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

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