Food displayed include Salmon, a salad, a sliced orange, and orange juice

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.

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, ¼ lean protein, and ¼ 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.

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.

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.

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. Prevalence of Crohn’s Disease by Age

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 FODMAPs 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, it’s effectiveness in alleviating gastrointestinal symptoms makes it a promising approach for improving symptoms. Most importantly, the FODMAPs 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 FODMAPs?

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The InflammatoryBowelDisease.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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