Crohn’s Disease Diets To Help During Flares – And After Them
Reviewed by Dr. Michael Ruscio — Written by Catherine Day
- Physical Effects|
- Symptoms|
- Diets|
- Low-Fiber vs. Low-Residue|
- Diet for Beginners|
- Living with Crohn’s|
Those who suffer from often-painful and debilitating Crohn’s disease flare-ups are faced with a huge Catch-22.
It’s crucial to stay nourished when you’re in the active stage of this form of inflammatory bowel disease (IBD). But that’s not easy as it sounds.
- Many foods which could provide key nutritional benefits can make the flare-ups even worse.
- The small intestine becomes inflamed during a flare, making it even harder for the body to absorb nutrients.
- The discomfort and pain – sometimes accompanied by nausea and vomiting – causes many sufferers to partly or completely lose their appetite. Doctors often speak of “food avoidance” by Crohn’s sufferers.
There’s another complicating factor as well: every Crohn’s disease patient reacts differently to different foods. Something that causes or worsens a flare for one person might be perfectly harmless for another.
All of those factors make a Crohn’s disease diet extremely challenging, and they make it impossible to formulate a “one-size-fits-all” eating plan for those suffering with the disease. There are, however, some diet guidelines which benefit most Crohn’s patients when they’re in a flare. It’s also possible to structure a diet which may help prevent flare-ups from occurring in the future.
We’ll examine both of those issues, after a closer look at the reasons why Crohn’s disease is so difficult to treat.
The Physical Effects of Crohn’s Disease
More than three million Americans suffer from inflammatory bowel disease, and the Crohn’s & Colitis Foundation says that almost one-quarter of them have Crohn’s Disease. [1]
Most of the others suffer from ulcerative colitis, which causes similar types of pain but only develops in the large intestine. Crohn’s disease, by contrast, can affect any part of the digestive tract, from the anus all the way up to the mouth, although it most often sets up shop in the lower part of the small intestine known as the ileum.
Crohn’s is an autoimmune disease, believed to be triggered when bacteria in the GI tract trigger the body’s immune system by mistake. The immune system then tries to “fight” the non-existent infection and ends up attacking the body’s healthy cells. That’s what causes the telltale gastrointestinal inflammation – and painful symptoms – of IBD.
There’s no known cause of Crohn’s disease. Genetics is usually a factor, since the disease often runs in families. It’s also believed that smoking, a high-fat diet and regular use of birth control pills and NSAIDs like ibuprofen may increase the risk of developing Crohn disease. [2]
More importantly, this is a chronic illness and there’s no known cure. Most of those who are diagnosed with Crohn’s disease will have to live with it for the rest of their lives, and it can worsen over time because long periods of inflammation may cause intestinal tract bleeding, blockages or abscesses. If the damage becomes too serious, surgery (usually small bowel or large bowel resection) may be required. Crohn’s also increases the risk of developing colon cancer.
There are two pieces of “good” news for Crohn’s disease patients, however.
First, a number of over-the-counter and prescription medications can help Crohn’s sufferers. Most are used to reduce inflammation caused by the disease, but some temporarily suppress the immune system (which is responsible for causing the inflammation).
The other “good” news is that Crohn’s disease symptoms are not constant. The pain and other symptoms come and go in episodic flare-ups (or flares, as they’re commonly known) which vary from patient to patient, and the periods of remission can be quite lengthy for some people.
What makes that “good” news? Flares are often brought on by certain trigger foods in the Crohn’s sufferers’ diets – so controlling what patients eat can have a massive impact on the frequency and severity of their flare-ups.
Symptoms of Crohn’s Disease
Patients are willing to go to great lengths, even adopting dietary measures they normally wouldn’t consider, to alleviate the difficult symptoms of Crohn’s.
The most common issues are abdominal cramping and pain, along with diarrhea and periodic bouts of nausea and vomiting. Weight loss often accompanies them; eating is the last thing you want to do when you’re suffering terrible stomach pain.
As mentioned earlier, Crohn’s disease isn’t necessarily experienced just in the intestine, but can extend throughout the digestive system. So the inflammation caused by the disease can also spread to other areas of the body, and a lack of sufficient nutrition due to the lack of appetite can have its own effects.
That’s why other symptoms or effects may include such varied medical problems as:
- Tiredness and fever
- Anemia
- Joint pain
- Red and sore eyes
- Skin ulcers and mouth ulcers
- Swelling or blistering (often on the legs)
Those issues can be made even worse by the stress that Crohn’s disease sufferers usually experience.
It’s easy to understand why nearly every sufferer adopts some form of a “Crohn’s disease diet” to mitigate their symptoms during flares. Here’s what it entails.
Diets for Crohn’s Patients Experiencing Flares
Medical professionals usually suggest either a low-fiber or a low-residue diet for their patients who are having a flare-up of their Crohn’s disease.
The two are similar but the low-residue approach is even stricter, and is almost always recommended for those who have had complications caused by narrowing or blockage of the intestine.
Low-Fiber Diet vs. Low-Residue Diet
Doctors, pharmacists, TV commercials and even your mother have all told you to get plenty of fiber into your diet. If asked, though, most people probably can’t fully explain what “fiber” is. Since it’s such an important aspect of a Crohn’s disease diet, here’s a quick explanation.
