Crohn’s disease is a complex gastrointestinal condition that can cause issues such as nutrient malabsorption and inflammation throughout the digestive tract. As it is a disease of the digestive system, a Crohn’s disease diet can be an important way to help alleviate symptoms and support remission in patients.
You should speak to your doctor or a gastroenterologist before making dietary changes, particularly with a complex disease such as inflammatory bowel disease (the group of conditions Crohn’s belongs to). Additionally, patients with a stoma should take particular care to speak to their doctor or a dietician about what they can and can’t eat, especially when in a flare-up.
We’ve spoken to a medical doctor and a registered dietician to discuss what to eat in a flare up, in remission, and what to eat to avoid going into an IBD flare. They’ve given their advice for the management of this condition and how best to take care of yourself if you have problems with nutrient malabsorption due to your disease.
What to eat in a flare-up
Roxana Ehsani (opens in new tab), a registered dietitian nutritionist and a national media spokesperson for the Academy of Nutrition and Dietetics, says that it is best to eat a light, low-fat, bland diet during the first few days.
“It’s important to stay as well hydrated as possible, especially if experiencing lots of diarrhea or vomiting,” she adds. “Drinks and eating foods rich in electrolytes are important. You could sip on broths, like bone broth, to get fluids, sodium and protein. You might sip on sports drinks to get ample calories, easy-to-absorb and to tolerate carbohydrates, and electrolytes. If you can tolerate them, foods like yogurt — not for those with lactose intolerance — and crackers are easy for your gut to tolerate.
“Some people may enjoy peppermint or ginger tea to calm down any nausea or upset stomach. Eat meals low in fat and low in fiber, as both will be easier for an upset stomach to tolerate, digest and absorb.”
Roxana Ehsani is a board-certified specialist in sports dietetics and a National Media Spokesperson for the Academy of Nutrition and Dietetics. She holds a Bachelor of Science in Human Nutrition, Foods and Exercise from Virginia Tech and a Master of Science in Clinical Nutrition and Dietetics from the University of Pittsburgh and completed her dietetic internship at the University of Pittsburgh Medical Center.
Dr Deborah Lee, MD, from Dr Fox Online Pharmacy (opens in new tab), says that during a flare-up, it’s best to eat a low-fiber diet and avoid too much fat:
- Low-fiber fruit: Melon, peaches, nectarines, and cooked or canned fruits. Fruits should always be washed and peeled if possible – and don’t eat the skins.
- Low-fiber vegetables: Stick to non-cruciferous vegetables – tomatoes, peppers, courgettes, asparagus, onions, carrots, spinach and cucumber. Always peel them first and cook them well – don’t eat them raw.
- Lean protein: Chicken, fish, eggs, or tofu are ideal. Red meat tends to be high in saturated fat which can worsen symptoms. If you eat red meat, eat the best quality meat and cook it well so it is soft and easier to digest. Seedless nut butters, such as peanut butter, are another good protein option.
- Fatty fish: Salmon, trout, mackerel and tuna, contain large quantities of omega-3 fatty acids which are potent anti-inflammatories. Walnuts and flax seeds also contain large amounts of omega-3.
- Fats: Go for healthy unsaturated fats, such as olive oil, avocado or rapeseed oil. Don’t overdo it, stick to small amounts. Grill, bake or steam food rather than frying or roasting.
- Refined grains: White bread, rice and pasta are lower in fiber. Stick to foods that are less than 2g per serving of fiber.
- Probiotics and prebiotics: Probiotics include yogurt made with live cultures, kefir, tempeh and sauerkraut. Prebiotics include bananas and soy products.
Having worked for many years in the NHS, initially as a GP, and then as Lead Clinician for an integrated Community Sexual Health Service, Dr Deborah Lee now works as a health and medical writer, with an emphasis on women’s health. She is a menopause specialist.
What to avoid in a flare-up
Ehsani says that it is best to avoid any foods that will likely aggregate the stomach.
“Caffeinated drinks, such as coffee, soda, teas, or even sparkling waters may be too hard to stomach,” she says. “Avoid citrus fruits like lemon, lime, grapefruit, oranges and tomatoes, as acidic foods might be too harsh for your stomach to tolerate. Avoid most dairy products; some people can tolerate yogurt, but all other forms of dairy should be avoided as it's harder for most people to tolerate.
