What can I eat with Crohn’s disease?
One of the most frequently asked questions when people are diagnosed with Crohn’s disease. However, it’s usually inadequately answered by most clinicians because there is no ‘prescribed’ protocol for longterm nutritional support. In fact no lifestyle changes are recommended beyond cessation of smoking. Actually, although IBD patients are highly interested in nutrition, only 8–16% are satisfied with the information they receive from their physicians [1]. However, if you have Crohn’s you probably know that some foods make you feel better or worse, 77% of Crohn’s patients avoid certain foods during remission and as many as 86% implement dietary restrictions during active disease [3].
When I was first diagnosed, I was told a range of different things from different doctors, e.g. “diet has no bearing whatsoever on your disease” and “stick to a low residue diet; white bread, jam, boiled sweets, no veggies etc. etc. add sugar to things to gain weight”. Ouch! It was a long time ago and I think things have generally moved on. Well, maybe not always so much.
Anyway, I was 23 and had no idea about nutrition but I knew that didn’t sound right! And I knew it didn’t feel right. And so came my interest (read ‘obsession’) in finding out more. Crohn’s is a cracker of a disease when it comes to nutritional therapy. Digestion is super impaired, so it’s really difficult to get the nutrients in, and the foods that ‘go down’ the most easily (processed and refined foods lacking in fibre) are the ones doing the most damage. Brilliant! It’s so so so complicated.
What works is different for everyone and the root cause and triggers of disease are different from person to person, so sorry if you wanted a list of foods to eat and foods to avoid, that’s not going to happen here. However I think there are some broad guidelines which are useful for all.
Maybe the best place to start is
WHAT NOT TO EAT.
Recent research is starting to focus on the correlation between the rise of Crohn’s disease (and auto-immunity in general) and the ‘Western diet’ [3-6] indeed a ‘Western lifestyle’. People have started to notice that Crohn’s and auto-immune disease in general is on the rise in rich developed countries and as countries become richer auto-immunity cases increase. Generally the cause of auto-immunity is attributed to a genetic predisposition plus environmental factors which trigger and drive disease expression. So far so good. So the increase must be environmental right? We didn’t just dramatically change genetically.
There are lots of things we do which are contrary to the way nature intended us to live, we don’t sleep enough, we stress too much, we’re surrounded by environmental toxins, we’re less and less connected to one another and nature and so on and our diets are a fundamentally important piece of the puzzle. Essentially, we have created foods which we are not supposed to consume. We’ve made them cheap. In some places we’ve made them the only thing which is accessible to people. Our bodies are rebelling.
Chiba M, Nakane K, Komatsu M. “Westernized Diet is the Most Ubiquitous Environmental Factor in Inflammatory Bowel Disease”. Perm J. 2019
WHAT TO DO:
Avoid all processed foods, ALWAYS. Processed foods have a detrimental effect on the gut’s microbiota [2-6]. They contain compounds that our bodies do not recognise as food and disrupt our microbiome. A healthy diverse microbiota is key to maintaining gut health and immunity as well as brain health (and pretty much every system in our body) [4]. Avoid refined baked goods, processed meat products, ‘diet’ and ‘light’ products, in fact anything made from more and a couple of ingredients (that you recognise to be actual food items).
Reduce or eliminate red meats and saturated fat, we know that high levels of saturated fat contribute to inflammation and have been proven to be a risk factor for IBD [4,5]. In fact one of the ways we can directly effect levels of inflammation in the body at a cellular level is to adjust the ratio between our intake of Omega 3 and Omega 6 fatty acids, in other words, reduce saturated fat and increase healthy fats.
Identify and eliminate food intolerances. If you have an intolerance or allergy to a food, its consumption will turn on the immune system and inflammation, impair gut integrity and can lead to gut permeability [8]. Work with a professional who can help you implement an elimination diet or do some food intolerance testing.
So….
WHAT TO EAT.
Eat lots of fruit and vegetables. I know. Hear me out. Eating fruits and vegetables has a regulatory effect on the intestinal microbiota which in turn effects so many aspects of the bodies functioning including, mucosal barrier function (that’s your gut lining), nutritional status, and intestinal immunity (in fact immunity full stop, think about other auto-immune co-morbidities) and nervous system regulation [3-5]. Gut bacteria also regulates weight gain/loss and could be one of the reasons why some people with Crohn’s find it difficult to shift the weight. Diets low in fruits and vegetables contribute to intestinal inflammation and dysbiosis (dis-regulation of the gut microbiota) so it’s super important that we don’t ditch the veggies and the fibre! If you’re struggling to eat these kinds of foods (and think I’m mad to even suggest it), I have strategies to help get you started!
Eat more Omega 3 and less Omega 6. We know that we can directly effect the structure of our cells and up or down regulate inflammation in the body through the kinds of fat that we eat. A Western diet is characterised by a significant increase in Omega 6 fatty acids (which tend to be pro-inflammatory) and a reduction in Omega 3 (which tend to be anti-inflammatory) [6]. Oily fish and fish oil supplementation are very potent sources of Omega 3 and can be really helpful here. For vegans it can be a bit more tricky especially if you are having troubles absorbing nutrients, but there are ways around it.
Phytochemicals are the magical compounds, often anti-inflammatory, found in fruits and vegetables and herbs and spices. They’re why turmeric, green tea and dark chocolate are so good for us. Adding as many of these beneficial ingredients as possible into our daily eating habit can help to down regulate inflammation [4].
Variety. Many people with IBD tend to stick to a small range of ‘safe’ foods but one of the things I encourage clients to do is to broaden the range of foods they eat to take in as many delicious healthy foods as possible. This is because one ‘wonder’ nutrient, e.g. turmeric, probably is not going to do it! My aim is to use every tool we can to move the body out of a state of inflammation and back to homeostasis.
It can be difficult to get started and you may need extra support until you nail what works for you exactly but nutritional changes can make a world of difference to disease progression in IBD. And let’s face it with a lifelong condition it’s worth the commitment. If you want to find out more then get in touch for a free chat about what’s going on with you.
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