June 10, 2011
You may have been told eating a bland, low-fiber, white-flour diet is unhealthy. But when symptoms of Crohn’s disease flare, it can lead to relief. What are some other ways to avoid and soothe symptoms of the disease? Read on for 11 tips from top experts. Plus, how well do you understand Chron’s disease? Take our quiz to find out…
It’s important to eat a rainbow-like variety of high-fiber foods such as fruits and vegetables, right? Not if you have Crohn’s disease. Those foods might actually aggravate your condition, dietitians say.
Potato products, bread and bananas were least likely to cause problems for people suffering symptoms of Crohn’s disease, according to a 2006 study from Utrecht University and University Medical Center, Netherlands.
“It sounds really unhealthy, but it’s only temporary,” says Susie Ofria, R.D., a registered dietitian at Gottlieb Memorial in Melrose Park, Ill. “Once you’re out of your flare, you can start reintroducing whole grains and raw veggies into your diet one item at a time.”
Besides white foods, “eating smaller meals and avoiding certain foods also can dramatically decrease pain and symptoms,” says Laura Jeffers, R.D., M.Ed., outpatient nutrition manager at the Cleveland Clinic.
Read on for 11 ways to minimize pain and discomfort during a Crohn’s disease flare.
1. Consult a doctor or dietitian who specializes in Crohn’s treatment.
The pain and inflammation of Crohn’s disease can ruin your appetite and make it hard to digest and absorb nutrients, says Armen Simonian, M.D., a Trenton-based gastroenterologist at Capital Health Regional Medical Center and director of the Center for Digestive Health in New Jersey.
That’s why women with Crohn’s disease are sitting ducks for nutritional deficiencies.
Dietitians can order blood tests to help you correct nutritional problems and pinpoint foods that exacerbate symptoms.
“A dietitian can help you figure out which foods are safe to eat and those that cause symptoms,” says Nicole Kuhl, R.D., a registered dietitian in Santa Monica, Calif.
2. Determine what triggers your flares.
Triggers can vary, says Susy Weems, Ph.D., R.D., director of nutrition sciences at Baylor University in Waco, Texas.
That’s why Crohn’s patients are advised to “keep a food diary to track what you’re eating and how you feel,” advises Lisa Moskowitz, R.D., a New York-based dietitian.Write down everything you eat for a month or two, including quantity, time and the symptoms you have. That will help you and your doctor or dietitian create a balanced diet that avoids foods that exacerbate symptoms of Crohn’s disease, like cramping, gas and diarrhea, she says.
“If a certain food bothers you, remove it from your diet for about a month and see if symptoms of Crohn’s disease improve,” Kuhl says.
Experts agree, however, that when symptoms flare, forget about normal healthy eating and stick to a “Wonder Bread” diet.
3. Don’t skimp on calories.
You’ll lose necessary nutrients if you have chronic diarrhea and possibly vomiting, according to the Crohn’s & Ulcerative Colitis Foundation (CCFA), a nonprofit organization for people with these digestive disorders.
That’s why your body needs more calories to fight Crohn’s disease.
Medications also work better if you’re well nourished, says the CCFA.
“With Crohn's disease, you need to eat a high-calorie, high-protein diet, even when you don't feel like eating,” Simonian says.
But big meals can overstress your digestive system, increasing gas, pain and diarrhea.
That’s why Weems advises sticking to “five or six small meals daily to ensure you get enough protein, calories and nutrients to replenish and repair your body.”
To aid digestion, take small bites of food and chew it really well, says Ofria.
“Also take vitamins and minerals that your physician recommends,” Weems says.
4. Cut back on fiber.
High-fiber foods like fresh fruits, vegetables and whole grains are not your friends during Crohn’s flare, says Jeffers.“Stick to a low-fiber diet that revolves around white bread and other refined white flour products, smooth and bland cooked cereals like Cream of Wheat, white rice and pastas, and well-cooked or steamed veggies (not cruciferous) that are soft enough to cut with the side of a fork,“ she says.
Here are more tips from Jeffers:
- Avoid vegetables like lentils, beans, legumes, cabbage, broccoli and onions. They’re difficult to digest and cause gas, bloating and pain.
- Avoid crunchy foods, such as raw veggies and fruits, which irritate your intestines and increase diarrhea.
- Steer clear of anything with hulls or seeds, such as nuts, seeds, popcorn, strawberries, watermelon, grapes and crunchy nut butters. (Smooth nut butters are an excellent alternative and a great source of protein.)
- Limit fruit to bananas. (Avoid fruits with skins, such as apples.)
- Canned fruit is fine if it doesn’t contain high fructose corn syrup, which can aggravate diarrhea.
- Avoid dried fruit, which is hard to digest and may get stuck in the intestines.
- Steer clear of citrus fruits, which have seeds and are also very acidic, because these may increase pain and irritation.
5. Eat healthy fats.
Foods rich in polyunsaturated fats (walnuts, olive, flaxseed oils and butters) and omega-3 fatty acids (salmon, tuna and mackerel), can promote healing, says Christian Renna, D.O., an integrated medicine physician who specializes in autoimmune diseases with Lifespan Medicine in Santa Monica, Calif.