“Sugar alcohols are found in sugar-free foods, diabetic-friendly foods, and in many gums and candies, and it’s best to avoid them as they can cause diarrhea. Alcohol should be avoided until symptoms resolve as well.”
Lee lists foods she encourages Crohn’s disease patients to avoid while in a flare-up:
- Seeds and nuts: These foods are rough, hard to digest, high in insoluble fiber and often pass through the gut undigested.
- Certain fruit: Avoid anything with the skin on, like raw fruits, or those especially high in insoluble fiber. Don’t eat dried fruits, including raisins and prunes, and avoid fruit pulp, such as in fruit juices. Strawberries contain a lot of small seeds and are best avoided.
- Certain vegetables: It’s best to avoid cruciferous vegetables, such as brussels sprouts, cauliflower, cabbage, kale, broccoli, watercress, and radishes, as well as raw vegetables, or vegetables with the skin left on. Everything you eat must be soft and well-cooked. Cooking food can break down the fiber slightly, changing it from insoluble fiber to soluble fiber and making it easier to digest, as seen in the journal of Plant Foods for Human Nutrition (opens in new tab).
- Lactose: Patients with Crohn’s are more likely to be lactose intolerant, and large amounts of lactose can cause symptoms to flare. Small amounts can be acceptable: so long as there is no true lactose intolerance. Dairy products are good sources of calcium, but this is why no more than two servings of dairy products a day are usually recommended. If you cannot tolerate lactose at all, a calcium supplement may be recommended by your doctor.
- Sugar and Sweeteners: Some studies suggest a high-sugar diet can worsen Crohn’s symptoms. Artificial sweeteners, such as aspartame, can also worsen symptoms. Xylitol and sorbitol are other possible culprits. These are all found in low-calorie drinks and sodas, ice-cream, sugar-free gum and sweets, which should all be avoided.
- Fatty/processed foods
- Spicy foods: “Capsaicin is the component in chili peppers that activates mucosal receptors to give the burning effect of chili spices in the mouth,” says Lee. “In one study, 41% of IBD sufferers thought eating spicy foods made their IBD symptoms worse. This means avoiding foods containing chili, chili powder, peppers, and paprika. It also included black pepper, mustard and horseradish. Don’t confuse this with turmeric, which contains curcumin, which can have an anti-inflammatory effect on the gut.”
Crohn’s disease diet: What to eat in remission
There isn’t any particular diet designed for Crohn’s disease, but following medically approved dietary guidelines can help you stay in remission long-term and reduce the symptoms you may experience. Around 30% of individuals with IBD also have concurrent IBS. For these individuals, a low FODMAP diet may help to control these IBS symptoms, depending on how disruptive they are.
Ehsani says that a Crohn’s disease diet when in remission is less restrictive. “You can eat a well-balanced, nutrient-rich diet containing good sources of lean proteins, whole grains, fruits, veggies, beans, nuts and seeds,” she says. “You might feel best eating smaller meals and more frequent meals throughout the day as it's easier to tolerate and digest. I always recommend keeping a food symptom journal and writing down your foods, along with your daily symptoms next to it, to see if there’s any foods that may trigger flare ups.”
Lee also encourages patients to take time over their meals and try to split them into smaller meals:
- Eat 4-6 small meals a day
- Plan your meals and cook from scratch
- Take time to eat your food slowly, chewing every mouthful
- Drink lots of water with your meals
- Keep a food diary
Crohn’s disease diet: Do you need to supplement?
Ehsani encourages those experiencing extended periods of diarrhea to supplement, as nutrient malabsorption can cause deficiencies. “People with Crohn’s who are experiencing chronic diarrhea may be malnourished and could benefit from a multivitamin,” she says. “People with Crohn’s are also more likely to have anemia, so regularly checking your iron levels is important and supplementing when low is necessary.”
Lee also mentions that it is important to supplement calcium if you are on steroids due to the impact they have on bone health. “Steroids affect bone metabolism and increase the risk of bone loss leading to osteopenia and osteoporosis,” she says. “Vitamin D is needed to absorb calcium in the gut, so these are best taken together. High-calcium foods include low-fat dairy products, leafy greens, salmon, sardines, tofu and any products marked as fortified with calcium.”
This article is for informational purposes only and is not meant to offer medical advice.