A Diet Guide for Crohn's Disease
    (Ayurveda and Modern Perspective)

    Best Dietary Guidance for Crohn's Disease Patients

    Food is one of the three pillars of life that is known as Tryoupstambha. There is a saying by Vaidya Jeevana:

     

    Pathye Sati Gadaarthasaya Kimoushada Nishevanaih |

    Pathye Asati Gadaarthasaya Kimoushadha Nishevanaiih ||

     

    If you follow a wholesome diet and regime, then there is no use for medicine and if you don’t follow a wholesome diet and regime then also there is no need for medicine.

    So following dos and don’ts i.e Pathya and Apathya is very important for the proper treatment of diseases.

    Pathya (Wholesome/ Meals to be taken) for a patient with Crohn's disease:

    As per Ayurvedic classical literature, Crohn’s disease is mainly co-related to Vataja Grahani and Atisara. So here, Pathya for Vataja grahani and Atisara is mentioned in Ayurveda and is considered as Pathya for Crohn’s disease.

    Pathya for Vataja Grehani (Crohn's disease)

    Pathya Apathya Vinirnya, Grahani Roga, by “Brahmanand Tripathi”, 60- 63, Bhaishjya Ratnavali 8/ 622- 625

     

    निद्रा छर्दन लंघन चिरभवा ये शालय: षष्टिका मण्डो लाजकृतो मसूरतुवरीमुदूगप्रसूता रसा:। निःशेषोद्धृतसारमेव दधि यत्सक्षीरजात॑ गवां छाग्या वा नवनीतमेव दधिज॑ तद्वत पयस्सम्भवम्‌।। छागान्याज्यपयोदधीनि तिलजं तैल॑ सुरा माक्षिकम  शालूक॑ बकुलं च दाडिमयुगं नव्यानि भव्यानि च । रम्भाया: कुसुम फल च तरुणं बिल्व॑ च श्रृंगाटकम चंगेरी विजया कपित्थकुटजाजाजी कसेरूणि च।। तक्रम काञ्चत सौनिषण्णदलकं जाती फल जाम्बव॑ धन्याकानि च तिन्दुकानि च महानिम्बो अरुणापेलवम्‌। क्रव्याल्लावशशैणतित्तिरिरसा: क्षुद्रा झशा:  सर्वशः खुड्डीशो मधुरालिका च खलिश: सर्व: कषायो रस:।। नाभे द्वय अंगुलकादधोर्धशशिवद्वंशास्थिमूले तथा।  दाह: प्रज्वलितायसा च कथित॑ पथ्यं ग्रहण्यातुरे।।

     

    The food and lifestyle habits that as per Ayurveda we can use to get benefits from Crohn’s disease:

     

    SleepingCurd of cow’s milk containing no butterHoney
    VomitingButter obtained from goat’s milk or curdBoth types of pomegranate
    Langhana (fasting)Ghritam of goat’s milkFruits and flowers of banana
    Taking old Sali rice, old Sasthi rice (rice harvested in 60 days),Cow’s milkThe pulp of fresh Bilva fruits
    Manda (A liquid obtained from cooked rice)Sesame oilSringataka, Changeri
    Pulse soup of Masura Dala, Adhya (pigeon peas), and Mudga DalaLiquorVijaya
    KapitthaButtermilkMeat soup of rabbit
    The bark of KutajaLeaves of Jatiphala, Jambu, coriander, Tinduka, MahanimbaTittira (partridge) and all types of small fish
    Cumin seedsThe meat of carnivorous birdsKhuda (one type of fish that flies for a short period
    Madhuralika (type of fish), Khalis (type of fish), and all types of sour liquids. One can also heat the patient around the areas two fingers up and two fingers down of the belly and also at the roots of the backbone. It also helps the patient with Crohn’s disease.

     

    Pathya for Atisara (Crohn’s disease)

     

    Pathya Apathya Vinirnya, Atisara Roga, by “Brahmanand Tripathi”, 46- 52, Bhaishjya Ratnavali 7/ 183- 189

     

    वमन॑ लड्डनं निद्रा पुराणाः शालिषष्टिका: । विलेपी लाजमण्डश्च मसूरतुवरीरस: ।। 

    शशेणलावहरिणक पिञ्जल भवा रसाः । सर्वे श्लद्रझषा: श्रृंगी खुड्शो मधुरालिका।। 

    तैल॑ छागघृतक्षीरे दधि तक गवामपि । दधिज॑ वा पयोज॑ वा नवनीत॑ गवाजयो: ।। 

    नवं रम्भापुष्पफलं क्षौद्रं जम्बुफलानि च । भ्रव्य॑ महादकं विश्व॑ शालूकं च विकड्तम्‌।। 

    कपित्थं बकुल बिल्व॑ तिन्दुक॑ दाडिम द्वयं। तालकं कज्चटदलं चांगेरी विजयारुणा ।। 

    जातीफल॑ च हीवेर॑ जीरक॑ गिरिमल्लिका । कस्तम्बरु महानिम्ब: कषाय: सकलो रस:।। 

    अन्नपानानि सर्वाणि दीपनानि लघूनि च ।नाभे द्वय अंगुलो अधस्तात्शस्त्रेणार्ध शशांकवत्‌। दाहो वंशास्थिमूले च प्रथ्यवर्गो अतिसारिणाम्‌ ।।

     

    The food and lifestyle habits that as per Ayurveda we can use to get benefits in Crohn’s diseases:

     

