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.
In ulcerative colitis, the colon is inflamed and the small intestine works normally. With Crohn’s disease, often the small intestine is inflamed, making it hard to digest and absorb key nutrients from food. The lack of sufficient nutrients, along with a poor appetite, can lead to malnutrition for people with Crohn’s disease. That malnutrition may result from alterations in taste, reduced food or nutrient intake, lack of sufficient nutrients, poor absorption, or the inflammatory bowel disease process itself.
When Crohn’s disease affects just the small intestine, it results in diarrhea and undernourishment. When the large intestine is also inflamed, diarrhea can be severe. Severe diarrhea combined with malnutrition often leads to problems. For example, a person with Crohn’s disease may suffer from anemia and have low levels of vitamin B12, folic acid, or iron.
Nutritional deficiencies and an inability to maintain a normal weight are serious problems for many people, even children, with Crohn’s disease.
What is Crohn’s disease diet plan?
You’ve probably read about different types of diets for Crohn’s disease on the Internet. 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.
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 butter)
- 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 low-fat poultry without skin and fish 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 a low-residue diet can help lessen abdominal pain, cramping, and diarrhea. And while scientific proof is lacking, this diet may also help decrease the frequency of bowel movements for some people. Foods to avoid on a low-residue diet may include:
- corn hulls
- raw fruits
Can keeping a daily food diary help me self-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 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 including 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 beneficial, particularly in reducing the risk of colorectal cancer, which may be higher in individuals 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 personal physician to see what dosage is ideal for your situation.
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. Some people with Crohn’s disease enjoy supplements such as Ensure Plus or Boost Plus when they need a boost in calories and nutrients.
Are there benefits to gain from omega-3 fatty acids and probiotics in relation to Crohn’s disease?
Numerous studies using fish oil and flaxseed oil suggest an important role for good fats in the inflammatory response that characterizes 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 the possibility that 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.
Get Your Gut Back On Track!
An estimated 110,000 people consume antibiotics daily in Ireland, between December/March. (Source: Health Protection Surveillance Centre).
We asked Nutritional Therapist Rosanna Davison for her Top Tips to get your gut back on track after an illness.
1. Take time out
Don’t push yourself too quickly. Remember your body needs time to rebuild its reserves and regain strength.
Take more rest than usual. If you need to sleep longer, go to bed earlier.
Cut back on non-essential activities; they can wait until you are feeling 100%.
- Embrace fibre-rich foods full of protective nutrients
Fresh vegetables and fruits are rich in dietary fibre, vitamins and antioxidants. Try eating seven to nine portions over the course of each day. Choose different colours so that you nourish your body with a variety of phytonutrients.
Eat a portion of complete protein at each meal, such as poultry, fish, eggs, beans, pulses or tofu.
Consume essential omega-3 fatty acids daily. Avocados, seeds (flax, chia) and oily fish (mackerel, wild and organic salmon), are naturally rich in anti-inflammatory fats.
- Go ‘fermented’
Fermented foods are rich in ‘friendly’ bacteria. Sauerkraut is simple to make at home or buy kefir or kimchi in your local health store.
- Reduce or eliminate sugary foods
Processed foods often contain refined sugars to enhance taste. Excess refined sugar and processed foods may encourage the growth of ‘unfriendly’ bacteria, so aim to buy and eat fresh food.
If you have a sweet tooth, try eating berries (strawberries, blackberries, blueberries, raspberries). They are rich in antioxidants and naturally low in sugar.
If you need a sweetener, try Stevia which is extracted from plant leaves and doesn’t impact blood sugar levels.
Do vegans need to take supplements?
A varied, wholesome vegan diet provides almost all essential nutrients in sufficient quantities. I hear you shouting ‘Noooo! It provides absolutely everything we need!’ and you may be right, but only if you regularly eat certain fortified foods. The sad truth is that modern food production systems and lifestyles make it more difficult for everyone – vegans or not – to get all they need from diet alone. It doesn’t mean a vegan diet is unnatural or unhealthy, in fact the opposite is true. It means that how we grow, produce and consume food has changed and, with an ever-growing population, the demands on the systems that produce our food are so high that certain nutrients become harder to obtain.
I get a lot of questions about supplements and understand why people are confused. Over the years, I’ve worked on many vegan research projects and as science and population studies reveal ever more data, the guidelines and recommendations change and evolve. Hence, what we were told 10 years ago may no longer be up-to-date and that’s why different opinions arise, depending on where and when we got our information. It’s my job to keep up-to-date, so hopefully I can bring some clarity to the supplement discussion!
