probiotics or "good" bacteria may be beneficial in Crohn's disease and ulcerative colitis. More studies are needed, though, to determine if these supplements can aid in healing the intestine in IBD.