    Vamana (Vomiting)ButtermilkSoups of lentil and pigeon pea, meat soup of rabbit, Ain (a kind of black deer), Lava bird, deer, Kapinjala (partridge), all kinds of small fishes, the Sringi fish, Madhuralika (a kind of fish), medicinal oil.
    Langana (fasting)Fresh banana fruits, honey (obtained from smaller bees), Jambu phala.Ghritam and milk obtained from goats and cow
    Nidra (sleeping is good for the patient of Atisara). Dried ginger, common ginger, Kamalakanda, Kapittha, Vikantaka, Bakula, Bilva, Tenduka, Dadima (both ripe and unripe ones), palm fruits, Kancata leaves, Cangeri, Vijay, Manjistha, Jatiphala, Hribera, cumin seeds, Girimallika, Kustumburu, Mahänimba, all kinds of stomachic foods, light meals and drinks. Sasthi variety of rice
    Old Sali variety of paddyThe point about two fingers below the naval as well as the point around the bottom of the backbone, both should be heated in a crescent shape. This measure also helps one to get a cure for Crohn’s disease.Vilepi (watery rice)

     

    Apathya (Anupshya) for Crohn’s diseases (Vataja Grahani)- Don’ts for Crohn’s diseases as per classical literature

     

    रक्त स्त्रुतिम  जागरम अम्बु  पानं स्नान॑ स्त्रियं वेगविनिग्रह॑

    नस्याज्जनस्वेदनधूमपान॑ श्रम॑ विरुद्धाशनमातपं च।। 

    गोधूमनिष्पावकलायमाष यवार्द्रकच्छत्रकराज माषाण।    

    उपोदिका वास्तुककाकमाची कूष्माण्डतुम्बीमधुशिमुकन्दान्।। 

    ताम्बूलमिक्षुं  बदर॑ रसाल मेव्वारुक॑ पूगफलं रसोनम् 

    धान्य  अम्ल  सौवीर तुष्  उदकानी   दुग्धं  गुड़ मस्तु नारिकेलम्।। 

    पुनर्नवाबाहतवैणवानि सर्वाणि शाकानि पत्रवन्ति। 

    दुष्टाग्बु गोवारि कुरंग नार्भि क्षारं समस्तानि सराणि चापि।। 

    द्राक्षामथाम्ल॑ लवणं सर गुर्वन्नपान॑ सकलं पूपम् 

    वैद्यश्च  चिकित्सन्‌  ग्रहणीविकार॑ विवर्जयेत  सन्ततमप्रमत्त:।।

     

    Pathya Apathya Vinirnya, Grahani Roga, by “Brahmanand Tripathi”,  64- 68, Bhaishjya Ratnavali 8/ 617- 621

     

    BloodlettingSmokingBarley
    Roaming during the nightHeavy workRajamasa
    Drinking excessive waterIncompatible foodUpodika
    Bathing, intercourseSunbathing or enjoying fire heatVastuka
    Stopping the flow of excretionsTaking food items prepared from wheatKakamachi 
    Nasal therapyWhite beansAsh gourd
    Application of collyriumPeasKasiphala
    Swedana therapyUrada (pulse soup)Tumbi
    Ripe drumstickBerryGarlic
    Potato and other tubersMangoTusodaka (Kanji of Yava along with its peels)
    Betel leavesSnake cucumber (Karkati)Jaggery
    SugarcaneBetel nutCoconut fruit or water
    PunarnavaAll types of leafy cuisineSalt
    The fruit of KantakariContaminated waterTaking heavily to digest meals
    Bamboo ShootsSour eatablesAll types of pudding, and Puri. 

     

    Apathya (Anupshya) for Crohn’s diseases (Atisara)- Don’ts for Crohn’s diseases as per classical literature

     

    स्वेदो अञ्जन॑ रुधिरमोक्षणमम्बुपानं स्नान॑ व्यवायमपि जागर धूमनस्यम्‌ ।

    अभ्यञ्जन सकलवेगविधारणानि रूक्षाण्यसात्प्यमशनं च विरुद्धमन्नरम।। 

    गोधूममाषयववास्तुककाकमाची निष्पावकन्दमधुशिग्रुरल्तालपूगम्‌ ।

    कूष्माण्डतुम्बिबदरं गुर चान्नपान॑ ताम्बूलमिश्वुगुडमद्यमुपोदिका च।। 

    द्वाक्षाम्लवेतसफलं लशुनं च धात्री दुष्टाम्बु मस्तु गृहवारि च नारिकेलम्‌ ।

    सस्नेहनं मृगमदो अखिलपत्रशाक॑ क्षार सराणि सकलानि पुनर्नवा च।। 

    इवारुक॑ लवणमम्लमपि प्रकोपो वर्गो अतिसारगदपीडितमानवेषु।।

     

    Pathya Apathya Vinirnya, Atisara Roga, by “Brahmanand Tripathi”, 57- 59, Bhaishjya Ratnavali 7/ 190- 192

     

    SwedanaMassaging with Ghritam and oilMadhu
    Use of AnjanaSuppression of natural urges and getting angrySigru
    Rakta Mokshana (bloodletting)The eatables which are to be avoided by the patient include incompatible foods Mango
    Drinking water in excess quantityWheatBetel nut
    IntercourseUradaAsh gourd
    Ratri Jagran (waking up late hours)BarleyBadari
    SmokingVastuka leavesFoods that are heavy to digest
    Nasal therapyKakamachiSugarcane
    LiquorAmalakiAll kinds of leafy vegetable
    DraksaContaminated water (in which are fallen old leaves of many trees)Ksara, Yavaksara
    AmlavetasaStale water
    Garlic pearlsMusk

    Books Written by Dr. Sahil Gupta (B.A.M.S, M.H.A.)

