it is a chronic autoimmune inflammatory bowel disease that can affect any part of the digestive tract (from the mouth to the anus). The most common is affecting the intestine, specifically the terminal ileum and the colon. It is a disease that usually forms outbreaks when it is active, giving rise to symptoms, and in remission phases when it is inactive. The dieticians – nutritionists of Alimmenta collegiate in the Col·legi de Dietistes – Nutricionistes de Catalunya can help you improve your quality of life with your daily diet.
What is Crohn’s disease?
Crohn’s disease is part of the so-called inflammatory bowel disease (IBD), where ulcerative colitis is also found. These diseases damage the intestine, altering its functioning. They are chronic diseases that, therefore, have no cure. For this reason, learning how to eat to avoid outbreaks and improve symptoms is very important.
Who is affected by Crohn’s disease?
It affects both men and women and usually first appears between the ages of 15 and 30. The incidence in industrialised countries is high, specifically in Spain, where 5.5 people per 100,000 inhabitants per year.
Causes of the disease
Crohn’s disease is idiopathic, meaning its cause is unknown. However, genetics seems essential since almost 20% of people with Crohn’s have a family member with some inflammatory bowel disease.
Along with genetic predisposition, environmental factors can favour the disease, such as tobacco, pollution, inadequate diets (consumption of refined foods), infections, etc.
Symptoms of Crohn’s disease
The main symptoms when there is a Crohn’s outbreak are:
- Diarrhoea with or without bleeding.
- Abdominal pain.
- loss of appetite
- Mouth ulcers and swollen gums.
Nutritional deficiencies due to Crohn’s disease
There is a risk of protein-energy malnutrition (malnutrition due to low protein and calorie intake). Most people with Crohn’s disease lose weight by eating little food, as they have a poor appetite, and many feel worse when swallowing. In the case of children with Crohn’s disease, growth may be delayed.
It is also important to note that there are drugs used to treat Crohn’s disease that promote nutrient malabsorption:
Cholestyramine: decreases the assimilation of fats and vitamins A, D, E and K.
Corticosteroids affect calcium absorption, and their massive use can cause kidney failure.
Salazopirin: decreases the absorption of vitamin B 9 (folic acid).
Some people can develop arthritis and joint problems due to the malabsorption of minerals in the intestine. The ability of the intestine to properly absorb nutrients will depend on the extent and location of the areas injured by the disease. Mostly there are usually problems with taking advantage of the following components of the diet for Crohn’s disease:
- Zinc: a deficit of this mineral causes a drop in the body’s immunity.
- Magnesium: a lack of magnesium can cause muscle and metabolism problems.
- Selenium: a selenium deficiency causes premature ageing and low protection against oxidative processes.
Vitamins: there are multiple deficiencies of vitamins, the most affected are A, E, B 1, B 2, B 6, and B 9.
Diet for Crohn’s disease
The main goals of nutritional intervention for people with Crohn’s disease are:
- Avoid states of malnutrition.
- Gain weight where necessary.
- Reduce inflammation of the areas affected by Crohn’s.
- Assess the existence of food intolerances and allergies.
- Boost the immune status to avoid infections and complications of the disease.
- Prevent deficiency states and nutritional deficiencies that can cause other common disorders such as osteoporosis.
- Protect the internal mucous membranes.
- Facilitate the digestion of food.
- Correct and improve intestinal transit.
Feeding in remission phase or asymptomatic
The feeding guidelines are differentiated according to the stage of the disease. In reissue phases where the symptoms of the disease are not suffered, we recommend the following:
- In Crohn’s disease, it is necessary to take into account if there are food intolerances.
- Follow a balanced and healthy diet for Crohn’s disease.
- Make a diet sufficient in calories and protein to avoid malnutrition.
Foods to avoid:
- Spinach, oranges, sausages.
- Alcohol, coffee and spicy.
- Butter and whole milk.
- Flatulent foods: cabbage, cauliflower, whole grains, carbonated drinks, legumes with skin.
- Foods with sorbitol: candy, gum, light or zero drinks.
Foods to boost:
- Whitefish and white meat (including lean pork).
- Foods are rich in omega-3 type EPA: oily fish.
- Foods rich in beta carotene: papaya, mango, carrot, pumpkin.
- Wheat germ and avocado for their contribution to vitamin E, C, selenium and zinc.
- Olive oil.
- Lactic bacteria: When tolerating dairy products, yoghurt can be given. In the opposite case, the indicated thing would be to take probiotics in the form of a compliment.
- Foods that provide quercetin: onion, apple, red cabbage, broccoli.
Diet during a Crohn’s flare
When there are symptoms, the diet must be modified according to each person’s discomfort. The diet during this stage must be hypercaloric (high in calories), hypolipidemic (very low in fat), hyper protein (high in protein), with low fibre content, anti-inflammatory, moisturising and easily digestible. In general, we recommend:
- Avoid the consumption of insoluble fibre from whole grains and the skin of fruits.
- Follow gluten- and lactose-free Crohn’s disease diet (especially if diarrhoea).
- Consume foods that provide soluble fibre in small amounts: quince jam, boiled/roasted apple and pear, and cooked carrot.
- Avoid foods rich in fat. Consume a maximum of 1 tablespoon of low-acid olive oil per day.
- Facilitate the body’s hydration by ingesting: water, vegetable broth, tea and oral serum.
- Increase the consumption of beta carotene: pumpkin, carrot, zucchini, mango.
- Take probiotic yoghurt or supplement.
- Make intakes of a little volume and spaced over time to facilitate digestion. Make six meals a day.
Some recommended foods are:
- White rice, rice paste and rice cakes
- Iberian ham without fat.
- Gluten-free bread.
- egg white
- boiled potato
Foods that we will try to avoid are:
- Whole cheeses.
- Red meat and sausages.
- Butter, margarine and cream.
- Recommended cooking: boiled, steam, microwave, papillote, oven at low or moderate temperature.
To go from this Crohn’s diet to normal eating, you must do it progressively and in small amounts.
Supplementation with natural products should always go hand in hand with a correct diet. The dietitian – nutritionist should be the person who guides and advises in this field. Among the products to be valued according to each particular case, we can contemplate:
- Glutamine improves digestion, nourishes colon cells, repairs muscle tissue and reduces diarrhoea and abdominal pain.
- Omega-3, evening primrose oil and borage oil for their anti-inflammatory effects.
- Probiotics strengthen the intestinal flora and improve the general condition of the intestine.
- Lactase enzyme to better digest dairy products.
- Soluble fibre: can be taken before meals to avoid the laxative effect produced by bile.
- Wheat germ for its contribution to zinc.
- Pollen for its beta-carotene content.
Nutritional control in Crohn’s disease
The dietitians – nutritionists at Alimmenta, can help you plan a personalised Crohn’s disease diet to improve your symptoms and increase your quality of life through a healthy and balanced diet.