What Should I Eat?

 

It’s not easy knowing which foods will help you feel your best, especially when you have Crohn's disease or ulcerative colitis. Research suggests diet plays a role in the development of IBD, the disease course, induction or maintenance of remission, reducing symptoms, and nutritional status.

 

We have several tips for a healthy diet that’s well-balanced and nutrient rich. These tips are for educational purposes only. You should work with your doctor or an IBD-focused registered dietitian to help you develop a personalized diet.

 

 

 

Foods to Consider Limiting in Diet | Foods to Increase in Your Diet | Food Preparation and Planning |

How Should I Eat When Flaring? | How Should I Eat When in Remission?

 

Foods to Consider Limiting in Diet

It is important to remember that people with IBD may have different experiences with food, and it does not affect everyone in the same way. Each person may even make diet choices depending on what may be going on with their disease, whether they may be in the midst of a flare, or in remission.

For some patients, there can be certain trigger foods. There are also foods associated with increasing risk for active disease. Some patients may choose to minimize certain foods in their diet, but it is always helpful to consult with your doctor, and a dietitian about your needs. 

Trigger foods:

Trigger foods are any food that causes unpleasant symptoms. Although they can lead to symptoms, trigger foods don’t necessarily cause harm (or inflammation) to your body. Everyone may have different trigger foods, although here are some common trigger foods and beverages:

• Foods high in insoluble fiber (does not dissolve in water) can be hard to digest: raw kale, skin of an apple, sunflower seeds
• High-fiber foods: Brussels sprouts, cabbage, cauliflower, asparagus
• High lactose-containing foods: cow’s milk, cream, ice cream, custard
• Sugar alcohols and artificial sweeteners: sorbitol, mannitol, xylitol, sucralose, aspartame, saccharin
• Added sugars and sugary foods: cookies, pastries, coconut sugar, honey, maple syrup
• High-fat foods: butter, cheesy dishes, fried foods
• Spicy foods: sriracha, chili powder
• Alcohol
• Caffeinated coffee/tea, energy drinks, other caffeinated beverages
• Sugar-sweetened beverages: soda, coffee/espresso drinks with sugar/syrup, juices

Foods associated with increased risk for inflammation:

Eating certain foods frequently over time has been found to increase the risk for inflammation¹. It’s okay to have these foods occasionally when you desire them, just have them in moderation. Instead of actively trying to restrict these foods, try to focus on adding more variety into your diet. For example, if you usually eat red meat every day, focus on adding a greater variety of protein into your diet so that you have chicken, turkey, tofu, eggs, tilapia, salmon, and tuna throughout the week. 

Foods associated with increased inflammation include:

• Red meat: beef, lamb, pork, veal, bison
• Processed meat: lunch/deli meat, bacon, hot dogs, sausages
• Coconut oil, dairy fat, palm oil

Emerging evidence suggests the following foods may play a role in inflammation (although more research is needed):

• Processed foods containing certain additives: carboxymethylcellulose, polysorbate-80, carrageenan, maltodextrin, titanium dioxide, sulfates, guar gum
• Artificial sweeteners: aspartame, sucralose, saccharin

Important points to keep in mind:

-   Be kind to yourself. It’s what your diet looks like as a whole, rather than a single day or meal, that makes the biggest difference. You can eat foods that may play a role in inflammation occasionally.

-   Disordered eating is common in people with GI diseases and is associated with worse disease outcomes². If you feel your relationship with food could be better, reach out to an IBD-focused dietitian and gut-specialized psychologist.

-    Some cultures frequently consume spicy foods or red meat. Instead of completely eliminating these traditional foods from your diet, try adapting recipes to swap out ingredients for better tolerated alternatives. You can also try eating less of the food so that you can still enjoy it but it doesn’t trigger symptoms.

 

Foods to Increase in Your Diet

When consumed frequently over time, certain foods have been found to decrease inflammation¹.

Foods to increase in your diet include:

• Fruits: bananas, raspberries, applesauce, blended fruit
• Vegetables: squashes, fork-tender cooked carrots, green beans
• Foods rich in omega 3 fatty acids: fatty fish (salmon, tuna, mackerel, etc.), walnut butter, chia seeds, flaxseed oil, flaxseed meal

Other healthy foods to include in your diet:

• Cooked and cooled or reheated starches: potatoes, sweet potatoes, rice, oatmeal
• Leafy green vegetables (try cooking and cutting into small pieces or blending them into smoothies)

 

Worried about not being able to digest fruits and vegetables?

Think about the type, texture, and amount of the fiber-containing food.

 

Type:

Can the fruit/vegetable dissolve in water quickly? If so, it’s likely to be high in soluble fiber. Raspberries are the perfect example. As soon as you drop a fresh raspberry into a glass of water, it will start to disintegrate. If a fruit/vegetable won’t dissolve in water, such as the skin of an apple, it’s high in insoluble fiber. Insoluble fiber can cause more frequent or urgent trips to the bathroom.

