Nutritional approaches to Crohn's disease

Crohn's disease can make eating and digestion incredibly unpleasant. Check out this guide for some tips to help you minimize discomfort with healthy eating.

Nutritional deficiencies are common in people with Crohn's disease for several reasons.

• During a flare-up, symptoms squelch appetite, and a person is unlikely to consume enough food to maintain weight and good nutrition.
• Nutrition can be a problem even during periods of remission; if the small intestine is damaged by inflammation, vitamins and nutrients are not absorbed properly.
• Surgical removal of portions of the intestine further impairs the body's ability to absorb nutrients.

Although some doctors advise patients to avoid all fried foods, dairy products, spices and high-fibre foods, there is no specific diet for Crohn's disease. The overall objective is to consume adequate calories, vitamins and minerals without exacerbating symptoms.

1. Eliminate any foods that provoke symptoms. Try eliminating any food that seems to create problems for several weeks, and keep a diary of symptoms to determine whether giving it up is helpful. Eliminate only one type of food at a time, such as milk and other dairy products.
2. Avoid foods high in fibre. High-fibre foods are generally discouraged because they may be irritating to the intestines, and they can also exacerbate diarrhea. High-fibre foods often are improperly digested and pass through to the colon where they can be digested by bacteria. This may cause bacterial overgrowth, which in turn can exacerbate Crohn's.
3. Avoid alcohol. Alcohol should be avoided as it can worsen intestinal bleeding; it lowers the body's immunity and it has been known to contribute to malnutrition.
4. Eat smaller, more frequent meals. Consuming six or more small meals a day is less likely to provoke symptoms than having three large ones.
5. Eat slowly and chew each mouthful thoroughly. This is good advice for anyone hoping to improve digestion, but it is of particular importance to those suffering from Crohn's disease.
6. Talk to your doctor about taking nutritional supplements. Even patients who can consume a normal diet may develop nutritional deficiencies because of poor absorption of nutrients; thus, many patients need to take a daily multivitamin and mineral supplement. High-dose vitamins should only be taken under a doctor's supervision. Those who develop vitamin B12 deficiency, for example, often need to take it by injection if they lack the intestinal substances to metabolize it.

Patients with severe symptoms or who have had extensive surgery may need a special high-calorie liquid formula, either as a nutritional supplement or as a replacement for normal meals.

• Again, such supplements should be prescribed by a doctor. In unusual cases, an elemental diet — a low-fat, easy-to-digest formula — may be prescribed. Unfortunately, such formulas often have an unpleasant taste, but if the patient is unable to drink it, it can be given through a feeding tube (known as enteral nutrition).
• The most severe cases of Crohn's disease may require total parenteral nutrition (TPN), in which all nutrients are given intravenously. TPN is most beneficial for patients who need to rest their intestinal tract so it can heal or who are unable to absorb enough nourishment from their regular diets. This approach is also beneficial in treating a child whose growth is being stunted by inadequate nutrition. Because it can be administered at home, TPN allows for a more normal lifestyle.

Keep this guide in mind and remember to contact your doctor before making any dietary changes.