We often think of carbohydrates as nothing more than starches and sugars. The body quickly burns the starches and sugars for energy, or stores them as fat. However, most carbs also include fiber, which is plant-based material that the body can’t process as easily. Some fiber (called soluble fiber) requires plenty of time to digest, and some of it (called insoluble fiber) can’t be digested at all. [3]
Why is that important? Because the more quickly food moves through the digestive tract, the more it hurts the already-irritated areas – exactly what Crohn’s patients are trying to avoid.
The time it takes to digest soluble fiber delays the emptying of the stomach, slowing the digestive process and easing the diarrhea so prevalent during Crohn’s flares. On the other hand, insoluble fiber can’t be digested, so it pulls water into the digestive system to help it move right through. The water causes quick stomach emptying, which aggravates abdominal pain, bloating and gas and causes even more diarrhea.
So most low-fiber Crohn’s diets don’t really focus on all high-fiber foods; they restrict insoluble fiber, the real culprit.
A low-residue diet goes even further. It drastically limits meat and dairy products, because high-fat foods are hard to digest, and because they increase the amount of stool (the “residue”) the body produces. In short: the less stool, the less difficulty in passing it, and the less pain it produces.
One more thing. When deciding what to eat on a Crohn’s diet, it’s important to remember that a separate but major problem is not wanting to eat at all. That means nutrition suffers when it’s needed most. For that reason, foods which provide important nutrients are also key to a successful diet for Crohn’s sufferers.
Here’s what all of that means in specific terms.
Crohn’s Disease Diet for Beginners
Why beginners? Because, as we’ve mentioned, every Crohn’s patient reacts differently to different food triggers. The approach most likely to quickly alleviate pain and suffering during a disease flare is to start with a rigorous low-residue diet plan, and then add foods one-at-a-time to see if they cause problems.
- Fruit and vegetables: Sadly, most raw fruits and veggies contain lots of insoluble fiber, making them poor choices for a Crohn’s diet. Those with skin and peels pose the biggest problem, but even raw broccoli and cauliflower can cause issues. Well-steamed vegetables, peeled soft vegetables like cucumbers and squash, cooked fruits, and soft fruits like bananas and cantaloupe are the best choices. Definitely avoid choices like beans and cabbage, well known to cause flatulence which will make GI symptoms worse.
- Proteins: Some red meat is allowed on a low-fiber diet, but it’s best to start by eliminating red meat and even poultry’s dark meat completely. Stick with lean pork, white meat poultry, fish, eggs and tofu, and experiment if you’d like once you’re beginning to feel better. The fatty acids in some fishes like salmon have been shown to relieve inflammation, helping Crohn’s patients quite a bit.
- Carbs: Refined grains like white bread, white rice and white pastas that most diets warn against are best for Crohn’s patients, because their soluble fiber makes them slow to digest. Oatmeal and low-fiber packaged cereals are OK, too. Whole grains and nuts may be “healthier,” but they’re likely to cause a lot more pain. And sorry to include this part, but you know it’s coming: no ice cream, cookies, candy or cake, and no fried foods or fatty food. Avoid processed and junk food when possible, especially if it’s salty or made with saturated fats.
- Dairy products: Be careful. Some suggest avoiding dairy completely, not only because much of it is high-fat, difficult to digest and can aggravate diarrhea and abdominal pain, but because some of the issues attributed to Crohn’s disease may actually be due to being lactose intolerant; the two commonly occur together. If you do want to keep some dairy in your diet, low-fat milk options are best. Yogurt can actually help alleviate some Crohn’s symptoms because of its probiotic content, but look for lactose-free yogurt if possible.
It’s probably obvious, but you should avoid most “spicy” foods and spices. Green herbs or benign options like ginger and turmeric are much safer. A Crohn’s diet should be accompanied by lots of water or herbal tea (green tea is particularly helpful [4]). Other beverages (especially soda and alcohol) will probably make things worse.
Some doctors suggest taking an even tougher approach with an “exclusion diet” that completely eliminates some of those categories (like grains, sugars or fruits). Three which show promise in clinical trials are the Low-FODMAP diet, the Specific Carbohydrate Diet and the Autoimmune Paleo diet [5][6][7].
A couple of other tips:
- Eat a number of small meals instead of a few big ones each day; that helps keep the digestive system flowing as smoothly as possible without the added strain of a big meal.
- Nutritional supplements are often crucial when following a special diet for Crohn’s instead of a healthy, balanced diet. Supplements can supply the vitamin B-12, vitamin D, folic acid, and other nutrients you may not get from a limited diet, but are crucial for overall health and the prevention of digestive diseases. Your doctor or a registered dietitian can advise you on whether supplements are necessary.
Living with Crohn’s Disease
It’s easy to go crazy when a Crohn’s flare is over and you can eat virtually anything you want. The problem is that you may be eating foods that you’re sensitive to – and putting yourself in line for a new flare sooner rather than later.
The smart move is to keep a food diary, tracking which foods are more likely to either trigger a flare or worsen an existing one. As you start compiling that list, you’ll be creating a road map for living with Crohn’s disease over the long-term; understanding how your body reacts to specific foods will tell you which ones are safe to eat when you’re in remission – and which ones are an invitation to another round of pain and suffering.