Diet and Nutrition in Crohn Disease

Most of us know that good nutrition is essential to good health. Good nutrition is even more important to people whose health is compromised by a chronic disease. When you have Crohn disease, maintaining good nutrition can be a real challenge.

Several factors contribute to nutritional problems in people with Crohn disease. When inflamed, the small intestine is not able to do its main job, which is absorbing nutrients from food. The degree of this impairment, called malabsorption, depends on the extent of inflammation and damage in the intestine.
 
To make matters worse, the intestinal inflammation and pain of the disease reduce your appetite, so you probably do not eat enough to supply your nutritional needs. Diarrhea further depletes important nutrients. Compounding the problem is the fact that people with a chronic illness such as Crohn disease require more calories and certain other nutrients than healthy people. The most common nutritional problem in people with Crohn disease is insufficient calorie intake.

The human body needs proteins, fats, calories, vitamins, and minerals to grow, build new cells and tissues, and carry out its many functions. Most of these nutrients are contained in the foods we eat. To ensure that we get all of the nutrients we need, we are advised to eat a balanced diet from the 4 food groups: meat and other proteins, dairy products, fruits and vegetables, and cereals and grains.
 
When we eat, foods are broken down in the stomach and intestines. Nutrients are absorbed through the wall of the small intestine, and the waste is eliminated as stool or feces when we have a bowel movement. This process is impaired in people with Crohn disease, and nutritional deficiencies can result. 

Nutritional deficiencies are a problem for almost everyone with Crohn disease, but they are most serious in children and teens who are still growing. Growth can be stunted permanently and sexual development (puberty) delayed in these young people. Girls and women can develop hormone imbalances and stop menstruating. Nutritional deficiencies also can prevent medications from working as well as they should in healthy people.
 
In general, nutritional deficiencies are not consistent with good health. They can make you to feel weak, tired, depressed, or just “blah.” They leave you vulnerable to infections and other diseases. They can stop anyone from looking, feeling, or performing at his or her best.

There is no evidence that diet has anything to do with causing inflammation or Crohn disease. No matter what you ate in the past, it probably played no part in your having Crohn disease today. Unfortunately, though, now that you have Crohn disease, you may find that you can no longer comfortably eat certain foods you once enjoyed.

There is no evidence linking food allergies with Crohn disease. Experts now believe that many people thought to have food allergies may actually be experiencing early symptoms of Crohn disease, ulcerative colitis, or similar digestive diseases.

There is no specific diet that is recommended for everyone with Crohn disease. However, many people with Crohn disease can reduce their symptoms by changing their eating habits or avoiding certain foods.
 
Foods that often cause problems are milk and other dairy products, spicy foods, fatty or fried foods, and high-fiber foods. Foods such as raw or dried fruits and vegetables, nuts, seeds, and popcorn may also worsen your symptoms. People often learn which foods they can or cannot tolerate through trial and error. 

There are many tasty foods that provide good nutrition and may not irritate your digestive tract. If you can tolerate dairy products, ice cream or milk shakes made with ice cream or yogurt are a good choice. Pizza or a cheeseburger may be a good choice. These foods are high in calories, satisfying, and taste good.
 
Remember, though, that a steady diet of high-fat, salty foods such as cheeseburgers can cause other problems such as heart disease or high blood pressure. You certainly don’t need those problems on top of Crohn disease. High-fat “junk” foods should not be daily fare.

Some people with Crohn disease are simply unable to meet their nutritional needs through the food they eat. Others are not able to take solid food during a severe Crohn flare or after surgery on their intestines. Still others, such as growing children, need extra nutritional support. Each of these groups may benefit from a special diet.
 
The 2 most widely used special diets are elemental diets and total parenteral nutrition. In some people these diets are temporary measures; others will be on special diets for the rest of their life.

