Chron’s Disease: Health With Nutrition
Crohn’s disease is a chronic inflammatory bowel disease (IBD) that affects about 2 in 1,000 Americans. Crohn’s and other forms of IBD are autoimmune diseases, which means the immune system attacks the intestinal lining, resulting in chronic inflammation. The disease can affect any part of the intestine, but usually affects the end of the small intestine and the beginning of the large intestine.
Symptoms can include persistent diarrhea, abdominal pain, cramping, fever, and bleeding. Some people experience loss of appetite, fatigue, and weight loss. The goal of treatment is to decrease intestinal inflammation and prevent future symptom flare-ups. Medication is the main treatment, but surgery to remove affected areas of the intestine may be necessary. However, surgery doesn’t prevent Crohn’s from returning elsewhere in the intestine. This has led to a closer look at how nutrition can support treatment.
Food, the Gut and Crohn’s. As researchers understand more about the interaction between the intestinal (gut) microbiota, the immune system, and inflammation, they’ve started to focus more on the role of food in both the development and management of Crohn’s. That’s because various components in food may affect the function of the intestinal lining and the health of the intestinal microbiota.
It’s still unclear how food choices impact Crohn’s risk, but a diet high in protein and fat, from meat in particular, has been linked to increased risk, while a diet rich in fiber, especially from fruit and cruciferous vegetables, is linked to reduced risk—and to a healthier gut microbiota. Preliminary research suggests that certain food additives, including emulsifiers and thickeners like carrageenan and xanthan gum, can disrupt intestinal health, possibly increasing risk in susceptible people.
“In my experience, diet modifications can provide a number of beneficial effects, from improvement of gastrointestinal discomfort to improved psychological wellbeing,” says Julie Cepo, RD, who specializes in Crohn’s and IBD at Mount Sinai Hospital in Toronto. She points out that Crohn’s disease affects people very differently, in part because of the complex relationship between food and the gut microbiota. “It’s important that individuals living with Crohn’s do not blame disease recurrence only on their diet.”
Healing Dietary Patterns. Enteral nutrition (EN), commonly known as tube feeding, has been shown to help the intestines heal in people with Crohn’s, but that’s not practical—or appealing—for the long term. That’s why researchers are looking harder at how real-food diets may help manage symptoms. The evidence points toward eliminating certain foods and including fiber-rich plant foods. These are the more promising dietary strategies being studied right now, but more research is needed to know for sure if they effectively manage symptoms:
Crohn’s Disease Exclusion Diet (CDED). CDED combines partial EN with a diet that strictly excludes animal fat, high sugar intake, gliadin, emulsifiers, and maltodextrin. In a pilot study the majority of patients saw at least some improvement, with most achieving remission.
Specific Carbohydrate Diet (SCD). This diet is based on the theory that carbohydrates from grains, starches, sugars, and dairy pass undigested into the colon, leading to overproduction of mucus and intestinal injury.
Low-FODMAP Diet. FODMAPs are highly fermentable, poorly absorbed carbohydrates and sugar alcohols (see EN July 2016, Page 3, What is the low FODMAP diet?). When someone with Crohn’s is in remission but still experiencing symptoms like gas, bloating, diarrhea or constipation, a low-FODMAP diet may help.
Anti-Inflammatory Diet. The Anti-Inflammatory Diet for IBD led to reduction of symptoms and need for medication in eight patients with Crohn’s.
Semi-Vegetarian Diet. In a small study, patients ate a semi-vegetarian diet (vegetarian diet with fish once per week and meat once every two weeks) while on drug therapy. Two years after achieving remission, most patients who stayed on the semi-vegetarian diet were still symptom-free, whereas three in four patients who returned to a regular diet had relapsed.
Food for Thought. Cepo says the quest for symptom relief can make popular elimination diets more appealing, but points out that it’s important to replace the nutrients lost by eliminating a food or food group, and allow enough time to know for sure if eliminating certain foods makes a difference. “I’ve learned that some patients intuitively discover improvements from avoidance of specific foods through trial and error, but that these avoided foods are different from person to person,” she says.
Working with a registered dietitian who is familiar with Crohn’s disease can be invaluable in correctly identifying foods that cause symptom flare-ups while keeping as varied a diet as possible and avoiding nutrition shortfalls.
—Carrie Dennett, MPH, RDN
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