Managing Crohn’s Disease with the help of a dietitian nutritionist

Manage your Crohn’s disease with the help of a dietitian nutritionist
Nutrition
Gut Health
Written By:
Sarah Glinski, RD

As someone living with Crohn’s disease, you’ve worked with many different healthcare providers - but have you worked with a Crohn’s nutritionist or dietitian? 

While diet is important for anyone who wants to stay healthy, it’s even more important for people living with Crohn’s disease. That’s because the food you eat can have a profound impact on your symptoms and overall gut health.

People with Crohn’s disease are also more prone to becoming malnourished. A Crohn’s nutritionist can help identify gaps in your diet and foods that trigger flare-ups. Together, you’ll be able to build a diet plan that improves your long-term gut health and helps with symptom remission.  

What is Crohn’s disease?

Crohn’s disease is a subtype of the broader category of diseases called Inflammatory Bowel Disease (IBD). It causes inflammation in your digestive tract, which can lead to unpleasant symptoms such as:

·  Abdominal pain

·  Severe diarrhea

·  Fatigue

·  Weight loss

·  Malnutrition

·  Nutrient deficiencies

It most commonly occurs in the small intestine, and the inflammation often affects the deeper layers of the bowel.

While there are many different proposed mechanisms by which Crohn’s disease develops, emerging evidence suggests that a Westernized diet is associated with the development of IBD. Specifically, a diet that is high in sugar, processed foods, and saturated and trans fats, and low in fruits, vegetables, and fiber has been linked to the development of IBD.

What is a Crohn’s nutritionist?

A Crohn’s nutritionist or dietitian is a nutrition professional with experience working with people with Crohn’s disease. They may also work with people with other gut diseases, like Ulcerative Colitis, Irritable Bowel Syndrome, and Celiac Disease.

It’s important to ensure that your nutritionist or dietitian has experience working with people with Crohn’s disease, as the nutritional treatment of Crohn’s disease can be complex and may lead to nutrient deficiencies if not followed correctly.

Why work with a Crohn’s nutritionist or dietitian?

The Crohn’s and Colitis Foundation explains that once you develop Crohn’s disease, paying attention to what you eat may help with reducing symptoms and promoting gut healing.

A 2019 study published in the Journal of Gastroenterology and Hepatology looked at dietary risk factors for IBD, as well as common beliefs about diet among people with IBD. They found that people with IBD (like Crohn’s disease) are at an increased risk of malnutrition. This is because Crohn’s disease is a chronic condition. The risk of malnutrition is affected by how severe the gut inflammation is, certain complications of the disease, and an inadequate or unbalanced diet.

Since malnutrition is associated with an increased risk of going to the hospital, as well as longer hospital stays, working with a Crohn’s nutritionist who can guide you with your diet is an important part of your treatment plan.

Another issue faced by people with Crohn’s disease is extremely restrictive diets leading to vitamin and mineral deficiencies. A study published in the American Journal of Gastroenterology found that this is because restrictive diets often cut out entire food groups, such as grains, milk, and certain fruits and vegetables.

According to a study published in Clinical Nutrition, common nutrient deficiencies include iron, vitamin B12, vitamin D, and zinc. 

Working with a Crohn’s nutritionist can help you ensure you’re not missing out on vital nutrients from your diet. They can also provide recommendations for supplementation if you’re unable to get the nutrients through diet alone.

What to eat with Crohn’s disease

While traditional pharmacological therapies used to treat Crohn’s disease are important, many of these medications have undesirable side effects, and for some people, are not effective for achieving long-term remission. Therefore, there is growing interest in the use of nutrition therapy to promote remission and gut healing.

Crohn’s nutrition will differ depending on whether you’re currently experiencing a flare-up of your symptoms. Regardless of whether you’re in remission or experiencing an active flare-up, nutrition therapy is an important part of your treatment plan.

What to avoid when you’re having a Crohn’s flare-up

If you’re in the middle of a Crohn’s flare-up, there may be certain foods that make your symptoms worse. If you’re eliminating foods from your diet, it’s best to work with a Crohn’s nutritionist or dietitian to ensure you’re not missing out on important nutrients. 

