Dear Dietician: Crohn's disease

Dear Dietitian,

I was recently diagnosed with Crohn's disease, and I'm having a hard time figuring out what foods I should avoid. Can you help?

Signed,

Kathleen

Dear Kathleen,

I know this is a tough condition to deal with, having seen more cases in my last few years of clinical practice than ever before. For readers who are not familiar, Crohn's disease is one of two types of inflammatory bowel disease (IBD), the other being ulcerative colitis. As the term ulcerative implies, small sores or ulcers form in different parts of the gastrointestinal (GI) tract. With Crohn's the ulcers can occur anywhere from the mouth to the anus; whereas, with ulcerative colitis, the sores are usually limited to the colon and rectum.

According to the Crohn's & Colitis Foundation, IBD affects as many as 1.6 million Americans, most of whom are diagnosed by age 35. Interestingly, Crohn's is named for Dr. Burrill Crohn, who first described the disease in 1932.

The cause of IBD in unclear, but it is thought to be a combination of genetics, immune responses, and environmental factors, such as smoking. As with any illness, stress can make symptoms worse. Symptoms of IBD include diarrhea, bloody stools, stomach cramping, malnutrition, and unintended weight loss.

Malnutrition can occur during an IBD flare because some nutrients cannot be adequately absorbed in the intestines. The most common deficiencies are iron, vitamins B1, B6, and B12, vitamin D, vitamin K, folic acid, and selenium.

There is no specific diet for IBD. Studies have been conducted with IBD and a low fiber diet as well as a high fiber diet, but neither was found to be therapeutic. It's diet as tolerated. The best advice is to keep a food diary of things you cannot tolerate. You may also want to write down your feelings at that time to identify certain situations that may trigger a flare.

During a flare, avoid high fiber foods like raw fruits and vegetables, beans, whole wheat bread, and high fiber cereals (5 grams of fiber or more per serving). You may also need to limit dairy products during this time as lactose may increase diarrhea. Stick to bland foods like white bread, white pasta, canned fruit and vegetables. You can obtain protein from chicken breast, fish, or peanut butter.

Following are general nutrition tips for people with IBD:

o Keep a food diary and avoid problem foods

o Eat small, more frequent meals

o Drink plenty of water or noncaffeinated beverages

o Try reduced fat foods

o Avoid alcohol or drink sparingly

o Avoid hot, spicy foods

It is important that people with IBD follow a diet that is adequate in protein and calories. Consult a Registered Dietitian (R.D.) to obtain a healthy meal plan with vitamin and mineral replacement.

Sincerely,

Dear Dietitian

Leanne McCrate, RD, LD, CNSC, is an award-winning dietitian based in Missouri. Her mission is to educate the public on sound, evidence-based nutrition. Do you have a nutrition question? Email her today at [email protected].