    Crohn’s diseases diet guide (Modern point of view)

    Follow Low Residue Diet (LRD)

     

    If you are experiencing the symptoms like diarrhea, abdominal pain, cramping, and active flare ups associated with gastrointestinal condition i.e due to Crohn’s disease, or if you are preparing for colonoscopy or recovering from bowel surgery due to Crohn’s disease that LRD i.e low residue diet is the best option for you.

     

    What is LRD?

     

    LRD is the low residue diet in which residue means after digestion the solid contents that end up in the large intestine. This residue not only includes unabsorbed and undigested food i.e mostly the dietary fibers but bacteria, and gastric secretions also. In this diet therefore dietary fiber is limited to less than 10- 15 mg per day. Along with this, some foods are restricted in a low-residue diet that stimulates bowel activity. 

     

    The goal of the low residue diet: The main aim of introducing the LRD diet to the patient is to decrease the frequency and size of bowel movements which as result reduces the pain-associated symptoms.

     

    Difference between LFD (Low Fiber Diet) and LRD (Low Residue Diet)

     

    Both the Low Fiber Diet and Low Residue Diet are similar except that in the Low Residue Diet along with less intake of fiber, in this diet some foods are restricted like milk which increases stool weight and colonic residue.

     

    Foods that are restricted in Low Residue Diet

     

    • Crunchy peanut butter- Crunchy peanut butter should be avoided but smooth peanut butter can be taken but on the limit.
    • Cauliflower, broccoli, Swiss chard, cabbage, brussels sprouts, and kale should be avoided in both cooked and raw form.
    • Gristle meat
    • Pasta is prepared from millet, buckwheat, popcorn, flax, oatmeal, etc.
    • Lentils, dried beans, peas
    • Seeds and nuts

     

    Foods that you can take when you are on LRD (Low Residue Diet)

     

    • Fish, eggs, lean meat
    • Salad dressings
    • Carrots, cucumber, mushroom, eggplant, beans, etc should be used in cooked form.
    • Pulpless or seedless juice
    • White rice
    • Milk, pudding, cream-based soups, and yogurt should be limited to two cups/per day. Don’t take all things mentioned above on the same day.
    • Seedless fruits
    • Well-cooked fruits like peeled apples, cantaloupe, bananas, grapes, etc.

     

    Limitation of LRD

     

    LRD gives marvelous results in the management of symptoms during the acute episode of Crohn’s disease. However, in prolonged time Low Residue Diet may result in nutritional deficiencies. So, consult a dietician if this diet is right for you.

     

    Include CDED (Crohn’s diseases exclusion diet)

     

    CDED is mainly the exclusion diet in which the food increases inflammation, negatively affects the gut microbiome, and negatively affects the intestinal ability to absorb nutrition are excluded from the diet of the patient.

     

    The food that is excluded from CDED is as follows:

     

    • Animal fat
    • Wheat
    • Dairy
    • Processed food
    • Additives 
    • Red meat 

     

    The food that is included in CDED is as follows:

     

    • Fruits
    • Vegetables
    • Rice 
    • Potatoes
    • Egg 
    • Lean meat, etc.

     

    Along with this PEN (Partial enteral nutrition) is also recommended in CDED, to achieve the nutrition and energy needed by Crohn’s disease patients.

     

    Include CD- a treat diet

     

    In this diet complex carbohydrates like lactose, alcohol, gluten, etc are eliminated from the diet, and fruits, vegetables, and proteins are increased in the diet. A CD-treat diet is an anti-inflammatory whole food-based diet.

     

    Include a Vitamin D-rich diet

     

    Most people think that Vitamin D plays an important role only for bone metabolism and calcium homeostasis, but Vitamin D is linked with health benefits that extend far beyond its mentioned actions. Research has proved that Vitamin D exhibits potent anti-inflammatory and immune-modulator effects and studies also suggested that there is a strong correlation between decreased Vitamin D and increased Crohn’s disease activity.

     

    Facts:

     

    • Lower serum level of Vitamin D has been found in patients with Crohn’s disease and Ulcerative colitis especially in spring and winter months when vitamin D synthesis (UV induced) is lower.
    • Dietary malabsorption of Vitamin D is more common in IBD patients.

     

    Importance of Vitamin D in Crohn’s diseases 

     

    • Vitamin D helps in regulating gut mucosal immunity.
    • It affects innate immune barrier function.
    • Affects gut epithelial integrity
    • In Crohn’s diseases, Vitamin D helps in the development and function of T- cells

     

    Cause of Vitamin D deficiency in Crohn’s diseases patient

     

    • Dietary restriction
    • Living in a climate with lower temperatures or lower levels of sunlight
    • Genetic factors also play important role in circulating Vitamin D in the body

     

    How Vitamin D helps Crohn’s disease patients?

     

    The mechanism of the effect of Vitamin D on Crohn’s disease is based on the potent anti-inflammatory, anti-bacterial and immunomodulatory activity of Vitamin D. The immune-modulatory activity of vitamin D helps in modulating the pathology of gastrointestinal inflammation and dysregulation. Along with this Vitamin D regulates the proteins associated with epithelial cell gap junctions, thus maintaining gastrointestinal barrier integrity. Vitamin D also helps to maintain the homeostasis of microbiota. Through all these activities Vitamin D helps in preventing the onset as well as the progression of Crohn’s disease.

