Diet and Nutrition

Patients who live with Crohn's Disease know that it's hard to take eating for granted. There is no evidence that diet can cause the disease (1), but what a patient eats can make symptoms worse.

The problems stem from Crohn's damage to the digestive tract, which can affect both the small intestine and the colon. The small intestine is where food is mixed with digestive secretions and is broken down into small molecules (2). Microscopic, finger-like projections called villi line the intestine (3). They absorb nutrients and then pass them along to nearby capillaries, where nourishment enters the bloodstream. With Crohn's, the lining is often inflamed, hampering the intestine's ability to absorb nutrients. This can lead to malnourishment, even if the patient is eating a balanced diet (2).

Watery food residue and secretions that are not digested in the small intestine pass into the large intestine (2). Depending on how extensively inflamed the small intestine is, nutrients and digestive secretions can escape into the large intestine and interfere with the normal water resorption function of the large intestine, leading to diarrhea (2). When Crohn's has also affected the colon, the problem is compounded and can further exacerbate the diarrhea (2). When Crohn's has also affected the colon, the problem is compounded and can further exacerbate the diarrhea (2).

The Risks to Patients' Health

Beyond the pain and discomfort, Crohn's patients also face serious complications from loss of nutrients and fluids.

  • Poor growth in children and teens (2);
  • Anemia and neurological problems, caused by a damaged small intestine, that is unable to absorb vitamin B-12 (4, 5);
  • Metabolic bone disease, resulting from deficiencies of calcium and vitamin D (6);
  • Magnesium deficiencies, common in patients who have had bowel resection(6), can result in muscle cramps, seizures and abnormal heart rhythms in extreme cases (7);
  • Weight loss in females can impact hormonal levels and menstruation (2);
  • Dehydration can lead to weakness and kidney problems (2);
  • Medications tend to be less effective when patients have inadequate nutritional status (2).

Ways to Maintain Health

Healthy eating habits are important for everybody, but especially for Crohn's patients. There are no blanket rules on foods to avoid (2). The physician and dietician should tailor advice based on the patient's specific medical history and what foods cause physical distress. The goal is for the patient to maintain proper nutrition, with as few flare-ups and symptoms as possible.

Daily Diet Strategies

  • Eat a healthy diet. This means consuming both an adequate amount of calories and nutrients, and a balanced variety from all food groups, including carbohydrates, proteins and fats (2);
  • Drink plenty of fluids. This is especially important during bouts of diarrhea, when patients risk dehydration and salt loss (2);
  • Eat smaller meals. A small meal every four hours can be easier on a patient's digestive system than the traditional three, larger meals a day (2);
  • Avoid foods that make symptoms worse. Every patient is different, but irritants for many include lactose-containing milk and dairy products, and raw fruits and vegetables. Spicy foods can cause trouble, too (1);
  • Beware of fat. Patients who have had parts of their small intestine removed can have difficulty absorbing fat. They should go easy on greasy or fried foods which can cause diarrhea and gas (2).

Special Diets and Supplements

  • Low-fiber with low-residue diet (2): Patients with small bowel Crohn's disease who develop a stricture of the lower small instestine can often find relief from their painful symptoms by reducing foods that add a "scrapy" residue to the stool. These include raw fruits and vegetables, as well as nuts and corn hulls.
  • Vitamins and minerals: Physicians should monitor patients to be sure they are getting enough vitamins and minerals in their diet. Taking a daily multivitamin supplement may be an option as well. Patients who have undergone intestinal surgery may especially need supplements of vitamin D and vitamin B-12 (2). Patients avoiding dairy products, or who are taking steroids such as prednisone, should supplement their daily diet with 1,500 mg of calcium (2, 6).
  • Nutritional support: In extreme cases, enteral nutrition, delivered through a tube, from the nose into the stomach, can play a role. When patients have severe malabsorption or are experiencing too much pain to ingest solid food, enteral feeding can provide all the nutrients they need, even while sleeping at night (2, 7).

This information is intended for healthcare professionals only.


References

  1. Mayo Clinic Staff. (June 2, 2006). Crohn's Disease: Can diet worsen symptoms? In Ask a Digestive System Specialist. Available at: http://www.mayoclinic.com/health/crohns-disease/an00353. Accessed June 28, 2006.
  2. Diet and Nutrition (2006). Reviewed by members of Crohn's & Colitis Foundation of America's National Scientific Advisory Committee. Available at: http://www.ccfa.org/info/diet?LMI=2.5. Accessed June 16, 2006.
  3. Keigo, DJ, Gariepy CC. Anatomy, Histology, Embryology and Developmental Anomalies of the Small and Large Intestine. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease Pathophysiology/Diagnosis/Management. 7th ed. St. Louis, MO: W.B. Saunders Co; 2002:1643-1646.
  4. Mayo Clinic Staff (March 11, 2005). Complications. In Vitamin Deficiency Anemia Overview. Available at: http://www.mayoclinic.com/health/vitamin-deficiency-anemia/DS00325/DSECTION=6. Accessed June 30, 2006.
  5. Mayo Clinic Staff (March 11, 2005). Causes. In Vitamin Deficiency Anemia Overview. Available at: http://www.mayoclinic.com/health/vitamin-deficiency-anemia/DS00325/DSECTION=3. Accessed June 30, 2006.
  6. Khursheed N. Jeejeebhoy, (April 2002). Clinical nutrition: 6. Management of nutritional problems of patients with Crohn's disease, Canadian Medical Association Journal, 166: 913 - 918. Available at: http://www.cmaj.ca/cgi/content/full/166/7/913. Accessed June 29, 2006.
  7. National Institute of Health, Office of Dietary Supplements, (December 5, 2005). Magnesium. Available at: http://ods.od.nih.gov/factsheets/magnesium.asp#ref. Accessed June 30, 2006.
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