15 Healthy-Eating Tips for Crohn's Disease
What, and how, to eat
Crohn's disease is a chronic, incurable inflammatory bowel disease (IBD). Symptoms include severe belly pain and diarrhea, among others.
Certain foods or eating habits can exacerbate Crohn's disease symptoms, although they aren't the underlying cause or trigger of the IBD, says Sunanda Kane, MD, professor of gastroenterology at the Mayo Clinic, in Rochester, Minn.
Each person is different, so you may need to use trial and error to see what types of food or eating habits help (or hurt) your symptoms.
Talk to a nutritionist
If you have Crohn's disease and are concerned about your nutrition, it would be a good idea to talk with an RD, especially one who is familiar with IBD, says Julie Cepo, a registered dietitian who works with IBD patients at Mount Sinai Hospital, in Toronto, and is coauthor of the Crohn's & Colitis Diet Guide (amazon.com).
"I help them come up with an eating strategy that they can tolerate but that also works with their personal and cultural preferences and food philosophies," Cepo says.
Seeing a nutritionist who doesn't understand IBD, on the other hand, may do more harm than good, warns Dr. Kane.
Write it down
"Also, I ask people not to introduce a lot of new foods too quickly," says Cepo. "Introduce them one at a time and wait a day or two to see if affects your symptoms."
It's not a bad idea to try new foods at home first, before eating them in a social situation.
Eat small, frequent meals
Small, frequent meals can help. You can still eat three meals a day, but make them a bit smaller than usual, and supplement them with several well-balanced snacks in between.
"You won't go into your next meal as hungry, and you'll be less likely to overeat, which may lead to bloating," says Cepo.
Go easy on the grease
So, people with Crohn's disease should stay away from greasy or deep-fried foods. Cream-based sauces, like mayonnaise or Alfredo sauce, can also be problematic.
Try a reduced-fiber diet
This diet reduces cramps, diarrhea, and the volume, consistency, and frequency of stool. You can still have soluble fiber. Fruits and vegetables aren't off limits eithercook them to cut their fiber, or remove the seeds, skins, and fibrous membranes.
Cepo recommends the diet only to manage symptoms in the short-term. If you're feeling better and your doctor says it's OK, go back to a healthier diet.
Be careful with dairy
For these people, dairy may explain some of the pain and GI problems associated with IBD.
"If you realize that dairy does affect you, it may not be a case of avoiding it completely, but it's a question of finding out how much you can tolerate," says Cepo. "Two pieces of pizza with cheese might be OK, but three might be too much."
"We call it roughage, and it's rough on your system," says Dr. Kane. "For a healthy intestine, that is a good thing, but for an inflamed one, it can be bad. Having to process things that are still intact will make some people really uncomfortable."
Dr. Kane suggests trying a "low-residue diet" that is low in fiber and other foods that are difficult to digest like raw fruit, vegetable peels, and seeds. "When you have active IBD symptoms, these foods are just going to make you feel lousy," she says.
Prep foods in a new way
Stringy foods like onions may be better tolerated if minced into very small pieces, just as seeds and nuts seem to cause fewer symptoms when they're ground. Chickpeas and sesame seeds, for example, may cause problems, but hummus, which is made with ground chickpeas, and tahini, a sesame-seed paste, may not.
Cepo cautions patients to limit beverages with caffeine, carbonation, or too much sugarall things that can make GI symptoms worse.
Water is a good choice, she says, as are diluted fruit juices without a high sugar content. For people who are very sick and at risk of becoming dehydrated, an over-the-counter rehydration fluid like Gatorade can replenish fluids and electrolytes.
Pump up your electrolytes
To get more potassium, eat potatoes (without skin), bananas, tomato juice or sauce, avocados, melon, or citrus fruits like grapefruit or orange (with the membrane removed, if needed). Coconut water is also a good source of potassium, and a good way to stay hydrated.
Don't skimp on protein
"People say to me, ‘I gave up red meat because I can't digest it,' but it's because they're trying to eat a normal American-size helping of steak or a giant burger," says Dr. Kane. "I tell them to eat 6 ounces of really good quality red meat; that way they'll get the iron and protein they need without overdoing it." Fish, tofu, beans, and eggs, if they're well tolerated, are also good protein sources.
Season with ground spices
Cepo recommends using flaked or chopped spices and herbs. "If you find you have any symptoms, hold back a little more the next time you use it."
Consider a liquid diet
A liquid diet can give the intestines a rest, which can help suppress symptoms. However, this diet should be carefully planned with your doctor to ensure you're getting all the right nutrients.
High-calorie liquid supplements, such as Ensure Plus or Boost Plus, can add nutrients and calories to any diet, as well, if you're not getting enough from food alone.
Supplement with vitamins
People who avoid dairy should also consider taking about 1,500 milligrams of calcium with 800 IU of vitamin D daily. Those who have had small-intestine surgery probably need extra vitamin B12, too.
Talk to your doctor before taking any supplement, and remember, supplements should do just that: supplement the nutrients you get from foods, rather than replace them.
Eat normally when you're well
"It can be hard for someone, knowing that the last time they ate celery they had a terrible experience, but it may be tolerated again when the disease is in remission," Cepo says. "Working with a dietitian or a doctor can help you build back up confidence and improve that relationship with food."
As long as you don't have any ongoing bowel issues or long-term narrowing of your intestine, following general healthy-eating guidelines is a good strategy, says Cepo.