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Crohn's Disease

Crohn’s disease is a chronic, recurrent inflammatory disease of the intestinal tract.  The intestinal tract has four major parts: the esophagus, or food tube; the stomach, where food is churned and digested; the long, small bowel, where nutrients, calories, and vitamins are absorbed; and the colon and rectum, where water is absorbed and stool is stored.  The two primary sites for Crohn’s disease are the ileum, which is the last portion of the small bowel, and the colon.  The condition begins as small, microscopic nests in inflammation which persist and smolder.  The lining of the bowel can then become ulcerated and the bowel wall thickened.  Eventually, the bowel may become narrowed or obstructed and surgery would be needed.

What causes Crohn’s Disease? 

There is now evidence of a genetic link as Crohn’s frequently shows up in a family group.  In addition, there is evidence that the normal bacteria that grow in the lower gut may, in some matter, act to promote inflammation.  The body’s immune system, which protects it against many different infections, is known to be a factor.  There are still a number of unknowns about the cause of the disease.  Fortunately, a great deal is known about the disease and especially its treatment.

Who develops Crohn’s Disease? 

The condition occurs in both sexes and among all age groups, although it most frequently begins in young people.  Jewish people are at increased risk of developing Crohn’s, while African Americans are at decreased risk, which indicates the genetic link in this disease.

Symptoms

The symptoms of Crohn’s disease depend on where in the intestinal tract the disorder appears.  When the ileum (ileitis) is involved, recurrent pain may be experienced in the right lower abdomen.  At times, the pain mimics acute appendicitis.  When the colon is the site, diarrhea (sometimes bloody) may occur, along with fever and weight loss.  Crohn’s disease often affects the anal area where there may be a draining sinus tract called a fistula. 

When the disease is active, fatigue and lethargy appear.  In children and adolescents there may be difficulty gaining or maintaining weight.

Dietary Treatment of Crohn’s Disease

There are no foods known to actually injure the bowel.  However, during an acute phase of the disease, bulky foods, milk, and milk products may increase diarrhea and cramping.  Generally, the patient is advised to eat a well-balanced diet, with adequate protein and calories.  A multivitamin and iron supplementation may be recommended by the physician or dietitian.

During a flare-up of Crohn’s Disease, it is important to follow a diet low in fiber and low in residue.  This is to ensure that your bowels are allowed rest during healing.  Refer to the next page to find out foods allowed/foods to avoid in a low fiber/low residue meal plan.

It is a good idea to follow the low-fiber, low-residue diet approximately 4-6 weeks after a flare-up.  This time just allows for more healing.  Once you have reached the healthy phase of Crohn’s Disease, you can gradually begin re-introducing high-fiber, low-residue foods back into the diet.  This will ensure that foodstuff is pushed quickly through your bowels, allowing for less irritation on sensitive tissue.  Fiber also helps to cleanse the bowel of any unwanted residue.

It is important to reintroduce these foods slowly, maybe only one or two foods in one given week.  This slow procedure will help you to understand the effects of some foods on your body, and may help you to decide easier what foods are intolerable to you. 

The tricky part of Crohn’s disease is that not all foods are tolerable or intolerable to all individuals with Crohn’s.  The disease is very individualistic and each food must be measured individually with the person.  You may not have to give up your favorite foods.  As long as you feel they are tolerable to you, you may eat them.  The important thing to remember is to focus on your body’s reactions to each food item you eat.  Some food items that do tend to be tolerable for persons with Crohn’s disease are chicken, white bread, rice, potatoes, and lamb.  Common intolerable foods include: cereals, dairy products, nuts, raw fruit, tomatoes, high fiber products, alcohol, sweet corn, mushrooms, and spicy foods.

Stress, anxiety, and extreme emotions may aggravate symptoms of the disorder, but are not believed to cause it or make it worse.  Keeping yourself active and participating in daily physical activity can help to relieve stress and anxiety issues.  Any chronic disease can produce a serious emotional reaction, which can usually be handled through discussion with the physician. 

High Fiber, Low Residue Diet - During the Normal Healthy Phase 

When an inflammation occurs, allow the bowel to rest by following a low fiber/low residue diet as seen on the next page.  You should be compliant with this diet in order to prevent any further inflammation.  It is a good idea to continue following this diet for 4-6 weeks after the inflammation to allow for further healing.  After the 4-6 weeks, GRADUALLY reintroduce higher fiber foods.  This means introducing small portions one at a time.  For example, reintroduce raw apples one week and introduce a fresh spinach salad the next.  Going very slowly will allow for less irritation of a bowel that is now accustomed to a low fiber diet.  A high fiber/low residue diet should become a lifestyle behavior. 

Low Fiber, Low Residue Diet - During the Inflammation Phase