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Meal Planning for Crohn’s Disease

Reviewed by Neha Pathak, MD on October 20, 2020

By Kalee Eichelberger, as told to Stephanie Watson

At one point in my life, I wanted to go to medical school and become a doctor. But because of my struggle with Crohn's disease, I changed career paths entirely. The challenge of adjusting my diet to my disease led me to become a dietitian.

My health issues started early. I had health issues all through middle school and high school -- GI symptoms like abdominal pain, loose stools, nausea, and vomiting.

It took a little bit of time to put the pieces together and get diagnosed. I finally learned that I had Crohn's disease in 2012, when I was 17 years old.

The next challenge was finding a treatment that worked for me. My insurance company made me go through step therapy, where I had to try cheaper medications and fail on them before getting to try more expensive ones. Eventually I started on a biologic drug, which suppresses the part of my immune system that is triggering inflammatory bowel disease (IBD) symptoms. That has worked for me.

Underweight and Malnourished

Early in my disease, I had a very hard time maintaining my nutritional status. The combination of symptoms like abdominal pain, nausea, and vomiting made it difficult to eat and keep food in me. And really, who wants to eat when it triggers pain and discomfort?

On top of that, my GI tract was so inflamed that it wasn't properly absorbing nutrients. As a result, I was very underweight. I just couldn't keep the weight on.

It was really challenging for me to find foods and a diet plan that worked for me and didn't aggravate my symptoms. After what felt like endless attempts at changing my diet, I ended up so malnourished that I needed a feeding tube for a couple of years, plus a central line for IV fluids so I wouldn't get dehydrated.

For a while I was being fed solely through a tube to give my inflamed GI tract a rest. But I was gradually able to wean myself off of it.

My saving grace was getting connected to a phenomenal dietitian who showed me the link between medicine and nutrition and helped me create a diet plan that worked for me and my disease. When I realized what an asset a dietitian can be to people with IBD, I decided to go back to school and get a second degree in dietetics.

Fine-Tuning My Diet

My dietitian had me walk through my diet in very specific detail, asking me to record a food log of what I ate and how I felt throughout the day. He helped me figure out which foods were triggering my symptoms and helped me pinpoint my specific nutritional needs.

Through the process of trial and error, I learned which foods weren't working for me. One was high-fiber foods. Certain whole grains, nuts, and tough-to-chew fruits and vegetables with intact skins and seeds give me cramping and upset stomach. The lactose in dairy foods is also a problem for me, leaving me feeling bloated and uncomfortable.

I don't necessarily have to cut these foods entirely, but I do have to be more careful with them. I can have dairy and some fiber, as long as I watch the quantity. It's all about eating these foods in moderation and being aware of what else I'm eating throughout the day.

My Life With Crohn’s DiseaseJoe Cobucci has had an ebb and flow to his decades-long relationship with Crohn’s disease. Learn more about his journey and what he’s found works for him.212

[MUSIC PLAYING]



JOE COBUCCI: Through my journey,

it's been an ebb and flow.

There's been sniffing

about a time

where I have been really healthy

and my disease has been

in check, but then there's been

times where it has come back.

I was in my early teens

and was having a lot of bathroom

issues, urgency issues out

of nowhere, and it was very

frightening, because I wasn't

telling my parents,

because it was very

embarrassing.

Especially hanging around

with your friends, and all

of a sudden, you just

go to the bathroom

for no reason.



[MUSIC PLAYING]

Having

those additional challenges

were really isolating for me.

I limited myself

from many things.

When asked to do certain things,

I was very conscious of choosing

what I was going to do,

because I wanted to make sure

that I knew I could get

to the bathroom if I needed to.



[BIRDS CHIRPING]



Going to the doctor really

opened up my eyes

to that someone's

going to listen to me.

So when I was first diagnosed,

they called it ileitis,

but during that time frame,

things got better.

I was feeling good,

and it wasn't much of an issue.

And then later teens is when it

really came back at me

and really flared up,

and at point is when we got

the full diagnosis of Crohn's

disease.



I started off with a variety

of medications that were

available at the time,

and honestly, they had seemed

to work, and it changed

my attitude.

I felt uplifted.

