Do you know what to eat to keep Crohn’s disease under control? It can be a tricky question because the answer isn’t the same for everyone, says dietitian Anna Taylor, MS, RD, LD. “What works for one person won’t work for another,” she says. “So start with a balanced diet and then cut back on any foods that make your symptoms worse.”
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It’s also important to stay hydrated and keep your doctor in the loop to make sure you’re getting the vitamins and minerals you need, as Crohn’s patients sometimes need additional vitamin D, calcium or folate.
You want to also pay attention to your reaction to the following food types, which frequently trigger GI symptoms:
- 1. Insoluble fiber
- 2. Lactose
- 3. Fatty foods
- 4. Carbonated drinks, caffeine and alcohol
- 5. Sugar alcohols
- Keep a food log
- Prepare for a flare(up)
- How to Find Relief During a Crohn’s Flare
- Crohn’s Disease Symptoms You Can Manage
- Crohn’s Flare-ups
- What can affect Crohn’s disease flares?
- Managing Crohn’s flares
- Take your treatment as prescribed
- See your doctor on a regular basis
- Set up a support system
- Stay on track with your tests
- Maintain a healthy diet
- Here are a few other ways you can help minimize Crohn’s flares:
- Veggie Turkey Wrap
- Tomato Finger Sandwiches
- Easy Homemade Turkey Burger
- Oven Baked Potato Fries
- Yogurt Parfait
- Related posts:
1. Insoluble fiber
Insoluble fiber can make symptoms worse during flare-ups. If this is a trigger for you, avoid:
- Whole grains.
- Skins and seeds of fruits and vegetables.
Soluble fiber, however, may help make your diarrhea less frequent or less severe during flare-ups. Try these sources of soluble fiber:
- Psyllium (natural, bulk-forming seed husks found in various fiber supplements).
“Although beans contain both soluble and insoluble fiber, I recommend mostly avoiding beans during flare-ups; the insoluble fiber can make things worse,” says Ms. Taylor.
If you have lactose intolerance, you know to avoid milk, ice cream, and other high-lactose foods, which could make bloating, gas and diarrhea worse. You can try using an over-the-counter lactase enzyme tablet when you eat small amounts of dairy, Ms. Taylor says.
Even if lactose is not usually a problem for you, you may find that flare-ups or intestinal surgeries can sometimes bring on lactose intolerance.
3. Fatty foods
Fried foods, fast food, fatty meats and added fats/oils, can cause diarrhea and gas if you have problems with fat malabsorption.
“These triggers are especially common for people who have inflammation in the small intestine or have had part of the small intestine removed,” says Ms. Taylor.
4. Carbonated drinks, caffeine and alcohol
Soda and carbonated drinks can make bloating worse.
Caffeine and alcohol can affect your GI tract, triggering more diarrhea. Caffeine can loosen stools and increase peristalsis — wave-like movements that propel mass through the digestive tract.
Alcohol in any amount tends to irritate the lining of the digestive tract. If you consume caffeine and/or alcohol in high amounts, it can cause dehydration. This is more of a problem when you have diarrhea.
5. Sugar alcohols
The sorbitol and mannitol found in sugar-free gum and candies can make GI tract symptoms worse, potentially causing gas, bloating, abdominal cramping and diarrhea.
Keep a food log
Ms. Taylor says to keep in mind that every person is different, and what works for one person with Crohn’s disease may not work for another.
“The only way to identify which foods worsen or trigger your GI symptoms is to put in the time and effort of tracking,” she says.
A food log may suffice. Write down everything you eat, and any GI symptoms you are experiencing. “This can help you identify which foods are triggering worsened symptoms,” she says. “Or you may find the need to try an elimination diet under the supervision of a registered dietitian.”
If you suffer from Crohn’s disease, you’ve most likely been experimenting with different foods in your diet. Having to maneuver through restaurants, social gatherings, and food labels can be a stressful trigger in itself. Food related flare-ups can lead to a diminished quality of life and a decreased of motivation to eat, only making matters worse. Without a wholesome diet, Crohn’s can lead to severe malnutrition.
There’s no cure all diet for Crohns. Everyone is unique and every body responds differently. It is important to work with your primary care physician to discuss the optimal diet and treatment. Using this dietary guide will improve your self-management and help you feel in control of your condition. Learning to avoid foods that cause a flare-up will help reduce symptoms and promote healing of your body and mind.
