Crohn's and the FODMAP Elimination Diet
As far as we know, diet neither causes nor cures Crohn's or ulcerative colitis. However, certain diets have been shown to be helpful. It is important to differentiate between someone in an active disease state, otherwise known as a flare-up, and someone with disease remission.
Diet and nutrition while in remission from Crohn's or UC
When in remission, eating a balanced diet with fruits and vegetables, whole grains, lean meats, nuts, and healthy fats is recommended. While everyone is different, the MyPlate guidelines are a good place to start – make half your plate fruits and vegetables, a quarter lean protein, and a quarter whole grains or starches. Alcohol consumption is not advised.
Some Crohn's patients also have food allergies and sensitivities, so be aware of foods that cause you discomfort. For example, lactose intolerance is common among Crohn’s sufferers. Observe dairy restrictions if consuming cheese, yogurt, or milk gives you cramps, diarrhea, bloating, or constipation. If so, taking a lactase supplement could help. It is vitally important to eat well when in remission, as you may have become depleted of certain nutrients when you were in a flare.
Diet and nutrition while in a Crohn's flare
During an active flare, it is also important to maximize proper nutrition because the illness may increase your overall nutrition and energy needs. Though that is easier said than done, of course. Avoidance of certain foods might be helpful.
The FODMAP diet has been shown to be effective in alleviating IBS (irritable bowel syndrome) symptoms, namely gas, bloating, constipation, diarrhea, and stomach pain, and it is beginning to be considered in Crohn’s disease management, since Crohn's shares some of the same symptoms.
The FODMAP elimination diet
FODMAP stands for Fermentable Oligo-, Di- and Mono-saccharides And Polyols, which are gas-producing carbohydrates that are not easily digested by the body. By avoiding foods high in FODMAPs, symptoms can be minimized. So, in essence, you would be eating a low- or no-FODMAP diet. It’s not a life-long diet, but a trial diet to evaluate which foods are not tolerated.
Foods to eat or avoid on the FODMAP diet
Below is a list of foods to include (low or no FODMAP) and foods to avoid (high FODMAP) from Monash University, Department of Gastroenterology:
Table 1.
| Foods to Include (Low-FODMAPs) | Foods to Eat in Small Amounts | Foods to Avoid (High FODMAPs) | |
|---|---|---|---|
| Meat and fish | Beef, chicken, eggs, fish, kangaroo, lamb, pork, prawns, salmon, sardines, shrimp, tuna | ||
| Vegetables | Alfalfa, bell peppers, bok choy, brussels sprouts, cabbage (common and red), carrots, collard greens, cucumber, eggplant, endive, fennel bulb, fennel leaves, ginger root, green beans, kale, leek leaves, lettuce, okra, onion tops (greens only (scallion greens)), parsnips, unpeeled potato, pumpkin, radishes, spaghetti squash, spinach (baby), squash, swiss chard, tomato (canned, fresh), zucchini | Broccoli, butternut squash, celery, butternut squash | Artichokes, asparagus, beets, cabbage (savoy), cassava, cauliflower, corn, garlic, leeks, mushrooms, onion (Spanish, white, bulbs) shallots, sugar or snap peas, peas, |
| Fruit | Common banana, blueberry, breadfruit, cantaloupe, carambola, clementine, dragon fruit, durian, grapes, kiwi, lemon, lime, mandarin, melon (honeydew), orange, passion fruit, papaya, pineapple, raspberry, rhubarb, starfruit, strawberry, tamarind | Most dried or processed fruits, apples, apricots, avocado, blackberry, boysenberry, cherries, figs, grapefruit, mango, nectarine, peaches, pear, persimmon, plum, pomegranate, watermelon | |
| Grains | Oat bran, rice bran, buckwheat groats, maize, millet, quinoa, polenta, quinoa, rice, teff | Buckwheat kernels, | Barley, bulghur, wheat bran, couscous, freekeh, spelt, wheat, |
| Nuts and seeds | Chestnuts, macadamia, mixed nuts, brazil nuts, peanuts, peanut butter, pecans, pine nuts, walnuts chia seeds, poppy seeds, pumpkin seeds, sesame seeds, sunflower seeds | Hazelnuts | Almonds, cashews, pistachios |
| Fats and oils | Butter, margarine, mayonnaise, avocado, canola, olive, peanut, sesame, sunflower and vegetable oils | ||
| Dairy | Cheeses: camembert, cheddar, Colby, cottage, feta, goat, Havarti, mozzarella, pecorino, brie, swiss; whipped cream, lactose free milk, lactose free yogurt, almond milk, hemp milk, soy (protein) milk, coconut milk (from a can) | Cottage cheese, haloumi, ricotta, sour cream, heavy cream, vanilla ice cream | Buttermilk, custard, kefir, milk, yogurt, oat milk, rice milk, soy (bean) milk, coconut milk (long-life), soya milk |
| Confectionary, Sugars and Sweeteners: Dark chocolate, sugar (brown, white, raw, palm), stevia, maple syrup, rice malt syrup, jaggery | Confectionary, Sugars and Sweeteners: Coconut treacle, white chocolate, milk chocolate | Confectionary, Sugars and Sweeteners: Fruit bar, honey | |
| Condiments: Fish sauce, bbq sauce (unless contains onions and garlic), miso paste, oyster sauce, shrimp paste, soy sauce, sweet and sour sauce, tamarind paste, tomato sauce, rice wine vinegar, Worcestershire sauce, mustard, chutney, wasabi, capers in vinegar, | Condiments: Pesto sauce, quince paste, balsamic vinegar | Condiments: Ketchup, pasta sauces, relish, | |
| Herbs and Spices: Almost all herbs and most spices are allowed |
Source: Monash University, Department of Gastroenterology (1)
The effectiveness of the FODMAP elimination diet
The FODMAP diet doesn't speed the healing of or cure Crohn's, but it has been effective in at least diminishing feelings of bloating, cramping, gas, and diarrhea that can often accompany a Crohn's flare-up.
Although the FODMAP diet has not been well studied in relation to IBD, its effectiveness in alleviating gastrointestinal symptoms makes it a promising approach for improving symptoms. Most importantly, the FODMAP diet is meant to be short-term and ideally used under the guidance of a dietitian or other health professional for the sole purpose of identifying which category of carbohydrates causes discomfort.
How does it work? FODMAPs are eliminated for a short period until symptoms like diarrhea, constipation, gas, and bloating get controlled. Then, each category of FODMAPs is reintroduced one at a time and the individual is observed for the return of symptoms. When symptom-free for a specified time, the next category of FODMAPs is reintroduced.
The ultimate goal is to only have a few foods off-limits and to maximize variety in the diet. The FODMAP elimination diet is not meant to be a long-term diet as it is very prohibitive and can result in nutritional deficiencies.
How about you? Have you tried an elimination diet such as FODMAP for your Crohn's or colitis? Share in the comments below.
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