Crohn’s Disease: My Diet During Remission

Crohn’s disease is a type of inflammatory bowel disease. Crohn’s disease is a lifelong condition that can cause inflammation of any part of the gut from the mouth to the anus (bottom). All layers of the lining of the bowel may be inflamed and it most commonly affects the small and large bowel. Crohn’s disease tends to go through periods of remission with no symptoms, and periods of relapse when symptoms flare-up.

The cause of Crohn’s disease is not fully understood. Several factors are involved including a family tendency, an over-active immune system and environmental triggers e.g. smoking. No known cure is currently available. However, remission can be achieved and managed through medication and diet. In some cases, surgery may be required.

• Diarrhoea sometimes with blood or mucus
• Fever
• Abdominal pain (cramps)
• Blood in the stools
• Weight loss
• Pain in the abdomen (tummy area)
• Lack of energy/tiredness

Some people may experience:  

• Swollen joints  
• Mouth ulcers  
• Inflamed eyes or rashes on their body

Myth: My diet can cure Crohn's disease

Whilst diet can be changed to manage the symptoms associated with Crohn’s Disease, there is not enough evidence to support a “cure” for Crohn’s disease. Some people have found that removing certain foods from their diet have helped relieve symptoms like diarrhoea, cramping, bloating, and excess wind. Before making any changes to your diet please speak to your GP or Dietitian to help you make an informed decision.

Myth: I must remove all dairy foods from my diet

Many people living with Crohn’s disease may also live with an intolerance or sensitivity to a sugar found in dairy known as lactose. This may cause symptoms such as diarrhoea, excess wind, abdominal pain, bloating, and nausea. Whilst removing dairy items from your diet may help reduce your symptoms, you could be missing out on important minerals like calcium. It might be a good idea to try alternative dairy products enriched with calcium or lactose-free alternatives.

Myth: I must avoid all raw fruits and vegetables

For some people living with Crohn’s Disease, limiting the amount of raw fruits and vegetables may be important due to symptoms that arise from eating the fibre found in their skins or seeds. Others may be able to eat these foods without any issues. If you struggle with eating raw fruits or vegetables it is important to discuss with your dietitian ways to ensure that you are still optimising your intake of this food group without worsening symptoms or causing further nutritional issues.

Myth: I need to remove gluten from my diet

Gluten is a protein found in wheat, rye, and barley. For some people consumption of products containing gluten e.g., bread, pasta, or cereal can cause an inflammatory reaction where their immune system attacks their bowel causing extensive damage. This is a condition known as coeliac disease. If you don’t have Coeliac Disease but still suffer with symptoms with gluten containing foods it may be due to an intolerance that could be managed by trialling limiting gluten foods or following a low FODMAP diet. Please speak to your Dietitian if you would like support to follow this diet approach.

Nutrition during remission is important to prevent complications like osteoporosis, decrease the likelihood of infections, and maintain your overall health. Being well nourished in remission means that you can rebuild any lost muscle or weight lost during a flare-up and replenish lost nutrient stores.

Here are some tips for eating healthily during remission

Healthy eating is all about enjoying a variety of foods!

Proteins – meat and meat substitute (2 servings)

Protein is an important aspect of your diet as it serves as the building blocks for muscle growth, repair of body tissues, and helps support your immune system. This is especially important when following a Crohn’s disease flare up where your portions of your gut may experience damage as a result of inflammation.

This group serves as a source of:

• Iron – which is important for ensuring that your red blood cells can carry oxygen around your body where it is used to generate energy.
• Zinc – Helps to support your immune system and metabolic processes.
• B vitamins - like Vitamin B12; which is important for nerve function
• Omega-3 Fatty acids – important for reduce inflammation in your body and improve your heart and eye health.

If you follow a vegan diet, it’s important to ensure that you are adequately supplementing your diet with additional vitamins and minerals. This is because many plant based sources of protein do not naturally contain vitamins like B12. Please speak to your dietitian or doctor about ways to do this appropriately.

Note: some plant-based protein sources may be ultra processed to imitate animal products e.g., plant-based sausages and burgers. This means they have high amounts of saturated fats, sugar, and salt. It‘s important to eat these in moderation.

Carbohydrates and fibre

This group is responsible for providing you with mainly energy but also fibre (from wholegrain carbohydrate, which is important for proper bowel function), vitamins, and minerals. Depending on the symptoms you may experience you may also need to reduce your intake of fibre (e.g., from wholegrain varieties of starchy foods or fruits and vegetables) to help manage these. However, if you find that you can eat these foods with no issues, it is encouraged to do so.

Foods that commonly contain carbohydrates include:

• Bread
• Pasta
• Cereal
• Rice

Calcium and Vitamin D

Calcium is an important mineral to ensure you have healthy bones and teeth and helps strengthen your immune system to fight off diseases. It’s recommended to have at least 3 servings of dairy products or calcium fortified alternatives to ensure you have the recommended amount of calcium (1000mg/day).

Vitamin D is required to ensure that calcium is well absorbed by the body. Vitamin D is made as a result of skin exposure to the sun which is most effective from March to September where sunlight is at its peak in the UK. However, during the winter months (October to February) its production reduces as the strength of sunlight is decreases. It is recommended during winter months to take a daily vitamin D 10µg supplement. Some foods contain some vitamin D but not enough to meet your daily requirements. Before taking any supplements speak to your doctor or dietitian for more information.

Some sources of calcium include:

Fruit and vegetables

These provide much needed vitamins, minerals, energy, and fibre to help keep your body functioning as usual. You may find that fibre from some raw fruits and vegetables may worsen your symptoms, so it may help to try cooked or tinned vegetables as these might be easier to digest. If you have a stricture (a narrowing in the bowel) this can help reduce the likelihood of blockages and their associated symptoms.

Examples include:

Please note that some of these food items contain high levels of insoluble fibre which can worsen symptoms if you have a narrowing in your bowel (stricture). Please see the Diet and Stricture booklet for more information.

These types of foods are formulations of ingredients, typically created by series of industrial techniques and processes often including additives, preservatives and emulsifiers typically used to lengthen their shelf life, improve the flavour, texture, or even colour of foods.

Many of these foods contain high amounts of salt, sugar, and saturated fats to improve flavour meaning that their regular consumption can poorly impact our health if consumed long term. Research has shown that regular intake of ultra processed foods such as crisps, biscuits, sugary cereals, instant meals (e.g., packet noodles and instant soups), fizzy drinks, sweetened yoghurts, and energy drinks are linked to conditions like heart disease and type 2 diabetes.

There is no evidence to suggest ultra-processed foods cause Crohn’s Disease. However, research has shown that high intakes may exacerbate Crohn’s Disease symptoms because they have a negative impact on our gut bacteria and can activate inflammation in the gut. The following list of food additives have been cited in the literature to specifically link to gut inflammation should ideally be limited in the diet.

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