Prepare for a flare(up)
While having a flare-up, you want to focus on easily digestible, nourishing foods. Your digestive system has been inflamed, injured, and abused. Take time to rest and digest. The goal is to find your trigger food(s) by playing detective and finding out what makes your body react.
It’s important to focus on high-calorie, high protein, and nutrient-rich foods. Even if you don’t feel hungry, aim for 3 meals and 2-3 snacks per day. Smaller, more frequent meals will help you reach your nutrient goals. If you are unable to eat solid foods, focus on soft foods such as smoothies, broths, mashed potatoes, applesauce.
Count on Carbohydrates
Dietary fiber is extremely healthy for preventing disease, but since it is not digested it may lead to diarrhea and pain. Some Crohn’s cases have been related to a gluten allergy or sensitivity. Carbs on the FODMAP diet have been linked to IBD. They may lead to extra gas and fermentation in your gut.
Avoid or limit:
- Whole wheat or whole grain products
- Gluten containing foods (wheat, rye, barley, couscous, malt, etc)
- Beans, lentils, legumes
- Potato and yam
- Gluten-free bread or pasta
Pick your protein
It’s important to follow a high-calorie, high-protein diet because nutrients are not readily absorbed with Crohn’s. When it comes to choosing protein, focus on lower fat, plant-based, and cooked for easier digestion.
Avoid or limit:
- Fried or breaded meat
- Processed meats such as sausage
- Large quantities of red meat
- Eggs (if you can handle them)
- Tofu (if not following FODMAP diet)
Focus on the right fruits and vegetables
Fruits and vegetables are full of healing nutrients, however those that are raw, high in fiber, and on the FODMAP diet may cause a lot of stress to the digestive system.
Avoid or limit:
- Cruciferous vegetables (Broccoli, cabbage, cauliflower)
- Raw fruits and vegetables with skin
- Garlic and onion
- Well-cooked vegetables
Beware of some beverages
Staying hydrated is extremely important, particularly if you’ve been having diarrhea. Aim for a minimum of 8 glasses of water per day and focus on beverages with electrolytes if you’ve been having the runs. Alcohol is dehydrating and irritating so enjoy in moderation and pair with a meal and extra glass of water.
Avoid or limit:
- Caffeinated tea
- Alcohol (wine, beer, spirits)
- Herbal tea
Ditch the dairy
With a damaged stomach lining, comes decreased production of lactase, the enzyme that helps break down dairy products. This can lead to diarrhea, gas, and cramps. Since many people suffering from Crohn’s have a dairy intolerance, we recommend keeping it to minimum.
Avoid or limit:
- Butter and cream
- Ice cream
- Non-dairy alternatives (hemp milk, coconut milk, almond milk)
- Yogurt (unsweetened, low-fat)
- Taking lactase enzyme with dairy as needed
Some sauces and seasonings
Spicy foods can irritate the stomach lining, making symptoms worse. Packaged sauces such as mayo, which are full of fat, can cause diarrhea. Aim for nutrient-boosting and anti-inflammatory herbs and spices.
Avoid or limit:
- Pepper, chili, hot sauce, and wasabi
- Garlic and onions
- Fatty sauces and oils (mayo, butter, margarine, oils)
- Artificial sweeteners
- Fresh herbs
Once you identify what causes your symptoms to flare-up you can take steps to change your diet, focusing on the foods you can tolerate. Be creative and try new cooking methods, recipes, and preparation styles. It may be as simple as switching spices or cooking your vegetables. Finding pleasure in your meals and normalcy in your habits will help motivate you to eat. Rather than thinking of what you will lack, focus on what you can add and experiment with. The better you take care of yourself today, the sooner you will be back on track to feeling healthy and energized.
This article has been written by Lisa Booth, registered dietician and nutritionist, and co-founder of Nori Health. Content is based on her professional knowledge, and our collection of 100+ scientific research study papers.
How to Find Relief During a Crohn’s Flare
Soak in a warm bath to relieve some of the symptoms of Crohn’s. Roy Hsu/Alamy
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Even the most well-managed cases of Crohn’s disease can flare up occasionally. This often means that you’ll need to step up your treatment to bring your symptoms under control. Your doctor can help you determine if the flare is due to a worsening of the disease or a development of complications.
