Crohn's disease is a chronic inflammatory disease of the digestive system characterized by alternating flare-ups and periods of remission.
It manifests mainly as episodes of abdominal pain and diarrhea, which can last several weeks or even several months. If no treatment is started, fatigue, weight loss and even malnutrition may ensue.
Crohn's disease has many causes, involving genetic, autoimmune and environmental factors. The prevalence of this disease has tended to increase since the 1950s, and a higher prevalence is observed in industrialized countries, which suggests that environmental factors probably associated with the Western lifestyle might have a major influence on the development of the disease.
What role does diet play in the development of this disease?
Attempts have often been made to point the finger at diet as a causal factor in Crohn's disease. We know that our diet is generally higher in sugars and fats than in Asian countries. When people from countries where the prevalence of inflammatory disease is low immigrate to a country where the prevalence of inflammatory bowel disease is high, they acquire the same risk for developing the disease as that in the adoptive country.
In addition, some researchers have noted that people with Crohn's had a diet higher in refined sugars during the years before the disease was diagnosed, which suggests that foods high in refined sugars (such as white sugar, brown sugar, fructose, corn syrup, soft drinks, candy and desserts) might be a risk factor for developing Crohn's.
Similarly, eating large amounts of animal protein (especially that in meat) and fats (saturated and polyunsaturated fats, including omega-6) could also contribute to an increased risk of developing this disease. In contrast, it seems that a diet high in fibre (fruits, vegetables, whole-grain grain products, legumes) confers protection.
I feel that certain foods increase the symptoms of my illness. Should I eliminate them from my diet?
Many people with Crohn's disease feel that certain foods exacerbate the symptoms of their illness. Rest assured that no particular food in itself can worsen or cause a flare-up of this disease. We should be cautious when eliminating nutritional foods from our diet, for this could put us at risk for developing deficiencies in vitamins and other nutrients. Usually, the symptoms are associated with Crohn's per se rather than with a particular food.
Depending on the extent and where the disease is active in the small intestine, dairy products can sometimes temporarily be poorly tolerated because of lactose intolerance. Lactose is the natural sugar found in dairy products (milk, cheese, yogurt, ice cream. etc.). Abdominal pain, bloating and diarrhea are the main symptoms of lactose intolerance, and in most cases, they occur 30 minutes to 2 hours after eating foods with a high lactose content.
If you feel that you don't tolerate dairy products well, you can try eliminating all dairy products from your diet for a week to see if you are lactose-intolerant. After eliminating these products, reintroduce them gradually one at a time and carefully monitor your symptoms. If the bloating, abdominal pain and/or diarrhea disappear or gradually diminish with the dairy-free diet but reappear within 4 hours after eating a dairy product, it's possible that you are lactose-intolerant.
Lactose intolerance can vary from person to person. Some are intolerant to all dairy products, while others are intolerant only to milk. Before permanently eliminating these foods, which are an important source of calcium and vitamin D. talk to your doctor or pharmacist. There are many lactose-free products on the market, as well as lactase tablets, which may enable one to eat dairy products without being inconvenienced!
I frequently notice pieces of certain foods in my stool. Should I be concerned about this?
The presence of intact pieces of certain foods in one's stool is not necessarily associated with Crohn's disease being active or the food being poorly tolerated, but can instead simply be a sign of accelerated intestinal transit. In other words, the time an ingested food takes to travel from the mouth to the colon is faster. If you haven't lost any weight and don't have any other associated symptoms, there is no need to worry.
Should I take vitamin and mineral supplements?
It's not necessary to take vitamin and mineral supplements, especially if your diet is well balanced. Depending on your medical condition, your doctor may nonetheless suggest that you take vitamin D and/or calcium supplements, especially if you're taking cortisone (prednisone) to control your illness, since this medication reduces the absorption of these nutrients. Your doctor might also prescribe other vitamin and/or mineral supplements if your bowel can no longer properly absorb certain nutrients or if part of your small intestine has been resected. If you have iron-deficiency anemia. your doctor might also advise you to take iron tablets.
When my Crohn's is active, should I avoid eating certain foods?
To reduce discomfort during flare-ups, it's advisable to reduce your intake of dietary fibre (raw or unpeeled fruits and vegetables, whole-grain grain products, such as dark bread). These foods do not have any harmful effects as such on the gastrointestinal tract, but since dietary fibre increases stool volume, it makes sense to restrict your fibre intake during flare-ups. Cooked vegetables are more easily tolerated during flare-ups (cooked carrots, potatoes, etc.) than raw vegetables.
Don't forget that when a flare-up subsides, this restriction is no longer necessary and should not be continued, as you could deprive yourself of wholesome foods containing nutrients and essential vitamins. Therefore, as soon as your stool returns to normal or near normal, gradually aim for a well-balanced and as normal a diet as possible.
The only exception to this rule is if your doctor has told you that there is significant narrowing of your bowel (stenosis) due to your Crohn's disease. In this case, certain foods may partially block the passage and sometimes completely block the bowel and prevent the evacuation of gas and stool. You should therefore avoid swallowing fruit pits or seeds and limit your intake of fibre, such as that in dried fruit, nuts (almonds, hazelnuts, peanuts, etc.), corn and so on. Otherwise, definitely don't limit yourself. Savour each bite and enjoy one of the small pleasures in life!
What should I eat to avoid vitamin deficiencies?
