Crohn’s disease is a complex gastrointestinal condition that can cause problems such as nutrient malabsorption and inflammation throughout the digestive tract. Since it is a disease of the digestive system, a Crohn’s disease diet can be an important way to relieve symptoms and support remission in patients.
You should talk to your doctor or a gastroenterologist before making any changes to your diet, especially if you have a complex disease such as inflammatory bowel disease (the group of conditions to which Crohn’s disease belongs). In addition, ostomy patients should be extra careful to talk to their doctor or a dietitian about what they can and cannot eat, especially when they have a flare-up.
We spoke with a doctor and a registered dietitian to discuss what to eat in a flare-up, in remission, and what to eat to avoid having an IBD attack. They have given their advice on how to treat this condition and how best to take care of yourself if you are having nutrient malabsorption problems due to your illness.
What to eat during a flare-up?
Roxana Ehsanic (opens in new tab)a registered dietitian and a national media spokesperson for the Academy of Nutrition and Dietetics, says it is best to eat a light, low-fat, neutral diet for the first few days.
“It’s important to stay as hydrated as possible, especially if you have a lot of diarrhea or vomiting,” she adds. “Drinks and eating foods rich in electrolytes are important. You could sip on stock, such as bone broth, to get moisture, sodium, and protein. You can sip sports drinks to get enough calories, absorb them easily, and tolerate carbohydrates and electrolytes. If you can tolerate them, foods like yogurt — not for those with lactose intolerance — and crackers are easily tolerated by your gut.
“Some people may enjoy peppermint or ginger tea to soothe nausea or upset stomach. Eat meals that are low in fat and low in fiber, as both are easier to tolerate, digest and absorb by an upset stomach.”
Roxana Ehsani, MS, RD, CSA, LDN
Roxana Ehsani is a board-certified sports dietetics specialist and a national media spokesperson for the Academy of Nutrition and Dietetics. She holds a Bachelor of Science in Human Nutrition, Foods and Exercise from Virginia Tech and a Master of Science in Clinical Nutrition and Dietetics from the University of Pittsburgh and completed her diet internship at the University of Pittsburgh Medical Center.
dr. Deborah Lee, MD, of Dr. Fox Online Pharmacy (opens in new tab)says it’s best to eat a low-fiber diet during a flare-up and avoid too much fat:
- Low fiber fruit: Melon, peaches, nectarines and cooked or canned fruit. Fruit should always be washed and peeled if possible – and do not eat the peel.
- Low-fiber vegetables: Stick to non-cruciferous veggies — tomatoes, peppers, zucchini, asparagus, onions, carrots, spinach, and cucumber. Always peel them first and cook them well – don’t eat them raw.
- Lean proteins: Chicken, fish, eggs or tofu are ideal. Red meat tends to be high in saturated fat, which can make symptoms worse. If you eat red meat, eat the best quality meat and cook it well so that it is tender and easier to digest. Seedless nut butters, such as peanut butter, are another good protein option.
- Fat fish: Salmon, trout, mackerel and tuna contain high amounts of omega-3 fatty acids that are powerful anti-inflammatories. Walnuts and flaxseeds also contain high amounts of omega-3.
- Fats: Go for healthy unsaturated fats, such as olive oil, avocado or canola oil. Don’t overdo it, keep it to small amounts. Grill, bake or steam food instead of frying or frying.
- Refined Grains: White bread, rice and pasta contain less fiber. Stick to foods that contain less than 2 g per serving of fiber.
- Probiotics and Prebiotics: Probiotics include yogurt made with live cultures, kefir, tempeh, and sauerkraut. Prebiotics include bananas and soy products.
dr. Deborah Lee, MD
After working for many years in the NHS, initially as a GP and then as Chief Physician for an integrated community sexual health service, Dr. Deborah Lee now as a health and medical writer, with an emphasis on women’s health. She is a transition specialist.
What to avoid during a flare-up?
Ehsani says it’s best to avoid foods that are likely to cause the stomach to clump together.
“Caffeinated drinks, such as coffee, soda, tea, or even sparkling water, can be too hard to digest,” she says. “Avoid citrus fruits such as lemon, lime, grapefruit, oranges and tomatoes, as acidic foods can be too hard for your stomach to tolerate. Avoid most dairy products; some people can tolerate yogurt, but all other dairy should be avoided as it is harder for most people to tolerate.