 

Texture:

At times, it may be helpful to adjust the texture of the food. For example, raw kale and blended kale both contain the same amount of insoluble fiber, but blended kale is much better tolerated as it acts more like soluble fiber in the intestines. Instead of raw nuts, nut butters may be easier to digest.

 

Amount:

Instead of adding a lot of fruits and vegetables into your diet at once, which can increase frequent and urgent trips to the bathroom, try slowly adding them a little at a time.

 

For individuals with stricturing Crohn's disease:

Depending on how symptomatic you are, you may need to adjust the amount and/or texture of other foods, not just those that contain fiber. Some examples of foods that could be problematic include:

• Mushrooms
• Popcorn
• Steak 
• Dried meats or fruit
• Raw nuts
• Salads

 

Food Preparation and Planning

While there is no one-size-fits-all for meal planning, these tips can help guide you toward better daily nutrition:

• Stay hydrated—drink enough to keep your urine light yellow: water, broth, a smoothie, an enteral nutrition supplement, or an oral rehydration solution (hydrating beverage containing sugar and electrolyte salts)
• Prepare meals in advance
• Plan some quick and easy meals for days you’re too tired to cook bigger meals
• Keep your kitchen stocked with foods that don’t aggravate your symptoms
• Use simple cooking techniques: boil, grill, roast, steam, poach
• Create a plan for eating outside the home: review menus ahead of time, let friends/family members know if you prefer to bring your own meal to gatherings or holidays, and adapt cultural/religious recipes so that you can enjoy these special occasions

 

How Should I Eat When Flaring?

In general, it would be good to continue consuming the foods listed in the “foods to increase in your diet” section. You may also need to adjust the texture of fiber-containing foods to improve tolerance.

 

 

Resist self-imposed restrictive diets:

Unless your doctor or dietitian has instructed you to follow a specific diet and you’re getting adequate support, resist the urge to follow diets recommended to you by friends, family, or people on the internet. Just like medications, restrictive diets have potential side effects that can include nutrient deficiencies, unplanned weight loss/malnutrition, disordered eating, or progression to an eating disorder, all of which may negatively impact disease outcomes.

Increase protein:

Since protein needs increase during active disease, it’s also helpful to focus on consuming protein-containing foods throughout the day. Some examples of foods containing protein are chicken, tofu, fish, turkey, eggs, yogurt, beans, chia seeds, and nut butters.

Increase fluids:

If you’re having frequent loose stools, have a fecal infection, or have constipation or incomplete evacuation, it may be helpful to focus on increasing hydrating fluids. Some examples of hydrating fluids are water, broth, smoothies, and an oral rehydration solution.

Nutrient dense meals/snacks:

If your appetite has decreased, you’ve lost weight without trying recently, or have a fecal infection, it may be helpful to consume frequent, small, nutrient-packed meals or snacks.

 

Some examples include:

• Adding a snack (e.g., 1 tablespoon of peanut butter and a banana, hummus and crackers, or yogurt and berries)
• Adding olive oil to meals
• Adding ¼ to ½ an avocado to meals
• Having a smoothie between meals
• Adding sauces to meals (such as a lemon garlic tahini sauce)

Minimize food restrictions:

If you feel restricted, your diet is likely lacking variety. Every whole food contains different nutrients, so when you restrict a food, and especially a food group, from your diet, you’re at risk for nutrient deficiencies. Since this can negatively impact your disease, try to minimize food restrictions. If you’re unsure of what to eat and what is triggering your symptoms, work with an IBD-focused registered dietitian.

 

How Should I Eat When in Remission?

If you were adjusting the texture of foods during your flare, you can start reintroducing tougher-to-digest foods when you’re in remission. If you have stricturing Crohn’s disease, ask your doctor whether you should continue adjusting the texture of foods. Some trigger foods will only cause symptoms during active disease and others will be triggers regardless of disease activity.

 

Try to keep your diet as expansive as possible, especially including as many tolerated plant-based foods as possible, such as fruits, vegetables, nuts, seeds, herbs, and whole grains. Continue to consume plenty of foods that reduce the occurrence of active disease and minimize those that may lead to increased occurrences of active disease.

 

 

In remission but still have symptoms?

Reach out to an IBD-focused registered dietitian to help you find your trigger foods. They may suggest a low-FODMAP diet, if appropriate. 
 

 

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References: 

 

1. Levine A, Rhodes JM, Lindsay JO, et al. Dietary Guidance From the International Organization for the Study of Inflammatory Bowel Diseases. Clin Gastroenterol Hepatol. 2020;18(6):1381-1392. doi:10.1016/j.cgh.2020.01.046
2. Werlang ME, Sim LA, Lebow JR, Lacy BE. Assessing for Eating Disorders: A Primer for Gastroenterologists. Am J Gastroenterol. 2021;116(1):68-76. doi:10.14309/ajg.0000000000001029