Crohn's Disease and Diet

Because Crohn's disease affects the gut and symptoms often occur after meals, you may wonder if certain foods cause or contribute to the disorder. Many experts wonder about this too and research looking into the connection between diet and Crohn’s is ongoing.

“At this point, we don’t have an ideal diet for Crohn’s, but we do know that certain types of foods can make symptoms worse or better,” says Joshua Korzenik, MD, assistant professor of medicine at Harvard Medical School. Korzenik is the director for the Crohn’s and Colitis Center at Massachusetts General Hospital in Boston. To help ensure that you are eating a balanced diet and getting enough calories while avoiding symptoms, you can take these steps:

• Eat smaller meals and eat more often. Instead of eating three large meals, eat five small meals.
• Avoid high-fat, greasy, and fried foods such as cream sauces, butter, margarine, and anything deep fried. About one-third of people with Crohn’s find these foods harder to digest because they have difficulty digesting fat.
• Avoid high-fiber foods such as corn, popcorn, seeds, and nuts. These types of foods have shells and hulls that aren’t completely digested in the small intestine, which can aggravate symptoms.
• Get tested for lactose intolerance if you think you may have it. Many people avoid dairy because they think they are lactose intolerant when they are not. The only way to know for sure is to be tested. If you have the condition, you may be able to take supplements to help you digest dairy. If it’s possible, it’s important to continue to eat dairy because it is such a good source of nutrition and calories.
• Keep a food diary. This can help you determine which foods, if any, irritate your stomach more than others. 
• Try eating a softer, blander diet, rather than anything spicy and high in fiber during flares. This may cause less discomfort. Just be sure to eat a balance of foods from all food groups.
• Chronic diarrhea can lead to dehydration, making you feel weak and tired. It can also affect your kidneys and even lead to kidney stones, so it’s important to monitor how much you drink, especially in warmer weather. Talk with your doctor about how much fluid and what types of fluids you should be taking in every day. It’s best to avoid soda and caffeinated beverages as they can irritate your stomach.

Crohn's Disease: How a Dietitian Can Help

It’s a good idea to talk with your doctor about your nutritional needs and what you can do to ensure you are meeting them. You may want to ask your doctor about working with a registered dietitian (RD). This person can help you track what you eat, work with you to adjust your diet to help reduce symptoms during flares, and make sure you are getting all the nutrients and calories you need. “We always recommend that our patients work with an RD,” says Korzenik.

Crohn's and Nutritional Supplements

Depending on the extent and location of your disease, you may need to take nutritional supplements. Having Crohn’s disease can make it difficult to get the nutrients you need for a number of reasons:

• You may not feel like eating because of nausea, vomiting, and stomach pain. This in turn can cause weight loss.
• You may become dehydrated from fluid loss because of diarrhea and rectal bleeding. You may also develop an electrolyte imbalance. Electrolytes are important minerals in your body fluids that affect blood chemistry, muscle activity, and other functions. 
• Crohn’s can interfere with the ability of your intestines to digest and absorb nutrients from foods.

It’s a good idea for everyone with Crohn’s disease to take a daily multivitamin, and your doctor or RD may also recommend supplements, either as an injection or by pill or liquid, to help replace one or more of the following nutrients:

• B Vitamins: People who have Crohn’s disease in the small intestine are often deficient in vitamin B12. Also, some Crohn’s medications interfere with the absorption of folate, a type of B vitamin.
• Vitamin D: This is a common deficiency in people with Crohn’s disease. Vitamin D is important for bones and absorption of calcium. Vitamin D is produced when we are exposed to the sun, so people who don’t get outside very often or who live in more northern parts of the country are particularly at risk for a deficiency.
• Iron: People who have Crohn’s may experience intestinal bleeding that can lead to an iron deficiency and anemia.
• Potassium: Diarrhea can lead to potassium loss. Certain corticosteroids can also cause low levels of potassium.
• Magnesium: Chronic diarrhea, having Crohn’s in the small intestine, or having had a lot of your intestine removed can make it hard to get enough magnesium.
• Calcium: Not eating dairy products and poor absorption due to disease or surgery of the small intestine can lead to calcium deficiency. Long-term corticosteroid use can also cause bone loss.

Some studies are looking at the role of probiotics as a therapeutic option for Crohn’s disease. These are “friendly” bacteria in the intestines that help maintain GI health by keeping harmful bacteria in check. When the balance between helpful and harmful bacteria is thrown off, for example because of taking antibiotics, it can cause diarrhea and other problems.

Researchers have been studying the use of probiotics to help reduce symptoms and achieve remission of Crohn’s disease flares. At this point, studies are inconclusive about whether these substances can help, but research is ongoing.

Because your nutritional needs may vary depending upon whether or not you are in a flare and where you are in the progression of the disease, it’s best to consult with your dietitian or doctor before taking supplements or altering your diet in any way. That way you can be sure your nutritional needs are being met at all phases of your disease.

Nutritional Support for Crohn's

There may be times when your doctor may recommend nutritional support. This is the use of a nutrient-rich formula that is administered directly into your stomach or small intestine, called enteral nutrition.

The supplement is usually given at night through a feeding tube that leads from your nose to your stomach, or by an opening created in the abdominal wall where a tube can be placed. This allows you to get all the nutrition you need while you sleep and then go about your daily activities during the day.

In some cases, a different type of nutritional support may be used that bypasses the stomach and intestines. Total parenteral nutrition is delivered through a large blood vessel.