     

    Daily recommended dosage of Vitamin D

     

    AgeFemale Male Pregnancy Lactation 
    12 months400 IU (10 mcg)400 IU

    (10 mcg)

    13 years 600 IU (15 mcg)600 IU 

    (15 mcg)

        14- 80 years 600 IU (15 mcg)600 IU 

    (15 mcg)

    600 IU (15 mcg)600 IU (15 mcg)
        19- 50 years 600 IU (15 mcg)600 IU 

    (15 mcg)

    600 IU (15 mcg)600 IU (15 mcg)
        51- 70 years600 IU (15 mcg)600 IU 

    (15 mcg)

        Above 70 years 600 IU (20 mcg)600 IU 

    (20 mcg)

     

    Different countries and professionals recommend a different dosage of vitamin D. This variation depends on observational studies, clinical implication, etc. Like:

     

    • Endocrine society states recommend 1500- 2000 IU/ day for Adults, and 1000 IU/ day for children.
    • The United Kingdom government recommends 400 IU for citizens 4 years and above.

     

    Dietary sources of Vitamin D

     

    As we all know the main source of Vitamin D is sunlight, but there are also dietary sources that help to fulfill the requirement of Vitamin D in the body.

     

    The main dietary sources of Vitamin D are as follows:

     

    • Egg Yolks
    • Red meat
    • Oily fishes like salmon, mackerel, herring, and sardines
    • Liver
    • Fortified foods like various breakfast portions of cereal, fat spreads, etc.
    • Canned Tuna
    • Mushrooms treated with UV light
    • Soy, oat milk, almond

     

    Include Probiotics in your diet

     

    Probiotics help to reduce the various symptoms related to gastrointestinal diseases.

     

    What are Probiotics?

     

    There are two types of bacteria in our body i.e good or bad and Probiotics are the living good bacteria or yeast that naturally lives in our body. Various microbes in our bodies work together to keep our bodies healthy. These microbes include bacteria, yeast, protozoa, etc. The microbiome in everyone’s body is different, no two people in the world even twins have the same microbiome in their bodies. For microbes to become probiotics it needs some characteristics like it is safely consumed, beneficial to the body, surviving in the intestine after ingestion, and isolated from the human being.

     

    Where do Probiotics live in our body?

     

    The most common place for these good microbes i.e probiotics to live in our body is Gut but they also live in the vagina, mouth, skin, lungs, urinary tract, etc.

     

    Dietary sources of probiotics

     

    • Sourdough bread
    • Drinks: Fermented drinks like kombucha (fermented tea) or kefir (fermented dairy drink)
    • Kimchi 
    • Tempeh
    • Miso soup
    • Fermented pickles
    • Fermented sauerkraut 
    • Cottage cheese (avoid if lactose intolerance is present)
    • Yogurt (avoid if lactose intolerance is present)
    • Buttermilk (avoid if lactose intolerance is present)

     

    Caution

     

    As probiotics already exist in our body, they are generally considered safe for the body, but they may cause mild stomach upset, bloating, etc. in the first few days after starting to take them.

     

    Enteral and parenteral Nutrition therapy

     

    Crohn’s disease has symptoms of loss of appetite, due to which they often have a nutritional deficiency and require nutritional support. For this enteral and parenteral therapy remain important for Crohn’s disease.

     

    What is Enteral Nutrition therapy?

     

    Enteral means by way of the intestine. Therefore, it is the type of therapy in which a form of nutrition can be taken by mouth or through the feeding tube. In this type, a specific nutrition mixture is made that contains carbohydrates, vitamins, minerals, proteins, etc. Maltodextrins refined amino acid mixtures; few essential fatty acids are used in EN therapy. Enteral nutrition therapy is very helpful to children who are suffering from Crohn’s disease and whose appetite is poor and whose growth is a concern.

     

    Benefits of Enteral Nutrition therapy:

     

    • It reduces inflammation of the intestinal lining and inflammation in the mucosa.
    • As we know that microbiome imbalance occurs in Crohn’s disease and enteral therapy helps in healthy and balanced microbiome growth.
    • Due to poor appetite, nutritional needs are not filled in Crohn’s disease. Enteral therapy helps to enhance the nutritional status of the patient with Crohn’s disease.

     

    What is Parenteral Nutrition therapy?

     

    Parenteral means outside the digestive system, and in this therapy, the catheter is directly used in large veins of the arm, neck, and chest. This therapy is needed in a flare-up of the condition of Crohn’s disease.

     

    Semi-vegetarian diet

     

    This diet is very famous in Japan and is given to hospitalized patients with ulcerative colitis. In this diet, the patient is given egg, yogurt, vegetables, legumes, rice, and fruits on a daily basis along with a glass of milk and green tea occasionally. In this diet, animal protein is limited i.e., fish once a week and meat once in two weeks. A research study suggested that a semi-vegetarian diet was less likely to relapse into a flare condition of IBD i.e. Crohn’s disease and ulcerative colitis.

     

    Anti-inflammatory diet

     

    An anti-inflammatory diet contains food that minimizes your chances of having inflammation. Anti-inflammatory foods help to lower the chances of having flare-ups of Crohn’s disease. This diet is rich in antioxidants and helps to cope with external factors like stress, smoking, etc which increase the free radicals in the body.

     

    What is included in an anti-inflammatory diet?

     

    An anti-inflammatory diet contains various types of fruits, vegetables, lean protein, whole grains, spices, omega- 3 rich food, etc. 

     

    The Mediterranean diet and DASH diet is an example of anti-inflammatory diets.

     

    Mediterranean Diet

     

    The Mediterranean diet is plant-based, an interest which began in the 1950s. This diet is based on the traditional cuisines of the countries that border the Mediterranean Sea like Greece, Italy, etc.

     

    The Mediterranean diet is recommended mainly for heart diseases, but it gives wonderful results for Crohn’s disease. According to a recent study published in Gastroenterology, the Mediterranean diet will improve inflammation, symptoms, and quality of life of Crohn’s disease patients within 12 weeks.

