Crohn disease is an idiopathic, chronic, transmural inflammatory process of the bowel that often leads to fibrosis and obstructive symptoms, which can affect any part of the gastrointestinal (GI) tract from the mouth to the anus.
Most digestion and absorption occurs in the small intestine. The small intestine has 3 parts: 1) the duodenum, 2) the jejunum, and 3) theileum. Enzymes and other substances made by intestinal cells, the pancreas, and the liver are secreted into the small intestine and breakdown starches, sugars, fats, and proteins. Absorption of nutrients occurs through the millions of tiny fingerlike projections called villi and the even tinier projections on the villi called microvilli. Any undigested material moves to the large intestine. The large intestine or colon has four sections called the 1) cecum/ascending colon, 2) transverse colon, 3) descending colon/sigmoid, and 4) rectum. The main job of the large intestine is to remove water and salts (electrolytes) from the undigested material and to form solid waste (feces) that can be excreted. The remaining contents of the large intestine move to the rectum, where feces are stored until they leave the body through the anus as a bowel movement. (emedicinehealth.com)
Crohn’s disease is sometimes called regional enteritis or ileitis. It and a similar condition called ulcerative colitis are referred to together asinflammatory bowel disease (IBD). These illnesses are known for their unpredictable flares and remissions.
Crohn’s disease can be a debilitating illness. However, with medical treatment and other measures used to reduce the discomfort of flares, most people learn to cope with the condition. Almost everyone with Crohn’s disease can live a normal life.(emedicinehealth.com)
What Is Inflammatory Bowel Disease?
Inflammatory bowel disease (IBD) refers to chronic conditions that cause inflammation in some part of the intestines. The intestinal walls become swollen, inflamed, and develop ulcers, which can cause discomfort and serious digestive problems. The exact symptoms depend on which part of the digestive tract is involved. (webmd.com)
Types of IBD: Crohn’s Disease
Crohn’s disease is a form of IBD that can occur anywhere along the digestive tract — from the mouth to the anus. It affects the deeper layers of the digestive lining and can occur as “skip lesions” between healthy areas. Crohn’s often involves the small intestine, the colon, or both. Internal tissues may develop shallow, crater-like areas or deeper sores and a cobblestone (webmd.com)
TYPES OF IBD: ULCERATIVE COLITIS
Unlike Crohn’s disease, ulcerative colitis only involves the colon and rectum. Inflammation and ulcers typically affect only the innermost lining in these areas, compared with the deeper lesions seen in Crohn’s disease. Often only the lower (sigmoid) colon is affected, but it can occur higher up, too. The more of the colon that is affected, the worse the symptoms will be.
Symptoms of IBD (Inflammatory Bowel disease)
The symptoms of ulcerative colitis and Crohn’s disease are similar:
- Abdominal pain or cramping
- Diarrhea multiple times per day
- Bloody stools
- Weight loss
Other Symptoms of IBD (INFLAMMATORY BOWEL DISEASE)
People with IBD may have symptoms outside the digestive tract, such as:
- Mouth sores and skin problems
- Eye problems that affect vision
What Causes IBD?
Doctors aren’t sure what causes IBD. Most believe something triggers the body’s immune system to produce an unhealthy inflammatory reaction in the digestive tract. Ongoing research has uncovered specific genes linked to ulcerative colitis and Crohn’s disease.
IBD is sometimes confused with IBS, which stands for irritable bowel syndrome. Both conditions can cause chronic digestive problems, but there are significant differences between the two. People with IBD have inflammation, ulcers, and other damage visible inside the digestive tract. In contrast, there is no damage in IBS, despite symptoms such as cramping, diarrhea, and constipation. IBS is much more common but less serious than IBD. (webmd.com)
How is Crohn’s disease treated?
There is no cure for Crohn’s disease. Treatment is determined by the severity and location of the disease. Because the disease can sometimes go into remission on its own, it’s not always possible to determine whether a specific treatment has been effective.
When Crohn’s disease is active, treatment has three objectives:
Help with getting proper nutrition
Medications are generally the first step in treating Crohn’s disease. A partial list of these drugs includes:
For people with nutrition problems, supplements are often prescribed.
Two-thirds to three-quarters of people with Crohn’s disease will eventually need surgery to treat their illness. There are several reasons why surgery might be needed:
The medications are not working to control symptoms or do not work effectively enough.
The drug side effects are unbearable.
The person has serious complications that only surgery can correct.
What are the complications of Crohn’s disease that might require surgery?
Patients who have the following complications of Crohn’s may need surgery:
The formation of a stricture (a scar), which is a narrowing in the bowel that can cause obstructions (blockages)
Extensive bleeding in the intestine
A hole, or perforation, in the bowel wall
The formation of a fistula, which is a connection between two parts of the body that do not normally connect
The formation of an abscess, which is a pocket of pus caused by infection
A condition known as toxic megacolon, in which the colon, or large intestine, is severely stretched out and toxins spread through the blood.
What kinds of surgery are performed to treat Crohn’s disease?
