I. What is Crohn’s disease?
Crohn’s disease (CD) is an inflammatory disease of the intestine of unknown etiology caused by the interaction of genetic and environmental factors, which can involve any part of the gastrointestinal tract, but is usually found in the terminal ileum and right hemicolectomy. Extra-intestinal manifestations. The disease is common in Europe and the United States, but the prevalence in China is increasing year by year.
Why do we need to propose dietary guidelines for Crohn’s disease?
There are many dietary guidelines for Crohn’s disease on the Internet, but in fact there is no scientific dietary standard for this disease. Most experts believe that a so-called “meal plan” means that the patient can identify the specific foods that cause gastrointestinal symptoms and avoid them, so that abdominal pain, bloating and diarrhea can be easily controlled. At the same time, the inflammation of the intestinal tract will be relieved as soon as possible.
An effective meal plan for Crohn’s disease is based on expert reviews that emphasize smaller, more frequent meals, less residue and low-fat diets to ensure that the body gets plenty of protein, calories, and nutrients. As in addition, vitamin and mineral supplements are needed. Doing this will be able to meet the nutritional needs of the body.
Do Crohn’s patients need a high-calorie, high-nutrition, high-quality protein diet?
Yes, very much so. Due to the long duration of the disease, extensive lesions, high fever, fistula, anemia, diarrhea and other symptoms, the patient consumes more nutrients, so the nutrient supply should be more than 1500 kcal and 100 g of protein per day according to the requirements of systemic diseases. High-calorie foods are foods with high starch or sugar content (carbohydrates), such as white rice and meat. High-nutrient foods should be selected with high nutritional value per unit amount, such as beverages instead of drinking water. You can also combine two or more ingredients to make a diet, such as steamed eggs in liver soup and vegetable juice, boiled chicken soup with hanging noodles, fruit juice with lotus root powder, eggs and noodles made into noodles and wonton skins, etc. High-quality protein foods include: fish, poultry, meat, eggs, tofu and dairy products, although peanuts and beans also contain a large amount of protein, but patients tolerate it poorly.
Fourth, Crohn’s patients should choose which foods for the main diet and side dishes?
The staple food should be fine, with rich flour, good rice, etc. Forbid the use of coarse grains, such as corn flour, millet, whole wheat flour made of food, so as not to increase the intestinal burden and damage.
Side dishes can be lean meat, fish, chicken, liver, eggs, etc. as the main source of providing protein, and limit cow’s milk during the active period. Do not eat flatulent foods, such as soybeans, scallions, etc. Vegetables can be chosen from potatoes, yams, carrots and other tuberous foods that contain little crude fiber.
V. What foods should Crohn’s patients avoid?
It depends on the situation. If a food can cause a digestive reaction, avoid it and distinguish whether you are allergic or intolerant to the food. Many people are often intolerant to foods, and it is better to perform an “elimination test” to determine which foods to avoid than an “allergy test” of the skin or blood.
The foods that cause gastrointestinal symptoms are different in Crohn’s patients. The following foods are likely to cause symptoms.
Alcohol (mixed drinks, beer, wine);
Butter, mayonnaise, margarine, oils;
Carbonated beverages;
Coffee, tea, chocolate;
Cereals, wheat;
Dairy products;
Fatty foods (fried foods);
Excess fiber foods;
Gas-producing foods (lentils, beans, cabbage, green cabbage, onions);
Nuts and seeds (peanut butter, other nut butters)
Raw fruits;
Raw vegetables;
Red meat and pork;
Spicy foods;
All grains and bran;
Once you find that some foods can cause symptoms, you can choose other foods or learn new ways to cook to relieve symptoms. Try different foods and the most suitable cooking methods, for example, if a certain vegetable causes symptoms, there is no need to give it up. You can choose to steam, boil or stew to get rid of gastrointestinal symptoms.
Limiting the intake of foods that can cause symptoms can help control Crohn’s disease flare-ups. But do not restrict too strictly, otherwise it often causes malnutrition and leads to worsening of Crohn’s disease. This requires taking foods that are high in nutritional value.
Create a diet log to record which foods cause gastrointestinal symptoms. In fact, this diet log will not only help you avoid these foods, but will reveal whether your diet needs nutritional supplementation. By reviewing the diet log, your dietitian will be able to recommend dietary amounts based on your age, gender and weight. You can also increase the amount of your diet, change the taste of your diet, or improve your diet log.
6. Do Crohn’s patients need to eat a diet with less residue?
A low crumb diet means eating foods that are low in fiber. For example, cereals, toast bread, white rice, fruit juices, vegetable juices and animal products such as meat, poultry, fish, eggs, dairy products, fats, etc. Limit excessive fiber diets such as nuts, seeds, cereals, corn, fruits, and a wide variety of vegetables. If there is a narrowing of the small intestine, too much fiber does not pass easily, and with the extensive lesions, once too much fiber food enters the small intestine it causes contractions and abdominal pain, and since they are not completely digested and absorbed by the small intestine, it causes diarrhea. Many patients with small bowel Crohn’s have low small bowel stenosis (ileus). In order to give the intestine proper rest and relieve the symptoms of abdominal pain and diarrhea, the diet should avoid mechanical stimulation as much as possible and adopt a less residue, low-fiber diet. There is no scientific evidence that a diet with less residue can help some patients reduce the frequency of intestinal motility.