     

    This diet is recommended by the International Organization for the Study of Inflammatory Bowel Diseases (IOIBD).

     

    What is included in the Mediterranean diet?

     

    • Plant-based various foods like vegetables, legumes, fruits, herbs, spices, nuts, seeds, etc. are included in the diet.
    • In this diet seafood, dairy, fish, poultry, etc. are included in moderation, and sweets and red meat are eaten occasionally. 
    • Olive oil which provides monosaturated fats is the main source of healthy fats in this diet.
    • Wine is also associated with this diet, but it is taken in moderation.

     

    How can you plan for a Mediterranean diet?

     

    • First start including vegetables, whole grains, and beans in your diet.
    • In the Mediterranean diet, fish can be included in the diet at least twice a week.
    • Serve fresh fruits for dessert instead of sweets
    • Use olive for the preparation of food instead of other oils or butter.

     

    The DASH diet

     

    DASH diet is the diet that is planned for the patient with hypertension to control or lower high blood pressure. In this diet food rich in potassium, calcium, and magnesium and lowers in sodium are taken. This diet includes plenty of fruits, vegetables, etc. but is low in dairy products as well as poultry, fish, whole grains, and nuts.

     

    What kind of food should you include in the Dash diet?

     

    • In the DASH diet, the food that is low in saturated fats is included in the diet.
    • Food that is rich in calcium, magnesium, potassium, fibers, etc.
    • The food is low in potassium.

     

    Components of the DASH diet:

     

    • Vegetables, Fruits: 4- 5 servings per day
    • Grains: 6- 8 servings per day
    • Low-fat dairy products: 2- 3 servings per day.
    • Poultry, fish, lean meats: 1 egg or 1-ounce meat, etc. per day or in 2 days
    • Fats and oil: 2- 3 servings per day is allowed.
    • Nuts, legumes, seeds: 4- 5 servings per week

     

    The DASH diet recommendation is very similar to the Mediterranean diet, it helps in improving the quality of life of Crohn’s disease patients.

     

    Choose your fiber food wisely

     

    Fiber is part of a healthy balanced diet. According to the academy of nutrition and dietetics, 38 grams/ day for men and 28 grams/ day for women is the fiber recommendation for a healthy life. For children, the requirement of fiber is the number of grams equal to their age plus 5 in them. As we know how much fiber is important for us but this fiber may become problematic to us sometimes, especially to IBD patients (Crohn’s disease patients) during flare-ups. So, it is recommended to take soluble fiber more during flare-ups and avoid insoluble fiber.

     

    Food recommended in Flare-ups of IBD (Crohn’s disease):

     

    • Easy to digest fruits and vegetables like apple sauce, melons, potatoes, asparagus, etc.
    • Vegetables stocked and added to pasta or rice should be taken.
    • During the intake of food remove the skin as it is rich in fiber and remove the seeds.
    • During a flare-up avoid uncooked or raw food and prefer nicely cooked food.
    • Brussels, broccoli, and cauliflower tend to produce gas, so it is best to avoid them during flare-ups.
    • Cooked fruit should be taken when diarrhea is severe during flare-ups.
    • Refined grain should be taken during flare-ups.
    • Protein amount should be increased during the flare as it is needed to recover from inflammation. Animal protein like eggs, fish especially oily fish, etc should be included in the diet.
    • Whole seeds, nuts, and fried and processed food should be avoided during flare-ups.

     

    Follow a low FODMAP diet

     

    FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. FODMAP is the carbohydrates that are difficult to digest as they pull more water to the bowel and increase bloating, gas, pain, diarrhea, etc. intake of a low FODMAP diet may decrease your symptoms associated with Crohn’s disease.

     

    Food that is low in FODMAP are:

     

    • Eggs
    • Meat
    • Rice
    • Quinoa
    • Fruits like blueberries, grapes, strawberries, oranges, etc.
    • Vegetables like eggplant, green beans, pumpkin, carrot, zucchini, etc.

     

    Avoid:

     

    • Fruits like Mango, plum, apple, watermelon, and peach.
    • Vegetables, like broccoli, onion, asparagus, and artichokes.
    • High fructose corn syrup.
    • Legumes like lentils, kidney beans, chickpeas
    • Lactose should also be avoided if you are lactose intolerant.

     

    AIP diet (Autoimmune Protocol Diet)

     

    The AIP diet is specially designed to reduce symptoms like inflammation and pain in autoimmune diseases, IBD i.e Crohn’s disease, Ulcerative colitis, etc. As we know that in Crohn’s disease the body’s immune system starts attacking the healthy cells of the body rather than fighting with infection. Recent research has revealed that certain foods increase intestinal permeability by damaging the gut barrier which results in a leaky gut, and results in diseases like Crohn’s disease. So, the AIP diet aims to replace this kind of food with dense nutrient food which reduces inflammation and flare-ups of diseases like Crohn’s disease. AIP diet very resembles the Paleo diet, and all foods are avoided and allowed in a manner in these diets.

     

    AIP diet is given in two phases:

     

    • The elimination phases 
    • The reintroduction phases

     

    The elimination phases: 

     

    • In this phase the food that is meant to cause gut inflammation, imbalance good and bad bacteria in the gut, or imbalance the immune response is eliminated.
    • In this elimination phase, food like seeds, nuts, grains, legumes, eggs, dairy, and nightshade vegetables are avoided.
    • Coffee, food additives, alcohol, and tobacco are also completely avoided.
    • Along with this in this phase nutrient, dense foods like fermented food, bone broth, and minimally processed meat are included in the diet.
    • With this patients are also advised to improve their lifestyle like sleep, physical activity, etc.