Some foods that may trigger a Crohn’s flare-up include:

·  Foods that are high in insoluble fiber that are hard to digest (e.g., fruits with skin and seeds, raw green vegetables, whole nuts, and whole grains).

·  Foods high in lactose, the sugar found in dairy products like milk, cream, yogurt, and cheese

·  Sugar alcohols like sorbitol and mannitol

·  Sugary foods

·  High-fat foods

·  Alcohol and caffeinated drinks

·  Spicy foods

Foods to eat when you’re having a Crohn’s flare-up

Since many trigger foods are high in nutrients, it’s important to ensure you’re eating a variety of better-tolerated foods to get the nutrients you need.

Foods that may be better tolerated during a Crohn’s flare include:

·  Low-fiber fruits (like bananas, cantaloupe, and cooked fruits without the skins)

·  Lean protein (like fish, white meat poultry, eggs, and firm tofu)

·  Refined grains (like white bread and white pasta)

·  Fully cooked, seedless, skinless, non-cruciferous vegetables (like cucumbers, potatoes, and squash)

·  Oral nutrition supplements or homemade protein shakes 

Foods to eat when you’re in remission

If you’re in remission, it’s important to have a diverse and nutrient-rich diet. If you’re reintroducing foods, do so slowly to avoid irritating your gut.

Foods to eat during remission include:

·  Fiber-rich foods, like oats, beans, nuts, and whole grains (unless you have been advised by your doctor to continue a low-fiber diet)

·  Protein

·  Fruits and vegetables. Aim to eat as many different colors as possible, as different colored fruits and vegetables contain different nutrients.

·  Calcium-rich foods (like leafy greens, yogurt, and milk)

Exclusive enteral nutrition for Crohn’s disease

In some cases, exclusive enteral nutrition may be used to treat Crohn’s disease. 

Enteral nutrition is a formula-based diet that contains all the nutrients you need in a powder or liquid form. Exclusive enteral nutrition provides 100% of your daily nutritional requirements and is a low-risk and minimally invasive therapy.

Exclusive enteral nutrition is recommended as first-line treatment for children with Crohn’s disease, with remission rates of up to 80%. It is not routinely used in adult populations in Western countries because many people have trouble sticking to a completely liquid diet.

There are several ways exclusive enteral nutrition is thought to help induce Crohn’s disease remission, including reducing inflammation and altering the gut microbiota.

Exclusive enteral nutrition may be beneficial in the following cases:

·  People with active disease who wish to induce remission

·  People trying to maintain remission

·  People looking to avoid starting or increasing dosages of medications that have undesirable side effects

·  People for whom medications have not been able to effectively induce remission 

If you’re interested in trying exclusive enteral nutrition to induce Crohn’s disease remission, it’s extremely important to work alongside a Crohn’s nutritionist. In addition, it’s important to work with a Crohn’s nutritionist when you’re reintroducing solid foods into your diet, as solid foods should be reintroduced gradually and strategically.

How can I find a Crohn’s nutritionist near me?

While the COVID-19 pandemic has been frustrating, there have been a few positives that have come from it. Prior to the pandemic, care was usually delivered in person, which made it difficult for many people living in rural or under-serviced areas to see a Crohn’s nutritionist or dietitian.

However, with COVID-19, we saw a shift of many healthcare services to virtual care. This has given healthcare providers the opportunity to work with people from the comfort of their homes, which is often more convenient and less stressful.

At Nourish, our Crohn’s nutritionists and dietitians provide high-quality, 100% virtual care that you can access in the comfort of your own home.

Nourish is here to help

Living with Crohn’s disease can be challenging, and symptoms and management can be very different depending on whether you’ve achieved remission. Diet can play a key role, but it differs from person to person. That’s why it’s important to work with a Crohn’s nutritionist who can tailor a nutrition plan that’s as unique as you are. 

Working with a Crohn’s nutritionist is important because restrictive diets can lead to malnutrition and vitamin and mineral deficiencies. At Nourish, we help people with Crohn’s disease achieve health and wellness through virtual, personalized nutrition counseling. Our services are covered by insurance and 100% remote. Click here to get in touch and book an appointment today!