Crohn's Cuisine: The Best Ingredients to Use

It is hard to define a Crohn's cuisine or to specify a Crohn's diet. One reason is that no food has been directly linked to Crohn's disease, the way that gluten is linked to celiac disease. No food causes Crohn's disease, and no specific diet or food can cure it. Foods can of course affect the symptoms of the disease, making them worse or easing them, but that's not the same as causing it. Another problem in defining a Crohn's cuisine is that different foods affect different people differently; each Crohn's patient will have his or her own list of "safe foods" and "foods to avoid," and while some may overlap, it's unlikely that any two will be identical.

That said, one food group Crohn's patients are often warned about is dairy. This is very misleading. Only patients who already have a lactose intolerance will have problems with dairy products; most other Crohn's patients can generally tolerate them between flares; I do. Lactose-intolerant patients often find that they can consume some dairy by using a product with lactase enzymes, such as Lactaid TM. During a flare or a relapse of the illness, the digestibility, or perhaps lack thereof, of dairy products can cause the stomach to produce more acid, which will cause pain and inflammation of the stomach lining. Dairy foods high in fats, such as whole milk, butter, and cheese, will not be completely absorbed by the small intestine, which usually narrows during a Crohn's flare. This can lead to gas and diarrhea. Neverthelesss, dairy can be included in most Crohn's recipes, as long as the patient is not lactose-intolerant, or is not having a flare.

Raw fruits and vegetables present a bit of a conundrum to Crohn's patients. On the one hand, many doctors advise a nutritious diet rich in raw fruits and vegetables and high in fiber. For many Crohn's patients (including me), but not all, these fiber-rich foods seem to trigger flares. Certainly during flares, Crohn's patients should stick to a low-fiber diet. Some vegetables that seem to bother more Crohn's patients than not include some Chinese vegetables like bok choy, as well as vegetables in the broccoli family (including cauliflower, cabbage, and brussels sprouts). Fruit and vegetables should still be a part of a Crohn's patient's diet, cooked if that helps, between flares.

Seeds, nuts, and dried legumes (peas, lentils, etc.) fall into the same sort of catch-22 as do fruits and vegetables for Crohn's patients. They are all healthy foods, and recommended to Crohn's patients as part of a healthy diet; at the same time they can trigger flares for some, though not all, Crohn's patients; during a flare, they should be avoided. Whole grain breads, corn, and popcorn fall into this same sort of category.

Other foods suggested to cause problems for Crohn's patients include onion, garlic, tomatoes, anything with caffeine, fatty foods (see above with dairy), alcohol, sorbitol (an artificial sweetener), carbonated beverages, and high acid fruits such as citrus fruits, pineapple, and strawberries. Spicy foods are also often warned against, although many Crohn's patients tolerate them well. Not one of these mentioned foods causes problems for all Crohn's patients, even during a flare. They can be included in a diet for a Crohn's patient as long as they don't cause that specific patient problems.

When a Crohn's patient is having a severe flare, causing a narrowing of the small intestine, a low-fiber with low-residue diet may be recommended. Such a diet minimizes the conusmption of high fiber foods, and may become a temporary liquid diet. When the narrowing resolves, the Crohn's patient can usually return to a more normal diet.

The best thing for a Crohn's patient to do is to keep a food diet. Write down everything you eat for a month or two; include how much you eat, what time of day you eat it, and what symptoms follow, if any. When you have a good record, sit down with your doctor or a registered dietician and work out a diet that provides balanced nutrition and avoids using any foods that cause or worsen symptoms such as cramping, gas, and diarrhea. Each Crohn's patient needs his or her own individualized diet, because no one food affects different Crohn's patients the same way.

Some foods are recommended for Crohn's patients. Elaine Gottschall, M.S., proposes a "Specific Carbohydrate Diet" (or SCD) in her book Breaking the Vicious Cycle (revised in 1994). This book is supported by testimonials, but there is no scientific evidence that the diet may actually help Crohn's patients. In fact, because of the amount of complex, poorly digestible carbohydrates advocated in the diet, many Crohn's patients would find this diet hard to maintain without undergoing frequent painful flares. The Crohn's and Colitis Foundation of America (CCFA) states on their website that while this and other touted Crohn's diets "might be worth a try" the best thing for Crohn's patients to do is to allow their doctor, nutritionist, and their own food diary to help them develop their own personal diet.

Some foods are now considered nutritional therapy for Crohn's disease and ulcerative colitis because they may actually help manage the disease. They include Omega 6 oils and probiotics. Omega 6 and other healthy oils are found in fish oil and flaxseed. The psyllium in flaxseed help the colon to produce short-chain fatty acids, which help the lining of the colon to fix itself. Flaxseed and fish oils can be added to food or taken as capsules. Probiotics are the "good" or "healthy" bacteria that can restore balance to the flora in your digestive system. Lactobacillus preparations and live-culture yogurt can help not just in avoiding a flare, but in easing the symptoms of one when you have one. This is an area of intense research right now, and Crohn's patients can expect new and helpful supplements in the near future.

Because an inflamed intestine is an intestine that doesn't properly absorb nutrients, a part of every Crohn's patient's diet should be a multi-vitamin and mineral substance. Additional amounts of magnesium, calcium, and folate or folic acid may be needed on top of the multi-vitamin. You should consult your doctor about this.

The best thing for any Crohn's patient to do is to stick to your "safe-food" list as much as possible, while keeping a balanced diet; to change your eating habits from 2 to 3 large meals to 4 to 6 smaller (think "fist-sized) meals per day, to ease the burden on your digestive tract; to drink plenty of clean water daily; and to add some "nutritional therapy" to your diet two or three days a week, at least. Moderate exercise in fresh air, when your condition allows, is often considered part of the diet by physicians, and will help your intestinal tract to do its job. If you find yourself skipping meals because eating anything hurts, it's time to pay another visit to your gastroenterologist.