Crohn’s disease (CD) is a chronic condition that causes inflammation and irritation in the gastrointestinal tract. CD sufferers have to pay special attention to what they eat, both because they are at risk for malnutrition, and because certain foods can worsen or trigger their symptoms. Managing a CD patient’s diet is an important part of the overall treatment plan.
Symptoms of CD
CD can affect anywhere along the gastrointestinal tract from mouth to anus, although it commonly involves the ileum or colon. Inflammation can interfere with the digestion and absorption of nutrients. When partially digested food travels through the colon, it can cause persistent diarrhea, abdominal pain and cramping. Other symptoms of CD include fever, nausea and rectal bleeding.
CD is marked by times of intense symptoms, called flare-ups, followed by reduced symptoms and no symptoms, called remission. Periods of remission can last from weeks to years.
Nutrition and Crohn’s
It’s common for people with CD to have trouble maintaining adequate nutrition. Bothersome symptoms can cause appetite loss, reduced nutrient intake and weight decline. CD may also change how the body metabolizes certain nutrients, and side effects of CD medications can affect how some nutrients are absorbed by the body. These challenges can lead to nutrient deficiencies and malnutrition. Studies show that between 20–85 percent of people with CD have some degree of malnourishment.
Nutrition is also significant because what a patient eats can directly affect their CD symptoms. Dietary choices won’t cure CD, but certain foods may worsen symptoms and exacerbate the condition.
Diets for CD
Everyone with CD should strive to eat a nutritious, well-balanced diet. The specifics of the CD diet are individualized. The diet a patient’s physician recommends depends on several factors, including symptoms, medications, nutritional deficiencies, whether the illness is active or in remission, what part of the intestine is affected and medical history.
Some patients with CD are able to eat a normal diet when their disease is in remission and only modify their diet during times of flares. However, other patients need to strictly follow their nutrition plan at all times to help keep CD symptoms under control.
There’s no one specific diet supported by robust scientific evidence. The effectiveness of the following diets is primarily anecdotal, but the research is promising.
Elimination diet
An elimination diet is the process of removing foods from the diet that bring on symptoms. Although there is no clear evidence of a direct link between the elimination of trigger foods and a reduction of inflammation, it can help patients control symptoms, especially during a flare up.
Specific trigger foods vary between people, and figuring out trigger foods is often a matter of trial and error. Patients can keep a detailed food log of what and when they eat and their symptoms for several weeks. This can help pinpoint which foods aggravate the condition. Patients should remove one suspect food from their diets at a time and note if their symptoms improve. Lactose, found in milk and milk products, is a common trigger for many patients with CD.
An elimination diet should be done under the supervision of a physician or registered dietitian to ensure CD patients are getting adequate nutrition. Supplementation may be needed if certain food groups are removed from the diet.
Low FODMAP (fermentable oligo-, di-, mono-saccharides and polyols) diet
FODMAPs are highly fermentable but poorly absorbed carbohydrates and polyols that may cause gastrointestinal symptoms. One notable study shows that a low FODMAP diet helped alleviate symptoms in 50 percent of CD patients, including abdominal pain, bloating, gas and diarrhea. However, the diet was linked with worsened constipation. Examples of foods high in FODMAPs that should be avoided include wheat and onions (fructo-oligosaccharides), dairy products (lactose), apples and honey (fructose), legumes (fructo-oligosaccharides and galactans) and artificial sweeteners (sorbitol).
Specific carbohydrate diet
Complex carbohydrates may pass undigested through the colon, causing an overproduction of mucus, acids and toxins that can harm the intestines. This may contribute to CD symptoms. Restricting carbohydrates in the forms of grains, lactose and sucrose has been shown to be beneficial for CD patients in some case studies. This diet limits vegetables, fruits, nuts, honey and yogurt, for example.
Other diets
There’s limited scientific and anecdotal support that certain other diets have been helpful for some people with CD, such as anti-inflammatory diets and semi-vegetarian diets. These diets need further research to determine their effectiveness.
Patients should be wary of following diets that promise great results for CD. Often, these diets are made popular by patient testimonials and aren’t backed by research. They also tend to be challenging to adhere to and overly restrictive.
Nutrition support
Enteral nutrition (EN) support through elemental, semi-elemental or polymeric formulations may be needed for patients who are malnourished to increase the caloric and protein intake. Supplemental EN can also aid in reducing CD symptoms. In one study, patients with CD who received 50 percent of their nutritional requirements as EN had lower relapse rates compared to people on a normal diet. In another study, remission rates were higher after one year in CD patients who consumed a regular diet supplemented with partial EN compared to those on a standard diet. Exclusive enteral nutrition (EEN), in which no other food is consumed, has been shown to induce mucosal healing and prolong remission of CD, especially in children and adolescents.
Ongoing care
CD changes over time, so the diet that controls symptoms well for a patient now may not work best in the future. Patients should work closely with their physician and dietitian and discuss any new symptoms or dietary challenges. Together, the healthcare team and the patient can create a diet plan that works best for managing CD symptoms.
Although it is intended to be accurate, neither Walgreen Co., its subsidiaries or affiliates, nor any other party assumes for loss or damage due to reliance on this material. Walgreens does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned in the article. Reliance on any information provided by this article is solely at your own risk.
Amy Magill, MA, RD, LDN is Manager of Clinical Programs at Walgreens, where you can find a variety of vitamins to supplement special diets. Amy is passionate about helping others make positive lifestyle changes to improve their health and reduce risks for nutrition-related diseases.
Sources:
Nutrition and dietary interventions in adults with inflammatory bowel disease. UpToDate. https://www.uptodate.com/contents/nutrition-and-dietary-interventions-in-adults-with-inflammatory-bowel-disease
Low-FODMAP diet 101: what is the low-FODMAP diet? American Gastroenterological Association. http://www.gastro.org/info_for_patients/low-fodmap-diet-101-what-is-the-low-fodmap-diet
Dennett, C. Digestive wellness: Crohn's disease. Today’s Dietitian, 18(12):12.
http://www.todaysdietitian.com/newarchives/1216p12.shtml
Gearry RB. Reduction of dietary poorly absorbed short chain carbohydrates FODMAPs improves abdominal symptoms in patients with inflammatory bowel disease a pilot study. Journal of Crohn’s and Colitis. 2008. 3 (1):8-14.
http://www.fodmapdieet.nl/pdf/Reduction%20of%20dietary%20poorly%20absorbed%20short-chain%20carbohydrates%20(FODMAPs)%20improves%20abdominal%20symptoms%20in%20patients%20with%20inflammatory%20bowel%20disease-a%20pilot%20study.pdf
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.