Surgery to treat Crohn’s disease depends on several factors:
Where the disease is located in the intestines
How severe the disease is
The purpose of the surgery — which complication it will treat
It’s important to note that surgery, like medications, does not cure Crohn’s disease. After the diseased part of the bowel is removed, Crohn’s can reappear in some other part of the intestine or elsewhere.
Many people are wary of having surgery to treat Crohn’s disease. Each part of the intestines serves a particular purpose and removing part of the bowels may impair bowel function, leading to diarrhea or malnutrition. Also, surgery is not for everyone. It is best to collect as much information as possible and to consult closely with the appropriate health care professionals to determine the best possible treatment.
Surgery for Crohn’s Disease
Here are the kinds of surgery that are done:
Strictureplasty. Crohn’s disease in the small intestine often shows up in alternating areas of the bowel. As a result, a diseased portion of the bowel is connected to a disease-free portion. Strictureplasty is a surgical procedure to widen the narrow area of the small intestine in a portion that is affected by the disease. No part of the intestine is removed.
Resection. Resection is a surgical procedure in which part of the intestine is removed. This surgery may be necessary when the stricture is very long. It may also be necessary when there are many strictures located near each other. The remaining healthy bowel sections are sewn together to create what’s called an anastomosis. The removal of the diseased portion of the bowel may provide the patient with relief from symptoms for many years. But the disease can come back at or near the point where the two sections of bowel are sewn together.
Colectomy. Colectomy is the removal of the entire colon. This surgery might be done if the disease is severe and extensive enough. It may be possible to connect the rectum to the small intestine — ileum — if the rectum is not affected by Crohn’s disease.
Proctocolectomy. If both the rectum and colon are affected, both are removed with a surgery called a proctocolectomy. A proctocolectomy is performed along with an ileostomy. The latter surgery brings the end of the small intestine through a hole in the lower abdomen so that waste can exit the body. The hole is called a stoma. When this procedure is necessary, the waste drains into an external bag that has to be emptied throughout the day. The bag or pouch is concealed by clothing and is not noticeable.
In about half of adults who have a resection to treat Crohn’s disease, the disease recurs (comes back) within five years. The recurrence is normally near the site of the joining of two sections of healthy bowel — anastomosis — or at the site of the ileostomy.
The risk of recurrence may be lessened by taking medication to reduce inflammation. These medications include drugs that contain 5-aminosalicylic acid (5-ASA agents, like aspirin but designed to work in the intestintes) or drugs that manipulate the immune system response. These drugs are known as immunomodulators. Often, recurrent Crohn’s disease requires treatment that involves only medication. But about half of those who experience recurrent Crohn’s disease will require another surgery.
Are there other times when surgery is used to treat Crohn’s disease?
A person with Crohn’s disease who has developed a fistula or an abscess may need surgery. Fistulas, the abnormal passageways, may first be treated with medication. But if drugs do not help the fistulas to close, then the patient will need a bowel resection (removal of the problem area) and anastomosis (reconnection of the normal bowel).
In order to heal an abscess, the pocket of infection usually must be drained. The patient will have a computed tomography (CT) scan to let the doctor locate the abscess. In some cases, the pus can be fully drained with a tube place through the skin. In many cases, however, surgery is needed to treat the abscess.
Medical Reference: webmd.com
Natural Treatments for Crohn’s Disease
The first line of treatment for Crohn’s is typically medication, but more patients are also seeking natural treatments to ease their symptoms. Natural treatments are sometimes also called alternative, complementary, or integrative medicine.
While all three terms generally refer to a treatment outside of typical mainstream medicine, they actually refer to different things.
- Alternative medicine means you’re using a nonmainstream, nontraditional approach to treat an illness rather than a conventional, evidence-based medicine.
- Complementary medicine means you’re using a nonmainstream approach along with conventional therapy.
- Integrative medicine means you’re using a nonmainstream treatment and a conventional treatment in a complementary way.
Here are six natural treatments for Crohn’s disease.
Your gastrointestinal tract contains “good” bacteria, which help with digestion and offer protection against “bad” bacteria. If you’ve taken antibiotics or have an illness, you may not have a sufficient supply of the good bacteria.
Probiotics are living microorganisms that you can consume. They are found in certain foods or you can take probiotic supplements. They act very much like the good bacteria in your gut. Probiotics may be more or less beneficial depending on the location and stage of your disease. Some strains might work for one person but not others.
Although yogurt is one of the most common sources of probiotics, many people with Crohn’s disease are sensitive to dairy products. Other foods that contain probiotic include:
If you decide to try probiotics, talk to your doctor first.
Prebiotics are nondigestible carbohydrates found in things like:
Prebiotics are food for probiotics and for intestinal bacteria. Adding prebiotics to your diet might improve the function of your normal intestinal bacteria. Using prebiotics along with probiotics might make the probiotics more effective.
Fish oil has long been used to promote cholesterol health, but its also been suggested that it has benefits for Crohn’s patients. Omega-3 fatty acids, found in fish oil, may have anti-inflammatory properties and may help reduce Crohn’s symptoms. One study found that patients taking fish oil were twice as likely to remain in remission as those who took a placebo.
Talk to your doctor before starting fish oil supplementation. Taking high doses of fish oil, or taking it in combination with blood thinning medication, may lead to bleeding problems.
