Dieting when You Have Crohn's: Safely Lose Weight

Many Crohn's patients never need to lose weight. Don't envy them; the reason they're thin is that they've learned that for them, eating equals pain and suffering. Often a diagnosis of Crohn's is reached when a parent or concerned spouse or friend brings the patient in because she's been losing weight to the point of appearing anorexic.

The use of steroids in Crohn's disease causes a puffiness that many equate with weight-gain, although that puffiness is a side effect and not actual weight. Steroids can and do often cause real weight gain, though, and it is a side effect of some of the other medications used to treat Crohn's patients. If you have weight gain from steroids such as prednisone, talk to your physician about other possible treatment options. Most weight gains in symptomatic Crohn's patients comes from steroids, and you're likely to be better off by changing the medication, if that's possible, than by trying to lose weight through a diet, which has the potential to cause malnutrition along with weight loss.

I'll use the line every weight loss program or exercise video uses here: Talk with your physician before starting any diet or exercise program, and make sure the physician understands not just Crohn's in general, but you and your Crohn's history. I would advise Crohn's patients to talk with a dietician who is familiar with Crohn's disease, too, just to make sure that your eating plan contains all the nutrients you need. I'd also advise you to take a multi-vitamin supplement with minerals if you're not already taking one.

If you want to lose weight, you need to realize that there are two components: diet and exercise. It can be really difficult for Crohn's patients to exercise to the level that will cause weight loss, especially during a flare, when you don't want to leave your bathroom. You need to try to at least exercise at a maintenance level. Changing or reducing your food intake, by itself, won't be very effective unless you add in that exercise. If you're between flares, I'd advise that you do water exercise; it's less stressful to your joints but can provide a great cardiovascular work-out, as well as incorporate some strength training. If you don't have access to a pool, then walk or bicycle as your health allows. Trying yoga or pilates in your own home can increase your flexibility and strengthen and tone your muscles, while providing some cardiovascular benefits at the same time. Yoga has proven to reduce stress for many Crohn's patients, another benefit.

Now is the time that you should pull out your two food lists: the "can eat" and "can't eat" list. If you don't have them, spend the first two weeks of your diet writing down everything you eat, and how you feel after eating it, and write any foods that you already know you can or can't eat onto the appropriate list. Your diet will have to focus on the "can eat" foods, since the other list will bring on a flare.

A problem you're likely to encounter is that most popular diet plans tells you to increase your intake of fiber. Some Crohn's patients have little to no problem doing this during periods of remission; for others, eating high fiber foods like broccoli or cabbage or beans will bring on a flare, or make an on-going flare worse. Many doctors who treat Crohn's patients tell their patients to reduce their intake of fiber, and to eat lower-fiber options, like white bread instead of wheat bread. (As a personal aside, I find this rather ironic, since I believe that a low fiber diet may be one of the causative factors in Crohn's disease.)

You should have decreased your fat intake after being diagnosed with Crohn's disease. If you haven't, then decrease it now, and replace some of the fat you are eating with a healthier choice. Olive oil is a "good" fat; so are oils from nuts. Choose proteins that are low in fat and easy to digest. Eat as many fruits and vegetables as you can, choosing from the "can eat" list, obviously. Most Crohn's patients can eat bananas and cantaloupe with few problem; if you can't, find something that you can eat. If you remove the skin from peaches and plums, they'll be messy but less likely to upset your intestines. Eating baby food fruits with no sugar added is one alternative for getting the nutrition of fruit without the fiber, if fruit is hard for you to eat. Baby food vegetables are also a replacement option for vegetables. Just be sure to choose a brand that contains only the fruit or vegetables, and no sugar or filler.

An absolute must for Crohn's patients who are trying to lose weight is to stay hydrated. Whether you choose water, green or herbal tea, or juice, drink. Coffee doesn't count, because the caffeine acts as a diuretic. Yes, you'll lose weight if you use a diuretic, but first, it's very hard on your intestines to become dehydrated (they could become inflamed), and second, any "water weight" you lose will come right back as soon as you start eating or drinking again. If you feel hungry, have a glass of something first. If you're still hungry, eat only as much as you want to. Eat very slowly; we've all heard that it takes about 20 minutes for your stomach to send a signal to your brain that it's full, so stop eating as soon as you begin to feel slightly full.

Not too long ago we were told to drink two liters, or 5 to 6 eight-ounce glasses of water a day. More recent studies have shown that we get a lot of moisture in the food we eat, so that amount can be cut in half unless you're sticking to very dry foods.

In those first two weeks, write down how you feel emotionally when you eat, as well as what you eat and how you feel physically. Just like everyone else, Crohn's patients seek "comfort foods" and often eat for emotional reasons instead of hunger. Make sure you have something to occupy your hands if you're bored, lonely or sad and thinking about eating.

One last bit of advice is to eat several small meals or snacks during the day instead of two to three large meals. Your body can metabolize your food better that way, which means less pain in your intestines as well as more calories burned. Eating breakfast starts your metabolism towards high gear, and keeping it fueled with small amounts throughout the day keeps it in high gear. Finally, stay in touch with your doctor on a regular basis as you diet.