A balanced diet with no restrictions is the best way to prevent vitamin and/or mineral deficiencies. If balanced, your dietary intakes will usually suffice. If you have low iron reserves, it might be useful to eat foods that are high in iron, such as liver and red meat. You should take in enough calcium to prevent your bones from demineralizing, which can happen with the use of cortisone derivatives (prednisone). Consume at least two portions of dairy products — milk, cheese and/ or yogurt — daily, if well tolerated.
Vitamin D is necessary to ensure good calcium and magnesium absorption. Vitamin D is found in food (especially milk), and it is also synthesized by our skin through the action of sunlight. If you have problems meeting your calorie, vitamin and mineral requirements during a flare-up of your illness, an oral supplement in the form of a liquid or pudding meal replacement or diet supplement might be recommended so that you receive all the necessary nutrients for optimizing your treatment and aiming for a possible remission of your illness. If you have had surgery that involved a rather large resection of the last portion of your small intestine, your doctor may prescribe vitamin 13, 2 as a monthly injection to prevent a deficiency in this vitamin.
Are probiotics useful for my condition?
Probiotics sold in tablets or added to certain foods, such as yogurt, are bacteria that can be useful for restoring the natural bacterial flora in the digestive system. Based on current research, probiotics do not seem to be effective in preventing a relapse of or maintaining remission in Crohn's disease. If you nonetheless want to take probiotics, it's important that you talk to your doctor to make sure that there aren't any contraindications with the use of certain drugs.
Are Omega-3s useful for my condition?
Omega-3s occur naturally in certain foods, such as canola oil and flaxseed oil, and in fatty fish, such as salmon, cod and herring. They are also sold in capsules in pharmacies. Although antiinflammatory properties are attributed to them, the current data do not seem to suggest that they are useful for reducing bowel inflammation or for maintaining remission in Crohn's disease, In any event, omega-3s are recognized as being beneficial for heart health and mood, and there aren't any contraindications to taking them if you want to do this!
I'm afraid to reintroduce foods after a flare-up. What should I do?
Go ahead and reintroduce the foods gradually. If the symptoms of your illness have disappeared with treatment, you shouldn't be worried about eating again normally! Feel free to try to eat again a food that you didn't tolerate well a few days or a few weeks earlier. It's very likely that it won't cause you any problems.
I have Crohn's Disease and would like to become pregnant. Do I need to be on a special diet?
If you want to become pregnant, it's very important that your illness be in remission before and throughout your pregnancy. If you're taking medications, your doctor will check that they are safe for carrying a pregnancy to term problem-free. Talk to your doctor about Crohn's medications that you can continue taking during conception and throughout your pregnancy. Be sure to consult your doctor before you stop taking any medication. A folic acid supplement is essential during the first 3 months preceding conception and during the first 3 months of pregnancy in order to reduce the risk of spinal cord defects in the baby (spina bifida). It's important to continue to eat a good, balanced diet and to limit your intake of overly sweet and overly fatty foods. During your pregnancy, you will probably be advised to take a multivitamin supplement. Feel free to consult your doctor if you experience any symptoms of your illness during your pregnancy so that an appropriate medication can be started as soon as possible to control the disease and ensure a normal pregnancy.
Can I breastfeed my baby?
If you plan to breastfeed, talk to your doctor so that he/she can check that you can continue taking your medications without any problems. Interestingly, breastfeeding could lower the risk of your baby developing Crohn's disease.
I have an ostomy. Do I need to be on a special diet?
Having an ostomy doesn't mean that you have to be on a special diet. Your diet should simply be balanced, like for anyone else, and it should, above all, provide pleasure! If you have a colostomy, there aren't any restrictions that you need to follow. In the case of an ileostomy, stool may be somewhat more liquidy and abundant. If you have just had surgery involving the installation of an ileostomy, it will be suggested, at the beginning, that you eat a low-fibre diet. However, in a few weeks, the small intestine will learn to reabsorb water to a greater degree. Little by little, there will be no need for the low-fibre diet and you will be able to gradually reintroduce cooked fruits and vegetables, then raw fruits and vegetables and other foods that are high in fibre. Your diet can return to normal after a month.
Remember especially to drink plenty of fluids, unless your doctor advises you otherwise if a very large portion of your small intestine has been resected, leaving a short bowel. In such case, your doctor and your nutritionist can advise you on the ideal diet to follow. Certain foods may promote the production of gas and should be eaten in moderation, such as mushrooms, turnips, artichokes and legumes.
Eat slowly, cut down on gum, soft drinks and sparkling beverages, and remember that drinking liquids with a straw promotes the swallowing of air and, as a result, intestinal gas! You may notice that certain foods produce strong odours when you empty your bag. Examples include onions, garlic, broccoli, asparagus, cabbage, Brussels sprouts, cauliflower, fish, certain cheeses, eggs, legumes, cucumbers, turnips, coffee, radishes and alcohol.
On the other hand, certain foods, such as yogurt and parsley, can reduce odours. Eating at regular times and chewing slowly are two good eating habits to be adopted. Some foods, such as tomato juice, fruit juices containing cherry or cranberry, and red jellies can turn stool red. No need to worry.
Lastly, please remember that eating is one of life's pleasures and that adopting healthy eating habits contributes to maintaining our health capital and further equip us to deal with this disease. Bon appetite!