Acupuncture is an ancient practice that uses thin needles inserted into specific points on your body. It’s believed that this stimulates your brain to release endorphins. Endorphins are chemicals that block pain. They may also strengthen your immune system and help fight infection.
Biofeedback is a form of relaxation therapy. With the help of a machine, you’re able to see how your body responds to pain. You can also learn how to control your responses to:
- body temperature
- perspiration level
- blood flow
- brain waves
Overtime, you can learn to manage your muscle contractions and pain.
Herbal and Botanical Treatments
There are some herbal and botanical treatments that may help ease the symptoms of Crohn’s disease. These include:
Talk to you doctor before trying any herbal or botanical treatments. Some can interact dangerously with medications you might be taking. They may also have undesirable side effects.
As always, it’s a good idea to talk to your doctor about any other therapies you’re considering. Some therapies may work well in conjunction with the medical treatments you currently use. Others may interact dangerously with your medical treatments.
Remission and Relapse
Inflammation from Crohn’s disease can happen anywhere along the digestive tract. It most commonly affects the end of the small intestine (the ileum) and the beginning of the large intestine (colon).
Even with treatment, people with Crohn’s disease will likely experience flare-ups, or periods of time when disease symptoms are very active.
During periods of remission, no symptoms of the disease are noticeable. The lining of the digestive tract heals and shows no signs of inflammation.
Periods of remission can last anywhere from a few days to years. The main goal of Crohn’s disease treatment is to achieve and maintain remission.
There are two main types of treatment for Crohn’s disease: medications and surgery.
Most Crohn’s disease medications are meant to help reduce inflammation in the gastrointestinal tract. Some medicines are used to treat flares, while others help keep Crohn’s in remission once symptoms have gone away.
Surgery is an option, but it’s usually saved for hard-to-treat disease. Surgery can be used to open a part of the intestine that has become blocked. Surgery also can be used to remove a damaged portion of the intestine.
Surgery doesn’t cure Crohn’s, but it can help to achieve remission. About 70 percent of people with Crohn’s will need surgery at some point in their lives.
It’s not always possible to know what causes a flare. Flares happen even while you’re taking your medications as prescribed.
There are a few known triggers for flare-ups. They include:
- Stress: Stressful situations or strong emotions can lead to flare-ups. It’s impossible to eliminate all stressful-producing events in life, but you can change the way your body reacts to stressful situations.
- Missed medications: Many people with Crohn’s disease take medications on a daily basis, even during periods of remission. It’s not uncommon to miss some medication doses, but long periods of not taking prescribed medications can lead to flare-ups.
- Use of nonsteroidal anti-inflammatory drugs (NSAIDs): Some commonly used medications, including aspirin, naproxen (Aleve), and ibuprofen (Motrin, Advil), are possible triggers for flares.
- Use of antibiotics: Using antibiotics can lead to changes in the bacteria that normally live in the intestine. This can lead to inflammation and symptom flares in some people with Crohn’s.
- Smoking: People who smoke tend to have more flares than nonsmokers.
- Certain foods: Some people have diet-related flare triggers. No one type of food aggravates symptoms in all people with Crohn’s. Keeping a food diary to identify any potential triggers can help you to better understand how your diet relates to your symptoms.
Crohn’s is an unpredictable disease and is not the same for everyone. Your relapse and remission cycle will vary depending on your symptoms and environmental triggers.
If You Have Crohn’s Complications
It Involves More Than Your Colon
You already know this disease affects your digestion. Did you know it can also lead to bone loss, eye problems, back pain, arthritis, gallstones, and skin and liver problems? Your choices can make those problems less likely.
Keep Your Bones Strong
Make sure you get enough calcium and vitamin D. Crohn’s disease makes bone loss and osteoporosis (thinning bones) more likely. Steroids used to treat Crohn’s can also erode your bones. Most experts say you need between 1,000 and 1,300 milligrams of calcium and between 600 and 800 international units of vitamin D. Ask your doctor how much is right for you.
Protect Your Eyes and Vision
Tell your doctor if you notice eye problems like blurred vision, redness, and dryness. This disease can affect many parts of the eye, including the cornea, tear ducts, and outer coating of the white of the eye. When you control Crohn’s flares, most eye complications improve. Your doctor may prescribe drops to help.
Ease Joint Pain
About 1 in 4 people with the disease gets arthritis, or inflamed joints. You may have pain in your elbows, wrists, knees, and ankles. This type of arthritis doesn’t cause lasting damage. The pain will usually go away when your Crohn’s symptoms do. Some people get pain and stiffness in their lower back, which can be more serious. Your doctor may prescribe medications and tell you to rest.
Crohn’s can harm your small intestine, which leads to gallstones. Up to a third of people with the disease get them. When your small intestine is damaged, your body can’t absorb bile salts that it creates to break down waste. The salts form gallstones. Symptoms include sudden pain in your upper right abdomen and nausea. Treatment ranges from medications to surgery.
Watch for changes in your skin. A small number of people with Crohn’s get red bumps on their shins, ankles, and arms. Doctors call these erythema nodosum. Only a fewer will get blisters that turn into chronic deep ulcers, but it can happen.