Do Crohn’s patients need a liquid diet?
Some studies have shown that a liquid diet can help people maintain a certain level of health, and there is evidence that Crohn’s patients can benefit from a high-calorie liquid diet. By giving the intestines the necessary rest, a liquid diet helps Crohn’s patients manage their symptoms. In addition, a fluid diet or a high-calorie fluid can help Crohn’s patients who need high nutrition or malabsorption in the short term.
Do Crohn’s patients need fluid and inorganic salt supplements?
Yes, in the case of chronic diarrhea, the risk of dehydration is obvious. If fluid replacement does not keep up with the diarrhea, renal function will soon be compromised. Crohn’s patients and other patients with diarrhea have an increasing incidence of kidney stones. Moreover, dehydration and salt loss can exacerbate physical weakness. For these reasons, Crohn’s patients should consume adequate fluids in warm climates to compensate for the large loss of inorganic salts and water through the skin. As a rule of thumb, one half ounce of water per pound of body weight should be consumed per day. That is, a 140-pound person should drink 70 ounces of water per day, or 80 ounces or 1/3 cup. Suction rather than swallowing, which can cause discomfort.
IX. How can Crohn’s patients reduce abdominal pain and other discomfort after eating and drinking?
During an attack of the disease, abdominal discomfort and pain often occur after a meal and can be relieved in the following ways.
Eat less and more meals: Eat five meals every two to three hours instead of the traditional three meals a day. In order to reduce the burden on the intestinal tract and to supplement nutrition, you should eat more meals in a gradual manner and in small portions. Do not be too hasty, so as not to be counterproductive.
Reduce the intake of greasy and fried foods: butter, margarine, creamy sauces, and pork products can cause diarrhea as well as bloating. These symptoms are more frequent in patients who have undergone small bowel resection, so fat should be limited to less than 40 grams per day.
Avoid irritation of the intestinal mucosa by abstaining from all kinds of strong and stimulating condiments, such as chili peppers, spices and alcohol.
Limit the intake of milk and milk products if you are lactose intolerant. Some people, whether they have Crohn’s disease or not, are unable to digest lactose, which is found in milk and dairy products. This is due to a lack of a digestive enzyme called lactase on the surface of the small intestine. Indigestion of lactose can lead to abdominal pain, bloating and diarrhea. The symptoms of lactose intolerance can resemble the symptoms of Crohn’s disease, so it can sometimes be difficult to identify. If this condition occurs, milk intake should be limited. Many products that are supplemented with lactase will no longer have similar symptoms. Your dietitian will help you or your child. However, it is necessary to consume some essential products in small amounts because they represent a source of nutrition, including calcium and protein.
However, some people who follow these diets still experience abdominal cramps after meals. It is up to the medication to treat it. For example, prednisone as well as corticosteroids will reduce the inflammation of the small intestine and bring it back to normal. When the disease is stable, taking a painkiller or antidiarrheal 15 to 20 minutes before eating will help you relieve symptoms and maintain good nutrition. Do not take medication before meals if you have a combination of several serious diseases.
Can Crohn’s patients eat fast food or “junk” food?
Children with Crohn’s disease face special challenges and need to consume highly nutritious foods. Parents generally believe that fast food is not healthy, but this is not necessarily the case. Some foods provide a variety of needed nutrients, such as pizza. Cheese provides calcium, protein and vitamin D. Potato juice is rich in vitamins A and C, and potato skins are rich in vitamin B. Other foods are also nutritious, such as burgers and sandwiches, even though they are above the prescribed threshold for fat and salt. Milkshakes and ice cream are rich in calcium, protein and calories. If you are lactose intolerant, you can take some lactase tablets before the diet to overcome the discomfort reaction.
XI. Should Crohn’s patients take vitamins? If so, which ones should I take?
Vitamin B12 is mainly absorbed in the lower ileum, that means that patients who have colitis or have undergone small bowel surgery are vitamin B12 deficient because they do not absorb enough of the vitamin from diet or oral supplementation. To compensate for this deficiency, monthly intramuscular injections of vitamin B12 are necessary. Patients taking salazosulfapyridine often have a folic acid deficiency. They should take folic acid tablets at 1 mg/d. For most patients with chronic Crohn’s, regular multivitamin preparations are worthwhile. Other vitamins such as vitamin D are also needed if there is dyspepsia or if they have undergone small bowel surgery. Up to 68% of Crohn’s patients are deficient in vitamin D, which is essential for bone synthesis and calcium metabolism. An article in the American Journal of Preventive Medicine reports that high doses of vitamin D (1000-2000 IU/d) are beneficial, especially in reducing the risk of colorectal cancer, which is highly prevalent in inflammatory bowel disease. The National Academy of Sciences states that 2000 IU/d of vitamin D is very safe. Fat-soluble vitamins A E K D are less easily absorbed than water-soluble vitamins. Therefore, fat-soluble vitamins should be properly supplemented, and solutions of vitamins should be more easily absorbed than tablets.