I felt like there was now

something I could take,

a diagnosis.

I could feel normal,

and it was kind of allowing me

to be open to doing things.



[MUSIC PLAYING]



At one point in my younger life,

I thought, you know, it wasn't

possible to have

a full-time job.

It wasn't possible to travel

to Europe.

It wasn't possible to have

a family.

All of those things

are possible.

I don't want Crohn's disease

to limit myself,

and I don't want to limit all

the patients.

You can have a vibrant life.



One of the things that I've

learned is the medication

is a important part

of my disease journey,

but also trying to alleviate

stress, adding exercise, having

the right amount of sleep.

At this current stage,

I'm taking

an injectable medication that

is really helping me

to flourish.

So along with my physician

and dietitian,

we've found a pathway that's

best for me.

So I try to eat lean meats.

I try to eat vegetables.

Sometimes it's just having rice,

just kind of bland foods.

The main thing that I've done

over the years have tried

to avoid are really raw foods.

They really are not my friend.



This is a lifelong journey.

Sometimes it is challenging,

and I try to be

a positive and resilient person.

It's OK having Crohn's disease

and feeling isolated and having

fear and worry.

But taking control

of your disease,

find the right physician,

and finding a community

is helpful to be able to say,

you know, I want to do that.

I'm going to do that.



I've been

fortunate over the many years

to have run over 60-plus half

marathons and seven marathons.

So I will say for all

the patients that are out there

that suffer with Crohn's

disease,

you know, it's like one

foot in front of the other,

and before you know it,

you're out there,

and you're doing something you

may never have done.

Whatever makes you happy,

but I found a lot of strength

in running.

I'd have not let things slow me

down.

Joe Cobucci/delivery/aws/b8/7d/b87d0106-f455-4fe0-9b45-e8ff3542d1b3/9795647f-a39d-432c-9057-07df6ab2857a_patient-perspective-crohns-joe-2021-update_,4500k,2500k,1000k,750k,400k,.mp412/05/2020 12:00:0018001200photo of patient perspective crohns joe video/webmd/consumer_assets/site_images/article_thumbnails/video/patient_perspective_crohns_joe_video/1800x1200_patient_perspective_crohns_joe_video.jpg091e9c5e8209445e

I've had to take supplements to fill in the nutritional gaps from cutting these foods from my diet and from my other disease-induced vitamin deficiencies. For example, I wasn’t getting enough vitamin D  when I cut back on dairy foods, so my gastroenterologist suggested I take a calcium/vitamin D supplement.

Continued

Overall, I still eat a pretty well-rounded diet, although it's relatively bland. I avoid spicy and acidic foods because they can trigger my GI symptoms. If I eat any meat, it's typically lean -- nothing too fatty. And I don't eat a whole lot of fried or processed foods.

When I do have fruits and vegetables I steam or boil them, rather than eating them raw. They're easier to digest that way. And I avoid pulpy or seedy fruits.

What I've Learned

Living with Crohn's disease has given me a lot of empathy toward the people I work with. Eating is such a social component of everyday life, and it can become so stressful when you have IBD as there is no one-size-fits-all approach. Diet is very individualistic. I try to be patient as we work to find the diet that's right for them.

Continued

Having been on the receiving end of a feeding tube, I understand what a challenge it is to maintain nutritional status and what a big task it is to need nutritional support. I remember how much my dietitian at the time empowered me to take control over my health and nutrition. If I could be that advocate for just one of my patients, I can honestly say that I’m grateful for my IBD and for the journey it has  brought me on.

Continued

Thankfully, I'm in remission today. I feel very healthy. I'm really empowered by what I've learned throughout the years, both from working with a dietitian and being a dietitian.

It was a journey to get to where I am today, and I hope that more people can get to the same point. I've learned how important it is to do your research as someone with Crohn's disease. There's so much conflicting information on the internet about IBD and diet.

It's always important to work with trained specialists like a gastroenterologist and dietitian. Rely on the them, but don't be afraid to advocate for yourself. No one knows your body better than you do.

WebMD Feature

Sources

SOURCE:

Kalee Eichelberger, RD, LDN, Orlando Regional Medical Center.

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