Do you feel unusually tired or have itching, yellowing of the skin (called jaundice), or pressure in your upper abdomen? Those could be signs that Crohn’s is affecting your liver. Bring your doctor up to speed. He’ll examine your blood tests, ultrasounds, and maybe even a biopsy to see if there’s a problem.
If you have pain and stiffness in your lower spine, let your doctor know. It’s rare, but you might have spondylitis, a form of arthritis linked to Crohn’s. Over time, it can cause the bones in your spine to permanently fuse together. This is called ankylosing spondylitis. It happens in up to 3% of people with Crohn’s. Early treatment can help you keep your flexibility. Stretching exercises and using moist heat on your back can help you feel better.
Like many serious long-term illnesses, Crohn’s disease can make you depressed and anxious. That, in turn, can worsen your physical symptoms and make it harder to get better. Talk therapy and medications can help you manage these feelings.
See Your Doctors Regularly
Regular checkups with your primary doctor and your gastroenterologist are key. Put all appointments on your calendar. Let your doctor know about about any changes in your health, and mention any medications or supplements you’re taking.
Referred to me by her GP in November 2003, Pauline had been diagnosed with Crohn’s disease in 2000 but her GP mentioned in his letter that she probably had already suffered symptoms due to the disease in 1993.
Pauline was 39 when I met her first and she told me that she had severe backaches with shooting pains in her 20s. The slightest movement would aggravate her pain. As she had injured her back as a child, she always thought the pain was due to this.
Ten years ago, she developed an anal fissure with severe pains passing stools. This was eventually operated on in 2000, but three weeks after the operation she again started to have severe pain when passing stools and had ulcers in the back passage. She also had mouth ulcers at the time with extreme pain and she could hardly eat or drink. She started to feel unwell generally, had a high temperature, plus diarrhoea and stiff joints. Her ankles were swollen and she could hardly move or walk. Pauline had to stay off work for three months. At that stage she was referred to a specialist and diagnosed with Crohn’s disease.
Since then she has had several flare-ups when she always has similar symptoms. The first sign is usually that she develops back pain and stiffness. Her joints swell up and become stiff and painful, which makes it very difficult for her to move. She also develops loose and foul smelling bowel motions, lately with blood and mucus. She has abdominal cramps and a permanent sense of a lump in her stomach. She sometimes loses control over her bladder and bowels and has had some accidents and feels extremely tired and exhausted and generally unwell.
Pauline feels that these episodes can be triggered by stress and her symptoms can be aggravated by dairy produce. She frequently has night sweats and she also had episodes of iritis, inflammation of her eyes, in the past.
She has already excluded dairy produce which has been beneficial. Her consultant had put her on Mercaptopurin daily which is a medicine also used in the treatment of leukaemia and Dexamethasone eye drops for episodes of iritis.
Pauline lives with her partner and eight year-old son and works in customer service for a company selling legal books. She loves her job and loves speaking to the customers on the phone. She feels this is “fantastic”.
Having a very bubbly personality, Pauline describes herself as over-enthusiastic and excitable and quite a happy person who loves to talk a lot. She says people sometimes find her “too much”. She is very impatient and can be short-tempered. She dislikes to be told things and dislikes change. She is a kind person and feels anxious if she has to speak in public.
Of her general symptoms, she says that she is a chilly person, disliking the cold and that she perspires easily. She craves cheese and sweets and does not tolerate dairy produce. She needs a lot of sleep, often waking up at 2am but sleeps quite deeply on her right side. She talks during her sleep and her eyes are often half-open. She dreams a lot, recurrently of houses and rooms but also about teeth.
When considering her case, I was mainly thinking of remedies such as Phosphorus and Sepia, but Nux vomica, Causticum and Thuja were also ones I considered for her constitutionally. The last as her son, whom I treated for asthma, had a good response to Thuja and sometimes children and their parents, in particular mother and child, can respond to the same remedy.
Nevertheless, I eventually decided to give her Sepia. What swayed me was the strong focus on her back pain, which is very typical for Sepia, and symptoms such as the lump sensation in her stomach. I gave her Sepia 200c, three single doses within 24 hours. However, as Phosphorus is a good remedy for inflammatory bowel disease, I prescribed Phosphorus 30c twice weekly in four weeks’ time, more on a symptomatic level.
When I saw her again two months later, she was already much better. Her energy levels had improved, her joints weren’t aching and the night sweats were better too. She could sleep through the night and had been able to stop Mercaptopurin one month before without any negative effects. This had not been possible in the past. She had noticed the improvement after the Sepia, but the night sweats improved when taking Phosphorus and did come back when she omitted a dose. Over the next six months she required two more doses of Sepia 200c and I advised her to continue with the Phosphorus regularly.
She then came back with a flare-up of her Crohn’s disease, experiencing burning pain in her abdomen, pain and stiffness in her back and hips, iritis and low energy levels. When I asked what had happened, she told me that she had applied for a better paid job in her company but that she didn’t get it. She was very angry, feeling it was terribly unfair and that people were conspiring against her. She just couldn’t understand why they hadn’t given her the job but did not talk to anyone about it.
