Nutrition in Crohn's disease

In general, there are no specific foods that have to be avoided by the Crohn's patient. Patients should try and eat a balanced diet and avoid food which upsets them. However, in particular situations then dietary modification is necessary:

• high fibre foods, e.g. fruit and vegetables, may precipitate abdominal pain in some patients - especially those with small intestinal disease. In this group of patients a low residue diet, e.g. avoidance of vegetables, brown bread may bring symptomatic relief
• low fat diets: if steatorrhoea is a main complaint
• exclusion diet: this is as reliable as corticosteroids in producing remission in acute disease - success rate as high as 90%; however, most patients relapse soon after the resumption of a normal diet
• fish oil - there is evidence that enteric-coated fish oil preparations may reduce relapse rate and maintain remission in patients with Crohn's disease
  • the anti-inflammatory omega-3-polyunsaturated fatty acids (PUFAs) from fish oils - the importance of dietary intake of PUFA has been gleaned from epidemiological observations that Eskimos have a low incidence of inflammatory bowel disease (IBD)
• probiotics - there is ongoing interest in the use of probiotics in the treatment of IBD.
  • probiotics are live non-pathogenic organisms such as various Lactobacillus species, which aim to confer health benefits by improving the gut micro-organism environment (1)
• vitamins and minerals: if there are specific nutritional deficiencies
• malnourishment: if the patient has active disease or is perioperative then parenteral nutrition may be indicated

dietary measures for inducing remission in Crohn's disease (4)

• enteral nutrition should be considered as an alternative to a conventional glucocorticosteroid to induce remission for:
  • children in whom there is concern about growth or side effects, and young people in whom there is concern about growth
    

Reference:

1. Prescriber (2004); 15(5).
2. Riordan, A.M. et al. (1993). Treatment of active Crohn's disease by exclusion diet: East Anglian Multicentre Controlled Trial. Lancet; 342: 1131-34.
3. Belluzzi A et al (1996). Effect of enteric-coated fish oil preparation on relapses in Crohn's disease. NEJM;334: 1557-60.
4. NICE (May 2019). Crohn's disease Management in adults, children and young people