XII. What minerals can Crohn’s patients take?
In most Crohn’s patients, there is no significant mineral deficiency, however, iron deficiency is common in ulcerative colitis and Crohn’s disease colitis, but they differ in small bowel lesions. This is due to inflammation or ulceration of the colon resulting in bleeding. The level of iron in the blood can be measured, and if there is a real deficiency, iron can be supplemented by oral tablets or solutions. The usual dose is 8 to 27 mg 2-3 times a day. Oral iron often results in the passing of black stools, which may be confused with gastrointestinal bleeding.
Other minerals include potassium and magnesium, which can be low due to diarrhea and vomiting or hormone therapy. Potassium can be supplemented by consuming vegetable juice, fruit juice or potassium chloride tablets or other means. Oral supplementation of magnesium oxide is necessary for patients with Crohn’s disease causing diarrhea or extensive small bowel lesions or partial resection of the small intestine.
Micronutrients are essential nutrients for the body and they are essential for certain important physiological functions. Crohn’s patients can suffer from micronutrient deficiencies due to reduced intake of nutrients and lesions of the small intestine.
Crohn’s patients have a high need for calcium. Inadequate intake of calcium is due to their lactose intolerance or they think they are not deficient. Or they consume enough calcium but do not fully absorb it due to lesions or resection of the small intestine. There are also drugs used to treat Crohn’s disease that can affect bone synthesis. Prolonged use of prednisolone or other hormones can also slow down the process of osteogenesis and osteolysis, which can also affect calcium absorption. In addition to hormone use, Crohn’s disease itself is associated with osteoporosis, so a BMD screening is necessary.
If hormone therapy is necessary, lower doses or alternate day doses may reduce the bone loss associated with Crohn’s disease. Patients should take 1500 mg of calcium three times a day. Vitamin D is also necessary.
XIII. Is nutrition important for Crohn’s patients?
Yes, it is very important. Malnutrition occurs in Crohn’s patients, especially those involved in the small intestine, for the following reasons.
Lack of appetite – nausea, abdominal pain, and changes in taste can all lead to inadequate food intake.
Chronic disease increases the body’s expenditure of calories and capacity, especially during episodes of illness. ‘
Crohn’s disease is usually associated with poor digestion and absorption of proteins, fats, carbohydrates, water, and various vitamins and minerals, so these substances are not really taken into the body.
Good nutrition restores the body to health, so efforts must be made to avoid malnutrition. Restoring and maintaining nutrition is key to treating Crohn’s disease for the following reasons.
Medication is more effective in patients with good nutritional status.
When Crohn’s patients lose protein and other nutrients, they need more food to compensate. This can aggravate the condition of a Crohn’s patient who is having an attack.
The loss of protein, calories and other nutrients can cause growth retardation in children and adolescents.
Weight loss in women and girls can affect their hormone levels, leading to menstrual irregularities and even menopause.
Therefore, for Crohn’s patients, it is important to enhance nutritional support. The two main types of nutritional support include enteral nutrition and parenteral nutrition support.
Enteral nutrition can provide high nutrients directly to the patient’s stomach and small intestine. The well known enteral nutrition solution can be administered nasally through a nasogastric tube (NG) throughout the night. This method allows the patient to receive nutrition while resting. In the early morning, they can remove the nasogastric tube to go to work or school or to engage in normal activities. This allows the patient to receive all the nutrition they need.
Enteral nutrition can also be given through a gastrostomy tube. A gastrostomy is a surgical procedure in which a percutaneous drainage tube is placed into the stomach lumen for nutrition. This nutrition can be given overnight and also intermittently during the day. Some patients prefer gastrostomy nutrition because it avoids the pain of a nasal cannula.
Parenteral nutrition (TPN) is administered through a vena cava catheter that injects nutrient solution into the large vessels into the body. Although it allows the intestines to rest and replenish the various nutrients needed, parenteral nutrition has many more complications than enteral nutrition, is much more expensive, and requires specialized training to use.
XIV. Can adherence to this diet help control Crohn’s disease?
There is no one diet or meal plan that will work for every Crohn’s patient. The diet must be individualized and must be tailored to fit, depending largely on which disease is present and where the small bowel lesions are located. In addition, these diseases are not static and the way the diet is eaten can affect how the disease changes. The key is to try to find a balanced and healthy diet.
Using this dietary journal will help you get a properly balanced diet. It shows whether you are getting enough protein, carbohydrates, fats, water and enough calories to maintain your weight and energy.
To start a meal log, record in a small notebook the foods and amounts consumed each day, noting the date, the food, and the symptoms that occurred after taking a particular food.
After a month or two, make an appointment to review the dietary log with your registered dietitian, who will determine whether you are eating a balanced diet, getting the necessary nutrients, needing supplements, etc.
In conclusion, diet as well as nutrition does not cause Crohn’s disease, but a balanced nutritional diet can help restore your body to health. Proper nutrition depends heavily on whether you have Crohn’s disease or ulcerative colitis, and where the small bowel lesions are located. This is why discussing nutrition with a dietitian is so important to your health and the treatment of Crohn’s disease.