I told her to increase Phosphorus to once daily doses until her symptoms had settled and to repeat Sepia in the next higher potency, 1M at that stage. However, I told her to use her conventional medication if symptoms did not settle quickly. I also prescribed Mercurius sol 6c three times per day, when required, for her iritis.
When I saw her next, two months later, she had much improved. The pain had settled, her joints and back were fine and her energy levels better. She had taken Mercaptopurin for ten days but stopped it again and had been well.
Over the following two years, she had been really well apart from one chest and throat infection. She continued with Phosphorus 30c once weekly and Sepia 1M every few months.
A year ago she came to see me with severe back pain again, associated with stiffness and pain in her hip. She had been run down and felt this might be a precursor for the Crohn’s again. She had already tried Sepia, but this time it did not seem to affect her symptoms. I prescribed Rhus tox 30c once daily until the back pain had settled and told her to then take Phosphorus 200c, three single doses within 24 hours. She has been fine since with one more minor episode of back pain, which responded well again to Rhus tox. She now takes Phosphorus 200c every few months if her general well-being deteriorates.
The remedies that helped Pauline most were Sepia, the ink of the cuttle fish, and Phosphorus, a remedy from the mineral kingdom and an element from the periodic table. On first glance, this seems strange as they come from completely different sources. However, patients who require Sepia sometimes appear quite “phosphoric” and this might be due to the fact that the cuttle fish itself contains a lot of Phosphorus.
In retrospect, I would say that Pauline is probably more of a Phosphorus type constitutionally. However, she had good responses to Sepia initially, possibly due to the overlapping symptoms of both remedies. The question why she responded and which one is her constitutional remedy is probably quite academic though, as the main thing is that Pauline’s symptoms improved and that she is on her path to health.
Phosphorus means the “light-bringer” (the Greek word “phos” means light and “phoros” means bringing or bearing). Phosphorus is a poisonous substance and reacts violently. It is used in the manufacture of safety matches. On a physical level, Phosphorus’s destructive processes dominate the homeopathic picture, such as irritation and inflammation of the lining of organs, inflammation of nerves and the spinal cord and destruction of bones. Its picture also contains haemorrhages and general weakness. But just like the fire, destructive as it can be, it also brings warmth, light and sustains life.
As Phosphorus brings light in the physical sense, the Phosphorus type of person is a light-bringer in other ways. He or she is a very open and extrovert person who makes you feel good in their presence. Often, when they enter the room you have a sense that the light has been switched on. No wonder that during homeopathic training, when everyone is usually eager to find his or her own constitutional remedy, everyone wants to be a “Phosphorus”! These individuals are very warm, sociable and sympathetic and very sensitive to all impressions. They are often quite artistic and imaginative but can also be full of fears and anxieties.
I always find it fascinating how the richness of nature, contained within our remedies, if matched to the richness of life within our patients, can stimulate growth, health and wellbeing!
Andrea Wiessner T(GP) MD MFHom RCST trained as a GP but has been practising homeopathy full-time for nine years. She has been working at the Royal London Homeopathic Hospital and in private practice. She also practises Cranio Sacral Therapy.
Top Foods to Avoid With Crohn’s Disease
For a person with Crohn’s disease, eating a healthy diet isn’t as simple as it may seem. If you’re experiencing chronic diarrhea, you may have nutritional deficiencies to overcome, and this is especially true for children with Crohn’s disease that affects the small bowel. On top of this, certain foods — even foods that are considered nutritious, such as raw fruits and vegetables — can trigger a Crohn’s flare or worsen symptoms. “Foods differ for each person, and people often choose to avoid them,” says Ryan S. Carvalho, MD, attending physician in the division of gastroenterology and nutrition at Nationwide Children’s Hospital in Columbus, Ohio. “However, caution is necessary to prevent excessive calorie, protein, and nutrient deprivation.” It’s easy to see why eating a good diet with Crohn’s is so important.
Even children notice when certain foods trigger theirCrohn’s symptoms, says Dr. Carvalho. Because foods that may act as triggers vary so widely, he suggests using a food diary to establish your diet for Crohn’s disease. “Maintaining a diary will also help you calculate your average calorie, protein, nutrient, and vitamin intake with the help of a dietitian,” Carvalho says. The following foods are considered common triggers for a Crohn’s flare — be particularly aware of your reaction when you eat them and jot down all the details in your food diary.
Beware the Dangers of Dairy
If you have Crohn’s disease, it’s not uncommon to also be lactose intolerant. That means you don’t adequately digest lactose, the sugar found in milk, and as a result you may have symptoms such as cramping, bloating, diarrhea, and gas, says Gina Jarman Hill, PhD, RD, an associate professor of nutrition at Texas Christian University in Fort Worth. “Dairy products are a good source of calcium, vitamin D, and protein, so if you completely avoid these foods, you must obtain these nutrients elsewhere,” she says. To minimize Crohn’s symptoms while staying healthy, try getting these nutrients from green leafy vegetables, fortified juices and cereals, or supplements. (everydayhealth.com)
Skip on the Spicy Foods
When your Crohn’s symptoms are in overdrive, spicy foods may result in even more pain for you, says Hill. “However, this is different from one person to the next,” she adds, “so it is important to identify those foods that are or are not tolerated.” If you find certain spices irritating during a Crohn’s flare, mild herbs and small amounts of citrus juices for seasoning can provide flavor in their place — it makes sense to always have them handy for jazzing up your diet.
