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Tips From Our Nutritionist

Food Allergies vs Intolerances
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.

The Disadvantages of an Overly Strict Diet

If Crohn's disease (CD) sufferers follow all the advice found on the Internet or in books about which foods to avoid, they risk nutritional deficiencies from such a limited list of allowed foods. Your physician or a dietitian or nutritional expert recommended by your doctor should be consulted before you remove foods from your diet.

Some popular diets for Crohn’s recommend eliminating particular carbohydrates. However, the scientific evidence for this is far from conclusive. While a few sufferers report relief from symptoms on these strict regimes, the effect is often short-lived or leaves sufferers on such a restricted diet that they cannot sustain it. Those continuing on these diets may risk nutrient deficiencies from the narrow choices of foods.

Everyone is an individual. True food allergy usually means that if you eat even a trace of the offending food, you will have a reaction. Food intolerance means that you can tolerate small amounts of a food, but larger quantities trigger discomfort. For example, people who avoid milk because they are lactose (milk sugar) intolerant can often cope with small amounts of milk in foods, but they will suffer discomfort if they drink a big milkshake. When Crohn’s is very severe in the small intestine, lactose intolerance may occur. But unless your doctor has diagnosed this, there may be no reason to avoid milk as it contributes a significant amount of protein, calcium, and vitamins in your diet. There are also lactose-free milk alternatives available, such as sweet acidophilus milk or soy milk containing calcium.

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Other Foods to Avoid

You should probably avoid foods high in fat and added sugars, as well as the foods you know you can’t tolerate. Do not cut out healthy foods that bother other Crohn’s patients unless you have had a bad reaction to these foods on more than one occasion. It is important to understand that allergies and food intolerances vary in individuals and you may not be bothered by food that others cannot tolerate. Avoid missing out on your favorite healthy foods unnecessarily.

The Crohn's Wellness WidgetTM for your iPhone or desktop can help you keep track of what you eat and how it makes you feel. You can download it here.

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Fiber: High or Low?

Advice about foods containing fiber can be confusing, depending on what you read. Choose soluble fiber sources or resistant starch (RS) as they provide short-chain fatty acids. Historically, starch has been thought to be 100% digested as glucose in the small intestine. But research over the last few decades has found that a significant portion (about 10%) is not digested in the small intestine and passes into the large intestine, where it helps gut bacteria with fermentation. This starch is called RS and many nutritionists think that it should be classified as a component of dietary fiber. The bacteria in the large intestine produce short-chain fatty acids from the RS, which may help maintain the health of cells lining the colon (colonocytes). These fatty acids are also absorbed into the bloodstream and may play a role in lowering blood cholesterol levels.

Fiber provides food for your good gut bacteria. Soluble fiber is found in oats, rice, or barley bran, but not in wheat bran. Pectins, another source of fiber, are found in fruits and seeds. Plantago ovata (psyllium) is another good source of soluble fiber. RS occurs in cooked, cooled foods like potatoes and rice. The cooling process allows gels to form, which resist digestion in the small bowel. Instead, the food enters the large bowel to be digested by bacteria and form volatile fatty acids. These compounds provide fuel for the large bowel cells and may be protective in Crohn’s. Thus, increasing the RS in your diet by eating cooked, cooled potatoes, rice, and pasta may be beneficial (see the Pesto Pasta [or Rice] Salad recipe).

If you are having a flare-up, you may need a low-fiber (or low-residue) diet. When you are well and do not have any strictures or blockages, the best advice is to eat a well-balanced diet. Thus you may need to vary your fiber intake depending on the activity of your disease (see the Date Scones recipe, which can be made with whole grain or white flour).

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Caffeine and Crohn's

There is some evidence to suggest that caffeine has a negative effect in CD. Caffeine is a stimulant to the central nervous system and should be consumed in moderation. Remember to avoid anything that causes discomfort.

Recipes

Date Scones

Date Scones

Tags: High fiber, healthy, breakfast, easy

Quick and easy to prepare.

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Pesto Pasta (or Rice) Salad

Pesto Pasta (or Rice) Salad

Tags: Lunch, easy, summer

A delicious summer lunch that works for lunchboxes.

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Omega-3 Healthy Potato Wedges

Omega-3 Healthy Potato Wedges

Tags: Side dish, kid friendly, easy, quick

Perfect for casual dinners and BBQs.

Read more »

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