“People who’ve lived with Crohn’s all their lives get to know their symptoms and flares very well, but even the most experienced can get confused,” says Cyrus Tamboli, MD, a gastroenterologist and director of the inflammatory bowel diseases service at the University of Arkansas for Medical Sciences in Little Rock. A Crohn’s disease flare implies a worsening of the inflammation, but symptoms can occur for other reasons, namely complications of the disease. “This can include an infection, an abscess, or rarely, a tumor in the colon,” Dr. Tamboli says.
If inflammation is causing your symptoms, your doctor might need to adjust the dosage of your medications. A short-term adjustment, or dose tailoring, may be enough to get symptoms back under control, according to a study published in February 2015 in the Internal Medicine Journal. However, Tamboli says your doctor might also order tests to find out whether you’re experiencing complications that would benefit from other treatment.
Crohn’s Disease Symptoms You Can Manage
While you’re waiting for treatment to kick in, there are things you can do to get relief from symptoms. Try these tips to help manage the most common Crohn’s disease symptoms, including:
Dehydration Start by making sure you’re getting enough fluids. “The best thing people with Crohn’s disease can do is to be able to make lots of clear urine by drinking plenty of fluids,” says Peter Higgins, MD, PhD, director of the inflammatory bowel disease research program at the University of Michigan Medical School in Ann Arbor.
The Crohn’s and Colitis Foundation (CCF) suggests drinking at least 8 ounces of water a day, or enough so that your urine is clear. Ask your doctor if you can stay hydrated well enough on your own or if you need to be rehydrated intravenously at your local clinic.
Discomfort from diarrhea Frequent bowel movements can create irritation. For relief, the CCF suggests to:
- Soak in a warm bath and gently pat peri-anal skin dry.
- Apply an emollient to protect delicate peri-anal skin.
- Avoid foods or beverages that might worsen diarrhea.
Abdominal pain Cramping, bloating, and gas can be painful. Try these steps to reduce discomfort:
- Eat smaller meals, but eat them more often to get enough calories.
- Avoid foods that might worsen cramping, such as dairy products and fatty foods.
- Limit high-fiber foods.
Nausea Talk with your doctor if nausea is keeping you from eating, drinking, or taking medications. Dr. Higgins says that some people might need anti-nausea medications that either dissolve slowly in the mouth or are available as suppositories. You can also try to relieve nausea naturally with options such as ginger or aromatherapy.
Weight loss If a Crohn’s disease flare keeps you from eating, drinking, or absorbing nutrients, weight loss can be a serious concern. The CCF recommends these steps to maintain a healthy weight:
- Work with a dietitian to create a plan for eating well despite your symptoms.
- Look for high-calorie, nutrient-dense foods you can tolerate. Consider peanut butter, bananas, cooked white rice, canned fruits, and cooked fish.
- Keep a food diary to keep track of the calories you take in.
- Rapid weight loss may require medical attention, so keep your doctor informed.
Fever Fever is triggered by inflammation and will likely decrease as your treatment starts to work. Avoid taking nonsteroidal anti-inflammatory drugs (NSAIDs) without your doctor’s approval because they can aggravate the digestive system, Tamboli says. Acetaminophen is usually safe as long as you don’t exceed the recommended dosage.
Fatigue Higgins says fatigue should improve if you stay hydrated, manage your diet, and stick to your treatment plan. To avoid worsening fatigue, get enough sleep and pace yourself throughout the day.
Mouth sores If mouth sores are part of a Crohn’s disease flare, ask your doctor about using lidocaine jelly to manage discomfort, Higgins says. The CCF recommends using medicinal mouthwashes as an option for some mouth sores.
Vision trouble About 10 percent of people with Crohn’s disease experience symptoms such as blurring vision, eye pain, dry eye, and sensitivity to light, according to the CCF. Make sure your eye doctor knows you have Crohn’s, and ask whether there are any eye drops that can help you manage your symptoms and protect your eyes from inflammation.
Skin problems Symptoms of a Crohn’s disease flare can include tender red bumps, skin tags, and mouth sores, as well as damage to the sensitive skin around the anus. Try these skin care tips:
- Keep peri-anal skin clean and dry.
