patient education : 16177--Nutrition and Crohn's Disease

Nutrition and Crohn’s Disease

There is no special diet for people with Crohn’s disease. This means that research has not shown any particular foods either help or worsen disease activity.

 However, ensuring good nutrition is an important part of managing Crohn’s disease. People with Crohn’s disease are at increased risk for malnutrition and nutrient deficiencies. Poor nutrition makes it more difficult for your body to heal and fight infection. Malnutrition may also cause you to feel tired. 

People with Crohn’s disease should follow a balanced diet and be sure to get enough calories, protein, vitamins, minerals, and fluid. No specific foods must be avoided, but some people may notice that certain foods cause discomfort. If this is true for you, avoid these foods. Nutrition needs vary from person to person, so it is best to meet with a Registered Dietitian who can help you individualize your diet.

Calories and Protein

• You must eat and/or drink enough calories every day to stay at a healthy weight. People generally need more calories when they are acutely ill, such as when you are experiencing a Crohn’s flare. Rapid weight loss is a sign of malnutrition.
• The inflammation caused by Crohn’s disease increases your body’s protein needs. Too little protein intake may harm your body’s ability to heal and also leads to muscle loss. High protein foods include meats, fish, eggs, milk, cheese, yogurt, tofu, soy milk, or other products made from soybeans.

Vitamins and Minerals

• Vitamin B12 is important for normal body function. Vitamin B12 is absorbed in the ileum, a part of the small bowel often affected by Crohn’s disease. Vitamin B12 levels can be checked with a simple blood test. A supplement may be recommended if your level is low.
• Calcium and vitamin D are needed for healthy bones. Many adults do not take in enough of these nutrients, but people with Crohn’s disease are at higher risk if they avoid dairy products, since these are primary sources of calcium and vitamin D. If you avoid dairy, you may not need to – read the section below on Lactose Intolerance for more information.
• Other vitamins and minerals of special concern include: 
  • Folic acid, especially if you are on sulfasalazine or methotrexate.
  • Iron, especially if blood loss from the intestine occurs.
  • Your physician or dietitian may recommend additional vitamin and/or mineral supplements based on laboratory values or clinical condition.

Low Fiber/Low Residue: Is it necessary?

No! Dietary fiber is an important part of a balanced, healthy diet. Fiber provides energy for your colon and it also helps regulate cholesterol levels.

 If you have Crohn’s disease, there is no need to limit your intake of dietary fiber. Nor do you need to eat more than the recommended amount for the general population. Recommended daily fiber intake is 21-24 grams for women and 30-38 grams for men. Trial and error is the best way to figure out the amount of fiber you are able to tolerate in your diet. Different people feel good with different amounts, and the amount that feels best for you may also change during a Crohn’s flare.

What about the special diet I read about?

Several different diet programs have made claims that following a special eating pattern may help reduce Crohn’s disease symptoms. Currently, no good quality research studies support any special diet for treating Crohn’s disease. Some diets may temporarily improve GI symptoms because they restrict hard to digest carbohydrates, but these diets do not change the inflammation of the bowel. Unlike celiac disease, in which the body is allergic to gluten, Crohn’s disease is not a food allergy, so eliminating foods will not heal you.

You are welcome to test different eating patterns, but be careful not to restrict your diet to the point that you lose weight unintentionally. Work with a Registered Dietitian if you are following any special diet to ensure you are maintaining a balanced diet.

Special Situations

Lactose intolerance  

• Lactose is a sugar found in milk and some other dairy products. Many healthy adults may have difficulty digesting lactose and dairy products (especially in large amounts) due to low levels of lactase, the enzyme needed to break down lactose. Patients with Crohn’s disease do not have a higher incidence of lactose intolerance than the rest of the population.
• Symptoms of lactose intolerance include cramping, bloating, gas, and/or diarrhea after consuming dairy products. 
• Not all people with Crohn’s disease will experience lactose intolerance and routine avoidance of dairy products is not needed. Dairy products are a good source of calories, protein, vitamins, and minerals. 
• If dairy products cause discomfort, they should be avoided or consumed in small amounts as tolerated. Discuss your calcium and vitamin D intake with your dietitian. 

Strictures, partial obstruction, or narrowed areas of bowel

• If your doctor has informed you that you have intestinal strictures, a partial bowel obstruction, or that you have areas in the bowel which are narrowed, a low fiber diet may be recommended.
• On a low fiber diet, the following foods should be avoided: raw fruits and vegetables (especially those with pulp, edible skins or seeds), corn, beans, nuts, seeds, popcorn, raisins, whole grain products, bran products, and fiber supplements. It is also important to always chew foods well.

Additional Resources

• Crohn’s & Colitis Foundation of America: http://www.ccfa.org

• UVA Medical Nutrition Support Team: www.GInutrition.virginia.edu
  • Scroll down to the link for Nutrition Articles in Practical Gastroenterology
    • Article on Inflammatory Bowel Disease is found in the May 2003 issue
    • Article on Lactose Intolerance is in the February 2013 issue.
    • For more information on lactose intolerance, low fiber diets, or bone health, click on the link for Patient Education Handouts.