There are about 1.4 millions sufferers from Inflammatory Bowel Disease in the United States , about 40 percent of whom suffer from Crohn's disease. Nearly all these patients have inflammation of their large bowels, with diarrhoea, blood in stool, abdominal cramps and poor general health. Antigens (foreign proteins) in diet may often worsen the inflammation, and although bowel rest may be helpful in severe cases, it is not practical for Crohn's sufferers on a long-term basis.

Nutrition has a major impact on the course of the illness. First, it can provide a therapeutic effect by reducing the inflammation. Second, it can replenish the body with nutrients and vitamins as Crohn's patients are often malnourished. Thirdly, there is a growing body of opinion that nutritional therapy can reduce or even replace long-term steroid treatment.

Principles of nutrition in Crohn's disease

Diet

Depending on the level of activity of Crohn's disease, the abbreviated terminology used in this site is - active (A), when only a simple, elemental diet is recommended; in remission ( R ), when a balanced, high fiber diet is recommended for most; and bowel complications (BC), when the disease has resulted in narrowing and strictures of the gut, where a low fiber residue diet is recommended. In some instances, Crohn's disease results in malabsorption (M), when a low-fat diet is important.

Although elemental liquid diets administered in active disease can lead to remission, it would not be discussed further in the site as these are special diets only to be used under medical supervision. A few simple recipes marked A, although not 'strictly' elemental, are simple to digest and are suitable for those with an active, but mild form of the disease, when some simple foods are allowed by your physician.

Exclusion and avoidance diets

This is a controversial area , as there is no firm evidence that permanent avoidance helps in preventing remission. But dietary allergy to peanuts, soy, gluten, tomatoes and milk (lactose) intolerance can worsen Crohn's disease, and should be carefully considered or 'trialled' out.

In addition, inflamed bowels are also irritated by alcohol, caffeine, Brassica vegetables ( cauliflower, cabbage, Brussel's sprouts, broccoli) which should be best avoided in active disease.

Fat and protein

Fat is a controversial area in Crohn's disease, and although in the presence of advanced, complicated Crohn's disease, fat may not be absorbed leading to malabsorption and fatty stool, it must be remembered that fat avoidance may lead to deficiency of fat soluble vitamins ( A , D, E, K ). But omega-3 fatty acids, in canola, soya bean, fish oils, nuts, seeds and olive oil is much easily digested than saturated fats, and can be used also as a vehicle for vitamins as well. Our recipes would reflect this fact.

Protein malabsorption is also a nutritional problem, and it is important to have a relatively high-protein intake in diets. In line with the fat recommendations above, fish and soya are excellent sources of protein and fat in Crohn's patients. Oily fish like salmon and tuna are ideal as well, although poultry and lean meat could be low-fat, high-protein alternatives. Dried beans and legumes are also important sources to incorporate.

Complex carbohydrates

Whole grains, fruits and vegetables should make up more than half of the caloric requirements, and complex carbohydrates are best because they provide valuable fibre. Whereas simple sugars cause bloating and inflammation of the gut, and best avoided in Crohn's disease, complex carbohydrates are protective. In addition fresh fruits are an excellent source of water soluble vitamins and minerals, and apples, grapefruit, oranges, raspberries, blueberries and strawberries might actually be protective. But dried or preserved fruits and high sugar fruits ( e.g. grapes, watermelon, or pineapple ) are best avoided due to their possible inflammatory effects. Potassium -rich foods ( bananas, avocados and potatoes) are also important.

High fluid intake

High fluid intake is extremely important, and although caffeinated beverages are important, green tea has been reported to have protective effects due to its high flavinoid content.