Elemental diets are liquid diets that contain all the nutrients your body needs. The nutrients are usually in digested form so they put no stress on the digestive system. Elemental diets supply all your nutritional needs while giving your digestive system a rest.

Total parenteral nutrition is another way of supplying all your nutritional needs. The nutrients are given directly into the bloodstream via a vein. This intravenous feeding generally is reserved for people who are unable to digest food or are severely malnourished. People with severe inflammation not responsive to medications, complications from Crohn disease such as fistulas, or a very small amount of bowel left that is insufficient to digest and absorb food may also receive TPN. 

Your need for vitamin and mineral supplements depends on several factors: your diet, which parts of your digestive tract are affected, and whether you have had surgery on your small intestine. The most common vitamin deficiencies are vitamins D and B-12, and the most common mineral deficiencies are iron, calcium, potassium, and magnesium. Talk to your health care provider about taking supplements.

Some medications used to treat Crohn disease, such as sulfasalazine, can interfere with absorption of nutrients from food. Certain medications taken for other medical conditions also can affect levels of vitamins and minerals in the body. Ask your health care provider to review all of your medications.

Drinking alcohol is not recommended for most people with Crohn disease. Alcohol may irritate the lining of the intestinal wall, causing or worsening symptoms such as vomiting, diarrhea, and bleeding. It also may contribute to malabsorption, further complicating nutritional deficiencies. Alcohol interacts with many medications, causing side effects that may be serious. Finally, alcohol disrupts sleep cycles and can leave you feeling tired and irritable the next day. However, if alcohol is well tolerated and not causing any complications, it can be consumed in moderation.

Chronic diarrhea can lead to dehydration very easily. Dehydration makes you feel weak, tired, light-headed, or just “blah.” It can cause headaches, abdominal pain, and other symptoms. It also can place dangerous strain on your kidneys. Dehydration can be avoided by making a special effort to take in plenty of nonalcoholic fluids. You should take at least 8 full glasses of fluid every day. Try to stick to water, diluted fruit juice, sports drinks, decaffeinated beverages, and fruit and vegetable drinks. Avoid caffeinated beverages and sodas.

These tips may help you feel better during and after eating:

• Keep a food diary. Record everything you eat and whether it causes you any problems. Design your own diet around what works for you.
  
  
• Stock your home with foods that you enjoy and do not cause you problems.
  
  
• Eat several small meals a day rather than a few large meals. This helps many people reduce or avoid symptoms.
  
  
• Eat when you are hungry.
  
  
• Take small bites of food and chew each bite completely.

Your health care provider should be able to provide suggestions and guidance on diet choices. If you feel you need more help designing a diet that works best for you, ask him or her to refer you to a dietitian. These professionals are trained to tailor diets for individuals with specific diseases.

Check the web site of the Crohn’s & Colitis Foundation of America for more information.

Crohn’s & Colitis Foundation of America (CCFA)
386 Park Avenue South
17^th Floor
New York, NY 10016
(800) 932-2423
 
National Digestive Diseases Information Clearinghouse
National Institute of Diabetes and Digestive and Kidney Disease
National Institutes of Health
2 Information Way
Bethesda, MD 20802-3570

|Web Links|

American Gastroenterological Association, Inflammatory Bowel Disease

Crohn's & Colitis Foundation of America

National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), Crohn's Disease

Pediatric Crohn’s & Colitis Association, Inc.

United Ostomy Association, Inc.

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Author: Kathryn L Hale, MS, PA-C, Medical Writer, .com, Inc.

Coauthor(s): Sandeep Mukherjee, MD, MB, BCh, Assistant Professor, Department of Internal Medicine, Section of Gastroenterology and Hepatology, University of Nebraska Medical Center.

Editors: Simmy Bank, MD, MB, ChB, Chair, Professor, Department of Internal Medicine, Division of Gastroenterology, Long Island Jewish Hospital, Albert Einstein College of Medicine; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; BS Anand, MD, Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor University College of Medicine.