Fried food isn’t good for anyone, and its greasiness may be especially problematic for people with Crohn’s, Dalessandro says. “The more you can stay away from foods like that, the better off you’ll be.” (everydayhealth.com)
Use Caution With Fried or Greasy Foods
For people with Crohn’s disease, the fat in foods like fried chicken, french fries, heavy sauces, and creams is often not fully absorbed in the small intestine. This in turn leads to Crohn’s symptoms like cramping or loose stools. Rather than fried and greasy foods, choose foods that are baked, broiled, or steamed for your diet for Crohn’s, says Hill. “However, fat should only be restricted if you’re experiencing fatty stools.” (everydayhealth.com)
Steer Clear of High-Fiber Foods
Though most people should be getting plenty of fiber from sources such as whole grains, fruits, and vegetables, the opposite is true for many individuals with Crohn’s disease. When Crohn’s symptoms are at their worst, make refined breads and pastas part of your modified diet. “They are normally better tolerated than their higher-fiber counterparts,” Hill explains. (everydayhealth.com)
Look Out for Foods With Gluten
Hill notes that refined wheat products are usually a better choice than whole grain options for people with active Crohn’s flares, but this alternative won’t help if you can’t digest the gluten found in wheat products. “Some people with Crohn’s disease may be gluten intolerant,” she says. If that’s the case, avoid all products that contain gluten in your diet. (everydayhealth.com)
Nuts are nutritious, but when eaten raw, most people with Crohn’s won’t reap the benefits of their healthy fats and high protein content.
“You can’t masticate them enough to get them to a consistency that’s really easy for the gut to digest,” explains Dalessandro, who is a nutritional advisor to the Crohn’s & Colitis Foundation of America.
Like other rough and hard-to-digest foods, she adds, they can further irritate the lining of your gut, worsening your symptoms. (health.com)
Fruit with skin
An apple a day may keep the doctor away, but if it isn’t peeled, it can cause major digestive distress for someone with Crohn’s.
The same goes for vegetables with edible peels, like cucumbers. Strip them off before you eat them. In fact, some people with Crohn’s find they can eat raw fruit and even some raw vegetables if they’ve been peeled.
In general, cooked or canned fruits and vegetables are often a better choice than raw. (health.com)
Whole grains are good for everyone—except a person with Crohn’s disease who’s having a flare-up.
Popcorn is technically a whole grain, and it’s probably among the hardest of all those grains to digest. The same goes for corn on the cob.
“Anything that’s really rough to digest would possibly be detrimental and cause more symptoms and possibly slow the healing process,” says Dalessandro. “That’s been my experience with a lot of patients, and myself.” (health.com)
It’s extremely important for people with Crohn’s disease to get enough protein; at least 25% of your daily calorie intake should be protein-based.
But eating fatty and cured meats, like bacon, is not the best way to add protein to your diet.
These foods offer little nutritional benefit, while their high fat content can aggravate diarrhea for some people. Instead, choose lean high-quality proteins, like fish, soy, and smooth nut butters. (health.com)
During a flare, people with Crohn’s should avoid foods that contain lots of seeds, such as strawberries, raspberries, and tomatoes, Dalessandro advises.
“Those things don’t get digested fully and can cause more diarrhea,” she explains. “You want to stay away from things that are rough on the digestive system…it’s kind of like sandpaper on an open wound.”
Also, skip rye bread and other baked goods that contain seeds. (health.com)
Maybe it’s the skin, maybe it’s the seeds, or maybe it’s the acidity, but many people with Crohn’s find that eating tomatoes in any form worsens their symptoms, whether it’s a raw tomato in a salad or spaghetti sauce. (health.com)
Coffee, chocolate, and carbonated beverages
Many coffee lovers have to swear off java after getting a diagnosis of Crohn’s.
“Anything with caffeine is really bad, chocolate is really bad,” says Julie Novack, 44, a senior credit underwriter at Wells Fargo in Charlotte, North Carolina, who has ulcerative colitis.
Novack and other people with IBD can also have trouble with caffeinated sodas, while bubbly drinks—caffeinated or no—can be triggers as well.
Use caution when drinking alcohol, as it can be a problem for some people with inflammatory bowel disease.
“If I drink too much of it or too often it will sometimes cause a flare or seems to cause a small flare,” says Marge McDonald, 46, who directs the Burlington Senior Center in Massachusetts and has ulcerative colitis. (health.com)
Corn, beans, and stringy vegetables like raw celery and broccoli aren’t easily digested; in Crohn’s they can cause cramping, bloating, and diarrhea.
“We call it roughage, and it’s rough on your system,” says Dr. Kane. “For a healthy intestine, that is a good thing, but for an inflamed one, it can be bad. Having to process things that are still intact will make some people really uncomfortable.”
