People with Crohn's disease have their pick of diet and cookbooks that promise to make their lives better. But what role, if any, does diet and nutrition play in Crohn's disease?
Crohn's disease is an autoimmune condition that affects the gastrointestinal tract. Many of its symptoms are the same symptoms you get when your food doesn't agree with you.
For most people, abdominal cramps, bloating and diarrhea are signs that we need to change our diet. But Crohn's is not nearly so simple.
dailyRx spoke with Lisa Cimperman, a clinical dietitian at University Hospital in Cincinnati, Ohio, and nutritional adviser for the Crohn's and Colitis Foundation of America. She said that although patients can use diet and nutrition to manage their symptoms, there are no food rules or supplements that can cure the disease itself.
“Diet and nutrition do not cause Crohn's,” she told us. “And your diet cannot treat Crohn's disease alone. You're going to need more targeted therapies.”
These therapies – whether it's medications or surgery – focus in on the immune system, which cause the gastrointestinal symptoms. But there's ongoing research to learn how diet can “temper” the immune response, Cimperman said.
Cimperman shared a few valuable pieces of advice on diet and nutrition for people with Crohn's.
The First Steps
If you've recently been diagnosed with Crohn's, it's important to surround yourself with people who can provide support, Cimperman told us. It's a good idea to see a dietitian who has a background in Crohn's.
“I can't tell you how many people have just sat down with me for an hour, and we go over basic things and they feel so much better,” she said. “Simply having face to face contact and individualized discussion puts a lot of people at ease.”
Cimperman is wary of recommending any one particular diet, and warns against any diet or cookbook that claims to cure Crohn's.
“Some of the diet books are just fine, whereas others are too restrictive, or not based on science, or they promise more than what we know you can actually deliver for food or nutrition,” she said. “If there's a long list of foods you shouldn't eat, that's a red flag. “If anyone is proposing long list of supplements, pills, or vitamins to take, that's also a red flag.”
Cimperman said the best course of action is to have an individualized diet plan that's been checked out with a doctor or dietitian. She strongly recommends keeping a food diary.
Keeping a Food Diary
A food diary is a simple and science-based way to keep a healthy diet and cut out foods that consistently aggravate your symptoms.
Cimperman described how to create your food diary in a regular notebook.
“On one side of the page, write down exactly what you eat. And on other side of the page, you write down any particular symptoms you might be having. You can look at this and maybe begin to see some patterns of foods that are irritating or foods you might have problems with.”
“This will help your doctor or dietitian take a look at your diet as a whole, and make sure your diet is a healthy diet and you're getting all the nutrients that you need.”
A common mistake that Crohn's patients make with their diet is to cut out too many foods. “The more food you cut out, the higher the likelihood of developing nutritional deficiencies,” Cimperman said.
Nutritional deficiencies can cause another set of health problems. A food diary solves this issue by helping you substitute the foods that you cut out with other foods or supplements.
Vitamins and Supplements
Again, vitamin and supplement recommendations should be individualized, Cimperman advised. But there are common nutritional needs among Crohn's patients.
Cimperman recommends looking at vitamin D and calcium because some of the medical therapies used to treat Crohn's negatively affect these minerals in the body. It's also common for Crohn's patients to be lactose intolerant, which may be another reason to consider taking extra calcium.
Many people with Crohn's are anemic and need extra iron, Cimperman said. B12 is a vitamin that's sensitive to disruptions in the gastrointestinal tract, and may need to be supplemented through a pill.
Omega 3 fatty acids could help people with Crohn's due to its anti-inflammatory properties, said Cimperman, although not enough research has been done to show a powerful effect.
Probiotics is another area where research is being done, Cimperman said. Probiotics supply “good bacteria” which may be have a beneficial effect on the gut.
There are several probiotic products on the market, and they're also found in fermented foods.
In general, Cimperman recommends taking a daily multivitamin as well as vitamin D and calcium supplements. But she emphasized that any nutritional supplement is intended to back up a healthy diet.
General Rules of Thumb
People with Crohn's have periods of “flare-ups” when the gastrointestinal tract is inflamed and their symptoms are aggravated. That's when they're more likely to be more sensitive to foods, eat less, and experience decreased appetite.
For those times, Cimperman said there are a few general diet tips.
1. Follow a low-fiber diet.
2. Decrease intake of bran, and raw fruits and vegetables.
3. Don't eat many nuts or seeds, which are difficult to digest.
She said that during periods when people are not having a flare, they should follow their individualized diet. With that in mind, she said it's a good idea to eat whole grains and cook fruits and vegetables a little before you eat them.
Cimperman emphasized that diet is a lifelong health concern.
“When you talk about diet, it's not just what you eat today, or it's not what you've eaten through past year. Its what you've eaten over your entire life that affects your health at the present time. That's why it's difficult to really hone in on one single component that might be the most helpful,” she said.
She said that diet is not just a collection of foods and nutrients. It has a lot to do with how different foods and nutrients interact with each other in a system. That's why it's so complicated.
“It's not easy topic to study, but I am hopeful that we're making progress in being able to give individuals more targeted recommendations,” she told dailyRx.
For more information on living with Crohn's and to find a support group, contact the Crohn's and Colitis Foundation of America.