Can diet help people with Crohn's disease?
Everyone with Crohn’s has their own story and people make different decisions about how to live with the disease. Many people are told by their doctor that diet has nothing to do with Crohn’s. Science does currently show that the best treatment for inducing remission (significantly reducing the severity of symptoms) is steroids. However, it is not true to say that diet and nutrition have nothing to do with Crohn’s.
There are three keys areas of interest:
- Inducing remission.
- Staying in remission for longer.
- Health and quality of life whilst in remission.
Diet can help those who cannot take steroids for example children, pregnant and breastfeeding women or those who find they need higher doses of steroids to sustain remission than would normally be recommended.
If steroids are not for you then stopping all food and drink except water and taking a specially prescribed liquid diet for two to three weeks can induce remission. This diet should be prescribed and supervised by a registered dietitian working with your gastroenterology team.
Once you have achieved remission food can be gradually reintroduced starting with a limited selection of foods known as the LOFFLEX diet. This stands for low fat, fibre limited exclusion diet and it should be followed for two weeks. Your dietitian will give you recipes and advice to make the diet more palatable. After this time foods can be gradually reintroduced over several months. The diet is essentially a diagnostic tool to find out which foods you can and cannot tolerate and the eventual list of foods is different for everyone. At the end of the process, your dietitian will assess your diet and give advice to ensure that you maintain weight and stay in good overall health.
Staying in remission
There is some evidence that following the LOFFLEX diet to identify foods that trigger symptoms and then sticking mainly to your list of 'safe' foods can help you stay in remission for longer. You should have regular reviews with your dietitian to make sure that all your nutritional needs continue to be met.
Enjoying the best possible quality of life and health whilst in remission
The aim is to have a healthy, balanced diet whilst keeping any niggling symptoms to a minimum. Advice varies from person to person depending on symptoms and your specific circumstances but the core advice is the same as for the general population. If you have used the LOFFLEX diet and have identified some trigger foods then you should follow the advice below whilst avoiding your trigger foods as much as possible. The key points to remember are:
- Eat at least five portions of fruit/vegetables every day and include a wide variety. If you can’t tolerate this then try removing skins, pith, seeds and stalks and/or try having them in smoothies or pureed in soups. If you suffer with wind or bloating avoid peas, beans and brassicas (eg: cabbage, cauliflower, broccoli).
- Include whatever high fibre foods you tolerate. If you have strictures you may need to follow a low fibre diet but if you have constipation fibre may help you. If you are able to tolerate fibre then as well as fruit and vegetables have unsweetened breakfast cereal, bread, potato, rice, pasta and couscous and if you can tolerate the wholegrain versions then that’s great. Most people find that things like granary bread are best avoided because of the lumps of grain.
- Have three portions of dairy foods each day or if dairy foods trigger symptoms for you use dairy alternatives such as soya drinks and yogurts but make sure they have been fortified with calcium for strong bones. Choose lower-fat and lower-sugar options unless you are trying to put on weight after a flare-up.
- Eat fish, eggs, lean meat and poultry to get protein for strong muscles and cell renewal and include some beans and pulses if you tolerate them.
- Watch your fat and oil intake and avoid fatty/processed meats and fatty convenience foods unless you are trying to gain weight after a flare-up. Check labels and avoid trans fats wherever possible as these increase your risk of heart disease, stroke and type 2 diabetes. Trans fats tend to be found in cakes, biscuits and confectionery. If you use oil in cooking use rapeseed oil or olive oil as these are healthier for your heart. Heat the oil gently to minimise the production of aldehydes which have been linked with higher rates of cancer Have one portion of oily fish every week for those good omega 3 fats e.g. salmon, mackerel, sardines, pilchards.
- Keep added or free sugars below 6tsp/day unless you are trying to gain weight.
- Drink plenty of fluids – six to eight cups or glasses a day. Please keep at or below 14 units of alcohol per week. Alcohol increases the risk of cancer, doesn’t count towards your six to eight glasses of fluid and often triggers symptoms! Avoid those sugary drinks as much as you can. If you suffer with wind avoid fizzy drink.
As well as all this standard advice for healthy eating there are a few extra things to bear in mind if you have Crohn’s. Your dietitian will check your risk of iron deficiency, vitamin B12 deficiency, your calcium and vitamin D intake (as the risk of osteoporosis is higher for people with Crohn’s) and your absorption of fat and fat-soluble vitamins. Sometimes supplements are required in addition to a healthy diet but everyone is different and your dietitian will give you advice tailored to your specific needs.
So there is a lot to think about but the key thing is to remember that everyone’s symptoms and circumstances are different so do get regular assessments and advice.