So what’s needed? The trio of nutrients to keep a close eye on are vitamin B12, vitamin D and iodine. You may not need to supplement with all these, all year long, but it depends on several factors. Read on…
Vitamin B12 naturally comes from bacteria in the soil and both people and animals would traditionally have got it from eating unwashed plants. However, we not only wash vegetables before we eat them (and for good reasons), but food production is now so sanitised that most vegetables are washed in chlorine, or other sterilising solutions, so there’s not a trace of B12 left.
People are not generally aware that most farmed animals are given B12 supplements and this is how the vitamin eventually ends up in their flesh. So, the argument that meat is a natural source of B12 doesn’t really stack up as meat-eaters essentially consume B12 supplements recycled by the animals that were given them!
It is absolutely necessary that we have a reliable source of vitamin B12 for our bodies. We need it to make red blood cells, for a healthy heart and circulation, and it’s essential for the nervous system. It takes years to develop a B12 deficiency, so on one hand, you don’t need to worry about not having taken B12 for a while. On the other hand, you do need to pay attention, as when symptoms develop, it’s usually serious.
To ensure adequate intake, you should have at least 5µg (micrograms) daily from supplements or fortified foods. The B12 used in both foods and supplements is produced commercially by growing bacterial cultures in large vats – and it’s always suitable for vegans.
There are two forms of B12 in supplements – cyanocobalamin (cheap) and methylcobalamin (expensive). Cyanocobalamin is the stable ‘inactive,’ form of B12 and is used in supplements and to fortify foods and drinks. Once ingested, it’s activated by your body so it can be used. Methylcobalamin is the ‘active’ form of vitamin B12 as it does not require any metabolic reactions to be activated. It costs more and is not so stable.
So which one to choose? Unless you’re a heavy smoker, have kidney failure or any other serious condition affecting your metabolism, cyanocobalamin – the cheap form of B12 – is perfectly fine. Intakes up to 2,000µg a day are safe and you can take either a lower dose daily or a higher dose a couple of times a week.
We need vitamin D for healthy bones, teeth and muscles and it also performs other essential functions in our metabolism. It is produced in the skin when exposed to sunlight and this is the main source of vitamin D for most people. However, if you always use sun-block, cover most of your skin or live in a country, like the UK, where we don’t get enough sunlight over the winter, you need a supplement, whether you’re vegan or not.
The UK Government now recommends that we all take a supplement from October to April and, if you protect your skin ferociously over the sunnier spring and summer months, you should take a supplement all year long. Otherwise, just 20 minutes of sunlight on the face and arms is all that is required by the body to manufacture sufficient vitamin D.
Fortified breakfast cereals, bread, plant milks and vegan margarines can be useful sources if exposure to sunlight is not practicable, but may not be enough. When it comes to supplements, there are two types and your body can use both, but it’s advisable to check the source – vitamin D2 is always vegan, but vitamin D3 can be of animal origin. Many vegan foods are fortified with vitamin D2 and labelled so, but if not specified, especially on cereal products, vitamin D tends to be of animal origin. If you choose to supplement your diet, there’s a range of quality and affordable vegan supplements with vitamin D2. There are also those made from algae or mushrooms that contain D3 and these are recommended if you need a higher dose. When deciding on your dosage, 10µg per day is enough and you shouldn’t go above 25µg.
Iodine has been a hot topic lately, especially with plenty of tabloid ‘experts’ warning that vegans are missing out. This mineral is necessary for thyroid function and helps to regulate how energy is produced and used in the body.
The amount of iodine in plants depends upon the iodine content of the soil in/on which they are grown. The closer to the sea, the more iodine and therefore vegans can get enough from plant foods, but there’s no guarantee. Seaweed, which of course grows in seawater, is always a good source and includes nori, laver, dulse and the kelp family (kombu, arame, wakame). But be warned – kelp absorbs far more than other seaweeds and you can get too much iodine from it. So, while seaweed consumption is encouraged, kelp should be used only sparingly.
It’s best to use a kelp supplement so you know exactly how much iodine you’re taking – it’s cheap, reliable and you don’t have to worry about taking too much. The recommended daily intake is 140µg and intakes up to 500µg are considered safe. In many countries, iodised salt is commonly used to ensure iodine intake, but it’s not the norm in the UK.
The dairy industry has been boasting about the iodine content of cow’s milk. What they don’t tell you is that it’s not a natural component of milk, but comes from iodinated cattle feed, supplements, iodophor medication, iodine-containing sterilisers of milking equipment, teat dips and udder washes. Cow’s milk is neither a natural nor the best source of iodine, so we can happily leave all that dairy out of our diet.
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