Crohn's Disease An Overview

What is Crohn's Disease?

Crohn’s disease (CD) is one of the two chronic inflammatory bowel diseases. It is an inflammatory response to intestinal microbes and can transcend to affect any region of the intestines. It is most associated with the ileum and the colon. The pathophysiology of CD is not completely understood, but includes genetic predisposition, environmental/dietary triggers, and intestine integrity. CD can cause chronic diarrhea, abdominal pain, weight loss, fever, rectal bleeding, abdominal tenderness, and potentially malabsorption.

The incidence of CD has increased annually since 1940, with the highest prevalence in Westernized nations. As mentioned above, genetic factors play a role in the development of CD; however, other risk factors include smoking, low physical activity level, history of childhood infection, formula feeding during infancy, oral contraceptive use, frequent antibiotic use, and dietary factors.

The goal of Crohn’s disease is to induce remission and remain in remission for as long as possible. This decreases symptoms and improves quality of life. Most often medications, such as anti-inflammatories or steroids, are needed to induce a remission and aims to decrease inflammation of the intestines. Maintaining a healthy intestine is ideal for CD. Intestinal health can encompass many things, but primarily we are interested in decreasing inflammation and promoting a healthy intestinal microbiota. Your microbiota is a collection of microorganisms such as bacteria, viruses, and parasites that inhabit an area in the body. A healthy intestinal microbiota can maintain the integrity of your intestines, produce anti-inflammatory substances, support your immune system, and produce some of the bodies needed vitamins!

Crohn's Disease and nutrition

Dietary risks to developing CD and to evoke a flare up in CD are identical. Dietary risks include high refined sugar, saturated fat, animal protein, and alcohol intake.

Refined sugar

Refined/added sugars can suppress the mucosal immune system and cause inflammation. Some examples include corn syrup, high fructose corn syrup, cane sugar, coconut sugar, brown sugar, brown rice syrup, fruit juice concentrates, agave, honey, and other syrups/sugars. You can replace these in the diets by gravitating towards fresh fruits and less sweetened products like dark chocolate. Some sneaky sources of sugars can come from even “healthy” seeming products like yogurts, marinades, salad dressings, condiments, and breads.

Saturated Fat

Food high in saturated fat includes fried foods, fast food products, butter, high fat dairy such as whole milk and ice cream, red meat, and processed foods like baked goods and sausages. Aim for less inflammatory fat choices like your unsaturated fats that come from nuts, seeds, olive oils, and fishes.

Animal protein intake

High protein intake, especially from red meats and processed meats can alter the bacteria in the intestines and produce inflammatory byproducts. Try choosing lean proteins like eggs, chicken, turkey, fish, and shellfish when consuming animal and fish products. Explore with some vegetarian options such as edamame, tofu, beans, lentils, and quinoa.

Alcohol

Alcohol consumption can also cause a flare up of CD and irritate the intestinal tract. It is best to completely eliminate or consume in very small doses. Mocktails and seltzers are great alternatives to alcohol!

Follow these recommendations

It may seem daunting looking at a list of what you cannot have, which is why focusing on what you can have may be more important! Dietary approaches should aim to stay as anti-inflammatory as possible and support the gut microbiota. Go to recommendations for CD include:

Increase Fiber

A high fiber diet can normalize bowl movements, support the growth of beneficial bacteria in the intestines, and keep the intestines clean. Fiber is a non-digestible carbohydrate and will come from the following foods: whole grains, fruits, vegetables, beans, lentils, nuts, and seeds. High sources of fiber include lentils, oats, whole grains like farro, broccoli, chickpeas, chia seeds, ground flax, kiwi, and blackberries. Fiber intake should at a minimum be at 25-30 grams but can exceed that number! It is best to start slow introducing more fiber into your diet and make sure you are drinking plenty of water with it.

Consumer Fruits and Vegetables

Controlling the inflammation of the intestines is key in managing CD. Consuming a diet high in antioxidants to fight against free radicals and reactive oxygen species can help to encourage an anti-inflammatory intestine. All fruits and vegetables, frozen and fresh, are great options! Aim for 5 servings minimum of fruits and vegetables daily. Try to get a variety of color and eat the rainbow of colors from red to purple. A variety of colors will ensure you get a great variety of antioxidants. A serving of vegetables is 1 cup cooked or raw and 2 cups of leafy greens. A serving of fruit includes 1 cup or 1 whole fruit.

Eliminate Processed Foods

This is probably the hardest guideline to follow, as a lot of foods in the US are processed! Do not drive yourself crazy with this but eliminate any product where you are unable to pronounce the ingredient, or you have no idea what it is. This simple rule helps to remove products packed with artificial flavors, colorings, and sweeteners that may alter your gut microflora.

Try a Flexitarian DIet

There has been some strong research on a longer duration of remission in CD patients while on a vegetarian diet. No need to eliminate animal proteins completely but try to incorporate some plant-based proteins throughout the week. Eating more plant based two or three times per week can help bring more fiber into your diet as well. Below are some of my favorite plant based products:

Altering your diet can seem very intensive, but take it step by step! Start by eliminating one or two products that may increase risks and/or including one or two products that may benefit CD. Even small changes can be successful!

Other Considerations

Dietary factors are not the only tools to aid with CD, both physical activity and stress can impact CD. It is important to stay active within your means and maintain a good physical activity regiment. Stress can impact the health of your intestines and increase inflammation in the body. Focusing on finding good stress management techniques can be a helpful tool to help manage CD.

When diagnosed with CD it is common to feel nervous and scared. Finding healthcare professionals that can help you better understand the disease is important. Dietary guidance by a Registered Dietitian can help to maintain remission and improve the integrity of the intestines! Everyone is different, a more individualized plan may be needed to help you manage your CD. Registered Dietitians at Husk Nutrition work with your personal habits, other diagnoses, food likes and dislikes and help create a plan for you. We discuss and implement lifestyle change and talk through strategies to stay on track with your goals.

By Elle Bernardo, Registered Dietitian

References

Dietary factors are not the only tools to aid with CD, both physical activity and stress can impact CD. It is important to stay active within your means and maintain a good physical activity regiment. Stress can impact the health of your intestines and increase inflammation in the body. Focusing on finding good stress management techniques can be a helpful tool to help manage CD.

By Elle Bernardo, Registered Dietitian
Elle Bernardo is a Registered Dietitian in the states of New Jersey, Pennsylvania, Oregon, Utah and Washington.