     

    Duration of elimination phase: This phase varies from patient to patient. Typically, this phase of the diet is maintained until the patient starts feeling noticeable changes in their symptoms.

     

    The reintroduction phases

     

    • As soon as the patient starts improving in their symptoms, the reintroduction phase is started.
    • In this phase, all the food that is eliminated during the elimination phase is reintroduced to the patient one by one, based on individual tolerance.
    • The goal of this reintroduction phase is for the patient to come to know which food is specifically contributing to his symptoms or flare. So they should know what to include and what to eliminate from their food in the future also.
    • This phase helps patients to understand the widest variety of food that they can tolerate.

     

    Paleo diet for Crohn’s diseases

     

    The Paleo diet is the prehistoric human diet that has been eaten approximately 2. 5 million to 10, 000 years ago i.e., during the paleolithic era. The paleolithic diet is also known as the stone age diet, hunter-gatherer diet, or caveman diet.

     

    In this diet, intake of food is obtained by gathering and hunting like fish, fruits, vegetables, lean meat, etc.

     

    What is the purpose of the Paleo diet?

     

    • The purpose of this diet is that the human body is genetically mismatched to modern diet and this mismatch is believed to be the cause of various diseases like obesity, diabetes, ulcerative colitis, etc.

     

    What can you eat on the Paleo diet?

     

    • 30% of your daily calorie intake should be lean meat, especially grass-fed animals.
    • Omega- 3- fatty acid-rich fish like Salmon, albacore tuna, etc.
    • The oil that is obtained from nuts and fruits like olive oil, walnut oil, etc.
    • Fruits 
    • Vegetables

     

    What to avoid in the Paleo diet?

     

    • Various legumes like peanuts, beans, lentils, peas, etc.
    • Grains like oats, barley, wheat, etc.
    • Refined sugar
    • Salt
    • Potatoes
    • Highly processed food
    • Dairy products

     

    Benefits of the Paleo diet for Crohn’s disease:

     

    The food items that are mentioned above to avoid Crohn’s disease are common triggers for a flare of Crohn’s disease.

     

    Below some reasons are mentioned which make us understand how the Paleo diet is useful in Crohn’s diet:

     

    Dairy products: Crohn’s diet has symptoms like diarrhea, gas, abdominal cramping, etc. Avoiding dairy products help us to manage these symptoms with this dairy intolerance is very common among patients with Crohn’s diet. In the Paleo diet, dairy products are avoided.

     

    Whole grains: Whole grain causes gas and increases the stool bulk. So, we can say that whole grains flare up the symptoms of Crohn’s disease along with this worsen the symptoms of proctitis, which is a common condition present in Crohn’s disease. Eliminating whole grains as per the Paleo diet relieves symptoms of Crohn’s disease.

     

    Legumes: Legumes increase stool output and aggravate bowels and gas which are common flares up of Crohn’s disease. In Paleo, diet legumes are the food that is avoided.

     

    Intake of fish: In the paleo diet various kinds of fish are included. These fishes are rich in omega- 3- acids, antioxidants, etc that reduce inflammation, have a protective effect on tissues, encourage healing, and help to achieve a longer period of remission in Crohn’s disease.

     

    Crohn’s disease and nutritional supplements

     

    In Crohn’s disease patients may become deficient in nutrients like Vitamin A, folic acid, Vitamin D, Vitamin E, Vitamin K, etc. To overcome this here is the diet recommended for Crohn’s diseases patient to overcome the deficiency of particular nutrients:

     

    Vitamin D: Egg, oily fish, chicken liver, beef, fortified cereals, tuna, salmon, butter, etc.

     

    Vitamin B12: Sockeye salmon, clams, and mussels like mollusks, beef liver, crab, pork, oyster, asparagus, mushroom, mung bean sprout, Tasa jute, etc.

     

    Vitamin E: Almonds, safflower oil, wheat germ oil, sunflower oil, corn oil.

     

    Folic acid (folate): Citrus food, wheat bran, rice, pork, dark leafy greens, legumes, shellfish, liver, etc.

     

    Magnesium: Black-eyed peas, potatoes, spinach, almonds, halibut, nuts.

     

    Vitamin A: Carrot, kale, red peppers, apricots, black-eyed pea, mangoes.

     

    Calcium: Collard greens, bok choy, salmon, oranges, low-fat milk, molasses, calcium-fortified food.

     

    Vitamin K: Cabbage, cereal, soybeans.

     

    Potassium: Tomatoes, sweet potatoes, potatoes, winter squash, white beans, prune juice, yogurt.

     

    Zinc: Red meat, bran nuts, green peas, legumes, liver, dark meat, etc.

     

    Can we take Junk food or fast food if we are suffering from Crohn’s disease?

     

    Yes, we can take junk foods and fatty food for Crohn’s disease but in moderation.

     

    As we know that eating nutritious food is high on the list of Crohn’s diseases patients. Some fast food also provides a good amount of nutrition and calories to the body Pizza, the Presence of Cheese offers proteins, vitamin D, calcium, etc, and the crust of the pizza supplies vitamin B. Same is the case if you take cheeseburger, hamburger, etc. so if you are a lover of junk food then it should be taken but in moderation form and not in regular basis.

     

    Crohn’s disease diet during traveling

     

    Everyone is at increased risk of getting diarrhea during traveling due to the food and water that is contaminated due to bacteria, viruses, parasites, etc. So if you are suffering from Crohn’s disease you should stick to the diet that is recommended to you unless you feel confident regarding trying new food or sanitation or hygiene related to that food.

