Crohn's disease diet: What to eat and avoid to manage symptoms

man cooking salmon in a frying pan with courgettes and asparagus — (Image credit: Getty Images)

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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.

“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.

Roxana Ehsani registered dietitian nutritionist

Roxana Ehsani, MS, RD, CSSD, LDN

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.

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.

“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.

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.

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.”

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.”

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.”

Lou Mudge is a health writer based in Bath, United Kingdom for Future PLC. She holds an undergraduate degree in creative writing from Bath Spa University, and her work has appeared in Live Science, Tom's Guide, Fit & Well, Coach, T3, and Tech Radar, among others. She regularly writes about health and fitness-related topics such as air quality, gut health, diet and nutrition and the impacts these things have on our lives.

She has worked for the University of Bath on a chemistry research project and produced a short book in collaboration with the department of education at Bath Spa University.

Crohn's disease diet: What to eat and what to avoid to manage symptoms

What to eat in a flare-up

What to avoid in a flare-up

Crohn’s disease diet: What to eat in remission

Crohn’s disease diet: Do you need to supplement?