The anti-inflammatory nature of omega-3 fatty acids eases Crohn’s symptoms, according to a 2011 study conducted at the Center for Inflammatory Bowel Disease at St. Panteleimon General Hospital in Nicea, Greece.
6. Drink plenty of liquids.
“People with Crohn’s disease are at increased risk for diarrhea, so drink lots of water with and in between meals to avoid dehydration,” says Jeffers, who also offers these tips:
- For each pound you weigh, drink one half-ounce of water per day, in addition to water-based foods, such as soups.
- Also avoid highly acidic fruit juices made with citrus, cranberries and pineapple, which increase inflammation.
You may be able to tolerate low-acid juices made with bananas, pears, mangoes, grapes, watermelon, coconut and apricots. Avoid fruit-flavored juices and drinks that contain high fructose corn syrup, which also increases inflammation.
- Sip beverages rather than gulp them. Gulping introduces air into the digestive system, causing discomfort.
- Avoid carbonated beverages like soft drinks and sparkling waters because they increase gas and flatulence. Most soft drinks also contain high fructose corn syrup.
- Avoid caffeinated beverages like coffee, tea and chocolate-based drinks, which increase inflammation and exacerbate diarrhea.
- Stay away from alcohol, including beer, wine and hard liquor, which irritates intestines and increases pain.
So what can you drink? Sip homemade chicken or vegetable broth.
“You’re getting a really nutritious drink that’s easy to digest,” Kuhl says.
7. Focus on lean protein.
Your body needs protein to build and heal tissue. If you have Crohn’s disease, you may not absorb enough to promote healing and prevent muscle wasting, says Moskowitz.To reduce pain, gas and other symptoms, try these tips:
- If red meat makes you feel queasy and exacerbates diarrhea, switch to leaner cuts like sirloin or ground round, or stick to fish or poultry without the skin, says Moskowitz.
- Avoid fatty hot dogs, sausage, pork and anything with a tough skin. The fat can cause diarrhea and their skin can be difficult to digest, says Jeffers.
- Liquid formulas like Ensure, Glucerna and Pulmocare, which are absorbed in the upper rather than in the lower intestine, help some Crohn’s patients, says Jeffers.
8. Watch out for dairy products.
You may feel better if you limit or avoid dairy products during your flare.
“They may cause gas, abdominal pain and diarrhea in some women with Crohn’s,” says Jeffers.
Can’t live without your milk mustache? Try lactose-free varieties or add an enzyme product, such as Lactaid, which breaks down lactose, suggests the CCFA.
Or for a healthy, easy-to-digest protein, eat plain yogurt. It contains acidophilus, a probiotic that has been shown to ease Crohn’s symptoms.
9. Get plenty of vitamin D.
Vitamin-D deficiency, which is more common in northern climates that get less sun, can lead to Crohn’s disease, according to a 2010 study conducted at McGill University and the Université de Montréal.
If Crohn’s disease runs in your immediate family, you may be able to ward it off by getting enough vitamin D, the study advises.
If you already have Crohn’s, this powerful anti-inflammatory vitamin and hormone can relieve inflammation and ease symptoms, says Michael Holick, Ph.D., M.D., professor of medicine, physiology and biophysics at Boston University Medical School, prominent vitamin-D researcher and author of The Vitamin D Solution (Penguin).
The Institute of Medicine, an arm of the National Academy of Sciences, recommends getting 600 International Units (IUs) of vitamin D daily.
The best source of vitamin D is the sun, which activates the body’s production of vitamin D, says Holick.If you don’t get enough sun, eat foods rich in vitamin D, including beef liver, egg yolks, sardines, salmon, shrimp, cod and, if you’re able to, fortified milk. Also take a vitamin-D supplement.
10. Avoid hot spices and fake sugar.
Spicy foods like four-alarm Mexican, Thai or Indian cuisine, as well as whole spices, can irritate the lining of your intestines and increase pain, says Jeffers.
Avoid hot spices like chili powder, ginger, horseradish, Chinese mustard and black pepper.
But if you’re going to use whole spices in cooking, make sure they’re very mild and finely ground,” Jeffers says.
And avoid artificial sugar substitutes.
“Sorbitol, found in sports drinks, soft drinks and many processed foods, can really put you over the edge if you have Crohn’s disease,” Moskowitz says.
That’s because sorbitol can damage the intestinal mucosa, trigger spasms and increase inflammation, according to a 2009 Brown University study.
11. Embrace probiotics, not prebiotics.
Pro- and pre-biotics are all the rage for improving digestion, but will they relieve symptoms of Crohn’s disease? Probiotics are friendly bacteria that live in your gut and aid digestion, while prebiotics help stimulate the growth of the beneficial bacteria, says the Mayo Clinic.
A 2011 study conducted by the Center for Inflammatory Bowel Disease at Saint Panteleimon General Hospital in Nicea, Greece found that probiotics relieved Crohn’s symptoms.
But prebiotics appear to add fuel to the fire. A 2010 Harvard study found that prebiotics didn’t ease Crohn’s symptoms, and increased flatulence.
How Well Do You Understand Chron's Disease?
A diagnosis of Crohn’s disease comes as a shock for many people, some who never suspected their abdominal discomfort could be something serious. This inflammatory disorder has far-ranging – and often serious – symptoms. Find out how much you know about it.