     

    Precaution related to your diet in traveling if you are suffering from Crohn’s disease:

     

    • Avoid uncooked food as much as possible like raw vegetables, eggs, salads, fish, etc.
    • Avoid uncooked or reheated food.
    • The food from street sellers should be avoided
    • Avoid draught drinks
    • Stick to bottled drinks or cans
    • Fruits should be washed properly from bottled water
    • During travel, use bottled water for brushing your teeth 

    Dr. Sahil Gupta

    Have A Health Issue?

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    – Dr. Sahil Gupta (B.A.M.S., M.H.A.)

    Ayurvedic Allergy Specialist
    CEO & Founder of IAFA®

    Recent Research on Crohn’s Diseases Diet

    • Olendzki BC, Silverstein TD, Persuitte GM, Ma Y, Baldwin KR, Cave D. An anti-inflammatory diet as a treatment for inflammatory bowel disease: a case series report. Nutr J. 2014 Jan 16; 13: 5. doi: 10. 1186/ 1475- 2891- 13- 5.
    • Heerasing N, Thompson B, Hendy P, et al. Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn’s disease. Aliment Pharmacology 2017: 45: 660- 69. Doi: 10. 1111/ apt. 13934.
    • Cox SR, Lindsay JO, Fromentin S, Stagg AJ, McCarthy NE, Galleron N, Ibrahim SB, Roume H, Leverenz F, Pons N, Maziers N, Lomer MC, Ehrlich SD, Irving PM, Whelan K. Effects of Low FODMAP Diet on Symptoms, Fecal Microbiome, and Markers of Inflammation in Patients With Quiescent Inflammatory Bowel Disease in a Randomized Trial. Gastroenterology. 2020 Jan; 158 (1): 176- 188. e7. doi: 10. 1053/ j. gastro. 2019. 09. 024. Epub 2019 Oct 2.
    • Levine A, Scaldaferri F, Sarbagili Shabat C, et al. OP01 Comparison of fecal transplantation, fecal transplantation with the novel UC diet or the UC diet alone for Refractory Mild to Moderate Active Ulcerative Colitis: The CRAFT UC randomized controlled trial. Journal of Crohn’s and Colitis 2021: 15(Supplement 1): S001. doi: 10. 1093/ ecco- jcc/ jjab165. 
    • Konijeti GG, Kim N, Lewis JD, Groven S, Chandrasekaran A, Grande S, Diamant C, Singh E, Oliveira G, Wang X, Molparia B, Torkamani A. Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. Inflamm Bowel Dis. 2017 Nov; 23 (11): 2054- 2060. doi: 10. 1097/ MIB. 0000000000001221.
    • Chandrasekaran A, Groven S, Lewis JD, Levy SS, Diamant C, Singh E, Konijeti GG. An Autoimmune Protocol Diet Improves Patient-Reported Quality of Life in Inflammatory Bowel Disease. Crohns Colitis 360. 2019 Oct; 1 (3): otz019. doi: 10. 1093/ crocol/ otz019. Epub 2019 Aug 7.
    • Meade S, Patel KV, Luber RP, et al. A retrospective cohort study: pre-operative oral enteral nutritional optimization for Crohn’s disease in a UK tertiary IBD Centre. Aliment Pharmacol Ther 2022: 56: 646- 63. Doi: 10. 1111/ apt. 17055.
    • Svolos V, Hansen R, Nichols B, Quince C, Ijaz UZ, Papadopoulou RT, Edwards CA, Watson D, Alghamdi A, Brejnrod A, Anzalone C, Duncan H, Gervais L, Tayler R, Salmond J, Bolognini D, Klopfleisch R, Gaya DR, Milling S, Russell RK, Gerasimidis K. Treatment of Active Crohn’s Disease with an Ordinary Food-based Diet That Replicates Exclusive Enteral Nutrition. Gastroenterology. 2019 Apr; 156 (5): 1354- 1367. e6. doi: 10. 1053/ j. gastro. 2018. 12. 002. Epub 2018 Dec 11.
    • Chandrasekaran A, Molparia B, Akhtar E, Wang X, Lewis JD, Chang JT, Oliveira G, Torkamani A, Konijeti GG. The Autoimmune Protocol Diet Modifies Intestinal RNA Expression in Inflammatory Bowel Disease. Crohns Colitis 360. 2019 Oct; 1 (3): otz 016. doi: 10. 1093/ crocol/ otz 016. Epub 2019 Jul 12.
    • Chiba M, Abe T, Tsuda H, et al. Lifestyle-related disease in Crohn’s disease: relapse prevention by a semi-vegetarian diet. World J Gastroenterol. 2010; 16 (20): 2484- 2495. doi: 10. 3748/ wjg. v16. i20. 2484
    • Sarbagili-Shabat C, Albenberg L, Van Limbergen J, et al. A novel UC exclusion diet and antibiotics for treatment of mild to moderate pediatric ulcerative colitis: a prospective open-label pilot study. Nutrients 2021: 13: 3736. Doi: 10. 3390/ nu13113736.
    • Suskind DL, Cohen SA, Brittnacher MJ, Wahbeh G, Lee D, Shaffer ML, Braly K, Hayden HS, Klein J, Gold B, Giefer M, Stallworth A, Miller SI. Clinical and Fecal Microbial Changes With Diet Therapy in Active Inflammatory Bowel Disease. J Clin Gastroenterol. 2018 Feb; 52 (2): 155- 163. doi: 10. 1097/ MCG. 0000000000000772.
    • https://www.fda.gov/regulatory-information/search-fda-guidance-documents/enforcement-policy-regarding-investigational-new-drug-requirements-use-fecal-microbiota-0
    • Hirai F, Takeda T, Takada Y, et al. Efficacy of enteral nutrition in patients with Crohn’s disease on maintenance anti-TNF-alpha antibody therapy: a meta-analysis. J Gastroenterol 2020: 55 (2): 133- 41. Doi: 10. 1007/ s00535- 019- 01634- 1. 
    • Bodini G, Zanella C, Crespi M, Lo Pumo S, Demarzo MG, Savarino E, Savarino V, Giannini EG.
    • A randomized, 6-wk trial of a low FODMAP diet in patients with inflammatory bowel disease. Nutrition. 2019 Nov- Dec; 67-68: 110542. doi: 10. 1016/ j. nut. 2019. 06. 023. Epub 2019 Jul 1.
    • Lewis JD, Sandler RS, Brotherton C, Brensinger C, Li H, Kappelman MD, Daniel SG, Bittinger K, Albenberg L, Valentine JF, Hanson JS, Suskind DL, Meyer A, Compher CW, Bewtra M, Saxena A, Dobes A, Cohen BL, Flynn AD, Fischer M, Saha S, Swaminath A, Yacyshyn B, Scherl E, Horst S, Curtis JR, Braly K, Nessel L, McCauley M, McKeever L, Herfarth H; DINE-CD Study Group. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults with Crohn’s Disease. Gastroenterology. 2021 Sep; 161 (3): 837- 852. e9. doi: 10. 1053/ j. gastro. 2021. 05. 047. Pub 2021 May 27.
    • Chicco F, Magrì S, Cingolani A, et al. Multidimensional Impact of Mediterranean Diet on IBD Patients. Inflammatory Bowel Diseases 2020: 27 (1): 1- 9. Doi: 10. 1093/ ibd/ izaa097.
    • Levine A, Rhodes JM, Lindsay JO, et al. Dietary Guidance from the International Organization for the Study of Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association 2020: 18 (6): 1381- 92. Doi: 10. 1016/ j. cgh. 2020. 01. 046. 
    • Lewis JD, Sandler RS, Brotherton C, Brensinger C, Li H, Kappelman MD, Daniel SG, Bittinger K, Albenberg L, Valentine JF, Hanson JS, Suskind DL, Meyer A, Compher CW, Bewtra M, Saxena A, Dobes A, Cohen BL, Flynn AD, Fischer M, Saha S, Swaminath A, Yacyshyn B, Scherl E, Horst S, Curtis JR, Braly K, Nessel L, McCauley M, McKeever L, Herfarth H; DINE-CD Study Group. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults with Crohn’s Disease. Gastroenterology. 2021 Sep; 161 (3): 837- 852. e9. doi: 10. 1053/ j. gastro. 2021. 05. 047. Epub 2021 May 27.
    • Suskind DL, Lee D, Kim YM, Wahbeh G, Singh N, Braly K, Nuding M, Nicora CD, Purvine SO, Lipton MS, Jansson JK, Nelson WC. The Specific Carbohydrate Diet and Diet Modification as Induction Therapy for Pediatric Crohn’s Disease: A Randomized Diet Controlled Trial. Nutrients. 2020 Dec 6; 12 (12): 3749. doi: 10. 3390/ nu12123749.
    • Abdalla S, Benoist S, Maggiori L, et al. Impact of preoperative enteral nutritional support on postoperative outcome in patients with Crohn’s disease complicated by malnutrition. Colorectal Dis 2021: 23: 1451- 62. Doi: 10. 1111/ code. 15600.