Dr. Kane suggests trying a “low-residue diet” that is low in fiber and other foods that are difficult to digest like raw fruit, vegetable peels, and seeds. “When you have active IBD symptoms, these foods are just going to make you feel lousy,” she says. (health.com)
Specific foods don’t cause or trigger Crohn’s disease. However, some foods or eating habits can exacerbate symptoms. Each person is different, so you may need to use trial and error to see what helps (or hurts) your symptoms.
What, and how, to eat
by Amanda MacMillan
Crohn’s disease is a chronic, incurable inflammatory bowel disease (IBD). Symptoms include severe belly pain and diarrhea, among others.
Certain foods or eating habits can exacerbate Crohn’s disease symptoms, although they aren’t the underlying cause or trigger of the IBD, says Sunanda Kane, MD, professor of gastroenterology at the Mayo Clinic, in Rochester, Minn.
Each person is different, so you may need to use trial and error to see what types of food or eating habits help (or hurt) your symptoms.
Foods That May Help Ease Crohn’s Symptoms
The foods that you put into your body can have an impact on the severity of your Crohn’s symptoms. Crohn’s patients identify various foods as triggers, and others as foods that help ease symptoms. However, both triggers and “power foods” are highly variable and individual in their expression—what works for one person might not work for someone else, or might even make symptoms worse.
We overview some foods that Crohn’s patients have reported benefits from that are listed below. By eating one or more of these foods during a flare-up, you may be able to reduce symptoms and lead a more pain-free life. We can’t guarantee success, but these are certainly worth investigation.
Live-culture yogurt can be a great food to eat if you suffer from Crohn’s disease. The probiotics in this form of yogurt can help in aiding with recovery of the intestine (CCFA, 2004). You may want to avoid yogurts, however, if you find you have trouble with digestion of dairy proteins, as this can make Crohn’s-associated diarrhea and gas symptoms worse.
Oily fish such as salmon, tuna, and herring may help with some of your Crohn’s symptoms (Cleveland Clinic, 2009). Certain types of both contain omega-3 fatty acids, which have anti-inflammatory properties and may help reduce the inflammation that causes the worst of your symptoms (Simopoulos, 2002).
Fruits & Vegetables
A diet containing plenty of fruits and vegetables can help make symptoms less severe (UMMC, 2010). If, however, you find that raw fruits exacerbate a flare-up, give unsweetened applesauce and bananas a try. Both are good for you and can fulfill your craving for healthy sweetness.
For many Crohn’s patients, carrots can be a great vegetable for getting your fill of nutrients without aggravating symptoms. During a Crohn’s flare-up, be sure to cook the carrots until they’re soft and tender, as cooked carrots aren’t only easy to digest, but they also contain antioxidants that may help with Crohn’s symptoms (Aghdassi et al., 2003).
Cheese can be a great way to put calcium back into your diet without having to get it from milk. As was mentioned earlier, dairy products such as cheese can be hard on digestion for some Crohn’s patients. Certain cheeses have reduced amounts of lactose, including Swiss and cheddar. Greasy foods containing cheese, however, are best avoided in order to reduce likelihood of diarrhea and gas symptoms (NIH, 2012).
If you suffer from Crohn’s, you may find it helpful to avoid cereals that are high in fiber, especially whole-wheat or whole-grain cereals. However, there are certain cereals with low amounts of fiber that will help you get your nutritional requirements. These include refined cereals, such as Cream of Wheat, and dry cereals such as Special K, Corn Flakes, and Rice Krispies (Mayo Clinic, 2011; NIH, 2012).
High-calorie liquid nutritional formulas, such as those produced by Ensure, can potentially be great for use during a Crohn’s flare-up (NDDIC, 2011). These shakes, which come in a variety of palatable flavors, are packed with the nutrients you may be missing by having to avoid certain foods that you find aggravate symptoms. This can help boost your energy level and strengthen your immune system, which will help restore your body’s natural balance. If you’re dealing with a need to gain weight, there are formulas that can help you regain any weight you may have lost. It should be noted that Ensure contains dairy, however, which may not agree with certain Crohn’s patients.
Low-Fiber Foods and More
If you’re looking for a way to potentially decrease your Crohn’s symptoms through diet, look for low-fiber and soluble fiber foods, which tend to be easier on the digestive system. You may want to take vitamin supplements during this time in order to ensure that you’re getting the nutrition you need to fight inflammation (Mayo Clinic, 2011).
You should consult with your healthcare provider about decisions regarding your diet or taking vitamins and supplements. Your provider may refer you to a dietitian to help with planning out your meals (NDDIC, 2011).
You may want to skip the high-fiber potato skins, as they are likely to aggravate inflammation, but the insides of potatoes can be great to eat during a Crohn’s flare-up. Like bananas, potatoes provide a great source of potassium, and can potentially help your body maintain its balance of fluids while you’re battling inflammation (Linus Pauling Institute, 2010).
Don’t skimp on protein
People with Crohn’s disease often give up meat, beans, and cheese. But without protein, you can lose muscle mass.