- Use moisturizers.
- Avoid tight clothing that might irritate peri-anal skin.
Taking these self-care steps should help you to feel more comfortable during a flare of Crohn’s disease symptoms.
When you’re experiencing a Crohn’s flare-upThe sudden intensification of disease symptoms or the return of symptoms suddenly., your gastrointestinal (GI) tract may be inflamed, and that may cause you to have frequent or urgent bowel movements, diarrhea, bloody stool, and/or abdominal pain. Other symptoms may include fatigue, lack of appetite, and weight loss. Crohn’s can be progressive, so over time, your symptoms could get worse. You should tell your doctor any time you are experiencing symptoms or worsening of symptoms, and because Crohn’s can affect the entire GI tract — from the mouth to the anus — you should bring up symptoms even if you don’t think they are related to Crohn’s. Having a restroom request card on hand can be helpful when unexpected symptoms arise.
Crohn’s disease typically varies between periods when the disease is active, or flaring up, and when it is in remission (few or no symptoms). Crohn’s disease varies from person to person and may change over time.
What can affect Crohn’s disease flares?
There are several things that can affect Crohn’s disease symptoms, including:
Skipping doses or taking the wrong dose of your medication
If you experience flares and are taking your medications as prescribed, talk to your doctor about changing your dose, frequency, or type of medication.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs such as aspirin, naproxen, and ibuprofen may irritate the bowel, which can cause symptoms to flare up. Ask your doctor if you are able to take acetaminophen instead for fever or mild pain.
Antibiotics treat bacterial infections, but can also change the balance of bacteria that live in the intestines, which can cause diarrhea. Tell your gastroenterologist if you experience a flare while taking antibiotics.
Smoking cigarettes can trigger a flare-up, and people with Crohn’s disease who smoke may also have more need for surgery.
Because stress can affect Crohn’s symptoms, it might be helpful to learn and incorporate stress-management techniques into your routine, such as yoga or meditation.
Foods that irritate your gastrointestinal (GI) tract
Even though there is no evidence that food causes Crohn’s disease, certain foods can impact your symptoms. Keeping a food diary can help you determine which foods to avoid based on your experience—and consulting with your doctor and/or a dietitian can help you plan a diet that works for you.
Managing Crohn’s flares
Here are some ways you can help minimize flare-ups and maximize your health:
Take your treatment as prescribed
As your doctor has probably told you, it’s very important to take your current treatment as prescribed even if you are feeling better. Although managing Crohn’s disease is more than just taking medicine, the best way to deal with Crohn’s disease symptoms and flare-ups is to find an effective treatment plan. Many people can keep Crohn’s in remission (few or no symptoms) with the medications that are right for them.
Corticosteroids (Steroids)Given orally, as an injection, rectally, or intravenously, these medications help reduce inflammation by suppressing the immune system and are usually given to help with moderate to severe Crohn’s and ulcerative colitis symptoms. Steroids are not intended for long-term use. are often prescribed to treat flare-ups. However, they are best suited for short-term control of symptoms, and should not be used for long periods of time. If not used appropriately, patients can become steroid dependent or resistant.
See your doctor on a regular basis
Your doctor will likely ask that you come in for check-ups on a regular basis, and you should also be able to contact your doctor when you have a question or to help you manage a Crohn’s flare. Establishing a good relationship with your doctor can help you be honest about your symptoms and how they affect you so that your gastroenterologist can determine which treatment is best for you.
Having a healthcare team (nurses, a nutritionist, a social worker or psychologist) that you can turn to for guidance can also help you manage Crohn’s flare-ups. Remember, your healthcare team is there to work with you on your overall well-being, not just your treatment.
Set up a support system
In addition to your healthcare team, educating your family and close friends about Crohn’s disease will help them understand what you may be going through. Don’t be afraid to ask for support when you need it.
Stay on track with your tests
Ask your doctor how often you should get diagnostic tests and/or procedures, which can help you identify many treatment side effects or signs of Crohn’s disease progression.
Maintain a healthy diet
There is no particular diet that is appropriate for all people with Crohn’s disease. However, getting proper nutrition is essential to help minimize the effects of Crohn’s. Ask your doctor or consult with a dietitian or nutritionist to help you figure out your own diet plan and whether you may need to take vitamin and/or mineral supplements.
