Crohn’s disease is an inflammatory bowel disease characterized by chronic inflammation in your gastrointestinal tract. This inflammation can be found in your small intestine (most common), your large intestine, or both. The main cause of Crohn’s is still unknown, although genetic predisposition and improper immune system response may play a role. Poor diet and high stress levels can also influence Crohn’s symptoms. In addition to medical treatments, whole body interventions that target food and mood may help to improve your overall quality of life. (Source, Source)
In this article we’ll provide an overview of Crohn’s symptoms, what to eat during a Crohn’s flare-up, and 4 therapeutic diets that may help support remission.
Symptoms of Crohn’s Disease
Crohn’s disease occurs when your immune system mistakenly attacks healthy tissues lining your gastrointestinal tract, which swell and become inflamed. Symptoms of Crohn’s disease and their severity may differ from one person to another, depending on how much inflammation has spread and whether other organs are affected. When symptoms are not active, this is known as a period of remission. Interventions, both medical and complementary, are designed to keep people with Crohn’s in periods of remission for as long as possible and limit the effect of chronic inflammation in the body. (Source)
A Crohn’s flare-up occurs when symptoms suddenly increase in severity, often after a period of remission. In some cases, the cause of a flare-up may not be clear. To further complicate matters, foods that may be tolerated during remission are sometimes no longer advised during a flare-up as they can worsen symptoms. This emphasizes the importance of working with your care team to develop a personalized plan designed for your unique circumstances. (Source)
The Crohn’s and Colitis Foundation lists the following foods to avoid during a flare-up:
high-fat foods (such as fried foods, butter, and coconut)
alcohol and caffeinated beverages
high fiber fruits with peels and seeds (such as apples)
raw cruciferous vegetables (such as cauliflower and broccoli)
The Crohn’s and Colitis Foundation also lists eggs, firm tofu, and refined grains as potentially safe foods during a flare-up. However, these foods may provoke food allergies or sensitivities in those with digestive problems or autoimmunity issues. Depending on your health history, consuming them may not be advised. (Source)
Vitamin and mineral deficiencies can occur in Crohn’s disease because of improper digestive function or removing food groups during diet elimination periods. In addition to temporary dietary changes, your care team may also recommend nutritional supplements. (Source)
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Certain therapeutic diets have been studied for their ability to reduce symptoms associated with Crohn’s disease, lengthen periods of remission, and improve quality of life. Notably 4 diets, including the low FODMAP diet, the autoimmune protocol (AIP) diet, the specific carbohydrate diet (SCD), and the Mediterranean diet (all described below) offer promising results for those with Crohn’s disease. (Source)
Still, despite small studies supporting the implementation of these diets alongside medical treatment, research with a larger scope and sample size is necessary to make widespread recommendations. (Source)
Low FODMAP Diet
The low FODMAP diet is designed to eliminate or reduce foods that contain high amounts of fermentable carbohydrates, abbreviated as FODMAPs, which are found across most food groups.
The low FODMAP diet is typically recommended for those with irritable bowel syndrome (IBS), a disorder categorized by changes in bowel function including bloating, diarrhea, or constipation. Eliminating foods high in FODMAPs has been found to be effective in curbing common symptoms associated with IBS, as demonstrated by a 2022 meta-analysis published in the journal Gut. (Source, Source)
Due to acronym similarity, IBS is sometimes confused with inflammatory bowel diseases (IBD), which encompass the autoimmune disorders Crohn’s disease and ulcerative colitis. To further complicate matters, up to 44% of people with IBD report symptoms of IBS, making the low FODMAP diet a candidate for people with Crohn’s. (Source, Source)
A 2020 review, published in the journal Nutrients, identified 12 studies that showed the benefits of a low FODMAP diet in curbing symptoms of Crohn’s, especially those mirroring IBS symptoms. These studies ranged in sample size, subject type (human and animal studies), and style of research, suggesting the need for additional clinical trials involving more people with Crohn’s. (Source)
Autoimmune Protocol Diet
The autoimmune protocol (AIP) diet removes potential allergens and certain food groups that may result in low-grade inflammation, while also adding anti-inflammatory foods to support healing. The AIP diet has been studied for its ability to improve digestive function and is known for its incorporation of lifestyle modifications to further support overall well-being.
In a small 2017 study published in the journal Inflammatory Bowel Diseases, following the AIP diet was reported to reduce Crohn’s related symptoms and inflammation levels when measured with endoscopy, a common procedure used to monitor the progression of IBD. A small 2019 cohort study published in Crohn’s and Colitis 360 alsofound that introducing an AIP diet could reduce IBD symptoms as early as 3 weeks into the intervention. (Source, Source).
Specific Carbohydrate Diet
The specific carbohydrate diet (SCD) removes all grains from the diet, while reducing foods high in lactose (found in some dairy products), certain sugars, and other carbohydrates rich in fiber. (Source)
A small 2018 study published in the Journal of Clinical Gastroenterology found that an SCD protocol lowered inflammatory lab markers in pediatric Crohn’s patients. Another small pediatric study conducted in 2020 found that, compared to a whole foods diet, a SCD protocol resulted in a larger drop of inflammation levels. (Source, Source)
The Mediterranean Diet
The Mediterranean diet differs from the SCD protocol, focusing instead on fiber-rich vegetables, fresh fruits, nuts, whole grains, fatty fish, and extra virgin olive oil (EVOO). A 2021 randomized controlled trial published in Gastroenterology found that the Mediterranean diet was as effective as the SCD protocol in achieving symptom remission for those with Crohn’s. (Source)
The anti-inflammatory profile of the Mediterranean diet, including EVOO as a therapeutic food, has been studied for its ability to reduce intestinal inflammation and improve digestive function. A 2021 clinical trial published in the journal Inflammatory Bowel Diseases found that after following the Mediterranean diet for 6 months, people with Crohn’s and ulcerative colitis had improved liver function and increased IBD remission rates. (Source, Source)
Given the scientific data supporting the Mediterranean style of eating and its associated healthy lifestyle patterns, this diet is recommended by the International Organization for the Study on Inflammatory Bowel Disease, a group dedicated to improving the health of people with IBD around the world. (Source)
The Bottom Line on What to Eat During a Crohn’s Flare-Up
While making changes to your diet during a flare-up may help to reduce your symptoms in the short term, evidence supports introducing a longer-term therapeutic diet to minimize the likelihood of a flare-up in the first place.
Weighing the latest scientific evidence and determining which diet is right for you shouldn’t fall on your shoulders alone. The WellTheory membership allows you to work with a qualified nutritionist, who can design a personalized dietary and lifestyle plan to meet your unique nutritional needs.