    Diet guide for Crohn’s diseases

    References

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    • https://www.medicalnewstoday.com/articles/320233#what-is-an-anti-inflammatory-diet
    • https://www.medicalnewstoday.com/articles/enteral-diet-for-crohns
    • https://www.crohnscolitisfoundation.org/sites/default/files/legacy/assets/pdfs/diet-nutrition-2013.pdf
    • https://www.healthline.com/health/crohns-disease/types#the-five-types
    • Olendzki BC, Silverstein TD, Persuitte GM, Ma Y, Baldwin KR, Cave D. An anti-inflammatory diet as a treatment for inflammatory bowel disease: a case series report. Nutr J. 2014 Jan 16; 13: 5. doi: 10. 1186/ 1475- 2891- 13- 5.
    • Heerasing N, Thompson B, Hendy P, et al. Exclusive enteral nutrition provides an effective bridge to safer interval elective surgery for adults with Crohn’s disease. Aliment Pharmacology 2017: 45: 660- 69. Doi: 10. 1111/ apt. 13934.
    • Levine A, Rhodes JM, Lindsay JO, et al. Dietary Guidance from the International Organization for the Study of Inflammatory Bowel Diseases. Clinical Gastroenterology and Hepatology: The Official Clinical Practice Journal of the American Gastroenterological Association 2020: 18 (6): 1381- 92. Doi: 10. 1016/ j. cgh. 2020. 01. 046. 
    • Lewis JD, Sandler RS, Brotherton C, Brensinger C, Li H, Kappelman MD, Daniel SG, Bittinger K, Albenberg L, Valentine JF, Hanson JS, Suskind DL, Meyer A, Compher CW, Bewtra M, Saxena A, Dobes A, Cohen BL, Flynn AD, Fischer M, Saha S, Swaminath A, Yacyshyn B, Scherl E, Horst S, Curtis JR, Braly K, Nessel L, McCauley M, McKeever L, Herfarth H; DINE-CD Study Group. A Randomized Trial Comparing the Specific Carbohydrate Diet to a Mediterranean Diet in Adults with Crohn’s Disease. Gastroenterology. 2021 Sep; 161 (3): 837- 852. e9. doi: 10. 1053/ j. gastro. 2021. 05. 047. Epub 2021 May 27.

    Article Written By: Dr. Sahil Gupta, Ayurvedic Allergy Specialist

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