“Sugar alcohols are found in sugar-free foods, diabetes-friendly foods, and in many gums and candies, and it’s best to avoid them as they can cause diarrhea. Alcohol should be avoided until symptoms disappear as well.”
Lee lists foods she encourages Crohn’s disease patients to avoid during a flare-up:
- Seeds and nuts: These foods are raw, difficult to digest, high in insoluble fiber, and often pass through the gut undigested.
- certain fruits: Avoid anything with the skin on, such as raw fruit or fruit that is particularly high in insoluble fiber. Do not eat dried fruit, including raisins and prunes, and avoid pulp, such as in fruit juices. Strawberries contain many small seeds and are best avoided.
- Certain vegetables: It’s best to avoid cruciferous vegetables, such as Brussels sprouts, cauliflower, cabbage, kale, broccoli, watercress, and radishes, as well as raw or skin-on vegetables. Everything you eat should be soft and well cooked. Cooking food can break down the fiber somewhat, turning it from insoluble fiber to soluble fiber and making it easier to digest, as seen in the journal Plant Foods for Human Nutrition (opens in new tab).
- lactose: Patients with Crohn’s disease are more likely to have lactose intolerance, and large amounts of lactose can cause symptoms. Small amounts may be acceptable: as long as there is no true lactose intolerance. Dairy products are good sources of calcium, so no more than two servings of dairy products per day are usually recommended. If you are intolerant of lactose at all, a calcium supplement may be recommended by your doctor.
- Sugar and sweeteners: Some research suggests that a diet high in sugar can make Crohn’s symptoms worse. Artificial sweeteners, such as aspartame, can also make symptoms worse. Xylitol and sorbitol are other possible culprits. These can all be found in low-calorie and soft drinks, ice cream, sugar-free gum and candy, all of which should be avoided.
- Fatty/processed foods
- Spicy foods: “Capsaicin is the compound in chili peppers that activates mucosal receptors to provide the burning effect of chili spice in the mouth,” says Lee. “In one study, 41% of IBD patients thought that eating spicy foods made their IBD symptoms worse. This means avoiding foods containing chili, chili powder, chilies, and paprika. It also contained black pepper, mustard, and horseradish. Don’t confuse this with turmeric, which contains curcumin, which can have an anti-inflammatory effect on the gut.”
The Crohn’s Disease Diet: What to Eat in Remission?
There is no special diet designed for Crohn’s disease, but following medically approved dietary guidelines can help you stay in remission for a long time and reduce the symptoms you may be experiencing. About 30% of individuals with IBD also have concurrent IBS. For these individuals, a low FODMAP diet can help control these IBS symptoms, depending on how disruptive they are.
Ehsani says a diet with Crohn’s disease in remission is less restrictive. “You can eat a balanced, nutrient-dense diet that includes good sources of lean protein, whole grains, fruits, vegetables, beans, nuts, and seeds,” she says. “You may feel best if you eat smaller meals and more often throughout the day, as it is easier to tolerate and digest. I always recommend keeping a food symptom diary and writing down your foods, together with your daily symptoms next to it, to see if there are any foods that might trigger flare-ups.
Lee also encourages patients to take time for their meals and break them down into smaller meals:
- Eat 4-6 small meals a day
- Plan your meals and cook from scratch
- Take the time to eat your food slowly and chew every bite
- Drink plenty of water with your meals
- Keep a food diary
Crohn’s Diet: Should You Supplement?
Ehsani encourages those who have prolonged diarrhea to supplement, as poor absorption of nutrients can cause deficiencies. “People with Crohn’s disease who have chronic diarrhea may be malnourished and may benefit from a multivitamin,” she says. “People with Crohn’s disease are also more likely to have anemia, so it’s important to regularly monitor your iron levels and supplement when low is needed.”
Lee also mentions the importance of supplementing with calcium when taking steroids because of the impact they have on bone health. “Steroids affect bone metabolism and increase the risk of bone loss leading to osteopenia and osteoporosis,” she says. “Vitamin D is needed to absorb calcium in the gut, so it’s best to take these together. Foods high in calcium include low-fat dairy, leafy greens, salmon, sardines, tofu, and any products marked as fortified with calcium.”
This article is for informational purposes only and is not intended as medical advice.