Diet and Health FAQ

Tagged As: Diet For Crohns Disease

Question:
I am looking for any accurate and helpful information about the effects of diet and Crohn's Disease?  I have heard way too many different opinions, and would like something substantial.

Answer:
Crohn's disease is a poorly understood GI disease that is local in nature (only a small section of the gut is affected).  This disease is also called regional enteritis.  Colitis, more appropriately called ulcerative colitis, affects much more of the gut, usually the entire gut.  Both involve an inflammatory response.  For colitis, an autoimmune response appears to be the cause (the immune system identifies the gut as foreign tissue and starts attacking it).  As with most autoimmune diseases, genetics appear to play a role.  I don't think that a strong genetic link has been shown to occur in Crohn's disease but I may be wrong. For Crohn's disease, it's not quite so simple (though medically it's a lot easier to deal with since only a section of the gut is affected).  Onset is usually between the ages of 15 and 35.  Only about 25% of the cases go into remission.  The diet (from Sylvia's book Nutrition and diagnosis-related care) is critical in helping patient's deal with Crohn's disease.  The first thing is to rule out wheat, gluten and lactose intolerances.  While food allergies involving other dietary components (food additives, sugar, peanuts, etc.), Sylvia's feeling is that this is unlikely after wheat, gluten and lactose sensitivity have been ruled out. Food allergy testing is considered by some to be quackery.  It's really hard to find a good allergist who is familiar with food allergies. I heard one talk at a meeting recently in Chicago and he felt that 30-50% of all irritable bowl - inflammatory bowl syndromes (of which Crohn's is one) are caused by food allergies.  Colitis, which involves the entire gut is not likely to be a reaction to food allergens.  If one looks at the sites in the gut where Crohn's flares up, it is in areas where movement of food is usually slow.  If I had Crohn's disease or thought that there was a possibility that I would eventuallly develop it, I'd try to find a good allergist who knows how to test for food allergies.  From Werbach's book, Nutritional Influences on Illness, 7/11 patients with Crohn's disease tested positive for milk, wheat and/or soy protein allergies. Ann Allergy 64:345-51(1990). 100 normal controls were compared with 50 Crohn's patients for RAST response to 10 selected foods (foods known to cause food allergies in humans).  A positive RAST response was significantly higher in the Crohn's group of patients. Hepatogastroenterolory 33:128-130(1986).  Lactose intolerance is found in 25-35% of all Crohn's patients. Wien Klin Wochenschr 98:774-779(1986).  When food allergies are identified and eliminated from the diet of patient's with Crohn's disease, 7/10 patients (70%) stayed in remission for 6 months while 0/10 who weren't tested for food allergies stayed in remission. Lancet 2:177-80(1985). Food allergy should be checked out. I'd take it further than Sylvia's recommendation and try to find someone who can do all the known food allergens.  The Lancet study used the flush method (water fast) followed by single food diets.  After each food, another water fast.  This is considered to be the most sensitive way to test for food allergies.  I'm not an immunologist but I do know that there is tremendous controversy over RAST testing and the whole area of allergy testing in general.  Maybe you should put something in Sci.Med. and see what advice you can get their. I should point out that some (and it may actually the majority) doctors don't think food allergies have anything at all to do with bowl disease. A review article nicely summarizes this sentiment. J.R.Coll.Physicians. London 20:45-48(1986).  While immune response against food allergens can be demonstrated in Crohn's patient's this is most likely an artifact produced by the inflamed bowl which lets allergens enter the blood.  A more likely explanation for Crohn's and other inflammatory bowl diseases is a change in the consistency of the food (fiber content) or bacterial flora in the gut. This leads into diet.  Sylvia suggests a low residue diet (no roughage or fiber) with fat elimination if fat is coming out in the stool.  Heavy supplement use is needed in addition to electrolyte replacement.  All vitamins and minerals are needed because of the poor absorption but special emphasis should be placed on vitamin C, B6, B12, foliate, D, A, E, and K.   Minerals needed in high amounts are iron, zinc, copper, calcium, and potassium.  Your doctor would need to determine how much of each is needed.  Small frequent meals are preferred.  Call the Crohn's and Colitis Foundation of America (800) 343-3637 for more information on diet. Now Werback has references for almost all the vitamins and minerals showing that more is needed in Crohn's disease.  He hedges though and says intake may be inadequate.  The key is status.  In remission, good absorption is probably occurring while during flair ups you are faced with poor absorption.  A high fiber, low sugar diet is the best diet for Crohn's in Werback's book.  But there is one paper that refutes any link between sugar and Crohn's disease.  If you have evidence of bowl disease, I'd make the effort to cut back on sugar consumption, it can't hurt and it may help. Why did Sylvia say low residue diet and Werbach say high fiber diet? One diet is for treatment during flair ups (low residue), the other is intended to try to keep the inflammatory attack from occurring again (high fiber to move the food through the gut faster).  If you have gut obstructions or lesions (inflammation), the high-fiber diet is a no no. I'm not surprised that you are confused about the best kind of diet for Crohn's disease.  My Father-in-Law had Crohn's disease and his doctor's drove him crazy because they were constantly making him go on and then off low residue diets.  He finally said to hell with them and stayed on the high-fiber diet even when his gut was killing him.  The Crohn's eventually went away and his smoking ended up killing him.