Here are a few other ways you can help minimize Crohn’s flares:
Get regular exercise:
Talk to your doctor about setting up an appropriate exercise plan.
Smoking can make symptoms worse and make Crohn’s disease more difficult to treat.
Manage your stress levels
Stress-management techniques can help you stay calm.
Author: Megan Hall, Registered Dietitian
People with Crohn’s disease often have to pay close attention to the foods they eat. Dietary restrictions can be frustrating, but you can mix up your meals and enjoy your favorite summer flavors without triggering a Crohn’s flare-up. Here are some summer recipes that are easy to make and easy to digest for many people who have Crohn’s disease.
Veggie Turkey Wrap
Grab your favorite summer veggies and create turkey veggie wraps for an on-the-go snack. These portable finger foods are great on hot summer days. Slice red bell peppers, cucumbers, carrots and zucchini into long, thin strips. Place them on a slice of turkey and roll your veggies into a tasty veggie turkey wrap. If vegetables aggravate your Crohn’s symptoms, try cooking them beforehand and peeling the skin. Cooked vegetables are often easier to digest. Peeling the skin off vegetables before eating them can reduce the fiber and make them easier on your body.
Tomato Finger Sandwiches
4 slices baguette bread
8 teaspoons reduced-fat mayonnaise, divided
4 slices fresh tomato
4 teaspoons fresh basil, chopped
1/8 teaspoon garlic salt
1/8 teaspoon salt
1/8 teaspoon ground black pepper
Some Crohn’s patients switch their diet to eat smaller meals more often. This simple recipe features summer ingredients to make finger sandwiches that are light and delicious. All you have to do is slice your baguette, spread a thin layer of mayonnaise, top with fresh tomatoes and sprinkle it with basil, garlic salt, salt and pepper. For an added crunch, broil your tomato finger sandwiches for about two minutes in the oven.
Easy Homemade Turkey Burger
1/2 pound lean ground turkey
2 tablespoons oat bran
1/4 cup oats
2 tablespoons fat-free milk
1 teaspoon dehydrated onion flakes
1 dash black, ground pepper
Grilled burgers are a summer staple. This summer you can enjoy your burgers and the health benefits that come with this easy homemade turkey burger. Mix all the ingredients above and form them into two turkey burger patties. The ingredients in here make it low in fat and fiber, which may be better for people with Crohn’s disease. If you prepare the burgers in advance and freeze them, it becomes a quick and easy meal. Many Crohn’s patients worry about what to eat when invited to summer cookouts. You can throw together these easy homemade turkey burgers and bring them to your summer barbeques. Just be prepared to share them with your friends!
Oven Baked Potato Fries
1 large potato
2 teaspoons olive oil
1/4 teaspoon onion powder
1/4 teaspoon garlic salt
1/4 teaspoon parsley
Fried foods don’t always sit well with people who have Crohn’s. Here’s a delicious alternative for those of us who love French fries.
Oven baked potato fries have the flavor you love without the risk of aggravating your Crohn’s symptoms. Simply slice potatoes into thin strips, drizzle them in olive oil and sprinkle onion powder, garlic salt and parsley to taste. For parmesan potato fries, add a layer of grated parmesan cheese on top before baking your fries at 400 degrees Fahrenheit for roughly 35 minutes.
Yogurt parfaits make great summer treats at any time of day but we especially love them as a healthier dessert option. To make your own, start with your favorite non-dairy yogurt. Non-dairy yogurts are often made with coconut milk, almond milk or soy. Layer the yogurt with your favorite summer fruits and some whole-grain granola or walnuts. Look for fruits that are easy to digest, such as bananas, raspberries or blueberries.
For more Crohn’s-Friendly recipes, visit EverydayHealth.com. These recipes are made with ingredients generally tolerated well by people with Crohn’s disease. However, if any of these foods might trigger a flare-up for you, look for substitutions or talk with a registered dietitian. HPS patients can contact me, Megan Hall, a registered dietitian on the Hy-Vee Pharmacy Solutions patient care team. If you’re having a hard time managing your Crohn’s disease, talk with your doctor or pharmacist.