“People say to me, ‘I gave up red meat because I can’t digest it,’ but it’s because they’re trying to eat a normal American-size helping of steak or a giant burger,” says Dr. Kane. “I tell them to eat 6 ounces of really good quality red meat; that way they’ll get the iron and protein they need without overdoing it.” Fish, tofu, beans, and eggs, if they’re well tolerated, are also good protein sources. (health.com)
Consider a liquid diet
Although it’s not a long-term solution, people with Crohn’s—especially those with intestinal blockages who are unable to process solid foods—can try a temporary liquid diet.
A liquid diet can give the intestines a rest, which can help suppress symptoms. However, this diet should be carefully planned with your doctor to ensure you’re getting all the right nutrients.
High-calorie liquid supplements, such as Ensure Plus or Boost Plus, can add nutrients and calories to any diet, as well, if you’re not getting enough from food alone. (health.com)
Talk to a nutritionist
If you have Crohn’s disease and are concerned about your nutrition, it would be a good idea to talk with an RD, especially one who is familiar with IBD, says Julie Cepo, a registered dietitian who works with IBD patients at Mount Sinai Hospital, in Toronto, and is coauthor of the Crohn’s & Colitis Diet Guide(amazon.com).
“I help them come up with an eating strategy that they can tolerate but that also works with their personal and cultural preferences and food philosophies,” Cepo says.
Seeing a nutritionist who doesn’t understand IBD, on the other hand, may do more harm than good, warns Dr. Kane.
Write it down
Keep track of everything you eat, how you feel after you eat it, and the status of your disease to determine what types of food worsen your IBD symptoms. Because it’s different for every person, writing everything down is the best way to learn what your body can and can’t process.
“Also, I ask people not to introduce a lot of new foods too quickly,” says Cepo. “Introduce them one at a time and wait a day or two to see if affects your symptoms.”
It’s not a bad idea to try new foods at home first, before eating them in a social situation.
Eat small, frequent meals
Portion control is important, because eating too much at one time can make it hard for the body to digest food.
Small, frequent meals can help. You can still eat three meals a day, but make them a bit smaller than usual, and supplement them with several well-balanced snacks in between.
“You won’t go into your next meal as hungry, and you’ll be less likely to overeat, which may lead to bloating,” says Cepo.
Prep foods in a new way
Many foods that are a problem when raw or whole can be eaten if prepared differently, says Cepo. “We try to focus on what people can still have; often that means cooking foods well, like string beans, cauliflower, or carrots and sweet potatoes.”
Stringy foods like onions may be better tolerated if minced into very small pieces, just as seeds and nuts seem to cause fewer symptoms when they’re ground. Chickpeas and sesame seeds, for example, may cause problems, but hummus, which is made with ground chickpeas, and tahini, a sesame-seed paste, may not.
Water intake is always important, but critically so if you have frequent diarrhea.
Cepo cautions patients to limit beverages with caffeine, carbonation, or too much sugar—all things that can make GI symptoms worse.
Water is a good choice, she says, as are diluted fruit juices without a high sugar content. For people who are very sick and at risk of becoming dehydrated, an over-the-counter rehydration fluid like Gatorade can replenish fluids and electrolytes.
Pump up your electrolytes
Replenish lost electrolytes like sodium and potassium if you’re having loose stools. “One option is to sprinkle salt liberally on your food,” says Cepo. You can also sip broths or bouillons, and choose salty snacks like pretzels, crackers, rice cakes, or potato chips.
To get more potassium, eat potatoes (without skin), bananas, tomato juice or sauce, avocados, melon, or citrus fruits like grapefruit or orange (with the membrane removed, if needed). Coconut water is also a good source of potassium, and a good way to stay hydrated.
Season with ground spices
Spicy food can be a problem, but that’s no reason to ban all herbs and spices from your kitchen. “I see spice as an important part of any diet, especially since one of the side effects of IBD is having a depressed appetite,” says Cepo. “Anything we can do to stimulate people’s interest in food is a good thing.”
Cepo recommends using flaked or chopped spices and herbs. “If you find you have any symptoms, hold back a little more the next time you use it.”
Supplement with vitamins
All people with IBD should take a multivitamin, says Dr. Kane, because they’re probably not getting all the nutrients they need.
People who avoid dairy should also consider taking about 1,500 milligrams of calcium with 800 IU of vitamin D daily. Those who have had small-intestine surgery probably need extra vitamin B12, too.
Talk to your doctor before taking any supplement, and remember, supplements should do just that: supplement the nutrients you get from foods, rather than replace them.
Eat normally when you’re well
In between Crohn’s flare-ups, if you’re feeling better, eat normally and enjoy your food.
“It can be hard for someone, knowing that the last time they ate celery they had a terrible experience, but it may be tolerated again when the disease is in remission,” Cepo says. “Working with a dietitian or a doctor can help you build back up confidence and improve that relationship with food.”
As long as you don’t have any ongoing bowel issues or long-term narrowing of your intestine, following general healthy-eating guidelines is a good strategy, says Cepo.
Crohn’s is a chronic disease so there’s no cure. However, there are medications available to help manage the symptoms and prevent relapse.
Healthline content is strictly informational and should not be considered medical advice. See a certified medical professional for diagnosis and treatment recommendations.