by dietitian and nutritionist Alison Bencke

Note: these tips should not replace advice from your physician. Always check with your physician before making any changes to your eating habits.

Yes. A healthy, balanced diet is important when dealing with Crohn's disease. When your disease is inactive (in remission), you need to eat well to help raise your nutrient levels from previous flare-ups. This ensures a good supply of nutrients to replace damaged cells and tissues from the inflammatory processes.

A poor or inadequate diet further jeopardizes health. If there is active disease in the small bowel, absorption of nutrients into your body may be reduced. Therefore increased energy and nutrients, especially protein, are needed during and following disease flare-ups. If you have active inflammation in your ileum (the lower end of your small bowel) your doctor may suggest nutritional supplements including folate, iron and vitamin B12. Absorption of these nutrients normally occurs in the ileum, and may be impaired by a flare-up. Other nutrients, such as fat soluble vitamins A and D, may need to be supplemented if you are on certain medications. Always talk to your doctor before taking any new vitamin supplements.

The exact causes of chronic gut inflammation are unclear. However poor eating habits and "junk food" high in animal fat or saturated fats, typical of western style diets, are suspected of triggering Crohn's disease in genetically susceptible people. Omega-3 fats in fish oil and in some vegetables and nuts may help protect against inflammation.

One diet suggested for Crohn's disease patients when well is the same as that recommended for everyone wishing to reduce their risk of chronic illnesses and is similar to a Mediterranean style of diet. For adults, this is a low fat eating pattern (particularly saturated fat), increased omega-3 polyunsaturated fats (omega-3), and increased fiber. A low fiber/roughage diet may not be necessary when your disease is in remission, unless you have strictures or fistulas.

Foods to possibly include are:

• Fish which contain omega-3 fats
• Lots of fruits and vegetables
• Legumes
• Some nuts (crush in recipes if necessary)
• Whole grained cereals and breads
• Olive or high omega-3 oils such as canola or grape seed oils

You might consider adding lean red meats and dairy products for additional vitamins and minerals. If you have food allergies, are vegan or vegetarian, check with your doctor, dietitian, or nutritionist. To achieve a well balanced diet with adequate energy and all essential nutrients, selecting a wide variety of foods from these groups every day is recommended by MyPyramid. Please check with your physician before making any changes to your eating habits, or if you have questions about the following recommendations.

• Breads, cereals and grains – Whole grain breakfast cereals (many are fortified with folate), whole grain breads, crackers, muffins, rice, pasta and corn (use creamy corn only if you have strictures). These foods provide soluble and insoluble fibers, starches, carbohydrates, B vitamins, iron, some zinc and energy. Amount required depends on your energy needs; however a minimum healthy guideline is 6 oz. of bread or its equivalent everyday.
• Vegetables and fruits – These are good sources of many vitamins, minerals, and fiber. Many provide folate, vitamins A and D, small amounts of iron, magnesium, vitamin B6, vitamin C. Aim for 2 1/2 cups of vegetables and 2 cups of fruit everyday.
• Milk and milk products – Milk, yogurt, and cheese, especially varieties fortified with calcium. In addition to calcium, these contribute significant protein, zinc, some vitamins and energy. Aim for 3 servings every day. If you avoid milk because of lactose intolerance or personal choice, the most reliable way to get the health benefits of milk is to choose lactose-free alternatives within the milk group, such as cheese, yogurt, or lactose-free milk, or to consume the enzyme lactase before consuming milk products.
• Meats, fish, eggs and alternative, e.g., soy – These foods provide concentrated sources of protein. Select lean meat cuts (try to avoid chicken skin) and omega-3 eggs. Eat fish, particularly oily fish, at least once a week. You might include lean red meat (beef, lamb, pork) 3-4 times a week for adequate iron and zinc. Soy products are another useful source of protein. Healthy eating guidelines suggest 5 ½ oz. of these protein rich foods everyday.
• Fats and oils – These provide energy, vitamins A, D and E, and essential fatty acids. Choose olive, canola and flaxseed oils, and canola margarine which are good sources of the beneficial omega-3 fats.

Crohn's disease sufferers with strictures (narrowing in the gut) may have problems with hard foods like whole peas, whole corn and some seeds. These may be unable to pass through the stricture, leading to pain and possible bowel blockage. Please check with your physician, dietitian or nutritionist regarding what diet you should follow. Some recommendations include, hard foods like whole peas, whole corn and some seeds. Whole nuts or hard raw vegetables should be avoided or pureed or finely chopped in recipes.

If any strictures are high up in the small intestine, meats can be cut up or minced. Lean red meat should not be avoided without consulting your doctor and dietitian as they supply significant amounts of protein, iron, vitamin B12 and zinc. Large volumes of fiber may also cause discomfort or blockages in patients with strictures. A low residue or fiber diet should be used during this period.

• Whole grain pancakes with apricot ricotta
• Poached pears in blood orange juice with honey thickened yogurt
• Multi-colored lunch wrap